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<\/p>\nAccording to the World Health Organization (WHO), the majority of oral diseases can be prevented through simple, evidence-based, and cost-effective methods. There is substantial evidence demonstrating the impact of general health on the course of oral diseases, and vice versa. For example, severe periodontitis aggravates the course of diabetes, as well as cardiovascular, digestive, and other systemic diseases. According to numerous studies, the life expectancy of edentulous individuals is lower compared to those who have teeth, and toothlessness is also associated with a higher risk of mortality. Consequently, maintaining oral health is as important as proper nutrition, physical activity, and the prevention, early detection, and treatment of cardiovascular or other diseases. Severe periodontitis (inflammation of the gums and bone surrounding the teeth) is the sixth most prevalent chronic disease in the world. The first and most common symptom of periodontitis\u2014bleeding gums, seemingly a harmless and very widespread condition\u2014is often considered normal or an inevitable part of tooth brushing. However, if periodontitis is not detected and treated in a timely manner upon observing this symptom, the disease will eventually result in tooth loss.<\/p>\n
Gum diseases are treated not by a general dentist or an oral surgeon, but by a periodontist. In many European countries (Italy, Spain, Great Britain, Switzerland, France, etc.) and the United States, periodontology is a distinct branch of dentistry. After graduating from the faculty of dentistry, doctors undergo a two- or three-year postgraduate training course (master’s program\/residency) to study this specialty. In Georgia, there is likely a person practicing this specialty in almost every dental clinic; however, it should be noted that such a specialty is not distinguished in the national list of specialties, nor is there a postgraduate training course, or residency, available at any university base. And yet, is such a specialist and three years of study truly necessary to master this specialty? How are such specialists educated outside of Georgia?<\/p>\n
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John Riggs (1810-1885) was an American physician who is considered the first periodontist in the world. He was born in Connecticut (USA) and treated only gum diseases. He believed that the cause of inflammatory periodontal diseases was supragingival and subgingival dental calculus (tartar), which leads to the breakdown of the bone surrounding the tooth. Riggs was so fascinated by the concept of oral hygiene that, in his opinion, if individuals brushed their teeth well enough and frequently enough, they would no longer develop caries. He also noted that maintaining oral hygiene is of great importance in the effective treatment of periodontitis, and it is essential to conduct maintenance therapy after treatment to achieve long-term preservation of the treatment results.<\/p>\n
The first periodontal association was also established in the USA on May 23, 1914; it was initially named the “American Academy of Oral Prophylaxis and Periodontology,” and in 1919 it was renamed the “American Academy of Periodontology” (AAP), which remains one of the leading organizations in the world today. In 1947, the American Dental Association officially separated oral surgery and periodontics as the first two distinct specialties in dentistry. At the beginning of the 20th century, Abraham Flexner (1866-1959) emerged as the individual who drastically transformed medical education and the quality of care in the United States and Canada. He conducted a study commissioned by the Carnegie Foundation and published a 345-page report in 1910, which had a significant impact on raising the standards of medical education. Following the publication of this report, many low-quality medical training centers were closed, and the necessity of conducting scientific research for the development of the field was emphasized. In 1926, a 665-page report on dental education was published, which laid the foundation for the inclusion of research programs in university dental education and significantly changed the quality of dental education and, consequently, treatment.<\/p>\n
Although dentistry, and specifically periodontics, was developing rapidly in the US, the migration of members of Professor Gottlieb’s scientific team from Vienna (Austria) during World War II played a pivotal role in accelerating the field’s development even further. Specifically, Professor Gottlieb, Orban, and other colleagues elevated education and research activities in American universities to a higher level. The combination of Vienna’s biological research approaches with the technical equipment of the US gave rise to a new era in dental science. Furthermore, after migrating to the US, Norwegian professor Sigurd Ramfjord (1911-1997) shed light on many controversial issues in periodontology of that time through his research at the University of Michigan, proving once again that the maintenance of proper oral hygiene by the patient is the guarantee of halting the progression of periodontitis. Ramfjord was the first to introduce randomized controlled trials in periodontology.<\/p>\n
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Over decades, as a result of scientific research conducted by these and other researchers, significant evidence has been gathered regarding the causes and course of inflammatory periodontal diseases (gingivitis and periodontitis). Today, it is well known that an increase in the number of microorganisms due to poor oral hygiene in individuals with a predisposition is the cause of the development of these diseases. Meanwhile, various risk factors such as the use of tobacco, e-cigarettes, or heated tobacco products, diabetes, and other diseases contribute to the rapid progression of periodontitis. The prevention and treatment of periodontitis do not imply only the control of oral bacterial plaque (through hygiene maintenance by the patient or the removal of supragingival and subgingival calculus by a doctor). Not infrequently, surgical intervention becomes necessary to restore the bone around a tooth damaged by periodontitis or to smooth an uneven contour. Performing these procedures requires special education and manual skills, which periodontists study during a 3-year master’s program course.<\/p>\n
The ongoing progress in the field of periodontology in Europe, which has been observed since the 1970s, should be noted. Today, Italy and Spain are the world centers of periodontal education. Particularly in Italy, gum grafting surgeries have been refined and developed, leading to improved aesthetic outcomes. The European Federation of Periodontology (EFP), which is the main professional association in Europe, was officially established in 1991 and currently consists of 43 European country associations, including Georgia’s, as well as 14 non-European country associations. In 2020, 2022, 2023, and 2025, guidelines for the treatment of periodontitis, peri-implantitis, and gingival recession were developed by the EFP.<\/p>\n
One must also mention the growing rate of peri-implantitis\u2014inflammation of the mucosa and bone surrounding a dental implant\u2014in every country across the world. The dental implant was created in 1967 by the Swedish scientist Per-Ingvar Br\u00e5nemark (1929-2014) for the treatment of edentulous patients. Since then, implant manufacturing technology has been refined, and both its integration into the jawbone and aesthetic restorations on implants have improved; however, despite these achievements, the treatment of peri-implantitis still remains a medical dilemma. Today, there are no effective methods for treating peri-implantitis, which makes disease prevention the most important challenge.<\/p>\n
According to several systematic reviews and consensus documents, peri-implantitis develops in approximately 20% of patients and around 10% of implants. Given that more than 12 million implants are placed worldwide annually, peri-implantitis affects more than 1 million implants each year. The main risk factors for the development of this disease are untreated periodontitis, uncontrolled diabetes, and tobacco use. Therefore, monitoring implant patients and implementing preventive measures against the development of peri-implantitis is also the prerogative of a periodontist. It should also be noted that in Europe and the US, the final or third academic year of the periodontology master’s program is dedicated to the study of implantology.<\/p>\n
Georgia is still far from the level of education in periodontology and implantology that the development of these fields requires. In both periodontology and implantology, specialists are retrained in these directions after only a few months of study. Until periodontology is distinguished as a separate specialty, an official residency program is created, scientific foundations are taught, and high-quality research is introduced in Georgia, it is difficult to achieve the quality of service found in Europe or the US.<\/p>\n
Before then, I would like to conclude this article with one very interesting study. Between 1972 and 2002, a study was conducted in Sweden where 550 individuals were observed. Before the study began, all patients underwent caries treatment, correction of defective fillings, and non-surgical periodontal treatment. The patients were taught oral hygiene maintenance methods, and based on their risk of caries or periodontitis progression, they were recalled to the clinic for follow-up visits once every three, six, or twelve months. After 30 years, 375 individuals completed the study. 107 individuals did not develop a single new cavity, while a hundred individuals developed a maximum of three new cavities. The majority of patients did not experience a relapse of periodontitis or progressive bone loss. Over these 30 years, only twenty-one teeth in total were lost due to periodontitis and caries.<\/p>\n
Conclusion: Maintaining proper oral hygiene and utilizing correct methods of dental monitoring and treatment allow for the preservation of teeth for a lifetime. Using interdental cleaning tools alongside a toothbrush is the most effective method for reducing dental plaque and improving the health of periodontal tissues. You probably remembered Professor Riggs, as he argued the exact same thing a century earlier!<\/p>\n
Author: Tea Natsvlishvili, Founder of the Georgian Society of Periodontology and Implantology<\/p>\n","protected":false},"excerpt":{"rendered":"
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