Prevora Blog

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 Mauriello provided some unpublished data from the Atherosclerosis Risk in the Community Study (ARIC), a large prospective study of risk factors for cardiovascular disease funded by the National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

Hello,

As most of you are aware the International Association for Dental Research (IADR) held their General Session last week here in Toronto at the Metro Toronto Convention Centre. This session included symposia and poster presentations by researchers from around the world.

From the General Session we will be making a couple of blog posts. One will discuss the impact of psychiartric medication on oral health status as presented by Dr Tina Papas of Tufts University. The other will discuss the collaboration between dentistry and medicine when dealing with oral and systemic health, which was presented by Dr Bill Costerton of the University of Southern Calironia.

Also we at CHX Technologies were very happy to host a reception at the University Club on July 2nd in conjuction with the IADR Session, and I would like to take this opportunity to thank all of those people who attended the reception and made it a very enjoyable evenning.

Take care,
Tyler

At the recent International Association of Dental Research (IADR) meeting held in Toronto, Dr. Tina Papas (Tufts University School of Dental Medicine, Boston) presented the results of a nine month study on the changes in oral health status in patients taking psychiatric medications compared to patients who were taking medications known to cause xerostomia (dry mouth). It is well known that many psychiatric drugs such as those used to treat anxiety, depression and those with an effect on the autonomic nervous system all have a xerogenic (drying) effect. Medications that cause dry mouth have been shown to contribute to a higher caries rate.

In her abstract Dr. Papas was able to demonstrate in a population of 653 patients that psychiatric drugs led to a significantly higher increase in periodontal attachment loss and recession and a significantly higher increment of caries than even drugs known to cause xerostomia. This is despite having acceptable oral hygiene habits and receiving regular dental visits.

This reinforces data by Rindal published in 2005 (Community Dentistry and Oral Epidemiology, 33:74-80) demonstrating that for patients taking antidepressants the restoration rate is an amazing 60% higher than for those taking no medication at all.

Clearly, understanding a patient’s medical history and specifically the use of psychiatric drugs could be critical in identifying this risk factor for caries and assist in the development of preventive treatment strategies.

See the link below for the abstract of Dr Papas’ presention

IADR Session 1513 Changes in Oral Health Status in Volunteers on Psychiatric Medications

Take Care,
Tyler

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.

“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

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