The prevalence of potentially undiagnosed type II diabetes in patients with chronic periodontitis attending a general dental practice in London - a feasibility study.

Introduction In the UK alone, it is estimated that one in four people with type II diabetes are currently undiagnosed.Aim To investigate the prevalence of potentially undiagnosed type II diabetes in patients with chronic periodontitis attending a general dental practice in North London.Methods Patients aged 35 years and over, who had not been diagnosed with diabetes, attending for routine examination and diagnosed with chronic periodontitis, were offered screening for diabetes risk using the self-reporting Finnish Diabetes Risk Score (FINDRISC) questionnaire. If the score showed an increased risk of developing type II diabetes, a referral letter was sent to their general medical practitioner (GMP) for formal testing. The uptake and results of the test were recorded.Results Over the 12-month period, a total of 51 patients were eligible to take part, with 40 agreeing to participate (78% participation rate). Nineteen participants (48%) were found to be at a significantly increased risk of developing type II diabetes based on the recommended FINDRISC cut-off point and were referred to their GMP for formal testing. Eleven participants (58%) scored above the FINDRISC cut-off point and were categorised as high-risk. A further six participants (32%) fell into the moderate-risk category and two participants (10%) fell into the slightly elevated-risk category. Of the 19 participants who were referred for formal testing, four were not found to have type II diabetes, nine were found to have intermediate hyperglycaemia (or prediabetes) and two participants were diagnosed with type II diabetes.Conclusions This study confirmed a method of diabetes risk screening that has a good rate of uptake by patients and is practical for use in general dental practice. A moderate proportion of patients were identified as having an increased risk of developing diabetes and just under half were referred for formal testing. The study has shown an effective method for identifying undiagnosed type II diabetes and prediabetes in patients diagnosed with periodontitis who attend general dental practice.

Periodontal diagnosis in the context of the BSP implementation plan for the 2017 classification system of periodontal diseases and conditions: presentation of a patient with severe periodontitis following successful periodontal therapy and supportive periodontal treatment.

Case report A case of a 59-year-old female patient who attended with a history of periodontitis, who had been successfully treated and maintained for several years, is described. Following a full periodontal assessment, the patient was diagnosed with 'generalised periodontitis; stage IV; grade C; currently stable'.Conclusion The present case report exemplifies the use of the 2017 classification system in a successfully treated and well-maintained patient whose treatment need is supportive periodontal treatment. It recognises the fact that, by staging and grading, the patient is a high-risk periodontitis patient due to historical disease experience, but also that following successful therapy and maintenance she is currently 'stable' with no need for active periodontal therapy.

Periodontal diagnosis in the context of the BSP implementation plan for the 2017 classification system of periodontal diseases and conditions: presentation of a patient with a history of periodontal treatment.

This case report is the fourth in a series that illustrates the application of the BSP implementation plan for diagnosing periodontitis patients according to the 2017 classification. It demonstrates the diagnostic approach and disease classification for a previously treated patient who presented with a diagnosis of unstable generalised periodontitis; stage IV, grade C. We describe a case of a 49-year-old patient who attended with a history of periodontal treatment over several years. Following a full periodontal assessment, the patient was diagnosed with 'generalised periodontitis; stage IV, grade C; currently unstable'. This case report presents an example of how to classify and diagnose a patient using the 2017 classification system and highlights challenges with the application of the new classification in patients with a previous history of periodontal therapy.

Recommendations on the clinical application of air polishing for the management of peri-implant mucositis and peri-implantitis.

Air polishing was introduced as an alternative approach for the supra- and submucosal biofilm management at dental implants. An international expert meeting involving competent clinicians and researchers took place during the EUROPERIO 8 conference in London, UK, on 4 June 2015. Prior to this meeting a comprehensive systematic review dealing with the efficacy of air polishing in the treatment of peri-implant mucositis and peri-implantitis was prepared and served as a basis for the group discussions. This paper summarizes the consensus statements and practical recommendations on the clinical application of air polishing for the management of peri-implant mucositis and peri-implantitis.

Minimally-invasive non-surgical periodontal therapy.

UNLABELLED: Periodontitis is a complex disease that has both oral and systemic consequences. The treatment of periodontitis may be both surgical and non-surgical but, in recent years, there has been a shift towards managing disease non-surgically in preference to surgery. Fundamental to all types of therapy is the patient's role in disease control, in the form of self-performed plaque control, and it is important that the patient understands this. Non-surgical periodontal therapy has a long history and has traditionally been carried out using a variety of hand and powered instruments, the objective being root surface disinfection by the removal of plaque, calculus and contaminated root cementum. However, over the last 30 years or so, it has become apparent that calculus does not cause disease, cementum does not become significantly infected and bacteria and their toxins are only loosely adherent to the diseased root surface. This has led to the development of less invasive instrumentation principles which may be better for patients, more cost-effective and more easily applied in different clinical settings. CLINICAL RELEVANCE: This paper aims to describe and justify a minimally-invasive approach to the management of the diseased root surface in periodontitis, to clarify the terminology used and to suggest how these principles may be applied in general practice.

The role of self-administered plaque control in the management of periodontal diseases: 2. Motivation, techniques and assessment.

The delivery of oral hygiene advice is a crucial component of the management of patients susceptible to periodontal disease. However, the complexity of the issues surrounding such advice is frequently underestimated. It is not simply a question of manual dexterity; many factors influence compliance and motivation, including lifestyle, beliefs, attitude and understanding, and such factors need to be taken into account in order to effect permanent change in a patient's habits. This article reviews these issues and examines oral hygiene techniques and methods of assessment.

The role of self-administered plaque control in the management of periodontal diseases: I. A review of the evidence.

In periodontal treatment the importance of self-performed plaque control is frequently acknowledged but often underestimated. This article reviews the evidence relating to the effects of good oral hygiene on both the initiation and progression of gingivitis and periodontitis, and on treatment outcomes. Recent evidence suggests that an optimal level of supragingival plaque control can have profound effects on the subgingival microflora and this, together with evidence indicating that root surface microbial contaminants are superficially located within the biofilm, has significant therapeutic implications.