At the meeting, the key opinion leaders agreed on the following periodontal health consensus statement:
• ‘Effective plaque and calculus removal is key to oral health;
• Dental healthcare professionals have a responsibility to educate patients on their disease status and to direct patients appropriately;
• Patients should receive tailored oral hygiene instruction and demonstration;
• Patients have a responsibility to act upon the advice given by dental healthcare professionals;
• For effective management optimal patient home care and professional debridement are both essential;
• Long-term periodontal maintenance with continuity of care is critical for successful treatment outcome;
•Clinically proven mouthwashes, gels and pastes should be considered for recommendation to those individuals who are not achieving optimal levels of plaque control in their home care routine.’
The Florida Probe handpiece exerts a constant force regardless of the strength or pressure of the operator, which guarantees accuracy and reproducibility between users.
Alternatively, the new VoiceWorks microphone and headset system can be used to capture the same data into the same software.
Using either system means there is no need to have another member of staff present to record the results.
The Florida Probe aids patient communication by providing a detailed periodontal chart that can be used to create a “treatment map” for scaling and root planing, subgingival antimicrobials or laser treatment. When combined with the patient diagnosis sheet, this becomes an invaluable clinical and legal record of informed consent to protect your practice.
To explore the benefits of utilising the Florida Probe, contact Clark Dental’s team of experts who will be pleased to demonstrate and offer advice about the Florida Probe System and the new Voice Works system.
The World Health Organisation (WHO) defines antibiotic resistance as “resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it.1” They go on further to say it is a “natural phenomenon” and that the misuse and overuse of the medication accelerates this worldwide problem. The effect of this “ticking time bomb” is felt across the health of the global population and worldwide healthcare budgets.
The meeting in May created five strategic objectives to tackle the issue including increasing awareness and understanding, reducing the incidence of infection and developing the economic case for sustainable investment2. A survey carried out by the WHO a month earlier found that of 133 participating countries, only 34 had a comprehensive national plan to fight resistance to antibiotics. It discussed how management of the situation was paramount but due to inadequate laboratory capacity, infrastructure and data management practice, trends and outbreaks were poorly detected and monitored. Importantly, many countries had no stringent guidelines on the prescription of antibiotics, which could result in overuse and misuse by prescribers.
There is not only the effect this issue has on the health of the global population, but also the impact it has on a country’s economy. Drug-resistant infections could kill an extra 10 million people across the world every year by 2050 if they are not treated successfully. By this date they could also cost the world around $100 trillion in lost output2. Health expenditure in most countries is rising steeply already and resistance to antibiotics is going to contribute significantly in the near future. Excess costs associated with the resistance are due to longer hospitalisation, delayed therapy, higher morbidity rates, the necessity for surgery and the need to use more expensive antibiotics3.
Jim O’Neill, an economist leading a review into antimicrobial resistance for the UK government, estimated that $37 billion is needed over the next 10 years to spur the pharmaceutical industry into developing innovations in this troublesome segment. He went on further to say that this was a “modest sum” compared to the cost of not doing anything. During the 1990’s, pharmaceutical companies withdrew from investing in this kind of research due to a high uncertainty around what the final market potential would be, and still the pipeline does not look particularly robust. Also, antibiotics work so fast and so well that they provide relatively weak returns for high investment. Companies prefer to channel their funds towards the treatment of chronic illnesses, such as diabetes, as drug treatment for this type of disease will be taken for longer periods of time; usually for the rest of the patient’s life.
This naturally occurring threat is not going to be eradicated without preventative measures being implemented globally. In one research paper on the subject, Sipahi suggests that the following strategies should be followed:
- Optimal use of existing antimicrobial agents
- Where possible, use alternative therapies
- Increase immunity
- Educate healthcare professionals
- Regulations and policies
- Stringent infection control protocols3.
There are scientists working to develop new drugs able to combat bacteria that are resistant to antibiotics. One of the more recent discoveries reported in The Guardian earlier this year has been hailed as a “game changer” and is called teixobactin. It can kill a wide range of bacteria, including Methicillin-resistant Staphylococcus aureus (MRSA). Teixobactin works by blocking the capacity of resistant bacteria to build cell walls, therefore making it almost impossible for bacteria to develop resistance4. It is, of course, still early days.
Alternatives to Antibiotics
The alternative is to use drugs and therapies that do not contain antibiotics, yet are as effective in the results that they deliver. PerioChip® is a non-antibiotic solution and can therefore be used in the longer term. It is designed for use in conjunction with traditional treatment to suppress bacterial flora in periodontal pockets of 5mm or more. It contains 2.5 mg of Chlorhexidine Digluconate and is recommended for first line treatment of periodontal pocketing. Results from clinical studies show a pocket reduction of more than 2mm in almost three quarters of patients when placed every three months5.
Antibiotic resistance is a looming problem that all governments and healthcare professionals around the world need to take responsibility for. With alternatives to antibiotics available that can be used in dental treatment plans, dental practitioners need to carefully consider what they prescribe and ensure they are doing what they can.
Summary of product link;
Abbreviated Prescribing Information
PerioChip® 2.5mg Dental Insert (Chlorhexidine digluconate)
For full prescribing information, including side effects, precautions and contraindications, see Summary of Product Characteristics (SmPC).
Presentation: Dental insert: bullet shaped orange brown containing Chlorhexidine digluconate 2.5mg.
Indications: PerioChip® is an adjunctive antimicrobial treatment for moderate to severe chronic periodontal disease in adults with pocketing, combined with Root Surface Debridement (RSD). Not indicated in children and adolescents.
Dosage and Administration: One PerioChip® is inserted into a periodontal pocket with a probing pocket depth of ?5mm. Retreatment with PerioChip® following mechanical plaque removal at 3 month intervals may provide additional benefit if pocket depth remains ?5mm. For details see SmPC. Removal is unnecessary as PerioChip® biodegrades.
Contraindications: Hypersensitivity to Chlorhexidine digluconate or excipients.
Precautions: Allergic reactions have occurred but are rare.
Interactions: Avoid nystatin: antagonistic of Chlorhexidine. Chlorhexidine is incompatible with anionic agents present in some toothpastes and with dietary sucrose, but there is no significant impact on the efficacy of PerioChip®.
Undesirable effects: During the first few days after insertion, transient pain or discomfort of gums or teeth; redness and/or swelling of the gums.
Overdose: Not reported
Pregnancy/ Lactation: Controlled studies in pregnant women have not been conducted, so weigh expected benefits against possible foetal risks: caution in nursing mothers (see SmPC).
NHS list price: £207.20
Legal category: P, Product Licence Number: PL 14017/0035
MA holder: Full prescribing information is available on request from Dexcel Pharma Ltd, 7 Sopwith Way, Drayton Fields Industrial Estate, Daventry, Northants, NN11 8PB.
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to:
Dexcel Pharma Ltd on 01748 828784
1. Fact Sheet No194, WHO
3. Sipahi OR. Economics of antibiotic resistance. Expert Rev Anti Infect Ther. 2008 Aug;6(4):523-39. doi: 10.1586/14787184.108.40.2063.
4. The Guardian, 7th January 2015
5. Soslkolne W.A et al. Probing depth changes following 2 years of periodontal maintenance therapy including adjunctive controlled-release of chlorhexidine. JOP 2003;74:420-427
In the UK, periodontitis affects about half of all adults with up to 15% estimated to have the condition severely. These shocking statistics echo the findings of the 2009 Adult Dental Health Survey, which reported that, although this generation has a better outlook than their predecessors, there are still many people whose oral health and function does not meet the best possible standards.
Periodontal disease is a particular area of concern because it can cause serious oral health problems and when left untreated, and can result in tooth loss as well as deterioration of both gingiva and bone. Ominously the potential effects and implications of periodontal disease may also extend beyond oral health and recent research has established that periodontal infection is a probable risk factor for various systemic diseases, including pulmonary disease.
Furthermore, periodontal disease has the capability of changing the chemical composition of the blood and glucose levels as well as interfering with the body's inflammatory system and thereby increasing the risk of diabetes, rheumatoid arthritis, respiratory and cardiovascular diseases.,
As we know, tobacco use, stress and obesity may be significant risk factors in the development and progression of periodontal disease. However people with other general health conditions also have an increased risk of developing the condition. Evidence has consistently revealed that diabetes is a risk factor for the prevalence of gingivitis and periodontitis and a five-year follow-up, population-based study in Taiwan has also indicated that patients with osteoporosis might have an increased chance of developing periodontitis.
Over the last few decades the concept of a genetic vulnerability to periodontal disease has also been investigated. Since the completion of the Human Genome Project (HGP), researchers have found evidence to suggest that a key element of whether individuals develop periodontitis appears to be controlled by the way they interact with environmental agents including biofilm. These researchers also believe that periodontal disease could be categorised more effectively using pathobiology-based grouping as well as the clinical presentation of the disease, rather than the current clinical only classifications of ‘chronic’ and ‘aggressive’.
A new system for categorising periodontitis based on the molecular profiling of gingival tissues has therefore been devised, which could enable earlier diagnosis and more personalised treatment. It is hoped that patients found to be highly susceptible to severe periodontitis may be considered for assertive therapy even if that person only show indicators. This would then prevent aggressive progression, bone and tooth loss.
Helping patients to understand the threat of periodontal disease not only with regard to oral health but also in relation to other potential health risks is vital. Of course treatment for periodontal disease depends upon each individual case, but every patient must appreciate the importance of practicing good oral hygiene. Employing an improved oral health care regime may be enough to kerb further development of the disease in some patients, although professional scaling and debridement is commonly required to remove plaque, calculus and biofilm from the teeth and roots.
For some patients it is necessary to include on-going periodontal therapy with medication to keep infection under control and to heal periodontal pockets. Nevertheless, in aggressive cases it may be necessary to perform flap surgery to clean the area thoroughly and suture periodontal pockets. Some of these patients may also require bone grafting to promote new growth or tissue regeneration to cover any exposed tooth roots.
In many cases a general dentist, therapist or hygienist can treat patients with periodontal disease successfully. However, in complex or unresponsive cases the skills of a specialist periodontist may be needed. By creating a good working relationship with a reliable referral practice, such as London Smile Clinic, your patients can benefit from specialist clinical skills in a wide spectrum of dentistry. With a wealth of experience in oral and maxillo-facial surgery, Dr. Hatem Algraffee, specialist periodontist at London Smile Clinic
 N.J. Kassebaum, E. Bernabé, M. Dahiya, B. Bhandari, C.J.L. Murray, W. Marcenes. Global Burden of Untreated Caries: A Systematic Review and Metaregression J DENT RES, May 2015; vol. 94, 5: pp. 650-658, first published on March 4, 2015
 http://www.nhs.uk/Conditions/Gum-disease/Pages/Introduction.aspx [Accessed 29th April 2015]
 2009 Adult Dental Health Survey (ADHS) http://www.hscic.gov.uk/catalogue/PUB01086/adul-dent-heal-surv-summ-them-exec-2009-rep2.pdf
 Scannapieco FA, Papandonatos GD, Dunford RG. Associations between oral conditions and respiratory disease in a national sample survey population. Ann Periodontol 1998;3:251-256.
 American Academy of Periodontology. http://www.perio.org/consumer/risk-factors
 Association between respiratory disease in hospitalized patients and periodontal disease: a cross-sectional study. Sharma, N., Shamsuddin, H. J. Periodontol. August 2011. pp1155-1160. Available at: http://www.pharmaden.net/pdf/articles/2.pdf
 Machado AC, Quirino MR, Nascimento LF. Relation between chronic periodontal disease and plasmatic levels of triglycerides, total cholesterol and fractions. Brazilian oral research, 2005, 19(4):284–9.
 Genco RJ et al. Overview of risk factors for periodontal disease and implications for diabetes and cardiovascular disease. Compendium of continuing education in dentistry, 2001, 22(2 Spec. No.):21–3.
 Mealey BL, Oates TW. Diabetes mellitus and periodontal diseases. J Periodontol. 2006;77:1289-1303.
4 Research, Science and Therapy Committee of the American Academy of Periodontology. Informational paper: implications of genetic technology for the management of periodontal diseases. J Periodontol. 2005 May;76(5):850-7.
5 Schafer AS, Jepsen S, Loos BG. Periodontal genetics: a decade of genetic association studies mandates better study designs. J Clin Periodontol. 2011 Feb;38(2):103-7.
 Gingival Tissue Transcriptomes Identify Phenotypically Distinct Classes of Periodontitis. Panos N, Papapanou M, Kebschull R.T, Demmer B, Grün P, Guarnieri P, Pavlidis P (University of British Columbia, Vancouver, BC, Canada) March 2014. http://jdr.sagepub.com/content/early/2014/03/17/0022034514527288 [Accessed 25th March 2015]