Post on 14-Apr-2017
Filippo GrazianiDDS, MClinDent, PhD
University of PisaSchool of Dentistry
Periodontology
University Hospital of PisaUnit of Dentistry and Oral Surgery
Section of Periodontology
Control of periodontal infection: effects on overall health and well-being
Periodontitis & Systemic Involvements Periodontitis & Psychosocial Involvements Treatment effects on General Health Treatment effects on Psyco-Social Well-Being Conclusions
Overview
Overview
Periodontitis & Systemic Involvements Periodontitis & Psychosocial Involvements Treatment effects on General Health Treatment effects on Psyco-Social Well-Being Conclusions
6° Most Prevalent Condition 10.8% (95% CI: 10.1%-11.6%) 743 milion worldwide
Prevalence
Bacteria Inflammation = ClinicalSequelae
+
Periodontitis
Edentulism
Social Factors (Aesthetic, Speaking)
Function (Malnutrition,
Gastric disease)
Cognitive Alterations
Costs
Periomedicine Rationale
Graziani & Tonetti Management of cardiovascular risk in
patients with periodontal diseasesIn “Current Advances in Cardiovascular
Risk” 2012
Periomedicine Rationale
Bacteriemia
Forner, Larsen, Kilian, HolmstrupIncidence of bacteremia after
chewing, tooth brushing and scaling in individuals with periodontal inflammation
Journal of Clinical Periodontology 2006
PeriodontitisGingivitisHealthy Controls
20%0%0%
10%0%0%
75%20%10%
Chewing Brushing Scaling
Bacteriemia
Reyes, Herrera, Kozarov, Roldan, Progulske-Fox Periodontal bacterial invasion and infection: contribution to atherosclerotic pathology.
Journal of Clinical Periodontology 2013
Jain, Batista Jr, Serhan, Stahl, Van DykeRole for periodontitis in the progression of
lipid deposition in an animal model Infection and Immunity 2003
Systemic Inflammation
Bacteria + Inflammation
C-Reactive Protein
Ridker & SilvertownInflammation, C-Reactive Protein and
AtherothrombosisJournal of Periodontology 2008
Perio & CRP
Paraskevas, Huizinga, Loos A systematic review and meta-analyses on
C-reactive protein in relation to periodontitisJournal of Clinical Periodontology 2008
Vascular-Endothelial Function
Tsioufis , Kasiakogias, Thomopoulos Stefanadis Periodontitis and blood pressure:
The concept of dental hypertension. Atherosclerosis. 2011
NHANES : 12000 subjects
Mean sistolic BP > in Perio+ subjects (mild-severe).
Linear correlation among SBP and perio severity
Holtfreter, Empen, Glaser, Lorbeer, Volzke et al.Periodontitis Is Associated with Endothelial
Dysfunction in a General Population: A Cross-Sectional Study.
PLoS ONE 201
Vascular-Endothelial Function
The Endothelium
TA tunica adventitia TM tunica media EC endothelial cells LU arteriole lumen TI tunica intima
5 m
SURFACE: 400 m2 WEIGHT: 1.5 Kg cell n°: 1.200.000.000 Orlandi, Suvan, Petrie, Donos, Masi, Hingorani,
Deanfield, D'Aiuto Association between periodontal disease and its treatment,flow-
mediated dilatation and carotid intima-media thickness. Atherosclerosis. 2014
c-IMT measurements (5452 subjects)
Perio cases showed a greater c-IMT (0.08 mm)
(per every 0.1mm of c-IMT difference the RR ofmyocardial infarction increases of 1.15 times and
for stroke increases of 1.18 times)
Shimazi, Saito, Kiyohara, Kato, Kubo, KogaRelationship between electrocardiographic
abnormalities and periodontal disease: the Hisayama Study.
Journal of Periodontology 2004
Average PD, CAL are associated with ECG abnormalities (O.R. 1.6)
Franek, Klamczynska, Ganowicz, et al. Association of chronic periodontitis with left
ventricular mass and central blood pressure in treated patients withessential hypertension.
American Journal of Hypertension 2009
Severe Perio to the cardiologist?
Heart Function
Lockhart et al.Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association? A scientific statement from the Am. Heart Association
Circulation 2012
Periodontal disease (PD)is associated with atherosclerotic vascular
disease independent of known confounders
Atherosclerosis
Perio & Lipid Metabolism
Nibali, D’Aiuto, Griffiths, Patel, Suvan, Tonetti Severe periodontitis is associated with
systemic inflammation and a dysmetabolic status: a case–control study.
Journal of Clinical Periodontology 2007
High Density Lipoproteins are considered as “heart protectors” ( the higher the
level the lower atheroscelrosis)
Severe Perio (HEP) shows significantly lower values of HDL than healthy controls
(1.14 mmol/L, p<0.001)
%AL ≥5 mm category experienced an 0.08% greater 5-year increase in HBA1C
Demmer, Desvarieux, Holtfreter, Jacobs Jr, Wallaschofski, Nauck, Volzke, KocherPeriodontal status and A1C change:
longitudinal results from the study of health in Pomerania Diabetes Care 2010
-0.05
0
0.05
0.1
0.15
0.2
0.25
CRP≥ 1mg/lCRP< 1mg/l
5 ye
ar a
bsol
ute
HBA1
c ch
ange
(%)
Q1 Q2 Q3 Q4 Edentulous %AL≥ 5mm
Metabolic Function
Dietrich , Joshipura, Dawson-Hughes, Bischoff-Ferrari. Association between serum
concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population. American Journal of Clinical Nutrition 2004
Inverse association between serum 25(OH)D3 concentrations and periodontitis in subjects > 50 y.
When compared with highest Vit. D quintile, these subjects lost 27% (95% CI: 12%, 42%) and 23% (95% CI: 8%, 38%) more attachment.
Kuzmanova, Jansen, Schoenmaker, Nazmi, Teeuw, Bizzarro, Loos , van der Velden Vitamin C in plasma and leucocytes in
periodontitis. Journal of Clinical Periodontology 2012
Xu & Lu Prospective association of periodontitis with
cardiovascular and all-cause mortality: NHANES III follow-up study
Atherosclerosis 2011
Mortality
Borgnakke, Ylostalo, Taylor, Genco Effect of periodontal disease on diabetes:
systematic review of epidemiologic evidence Journal of Clinical Periodontology 2013
Diabetics with severe periodontitis die 3.5
more for cardio-renal death
Take Home Message
Periodontal patients compared to controls:
Higher level of systemic inflammation Pressure and vascular lower efficiency Cardiac alterations Metabolism deficiency Possible higher risk of death
Manifesto
Overview
Periodontitis & Systemic Involvements Periodontitis & Psychosocial Involvements Treatment effects on General Health Treatment effects on Psyco-Social Well-Being Conclusions
Stress
Allostatic Load
Higher Susceptibility to
Periodontitis
Boyapati & WangThe role of stress in periodontal disease
and wound healing.Periodontology 2000. 2007
Poor Behaviours
smoking, + alcohol,
comfort eating, risk taking,
sleep deprivation
Low Plaque Control
Hypothalamus
↑ Corticotropin realising hormon
(CRH)
Pituitary Gland
↑ Adrenocorti-cotropic hormon
Suprarenal Cortex
↑ Cortisol Release
Autonomous Nervous system
Suprarenal Medullae
↑ Epinephrin & Norepinephrine
↑ Glucose level, GF Alteration, ↑ Citokines
levels , Immunodepression
Stress & Clinical Perio
Genco, Ho, Grossi, Dunford, TedescoRelationship to Stress, Distress and inadequate
copying behaviour to Periodontal DiseaseJournal of Periodontology 1999
1426 Periodontal Patients
4 questionnaires Life Events Scale Measures of Chronic Stress Measures of Distress Coping Styles and Strategies
Adjusted for counfounds: smoking, age, gender, general health
Stress (as financial strain) associated with higher levels of CAL and bone loss (OR 1.7 & 1.68)
Subjects with good copying behaviour = subjects with no stress despite financial strain
Salivary Cortisol Levels
Genco, Ho, Kopman, Grossi, Dunford, TedescoModels to Evaluate the Role of Stress in
Periodontal Disease Annals of Periodontology 1998
Severe Periodontitis, a high level of financial strain, and
high emotion-focused coping
Little or no periodontal disease, low financial strain, and low levels of emotion-
focused coping
11.04 ± 4.4 nmol/L 8.6 ± 4.1 nmol/L
Financial Strain
Ng, Leung A community study on the relationship
between stress, coping, affective dispositions and periodontal attachment loss
Community Dent Oral Epidemiol. 2006Healthy Low Moderate High Severe
0
0.5
1
1.5
2
2.5
3
3.5
JobFinancial
1000 subjects Cross-sectional
Study
Quality of Life
Quality of life is concerned with the degree to
which a person enjoys the important possibilities of life as well-being is maintained
OHRQoL
Oral Health Related Quality of Life (OHRQoL)
Assessing impact of Disease/Treatment on patient’s daily lifethrough Questionnaires/interviews:
Oral Health Impact Profile (OHIP)-14, -20, -49, -UK General Oral Health Assessment Index (GOAI) Oral Impacts on Daily Performances (OIDP)
Shanbhag, Dahiya, Croucher The impact of periodontal therapy on oral
health-related quality of life in adults: a systematic review.
J Clin Periodontol 2012;39: 725–735.
OHRQoL
ORAL HEALTH RELATED
QUALITY OF LIFE
FUNCTIONS Mastication Speech
PSYCHOLOGY Appearance Self esteem
SOCIAL Intimacy Communication
PAIN/DISCOMFORT Acute Chronic
QoL & Perio
Needleman, McGrath, Floyd & Biddle Impact of oral health on the life quality of
periodontal patients Journal of Clinical Periodontology 2004
The impact of oral health of life is significant
90% of the subjects (185/205) feels that oral health had a significant impact on their lives
Symptoms are related (gengival bleeding, halythosis, ecc.)
Take Home Message
Stress, Financial Burden, Depression, Anxiety are strongly associated to Periodontitis
Quality of Life is tremendously affected by periodontal disease
There is a tendency of direct association between severity of the disease and Psychological aspects
Severe disease affects even more the QoL
Overview
Periodontitis & Systemic Involvements Periodontitis & Psychosocial Involvements Treatment effects on General Health Treatment effects on Psyco-Social Well-Being Conclusions
To Arrest Disease Progression
To Nullify Symptoms and Perception
To Restore (Regenerate) Lost Tissues
To Maintain & Support = keep teeth
longer
Patient-Centered Treatment Goals
Treatment Philosopy
Paradigm Shift: from Certainty to Probability
Periodontal Disease cannot be removed but controlled
Periodontal Treatment: altering factors which may increase the risk of disease progression
Risk of Progression
Lang &Tonetti Periodontal Risk Assestment (PRA) for
patients in Supportive Periodontal Therapy Oral Health & Preventive Dentistry 2003
Trombelli, Farina, Ferrari, Pasetti, Calura Comparison between two
methods for periodontal risk assessment Minerva Stomatologica 2009
somma: 0-2punteggio di rischio 1
somma: 3-5punteggio di rischio 2
RISCHIOBASSO
RISCHIOMEDIO-BASSO
RISCHIO MEDIO
RISCHIOMEDIO-ALTO
RISCHIO ALTO
somma: 6-8punteggio di rischio 3
somma: 9-14punteggio di rischio 4
somma: 15-24punteggio di rischio 5
Treatment Scheme
Adjuntive Pharmaceutics
Diagnosis
Health/Gingivitis Periodontitis
Re-Examination
Causative Treatment
Need for Surgery? Success
Supportive TX
Perio/Implant Surgery
Re-Examination
Primary Prevention
NOYESYES
NO
PHASE 1
PHASE 2
PHASE 3
Discepoli, Nisi, Gennai, Karapetsa, Cei, GrazianiPatient perception of periodontal disease
in a cohort of 240 patientsJournal of Clinical Periodontology 2015
Periodontal disease is not silent (15% had no symptoms) Main symptom is bleeding (49.2%), followed by halythosys
(41.7%) and mobility (38.4%) Many symptoms are not recognized as “symptoms” Self perception of bleeding and mobility were associated to
severe periodontitis (OR=3.5). Pooled together symptoms show specificity of 91.2/81.2 for severe/mild
Symptoms
Periodontal Treatment
Periodontal treatment successfully decreases gingival inflammation, obtains pocket reduction/closure
and improvement of clinical attachment level
Van der Weijden & Timmerman A systematic review on the clinical efficacy
of subgingival debridement in the treatment of chronic periodontitis.
Journal of Clinical Periodontology 2002
Bruno 63 yrs Hypertension treated with β-blockers Former Smokers Chief complaint: Halythosis
Non-Surgical Treatment
Re-examination
Non-Surgical Treatment
Salvadori Bruno Periodontal Charting
Sondaggio 3 3 3 3 2 3 2 1 2 3 1 3 2 1 2 1 1 1 2 1 2 3 1 3 2 1 2 3 1 3 2 1 3 3 2 3 3 1 3 3 2 2 3 3 3 3 2 3RecessioneSanguinamentoIndice PlaccaForcazione
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Sondaggio 3 2 3 3 3 4 3 3 3 3 2 3 3 1 2 3 1 3 2 1 2 1 1 3 2 1 2 1 1 1 2 1 3 2 1 2 3 1 3 3 2 3 3 2 3 3 3 3RecessioneSanguinamentoIndice PlaccaForcazione
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Mobilità
F.M.B.S.#### ####F.M.P.S.
33 37363241
ARCATA DENTARIA INFERIORE
3144 353448 47 46 45 4243
V
P
38
Sondaggio 3 1 6 6 3 3 3 2 3 4 1 3 3 1 5 4 2 5 5 2 5 5 1 6 5 2 4 5 2 4 4 2 4 5 2 6 5 2 6 5 5 5 6 3 5 6 5 5RecessioneSanguinamento 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1Indice PlaccaForcazione
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Sondaggio 5 5 5 5 3 5 6 3 5 5 2 4 3 2 3 4 3 4 3 3 3 1 1 1 1 1 2 1 1 1 3 1 2 3 1 2 3 3 3 3 3 4 5 4 3 4 4 4RecessioneSanguinamentoIndice PlaccaForcazione
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Mobilità
3544 31 33 3734 38363241
ARCATA DENTARIA INFERIORE
43
V
P
48 47 46 45 42
Tooth Mortality
Graziani, Gennai, Cei, Cairo, Baggiani, Miccoli, Gabriele , Tonetti
Clinical performance of access flap surgery in the treatment of the
intrabony defect.
J Clin Periodontol. 2012
Graziani, Gennai, Cei, Ducci, Discepoli, Carmignani, Tonetti
Does enamel matrix derivative application provide additional clinical benefits in
residual periodontal pockets associated with suprabony defects?
J Clin Periodontol. 2014
Graziani, Gennai, Karapetsa, Rosini, Gabriele, Tonetti
Clinical performance of access flap surgery in the treatment of class II
furcation defects.
J Clin Periodontol. 2015
Salvadori Bruno Tooth Mortality
O,11 Teeth lost/patient*year maintenance (Tonetti et al. 2000)
Molars with furcation are lost more frequently. The higher the degreee of furcation the more can be lost in long term (Nibali et al. 2016)
However a significant portion of teeth are not lost after treatment in the very long term (Hirschfield & Wasserman 1978)
Inflammation
Graziani, Cei, Gabriele, TonettiEffects of non surgical peridontal
therapy on kidneyJournal of Clinical Periodontology 2010
Baseline 1day 1 week 1 month 3 months
Timepoints
0
10
20
30
VES
14
34
54
74
84
94
Baseline 1day 1 week 1 month 3 months
Timepoints
0,00
1,00
2,00
3,00
4,00
PCR
37
11
3
71
76
Baseline 1day 1 week 1 month 3 months
Timepoints
0,00
0,10
0,20
0,30
0,40
0,50
0,60
D-Dim
er
7
28
5775
3
34
32
47
67
68
Baseline 1day 1 week 1 month 3 months
Timepoints
0,0
50,0
100,0
150,0
200,0
250,0
300,0
sier
o-am
iloid
e a
23
56
3
37
76
Graziani, Gennai, Gabriele, Nisi, D'Aiuto. Acute-phase response following full-mouth versus
quadrant non-surgicalperiodontal treatment: A randomized clinical trial.
Journal of Clinical Periodontology 2015
B a sel ine D a y 1 D a y7 D a y 900
1
2
3
4
5
6
7
CRPM
g/L
RELATIVE INCREASE AT DAY 1
0%
50%
100%
150%
200%
250%
300%
350%
400%
FM-SRPQ-SRP
* p<0.01 between groups at day 1** p<0.05 between groups at day 1
*
**
Short-term Inflammation
Graziani, Gennai, Gabriele, Nisi, D'Aiuto. Acute-phase response following full-mouth versus
quadrant non-surgicalperiodontal treatment: A randomized clinical trial.
Journal of Clinical Periodontology 2015
Treatment time is related to the inflammatory
response
Short-term Inflammation
Visioni Linguali – Luglio 2014
Salvadori Bruno
Visioni Linguali – Luglio 2014
Salvadori Bruno
Luca 46 yrs Systemically Healthy No complaint Referred
RE-EXAMINATION
Diagnosis
Health Gengivitis Periodontitis
Re-Examination
Causative Treatment Causative TreatmentPrimary Prevention
PHASE 1
Periodontitis Control and Re-examination
F. Graziani
Re-examination: from Patient to Site. Managing residual pockets and furcations.
Graziani et al.Systemic inflammation following non-surgical
and surgical periodontal therapyJournal of Clinical Periodontology 2010
Non surgical Periodontal Treatment is strongly
associated to inflammatory response
Short-term Inflammation
Soraia 56 yrs Professional Singer, Hyperglicemia, Overweight Chief complaint: Bleeding on Brushing, receeding gums #PPD>3mm 67, PPD>5mm 15, FMPS : 88%, FMBS: 79%
Medium-term Inflammation
Soraia 56 yrs Professional Singer, Hyperglicemia, Overweight Chief complaint: Bleeding on Brushing, receeding gums #PPD>3mm 67, PPD>5mm 15, FMPS : 88%, FMBS: 79%
Medium-term Inflammation
Medium-term Inflammation
FMPS: 88% to 12% FMBS: 79% to 9% #PPD>4mm 67 to 0 No Furc +
Medium-term Inflammation
Soraia 56 yrs Professional Singer, Hyperglicemia, Overweight Chief complaint: Bleeding on Brushing, receeding gums #PPD>3mm 67, PPD>5mm 15, FMPS : 88%, FMBS: 79%
Medium-term Inflammation
Graziani et al.Systemic inflammation following non-surgical
and surgical periodontal therapyJournal of Clinical Periodontology 2010
Medium-term Inflammation
Overall inflammation tend to decrease along the control of the periodontal infection (i.e. active treatment)
Teeuw, Slot, Susanto, Gerdes, Abbas, D’Aiuto, Kastelein, Loos Treatment of periodontitis
improves the atherosclerotic profile: a systematic review and meta-analysis.
Journal of Clinical Periodontology 2014
Inflammation
Hs-CRP is significantly reduced by Perio Tx
Especially in subjects with co-morbidities, normal weigtht or non-smoking
Endothelial Function
Orlandi, Suvan, Petrie, Donos, Masi, Hingorani, Deanfield, D'Aiuto Association between
periodontal disease and its treatment,flow-mediated dilatation and carotid intima-media
thickness. Atherosclerosis. 2014
Engebretson & Kocher Evidence that periodontal treatment improves
diabetesoutcomes: a systematic review and meta-analysis.
Journal of Clinical Periodontology 2013
Yun Singh Koromantzos Jones Katagari Sun
-0.4
-0.2
0
0.2
0.4
0.6
0.8 Tx ParoNo Tx Paro
HbA1c reduction 3 months after perio tx
• 719 subjects•Mean weighted difference: 0,36%
(95% CI -0.54 to -0.19%)• Heterogeneity: I² = 9%
Glucose Metabolism
Lipids Metabolism
Teeuw, Slot, Susanto, Gerdes, Abbas, D’Aiuto, Kastelein, Loos Treatment of periodontitis
improves the atherosclerotic profile: a systematic review and meta-analysis.
Journal of Clinical Periodontology 2014
Triglycerides 0.24 mmol/l (CI: 0.26; 0.22, p < 0.00001)
Total cholesterol 0.15 mmol/l (CI: 0.29; 0.01, p = 0.03)
HDL-C 0.05 mmol/l (CI: 0.03; 0.06, p < 0.00001)
Nutraceutic
Dodington, Fritz, Sullivan, Ward Higher Intakes of Fruits and Vegetables, β-Carotene,
Vitamin C, α-Tocopherol, EPA, and DHA Are Positively Associated with Periodontal Healing after Nonsurgical
Periodontal Therapy in Nonsmokers but Not in Smokers.The Journal of Nutrition 2004
Higher dietary intakes of fruits and vegetables, b-carotene, vitamin C, a-tocopherol, EPA, and DHA are associated with greater reductions in PD after SRP in
nonsmokers with periodontal disease.
Nutraceutic
Reduction of Bleeding and Plaque in un treated patients (p<0.0001)
Possible adjunctive effects in deep pockets after treatment
Graziani, Discepoli, Gennai, Karapetsa, Rosema, Van der Velden The effect of twice daily kiwifruit
consumption on periodontal and systemic conditions before and after treatment.
Journal of Clinical Periodontology Submitted
Overview
Periodontitis & Systemic Involvements Periodontitis & Psychosocial Involvements Treatment effects on General Health Treatment effects on Psyco-Social Well-Being Conclusions
Re-examination
Valerio 43 yrs Personal Trainer, Systemicaly Healthy Chief complaint: Bleeding on Brushing #PPD>3mm 120, PPD>5mm 47, FMPS : 84%, FMBS: 61%
Treatment effect on Quality of Life
Increase of OHRQoL after periodontal treatment is shown.
No differences among various type of non surgical tx.
No adjunctive effects are noted after surgery if the subjects had received already non surgical tx.
Shanbhag, Dahiya, Croucher The impact of periodontal therapy on oral
health-related quality of life in adults: a systematic review.
J Clin Periodontol 2012;39: 725–735.
403 subjects 58,3 % females 19,3% Former smokers, 33,5% smokers, 47,3% never-smokers Questionnaire of 88 items, divided in 7 areas before and after treatment
Perio-Perception Study
OHIP-14 PSQI(Sleep)
MACQ(Memory)
IIEF-5(Erection) Fagerstrom Perio-
SimptomsPerio-
Perception
Perio-Perception Study
Baseline Post-treatment
OHIP-14 31,30±14,07 12,49±11,87*
PSQI 3,6±3,06 3,62±1,51
MACQ 7,18±3,03 3,62±1,51*
IIEF-5 22,58±1,08 22,27±1,21
Fagerstrom 8,08±1,63 7,33±1,75*
Periosintomatology 7,90±3,49 5,91±2,94*
Perioperception 11,25±3,12 3,84±4,06*
*P<0.05 compared to baseline
Perio-Perception Study
Slight Moderate Severe0
1
2
3
4
5
6
1.41
4.04
5.32
1.79
3.4 3.52
Baseline Post-treatment
P<0.05
Slight Moderate Severe6.6
6.8
7
7.2
7.4
7.6
7.8
8
8.2
8.4
8.6
7.9
8.45
8.06
7.63
8.33
7.22
Baseline Post-treatment
P<0.05Pittsburgh Sleep Index Fagerstrom
Perio-Perception Study
Do you think that periodontal disease could increase your stress?
Do you think that periodontitis is damaging your sleep quality?
Slight Moderate Severe0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
77.50%
87.50% 85.70%
22.20%17.80%
27.20%
Slight Moderate Severe0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
55.30%
68.20%
62.00%
24.40%
30.80%
20.30%
All p<0.05
Quality of Treatment
QUality Index of PEriodontal Treatment (QUIPET)
304 subjects in 14 European centres
Clinical Data & Quality Evaluation
OHIP-14, VAS & Quality Evaluation
Professional Performance
(TECHNICALITY)
Resources Usage(EFFICIENCY)
Patient Satisfaction
Risk Managment
(SAFETY)
World Health Organisation. The principles of quality assurance
Copenhagen: WHO, 1983.
QUIPET
No correlation was noted among therapists and patients in terms of correlation of quality appreciation ( p=0.983).
Quality perception is higher among patients Quality perception is influenced by many intangible factors
Conclusions
Periodontal disease has an impact that extends beyond the border of the oral cavity
Periodontal Treatment produces not exclusively oral benefits also improvements of general health and quality of life perception
Limitations: NO hard clinical endpoints (Incidence of CVD disease or depression)
We treat Patients (not teeth, gums or millimetres). The social opportunity of an holistic approach to our patient is humongous
GRAZIE