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It is my pleasure to welcome you to this special issue of Dental Update on the topic of Periodontology. As President of the British Society of Periodontology and Implant Dentistry (BSP), it is my sincere hope that you will find the articles in this issue enjoyable to read, informative, and a good reference source for the future.
Work on this special issue was led by the BSP's Early Career Group, and began about one year ago, with the selection of the topics and the authors for the articles. The articles were written by a range of colleagues from across the country, including specialists and non-specialists, some senior while others are in the earlier stages of their career, and some based in hospitals and universities as well as those who are practice based. This mix of authors was intentional, to create teams of authors at different stages of their careers and working in different contexts, and I hope you will agree that the end result is a very accessible and practical series that will be of value to dental teams wherever they are working.
A key theme running through the articles is how best to work within the ‘Steps of care’ for treating periodontal diseases, as developed originally through the European Federation of Periodontology (EFP), which holds annual workshops to generate guidance for the dental profession. Once the guidelines have been developed by the EFP, the periodontal societies across Europe then incorporate them into national guidance. This process is known as ‘adolopment’, which means a combination of adopting and adapting the European guidelines to fit within each country's national context of oral healthcare delivery. Thus, the BSP has been very active in this process of adolopment of the S3 guidelines to the UK setting, such as for treatment of stage I–III periodontitis, stage IV periodontitis, and peri-implant diseases and conditions. ‘S3’ in this context means that the guidance has been developed at the highest quality level (‘S3 format’), which includes both a systematic appraisal of the published evidence as well as involving the clinical experience and expertise of a range of stakeholders in interpreting the evidence prior to making recommendations.
A major challenge within NHS dentistry that regularly dominates the headlines is access to NHS care, primarily as a result of failure of the dental contract to serve patients, or the profession, adequately. Neither the UDA nor fee-per-item systems work well for the prevention and treatment of periodontal diseases, these being complex chronic diseases that require a long-term, patient-focused preventive management strategy involving professionally delivered care, patient behaviour change and risk-factor modification. Prevention is better than cure, and nowhere is this more the case than with periodontal diseases. Treatment of gingivitis is the primary prevention strategy for periodontitis, and it is essential that dental contracts permit the dental team to identify, diagnose and treat gingivitis. For patients with periodontitis, we know that routine non-surgical periodontal treatment is highly successful in the great majority of cases, providing that sufficient time is afforded to the clinician to be able to treat the disease properly. This involves regular oral health reviews at an appropriate recall frequency, sufficient chairtime to treat disease effectively, and remuneration systems that reward disease prevention, rather than managing disease consequences.
Prevention of periodontitis is also important in view of the fact that good periodontal and oral health is integral to good general health. We are all aware of the links between periodontitis and systemic diseases, such as diabetes and cardiovascular disease, which underscores the importance of preventing and treating periodontal diseases not only for individual patient benefit, but also for society, given the huge costs of treating periodontitis globally and the additional impacts on systemic diseases. The challenge of doing this within the NHS landscape is obvious to all, however, and the BSP continues to work hard with all stakeholders, including the Office of the Chief Dental Officer (OCDO) to reinforce the urgent need to ensure prevention and effective treatment for periodontal disease is placed at the heart of NHS dental care. Indeed, it is a significant achievement that NHS England (NHSE) have adopted the concept of the S3 clinical guidance and have made provision for staged periodontal care through the ‘phased care’ protocols outlined in the ‘Avoidance of Doubt’ document (freely available at the BSP website: www.bsperio.org.uk). Here, additional UDA payments are made available for the management of engaging patients, shifting the focus to patient engagement in prevention. Readers will also find useful the Healthy Gums Do Matter toolkit, developed by the Greater Manchester Local Dental Network to help improve the standard of periodontal care in practice settings, also available at the BSP website.
The BSP is very active in providing guidance for the dental team, and all our guidance can be accessed via our website. You don't have to be a member of the BSP to access most of our resources. Here you can find the flowchart for implementing the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions, or the guidance for delivering the Steps of Care under the UDA banding system, to be read in conjunction with the Avoidance of Doubt document. There are also very useful resources for patients, such as FAQs on periodontal diseases and implants. For our members, there is a series of free webinars through the year, with full allocation of CPD points. I also encourage you to consider attending the BSP Annual Conference, this year to be held in the wonderful city of Newcastle upon Tyne, 9–11 October 2024. The conference theme is Interdisciplinarity, and a stellar line-up of world-renowned speakers has been confirmed for the conference. Full details are on the BSP website.
Lastly, I would like to thank the editorial team at Dental Update for giving BSP the opportunity to produce this special issue on Periodontology. I hope you will find that it provides very relevant content and practical advice for managing the periodontal conditions routinely encountered in clinical practice.