Dental Asia May/June 2018

Dental Prole
According to Dr. Mariotti, over the
lifetime of an implant, it is cheaper to keep
a tooth versus an implant. Aesthetically,
with the patient’s preference, there is not
a whole lot of dierence between implants
and natural teeth. For Dr. Mariotti, keeping
the actual natural tooth is an advantage for
the patient and for the dentist as managing
it is easier, as implants, once aected by
peri-implantitis, are very dicult to treat
and maintain.
Susceptibility to the disease
One of the risk factors for peri-implantis are
patients who have concurrent periodontal
disease. Part of the reason why people lose
their teeth is because they had uncontrolled
periodontitis and a patient who lost some
or most of his teeth from periodontal
disease is most likely to be susceptible to
the disease again if implants are placed.
The dentist should nd out the patient’s
history and determine the root cause of
the disease before suggesting implants.
Dr. Mariotti believes in the importance
of the conversation between patient and
dentist wherein the dentist thoroughly
explains the risk as well as the benefits
of having implants. The patient must be
fully informed and understand the whole
situation before moving forward. Having
that in mind though, Dr. Mariotti highlighted
that there is a quality of life issue as well.
If the patient understands the risks and
is willing to make a dierence in the way
they treat their implant, then providing
an implant for the patient can benet and
improve the quality of their life.
Maintenance of teeth and implants
Meanwhile, when asked about the
differences in maintaining natural teeth
compared to implants, Dr. Mariotti
answered that they’re basically the same.
He believes that there are a number of
things patients, with or without implants,
should do. The most important of which is
to develop a personalised treatment plan
with the help of their dentist.
For example, most patients are not fond
of removing interproximal plaque with
flossing. In this situation, dentists have
to gure out how they are going to help
motivate their patients with interproximal
plaque removal in a different manner.
For example, dentists could suggest
interproximal brushes or waterpiks.
Patient needs vary and depend on what
they are dealing with. Dr. Mariotti suggests
that if a patient is young and not suering
from periodontitis, they need to brush for
at least two minutes with a toothpaste that
contains uoride (caries prevention). But if
a patient has periodontal disease they need
a toothpaste that will reduce inammation
as well as plaque.
“Since patients don’t usually brush for
the full two minutes, I think patients need
something with substantivity that will
endure in the oral cavity. So if patients suer
from periondontitis, I recommend products
like Colgate Total which has Triclosan and
reduces inammation,” stated Dr. Mariotti.
Dr. Mariotti adds that mouthrinses should
only be used if the dentist advises it. The use
of mouthrinses add cost and demand more
time from patients. There have been studies
that demonstrate patients will primarily use
o n ly two devi c es to c lea n th ei r teeth . So ,
Dr. Mariotti believes that less products/
equipment make the patient more compliant
and focused on their oral regimen.
With regard to manual and electric
toothbrushes, Dr. Mariotti prefers the
latter. Based on systematic reviews, they
say electric brushes with oscillating heads
are statistically better. But if patients do
prefer manual toothbrush he suggests
that soft bristles are the best. To each his
own. Regardless of which toothbrush a
patient prefers, it will always depend on the
quality and proper technique of brushing
that matters.
Dr. Mariotti emphasised brushing,
interproximal cleaning, the use of certain
suggested products, and regular visits to
dentists to have the best achievable oral
health.
“Everyone is dierent and that’s what
makes humanity wonderful. Everyone has
a slightly dierent response to dierent
stimuli. And I think dentistry is going in
the direction where they are starting to
personalise dentistry to the person. I think
“precision dentistry” is going to be the
next realm where dentists start to, due
to a patient’s genetic make-up and things
they do, prescribe a specic regimen for
patients to do.”
Looking ahead
Dr. Mariotti looks forward to what dentistry
can bring in the near future. He believes
that there will be more innovations on
diagnosis and making home care simpler
and less laborious. Also, he anticipates
the development of more dental devices
and more innovation in toothpastes and
toothbrushes to reduce the incidence of
periodontal disease.
Dr. Mariotti expects the industry and
governments to be better in promoting
prevention of the disease. He started a
safety net clinic where he works with a
physician group for patients who could
not aord dental care. Dr. Mariotti shared
how he emphasised to the physicians the
importance of preventive care.
“For example, if someone has lung
cancer you just don’t ignore the fact that the
person is smoking. Same thing in dentistry,
if someone lost their teeth due to dental
caries you have to talk to them about what
they consume, how they consume sugar
and how they clean their teeth. So, I think
awareness is another thing that has to come
up in the future,” he added.
Dr. Mariotti believes that dentistry will
be moving forward with regenerative
therapies, not only bone regeneration
b u t e v e n t u a l l y r e g e n e r a t i n g t o o t h
(enamel, dentin and pulp). He said it is
unlikely to be any time in the near future
but he would be expecting it and that it
would be a game-changer in dentistry when
it happens. DA
34 DENTAL ASIA
MAY / JUNE 2018