Primary Prevention of Periodontal Disease

On November 9, EFP leaders had live-streamed a webinar in which their guidelines were provided based on conclusions drawn from the 2014 EFP workshop in Segovia, Spain. The 11th European workshop was by and large about prevention, and extensive systematic reviews and position papers had been published earlier this year in the Journal of Clinical Periodontology. A video of the webinar can be seen here.

The panel comprising Professors Mariano Sanz, Maurizio Tonetti, Iain Chapple and Søren Jepsen had an emphasis on primary prevention in subjects without periodontal or peri-implant diseases, especially the former of which had largely been ignored in recent decades. Tonetti stressed several times that, while prevention of dental caries and oral cancer has been very successful, periodontal disease has apparently lost ground.

It was mentioned as one of the most surprising results of the workshop that a meta-review by Sälzer et al. (2015) had found some (low quality) evidence that interdental brushes have an additional effect on interdental plaque reduction, while no evidence was found for dental floss. Effects on gingival inflammation were inconclusive anyway. Chapple stressed that flossing may be challenging for some. Floss should be used only in healthy situations when interdental embrasures are too tight for the insertion of interdental brushes. The message, which had already been spread in the lay press, may be utterly misleadingly. If one seriously wants to focus on primary prevention, these situations (healthy situations without papilla loss) have to be properly addressed and interdental brushes avoided.

That the EFP wants to give primary prevention of periodontal (and peri-implant) diseases high priority is very remarkable. But how should that be accomplished facing dwindling resources everywhere? As a matter of fact, the last four decades have seen considerable progress in oral microbiological issues, possible regeneration of periodontal tissues, especially all aspects of implant dentistry and so-called periodontal medicine. All new knowledge (maybe except implant dentistry) has not really changed our daily approach of treatment. Jan Lindhe, in the closing ceremony of Europerio 8 in June (go to 1:04:30), made somewhat annoyed the point that “we should not be primadonnas here on stage” and thus considers non-surgical periodontal therapy essential and also pocket elimination a very valid procedure. This may tell volumes about his assessment of new tissue-saving flap designs, when they are indicated and how they should be applied in daily practice. Apparently rarely. And also that of Klaus Lang’s claim of the necessity of “very low plaque levels”. In a recent interview published in the British Dental Journal, Lindhe amazingly strongly advised us not to become “pseudo-doctors” for all kinds of systemic diseases.

Recent epidemiological surveys, indicating an alarming increase of prevalence and severity of periodontitis among aging populations in the west but also billions of underprivileged humans in underdeveloped countries, have uncovered the real problem in periodontology. Chapple mentioned that severe periodontitis has now been identified the 6th most prevalent disease while periodontitis as such is most probably the most prevalent. It is not about very limited indications for very limited periodontal regeneration with indeed questionable clinical relevance. It is not about very expensive treatments in a few patients by few master clinicians, in particular, when compared to treatments provided by our medical colleagues. It can no longer be about the administration of even more antibiotics. Periodontitis is a global public health problem.

Good that our thought leaders are beginning to recognize this. But how should primary prevention be accomplished facing dwindling resources everywhere?

27 November 2015 @ 4:53 am.

Last modified November 27, 2015.

 

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