In a previous post, I had expressed my concerns about day-to-day applicability of the new Staging and Grading system of periodontitis. In particular teaching it to undergraduate students has turned out to be difficult and short-time experience with it had already led to my decision: Here at UTK/IKO we won’t do attachment level measurements (apparently one main prerequisite in the new system) on a routine basis in order to distinguish initial (formerly mild) from moderate periodontitis and severe from very severe disease, save diagnosis of periodontally healthy patients.
How this may actually work has been shown in the recent Fédération Dentaire Internationale (FDI) chairside guide which uses very similar definitions but without systematically recorded clinical attachment levels, see below. When it comes to grading, there are differences as to the current EFP/AAP suggestions, but not fundamental.
Yesterday, Tonetti and Sanz have published decision making “algorithms” for clinical practice and education which once more prove that EFP/AAP suggestions are academically sound but extremely hard to implement in a clinical setting.
Here come the seven decision making flow charts which will be printed soon in the Journal of Clinical Periodontology.
The issue mentioned in the title was dealt with in a systematic review of the Cochrane Collaboration which was published 3 1/2 years ago. It confirmed that, since the publication of the PAVE pilot study in 2009, no further evidence had emerged. The authors of the Cochrane review concluded,
We found very low quality evidence that was insufficient to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis. No evidence on primary prevention was found.
Possible systemic effects of periodontal treatment had been claimed for a very long time, and lack of evidence, or evidence for their clinical irrelevance, had never been accepted by many colleagues, indeed.
The most recent attempt of reviving the largely lapsed interest by most of our medical colleagues in the Perio-Systemic link, in particular its cardiovascular branch, was launched earlier this week when a of the European Federation of Periodontology (EFP) met colleagues of the World Heart Federation (WHF) in Madrid. The aim of the workshop was to “explore the links between periodontal disease and cardiovascular disease and draw up a series of recommendations.”
In a previous post, I have expressed considerable concern about an assumed advertorial in our leading periodontal journal, JCP. Quintessence Publishing was about to launch their fourth installment of “3D” animated, short (each 15-17 min) movies all called Cell-to-Cell Communication, “Oral Health and General Health – The Links between Periodontitis, Atherosclerosis, and Diabetes.” Previous movies have been offered for purchase by QuintPub for a remarkable amount of around $100. Luckily, the new one can now be found on the EFP homepage and accessed by members and non-members for free.
It is remarkable that the prestigious Journal of Clinical Periodontology, founded by Hans Mühlemann and edited for decades by Jan Lindhe, is going to publish a commercial for a Quintessence Publishing and Sunstar production, part of a Quintpub series of DVDs (all called Cell-to-Cell Communication) of short (each runs for about 15 minutes) animated (“3D”) movies. The first installations in this series had been about inflammatory reactions in the periodontium (I had critically reported on its educational value here), periodontal regeneration and osseointegration.
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.