INFORMATIVE ARTICLES
Compliance as a Major Risk Factor in Periodontal Disease Progression
By Robert A. Levine, D.D.S., P.C.
Thomas G. Wilson, DDS
(Compend Contin Educ Dent, Vol. XII, No. 12, Pg 1072)
Periodontal diseases are site specific, often symptomless, and may progress slowly or rapidly if not treated, with eventual tooth loss being the end point. Controlling these chronic diseases requires monitoring by a dentist who has advanced training in periodontal therapy.
Table 1 - Compliance
- Extent to which a person's behavior coincides with medical or health advice
- Has a direct affect on efficacy of therapy
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Because periodontal maintenance is a key to long-term case success, and patient compliance is a major factor in controlling disease, it is imperative that follow-up care is provided for patients to maintain oral health. Numerous studies have documented the need for 3 month maintenance visits for the average periodontal patient; however, each patient's needs vary. One study found that patients in a periodontist's maintenance program who were good compliers did not lose any teeth, whereas the more erratic the compliance to the recommended maintenance schedule, the greater the chance of tooth loss. Thus, lack of compliance becomes a significant risk factor for future disease progression and should be grouped with the other potential risk factors that are presently recognized as contributing to the progression of periodontal disease.
Table 2 - Chronic Diseases are Nonthreatening
- Patients likely will not do what the clinician asks
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The other risk factors that have been documented are genetic predisposition, smoking, diabetes, stress (personal or work-related), parafunction, pregnancy, iatrogenic dentistry (overhanging restorations), contracting the disease from an untreated spouse, and most recently documented, having a history of rheumatoid arthritis.
Compliance can be defined as the extent to which a person's behavior coincides with medical or health advice. With periodontal therapy, compliance can directly affect the efficacy of the therapy itself (Table 1).
Table 3 - One Third Rule
- 1/3 Complete Compliance
- 1/3 Erratic Compliance
- 1/3 No Compliance
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In chronic diseases that the patient recognizes as nonthreatening, such as periodontal disease, research shows that in medicine and periodontics, the "one third rule" often applies (Table 2).One third of all patients will comply, approximately one third comply erratically, and the final one third will not comply at all (Table 3). Less than complete compliance is more the rule than the exception in terms of compliance to suggested personal oral hygiene and suggested maintenance (supportive periodontal treatment)...
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