Still advertising lies

I may or may not be reading the right type of newspaper (if and when I have time!), therefore I may or may not be reading the right type of advertising! I refer specifically to half page advertising (which, my analysis indicates, costs in the region of £30,000) promising comfortable, long-lasting dental implant treatment, be that single tooth, all on four, or alternatives, for patients whose mouths are neglected and, in most cases, as far as I could judge from the illustrations, riddled with periodontal disease. If we read the article by Emma Elliot and colleagues¹ in the current issue, then there is a possibility that such patients may have a psychiatric self-neglect problem, which is the first thing that may make them unsuitable for (implant) treatment, which readers will know involves meticulous home and professional aftercare. Add to that that the research is loud and clear that dental implants do not perform optimally when placed in the mouths of patients who have existing or pre-existing periodontal disease² or in smokers.³ This is confirmed by a recently published systematic review by Ferreira and co-workers, who identified 1823 articles and included 19 cross-sectional, case-control and cohort studies.⁴ They concluded that the presence or history of periodontal disease was a potential risk factor for various complications in implant therapy, with an increased risk of 2.3 times, including an increased risk of marginal bone loss, implant loss and the occurrence of peri-implantitis (a condition that is notoriously difficult to correct), which may jeopardize the longevity of dental implants. They advised that individuals with active periodontitis should undergo effective periodontal therapy prior to implant rehabilitation in order to reduce the risk of developing peri-implantitis. In addition, individuals with a history of periodontitis, rehabilitated with implants, should remain in a rigorous maintenance programme due to their susceptibility. Do the potential patients responding to the aforementioned advertising understand any of this?

May I also quote from a recent paper by Dragan and co-workers:⁵ ‘…there has been an unrealistic optimism about the predictability, survival, success and utility of dental implants in every scenario.’ This paper gave details of participants in a massive open online course in implant dentistry who had placed and restored implants and who had completed a 25-item online questionnaire. There were a total of 1015 respondents from 84 countries. There were significant differences in reported challenges and complications, depending upon dentists' time in practice, age and postgraduate education. The challenge in implant positioning was more frequently identified by ‘young post-graduate-educated’ dentists. Obtaining implant education in university settings was the most frequent recommendation by respondents, with the authors concluding that time in practice is a parameter to be considered when designing implant education and, ultimately, success They further concluded that ‘quality-assured and practice-directed education is needed at a global level, to support in particular, recent graduates who now seem to engage with implant dentistry early in their career.’ It seems that a weekend implant course in Gatwick is not enough! Implants are not the panacea that the adverts, which I have seen, imply.

I touched on this subject approximately 4 years ago, having seen implant advertising of a dubious nature in a local newspaper.⁶ At that time, I quoted Dr Phil Ower, a valued teacher of periodontology, when he said: a perio patient is always a perio patient. Now that the advertising of magic results has spread to a national level, the problems that unsuspecting and inappropriate patients encounter, will also spread to a national level: I would therefore be surprised if adverse medico-legal consequences do not follow unmet patients' expectations, given that it is clear that implants fail in patients with previously untreated periodontal disease. Who pays for that? We all do, via our indemnity subscriptions! I also asked myself, have the clinicians employed by the company purveying this advertising been involved in writing, or even proofreading, them? If they have, then they should be aware that the advertising can potentially mislead patients, and the General Dental Council therefore might be interested. It may also be of interest that King et al² advised that the issue of peri-implantitis was raised in the House of Lords in 2014, and that complaints to the General Dental Council relating to implants have been rising.² Perhaps we all should interested, as inappropriate patient selection and treatment risks bringing the profession into disrepute. Not even the advertisements in Dental Update are peer reviewed, so this will also apply to those in a national newspaper. Surely the clinicians in the clinics will have seen them? And, if not, who can stop these companies continuing to advertise lies?

It's the last issue of 2022! Therefore, as we reach the end of another year of Dental Update, I wish all readers, everywhere, Season's Greetings, a happy and peaceful, and, above all, healthy, 2023. I also thank you, the readers of Dental Update, for continuing to subscribe to our journal during these difficult times – I hope that you have found this year's issues valuable for your clinical practice (if you have not, then please let us know via the website – each issue has a comments section). I also wish to thank the Editorial Board for their input and wisdom, our superb authors for sifting through the voluminous dental literature and telling us what it really means by way of the review articles that they write, our peer reviewers for their advice and, finally, the excellent team at Sutton, led by Stuart Thompson, Fiona Creagh and Lisa Dunbar, for producing each super issue.

Finally, following the depressing reports of the demise of NHS dentistry in England, as mentioned by me in my Comments, and by other commentators earlier in the year, let's hope that its future becomes more assured, even in these straightened financial times. Indeed, that the future of dental practice, as we know it, also survives the financial difficulties that undoubtedly lie ahead in the new year.