The American Academy of Periodontology (AAP) recently published a detailed statement on comprehensive periodontal therapy that is intended to serve as a clinical road map for any dental professional who supervises, administers, teaches, or regulates the provision of periodontal therapy.
Published in the July issue of the Journal of Periodontology, the Comprehensive Periodontal Therapy Statement provides an overview of the following elements, which the AAP believes constitute efficient and effective periodontal treatment:
- Scope of Periodontal Therapy
- Periodontal Evaluation
- Establishing a Diagnosis, Prognosis, and Treatment Plan
- Informed Consent and Patient Records
- Treatment Procedures
- Evaluation of Therapy
- Factors Modifying Results
- Periodontal Maintenance Therapy
In an effort to obtain more insight into why the statement was developed and how it can have a positive impact on the dental profession and patients alike, we spoke to Dr. Diego Velasquez, a periodontist who practices in Fenton, Michigan, and was involved with the publication of the statement.
: Dr. Velasquez, why was the Comprehensive Periodontal Therapy Statement developed?
DV: Periodontists are frequently asked by general practitioner (GP) dentists if there is a document addressing periodontal therapy that could be incorporated by dentists, hygienists, and the entire dental team. And the answer was, “There are some existing publications, but no comprehensive papers providing information that could be readily available for incorporation in dental practices.”
For example, there were published articles, but much of that material was outdated. There were scattered pieces of literature, and some of them did not adequately encompass best practices in regard to disease-state definitions or treatment options. This statement helps fill this void.
In addition, research conducted by the AAP and the Centers for Disease Control showed that prevalence rates of periodontal disease in the United States may have been underestimated by as much as 50 percent. The development of the Comprehensive Periodontal Therapy Statement provides an overview of the components that should constitute efficient and effective periodontal treatment and may help reduce these prevalence rates moving forward.
: So the Comprehensive Periodontal Therapy Statement addresses all these issues?
DV: Yes, and then some. This document summarizes evidence-based practices that put new emphasis on how clinicians assess the goals and outcomes of periodontal therapy. This clinical goal-setting takes into account that periodontal disease is regarded as being treatable, not curable. This is a treatment model very much like those for chronic systemic diseases such as diabetes.
: Is this a more realistic approach?
DV: Yes. I believe it will go a long way in eliminating some of the frustration shared by clinicians and patients alike. There is still a lot of patient education and communication that needs to take place to recalibrate the expectations of periodontal disease treatment, which requires ongoing monitoring and treatment to keep bacterial loads and inflammation below tolerance thresholds for each patient.
: That’s a bleak prognosis – a lifetime of maintenance therapy.
DV: There is an upside; based on what we now know, there is a tremendous opportunity and responsibility for dental professionals to motivate patients who show early stages of periodontal disease to follow the recommended course of treatment in order to prevent the development of a more severe pattern of disease. The conversation can go something like, “You have gum disease in an early stage, which is easier to treat. If we don’t address it now, it may progress to a more advanced and harder-to-manage form that could result in tooth loss and end up affecting your overall health and quality of life.”
: How has this statement been received so far?
DV: I’m encouraged by the positive feedback I have received from my referring colleagues and from hygienists who attended a recent study club presentation my office hosted on comprehensive periodontal therapy. Now more than ever, I’m very optimistic about the future based on the high level of interest shown by recent dental school graduates – they are hungry for clinically validated information regarding periodontal disease diagnosis and treatment they may not have received in dental school.
: What are the AAP’s short- and long-term goals for the Comprehensive Periodontal Therapy Statement?
DV: The short-term goal was to provide an educational resource that can be used by the entire dental profession. The long-term goal is to keep building upon this foundation to develop additional information as deemed necessary. The overarching clinical goal is to diagnose and treat periodontal disease earlier to minimize its devastating effects and provide our patients with the highest standard of care possible.
: Any final thoughts?
DV: Adopting change is always a challenge, especially when it comes to modifying patient behavior. It is our responsibility as dental professionals to communicate our clinical goals for an ideal standard of care. All change starts somewhere and has a beginning. In my opinion, the Comprehensive Periodontal Therapy Statement is a strong start.