Periodontal Practice Research Articles

Compliance With Supportive Periodontal Therapy

All new patients commencing supportive periodontal therapy (periodontal maintenance) after treatment in a specialist periodontal practice from 1983 to 1986 were identified from practice records. Based on their compliance with the recommended schedule of visits, the patients were classified as either compliant or non-compliant. The results indicated that there were no significant differences between compliant and non-compliant patients with regards to age, sex, number of missing teeth, plaque score, or periodontal disease severity. More non-compliant patients than compliant patients were smokers (P less than 0.05). By contrast, more compliant patients were covered by private dental insurance (P less than 0.01) and more had periodontal surgery during treatment (P less than 0.001). Only 36% of the initial patient sample was found to be compliant at the end of 1989, with the greatest patient loss in the first year of supportive periodontal therapy of about 42%. The annual attrition rate decreased in subsequent years to average about 10% of those remaining in each year, indicating that a patient is more likely to remain compliant if he or she attends for at least 1 year of supportive periodontal treatment. Non-compliant patients were sent a questionnaire seeking reasons for their non-compliance. Forty percent of the questionnaires were returned. The most common reason given for non-compliance was that a general dental practitioner was attending to the patient's periodontal treatment needs. Many considered supportive periodontal therapy to be too expensive, while a significant proportion considered that they no longer required treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

反射スペクトル解析法による歯肉微小循環機能の測定 特に，プローブと歯肉との接触条件および測定部位の影響

The purpose of this study was to examine the effect of contact between the probe and gingiva, and to compare the parameters between arches, regions, and surfaces in measurement of gingival microvascular function by tissue reflectance spectrophotometry (TRS). The index of hemoglobin concentration (Hb index) and the index of oxygen saturation (SO2 index) in papillary gingiva were assessed with TRS in a standardized manner. Gingival spectra were measured immediately before and during contact between the optical probe and gingival tissue. The Hb index showed a maximum value during the procedure when the probe was in the first contact with gingiva. The SO2 index showed lower values before the contact and higher values after the first contact. When the probe/gingiva surface angle increased, the Hb index decreased but the SO2 index showed little change. These results indicate that good reliability of the measurement could be obtained by selection of a representative spectrum showing the maximum Hb index among several spectra measured at the same site. Reflectance spectra were also measured at various locations of the upper and lower arches in subjects with clinically healthy gingiva. Coefficients of variation of both indices in lingual/palatal surfaces and in molar teeth were higher than those in facial surfaces and incisor teeth, respectively. Analysis of variances indicated significant differences in both indices between facial and lingual/palatal surfaces and among the teeth but no difference between the sides and between the arches. Significant interactions were observed in both indices between arch and surface, and in Hb index between arch and tooth. Thus, the application of TRS measurements in periodontal practice should consider differences in TRS parameters at a given location in the mouth.

Occupational health problems and adverse patient reactions in periodontics

The purpose of the present survey was to assess the nature and extent of adverse reactions to materials and procedures among personnel in periodontal practice and their patients. A questionnaire was mailed to practicing members of the Swedish Society of Periodontists. A total of 85, about 65%, responded together with 44 dental hygienists and 64 chairside assistants. 42% had experienced adverse reactions. The majority of complaints were related to dermatoses of the hands and fingers. The remainder were respiratory or eye reactions. A specifical problem characteristically involving the hygienists, was musculoskeletal stress reactions. Many of the dermatoses were of moderate severity, and were associated with seasonal, air-ventilation problems or were unexplained. The most severe reactions were reported by atopic persons. The reactions were attributed to hand washing procedures, the use of latex gloves and other disposable personal equipment such as face masks and caps. Reactions attributed to dental materials or local anaesthetics, characteristic of other reports from general dental practice, were absent. The survey indicated that personnel in periodontal practice have problems similar to many other categories of health personnel. Patient reactions were encountered at a frequency of 1 every other year per periodontist. The majority were intraoral reactions to chlorhexidine mouthrinses. Other patient reactions were associated with exposure to latex gloves, eugenol-containing periodontal packs, methacrylates and nickel-containing instruments. 2 instances of anaphylactoid reactions to latex gloves were encountered.

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.

The relationship of initial clinical parameters to the long-term response in 112 cases of periodontal disease.

The purpose of the present study was to determine whether any of the clinical parameters recorded during an initial periodontal examination would relate to the course of periodontal cases maintained for long periods of time. Based on available documentation, cases which had a downhill course were assembled from a population previously studied. In addition, long-term cases currently under maintenance care were drawn from our private practice. On average, the patients had been under care for 23 years. The study population was heavily weighted toward downhill cases to better compare these cases with those usually found in periodontal practice. Positive statistical correlations were found between the amount of subgingival calculus and the degree of gingival inflammation at initial examination. Disease severity initially was positively correlated to long-term course of disease. The amount of subgingival calculus did not relate to the long-term result. There was a strong correlation between inflammatory gingival hyperplasia initially and good long-term maintenance. The results suggest that, in combination, initial characteristics of periodontal cases coupled with long-term results of treatment may aid in further subclassifying the periodontal diseases.

Tooth loss in maintenance patients in a private periodontal practice.

A group of 162 maintenance patients, previously studied for compliance to suggested maintenance schedules, were surveyed for tooth loss over a 5-year period. The group was divided into those who complied to suggested maintenance schedules and those whose compliance was erratic. It was found that none of the patients who had complied to suggested maintenance schedules lost any teeth. In the erratic group, where all tooth loss occurred, it was found that the more often a patient presented for maintenance, the less likely he was to lose teeth. These findings are discussed in relation to current studies on efficacy of various therapies for periodontal diseases.

The long-term effectiveness of periodontal therapy in a clinical practice.

A retrospective study was conducted of 620 patients in a periodontal practice over the years 1960 to 1982. Various periodontal therapies were assessed by using careful office protocols, meticulous record-keeping and well-defined outcome criteria. Four treatment outcome categories were used: two representing satisfactory outcomes (referred to as "STABLE"), and two unsatisfactory outcomes ("UNSTABLE"). The percentages of patients in the STABLE categories following different therapies were: (1) nonsurgical treatment, 63.6%; (2) closed curettage, 73.1%; (3) open curettage, 95.0%; (4) modified Widman flap, 91.6%; (5) full flap and osseous surgery, 71.1%. The major conclusions were that the modified Widman flap and open curettage were more effective than flap and osseous surgery, and much more effective than closed curettage when it was employed as an alternative treatment (54.8% STABLE) to the osseous surgery (71.1% STABLE). Thus, moderate surgical therapies appear to be at least as effective as ostectomy procedures in the treatment of periodontal disease, while nonsurgical and closed curettage therapies appear to be less effective.

Compliance with maintenance therapy in a private periodontal practice.

The purpose of this study was to determine patient compliance with suggested maintenance schedules. All patients eligible for maintenance therapy in a private periodontal practice were included. The study covered a period of 8 years. All patients had chronic inflammatory periodontal disease and had been eligible for at least 1 year of maintenance therapy before the close of data collection. A total of 961 patients were studied; only 16% complied with recommended maintenance schedules. Erratic compliance was found in 49% of the patients and 34% never reported for any maintenance therapy.

歯周治療に関係する下がく第１大臼歯の諸形質の相互関係

Furcation involvement has been reported to lead poor prognosis because of its complicated morphological bases. Many reports have been made on the anatomical characteristics of molars intending to improve the prognosis.In the present experiment, 54 extracted mandibular first molars were used to find the anatomical characteristics and their mutual relationships, from the periodontal point of viewing, aiding in the diagnosis of furcation involvement.As a result, buccal grove was found in 100%, lingual groove in 96.3%, buccal cervical enemel projection in 68.5%, lingual enamel projection in 33.3% among mandibular first molar teeth examined. Root fluting was seen more frequently and more distinctly on the furcation side of the root than on the other side of the root. Bifurcational ridge was found in 75.9%.There were mutual relationships between some of the less important characteristics, but as far as the coronal and the root structures are concerned, mutual relationships which might be able to regard as a diagnostic criteria in the daily periodontal practice were failed to found.

Behavioral research in preventive dentistry: educational and contingency management approaches to the problem of patient compliance.

This study examined the effects of reinforcement on compliance with an oral hygiene education program. Patients 18 years of age or older who enrolled in an ongoing program at a periodontal practice received 3-5 sessions of instruction in preventive dental care. Using a between-subjects design, patients who entered the program during alternating months also had a portion of their fees refunded contingent upon improvements in their dental plaque scores. Pre- and posttreatment data showed that all subjects exhibited lower plaque levels following the program, but that greater improvements were seen in patients who were exposed to the fee reduction contingency. Plaque scores taken at a 6-month follow-up revealed some relapse for the Fee Reduction subjects. However, their scores were still substantially better than pretreatment, and better than those of the Education only subjects, whose data differed little from untreated Controls. Methodological and practical issues related to behavioral research in preventive dentistry are discussed.

Restoration of root-resected teeth

M any multirooted teeth are lost because one root is so severely affected by periodontitis that it cannot be eflectively treated by periodontal therapy. Many of these teeth can be restored to health by combining periodontal therapy with root resection of the severely involved root (Fig. 1). Also, there are dentists who believe that all teeth with bifurcation involvement of periodontal disease should be extracted. These teeth can often be saved with root resection or bicuspidization (Fig. 2).‘-’ Root resection was described as early as 1886 and has become an established procedure in periodontal practice.” Root amputation is defined as the removal of the root apical to the furcation without alteration of the crown. Hemisection is the surgical separation of a multirooted tooth through the furcation area in such a way that the blocked, defective, or periodontally affected root or roots may be surgically removed along with the associated portion of the crown.’ Root resection refers to removal of the root without reference to how the crown is treated. The decision to include root resection in periodontal therapy is the responsibility of both the fixed prosthodontis t and periodontist, since there are numerous problems in the restoration of these teeth.

A Long‐Term Survey of Tooth Loss in 600 Treated Periodontal Patients

1. Six hundred patients in a private periodontal practice were reexamined an average of 22 years after their active treatment and the patterns of tooth loss were observed. 2. During the post-treatment period, 300 patients had lost no teeth from periodontal disease, 199 had lost one to three teeth, 76 had lost 4 to 9 teeth and 25 had lost 10 to 23 teeth. 3. Of 2,139 teeth that originally had been considered of questionable prognosis, 666 were lost. Of these, 394 were lost by one sixth of the patients and only 272 by the other five-sixths. 4. Of 1,464 teeth which originally had furcation involvements, 460 were lost, 240 of them by one-sixth of the patients who deteriorated most. 5. The mortality of teeth which were treated with periodontal surgery was compared with that of teeth which did not have surgery. Tooth retention seemed more closely related to the case type than the surgery performed. 6. In general, periodontal disease is bilaterally symmetrical and there is a predictable order of likelihood of tooth loss according to position in the arch.

Retreatment in Periodontal Practice

Periodontal disease has a greater or lesser tendency to recur. The therapist controls rather than cures the condition. Careful maintenance is as important as skillful original treatment if periodontal health is to be maintained. At the time of the original treatment, every patient should be informed that retreatment of some type is occasionally necessary. Patients with recurrence of disease should be treated as conservatively as possible and every effort should be made to find the cause of failure. Surgical retreatment should be done only after a reasonable effort has been made to improve the situation by other means. The deepened crevice that does not bleed when probed and is not accompanied by bone loss does not provide justification for surgical retreatment. This report has reviewed some of the reasons for treatment failures and has presented a philosophy for their management.

Studies on the utilization of oxidation-reduction indicator for dental plaque disclosing (author's transl)

The aim of this investigation was to demonstrate the plaque maturity accumulated on tooth surface using Oxidation-Reduction Indicator in situ. The ingredients of this disclosing solution are Methylene Blue and 2, 3, 5-Triphenyltetrazolium Chloride generally used in histochemical investigations.No gingival inflammation and caries free subject was selected. The participant was told to abolish oral hygiene and allowed to develope the plaque on tooth surface for 7 days. On day 1, 3, 5 and 7 of no oral hygiene periods, new disclosing solution was topically applied on tooth surface.At the time of topical application on 3 days plaque, it was disclosed in blue tone, but gradually changed to red localized to the area of gingival margin. More typical results were obtained in 7 days mature plaque. The blue tone was instantly fading and blue plaque almost changed to red within 10min.The results of this experiments have demonstrated that it is possible to distinguish the old, thick mature plaque from new one. Patient can easily visualize the appearance of plaque changing in colour, so it is very usefull for patient motivation in periodontal practice.

Role of occlusion in the etiology and treatment of periodontal disease.

Early in this century, trauma from occlusion* (also occlusal trauma, traumatism) was recognized as a pathologic change occurring in the periodontium,1 but it was considered a separate condition from periodontitis, the common form of chronic destructive periodontal disease. It was the prevailing concept that periodontitis was purely an inflammatory disease, in which periodontal pockets and tissue destruction were produced by inflammation alone. When trauma from occlusion was also present, it was thought to be unrelated to the destruction, and tooth loss was attributed to inflammation.2 This separation of periodontitis and trauma from occlusion seriously influenced the development of periodontal practice. It led many practitioners to minimize the significance of trauma from occlusion in periodontal disease and to question the treatment value of occlusal correction. Two particular research findings led to the impression that trauma from occlusion was not necessarily a serious matter in periodontal diagnosis and treatment: (1) trauma from occlusion does not cause periodontal pockets3-5; and (2) trauma from occlusion is a reversible tissue change. Both findings were valid insofar as they went, but they were extrapolated to justify erroneous conclusions. Because trauma from occlusion did not cause periodontal pockets, the misconception arose that it did not influence periodontal pockets originating from other factors. Some

Work Simplification and Efficiency in Periodontal Practice

To summarize, the efficient management of the periodontal patient depends upon an understanding of all the problems associated with periodontal disease. The dentist should be prepared to efficiently diagnose the disease in all its complex manifestations. He should be prepared to treat the disease quickly and efficiently without causing excessive trauma to the patient. He should be able to follow through with a minimum of effort and a minimum of expenditure of time so that maximum effectiveness can be achieved by the dentist for the benefit of patients who have the most common disease of mankind in the age groups of 35 and above.

Practice Management, Economics and Case Presentation in Periodontics

This information on periodontal practice management, economics and case presentation has been arranged to permit the general practitioner of dentistry by the use of a manual to follow step by step procedures in a programed manner, thus enabling him to bring about the transition of the uninformed patient to one cognizant of his periodontal problems, the need for therapy, and the maintenance of his case by recall preventive treatments.

Psychological Considerations in Periodontology

From three patients in a periodontal practice, personality histories were obtained. One of them was followed through a period of treatment and specific criteria in handling this patient psychologically were developed. Certain analogies in all three personality profiles were revealed which were found to corroborate the results of a former study. It is concluded that awareness of possible psychological components in periodontal disease and knowledge of their nature can aid in therapy.

Periodontal Therapy

This second edition is essentially the same text which was published 4 years ago. As with the first edition, this one is almost entirely devoted to the clinical aspects of periodontal treatment. Many of the more recent advances made in periodontal treatment procedures have been included, such as vestibular surgery and the intra-alveolar pocket operation. The new edition gives more attention to the various special problems encountered in everyday periodontal practice. Greater emphasis is placed on recognition of periodontal diseases and local environmental factors. A significant change in the second edition is the greater importance given to diagnosis, evaluation, and treatment planning for the whole dental apparatus. In scope, this edition embraces all aspects of periodontal treatment procedures, new methods, and recent trends in the profession. It would have been desirable to have some of the basic biological factors of periodontology incorporated into this text, as thoroughly covered in the

The Role of the Dental Hygienist in Periodontal Practice

The Role of the Dental Hygienist in Periodontal Practice