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ePaper created 2016-02-02, 09:16:44 | version 1.38.0
science & practice 8 AEEDC Dubai 2016 Traditionally, dentists have been taught that both dental caries and periodontal disease develop and progress as a direct result of pa- tients’ over-frequent consumption of refined sugars and patients’ fail- ure to remove bacterial plaque ef- fectively. Miller’s acidogenic the- ory of caries development and the non-specific plaque hypothesis based on Loe’s work in the 1960s allow dentists to present a simple cause-and-effect explanation to pa- tients. Since then, the dental profession has blamed patients’ poor oral hy- gieneforperiodontalbreakdownand dentalcarieswhileoftenfailingtodi- agnose and treat other contributing causative factors. Unfortunately, whileplaqueisgenerallyanecessary ingredient of common dental dis- eases, the explanation contained in thesetheoriesofitspivotalroleissim- plisticgivencurrentknowledge.This brief article will attempt to put the more significant risk factors in con- text. Plaque Gingivitis is a natural bodily re- sponsetobacterialaccumulationand as such is non-specific. Effective plaque removal will generally re- verse gingivitis. The concept of in- evitable progression from gingivitis todestructiveperiodontitisiforalhy- giene is not good is, however, flawed. Figure 1 shows a 46-year-old patient with non-existent oral hygiene over several years. Figure 2 shows the same patient one month later after around 90min of scaling and polish- ing by a student dental hygienist. He hadnoactivecariesandnomorethan 10%boneloss. It has become increasingly evi- dent that while some patients are “susceptible” to periodontal break- down, others are more “resistant”. Commonamongthesehost-basedfac- torsleadingtogreaterbreakdownare the presence of diabetes and a smok- inghabit. Diabetes Several authors have demon- strated a clear relationship between degree of hyperglycaemia and sever- ityofperiodontitis,andtheriskofcar- dio-renal mortality (ischaemic heart disease and diabetic nephropathy combined)isthreetimeshigherindi- abetics with severe periodontitis thanindiabeticswithoutsevereperi- odontitis.1 Javed et al. showed that scalingandrootplaninginprediabet- ics reduced glycated haemoglobin (HbA1c) by 1% at three months,2 and reductions in HbA1c of 0.3–1% have beenconfirmedinseveralotherstud- ies in both Type 1 and Type 2 diabet- ics.Thereareestimatedtobe745,940 diabetics in the United Arab Emi- rates. In 304,000 of those cases, the condition has not been diagnosed, and 934,300 people have impaired glucosetolerance,aprediabeticstate © 2015 A-dec Inc. All rights reserved. Evolved The new A-dec 300 Designed as a modular solution, A-dec 300 is a whole system that lets you pick and choose the features you want, within the price point you need. And we didnt skimp on comfort. With pressure mapped, contoured surfaces and virtual pivot back, patients are relaxed and supported. Ergonomic and economic just got better. Visit a-dec.com/300 or contact international@a-dec.com to explore all of the possibilities. A-dec Inc AdecDental AdecDentalEquip AEEDC Stand 6C01 AD Plaque,sugar,obesity,diabetesandsmoking Reassessing risk factors for periodontal disease By Crawford Bain, UAE Crawford Bain Fig. 1: Patient at presentation (he requested extraction of all mandibular teeth). Fig.2:Thesamepatientonemonthafterscal- ing and polishing (he asked how he could maintain the teeth in this condition).