Abstract
Background
Periodontitis is a chronic, inflammatory disease that has increased in prevalence by 24% over the last 19 years (1990 to 2019) (WHO, 2023). Arising from a dysbiotic relationship between the plaque biofilm and host response, it is characterised by the loss of periodontal supporting structures. According to the 2017 World Workshop of Periodontology Classification, a patient is diagnosed as having periodontitis if they have detectable interdental clinical attachment levels (CAL) at ≥2 nonadjacent teeth or CAL ≥3mm and probing pocket depths (PPD) >3mm buccally at ≥2 teeth. Different periodontal parameters are key components of the final classification of periodontitis. These periodontal parameters have been commonly used to diagnose periodontal patients, and they assist in the clinical decision-making process.
The two main treatment options for periodontal disease are either non-surgical or surgical (with or without adjunctive options). Both have been shown to be effective for periodontal patients, but patients’ adherence to good oral hygiene maintenance can affect their treatment outcomes. Non-surgical treatment involves debridement of affected root surfaces with powered devices or hand curettes. Different surgical approaches have been developed over the years for different indications.
Clinical outcomes can be defined and used as a measurable change in clinical parameters to determine the endpoint of treatment and determine the effectiveness of treatment (National Institutes of Health, 2023). When measuring the clinical outcomes of periodontal disease and its response to treatment, a measurable endpoint should be used. This endpoint is commonly determined by measuring the loss or gain in periodontal parameters (CAL, PPD and gingival inflammation).
Many studies have been conducted in a university setting but they do not commonly assess the clinical outcomes of patients treated by the postgraduate periodontal students. In published studies, it is more common for them to be examining specific treatments or interventions and how they affect the outcomes. By contrast, the current study described the clinical characteristics of patients seen in the postgraduate periodontology discipline and investigated their clinical outcomes.
Methods
This study was completed retrospectively in the Periodontology discipline at the University of Otago, Dunedin, New Zealand. Patients seen by Periodontology Doctor of Clinical Dentistry (DClinDent) students between 2015 and 2017 had their notes examined and data extracted for analysis. They were included if they had been diagnosed with periodontitis and received at least one round of periodontal treatment from one of the postgraduate students seen during that time. The patients were identified by examining the postgraduate students’ assigned patient lists and their submitted logbooks. Detailed data were extracted from the patients case notes and their recorded advanced periodontal charting. Overall, the information collected included their demographic characteristics, dental status, periodontal status, and treatment details. This information was recorded numerically on an Microsoft Excel spreadsheet and was systematically analysed using SPSS IBM Corporation Version 20. The analysis assessed the extent and severity of patients’ disease, and how the parameters recorded changed over the study period. It also assessed whether the patients improved, showed no change or worsened, and whether the treatment they received affected their outcomes. Effect sizes were computed to measure the magnitude of change between periodontal parameters recorded at baseline and those following treatment (at follow-up), by dividing the change in clinical score by the standard deviation of the baseline score. The data were also compared with estimates from the most recent national oral health survey (Ministry of Health, 2010).
Results
Baseline data were available for 218 patients; there were slightly more females than males (N = 121, 55.5% and N = 97, 44.5% respectively). There were more 45-to-54-year-olds (N = 84, 38.4%) and those aged 65+ years (N = 38, 17.4%). More patients were former smokers (N = 96, 44.0%) than never or current smokers (N = 70, 32.1% and N = 45, 20.6% respectively). More females than males were never or current smokers. There were more non-diabetics (N = 201, 92.2%) than diabetics (N = 17, 7.8%) and of those that were diabetic, more were males than females. Pocket depth (PD) of 5+mm involved approximately one-fifth of sites (mean = 17.3%, standard deviation (SD) =15.0) and one-third of sites measured had 5+mm clinical attachment levels (CAL) (mean =32.6%, SD = 21.2). Males had a higher extent and severity of CAL and class II or III furcation involvement than females.
The extent and severity of periodontal parameters decreased between baseline and follow-up. The extent of PD of 5+mm showed the largest improvement from baseline (mean = 18.1% of measured sites affected, SD = 15.6) to follow-up (mean = 6.3%, SD = 7.3), with the greatest effect size (0.8, indicating a large effect). Moderate effect sizes were seen with the extent of bleeding on probing (BoP) and suppuration from baseline to follow-up. Those that were followed-up over a longer period saw more improvements in all periodontal parameters. Both surgical and non-surgical periodontal therapy showed improvements in the periodontal parameters. However, furcation-involved teeth showed more improvement from surgery (mean = 3.0, SD = 3.6) than if the patient did not undergo surgery (mean = 1.7, SD = 2.1). In comparison, non-surgical treatment showed more improvements in tooth mobility than did surgical procedures.
The findings from the current study were compared with the findings of the 2009 national survey of the New Zealand population. This showed those seen by the periodontology discipline at The University of Otago had a considerably higher extent of PD and CAL 5+mm and 6+mm than those in the general population.
Conclusion
Patients treated by DClinDent students between 2015 and 2017 had much more severe and extensive periodontitis than the general population, but showed marked improvement in their periodontal parameters after treatment. Both surgical and non-surgical modalities showed improvements and have shown to be viable treatment options for periodontitis patients.