Periodontists and oral surgeons' peri-implantitis-related education, knowledge, attitudes, and professional behavior: A national survey

OBJECTIVES

Each year, approximately 5 million dental implants are placed in the United States and one out of three patients is likely to experience peri-implantitis (PI). The objectives were to compare the PI-related education, knowledge, attitudes, and professional behavior of periodontists and oral maxillofacial surgeons (OMS), and to explore relationships between these constructs of interest.

METHODS

A total of 389 periodontists and 161 OMS responded to a web-based survey. Descriptive and inferential statistical analyses (independent sample t-tests, chi-square tests, and correlational analyses) were conducted.

RESULTS

On average, periodontists reported a higher percentage of time spent in residency on implant surgery (21.02% vs. 7.27%; p < 0.001), better education about PI (5-point scale with 1 = not at all well: means: 2.86 vs. 2.59; p < 0.001), and better knowledge of risk factors (4.07 vs. 3.86; p < 0.001) than OMS. Periodontists argued that oral hygiene-related treatment (4.45 vs. 4.22; p = 0.001) and regeneration-focused treatments such as guided tissue regeneration (3.62 vs. 3.20; p < 0.001) contributed more to successfully treating PI and used these treatments more in their practices (4.86 vs. 4.56; p < 0.001/3.06 vs. 2.68; p < 0.001) than OMS. They also considered PI as a more serious problem than OMS (4.55 vs. 3.80; p < 0.001). The better the respondents' PI-related knowledge was, the more they considered PI as a serious problem (r = 0.19; p < 0.001). The more cases they treated per month, the more they considered PI as a serious problem (r = 0.19; p < 0.001).

CONCLUSIONS

The results of the present study highlight the lack of standardization in the specialty training of periodontists and OMS. Best practice guidelines for the diagnosis and treatment of PI are needed to optimize graduate education about this important topic.

Periodontists and stem cell-based therapy for alveolar bone regeneration: A national survey

BACKGROUND

Stem cell-based therapy for bone regeneration has received attention in medical settings but has not yet been used in clinical practice for treating alveolar bone defects. The objectives of this study were to explore whether periodontists had heard about this approach, and if so how, how interested they were to learn about it, which attitudes and behavioral intentions they had related to using stem cell-based grafting, and what they would like to know before using this approach.

METHODS

Anonymous survey data were collected from 481 members of the American Academy of Periodontology (response rate: 19.41%).

RESULTS

Responses showed 35.3% had heard about stem cell-based therapy, mostly from publications (9.6%) and meetings (8.3%); 76.1% wanted to learn about it through in-person continuing education (CE) courses, 68.6% in online CE courses, and 57.1% from manuals; 73% considered this approach promising; and 54.9% preferred it to traditional approaches. It was important to them that it would result in more bone volume (93%), better bone quality (90.4%), and accelerated healing (83.2%). Also, 60.1% considered it likely/very likely that they would adopt this approach, 54% that patients would prefer it, and 62.1% that it would benefit their practice. When asked what they would like to know about this approach, information about short- and long-term outcomes, cost, and logistical considerations were most frequently named.

CONCLUSIONS

These findings provide the basis to develop educational interventions for periodontists about this novel approach and inform future research activities aimed to translate this approach to clinical practice.

A Comprehensive Mixed Methods Approach for Studying the Quality of Life of Colombian Periodontists

This study analyzed the association of the sociodemographic, labor, and health conditions on the quality of life (QOL) of the periodontists in Colombia. A mixed study (explanatory sequential design) was conducted. The first quantitative phase was carried out by a cross-sectional survey (n = 187; 60.4% females). Variables: sociodemographics, labor, and health conditions, QOL (WHOQOL-BREF). Normality tests, descriptive statistics, and bivariate analyzes were performed. Factors associated with QOL were established using multivariate linear regression. A second qualitative phase with two focus groups (FGs) delved into those aspects of relevance, through qualitative content analysis and triangulation of information. The multivariate linear regression analysis showed that the factors associated with the QOL scores were in the case of men and negatively (QOL decreases): having low social support (p < 0.001), reporting poor mental health (p < 0.01). For women, QOL scores were negatively associated with low social support (p < 0.001), reporting poor general and mental health (p < 0.01), having greater stress at work (p < 0.05), having a temporary contract (p < 0.05), and living in a medium or low socioeconomic status (p < 0.05). The analysis of the FG allowed us to understand how QOL is permeated by the social context. The specialization of periodontics has generated a change in living conditions, and an adaptation to the workplace that allows them to gain recognition and a higher QOL. In conclusion, the QOL of periodontists is defined in subjective terms (standards) and related to social and labor conditions. Follow-up and evaluation strategies of the general conditions of these clinical specialists in Colombia are required.

Oral Hygiene Instructions and Methods: A Comparative Survey of European General Dentists, Periodontists and Dental Hygienists

PURPOSE

To study the practices of general dentists, periodontists and dental hygienists who are members of the European Federation of Periodontology, regarding oral hygiene education, plaque control assessment, recommended dental and interdental hygiene tools, and antimicrobial agents.

MATERIALS AND METHODS

A web-based survey was sent to 13,622 members of the European Federation of Periodontology (EFP) through its 29 national member societies. It targeted general dentists (GD), specialists in periodontology (DSP) and dental hygienists (DH). Data were collected between 24 April and 17 May 2015. A data-driven statistical analysis was conducted and differences between professions were explored.

RESULTS

A total of 2076 answers were collected. Only the 2009 answers originating from GD, DSP and DH were analysed (67 answers originated from other professions and were excluded). Among those 2009 respondents, 43.2% were DSP and 37.2% were GD. Overall, DH, DSP and GD reported spending 17.1 minutes for the initial teaching of OH, with differences between professions (p < 0.0001). DH, GD and DSP exhibited differences in the type of toothbrushes they recommend (p < 0.0001). DSP recommended electric and manual toothbrushes (TB) equally. DH predominantly recommended electric TB (56.8%). Overall, 95% of DH, DSP and GD recommended interdental brushes, with no statistically significant differences between professions. Low concentration chlorhexidine was considered the most relevant antimicrobial agent for daily oral care of periodontitis patients. Half of GD prescribed antimicrobial mouthrinses for long-term use in 70%-100% of their patients with periodontitis.

CONCLUSION

EFP-affiliated practitioners allocate a significant amount of time to educating patients on oral health. Their practices are mostly in line with the current scientific evidence. Some discrepancies were found between the different professions. Similar surveys could be conducted over time to monitor the evolution of practices.

Analysis of root coverage esthetic score in patients treated for gingival recession: An interexaminer reliability

Background:

Awareness about pink esthetics among dentists in general needs to be assessed as root coverage procedures are the mainstay of treatment for gingival recession. Concordance among the dentists in figuring out the esthetic outcomes after root coverage procedures is inconsistent. Hence, this study aims to evaluate inter- and intra-examiner reliability of root coverage esthetic scores (RES) between periodontists and nonperiodontists.

Materials and Methods:

The study was conducted using twenty baseline and 6-month posttreatment photographs of Miller's Class I and Class II gingival recessions. The participants that constituted ten periodontists and ten nonperiodontists were assembled in the seminar hall to receive training on protocol and procedures for RES by the investigator. All the participants were shown twenty projections of side-by-side baseline and 6-month outcomes of root coverage procedures. Each projection was shown for 30 s during which the participants were made to use RES system to evaluate the surgical outcomes.

Results:

Periodontists showed the highest reliability in the scores of marginal tissue contour with an overall intraexaminer reliability to be perfect among periodontists. Intraexaminer reliability among nonperiodontists was fair, and gingival margin was the parameter with the highest reliability among them. Interexaminer reliability between periodontists and nonperiodontists showed slight reliability concerning gingival margin, and fair reliability was found for marginal tissue contour, soft-tissue texture, mucogingival junction, and gingival color.

Conclusion:

Satisfying the esthetic component of gingiva is the duty of every dentist in general and not only the periodontists. Significant variability was found in esthetic scores between the groups, which can probably be attributed to the lack of sufficient knowledge regarding pink esthetics among the nonperiodontists, which needs to be improved.

Factors influencing the periodontal referral behaviour of the general dental practitioners to a periodontist: A cross-sectional survey

Aim

In India, dental care scenario is unique and unequally available to the general population with both government-run hospitals and private dental clinics catering to the oral healthcare needs of the patients. There is lack of studies to address how periodontal diseases are managed in general dental practice in India. This study aimed to understand the periodontal referral patterns of general dental practitioners (GDP) to a periodontist in Karnataka state, India.

Materials and Methods

This study employed a qualitative approach. Purposive samples of 400 referring dentists were interviewed using structured in-depth questionnaire. The questionnaire consists of a combination of selected response to the questions and close-ended questions, which was distributed to the GDPs of Karnataka state.

Results

This survey shows deficient delivery of definitive periodontal treatment. Only 2% of the GDP reported that 80%-100% of their patients received scaling. Location of the practice appeared to have a major role in periodontal referral. Farther the location of the practice from district headquarters, poor was the referral. Clinical skill of the specialist appeared to have a major influence on the selection of specialist followed by academic qualification.

Conclusion

This survey provides insight into the periodontal referral process by GDPs in India.

Effects of gingival margin asymmetries on the smile esthetic perception of dental professionals and lay people

OBJECTIVE

To determine the effects of different gingival margin asymmetries of anterior tooth on the smile esthetic perceptions of dentists, prosthodontists, periodontists and lay people.

MATERIALS AND METHODS

A frontal close-up smile photo of a woman was used in this study. Image was digitally altered in order to create gingival margin asymmetries in left maxillary central, lateral incisors, and canines. Four stages of alterations were made in 0.5 mm increments. The final images were randomly assessed by 240 evaluators: 60 dentists, 60 prosthodontists, 60 periodontists, and 60 lay people. Questionnaire was carried out by a single researcher and each rater was asked to evaluate the attractiveness of the smile images by using the visual analog scale. Collected data were analyzed by using one-way ANOVA test with post hoc Scheffé test.

RESULTS

Smiles with 0.5 mm gingival margin asymmetries were found to be more esthetic, while 2 mm gingival asymmetries were less esthetic (P ˂ .001). Lay people's esthetic scores were higher than other groups in all degrees of asymmetries (P ˂ .001). Esthetic scores of canine teeth were higher than, lateral, and central teeth (P ˂ .001).

CONCLUSIONS

As the amount of asymmetries increased, esthetic scores decreased in all groups. Gingival margin asymmetries were less perceptible laterally.

CLINICAL SIGNIFICANCE

This study may help dental professionals to understand which gingival asymmetries are found by patients as esthetic or unesthetic and guides them in their dental treatment, especially in the aesthetic zone.

Prescribing trends of systemic antibiotics by periodontists in Australia

BACKGROUND

Antibiotics are a common systemic pharmaceutical therapy in periodontal conditions for dental practitioners as well as specialists. However, there is limited information about prescribing patterns amongst the periodontists within Australia. The objective of this study is to examine current patterns and perceptions in prescribing systemic antibiotics for the treatment of periodontal and peri-implant diseases.

METHODS

An online questionnaire was disseminated to Australian practicing members of the Australia and New Zealand Academy of Periodontists (ANZAP) to determine their antibiotic prescribing patterns for different periodontal conditions. Indications that were analyzed included: chronic periodontitis, plaque-induced gingivitis, aggressive periodontitis, acute gingival and periodontal conditions, conditions associated with implants and implant placement, periodontal regeneration, and mucogingival surgery.

RESULTS

Out of the 50 members that participated in the study, 38 completed the questionnaire. Systemic antibiotics prescription patterns varied markedly for different periodontal or peri-implant diseases among respondents. 79% reported prescription of systemic antibiotics in the treatment of chronic periodontitis whereas 52.6%, 55.3%, 18.4% of the respondents did so for periodontal regeneration procedures, implant placement surgery, and mucogingival surgery, respectively. Azithromycin, the combination of Amoxicillin and Metronidazole, and Amoxicillin were the three most commonly prescribed systemic antibiotics.

CONCLUSION

Based on the results of this survey, systemic antibiotics are widely used by the group of periodontists surveyed in this study in Australia with varying rates and patterns for different periodontal and peri-implant conditions. The current study highlights the need for recommendations and guidelines in the prescription of antibiotics for periodontal and peri-implant conditions.

Attitude of dental hygienists, general practitioners and periodontists towards preventive oral care: an exploratory study

INTRODUCTION

Promoting oral hygiene and stimulating patient's responsibility for his/her personal health remain challenging objectives. The presence of dental hygienists has led to delegation of preventive tasks. However, in some countries, such as Belgium, this profession is not yet legalized. The aim of this exploratory study was to compare the attitude towards oral-hygiene instructions and patient motivational actions by dental hygienists and by general practitioners/periodontists in a context without dental hygienists.

MATERIALS AND METHODS

A questionnaire on demographics (six items), oral-hygiene instructions (eight items) and patient motivational actions (six items) was distributed to 241 Dutch dental hygienists, 692 general practitioners and 32 periodontists in Flanders/Belgium. Statistical analysis included Fisher's exact-test, Pearson's chi-square test and multiple (multinomial) logistic regression analysis to observe the influence of profession, age, workload, practice area and chair-assistance.

RESULTS

Significant variance was found between general practitioners and dental hygienists (in 13 of 14 items), between general practitioners and periodontists (in nine of 14 items) and between dental hygienists and periodontists (in five of 14 items). In addition to qualification, chair-assistance was also identified as affecting the attitude towards preventive oral care.

CONCLUSION

The present study identified divergence in the application of, and experienced barriers and opinions about, oral-hygiene instructions and patient motivational actions between dental hygienists and general practitioners/periodontists in a context without dental hygienists. In response to the barriers reported it is suggested that preventive oriented care may benefit from the deployment of dental hygienists to increase access to qualified preventive oral care.