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CLINICAL PRACTICE
Dental Practice-Based Research Networks
Clinical studies evaluating or compar- ent DPBRN regions, proposed to be associat-
ed with differences in training and local norms.
ing treatments have often been conducted
Adjunctive diagnostics were rarely used.1
in controlled university settings, and are some- 16%
times criticized as not representing the con-
ditions encountered in clinical practice. As a Managing Questionable Occlusal
result, medical and dental practice-based Caries (QOC) Lesions 6%
research networks have been developed that In QOC lesions, surface changes indica-
combine data from a large number of private tive of caries are present (e.g., roughness or
practices, each following a defined protocol, staining), while radiographic evidence is Occlusal with Proximal with
and allow for the variances that occur in the absent. QOC lesions (n = 1,341) were assessed enamel caries enamel caries
provision of care in the community. Dental at baseline by 82 DPBRN dentists, and at 20
practice-based research networks (DPBRNs) months the same surfaces were reexamined Figure 1. Percentage of restored surfaces with only enamel
(by 53 of 82 dentists).2 At baseline, 116 lesions caries lesions.
have generated data on clinical questions and
reports are now being published. In particu- were treated invasively, 192 received sealants, Managing Failed Restorations
lar, information regarding different approach- and for the remainder, fluorides and/or oral When restorations fail, options include
es to the management of dental caries and hygiene instruction were provided and the repair or replacement of the restorations, or
endodontic lesions is being generated.1-7 This lesions monitored. At 20 months, 90% of the more extensive treatment. Among 194 DPBRN
information provides insight into current prac- monitored lesions continued to be monitored; dentists, treatment decisions for failed restora-
tices and challenges, and suggests future clin- 61 were sealed and the remaining 4% restored. tions (n = 8,770 in 6,643 patients) varied with
ical approaches. Of the surfaces initially sealed, two required the reason for failure, restorative material, loca-
invasive treatment. It was concluded that a tion and type of tooth, restoration size (num-
Findings from DPBRNs: monitoring approach would be appropriate ber of surfaces), and whether the treating den-
Dental Caries Management for QOC lesions.2 tist had placed the original restoration.4 Overall,
Evidence-based dental caries manage- repair was more likely if the treating dentist,
ment involves caries risk assessment (CRA), Management of Enamel Caries rather than another dentist, had placed the
accurate diagnosis of caries lesions as early as An observational study with 229 dentists failed restoration (p < 0.001). Repair of molar
possible, and a staged approach whereby early was conducted to determine treatment pro- restorations was also more likely when the treat-
lesions are managed preventively and more vided for occlusal and proximal caries lesions ing dentist, rather than another dentist, had
advanced lesions are restored. Each aspect in virgin surfaces in 4,397 patients.3 Seven hun- placed that restoration (p < 0.001). Amalgam
has been investigated in DPBRNs. dred and eighteen of 4,064 occlusal surfaces restorations and fractured restorations were
(16%) and 246 of 4,149 proximal surfaces more likely to be replaced than non-amalgam
Diagnosing Primary Caries Lesions (6%) that were restored had only enamel restorations and non-fractured restorations if
Factors associated with the use and selec- caries (see Figure 1). Placement of occlusal the treating dentist had placed the original
tion of diagnostic techniques to assess one-sur- restorations limited to the enamel varied by restoration (p < 0.001 and p = 0.001, respec-
face primary caries lesions prior to restoration practice type, and varied by region from 4% tively); replacement of amalgam restorations
placement on a virgin surface were measured to 24% (p < 0.05). Treatment variations was also more likely if a different dentist had
in a study involving 228 DPBRN dentists and observed for proximal surfaces were similar. placed the failed restoration (p < 0.001).4
more than 5,500 surfaces.1 The frequency of Other significant factors for treatment pro-
use of diagnostic techniques was surface- vided included the ethnicity of the dentist and The management of enamel caries
dependent (p < 0.0001); as would be expect- patient. Very few occlusal enamel restorations
lesions and failed restorations
ed based on current recommendations and were placed by dentists in the Scandinavian
standards of care, a visual-tactile examination region; noninvasive treatment of enamel caries varies significantly among
together with radiographs were most frequently lesions is widely practiced in Scandinavia,8 in DPBRN dentists.
used for posterior proximal lesions.1 Fewer line with evidence-based recommendations
insured than uninsured patients and fewer for patients at low and moderate risk for caries.
older patients received radiographs. It was In US DPBRN regions, fewer occlusal enam- Findings in Endodontics
hypothesized that insurance benefits limited el restorations were placed by dentists per- In other DPBRN research, isolation tech-
the number of radiographs taken, as did older forming CRA.3 Nonetheless, no statistically niques5,6 and severe post-treatment pain7 have
patients staying with the same dentist for a long significant differences were observed in a sep- been studied. While use of a rubber dam is
time. Significant differences in the frequency arate study of patient-specific caries preven- considered the standard of care during root
of radiographs were also observed for differ- tive protocols based on use of CRA.9 canal therapy (RCT),10 in one study with 1,490
ORAL CARE REPORT 5
DPBRN clinicians, only 47% reported always Outcomes of Involvement Dental PBRN. Tex Dent J 2015;132(2):102-9.
using a rubber dam; 12% always used cotton 2. Makhija SK, Gilbert GH, Funkhouser E, Bader
rolls, 5% sometimes used no isolation, and the
in a DPBRN JD, Gordan VV, Rindal BJ, et al. Twenty-month
Treatment differences based on the
remainder used a variety of isolation methods follow-up of occlusal carious lesions deemed
degree of involvement of clinicians within a
(see Figure 2).5 Factors influencing rubber dam DPBRN have been observed. The management
questionable at baseline: Findings from The
use included time since graduation, frequen- National Dental Practice-Based Research
of dental caries was investigated in one study
cy of performing RCT, clinic setting, and Network. J Am Dent Assoc 2014;145(11):1112-8.
spanning 2005 through 2011 and involving
whether additional training had been received.5 17 clinic sites; increasing involvement lead to
3. Fellows JL, Gordan VV, Gilbert GH, Rindal
Attitudes and beliefs regarding the effective- DB, Qvist V, Litaker MS, et al. Dentist and prac-
significantly decreased restoration rates.11 Over
ness, convenience, time required, and ease- tice characteristics associated with restora-
the six-year period, restoration rates for den-
of-use of rubber dams vary significantly.6 Based tal caries lesions dropped from 79.5% to 47.6%
tive treatment of enamel caries in permanent
on responses from DPBRN dentists, the den- teeth: multiple-regression modeling of obser-
overall (p < 0.01). Between 2005 and 2008,
tists could be grouped into 4 categories; the vational clinical data from The National
the reduction in restoration rates by dentists
group collectively regarding rubber dams as Dental PBRN. Am J Dent 2014;27(2):91-9.
who were highly involved in the DPBRN was
ineffective and difficult to use had the lowest 4. Gordan VV, Riley J, 3rd, Geraldeli S, Williams
approximately double the reductions of less
consistent usage (7%), versus 82% of the group involved dentists (see Figure 3). It was also
OD, Spoto JC, 3rd, Gilbert GH, National
regarding rubber dams as most effective.6 found that attendance at meetings was asso-
Dental PCG. The decision to repair or replace
a defective restoration is affected by who
ciated with reductions in the number of restora-
47% placed the original restoration: findings from
tions placed by individual dentists, and that
the National Dental PBRN. Tex Dent J
over time an additional effect was noted, where-
2015;132(7):448-58.
36% by less engaged dentists within the DPBRN
5. Lawson NC, Gilbert GH, Funkhouser E,
also changed treatment behaviors.11
Eleazer PD, Benjamin PL, Worley DC,
National Dental PCG. General dentists’ use
n 2005 of isolation techniques during root canal treat-
n 2008 88% ment: from the National Dental Practice-based
12% 82% Research Network. J Endod 2015;41(8):1219-
73% 25.
5% 6. Gilbert GH, Riley JL, Eleazer PD, et al.
63% Discordance between presumed standard of
care and actual clinical practice: the exam-
n Rubber dam always ple of rubber dam use during root canal treat-
n Cotton rolls always ment in the National Dental Practice-Based
n No isolation sometimes Research Network. BMJ Open 2015;5:e009779.
High Involvement Low Involvement
n Variety of methods doi:10.1136/bmjopen-2015-009779.
7. Law AS, Nixdorf DR, Aguirre AM, Reams GJ,
Figure 2. Isolation techniques used by DPBRN dentists. Figure 3. Restoration rates by DPBRN dentists between 2005 Tortomasi AJ, Manne BD, Harris DR, National
and 2008.
Dental PCG. Predicting severe pain after root
canal therapy in the National Dental PBRN.
Attitudes and beliefs regarding the Conclusions J Dent Res 2015;94(3 Suppl):37-43.
Although DPBRN studies involve non-
effectiveness, convenience, time random selection of clinicians, they have more
8. Voinea-Griffin A, Rindal DB, Fellows JL,
required, and ease-of-use of rubber commonalities with general practice than uni-
Barasch A, Gilbert GH, Safford MM. DPBRN
Collaborative Group. Pay-for-performance
dams vary significantly. versity settings. Research studies within
in dentistry: what we know. J Health Qual
DPBRNs, as discussed in this article, provide
2010;32:51-8.
insights on treatment differences in a real-
Potential predictors of severe pain fol- life setting. Participating in a DPBRN offers
9. Riley JL, 3rd, Gordan VV, Ajmo CT, Bockman
lowing RCT were researched in a study involv- opportunities for involvement in research
H, Jackson MB, Gilbert GH. Dentists’ use of
ing 62 clinicians.7 Pain assessments were made which in itself increases the practice of evi-
caries risk assessment and individualized caries
≤ 1 week pre-treatment for patients, and 1 week dence-based care, and over time less engaged
prevention for their adult patients: Findings
post-treatment for patients completing the practitioners in the same DPBRN setting also
from The Dental Practice-Based Research
study (n = 652). Pre-operative predictors of Network. Tex Dent J 2015;132(1):18-29.
make care decisions based on evidence. This
severe pain were determined to include: pain research can then be used to determine strate-
10. American Association of Endodontists. AAE
intensity (p = 0.0003); number of days when gies to promote the use of evidence-based care
Position Statement: Dental Dams. Available
pain interfered with normal activities by dental professionals, leading to improved
at: http://www.aae.org/uploadedfiles/clini-
(p = 0.0005); a diagnosis of symptomatic api- clinical outcomes. O C cal_resources/guidelines_and_position_state-
cal periodontitis (p = 0.045); and, pain wors- ments/dentaldamstatement.pdf.
ened by stress (p = 0.013).7 The identification References 11. Rindal DB, Flottemesch TJ, Durand EU,
of predictors of severe pain using real-life 1. Rindal BJ, Gordan VV, Litaker MS, Bader JD, Godlevsky OV, Schmidt AM, Gilbert GH,
DPBRN data means that patients could be Fellows JL, Qvist V, Wallace-Dawson MC, National Dental PCG. Practice change toward
more accurately informed on the likelihood Anderson ML, Gilbert GH. Methods dentists better adherence to evidence-based treatment
of post-operative pain and that pain could be use to diagnose primary caries lesions prior of early dental decay in the National Dental
better managed.7 to restorative treatment: Findings from The PBRN. Implement Sci 2014;9:177.
6 ORAL CARE REPORT
TECHNOLOGY
Use of Lasers for Periodontal Treatment
Laser is an acronym for “light amplifi- debridement alone. It was, however, further
concluded that evidence was limited and that There is evidence that the use of
cation by stimulated emission of radiation,”
and is a technology that utilizes light emitted
long-term, randomized clinical trials are nec- diode lasers for PDT in
essary.6 In a separate review of nine studies
coherently, resulting in an intensely focused
published up to September 2013, it was con-
conjunction with traditional non-
beam that can be used to accomplish a range surgical periodontal therapy may
cluded that improvements in PPD and clini-
of tasks. The application of lasers in surgery
has generated a great deal of interest in many
cal attachment levels (CAL) with adjunctive be of benefit, while there is
use of a diode laser were similar to those of insufficient evidence for non-PDT
healthcare disciplines. In dentistry, the use
traditional periodontal debridement alone,
of lasers for periodontal therapy has been of
and that while bleeding scores were signifi-
use of diode lasers, or for Nd:YAG
particular interest, however results regard- or erbium lasers.
cantly reduced, the reduction was minimal
ing efficacy are mixed. There is some evidence
and of questionable clinical relevance.8
that lasers can be an effective adjunct when
Randomized controlled trials on diode ty.12-15 An immediate decrease in sensitivity, with
used as part of nonsurgical periodontal ther-
lasers (n = 14), Nd:YAG lasers (n = 3) and relief maintained at 30 days, has been observed
apy, while the data regarding use of lasers dur-
erbium lasers (n = 3) were included in an evi- following one treatment with a diode laser.13
ing periodontal surgery does not support the
dence-based review comparing traditional peri- The ability of lasers to relieve dentinal hyper-
use of these devices. This area of research suf-
odontal debridement alone and with adjunc- sensitivity is a desirable attribute, given that
fers from a paucity of well-controlled clinical
tive therapies.9 Using diode lasers for photo- the smear layer on exposed root surface dentin
trials.
dynamic therapy (PDT; n = 10) was found to is removed during periodontal debridement.
offer a potential benefit.9 During PDT, the
Lasers for Periodontal sulcus is irrigated with methylene blue dye, Surgical Periodontal Therapy
Procedures after which the laser light interacts with the Surgical periodontal procedures include
The use of lasers has been proposed for dye and causes bacterial cell death.4 The review- gingivectomy, flap surgery, and regenerative
sulcular debridement, laser-assisted new attach- ers were unable to determine whether the procedures using guided tissue regeneration
ment procedures (LANAP), reduction of moderate benefit outweighed potential harm. (GTR) and enamel matrix derivatives (EMD).
biofilm, wound healing, periodontal debride- No evidence was found for any benefit with A review of randomized controlled trials (n =
ment, gingivectomy, crown lengthening, and adjunctive use of Nd:YAG or erbium lasers, 9) published in English up to December 2014
wound healing.1 Lasers used include CO2, or for diode lasers used for non-PDT (n = 4; was conducted to assess the efficacy of surgical
Nd:YAG, ERL, and diode lasers; wavelengths see table).9 periodontal procedures with and without adjunc-
used range from 532 nm to 10,600 nm.2-4 LANAP and soft tissue curettage proce- tive use of lasers.16 No statistically significant dif-
dures remove sulcular epithelium and have ferences in PPD reductions were observed for
Nonsurgical Periodontal Therapy been promoted as a method to enhance clin- flap surgery or GTR/EMD, with and without
The American Academy of Periodontology ical attachment. Nonetheless, no clinically use of a laser (p = 0.33 and p = 0.98, respective-
issued a position paper in 2011, stating that
there was minimal evidence supporting the
use of lasers as an adjunct or monotherapy for Evidence for Benefit of Adjunctive Use of Lasers with Traditional Periodontal Debridement9
subgingival debridement, and inconsistent Type # Total Evidence
results for bacterial reductions.5 Since then, a Studies Participants of Benefit
number of additional studies and several sys-
tematic reviews examining their use for peri- Diode for PDT 10 306 Some benefit, unclear if benefit
odontal debridement have been published. outweighs potential harm
One systematic review examined stud- Diode (non-PDT) 4 98 Insufficient
ies published between 1990 and 2012 on diode
and Nd:YAG lasers.6 Randomized con- Erbium 3 82 Insufficient
trolled/controlled/retrospective studies of Nd:YAG 3 82 Insufficient
at least six months’ duration and conducted
Adapted from: ADA Center for Evidence-Based Dentistry. Systematic review and meta-analysis on the nonsurgical
in otherwise healthy adults were included; treatment of chronic periodontitis by scaling and root planing with or without adjuncts. July 2015.
these studies evaluated periodontal pocket
probing depth (PPD) reductions, bleeding significant improvements in CAL are observed ly); similar results were also found for CAL gains
on probing (BOP), and gain in clinical attach- following these procedures compared with following flap surgery or GTR/EMD (p = 0.44
ment levels. Six of 77 studies met the inclu- traditional nonsurgical periodontal therapy.10,11 and p = 0.78, respectively).16
sion criteria, and a prior review on Nd:YAG When used to perform a gingivectomy,
lasers was also examined.6,7 Six studies demon-
strated reduced PPD and BOP. It was con-
Reducing Dentinal Hypersensitivity soft-tissue lasers provide good visualization
Several studies have found lasers to be of the clinical site. Since lasers also promote
cluded that adjunctive use of diode and tissue coagulation and hemostasis, their use
effective in sealing dentinal tubules, includ-
Nd:YAG lasers may result in additional clini- may also reduce transient bacteremia during
ing carbon dioxide and diode lasers, thereby
cal benefit compared to traditional periodontal surgical procedures.17
providing relief from dentinal hypersensitivi-
ORAL CARE REPORT 7
PREVENTIVE DENTISTRY
Maintenance of Dental Implants
Dental implants have proven to be a al implant scalers or implant-safe ultrasonic
scalers with plastic tips. A prophylaxis using No
transformative treatment for the replacement 87.4%
a rubber cup or brush, flossing, and/or air maintenance
of missing teeth.1 Nevertheless, complications
polishing with glycine powder may also be
do occur and it can be anticipated that these Irregular
performed. Oral hygiene instruction should 94.3%
will be encountered more frequently in clin- maintenance
be provided and, as indicated, tobacco cessa-
ical practice with the widespread adoption
tion and other behavior modification advice
of dental implant treatment.2 Potential com- Regular
given.7,8 Home care consists of twice-daily 97.6%
plications following osseointegration include maintenance
brushing, interdental cleaning, and poten-
peri-implant mucositis, peri-implantitis,
tially the use of adjunctive devices and antimi-
implant loss, and prosthetic problems. Peri- Figure 2. Four-year cumulative survival rates.
crobial agents. Home care should be cus-
implant mucositis and peri-implantitis, respec-
tomized for the individual patient. Removable
tively, are similar to gingivitis and periodonti- titis, which is especially important since peri-
superstructures should be removed and
tis.3 Peri-implant mucositis is a plaque-induced implantitis typically progresses more quickly
cleaned extra-orally with a soft brush and den-
inflammation of the peri-implant soft tissues than periodontitis.3,13 Furthermore, at this time
ture-cleaning agent.9
that presents with bleeding on probing and/or there is no evidence-based standard of care
Successful prevention of peri-implant dis-
suppuration, and increased probing depths; or effective nonsurgical intervention treat-
ease has been reported with maintenance
peri-implantitis additionally involves progres- ment for peri-implantitis;3 this further increas-
recalls ranging from three to four months and
sive loss of peri-implant bone in excess of the es the importance of prevention, early diag-
up to 18 months.7 The frequency of mainte-
amount that would be expected with physio- nosis, and treatment of peri-implant mucosi-
nance therapy should be determined by clin-
logical bone remodelling.3 tis before it can progress to peri-implantitis.
ical judgment, together with the needs of indi-
Given the increasing number of implants
vidual patients, e.g., a patient with excellent
Prevalence and Risk Factors oral hygiene versus a patient with poor oral
placed each year, improved patient compli-
The prevalence of peri-implant mucosi- ance with maintenance therapy is one of the
hygiene. Clinical practice guidelines were
tis and peri-implantitis varies across studies, in key components required to combat an
recently issued by the American College of
part due to variable definitions of both diseases increasing number of complications.
Prosthodontists, recommending periodic
in different studies. The prevalence of peri- Educating patients on the importance of reg-
recalls at least every six months and more often
implant mucositis and peri-implantitis ranges ular maintenance visits based on individual
for at-risk patients.9 Maintenance visits can
across studies from 19% to 65% and 1% to risk and encouraging patient personal oral
help reverse peri-implant mucositis before
47%, respectively; the corresponding weight- hygiene are critical to minimize and manage
peri-implantitis can develop. Maintenance
ed mean prevalences are 43% and 22%.4 peri-implant disease, and thereby improve
therapy every six months, together with excel-
Risk factors include a history of periodon- treatment outcomes for patients. O C
lent oral hygiene results, has also been found
tal disease, poor oral hygiene, an inability to clean to result in good long-term clinical outcomes
around implant restorations and prostheses, References
following peri-implant surgery to treat peri-
smoking, and the presence of residual cement 1. Moraschini V, Poubel LA, Ferreira VF, Barboza
implantitis, with one five-year study finding Edos S. Evaluation of survival and success rates of
(see Figure 1).3 In a 10-year study on the influ- no attachment loss in 87% of implants treat-
ence of a history of periodontal disease, signifi- dental implants reported in longitudinal studies
ed (n = 71).10 with a follow-up period of at least 10 years: a sys-
cant differences in the number of patients expe-
riencing peri-implant bone loss were observed.5 tematic review. Int J Oral Maxillofac Surg
In that study, 10.7% of patients with no history Clinical practice guidelines recom- 2015;44(3):377-88.
of periodontal disease had received treatment mend periodic recalls at least 2. Tarnow DP. Increasing prevalence of peri-implanti-
for peri-implant disease in the intervening years, tis: How will we manage? J Dent Res 2016;95(1):7-8.
every 6 months and more often for 3. American Academy of Periodontology. Peri-implant
compared with 27% and 47.2% of patients with
a history of moderate and severe periodontal
at-risk implant patients. mucositis and peri-implantitis: A current under-
disease, respectively. Eighteen implants (of 101 standing of their diagnoses and clinical implica-
re-examined) had been lost; of the remaining tions. J Periodontol 2013;84(4):436-43.
The Impact of Discontinued
83 implants, a probing depth ≥ 6 mm was found Maintenance Therapy
4. Derks J, Tomasi C. Peri-implant health and dis-
in 1.7% of patients with no history of periodon- ease. A systematic review of current epidemiolo-
Discontinuation of implant maintenance gy. J Clin Periodontol 2015;42(16 Suppl):158-71.
tal disease, compared with 15.9% and 27.2%, is a frequently occurring problem. In a
respectively, in patients with a history of moder- 5. Roccuzzo M, Bonino F, Aglietta M, Dalmasso P.
Japanese study, 26.6% of implant patients Ten-year results of a three arms prospective cohort
ate and severe periodontal disease.5 (n = 688) had discontinued maintenance over study on implants in periodontally compromised
a three-year period (i.e., did not return with- patients. Part 2: clinical results. Clin Oral Implants
Risk Factors for in six months of the prior maintenance visit); Res 2012;23:389–95.
Peri-Implant Disease discontinuation was greater in patients with 6. Monje A, Aranda L, Diaz KT, Alarcón MA,
• History of periodontal disease poorer plaque control.11 In a study following Bagramian RA, Wang HL, Catena A. Impact of
• Poor oral hygiene 80 patients who had previously experienced maintenance therapy for the prevention of peri-
• Lack of/inadequate implant peri-implant mucositis, 18% of patients who implant diseases: A systematic review and meta-
maintenance received preventive maintenance and 43.9% analysis. J Dent Res 2016; 95(4):372-9.
• Inability to clean around restorations of patients who did not receive regular pre- 7. Gay IC, Tran DT, Weltman R, Parthasarathy K, Diaz-
• Smoking ventive maintenance experienced peri-implan- Rodriguez J, Walji M, Fu Y, Friedman L. Role of sup-
• Presence of residual cement titis within five years.12 portive maintenance therapy on implant survival: a
university-based 17 years retrospective analysis. Int
Figure 1. Risk factors for peri-implant disease. Implant patients who receive J Dent Hyg 2015 Dec 22. [Epub ahead of print]
regular preventive maintenance 8. Mishler OP, Shiau HJ. Management of peri-implant
Poorly controlled diabetes mellitus and
disease: A current appraisal. J Evid Based Dent Pract
occlusal overload may also be associated with are less likely to experience 2014;14S:53-9.
peri-implantitis.3 In addition, an absence peri-implantitis. 9. Bidra AS, Daubert DM, Garcia LT, Kosinski TF,
of/inadequate peri-implant maintenance ther-
Nenn CA, Olsen JA, Platt JA, Wingrove SS,
apy is a known risk factor for peri-implant dis- A university-based retrospective chart Chandler ND, Curtis DA. Clinical practice guide-
ease.6 Implant maintenance is essential to help review, spanning a 17-year period, assessed lines for recall and maintenance of patients with
prevent clinical complications, and both per- implant survival rates in 1,020 patients for one tooth-borne and implant-borne dental restora-
sonal and professional care are necessary com- randomly selected implant per patient. Four tions. J Am Dent Assoc 2016;147(1):67-74.
ponents of a successful maintenance program. years post-placement, the cumulative survival 10. Serino G, Turri A, Lang NP. Maintenance thera-
rates with regular (at least annual), irregular, py in patients following the surgical treatment of
A history of periodontal disease and no maintenance visits to the university peri-implantitis: a 5-year follow-up study. Clin Oral
clinic were 97.6%, 94.3%, and 87.4%, respec- Implants Res 2015;26(8):950-6.
increases risk for peri-implant tively (see Figure 2).7 In addition, the implant 11. Arai K, Takeda Y, Mori Y, Terauchi R, Furumori
mucositis and peri-implantitis. failure rate was 90% lower for patients receiv- T, Tanaka S, Miyake T, Baba S, Kawazoe T. Analysis
ing regular maintenance versus no mainte- of factors associated with maintenance discontin-
nance (p = 0.001).7 All implants were stan- uation in implant patients. SpringerPlus 2015;4:767.
Maintenance Visits and Therapy dard lengths and diameters. 12. Costa FO, Takenaka-Martinez S, Cota LO, Ferreira
A thorough extra- and intra-oral exami- SD, Silva GL, Costa JE. Peri-implant disease in sub-
nation is required at periodic maintenance Implications and Conclusions jects with and without preventive maintenance: a 5-
visits, together with radiographs to assess cre- Discontinuing a regular maintenance pro- year follow-up. J Clin Periodontol 2012;39(2):173-81.
stal bone levels and compare them with the gram is clearly associated with an increased 13. Berglundh T, Zitzmann N, Donati M. Are peri-
crestal bone levels at baseline and follow-up risk of complications. Regular maintenance implantitis lesions different from periodontitis
examinations. Maintenance therapy includes therapy is effective in reversing peri-implant lesions? J Clin Periodontol 2011;38(11 Suppl):
removal of plaque and calculus using manu- mucositis before it progresses to peri-implan- 188-202.
ORAL CARE REPORT 11
HEALTHCARE TRENDS
The Best Jobs of 2016: Good
News for the Dental Profession?
U .S. News and World Report is a weekly magazine covering news and current events. It is well known
for its rankings of colleges and universities, hospitals, and other aspects of our society. The magazine’s
rankings are well publicized, and are used as an unofficial gauge of what is best in the United States.
A recent report from U.S. News and World Report listed the best jobs for 2016.1 The report ranks jobs in
essential industries, including health care, technology, business, sales and marketing, and social services.
Overall, the editors believe the job market is robust, with a projected increase of 6.5% between 2014 and
2024. This will mean 10 million new jobs in the next decade. The rankings for jobs consider the number
of job opportunities, potential for growth, work-life balance, and compensation. The list includes the 100
Editor-in-Chief top jobs, as well as by specific criteria, such as best salary. Of note, “Orthodontist” and “Dentist” were the
Ira B. Lamster, DDS, MMSc two top jobs on the list, and “Oral and Maxillofacial Surgeon” was third on the list of best-paying jobs,
Professor of Health Policy & after “Anesthesiologist” and “Surgeon.” “Dental Hygienist” was on the list at number thirty-two.
Management, Since the U.S. News and World Report rankings are highly regarded and often cited, this ranking
Mailman School of Public Health reflects positively upon the dental profession. A report such as this, however, must stimulate a broader
Dean Emeritus, discussion of both the current state of the dental profession and the profession’s future.
Columbia University College of The dental profession offers many advantages to someone considering a career in health care.
Dental Medicine Enhancing a person’s ability to function and eat a balanced diet, alleviating pain when present, and
International Editorial Board improving a patient’s smile, general appearance, and ability to socialize are all important, meaningful
P. Mark Bartold, BDS, BScDent outcomes. Dental providers often develop long-standing relationships with their patients, and become
(Hons), PhD, DDSc, FRACDS more than just a provider delivering a service on a routine schedule. However, the external and internal
(Perio); Australia stressors faced by the profession must also be considered.
John J. Clarkson, BDS, PhD; Ireland
The American Dental Association, through its Health Policy Institute, has examined the “Future of
Dentistry”2 and identified a number of trends that define the profession at present, and will shape the
Kevin Roach, BSc, DDS, FACD; future. The five trends that define the present include
Canada
1. increased utilization of dental services by children, but reduced utilization by working age
Prof. Cassiano K. Rösing; Brazil adults;
Mariano Sanz, DDS, MD; Spain 2. cost barriers for some working-age adults needing oral healthcare services;
Ann Spolarich, RDH, PhD; USA
3. per capita spending on dental services in the United States has plateaued;
4. an increasing number of dentists entering the workforce; and
Xing Wang, MD, PhD; China 5. dentists’ earnings are declining, which is similar to what is seen for other professions, includ-
Rebecca S. Wilder, RDH, MS; USA ing attorneys and veterinarians.
David T.W. Wong, DMD, DMSc; USA The 5 forces reshaping dental practice include
1. a changing, larger healthcare environment with a greater emphasis on prevention and well-
© 2016 Colgate-Palmolive Company. ness, and a so-called “pay for performance” that places value on longer-term outcomes of
All rights reserved. care;
2. an increase in the number of children seeking dental care (due in part to the expansion of
The Oral Care Report Medicaid coverage), as well as the percent of older adults who require care as edentulism is
(ISSN 1520-0167) is supported by reduced;
the Colgate-Palmolive Company for
3. an increase in consumerism as health care is viewed by patients as a commodity and value
oral care professionals.
becomes important.
4. the need for dental care to consider how it can become involved in interprofessional prac-
Editorial Quality Control by Teri S.
Siegel. Layout and graphic design by
tice, as the focus shifts to providers working together; and
Horizons Advertising and Graphic 5. a diminishing number of solo dental practices and a greater number of group practices.
Design, Morrisville, PA (USA). Further, these challenges will be accompanied by opportunities:
1. Dental professionals should welcome the emphasis on value, where the focus is on improved
Published by Professional Audience patient outcomes at a lower cost.
Communications, Inc., Yardley, PA 2. The greater demand for services by children and older adults should be addressed. Further,
(USA). there is expected to be an increase in the number of adult Medicaid enrollees as states expand
these programs.
E-mail comments and queries to the 3. Collaboration with other healthcare providers will improve patient flow between healthcare
Editor, Oral Care Report... disciplines.
ColgateOralCareReport@gmail.com These vectors are driven in part by external forces, but changes in how care is delivered are also
occurring, including a reduced reliance on dental amalgam,3 the development of new, “smart” dental
materials, and the continuing development of implantology. The use of auxiliaries to expand access to
care continues to be discussed and debated,4 and the ability to provide dental services to a greater num-
ber of people will be one critical measure of how successful the dental profession will be in the future.
Change characterizes health care. While health care in general remains an attractive career option,
Earn 3 CE credits the dental profession must try to shape, not be shaped, by these influences. As the healthcare landscape
for this issue changes, each of us, either individually or as part of a local, regional, or national effort, must participate
of the in defining the future of the profession. This will be accomplished by balancing exciting clinical advances5,6
Oral Care Report with the need to deliver cost-efficient care to the largest number of patients, especially those with diffi-
online at culty accessing services.7,8 O C
www.colgateprofessional.com.
References:
1. Snider S. Introducing the Best Jobs of 2016. U.S. News. http://money.usnews.com/money/careers/arti-
cles/2016-01-26/introducing-the-best-jobs-of-2016.
2. Future of Dentistry. American Dental Association. http://www.ada.org/en/education-careers/dental-student-
resources/ada-success/future-of-dentistry.
3. Mackey TK, Contreras JT, Liang BA. The Minamata Convention on Mercury: attempting to address the global
controversy of dental amalgam use and mercury waste disposal. Sci Total Environ 2014;472:125-9.
4. Fiset L. DENTEX: The emergence of dental therapists in the United States. JAAPA 2016;29:1-5.
5. de Sousa FF, Ferraz C, Rodrigues LK, Nojosa Jde S, Yamauti M. Nanotechnology in dentistry: drug delivery sys-
tems for the control of biofilm-dependent oral diseases. Curr Drug Deliv 2014;11:719-28.
6. Hammerle CH, Cordaro L, van Assche N, Benic GI, Bornstein M, Gamper F, et al. Digital technologies to sup-
port planning, treatment, and fabrication processes and outcome assessments in implant dentistry. Summary
and consensus statements. The 4th EAO consensus conference 2015. Clin Oral Implants Res 2015;26(Suppl
11):97-101.
7. Dahm TS, Bruhn A, LeMaster M. Oral care in the long-term care of older patients: How can the dental hygien-
ist meet the need? J Dent Hyg 2015;89:229-37.
8. Dyer TA, Robinson PG. The acceptability of care provided by dental auxiliaries: A systematic review. J Am Dent
Assoc 2016;147:244-54.