Dental Tribune Indian Edition

17Dental Tribune Indian Edition - April 2013 World News Aggressive and chronic periodonti tis share many clinical features yet are also different in terms of deve lopment and progression. On occasion of Europerio 7 in Vienna this month, Dr Cristiano Tomasi from the Univer sity of Gothenburg in Sweden spoke with DTI Group Editor Daniel Zim mermann about the importance of early identification and why the iden tification of risk factors associated with both forms of periodontal dise ase remains difficult. Daniel Zimmermann: Both chro- nic and aggressive periodontitis are complex infections. What is the basic microbiology underlying this disease? Dr Cristiano Tomasi: Probably the most important microbiological feature is the establishment of a sub gingival biofilm. The evidence sug gests that periodontal disease is not related to a specific microorganism but rather to a complex environment of many different species that live in symbiosis. In a susceptible subject, the biofilm challenge will prompt a host response that will lead to the destruction of pe riodontal support. It is estimated that between ten and 15 per cent of adults in develo- ped countries suffer from chronic periodontitis. Are there any figures available for the aggressive form? This question is not easy to answer. In fact, even for chronic periodonti tis, prevalence differs significantly, depending on disease definition and the population studied. Furthermo re, most epidemiological studies have only addressed the prevalence of periodontitis, with no distinction between the aggressive and chronic forms. The range in prevalence when mild cases are included may reach 40 per cent in a population. The prevalence of the aggressive form, according to one study, was 4 percent for localised forms and 2 percent for generalised forms in a population ranging betwe en the ages of 18 and 30. Other studies have suggested prevalence of severe cases in a young population of up to 8 percent. Generally speaking, we still lack epidemiological data from studies that directly address this question. One of the main differences between both forms appears to be the age group in which they com- monly occur. Age remains an important parame ter for distinguishing the two forms. While severe cases at age 20 are commonly recognised as aggressive, those at 60 are mainly diagnosed as chronic. The diagnosis of both forms, however, is clinical and basically fol lows the same steps. A problem is that in many cases it is not actually possible to identify the age at which the periodontal disease started, so it is not easy to draw con clusions on clinical features related to age of onset. What are the main challenges in dif- ferentiating between both forms? I really think that the most impor tant thing is to diagnose and intercept periodontitis as early as possible. A screening probing can reveal initial periodontal destruction and signs of inflammation quite easily, allowing for an early and effective interven tion. Marking the fine distinction betwe en aggressive and chronic forms could be another step, but the implica tions of these studies would be more interesting for researchers than for clinicians. If we are successful in our treatment, is it really important what we call the disease? And if we are not successful, do we blame the name of the disease? One clinical consideration may be that the systemic use of antibiotics as adjunctive treatment is supported by studies on aggressive cases, but I think that with regard to the problem of microbial resistance induced by excessive use of antimicrobials, this approach should never be the choice for initial treatment, but be considered after reevaluation to accompany me chanical retreatment of the remaining diseased sites. This view, however, is not shared by some periodontologists, who view the first treatment attempt as the important one. Both forms of periodontitis sha- re risk factors. What are the most common? Periodontal disease is clearly the result of an unbalanced host response to the microbial challenge. It is there fore obvious that the genetic setup of the host and the microbial composi tion of the biofilm are recognised as risk factors for the development of the disease. Environmental factors like smo king and stress have also been corre lated with the progression of the dise ase and its most severe forms. It is a more difficult task to deter mine risk factors that are clearly as sociated with one of the two forms of the disease. A few studies have shown specific bacteria to be associated with ag gressive forms, but others have also reported aggressive forms without the presence of those bacteria. The same thing happened with specific genetic polymorphisms. New insights are expected to come from epigene tic studies, in which the activation of specific genes is related to local envi ronmental factors. How important would these be con- sidered to be? Unfortunately, it is still not clear. Some risk factors are related to the establishment of the disease, while others are related to the progression rate. As I said before, the evidence for risk factors related to a specific form is still weak and the evidence not as strong as we would like it to be. You have presented at the 7th con- gress of the European Federation of Periodontology. What can partici- pants expect to take home from the presentation? I hope to clarify the similarities and differences between the two forms of periodontitis. We will go through the most recent published results on tho se issues and try to sort things out as much as possible. I see this as a real challenge. I will share my thoughts and my doubts on some questions that every clinician has to face on a daily basis. Thank you very much for this inter- view. DT “Evidence for risk factors related to a specific form is still weak” An interview with Dr Cristiano Tomasi, Sweden, on aggressive vs. chronic periodontitis “If we are successful in our treatment, is it really important how what we call the disease?” Dr Cristiano Tomasi Intraoral device manœuvres wheelchairDTI ATLANTA, Ga., USA: Researchers at the Georgia Institute of Technology have developed the latest version of the intraoral Tongue Drive System, which is embedded into a dental re tainer and is worn inside the mouth. The system, which only requires free movement of the tongue, allows peo ple with highlevel spinal cord injury to control a powered wheelchair. The user receives a clinical tongue piercing, with which he can control the magnetic field sensors mounted on the device’s four corners. The sensors track the relative location of the ma gnetic piercing and transmit the data wirelessly to an iPod or iPhone. Sof tware installed on this computer devi ce interprets the user’s tongue position and moves the wheelchair accordingly. In earlier versions, the sensors were attached to an externally worn headset. “One of the problems we encountered with this earlier version was that it could shift on a user’s head and would need to be recalibrated,” said Maysam Ghovanloo, associate professor at the institute. The new device sits tightly against the roof of the mouth because it is moulded from dental impressions. As it is worn inside the mouth, it is pro tected against such disturbances and is less conspicuous. The new device includes a lithium ion battery and an induction coil to charge the battery. It is covered with an insulating, water resistant material and vacuum moulded inside standard dental acrylic. The researchers also created a mul tifunctional interface, which holds the iPod, receives and delivers the sensor data, charges the iPod and is fitted with a holder for charging the dental retai ner at night. The system can be hooked up to any standard electric wheelchair. Ghovanloo and his team plan to be gin testing the usability of the system by ablebodied individuals soon and then move onto clinical trials.DT People living in Morley, Western Australia, should better take their dental hygiene seriously. Latest statistics by the Government of Western Australia Department of Health have revealed that getting an appointment for a nonemergency dental procedure in the small su burb near the city of Perth can toll up to three years. According to figures of the latest Western Australia Health Perfor mance report, similiar waiting times have recently been observed throu ghout the state ranging between one and a half and two years on average. Besides Morley, patients from Ama dale and Fremantle also had to wait 18 months for a dental appointment. Overall, more than 24,000 patients are waiting for treatment in public dental clinics. Health officials said that the latest increase in dental appoin tments was due to rising awareness of people that are eligible for sub sidised dental treatment including lowincome families and pensio ners. More than 400,000 people or one fifth of the population are currently estimated to fall into that category.DT Waiting times accumulate