Archive for July, 2010

Insurance Limitations

Tuesday, July 27th, 2010

You may be surprised to find that treatment of periodontal disease may cost you less if you go to a periodontist that is not restricted by an agreement with your dental insurer. (i.e. non-participating).   A non-participating provider will not be limited to only the treatment options allowed by your insurance carrier’s list, and therefore will be able to provide treatments that may be: 

A.  More up-to-date
B.  Less invasive
C.  More effective
D.  Prevention oriented   

There is an abundance of evidence that shows that conservative, preventive care can greatly diminish or completely eliminate the need for periodontal surgery.  And if surgery is indicated, the surgical treatment is far more effective.  Because dental insurance does not allow adequate reimbursement for the most up-to-date treatments, a participating provider may be limited to providing outdated procedures, (usually recommending surgery immediately), just to maintain profitability.   

A perfect example of a conservative, preventive treatment option is the perioscope.  The perioscope is a high tech instrument that provides a non-surgical alternative to traditional periodontal surgery.  Dental insurance does not recognize the perioscope on its list of “covered procedures”.  Therefore, a participating dental provider would not offer patients this state-of-the-art treatment option; an option that avoids cutting, can be even more effective than surgery and costs less. 

Do yourself a favor – get a second opinion with a periodontal provider who offers the perioscope.  You may be surprised to find that you have other effective treatment options.   And please remember that although we are not on your provider list, we will still file your claims for coverage where applicable. 

To find out more, visit our website, www.pittsburghimplantsandperio.com

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Periodontal Disease and Recurrent Cardiovascular Events in Survivors of Myocardial Infarction (MI): The Western New York Acute MI Study

Tuesday, July 13th, 2010

Background: Periodontal disease and cardiovascular disease (CVD) have been the focus of much research, but little is known about their roles in the recurrent event risk in patients with CVD.  This study investigates whether periodontal disease is related to recurrent CVD events and mortality in survivors of incident myocardial infarction (MI). 

Methods:  Participants (668 males and 216 females; mean age: 54 +/- 8.5 years) were recruited (1997 through 2004) from two western New York county hospitals and completed an interviewer-administered questionnaire regarding lifestyle habits, clinical measurements, and a comprehensive dental examination.  The periodontal disease status was measured by the mean clinical attachment loss (AL).  Follow-up surveys assessed hospitalizations or medical procedures; cardiovascular events were validated by medical records.  A National Death Index (NDI) Plus search was conducted.  The outcome was recurrent fatal and non-fatal cardiovascular events (International Classification of Diseases codes 390-450). 

Results: After an average follow-up of 2.9 years, 154 events were reported.  Among never-smokers, the adjusted hazard ratio (95% confidence interval) for the mean clinical AL (millimeters) was 1.43 (1.09-1.89).  No associations were found in ever-smokers (clinical AL by smoking interaction: p <0.05). 

Conclusion: These findings indicate that periodontal disease may be an important factor in determining recurrent cardiovascular events in MI patients and not merely a marker for the effects of cigarette smoking.

J Periodontology 2010;81:502-511.

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Maternal Periodontal Disease and Preterm or Extreme Preterm Birth: An Ordinal Logistic Regression Analysis

Tuesday, July 13th, 2010

Background: Despite previous studies addressing the link between preterm or low birth weight infants and maternal periodontitis, extreme preterm births have received far less attention.  This study is designed to address the possible association between maternal periodontal disease and preterm or extreme preterm birth. 

Methods: Immediately after childbirth, 1,207 women underwent an examination in which periodontal disease was assessed according to two alternative definitions: 1) four or more teeth with at least one site showing probing depth (PD) > or = 4mm and clinical attachment loss (AL) > or = 3mm, and 2) at least one site showing PD and clinical AL > or = 4mm.  For each of these definitions, two types of multivariate analysis were conducted: a linear regression analysis for the number of gestation weeks, and a more specific ordinal logistic regression analysis for the ordinal variable gestation time categorized as normal (term) (n=1,046 women) or mild-moderate (n=146 women) or extreme preterm (n=15 women). 

Results:  Periodontal disease was associated with fewer weeks of gestation by linear regression (definition 1: P = 0.012: definition 2: P<0.001 and with preterm (n=161: mild-moderate and extreme) or extreme preterm births (n=15) by ordinal logistic regression (definition 1: odds ratio [OR] = 1.83, 95% confidence interval [CI]: 1.28 to 2.62: definition 2: OR = 2.37, 95% CI: 1.62 to 3.46). 

Conclusion: Our findings suggest that periodontal disease is associated with a premature or extremely premature birth. 

J Periodontology 2010;81:350-358

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SUPPORTIVE PERIODONTAL THERAPY ENHANCES LONG-TERM OUTCOMES OF IMPLANT THERAPY

Wednesday, July 7th, 2010

Why patients with periodontal disease and dental implants should have a periodontist who does plaque and bleeding scores.  

History of periodontitis has been described as a risk indicator for peri-implantitis.  Risk assessments of implant therapy in well-defined patients are necessary to clarify this clinical relevance.  Roccuzzo et al. conducted a 10-year prospective, three-arm cohort study on implants in periodontally compromised patients.  One hundred twelve partially edentulous patients were divided into periodontally healthy patients (PHP), patients with moderate chronic periodontitis (moderate PCP), and patients with severe chronic periodontitis (severe PCP).  Two hundred sixty-four titanium plasma-sprayed implants were installed to support fixed prosthesis after successful completion of initial periodontal therapy.  Eleven patients (18 implants) were lost at the 10-year follow-up.  Clinical measures, radiographic bone changes, and adherence to supportive periodontal therapy (SPT) were recorded in 101 patients with 246 implants, (28 PHP, 37 moderate PCP and 36 severe PCP) at the 10-year follow up.  Results showed that 18 of the 246 implants were lost due to biological complications.  Full-mouth plaque score was similar in the three groups, but full-mouth bleeding score was higher in severe PCP.  The survival rate was 96.6%, 92.8%, and 90%, respectively, for PHP, moderate PCP and severe PCP.  Although there were no intergroup differences for mean bone loss,  (.075 +/- 0.88 mm in PHP, 1.14 +/- 1.11mm in moderate PCP, and 0.98 +/- 1.22mm in severe PCP), the percentage of sites with bone loss greater than or equal to 3mm indicated a statistically significant difference between PHP (4.7%) and severe PCP (15.1%).  A significantly high proportion of PCP who did not adhere to SPT had bone loss (11 of 18 patients) and implant loss (nine of 18 patients).  The authors concluded that patients with a history of periodontitis, especially those who do not adhere to SPT, are at a higher risk for implant loss and bone loss.  In summary, the results showed the importance of compliance to SPT in enhancing the long-term outcomes of implant therapy, particularly in subjects with periodontitis.  

Complete article can be found the Journal of Periodontology, Volume 81, Number 6, June 2010, page 797.

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