Debora Matthews

Putting Your Money Where Your Mouth Is: Willingness to Pay for Dental Gel

AbstractObjectives: To measure preferences and willingness to pay (WTP) for a novel anaesthetic (dental gel) versus existing anaesthetic options for periodontal maintenance visits. Design: The study was conducted by developing and administering a survey, composed of a modified decision aid and a WTP instrument. The decision aid provided clinical information in layman’ terms. Patients stated their anaesthetic preference; WTP elicited the hypothetical amount of money a subject would pay to have dental gel available for maintenance cleaning, should they require anaesthetic. Patients: Periodontal recall patients (n = 97; ‘recall’) and participants from the general population (n = 196; ‘general’) from southwestern Ontario, Canada. Results: The overwhelming majority of participants chose dental gel over injectable local anaesthetic or no anaesthetic as their first anaesthetic preference (general: 81.0%; recall: 82.5%). The median WTP for dental gel was 20.00 Canadian dollars (

The Canadian systemic sclerosis oral health study: orofacial manifestations and oral health-related quality of life in systemic sclerosis compared with the general population

Can) per visit for the general population and

Oral health-related quality of life in an aging Canadian population

Can10.00 for the recall population (1999 values). The majority of participants were willing to pay an insurance premium for dental gel, even if they did not personally prefer dental gel (general: 72.4%; recall: 73.2%). The median monthly premium to have dental gel available for any plan beneficiary requiring scaling and root planing (SRP) during maintenance was

Assessing the Quality of Randomized Controlled Trials Examining Psychological Interventions for Pediatric Procedural Pain: Recommendations for Quality Improvement

Can2.00 per month for both groups. Conclusions: In this population, an alternative to traditional injectable local anaesthetic (i.e. dental gel) was overwhelmingly preferred by both general population participants and recall patients for maintenance cleaning procedures. Most participants were willing to pay to have dental gel available, either for themselves or for others.

The oral health of ageing baby boomers: a comparison of adults aged 45-64 and those 65 years and older

OBJECTIVE The aim of this study was to compare oral abnormalities and oral health-related quality of life (HRQoL) of patients with SSc with the general population. METHODS SSc patients and healthy controls were enrolled in a multisite cross-sectional study. A standardized oral examination was performed. Oral HRQoL was measured with the Oral Health Impact Profile (OHIP). Multivariate regression analyses were performed to identify associations between SSc, oral abnormalities and oral HRQoL. RESULTS We assessed 163 SSc patients and 231 controls. SSc patients had more decayed teeth (SSc 0.88, controls 0.59, P = 0.0465) and periodontal disease [number of teeth with pocket depth (PD) >3 mm or clinical attachment level (CAL) ≥5.5 mm; SSc 5.23, controls 2.94, P < 0.0001]. SSc patients produced less saliva (SSc 147.52 mg/min, controls 163.19 mg/min, P = 0.0259) and their interincisal distance was smaller (SSc 37.68 mm, controls 44.30 mm, P < 0.0001). SSc patients had significantly reduced oral HRQoL compared with controls (mean OHIP score: SSc 41.58, controls 26.67, P < 0.0001). Multivariate regression analyses confirmed that SSc was a significant independent predictor of missing teeth, periodontal disease, interincisal distance, saliva production and OHIP scores. CONCLUSION Subjects with SSc have impaired oral health and oral HRQoL compared with the general population. These data can be used to develop targeted interventions to improve oral health and HRQoL in SSc.

The Canadian Systemic Sclerosis Oral Health Study IV: oral radiographic manifestations in systemic sclerosis compared with the general population

BackgroundThe purpose of the study is to describe the impact of oral health-related quality of life (OHRQoL) on the lives of pre-seniors and seniors living in Nova Scotia, Canada.MethodsThis cross-sectional study involved 1461 participants, grouped by age (pre-seniors [45–64] and seniors [65+]) and residential status (long-term care facility [LTC] or community). OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14) in a random digit dialing telephone survey (for community residents) or a face-to-face interview (for LTC residents). Intra-oral examinations were performed by one of six dentists calibrated to W.H.O. standards.ResultsApproximately one in four pre-seniors and seniors reported at least one OHRQoL impact ‘fairly/very often’. The most commonly reported impacts were within the dimensions ‘physical pain’ and ‘psychological discomfort’. It was found that 12.2% of LTC residents found it uncomfortable to eat any foods ‘fairly/very’ often compared to 7.7% in the community, and 11.6% of LTC residents reported being self-conscious ‘fairly/very often’ compared to 8.2% in the community. Of those residing in the community, pre-seniors (28.8%) reported significantly more impacts than seniors (22.0%); but there were no significant differences in OHRQoL between pre-seniors (21.2%) and seniors (25.3%) in LTC. Pre-seniors living in the community scored significantly higher than community dwelling seniors on prevalence, extent and severity of OHIP-14 scores. Logistic regression revealed that for the community dwelling sample, individuals living in rural areas in addition to those being born outside of Canada were approximately 2.0 times more likely to report an impact ‘fairly/very often’, whereas among the LTC sample, those having a high school education or less were 2.3 times more likely to report an impact.ConclusionsFindings indicate that the oral health and OHRQoL of both pre-seniors and seniors in LTC residents is poor. Community dwelling pre-seniors have the highest prevalence rate of oral impacts.

Prevention and treatment of periodontal diseases in primary care.

OBJECTIVE Systematic reviews of randomized controlled trials (RCTs) support the efficacy of psychological interventions for procedural pain management. However, methodological limitations (e.g., inadequate randomization) have affected the quality of this research, thereby weakening RCT findings. METHODS Detailed quality coding was conducted on 28 RCTs included in a systematic review of psychological interventions for pediatric procedural pain. RESULTS The majority of RCTs were of poor to low quality (criteria reported in <50% of RCTs). Commonly reported criteria addressed study background, conditions, statistical analyses, and interpretation of results. Commonly nonreported criteria included treatment administration, evaluation of treatment efficacy (effect sizes, summary statistics, intention-to-treat analyses), caregiver demographics, follow-up, and participant flow. Quality was greater in more recent trials, and did not vary by journal type (psychology vs. medical). CONCLUSION Despite poor quality ratings, quality reporting in psychological RCTs for pediatric procedural pain has improved over time. Recommendations for quality enhancement are provided.

Relationship Between Disease Characteristics and Orofacial Manifestations in Systemic Sclerosis: Canadian Systemic Sclerosis Oral Health Study III

OBJECTIVES To compare the oral health status of adults aged 45-64 (baby boomers) and those aged 65 and older. METHODS An observational, cross-sectional survey of adults living independently in rural and urban settings in Nova Scotia, Canada was conducted. Using random digit dialing, calibrated interviewers completed a telephone survey, and clinicians calibrated to WHO standards conducted clinical examinations. Weighting was used to correct for sampling bias. RESULTS 747 community dwelling adults completed both the clinical exam and the questionnaire (n=411, age 45-64; n=336, age 65 or older). Rates of edentulism were low (2.6% aged 45-64; 15.7% aged 65+; p<0.001). Untreated root caries was greater in the older dentate group (19.7 vs. 10.1%; p<0.001). Being 65 years of age or older was identified as a predictor of increased decayed, missing, filled teeth, presence of decayed and/or filled roots and presence of attachment loss≥4 mm, but was not a significant predictor of presence of untreated coronal caries. CONCLUSIONS A falling rate of edentulism and a higher risk for root caries with increasing age may predict the need for more complex dental care as our population ages.

Possible link between periodontal disease and coronary heart disease.

OBJECTIVE The aim of this study was to compare oral radiologic abnormalities associated with systemic sclerosis (SSc) against abnormalities in the general population. STUDY DESIGN Patients with SSc and healthy controls were enrolled in a multi-site cross-sectional study. Included in the radiology examination were a panoramic radiograph, four bitewings, and an anterior mandibular periapical radiograph. Radiographs were evaluated by two oral and maxillofacial radiologists tested for interobserver and intraobserver reliability. Chi-squared tests, Fisher exact tests, and Mann Whitney U tests were used to summarize the radiologic manifestations of patients and controls. RESULTS We assessed 163 SSc patients and 231 controls. Widening of the periodontal ligament space (PLS) (P < .001), with higher percentage of teeth with PLS widening (P < .001), was significantly more frequent in patients with SSc than in controls. The most significant differences between the two groups were found in the molars and premolars (P < .001). Moreover, 26% of the patients with SSc had a periapical PLS greater than 0.19 mm compared with 13% of the controls (P = .003). Patients with SSc had significantly more erosions compared with controls (14.5% vs. 3.6%; P < .001), mostly in the condyles (P = .022), coronoid processes (P = .005) and other locations (P = .012). CONCLUSION Patients with SSc had more teeth with PLS widening and erosions of the mandible compared with controls.

No good evidence to link toothbrushing trauma to gingival recession.

Scope and purposeThe aim of this guidance is to support the dental team to; manage patients with periodontal diseases in primary care appropriately; improve the quality of decision making for referral to secondary care; improve the overall oral health of the population. It focuses on the prevention and non-surgical treatment of periodontal diseases and implant diseases in primary care. The surgical treatment of periodontal and implant diseases and the management of patients by periodontal specialists or in a secondary care setting are outwith the scope of this guidance and are not discussed in detail. The guidance is based on existing guidelines, including those from the British Society of Periodontology, relevant systematic reviews, research evidence and the opinion of experts and experienced practitioners.MethodologyThe methodological approach is based on the international standards set out by the Appraisal of Guidelines Research and Evaluation (AGREE) Collaboration (www.agreetrust.org). The guiding principle for developing guidance within SDCEP is to first source existing guidelines, policy documents, legislation or other recommendations. Similarly, relevant systematic reviews are also initially identified. These documents are appraised for their quality of development, evidence base and applicability to the remit of the guidance under development. In the absence of these documents or when supplementary information is required, other published literature and unpublished work may be sought.Review and updatingThe guidance will be reviewed in three years and updated accordingly.RecommendationsRecommendations are provided for assessment and diagnosis; changing patient behaviour; treatment of gingival conditions; periodontal conditions; long term maintenance; management of patients with dental implants; referral and record keeping. The key recommendations highlighted are: Assess and explain risk factors for periodontal diseases to patientsScreen all patients for periodontal diseases at every routine examinationCarry out a full periodontal examination for patients with BPE scores 3, 4 and *Use the Oral Hygiene TIPPS (talk, instruct, practise, plan, support) behaviour change strategy to address inadequate plaque removalRaise the issue of smoking cessation where appropriateEncourage patients to modify other lifestyle factors that may impact on their oral healthEnsure the patient is able to perform optimal plaque removalRemove supra-gingival plaque, calculus and stain and sub-gingival depositsEnsure that local plaque retentive factors are correctedRemove supra-gingival plaque, calculus and stain and correct any local plaque retentive factors. Carry out root surface instrumentation at sites ≥4 mm probing depth where sub-gingival deposits are present or which bleed on probingDo not use antimicrobial medication to treat chronic periodontitisRemove supra-gingival plaque, calculus and stain and sub-gingival deposits and ensure that local plaque retentive factors are correctedAssign an individuals risk level based on the patients medical history and oral health status and schedule recall appointments accordinglyEnsure the patient is able to perform optimal plaque removal around the dental implant(s)Examine the peri-implant tissues for signs of inflammation and bleeding on probing and/or suppuration and remove supra- and sub- mucosal plaque and calculus deposits and excess residual cementPerform radiographic examination only where clinically indicatedConsult any locally produced referral guidelines and the BSP ‘Referral Policy and Parameters of Care’ to determine if the patient is a suitable candidate for referralCarry out initial therapy to address inadequate plaque removal, smoking status (if applicable) and to remove supra- and sub-gingival depositsProvide supportive periodontal therapy and monitoring for patients who have been discharged from secondary careRecord the results of the periodontal examinations (basic and/or full) carried out and the current standard of oral hygieneRecord the diagnosis, suggested treatment plan and details of costsDocument any discussions you have with the patient, for example, treatment options, risks and benefits of treatment, oral hygiene advice, smoking cessation, alcohol consumption and/or other lifestyle factors.Research recommendationsThere is a need for high-quality research carried out within an appropriate governance framework to improve the evidence base in the following areas: barriers and facilitators to the delivery of oral hygiene interventions in primary care;behaviour change interventions to improve inadequate oral hygiene;optimal timescales for provision of routine supra-gingival debridement (dental prophylaxis) and supportive periodontal therapy;effectiveness of supportive periodontal therapy regimens;effectiveness of supportive therapy regimens to maintain peri-implant tissues;effectiveness of interventions to treat peri-implant mucositis and peri-implantitis.Consensus is urgently required on the importance and validity of surrogate periodontal outcomes (eg bleeding on probing, changes in clinical probing depth and clinical attachment level and bone levels) and their relationship to true outcomes (eg tooth loss and patient-centred outcomes) so that consistency can be achieved across studies. There is also a need for independent research into the effectiveness of oral hygiene tools such as toothbrushes, interdental aids, toothpastes and mouthwashes and gels containing antibacterial agents.