An overview of periodontal regenerative procedures for the general dental practitioner.

The complete regeneration of the periodontal tissues following periodontal disease remains an unmet challenge, and has presented clinicians with a remarkably difficult clinical challenge to solve given the extensive research in this area and our current understanding of the biology of the periodontal tissues. In particular as clinicians we look for treatments that will improve the predictability of the procedure, improve the magnitude of the effect of treatment, and perhaps most importantly in the long term would extend the indications for treatment beyond the need for single enclosed bony defects to allow for suprabony regeneration, preferably with beneficial effects on the gingival soft tissues. A rapid development in both innovative methods and products for the correction of periodontal deficiencies have been reported during the last three decades. For example, guided tissue regeneration with or without the use of bone supplements has been a well-proven treatment modality for the reconstruction of bony defects prior to the tissue engineering era. Active biomaterials have been subsequently introduced to the periodontal community with supporting dental literature suggesting that certain factors should be taken into consideration when undertaking periodontal regenerative procedures. These factors as well as a number of other translational research issues will need to be addressed, and ultimately it is vital that we do not extrapolate results from pre-clinical and animal studies without conducting extensive randomized clinical trials to substantiate outcomes from these procedures. Whatever the outcomes, the pursuit of regeneration of the periodontal tissues remains a goal worth pursuing for our patients. The aim of the review, therefore is to update clinicians on the recent advances in both materials and techniques in periodontal regenerative procedures and to highlight the importance of both patient factors and the technical aspects of regenerative procedures.

Is there a role for community pharmacists in promoting oral health?

AIM: The main aim of the present study was to investigate whether pharmacists recognised that they have a role in the promotion of oral health advice within the community. METHODS: A cross sectional survey was conducted using a structured questionnaire which was distributed to randomly selected pharmacies (n = 1,500) in the London area. RESULTS: Six hundred and forty-five pharmacies (43%) responded to the initial invitation and 589 (39%) of pharmacy participants acknowledged that pharmacists should have a role in oral health promotion. Participants from 354 pharmacies (23.6%) subsequently agreed to complete the questionnaire. Of those pharmacies completing the questionnaire, 99.4% of the pharmacy participants recognised that there was a role for pharmacists in oral health promotion. Although 91.5% of the pharmacists reported a fairly high level of knowledge for most of the common oral conditions, they also indicated that they were interested in receiving further training on oral conditions through continuing professional development (CPD) courses. A number of the pharmacies (72.5%) expressed a willingness to incorporate oral health promotion within the NHS pharmacy contract. CONCLUSION: Pharmacies may be used effectively in oral health promotion by virtue of their frequent contact with members of public. As a result of their established role in promoting and improving the health within the community, it may possible to incorporate oral health within the existing NHS contract.

Accuracy and reproducibility of probe forces during simulated periodontal pocket depth measurements.

AIM: The aim of the present study was to measure the accuracy and reproducibility of probe forces in simulated assessments of periodontal pocket depth. The study included experienced and inexperienced examiners and used manual and pressure-sensitive probes. MATERIALS AND METHODS: Sixty-one participants were divided into seven groups and asked to probe selected anterior and posterior sites with three different probes (Williams 14W, Chapple UB-CF-15, and Vivacare TPS probes). The model was positioned on a digital electronic balance to measure force, which was recorded initially and after 15 min. Probe preferences were recorded. Accuracy was measured by comparing to a standardized 25 g force, and reproducibility was calculated for all duplicate measurements. RESULTS: The Vivacare probe produced the most accurate and most reproducible forces, whereas the Williams probe produced the least accurate and least reproducible forces. Probe forces were lighter at anterior sites compared to posterior sites at baseline. Probe forces were reduced at both sites after 15 min compared to baseline. CONCLUSIONS: Vivacare TPS periodontal probes are more accurate and reproducible than Chapple and Williams probes. Many clinicians in this study preferred the Chapple probe.

The Efficacy of Selected Desensitizing OTC Products: A Systematic Review.

Objectives. The aim of the present study was to review the published literature in order to identify relevant studies for inclusion and to determine whether there was any evidence on the clinical effectiveness of selected desensitizing toothpastes, calcium sodium phosphosilicate (CSPS), amorphous calcium phosphate (ACP), nanohydroxyapatite, and casein phosphopeptide-amorphous calcium phosphate (tooth mousse) on reducing dentine hypersensitivity (DH). Materials and Methods. Following a review of 593 papers identified from searching both electronic databases (PUBMED) and hand searching of relevant written journals, only 5 papers were accepted for inclusion. Results. Analysis of the included studies (3 CSPS and 2 ACP) would suggest that there may be some benefit for patients using these products for reducing DH. No direct comparative studies were available to assess all these products under the same conditions neither were there any comparative randomised controlled studies that compared at least two of these products in determining their effectiveness in treating DH. Conclusions. Due to the small number of included studies, there are limited clinical data to support any claims of clinical efficacy of these OTC products. Further studies are therefore required to determine the efficacy of these products in well-controlled RCT studies with a larger sample size.

Preferences of UK-Based Dentists When Undertaking Root Coverage and Regenerative Procedures: A Pilot Questionnaire Study.

Objectives. The purpose of the present study was to evaluate the awareness and preferences of registered United Kingdom (UK) dentists specialising or with an interest in periodontics in root coverage and regenerative procedures. Methods. A cross-sectional postal survey of 366 dentists was conducted. The questionnaire was divided in two sections and most of the questions were giving the option of multiple answers. Frequencies and associations between the demographic profiles of the participants with their answers were evaluated. Results. 63% of dentists with an interest in periodontics and 32% of specialists returned the questionnaire. Guided tissue regeneration procedures and the use of enamel matrix derivatives were recommended for the reconstruction of bony defects and both subepithelial connective tissue graft and coronally advanced flap with or without enamel matrix derivatives were the most popular choices for root coverage. Smoking was considered a contraindication by most of the participants and conflicting responses were given regarding the use of antibiotics as part of the care following regenerative procedures. Conclusions. The participants incorporated both traditional and "novel" techniques and products in reconstructive procedures and appeared to be up to date with the evidence from the dental literature. However, it was evident that there was confusion regarding the role of antibiotics in regenerative procedures.

In-vitro accuracy and reproducibility evaluation of probing depth measurements of selected periodontal probes.

AIM: The purpose of the present in vitro study was to measure the accuracy and reproducibility of three periodontal probes. To eliminate environment- or examiner-related probing errors, two aluminum blocks with predrilled holes of varying depths were examined by participants who had been trained in probing before the study. This methodology improved the likelihood that any probing errors identified were generated by the probes themselves. MATERIALS AND METHODS: Three probes, Williams 14 W (Hu-Friedy Mfg. Co., LLC, UK), Chapple UB-CF-15 (Implantium, Shrewsbury, UK), and Vivacare TPS (Ivoclar Vivadent, Enderby, UK), were randomly distributed to 23 participants (9 males and 14 females; mean age: 31.35 years). Participants measured 30 holes in two aluminum blocks, average 20 days, SD = 341.05. For each hole, the mean measured depth was calculated for each participant and compared to the true depth. Intra- and inter-examiner accuracy and reproducibility for each of the duplicate measurements were calculated. Data were analyzed by paired-samples t-test with the SPSS 18 software package (IBM Portsmouth, UK). A p-value <0.05 indicated statistical significance. Tables were constructed from the data. RESULTS: When used by participants, the Williams 14 W probe was reproducible but not necessarily accurate; Vivacare TPS was neither accurate nor reproducible; and Chapple UBCF-15 was both accurate and reproducible. CONCLUSION: Depth measurements with the Chapple UB-CF-15 probe were more accurate and reproducible compared to measurements with the Vivacare TPS and Williams 14 W probes. This in vitro model may be useful for intra-examiner calibration or clinician training prior to the clinical evaluation of patients or in longitudinal studies involving periodontal evaluation.

The efficacy of strontium and potassium toothpastes in treating dentine hypersensitivity: a systematic review.

Objectives. The aim of the present paper was to review the published literature in order to identify all relevant studies for inclusion and to determine whether there was any evidence of the efficacy of strontium and potassium toothpastes in the treatment of dentine hypersensitivity (DH). Methods. Following a review of 94 relevant papers both from searching electronic databases (PUBMED) and hand searching of relevant written journals, 13 studies were identified, and 7 papers (1 for strontium-based toothpastes and 6 for potassium-based toothpastes) were finally accepted for inclusion. The main outcome measures were the methodology and assessment used by Investigators in studies designed to evaluate DH. Results. The results of the present paper would indicate that the reported efficacy of both strontium- and potassium-based toothpastes in relieving DH is questionable. Conclusions. The results from the present paper would appear to support the conclusions of previous investigators that there is only minimal evidence for the efficacy of both strontium- and potassium-based toothpastes in relieving symptoms of DH.

The Prevalence of Root Sensitivity following Periodontal Therapy: A Systematic Review.

The reported prevalence of dentine/root (hyper)sensitivity (DH/RS) in the published literature varies, and this may be due in part to a) the different study populations and (b) the different methodologies employed in evaluating the pain response. According to von Troil et al. (2002) there are limited data available in terms of the prevalence and intensity of DH/RS following periodontal therapy. Objectives. The aim of the present study was therefore to review the literature in order to identify all relevant studies for inclusion and to determine whether there was any evidence of DH/RS following periodontal procedures in the published literature up to 31st December 2009 using an agreed search protocol. Methods. 840 papers were identified, from searching both electronic databases (PUBMED) and hand searching of relevant written journals. Twelve papers were subsequently accepted for inclusion. Results. The results of the present study would indicate that the reported prevalence for DH/RS (following nonsurgical therapy) was between 62.5% and 90% one day after treatment decreasing to approximately 52.6% to 55% after one week. The prevalence of DH/RS following surgical therapy was between 76.8% and 80.4% one day after treatment subsequently decreasing over time to 36.8% after 1 week, 33.4% after 2 weeks, 29.6% after 4 weeks, and 21.7% after 8 weeks. Conclusions. It is evident from reviewing the included studies that patients may suffer from mild discomfort following periodontal procedures although both the prevalence and intensity of DH/RS may vary depending on the duration and the type of procedure involved. Most of the studies included in this paper would tend to suggest that DH/RS may be relatively mild/moderate in nature and transient in duration.

In vitro quantification of changes in human dentine tubule parameters using SEM and digital analysis.

Dentine hypersensitivity is recognized as a pain arising from fluid movement within dentine tubules that are open to the oral environment. Blocking the tubules is considered to be the principal aim of treatment, and the accurate assessment of tubule occlusion is the primary goal of many in vitro studies. This assessment usually comprises either measuring tubule permeability or scanning electron microscope examination of the dentine surface. Several scanning microscopy studies have claimed to quantify tubule occlusion, but are descriptive, qualitative or semi-quantitative evaluations. The present study was undertaken to assess the use of digital image analysis in quantifying the effectiveness of a selected desensitizing agent from micrographs of control and treated dentine surfaces. Using a dentine disc model, an accurate methodology was sought to investigate the occluding potential of Butler Protect (J.O. Butler, Chicago, IL, USA). Subjective examination of the images indicated there was little difference after a single application, but considerable effect after 20 applications. Quantitative digital analysis of a test image, demonstrated reproducibility between two examiners when used in fully- and semi-automated mode. After a single application of Butler Protect, multilevel statistical modelling demonstrated decreases in tubule area and maximum, minimum and mean diameter measurements (P < 0.001), whereas single level analysis showed increases in area and maximum and mean diameters. Multiple application of Butler Protect demonstrated even greater decreases in all parameters (P < 0.001). This quantitative methodology was reproducible between examiners and, when combined with good controls and multilevel statistical modelling, was able to discriminate a single application of desensitizing agent.

Clinical evaluation of ferric oxalate in relieving dentine hypersensitivity.

Previous in vitro permeability and scanning electron microscopic (SEM) studies have demonstrated the effectiveness of the oxalate ion in dentine permeability reduction and effective tubule occlusion. The aim of this randomized double-blind, split mouth 4-week clinical study, therefore was to determine whether a 1-min application of ferric oxalate (Sensodyne Sealant) on exposed root dentine was effective in reducing dentine hypersensitivity (DH). Thirteen subjects [8F:5M, mean age 46.2 (s.d. 4.15) years] completed the study. The subjective response was evaluated by tactile, thermal and evaporative methods of assessment. Data were collected at baseline and post-application at +5 min and 4 weeks. Analysis was based on paired t-test (P=0.05) and Wilcoxon-Mann-Whitney tests. No statistically significant differences were noted between ferric oxalate and placebo preparations at +5 min and 4 weeks for any of the test stimuli. There was, however, a clear trend towards immediate reduction (+5 min) in DH reverting back to baseline values at 4 weeks with the exception of the Biomat Thermal Probe mean values, which maintained the reductions in DH compared with placebo. The results of the present study demonstrated that a 1-min application of ferric oxalate is both rapid and effective in reducing DH although its long-term effectiveness still needs to be determined.

The effect of oral care feed-back devices on plaque removal and attitudes towards oral care.

OBJECTIVES: Two studies were carried out to investigate whether the effect of specific oral care feed-back devices would result in better plaque removal (Study 1) and lead to changes in attitudes and views relating to oral health (Study 2). The objective of the first study was to compare the ability of a toothbrush system consisting of a new toothbrush plus plaque disclosing tablet (SIGNAL Integral) to remove supra-gingival plaque to that of a marketed toothbrush (Oral B Cross Action) following a single unsupervised brushing. METHODS: Study 1 had a cross-over design and included 21 healthy adult volunteers. Subjects refrained from any form of oral hygiene for 24 hours prior to each test session. Plaque levels (Modified Quigley-Hein Plaque index) were assessed prior to and following each unsupervised brushing. When the new toothbrush was used, subjects self-disclosed their plaque with a disclosing tablet (erythrosine) immediately prior to brushing. At each occasion, brushing time (in sec) was also recorded. Study 2 had a two-cell, parallel design (test and control group) and lasted for five days. Healthy adult volunteers were enrolled. Subjects in the test group (n = 30) were given a fluoride toothpaste and four saliva test strips to use at home. The saliva test strip is designed to change colour in the pH range of 6.5 to 10, allowing the user to verify the effect of brushing. The control group (n = 29) received no saliva test strips. Subjects completed a questionnaire after 4 days of product use. RESULTS: In Study 1, significantly more plaque was removed (p < 0.05) and brushing time was increased by more than 20% when subjects used the new toothbrush together with the disclosing tablet compared to brushing with the marketed toothbrush. In Study 2, significant increases in motivation relating to oral hygiene were found in the test group who had been using the saliva test strip. CONCLUSION: The two studies have provided significant evidence that the provision of feed-back devices in an oral care context can lead to improved removal of plaque and increased motivation.

The effect of a toothpaste containing 2% zinc citrate and 0.3% Triclosan on bacterial viability and plaque growth in vivo compared to a toothpaste containing 0.3% Triclosan and 2% copolymer.

OBJECTIVE: To compare the antimicrobial efficacy and effect on plaque growth of a new silica-based fluoride toothpaste containing 2% zinc citrate/ 0.3% Triclosan with a silica-based fluoride toothpaste containing 0.3% Triclosan/2% copolymer. METHODS: In Study 1, plaque was collected after one week's use of each toothpaste and assessed for bacterial viability, live/ dead ratio and microbial membrane integrity. In study 2, plaque was measured immediately and 18 hours after a single brushing with the specified toothpastes. RESULTS: The 2% zinc citrate/0.3% Triclosan formulation significantly reduced the total number of viable aerobic and anaerobic bacteria (p = 0.0223 and p = 0.0443 respectively) compared to the 0.3% Triclosan/2% copolymer formulation. Both toothpastes increased the bacterial membrane permeability significantly. However, the proportion of live bacteria for the 2% zinc citrate/0.3% Triclosan product was significantly reduced (p < 0.05). Study 2 showed significantly less plaque growth 18 hours after using the 2% zinc citrate/0.3% Triclosan toothpaste compared to the 0.3% Triclosan/2% copolymer toothpaste (p < 0.01). CONCLUSION: Regular use of a fluoride toothpaste containing 2% zinc citrate and 0.3% Triclosan, significantly reduced the viability of plaque bacteria compared to a fluoride toothpaste containing 0.3% Triclosan/ 2% copolymer 12 hours after brushing. In addition, a clinical plaque growth study confirmed that this anti-microbial efficacy leads to a significant reduction in plaque growth.

The effects of a novel Bioglass dentifrice on dentine sensitivity: a scanning electron microscopy investigation.

Dentine sensitivity (DS) is a common condition which affects 8-35% of the population. Both In-Office and Over-the-Counter products have been used in treatment, usually occluding open dentine tubules on the exposed root surface. Currently there appears to be no ideal material which permanently occludes dentine tubules. Bioactive and biocompatible glasses are known to induce osteogenesis in physiological systems and may offer suitable materials for surface reactivity which could theoretically occlude tubules. A new dentifrice formulation containing a modified Bioglass material replacing part of the abrasive silica component was compared with original 45S6 bioactive glass. Dentine discs were treated with original Bioglass, three coded dentifrices containing 0, 2.5 and 7.5% Bioglass and two further selected dentifrice products. These specimens were prepared for scanning electron microscopy (SEM) and viewed in a Cambridge stereoscan 90B. The results demonstrated that original bioactive glass particles covered the dentine surface and/or occluded dentine tubules, although this original formulation was easily dislodged. Dentifrice with different ratios of added Bioglass was assessed to provide greater surface coverage and tubule occlusion than without Bioglass. It was concluded that the inclusion of bioactive glass particles in a suitably formulated vehicle may be an effective agent for the treatment of dentine sensitivity.

Dentists' perceptions of dentine hypersensitivity and knowledge of its treatment.

The aim of the present investigation was to determine by questionnaire, UK dentists' perception of Dentine Hypersensitivity (DH) and knowledge of its treatment. A total of 403 questionnaires were sent to a selected group of UK dentists who had either inquired about further postgraduate education or had attended a course at the Eastman Dental Institute/Hospital. A total of 181 of 403 dentists (44.9%) (118M; 36F, 17 no response, mean age 38.2 years [s.d. 8.97]) returned the questionnaire. About 92.8% (n=168) of responding dentists claimed to see patients with DH in their practice. According to the dentists' replies at least one of four of their patients suffered from the complaint. About 71.8% (n=130) of dentists reported that DH was a severe problem in at least 10% of their patients and that pain from DH lasted no more than 4 weeks. Most of responding dentists claimed to be asked about DH by their patients and stated that they offered advice or treatment to their patients. Nearly 87.3% (n=158) of responding dentists provided a wide range of treatment options/advice which included both in-office and over-the-counter (OTC) products. Popular responses included desensitizing pastes/gels, Topical F(-) varnishes and toothpastes/rinses/gels, advice on atraumatic tooth brushing, dentine bonding agents (DBA), glass-ionomer cements (GIC) and other unspecified restorations. Of the various in-office treatments Duraphat was the most cited choice of varnish/primer options. Sensodyne toothpaste was the most popular of the specified OTC products. Most dentists appeared to understand the aetiological features associated with DH and provided a wide range of factors including the effects of incorrect tooth brushing, dietary acids as well as the possible influence on non-dental topics such as stress. Most responding dentists believed that their advice on DH was generally effective although they did highlight that certain aspects on the condition were lacking such as appropriate scientific information including the prevention of DH and its treatment. The results from the present study highlight several discrepancies in the perception and knowledge of the treatment of DH between dentists and their patients. The results from this study are, however, reasonably consistent with those previously reported by Dutch investigators. The results from this study also highlighted a need for guidelines on the aetiology, prevention and treatment of DH for both dentists and their patients. The reported average frequency and duration of discomfort from DH by the responding dentists appeared to be consistent with the available literature.

Dentine hypersensitivity in subjects recruited for clinical trials: clinical evaluation, prevalence and intra-oral distribution.

Relatively few studies have reported on the frequency, distribution and severity of dentine hypersensitivity (DH) in subjects recruited for clinical trials of desensitizing agents. Potential subjects (n= 48 M, 81 F, mean age 35.1 years) for inclusion into such a study were screened to determine the extent of the problem. 117 subjects (41 M, 76 F) mean age 24.9 years were clinically examined. Evaluation by questionnaire indicated that the prevalence of DH was proportionately higher in the 20-29.9 years (34.9%), and 30-39.9 years groups (33.3%), respectively. Sensitivity to cold was the main presenting symptom. Tactile (probe) and cold air (dental air syringe) stimuli were used to clinically evaluate DH. Of the teeth eligible for evaluation 1561/3136 (49.8%) responded to either one or both of the test stimuli; 274/3136 (8.7%) responded to tactile only stimulation, 779/3136 (24.8%) to thermal only stimulation and 508/3136 (16.2%) to both tactile and thermal stimulation. Of those teeth responding to the stimuli, 477 (30.6%) were premolars, 437 (28%) incisors, 415 (26.8%) molars and 232 (14.9%) canines. The results agree with those of previously reported studies in that DH is most frequently observed on premolars and that proportionately more teeth are sensitive to evaporative than to tactile stimulation. Furthermore it would appear from the results of the study that tactile is less effective than thermal/evaporative stimulation in the evaluation of DH.

A study of the prevalence and distribution of dentine sensitivity in a population of 17-58-year-old serving personnel on an RAF base in the Midlands.

Previous studies have reported on dentine sensitivity (DS) prevalence in hospital and general practice populations. Results from these studies indicate that perception and prevalence of DS vary depending on the population. The study aimed to determine any major differences in the perception and prevalence of DS in subjects in a military training establishment. Questionnaires from 228 subjects [188 completed by males, 39 completed by females, with one person not indicating their gender of mean age 24.0 years (s.d. 7.16)] were collected and analysed using the Statistical Package for the Social Sciences (SPSS). Fifty percent of the subjects (n=114) claimed to have DS. Yet approximately 30% of the subjects (29.8%, n=68) perceived the condition as a slight problem and approximately 40% of the subjects (40.8%, n=93) claimed it was an occasional problem and approximately 50% (49.1%, n=112) did not seek treatment. Seventeen subjects (7.5%) used a desensitizing paste during periods of discomfort. No clear pattern emerged with regard to seasonal variation in DS although 5.7% (n=13) subjects considered DS to be more of a problem in winter. Only 7.9% (n=18) reported any previous periodontal surgery, consistent with previous studies (12.6 and 15.5%). Of those who received regular scaling (27.2%, n=62), only 23 (10.1%) reported any discomfort following treatment, which did not last >or=5 days. The results indicate that self-reporting of DS was similar to previous reports, although it is of fundamental importance that such studies should be supplemented with a thorough clinical examination to determine more reliable prevalence data.

The effects of oxalate-containing products on the exposed dentine surface: an SEM investigation.

In-office products containing oxalates have been claimed to be clinically effective in reducing dentine sensitivity, although there has been limited supporting clinical data. The rationale for their use appears to be based on their potential to act as occluding and/or nerve desensitizing agents. Four commercially available oxalate-containing products were applied to etched dentine discs and the extent of tubule occlusion was observed by scanning electron microscopy. Tenure Quick (aluminium oxalate), Sensodyne Sealant (ferric oxalate) and MS Coat (oxalic acid) covered the dentine surface and occluded the tubules. However, Butler Protect (potassium oxalate) did not cover the surface to any great extent but provided some occlusion. The presence of oxalates after application to glass slides and dentine discs was examined using thin film X-ray diffraction. From samples on glass, only potassium oxalate could be clearly identified (JCPDS 14-0845). No oxalate was detected on dentine discs in either thin film geometry or standard theta two theta mode. We have demonstrated that professionally applied in-office products containing oxalate are capable of covering the dentine surface and/or occluding the tubules to varying degrees. However, X-ray diffraction analysis was unable to confirm the oxalate profile for all products as described in the available commercial literature.

Training in cognitive-behavioural therapy for mental health professionals: a pilot study of videoconferencing.

A foundation course in cognitive-behavioural therapy (CBT) was developed specifically for delivery via videoconferencing at 256 kbit/s. A two-part, 20-week programme was evaluated at seven sites, with a total of 12 participants, in rural and remote Western Australia. Eleven of the participants completed a pre- and post-training knowledge test. There was a significant improvement in their knowledge of CBT after training. Ten participants also completed a satisfaction questionnaire. The majority were satisfied with the training they received and stated that the training had given them greater confidence in their ability to use CBT with their patients. This study lends support to the use of videoconferencing in the training of rural and remote mental health practitioners.

Systemic and local antimicrobial use in periodontal therapy in England and Wales.

BACKGROUND/AIMS: The aim of this study was to investigate antimicrobial use during periodontal therapy in dental practice in England & Wales. METHOD: This was a postal questionnaire survey of 800 dentists, 400 general dental practitioners (GDP) in National Health Service practice and 400 members of the British Society of Periodontology (Periodontal Society) primarily in dental practice. We designed and piloted a questionnaire to evaluate both systemic and local antibiotic use with periodontal therapy as well as factors affecting their prescription. In addition, we also investigated the potential use of antibiotic sensitivity testing, since this has been recommended prior to prescribing antibiotics. Two follow-up mailings were used to encourage non-responders. RESULTS: The useable return rate for the questionnaires was 587/800 (73%). Systemic antibiotics were used by 7.4% Periodontal Society members and 18.4% GDP for untreated adult periodontitis patients (p<0.001). Antimicrobials were prescribed more frequently by Periodontal Society members in early onset (52.7%) and refractory periodontitis patients (49.6%), and this was highly statistically significantly greater usage than GDP (p<0.001). Regarding local antimicrobials, usage for untreated adult periodontitis was Periodontal Society 8.9% and GDP 5.4%. Higher usage of local antimicrobials was found both for the treatment of recurrent pocketing in adult periodontitis (Periodontal Society 26.3%, GDP 14.8%, p<0.014) and refractory periodontitis (Periodontal Society 30.8%, GDP 15.2%, p<0.001). As reasons for using local antimicrobials, more than 80% of all respondents stated superiority over root debridement alone. Barriers to use included cost, no perceived need and lack of supporting research data. The percentage of responders considering diagnostic microbiology either theoretically or at a cost of pound 60 were by group, Periodontal Society 83% & 70.4% and GDP 76% & 51.2%. 33% of Periodontal Society members and 3.8% of GDP spent at least 45 min per quadrant on root planing and Periodontal Society members had a greater exposure to lectures on both systemic and local drug therapy compared with GDP (p<0.001). CONCLUSIONS: Systemic antimicrobial use was infrequent for adult periodontitis and generally in line with current recommendations for other disease types. Whilst local antimicrobial therapy for periodontitis was not widespread, a substantial minority of dentists use this form of therapy and most believe that it is more effective than root debridement alone.