Reproducibility of Manual Periodontal Probing Following a Comprehensive Standardization and Calibration Training Program.

Background: Clinical standardization and calibration training is recommended to increase the reproducibility of periodontal probing, but its impact on manual periodontal probing outcomes has received little attention. This study examined the reproducibility of manual periodontal probing performed by a periodontist after completion of a comprehensive standardization and calibration training program. Methods: A newly-educated periodontist was subjected to an individualized periodontal probing standardization and calibration training program involving approximately 24 total hours of lecture, bench-top, and clinical instruction/evaluation. Satisfactory completion of each portion of the training program required ≥ 95% intra-examiner agreement within 1 mm between initial and repeat measurements, and a ≥ 90% level of exact agreement with measurements by a "gold standard" examiner. The periodontist then evaluated bleeding on probing (BOP) and performed duplicate measurements of probing depth (PD) and the distance between the cementoenamel junction and gingival margin (CEJ-GM) with a manual periodontal probe on 567 periodontal sites exhibiting ≥ 5 mm PD with BOP in 39 adults. Clinical periodontal attachment level (CAL) was calculated for each site as (PD) - (CEJ-GM). Results: Intra-examiner measurement error (the standard deviation for a single measurement) was found to be 0.21 mm for PD, 0.15 mm for CEJ-GM, and 0.26 mm for CAL. Replicate assessments of PD and CAL yielded excellent exact agreement kappa scores of 0.86 and 0.87, respectively. Greater intra-examiner measurement error was found at periodontal sites with more gingival inflammation as measured by higher BOP index scores. Conclusion: These findings demonstrate that a rigorous periodontal probing standardization and calibration training program facilitates acquisition of highly reproducible PD and CAL assessments in moderate to deep inflamed periodontal pockets with a manual periodontal probe. Similar formal hands-on training should be incorporated into dental education programs and clinical research studies to improve the diagnostic performance of manual periodontal probing of the periodontium.

Evidence-based considerations for the clinical use of locally delivered, controlled-release antimicrobials in periodontal therapy.

PURPOSE: Locally delivered, controlled-release antimicrobials have long been available in dentistry. Their utilization in routine clinical practice, however, has been slow, perhaps because of concerns about clinical benefits or costs or possibly due to a lack of understanding of their efficacy or proper use. In this paper the evidence regarding locally delivered, controlled-released antimicrobials is considered, and some of the controversies surrounding these agents are discussed. Evidence-based considerations regarding their use are also summarized. Scaling and root planing (SRP) procedures are the backbone of non-surgical periodontal therapy. Since a number of well designed clinical trials have demonstrated that adjunctive, locally delivered, controlled-release antimicrobials make SRP significantly more effective to reduce clinical signs of chronic periodontitis with a known safety profile, and since SRP procedures have previously been considered the standard of care for non-surgical periodontal therapy, a case is made that SRP in combination with adjunctive therapy, administered in a manner consistent with the approved full prescribing information, could be considered a new standard.

Application of evidence-based dentistry: from research to clinical periodontal practice.

Dentists need to make daily decisions regarding patient care, and these decisions should essentially be scientifically sound. Evidence-based dentistry is meant to empower clinicians to provide the most contemporary treatment. The benefits of applying the evidence-based method in clinical practice include application of the most updated treatment and stronger reasoning to justify the treatment. A vast amount of information is readily accessible with today's digital technology, and a standardized search protocol can be developed to ensure that a literature search is valid, specific and repeatable. It involves developing a preset question (population, intervention, comparison and outcome; PICO) and search protocol. It is usually used academically to perform commissioned reviews, but it can also be applied to answer simple clinical queries. The scientific evidence thus obtained can then be considered along with patient preferences and values, clinical patient circumstances and the practitioner's experience and judgment in order to make the treatment decision. This paper describes how clinicians can incorporate evidence-based methods into patient care and presents a clinical example to illustrate the process.

Associations between periodontal diseases and systemic diseases: a review of the inter-relationships and interactions with diabetes, respiratory diseases, cardiovascular diseases and osteoporosis.

The aim of this review article is to examine the associations between periodontal diseases and common systemic diseases, namely diabetes, respiratory diseases, cardiovascular diseases and osteoporosis. A substantial number of review articles have been published to elucidate the relationships between these diseases; however, none provide a complete overview on this topic from the aspects of definition, classification, clinical characteristics and manifestations, inter-relationships and interactions, proposed schematic mechanisms, clinical implications and management of periodontal patients with these systemic diseases. The aim of this article is to provide an overall understanding and general concepts of these issues in a concise and inter-related manner.