myDentalScore: an interactive tool for your dental website

December 10th, 2010

How does your dental website draw in new customers and encourage them to call you?

mydentalscore myDentalScore: an interactive tool for your dental website

myDentalScore is PreViser’s new interactive tool for YOUR practice website. Through a simple health questionnaire, myDentalScore generates scores for gum disease risk and severity, oral cancer risk, and restorative risk and needs, encouraging your patients to think about important oral risk factors and then come and discuss their status with you.

  • Increases patient interaction and awareness of the importance of professional dental care
  • Encourages patients to come to you to talk about their needs
  • Informs them of the wider implications of their oral health 
  • Is tailored to your practice

AND

  • is available for use on your website for just £125 for the first year and £75 thereafter (or a one-off £50 for PreViser clinical software subscribers).

> See a demonstration myDentalScore site here

Purchase a tailored copy of myDentalScore from the www.previser.co.uk website here

Or call us on 07725125291

Posted in About PreViser, About risk assessment | No Comments »

Look after your gums and protect yourself from rheumatoid arthritis

October 28th, 2010

Ah, if only it were that clear….

But don’t discount it yet.  What we do know is that:

  • Rheumatoid arthritis (RA) and periodontitis are both chronic inflammatory diseases.
  • The vast majority of clinical and epidemiological studies indicate that patients with RA have an increased prevalence of periodontitis and tooth loss.
  • A US population-based study on the over 60s showed that people with four out of six criteria for RA had a fourfold increased risk of having periodontitis, after adjusting for age, sex, ethnicity and smoking.
  • Periodontitis might be an important modifiable risk factor for RA.

    • What we don’t yet know is the mechanism for the association.  Is RA a causal factor for periodontitis for example through systemic bone loss, medications used to control inflammation or loss of manual dexterity leading to plaque accumulation?  Is periodontitis a trigger for a breach in immune tolerance in RA patients, thereby initiating and/or sustaining the immune-mediated inflammatory joint injury in RA?  Or could the relationship simply be a result of exposure to common genetic, environmental or behavioural factors?
     
    The 2009 paper by dePablo, Chapple, Buckley & Dietrich, in the influential journal Nature Reviews Rheumatology on “Periodontitis in Systemic Rheumatic Diseases” reviews the science and proposes a number of biologically plausible causal and non-causal mechanisms which could account for the association.  If you are interested to learn more, follow the link to the abstract here.

    Further research is underway and the European Union have funded a large consortium of researchers in Rheumatology and Periodontology (including those from Birmingham UK above), whose aim is to help clarify some of the issues raised in the review paper concerning the relationship between periodontitis and RA. 

    Certainly RA patient groups would much rather control their RA symptoms by improving and maintaining their periodontal health, than taking many of the unpleasant drugs they currently have to take, with significant associated side effects.

    Meanwhile, this simply adds to the growing number of reasons to take care of your gums.

    Posted in Perio-systemic links | No Comments »

    No toothbrushing, stone age diet and your gums

    September 28th, 2010

    What happens to the periodontal (gum) health of 10 people if you put them in a Stone Age environment for 4 weeks with no toothbrushes?!    This interesting, if small scale, study was undertaken by Baumgartner et al in 2009.  The subjects’ periodontal health was measured at baseline using four indicators: bleeding on probing (BOP), gingival (GI) and plaque indices (PI) and probing depths (PD).  The subjects who were participating in a Swiss TV documentary:

  • ate cereals, wild fruits, nuts, herbs, mushrooms, honey, some salt and dried meat.
  • had no access to modern oral hygiene methods (some of the group used twigs to clean their teeth)

    • Four weeks later their periodontal health was re-assessed using the same measures.  In the absence of modern oral hygiene you might have expected that their gums would have suffered.  This is the case when similar studies are conducted without dietary changes.

    In fact what was found was that only the level of plaque increased.  With this diet, rich in antioxidants and and anti-inflammatory components and with no refined sugar, there was no clinical evidence of increased gingival inflammation and PD and BOP decreased over time.   

    The authors concluded:   Diet matters in the control or development of gingivitis in the absence of oral hygiene measures over a 4 week period. 

    We’ll examine the relationship between nutrition and periodontal disease in future posts.  For the moment it is sufficient to say that evidence for nutrition as a risk factor is growing but not yet sufficiently robust.

    www.previser.co.uk

    Posted in Perio Risk Factors | No Comments »

    Whoopi Goldberg talks about gum disease

    September 24th, 2010

    Brilliant video clip from Whoopi Goldberg on why it is important to look after your gums…and the consequences of her neglect…. 

    Thanks to Sheila Scott for bringing this to our attention in her September e-zine

    Posted in Risk Videos | No Comments »

    Why we die

    September 22nd, 2010

    Cheerful, huh!   But do you know?

    The statistics show the following:

    why we die 300x200 Why we die

    Which leads us on to risk.  Chronic disease is largely explained by major modifiable risk factors which are:

    • unhealthy diets
    • physical inactivity
    • tobacco use

    ……..and maybe also periodontitis?

    A 25 year longitudinal study  published by Garcia et al (Ann Periodontology 1998) showed that men with periodontitis die younger.  This was after controlling for smoking status, age, blood pressure, cholesterol, and family history of heart disease.  Garcia et al examined all cause mortality in 804 healthy males, a proportion of whom had periodontitis at baseline. 

    In 2009, the data set was revisited by Jiminez et al.  Forty years from the start of the study, 516 of the group had died.  What the data showed was a 1.46-fold increase in “all cause” rate of death in men with moderate to severe alveolar bone loss (ABL) compared to men with no or minor ABL.  Why?  Read a hypothesis on the focal inflammation theory here

    The conclusion?   Time to take care of those gums….it’s not just your teeth that you are putting at risk.

    Posted in Perio-systemic links | No Comments »

    The consequences of failure to change behaviour can be terminal

    September 17th, 2010

    A light hearted Friday video clip from PreViser. 

    Not so funny though: research has shown that patients with severe periodontitis die younger.  More to follow….

    Posted in Risk Videos | No Comments »

    Stopping periodontal disease (and caries) in its tracks

    August 31st, 2010

    PreViser quantifies a patient’s risk of perio disease on a scale of 1-5 and their current disease level on a scale of 1-100.  But this is only useful if we can act on the information.

    The landmark 30 year  longitudinal study which demonstrated just what is achievable was reported by Axelsson et al.  In 1971 over 550 patients were recruited, 375 to a test group and 180 to a control group.  This paper reports on the results of the first 15 years and this link gives the abstract of the 2004 paper at 30 years. 

    In summary:

  • For the first 6 years the test group were given intensive instruction and training in oral hygiene and frequent hygiene appointments
  • Controls from the same age cohort received standard dental care

    • After 6 years:

  • New and recurrent caries were reduced by >98%
  • Frequency of periodontitis was reduced by >95%
  • Attachment loss was arrested; had attachment gain
  • The control group was discontinued for ethical reasons

    •  Participants were retained in the preventive program with the number of hygiene appointments reassessed based on risk.  The test group was re-examined after 30 years when it was found:

  • Few teeth were lost during the 30 years of maintenance; 0.4-1.8 in different age cohorts.
  • The main reason for tooth loss was root fracture; only 21 teeth were lost because of progressive periodontitis or caries.
  • The mean number of new caries lesions was 1.2, 1.7 and 2.1 in the three groups.About 80% of the lesions were classified as recurrent caries.
  • Most sites, buccal sites being the exception, exhibited no sign of attachment loss. Further, on approximal surfaces there was some gain of attachment between 1972 and 2002 in all age groups.

    • The key?  Risk based preventive treatment and patients who were educated and motivated in home care.  Learn more at www.previser.co.uk.

    Posted in About PreViser, About risk assessment | No Comments »

    Do your patients know?

    August 25th, 2010

    Perio disease is the cause of 50-60% of tooth loss in adults. That is bad enough. But do your patients know it is not just their teeth that they putting at risk?  Prof Iain Chapple highlights below findings from some recent research on the evidence for links between periodontal disease and other chronic inflammatory conditions:

  • Diabetes – periodontal disease is an independent predictor of incident diabetes (Demmer et al Diabetes Care 2008) and periodontal therapy improves glycaemic control (Stewart et al J Clin Perio 2001)
  • CVD – men <65 yrs of age with periodontal bone loss have an increased hazard ratio of incident coronary heart disease of 2.12 (Dietrich et al, Circulation 2008)
  • Rheumatoid arthritis patients are 82% more likely to have periodontitis and seropositive RA patients are 120% more likely (dePablo et al, J Rheumatol 2008)
  • Stroke – periodontal bone loss is associated with an increased hazard ratio of stroke of 3.52 and 5.81 in under 65 yr-olds (Jimenez et al, Stroke, 2009)

    • For links to the relevant articles please scroll down the page here. 

    Are your patients at risk (see www.previser.co.uk).  And do they know the wider implications?

    Posted in Perio-systemic links | No Comments »

    Friday video

    July 22nd, 2010

    An old favourite. Short and sweet, with a splash of risk but no perio

    Posted in Risk Videos | No Comments »

    All patients are not created equal

    July 19th, 2010

    In the past it was thought that every patient would get periodontitis.   Why then bother to define a patient by their risk level?  Knowledge has moved on.  We know that patients exhibit a wide spectrum of risk which changes over time.  We now have a clearer understanding of systemic and local periodontal risk factors, and we have a systematic way (PreViser) of assessing their complex interactions to enable us to predict future bone and tooth loss (Page et al 2003). 

    periodontally immune 300x195 All patients are not created equal

    We know that about 10% of patients are disease resistant (Löe et al 1986).  Take this 45 year old gentleman, who never brushes his teeth and who has marginal gingivitis but no periodontal pocketing or bone loss. He will probably never lose teeth through periodontitis, despite his lack of oral hygiene. 

    perio high risk 300x196 All patients are not created equalAnd at the other end of the spectrum you have patients such as this 19 year old girl who has good oral hygiene, apparently minimal inflammation but 9mm pockets.  She is clearly very high risk.  But knowing this before the onset / progression of disease enables us to adopt appropriate preventive measures.

    Given recent developments in our understanding together with the research which proves that periodontal disease is preventable (subject of future post), it is no longer acceptable to simply treat all patients as equal and repair the disease as it presents.  Risk assessment should form the basis of our treatment plans, and our patients have to be made aware of where they stand.  They need to know what actions they can take to reduce the risk both of losing their teeth, and also the other systemic diseases that are known to be associated with perio disease.

    The American Academy of Periodontology has stated that risk assessment should be a component of every dental and periodontal examination (see here).  The conclusions from the Steele report were that every new patient should be assessed for periodontal (and caries and oral cancer) risk.   

    Do you have a protocol in place?  Do your patients know?

    Posted in About PreViser | No Comments »

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