Prevora Blog

A family dentist recently asked if caries originates when the mother cross-infects her young infant with Streptococci mutans, would adults cross infect others who had been treated with Prevora, and thereby negate the prevention of this treatment? Here is what the studies indicate:

1. Two studies have shown that cross-infection can occur after the early childhood. A Finnish study found that 2 of 4 married couples shared the same sero- and ribotypes of S. mutans.[1] A Dutch study found that 2 out of 12 families (father, mother, child over 5 years of age) harbored strains of mutans streptococci with a similar profile.[2]

2. On the other hand, two Swedish reports show that cross-infection between adults is difficult. On study found that none of the individuals in 13 pairs of couples had identical genotypes of mutans streptococci.[3] A similar study found that few spouses amongst a group of 25 Swedish pairs and 11 Chinese pairs acquired mutans streptococci from each other over a period of 2 to 5 years.[4]

3. The literature does show that the composition of dental plaques over several years remain remarkably stable despite the fact that new species are continually being introduced into the oral cavity and indigenous microbes are repeatedly being removed by oral hygiene procedures.[5] This stability is attributed to the characteristics of the biofilm, a complex web of many different microorganisms which serves to prolong vitality and mortality. It has been shown that the biofilm on the tooth surface re-emerges rapidly after brushing and flossing; this is partly due to the difficulty of cleaning the tooth surface – even after careful oral hygiene technique, there are still approximately 10⁶ bacteria per mm² adhering to the enamel.[6] At the root surface, the residual biofilm after cleaning is also substantial; for example, a professional debridement of the root surface can remove about 99% of viable bacteria, but about 10⁵ cfu remain the tubules, surface indentations or adjacent soft tissue. Recolonization of the root surface then occurs and viable counts can reach pre-treatment values within 3 to 7 days.[7]

So what does this evidence mean for Prevora and the opportunity for re-infection within a couple or a family after treatment? It would appear that while cross-infection is possible, it is unlikely between adults. Cross-infection may happen, moreover, immediately following a dental cleaning, not just Prevora. Without Prevora, the patient’s risks are clearly heightened for (more) root caries. Withholding Prevora treatment because of some unlikely event of cross-infection, seems to raise the risks un-necessarily. Perhaps another strategy could be considered: have both spouses treated.

Ross Perry

Hello Everyone,

I would like to take this opportunity to introduce a new co-author who will be starting to write posts for this blog. The new author is Todd, one of my fellow Professional Education Advisors with the Partners in Prevention. Todd represents the offices within the Partners in Prevention who are located in Central Toronto and the Northern part of the GTA.

Going forward both Todd and myself will be writing posts in order to give you the readers, a different point of view on the topics and to provide you with a perspective of how the material affects the offices in the different geographical regions.

I know that I am looking forward to Todd’s posts and I would like to take this time to thank him in advance for his contributions.

Until the next time,

Tyler

Hello everyone,

Recently the Partners in Prevention held its first guest speaker event which featured Dr Sally Mauriello an associate professor and coordinator of the Dental Hygiene Program at the School of Dentistry at the University of North Carolina. Dr Mauriello is one the lead researchers of the link between root caries and systemic health. She presented the finding of her research during presentations to the upper year hygiene classes at both George Brown College and the Canadian Academy of Dental Hygiene, as well as a contingent of the Partners in Prevention in Oakville. All three of these presentations were very well received by the audience and elicited many insightful questions and discussion.

Dr Mauriello’s findings have been summarized in three abstracts that have published over the past ten years a brief summary of these finding is below.

• In 1996, Mauriello reported that older adults with ≥ 2 new root caries lesions were four times more likely to die during the 3 to 5 year follow period, than those with fewer than 2 root lesions.[1] A subsequent study in 1999 by the Mauriello research team extended and confirmed these findings.[2]
• A 2006, Mauriello reported that amongst Americans aged 52-74 the incidence of heart attack over a 6 year period was 4.7% amongst the root caries group versus 2.4% for those without root decay.[3] In a regression analysis, root caries was significantly associated with a heart attack in this population, adjusting for periodontal pocketing, race, age, sex and the usual risk factors such as smoking, income, diabetes, hypertension and LDL

In her recent visit to Toronto, Dr. Mauriello provided some unpublished data from the Atherosclerosis Risk in the Community Study (ARIC), a large prospective study of risk factors for cardiovascular disease funded by the National Institutes of Health in the late 1980s and 1990s. ARIC tracked over 15,000 middle-aged Americans for cardiovascular disease over 10 years. Scientific articles from ARIC are still being published but the root caries connection has yet to be described. Dr. Mauriello reported that in ARIC, root caries out-weighed cholesterol as a risk factor for heart disease.

This link between root caries and overall health is still being investigated and is not completely understood at this point. However there is beginning to be more and more evidence of this link in the published literature. One of the most interesting articles has come from a Japanese research group which detected significant quantities of Streptococcus mutans in surgically removed heart valves and atheromatous plaque of patients with cardiovascular problems (Chart 1). This may indicate a pronounced or prolonged Bacteremia effect from recurrent root caries. The results of this study indicate that S. mutans is a possible causative agent of cardiovascular disease[4].

Chart 1

Source: Nakano K. et al, 2006. Detection of Cariogenic Streptococcus mutans in Extirpated Heart Valve and Atheromatous Plaque Specimens. J Clin Micro, 44: 3313 – 3317.

You can read more about both Dr Mauriello and the Japanese studies by following the links to the articles below.

Dr Sally Mauriello’s Research

Detection of Cariogenic Streptococcus mutans in Extirpated Heart Valve and Atheromatous Plaque Specimens

I hope that this post has given you a little more insight into the relationship between root caries and overall health and that it makes you look forward to the next Partners in Prevention guest lecture event.

Until the next time, take care
Tyler

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1 Mauriello S et al. 1996. Risk modeling for root caries and mortality in older adults. IADR Abstract 896.
2 Mauriello S et al. 1999. Root caries incidence as a risk predictor for mortality. IADR Abstract 3582.
3 Mauriello S et al. 2006. Root caries prevalence and incident myocardial infarction. IADR Abstract 1471.
4 Nakano K. et al, 2006. Detection of Cariogenic Streptococcus mutans in Extirpated Heart Valve and Atheromatous Plaque Specimens. J Clin Micro, 44: 3313 – 3317

I was recently in a dental clinic and one of the hygienists asked me: What is this “Partners in Prevention” thing that I keep hearing about?

I explained to her that Partners in Prevention is a growing network of dental professionals throughout Canada who are trained to provide more preventive services to older adult dental patients. I talked to her about how the program is a unique education, training and promotion program designed to expand those dental services most preferred by Boomer Plus patients (those age 40+).

This network responds to the most significant opportunity now in dental care — more prevention to an aging community.  The hygienist I was speaking to agreed that older patients tend to “disappear” from the normal recall pattern in her office — seniors just don’t visit the office as much as younger patients do. And with more and more seniors, her hygiene team was beginning to wonder about its bookings.

I asked this hygienist if she and her hygiene team had ever asked these older patients what they preferred in their dental care? She said, rather embarrassed, that she had never thought of doing so. I said that our company had asked many older Canadians this fundamental question in several surveys and found that overwhelmingly, these older patients wanted more prevention, far more than other dental services such as cosmetics, implants, crowns, etc.

So, with the aging of her patients, this hygienist understood the importance of shifting her efforts to new preventive services such as Prevora, the antibacterial tooth coating which is the only approved preventive treatment for root caries.

This conversation with the hygienist explains the rationale to Partners in Prevention. It is a network  of dental offices shifting their services to more preventive care, as this is what their aging community best responds to.

Our company’s ongoing market research has indicated that 8 out of 10 of older patients want to pursue preventive strategies and almost all of them are willing to pay for this, regardless of insurance. In a recent survey conducted by Ipsos – Reid, it was demonstrated that 2 out of 10 patients would look for a dental office that is a Partner in Prevention and 4 out of 10 will ask you about it and expect your clinic to be a part of this growing network.

What is the cost of joining the Partners in Prevention network?  There is no charge for the following services but every Partner is committed to recommending prevention of root caries with Prevora, when it is appropriate. And given that Prevora is the only proven and approved preventive treatment for this most common disease in aging Canada, that commitment only makes sense.

The Partners in Prevention program means you will be raising the profile of your clinic in your community. You will be improving the level of care you provide to your patients while developing a more efficient and productive hygiene department, gaining the required continuous education credits and at the same time increasing the value of your practice.. There are a wide range of services within the Partners in Prevention program that are offered at no charge to a partner practice some of which are listed below.

Partners in Prevention consists of education programs that include:
● Semi-annual Educational Seminar Series
● Guest Lecture Series
● Lunch and Learn Sessions
● Training Sessions
● Hygienist education courses

As well there are education resources consisting of:

A Partners in Prevention Monthly Newsletter, a Partners in Prevention website, a Prevention of root caries video and a Prevora video, Patient brochures, Prevora poster and a Prevora blog.

Along with this there will be extensive training on identifying the patients at risk, counseling patients on appropriate preventive therapy and the application of Prevora – the only approved treatment for the prevention of root caries.

Once your clinic is on board with the Partners in Prevention program it will be included in:

• On-page advertising in your local newspaper media
• Inserts listing the Partner in Prevention clinics in your local newspaper media

At the end of my chat with this hygientist, it was clear to her that becoming a Partner in Prevention was a way to set a new standard of care for their older patients. A standard of care that they want and are willing to pay for.

I hope that this helps out with your understanding of what the Partners in Prevention is all about and if you would like more information see the website www.partnersinprevention.ca 

Take care,
Tyler

Hi Everybody,

I just wanted to let everybody know that we have another guest author this week. Elizabeth Perry, an HR professional has been kind enough to write us a post about the changing environment of dental plans in Ontario.

I hope that all of you enjoy her post and as always feel free to make comments and engage in a discussion on this or any other topics that you see on this blog

Take care,
Tyler

Hello,

I just wanted to let everybody know that I will be having a special guest author write a post. Sandie Ballargeon, a dental practice management coach and the featured speaker during the recent Prevora seminars, has been kind enough to write a brief summary of her presentation from those seminars. This will be the next post on the blog so stay tuned for that.

Take care,

Tyler

Hello everybody,

Thanks for visiting my little platform to inform all of you about new and interesting things about preventative dentistry, science and my daily adventures as product specialist for Prevora. I hope that you find the topics interesting. If you have any questions or suggestions let me know and I will respond to the best of my ability.

Thanks again and take care
TYLER