The American Academy of Periodontology read with interest Dr. Gordon Christensen’s November JADA column, "The Advantages of Minimally Invasive Dentistry" (
JADA 2005;136:1563–5
). On behalf of the Academy and the members and patients we serve, I find the anecdotal statements related to the dental community’s increased interest in "accomplishing more treatment than required" and "placing implants," as well as "a decline in interest in periodontal therapy," insulting to my periodontist and general practitioner colleagues. Research shows that oftentimes patients’ level of disease, or damage caused by disease, requires more extensive treatment.1
These insinuations of inappropriate or overtreatment violate the essential trust that constitutes the core of the doctor-patient relationship. As health care practitioners, we have taken a vow to recommend any treatment that has proven to be effective in improving the health of our patients, and that meets their needs and interests. As it relates to periodontal disease, we know that it is a chronic inflammatory condition that requires careful monitoring and treatment throughout a patient’s life.
This is especially important for patients with inflammatory-related risk factors common to periodontal disease and general health conditions such as diabetes, cardiovascular disease and pregnancy. Oftentimes, these patients’ care requires careful comanagement between the periodontist and referring dentist, so to suggest that most cases can be "easily" treated without tried and true "conventional periodontal therapy" is irresponsible and could negatively affect the health of our patients.
The Academy’s mission, as supported by our periodontist and general practitioner members, is to advance the oral health and well-being of patients through expertise in periodontics, implants, periodontal medicine, periodontal plastic surgery and oral reconstructive surgery. Helping all patients achieve periodontal health is the keystone of this mission, with the supporting elements offering options for patients who wish to correct damage caused by the disease or to improve appearance.
I suggest that Dr. Christensen review the ADA Principles of Ethics and Code of Professional Conduct before he implies that the dental profession is in violation of these guiding principles. Of particular interest might be the principle of patient autonomy that states: "[T]he dentist’s primary obligations include involving patients in treatment decisions in a meaningful way, with due consideration being given to the patient’s needs, desires and abilities."2 This is a standard, I believe, that most of us feel comfortable achieving every day.
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