Oral Health

Unmet needs

Two stories recently crossed my desk to underscore the need for Prevora.

The first story in the Washington Post was about children and adults with Special Needs having limited access to effective preventive oral health services,

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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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To improve health disparities, focus on oral health

That’s the recommendation on a new blog from the Robert Wood Johnson Foundation. How so? well, here’s an argument.
Let’s begin by recognizing chronic diseases such as diabetes and COPD have a much higher prevalence in poorer communities than rich ones. For example, about 4 in 100 adults in Rosedale (high income) in Toronto have diabetes, whereas, 3 kilometers away in St. Jamestown (low income), 12 in 100 are diabetic.

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Healthcare savings via prevention of chronic disease

A new study which examines why American spending on healthcare has shown little growth over the past few years, reports that a key reason is healthier hearts among Seniors.

Between 1999 and 2012, American per capita spending on cardiovascular and cerebrovascular diseases (heart attack, cardiac arrest, stroke, etc.) declined by $827 per person. Spending on a related category called cardiovascular risk factors (high blood pressure, high cholesterol, diabetes) also fell $802 per person below the trend line.

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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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