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Periodontics Today and in the Future

Gordon L. Douglass, DDS

Copyright 2002 Journal of the California Dental Association.

Author:

Gordon L. Douglass, DDS, is a past president of the Sacramento District Dental Society, a past president of the California Society of Periodontists and has practiced in Sacramento for the past 29 years. Dr. Douglass will assume the presidency of the American Academy of Periodontology later this year.

Periodontics, like all areas of dentistry, has changed significantly during the past 25 years. Through treatment and prevention, dentistry has changed the dental disease profile of the American public. The average patient has less caries, less periodontal disease, and more teeth than the patient of 25 to 30 years ago. In 1973, almost 50 percent of the population age 65 to 74 was edentulous; today that number is less than 30 percent. The number of partially edentulous patients has declined as well. The effect of fluoride, preventive care, and dental treatment has been significant. The gradual decrease in dental disease will continue, and we will all be treating healthier, older patients.

Periodontal services in particular have increased dramatically during the past 25 years. A study on dental services from 1980 to 1995 by Eklund showed an increase of 89 percent in periodontal services in 25- to 34-year-olds and 56 percent in patients 65 years or older. The vast majority of this increase was in nonsurgical periodontal services provided by general dental offices. Today, the increase continues for patients 65 or older, but the overall number of periodontal services provided by all of us in dentistry is declining according to American Dental Association data. This confirms the continued dental health improvement of the patient base we all treat.

The specialty of periodontics, like all of dentistry, is changing to meet the demands of our patients. There has been and continues to be an increasing demand for cosmetic and regenerative services, including dental implants. As restorative dentistry offers improved esthetic options for teeth, periodontics offers an ever-improving array of cosmetic procedures to support the efforts of the restorative dentist. The advances in regeneration of lost hard and soft tissues in periodontics have led to a trend of reduction in resective surgery and an increase in regenerative therapy. Predictable evidence-based treatments for gingival tissues and bone are available today and will continue to increase in the future. It is anticipated that this shift will continue, combined with a trend toward microsurgery, which is significantly less invasive than older surgical techniques.

Today, the most rapidly growing area in periodontal practice is the placement of dental implants and regeneration of lost soft and hard tissues for future implant placement. Extensive periodontal research into bone regeneration during the past 15 to 20 years has provided the science and techniques for this increase, and periodontists’ close involvement with restorative dentists in the prosthetic rehabilitation of patients with damaged dentitions has provided the clinical collaborative skills necessary for this growth. Today, there is extensive research in bio-engineering science, which will revolutionize our regenerative services of tomorrow.

The management of the periodontal patient in the future will be affected by a variety of factors. The first and perhaps most important is the relationship of periodontal disease to systemic disease. Two areas -- diabetes and low-birth-weight premature babies -- have been shown to have direct links to periodontal disease severity. For patients with diabetes, significant periodontal disease may make stabilizing their diabetes more difficult; and, conversely, if they have periodontal disease, it may increase in severity and be more difficult to bring under control if their diabetes is not stable. Recently, Marjorie K. Jeffcoat, DMD, announced that her Alabama research team’s first interventional data showed a significant reduction in the incidence of premature babies in their high-risk group with scaling and root planing in the second trimester of pregnancy.

The other systemic link of concern is the relationship between periodontal disease and cardiovascular disease. Significant periodontal disease appears to be a risk factor for cardiovascular disease. People with periodontal disease have twice the risk for heart attack and stroke. The exact nature of the relationship is not known today, but with studies continuing to show an increased risk for individuals with extensive periodontal disease and tooth loss, prudence recommends attaining periodontal health to aid an individual’s overall health.

Periodontal therapy will continue the present evolution of becoming more biologically based and less invasive. Our current crude assessments of risk factors, such as smoking and diabetes, will improve dramatically with effective tests and evaluations that will aid the therapist in directing therapy to the specific needs of an individual patient. There will continue to be an increase in host-modulating agents and inflammatory mediators, which will aid in the management of susceptible patients. Much of the treatment of early to moderate periodontitis will be provided by general practices with ever-increasing sophistication and skill. Surgical procedures will continue to become more focused and less invasive with an emphasis on regeneration of lost or damaged tissues. However, for the near term, we will still need to rely on mechanical debridement to decrease the bacterial load and promote healing.

The advances we have made in the past 25 years in prevention, disease management, and tissue regeneration will seem minor compared to the advances in the near future. Shortly, we will have diagnostic tests that will be truly prognostic with the risk information they will give the therapist. Host-modulating agents such as inflammatory mediators will greatly improve the host’s response and resistance. Tissue engineering will replace or augment today’s surgical procedures. Our patients will continue to be healthier and have improved prevention techniques. Overall, the future of periodontal health as well as the overall dental health of the American public looks very promising.

To request a printed copy of this article, please contact/Gordon L. Douglass, DDS, 3960 El Camino Ave., Suite 1, Sacramento, CA 95821.