Periodontal therapeutics--a viable option?
Research in recent years in periodontology has seen a shift from surgery towards medicine. While surgery, particularly regenerative, and including implants, continues to form an important element of periodontal treatment, the volume of treatment required and the results of recent and ongoing non-surgical studies clearly show that most future periodontics will be based on a physician-type approach. Improved diagnostics based on more precise periodontal disease classification, simplification of mechanical oral hygiene equipment and procedures, and the development of conventional and non-conventional chemical and physical adjuncts may be expected to reduce the rate of common periodontal disease advance, resulting in less complex treatments, and more of the latter coming to lie within the competence of the generalist and the hygienist working together. The rationale for non-surgical adjunctive therapy is extensive, far beyond the usual antimicrobial logic. It will also be important to control the oral microflora for systemic reasons, since increasingly strong links are being established between focal infection of oral origin, much of it periodontal, and a range of systemic diseases, including coronary heart disease, stroke, gastrointestinal disorders, and low birth weight, apart from severe, overt systemic infections. All these developments derive from a greatly improved understanding of the fundamentally ecological nature of the natural microbial biofilm that is dental plaque, and of its interactions with its human host.
Department of Periodontology, Eastman Dental Institute and Hospital, University College London, UK.
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Newman
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018441:Biofilms; D002561:Cerebrovascular Disorders / Q000209:etiology; D003327:Coronary Disease / Q000209:etiology; D003756:Dental Hygienists; D015921:Dental Implants; D003773:Dental Plaque / Q000382:microbiology; D003815:Dentists; D004867:Equipment Design; D005491:Focal Infection, Dental / Q000517:prevention & control; D005544:Forecasting; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D009910:Oral Hygiene / Q000295:instrumentation / Q000379:methods; D010348:Patient Care Team; D010510:Periodontal Diseases / Q000145:classification / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D010517:Periodontics / Q000639:trends; D012038:Regeneration; D018805:Sepsis / Q000517:prevention & control
D000900:Anti-Bacterial Agents; D015921:Dental Implants