Spring Meeting 2008 Abstracts

How have we become so confused? - Dr J B Kieser

Much of the confusion in periodontics stems from professional preoccupation with the effects of disease, an approach that may well be at variance with the patient.s perspective of the problem. Thus, clinical research has often been based on the assumption that the pathological features of the disease process are of paramount importance and consequently the focus of research has been on the establishment of the best corrective techniques. Consequently the motivation for research has been more dependent upon operator interest and professional satisfaction, as visualised in the surrogate treatment objectives of an improved radiographic appearance and reduced probing levels, than on true benefits to the patient.

In contrast to this mechanistic approach, comparable outcomes have been demonstrated for simple treatment approaches, provided optimal plaque control has been ensured. However, rather than altering direction in favour of the seemingly critical role of the patient in therapy, alternative operative exercises such as periodontal tissue regeneration have been avidly pursued. More importantly, in cases of progressive breakdown, improved plaque control has often been misinterpreted as optimal plaque control, leading to the risk of clinical designation of refractory disease and the prescription of these alternative treatments. Such approaches have prevailed without first establishing that the anticipated outcomes of these therapies would actually ensure disease control.

The resulting clinical quandary could be resolved by addressing, in a semi-Socratic fashion, patients. perceptions of the clinical problems as presented to them by the clinician.

A patient-orientated approach to periodontics could then evolve, de-emphasising the traditionally dominant role of the professional and allowing the patient to accept responsibility for periodontal health. However, the apparent failure of such strategies in other spheres of medicine (for example cardiac disease) would suggest the need for an alternative approach. The concept of tolerable levels of disease being accepted, in preference to progressively more complex professional interventions, has much to commend it.