Dental Services and Health Outcomes in the New York State Medicaid Program.

Previous reports suggest that periodontal treatment is associated with improved health care outcomes and reduced costs. Using data from the New York State Medicaid program, rates of emergency department (ED) use and inpatient admissions (IPs), as well as costs for ED, IPs, pharmacy, and total health care, were studied to determine the association of preventive dental care to health care outcomes. Utilization of dental services in the first 2 y (July 2012-June 2014) was compared to health care outcomes in the final year (July 2014-June 2015). Costs and utilization for members who did not receive dental services (No Dental) were compared to those who received any dental care (Any Dental), any preventive dental care (PDC), PDC without an extraction and/or endodontic treatment (PDC without Ext/Endo), PDC with an Ext/Endo (PDC with Ext/Endo), or Ext/Endo without PDC (Ext/Endo without PDC). Propensity scores were used to adjust for potential confounders. After adjustment, ED rate ratios were significantly lower for PDC and PDC without Ext/Endo but higher for the Any Dental and Ext/Endo without PDC. IP ratios were lower for all treatment groups except Ext/Endo without PDC. ED costs differed little compared to the No Dental group except for Ext/Endo without PDC. For IPs, costs per member were significantly lower for all groups (-$262.91 [95% confidence interval (CI), -325.40 to -200.42] to -$379.82 [95% CI, -451.27 to -308.37]) except for Ext/Endo without PDC. For total health care costs, Ext/Endo without PDC had a significantly greater total health care cost ($530.50 [95% CI, 156.99-904.01]). Each additional PDC visit was associated with a 3% reduction in the relative risk for ED and 9% reduction for IPs. Costs also decreased for total health care (-$235.64 [95% CI, -299.95 to -171.33]) and IP (-$181.39 [95% CI, -208.73 to -154.05]). In conclusion, an association between PDC and improved health care outcomes was observed, with the opposite association for Ext/Endo without PDC.

Microbiological study of HIV-related periodontitis.

The subgingival microbiota in 14 persons with HIV-periodontitis was examined. Subgingival plaque samples were collected with paper points, transported in VMGA III, and plated on anaerobic enriched brucella blood agar and various selective media. HIV-periodontitis sites revealed Actinobacillus actinomycetemcomitans, Wolinella recta, Peptostreptococcus micros, and Bacteroides intermedius, each averaging 7% to 16% of the cultivable subgingival flora in positive patients. High levels of spirochetes also were detected in diseased sites with phase-contrast microscopy. Low levels of Candida albicans or enteric Gram-negative rods were recovered in the subgingival flora in 7 HIV-periodontitis patients or Bacteroides fragilis, Fusobacterium necrophorum, Fusobacterium varium, and Eubacterium aerofaciens were recovered in 8 patients. These findings suggest that the major components of the subgingival microbial flora in HIV-periodontitis are similar to those associated with adult periodontitis in systemically healthy persons. However, HIV-periodontitis lesions also may contain organisms which are rarely found in common types of periodontitis. The etiological significance of specific periodontal organisms in HIV-periodontitis awaits further longitudinal study.

Dental complications after treating patients with AIDS.

Post-procedural complications were assessed for 331 patients with AIDS after a wide range of outpatient dental procedures. Only patients with a CD4+ cell count < or = 200 cells/mm3 were included. Patients' charts were reviewed retrospectively by the treating dentist. The overall complication rate was 0.9 percent.

Developing support programs for dentists with infectious disease.

The American Dental Association (ADA) has developed many resources to address growing concerns regarding HIV (human immunodeficiency virus) issues in dental practice, including continuing education courses, workshops, journal articles, and monographs. In addition, the ADA Council on Dental Practice has established a network for dentists with HIV/AIDS (acquired immune deficiency syndrome). The network has been named PEERS, which stands for Prevention, Education, Ethics, Resources, and Support. This paper provides guidelines for developing programs in each state to address the needs of dentists with HIV/AIDS.

Intestinal uptake of macromolecules. V. Comparison of the in vitro uptake by rat small intestine of antigen-antibody complexes prepared in antibody or antigen excess.

The in vitro absorption by rat jejunal and ileal gut sacs of soluble antigen-antibody complexes and of antigen alone was compared. Complexes prepared in 2-fold antibody excess were absorbed in significantly smaller quantities than was antigen alone. Complexes prepared in 50-fold antigen excess were absorbed by jejunal gut sacs in quantities equivalent to that antigen alone, whereas the absorption of such complexes by ileal sacs was somewhat decreased compared to that of antigen. There was less radiolabeled antigen tightly bound to the intestinal mucosa of gut sacs exposed to complexes prepared in antigen or antibody excess compared to antigen alone. Complexes prepared in antibody excess appeared to stimulate secretion of mucus and complexes were associated with the mucus fraction. It was suggested that the large size of complexes prepared in antibody excess may result in their trapping in the mucus coat of the gut, thereby preventing contact with the surface of the enterocyte from whence uptake by pinocytosis is initiated. In addition, complexes appear to be shed from the surface with mucus by a mechanism still to be elucidated.