Variation in periodontal referral by general dental practitioners

Abstract. This study investigated the extent of and reasons for variation in the periodontal referral patterns of general dental practitioners in Northern Ireland. A questionnaire was circulated to all general dental practitioners in Northern Ireland. This questionnaire investigated the management of periodontal disease in the general dental service and referral for specialist periodontal advice and treatment, A usable return was made by 355 (68%) of those surveyed. The mean number of periodontal referrals by each respondent in the past year was 6.5 (SD 7.7), range 0 to 80. Backward stepwise logistic regression analysis indicated that independent predictors of high referral rate were practice location close to the referral centre ( p <0.0001); dissatisfaction with ability to treat periodontal disease under the National Health Service ( p =0.001); that previous refusals of referral had not dissuaded a dentist from continuing to offer referral ( p =0.002); not offering root planing as a treatment ( p =0.005); and perceived inadequate postgraduate education in periodontology ( p =0.03). It is concluded that considerable variation exists between general dental practitioners working in Northern Ireland in relation to the referral of patients for specialist periodontal advice and treatment. It is further concluded that in many cases non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in relation to periodontal referral.     

Factors influencing the diagnosis and treatment of periodontal disease by dental practitioners in Victoria

BACKGROUND: Healthy periodontal tissues are essential to overall dental health. Therefore, the detection and management of periodontal disease is an integral part of general dental practice. The aim of this study was to investigate confidence in diagnosis and management of periodontal disease by general dental practitioners (GDPs), assess if the Dental Practice Board guidelines on periodontal record keeping are being addressed, and, if necessary, try to find ways of improving the periodontal knowledge of GDPs. METHODS: A survey assessing practitioner confidence in diagnosing and treating periodontal disease was sent to a random selection of 550 dental care providers registered with the Dental Practice Board of Victoria. RESULTS: Two hundred and eighty five (51.8 per cent) of questionnaires were returned completed. It was found that 79.7 per cent of the sampled population screened all new patients for periodontal disease. The majority of respondents felt confident to diagnose and treat gingivitis and initial periodontitis. However, only 61.9 per cent felt confident to diagnose aggressive/early onset periodontitis, and many were not confident in treating advanced periodontitis (36.3 per cent) or aggressive periodontitis (51.6 per cent). The majority of dentists reported that they provided most of the non surgical periodontal therapy to their patients, while most surgical treatments were referred to specialist periodontists. Factors deemed to be important in influencing the decision to provide periodontal treatment included level of training and ability to motivate patients to improve oral hygiene. Many responents requested periodontic continuing education (CE) courses be run. CONCLUSIONS: Most of the dentists surveyed were confident to diagnose periodontal disease and to treat the more common presentations of periodontal disease. There is some evidence to suggest that some practitioners are not following the minimum requirements set by the Dental Practice Board of Victoria in relation to periodontal record keeping. The results also indicate a need for more periodontic CE courses in Victoria.     

Comparison of radiographic and clinical signs of early periodontal disease

abstract — The purpose of the study was to examine the justification of the common assumption that early periodontal disease can be diagnosed on the basis of qualitative radiographic changes in the alveolar bone margin. The material comprised 100 bite wing radiographs of quantitatively intact interdental septa between the mandibular first and second premolars of 65 males aged 19–22 years. The width of the periodontal space, the continuity of the crestal cortical bone layer, and the pattern of trabeculation of each septum were used as criteria for classifying the septa as either healthy or probably or positively diseased. The study revealed that no relationship exists between the Gingival Index score and the presently studied qualitative radiographic findings. It was concluded that the constant interplay between physiologic constructive and destructive phases within the alveolar bone efficiently masks the minute qualitative radiographic changes pertaining to early periodontal disease.     

Energy intake, dental caries and periodontal disease in 11-year-old black children in two regions of Southern Africa: KwaZulu and Namibia

Abstract The study examined energy intake in relation to dental caries and periodontal disease in 11-yr-old rural and urban black children in low fluoride areas of KwaZulu and Namibia (0.15 ppm F) and one higher fluoride area of Namibia (1.56 ppm F). Twenty-four hour dietary recalls were conducted by trained interviewers and daily energy intake estimated using the MRC dietary analysis programme. DMFS was recorded according to WHO criteria; periodontal disease was measured using CPITN and SAS was used for statistical analysis. The prevalence of dental caries and periodontal disease (using CPITN), were compared within three energy groupings; ≤850 kcal/day; > 850, < 1400 kcal/day and ≥1400 kcal/day. The rural low fluoride Namibian children had the lowest mean energy intake (616 kcal/day), which also was the grouping with highest healthy periodontal prevalence (65%). The urban groups had higher energy intakes than the rural communities. Statistically significant effects on caries prevalence were seen for country and fluoride grouping; for periodontal disease, significant effects were noted for country, fluoride group and environment. Energy intake had no statistically significant effect, so this is not a risk marker for the disease.     

Factors influencing the periodontal referral process

Background: General dental practitioners (GPs) assess the periodontal status of patients and make decisions to treat patients or refer them to a periodontist. There is little information available regarding this process. The purpose of this study is to identify significant factors that GPs consider important in selecting a particular periodontist. The findings were compared and contrasted with responses of periodontists to gain perspectives from both groups involved in the referral process. Methods: Data from an online cross‐sectional survey of GPs (n = 533) and periodontists (n = 533) who practice in the southeastern region of the United States (from the databases of the American Dental Association and American Academy of Periodontology member directories) were obtained. Results: The specialist's clinical skill was identified as the most important factor influencing periodontal referrals by GPs, whereas periodontists identified a previous positive experience between a GP and periodontist as the most important factor. In a descending order of importance, the top three rating averages (rated out of five) by GPs were clinical skill (4.84), a previous positive experience between a GP and periodontist (4.57), and communication (4.52). The top three factors of periodontists were a previous positive experience between a GP and periodontist (4.66), communication (4.40), and the likelihood of a good patient and periodontist rapport (4.29). Conclusions: The periodontist's clinical skill was chosen by GPs as the primary factor influencing the referral decisions of GPs. Periodontists perceived a previous positive experience between the GP and periodontist as the most influential factor. Further studies are required to gain more insight into the referral process.     

Periodontal treatment practices of Finnish dentists

OBJECTIVES: To evaluate the treatment practices of Finnish general practitioners (GPs) and dental teachers (DTs) regarding periodontal treatment modalities, and their knowledge of possible contraindications for periodontal surgery. MATERIAL AND METHODS: A questionnaire on two periodontal cases was mailed to 400 GPs, selected by stratified randomization from the public and private sector, and to 47 DTs. The response rate was 77%. Respondents were asked to choose the optimal treatment for a patient with a bleeding, 8-mm-deep periodontal pocket and to consider the influence on their treatment decision of the six possible contraindications for periodontal surgery presented, two of which were absolute (inadequate oral hygiene and poorly controlled diabetes) and four of which were relative contraindications. The respondents' treatment decisions were compared with recommendations from textbooks and the Consensus Report from the 1996 World Workshop of Periodontology. RESULTS: The majority of public (65%) and private (70%) dentists and almost all of the DTs chose treatment in agreement with recommendations. Correct answers from dentists were associated with a greater number of days in continuing education (OR = 1.5; p= 0.005). The two absolute contraindications were known by 38% of public and 31% of private sector dentists, and by 29% of DTs. The respective figures for relative contraindications were 40, 58 and 53%. CONCLUSION: The majority of Finnish dentists followed the recommendations, but elaboration of international guidelines for good clinical practice is still needed to help clinicians to make optimal treatment decisions.     

慢性牙周病患者牙弓宽度的测量和分析

目的:探讨牙周病患者与正常对照组牙弓宽度的差异及其意义。方法:选取48名慢性牙周病患者以及228名牙周正常的大学生,所有受试者均取研究模,选择双侧上颌第一前磨牙的近颊牙合角、下颌第一前磨牙的舌尖、上颌第一磨牙颊面沟的颊牙合面交点以及下颌第一磨牙舌面沟的舌牙合面交点为标志点,分别测量上述同名标志点之间的距离,依次记作上、下颌第一前磨牙牙弓宽度和上、下颌第一磨牙牙弓宽度。结果:牙周病患者的上、下颌第一前磨牙牙弓宽度以及下颌第一磨牙牙弓宽度明显小于大学生对照组(P<0.01),上颌第一磨牙牙弓宽度两组间未见明显差异(P>0.05)。结论:上、下牙弓宽度不调与牙周病有密切关系。     

基于催眠和认知行为疗法的儿童牙科行为管理

 恐惧是儿童牙科行为管理问题的核心，使患儿免于恐惧是行为管理的关键。借鉴催眠和认知行为疗法的理论与方法，由行为引导师带领患儿逐步逐级放松，培育积极正面牙科观念，最终实现自主配合牙科治疗的过程称为“行为管理”。针对常见的行为管理问题，文章简要介绍了快速赢得患儿信任、系统脱敏和记忆重构的引导流程。     

Occurrence of caries and periodontal disease in selenium-treated patients with Spielmeyer-Sjögren's disease

Abstract – The possible influence of continuous exposure to selenium on dental caries and gingivitis was examined during a clinical trial of selenium administration to patients suffering from a progressive encephalopathy, Spielmeyer-Sjögren's disease. The study group consisted of eight children (mean age 12.5 years) and a control group of the same age and size from the same institution. DMFS- and Gingival Bleeding Indices were recorded at the onset of the selenium medication and thereafter once a year. No difference in the caries incidence or in the prevalence of gingivitis between the two groups could be shown during the follow-up period.     

短牙弓修复方法在牙周病患者中的临床应用

目的:将短牙弓(Shortened dental arch,SDA)治疗法应用于修复牙周病患者的牙列缺损。方法:对象为采用SDA治疗法修复的11例牙周病牙列缺损的患者,戴牙时间为6个月。检测方法为X线检查、牙齿松动度检查、测量咀嚼效率以及问卷调查。结果:11例患者对SDA修复表示满意,咀嚼功能明显改善,能满足患者的日常饮食要求。结论:SDA治疗法合理经济,易于适应,有利于牙周病患者余留牙的稳定和恢复。     

Plaque, caries, periodontal diseases, and acculturation among Yanomamö Indians, Venezuela

abstract The number of DM and d teeth and surfaces was recorded for 220 Yanomamö, Indians from three groups of villages with different degrees of contact with Western culture. Specimens of plaque were taken from the teeth, transported in a holding solution, cultured and examined for specific oral streptococci. In addition, the periodontal health and oral by giene of one group of villagers were assessed using the Russell PI and the Greene & Ver million OHIS. Caries experience among the Yanomamö was shown to be positively associated with exposure to Western culture. S. mutans was recovered with about the same frequency from specimens taken from the teeth of Indians living at all three village locations. However, the presence of S. mutans alone did not account for the disparity in dental caries scores. The examinees had abundant and persistent accumulations of soft deposits on their teeth accompanied by markedly inflamed gingival tissues. However, periodontal pockets and loss of appreciable amounts of bone did not appear as early in life nor were they as sever as reported for some other populations which practice little oral hygiene. Those disparities in the distribution of plaque-induced oral diseases between Western populations and the Yanomamö warrant further study.     

Natural distribution of oral Actinobacillus actinomycetemcomitans in young men with minimal periodontal disease

A total of 1005 subgingival and extracrevicular samples from 201 male recruits, 18–25 yr old, were selectively cultivated for Actinobacillus actinomycetemcomitans. The organism was isolated in 55 subjects (27%); 9.5% of pooled subgingival plaque samples from first molars, 14% cheek mucosa, 20% dorsum of tongue and 20% saliva samples were culture-positive. In order to divide the study population into distinct clinical categories, cluster analysis was performed, based on previous caries experience, probing pocket depth categories, bleeding scores, visible plaque and calculus. Two clusters (n=86 and n=92, respectively) were identified with no or minimal periodontal disease (mean±standard deviation % of periodontal probing depth 1–2 mm 78.7±10.4% and 57.4±12.6%, respectively; virtually no periodontal probing/depth in excess of 4 mm) and a relatively low DMF-S (22±13). A third cluster (n=22) had, in contrast, a high DMF-S (47.7±173) and a relatively high % of periodontal pockets of ≥5 mm (5.9 ±5.2%). Prevalence of A. actinomycetemcomitans in this cluster was 41%, while the organism was found in 23% and 27% in the minimally diseased populations (p<0.15). Whereas no heterogeneity of associations between subgingival and extracrevicular occurrence of the organism could be ascertained in different clusters, the organism was significantly more often identified in extracrevicular material, especially dorsum of tongue samples, compared with subgingival plaque (McNemar's X²=12.45, p<0.001). Multiple linear regression analysis revealed the number of A. actino-mycetemcomitans positive samples as well as the % of sites bleeding on probing being positively associated with the % of sites with a probing pocket depth of ≥5 mm (R2=0.345, p≤0.0001). The present large-scale investigation points to the wide distribution of this putative periodontopathogen in young individuals with minimal periodontal disease.     

Fluoridation effects on periodontal disease among adults

Numerous studies report that water fluoridation reduces caries in children, but little current evidence exists about fluoridation's effects on the periodontal health of adults. To address this issue, we estimated fluoridation effects on periodontal disease among 1066 Washington state employees and their spouses, aged 20 to 34, with current residences divided evenly between fluoridated and nonfluoridated communities. Subjects were interviewed by telephone to collect residence histories, personal characteristics and other data. Each subject's lifetime years of fluoridation exposure (YFE) was calculated from the person's residence history and the U.S. Centers for Disease Control's Fluoridation Census . Oral assessments were conducted to measure the extent of periodontal disease. Relative to adults with no exposure, continuous lifetime exposure reduced the probability of attachment loss from 0.87 to 0.72. Similar benefits were obtained for bleeding gingiva and calculus. The estimates of fluoridation's benefits were not influenced by selection bias due to subjects' nonparticipation in the oral assessments.     

牙周病患者种植治疗的相关风险因素

牙周病是导致牙齿缺失的主要疾病之一。随着口腔种植技术的发展,越来越多的牙周病患者选择种植治疗修复缺失牙。牙周病与种植牙在诸多方面存在关联,且牙周病患者发生种植牙失败的风险较高,在对牙周病患者进行种植治疗之前,应对口腔局部条件、全身状况、生活习惯等进行评估,以利于种植方案的选择和风险规避。本文就牙周病患者种植治疗相关风险因素的研究进展作一综述。     

The provision of orthodontic services by general dental practitioners. 2. Factors influencing variation in service provision

Previous work has shown that variations exist amongst general dental practitioners in the volume and type of orthodontic services provided, the type of orthodontic appliances used, and the objectives of the orthodontic treatment. The aims of this survey were to identify practitioner characteristics that account for variations in the level of orthodontic services provided and which distinguish providers and non-providers of orthodontic services. Multiple regression analysis revealed that four practitioner characteristics explained 41 per cent of the variance in the number of orthodontic patients treated. Dentists who treated more orthodontic patients: 1) treated more general practice patients; 2) frequently used multiple sources to keep up to date in orthodontics; 3) perceived their patient base to contain more children; and 4) were likely to have attended a Truitt course. Eleven variables best distinguished providers from non-providers of orthodontic treatment; 1, 2 and 3 above had the highest correlation with the discriminant function. The Null Hypothesis that selected characteristics of dentists providing orthodontic services were no different from those of dentists not providing orthodontic services was rejected. The provision of orthodontic services was associated with a higher level of continuing orthodontic education as well as treating more general practice patients, especially children.     

Root-dentin sensitivity following non-surgical periodontal treatment

BACKGROUND, AIMS: Little clinical data exist on the incidence and severity by which root dentin sensitivity (RDS) results from periodontal therapy. The aim of the present clinical trial was to study the degree to which a sample of patients requiring non-surgical periodontal treatment develops RDS. MATERIAL AND METHODS: Alterations in RDS was followed in 35 patients (29-65 years of age) requiring non-surgical treatment for moderate to advanced periodontal disease. Inclusion criteria for participation were need for periodontal treatment in at least 2 quadrants comprising a minimum of 4 teeth with vital pulps, no open caries lesions, no dental treatment in the last 3 months and no ongoing treatment for RDS. Baseline and follow-up recordings included responses of teeth to pain stimuli (directed compressed air) at buccal surfaces as graded by the patient on a 10-cm visual analogue scale (VAS). Periodontal therapy consisted of oral hygiene instruction (OH) followed by supra- and subgingival scaling/root planing by hand and ultrasonic instrumentation of one quadrant per each of the subsequent weeks. Thus, follow-up data included pain assessment after 1-3 weeks of OH alone, and 1-4 weeks post-instrumentation. RESULTS: There was a statistically significant reduction in mean VAS scoring over time in quadrants where only meticulous plaque control had been maintained, while VAS mean values increased significantly after instrumentation (p<0.001). Also the % of subjects reporting higher mean VAS values increased after instrumentation. Changes in mean VAS scores were generally moderate and only 9 patients gave an increase on VAS of >2 cm for 3 or more teeth. A statistically significantly higher increase of RDS was observed for initially sensitive teeth (VAS>0) than for teeth not responding at baseline (p<0.001). Although a reduction in the intensity of RDS could be noticed during the later phase of the 4-week follow-up period after scaling and root planing, the percentage of sensitive teeth remained unchanged. CONCLUSION: The data confirm that meticulous plaque control will diminish RDS problems and that scaling and root planing procedures in periodontal therapy result in an increase of teeth that respond to painful stimuli. However, pain experiences in general appeared minor and only a few teeth in a few patients developed highly sensitive root surfaces following instrumentation.     

The relationship between selected measures of periodontal status and demographic and behavioural risk factors

OBJECTIVE: To assess differences between selected periodontal measures by demographic and behavioural factors in a nationally representative sample of the United States. METHODS: Data for 11,347 person's ages 20-79 years from the third National Health and Nutrition Examination Survey (NHANES III) were used. Indices and measures constructed from NHANES III data used for this study were: derived community periodontal index (dCPI), attachment loss extent index (ALEI), attachment loss (AL) scores, and a Periodontal Status Measure (PSM) developed for this study. RESULTS: The influence of demographic and behavioural factors varied across the four indices examined in multivariate cumulative logistic models. Moreover, there was significant effect modification by cigarette smoking with age in the ALEI and AL models. The odds ratio (OR) of increasing periodontal disease status among 20-39 year olds as measured by AL or ALEI for current smokers compared with non-smokers were OR=6.2 (95% confidence interval (CI)=4.1, 8.7) and OR=5.6 (95% CI=3.7, 8.7), respectively. In a similar comparison, the OR for dCPI was 2.6 (95% CI=1.7, 3.8). Furthermore, Mexican American ethnicity was generally not significant in any models using dCPI, PSM, AL, or ALEI and prior dental visit was more likely to be significant only in the dCPI and PSM models. DISCUSSION: Among the well-known demographic and behavioural influences on periodontal health status, some, such as race/ethnicity and prior dental visit status have different relationships with differing periodontal measures employed to assess periodontal status. Moreover, potential interactions among cofactors also are dependent upon the measure selected. Periodontal research findings may be influenced significantly by periodontal measure selection and its affect on measurement validity. This may have particular relevance to issues concerning disease surveillance and assessing reduction of disparities in oral health. Consequently, a renewed approach to developing appropriate measures for periodontal epidemiology is needed.