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Chen X, Niu W, Hu G, Chen C. Cost-effectiveness and cost-utility analyses of three different gargles in the treatment of chronic periodontitis. PLoS One 2024; 19:e0302592. [PMID: 38717998 PMCID: PMC11078434 DOI: 10.1371/journal.pone.0302592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the economics of three different gargles in the treatment of chronic periodontitis. METHODS A total of 108 patients with periodontitis received one of the following three gargles: xipayi, compound chlorhexidine, or Kangfuxin gargle. The basic information of the patients, the costs of the gargles, the periodontal indexes before and after treatment, and the scores of the 3-level version of the EuroQol Five Dimensions Questionnaire were collected. The cost-effectiveness and cost-utility of the various gargles were determined. RESULTS The cost-effectiveness ratios (CER) of the three groups after treatment were 1828.75, 1573.34, and 1876.92 RMB, respectively. The utility values before treatment were 0.92, 0.90, and 0.91, respectively, and the utility values after treatment were 0.98, 0.98, and 0.97, respectively. The cost-utility ratios (CURs) were 213.43, 195.61, and 301.53 RMB, respectively. CONCLUSIONS For each increase in effective rate and quality-adjusted life years, the treatment cost of periodontitis patients was lower than the gross domestic product per capita of Jiangsu Province, indicating that the treatment cost is completely worth it. The CER and CUR results were the same, and the compound chlorhexidine group was the lowest, demonstrating that when the same therapeutic effect was achieved, it cost the least.
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Affiliation(s)
- Xin Chen
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Wenzhi Niu
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Guangyu Hu
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Changfeng Chen
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
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Saleh MHA, Dias DR, Kumar P. The economic and societal impact of periodontal and peri-implant diseases. Periodontol 2000 2024. [PMID: 38693603 DOI: 10.1111/prd.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Debora R Dias
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| | - Purnima Kumar
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Neumann D, Tiberius V, Biendarra F. Adopting wearables to customize health insurance contributions: a ranking-type Delphi. BMC Med Inform Decis Mak 2022; 22:112. [PMID: 35477495 PMCID: PMC9044726 DOI: 10.1186/s12911-022-01851-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/13/2022] [Indexed: 01/03/2023] Open
Abstract
Background Wearables, as small portable computer systems worn on the body, can track user fitness and health data, which can be used to customize health insurance contributions individually. In particular, insured individuals with a healthy lifestyle can receive a reduction of their contributions to be paid. However, this potential is hardly used in practice.
Objective This study aims to identify which barrier factors impede the usage of wearables for assessing individual risk scores for health insurances, despite its technological feasibility, and to rank these barriers according to their relevance. Methods To reach these goals, we conduct a ranking-type Delphi study with the following three stages. First, we collected possible barrier factors from a panel of 16 experts and consolidated them to a list of 11 barrier categories. Second, the panel was asked to rank them regarding their relevance. Third, to enhance the panel consensus, the ranking was revealed to the experts, who were then asked to re-rank the barriers. Results The results suggest that regulation is the most important barrier. Other relevant barriers are false or inaccurate measurements and application errors caused by the users. Additionally, insurers could lack the required technological competence to use the wearable data appropriately. Conclusion A wider use of wearables and health apps could be achieved through regulatory modifications, especially regarding privacy issues. Even after assuring stricter regulations, users’ privacy concerns could partly remain, if the data exchange between wearables manufacturers, health app providers, and health insurers does not become more transparent.
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Tay JRH, Ng E, Nair R, Tan ZS, Tan SHX. Economic evaluations in the treatment and evaluation of patients with periodontal disease: A critical review. J Clin Periodontol 2021; 48:679-694. [PMID: 33768622 DOI: 10.1111/jcpe.13456] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the types and quality of reporting of economic evaluations carried out in the clinical management of periodontal disease over 32 years from 1987 to 2019. MATERIAL AND METHODS A systematic search of articles from 1987 to 2019 was conducted using PubMed, Web of Science, The Cochrane Central Register of Controlled Trials, Health Technology Assessment Database and Embase. The quality of the economic evaluations was assessed based on the Consolidated Health Economic Evaluation Reporting Standard checklist. Due to considerable between-study heterogeneity, a meta-analysis was not performed. RESULTS Twenty one publications were included. 11 studies used cost-effectiveness analysis, five used cost-minimization analysis, four used cost-utility analysis and two used cost-benefit analysis. Comparators, choice of health outcomes, estimating resources and costs were fully reported in all studies. Many studies had inadequate reporting in terms of estimating resources and costs, choice of health outcomes, characterizing heterogeneity and study perspective. CONCLUSIONS There has been an increase in health economics studies in the field of clinical periodontology over the past decade. Several studies did not report study perspective, and the health outcomes chosen were not relevant for some studies. Future studies should follow an economic evaluation checklist for high-quality reporting and consistency.
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Affiliation(s)
- John Rong Hao Tay
- Discipline of Periodontics, Faculty of Dentistry, National University of Singapore, Singapore City, Singapore.,Department of Restorative Dentistry, National Dental Centre Singapore, Singapore City, Singapore
| | - Ethan Ng
- Discipline of Periodontics, Faculty of Dentistry, National University of Singapore, Singapore City, Singapore.,Department of Restorative Dentistry, National Dental Centre Singapore, Singapore City, Singapore
| | - Rahul Nair
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Zhe Sheng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
| | - Sharon Hui Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
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Steinberg D, Friedman M. Sustained-release delivery of antimicrobial drugs for the treatment of periodontal diseases: Fantasy or already reality? Periodontol 2000 2020; 84:176-187. [PMID: 32844422 DOI: 10.1111/prd.12341] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Periodontal diseases are prevalent in humans. Conventional means of combating these diseases involve basic oral hygiene, mostly toothbrushing, use of mouthwashes, and flossing. Supplementary means of treatment, either clinical or pharmaceutical, are often necessary. The use of sustained-release delivery systems, applied locally to the periodontal pocket, seems to be one feasible approach: local sustained-release delivery of antibacterial agents to treat periodontal diseases is conceivable. The use of local (intrapocket) sustained-release delivery systems has numerous clinical, pharmacologic, and toxicologic advantages over conventional treatments for periodontal diseases. Sustained-release technology has been proven to be effective over the last few decades. Films, gels, and fibers are the three main classical intrapocket pharmaceutical delivery systems. Research today is more focused on improving drug delivery, and less on introducing new drugs. New approaches, eg, those making use of nanotechnology, are emerging for local drug-delivery systems. The local sustained-release delivery system concept is innovative and a few products are already commercially available.
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Affiliation(s)
- Doron Steinberg
- Biofilm Research Laboratory, Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Friedman
- School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
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6
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Rinne CA, Dagassan-Berndt DC, Connert T, Müller-Gerbl M, Weiger R, Walter C. Impact of CBCT image quality on the confidence of furcation measurements. J Clin Periodontol 2020; 47:816-824. [PMID: 32324295 DOI: 10.1111/jcpe.13298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/27/2020] [Accepted: 04/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND To investigate the impact of scanning parameter in cone-beam computed tomography (CBCT) images on accuracy and confidence with measurements of furcation involvement (FI) in maxillary molars. MATERIAL AND METHODS Six half cadaver heads with present maxillary molars (n = 10) were available. CBCT scans with the fixed-parameter field of view (4 × 4 cm, 12 × 17 cm) amperage and voltage (4 mA, 90 kV) and with varying scan modes (SM), that is images/scan (IS), voxel sizes (VZ) and rotation (R), were performed using one CBCT apparatus. The images were analysed by two calibrated investigators. Horizontal FI's were measured in mm or a "through and through" destruction (FI degree III) was recorded. Each rater scored the FI measurements performed in each scan as "confident" or as "not confident". Data were statistically analysed using chi-square tests. RESULTS The agreement between CBCT FI measurements and intra-surgical FI measurements varied according to SM (SM HiSp 180°, 0.08: kappa 0.538, CI; 95%: 0.362-0.714; SM Std. 360°, 0.25: kappa 0.698, CI; 95%: 0.534-0.861). The number of measurements scored as "confident" varied according to SM (SM Std. 360°, 0.08:52 out of 60 measurements; SM Std. 360°, 0.25:16 out of 60 measurements; p < .001). CONCLUSIONS SM of CBCT significantly affect the confidence with FI measurements in maxillary molars.
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Affiliation(s)
- Carin Aime Rinne
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Basel, Switzerland
| | - Dorothea C Dagassan-Berndt
- Department of Oral Surgery, Oral Radiology and Oral Medicine University Center of Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Thomas Connert
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Basel, Switzerland
| | | | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Basel, Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Basel, Switzerland
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Tan OL, Safii SH, Razali M. Commercial Local Pharmacotherapeutics and Adjunctive Agents for Nonsurgical Treatment of Periodontitis: A Contemporary Review of Clinical Efficacies and Challenges. Antibiotics (Basel) 2019; 9:E11. [PMID: 31905889 PMCID: PMC7169417 DOI: 10.3390/antibiotics9010011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 12/19/2022] Open
Abstract
Periodontal infections tend to be site-specific, mostly confined to the periodontal pocket. With the surge of antibiotic-resistant bacteria, the trend is shifting towards other therapeutic modalities, especially locally delivered approaches that include other pharmacotherapeutic drugs and medical devices. This narrative review aimed to provide insights into the clinical efficacy of local drug delivery and adjunctive agents used in nonsurgical management of periodontitis. Electronic (PubMed/MEDLINE, CENTRAL, and EMBASE) and bibliographic searches of past systematic reviews were carried out to identify previous publications on the topic. Only relevant literature and randomized controlled trials published in English were selected. In addition, a literature review was developed based on the selected articles. Experimental drugs or agents were excluded. This review highlights the clinically proven and commercially available therapeutic agents related to the management of periodontal disease with comparisons of their clinical efficacies and challenges. A vast array of commercial local pharmacotherapeutic agents had been clinically tested, but the methodologies and clinical results varied within and between each agent used, causing difficulty in drawing conclusions and providing support to the superiority of one agent over another. Considering the benefit-cost ratio with the modest clinical results, the long-term usefulness of these agents remains debatable.
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Affiliation(s)
- Oi Leng Tan
- Faculty of Dentistry, Centre for Restorative Dentistry, Unit of Periodontology, National University of Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Syarida Hasnur Safii
- Faculty of Dentistry, Department of Restorative Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Masfueh Razali
- Faculty of Dentistry, Centre for Restorative Dentistry, Unit of Periodontology, National University of Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
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Joda T, Ferrari M, Gallucci GO, Wittneben JG, Brägger U. Digital technology in fixed implant prosthodontics. Periodontol 2000 2018; 73:178-192. [PMID: 28000274 DOI: 10.1111/prd.12164] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Digital protocols are increasingly influencing prosthodontic treatment concepts. Implant-supported single-unit and short-span reconstructions will benefit mostly from the present digital trends. In these protocols, monolithic implant crowns connected to prefabricated titanium abutments, which are created based on data obtained from an intraoral scan followed by virtual design and production, without the need of a physical master cast, have to be considered in lieu of conventional manufacturing techniques for posterior implant restorations. No space for storage is needed in the complete digital workflow, and if a remake is required a replica of the original reconstruction can be produced quickly and inexpensively using rapid prototyping. The technological process is split into subtractive methods, such as milling or laser ablation, and additive processing, such as three-dimensional printing and selective laser melting. The dimensions of the supra-implant soft-tissue architecture can be calculated in advance of implant placement, according to the morphologic copy, and consequently are individualized for each patient. All these technologies have to be considered before implementing new digital dental workflows in daily routine. The correct indication and application are prerequisite and crucial for the success of the overall therapy, and, finally, for a satisfied patient. This includes a teamwork approach and equally affects the clinician, the dental assistant and the technician as well. The digitization process has the potential to change the entire dental profession. The major benefits will be reduced production costs, improvement in time efficiency and fulfilment of patients' perceptions of a modernized treatment concept.
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Graziani F, Karapetsa D, Mardas N, Leow N, Donos N. Surgical treatment of the residual periodontal pocket. Periodontol 2000 2017; 76:150-163. [PMID: 29193404 DOI: 10.1111/prd.12156] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 01/28/2023]
Abstract
The ultimate goal of periodontal therapy is to prevent further disease progression in order to reduce the risk of tooth loss. This objective can be achieved through a number of therapeutic modalities comprising both the nonsurgical and surgical phases of periodontal therapy. Nonsurgical periodontal treatment has been shown to control periodontal infection and to arrest progression of the disease in a significant number of cases. However, despite completion of nonsurgical treatment, a number of periodontal pockets, defined as 'residual', often remain. The presence of residual pockets may jeopardize tooth survival and be a risk factor of further disease progression, and ultimately tooth loss. Therefore, the aim of this review is to analyze the knowledge available on the indications for and the performance of periodontal surgical treatment of residual pockets in terms of 'traditional' (clinical, microbiological), patient-based and systemic health outcomes.
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Mac Giolla Phadraig C, Nunn J, Guerin S, Normand C. Should we provide oral health training for staff caring for people with intellectual disabilities in community based residential care? A cost-effectiveness analysis. EVALUATION AND PROGRAM PLANNING 2016; 55:46-54. [PMID: 26722699 DOI: 10.1016/j.evalprogplan.2015.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 12/07/2015] [Accepted: 12/10/2015] [Indexed: 06/05/2023]
Abstract
Oral health training is often introduced into community-based residential settings to improve the oral health of people with intellectual disabilities (ID). There is a lack of appropriate evaluation of such programs, leading to difficulty in deciding how best to allocate scarce resources to achieve maximum effect. This article reports an economic analysis of one such oral health program, undertaken as part of a cluster randomized controlled trial. Firstly, we report a cost-effectiveness analysis of training care-staff compared to no training, using incremental cost-effectiveness ratios (ICERs). Effectiveness was measured as change in knowledge, reported behaviors, attitude and self-efficacy, using validated scales (K&BAS). Secondly, we costed training as it was scaled up to include all staff within the service provider in question. Data were collected in Dublin, Ireland in 2009. It cost between €7000 and €10,000 more to achieve modest improvement in K&BAS scores among a subsample of 162 care-staff, in comparison to doing nothing. Considering scaled up first round training, it cost between €58,000 and €64,000 to train the whole population of staff, from a combined dental and disability service perspective. Less than €15,000-€20,000 of this was additional to the cost of doing nothing (incremental cost). From a dental perspective, a further, second training cycle including all staff would cost between €561 and €3484 (capital costs) and €5815 (operating costs) on a two yearly basis. This study indicates that the program was a cost-effective means of improving self-reported measures and possibly oral health, relative to doing nothing. This was mainly due to low cost, rather than the large effect. In this instance, the use of cost effectiveness analysis has produced evidence, which may be more useful to decision makers than that arising from traditional methods of evaluation. There is a need for CEAs of effective interventions to allow comparison between programs. Suggestions to reduce cost are presented.
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Affiliation(s)
- Caoimhin Mac Giolla Phadraig
- Department of Child and Public Dental Health, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland; School of Dental Science, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland.
| | - June Nunn
- Department of Child and Public Dental Health, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland; School of Dental Science, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland
| | - Suzanne Guerin
- Centre for Disability Studies, School of Psychology, UCD, Dublin, Ireland
| | - Charles Normand
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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Mohd Dom TN, Ayob R, Abd Muttalib K, Aljunid SM. National Economic Burden Associated with Management of Periodontitis in Malaysia. Int J Dent 2016; 2016:1891074. [PMID: 27092180 PMCID: PMC4820592 DOI: 10.1155/2016/1891074] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 01/14/2016] [Accepted: 02/15/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives. The aim of this study is to estimate the economic burden associated with the management of periodontitis in Malaysia from the societal perspective. Methods. We estimated the economic burden of periodontitis by combining the disease prevalence with its treatment costs. We estimated treatment costs (with 2012 value of Malaysian Ringgit) using the cost-of-illness approach and included both direct and indirect costs. We used the National Oral Health Survey for Adults (2010) data to estimate the prevalence of periodontitis and 2010 national census data to estimate the adult population at risk for periodontitis. Results. The economic burden of managing all cases of periodontitis at the national level from the societal perspective was approximately MYR 32.5 billion, accounting for 3.83% of the 2012 Gross Domestic Product of the country. It would cost the nation MYR 18.3 billion to treat patients with moderate periodontitis and MYR 13.7 billion to treat patients with severe periodontitis. Conclusion. The economic burden of periodontitis in Malaysia is substantial and comparable with that of other chronic diseases in the country. This is attributable to its high prevalence and high cost of treatment. Judicious application of promotive, preventive, and curative approaches to periodontitis management is decidedly warranted.
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Affiliation(s)
- Tuti Ningseh Mohd Dom
- Department of Dental Public Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Rasidah Ayob
- Oral Health Division, Ministry of Health Malaysia, 62584 Putra Jaya, Malaysia
| | - Khairiyah Abd Muttalib
- Oral Health Division, Ministry of Health Malaysia, 62584 Putra Jaya, Malaysia
- Faculty of Dentistry, SEGi University, No. 9, Jalan Teknologi, Taman Sains Selangor, Kota Damansara, PJU 5, 47810 Petaling Jaya, Selangor, Malaysia
| | - Syed Mohamed Aljunid
- International Centre for Casemix and Clinical Coding, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
- Department of Health Policy and Management, Faculty of Public Health, Kuwait University, P.O. Box 24923, 13110 Safat, Kuwait
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12
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Dumitrescu AL. Editorial: Periodontal Disease - A Public Health Problem. Front Public Health 2016; 3:278. [PMID: 26779473 PMCID: PMC4705816 DOI: 10.3389/fpubh.2015.00278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/09/2015] [Indexed: 01/22/2023] Open
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13
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Schmidt JC, Walter C, Amato M, Weiger R. Treatment of periodontal-endodontic lesions - a systematic review. J Clin Periodontol 2014; 41:779-90. [DOI: 10.1111/jcpe.12265] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Julia C. Schmidt
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel Switzerland
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel Switzerland
| | - Mauro Amato
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel Switzerland
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14
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Mohd-Dom T, Ayob R, Mohd-Nur A, Abdul-Manaf MR, Ishak N, Abdul-Muttalib K, Aljunid SM, Ahmad-Yaziz Y, Abdul-Aziz H, Kasan N, Mohd-Asari AS. Cost analysis of periodontitis management in public sector specialist dental clinics. BMC Oral Health 2014; 14:56. [PMID: 24884465 PMCID: PMC4033493 DOI: 10.1186/1472-6831-14-56] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 05/09/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The objective of this paper is to quantify the cost of periodontitis management at public sector specialist periodontal clinic settings and analyse the distribution of cost components. METHODS Five specialist periodontal clinics in the Ministry of Health represented the public sector in providing clinical and cost data for this study. Newly-diagnosed periodontitis patients (N = 165) were recruited and followed up for one year of specialist periodontal care. Direct and indirect costs from the societal viewpoint were included in the cost analysis. They were measured in 2012 Ringgit Malaysia (MYR) and estimated from the societal perspective using activity-based and step-down costing methods, and substantiated by clinical pathways. Cost of dental equipment, consumables and labour (average treatment time) for each procedure was measured using activity-based costing method. Meanwhile, unit cost calculations for clinic administration, utilities and maintenance used step-down approach. Patient expenditures and absence from work were recorded via diary entries. The conversion from MYR to Euro was based on the 2012 rate (1€ = MYR4). RESULTS A total of 2900 procedures were provided, with an average cost of MYR 2820 (€705) per patient for the study year, and MYR 376 (€94) per outpatient visit. Out of this, 90% was contributed by provider cost and 10% by patient cost; 94% for direct cost and 4% for lost productivity. Treatment of aggressive periodontitis was significantly higher than for chronic periodontitis (t-test, P = 0.003). Higher costs were expended as disease severity increased (ANOVA, P = 0.022) and for patients requiring surgeries (ANOVA, P < 0.001). Providers generally spent most on consumables while patients spent most on transportation. CONCLUSIONS Cost of providing dental treatment for periodontitis patients at public sector specialist settings were substantial and comparable with some non-communicable diseases. These findings provide basis for identifying potential cost-reducing strategies, estimating economic burden of periodontitis management and performing economic evaluation of the specialist periodontal programme.
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Affiliation(s)
- Tuti Mohd-Dom
- Department of Dental Public Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rasidah Ayob
- Oral Health Division, Ministry of Health, Malaysia, Putra Jaya, Malaysia
| | - Amrizal Mohd-Nur
- International Centre for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd R Abdul-Manaf
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noorlin Ishak
- Oral Health Division, Ministry of Health, Malaysia, Putra Jaya, Malaysia
| | | | - Syed M Aljunid
- International Centre for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Hanizah Abdul-Aziz
- Oral Health Division, Ministry of Health, Malaysia, Putra Jaya, Malaysia
| | - Noordin Kasan
- Oral Health Division, Ministry of Health, Malaysia, Putra Jaya, Malaysia
| | - Ahmad S Mohd-Asari
- Oral Health Division, Ministry of Health, Malaysia, Putra Jaya, Malaysia
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Cost-Effectiveness of Periodontitis Management in Public Sector Specialist Periodontal Clinics: A Societal Perspective Research in Malaysia. Value Health Reg Issues 2014; 3:117-123. [DOI: 10.1016/j.vhri.2014.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fardal Ø, Grytten J. Applying quality assurance in real time
to compliant long-term periodontal maintenance patients utilizing cost-effectiveness and cost utility. J Clin Periodontol 2014; 41:604-11. [DOI: 10.1111/jcpe.12252] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 12/11/2022]
Affiliation(s)
| | - Jostein Grytten
- Institute of Community Dentistry; University of Oslo; Blindern Oslo Norway
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Bullon P, Jaramillo R, Santos-Garcia R, Rios-Santos V, Ramirez M, Fernandez-Palacin A, Fernandez-Riejos P. Relation of Periodontitis and Metabolic Syndrome With Gestational Glucose Metabolism Disorder. J Periodontol 2014; 85:e1-8. [DOI: 10.1902/jop.2013.130319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Listl S, Birch S. Reconsidering value for money in periodontal treatment. J Clin Periodontol 2013; 40:345-8. [DOI: 10.1111/jcpe.12085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Stefan Listl
- Department of Conservative Dentistry; University of Heidelberg; Heidelberg Germany
- Munich Center for the Economics of Aging; Max-Planck-Institute for Social Law and Social Policy; Munich Germany
| | - Stephen Birch
- Centre for Health Economics and Policy Analysis; McMaster University; Hamilton ON Canada
- School of Community Based Medicine; University of Manchester; Manchester UK
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Fardal Ø, O’Neill C, Gjermo P, Fardal E, Sandvik L, Hansen BF, Linden GJ. The Lifetime Direct Cost of Periodontal Treatment: A Case Study From a Norwegian Specialist Practice. J Periodontol 2012; 83:1455-62. [DOI: 10.1902/jop.2012.110689] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Donos N, Laurell L, Mardas N. Hierarchical decisions on teeth vs. implants in the periodontitis-susceptible patient: the modern dilemma. Periodontol 2000 2012; 59:89-110. [PMID: 22507062 DOI: 10.1111/j.1600-0757.2011.00433.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is estimated that advanced periodontitis typically affects about 10% of most adult populations studied. These individuals can be considered highly susceptible to periodontitis and often present difficulties for clinicians in therapeutic decision making, especially when dental implants are involved. Poor plaque control and smoking are well established risk factors for periodontitis, as well as for peri-implant disease. Long-term follow-up studies have clearly demonstrated that treatment of periodontal disease, even if advanced, can be successful in arresting disease progression and preventing (or at least significantly delaying) tooth loss. With the increasing development of implant dentistry, traditional well documented and evidence-based therapies to treat periodontal diseases may sometimes not be used to their full potential. Instead, there appears to be an increasing tendency to extract periodontally compromised teeth and replace them with implants, as if implants can solve the problem. However, peri-implant diseases are prevalent, affecting between 28% and 56% of people with implants, and (at the implant level) 12-43% of implants. A history of periodontal disease, smoking and poor oral hygiene are all risk factors for developing peri-implantitis. Unlike periodontitis, there are currently no predictable means for treating peri-implantitis, although resective surgery seems to be the most effective technique. Consequently, if implant treatment is considered in patients who are susceptible to periodontitis, it should be preceded by appropriate and adequate periodontal treatment or re-treatment to control the condition, and should be followed by a stringent supportive maintenance program to prevent the development of peri-implant disease. The decision whether implant treatment should be performed should be based on an assessment of the patient's risk profile at the subject level, as well as at the site level.
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Scheuber S, Hicklin S, Brägger U. Implants versus short-span fixed bridges: survival, complications, patients' benefits. A systematic review on economic aspects. Clin Oral Implants Res 2012; 23 Suppl 6:50-62. [PMID: 23062127 DOI: 10.1111/j.1600-0501.2012.02543.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sybille Scheuber
- University of Bern; School of Dental Medicine; Bern; Switzerland
| | - Stefan Hicklin
- University of Bern; School of Dental Medicine; Bern; Switzerland
| | - Urs Brägger
- University of Bern; School of Dental Medicine; Bern; Switzerland
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Walter C, Weiger R, Dietrich T, Lang NP, Zitzmann NU. Does three-dimensional imaging offer a financial benefit for treating maxillary molars with furcation involvement? - A pilot clinical case series. Clin Oral Implants Res 2011; 23:351-8. [DOI: 10.1111/j.1600-0501.2011.02330.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2011] [Indexed: 11/28/2022]
Affiliation(s)
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel; Switzerland
| | - Thomas Dietrich
- Department of Oral Surgery; School of Dentistry; University of Birmingham; Birmingham; UK
| | | | - Nicola U. Zitzmann
- Department of Periodontology, Endodontology and Cariology; University of Basel; Basel; Switzerland
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Heasman PA, Vernazza CR, Gaunt FL, Pennington MW. Cost-effectiveness of adjunctive antimicrobials in the treatment of periodontitis. Periodontol 2000 2010; 55:217-30. [DOI: 10.1111/j.1600-0757.2010.00341.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Listl S, Tu YK, Faggion Jr. CM. A cost-effectiveness evaluation of enamel matrix derivatives alone or in conjunction with regenerative devices in the treatment of periodontal intra-osseous defects. J Clin Periodontol 2010; 37:920-7. [DOI: 10.1111/j.1600-051x.2010.01611.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PURPOSE To identify the most cost-effective approach to sinus lifting on the basis of currently available evidence. METHODS We incorporate the costs and clinical outcomes of nine different sinus lift techniques within a decision tree model in which costs are based on insurance regulations in Germany and health outcomes follow two recent meta-analyses. The most cost-effective treatment option is identified on the basis of the maximum net benefit criterion. Uncertainties regarding health outcomes are incorporated via probabilistic sensitivity analysis based on Monte-Carlo simulation. RESULTS When there are no financial restrictions, the optimum treatment strategy is the lateral approach with autogenous particulate bone and a resorbable membrane. When, however, monetary resources for sinus-floor elevation are scarce, the most cost-effective option is the transalveolar technique without bone grafting. Only if relatively high costs can be afforded or if initial bone height at implant site is below 5 mm is the maximum net benefit achieved by lateral approaches. CONCLUSIONS On the basis of currently available evidence, the transalveolar technique is advisable when monetary resources for sinus-floor elevation are scarce and initial bone height is sufficiently high. Lateral approaches are primarily recommended for lower pre-operative bone heights.
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Affiliation(s)
- Stefan Listl
- Department of Conservative Dentistry, University of Heidelberg, Heidelberg, Germany.
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Gjermo PE, Grytten J. Cost-effectiveness of various treatment modalities for adult chronic periodontitis. Periodontol 2000 2009; 51:269-75. [DOI: 10.1111/j.1600-0757.2009.00313.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pretzl B, Wiedemann D, Cosgarea R, Kaltschmitt J, Kim TS, Staehle HJ, Eickholz P. Effort and costs of tooth preservation in supportive periodontal treatment in a German population. J Clin Periodontol 2009; 36:669-76. [DOI: 10.1111/j.1600-051x.2009.01409.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pennington M, Vernazza C, Heasman P. Making the leap from cost analysis to cost-effectiveness. J Clin Periodontol 2009; 36:667-8. [DOI: 10.1111/j.1600-051x.2009.01424.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gürkan A, Emingil G, Çınarcık S, Berdeli A. Post-treatment effects of subantimicrobial dose doxycycline on clinical parameters and gingival crevicular fluid transforming growth factor-β1in severe, generalized chronic periodontitis. Int J Dent Hyg 2008; 6:84-92. [DOI: 10.1111/j.1601-5037.2007.00268.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Winning T, Needleman I, Rohlin M, Carrassi A, Chadwick B, Eaton K, Hardwick K, Ivancakova R, Jallaludin RL, Johnsen D, Kim JG, Lekkas D, Li D, Onisei D, Pissiotis A, Reynolds P, Tonni I, Vanobbergen J, Vassileva R, Virtanen J, Wesselink P, Wilson N. Evidence-based care and the curriculum. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2008; 12 Suppl 1:48-63. [PMID: 18289268 DOI: 10.1111/j.1600-0579.2007.00480.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
An evidence-based (EB) approach has been a significant driver in reforming healthcare over the past two decades. This change has extended across a broad range of health professions, including oral healthcare. A key element in achieving an EB approach to oral healthcare is educating our practitioners, both current and future. This involves providing opportunities integrated within simulated and actual clinical settings for practitioners to learn and apply the principles and processes of evidence-based oral healthcare (EBOHC). Therefore, the focus of this discussion will be on ways in which EBOHC and associated research activities can be implemented into curricula, with the aim of improving patient care. This paper will initially define the scope of EBOHC and research, what these involve, why they are important, and issues that we need to manage when implementing EBOHC. This will be followed by a discussion of factors that enable successful implementation of EBOHC and research into curricula. The paper concludes with suggestions on the future of EBOHC and research in curricula. Key recommendations related to curricula include strengthening of the culture of a scientific approach to education and oral healthcare provision; complete integration of EBOHC into the curriculum at all levels; and faculty development to implement EBOHC based on their needs and evidence of effective approaches. Key recommendations to support implementation and maintenance of EBOHC include recognition and funding for high-quality systematic reviews and development of associated methodologies relevant for global environments; building global capacity of EBOHC researchers; research into improving translation of effective interventions into education and healthcare practice, including patient-reported outcomes, safety and harms, understanding and incorporation of patient values into EB decision-making, economic evaluation research specific to oral healthcare and effective methods for changing practitioner (faculty) behaviours; and extend access to synthesized research in 'user friendly' formats and languages tailored to meet users' needs. Realizing these recommendations may help to improve access to effective healthcare as a basic human right.
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Affiliation(s)
- T Winning
- The University of Adelaide, Adelaide, SA, Australia.
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Ide R, Hoshuyama T, Takahashi K. The Effect of Periodontal Disease on Medical and Dental Costs in a Middle-Aged Japanese Population: A Longitudinal Worksite Study. J Periodontol 2007; 78:2120-6. [DOI: 10.1902/jop.2007.070193] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Flemmig TF. Locally delivered antimicrobials adjunctive to scaling and root planing provide additional PD reduction and CAL gain in the treatment of chronic periodontitis. J Evid Based Dent Pract 2006; 6:220-1. [PMID: 17138445 DOI: 10.1016/j.jebdp.2006.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas F Flemmig
- University of Washington, Department of Periodontics, Box 357444, Seattle, WA 98195-7444, USA.
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Heasman L, Stacey F, Preshaw PM, McCracken GI, Hepburn S, Heasman PA. The effect of smoking on periodontal treatment response: a review of clinical evidence. J Clin Periodontol 2006; 33:241-53. [PMID: 16553633 DOI: 10.1111/j.1600-051x.2006.00902.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Smoking has been identified as a significant risk factor for periodontal diseases and is regarded as being responsible for incomplete or delayed healing in patients following treatment. AIM AND METHOD The aim of this conventional review was to review, collate and tabulate the relative effectiveness of treatments of chronic periodontitis in smokers, non-smokers and ex-smokers. OBSERVATIONS The majority of clinical trials show significantly greater reductions in probing depths and bleeding on probing, and significantly greater gain of clinical attachment following non-surgical and surgical treatments in non-smokers compared with smokers. This benefit is also seen at class I and II furcation sites and in patients prescribed systemic or local antimicrobial treatments. CONCLUSIONS Data from epidemiological, cross-sectional and case-control studies strongly suggest that quitting smoking is beneficial to patients following periodontal treatments. The periodontal status of ex-smokers following treatment suggests that quitting the habit is beneficial although there are only limited data from long-term longitudinal clinical trials to demonstrate unequivocally the periodontal benefit of quitting smoking.
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Affiliation(s)
- L Heasman
- School of Dental Sciences, University of Newcastle upon Tyne, UK
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Davies I, Karring T, Norderyd O. Advances in the behavioural and public health aspects of periodontitis.. Group D Consensus report of the fifth European workshop in periodontology. J Clin Periodontol 2005; 32 Suppl 6:326-7. [PMID: 16128847 DOI: 10.1111/j.1600-051x.2005.00826.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ian Davies
- Department of Periodontology, University of Hong Kong, Hong Kong
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