An examination of periodontal treatment and per member per month (PMPM) medical costs in an insured population

BACKGROUND: Chronic medical conditions have been associated with periodontal disease. This study examined if periodontal treatment can contribute to changes in overall risk and medical expenditures for three chronic conditions [Diabetes Mellitus (DM), Coronary Artery Disease (CAD), and Cerebrovascular Disease (CVD)]. METHODS: 116,306 enrollees participating in a preferred provider organization (PPO) insurance plan with continuous dental and medical coverage between January 1, 2001 and December 30, 2002, exhibiting one of three chronic conditions (DM, CAD, or CVD) were examined. This study was a population-based retrospective cohort study. Aggregate costs for medical services were used as a proxy for overall disease burden. The cost for medical care was measured in Per Member Per Month (PMPM) dollars by aggregating all medical expenditures by diagnoses that corresponded to the International Classification of Diseases, 9(th )Edition, (ICD-9) codebook. To control for differences in the overall disease burden of each group, a previously calculated retrospective risk score utilizing Symmetry Health Data Systems, Inc. Episode Risk Groups™ (ERGs) were utilized for DM, CAD or CVD diagnosis groups within distinct dental services groups including; periodontal treatment (periodontitis or gingivitis), dental maintenance services (DMS), other dental services, or to a no dental services group. The differences between group means were tested for statistical significance using log-transformed values of the individual total paid amounts. RESULTS: The DM, CAD and CVD condition groups who received periodontitis treatment incurred significantly higher PMPM medical costs than enrollees who received gingivitis treatment, DMS, other dental services, or no dental services (p < .001). DM, CAD, and CVD condition groups who received periodontitis treatment had significantly lower retrospective risk scores (ERGs) than enrollees who received gingivitis treatment, DMS, other dental services, or no dental services (p < .001). CONCLUSION: This two-year retrospective examination of a large insurance company database revealed a possible association between periodontal treatment and PMPM medical costs. The findings suggest that periodontitis treatment (a proxy for the presence of periodontitis) has an impact on the PMPM medical costs for the three chronic conditions (DM, CAD, and CVD). Additional studies are indicated to examine if this relationship is maintained after adjusting for confounding factors such as smoking and SES

Professional life cycle changes and their effect on knowledge level of dental practitioners

Utilizing a national data set (U.S.A.), the effect of age and age-related professional characteristics on dentists' knowledge with regard to prevention of infective endocarditis was examined. The following research questions were addressed: (1) Do age-related characteristics produce different effects on knowledge level at various stages of professional careers?; (2) What are the key changes in these age-related characteristics and what processes are suggested by these changes? Multiple regression analysis assessed the influence of potential predictors of variation in knowledge level with regard to prevention of infective endocarditis for the entire sample. Using these findings as a guide, variation in the effect of significant predictor variables was then analyzed for three time segments of approximately equal duration: early professional life . Age had a profoundly negative effect on knowledge level, i.e. the level progressively declines as clinicians grow older. The impact of the age-related characteristics on knowledge level of infective endocarditis prevention also varied according to the stage of the professional life cycle. Indices measuring the size or extent of theoretical understanding, in-office networks, institutional affiliations, and consulting networks were significant predictors of endocarditis prevention knowledge for younger clinicians. For those 40-54, only practice organization (office business and staff size and diversity) was a significant predictor, while for older clinicians theoretical understanding was the only significant predictor. Differences in the mean levels of these predictor (independent) variables across age groups were also examined via ANOVA. Level of activity, or extent of professional practice characteristics, varied from high to low with increased age on subject dentists. It is not necessarily age qua age which is responsible for the decline in knowledge level, but also age-related changes in professional life cycle attributes. Efforts to increase knowledge with regard to infective endocarditis prevention should focus on encouraging increased levels of activities on age-specific statistically significant predictor variables, with particular emphasis on increasing the level of theoretical understanding for the oldest and most deficient group.age knowledge dentists career

Predicting dentists' perceived occupational risk for HIV infection

This study posed two questions: what is the level of perceived occupational risk among American general practice dentists (GPDs)? What factors influence perception of occupational risk for HIV infection among GPDs? In data obtained from a national mail survey of 1351 GPDs (response rate, 88%) 31% of American GPDs expressed disagreement with the statement that HIV + individuals can be safely treated in their office settings. Of the 16 variables entered into a multiple regression equation, 9 variables had a statistically significant influence on dentists' assessment of occupational risk. In order of their influence they were (1) concern re the economic viability of the practice, (2) ethical obligation to treat patients at risk, (3) certainty of having treated patients with HIV infection, (4) risk attributed to four accidental occupational exposures, (5) concern re treatment of homosexuals, (6) relevant continuing education exposure, (7) personal worry re transmission of HIV infection from patients, (8) implementation of infection control behaviors, (9) number of patients seen per week. Statistically nonsignificant predictors of interest included age, knowledge level re HIV transmission routes, practice location in a high prevalence area, and perceived effectiveness of infection control behaviors. Results argue for intervention programs with less focus on delivery of factual information regarding the transmission of the disease and the effectiveness of infection control techniques, and more emphasis on the themes of practice economic viability, professional ethics, and structured educational encounters involving dentists' knowing exposure to HIV-infected patients.AIDS risk dentists survey

Predictors of dentists' level of knowledge regarding the recommended prophylactic regimen for patients with rheumatic heart disease

Maintaining knowledge of clinical practices, confirming to the latest scientific information, is a major challenge for health professionals. The study aims were (1) to measure clinicians' knowledge and (2) to determine what social factors could best explain and predict those dental clinicians who are most knowledgeable about current expert recommendations for the use of appropriate antibiotic regimens for patients at risk for bacterial endocarditis. Telephone interviews were conducted with 322 New York State dentists, assigned to the study by a computer-generated randomization procedure from lists of oral surgeons, urban general practitioners and rural general practitioners. Data demonstrated extraordinary differences in level of knowledge between oral surgeons and general practitioners, while the level of knowledge between urban and rural general practice groups was quite similar. General Linear Model (GLM)-based analyses indicated that practice size, rationalization of practice, and practice setting and affiliations contributed to the explanation of knowledge level among general practitioners, when adjusted for age. R2s for each of those variables and age, ranged from a low of 0.132 to a high of 0.334. Age made a significant contribution to the explanation of knowledge level in all of the models presented, while the explanatory power of the practice structure variables varied according to respondent's locale (urban vs rural) and age (younger vs older). In order to assess the impact of these structural variables, they were dichotomized (high-low) and entered into a GLM program which accounted for age and locale. Differences in excess of 20 points (on a 0-100 knowledge scale) were sometimes noted. The findings demonstrate the importance of specifying variable relationships in explaining level of knowledge and also suggest, albeit indirectly, differences in the processes by which urban and rural and young and old general practitioners come to know.

Evidence-Based Criteria for Differential Treatment Planning of Implant Restorations for the Maxillary Edentulous Patient.

Since the introduction of the endosseous concept to North America in 1982, there have been new permutations of the original ad modum Branemark design to meet the unique demands of treating the edentulous maxilla with an implant restoration. While there is a growing body of clinical evidence to assist the student, faculty, and private practitioner in the algorithms for design selection, confusion persists because of difficulty in assessing the external and internal validity of the relevant studies. The purpose of this article is to review clinician- and patient-mediated factors for implant restoration of the edentulous maxilla in light of the hierarchical level of available evidence, with the aim of elucidating the benefit/risk calculus of various treatment modalities