Decision making in treatment and co-management of periodontal infection: elimination or progression? Faire des choix dans le traitement et la co-gestion de la parodontite: réduction ou récidive?

An accurate prediction of disease progression after periodontal therapy would enable the clinician to intervene where and whenever necessary and to individualize supportive care. Unfortunately, predicting continued clinical attachment loss on the basis of clinical parameters on a site and tooth level seems relatively unreliable. Consequently, the clinician could play safe by possibly performing overtreatment. Reality shows, however, that persistent pathology prevails in some cases. A recent study has indicated that deep residual pockets of at least 6 mm following active periodontal therapy represent a risk for further disease progression and tooth loss. Significant associations have been shown on a site, tooth and patient level. This finding promotes a pocket elimination approach for the treatment of periodontitis. The strategy, which includes a strict extraction policy for hopeless teeth and thorough pocket disinfection usually by means of surgery, reduces the work load during supportive care. Indeed, additional tooth loss will be limited and a low prevalence of deep residual pockets limits the need for re-treatment. Besides active periodontal therapy supportive care is of pivotal importance to limit disease progression. The appropriate interval is selected on the basis of the patient's risk profile by the periodontist. Since specialists are usually understaffed to provide this for all patients, a 'co-management' concept seems the best alternative. This concept includes regular visits to the specialist and general practitioner. On the other hand, auxiliary personnel can be helpful to assist careproviders in organizing supportive therapy. This concept has proven to be effective over the world except for Belgium where oral hygienists are nonexisting and not allowed by law. Maybe it is time to reorganise health care policy in the benefit of clinicians and patients.