In April 2015, a group of key opinion leaders met with a team from Johnson & Johnson at a National Advisory Panel event in Dublin to advise on the topic of ‘Improving the periodontal health of Irish population – prevention and treatment’.

At the meeting, the key opinion leaders agreed on the following periodontal health consensus statement:

• ‘Effective plaque and calculus removal is key to oral health;

• Dental healthcare professionals have a responsibility to educate patients on their disease status and to direct patients appropriately;

• Patients should receive tailored oral hygiene instruction and demonstration;

• Patients have a responsibility to act upon the advice given by dental healthcare professionals;

• For effective management optimal patient home care and professional debridement are both essential;

• Long-term periodontal maintenance with continuity of care is critical for successful treatment outcome;

•Clinically proven mouthwashes, gels and pastes should be considered for recommendation to those individuals who are not achieving optimal levels of plaque control in their home care routine.’

The key opinion leaders were:

For a complete electronic probing and charting system that allows a single operator to complete a comprehensive periodontal exam in under ten minutes, turn to the Florida Probe from Clark Dental.

The Florida Probe handpiece exerts a constant force regardless of the strength or pressure of the operator, which guarantees accuracy and reproducibility between users.

Alternatively, the new VoiceWorks microphone and headset system can be used to capture the same data into the same software.

Using either system means there is no need to have another member of staff present to record the results. 

The Florida Probe aids patient communication by providing a detailed periodontal chart that can be used to create a “treatment map” for scaling and root planing, subgingival antimicrobials or laser treatment. When combined with the patient diagnosis sheet, this becomes an invaluable clinical and legal record of informed consent to protect your practice.

To explore the benefits of utilising the Florida Probe, contact Clark Dental’s team of experts who will be pleased to demonstrate and offer advice about the Florida Probe System and the new Voice Works system.

For more information call Clark Dental on 01268 733 146, email This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.clarkdental.co.uk

In May 2015, the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance, including antibiotic resistance, the most urgent drug resistant trend.

The World Health Organisation (WHO) defines antibiotic resistance as “resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it.¹” They go on further to say it is a “natural phenomenon” and that the misuse and overuse of the medication accelerates this worldwide problem. The effect of this “ticking time bomb” is felt across the health of the global population and worldwide healthcare budgets.

The meeting in May created five strategic objectives to tackle the issue including increasing awareness and understanding, reducing the incidence of infection and developing the economic case for sustainable investment². A survey carried out by the WHO a month earlier found that of 133 participating countries, only 34 had a comprehensive national plan to fight resistance to antibiotics. It discussed how management of the situation was paramount but due to inadequate laboratory capacity, infrastructure and data management practice, trends and outbreaks were poorly detected and monitored. Importantly, many countries had no stringent guidelines on the prescription of antibiotics, which could result in overuse and misuse by prescribers.

Excess Expenditure

There is not only the effect this issue has on the health of the global population, but also the impact it has on a country’s economy. Drug-resistant infections could kill an extra 10 million people across the world every year by 2050 if they are not treated successfully. By this date they could also cost the world around $100 trillion in lost output². Health expenditure in most countries is rising steeply already and resistance to antibiotics is going to contribute significantly in the near future. Excess costs associated with the resistance are due to longer hospitalisation, delayed therapy, higher morbidity rates, the necessity for surgery and the need to use more expensive antibiotics³.

Jim O’Neill, an economist leading a review into antimicrobial resistance for the UK government, estimated that $37 billion is needed over the next 10 years to spur the pharmaceutical industry into developing innovations in this troublesome segment. He went on further to say that this was a “modest sum” compared to the cost of not doing anything. During the 1990’s, pharmaceutical companies withdrew from investing in this kind of research due to a high uncertainty around what the final market potential would be, and still the pipeline does not look particularly robust. Also, antibiotics work so fast and so well that they provide relatively weak returns for high investment. Companies prefer to channel their funds towards the treatment of chronic illnesses, such as diabetes, as drug treatment for this type of disease will be taken for longer periods of time; usually for the rest of the patient’s life.

Prevention Strategies

This naturally occurring threat is not going to be eradicated without preventative measures being implemented globally. In one research paper on the subject, Sipahi suggests that the following strategies should be followed:

-       Optimal use of existing antimicrobial agents

-       Where possible, use alternative therapies

-       Increase immunity

-       Educate healthcare professionals

-       Regulations and policies

-       Stringent infection control protocols³.

There are scientists working to develop new drugs able to combat bacteria that are resistant to antibiotics. One of the more recent discoveries reported in The Guardian earlier this year has been hailed as a “game changer” and is called teixobactin. It can kill a wide range of bacteria, including Methicillin-resistant Staphylococcus aureus (MRSA). Teixobactin works by blocking the capacity of resistant bacteria to build cell walls, therefore making it almost impossible for bacteria to develop resistance⁴. It is, of course, still early days.

Alternatives to Antibiotics

The alternative is to use drugs and therapies that do not contain antibiotics, yet are as effective in the results that they deliver. PerioChip® is a non-antibiotic solution and can therefore be used in the longer term. It is designed for use in conjunction with traditional treatment to suppress bacterial flora in periodontal pockets of 5mm or more. It contains 2.5 mg of Chlorhexidine Digluconate and is recommended for first line treatment of periodontal pocketing. Results from clinical studies show a pocket reduction of more than 2mm in almost three quarters of patients when placed every three months⁵.

Antibiotic resistance is a looming problem that all governments and healthcare professionals around the world need to take responsibility for. With alternatives to antibiotics available that can be used in dental treatment plans, dental practitioners need to carefully consider what they prescribe and ensure they are doing what they can.

To order PerioChip® or for further information Freephone 0800 013 2333 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

Summary of product link;

http://www.old.health.gov.il/units/pharmacy/trufot/alonim/PerioChip_dr_1337488974840.pdf

Abbreviated Prescribing Information

PerioChip® 2.5mg Dental Insert (Chlorhexidine digluconate)

For full prescribing information, including side effects, precautions and contraindications, see Summary of Product Characteristics (SmPC).

Presentation: Dental insert: bullet shaped orange brown containing Chlorhexidine digluconate 2.5mg.

Indications: PerioChip® is an adjunctive antimicrobial treatment for moderate to severe chronic periodontal disease in adults with pocketing, combined with Root Surface Debridement (RSD). Not indicated in children and adolescents.

Dosage and Administration: One PerioChip® is inserted into a periodontal pocket with a probing pocket depth of ?5mm. Retreatment with PerioChip® following mechanical plaque removal at 3 month intervals may provide additional benefit if pocket depth remains ?5mm. For details see SmPC. Removal is unnecessary as PerioChip® biodegrades.

Contraindications: Hypersensitivity to Chlorhexidine digluconate or excipients.

Precautions: Allergic reactions have occurred but are rare.

Interactions: Avoid nystatin: antagonistic of Chlorhexidine. Chlorhexidine is incompatible with anionic agents present in some toothpastes and with dietary sucrose, but there is no significant impact on the efficacy of PerioChip®.

Undesirable effects: During the first few days after insertion, transient pain or discomfort of gums or teeth; redness and/or swelling of the gums.

Overdose: Not reported

Pregnancy/ Lactation: Controlled studies in pregnant women have not been conducted, so weigh expected benefits against possible foetal risks: caution in nursing mothers (see SmPC).

NHS list price: £207.20

Legal category: P, Product Licence Number: PL 14017/0035

MA holder: Full prescribing information is available on request from Dexcel Pharma Ltd, 7 Sopwith Way, Drayton Fields Industrial Estate, Daventry, Northants, NN11 8PB.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard.

Adverse events should also be reported to:

Dexcel Pharma Ltd on 01748 828784

1. Fact Sheet No194, WHO

2. http://amr-review.org

3. Sipahi OR. Economics of antibiotic resistance. Expert Rev Anti Infect Ther. 2008 Aug;6(4):523-39. doi: 10.1586/14787210.6.4.523.

4. The Guardian, 7^th January 2015

5. Soslkolne W.A et al. Probing depth changes following 2 years of periodontal maintenance therapy including adjunctive controlled-release of chlorhexidine. JOP 2003;74:420-427

Described as a global burden, severe periodontitis has been reported to be the sixth most prevalent medical condition in the world.[1]

In the UK, periodontitis affects about half of all adults with up to 15% estimated to have the condition severely.[2] These shocking statistics echo the findings of the 2009 Adult Dental Health Survey, which reported that, although this generation has a better outlook than their predecessors, there are still many people whose oral health and function does not meet the best possible standards.[3]

Periodontal disease is a particular area of concern because it can cause serious oral health problems and when left untreated, and can result in tooth loss as well as deterioration of both gingiva and bone. Ominously the potential effects and implications of periodontal disease may also extend beyond oral health and recent research has established that periodontal infection is a probable risk factor for various systemic diseases, including pulmonary disease.[4]

Furthermore, periodontal disease has the capability of changing the chemical composition of the blood and glucose levels as well as interfering with the body's inflammatory system and thereby increasing the risk of diabetes, rheumatoid arthritis,[5] respiratory[6] and cardiovascular diseases.[7]^,[8]

As we know, tobacco use, stress and obesity may be significant risk factors in the development and progression of periodontal disease. However people with other general health conditions also have an increased risk of developing the condition. Evidence has consistently revealed that diabetes is a risk factor for the prevalence of gingivitis and periodontitis^[9] and a five-year follow-up, population-based study in Taiwan[10] has also indicated that patients with osteoporosis might have an increased chance of developing periodontitis.