The April JADA article by Dr. Dwight E. McLeod, "A Practical Approach to Diagnosis and Treatment of Periodontal Disease," is welcome music to my periodontist ears.
In some respects, though, the article sings the same old periodontal tune. "Practical" approaches to the complexities of periodontal diagnosis and treatment too often conclude with vague recommendations, such as this article’s guidelines for selecting adjunctive periodontal therapies. The author suggests that adjunctive therapies (Atridox, Periostat) should be reserved for "only those [patients] who may benefit from the aforementioned therapies."
Huh? How practical is that advice? Unfortunately, we aren’t yet diagnostically sophisticated enough to identify these patients in advance. Wouldn’t it be infinitely more useful if "practical" periodontal articles provided clinicians with actual guidelines (rather than vague statements such as "use it only where it will work"), which they could use to increase the likelihood that the recommended therapy will be cost-effective. That is, the improvement from the therapy will justify the involved time, effort and expense.
We are in a time of serious dental medicine. Using these new therapies, we can solve clinical problems that previously had been difficult to manage. Wouldn’t it be great if future "practical" articles concluded with clinically realistic decision pathways that could guide the practitioner in determining which sites during initial therapy and which sites in maintenance therapy could benefit from adjunctive therapy?
I am making these treatment decisions every day. Genuinely practical information that could improve effectiveness in making these decisions would be of tremendous benefit to me, my patients and the patients of all clinicians.
