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Worldental Daily, Thursday, 30 August 2012

Opinion Thursday, 30 August 2012 T he appropriate use of different oral health promotion/preven- tive interventions and mate- rials, as well as treatment options in public policy is crucial for the im- provement of the oral health of in- dividuals and populations. Whether one is a private practice dentist doingtreatmentplanningorapublic health dentist assessing the needs of a community, the approach is the same. In order to assess which preven- tive and promotion intervention to use,itisutterlyimportanttoevaluate the needs and current oral health status of the individual or population first, as well to conduct an assess- ment of the community. The oral health assessment would include the incidence of caries, periodontal disease, and oral cancer. The assess- mentofthecommunitywouldinclude elements such as whether there is a community water system, whether the community is fluoridated and at whatlevel,andtheavailabilityofden- tal and other health professionals. Canada recently completed an oral health survey that established thecurrentoralhealthstatusofCana- dians and, in addition to describing the needs of the population, it es- tablished a baseline to which the effectiveness of any intervention can becompared.Thisassessment,along with an in-depth understanding of the dental public health community and the particularities of a commu- nity, lays the necessary groundwork for determining the intervention ap- proach to take. In addition to understanding the needs of an individual or a popula- tion, it is also important to compare the reach, effectiveness and costs of an intervention in order to deter- mine which intervention will have the greatest impact. For example, a community with a high incidence of caries and a viable central water supply may benefit from introducing water fluoridation. At a cost per per- son of $0.77 to $4 and a potential 20 to 40 per cent reduction in caries, water fluoridation is a cost-effective initiative for the appropriate com- munity. A community without a viable central water infrastructure mightbenefitfromafluoride-varnish programme, which has a cost per person of $24 to $51 and a potential 24 to 46 per cent reduction in caries. Anotherpotentialinterventioncould be a sealant programme, which has a cost per person of $20 to $36 and a potential 23 to 87 per cent reduction in caries; however, this programme relies heavily on the availability and participation of dental profession- als. All of the above-listed inter- ventions have been proven to be successful in individuals and in com- munities and can improve the oral health of a population; however, one invention (or a combination of a few interventions) may be more suitable after an assessment of the situation. In terms of treatment options, an understanding of the individual or community is also vital when making clinical decisions involving different dental materials. For example, when decidingbetweencompositeoramal- gam fillings for treatment of caries, establishing the ease of access to a dentalprofessionalandthesizeofthe cavity are key. Amalgam is inexpen- sive, durable, and relatively fast and easy to place. Composites may cost more,maynotbeasstrongordurable in locations where they are subject to forces produced by chewing, and are often more difficult to place. In some remote communities with lim- ited access to a dental professional, amalgam fillings may be the material of choice. In summary, it is essential when making an intervention or treatment decisiontoevaluateandconsiderthe results of a thorough needs assess- ment, the pros, cons and effective- ness of the proposed intervention, as well as the associated costs. This detailedplanningfromtheoutsetwill translate into health improvements in a population. DrPeterCooneyistheChiefDental OfficerofCanada.Thismorning,hewill present a paper on dental materials together with Dr Gottfried Schmalz from Germany in Hall F of the HKCEC. IDrPeterCooney “...it is utterly important to first evaluate the needs and current oral health status of the individual or population first...” T his afternoon, the German implantology expert Dr Frank Schwarz will be presenting a lecture on the successful treatment of peri-implantatis. Worldental Daily hadtoopportunitytospeakwithhim about the condition and the latest treatment approaches. I Peri-implantitis seems to remain a huge clinical problem. What chal- lenge does the condition pose to the dental community? Owingtotheincreasingnumberof dental implants placed, post-implant complications will gain relevance in the future. I How many patients are estimated to be affected? According to the current consen- sus statement by the European As- sociation for Osseointegration, one out of five implant patients are likely to develop peri-implantitis. Similar estimates concerning mucositis are lacking. I Experts say that the number of implant treatments will increase above average in the next few years, particularly in Asia. What conse- quences will this have on the dental community in the region regarding peri-implantitis? Besides the need for more re- search activities in this important field, measures have to be imple- mented to assure quality, as well as educational standards for dentists who want to offer implant treatment. We must also consider the impor- tance of iatrogenic factors, which can promote peri-implant infections. I A number of treatment methods for peri-implantitis are available. Con- sideringthelatestresearchfindings, which of these are likely to have the most successful clinical outcome? In general, surgical procedures seem to have an advantage over non- surgical treatment approaches. I Is there one effective method of treatmentorisitacombinationofdif- ferent methods that ensures long- term success? For a successful therapeutic out- come,severalfactorshavetobetaken into account. The configuration and morphology of peri-implant bone defects, which have been considered to be of lesser importance, seem to play a very important role actually. I New implants and implant surfaces promise even better osseointegra- tion. Will this have an effect on the development and treatment of peri- implantitis? New implant modifications have to be studied and assessed with re- gard to these aspects. I What are the most promising treat- ment approaches, in your opinion? I will give a comprehensive review oftheminmyFDIlectureonThursday. IThank you very much. 04 www.fdiworldental.org Global oral health in the context of preventive/treatment interventions and materials ByDrPeterCooney,Canada IDrFrankSchwarz AD One out of five implant patients are likely to develop peri-implantitis AninterviewwithDrFrankSchwarz,Germany