Periodontal health and global public health.

Chronic diseases are a growing burden to people, to health-care systems and to societies across the world. The rapid increase in the burden of chronic diseases is particularly prevalent in the developing countries. Periodontal disease is one of the two most important oral diseases contributing to the global burden of chronic disease. In addition to social determinants, periodontal health status is related to several proximal factors. Modifiable risk factors, such as tobacco use, excessive alcohol consumption, poor diet and nutrition, obesity, psychological stress and insufficient personal/oral hygiene, are important and these principal risk factors for periodontal disease are shared by other chronic diseases. The present monograph is devoted to the existing evidence on the practice of public health related to periodontal health. Public health is defined as the process of mobilizing and engaging local, national and international resources to assure that people can be healthy. Social determinants of health, environmental hazards and unhealthy lifestyles are prioritized in modern public health-care. Disease prevention and health promotion are cornerstones in actions for public health. This volume of Periodontology 2000 is entitled 'Periodontal health and global public health'; the 12 articles of this volume discuss different aspects of this statement. It covers a range of subjects from public health issues to patient care. This monograph intends to stimulate community action research in the field of periodontology in order to help the development of appropriate public health intervention and relevant surveillance programs. It also expects to stimulate health authorities and professional organizations to initiate and support actions to promote periodontal health in their respective countries.

Oral health care systems in developing and developed countries.

Health care systems are essential for promoting, improving and maintaining health of the population. Through an efficient health service, patients can be advised of disease that may be present and so facilitate treatment; risks factors whose modification could reduce the incidence of disease and illness in the future can be identified, and further, how controlling such factors can contribute to maintain a good quality of life. In developed countries, clinics or hospitals may be supported by health professionals from various specialties that allow their cooperation to benefit the patient; these institutions or clinics may be equipped with the latest technical facilities. In developing countries, health services are mostly directed to provide emergency care only or interventions towards certain age group population. The most common diseases are dental caries and periodontal disease and frequently intervention procedures aim, at treating existing problems and restore teeth and related structure to normal function. It is unfortunate that the low priority given to oral health hinders acquisition of data and establishment of effective periodontal care programmes in developing countries but also in some developed countries where the periodontal profile is also less than satisfactory. Despite the fact that in several developed countries there are advanced programmes oriented to periodontal disease treatments, the concern is related to the lack of preventive oriented treatments. According to data available on periodontal status of populations from developed countries, despite the number of dentists and trained specialists, dental health professionals do not presently meet adequately the need for prevention, focusing mainly on curative care. The need for strengthening disease prevention and health promotion programmes in order to improve oral health conditions and particularly periodontal status in the majority of countries around the world is evident. Unfortunately, in many countries, the human, financial and material resources are still insufficient to meet the need for oral health care services and to provide universal access, especially in disadvantaged communities, in both developing and developed countries. Moreover, even though the most widespread illnesses are avoidable, not all population groups are well informed about or able to take advantage of the proper measures for oral health promotion. In addition, in many countries, oral health care needs to be fully integrated into national or community health programmes. Improving oral health is a very challenging objective in developing countries, but also in developed countries, especially with the accelerated aging of the population now underway and intensifying over the coming years.

Translating science into action--prevention of periodontal disease at patient level.

For years, prevention of periodontal disease has focused mainly on improving patient oral hygiene. The role of the dentist and dental hygienist was to 'motivate' the patient to adopt the proper technique for plaque removal. Today, prevention has shifted to a broader and more comprehensive approach with preventive interventions that target local etiologic as well as general risk factors. The present report, which focuses on prevention at the patient level, describes the current trend in preventive care characterized by a global and patient-centered approach.

Effect of chlorhexidine/thymol and fluoride varnishes on dental biofilm formation in vitro.

This study evaluated the effect of chlorhexidine/thymol (CHX/T) and fluoride (F) varnishes on biofilm formation in vitro. Hydroxyapatite discs coated with varnish were first immersed in saline for 0, 3, 7 or 14 d, then immersed in pasteurized saliva. The discs were incubated for 20 h with a bacterial suspension containing Actinomyces naeslundii, Fusobacterium nucleatum, Streptococcus oralis, and Veillonella dispar. Uncoated discs were used as controls. Growth of bacteria on the discs was evaluated by culture and by scanning electron microscopy (SEM). Bacterial vitality was examined by fluorescence staining. In the CHX/T-treated group, bacterial accumulation was delayed, and the total number of bacteria was significantly lower than in the controls. In the F-treated group, the total number of bacteria did not differ from the control, although the number of S. oralis was lower. Bacterial vitality in the CHX/T and F groups did not differ from that in the controls. The total number of bacteria on the CHX/T-treated discs immersed in saline was significantly higher than that on the non-immersed discs. Biofilm development was inhibited by the CHX/T varnish but not by the F varnish. The effect of the CHX/T varnish decreased following the immersion of discs in saline.

Periodontology as a recognized dental speciality in Europe.

The impetus of the Bologna Process under the auspices of European Union governments has raised enormous expectations. It is the major educational change in Europe within the last 50 years and all the focus from university institutions, learned societies and thematic networks has shifted to this process, with the aim of developing consensus schemes in order to arrive at the expected European Convergence in Higher Education (to be completed by 2010). Dentistry as one of the health professions with clear Educational Standards, as defined by the European Dental Directives, is also reviewing its educational processes within this Bachelor-Master-Doctorate scheme and evaluating how the current and future dental specialities should be accommodated within this framework. Among these specialities, Periodontology is currently considered a formal dental speciality in 11 countries belonging to the EU however it lacks this legal status in the rest of the 14 EU countries. The purpose of this position paper is to provide evidence for the need for a recognized specialty in Periodontology at European level focusing on both the educational and professional perspective, with the hope of providing discussions that may contribute to facilitate its legal establishment as a new dental speciality in Europe.

Five-year maintenance follow-up of early-onset periodontitis patients.

OBJECTIVES: The purpose of this study was to evaluate the clinical and microbiological status of patients with early-onset or aggressive periodontitis (EOP) who had received supportive periodontal care (SPC) every 3-6 months for a period of 5 years, following active periodontal treatment. MATERIAL AND METHODS: The study population consisted of 25 individuals with early-onset periodontitis. Clinical examination and recordings of probing pocket depth (PPD) and clinical attachment level (CAL) were performed at baseline prior to treatment (T0), 3 months following the termination of active periodontal treatment (T1) and annually at the SPC appointments (T2,T3,T4,T5). Microbiological samples were obtained at the 5-year SPC (T5). Subgingival plaque samples for each individual were collected from one deep pocket (>5 mm), based on pretreatment measurements, randomly selected in each quadrant. The levels of Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola were determined using oligonucleotide probe hybridization. RESULTS: During the 5-year period, the mean of SPC/patient was 12.7 sessions. A significant improvement was observed in PPD, CAL, gingival bleeding index and suppuration following treatment. However, between T1 and T5, 134 sites in 20 patients deteriorated with a CAL loss of> or =2 mm. Out of these 134 sites showing disease progression, microbial samples were randomly obtained in 13 sites (9.7%) from 8 patients. Among other factors, smoking and stress were found to have significant predictive value on the future attachment loss. P. gingivalis, T. denticola and total bacterial load were statistically significantly higher in patients who experienced disease progression during the 5-year maintenance period. CONCLUSIONS: For most EOP patients, regular SPC was effective in maintaining clinical and microbiological improvements attained after active periodontal therapy. However, a small percentage of sites was identified as progressive in 20 patients. Variables found to be related to periodontal progression were the presence of as well as the high bacterial counts of P. gingivalis, T. denticola and total bacterial load, number of acute episodes, number of teeth lost, smoking and stress.

[Fluoride content of Swiss drinking water]. / Teneur en fluorures des eaux de distribution en Suisse.

Fluoride contained in oral hygiene products plays a key role in the prevention of dental caries. Its efficacy is mainly due to a topical effect. Other possible sources of fluoride, with a systemic effect, are found in drinking water, table salt as well as food and drinks. It is important to consider all these various sources, including drinking water, in order to determine the total exposure to fluorides within a population. Water consumption may vary but its role cannot be neglected. The aim of this study was to collect data on the fluoride concentrations in drinking water in the different regions of Switzerland. Information was collected from the health authorities of each canton during a survey conducted between 1998 and 1999. The data showed that fluoride content in drinking water was low (< or = 0.3 mg/l) in the majority of the cantons. In nearly sixty localities, fluoride content was equal or above 0.5 mg/l: for 24 wells, the fluoride concentration was between 0.5 mg/l and 0.7 mg/l; for another 35 wells, fluoride content was > or = 0.7 mg/l.