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Milosavljevic A, Stavropoulos A, Descroix V, Götrick B. A questionnaire-based study evaluating differences between dental students in Paris (F) and Malmö (SE) regarding diagnosis and treatment decisions of patients with different severity levels of periodontal diseases. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2018; 22:e392-e399. [PMID: 29316064 DOI: 10.1111/eje.12317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
AIM To evaluate differences between last-year dental students in Paris (F) and Malmö (SE) Dental Schools, in regard to their judgement and decision-making within periodontology. MATERIALS AND METHODS Ninety-six last-year dental students from Paris and 45 from Malmö participated in a questionnaire study based on four patient cases: (i) Patient case with generalised alveolar bone loss but no signs of inflammation (Well-maintained), (ii) Patient case with generalised alveolar bone loss and signs of inflammation (Periodontitis), (iii) Patient case with no alveolar bone loss and no signs of inflammation (Healthy) and (iv) Patient case with no alveolar bone loss but with signs of inflammation (Gingivitis). Through multiple-choice questions, the students judged each case as healthy or diseased proposed a diagnosis and treatment measures and estimated the treatment time for each patient. Furthermore, they assessed the prognosis of each patient in case of no treatment. RESULTS Based on a response rate of 83%, the majority in both groups judged all the patients as diseased. More Paris students diagnosed the healthy and the gingivitis case as having periodontitis (P < .05). Furthermore, a larger number of students from Paris recommended several treatment measures and estimated longer treatment times for all the cases (P < .05) and estimated a higher risk for disease progression for the healthy and the gingivitis case (P < .05). CONCLUSIONS Significant variation between students from Paris and Malmö Dental Schools in regard to judgement and decision-making was observed; this may in turn imply that there is still need of improving consistency amongst undergraduate educations in periodontology in Europe.
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Affiliation(s)
- A Milosavljevic
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - A Stavropoulos
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - V Descroix
- UFR Odontologie, Université Paris Diderot, Paris, France
| | - B Götrick
- Department of Oral Diagnostics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Sai Sujai GVN, Triveni VSS, Barath S, Harikishan G. Periodontal risk calculator versus periodontal risk assessment. J Pharm Bioallied Sci 2015; 7:S656-9. [PMID: 26538938 PMCID: PMC4606680 DOI: 10.4103/0975-7406.163593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: The purpose of study was twofold: To determine the extent of inter valuator and inter group variation in risk scores assigned to study subjects by PRC and PRA. To explore the relationship between risk scores assigned by PRC and using the PRA. Materials and Methods: 57 patients (33 male patients and 24 Female patients between 20 and 65 years age group) were assessed with PRC and PRA tools during their first visit. Results and Conclusion: We entered the resulting information in to the PRC and PRA to obtained a riskscore for each subject at first visit. The chi-square test significance between PRC and PRA is < 0.05 indicatesthe accuracy of the both tools.
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Affiliation(s)
- G V Naga Sai Sujai
- Department of Periodontics, Lenora Institute of Dental Sciences, Rajanagaram, Rajamundry, Andhra Pradesh, India
| | - V S S Triveni
- Department of Periodontics, Lenora Institute of Dental Sciences, Rajanagaram, Rajamundry, Andhra Pradesh, India
| | - S Barath
- Department of Periodontics, Lenora Institute of Dental Sciences, Rajanagaram, Rajamundry, Andhra Pradesh, India
| | - G Harikishan
- Department of Periodontics, Lenora Institute of Dental Sciences, Rajanagaram, Rajamundry, Andhra Pradesh, India
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Lang NP, Suvan JE, Tonetti MS. Risk factor assessment tools for the prevention of periodontitis progression a systematic review. J Clin Periodontol 2015; 42 Suppl 16:S59-70. [DOI: 10.1111/jcpe.12350] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Niklaus P. Lang
- Universities of Berne and Zurich; Berne Zurich Switzerland
- University College London Eastman Dental Institute; London UK
- European Research Group on Periodontology (ERGOPerio); Genova Italy
| | - Jean E. Suvan
- University College London Eastman Dental Institute; London UK
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Milosavljevic A, Götrick B, Hallström H, Jansson H, Knutsson K. Different treatment strategies are applied to patients with the same periodontal status in general dentistry. Acta Odontol Scand 2014; 72:290-7. [PMID: 24053366 DOI: 10.3109/00016357.2013.824605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To analyse how general dental practitioners (GDPs) and dental hygienists judge and plan to treat patients with different periodontal conditions. MATERIALS AND METHODS Seventy-seven GDPs and 50 dental hygienists in a Swedish county, Halland, participated in a questionnaire study. The response rate was 94%. The questionnaire consisted of four simulated patient cases and an attached answer sheet. The patient cases had different periodontal status, ranging from healthy to moderate bone loss with general inflammation. The clinicians judged the periodontal status as healthy or diseased. If judged as diseased the clinicians suggested a diagnosis, selected treatment options and estimated the number of treatment sessions for each patient case. The clinicians were compared to each other regarding their judgement, as healthy or diseased, diagnostics and treatment. RESULTS Three out of four patients were judged both as healthy and diseased by different clinicians. If judged as diseased the patients were diagnosed as having gingivitis or periodontitis. Regardless of the clinicians' former judgement and diagnostics there were no differences (p > 0.05) in the selected treatment options but there was a difference (p < 0.05) in the suggested number of treatment sessions. CONCLUSIONS Clinicians' judgement of the same periodontal condition, as healthy or diseased, varies, which partly results in different treatment decisions considering the number of treatment sessions. The suggested number of treatment sessions varied also between clinicians even if they judged and diagnosed the condition likewise. The willingness to treat and suggested treatment options were not influenced by the variation in judgement and diagnostics.
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Kye W, Davidson R, Martin J, Engebretson S. Current Status of Periodontal Risk Assessment. J Evid Based Dent Pract 2012; 12:2-11. [DOI: 10.1016/s1532-3382(12)70002-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kaner D, Bernimoulin JP, Dietrich T, Kleber BM, Friedmann A. Calprotectin levels in gingival crevicular fluid predict disease activity in patients treated for generalized aggressive periodontitis. J Periodontal Res 2011; 46:417-26. [DOI: 10.1111/j.1600-0765.2011.01355.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Carollo-Bittel B, Persson RE, Persson GR, Lang NP. Supportive periodontal therapy for high- and low-risk patients. ACTA ACUST UNITED AC 2011; 2:110-6. [DOI: 10.1111/j.2041-1626.2011.00050.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zitzmann NU, Scherrer SS, Weiger R, Lang NP, Walter C. Preferences of dental care providers in maintaining compromised teeth in relation to their professional status: implants instead of periodontally involved maxillary molars? Clin Oral Implants Res 2010; 22:143-50. [DOI: 10.1111/j.1600-0501.2010.02062.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dimensional changes of periodontal soft tissues after intrasulcular incision. Clin Oral Investig 2009; 13:401-8. [PMID: 19172314 DOI: 10.1007/s00784-009-0251-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 01/12/2009] [Indexed: 10/21/2022]
Abstract
In maxillofacial surgery, intrasulcular incisions are often used. This prospective case series was established to evaluate the detrimental effects of intrasulcular incisions on periodontal structures. In 35 patients, measurements of probing depth and crown length before and 10 months postoperatively were performed to calculate changes of attachment level and gingival recession. In a subgroup, surgically treated sites were compared with untreated control sites. A nonparametric test was applied for longitudinal and split-mouth comparisons. Overall, intrasulcular incisions did not induce significant attachment loss. The frequency of sites losing > or = 2 mm of attachment was 5.0%, 2.6%, and 4.7% at mesial, buccal, and distal sites, respectively. Intrasulcular incisions caused only a slight increase in gingival recession by 0.4 +/- 0.5, 0.2 +/- 0.3, and 0.3 +/- 0.4 mm at mesial, buccal, and distal sites, respectively. Within the limitations of the study design, it can be concluded that intrasulcular incisions without additional vertical incisions do not impose a serious risk for attachment loss and/or gingival recession.
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Luciak-Donsberger C, Piribauer F. Evidence-Based Rationale Supports a National Periodontal Disease Screening Program. J Evid Based Dent Pract 2007; 7:51-9. [PMID: 17599649 DOI: 10.1016/j.jebdp.2007.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The evidence-based decision-making process that led to the inclusion of periodontal diseases (PD) in the newly revised Austrian National Periodic Health Examination (PHE) is described. Although intraoral inspection by physicians had already been a routine part of the PHE, obvious signs of PD, which are highly prevalent in Austria, have been largely ignored. OBJECTIVE The objectives of this periodontal screening (PS) program are to direct persons with a series of identifiable risk factors to seek proper care. METHOD The PS program development methodology was based on 2 factors: a systematic review of evidence-based publications that establish correlations between individual risk factors or multifactorial risk models with an increased susceptibility to progression of PD, and a selection of brief and cost-effective screening interventions that could be administered by nondental clinicians such as general physicians. RESULTS The final screening model is a 3-step intervention: CONCLUSION The final PS model within the Austrian PHE is based on a wealth of data justifying an evidence-based intervention. The Austrian population is likely to benefit in many ways from the intervention through increased awareness of PD and through a collaboration of medical and dental clinicians in their prevention.
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Affiliation(s)
- Claudia Luciak-Donsberger
- Department of Periodontology and Prophylaxis, Bernhard Gottlieb School of Dentistry, Medical University of Vienna, Austria
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Hughes FJ, Syed M, Koshy B, Marinho V, Bostanci N, McKay IJ, Curtis MA, Croucher RE, Marcenes W. Prognostic factors in the treatment of generalized aggressive periodontitis: I. Clinical features and initial outcome. J Clin Periodontol 2006; 33:663-70. [PMID: 16856897 DOI: 10.1111/j.1600-051x.2006.00966.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The aims of this study were to investigate prognostic factors for initial response to non-surgical periodontal treatment for generalized aggressive periodontitis. METHODS Seventy-nine patients with generalized aggressive periodontitis were included in this prospective follow-up intervention study. Patients' clinical and demographic parameters were collected at baseline and 10 weeks following a standard course of treatment (four visits of non-surgical root surface debridement together with OHI as required). The relationship between clinical variables and treatment outcome were analysed at site-specific level by chi(2) analysis and for patient-specific variables by logistic regression. RESULTS In general, there was a good response to the treatment provided. In deep sites the mean pocket depth reduction was 2.11+/-2.01 mm. Site-specific analysis showed that the presence of plaque had a small but significant predictive effect on outcome (odds ratio 1.4). Sites on teeth with grade II/III mobility showed a significantly reduced response to treatment. Twenty-five patients were classified as "non-responders". Current smoking was strongly associated with non-responding patients (odds ratio 3.8) in a logistic regression model; plaque, baseline bleeding and initial pocket depth were not significantly associated with treatment outcomes. CONCLUSIONS Overall, the results emphasize the importance of smoking as a negative prognostic factor, and suggest that treatment outcomes may be determined by a wide range of different determinants requiring further study.
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Affiliation(s)
- Francis J Hughes
- Collaborative Group in Risk Factors for Periodontal Disease, Institute of Dentistry, Queen Mary's School of Medicine, London, UK.
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Heitz-Mayfield LJA. Disease progression: identification of high-risk groups and individuals for periodontitis. J Clin Periodontol 2005; 32 Suppl 6:196-209. [PMID: 16128838 DOI: 10.1111/j.1600-051x.2005.00803.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS While the role of bacteria in the initiation of periodontitis is primary, a range of host-related factors influence the onset, clinical presentation and rate of progression of disease. The objectives of this review are (1) to present evidence for individual predictive factors associated with a patient's susceptibility to progression of periodontitis and (2) to describe the use of prognostic models aimed at identifying high-risk groups and individuals in a clinical setting. METHODS Relevant publications in the English language were identified after Medline and PubMed database searches. Because of a paucity of longitudinal studies investigating factors including clinical, demographic, environmental, behavioural, psychosocial, genetic, systemic and microbiologic parameters to identify individuals at risk for disease progression, some association studies were also included in this review. FINDINGS AND CONCLUSIONS Cigarette smoking is a strong predictor of progressive periodontitis, the effect of which is dose related. High levels of specific bacteria have been predictive of progressive periodontitis in some studies but not all. Diabetics with poor glycaemic control have an increased risk for progression of periodontitis. The evidence for the effect of a number of putative factors including interleukin-1 genotype, osteoporosis and psychosocial factors is inconclusive and requires further investigation in prospective longitudinal studies. Specific and sensitive diagnostic tests for the identification of individuals susceptible to disease progression are not yet a reality. While factors assessed independently may not be valuable in predicting risk of future attachment loss, the combination of factors in a multifactorial model may be useful in identifying individuals at risk for disease progression. A number of multifactorial models for risk assessment, at a subject level have been developed but require validation in prospective longitudinal studies.
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Affiliation(s)
- L J A Heitz-Mayfield
- Centre for Rural and Remote Oral Health, The University of Western Australia, Nedlands, WA, Australia.
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Affiliation(s)
- G Rutger Persson
- Department of Periodontology and Fixed Prosthodontics, School of Dental Medicine, Univerisity of Bern, Bern ,Switzerland and Departments of Periodontology and Oral Medicine, University of Washington, Seattle, Washington, USA
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Snoad R. Description of a System Designed to Assist Primary Dental Care Clinicians in Decision-Making with Regard to Specialist Periodontal Referrals and Report of Two Clinical Audits using the System. ACTA ACUST UNITED AC 2005; 12:135-41. [PMID: 16212824 DOI: 10.1308/135576105774342938] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Identifying which patients are at risk of significant periodontal breakdown and may need specialist care is a process fraught with problems. This paper summarises factors that should be considered by referring clinicians, describes a system to assist them, and presents the results of two sequential audits carried out in general dental practice using the system. Aims, Materials and Methods The author aims to present the system and the results of two sequential audits, carried out in the same eight general dental practices by 23 general dental practitioners (GDPs) after training from a specialist in periodontics. The system is based on the use of the Basic Periodontal Examination (BPE), a constant pressure periodontal probe, and a computer screen that prompts the clinician who is performing periodontal screening. A series of risk factors, including smoking, presence of relevant systemic disease and age, is used to modulate the score. Patients are then classified into one of three complexity groups. Those in the Complexity 3 group are deemed to be potentially at risk of significant periodontal breakdown and in need of referral for specialist advice and/or care, in accordance with the published British Society of Periodontology guidelines. In each audit a random sample of the records of ten dentate patients over the age of 20 years, who attended for recall or new examinations by each of the 23 GDPs over a calendar month, were assessed to see whether or not BPE scores had been recorded and whether or not those classified as Complexity 3 (and in need of referral) had been correctly identified and referred. Results In both audits the total random sample of patient records was 225 (ten for 22 dentists and five for the remaining dentist who only worked for a short time during the months of the audit). In the first audit cycle 139 (62%) of the random sample of records included a BPE score and 11 (8%) of the patients concerned were identified as Complexity 3 and referred for specialist advice and/or treatment. All 11 accepted the referral and when examined by the specialist in periodontics were confirmed as Complexity 3. In the second audit cycle, which took place seven months later, 179 (80%) of the random sample of patient records included a BPE score and 14 patients were assessed by their GDPs as being Complexity 3. All 14 accepted a referral and were deemed to be Complexity 3 when they were subsequently examined by the specialist in periodontics. Conclusion Although the full potential of the system was not investigated during the two audits, these preliminary results suggest that it may assist referring clinicians in identifying which patients to refer and encourage clinicians to perform periodontal screening.
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Affiliation(s)
- Urs Brägger
- Departemnt of Periodontology and Fixed Prosthodontics, School of Dental Medicine, University of Bern, Bern, Switzerland
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Abstract
The ultimate goal of periodontal disease prevention is to maintain the dentition over a lifetime in a state of health, comfort, and function in an aesthetically pleasing presentation. This article focuses on primary and secondary periodontal disease prevention as they relate to gingivitis and periodontitis. Risk assessment, mechanical plaque control, chemical plaque control, current clinical recommendations for optimal prevention, and future preventive strategies are discussed.
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Affiliation(s)
- Andrew R Dentino
- Department of Surgical Sciences, Marquette University School of Dentistry, P.O. Box 1881, Milwaukee, WI 53201-1881, USA.
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Fardal O, Linden GJ. Re-treatment profiles during long-term maintenance therapy in a periodontal practice in Norway. J Clin Periodontol 2005; 32:744-9. [PMID: 15966881 DOI: 10.1111/j.1600-051x.2005.00778.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Periodontal therapy coupled with active maintenance has been shown to be effective in maintaining periodontal health, however, the question of re-treatment is rarely alluded to in the literature. AIM To quantify the type and extent of re-treatment in a group of patients who had completed a definitive course of periodontal treatment in a Norwegian specialist periodontal practice. The study also investigated factors associated with the provision of periodontal surgery as a re-treatment modality. METHODS A consecutive group of patients who had comprehensive periodontal treatment, which included periodontal surgery, and were subsequently maintained for between 10 and 17 years were studied. RESULTS One hundred and one patients with an average age at reassessment of 59.4 (standard deviation (SD) 9.0) years were studied. The average length of the review period was 13.1 (SD 1.9) years. In addition to routine maintenance, 50 patients had further re-treatment and 40 of those who were re-treated had periodontal surgery in the study period. Logistic regression showed that independent predictors of surgical re-treatment, with the effects adjusted for other variables in the model, were uncertain or poor prognosis at baseline, erratic or poor post baseline compliance and a family history of periodontal disease. CONCLUSION Considerable amounts of re-treatment, including in many cases extensive non-surgical treatment or periodontal surgery, were provided for patients who had surgical periodontal treatment and were subsequently maintained for least 10 years in a specialist periodontal practice.
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