Interview: “The focus has to be on a population-based preventative approach”

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Interview: “The focus has to be on a population-based preventative approach”

Dr Harry-Sam Selikowitz, Chair of the FDI Science Committee (Photograph: FDI World Dental Federation)
Dental Tribune International

By Dental Tribune International

Tue. 6 September 2016

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This afternoon at Pavilion 15 (Earth Hall A, Level 2), Chair of the FDI World Dental Federation’s Science Committee Dr Harry-Sam Selikowitz from Norway will present a paper, titled “The global strategy and teamwork for periodontal health and overall health”. Dental Tribune Online spoke with him about the FDI’s new periodontal project and its goals for the future.

Dental Tribune Online: The FDI envisages developing a global project in the field of periodontal health. Why this area and why now?
Dr Harry-Sam Selikowitz: The FDI is becoming involved at this stage because periodontal disease is largely a public health problem. In many countries around the world, there are simply not enough dentists to treat periodontal disease, so the focus has to be on a population-based preventative approach. The World Health Organization’s 2010 Global Burden of Disease Study shows this and, certainly, my discussions with health officials in my home country of Norway indicate that they take the matter very seriously.

The present project on periodontal health also reflects the FDI’s current focus: traditionally, we have spoken about how to detect, treat and prevent disease; today, we are also talking about how to maintain the health of the population.

You recently held some exploratory talks on including peri-implant disease in the periodontal project. What factors inform the development of a programme to address this issue?

There are several factors at play here. The first is that, as in many areas of technology, progress means that implants are becoming cheaper and will become increasingly available to a wider public. This means that it would a good idea to resolve any related issues at a relatively early stage rather than five or ten years down the line.

Second, studies show that the same bacterial agents in the biofilm coating on normal teeth that cause inflammation also affect implants, so infection leading to tooth loss also leads to failure of implants. Thus, the same prevention measures that ensure a healthy dentition are equally appropriate for implants.

If the FDI decides to go ahead, what first steps do you envisage to launch the project?
The first step would be a survey among FDI member national dental associations on measures in place to promote oral health and manage periodontal disease. For example, smoking and tobacco use in general constitute one of the gravest dangers to periodontal health. Bearing in mind the breadth of FDI worldwide coverage of oral health issues, one question could be, “Is there a national policy on periodontal disease prevention or common risk factors with non-communicable disease in place in your country?”.

We also see the need for a toolkit on periodontal health advocacy and education to support the work of our national dental associations in bringing the subject to the attention of national health authorities and as a means of integrating periodontal health into their continuing education programmes.

Is there any work already underway?
The FDI Science Committee is already doing some groundwork in the field of monitoring and what really works in the prevention of periodontal disease. There is a lack of population-wide, evidence-based studies on preventative measures and this needs to be remedied. However, a lack of strong evidence does not mean that one or another preventative measure is ineffective. There is a distinction between evidence-based studies and what we have learnt as dentists through years of observation. What is interesting is that meta-analysis has shown reduced tooth loss between 1999 and 2010,[1] and we can infer that dental treatment and preventative measures have contributed to this.

What is the impact of poor periodontal health on general health?
There is not enough evidence on specific causality between periodontal disease and systemic and non-communicable diseases. However, it is undeniable that there is an association, and periodontal disease shares common risk factors with the main non-communicable diseases. For example, periodontal disease can worsen diabetes, and vice-versa.

Thank you very much for the interview.

Reference
1. Kassebaum, N.J., Bernabé, E., Dahiya, M., Bhandari, B., Murray, C.J. & Marcenes, W., “Global burden of severe tooth loss: A systematic review and meta-analysis”, Journal of Dental Research, 93/7 supplement (2014), 20S–28S.

Disclaimer: The opinions expressed in this interview do not necessarily reflect those of the FDI World Dental Federation.

Editorial note: This interview was published in the first 2016 Worldental Daily issue. The newspaper is being published during the 2016 FDI Annual World Dental Congress.

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