Dr. Mark J. Weingarden

CBS recently posted this on their blog.

If you needed another reason to brush and floss, maybe this will help.

Researchers at New York University have found that gum disease may increase the risk of cognitive dysfunction associated with Alzheimer’s disease.

This NYU study provides fresh evidence that gum inflammation is associated with inflammation in the brain.

The research team, led by Dr. Angela Kamer, assistant professor of periodontology & implant dentistry, studied 20 years of data from Denmark that support the hypothesis of a link between periodontal disease and Alzheimer’s.

Those with gum disease at age 70 were nine times more likely to test in the lower range of brain function tests compared to those with little or no periodontal inflammation.

Other health factors that tend to lower test scores, such as obesity, cigarette smoking, and tooth loss related to gum inflammation, were factored in, but the strong association held true.

Kamer is working on a follow-up study, which will include a more ethnically diverse pool of people.

www.cbsnews.com

Editorial by Jan Werner 

I have been a Patient Coordinator in the dental field for over 22 years now and I can tell you that dental treatment has evolved dramatically over those 22 years.  New products, new equipment and new techniques are introduced all the time, affording the dental patient the best opportunity ever for long term dental health.  Do you know what HASN’T changed much over the past 22 years?  Dental insurance.  Do you know why?  Because, dental insurance is designed to keep insurance companies financially healthy – not to keep patients dentally healthy. 

Twenty two years ago, most dental insurance programs provided patients an average benefit of $1000 per year for dental treatment.  Here we are 22 years later and what do most dental insurance programs offer per year?  $1000, of course.   The fact is that there is not one single product or service that hasn’t increased in cost over the years. Dental premiums certainly have.   So how could this same $1000 provide the same quality dental care it provided 22 years ago?   Obviously, it can’t.  But amazingly, patients still expect that they will receive quality dental care within the confines of what their dental insurance pays. 

In addition to the yearly limit set by dental insurance companies, reimbursement is also limited through use of specific dental “codes”.  Every procedure that is on the dental insurance company’s “list” has a code associated with it.  When a new dental procedure is introduced into the field of dentistry, one would assume that it would be assigned a code and added to the list.  Unfortunately, this is not the case.  It can take in excess of 10 years for insurance company’s to code a new procedure and sometimes the new procedures never make the list at all! 

Adding insult to injury, insurance companies dictate not only which procedures make the list, but also what percentage of the fee they reimburse on each procedure.  The goal of insurance companies is to pay as little as possible of the $1000 per patient, each year.  In other words, even though you GET $1000 per year, they certainly don’t want you to USE $1000 per year, and they make sure that you don’t.  Remember, the less they pay out, the more profitable they are.   

So the dental patient trustingly goes to the participating dental provider for care.  However, instead of providing treatment that may be more up-to-date, more conservative, more predictable, more comfortable or may even cost LESS, a participating practitioner, (because he has signed a contract with the insurance company), is more likely to plan treatment based on what is found on “the list”.   Participating providers may not even discuss (or perform) treatment options that are not on the list and patients often incorrectly assume, “if it isn’t on my insurance company’s list, then I must not need or want that treatment!”    

If only insurance companies would allow patients to spend the $1000 as they choose.  Dental providers could then offer patients ALL treatment options and patients could decide for themselves what level care they desire.  Unfortunately, this is not likely to happen, because patients would be much more likely to use their entire $1000 per year and the insurance companies would be much less profitable.   Bottom line, patients need to be aware of the limitations of their dental insurance’s list and they need to ask their provider about treatments options that may not be a part of that list.   Only then can they make a truly informed decision regarding their dental care.

If you have been told that you have periodontal disease, don’t proceed with treatment before finding out if you are a candidate for the perioscope.  

For the vast majority of patients with periodontal disease, the goal of treatment is to remove the plaque, (bacteria) and calcified plaque (tartar or calculus), to eliminate the infection and prevent progressive damage.  The perioscope is a very small camera that is placed gently below the gum in the area of concern.  It illuminates the site and then magnifies it 48 times. 

Before the perioscope was available, periodontists were limited to a surgical approach, done with the use of loupes, (special glasses) that provide at most 4 times magnification.  Although 4x is fairly dramatic, it is only 1/12 the sensitivity of the perioscope. Visibility of the problem area is critical whether the treating doctor is using conventional surgical instruments or a laser, and can critically affect the outcome of treatment.  Improved visibility translates to a significantly higher percentage of the plaque and calculus being successfully removed and therefore a potentially better result than without the perioscope.   

It is important to note that the perioscope:

1. Is more conservative than surgery.  There is no cutting involved.
2. Is often even more effective than surgery thanks to the magnification.
3. Is not covered by dental insurance.  However, the perioscope costs less than surgery, and since there is always a  co-pay with surgery, it may actually cost you less than treatment covered by insurance.  

We are one of only two offices in the Pittsburgh area to offer the perioscope and we have been doing so since 2000.   To learn more about the perioscope, visit our website at www.pittsburghimplantsandperio.com or call us at 412-487-8288.

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.

A recent article from the February issue of the Journal of Periodontology shows a relationship between periodontitis and rheumatoid arthritis.  Patients that had rheumatoid arthritis were far more likely to have moderate to severe periodontitis, and when they did it was manifested by higher acute-phase responses, and a higher number of tender and/or swollen joints.  It was postulated that periodontitis may be a risk factor for both rheumatoid arthritis onset and its progression. 

Some important points:

1. In addition to potentially worsening rheumatoid arthritis, the bacteria load associated with moderate to advanced periodontitis can be considerable and may have systemic implications including seeding itself to prosthetic joints.
2. Unfortunately, recent assessments have shown that fewer than half of general dentists examine their patients for periodontal disease, and that the prevalence and severity of periodontal disease is now considerably worse in our population than twenty years ago.  It can not be taken for granted that because a patient sees a dentist that they are periodontally healthy.  There usually are no symptoms.  

If you would like the entire article, please don’t hesitate to call and I would be happy to forward it to you. 

Mark J. Weingarden, D.M.D.

Newly released clinical recommendations encourage cardiologists to examine the    mouth and periodontists to ask questions about heart health.

 CHICAGO – June 1, 2009 – Cardiovascular disease, the leading killer of men and women in the United States, is a major public health issue contributing to 2,400 deaths each day.  Periodontal disease, a chronic inflammatory disease that destroys bone and gum tissues that support the teeth affects nearly 75 percent of Americans and is the major cause of adult tooth loss. And while the prevalence rates of these disease states seems grim, research suggests that managing one disease may reduce the risk for the other. 

A consensus paper on the relationship between heart disease and gum disease was recently published concurrently in the online versions of two leading publications, the American Journal of Cardiology (AJC), a publication circulated to 30,000 cardiologists, and the Journal of Periodontology (JOP), the official publication of the American Academy of Periodontology (AAP).  Developed in concert by cardiologist, the physicians specializing in treating diseases of the heart, and periodontists, the dentists with advanced training in the treatment and prevention of periodontal disease, the paper contains clinical recommendations for both medical and dental professionals to use in managing patients living with, or who are at risk for, either disease.  As a result of the paper, cardiologists may now examine a patient’s mouth, and periodontists may begin asking questions about heart health and family history of heart disease. 

The clinical recommendations were developed at a meeting held earlier this year of top opinion-leaders in both cardiology and periodontology.  I addition to the clinical recommendations, the consensus paper summarized the scientific evidence that links periodontal disease and cardiovascular disease and explains the underlying biologic and inflammatory mechanisms that may be the basis for the connection. 

According to Kenneth Kornman, DDS, PhD, Editor of the Journal of Periodontology and a co-author of the consensus report, the cooperation between the cardiology and periodontal communities is an important first step in helping patients reduce their risk of these associated diseases.  “Inflammation is a major risk factor for heart disease, and periodontal may increase the inflammation level throughout the body.  Since several studies have shown that patients with periodontal disease have an increased risk for cardiovascular disease, we felt it was important to develop clinical recommendations for our respective specialties.  Therefore, you will now see cardiologists and periodontists joining forces to help our patient.” 

For patients, this may mean receiving some unconventional advice from their periodontist or cardiologist.  The clinical recommendations outlined in the consensus paper advise that periodontists not only inform their patients of the increased risk of cardiovascular disease associated with periodontal disease, but also assess their risk for future cardiovascular disease and guide them to be evaluated for the major risk. 

To find out if you are at risk for periodontal disease, visit our website at www.pittsburghimplantsandperio.com.   Look under the Services tab and check out the section entitled, “Maintaining Your Periodontal Health”.   Or call Dr. Weingarden’s office at 412-487-8288.

Presently, the perception is that osteonecrosis has a very low incidence associated with oral bisphosphonates.  However, most of the information that I find available includes relatively limited term usage of these drugs – approximately three years.

However, I frequently see patients who have taken bisphosphonates for five, ten, twelve or more years!  To my knowledge, we are in uncharted territory regarding the risk of increased incidence of osteonecrosis for these patients.  What we do know is that these drugs accumulate with a perhaps undefined or unknown half-life, and the percentage of vital bone likely diminishes with usage over time.   

Unfortunately, the incidence of very significant, untreated, periodontal disease is on the rise.  I am seeing on a very regular basis, (as are periodontists across the country), patients presenting with increasingly advanced periodontal conditions.  This dramatic increase in disease severity, along with the extended usage of bisphosphonate drugs, can be potentially dangerous. 

It is also important to note that even advanced periodontal disease is most often completely without symptoms, and that fewer than 50% of general dentists today examine their patients for periodontal disease. Therefore, I am strongly encouraging physicians to refer their patients to a periodontist for dental clearance, prior to initiating bisphosphonate therapy.  With this minimal effort, we could greatly reduce the risk of osteocrenosis for our patients.

 I welcome your input or questions regarding this subject.

 Sincerely,

Mark J. Weingarden, D.M.D.

markjerome@msn.com

www.pittsburghimplantsandperio.com

By Jane Brody, Published November 16, 2009 

If I have one serious regret about my age, it is that my permanent teeth developed before New York, my hometown, got fluoridated water.  I first lost a permanent molar to decay in my early 20’s, and the resulting bridge has had to be replaced several times in subsequent decades, ultimately as a four-part apparatus. 

Now that has to go as well.  Because I could not floss and clean properly under the bridge and between the supporting crowns, I developed a severe periodontal infection. 

Dr. Michael Zidele, the young periodontist I consulted, took one look at my mouth and said: “This is not how we do restorations nowadays. A bridge is not a permanent solution and makes it too hard for most people to keep their gums and underlying bone healthy.  Now we do implants and individual crowns where needed.” 

More out of curiosity than distrust – and before I invested thousands of dollars and countless hours on new teeth – I did my own homework and got a second opinion.  Dr. Zidile, I learned, is correct.  In an overwhelming majority of cases, implants to replace lost teeth are by far the best long-term solution for maintaining a healthy mouth.  Also, because they rarely need to be replaced, in the long run they are more economical than bridges. 

Implants for replacing lost teeth have come a long way in the 25 years since I last wrote about them in this column.  Better materials, procedures and professional experience result in far fewer problems than occurred in the early years of implants.

Critical to their success, however, is proper selection of both patients and practitioners – and, after the implants, a commitment to good oral hygiene.  Dental implants must be treated like natural teeth: kept clean and free of plaque through proper brushing, flossing and periodic professional cleanings. 

“Bridges are not the standard of care anymore,” Dr. Lawrence J. Kessler, a periodontist and associate professor of surgery at the University of Miami School of Medicine, told me in an interview. “For most people who lose teeth, implants are the treatment of choice”.

The March 2010 issue of Golf Digest reported that Tiger Woods had undergone treatment that included “platelet rich plasma therapy or PRP”.   It said that Tiger has joined a growing list of elite athletes who has received platelet rich plasma therapy. Pittsburgh’s local news has reported using this procedure for many of our Pittsburgh Steelers. 

PRP treatments have been performed for over a decade and is something that athletes consider for sports-related injuries, including severe tendonitis, plantar fasciitis and muscle and ligament tears.

 This of course caught our eye, because in his effort to always stay in the forefront of periodontal treatment, Dr. Weingarden has been using PRP for the past ten years in many periodontal procedures.  This includes connective tissue grafting and sinus grafting for dental implants. 

 PRP is made from a small sample of the patient’s own blood and spun down in a computerized centrifuge to concentrate the platelets.  The concentrated platelets contain huge reservoirs of growth and healing factors.   Clinical data has shown that growth and wound healing factors accelerate the body’s normal healing process after surgery. 

 To learn more about PRP visit our website at: www.pittsburghimplantsandperio.com

In on ongoing effort to provide you with the best care possible, we have recently added the KODAK 9000 3D Extraoral Imaging System to our practice, revolutionizing patient treatment. 

The KODAK 9000 3D System is an innovative two-in-one solution providing access to powerful, focused field 3D images.  The capabilities of 3D imaging offer a wide range of diagnostic possibilities such as implant placement, surgical planning, extraction, examination of oral pathologies and third molar evaluations.   It also provides us the ability to detect dental infections that may involve the sinus. 

Most importantly, the KODAK 9000 3D System was designed to acquire 3D images on a specific dental region of interest, so technicians are able to target the exact area for the 3D exposure.  This significantly reduces the amount of radiation, delivering 10-30 times less exposure than other dental radiography systems. 

Benefits include:

• High-resolution images – your doctor can view your teeth and bone structure  more clearly
• Less radiation – more safety
• Improved patient care- your doctor can perform a wider range of diagnoses, helping reduce multiple visits, saving you time and money 

We are here to provide you with superb periodontal care, every time.  If you have any questions regarding our technologies, feel free to contact us: 

Dr. Mark Weingarden
4290 Route 8
Suite 104
Allison Park PA  15101
412-487-8288
www.pittsburghimplantsandperio.com