I was once accused, following a lecture I presented, of not living in the real world. I actually accepted it as a compliment.
Perhaps I do like to find alternative ways of looking at things – it makes life interesting. Do you remember a vote on the greatest invention in history? The bicycle won. Personally I felt it was a somewhat bizarre result; it should have been electricity. So let’s hold a vote with regards to the most useful tools in periodontics.
I suppose the BPE probe must come pretty high up. It has many useful functions and helps us design the treatment plan for a patient as well as protecting us from potential future litigation.
Ultrasonic cleaning instruments are the periodontal workhorse in my practice, and are responsible for controlling most of the inflammatory periodontal disease that I treat. These instruments make a significant difference to the health and welfare of my patients, and must be at the head of the pack, surely?
But what about antibiotics? Inflammatory periodontal disease is, after all, a chronic infection and if we can kill the bugs then we can control the disease. I believe that antibiotics are important, but are secondary to the previous two that I have already mentioned. They also do not come without some potential side effects. Antiseptics, such as Chlorhexidine, play a potentially more useful role overall with fewer side effects.
Following on from this, possibly the scalpel could win as an adjunctive therapy. It is cheap and gives us direct access to disease we cannot otherwise see to treat. This is surely the periodontal equivalent of the bicycle.
What about the newer therapies? Regeneration is the Holy Grail and a big buzzword in periodontal society. However, the overall impact it has on a patient and society as a whole, as opposed to an individual site, cannot compare with non-surgical therapy. And it comes at a price.
Host modulation and gene therapies look interesting and perhaps this is where the future lies. It is early days yet though and these therapies may or may not bear fruit. Perhaps this is the equivalent of how electricity would have been viewed 50 years before Thomas Edison.
So now for my ultimate choice: The ears. Perhaps I should live in the real world. Please don’t report me to the General Dental Council – I might get struck off. I will explain my reasoning in my next article.