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The face of modern day
dental practice has changed
beyond imagination.
Technological advances in
the field of dental sciences
combined with the economic
prosperity have witnessed a
dramatic surge in the number
of people seeking
state-of-the-art dental
treatment. Patients have
started attaching the
greatest importance to the
quality of treatment they
receive. Thanks to the
information explosion,
patients are well informed
of the various treatment
modalities that are
possible. With more and more
dental institutions coming
up every other day, patients
now have unlimited options
for getting their dental
treatment done. It is also
quite probable that the
treatment rendered by
practitioners shall be
evaluated frequently. To be
successful in such a
scenario, a practitioner has
no option other than
providing quality treatment
to their patients. It is
true that the ambience and
facilities of the clinic and
the behavior and approach of
the dentist has a major role
in determining the patient’s
attitude towards the dentist
and dental treatment in
general and adds to the
quality of the practice.
However, at the end of the
day, the only thing that
matters is whether your
treatment has contributed to
the long-term maintenance of
patient’s dentition in
function and esthetics. This
is possible only through
integrating all aspects of
dentistry into the day to
day clinical practice.
Restorative and prosthetic
treatments have
conventionally been the
major bread winners for a
general dental practitioner.
Therefore, it is but natural
that the practitioner is
inclined to looking into
these aspects most of the
times without paying much
attention to the periodontal
health of the patient.
Without a healthy
periodontium, no dental
treatment is going to be
successful in long-term. In
fact, many treatment
modalities like fixed
partial dentures,
orthodontic treatment, and
implants can have adverse
impact on the patient’s oral
health if the periodontal
aspect is neglected.
Periodontics has emerged as
a major specialty of
dentistry worldwide in terms
of the magnitude of
advancements taking place in
both clinical and research
aspects. Unfortunately, the
extent of periodontal
treatment that is being
provided in our general
dental practice is often
confined to scaling and
prescription of mouthwashes,
gels, and antibiotics. The
reasons for this are
manifold. First of all, the
undergraduate curriculum of
Periodontics does not
provide a student with much
scope for doing any
periodontal procedures other
than scaling. From a
practice point of view, many
people find periodontal
treatment financially less
rewarding considering the
time and effort involved.
Therefore, little effort is
made after graduation to
enhance and update one’s
knowledge and skills in the
subject. Periodontal
diseases up to a
considerable period of time
are rather asymptomatic
(other than bleeding gums)
and non-disturbing (in terms
of pain) for the patient.
Therefore, adequate patient
motivation and co-operation
may be absent or doubtful at
the outset. Finally, unlike
prosthetic and restorative
treatments, the success of
any periodontal treatment
depends to a major extent on
the patient’s oral hygiene
maintenance, of which the
dentist has no guarantee.
Accepting these as relevant
factors, they can no longer
be used as valid reasons for
overlooking the patient’s
periodontal health status.
It is true that complex
periodontal procedures like
flap surgeries and bone
grafting requires formal
training, however, the
number of patients who
definitely require these
procedures are comparatively
less. Majority of the
periodontal patients can be
treated by the general
practitioners themselves.
The key to successful
periodontal treatment (for
that case, any treatment) is
the proper diagnosis of the
case. Periodontal diagnosis
in the current practice set
up is largely based on the
evaluation of the patient’s
oral hygiene status, i.e.,
the amount of deposits on
the teeth. It is generally
assumed that patients with
more deposits have severe
periodontal disease. This is
not always true and often
leads to the underestimation
of the disease, especially
in younger patients.
Periodontal diagnosis is
never accurate without the
use of periodontal probes to
detect pockets and
radiographs to assess the
bone levels. X-rays also
help to detect conditions
like root caries and
periapical changes which
might be often misdiagnosed
as periodontal problems.
Scaling is another aspect
that is often taken for
granted in clinical
practice. It is often taken
so casually that some
clinicians entrust the
procedure to their untrained
assistants, which results in
incomplete / improper
scaling and makes the
procedure unimportant in the
eyes of the patient. It is
high time to change the view
regarding scaling as a
cosmetic procedure to remove
calculus and stains from the
visible areas of the teeth.
A proper scaling is basic to
all periodontal treatment
procedures. In fact,
astonishing clinical results
can be often achieved by a
thorough scaling alone.
Mouthwashes and antibiotics
must be used only as
supplements to scaling, not
to substitute it.
The value of spending time
with the patients to educate
and motivate them regarding
periodontal treatment is
often suspected by
practitioners. It is true
that initially considerable
motivational skills of the
doctor might be required to
convince the patient
regarding the benefits of
periodontal treatment and it
is quite probable that a
significant number of
patients might just drop
out. But from a positive
side, a motivated
periodontal patient is an
asset for the dentist.
Another important concern in
doing periodontal treatment
when compared to restorative
and prosthetic treatments is
“time spent vs. returns
gained”. If immediate
benefit is the only
objective, periodontal
treatment is time consuming
with lesser returns. But for
clinicians with a long-term
perspective and vision,
addressing the periodontal
problem of the patient along
with other treatments, shall
be truly rewarding in the
long run and contribute
considerably to the
goodwill.
In the recent years, the
contributory role of
periodontal diseases to
major systemic illnesses
like diabetes,
cardiovascular diseases,
respiratory diseases,
gastrointestinal problems,
and pregnancy related
problems have become more
evident. As medical
practitioners become more
aware of this aspect,
dentists can expect an
increase in the number of
patients referred for
periodontal treatment in the
coming days.
Present day practice
requires the integration of
all the specialties of
dentistry and there is no
reason why Periodontics
should be an exception.
Every practitioner should
try to incorporate the
practical aspects of
periodontal treatment into
their day-to-day practice.
This can be enhanced by
going through journals once
in a while, attending CDEs
and talks pertaining to
periodontal aspects, and
interacting with experts in
the field. Also, never be
reluctant to seek the help
of a Periodontist when
encountered with complicated
cases. Remember, an
interdisciplinary approach
can work wonders for even
the utterly hopeless cases;
we only need to widen our
approach |