When we compare and contrast between periodontology, endodontology and prosthodontics there are few similarities. Endo deals with the bugs on the inside of the root, perio on the outside and prostho groups together restoration of teeth and the replacement of missing or lost teeth. So we know of the clinical challenges for the dentist but how does that relate to the patient.
With Endo the key is the root canal (more critically the apical 3mm), cleaning it and sealing it. Essentially it is the dentist versus the tooth. Patient involvement is very limited. You would be hard pressed to be able to excite a patient with an obturation however many lateral canals MB2’s or MB3’s you fill! Patients tend to care most about pain and functioning where teeth have had an endodontic infection less so the actual quality of treatment.
The interaction with a patient when it comes to prosthodontics is a lot more involved. Negotiating tooth shape and position, discussing the relative merits of different materials or choosing between implants, dentures or bridges is very much a key component for successful treatment. Patients are likely to be more critical of an errant margin or poor retention on a denture than they are of an obturation that is short of the apex by 2mm !
Then we come to periodontology which removes some of the onus or focus of treatment from the dentist and places it upon the patient. Periodontal treatment, and more so at the specialist level, is incredibly intricate, detailed and technique sensitive. The best root surface debridement or connective tissue graft are only as good as the patients cleaning and the social risk factors they may present with such as smoking. In this situation much more differently from prostho and endo the patient holds a lot of the cards when it comes to the long term success of treatment. As such periodontal treatment needs excellent communication, in comparison once you get rubber dam on theres not much chit chat!
Oral hygiene, and as such the prevention, are key to all the treatment we do, from that small buccal cervical GIC due to a recession defect on a premolar to a complicated implant rehabilitation that may be at risk of peri-implantitis, periodontal health and treatment can be considered the bedrock of dental wellbeing.
In 2016 the British Society of Periodontology released the Good Practitioners Guide which covers a number of key areas in the assessment, prevention and management of periodontal problems. Click on the link to view the pdf.
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