Evaluating True Barriers to Dental Care for Patients with Periodontal Disease.

BACKGROUND: The cost of care is often reported as a primary reason why patients fail to seek dental treatment; however, this may not the only component. AIMS/OBJECTIVES: To examine an underserved population's perspective on the importance of dental care and barriers they face to seek treatment. The effectiveness of compliance incentives, such as gift cards, was also examined. METHODS: We conducted a survey study to gain insight of an underserved population's perspective of barriers to care and correlated the reported barriers with the true reasons of missed appointments in our study cohort. Appointment compliance was also examined before and after implementation of gift card incentives, appoitment reminder letters and additional staff. RESULTS: Most patients felt dental care was important/very important to them. However, no correlations were found between survey responses and true reasons for missing appointments. Eighty-seven percent of patients report having some form of financial difficulty and compliance statistically improved after implementation of financial compensation in this population (69% completed appointments before gift card implementation versus 75% after gift card implementation, p=0.01), but not after the implementation of additional appointment reminders and contact staff. DISCUSSION: Although the majority of patients reported dental care was important to them, there was an average of 31% missed appointments for patients who completed the survey and no correlations were found between the information patients reported and true reasons for non-compliance. Interestingly, even though care was free of charge, most patients reported to be in some form of financial difficulty and compliance was slightly improved through the implementation of financial compensation. Other potential barriers that need to be further examined include economic barriers, transportation, insurance utilization, and patient anxiety towards dental care. CONCLUSION: A survey is a resource to identify reasons why patients abstain from seeking care but may be not the best one as reasons reported do not correlate with true reasons of appointment failure. Financial compensation was shown to improve compliance with appointments. Further information gathering is necessary to gain insight into true barriers to dental care within an underserved population.

Clinical Characteristics of Localized Aggressive Periodontitis in Primary Dentition.

OBJECTIVES: Due to the low prevalence of localized aggressive periodontitis (LAP), clinical characteristics of LAP in primary dentition are derived from a few case reports/series in the literature. The goal of this study was to determine common clinical characteristics such as bone and root resorption patterns, in a series of cases with LAP in primary dentition. We hypothesize these cases present aggressive periodontal bone destruction starting mostly around first primary molars and atypical root resorption patterns. STUDY DESIGN: We have evaluated 33 LAP cases in primary dentition for pattern of bone destruction, root resorption and early exfoliation. RESULTS: Cases evaluated were aged 5-12 (mean=8.7 years). Thirty cases presented more severe bone loss on first than second molars, with relatively fast progression to second molars, altered pattern of root resorption, mostly external (n=16) and early exfoliation of primary teeth due to periodontal bone loss, rather than physiologic root resorption (n=11). CONCLUSIONS: This study showed common clinical characteristics found in LAP in primary molars, including possible initiation on first primary molars and abnormal root resorption patterns. These characteristics are important to be early identified and treated in order to prevent possible progression into the permanent dentition.

Long-term clinical response to treatment and maintenance of localized aggressive periodontitis: a cohort study.

AIM: To evaluate long-term clinical response to periodontal therapy and maintenance in localized aggressive periodontitis (LAP). MATERIALS AND METHODS: One hundred forty-one African Americans diagnosed with LAP, aged 5-25 years, were enrolled. Patients underwent periodontal mechanical debridement plus 1 week of amoxicillin/metronidazole. Mechanical therapy was repeated as needed and clinical parameters were recorded at baseline, 3, 6, 12, 18 and 24 months, and two additional annual follow-up visits after treatment. Radiographs from primary dentition of patients with LAP in permanent dentition, and additional healthy siblings (HS) were analysed retrospectively. RESULTS: Periodontal therapy significantly improved probing depth and clinical attachment level up to 4 years (mean reductions: 2.18 ± 1.03 and 2.80 ± 1.43 mm, respectively). Percentage of affected sites was reduced at all time points and maintained up to 4 years. Non-compliance with antibiotics/appointments negatively affected the treatment response. Ninety per cent of LAP patients in permanent dentition and 32% of HS presented radiographic bone loss in primary dentition. CONCLUSIONS: Mechanical debridement with 1 week of systemic antibiotics along with proper periodontal maintenance was effective in the treatment and successful maintenance of LAP for up to 4 years. LAP in permanent dentition may be preceded in the primary dentition. Clinicaltrials.gov #NCT01330719.