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prevention International magazine for oral health No. 1, 2017

opinion | understanding prevention health products, faulty reimbursement systems and a historical focus on re- storative dentistry are proving difficult issues to overcome. Clearly the number of periodon- tal disease patients is enormous and we need to rethink what we are do- ing. Fortunately, the endorsement of such a wide constituency of learned periodontist societies from around the world can be seen as a good omen. Often, prevention is neglected in dental practices in favour of diagnosis and restorative treatment. However, how can dental professionals equally im- plement these three steps in their daily practise? In developed countries, and in the higher socio-economic strata of de- veloping countries, health, rather than disease, is the future of medi- cine and dentistry, since people want to be healthy and for that, prevention is key. The best dental practices have already shifted their business models away from traditional restorative treat- ments alone and towards a different approach. Prevention makes excellent economic sense for the dentist, but from the patient’s perspective, pre- ventative treatment only works if it is of a very high quality. What are some of your key recommen- dations for short- and long-term pre- ventative treatment? And, where does primary prevention end and secondary prevention begin? You raise an important point. The sim- ple answer is with the diagnosis and choice of appropriate care pathways for different individuals. Primary preven- tion, or helping healthy people avoid the disease, is key. We know what to do in terms of behavioural modification and the promotion of a healthy lifestyle, oral hygiene instructions and delivery of the traditional periodontal preven- tive services (scaling and prophylaxis). This approach, however, requires diag- nosis, because the dentist must first establish that the patient does not suf- fer from periodontitis at the time for it to work. In the conclusions of the Preven- tion Workshop, organised by the EFP in 2014, we underline the fact that it is inappropriate to deliver professional primary preventive services to patients with undiagnosed periodontitis. So, each dentist needs to create different care pathways. One pathway for healthy subjects that need primary prevention, one for gingivitis patients who require treatment first and then primary preven- tion, and another for periodontitis sub- jects whose needs are totally different, including an accurate diagnosis, peri- odontal treatment planning, the comple- tion of a cycle of effective treatment and then—only then—prevention. Second- ary prevention in these cases implies a specific programme for high-risk indi- viduals who have had the disease and who are at a risk of recurrence. How important is an early and accu- rate diagnosis of periodontal disease for maximising the effectiveness of treat- ment? An early and accurate diagnosis is criti- cally important! Distinguishing between health, gingivitis and periodontitis with an appropriate screening test is the first step—similar tests, based on the WHO Community Periodontal Index, have been introduced in many coun- tries around the world by national peri- odontal societies. Whenever a patient has periodontitis, a complete examina- tion is mandatory in order to assess the specificity of the case, establish prognosis and choose the most ap- propriate treatment. Treatment without diagnosis is like walking with one eye shut—sometimes we reach the target, but only when we are lucky. Clinicians should also keep a very important is- sue in mind: that diagnosis is a statu- tory requirement in most jurisdictions around the world. Failure to diagnose or perform an accurate diagnosis remains the number one cause of litigation in our field. Some patients think that the dental pro- fessional alone can treat periodontal diseases. What should the role of the dental professional and the role of the patient be for the successful treatment of periodontal diseases? Here you refer to the need to estab- lish a therapeutic alliance between an informed patient and the dental pro- fessional for the treatment of dental diseases, which includes periodontal diseases. The key is communication. Personally, I like to present to the pa- tient the condition of his/her mouth, explain what periodontitis is, how it is treated and how its reoccurrence can be prevented. This is the time to clarify the importance of oral hygiene and risk factor management. However, your question has a deeper implication. As dentists, we always look at the pa- tient’s lack of compliance as an easy excuse for our lack of success. Allow me to elaborate: if I do not manage to adequately motivate one of my patients I ask myself (and my team) what we did wrong? It is my responsibility to help my patient understand the importance of their role and it is my duty to help them achieve our common goal of good oral health. So, the role of the patient is critical, but if they fail, I fail too. The paper – “Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action” – was written by four international experts including Maurizio Tonetti and EFP past president Søren Jepsen. More information: www.efp.org september 2017 13

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