Another edition of a joint EFP/AAP workshop has just closed in Chicago, and periodontal scientists and teachers all over the world are eagerly awaiting the proceedings to be published in our core scientific journals, the Journal of Periodontology and the Journal of Clinical Periodontology. The workshop’s agenda had been announced on the EFP website on Thursday this week.
Hallmarks of the previous Classification of Periodontal Diseases and Conditions of 1999 had included a thorough classification of gingival diseases and renaming, once more, juvenile/early-onset periodontitis as “aggressive”, and the more common “adult” form of periodontitis as “chronic”. Many scientists, in particular epidemiologists had considered the latter achievement as highly problematic. Not only that disease definitions included some laboratory tests not available to the common practitioner; progression rates were to be assessed as well. Both is utterly difficult, if impossible, in epidemiological research.
And, as assumed microbiological cause and pathogenesis of either chronic or aggressive periodontitis do not differ fundamentally, does a differentiation even make sense? What comes to one’s mind is, of course, diabetes where types I and II have different causation and can easily be differentiated despite common clinical signs and symptoms.
What’s wrong with a Google Scholar account? Everybody loves it, right? Years ago, I had created one (it needs just a Google account) and cleaned it from unrelated (as scientists with my last name and initials are plenty) articles. It neatly lists all my publications (in the order of highest to lowest quotations). It tells me (and others who might be interested in my work) the number of quotations and the number of recent quotations. It calculates my h-index and several other more or less informative metrics. And it alerts me of recent quotations, so I can easily check who quoted me and in which context.
Google Scholar’s algorithm doesn’t consider a “core collection” as Web of Science of Clarivate Analytics does. That means that Google Scholar also regards quotations in articles published in questionable open access journals, cites in doctoral or master theses (but, as far as I know, not books). And also quotes of books. In my opinion, a quotation is a quotation and if correct, it’s okay.
When I was approached by the Nobel Committee at Sweden’s Karolinska Institute in October last year, probably as having been recognized as “[h]older of [an] established post as full Professor[s] at the faculties of medicine in Sweden [or] holder[s] of similar post[s] at the faculties of medicine or similar institutions in Denmark, Finland, Iceland and Norway”; and invited to nominate a possible candidate for the Physiology and Medicine award 2017, I was wondering whether there would be a dentist who might deserve the honor.
According to Alfred Nobel’s (1833-1896) will,
[t]he said interest shall be divided into five equal parts, which shall be apportioned as follows: /- – -/ one part to the person who shall have made the most important discovery within the domain of physiology or medicine …
Well, I checked out most prolific and highly cited dentistry professionals (of course with a focus on Perio), made myself aware of previous years’ laureates, and immediately noticed there was none. Dentistry has made advances in the past hundred years or so, no doubt. But, when considering Perio (my field of interest), it might in fact be questioned whether our understanding of the pathogenesis of periodontal diseases has witnessed fundamental breakthroughs after, say, the late 1970s. Whether basic principles of treatment have changed. As a matter of fact, innovations, such as regenerative treatment, had no lasting effect as respective methods may be applied in a minority of lesions, i.e. deep infrabony lesions and a few furcation involvements only. And the main issues, prevention and treatment of more aggressive forms, seem to be yet unresolved. What appears to thrill both young and old dentists right now is a one-hundred-year-old claim of focal infection, the so-called Perio-Systemic link.
In a recent analysis of thousands of randomized controlled trials (RCT) in eight journals a simple method was offered which might enable skeptical scientist identification of data fabrication. Editor of the Anaesthesia journal John B. Carlisle of Torbay Hospital, UK, looked at baseline differences of means in more than 5000 randomized controlled trials, mainly in the field of Anesthesiology, but also more than 500 published in JAMA and more than 900 published in the New England Journal of Medicine . His study went online earlier this week. Analyzed articles were published between 2000 and 2015. In brief, if randomization was successful, baseline differences should be small. Giving p-values for baseline differences (in order to indicate successful randomization) is actually discouraged since they are not really interpretable, but Carlisle calculated them anyway. If the null hypothesis is true, p-values have a uniform distribution. So p-values between 0 and 1 would be equally likely.
Last weekend, EFP and International Diabetes Federation (IDF) delegates, in partnership with Sunstar, had met in Madrid and had worked on guidelines for dentists, medical doctors and patients with periodontitis and/or diabetes. The EFP website features some key findings when reviewing the literature. In particular, it is claimed that,
evidence suggests that periodontitis patients have a higher chance of developing pre-diabetes and type-2 diabetes and that people with periodontitis and diabetes have more difficulty in keeping their blood-sugar levels under control. Furthermore, patients with both diseases are more likely to develop diabetic complications than people with diabetes without periodontitis.
Current evidence indicates that in people with diabetes, periodontal therapy accompanied by effective self-performed oral hygiene at home is both safe and effective – even in people with poorly controlled diabetes. Similarly, there is consistent evidence that periodontal therapy reduces blood-sugar levels in people with diabetes and periodontitis. (Emphasis added.)