The podcast recording of the November 9 Prevention Workshop webinar – in which the four co-chairmen explained guidelines to prevent periodontal disease and peri-implantitis – is now available for viewing.
The online seminar, which was watched live by 420 viewers in 28 countries, was streamed live from a Madrid TV studio. It featured both informative videos and discussions between Mariano Sanz, Maurizio Tonetti, Iain Chapple, and Søren Jepsen about the conclusions and guidelines of the XI European Workshop in Periodontology, the Prevention Workshop.
“The outcomes of this workshop are fundamental for professionals and also for the periodontal and peri-implant health of our population,” said Prof Sanz, the chairman of the Prevention Workshop, in his introductory remarks.
The webinar covered all the key areas analysed by the Workshop, dedicated to 'Effective prevention of periodontal and peri-implant diseases,’ which took place in Spain in November 2014.
One of the biggest challenges highlighted by the four co-chairmen was changing the behavioural habits of patients at risk of periodontal or peri-implant diseases.
Prof Sanz highlighted the difficulties involved in assessing the susceptibility of patients, which “varies a lot”. He said there was a need for effective recall programmes so that patients could be continually re-assessed, as factors such as stress could affect their susceptibility.
Prof Tonetti, who chaired the Prevention Workshop’s working group on the principles of prevention in periodontal diseases, said that there were 750 million people around the world with periodontitis severe enough to put their teeth at risk of loss, an “incredible number”.
He said that while it was not yet possible to identify individual risk factors, it was possible to use risk-assessment approaches to assess segments of the population with different levels of risk of tooth loss. Prevention approaches needed to vary for the different patient groups: those with healthy gums, those with gingivitis, and those with periodontitis.
He added that patient compliance with oral-hygiene instructions was “the biggest challenge”, a point echoed by Prof Chapple, who pointed out that some patients need to devote 10-20 minutes twice a day to mechanical plaque control, and those that require longer hygiene times to maintain health might struggle to find that time and to reconcile this need with their busy lifestyles.
Chapple, who chaired the working group on the primary prevention of periodontitis, assessed various aspects of mechanical plaque control. While both manual and electric brushes were effective, rechargeable power brushes were “significantly more effective” than battery-powered brushes in reducing plaque scores and gingival inflammation. There was also a small but significant difference between power and manual brushing in favour of the former.
He emphasised the Workshop’s finding on flossing. “Perhaps what surprised most people was that there is really insufficient evidence to demonstrate that the use of dental floss offered any significant benefit for patients with gingivitis or periodontitis.”
The preferred method for interdental cleaning is the use of interdental brushes, with flossing restricted to situations where the gaps between teeth are too tight for a brush to enter without causing trauma.
Chemical agents, in mouth rinses and in toothpastes, used alongside mechanical plaque removal had “very clear and significant beneficial effects” in reducing gingival inflammation, explained Chapple. But he cautioned against patient self-medication because of possible side-effects and interactions with other substances in, for example, toothpastes. “They should only use these agents if advised to do so by oral health professionals”, he said.
Prof Chapple pointed out that there was no evidence to support the topical use of anti-inflammatory medication to control gingivitis and that the evidence for benefit following their systemic use was “incredibly thin”.
Prof Jepsen, chairman of the working group on primary prevention of peri-implant diseases, pointed out that half of patients with implants have peri-implant mucositits and 20 per cent develop peri-implantitis.
He outlined the importance of identifying bleeding around implants and crowns as a symptom of peri-implant mucositis, which needs to be successfully treated before it evolves into peri-implantitis. He emphasised that smoking was a big risk factor in peri-implantitis along with poor oral hygiene.
“The patient has to be instructed in proper oral hygiene measures and then it is possible to reduce the signs of inflammation quite significantly,” said Jepsen. “In addition, the professional has to do some plaque removal on a regular basis. And by doing so we are able to actually treat the mucositis.”
Secondary prevention, the process that begins once successful periodontal therapy has been applied to patients, represents a “weak link” in professional periodontal care, according to Prof Sanz, who chaired the working group on managing complications of gingival and periodontal diseases and professional mechanical plaque control. He stressed the need for good motivational techniques to keep patients visiting professionals.
Sanz said that studies show that more than 50% of patients stop visiting their dentist, although the secondary prevention of periodontitis is a “life-long” commitment.
Secondary prevention starts when treatment of periodontitis ends and Sanz stressed that “it is important to define our end-point of therapy.” He said that the Prevention Workshop agreed two targets – less than 15 per cent bleeding on probing and the elimination of pockets of 5mm or deeper – and “we need to treat until our patient is below these thresholds. That is when [secondary] prevention starts.”
Prof Tonetti added: “We have to recognise that the complete elimination of pockets may not be an attainable goal for all patient groups.”
Dentine sensitivity and halitosis (bad breath) were other topics covered in the 70-minute seminar, which concluded with a summary of the key messages of the Prevention Workshop.
Tonetti described the release of the workshop’s guidelines as a “time for renewed energy” in the prevention of periodontitis.
The proceedings and conclusions of the XI European Workshop in Periodontology, which was supported by educational grants from Procter & Gamble and Johnson & Johnson, are available online in a free, open-access supplement of the April 2015 issue of the Journal of Clinical Periodontology.
A study of the cost-effectiveness of non-surgical treatments for peri-implantitis, a summary of which has been published in JCP Digest 05 (2015:42), ranked treatments in terms of value for money but concluded that more evidence was needed to be able to reach firm conclusions.
The study, published in full in the May 2015 edition of the Journal of Clinical Periodontology (JCP), concluded that the treatments which offered best value for money were (in descending order) debridement alone, the use of Air-Flow technology, debridement combined with PerioChip (a biodegradable chip containing chlorhexidine gluconate), and debridement combined with local antibiotics.
But the researchers noted that the study was limited to the German healthcare model, used only a single parameter (probing pocket depth) to measure effectiveness, and used data from an online survey with a very limited number of responders. Moreover, there was considerable “decision uncertainty” because of a lack of robust evidence.
As a result, they concluded that “robust treatment recommendations for peri-implantitis require more comprehensive and patient-centred evidence.” This would appear to be a key priority area for research in order to provide more robust evidence-based guidance for clinicians managing peri-implant diseases.
The original paper, ‘Cost-effectiveness of non-surgical peri-implantitis treatments’, was written by Stefan Listl, Nadine Frühauf, Bettina Dannewitz, Christiane Weis, Yu-Kang Tu, Huei-Ju Chang, and Clovis Faggion Jr.
It was précised for the JCP Digest by postgraduate periodontology students at the Department of Oral Health Sciences in the Faculty of Medicine at the Catholic University of Leuven, Belgium, under the supervision of Marc Quirynen and Wim Teughels.
JCP Digest 05 is available for viewing and download in pdf format from the EFP website. Each edition of the JCP Digest provides a concise summary of a relevant research paper from the JCP. All issues can be accessed here.
Members of the executive committee and all the EFP’s committees met in Madrid from November 7 to 9, at the Media and Health Promotion Workshop, to draw up a communications plan for 2016.
They agreed an extensive series of activities for next year, which marks the 25th anniversary of the founding of the federation. These include a periodontal awareness campaign, a roadshow that will present EFP material at meetings of the federation’s national-society members, and activities to celebrate European Periodontology Day on May 12.
They also agreed to draw up a perio health-promotion strategy and to approach the World Health Organization (WHO) with the aim of giving a presentation to officials early in 2016. This would build on last June’s meetings with members of the European Parliament in Brussels.
A key part of the EFP’s promotional strategy will be aimed at increasing perio awareness among dentists and dental hygienists and at influencing national dental associations. The campaign will also seek to increase awareness of periodontal issues among organisations working with diabetes.
The EFP is planning to give presentations to the International Federation of Diabetes, the European Society of Cardiology, and the European Patients’ Forum.
Other plans for 2016 include the launch of an online perio magazine for patients and professionals, the relaunch of the EFP Manifesto, and the issuing of guidelines for celebrating periodontal health to be given to the national societies,
The Madrid meeting took the form of a three-day workshop, in which a team of 10 media and health-promotion professionals worked closely with EFP committee members in exploring how the federation can take forward its strategic vision of ‘Periodontal health for a better life.’
The workshop’s participants were given hands-on instruction in how to handle television and radio interviews, with practical sessions at the TV and radio studios of Madrid’s CEU San Pablo University.
There were also presentations on how to prepare communications plans and outreach campaigns, how to write effectively for different interest groups, how to manage social media, how to manage institutional relationships, and how to use scientific events and meetings.
The keynote lecture was given by Glenn Laverack, a leading expert in health promotion and empowerment who is an honorary professor of health promotion at the University of Southern Denmark.
Dr Laverack emphasised the importance of addressing not only individual patients but also inequality and the social determinants of health, saying that a health-promotion strategy should be both “top-down” (telling people what to do) and “bottom-up” (finding out what people’s needs are).
He posed the question “What can the EFP do?” and highlighted five approaches that the EFP could consider as part of future activities. Laverack said that the federation could provide an expert and legitimate collective voice, help provide an evidence base, fund activities directly and directly, build a CSO (civil society organisation) network, and take part in advocacy and lobbying.
He suggested that the time was right for the EFP to take its messages about the importance of periodontal health not only to European institutions but also to the World Health Organization. This idea was received enthusiastically by the committee members and plans are now being drawn up to send an EFP delegation to the WHO in Geneva early in 2016.
The team of professionals which led the individual workshops was put together by Nítida Branding, the communications consultancy which works closely with the EFP’s external affairs committee.
“It was a great workshop and we learnt a lot,” said Mariano Sanz, chairman of the European Workshop in Periodontology who acted as chairman for the Madrid event.
“Communication is of paramount importance to the European Federation of Periodontology,” said Edwin Winkel, chairman of the EFP’s external affairs committee. “Communication is not only important in relation to the national societies and the professionals but also to the public. This workshop helped us a lot to find the best strategies for the EFP to achieve this.”
Søren Jepsen, president of the EFP, said: “This workshop has shown us how we can move forward together, with more effective communication and new initiatives in health promotion that will help us to manifest our strategic vision of periodontal health for a better life.”
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