RESUMO
This study aimed to evaluate the effectiveness of the health insurance coverage of dental scaling (introduced in 2013) using the Community Periodontal Index of Treatment Needs parameter among Korean adults aged 20 years or older. We used the Korea National Health and Nutrition Examination Survey data from before and after 2013 to analyze the statistical significance and associations of the covariates with the prevalence of healthy periodontal tissues, prevalence of people in need of scaling, and prevalence of periodontal diseases. The results showed that the prevalence of healthy periodontal tissues increased by 4.9% (from 34.2% to 39.1%), the number of people in need of scaling decreased by 5% (from 65.9% to 60.9%), and the prevalence of periodontal diseases increased by 7.2% (from 23.4% to 30.6%). Moreover, after the scaling coverage policy, the odds ratio of the prevalence of healthy periodontal tissues was 1.10 times higher, the prevalence of the need for scaling was 1.5 times higher, and the prevalence of periodontal diseases was 0.90 times lower. Therefore, the state should formulate policies that provide dental biofilm management through a disclosing agent, impart education about oral hygiene, and develop a health management system that enables the concurrent management of periodontal diseases and systemic diseases.
Assuntos
Serviços de Saúde Bucal/estatística & dados numéricos , Raspagem Dentária/economia , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Doenças Periodontais/prevenção & controle , Adulto , Placa Dentária/terapia , Polimento Dentário/economia , Profilaxia Dentária/economia , Raspagem Dentária/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Doenças Periodontais/epidemiologia , Índice Periodontal , República da Coreia/epidemiologia , Adulto JovemRESUMO
BACKGROUND: In 2013, the national dental scaling insurance policy was introduced in South Korea. The purpose of this study is to determine the impact of the policy on inequalities in dental scaling usage. METHODS: Data of a nationally representative sample of 1,517,097 people over the age of 20 were obtained from the 2010-2016 Community Health Survey. Respondents who reported that they had not received dental scaling in the past year were defined as dental scaling non-users. The excess prevalence and relative prevalence ratio of dental scaling non-users were calculated for the pre-policy (2010-2012) and post-policy periods (2014-2016) using monthly household income levels. Additionally, trends of dental scaling inequalities were shown as concentration indexes. RESULTS: The prevalence of dental scaling non-users declined from 58.0 to 48.7% in the highest income group and from 86.3 to 78.8% in the lowest income group. However, the adjusted excess prevalence for the lowest income group compared with the highest had increased from 11.9 (95% CI: 11.9-11.9) to 15.5 (95% CI: 15.5-15.5)%, and the adjusted prevalence ratio increased from 1.19 (95% CI: 1.19-1.20) to 1.29 (95% CI: 1.29-1.30). Absolute and relative concentration indexes of dental scaling non-users increased after policy implementation. CONCLUSIONS: The national dental scaling insurance policy has increased socioeconomic inequalities in dental scaling usage. Because dental care access generally requires high individual agency, expanded dental coverage may have had limited effects in attenuating inequalities and inadvertently widened the gap. To reduce dental care inequalities, universal access with universal dental coverage should be considered.
Assuntos
Raspagem Dentária , Disparidades em Assistência à Saúde , Renda , Raspagem Dentária/economia , Feminino , Humanos , Masculino , Políticas , República da Coreia , Fatores SocioeconômicosRESUMO
AIM: This study assessed the long-term annual costs for treating aggressive periodontitis (AgP) patients. METHODS: A cohort of compliant AgP patients was retrospectively evaluated. Costs for active periodontal therapy (APT, including scaling and root planing, open flap debridement, root resections, but not pocket elimination or regenerative surgery) and supportive periodontal therapy (SPT, including also costs for restorative, endodontic, prosthetic and surgical treatments) were estimated from a mixed payer perspective in Germany. The impact of tooth- and patient-level factors on annual costs was assessed using mixed modelling. RESULTS: A total of 52 patients (mean [SD] age: 35.2/6.8 years), with 26.5 (4.0) teeth (38% with bone loss >50%) were treated. Mean follow-up (retention) time was 16.9 (5.4) years. Total treatment costs per patient and per tooth were 6,998 (3,807) and 267 (148) Euro, respectively. Approximately 87% of the costs were generated during SPT, 13% during APT. Annual patient- and tooth-level costs were 536 (209) and 20.1 (65.0) Euro, respectively. Annual tooth-level costs were significantly increased in patients aged 34 years or older, male patients, former or current smokers, teeth with furcation involvement degree II/III, and bone loss 50%-70%. CONCLUSIONS: Annual treatment costs for treating AgP patients were similar to those found for chronic periodontitis patients. Certain parameters might predict costs.
Assuntos
Periodontite Agressiva/economia , Periodontite Agressiva/terapia , Custos de Cuidados de Saúde , Adulto , Perda do Osso Alveolar/economia , Perda do Osso Alveolar/terapia , Periodontite Crônica/economia , Periodontite Crônica/terapia , Custos e Análise de Custo , Raspagem Dentária/economia , Endodontia/economia , Feminino , Defeitos da Furca/economia , Defeitos da Furca/terapia , Alemanha , Humanos , Masculino , Desbridamento Periodontal/economia , Estudos Retrospectivos , Fatores de Risco , Aplainamento Radicular/economia , FumantesRESUMO
Health insurance reduces the economic burden of diseases and enhances access to medical services. This study compared, among social classes, the utilization of preventive dental service before and after health insurance covered dental scaling. We analyzed time-series secondary data for 3 175 584 participants from 253 survey areas nationwide in the Community Health Survey (2009-2014) in Korea. The weighted proportion of participants who underwent dental scaling was defined as the scaling rate. Data regarding demographic and socioeconomic characteristics were collected. Scaling rates continuously increased over the 6-year period, particularly in 2014. College graduates had significantly higher scaling rates. Monthly income and scaling rate were positively related. Differences by education decreased over time. Differences by income were particularly high between 2012 and 2014. For women, the temporal rate was 2 times higher for professionals than for the unemployed. Despite increased dental scaling rates since the health coverage change in 2013, socioeconomic differences persist.
Assuntos
Serviços de Saúde Bucal/estatística & dados numéricos , Raspagem Dentária/economia , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Fatores Socioeconômicos , Adulto JovemRESUMO
A renewed interest in conservative surgical techniques has been fueled by new technology, changes in referral patterns to periodontists and a desire to achieve periodontal health in the least invasive, most cost-efficient manner possible. Trends suggest that an increasing amount of periodontal care is being provided in the offices of general dentists. If true, it is likely that patients receiving care in these offices will be offered simpler surgical treatment modalities that do not require an extensive armamentarium. The purpose of this article was to review the effectiveness of six relatively simple surgical techniques - gingivectomy, flap debridement, modified Widman flap, excisional new attachment procedure, modified excisional new attachment procedure and laser-assisted new attachment procedure - and to compare the results obtained using these procedures with the well-known clinical benefits of scaling and root planing. The intent was to determine whether the benefits of surgical procedures in the hands of most general dentists extend beyond those of conventional nonsurgical therapy.
Assuntos
Periodontite Crônica/cirurgia , Periodontite Crônica/terapia , Raspagem Dentária/métodos , Aplainamento Radicular/métodos , Tratamento Conservador/métodos , Raspagem Dentária/economia , Gengivectomia/métodos , Humanos , Terapia a Laser/métodos , Desbridamento Periodontal/métodos , Aplainamento Radicular/economia , Curetagem Subgengival/métodos , Retalhos CirúrgicosRESUMO
BACKGROUND: Patient charges and availability of dental services influence utilization of dental services. There is little available information on the cost of dental services and availability of materials and equipment in public dental facilities in Africa. This study aimed to determine the relative cost and availability of dental services, materials and equipment in public oral care facilities in Tanzania. The local factors affecting availability were also studied. METHODS: A survey of all district and regional dental clinics in selected regions was conducted in 2014. A total of 28/30 facilities participated in the study. A structured interview was undertaken amongst practitioners and clinic managers within the facilities. Daily resources for consumption (DRC) were used for estimation of patients' relative cost. DRC are the quantified average financial resources required for an adult Tanzanian's overall consumption per day. RESULTS: Tooth extractions were found to cost four times the DRC whereas restorations were 9-10 times the DRC. Studied facilities provided tooth extractions (100%), scaling (86%), fillings (79%), root canal treatment (46%) and fabrication of removable partial dentures (32%). The ratio of tooth fillings to extractions in the facilities was 1:16. Less than 50% of the facilities had any of the investigated dental materials consistently available throughout the year, and just three facilities had all the investigated equipment functional and in use. CONCLUSIONS: Dental materials and equipment availability, skills of the practitioners and the cost of services all play major roles in provision and utilization of comprehensive oral care. These factors are likely to be interlinked and should be taken into consideration when studying any of the factors individually.
Assuntos
Clínicas Odontológicas , Equipamentos Odontológicos , Serviços de Saúde Bucal/economia , Materiais Dentários , Honorários Odontológicos , Acessibilidade aos Serviços de Saúde , Setor Público , Adulto , Clínicas Odontológicas/economia , Clínicas Odontológicas/organização & administração , Equipamentos Odontológicos/economia , Serviços de Saúde Bucal/organização & administração , Materiais Dentários/economia , Restauração Dentária Permanente/economia , Raspagem Dentária/economia , Unidade Hospitalar de Odontologia/economia , Unidade Hospitalar de Odontologia/organização & administração , Planejamento de Dentadura/economia , Prótese Parcial Removível/economia , Recursos em Saúde/economia , Recursos em Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Setor Público/economia , Tratamento do Canal Radicular/economia , Tanzânia , Extração Dentária/economiaRESUMO
AIM: The aim of this study was to trial the methodology and administration processes of a public paediatric capitation programme provided in the period 1 July 2011 to 31 December 2011 through a Bachelor of Oral Health programme in rural New South Wales (NSW), Australia, where access to public dental services is limited. BASIC RESEARCH DESIGN: The principal structure of the programme was the development of three diagnostic pathways: active caries and pain (Pathway A); active caries and no pain (Pathway B); and no active caries and no pain (Pathway C). In 2011, de-identified treatment data for NSW public dental services' patients under 18 years of age were analysed to identify the top 10 dental treatment items. These items were clustered according to the mean decayed and/or filled surface of patients under 18 years of age who had decayed, filled or missing teeth. Each treatment item was allocated 60% of the 2011 Australian Government Department of Veteran Affairs Schedule of Fees. CLINICAL SETTING: The programme was trialled in Charles Sturt University dental facility in Wagga Wagga, NSW. PARTICIPANTS: The programme targeted patients in the following age groups: 0-5 years; 6-11 years; and 12-17 years. RESULT: The 6-month trial provided 361 patients with a capitation pathway, at a total cost of $47,567.90, averaging $131.76 per capitation pathway. The total number of items provided (n=2,070) equated to an average of 5.7 items per capitation diagnostic pathway. CONCLUSION: This model offered an early entry point for paediatric patients to access dental care that addressed their needs, whilst being flexible enough to be fiscally attractive.
Assuntos
Capitação , Assistência Odontológica para Crianças/economia , Setor Público/economia , Adolescente , Cariostáticos/economia , Criança , Pré-Escolar , Procedimentos Clínicos/economia , Índice CPO , Cárie Dentária/terapia , Restauração Dentária Permanente/economia , Raspagem Dentária/economia , Feminino , Fluoretos/economia , Humanos , Lactente , Recém-Nascido , Masculino , Área Carente de Assistência Médica , New South Wales , Selantes de Fossas e Fissuras/economia , Desenvolvimento de Programas , Serviços de Saúde Rural/economia , Extração Dentária/economia , Remineralização Dentária/economia , Odontalgia/terapiaRESUMO
BACKGROUND: Preventive dental care use remains relatively low in Japan, especially among working-age adults. Universal health insurance in Japan covers curative dental care with an out-of-pocket payment limit, though its coverage of preventive dental care is limited. The aim of this study was to test the hypothesis that income inequality in dental care use is found in preventive, but not curative dental care among working-age Japanese adults. METHODS: A cross-sectional survey was conducted using a computer-assisted, self-administered format for community residents aged 25-50 years. In all, 4357 residents agreed to participate and complete the questionnaire (valid response rate: 31.3%). Preventive dental care use was measured according to whether the participant had visited a dentist or a dental hygienist during the past year for dental scaling or fluoride or orthodontic treatments. Curative dental care use was assessed by dental visits for other reasons. The main explanatory variable was equivalent household income. Logistic regression analyses with linear trend tests were conducted to determine whether there were significant income-related gradients with curative or preventive dental care use. RESULTS: Among the respondents, 40.0% of men and 41.5% of women had used curative dental care in the past year; 24.1% of men and 34.1% of women had used preventive care. We found no significant income-related gradients of curative dental care among either men or women (p = 0.234 and p = 0.270, respectively). Significant income-related gradients of preventive care were observed among both men and women (p < 0.001 and p = 0.003, respectively). Among women, however, income-related differences were no longer significant (p = 0.126) after adjusting for education and other covariates. Compared with men with the lowest income, the highest-income group had a 1.79-fold significantly higher probability for using preventive dental care. CONCLUSIONS: The prevalence of preventive dental care use was lower than that of curative care. The results showed income-related inequality in preventive dental care use among men, though there were no significant income-related gradients of curative dental care use among either men or women. Educational attainment had a positive association with preventive dental care use only among women.
Assuntos
Assistência Odontológica/estatística & dados numéricos , Renda/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos , Adulto , Estudos Transversais , Assistência Odontológica/economia , Raspagem Dentária/economia , Raspagem Dentária/estatística & dados numéricos , Escolaridade , Emprego , Feminino , Fluoretos Tópicos/uso terapêutico , Acessibilidade aos Serviços de Saúde/economia , Humanos , Japão , Masculino , Estado Civil , Pessoa de Meia-Idade , Ortodontia Corretiva/economia , Ortodontia Corretiva/estatística & dados numéricos , Autoimagem , Fatores Sexuais , Serviços Urbanos de Saúde/economiaRESUMO
BACKGROUND: A previously described economic model was based on average values for patients diagnosed with chronic periodontitis (CP). However, tooth loss varies among treated patients and factors for tooth loss include CP severity and risk. The model was refined to incorporate CP severity and risk to determine the cost of treating a specific level of CP severity and risk that is associated with the benefit of tooth preservation. METHODS: A population that received and another that did not receive periodontal treatment were used to determine treatment costs and tooth loss. The number of teeth preserved was the difference of the number of teeth lost between the two populations. The cost of periodontal treatment was divided by the number of teeth preserved for combinations of CP severity and risk. RESULTS: The cost of periodontal treatment divided by the number of teeth preserved ranged from (US) $1,405 to $4,895 for high or moderate risk combined with any severity of CP and was more than $8,639 for low risk combined with mild CP. The cost of a three-unit bridge was $3,416, and the cost of a single-tooth replacement was $4,787. CONCLUSION: Periodontal treatment could be justified on the sole basis of tooth preservation when CP risk is moderate or high regardless of disease severity.
Assuntos
Periodontite Crônica/economia , Modelos Econômicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda do Osso Alveolar/classificação , Perda do Osso Alveolar/economia , Periodontite Crônica/classificação , Periodontite Crônica/terapia , Análise Custo-Benefício , Coroas/economia , Implantes Dentários para Um Único Dente/economia , Raspagem Dentária/economia , Prótese Parcial Fixa/economia , Honorários Odontológicos , Gengivite/classificação , Gengivite/economia , Gengivite/terapia , Custos de Cuidados de Saúde , Humanos , Pessoa de Meia-Idade , Índice Periodontal , Bolsa Periodontal/classificação , Bolsa Periodontal/economia , Bolsa Periodontal/cirurgia , Periodontite/classificação , Periodontite/economia , Periodontite/terapia , Fatores de Risco , Aplainamento Radicular/economia , Índice de Gravidade de Doença , Perda de Dente/economia , Perda de Dente/prevenção & controle , Adulto JovemRESUMO
AIM: To compare immediate surgery to scaling and root planing (SRP) in the treatment of advanced periodontal disease focusing on the prevalence of residual sites and cost-effectiveness (1); to evaluate the adjunctive effects of azithromycin in a second treatment phase (2). MATERIALS AND METHODS: Thirty-nine patients (18 males, 21 females; mean age: 54.6) received oral hygiene instructions and were randomly allocated to surgery (n = 19) or SRP (n = 20). Patients with residual pockets (≥6 mm) at 6 months received re-debridement of these sites and systemic azithromycin. Treatment groups were followed up to 12 months and evaluated in terms of clinical response parameters and cost-effectiveness. Chair-time was used to assess the financial impact of treatment. RESULTS: Both treatment arms were equally effective in terms of clinical outcome demonstrating less than 1% residual pockets at 12 months. Surgery imposed an extra 746 Euro on the patient up to 6 months when compared to SRP. At 12 months, 46 Euro of this amount could be offset as a result of a reduced need for supportive care. Only 6 patients in the surgery group needed systemic antibiotics, whereas 14 patients in the SRP needed such additional treatment. CONCLUSIONS: Although 700 Euro could be saved on average by performing SRP instead of surgery, the latter significantly reduced the need for supportive care and systemic antibiotics.
Assuntos
Periodontite Crônica/cirurgia , Raspagem Dentária/métodos , Aplainamento Radicular/métodos , Adulto , Idoso , Antibacterianos/economia , Antibacterianos/uso terapêutico , Azitromicina/economia , Azitromicina/uso terapêutico , Periodontite Crônica/economia , Periodontite Crônica/terapia , Terapia Combinada/economia , Análise Custo-Benefício , Índice de Placa Dentária , Raspagem Dentária/economia , Custos de Medicamentos , Feminino , Seguimentos , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Higiene Bucal/educação , Perda da Inserção Periodontal/cirurgia , Perda da Inserção Periodontal/terapia , Índice Periodontal , Bolsa Periodontal/cirurgia , Bolsa Periodontal/terapia , Estudos Prospectivos , Aplainamento Radicular/economia , Método Simples-Cego , Fatores de Tempo , Resultado do TratamentoRESUMO
Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.
Assuntos
Periodontite/terapia , Antibacterianos/uso terapêutico , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Raspagem Dentária/economia , Custos de Cuidados de Saúde , Humanos , Higiene Bucal/economia , Desbridamento Periodontal/economia , Desbridamento Periodontal/instrumentação , Periodontite/economia , Pobreza , Autocuidado/economiaAssuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Periodontite/tratamento farmacológico , Administração Oral , Administração Tópica , Antibacterianos/administração & dosagem , Quimioterapia Adjuvante/economia , Análise Custo-Benefício , Raspagem Dentária/economia , Humanos , Modelos Econômicos , Periodontite/economia , Anos de Vida Ajustados por Qualidade de VidaRESUMO
OBJECTIVES: Assessment of effort (number of visits) and costs of tooth preservation 10 years after initiation of anti-infective therapy. MATERIAL AND METHODS: Data of 98 patients who had received active periodontal treatment 10 years ago by the same examiner were analysed to gather information on effort and costs of supportive periodontal therapy (SPT). Clinical examination, interleukin-1 (IL-1) polymorphism test, smoking, search of patients' files (i.e. initial diagnosis), as well as a questionnaire on medical history and socioeconomic data were performed. Statistical analysis was performed using multivariate linear regression analysis. RESULTS: During 10 years of SPT patients had 14.8+/-7.4 visits. Number of visits was statistically significantly higher for individuals with a mean plaque control record >or=24 %. The number of subgingival scalings per tooth ranged from 0 to 14 (mean: 1.17). On tooth level several confounders could be identified: tooth type, initial bone loss, furcation involvement, abutment status, and previous regenerative surgery (p Assuntos
Periodontite Agressiva/economia
, Periodontite Crônica/economia
, Assistência Odontológica/economia
, Perda de Dente/economia
, Periodontite Agressiva/prevenção & controle
, Periodontite Agressiva/cirurgia
, Perda do Osso Alveolar/economia
, Anti-Infecciosos/economia
, Periodontite Crônica/prevenção & controle
, Periodontite Crônica/cirurgia
, Custos e Análise de Custo
, Dente Suporte/economia
, Assistência Odontológica/estatística & dados numéricos
, Implantes Dentários/economia
, Placa Dentária/prevenção & controle
, Raspagem Dentária/economia
, Raspagem Dentária/estatística & dados numéricos
, Prótese Parcial/economia
, Custos de Medicamentos
, Feminino
, Defeitos da Furca/economia
, Alemanha
, Regeneração Tecidual Guiada Periodontal/economia
, Humanos
, Masculino
, Anamnese
, Pessoa de Meia-Idade
, Índice de Higiene Oral
, Índice Periodontal
, Exame Físico
, Estudos Retrospectivos
, Fatores de Risco
, Fumar/economia
, Fatores Socioeconômicos
, Perda de Dente/prevenção & controle
, Resultado do Tratamento
RESUMO
OBJECTIVE: To systematically evaluate the evidence for effectiveness of supportive periodontal care (SPC) provided in specialist care and general practice for patients with chronic periodontitis; to construct a model for the cost effectiveness of SPC. SEARCH STRATEGY: Electronic database searches of MEDLINE, EMBASE and SCOPUS were performed with hand searching of relevant journals and Workshops of Periodontology. SELECTION CRITERIA: SPC for patients with chronic periodontitis, at least 12 months follow-up and clinical attachment level as a primary outcome. RESULTS: Three articles addressed the question (Nyman et al. 1975, Axelsson & Lindhe 1981, Cortellini et al. 1994): Deltas CAL for patients undergoing "specialist" SPC were 0.1 mm (2 years), 0.2 mm (6 years) and -0.01 mm (3 years) respectively. In generalist care the Deltas CAL during SPC were -2.2, -1.8 and -2.8 mm. Differences between specialist and generalist SPC were an extra 20.59 tooth years and 3.95 mm attachment loss for generalist SPC. Incremental cost-effectiveness ratios were an extra 288 euros for one tooth year or an extra 1503 euros/1 mm reduction in loss of attachment for SPC delivered in specialist care. CONCLUSION: SPC delivered in specialist as compared with general practice will result in greater stability of clinical attachment but this will be achieved at relatively greater cost.
Assuntos
Periodontite Crônica/prevenção & controle , Periodontite Crônica/economia , Análise Custo-Benefício , Higienistas Dentários/economia , Raspagem Dentária/economia , Progressão da Doença , Odontologia Geral/economia , Custos de Cuidados de Saúde , Humanos , Periodontia/economia , Recidiva , Aplainamento Radicular/economia , Resultado do TratamentoAssuntos
Raspagem Dentária/economia , Doenças Periodontais/prevenção & controle , Resultado da Gravidez/economia , Nascimento Prematuro/economia , Nascimento Prematuro/prevenção & controle , Redução de Custos , Análise Custo-Benefício , Parto Obstétrico/economia , Feminino , Idade Gestacional , Custos Hospitalares , Humanos , Recém-Nascido , Gravidez , Reino Unido , Estados UnidosRESUMO
BACKGROUND: The authors previously suggested that an adjunctive, controlled-release chlorhexidine, or CHX, chip may reduce periodontal surgical needs at little additional cost. This article presents an economic analysis of the CHX chip in general dental practice. METHODS: In a one-year prospective clinical trial, 484 chronic periodontitis patients in 52 general practices across the United States were treated with either scaling and root planing, or SRP, plus any therapy prescribed by treating, unblinded dentists; or SRP plus other therapy as above but including the CHX chip. Economic data were collected from bills, case report forms and 12-month treatment recommendations from blinded periodontist evaluators. RESULTS: Total dental charges were higher for SRP + CHX chip patients vs. SRP patients when CHX chip costs were included (P = .027) but lower when CHX chip costs were excluded (P = .012). About one-half of the CHX chip acquisition cost was offset by savings in other charges. SRP + CHX chip patients were about 50 percent less likely to undergo surgical procedures than were SRP patients (P = .021). At the end of the trial, periodontist evaluators recommended similar additional procedures for both groups: SRP, about 46 percent; maintenance, about 37 percent; surgery, 56 percent for SRP alone and 63 percent for SRP + CHX chip. CONCLUSIONS: Adjunctive CHX chip use for general-practice patients with periodontitis increased costs but reduced surgeries over one year. At study's end, periodontists recommended similar additional surgical treatment for both groups. CLINICAL IMPLICATIONS: In general practice, routine use of the CHX chip suggests that costs will be partially offset by reduced surgery over at least one year.
Assuntos
Anti-Infecciosos Locais/economia , Clorexidina/economia , Preparações de Ação Retardada/economia , Periodontite/economia , Periodontite/terapia , Adulto , Idoso , Análise de Variância , Anti-Infecciosos Locais/administração & dosagem , Clorexidina/administração & dosagem , Doença Crônica , Raspagem Dentária/economia , Feminino , Humanos , Formulário de Reclamação de Seguro , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Método Simples-CegoAssuntos
Antibacterianos/uso terapêutico , Raspagem Dentária , Doenças Periodontais/tratamento farmacológico , Antitricômonas/uso terapêutico , Raspagem Dentária/economia , Humanos , Meios de Comunicação de Massa , Metronidazol/uso terapêutico , Jornais como Assunto , Doenças Periodontais/economia , Doenças Periodontais/terapiaRESUMO
Cost-effectiveness analysis was used to evaluate alternative methods of periodontal disease control. The alternatives considered included non-surgical and surgical procedures as well as the use of antimicrobial agents. Data on costs were obtained from American Dental Association publications of average charges for periodontal services. The concept of quality-adjusted tooth-years (QATYs) was developed to provide an outcome measure which could be compared across treatments. The conclusions of this analysis are as follows: (1) Conservative non-surgical treatments for periodontal disease control not only have costs lower than surgical alternatives, as would be expected, but also maximize expected quality-adjusted tooth-years over a wide range of estimates; (2) antimicrobial therapy used as an adjunct to non-surgical treatment is likely to be both effective and cost-effective; and (3) quality of tooth-years is a critical consideration in the determination of outcome of periodontal treatment. For example, when tooth-years are not adjusted for quality, differences between treatments are diminished, and surgical treatment becomes as good as or better than more conservative treatments for some levels of disease severity.