Periodontal maintenance following active specialist treatment: Should patients stay put or return to primary dental care for continuing care? A comparison of outcomes based on the literature

Abstract

Objectives: To review the evidence for the efficacy of periodontal maintenance (PM) carried out in primary dental care (PDC) compared to the specialist setting for patients previously treated in a specialist setting for chronic (ChP) or aggressive (AgP) periodontitis. Methods:A focused PICO question and search protocol were developed. Online databases including MEDLINE, EMBASE, WEB OF SCIENCE™ and COCHRANE LIBRARY were searched along with specialist journals in the subject area of periodontal research.Selection criteria included studies that investigated delivery of PM in both specialist and PDC settings for patients with ChP or AgP over a minimum 12 months. We looked for studies that reported changes in clinical attachment levels (CAL), tooth loss, pocket probing depths (PPDs) and bleeding on probing (BoP) as outcome measures.Results: Eight cohort studies were chosen for inclusion. There was considerable heterogeneity found between the eight studies, which did not allow for quantitative (meta) analysis and statistical testing of differences between groups. Clinical attachment levels remained relatively stable in patients who received specialist PM with mean changes of −0.42 mm to +0.2 mm, while for those enrolled in PDC-based PM for periods >12 months, mean CAL losses were between −0.13 mm and −2.80 mm. PPD reduction for those subjects receiving specialist PM was between 0.05 and 1.8 mm for five studies but two cohorts experienced increases of 0.32 and 0.80 mm, respectively.Increases of up to 2.90 mm (range: −0.1 to +2.90) and a higher proportion of deeper pockets were noted among PDC PM cohorts. Higher rates of BoP among those in receipt of PDC PM were reported in half of all studies. There were insufficient long-term data to make any firm conclusions about the effect of the delivery of PM on tooth loss. Conclusion:Within the limitations of the data available, it appears that specialist PM is effective in sustaining periodontal stability following active specialist intervention.There is limited evidence that PDC provides the same level of care; however, the limited comparative data available suggest that outcomes could be slightly worse in PDC. | INTRODUCTIONPeriodontal maintenance (PM) follows active periodontal therapy (APT) and aims to prevent periodontal disease progression through close monitoring of the periodontal condition along with supra-and subgingival debridement and behaviour modification. | MATERIAL AND METHODSThe following PICO question was utilized to develop our review protocol:"for patients who have received specialist treatment for periodontitis (P), does receiving periodontal maintenance in PDC (I) prove as effective as receiving it in a specialist setting (C) in preventing disease progression and recurrence? (O)" A checklist based on the PRISMA (Preferred Reporting Items for Systematic Review and Metaanalyses) statement 18 was used and is summarized below (Figure 1). | Eligibility criteriaThe hierarchy of evidence search scope for this review included randomized controlled cli...

Success of non‐surgical periodontal therapy in adult periodontitis patients: A retrospective analysis

“…There is some evidence that primary dental care provides the same level of care. The limited comparative data available suggest that outcomes could be slightly worse in primary dental care …”

Clinical efficacy of single and multiple applications of antimicrobial photodynamic therapy in periodontal maintenance: A systematic review and network meta-analysis

“…It is well established that a residual PD of 5 mm represents a risk factor for further tooth loss [9,10]. Therefore, to maintain periodontal tissue stability after initial treatment, treated periodontitis patients should remain on maintenance and be closely monitored [11].…”

Oral health knowledge and behaviour among patient in supportive periodontal care in Sarawak

“…Under SPC, patients are required to attend a specialist clinic between 3 to 6 months annually, depending on the complexity of their periodontal status (Axelsson et al, 2004). Typically SPC includes an update of the medical and dental histories, dental and periodontal evaluation, removal of bacterial plaque and calculus supra and subgingivally, debridement if indicated, and a review of the patient's plaque removal efficacy (Leavy & Robertson, 2018). Within that gap of 3 to 6 months, it is crucial for the patient to selfmaintain their oral hygiene care at home to prevent the disease's recurrence.…”

“…This may be due to the lack of awareness and knowledge of the patient and the general dentist regarding the importance of specialist care for maintenance postperiodontal active therapy. There is evidence that patients who, after completing a course of periodontal therapy return to the care of general dentists, do not do as well in terms of periodontal stability as the patients who continue with a specialist maintenance programme (Axelsson & Lindhe, 1981;Cohen et al, 2003;Leavy & Robertson, 2018). Similarly, several studies have also reported non-compliance with oral selfhealth-care recommendations (Macgregor et al, 1998;Mohd-Dom et al, 2009).…”