Paediatric periodontal screening methods in undergraduate dental schools.

Introduction: Many forms of periodontal diseases affect children and adolescents. The simplified basic periodontal examination (BPE) is a screening tool for children aged seven to 17, which enables early recognition of such diseases. This study aims to investigate and compare methods of periodontal health assessments in the 'under-18s' across dental schools in the UK. Materials and method: A web-based questionnaire was issued via email to teaching members of staff in each of the 16 undergraduate dental universities across the UK. Results: Out of the 16 correspondents, ten universities completed the questionnaire, giving a response rate of 63%. All respondents were aware of methods of periodontal screening for children and adolescents such as the simplified BPE. All universities taught and used the 'simplified BPE'. The majority of universities started paediatric clinics in year three and carried out practical periodontal assessments in children aged seven and above, at first visit and at recall. Discussion and conclusion: All UK dental schools were aware of, taught and used the simplified BPE as a method of periodontal assessment. Most universities seemed to comply with the guidelines being implemented.

Validation of a model to evaluate the role of radiographs in the diagnosis and treatment planning of periodontal diseases.

OBJECTIVES: The purposes of this study were (i) to see if an indirect method of design (paper patients) could be developed for study of change affected by radiographs on diagnostic outcome and planned treatment of periodontal patients and (ii) to investigate the effect of the nature of clinical examination on the value of radiographs in reaching a periodontal diagnosis. Paper cases could allow the design of examiner blind studies where repeatability could be assessed. METHODS: 201 patients were assigned to one of four groups and clinically assessed according to group specifications. Radiographs were taken. Periodontal diagnoses and treatment plans were drawn up for each patient with and without radiographic information (real patient). Simulated paper transcriptions were made for each subject and diagnoses and treatment plans were again drawn up (paper patient). RESULTS: For many diagnoses and treatment options assessments were similar for real and paper patients. There was substantial agreement between periodontal diagnoses reached from real and paper assessments (kappa=0.68). Greater differences were seen for extractions and periodontal surgery. Paper assessments better replicated real assessments when more thorough clinical examinations were undertaken. The relatively time efficient Group 2 clinical assessment appeared to perform similarly to the extensive Group 4 clinical assessment. CONCLUSIONS: The model described may be useful for simulating real patients for studies of this nature. The Group 2 assessment appeared to give sufficient clinical information for patient management and may be an appropriate choice for initial diagnosis and treatment planning of periodontal patients.

Use of the basic periodontal examination and radiographs in the assessment of periodontal diseases in general dental practice.

OBJECTIVES: The aims of this study were to investigate (1) the use of the basic periodontal examination (BPE) by general dental practitioners (GDPs) and their selection of radiographs for the assessment of periodontal disease and (2) whether this selection concurred with existing selection (referral) criteria. METHODS: Three mailings of a self-completion questionnaire were sent to 800 GDPs working in the National Health General Dental Service in England and Wales. Dentists were presented with six clinical scenarios for which they were asked to describe their use of radiographs. RESULTS: Ninety-one percent of dentists reported that they used the BPE in new patients, with 56% using it for all patients; 84% of dentists used BPE in recall patients. BPE use was related to the dentists' age and postgraduate qualifications. There was a wide variation in the radiographic views used for periodontal disease assessment. The choice of radiographs was not generally in line with the Faculty of General Dental Practitioners (UK) 1998 selection criteria, particularly for the clinical scenarios of pocketing >5 mm, irregular pocketing or pockets associated with teeth with heavy restorations. Sixty seven percent of dentists concurred with recommendations for radiographs for a suspected periodontal-endodontic lesion. CONCLUSIONS: A majority of dentists reported clinical screening for periodontal diseases using the BPE. There was considerable variation in the selection and use of radiographs and practice was not in line with existing guidelines for many clinical situations. Evidence-based referral criteria should be actively promoted to ensure high standards of radiographic practice in general dental practice.

Radiographic equipment and techniques used in general dental practice: a survey of general dental practitioners in England and Wales.

OBJECTIVES: The aims of this study were to determine the self-reported use of panoramic radiography, D- and E-speed film, rectangular collimation, film holders, equipment fitted with a long spacer cone (>200 mm) and the bisecting angle and paralleling techniques by general dental practitioners and to see if use was related to the dentists' age and postgraduate qualifications. METHODS: Three mailings of a self-completion questionnaire were circulated to 800 general dental practitioners working in the National Health General Dental Service in England and Wales. RESULTS: A response rate of 74% was achieved. Sixty-one percent of general dental practitioners reported use of panoramic equipment. Fifty percent of dentists always used E-speed film and 18% always used rectangular collimation. Sixty-eight percent of dentists always used bitewing film holders though fewer (37%) used periapical film holders. Sixty-three percent of dentists always used a long cone. The bisecting angle technique was used by 70% of dentists with 22% always using this technique for periapical radiographs. Thirty-one percent always used the paralleling technique. Use of panoramic equipment, periapical film holders, bisecting angle and paralleling techniques were associated with the dentists' age. Use of periapical film holders, bisecting angle and paralleling techniques and rectangular collimation were associated with dentists' postgraduate qualifications. CONCLUSIONS: There are several features of radiographic equipment and techniques that can aid high quality imaging and reduce patient dose. Although a number of these are being used in general dental practice in England and Wales they have yet to achieve universal adoption.

Periodontal diseases in children and adolescents: I. Aetiology and diagnosis.

A number of periodontal diseases, some forms of which can be aggressive, can affect children and adolescents. Plaque is the key aetiological agent but local and systemic factors that can modify the response of the periodontal tissues to plaque may be identified from the history and during examination of the child or adolescent. Periodontal screening should be an integral part of the dental examination of younger individuals. It can be used in conjunction with the history and examination to reach a diagnosis, which then forms the basis for future management.

Gingival recession-its significance and management.

OBJECTIVES: To review the prevalence and current concepts of the mechanisms and aetiology of gingival recession and present the principles of assessment and management of the patient with gingival recession. DATA AND SOURCES: The literature was searched for review and original research papers relating prevalence, mechanisms, aetiology, assessment, and treatment of gingival recession using Medline and manual tracing of references cited in key papers otherwise not elicited. STUDY SELECTION: Studies with gingival recession as focus and pertinent to key aspects of review. RESULTS: Gingival recession is a common condition and its extent and prevalence increase with age. Many factors including trauma and periodontal disease have a role in its aetiology. The patient may develop signs and symptoms including pain from exposed dentine, root caries and aesthetic concerns. Management of gingival recession requires thorough patient assessment, identification of aetiological factors, and recording and monitoring of the extent and severity of the condition. Treatment should be directed at prevention of further progression and the control of symptoms and disease. The patient's aesthetic concerns should be appreciated. Surgical treatment of recession may be indicated to cover exposed root surfaces. Many surgical techniques have been described with varied reported clinical effectiveness. CONCLUSIONS: Gingival recession should be thoroughly assessed and evaluated in order to offer the most suitable management.

Periodontal diseases in children and adolescents: 2. Management.

Many of the periodontal diseases affecting children and adolescents can be successfully managed in general dental practice. The decision to treat the young patient in the practice setting or to refer to a periodontal specialist will depend on the complexity of treatment, patient factors and the expertise of the practitioner. Treatment should be provided in three phases: the initial cause-related phase is aimed at controlling microbial plaque; the corrective phase is intended to restore function and aesthetics; supportive periodontal therapy is aimed at preventing recurrence and progression of periodontal disease. Even in cases requiring specialist referral, the dental team in general practice has a key role in the initial and supportive phases of therapy.

Survey of radiographic practices for periodontal disease in UK and Irish dental teaching hospitals.

OBJECTIVES: To assess current radiographic practices in dental teaching hospitals for the management of patients with periodontal diseases. METHODS: All 17 dental teaching hospitals in UK and Ireland were sent a questionnaire on radiographic equipment and radiograph selection currently used for assessment of patients with destructive periodontal diseases. Opinions were recorded for advantages and disadvantages of the most frequently used radiographic views. RESULTS: A 100% response rate was achieved. All hospitals used panoramic and specific periapical radiographs as one of their radiographic regimes for patients with periodontal disease. Fifty-three per cent of respondents most frequently took panoramic and selected periapical radiographs. Twenty-four per cent took full mouth periapical radiographs (FMPAs) most frequently and 18% took a panoramic radiograph alone. Twenty-four per cent of hospitals operated a protocol for selection of radiographs for periodontal patients. CONCLUSIONS: The most commonly used views taken to assess periodontal status are panoramic radiographs with selected periapicals. Few hospitals operate a protocol for prescribing radiographs.

The usefulness of radiographs in diagnosis and management of periodontal diseases: a review.

OBJECTIVES: To review the periodontally significant diagnostic information obtainable from radiographs and the stages during periodontal therapy when the information may influence patient management and treatment outcomes. DATA: Confined to studies involving conventional radiography, as this remains the commonest imaging method in clinical dental practice and primary dental care setting. SOURCES: Literature was reviewed using Medline and manual tracing of references cited in key papers not otherwise elicited. STUDY SELECTION: Studies were selected in order to (i) define the role of radiographs in periodontal diagnosis and management at the initial, corrective and supportive (maintenance) phases of periodontal therapy and (ii) critically review the evidence for the value added by radiographs. CONCLUSIONS: Radiographs provide diagnostic information on alveolar bone levels, plaque retention factors, caries, furcation defects, subgingival calculus and additional pathology. Features visualised are dependent on the radiographic view. A relationship exists between probing attachment loss and radiographic bone height, with a range in level of correlation; clinical attachment may correspond more closely to surgical measurements of bone height. Radiographs can be used in planning initial, corrective and supportive phases of therapy, though some decisions may be made on clinical assessments alone. Evidence in the literature on benefit gained from radiographs taken for periodontal patients is sparse; the extent to which they influence the treatment provided and treatment outcomes is poorly addressed. Further research is indicated to define the role of radiographs when managing the periodontal patient to maximise the potential gain for the patient.

Helicobacter pylori infection and dental care.

Sixty two patients (mean age 45.6 years) were assessed for oral hygiene and periodontal disease by dental examination before endoscopy. Information about oral care, smoking, and dentures was obtained and samples of dental plaque collected. The presence of Helicobacter pylori in plaque as sought by culture and polymerase chain reaction (PCR), and gastric antral biopsy specimens were taken for histological examination. Although H pylori was detected in the antral specimens of 34 patients (54%) all of the cultures of dental plaque were negative, and PCR was only positive from the dentures of one patient. Smokers had poor oral hygiene, visited their dentist less often, and brushed their teeth less frequently. There was no correlation of H pylori gastritis with either dental hygiene or periodontal disease. These results suggest that dental plaque or dentures are not an important reservoir for H pylori and are probably not a significant factor in transmission of the organism. The conflicting results in published works may be caused by differences in sample collection, culture techniques, or oral contamination from gastric juice as a result of gastro-oesophageal reflux at the time of endoscopy.