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today AEEDC Dubai 2016

science & practice 10 AEEDC Dubai 2016 ofhyperglycaemia,orelevatedlevels ofbloodsugar.3 IntheUKProspective Diabetes Study, it was shown that Type 2 diabetics who reduce their HbA1c level by 1% are 19% less likely to suffer cataracts, 16% less likely to suffer heart failure and 43% less likely to suffer amputation or death duetoperipheralvasculardisease. Clearly, not only will control of di- abetesfacilitatemanagementofperi- odontitis,butalso,probablymoreim- portantly, effective management of periodontitis is likely to have major beneficial effects on the serious se- quelaeofdiabetes.Unfortunately,the medicalprofessionislargelyignorant of the potential benefits of establish- ing and maintaining periodontal health. The publication Type 1 Dia- betes in Adults: National Clinical Guideline for Diagnosis and Manage- ment in Primary and Secondary Care (updated in July 2014) was compiled byaconsensusreferencegroupmade up of 30 members.4 These included physicians, endocrinologists, nurses, ophthalmologists, dieticians, podia- trists and lay people, but no dentists. Its153pagesmakenomentionofden- tistry or periodontal disease. The Na- tional Institute for Health and Care Excellence document on Type 2 dia- betes,alsoupdatedin2014,toofailsto mentiondentistryorperiodontaldis- ease. Smoking We have known for over 20 years that smoking increases the risk of periodontalbreakdown.Oddsratios for developing periodontal disease as a result of smoking constitute a range: 2.5,5 3.97 for current smokers and 1.68 for former smokers,6 and 3.25 for light smokers to 7.28 for heavy smokers.7 A smoker with 20 pack years (20 cigarettes per day for 20years)isupto600%morelikelyto lose teeth owing to periodontal dis- ease, whereas a patient with poor plaquecontrolhasarounda15%risk of progressing to destructive peri- odontitis.Whythendowerefertohy- giene phase therapy when smoking is a much greater risk factor than poor oral hygiene? How many den- tistsspendasmuchtimeonsmoking cessation counselling as on oral hy- giene instruction? Sugar Traditionally, teaching on caries prevention has focused on the num- ber of sugar exposures per day, espe- cially between meals. Academic pae- dodontists suggest that provided therearetwodailyexposurestofluo- ride in toothpaste, a maximum of six sugar exposures a day is unlikely to leadtosignificantenameldecalcifica- tion in children. However, a large study conducted in 2015 by Bernabé et al. evaluated 1,702 adults over 11 years and concluded that “the amount of, but not the frequency of, sugars intake was significantly asso- ciated with DMFT (decayed, missing and filled teeth) throughout the fol- low-upperiod”.8 It thus appears that, at least in adults, “how much” is more impor- tant than “how often” with regard to sugar consumption. This is all the more significant since DMFT meas- ures real outcomes over significant time spans, while many studies on both caries and gingivitis are very short term and use surrogate out- comes, such as decalcification on an enamel sample, or plaque and gin- givitisindicesasthebasisoftheircon- clusions. Patients are only really in- terestedinrealoutcomes. Obesity ThethirdNationalHealthandNu- trition Examination Survey showed that body mass index was signifi- cantly associated with periodontal disease.Otherstudieshaveindicated alessstrongassociation,andwiththe compoundingvariableofbloodsugar levels in prediabetics, it is presently unclear whether obesity is in fact an independent risk factor or is associ- ated with the established role of dia- betes.Regardless,obesityisaknown riskfactorforType2diabetesandcar- diovascularproblems,anditispartof the dental professional’s role to in- form patients of these interrelation- ships. Itislikelythatcomprehensivepe- riodontal treatment of all obese/pre- diabetic patients would be signifi- cantly less costly and, hopefully, re- sultinfewifanyfatalities. Conclusion It is clear that the simple story of plaque control preventing progres- sion of common dental diseases is largelyfictionratherthanevidence- based fact. While effective oral hy- giene will always be a significant part of the management of dental diseases, the modern dental profes- sional must be equally aware of the other common risk factors outlined inthisarticle. Contactinfo A UK-certified specialist in peri- odontics, prosthodontics and restora- tive dentistry, Crawford Bain is cur- rentlyProfessorofPeriodontologyand Director of Post-Graduate Periodon- tics at the Hamdan bin Mohammed CollegeofDentalMedicineinDubaiin theUnitedArabEmirates.Hewillpres- ent two papers as part of the AEEDC 2015scientificprogrammeonTuesday morningandFridayafternoon. INTERNATIONAL ENDODONTIC CONGRESS FEATURING THE LEADING WORLD SPECIALISTS IN ENDODONTIC The event will take place w-8,-28,)D28)62%8-32%0)28%0<,-&-8-32)28%0 "%032;,-',;-00%003;8,)%88)2())783'31&-2)8,)4%68-'-4%8-32-2%7'-)28-A'):)28 with visiting the exhibition booths. 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