Prevora Blog

At the recent meeting of the International Association of Dental Research (IADR) in Toronto, one of CHX Technologies Regulatory and Clinical Affairs officers, Holly Byrd, attended one of the many sessions and was kind enough to provide us with a post about this session.

An important symposium was held on July 3rd: “How do Medicine and Dentistry Collaborate on Oral/Systemic Health?” (Sponsored by Johnson & Johnson Oral Healthcare). The presentation included Dr. Bill Costerton of the University of Southern California, talking about the role biofilms play in oral and systemic health.

Dr. Costerton, known as the “father of biofilms” after coining the term in the late 1970′s, describes biofilms as a group of bacteria that colonize a surface. Once believed to be responsible for over 65% of infections, the National Institutes of Health now estimates biofilms to be associated with 80% of infections. Biofilms are mobile cultures that have been found in such areas of the body as the inner ears, lungs, implanted medical devices and tooth surfaces (in the form of plaque). Biofilms are 1000x more resistant to antibiotics than monocultures. Dr. Costerton believes that the explanation for the high resistance to antibiotics is due to a sticky slime that is secreted by the bacteria, which acts as a protective barrier for the biofilm. This slime makes up the majority of the biofilm composition and is responsible for allowing passing monocultures to attach to existing colonizations. When a biofilm has grown to capacity, it has the ability to shed bacterial members to other parts of the body, including the bloodstream. These bacterial members can colonize in a new area of the body and create a large biofilm, similar to the one they originated from, creating an infection. This may explain the high burden of Streptococcus mutans on diseased heart tissue as reported by Nakano et al.

K. Nakano et al, “Detection of Cariogenic Streptococcus mutans in Extirpated Heart Valve and Atheromatous Plaque Specimens”, Journal of Clinical Microbiology, v.44, 2006, pp. 3313-3317.

Dr. Costerton gave a very informative and thought provoking presentation on the link between medicine and dentistry with respect to oral and systemic health. See the link below for an article about Dr. Costerton.

http://blogs.uscannenberg.org/annenbergfiles/2007/11/usc_professor_offers_fresh_loo.html

Holly
CHX Technologies
Regulatory & Clinical Affairs

We would like to hear your thoughts about this presention and how these two displicines of the health care system collaborate so feel free to add your comments to this post.

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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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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

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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

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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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Hello,

A few days ago, a colleague of mine passed along a study about the association between maternal periodontal disease , systemic inflammation and an elevated risk for preeclampsia that was published in the April edition of the American Journal of Obstetrics & Gynecology.

First and foremost I had to look up what preeclampsia was. At which time I discovered that preeclampsia is a serious complication involving the development of hypertension (high blood pressure) during pregnancy and can lead to premature delivery. For the purpose of this study the condition was categorized as 2 episodes of blood pressure greater than 140/90 mmHg and at least 1+ proteinuria on a catherized urine specimen.

In the study the presence of periodontal disease was defined as 1 or more tooth sites with greater than or equal to 4 mm pocket depth or 1 or more tooth pockets greater than 3 mm that bled on probing. During this study they also measure the level of C-reactive protein a known non-specific marker of inflammation in order to determine the level of systemic inflammation.

This study showed that expecting women with an increased level of C-reactive protein and periodontal disease were at an increased of developing preeclampsia

If you would like more information about this article you can follow the link below to the Reuters article from May 7th, or the article from the journal.

Reuters Article

Ruma M, Boggess K, Moss K, et al. Maternal periodontal disease, systemic inflammation, and risk for preeclampsia. Am J of Obstet Gynecol. 2008;198:389.el389.e5

Take care,
Tyler

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Hi everybody,

I recently came across a very interesting scientific paper in the April 1 issue of Circulation that defined a link between chronic periodontitis and edentulism and the risk of coronary heart disease (CHD). The topic of this paper is not new, and a lot of people know about the link between perio and CHD; however the research behind this link has never really been consistent or definitive. This is what makes this paper so interesting; finally there is some definitive proof of the relationship between these two diseases.

If you would like more information about this topic you can follow the link below which will lead you to the article in Circulation.

Age-Dependent Associations Between Chronic Periodontitis/Edentulism and Risk of Coronary Heart Disease

Take care,

Tyler

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Hello Everybody,

I was recently asked by one of our Partners in Prevention about the possibility of an allergic reaction to Prevora in a patient who has recently had surgery and is also allergic to “many” things.

The response that they received was as follows: there have been no know allergic reactions to Prevora and its ingredients during the clinical trials which have taken place over many years and involved thousands of patients. There have been only 2 or 3 cases of asthmatics having difficulties during the treatment and approximately 2% of patients having a mild topical irritation of the oral mucosa. Prevora’s safety profile has been rigorously reviewed by both Health Canada (DIN # 02046245) and the Irish Medical Board prior to receiving approval as a prescription drug.

Patients with known sensitivities to chlorhexidine, Sumatra benzoin, ethyl alcohol or polymethylmethacrylate should be consulted prior to treatment. Chlorhexidine the active ingredient in Prevora, is a very well know antimicrobial which has been used in dentistry throughout the World for over 50 years.

If you have any other questions about Prevora’s safety profile or contraindications feel free to leave a comment and I will be happy to reply

Regards,
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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