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ePaper created 2015-06-05, 15:15:11 | version 1.38.0
research I tant for future treatment needs. The over 65-year oldsareoftenfitandwellandhavehighexpectations for their continued health needs, even though they may also suffer from common medical conditions such as type 2 diabetes and hypertension and may take multiple medications. _Impact of periodontal disease Periodontal disease has typically been seen as a “silent disease” which might have few consequences unless resulting in tooth loss. However, there is now lots of evidence to refute this concept. Patients with periodontitis consistently report significant impacts oftheconditionontheirqualityoflife,particularlyim- pacting on function, aesthetics, comfort and self es- teem.Furthermore,evenmilddiseaseresultingingin- gival bleeding and perhaps halitosis impact on social acceptabilityandremainhighlylegitimatereasonsfor treatment need. Prevention of more severe disease is of course best achieved by primary prevention and early disease control by achievement of high levels of plaquecontroltogetherwithmanagementofmodifi- ableriskfactors,particularlysmokingcessation. Periodontaldiseasehasnowbeenassociatedwith risk of a number of other systemic conditions, most notably cardiovascular and cerebrovascular disease, among many other conditions. It has been clearly shownthatperiodontaldiseasecausesameasurable systemic inflammatory response but it is not at all clearthatperiodontaltreatmentactuallyreducesthe risk of these conditions, or whether the conditions are associated through common factors such as ge- netic predisposition. Nevertheless, given the impor- tance of these systemic conditions it is recom- mended that periodontal health should be regarded as part of general health. _Manpower Clearly there remains a major, often unmet, peri- odontal treatment need within the UK population, which represent a significant challenge for dental healthprofessionals. Therearecurrentlyover30,000 registered dentists and over 6,000 dental hygienists in the country. In addition, there are approximately 300 periodontists on the specialist list, who work mainly in private specialist practices or in the hospi- talanduniversityservices. Giventhatthereareanes- timated five million cases of moderate to severe pe- riodontitis, and perhaps 20 to 30 million with some signs of periodontal disease, it would appear that these relative proportions of dental manpower are not currently ideally suited for the provision of pri- mary and secondary periodontal care according to actualclinicalneeds. Thereareofcourseasignificant but unknown number of general dentists who pro- vide a degree of periodontal treatments that might otherwise considered to be at secondary care level. The number of specialist periodontists in training is small (certainly less than 20 every year), which is probably insufficient to maintain the total number on the specialist list over time. There is considerable interestandsomecommitmenttoprovidingagroup of dentists with additional skills in specific restora- tive specialties including periodontology, who could potentiallymeetmuchofthetreatmentneedforsec- ondary care periodontal treatment, but this group doesnotreallyexistatthepresenttime.Itshouldalso be commented that this model of periodontal care provisiondoesremainessentiallyuntestedonalarge scale at present. Overallthepictureofperiodontalcareprovisionin theUKatpresentismixedatbest.Inmostareasofthe I 23implants2_2015 Periodontal disease has typically been seen as a “silent disease” which might have few consequences unless resulting in tooth loss. [PICTURE: ©RA2STUDIO]