"The Nonsurgical Treatment of Patients With Periodontal Disease: Results After Five Years" by Dr. Walter J. Loesche and colleagues in March JADA calls attention to a very important issue facing many dental practitioners today: what is the most cost-effective, minimally invasive means to keep periodontal diseases at bay for each individual patient?
The American Academy of Periodontology, or AAP, treatment guidelines have always stressed that periodontal health should be achieved in the least invasive, cost-effective manner. This is often accomplished through nonsurgical periodontal treatment, including scaling and root planing, followed by adjunctive therapies such as systemic and local delivery antimicrobials, and host modulation as needed on a case-by-case basis.
Most periodontists would agree that, after scaling and root planing, many patients do not require additional active therapy, including surgical treatment. Most periodontists also agree that determining surgical needs before assessing a patient’s response to nonsurgical therapies—as the study suggests—is putting the cart before the horse. In fact, surgery is reserved for those situations when nonsurgical therapies have failed to achieve the desired clinical outcome of periodontal health.
Prescribing an antibiotic regimen to all patients also puts the cart before the horse. This blanket approach is not only unnecessary as most patients respond well without antibiotics, but it also disregards the Centers for Disease Control and Prevention recommendations for appropriate antibiotic use for health care providers. As health care providers, it is important for all dentists to consider antibiotic usage guidelines in treatment planning, so that we can preserve the effectiveness of these treatments for patients who do not initially respond to therapy, and can avoid contributing to one of the world’s most pressing public health problems, namely antibiotic resistance.
The AAP is pleased when new research furthers its members’ understanding of cost-effective, minimally invasive procedures in the treatment of periodontal disease. Unfortunately, when presented, this research often suggests an unnecessary dispute by pitting one treatment protocol against another.
It is important for patients and the dental community to understand that the debate over nonsurgical treatments vs. surgical procedures, as presented in this article, is a false one. The fact is that surgical and nonsurgical treatments are complementary and not mutually exclusive, and each has its place in achieving periodontal health.
