Mombelli vs. Shapira

The EFP website has posted the other day a debate between Professors Lior Shapira of the Jerusalem Hebrew University and Andrea Mombelli, Geneva. Is it time to rethink on the use of antibiotics in the treatment of periodontitis? Well, it actually is. One cannot continue just emphasizing the undeniable (if short-term) effect of antibiotics reducing the need and extent of periodontal surgery when administered as an adjunct to non-surgical treatment (Mombelli) without having the much bigger picture (real global threats of antibiotic resistance development) in mind (Shapiro). I have written about recent respective clinical reports on (transient) effects of adjunct antibiotics numerous times on this blog, see, for example here, here and here. I never concealed my opinion. Biofilm infections are indeed different.

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“Flossing Has No Effects”

Update below.

Flossing

No wonder when our professional societies and academies want to promote it with the above images. The Facebook page of the German Society of Periodontology features the left image while the right supports a recent statement by the American Academy of Periodontology’s President, Dr. Wayne Aldredge, regarding the U.S. Departments of Agriculture and Health and Human Services recent decision to remove flossing from the federal 2015-2020 Dietary Guidelines, citing the gap in quality research.

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When Should Evidence – Or Rather Lack Thereof – be Ignored?

When the European Federation of Periodontology (EFP) was about to publish their 2014 workshop proceedings, eyebrows were raised in particular after reports of a press conference emerged. I remember that “Flossing may be a waste of time” (as there was no evidence for the prevention of interdental gingivitis found after thorough literature search), but can’t find the respective newspaper article anymore. As Professor Iain Chapple outlined, if there is space in between teeth, interdental brushes would do better as an adjunct to toothbrushing.

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Twenty Years of Emdogain in Regenerative Periodontal Therapy

An enthusiastic opinion piece (erroneously designated Systematic Review) has just appeared in the August issue of the prestigious Journal of Clinical Periodontology (Miron et al. 2016). The 16 pages are authored by a remarkable number of 20 authors.

This is certainly not a systematic review as basic PRISMA requirements are not met. Not a single one. So, has this to be regarded just another old fashioned narrative review? I can’t help but when reading the first authors’ unwarranted zeal this may actually be just another brazen commercial. I am afraid that most if not all authors are listed on Straumann’s pay roll, the company which currently markets Emdogain. Thus, the required (for biomedical journals) Conflict of interest and source of funding statement sounds, well, frivolous.

The authors report no conflict of interest for the present review article. No funding was required [sic]/received by any of the co-authors for the present review article.

According to his CV, Dr. Miron alone received 270,500 CHF ($274,246) from Straumann between 2010 and 2015.

As the authors dare to suggest recommendations (called guidelines, however except a flow chart in the main text, see below, they are deeply buried in the paper’s supplement which can be accessed only online) without grading the presented evidence from randomized controlled and observational studies, it seems pertinent to judge, at least in part, whether respective suggestions have a sound scientific basis.

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Making the Public Aware?

While there is some evidence that shocking images of cancer and death on cigarette packs may have an impact on smoking behavior, it might be questioned whether ugly smiles (due to periodontitis and bad dentistry) would actually let patients hurry to their dentist doctor for prevention. The British Society of Periodontology which will face, after BREXIT, enormous problems as most dental care has recently been provided by (cheaper) expat dentists with EU nationalities who now fear of being expelled soon.

Oral health in the Kingdom has always be considered awful. But that is a direct consequence of bad dentistry, not “tolerance” of the British people as was suggested here.

6 August 2016 @ 10:45 am.

Last modified August 6, 2016.