Stefan Listl

Global Economic Impact of Dental Diseases

Reporting the economic burden of oral diseases is important to evaluate the societal relevance of preventing and addressing oral diseases. In addition to treatment costs, there are indirect costs to consider, mainly in terms of productivity losses due to absenteeism from work. The purpose of the present study was to estimate the direct and indirect costs of dental diseases worldwide to approximate the global economic impact. Estimation of direct treatment costs was based on a systematic approach. For estimation of indirect costs, an approach suggested by the World Health Organization’s Commission on Macroeconomics and Health was employed, which factored in 2010 values of gross domestic product per capita as provided by the International Monetary Fund and oral burden of disease estimates from the 2010 Global Burden of Disease Study. Direct treatment costs due to dental diseases worldwide were estimated at US

Income-related Inequalities in Dental Service Utilization by Europeans Aged 50+

298 billion yearly, corresponding to an average of 4.6% of global health expenditure. Indirect costs due to dental diseases worldwide amounted to US

Network Meta-Analysis for Evaluating Interventions in Implant Dentistry: The Case of Peri-Implantitis Treatment

144 billion yearly, corresponding to economic losses within the range of the 10 most frequent global causes of death. Within the limitations of currently available data sources and methodologies, these findings suggest that the global economic impact of dental diseases amounted to US

Inequalities in Dental Attendance throughout the Life-course

442 billion in 2010. Improvements in population oral health may imply substantial economic benefits not only in terms of reduced treatment costs but also because of fewer productivity losses in the labor market.

An economic evaluation of different sinus lift techniques.

The purpose of this study was to describe income-related inequalities in dental service utilization by the elderly populations residing in different European countries. We used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Wave 2), which contains information on utilization of dental services by 33,358 individuals aged 50+ years from 14 different countries. We assessed income-related inequalities in dental attendance and preventive and/or operative dental treatment by means of Concentration Indices (CI) and Slope Indices of Inequality (SII). We could identify a disproportionate concentration of access to treatment among the rich elderly populations in all 14 countries (relative inequality according to CI), as well as significantly higher access to treatment by individuals located in the highest in relation to the lowest income group for all countries except Italy and the Czech Republic (absolute inequality according to SII). Such differential utilization appears mainly attributable to inequalities in preventive dental visits, either alone or in combination with operative treatment. Persons’ oral health status explains substantial proportions of absolute but not of relative inequalities. Overall, there is considerable income-related inequality in dental service utilization by several elderly populations residing in Europe. More research is needed to identify the exact causes of such disparities.

Dental service utilization by Europeans aged 50 plus

BACKGROUND/AIM Evidence from head-to-head comparison trials on peri-implantitis treatment is limited, and it is therefore impossible to conduct a direct meta-analysis. We propose an alternative statistical method, network meta-analysis, for evidence synthesis, which enables to compare the results of multiple treatments. METHODS We searched, in triplicate, for randomized controlled trials (RCTs) and controlled trials in the PubMed, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and Latin American and Caribbean Health Sciences Literature databases up to and including August 2010. We also conducted a manual search of the reference lists regarding published systematic reviews and searched for gray literature in OpenSIGLE. We assessed changes in clinical attachment level (CAL) and pocket probing depth (PPD) after nonsurgical and surgical treatments of peri-implantitis. The risk of bias of selected studies was determined by the use of specific criteria, and it was performed in triplicate and independently. We used multilevel mixed modeling to perform the network meta-analysis and Markov Chain Monte Carlo simulation to obtain confidence intervals for the fixed and random effects. RESULTS Eleven studies were included in the review. All RCTs are at unclear or high risk of bias. Surgical therapy in conjunction with bone grafts and non-resorbable membranes achieved 3.52 mm greater PPD reduction than nonsurgical therapy alone, 95% high-probability density (HPD) intervals: -0.19, 6.81. Surgical treatment in conjunction with bone grafts and resorbable membranes achieved 2.80 mm greater CAL gain than nonsurgical therapy alone, 95% HPD intervals: -0.18, 5.59. CONCLUSION Surgical procedures in peri-implantitis treatment achieve more PPD reduction and CAL gain than nonsurgical approaches. Nevertheless, these results should be interpreted with caution because of the limited number of studies included and their low methodological quality. Network meta-analysis is a useful statistical methodology for evidence synthesis and to summarize the strength and limitation in the current evidence.

A cost‐effectiveness evaluation of enamel matrix derivatives alone or in conjunction with regenerative devices in the treatment of periodontal intra‐osseous defects

The purpose of this study was to identify socio-economic inequalities in regular dental attendance throughout the life-course. The analyses relied on data from SHARE (waves 1 to 3 of the Survey of Health, Ageing, and Retirement in Europe), which includes retrospective information on life-course dental attendance of 26,525 persons currently aged 50 years or greater from 13 European countries (Austria, Poland, Spain, Italy, the Netherlands, Belgium, Greece, the Czech Republic, France, Denmark, Switzerland, Germany, and Sweden). Inequalities in dental attendance were assessed by means of Concentration Indices. Socio-economic disparities in regular dental attendance were identified as early as childhood. Moreover, higher educational attainment resulted in increased probabilities of regular dental attendance throughout subsequent life-years in all nations. In most countries, inequality levels remained relatively inelastic throughout the life-course. These findings suggest that a considerable proportion of inequalities in dental care use is already established at childhood and persists throughout the life-course.

A systematic review and Bayesian network meta-analysis of randomized clinical trials on non-surgical treatments for peri-implantitis.

PURPOSE To identify the most cost-effective approach to sinus lifting on the basis of currently available evidence. METHODS We incorporate the costs and clinical outcomes of nine different sinus lift techniques within a decision tree model in which costs are based on insurance regulations in Germany and health outcomes follow two recent meta-analyses. The most cost-effective treatment option is identified on the basis of the maximum net benefit criterion. Uncertainties regarding health outcomes are incorporated via probabilistic sensitivity analysis based on Monte-Carlo simulation. RESULTS When there are no financial restrictions, the optimum treatment strategy is the lateral approach with autogenous particulate bone and a resorbable membrane. When, however, monetary resources for sinus-floor elevation are scarce, the most cost-effective option is the transalveolar technique without bone grafting. Only if relatively high costs can be afforded or if initial bone height at implant site is below 5 mm is the maximum net benefit achieved by lateral approaches. CONCLUSIONS On the basis of currently available evidence, the transalveolar technique is advisable when monetary resources for sinus-floor elevation are scarce and initial bone height is sufficiently high. Lateral approaches are primarily recommended for lower pre-operative bone heights.

How strong is the evidence for the need to restore posterior bounded edentulous spaces in adults? Grading the quality of evidence and the strength of recommendations

OBJECTIVES To describe variations in the utilization of dental services by persons aged 50+ from 14 European countries and to identify the extent to which such variations are attributable to differences in oral health need and in accessibility of dental care. METHODS We use data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Waves 2 and 3) and estimate a series of multivariate logistic regression models to analyze variations in dental service utilization (overall dental attendance, preventive treatment and/or operative treatment, dental attendance in early life years) RESULTS Overall dental attendance and incidence of solely preventive treatment are comparatively high in the Netherlands, Sweden, Denmark, Germany, and Switzerland. In contrast, overall dental attendance is relatively low in Spain, Italy, France, Greece, Poland, and Ireland. Moreover, a high incidence of solely operative treatment is observed in Austria, Italy, and France, whereas in the Netherlands, Sweden, Denmark, Switzerland, and Ireland, the incidence of solely operative treatment is comparably low. By and large, these variations persist even when controlling for cross-country differences in oral health need and in accessibility of dental care. CONCLUSIONS In comparison with other European regions, there is a tendency toward more frequent and preventive dental treatment of the elderly populations residing in Scandinavia and Western Europe. Such utilization patterns appear only partially attributable to differences in need for and accessibility of dental care.

Oral health conditions and cognitive functioning in middle and later adulthood.

PURPOSE To identify the most cost-effective approach to treatment of infrabony lesions with enamel matrix derivatives (EMD). METHODS We incorporated costs and clinical outcomes of 12 different treatment techniques (including flap operation, EMD alone, and EMD in association with other reconstructive devices) within a decision tree model in which costs were based on insurance regulations in Germany and health outcomes followed a recent meta-analysis. The most cost-effective treatment option was identified on the basis of the maximum net benefit criterion. RESULTS Treatment techniques using EMD were cost-efficient if the decision makers willingness-to-pay (WTP) was at least €150-175 per incremental mm of pocket probing depth reduction and clinical attachment level gain, respectively (1-year perspective). When EMD was affordable, the maximum net benefit was achieved by treatment with EMD in conjunction with bioactive glass or bovine bone substitutes. Additional application of platelet-rich plasma (PRP) or a resorbable membrane came at relatively high costs. CONCLUSIONS If EMD use is indicated, EMD in conjunction with either bioactive glass or bovine bone substitutes is more cost-effective than EMD alone. The additional use of PRP or a resorbable membrane may only be justifiable when monetary resources for treatment are very generous.