Producing guidance for the management of patients with chronic periodontal disease in general dental practice

Supportive periodontal care in dental practice: Part 2 - perceptions of locally referring UK general dental practitioners

Background Supportive periodontal care (SPC) is important in maintaining periodontal treatment outcomes. Hospital services provide specialist periodontal care at high costs. On completion of treatment, patients are discharged back to the general dental practitioner (GDP) to provide SPC. This project aimed to evaluate the change in GDPs' understanding of SPC over more than 20 years.Method A validated questionnaire about SPC was sent to GDPs during 1996 (397) and 2020 (300), with a response rate of 74% and 52%, respectively. The anonymous data were entered on a Microsoft Excel spreadsheet for analysis.Results In total, 98.5% of the GDPs in 1996 and 97% in 2020 perceived SPC to be highly important. Additionally, 49% in 2020 had a better understanding of SPC when compared to 1996 (42%). Finally, 70-74% (1996, 2020) of the GDPs indicated that they were responsible for SPC; however, 13-16% said that they were not.Conclusion and clinical relevance Notwithstanding the lower response rate in 2020, there has been an improvement in understanding and awareness of responsibility of SPC among GDPs. Reported challenges of provision were related to education and funding. If GDPs are to effectively deliver SPC, education and current funding should be addressed to prevent compromised treatment outcomes for patients.

Impact of Stress on Periodontal Health: Literature Revision

Stress is a physiological response of the body to stressful life events but may not be when the individual is persistently exposed to the stress trigger, and it negatively affects certain physiological functions, thus triggering psychosomatic diseases. In literature, chronic stress and inadequate coping strategies are found to mediate the risk and development of periodontitis; mechanisms have therefore been proposed to explain the effects of stress on the periodontium. Since stress is a prevalent problem in modern life and given the importance of maintaining oral health, the present literature review aimed to estimate the association between stress and periodontal disease. The research question adopted is the following: "Are psychological stress and periodontal disease related?" The search was conducted in August 2022 and limited to articles in electronic databases from 2017 to 2022 in English, excluding reviews and literature reviews. From the electronic databases, a total of 532 articles were identified and became 306 after reviews and duplicates were removed. An additional bibliographic search was conducted through the same electronic databases, controlled terms and keywords including only systematic reviews, which were previously excluded. Through the bibliography cited in the systematic reviews, an additional 18 articles were identified, with a new total of 324. As a result of reading the title and abstract of these 324 articles, an additional 295 were excluded. Reading the full text of the remaining 29 studies, 2 articles were excluded due to non-adherence to the eligibility criteria. The remaining 27 results were included in our literature review. It has been suggested in the literature that adverse socioeconomic conditions elicit a stress response, which can trigger periodontal inflammation. Most of the 27 articles included in the study confirm and demonstrate a positive association between psychological stress and periodontal disease. Numerous studies have shown the mechanisms through which chronic stress negatively affects periodontal tissues. Therefore, in the light of the results obtained from this review, it is important that oral health professionals, also for general health purposes, consider stress factors among the risk factors of periodontal disease, its severity and decreased efficacy of treatments. It is therefore advisable to act preventively through the interception of chronic stress.

Factors affecting periodontal disease referral and the adherence to guidelines among general dentists

BACKGROUND

Current research highlights a need to investigate the factors affecting periodontal disease referral. Limited literature exists on periodontal disease referral in Australia and no comparison to the periodontal disease referral guidelines exists.

OBJECTIVE

This study analyses the factors affecting periodontal disease referral and the adherence to guidelines in general dentists in Queensland, Australia.

METHODS

Fifty-seven general dentists who are members of the Australian Dental Association (Queensland) undertook an online survey.

RESULTS

The disease factor regarded as most important (90% of respondents) was unresolved inflammation upon re-evaluation. The non-disease factor regarded as most important (79% of respondents) was the operator's level of training. There is low awareness of the guidelines (36.7%) yet a reasonable adherence to them (78.3%). Of those aware of the guidelines, there was a statistically significant poorer adherence to the guidelines compared to those unaware (P = 0.036), while there is no significant difference in the adherence to guidelines between those who have and those who have not attended continuing professional development (CPD) courses (P = 0.66).

CONCLUSIONS

Adherence to current guidelines is not significantly impacted by the level of awareness of the guidelines or CPD attendance. The results from this study suggest a need to refine the current guidelines to better inform decisions about periodontal disease referrals.