Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

Dental research continued to grow during 1988. Unfortunately the quality does not always parallel the quantity of publications. This report obviously does not encompass all of the literature but focuses on studies that are related to trends and to matters that are considered controversial. Likewise the particular interests of the members of the American Academy of Restorative Dentistry were taken into consideration. The subjects covered include periodontics, preventive dentistry, bulp biology, craniomandibular disorders, ceramics, color in restorative dentistry, and dental materials.

[Periodontology yesterday and tomorrow. Epidemiology, aetiology and classification of periodontal diseases]

Modern periodontology is pervaded by a host of problems, and their solving may bring a considerable progress in this field. Views are verified on the incidence of parodontal diseases and their course. It is thought that the incidence of parodontal diseases is generally decreasing, and their course is more varied than it has been assumed as yet. An ever greater role is ascribed to bacteria in the aetiology of these diseases, this role is thought even to be a specific one. In connection with the advances in microbiological and histological examination new trends appear in the classification of parodontal diseases.

[Periodontology yesterday and tomorrow. Prevention, treatment and evaluation of therapeutic needs]

The therapeutic approach to parodontal diseases is still of small effectiveness, and, in the first place, not economic. The need arises for introduction of a practical and real programme for the control of parodontal diseases based on prophylaxis. Certain therapeutic methods require verification since they are not sufficiently sparing the parodontal tissues. Preference should be given to conservative approach, even in surgical treatment. The periodontological index of therapeutic needs facilitates the planning and realization of health education, prevention and treatment of parodontal diseases.

Private practice of periodontics. Past patterns, future prospects

The private practice of periodontics has grown in a comparatively short time from a handful of clinicians to a significant factor in the overall practice of dentists. Periodontics has matured into a specialty that interfaces with every aspect of dentistry. Patient awareness demands it service. With the changes taking place in the health delivery system, there has emerged insurance and capitation programs that have influenced the private practice of periodontics. Along with these changes have come economic factors that have encouraged many periodontists to seek new avenues of revenue such as implantology. The dental awareness of the public and the continuance of the high standards of periodontics will prevail. If this is the case, then the future prospects of the private practice of periodontics is ensured.

Changing concepts in periodontics

This article reflects long-term observations of a clinician in private practice. Significant changes have occurred in periodontology in the past 50 years, while basic principles of periodontics have remained firm. State of the art and predictions of the future of periodontal practice are based on experience gained in both a general practice and a practice limited to periodontics.

Teaching periodontics. Past patterns and future prospects

The article presents a brief history of the development of periodontal concepts and their data base. Because of the rapid change in periodontal science and knowledge, the author pleads for periodontal education based on "show, deliberate, choose, and do" in our dental curricula.

Periodontics of tomorrow

In the early post-World War II years, there was no unified paradigm to explain the etiology of periodontal diseases. Subsequent studies established that the diseases were caused by bacteria colonizing the gingiva and subgingiva, leading to rational approaches to treatment and prevention. Research to identify the principal and bacterial species involved and clarify host immune responses continues, aided by new cell and molecular techniques. Epidemiologic surveys show improved oral health in adults but indicate problems among older Americans. Future research should expand studies of periodontal tissue regeneration, resolve questions of disease activity and progression and include oral health promotion programs targeted to adults.

Report of Committee on Scientific Investigation of the American Academy of Restorative Dentistry

A few personal points seem appropriate in summary. It is axiomatic that while research solves problems, it also creates them. As an example, it is an accepted fact that dentistry more than any other profession has made serious inroads into putting itself out of business through research. Each year this report takes note of the reduction in dental caries in children, which has thus triggered a change in the nature of general practice. Be this as it may, it is well to acknowledge that major dental diseases are not disappearing, but their patterns in the population are changing, accompanied by an expansion of other services. Despite the optimistic picture painted earlier in this report, it is grossly premature to acclaim the elimination of caries, and thereby a significant segment of restorative dentistry. Of course the younger age groups have been the major beneficiaries of caries reduction. As the child ages from 9 to 16 years, the percentage of mouths free of caries drops by one half. In addition, the disease pattern in the adult population is being altered because of a longer life span and loss of fewer teeth. Unquestionably what we will, and are already seeing, is not an elimination of restorative dentistry but a different target and changes in procedures because of new materials, therapy, and expanded scope of services. There is yet another subtle change in the trend of dental research and it deals with the reduction in the number of dental schools worldwide and smaller class sizes in those schools. Dental research thereby suffers because of the traditional link between education and research. Thus the potential pool of researchers becomes smaller and research monies for training programs for dental investigators, particularly in clinical research, decreases. This year a surprising number of articles are concerned with manpower as it relates to research priorities. So, it is indeed a time that both the profession and the scientific community find filled with controversy and frustration. Yet never has there been a time that offers more in challenges and rewards.

The central role of the general practitioner in the treatment of periodontal disease

This paper is based on experience of periodontal practice in Yugoslavia, Bosnia and Herzegovina respectively. Factors of relevance to the multidisciplinary approach to periodontal therapy are the level of development of public health, the teaching curricula in periodontology in dental schools, the organization of public dental health services (demand only or systematic oral care services) including the target groups and the dentist to population ratios. Quantification of periodontal treatments, the Community Periodontal Index of Treatment Needs (CPITN) and the recent analysis of the American Academy of Periodontology on periodontics in the twenty-first century are also of great relevance. Periodontology is a higher level discipline of public as well as dental health. The specialist periodontist carries out all the treatments in periodontology undertaken by the general dental practitioner and more specialized treatments not usually performed by the generalist.

The role of the specialist periodontist

The major portion of periodontal care of the population belongs in the hands of the general dentist. This is because of the overwhelming number of patients with periodontal disease and the intimate relationship between the periodontal condition and restorative dentistry. The probable increase, in the near future, in the number of patients with periodontal problems will necessitate a greater understanding and an increased level of expertise for their solution on the part of the general practitioner of dentistry. However, there will always be a need for specialists to treat particularly difficult cases, patients with systemic health problems and situations in which complex prosthetic construction requires absolute assurance of reliable results.

The rise of consumerism in periodontics

Dentists can and should capitalize on the consumer movement. Consumerism is good practice management. This opinion is consistent with the excellent overview of changes in periodontics during the 1970s that are described in other articles of this symposium. No dentist can guarantee good periodontal health or successful treatment if the patient is not responsible doing all he can to prevent periodontal disease. When the patient has this attitude and has modified his oral hygiene habits in accordance with the recommendations of the general dentist, the patient then has the right to expect that most forms of gingivitis and periodontitis will occur only rarely, if at all.