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ePaper created 2015-06-05, 15:15:11 | version 1.38.0
I research country, those choosing to seek their periodontal care from the private sector, are able to access spe- cialist care from highly trained periodontists and theirteams,whooftenprovideawiderangeofeffec- tive and sophisticated treatment options. However, outsidethedentalschoolsthereislittleorverypatchy access to specialist treatment services within the NHS. Recognition of this manpower deficit and a move to address it through intermediate level train- ing in periodontal therapy is an encouraging but still unproven development. Possibly the most important health professional for the implementation of primary prevention are dentalhygienists.Althoughthereislittleevidenceon deployment of hygienists within primary care, anec- dote suggests that they may spend much of their time removing supragingival calculus (as prescribed by their employing dentists) without any routine at- tention to properly targeted attempts to provide ad- equatepersonalisedoralhygieneinstruction.Indeed the whole issue of the routine “scale and polish” as a therapeutic intervention has been questioned and is the subject of current research projects whose find- ings are yet to be reported. _Implantology Many aspects of implantology, including surgical management, management of soft and hard tissues, andmanagementofperi-implanthealthanddisease, are squarely within the realm of periodontal treat- ments, and implantology is indeed a substantial component of specialist training in periodontology. Whilst the growth in implant treatments has been markedlyslowerthaninmanyotherEuropeancoun- tries, there is now a large and ever growing use of dentalimplantsinUKdentalpracticeandawiderac- ceptancefromsignificantnumbersofpatientsofthe valueofimplantsandtheirpotentialcost/benefits. It isquiteclearthatthepotentialforimplanttreatment could never be met within the National Health Serv- ices as the costs could potentially swallow much of the total NHS budget. However some recognition of the clinical needs and cost/ benefits on a more indi- vidual basis even within the NHS dental services would appear to be inevitable in the future. There are two major developing issues, which are partly related to each other, which may particularly affect the periodontist practicing implant dentistry. Firstly, there is the growing problem of peri-implan- titis. Reported prevalence rates of long standing im- plantsdovarybutaretypicallyontheregionof30per cent. This progressive destructive condition creates particular problems as it appears to be much more difficult to manage than its first cousin, periodonti- tis. As many more implants have been placed for a number of years there is great concern about the growth of this condition. Secondly,apparentlyoblivioustotheaboveprob- lems and an understanding of long term survival ratesofteethandimplants,thereisadisturbingtrend amongstsometoadvocateearlyremovalofdiseased teeth and replacement by implants. There may be some short term gains for the dentist and/or patient to be had from this approach but it is a sure way to store up major new problems for the future. Sothereremainsalottodotackleperiodontaldis- ease in the UK. One of the most encouraging devel- opmentsinthenearfutureisthedevelopmentofcare pathways within the General Dental Services which place considerable emphasis on prevention, risk fac- tor management and tackling early periodontal dis- ease, as well as mapping out appropriate care path- ways for those in need of more involved periodontal treatment. This will inevitably be painful for some as it represents a new way of service delivery based on evidence based outcomes. 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 skills is successful. _Challenges remain Thechallengeofmanagingperiodontaldiseasein anincreasinglyagingpopulationarelikelytobecome a major issue going forward, and at time the profes- sion will have to consider how it interacts with gen- eral medical services, for example in screening and detection of the currently estimated 750,000 people in the UK who may have undiagnosed diabetes. The private sector looks set to increase its provision of specialistperiodontalcareandimplantprovision.The challenges of long term implant survival and man- agement of peri-implant disease will present new challengesformany.Therewillundoubtedlybenovel treatments and developments which we can only speculate on. Interesting times indeed but there is lots to do._ 24 I implants2_2015 about the author Francis Hughes is Professor of Periodontology at Kings College London and Chair of the EuroPerio8 conference in London. He can be contacted at: francis.hughes@kcl.ac.uk.