Prevora Blog

Hi everybody,

Recently we received a question from a patient through the Prevora website asking about what steps they can take in order to comply with the treatment protocol of Prevora. Below is their question and the response that they received.

Question: How do I care for my teeth throughout this process? Are there foods or liquids I should avoid? What about smoking, kissing or coffee?

You asked about care of your teeth while under protection with Prevora. That’s easy:

• Avoid brushing your teeth 24 hours after a Prevora application — let the coating bond to your teeth and do its job
• Avoid flossing for 3 days after a Prevora application ¾ again, in order to not remove the coating from in between your teeth
• Resume brushing your teeth with a new tooth brush to avoid contaminating your mouth the bacteria on your old tooth brush
• Avoid hard foods (a crusty roll, an apple) in the first 4 hours after treatment-you don’t want to remove the coating that was just put on the teeth
• Avoid sugary or acidic drinks (Coke, coffee, lemonade, orange juice) until 4 hours after treatment.

And that’s it. Otherwise, you can follow your regular diet and oral hygiene.

As for Smoking? That’s a risk factor for tooth decay at the gum line which scientists are just beginning to understand. Essentially, smoking shrinks the gums and exposes your tooth’s roots to the bacteria which puts them at risk.

Kissing? Always encouraged, even during Prevora!! But you raise an interesting point. The bacteria that causes tooth decay is communicated from mother to child when the child is very young. This cross-infection is minimal, however, after early childhood this doesn’t take place because our oral ecology becomes too complex later in life, to allow for it. There are no studies that I am aware of, to show that kissing amongst adults or amongst parents and their older children, leads to tooth decay.

As for coffee, as listed above you want to avoid drinking it immediately after your application of Prevora but within a few hours you can have that much needed cup of Joe.

Thanks again for the great questions.
Take care

Tyler

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Over the last couple of weeks during my meetings with our Partners in Prevention clinics there have been some questions around the length of Prevora therapy that seem to be on the minds of a few of the clinics. In order to address these questions I had a Q&A session with Dr John (Jack) Symington and asked him how he would proceed. Dr Symington is Professor Emeritus in Oral Surgery at the University of Toronto.

Q: What is the ongoing treatment regimen for Prevora after the patient has received the initial 4 applications in the 2 month span?

 A: The treatment regimen for each patient is going to be slightly different as it will need to address the individual’s specific risk factors. Some patients will be at higher risk of root caries due to the risk factors of gum recession, xerostomia, periodontal disease, poor oral hygiene and lack of manual dexterity. Clinical judgement on the part of the dental professional will need to be used and a more aggressive or passive treatment regimen may be better suited for a particular patient. However with that said there are some guidelines that can be followed.

After four applications of Prevora the chlorhexidine acetate (chx) can remain in the microtubules of the dentin for more than 42-60 days (6-8 weeks) which will help to combat the bacteria within the biofilm on the tooth surface. This is the rationale for the 4 applications within a short time span to maximise the concentration of chx and as a result control re-growth of the bacteria.

Six months after the final initial treatment of Prevora the efficacy starts to diminish due to the decrease in the concentration of chx. It is for this reason that the patient should receive an additional application of Prevora at this time.

At one year (12 months after the initial treatment) the dental professional must use their clinical judgement as to how many treatments the patient will receive at this time (1-4). The determining factor is the number of new caries that the patient has experienced over that 12 month period.

Examples of treatment regimens:

If the patient has no new caries and was previously experiencing 3-4 over the course of 12 months then a single application would be used at the 12 month recall appointment and then observe that patient’s progress over the next 6 months.

If the patient has no new caries at 6 months but then has new root caries at 12 months then it would be prudent to treat with 4 applications and observe again in 6 months.

With Prevora’s 41% reduction rate for root caries the process of minimizing the amount of new caries that develop is something that may have to be observed over the course of a few years. An example would be if a patient exhibits 5 new caries in the year prior to treatment it is possible that this could be reduced to 3 new caries in the first year of the treatment. Then by year 2 of the treatment the number of root caries could be down to 1 or less.

As with any treatment it is important to manage the expectations of the patient and to speak to them about the disease and how this course of action will benefit them and improve their oral health.

I hope that all of you will find this discussion beneficial and if you have any comment please feel free to pass them along

Take care,
Tyler

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Some recent surveys on dental benefits in Canada report the following:

Although estimates vary widely about the amount of the increase, it is generally accepted that dental benefit costs and health benefit costs continue to rise each year. The Toronto Board of Trade reported that 78% of employers had seen their costs increase in 2007; the Conference Board of Canada reported increased costs by 51% of employers. (Toronto Board of Trade, Benefits and Employment Practices: volume 6 of the Compensation survey for the Toronto Region, 2007 and Conference Board of Canada, Compensation Planning Outlook 2008).

Past cost containment strategies such as increased co-payments and deductibles, lagging the provincial fee schedule, etc. are considered inadequate to limit cost increases. Benefits consultants such as Buck Consultants are now urging employers to augment their efforts by emphasizing prevention and education in their benefits plans. The growth of wellness programs, fitness centres, vaccination programs, and health counseling and education are the evidence of the new priorities in benefit plans. (Buck Consultants, Canadian Health Care Trend Survey Results 2008, p. 7).

16.4% of GTA employers plan to introduce a dollar limit/cap on coverage for specific benefits in 2008; 16.4% also plan to introduce or increase employee contributions. 17.6% plan to introduce a wellness/health promotion program. (Toronto Board of Trade, Benefits and Employment Practices: volume 6 of the Compensation survey for the Toronto Region, 2007.)

Flexible benefits plans appeal to employers (who see them as a cost-saver) and employees (who see them as providing more control and value) . Hewitt Associates, a benefits consulting firm, reported in 2006 that 38% of Canadian employers offered flexible benefits, with an expected increase to 64% by 2009. (Hewitt Associates, Attracting and Retaining the New Workforce, 2006)

A new twist on flex benefits is the Health Spending Account (HSA) or Health Care Spending Account (HCSA). Typically, the HSA is offered alongside traditional health care and dental benefit plans, allowing employees to draw on the funds allocated to their account to pay for expenses not covered by the standard plans – for example, deductibles, co-payments, as well as any other eligible health supplies or services not covered by a government or private plan.

Ellen Whelan, a benefits consultant with Mercer HR Consulting, has written that Health Spending Accounts will be become much more common for providing retirement benefits in the future (Ellen Whelan, “Balancing Act” in Benefits Canada November 2006. p. 105).

According to Statistics Canada, one third of Canada’s population will be 50 years and older by 2012, and there will be more seniors than children in our country. The coming wave of retirements of baby boomers is well-documented. Yet only 16% of surveyed GTA employers offered dental benefits to their retired workers in 2007, according to the Toronto Board of Trade. In an Ontario-wide survey which focuses on smaller employers, the Central Ontario Industrial Relations Institute report that 20.2% of employers offer dental benefits to salaried retirees and 18.3% of employers offer them to hourly retirees. (Central Ontario Industrial Relations Institute, Annual Survey of Salaried Employees in Ontario, 2008 and COIRI, Annual Survey of Hourly-Paid Employees in Ontario, 2008).

The low rate of dental plan coverage for retired workers (16% vs. 83% for active salaried employees in the GTA) is a stark example of the effect of cost containment efforts by employers. From this low base, another 3.3% of GTA employers plan to eliminate benefits for future retirees in 2008. (Toronto Board of Trade, Benefits and Employment Practices: volume 6 of the Compensation survey for the Toronto Region, 2007.)

In the GTA in 2007, 83% of employers offered at least a basic level dental plan by to their salaried workers and 47% of employers offered the same to their hourly workers. 51% of employers offering plans provided 100% coverage; for the remainder who offered co-insurance, the most common co-insurance level was 50%. (Toronto Board of Trade, Benefits and Employment Practices: volume 6 of the Compensation survey for the Toronto Region, 2007.)

Elizabeth Perry

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“As I Think, Therefore I Am”

Have you ever wondered why your patients seem to think that it is o.k. to cancel their hygiene appointments or simply not show up? Nothing hurts, it’s JUST a cleaning, it’s not important. Or perhaps it’s because they have been hearing the same message communicated in the same way during each appointment and they have stopped listening.

In many ways, it is our own fault that patients don’t value appointments when we continue to call it a cleaning. How can we expect our patients to think any differently about hygiene appointments when we don’t communicate the true value? We must believe in the value of our services before our patients will.

Dental Hygienists do much more than clean teeth and they are not just tooth cleaners! They are highly trained, specialized health care therapists who promote oral health, prevent infection, perform therapeutic procedures, prevent disease, etc. Think about this, would you refer to a Registered Nurse as a bandage changer, an intravenous starter, a bed-pan changer, a medicine giver…..?

According to the definition of the CDHO -

“A dental hygienist is a registered oral health professional who performs a variety of roles including clinical therapy, health promotion, education, administration and research in a variety of practice environments. In all roles and practice environments, the dental hygienist works with the client/patient and other health professionals and using a problem-solving framework, bases all decisions, judgments, and interventions on current dental hygiene research and theory. As a registrant of a self-regulating profession, a dental hygienist must practice safely, ethically and effectively for the promotion of the oral health and well-being of the public”

As dental professionals, we must believe in the value of our services and communicate these important messages to our patients. Often our belief in our own services is clouded by our prejudgments which make our practices insurance driven and not patient focused. This allows the individual diagnosis and treatment plan to be dictated by insurance benefits and not the clinical needs of the patient. We make this problem worse by submitting predeterminations to insurance companies to “see” if the treatment is “covered.” That is clearly a prejudgment on our part that we think the patient won’t value the treatment unless their insurance company does.

Reality Check

In today’s economy we are facing a major economic downturn. Employers are faced with very tough choices and to avoid employee lay-offs, employers have to look at ways to reduce costs. One relatively easy way to cut costs is to reduce benefits plans. The most expensive component of a group benefits plan is the dental benefit and it is the first to be cut by plan administrators. Dental practices that are assignment based and insurance driven are at risk and will feel the impact of the economic downturn unless they change the way they think about their services and their patients.

The Canadian population is aging rapidly. The aging baby boomers have increased clinical needs and usually do not have dental benefits. They value prevention, health, esthetics and are willing to invest in purchases that fit with their active lifestyles. This important demographic group understands that prevention of disease is the key to good health. This is the demographic group has the highest percentage of wealth in our country. They value prevention, which is evident in the fact that they are the most likely group to get a flu shot, take a multivitamin, exercise and perhaps even take an aspirin per day as part of a heart health regimen. Today’s dental patients are well informed about tooth decay, its causes and implications including financial impact. Aging baby boomers are willing to invest in their continued good health and longevity and the combination of reduced benefits and increased awareness in prevention sets the stage for prevention.

When was the last time that this important target group has been offered a new preventive service?

There is a proverb that states “an ounce of prevention is worth a pound of cure.” Make your practice value driven by helping your patients to understand the value of preventive services offered by your highly skilled, specially trained regulated health care therapists – your dental hygienist.

Sandie Baillargeon

Business Analyst/Dental Practice Management Coach
(905) 336-7624
(905) 336-7938

visit my website at www.dentalofficeconsulting.com

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Hello everyone,

During a recent Lunch & Learn presentation the doctor used a great analogy to describe how Prevora interacts with the tooth surface.

The analogy went like this: The dentin of the root surface is a lot like a sponge and as Prevora stage 1 is applied to this sponge it is absorbed into the pores. Then Prevora stage 2 is like nail polish, in that it is painted on the tooth surface and acts as a protective coating for the tooth. Then just like nail polish, Prevora stage 2 gradually wears off over time through normal use.

I thought that this analogy was a very good way of explaining how Prevora interacts with the tooth surface in a manner that is easy for everybody to relate to.

I hope that this little analogy will provide some insight into how Prevora interacts with the tooth surface

Take care,
Tyler

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In a recent seminar that was held by Prevora, practice management consultant Sandie Baillargeon was talking about how to implement Prevora into your practice.

One of the points that really got my attention was when she began to talk about the cost of missed hygiene appointments. The general consensus among the hygienist in the room was that there was typically 1-2 appointments missed each day and from this input Sandie was able to come up with this calculation about the loss in revenue. The calculation was as follows:

Value of the appointment: $200 x 2 = $400 a day

Per Week: $400 x 5 days = $2 000

Per Month: $2000 x 4 weeks = $8 000

Per Year: $8000 x 12 Months = $96 000 in Lost Revenue

From this calculation you can see that anything that can help to avoid missed appointments would be of great benefit to the practice. Some of the things that Sandie suggested as a way to prevent these cancellations, was to let your patients know that the appointment was more than just a cleaning and that it was part of a preventive therapy. You also need to let the patients know “What’s in it for me?” by telling them about how this will affect their oral and overall health. Also work with the patient to schedule the appointment at a time that they will most likely be able to keep.

These were just a few of the things that Sandie talked about that I thought were of great interest and would have some practical implications. When you start talking about $96,000 in lost revenue, I think that most dental clinics would find this interesting as well.

Until next time, take care
TYLER

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