Numerous studies have shown that problems with oral health are strong co-indicators of other serious diseases such as diabetes, cancer, and cardiovascular disease. Now, a research team will explore innovative treatment options for periodontal diseases, specifically exploring ways to use combinatory antimicrobial approaches to disrupt biofilm such as plaque to increase the effectiveness of treating harmful oral bacteria.
Titled “Novel Strategies for Treatment of Periodontal Disease and Remediation of Oral Dysbosis,” the project comprises researchers from Wilfrid Laurier University, McMaster University, and the University of Toronto, as well as Mirexus Biotechnologies, funded by a GlycoNet Collaborative Team Grant. Also known as the Canadian Glycomics Network, GlycoNet is a pan-Canadian, multidisciplinary research network funded by the Canadian government aimed at delivering solutions to important health issues via the study of glycomes.
Mirexus Biotechnologies produces PhytoSpherix, an edible, water soluble, and biodegradable nanomaterial that’s chemically identical to glycogen and extracted from non-genetically modified corn. The human body stores glycogen, which is a natural polysaccharide, as a source of energy. Mirexus is currently investigating how PhytoSpherix can be leveraged across a variety of personal care applications.
The researchers aim to characterize biofilms formed during the establishment of a normal microflora compared to co-cultures of periodontal pathogenic organisms. Also, they will evaluate the changes to perio-pathogenic biofilms versus normal oral biofilms when challenged with combinations of various therapeutic and biofilm-disruptive additives to suggest novel treatment options that can be evaluated.
According to GlycoNet, Canadians spent approximately $12.8 billion on dental care and treatment costs in 2009, which was second in the nation only to cardiovascular disorders. Considering this financial burden as well as the increased risk of mortality associated with periodontal diseases and their connection with other systemic illnesses, the researchers believe that identifying innovative periodontal treatment options is a major health priority.
“GlycoNet’s support has brought together a unique team to tackle an important problem, and we will be excited to focus on this new opportunity in the commercialization of our unique, natural nanomaterial,” said Phil Whiting, president and CEO of Mirexus.
The 2017 KOL Access Webinar Series from OraVital Inc. will kick off with a pair of free sessions from pioneers in the oral-systemic health movement, Bradley Bale, MD, and Amy Doneen, DNP, ARNP, who are the authors of the bestselling book Beat the Heart Attack Gene. They also are coauthors of “High-Risk Periodontal Pathogens Contribute to the Pathogenesis of Atherosclerosis,” published by the British Medical Journal (BMJ) and the Postgraduate Medical Journal (PGMJ).
“This is a groundbreaking report that further validates the oral-systemic health link in general and, more specifically, the perio-cardio link,” said Dr. Jim Hyland, CEO of OraVital. “The PGMJ/BMJ manuscript clearly states, ‘periodontal disease due to high-risk pathogens is a cause of arterial disease.’ Now more than ever, dental clinicians can and should strengthen their commitment identifying and managing this form of periodontal disease.”
Bale will present the first webinar, “High-Risk Periodontal Pathogens Contribute to the Pathogenesis of Atherosclerosis,” on Thursday, February 9, at 8:30 pm est. He will discuss why periodontal disease due to high-risk pathogens must be considered a contributory cause of arterial disease and how the dental community has a significant opportunity to favorably impact the nation’s number one cause of death and disability—heart disease—by managing this type of periodontal disease.
Doneen then will present “Integrating the Science of Oral/Systemic Health into Clinical Practice” on Thursday, March 9 at 8:30 pm est. She will describe why it is necessary to respect the clinical context for which the information in the BMJ/PGMJ study can be applied to the clinical dental arena as well as why lines of communication must be created between medicine and dentistry that can clearly articulate the importance of understanding the oral pathogen burden as it relates to the vascular health of the individual patient.
Bale is an adjunct professor at the Texas Tech University Health Science Center, medical director of the Heart Health Program at Grace Clinic in Lubbock, Tex, and co-founder of the Bale/Doneen Method, which has been shown to halt, stabilize, and regress arterial disease. Doneen, also a co-founder of the Bale/Doneen Method, is medical director of the Heart Attack & Stroke Prevention Center and an adjunct professor at Texas Tech University Health Sciences.
- Calcium release stimulates1* hydroxyapatite and secondary dentin bridge formation2,3
- Alkaline pH promotes healing and apatite formation2,4
- Significant calcium release1 leads to protective seal5,7,8
- Protects and insulates the pulp5,6
- Moisture tolerant1 and radiopaque – can be placed under restorative materials and cements
- A protective liner for use under restorative materials, cements, or other base materials.
- Pulp capping agent: TheraCal LC may be placed directly on the pulpal exposures after hemostasis is obtained. It is indicated for any pulpal exposures, including caries exposures, mechanical exposures or exposures due to trauma.
- Radiopaque properties allow for easy detection on x-rays
- Gandolfi MG, Siboni F, Prati C. Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping. Int Endod J. 2012 Jun;45(6):571-9.
- ADA definitions for direct and indirect pulp capping at: http://www.ada.org/en/publications/cdt/glossary-of-dental-clinical-and-administrative-ter.
- Gandolfi MG, Siboni F, Taddei P, Modena E, and Prati C. Apatite-forming ability of TheraCal pulp-capping material, J Dent Res 90 (Spec Iss A):abstract number 2520, 2011 (www.dentalresearch.org).
- Okabe T, Sakamoto M, Takeuchi H, Matsushima K. (2006) Effects of pH on mineralization ability of human dental pulp cells. J Endod 32, 198-201.
- Sangwan P, Sangwan A, Duhan J, Rohilla A. Tertiary dentinogenesis with calcium hydroxide: a review of proposed mechanisms. Int Endod J. 2013; 46(1):3-19
- Savas S, Botsali MS, Kucukyilmaz E, Sari T. Evaluation of temperature changes in the pulp chamber during polymerization of light-cured pulp-capping materials by using a VALO LED light curing unit at different curing distances. Dent Mater J. 2014;33(6):764-9.
- Cantekin K. Bond strength of different restorative materials to light-curable mineral trioxide aggregate. J Clin Pediatr Dent. 2015 Winter;39(2):143-8.
- Nielsen M, Vanderweele R, Casey J, and Vandewalle K, USAF, JBSA-Lackland, TX. Mechanical properties of new dental pulp-capping materials over time. J Dent Res 93(Spec Iss A): 495, 2014 (www.dentalresearch.org).
The global dental consumables market will grow from its 2016 total of $25.45 billion at a compound annual growth rate of 6.8% to reach $35.35 billion by 2021, according to ResearchandMarkets. The company included dental restoration, orthodontics, periodontics, endodontics, infection control products, finishing and polishing products, and whitening products among other items in defining the market for evaluation.
The analyst firm attributes this growth to the rapid rise in the world’s geriatric population, growing dental tourism in emerging markets, rising rates of dental caries and other periodontal diseases, growing disposable incomes, greater demand for cosmetic dentistry, and increased dental care expenditures. But the company also expects high costs and limited reimbursements for dental care and a shortage of dental professionals will restrain some of the market’s growth.
The dental restoration segment accounted for the largest share of the global dental consumables market in 2015 due to its wide utilization by dental professionals in teeth regeneration and restoration procedures. Based on the type of end-users, ResearchandMarkets segmented the market into dental hospitals and clinics, dental academic and research institutes, and forensic laboratories.
In 2015, Europe commanded a major share of the dental consumables market due to its aging population, government expenditures, and high reimbursement rates. Also, implant dentistry got its start in Europe, so the penetration rate of dental implants there is very high. However, ResearchandMarkets expects the Asia-Pacific region to see the fastest growth through 2021 because of its growing geriatric population, increases in dental diseases, larger dental expenditures, and an increasing number of dental hospitals and clinics.
Augmented reality isn’t just for gamers anymore. A cross-disciplinary team of researchers at the University of Western Australia (UWA) is developing software that will enable dentists wearing augmented reality glasses to use hand gestures to access information that then will be displayed in their peripheral vision.
“A big problem at the moment is the amount of interruptions dentists face when performing procedures, with an estimated 20% of their day carrying out nonclinical tasks and a significant amount of time away from patients during a procedure to review critical information,” said lead developer Marcus Pham, an electrical engineering and computer science student.
“The technology we are developing will change this by providing dentists with all the information they need without them needing to interrupt a procedure, so they can focus entirely on the patient,” Pham said. “This means the time taken to carry out procedures will be drastically reduced, and the quality of dental work will also improve.”
Aside from providing these patient benefits, the technology also is designed to decrease costs in dentistry and help train dental school students. For example, it could provide students with accurate and fast feedback as they learn intricate manual tasks such as tooth preparation, instead of students seeking feedback from a teacher’s interpretation of their work.
The researchers have been selected as one of 10 teams in Australia to be included in the Commonwealth Scientific and Industrial Research Organization ON Accelerate3 program, a 12-week collaboration that connects experienced and aspiring researchers to develop business models, find funding, and improve marketing before commercialization.
The team also includes Paul Ichim, DMD, of UWA Dentistry, Thomas Braunl, PhD, of UWA Engineering, and Rob Shannon, project manager of the UWA Innovation Quarter. After developing and testing the technology with students at UWA Dentistry, the researchers hope it will be available for commercialization as early as next year.
The bacterial and fungal pathogens that form biofilm on traditional dental implants pose a significant risk for infections, since biofilm resists antimicrobial drugs like antibiotics. Now, researchers at the University of Leuven in Belgium have developed a titanium-silica dental implant that reduces these infection risks by fending off pathogens before biofilm forms.
“Our implant has a built-in reservoir underneath the crown of the tooth,” said Kaat De Cremer, PhD, lead author of the study. “A cover screw makes it easy to fill this reservoir with antimicrobial drugs. The implant is made of a porous composite material, so that the drugs gradually diffuse from the reservoir to the outside of the implant, which is in direct contact with the bone cells. As a result, the bacteria can no longer form a biofilm.”
The researchers subjected the implant to various tests for use with chlorhexidine mouthwash. According to the results, Streptococcus mutans can’t form biofilms on the outside of the implant when the reservoir is filled with chlorhexidine. Biofilms that were grown beforehand on the implant were eliminated in the same way, meaning the implant is effective in both preventing and curing infections.
The study, “Controlled Release of Chlorohexidine from a Mesoporous Silica-Containing Macroporous Titanium Dental Implant Prevents Microbial Biofilm Formation,” was published by European Cells and Materials.
Before you decide which NiTi file to use in your practice—or which you would want used on you if you were the patient—there are several factors to consider.
One of the most nerve-wracking things about performing root canals is file breakage. There is no worse feeling than placing a file in a tooth and having it come out shorter. This is especially a matter of concern when using mechanized NiTi files. So, there’s no arguing that file separation anxiety is important.
But what if your NiTi file unwinds? Or unwinds easily? Is that a reason for concern? Absolutely. An unwound endo file has failed its purpose, becomes obsolete, and, of course, would require replacement. More importantly, the unwinding of NiTi files is a “red flag” and may be a precursor for file separation. What does that mean to us wet-fingered dentists? Anxiety!
In turn, it’s no wonder that one of the most widely researched topics in endodontics is NiTi file performance as related to fracture resistance. The recent introduction of reciprocating NiTi files has further increased the curiosity into their performance both on their own and compared to traditional rotary NiTi files. Interestingly, studies have shown that NiTi files used in reciprocating motion, versus rotational, have extended lifespans.
The desire for the ultimate NiTi file and the competition between endodontic companies to promote their files has led many of them to market the (arguably) 2 most important issues in NiTi file usage: file separation and (low) file costs. However, the one quality that is rarely if ever promoted is resistance to file unwinding.
Although file separation is the worst thing that could happen, in 2017, there is no excuse for NiTi files to unwind, or at least unwind easily. One should consider file unwinding to be nearly as bad as file separation since both mean that the file has failed to perform as intended. Furthermore, file unwinding would require file replacement. More file replacements mean increased procedure time and increased anxiety.
I raised the point of file cost since, like you, I pay for my instruments and would love to find a file that is less expensive and doesn’t unwind—or at least doesn’t unwind easily. But well-performing files and low file costs don’t always go hand in hand. Hence, inexpensive but potentially poor performing files that require more replacements may not be cheaper after all.
Before you decide on a NiTi file, then, please also consider how resistant the file is to unwinding.
If you are interested in learning more about this and other endodontic topics, then I welcome you to the Chicago Midwinter Meeting. I’ll be presenting there on “Root Canals Done Faster, Better & Safer: A Practical Course for General Dentists” and “Controversies & Advances in Endodontics That Every Dentist Should Know,” without bias, on Friday, February 24.
Dr. Haas reports no disclosures.
Dr. Haas is a Certified Specialist in Endodontics and is extensively involved in continuing education to dentists. He is a Fellow of the Royal College of Dentists of Canada and is on staff at the University of Toronto Faculty of Dentistry and the Hospital for Sick Children. He maintains a full-time private practice limited to endodontics and microsurgery in Toronto. Dr. Haas can be reached at haasendoeducation.com.
Those of us who wore braces when we were younger can thank our orthodontists for the straight teeth we have now. And, the growing number of people who have had their teeth straightened as adults are also indebted to their orthodontists. But today’s families may hesitate before getting necessary treatment because of the costs and the complications involving insurance and payment.
Many dental plans cover orthodontics, but the coverage often differs from other dental services. Patients will usually pay a higher share of the cost, coverage may be limited to children, and there is often a lifetime maximum. Helping the families you treat understand the details of their plan and their payment options now can help them get ready for the time when they may need orthodontic care.
When Is It Time for the Orthodontist?
Orthodontic services are most common for children, although many adults now seek them, too. Whether such services are deemed medically necessary (which may make them more likely to be covered) or cosmetic, FAIR Health data show that private insurance claim lines for orthodontic services rose more steeply for adults than for children from 2007 to 2014 (see the figure).
The percent of claim lines stayed at about 11% from beginning to end of the period for the age ranges 5 to 12 years and 13 to 20 years, but increased sharply for all older age ranges, with the biggest increase seen among people aged 61 to 65 years: a fivefold increase from 4% to 20%. Still, most orthodontic care is prescribed for children.
How Do You Get Paid?
Even if your patients’ dental plans cover orthodontics, they most likely still will have out-of-pocket costs. Because orthodontic services continue for a long period of time, it’s beneficial for practitioners and patients alike when orthodontists offer a number of ways to pay. These may include:
- Installment payments, spread out during the course of the treatment: With this option, patients may have to pay a higher “down payment” when they begin treatment. Some orthodontists may also charge interest if patients miss a payment.
- Payment coupons, spread out for a defined period of time: With this option, patients might make a payment every month, like they would with a loan.
- Discounted pricing when patients pay the total cost of treatment up front.
- Financing treatment costs over time: With this option, patients may pay a lower amount each month, but keep paying it even after the treatment has ended.
Families who have a flexible spending arrangement (FSA) or health savings account (HSA) through an employer (see Flexible Spending Plans) may be able to use it to pay for orthodontic costs that their dental plan does not cover. But remember, they can only use money from their FSA or HSA after the service has been provided.
Families who are planning to use an FSA should make sure to keep track of how much money they will need to put away and decide whether they will pay in a lump sum or in installments over time. Also, they should make sure to check what documents they will need to provide to use their FSA or HSA. Sometimes the requirements might be different depending on how they are paying for the care.
How Much Will a Dental Plan Cover?
Dental plans usually cover 4 major classes of service. Each class is paid differently. These include:
- Diagnostic and preventive care, like cleanings, exams and x-rays: These services are usually covered in full (100%) up to a maximum charge amount per service.
- Basic restorative care, such as fillings, periodontal work, and root canals: These services are usually paid at a lower rate; 80% of a maximum charge amount per service is common.
- Major restorative care, such as crowns, bridges, and dentures: Plans usually pay 50% of a maximum charge amount per service for these services.
- Orthodontic services: Plans often cover up to 50% of the total charge for the services, up to a lifetime dollar maximum. This lifetime maximum is the total the plan will pay for all orthodontic treatment. It is usually separate from the dental maximum and, in some cases, may include charges for other services that are orthodontic-related but do not deal with “movement of teeth,” such as extractions of teeth to help create space.
You should also keep in mind that:
- Patients who are covered by a Dental Health Maintenance Organization (DHMO) will usually have fixed copayments for different types of orthodontic treatment.
- There is usually no deductible for orthodontic services.
- Adult orthodontic care often is not covered.
- Plans that cover orthodontic services may limit coverage to members or dependents under the age of 19 years and may require some chewing dysfunction to qualify for coverage.
Of course, not all plans cover orthodontic services, and each dental plan’s coverage may be different. It is a good idea for patients to check their dental plan booklet or contact their insurer or plan administrator so they understand how their plan works, what is covered, and what they can expect to pay out of pocket.
What If You’re Out of Network?
Sometimes, you may be outside of your patients’ plan network. If you are, these patients should make sure they find out how much they may have to pay. Different types of dental plans cover orthodontic care differently.
For example, a DHMO usually does not cover any out-of-network care, which means that the patients will have to pay the full cost. Or, if they have a fee-for-service plan that includes out-of-network care, the lifetime maximum may be lower than the full charge for orthodontic care (set at some percentage, such as 50%) and they will have pay for any treatment costs over that limit. A fee-for-service plan might also pay less for out-of-network services than in-network services.
In most cases, there is no major difference between the lifetime maximums for in-network and out-of-network services for orthodontics.
Help Your Patients Plan Ahead for Their Families’ Care
Patients who have a dental plan should read through their plan documents, ask their employer, or call their plan to make sure they know:
- The type of plan (like a DHMO or Dental Preferred Provider Organization [DPPO]);
- Which orthodontic services are covered;
- If and how their plan pays for out-of-network orthodontic services;
- The lifetime maximum amount for orthodontic services (they will have to pay the full cost above that limit);
- Whether there is an age limit to start and complete orthodontic care.
Also, you should discuss the cost and their payment options (such as paying a discounted price for the entire service up front) with your patients. Plus, they should find out if they can use the funds in their FSA or HSA. If so, they should make sure they understand how much they are going to have to pay, and when, so they know how much money to put away. They only can use these accounts after the services have already been provided.
You and your patients both can learn more about types of dental plans and how they cover care by referring to Dental Plans. And remember, encourage your patients to ask you as well as their dentist, employer, and insurer all the questions they need to know. Understanding their coverage and costs up front now will help you and them better plan for their family’s future and will give them another reason to smile.
Robin Gelburd, JD, is the president of FAIR Health, a national, independent nonprofit with the mission of bringing transparency to healthcare costs and insurance reimbursement. FAIR Health oversees the nation’s largest repository of private healthcare claims data, comprising more than 22 billion billed medical and dental charges that reflect the claims experience of over 150 million privately insured Americans. Follow on twitter @FAIRHealth.