Screening for prediabetes and type 2 diabetes in dental offices.

OBJECTIVES: Most Americans see dentists at least once a year. Chair-side screening and referral may improve diagnosis of prediabetes and diabetes. In this study, we developed a multivariate model to screen for dysglycemia (prediabetes and diabetes defined as HbA1c ≥5.7 percent) using information readily available to dentists and assessed the prevalence of dysglycemia in general dental practices. METHODS: We recruited 1,033 adults ≥30 years of age without histories of diabetes from 13 general dental practices. A sample of 181 participants selected on the basis of random capillary glucose levels and periodontal status underwent definitive diagnostic testing with hemoglobin A1c. Logistic models were fit to identify risk factors for dysglycemia, and sample weights were applied to estimate the prevalence of dysglycemia in the population ≥30 years of age. RESULTS: Individuals at high risk for dysglycemia could be identified using a questionnaire that assessed sex, history of hypertension, history of dyslipidemia, history of lost teeth, and either self-reported body mass index ≥35 kg/m(2) (severe obesity) or random capillary glucose ≥110 mg/dl. We estimate that 30 percent of patients ≥30 years of age seen in these general dental practices had dysglycemia. CONCLUSIONS: There is a substantial burden of dysglycemia in patients seen in general dental practices. Simple chair-side screening for dysglycemia that includes or does not include fingerstick random capillary glucose testing can be used to rapidly identify high-risk patients. PRACTICAL IMPLICATIONS: Further studies are needed to demonstrate the acceptability, feasibility, effectiveness, and cost-effectiveness of chair-side screening.

Is dentistry going to get into the salivary diagnostics game or watch from the sidelines?

What is salivary diagnostics and why should you care? Most of us dentists try to avoid or control saliva as it interferes with access, or chemical interactions in dental materials or impression materials, or when it is simply a nuisance. Periodically, we may note reduced flow or encounter a patient with xerostomia. Correspondingly, we then manage the many of today's existing commercialized oral-based tests were yesterday's proposed ideas or concepts, captured in the 1993 New York Academy of Sciences Conference on oral based diagnostics. When coupled with the emerging point-of-care technology, the potential of salivary diagnostics is even more compelling. In this section, I hope to elucidate for the reader the potential of salivary diagnostics for the dental profession and So what is the value proposition? How could this disruptive technology serve the dentist and the patients they treat? What must occur to facilitate the ongoing development and introduction of salivary diagnostics into the marketplace?

Is dentistry going to get into the salivary diagnostics game or watch from the sidelines?

What is salivary diagnostics and why should you care? Most of us dentists try to avoid or control saliva as it interferes with access, or chemical interactions in dental materials, or impression materials, or when it is simply a nuisance. Periodically, we may note reduced flow or encounter a patient with xerostomia. Correspondingly, we then manage the reduced flow in an attempt to maintain homeostasis. However, with the discovery of salivary biomarkers, saliva is taking on a new role.

The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, Medicare, and Medicaid.

BACKGROUND: Head and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Consequently the economic burden of oral cavity, oral pharyngeal, and salivary gland cancer (OC/OP/SG) must be understood. The cost of these cancers in the U.S. has not been investigated. METHODS: A retrospective analysis of administrative claims data for 6,812 OC/OP/SG cancer patients was undertaken. Total annual health care spending for OC/OP/SG cancer patients was compared to similar patients without OC/OP/SG cancer using propensity score matching for enrollees in commercial insurance, Medicare, and Medicaid. Indirect costs, as measured by short term disability days were compared for employed patients. RESULTS: Total annual health care spending for OC/OP/SG patients during the year after the index diagnosis was $79,151 for the Commercial population. Health care costs were higher for OC/OP/SG cancer patients with Commercial Insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303) and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01). Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of cost of care, from $96,520 in the Medicare population to $153,892 in the Commercial population. CONCLUSIONS: In the U.S., the cost of OC/OP/SG cancer is significant and may be the most costly cancer to treat in the U.S. The results of this analysis provide useful information to health care providers and decision makers in understanding the economic burden of head and neck cancer. Additionally, this cost information will greatly assist in determining the cost-effectiveness of new technologies and early detection systems. Earlier identification of cancers by patients and providers may potentially decrease health care costs, morbidity and mortality.

The dental treatment of patients with joint replacements: a position paper from the American Academy of Oral Medicine.

BACKGROUND: In February 2009, the American Academy of Orthopaedic Surgeons (AAOS) published an information statement in which the organization "recommends that clinicians consider antibiotic prophylaxis [AP] for all total joint replacement patients prior to any invasive procedure that may cause bacteremia." The leadership of the American Academy of Oral Medicine (AAOM) thought that there was a need to respond to this new statement. METHODS: The authors reviewed the literature on this subject as it relates to the AAOS's February 2009 information statement. The draft of the resulting report was reviewed and approved by the leadership of the AAOM and several dentists in North America who have expertise on this subject. RESULTS: The risk of patients' experiencing drug reactions or drug-resistant bacterial infections and the cost of antibiotic medications alone do not justify the practice of using AP in patients with prosthetic joints. CONCLUSIONS: The authors identified the major points of concern for a future multidisciplinary, systematic review of AP use in patients with prosthetic joints. In the meantime, they conclude that the new AAOS statement should not replace the 2003 joint consensus statement. CLINICAL IMPLICATIONS: Until this issue is resolved, dentists have three options: inform their patients with prosthetic joints about the risks associated with AP use and let them decide; continue to follow the 2003 guidelines; or suggest to the orthopedic surgeon that they both follow the 2003 guidelines.

Dentin bonding: SEM evaluation of the glass ionomer-dentim interface

The purpose of this study was to evaluate the microstructure of the glass ionomerdentin interface after various dentin surface treatments, and to determine which treatment established a hybrid layer at this interface. Thirty sound extracted human teeth (permanent molars) were stored in a disinfectant solution (0.2 percent sodium azide). The occlusal enamel was removed, the dentin exposed and divided into two halves allowing two different dentin treatments in the same tooth. All teeth were mounted in a hydrostatic intrapulpal pressure apparatus, to simulate the in vivo conditions, and removed 12 hours after restorations had been completed. Groups were studied with regards to dentin surface conditioning: 1) no dentin conditioning; 2) GC Conditioner; 3) Vitremer Primer; 4) 35 percent Phosphoric Acid + Vitremer Primer; 5) 35 percent Phosphoric Acid + Scotchbond Multi-Purpose Primer + Scotchbond Multi-Purpose Adhesive Resin. Standard procedures for preparing these specimens for SEM were utilized and the glass ionomer-dentin interface was evaluated under three different magnifications (300, 3000 and 13000 x). The presence and thickness of the hybrid layer was recorded for each specimen and a photomicrograph of a representative area was taken. The results indicated that the interfacial seal was more homogeneous when the dentin was conditioned with 35 percent Phosphoric Acid and either Vitremer Primer or Scotchbond Multi-Purpose was applied prior to the glass ionomer. This suggests that these two dentin treatments may provide better adhesion and less microleakage for glass ionomer restorations.