Evidence based Periodontology

1. Evidence based Periodontology Richard Tucker BDS MSc MClinDent MFDS MRD RCS Specialist in Periodontics Honorary Senior Lecturer Department of Periodontology

2. Where are the gaps? Public health issues • Global relevance of periodontal treatment • Developing world needs • Developed world needs • The prevalence of periodontitis at a population level (WHO global data bank, 1990) • effects of improvements in plaque control • Alternative approaches to treatment? • Prevention • UK adult dental health survey 1998

3. Where are the gaps? Subject level • Periodontitis as an aetiological risk for systemic diseases • The effect of host modulating treatments • Success and complications (eg peri-implantitis) of implants in the periodontitis patient • The identification of at risk subjects early in the patient’s life • Population level and resources

4. Where are the gaps?Lack of knowledge • Predictability of treatment (who will do well) • Primary and secondary care levels • Antibiotics have limited benefit • What are the factors that determine success? • Psychological contribution to success of behaviour change • Treatment without recession- the Holy Grail? • Iatrogenic factors as a risk for periodontitis

5. Patient reported outcomes • Short-term • Cost and time of treatment • Discomfort • Effort required to attain exceptional levels of plaque control • Long-term • ability to sustain plaque control • Recall requirements and the need for compliance • Continued resources required

6. Patient reported outcomes • Quality of life effects of periodontal disease and its treatment • The effect on aesthetics • Drifting • Recession (disease and treatment) • Tooth loss • Cost of tooth replacement (dental implants)

7. Gaps: Routine scaling and polishing • Frequency of visits with different risk groups • Quality of S&P • These are not really Cochrane types of questions • Comparison of SPT in primary and secondary care (Cochrane question) • Comparison of instrumentation: power tools vs manual (Cochrane question?) • Risk assessment validation

8. Extraction of a tooth/ teeth and replacement • Perio treatment vs extraction • Endodontic treatment vs nothing, extraction only, endodontics & crown • RCT for the above • The necessity of replacing molar teeth • Adhesive anterior dentistry vs implant replacements • Treatments for molar teeth perio/ endo/ restorative CQ

9. Endodontics • The necessity of retreatment of endodontics? • Outcome measures that are important to patients? • Quality of life issues perio and endo

10. Prosthodontics • Post design on root # and tooth loss • Apexification (children’s dentistry) • Caries treatment • Non-surgical intervention vs surgical

11. Tooth whitening • What harms are there from whitening in the long-term • Systemic and local factors over time (>10yrs) • Comparisons of whitening vs veneers, crowns etc

12. Patient centred outcomes • Survival, tooth loss, patient control over these decisions? • Discomfort • Financial • Aesthetics • Quality of life issues

13. Difficulties in research • Perio • Long-term follow-up (>10yrs) • Healthcare costs (individual) tooth replacement or treatment • Lobbying for RCTs when there is a large body of lesser quality evidence • Caries management