Interview: Prof. Phoebus Madianos next EuroPerio chairman

Prof. Madianos, can you tell me what made you decide on a career in dentistry and why you chose to specialise in periodontics?
Part of it probably is that I come from a medical family, but I think the main reason is about what it meant to get there. I was not very fond of studying classical subjects and was more into subjects that did not need a lot of reading, such as mathematics and physics. What appeals to me is using my mind to solve problems. Therefore, medical studies were a way for me to concentrate on what was most interesting to me rather than classical studies. I was also interested in working with people and therefore chose the medical field. I applied to both medical and dental schools but was more drawn to dentistry because it required a much shorter period of study and because it has to do with medical science but also, in a way, with art, because we have to work with our hands.

Periodontics is one of the more medical specialties, because it has a strong biological background and requires an understanding of basic sciences such as dentistry, microbiology, bone biology and wound healing. This is why, to me, periodontics is the basis of dentistry. It is also a surgical specialty and one of the more delicate of the specialties.

Do you agree with Dr Giovanni Zucchelli that you have to be a periodontist to be a good implantologist?
I totally agree. As far as the surgical aspect is concerned, which involves the placement of an implant, there are three reasons that I agree with Dr Zucchelli, two of which he mentioned. The first one is that it is crucial to have a healthy mouth, the periodontal structure. The second reason is that, after we place implants, we know how to maintain them, and finally, we are trained in the more delicate, meticulous, detailed kind of surgery; we are the best trained to handle tissue surgery. Furthermore, if implants are placed next to natural teeth, we are, again, the best-trained specialists to deal with this situation. The job of the periodontist is still to save teeth, not to extract them and place implants; however, as a result of the progress we have made in implantology and the aesthetic demands made by patients, it is necessary to know how to retain the teeth in a functional, biological and aesthetically acceptable way but, at the same time, to know how to treat them when they have to be replaced. This must be done in a functional, biological and aesthetically acceptable way as well. The goal is to have a functional result which looks as natural as the natural teeth.

How did you get involved with OMNIPRESS and the MASTERMINDS2 programme you took part in in May?
Yannis Roussis asked me to be the honorary president of the conference they organised with the Hellenic Society of Medicine and Dental Technology. As a professor, I choose to give talks only when invited by a scientific society or dental association and I thought it was important to take part in this conference. It was the first event the Hellenic Society of Medicine and Dental Technology had hosted and it was a big honour for me to take part.

What is the clinical significance of the new classification of periodontal diseases to you?
This is a step of paramount importance because it has been 20 years since the previous classification. There was a demand for a more biologically based and flexible classification, which would be able to incorporate new advancements and future knowledge. I also feel that the people involved in organising it, both from the European and the American side, have to be congratulated on a great achievement.

Can you provide an update about the correlation between periodontitis and systemic disease? What do we know today?
We have come a long way in terms of both research and knowledge about this association and are now able to summarise our findings and share them not only within the dental community but with the medical community as well and with the public in general. We have done that through special workshops organised by the EFP together with medical associations such as the World Heart Federation. These workshops and collaboration have been a breakthrough because we have realised the importance of collaborating in order to create guidelines not only for the dental community but also for medical practitioners and patients.

You mentioned the important influence of periodontal diseases on general health. Do you think they also affect psychological health? As an example, do you think that the periodontal health of Greek patients was affected in recent years because of the financial difficulties in the country and, if so, in what way?
Well, a financial crisis always has an impact on the psychological health of people and this is the case in Greece as well. We have evidence that psychological health affects periodontal disease so that could be a factor. At the same time, it is important to understand that, unfortunately, about 95% of dental care in Greece is private. The national healthcare system does not offer much dental care. So obviously the financial crisis not only affects periodontal health through psychological stress but for practical reasons as well because, obviously, not many people can afford dental and periodontal care. Of course, it goes both ways and has an effect on dental practitioners and dental practices.

Is there a trend in periodontics towards minimally invasive techniques as in many other specialties?
It is indeed the trend. The less invasive the techniques, the more effective they are. The less trauma you create with your surgical intervention, the better healing you will have.

Prof. Madianos, thank you so much for your time and answers.

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