Stroke and oral inflammation

Chronic oral inflammation (gingivitis and periodontal disease) is a well-known risk contributor to stroke. But are periodontal surgery and scaling effective in reducing the risks of stroke? A new, very large retrospective study of middle-age Koreans with oral inflammation indicates these procedures are helpful in reducing stroke. Data from Korean medical insurance claims show that…

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Thinking about dementia

A recent survey of Americans age 50 to 64, conducted by the University of Michigan reports 37% have been touched within their families by dementia. Almost half of respondents thought they would develop dementia in their lifetimes.

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Ping pong

…the (possibly deadly) game of bouncing patients between the dentists and the physician.

How So? Well, as explained as an example by a Forbes article, diabetics are considered the exclusive domain of physicians. Gum infections require a visit to the dentist. Yet these 2 chronic, inflammatory disease are interrelated.

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Rethinking geriatric oral healthcare

Hygienists often tell me their “horror stories” in serving older patients in retirement residences and nursing homes. These stories cover the waterfront – rampant decay among those with dementia, can’t get past the front door, gross inflammation in the mouth, preoccupation by the nursing team and unwillingness by the family to pay for better oral health until it is too late.

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Reducing medical costs

In this new age of containing medical costs, it seems the ultimate argument and purpose for oral health services is better overall health. For example, note this excerpt form a recent blog in Health Affairs, an influential journal in organizing the healthcare system: “Periodontal disease treatment can reduce medical costs in patients with diabetes, coronary artery disease, and cerebral vascular disease. Gum disease is strongly linked to poor cognitive brain function among patients with Alzheimer’s disease. The risk of developing dementia has been found to be higher in those with periodontitis than those without it.”

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Targeting high risk patients

A recent assessment from the Cochrane Reports concluded that regular hygiene visits for scaling and polishing (a routine procedure for preventing gum disease and tooth decay) had no clinical benefit. Here’s the data which supports this conclusion:

“Healthy” patients with no scaling and polishing over 3 years had 39.3% of their teeth with bleeding gums.

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Rewriting the job description

Sometimes new science and discoveries come along to rewrite the job description for an industry or profession. Think of the Internet and its redefinition of the community library, for example.

A similar situation may well be emerging in hygiene– er, let’s call it oral healthcare for reasons given below.

Recently, the bidirectional linkage between oral health and cognitive decline has heated up. If your patients haven’t already asked you about it, read this article.

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Targeting preventive services

The Cochrane Library recently updated its evaluation about the merits of a hygienist cleaning above and below the gum line. Its conclusion: target these procedures for those at very high risk of poor oral health because there is little evidence of clinical merit or cost-effectiveness for these hygiene procedures for adults at little or no risk.

While this makes sense, the reality is our dental insurance schemes in Canada do not recognize risk in their reimbursement for oral health services. Someone who is low risk has the same entitlements as those at high risk. Your gums are healthy — you get 10 units of scaling each year. Your gums are bleeding and inflamed — you get the same.

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Pay for performance in oral healthcare

Value based care and pay for performance contracts are quickly seeping into healthcare. Here’s an example. In 2019, a large Dutch insurer decided to pay its doctors and psychiatrists treating depression and mood disorders, on how much better the patient feels, rather than on the number of counseling sessions. (Not surprisingly, the Dutch Association of…

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