Treating patients with periodontitis – Dawn Woodward CuraproxFeatured Products Promotional Features
Posted by: The Probe 9th January 2020
Despite being entirely preventable, periodontitis affects an estimated 20-50% of the global population and remains a major cause of tooth loss.[i] The prevalence of periodontal disease emphasises the need for a comprehensive understanding of the diagnosis, risk factors and treatment of the disease, as well as the importance of effective patient-practitioner communication to successfully prevent and/or manage the condition. This is essential if clinicians are to effectively help patients avoid further complications resulting from periodontitis.
Dental professionals play a key role in the early recognition and diagnosis of periodontitis, which begins with evaluating patients through a Basic Periodontal Examination (BPE). This typically involves visually examining the patient’s overall oral condition, and probing the periodontal tissues to assess the presence of bleeding on probing, plaque and calculus deposits, and the depth of any periodontal pockets that may be present.
Patients that present with BPE codes of 3 or 4 require further examination through detailed periodontal charting, which is not only essential for diagnosis, but also to monitor the patient’s response to periodontal treatment. Generally, radiographs should also be used for periodontal assessment in these cases. This will be required to assess the extent of bone loss and can also be useful to track changes in bone level over time. Taking all these clinical findings into account will enable you to provide a diagnosis for the patient based on the current periodontal classification criteria, so that a treatment plan can be formulated accordingly.[ii]
There are various risk factors associated with periodontal disease that clinicians will be familiar with. One of the most significant of these is systemic conditions such as poorly controlled diabetes, which can play a huge role in the initiation and progression of periodontitis. In fact, research has discovered a bidirectional relationship between the two conditions, meaning diabetes can exacerbate periodontitis and vice versa.[iii]Patients with diabetes are three times more at risk of developing periodontal disease than non-diabetics.[iv]
Smoking and tobacco use is also a significant risk factor for periodontal disease, with one meta-analysis indicating that smokers are three times more likely to have severe periodontitis compared to non-smokers.[v]However, it is important to be aware that smokers with periodontitis may also present with fewer signs and symptoms of the disease than non-smokers. This could be explained by the fact that nicotine is a vasoconstrictor, meaning it can reduce blood flow, oedema and inflammation, making it more difficult to detect periodontal disease in smokers.[vi]
Clinicians know that poor oral hygiene is another well-established risk factor for periodontitis. A lack of adequate oral care at home can ultimately result in the build-up of plaque on the teeth and gums, which can cause periodontal disease if not routinely removed.i This emphasises the importance of educating patients on how to maintain a high standard of plaque control, particularly as some patients are not necessarily aware of the effect plaque can have on the development of periodontitis.
Being able to effectively communicate with patients is one of the most important elements of periodontal treatment. The disease should be explained to patients in detail so that they understand and appreciate that the success of periodontal therapy relies on them taking an active role in the process. Sufficient time should be taken to adequately educate patients on their responsibilities regarding disease prevention and management.
These responsibilities include attending routine maintenance appointments and implementing effective oral hygiene practises at home, such as twice-daily brushing and regular interdental cleaning. The effect that smoking can have on periodontal health should also be explained to patients and support made available to encourage cessation. Providing repeated and individually tailored instructions is key to motivating and engaging patients about oral hygiene.
Most forms of periodontitis can be treated with non-surgical techniques such as root surface debridement (RSD), using either hand or powered dental instruments. The aim of RSD is to disrupt and remove the plaque biofilm to minimise the bacterial challenge, thereby reducing inflammation in the periodontal tissues.[vii]Chemotherapeutics such as chlorhexidine (CHX) mouth rinse are useful as temporary adjuncts that can support the mechanical removal of plaque in acute situations. However, patient compliance can be an issue with CHX mouth rinses, as these solutions are well-known for having adverse side effects such as tooth discolouration, irritation of the oral mucosa and alteration of taste.[viii]
As an alternative, practitioners can recommend the Perio Plus+ mouth rinse range to patients. These innovative products combine CHX with CITROX® – a powerful anti-microbial, anti-oxidant and anti-inflammatory substance created using the natural bioflavonoids found in bitter oranges. This unique formula can effectively combat plaque to reduce the effects of periodontal disease, with minimal risk of adverse side effects traditionally associated with many leading CHX mouth rinses.
The long-term success of periodontal therapy depends on having a comprehensive understanding of the diagnosis, risk factors and treatment of the disease. Effective prevention and/or management of periodontitis also relies heavily on engaging with and empowering patients to maintain good oral hygiene. Plaque control is the cornerstone of periodontal therapy, so it is important that patients adopt an active role in the treatment process, with appropriate support provided by the dental team.
[i] Nazir, M. A. (2017) Prevalence of periodontal disease, its association with systemic diseases and prevention. International Journal of Health Sciences. 11(2): 72-80. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426403/. [Last accessed: 29.10.19].
[ii] Dietrich, T., Ower, P., Tank, M., West, N. X., Walter, C., Needleman, I., Hughes, F. J., Wadia, R., Milward, M. R., Hodge, P. J. and Chapple, I. L. C. (2019) Periodontal diagnosis in the context of the 2017 classification system of periodontal diseases and conditions – implementation in clinical practice. Br Dent J. 226(1): 16-22. DOI: 10.1038/sj.bdj.2019.3.
[iii] Agarwal, R. and Baid, R. (2017) Periodontitis and Diabetes: A Bidirectional, Cyclical Relationship – A Brief Review. Acta Med Int. 4(2): 46-49. DOI: 10.1403/ami.ami_16_17. Link: http://www.actamedicainternational.com/article.asp?issn=2349-0578;year=2017;volume=4;issue=2;spage=46;epage=49;aulast=Agarwal#ref19. [Last accessed: 29.10.19].
[iv] Emrich, L. J., Shlossman, M. and Genco, R. J. (1991) Periodontal Disease in Non-Insulin-Dependent Diabetes Mellitus. Journal of Periodontology. 62(2): 123–131. DOI: 10.1902/jop.19184.108.40.206.
[v] Papapanou, P. N. (1996) Periodontal Diseases: Epidemiology. Annals of Periodontology. 1(1): 1–36. DOI: 10.1902/annals.19220.127.116.11.
[vi] Gautam, D. K., Jindal, V., Gupta, S. C., Tuli, A., Kotwal, B. and Thakur, R. (2011). Effect of cigarette smoking on the periodontal health status: A comparative, cross sectional study. Journal of Indian Society of Periodontology. 15(4): 383–387. DOI: 10.4103/0972-124X.92575. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283937/. [Last accessed: 29.10.19].
[vii] Turani, D., Bissett, S. M. and Preshaw, P. M. (2013) Techniques for Effective Management of Periodontitis. Dental Update. 40(3): 181-4, 187-90, 193. DOI: 10.12968/denu.2013.40.3.181.
[viii] Krayer, J. W., Leite, R. S. and Kirkwood, K. L. (2010) Non-Surgical Chemotherapeutic Treatment Strategies for the Management of Periodontal Diseases. Dental Clinics of North America. 54(1): 13–33. DOI: 10.1016/j.cden.2009.08.010. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086469/. [Last accessed: 29.10.19].