Impact of periodontal therapy on general health: evidence from insurance data for five systemic conditions.

BACKGROUND: Treatment of periodontal (gum) disease may lessen the adverse consequences of some chronic systemic conditions. PURPOSE: To estimate the effects of periodontal therapy on medical costs and hospitalizations among individuals with diagnosed type 2 diabetes (T2D); coronary artery disease (CAD); cerebral vascular disease (CVD); rheumatoid arthritis (RA); and pregnancy in a retrospective observational cohort study. METHODS: Insurance claims data from 338,891 individuals with both medical and dental insurance coverage were analyzed in 2011-2013. Inclusion criteria were (1) a diagnosis of at least one of the five specified systemic conditions and (2) evidence of periodontal disease. Subjects were categorized according to whether they had completed treatment for periodontal disease in the baseline year, 2005. Outcomes were (1) total allowed medical costs and (2) number of hospitalizations, per subscriber per year, in 2005-2009. Except in the case of pregnancy, outcomes were aggregated without regard to reported cause. Individuals who were treated and untreated for periodontal disease were compared independently for the two outcomes and five systemic conditions using ANCOVA; age, gender, and T2D status were covariates. RESULTS: Statistically significant reductions in both outcomes (p<0.05) were found for T2D, CVD, CAD, and pregnancy, for which costs were lower by 40.2%, 40.9%, 10.7%, and 73.7%, respectively; results for hospital admissions were comparable. No treatment effect was observed in the RA cohorts. CONCLUSIONS: These cost-based results provide new, independent, and potentially valuable evidence that simple, noninvasive periodontal therapy may improve health outcomes in pregnancy and other systemic conditions.

Association of a common genetic factor, PTGER3, with outcome of periodontal therapy and preterm birth.

BACKGROUND: Clinical evidence suggests an association between preterm birth and periodontal disease. This study explores whether specific genetic polymorphisms are associated with success of periodontal therapy in pregnant women with periodontal disease and, further, whether any of these same polymorphisms are also associated with spontaneous preterm birth (sPTB). METHODS: One hundred sixty high-risk pregnant women (6 to 20 weeks of gestation) with periodontal disease (≥ 3 sites with attachment loss ≥ 4 mm) were studied. All women received scaling and root planing plus oral hygiene instruction. Periodontal examinations were performed before treatment and 20 weeks later. Participants were classified according to two study outcomes: 1) success or failure of periodontal treatment; and 2) presence or absence of sPTB. Maternal DNA samples from mucosal swabs were characterized using a 1536-SNP (single-nucleotide polymorphism) custom polymerase chain reaction chip. A probabilistic model of each dichotomous outcome, derived using a stepwise Bayesian procedure, was compared to respective null hypotheses on the basis of Monte Carlo simulations and significance estimates obtained using three measures (z-test, Welch t-test, and probability convolution). The models were further confirmed by logistic regression analyses. RESULTS: The models revealed a significant relation between a specific polymorphism of prostaglandin E receptor 3 (a gene associated with inflammatory response) and both periodontal treatment failure (odds ratio 11.09, P <0.0002) and sPTB (odds ratio 6.89, P < 0.0032). CONCLUSIONS: These results demonstrate that the risk of unsuccessful periodontal treatment is associated with tag SNPs in specific genes that regulate the inflammatory response, one of which is also associated with sPTB.

Clinical and histologic assessment of lateral alveolar ridge augmentation using a synthetic long-term bioabsorbable membrane and an allograft.

BACKGROUND: Guided bone regeneration (GBR) is a widely used procedure for augmenting alveolar ridge width prior to placement of endosseous implants. Various graft materials and barrier membranes (non-resorbable and bioabsorbable) have been used in GBR. The aim of this study was to assess the performance of a new bioabsorbable, synthetic polyglycolic acid/trimethylene carbonate (PGA/TMC) barrier membrane with an increased absorption time in conjunction with a combination of assayed demineralized bone matrix and cortical cancellous chips uniformly dispersed in a thermoplastic biologic carrier. METHODS: At 72 potential implant sites in 38 subjects, ridge width at the crest and 4 mm apical to the crest was measured before and 6 months after a GBR procedure using the long-term (LT) PGA/TMC membrane and an allograft in a thermoplastic carrier. Before placement of endosseous implants, 48 biopsy specimens were obtained from the augmentation sites and analyzed histomorphometrically. RESULTS: The GBR procedure increased the mean ridge width at the crest from 2.4 to 5.2 mm. This 216% change from baseline was significant (P <0.001). The mean width 4 mm apical to the crest increased from 4.4 to 7.5 mm, a significant (P <0.001) 174% change. The histomorphometric analysis showed that the biopsy specimens consisted, on average, of 57% bone (36% graft material and 21% new bone) and 43% soft tissue and space. CONCLUSION: Our findings suggest that the LT PGA/TMC barrier membrane, used in conjunction with an allograft, provides lateral alveolar ridge augmentation comparable to that achieved with other materials without the necessity for bone-graft harvesting or a second procedure to remove the barrier membrane.

Osteonecrosis of the jaw: balancing the benefits and risks of oral bisphosphonate treatment for osteoporosis.

Osteoporosis is a major public health problem. Oral bisphosphonates are effective for reducing the risk of osteoporotic fractures and are an important treatment option for patients at risk for this condition. Osteonecrosis of the jaw (ONJ) is uncommon among cancer patients who are receiving high-dose intravenous bisphosphonates and rarely is seen among patients who are taking oral bisphosphonates for osteoporosis. Dentists play an important role in discussing the implications of the overall dental and medical treatment plans with both patients and physicians. The low risk of ONJ with oral bisphosphonates should be balanced against the benefits of osteoporosis therapy.

Capacity for training in clinical research: status and opportunities.

The ability to base patient care on scientific evidence depends in part on the results of translational and applied research. The shortage of trained clinical researchers identified by several sources limits the availability of clinical research studies upon which to base evidence-based therapeutics. This premise suggests that the dental profession needs to train more clinical researchers and faculty to conduct clinical research and to teach its applications to practice. Increasing opportunities for clinical research training in a variety of settings should eventually increase the numbers of clinical researchers, raise faculty involvement in clinical research, and promote science transfer. This paper reports on the current status of clinical research in dental schools, specifies the diverse groups involved in the clinical research enterprise, and identifies underutilized opportunities and partnerships for clinical research training. Data on federal and nonfederal funding of clinical research and training programs are presented. Existing and novel mechanisms for expanding clinical research training throughout and across traditional as well as unconventional environments are explored.