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 patients 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 SP
• 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 (childrens 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 (gt10yrs)
• 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 (gt10yrs)
• Healthcare costs (individual) tooth replacement
  or treatment
• Lobbying for RCTs when there is a large body of
  lesser quality evidence
• Caries management