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Dental Tribune Middle East & Africa Edition | 1/2017 20 GENERAL DENTISTRY to address the relationship of the various risk factors to Peri-Implant diseases and implant failure. In view of the rapid increase in the use of dental implants and the self-evident truth that the vast majority of im- plantpatientslostteethduetoCaries or Periodontal Disease, it is equally important that dental health care professionals appreciate the relative importance of the risk factors out- linedaboveonPeri-implantdiseases. In a very recent extensive retrospec- tive study Derks et al (18) identify moderate to severe peri-implantitis in 14.5% of implant patients exam- ined, and report on the Odds Ratios of the various influencing factors. In a commentary on this study Tarnow (19) points out that even a modest incidence of 10% of patients with Peri-implantitis equates to 100000 new cases of Peri-implantis every year based on current numbers of implants being placed. It might be appropriate to consider this in a fu- turereviewarticle. Conclusions Our understanding of the relative importanceofthevariousmajorrisk factors for Caries and Periodontal diseases should be evidence based and current. At present it is reason- abletoconcludethefollowing: 1. Recent research has indicated that the total amount of sugar consump- tion is more important than the number of sugar exposures per day inthedevelopmentofcoronalcaries. 2. There is little to support the use of dental floss as a preventive measure fordentalcariesorgingivitis. 3. Effective toothbrushing, using a fluoride toothpaste and a power brush, is by far the most effective preventive measure to minimize dental caries and periodontal dis- eases. 4. To minimize the incidence of root caries in the elderly oral hygiene must be supplemented with peri- odicapplicationofafluorideorChlo- rhexidinepreparation. 5. While oral hygiene is important in controlling Periodontitis in the susceptiblepatient,compliancewith a comprehensive Supportive Peri- odontalMaintenanceRecallregimen is likely even more critical in pre- venting progression and tooth loss duetoPeriodontitis. 6. To achieve the best outcomes in periodontally susceptible patients who smoke, smoking cessation pro- grammes must accompany tradi- tional“Hygiene”phasetherapy. 7. To achieve the best outcomes in diabetic patients with Periodontitis the dental professional must work closely with the medical clinician re- sponsiblefordiabetescare.Improve- ments in one disease are likely to be complimented by improvements in theother. 8. When assessing the relevance of clinical research more credence should be given to longer term stud- ies measuring REAL outcomes than shorter term studies which use SUR- ROGATEoutcomes. References 1. Hujoel PP, Cunha-Cruz J, Banting DW, Loesche WJ Dental flossing and interproximal caries: a systematic review J Dent Res. 2006;85(4):298- 305. 2. Kressin et al Increased preventive practices lead to increased tooth retention J Dent Res. 2003;82(4):223- 227 3. Yaacob M, Worthington HV, Dea- con SA, Deery C, Walmsley A, Rob- inson PG, Glenny A. Powered ver- sus manual toothbrushing for oral health.Cochranereview2014 4. Ccahuana-Vásquez R.A et al. Effect of Frequency of Sucrose Exposure on Dental Biofilm Composition and Enamel Demineralization in the Presence of Fluoride. Caries Res 2007;41:9–15 5. E. Bernabé et al J Dent Res Pub- lished online before print November 9,2015 6. Tan HE, Lo ECM, DysonJE, Luo Y, Corbet EF A Randomized Trial on Root Caries Prevention in Elders J DentRes2010,89(10)1086-1090 7.BerchierCE,SlotDE,HapsS,Vander Weijden GA. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. IntJDentHyg.2008Nov;6(4):265-79 8. Lang NP, Cumming BR, Löe H.Toothbrushing frequency as it relates to plaque development and gingival health. J Periodontol. 1973 Jul;44(7):396-405. 9. Bosman CW, Powell RN The rever- salof localizedexperimentalgingivi- tis. A comparison between mechani- cal toothbrushing procedures and a 0.2% chlorhexidine mouthrinse. J Clin Periodontol. 1977 Aug;4(3):161- 72. 10. Ramfjord SP, Morrison EC, Bur- gettFG,NissleRR, ShickRA, ZannGL, and Knowles JW. Oral Hygiene and Maintenance of Periodontal Sup- port. JPerio(1982),53,(1),26-30 11. Lee CT Huang HY Sun TC Karim- bux N Impact of compliance on tooth loss during Supportive Perio Therapy – Systematic Review and Meta-analysis J Dent Res (2015); 94 (6):777-786 12. Papapanou PN and Lindhe J Epi- demiology of Periodontal disease. Clinical Periodontology and implant dentistry. Lindhe J, Lang NP and Kar- ring T Ed.(2008) 148-151; 5th Edition, BlackwellMunksgaard 13. Bolin A, Eklund G Frithiof L Lavst- edt S. The effect of changed smoking habits on marginal alveolar bone loss.Alongitudinalstudy.SwedDent J(1993):17;211-216. 14. Hyman JJ1, Reid BC Epidemiologic risk factors for periodontal attach- ment loss among adults in the Unit- ed States. J Clin Periodontol. (2003) Mar;30(3):230-7. 15. Preshaw PM Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrila- kisK,TaylorR Periodontitis and diabetes: a two- wayrelationship.Diabetologia(2012) 55,(1),21–31 16. Engebretson S, Kocher T. Evi- dence that periodontal treatment improves diabetes outcomes: a sys- tematic review and meta-analysis. J Clin Periodontol 2013; 40 (suppl. 14): S153–S163. 17. Javed F, Ahmed HB, Mehmood A, Bain CA, Romanos G Effect of non- surgicalperiodontaltherapy(withor without oral doxycycline delivery) on glycemic status and clinical peri- odontal parameters in patients with prediabetes: a short-term longitudi- nal randomized case–control study. ClinOralInvest(2014)18:1963-1968. 18. Derks J, Schaller D Håkansson J . Wennström JL Tomasi C Berglundh T. Effectiveness of Implant Therapy Analyzed in a Swedish Population - Prevalence of Peri-implantitis J Dent Res(2016).95(1)43-49 19.D.P.TarnowIncreasingPrevalence of Peri-implantitis: How Will We Manage? J Dent Res January (2016) 95(1):7-8 ◊Page18 Prof.CrawfordBain, ScotlandisaProfessor ofPeriodontology, DirectorofPost-Grad- uatePeriodontics, HamdanBinMoham- medCollegeofDental MedicineMohammedBinRashidUniver- sityofMedicineandHealthSciences GDCSpecialist List inPeriodontics,Pros- thodonticsandRestorativeDentistry.