Chlorhexidine products for caries – what works?

Posted on May 17, 2012

Most dental professionals know about chlorhexidine, the antibacterial substance in mouth rinses and gels which reduces plaque, improves oral hygiene and stains the teeth. Most don’t know, however, that there are various kinds (or salts) of chlorhexidine for use in the oral cavity. The most common chlorhexidine is gluconate and it is used in the rinses and gels. Another type of chlorhexidine is diacetate, which is used in Prevora.

Both are highly antimicrobial but the diacetate salt is particularly effective against Streptococcus mutans (Chart 1). As shown, various types of fluoride are not.
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What does patient consent mean when there is a real choice of treatment?

Posted on May 14, 2012

A recent article about informed consent (Dentistry.co.uk) contained the following:

With many more people undergoing elective treatments for aesthetic purposes, it’s absolutely vital that dental professionals go through the necessary procedure to obtain appropriate and valid consent before proceeding with any treatment.

Patients must receive a clear explanation of the proposed treatment, the cost, and any risk and alternative treatments – and then allowed a period of time in which to consider whether they wish to proceed

‘It’s important to remember that obtaining consent is not a one-off event. Dental professionals should be confirming at every appointment during the course of the treatment, that the patient understands the risks and benefits and that they can change their mind at any time. It’s also advisable to have consent protocols which help to ensure consistency across the dental team.’

In a new era when there is more effective preventive care with Prevora, informed consent needs to be provided for many, if not all, restorative procedures. That is because, no longer is dental decay unavoidable or un-preventable, and thereby no longer is restorative services the only approach to managing this disease.
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Chlorhexidine for the control of plaque

Posted on May 10, 2012

A recent systematic review of chlorhexidine’s ability to control dental plaque (also called the dental biofilm) found that this antimicrobial substance was consistently better than controls or other agents in managing gingivitis.

Chlorhexidine is a strong antimicrobial substance incorporated in oral rinses, oral gels, a tooth coating (Prevora), and a small implantable wafer (Periochip). Two forms of chlorhexidine are normally used: the gluconate salt and the acetate salt. The latter is more bactericidal to Streptococcus mutans, the primary microorganism in caries, but both salts are significantly more effective than fluoride in reducing cariogenic bacteria (Chart 1).
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How does the UK dentist regain his/her business confidence? Improve the value proposition of dental care.

Posted on May 7, 2012

The latest semi-annual survey of business confidence amongst UK healthcare professions, conducted by Lloyds Bank, showed dentists have little confidence about the future. The survey attributed this to the weak economy and to the pending revisions to the NHS contract in 2014.

There is little the dentist can do about either development. But there is a lot to be done about the value proposition of family dental care.

A value proposition is defined by Wikipedia as “a promise of value to be delivered and a belief from the customer of value that will be experienced.” It starts with understanding what the patient wants and expects from his/her professional dental care.

We have been surveying adults in the waiting room of several clinics in the England, to understand what the value proposition is for this type of patient. We have asked these patients to give us their reasons for attending the dental office, and what they hope and expect from their dental visit.
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Unbeneficial medical procedures – how do we handle public perception and professional habit?

Posted on May 3, 2012

Recently, we heard that 81-year-old billionaire Warren Buffett was diagnosed with prostate cancer after having the finding initially detected through a screening blood test to measure a cancer marker called prostate specific antigen (PSA). Mr.Buffett’s PSA testing occurred despite guidelines from a national task force that have been in place since 2008 recommending against the use of this screening test in men over age 75 due to its lack of benefit. But Mr. Buffett stands in good company. Nearly 44% of American men his age got screened with a PSA test in 2010, a rate that has remained unchanged since 2005, according to the Journal of the American Medical Association.
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Oral health risk behaviour – who follows this path?

Posted on April 30, 2012

In a study of oral health seeking behaviour practiced by Finnish adults, a strong connection was reported between health promoting or health risking behaviour and socio-economic status.

Significant factors for health-promoting behaviour for both men and women were: ages 55 – 64, intermediate or higher education, being married, and being employed.
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What to expect from combining fluoride and chlorhexidine to prevent adult caries

Posted on April 26, 2012

The current issue of Caries Research presents the results from a randomized controlled clinical trial of adults assessed to be at risk of dental decay.

The study enrolled 231 adults (mean age of 37 to 38 years) who attended a clinic in an American dental school. Most participants were considered high risk for dental decay because of cavities at screening and because of salivary mutans streptococci, lactobacilli and fluoride levels.
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Patients put a high value on cancer meds — (the same applies to good oral health)

Posted on April 23, 2012

A recent study of the patients’ willingness to pay for new cancer treatments found a stronger demand to pay, than calculated by policymakers.

As reported, “Patients and their families approach the whole question from a more personal angle, of course. And, not surprisingly, their estimations of value are quite different from those the cost-watching regulators come up with.”
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Patients Urged To Ask About The Cost Of Health Care

Posted on April 19, 2012

The continued upward spiral of health care costs has prompted policymakers in the US to urge Americans to ask their doctors about the cost of medical procedures, particularly those outside of normal insurance coverage.

But patients are not accustomed to asking about cost before visiting their doctor or lab or pharmacy. So there needs to be a lot of education about consumerism in medical care.
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What kind of Strep are we talking about? Does it really matter?

Posted on April 16, 2012

There seems to be increasing chatter about the importance of bacteria in the mouth to overall health. For example, the UK’s Daily Mail recently reported that a seemingly harmless Streptococcus bacteria (S. gordonii) in the dental plaque is linked to blood-stream infections and blood clots.

The phenomenon of bacteremia (microorganisms entering the blood stream) has been known for many years. Indeed, the role of S. gordonii in bacteremia is also well documented. Perhaps what is new here is the ability of these oral bacteria to initiate the clotting cascade.

But so what? What do you say to your patients who reads these kinds of articles in the Daily Mail?
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