“The Holford Partners Curaden Dental Clinic is where we can trial new products and concepts with our patients,” says Theodora, who works there as a dental hygienist and therapist. The dental clinic is where Curaden’s philosophy of prevention has become a reality, and it’s where Theodora trialled Prevention One almost three years ago. “Thanks to the clinic, we can try out everything that is coming out of Curaden and ensure it is used in the most effective way so we can provide our patients with the most innovative and highest quality prevention and care. The clinic has a lot of different professionals under one roof, so we have a wide range of disciplines, as well as dentitions and age groups to work with. As such, we have been able to trial Prevention One on a range of patient categories.”

Two birds with one stone

So, what is Prevention One? Basically, it is an innovative, prevention-based model for the dental practice to activate, reactivate and motivate existing and future patients. The concept not only makes prevention profitable for the practice, it enhances patient compliance and combines professional dental care with individual oral care at home. At home? The core element of Prevention One is the patient’s “BOB-score”, or bleeding on brushing-score. Using a mouth map as a visualisation tool on the Prevention One app or on the computer, patients can check at home which of their interdental spaces have active inflammation and which interdental brushes to use. This way, Prevention One kills two birds with one stone, since dental professionals can monitor their patients’ oral health and help them with their oral hygiene even outside the practice.

“We are not sitting in an ivory tower.”

“The whole Prevention One concept comes from Curaden Clinics, a new business department within Curaden” explains Tom, business developer for Prevention One. “The department was created to develop new concepts for dental clinics to use every day. We are not sitting in an ivory tower—with Prevention One, we’re introducing a concept that is useful in the daily routines of dental practices. Here, Theodora and I are like an odd couple. I do the marketing, business planning and even work as a video director every now and then, while Theodora is the clinical mind.” In addition to her role at Holford Partners, Theodora is Curaden Clinics’ main manager, bringing together her knowledge of all Curaden’s products and concepts and presenting, training and supporting clinicians and teams on how to implement Prevention One in order to achieve Curaden’s philosophy of “better health for you”. When this philosophy is implemented, it benefits patients and clinicians alike. “When patients are that engaged, clinicians gain satisfaction as well,” Theodora says. “Treatment is no longer a one-way street. It has spiced up my working life as a hygienist. When you send patients home blind, you lose compliance, which is disheartening for every professional. Now, patients have the information available to them at all times, as well as a visual aid to assist them.”

“Treatment is no longer a one-way street”

According to Tom, “the beauty of Prevention One is that it is not merely a retail solution. This goes beyond supplying professionals with a box of toothbrushes. Prevention One is a philosophy of co-operation with the clinics that helps patients in the end.” Theodora agrees: “For both of us, Prevention One is being part of something that moves dentistry towards prevention. It is a self-development and growth tool for clinicians that also helps practices grow and develop. It’s all about moving forward. And at the end of the day, dental professionals want to make a change.”

Tags: bleeding, bleeding on brushing, Curaden, curaden clinics, Curaprox, dental hygiene, huygen, huyghen, interdental, prevention, prevention one, score, theodora little, tom huigen

Lead by researchers from the University of Michigan (U-M) Institute for Healthcare Policy and Innovation, the research team conducted telephonic surveys with 4,090 participants of a representative sample of Healthy Michigan Plan enrollees to collect the required data for the study. Additionally, the survey also included more comprehensive interviews with 67 participants, in 2015 and 2016, who described the impact of their coverage in more detail. “What's interesting is that people reported palpable impacts on their health so quickly—usually this can take years to happen,” said Assistant Professor of Internal Medicine at U-M Dr. Renuka Tipirneni, the lead author of the study. According to the survey’s results, of those who were employed, more than two-thirds of the participants said that having Healthy Michigan Plan coverage had helped them at work and more than a third of those who had changed jobs in the last year said the coverage helped them get a better job. Those who said their health improved due to their new coverage were also four times more likely to say that they were doing a better job at work. Those who had a chronic condition were more likely to say that they were doing a better job at work since getting covered. The data for low-income earners showed that 80 per cent of those surveyed had incomes below the federal poverty level for their household at the time they took the survey in 2016—which was equivalent to about US$12,000 a year for an individual at the time. The rest had incomes less than 133 per cent of the federal poverty level, which varies depending on household size. Even those working close to full-time at minimum wage may qualify for the Healthy Michigan Plan. A quarter of the respondents were out of work when they took the telephone survey, yet more than half of them said that their Healthy Michigan Plan coverage improved their ability to look for a job. According to the research, those who were 51-years-old and over were especially likely to say this. The researchers believe their findings have implications for states, such as Virginia, Utah and Idaho that are set to expand their Medicaid programs in 2019, and for states that have sought permission from the federal Centers for Medicare & Medicaid Services to add a work or community engagement requirement to their existing Medicaid expansion program. “Our survey shows that a large portion of enrollees who have chronic illnesses or poor health are already working—this has many implications for the way we structure Medicaid programs,” explained Tipirneni. “Proponents of work requirements have stated they are looking for a positive impact on society by encouraging people to work or contribute to society in other ways. What we’re seeing from our data is that this new insurance coverage itself is having positive effects on enrollees’ health and work.” Arkansas was the first state to require Medicaid expansion enrollees to document that they were working or engaged in other activities. Recent data suggests that failure to meet the program’s work-hour reporting requirements resulted in thousands of enrollees losing their coverage. With Michigan and other states asking for permission to require some or all Medicaid enrollees to work, Tipirneni noted that, “we hope that states can use data from this and prior studies to consider the potential costs and benefits of work requirements in Medicaid.” Tipirneni and her colleagues recently published recommendations in the New England Journal of Medicine about how states could design such programs without creating undue risk that people with chronic illnesses would lose continuous coverage, and to help healthcare providers navigate their role in documenting which patients should be medically exempt from a work requirement. The study, titled “Changes in health and ability to work among Medicaid expansion enrollees: A mixed methods study”, was published on Dec. 5 in the Journal of General Internal Medicine.

Tags: health, Medicaid, oral health, survey

In the areas of diagnostics and therapy planning, owners of established practices have a number of options regarding upgrades to new technologies, while founders of new practices are now relying almost exclusively on digitalised tools and workflows. According to the IDS organisers, 3-D radiographic units, intra-oral scanners, and the virtual set-up and design of orthodontic equipment are just a few examples of the tools and procedures that visitors to the exhibition will be able to experience. Many of the changes that digital technologies have effected in orthodontics are irrefutable and their benefits are clear, such as in aligner therapy, where digital technologies now dominate preparatory measures for aesthetic dentistry. Regarding some of the emerging digital tools, however, such as support through artificial intelligence (AI), their scale of influence remains to be seen. At IDS, visitors will have the opportunity to inspect a number of different products related to aligner therapy treatment, such as software and virtual reality options for the subclassification of complex tooth movements, and to learn about the trend towards the use of AI support to warn of extreme tooth movements. According to the show organisers, AI-aided support of this nature is becoming more conceivable as the databases that would substantiate these tools continue to grow. The forthcoming instalment of the biennial trade fair will help practice owners learn about the developments that are driving orthodontics forward. “IDS 2019 will help visitors advance forward in all these points,” commented Mark Stephen Pace, Chairman of the Association of the German Dental Industry (VDDI), in a press release. “This is important because carrying out a consistent orthodontic treatment at an early point in time enables the avoidance of complications in later years from the very beginning. The world’s biggest showcase for dental medicine and dental technology in Cologne from 12 to 16 March 2019 contributes greatly to this,” he said. IDS takes place at the Koelnmesse fairground in Cologne every two years and is organised by the Gesellschaft zur Förderung der Dental-Industrie, the commercial enterprise of the VDDI, in collaboration with Koelnmesse. More information on the event and registration can be found here.

Dr Perez, when did you start specialising in sports dentistry? I began working with athletes in 1986. For 20 years, I was responsible for the health of tennis players in France. In France, we have a special organisation: the Fédération Française de Tennis (French Tennis Federation). They take care of the health of the tennis players, which is unique to France. In other countries, such as the United States, these federations do not cover the healthcare of athletes. They have to travel alone without any financial support. In France, athletes are obliged to visit physicians including cardiologists and dentists. This has been the case for 15 years. At the same time, tennis players and other athletes continue to complain about dental problems. Why is this the case? Athletes are also humans: they do not want to care about their teeth unless they are in pain. The first tennis players I treated were as young as 15-years-old. I instantly recognised many caries and the reason was their consumption of energy drinks. When they joined the French Tennis Federation, we immediately tried to cure the cavities. In the first year, we cured about ten cavities in the mouth of every male player. The oral situation among females was usually better. I think that female tennis players had about five cavities, so sugar consumption seemed to be stronger among males. This is a fact I usually communicate to my colleagues at the American Tennis Federation. Many American colleagues have now recognised this problem. In all countries, sugar was never considered a problem, only traumatic treatment. However, I am right to focus on caries and cavity treatment. Why don’t athletes get rid of sugary drinks then? A lot of business comes from encouraging the consumption of sugary drinks among athletes. And, when I became a member of the French Olympic committee, the main companies that supported those athletes were Coca Cola, Haribo, etc. We never talked about sugar consumption. I have quit the committee so I am not aware of the situation now. Another problem we have witnessed among athletes are wisdom teeth. That is now also considered a real problem that can impact their wellbeing. Since London 2012, the Olympic committee has realised that dental clinics during the Olympic Games have been the most visited medical institutions in the village because essentially healthcare is free. In particular, those athletes without social security frequent the clinics and are awaiting the Olympic Games just to be cured in time. In fact, the dental practice is now the most frequented clinic in the village. All of the dentists are very proud to prove to their medical colleagues that everybody needs dental care. At the same time, dental care is neglected in many athletes’ countries of origin despite the fact that oral health is fundamental for general health. Could you tell us one story about one of your famous patients? Yes, Andy Murray is a great example. He had a broken tooth between the quarter and semi-final of the Roland Garros tournament. It was a huge problem because he had a big cavity that was in danger of forming an abscess. He had visited another dentist six months before the start of the championship. He came to see me and I succeeded in stopping the pain, nothing else. At that time, I was not able to provide a full treatment and injections because certain medicine could be considered doping. So, I was obliged to do the best that I could. He did not lose because of me, but his broken tooth definitely contributed to his loss. At the time, he stopped the press conference because he had to go to the dentist. One journalist wrote that it was scandalous to go to a French dentist rather than an English dentist. How remarkable, right? Well, I also treat other top athletes but I cannot talk about them, of course. Why are you so interested in tennis? I used to play tennis. It is my favourite sport. It is also one of the main sports with cavities. Other teams have special dentists so I am not sure about those disciplines. However, fencers usually also have problems with cavities. They drink a lot of acidic drinks to maintain their concentration. Sometimes, they only have ten-minute breaks and one point can lead to losing the whole match. Every high-intensity sport usually involves high sugar consumption. As a consequence, erosion continues to be a problem. What can you do in terms of prophylaxis? All athletes understand the problem of bad oral health and its effect on muscular diseases. However, not everybody wants to go to the dentist despite these risks. What I do is to communicate with my colleagues and explain to them the psychology of the sportsmen. I tell them how they can explain preventive care to those athletes. The main thing I explain is the skills an athlete needs to have in order to be successful, such as discipline and an ability to concentrate. Certainly, we could push for a lot of preventive efforts with fluoride, for example, but in France, we have the problem that prevention is not paid for. And only three sport disciplines have money: football, tennis and golf. All other athletes do not make sufficient money and therefore cannot afford preventive treatment. Interestingly, the US Olympic Committee has decided, together with the government, that dental care is tax deductible. That is a huge step forward. What can you recommend to your dental colleagues if they treat an athlete? I recommend they have a different attitude for each sport and learn as much as possible about the discipline. They also need to learn about sugar intake and understand the importance of protective devices such as mouth guards. In the end, these dentists should also participate in athletes’ training sessions so that they can see what the athletes are doing. The most important thing is to have empathy with the athletes. Luckily, we have many dentists who practise sports professionally or recreationally. The most important thing during the match is to rinse the mouth with water after consuming energy drinks. This stops most of the acidic effect of the drink. You can see athletes spitting out the water after rinsing because they do not want to consume too much water. Will good oral health lead to better performance? Good oral health does not hurt! But I do not think that we can ameliorate the performance of an athlete. We can only secure their oral wellbeing. For this, I would be very happy if athletes visited a dentist at least once per year for a check-up. We should not only be considered technicians.

Tags: andy murray, caries prevention, prevention, sports, sports dentistry, sugary drinks

Bone Ring Technique was originally described as a one-stage procedure for vertical augmentation, in which an autogenous block bone graft is stabilized with a simultaneously inserted dental implant. Harvesting of bone from symphysis using a trephine appears to be safe and results in minimal morbidity. Autogenous bone used in Bone Ring Technique is accompanied by the fracture risk during removal or implant placement and usual donor site morbidities. The  allogenic bone ring is a pre-fabricated graft which allows bone augmentation and implant placement in a one-stage procedure. The main benefit of allogenic bone ring is the avoidance of harvesting of autogenous bone. However there is not enough data in the literature about the success of this graft material. The webinar will address the remodeling process of autogenous and allograft bone rings based on histological evaluations and histomorphometric analysis in an experimental animal model. In addition, the use of autogenous and allograft bone rings in vertical alveolar augmentation and sinus augmentation will be discussed in clinical cases.