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Dental Tribune United Kingdom Edition

Dental Tribune United Kingdom Edition | 1/201522 meet much of the treatment need for sec- ondarycareperiodontaltreatment,butthis group does not really exist at the present time. It should also be commented that this model of periodontal care provision does remain essentially untested on a large scale at present. Overallthepictureofperiodontalcarepro- visionintheUKatpresentismixedatbest.In most areas of the country, those choosing to seek their periodontal care from the private sector, are able to access specialist care from highly trained periodontists and their teams, who often provide a wide range of effective and sophisticated treatment options. How- ever, outside the dental schools there is little or very patchy access to specialist treatment services within the NHS. Recognition of this manpower deficit and a move to address it through intermediate level training in peri- odontal therapy is an encouraging but still unprovendevelopment. Possiblythemostimportanthealthprofes- sional for the implementation of primary prevention are dental hygienists. Although there is little evidence on deployment of hy- gienists within primary care, anecdote sug- geststhattheymayspendmuchoftheirtime removing supragingival calculus (as pre- scribed by their employing dentists) without anyroutineattentiontoproperlytargetedat- temptstoprovideadequatepersonalisedoral hygieneinstruction.Indeedthewholeissueof theroutine“scaleandpolish”asatherapeutic intervention has been questioned and is the subject of current research projects whose findingsareyettobereported. Implantology Many aspects of implantology, including surgical management, management of soft and hard tissues, and management of peri- implant health and disease, are squarely within the realm of periodontal treatments, andimplantologyisindeedasubstantialcom- ponent of specialist training in periodontol- ogy. Whilstthegrowthinimplanttreatments hasbeenmarkedlyslowerthaninmanyother European countries, there is now a large and evergrowinguseofdentalimplantsinUKden- talpracticeandawideracceptancefromsignif- icant numbers of patients of the value of im- plants and their potential cost/benefits. It is quiteclearthatthepotentialforimplanttreat- ment could never be met within the National Health Services as the costs could potentially swallow much of the total NHS budget. How- eversomerecognitionoftheclinicalneedsand cost/ benefits ona more individual basis even within the NHS dental services would appear tobeinevitableinthefuture. There are two major developing issues, which are partly related to each other, which may particularly affect the periodontist prac- ticing implant dentistry. Firstly, there is the growing problem of peri-implantitis. Re- ported prevalence rates of long standing im- plantsdovarybutaretypicallyontheregionof 30%. This progressive destructive condition createsparticularproblemsasitappearstobe much more difficult to manage than its first cousin,periodontitis. Asmanymoreimplants havebeenplacedforanumberofyearsthereis great concern about the growth of this condi- tion. Secondly,apparentlyoblivioustotheabove problems and an understanding of long term survival rates of teeth and implants, there is a disturbing trend amongst some to advocate early removal of diseased teeth and replace- ment by implants. There may be some short termgainsforthedentistand/orpatienttobe had from this approach but it is a sure way to storeupmajornewproblemsforthefuture. Sothereremainsalottodotackleperiodon- tal disease in the UK. One of the most encour- aging developments in the near future is the developmentofcarepathwayswithintheGen- eral Dental Services which place considerable emphasis on prevention, risk factor manage- mentandtacklingearlyperiodontaldisease,as well as mapping out appropriate care path- ways for those in need of more involved peri- odontal treatment. This will inevitably be painful for some as it represents a new way of service delivery based on evidence based out- comes. However it also carries with it the prospects for better provision of higher level periodontal care, particularly if the planned development of dentists with some specialist skillsissuccessful. Challengesremain Thechallengeofmanagingperiodontaldis- ease in an increasingly aging population are likely to become a major issue going forward, andattimetheprofessionwillhavetoconsider howitinteractswithgeneralmedicalservices, for example in screening and detection of the currentlyestimated750,000peopleintheUK whomayhaveundiagnoseddiabetes. The private sector looks set to increase its provision of specialist periodontal care and implant provision. The challenges of long term implant survival and management of peri-implant disease will present new chal- lenges for many. There will undoubtedly be noveltreatmentsanddevelopmentswhichwe can only speculate on. Interesting times in- deedbutthereislotstodo. AD Francis Hughes is Professor of Periodontology at Kings Col- lege London and Chair of the Europerio8 conference in London.He can be contacted at francis.hughes@kcl.ac.uk. TRENDS & APPLICATIONS DTUK0115_21-22_Hughes 09.04.15 15:36 Seite 22 DTUK0115_21-22_Hughes 09.04.1515:36 Seite 22

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