ABSTRACT
AIM: To compare immediate surgery to scaling and root planing (SRP) in the treatment of advanced periodontitis focusing on the prevalence of residual pockets after treatment and cost-effectiveness (1); to elucidate the adjunctive effects of azithromycin in a second-treatment phase (2) up to 36 months. MATERIALS AND METHODS: Thirty-nine patients (18 males, 21 females; mean age: 54.6) received oral hygiene instructions and were randomly allocated to surgery (n = 19) or SRP (n = 20). Patients with residual pockets (≥6 mm) at 6 months received re-debridement of these sites and systemic azithromycin. Clinical measurements were performed at 12, 24 and 36 months whereby residual pockets underwent re-debridement. Patients were evaluated in terms of clinical response parameters and cost-effectiveness. Chair-time was used to assess the financial impact of treatment. RESULTS: Only six patients in the surgery group required additional treatment at 6 months, whereas 14 patients in the SRP underwent this therapy. Both treatment arms were equally effective in terms of clinical outcome demonstrating <2% residual pockets at 36 months. Surgery imposed an extra 746 Euro on the patient up to 6 months compared to SRP. At 36 months, 69 Euro of this amount could be offset due to the lower need for re-treatment during maintenance phase. CONCLUSIONS: Surgery was ultimately associated with a significantly lower need for re-treatment during supportive care, however, at significantly higher costs over the 3 years.
ABSTRACT
AIM: To compare immediate surgery to scaling and root planing (SRP) in the treatment of advanced periodontal disease focusing on the prevalence of residual sites and cost-effectiveness (1); to evaluate the adjunctive effects of azithromycin in a second treatment phase (2). MATERIALS AND METHODS: Thirty-nine patients (18 males, 21 females; mean age: 54.6) received oral hygiene instructions and were randomly allocated to surgery (n = 19) or SRP (n = 20). Patients with residual pockets (≥6 mm) at 6 months received re-debridement of these sites and systemic azithromycin. Treatment groups were followed up to 12 months and evaluated in terms of clinical response parameters and cost-effectiveness. Chair-time was used to assess the financial impact of treatment. RESULTS: Both treatment arms were equally effective in terms of clinical outcome demonstrating less than 1% residual pockets at 12 months. Surgery imposed an extra 746 Euro on the patient up to 6 months when compared to SRP. At 12 months, 46 Euro of this amount could be offset as a result of a reduced need for supportive care. Only 6 patients in the surgery group needed systemic antibiotics, whereas 14 patients in the SRP needed such additional treatment. CONCLUSIONS: Although 700 Euro could be saved on average by performing SRP instead of surgery, the latter significantly reduced the need for supportive care and systemic antibiotics.
Subject(s)
Chronic Periodontitis/surgery , Dental Scaling/methods , Root Planing/methods , Adult , Aged , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Azithromycin/economics , Azithromycin/therapeutic use , Chronic Periodontitis/economics , Chronic Periodontitis/therapy , Combined Modality Therapy/economics , Cost-Benefit Analysis , Dental Plaque Index , Dental Scaling/economics , Drug Costs , Female , Follow-Up Studies , Health Care Costs , Humans , Male , Middle Aged , Oral Hygiene/education , Periodontal Attachment Loss/surgery , Periodontal Attachment Loss/therapy , Periodontal Index , Periodontal Pocket/surgery , Periodontal Pocket/therapy , Prospective Studies , Root Planing/economics , Single-Blind Method , Time Factors , Treatment OutcomeABSTRACT
The aim of this study was to gather data on occupational health effects among Flemish dentists. A questionnaire on various potential health effects was sent out to randomly selected Flemish dentists. Pilot experimental studies were performed on hearing and sensory function of the fingers on small groups of dentists. Audiometric data of both ears, gathered with an interval of 10 years, were analysed. Sensory tests of the fingers were performed for dominant and non-dominant hands in relation to exposure time to (ultra)sonic equipment. Positive responses for the questionnaire were as follows: low back pain, 54% (stress-correlated); vision problems, 52.3% (age-correlated); infections, 9%; allergies, 22.5% (mainly latex); stress level was scored 7 on a scale from 0 to 10; diminished sensitivity of the fingertips, 6% and auditory disorders, 19.6%. Pilot audiometric data showed a hearing loss at 4,000 Hz for the left ear, presumably indicative of occupational noise trauma. The two-point discrimination ability of the dominant hand tended to diminish in line with the number of years of practice. Dentists in Flanders were found to suffer from various health-related problems. More elaborate studies are required to provide more details on the risks for occupational hearing impairment and vibration hand neuropathy and to determine whether the problems described were related to the practice of dentistry.
