In the current issue of JOP two renowned American clinicians reflect on what they believe shaped modern periodontology, Michael K. McGuire and Thomas G. Wilson. I was a bit hesitant when considering commenting on their musing. When browsing through the AAP’s Open Forum every other day (basically a community made of American periodontist practitioners which is rarely joined by AAP officers or scientists for helpful clarification about what is evidence and what not) I met quite a lot professional frustration and, well, cluelessness.
Evidence based dentistry may have emerged not earlier than 15 years ago; with very revealing results. Only now, we may be able to grade the evidence and make reasonable recommendations: strong or weak, for or against. For instance, based on still moderate quality of evidence, GTR may only weakly be recommended for the treatment of a very limited number of certain periodontal lesions. Hasn’t that been a “megatrend” of the 1980s and 1990s which is over in 2014?
And then, practitioners may actually perceive “trends” when scientists may talk about “hot” issues. Periodontology has suffered for a long time from a terrible misconception: practitioners applied “hot” issues which they perceived as trends.
No, the perio-systemic link is not a game changer. I am not aware that the life of any perio-patient had been saved by properly treating his/her periodontal disease. And no, EBM is not a megatrend. It is the basis for every-day decision making in a field where expert practitioners are in the comfortable situation that they can rely on systematic reviews and many meta-analyses which cover most of our clinical questions. And again no, laser therapy, local delivery and host modulations are no wild cards anymore. McGuire and Wilson compare the situation reagrding these approaches with implant dentistry which has apparently transitioned from a dubious approach to standard of care. Well, that’s true, but it was EBM which made it possible. And it’s EBM which has not provided high quality evidence for the latter.
McGuire and Wilson conclude with, “Clearly these are exciting times!” when thinking of “3-D printing, salivary diagnostics, live cell therapies, minimally invasive techniques, and many more.” I am afraid that their patients will instantly share their opinion. Unjustified enthusiasm is one of the main prerequisites for a successful practitioner.
2 August 2014 @ 11:57 am.
Last modified May 11, 2016.
The November 2012 EFP and AAP workshop on systemic health and how it is affected by periodontal disease has resulted in the joint publication of a couple of valuable systematic reviews in both Journal of Clinical Periodontology and Journal of Periodontology. I have expressed my strong opinion here on this blog that, in essence, there was not so much new or surprising. That there is strong evidence for minor effects of periodontitis on, say, cardiovascular disease and that diabetes mellitus is affected by periodontal disease while it is a risk factor for gum disease itself has been known for decades. That, what organizers had claimed, there is now a need for intervention studies to show that the risk for cardiovascular events may be reduced, has been questioned on this blog and elsewhere.
I have criticized the workshop’s Manifesto, a press release which reduced the somewhat difficult to digest information to a message for the public (and I include here in particular most of the dental profession whose members may not be able or willing to read through the pages of documents, be it but systematic reviews let alone the original cohort studies). I have also suggested a brief example (based on a gut feeling of a possible risk ratio) in which the most relevant ethical problem of not treating huge cohorts for periodontal disease was mentioned while probably a great number of patients with periodontitis had to be treated successfully (number needed to treat) in order to prevent a single cardiovascular event (if the effect was causal) which renders the whole exercise probably irrelevant.