“Periodontal disease is initiated by specific bacteria that activate host mechanisms destroying bone and the connective tissue that supports the teeth. It has a relative high prevalence in the U.S. population, causing the greatest amount of tooth loss. Like any other inflammatory condition, periodontal diseases possess additional risk for susceptible people, contributing to serious diseases such as coronary heart disease and stroke, preterm low birth weight babies, and the regulation of blood glucose level in diabetics or respiratory diseases (1).”
With escalating costs in health care, the treatment and management of periodontal disease is becoming increasingly more imperative in the outcomes and costs of chronic diseases.
At the present time, diagnosis of periodontal disease relies on clinical and radiographic evidence. Clinical application of microbial diagnosis in periodontics is extremely limited, although readily available (2). The role of genetic factors in periodontal disease is well-recognized and genetic susceptibility tests are commercially available, such as Interleukin Genetics’, PerioPredict (3). (PerioPredict, measures the variation in interleuken-1, a key mediator of inflammation, all done with a cheek swab). The ability to measure the principal risk factors for periodontal disease, and therefore be able to better treat and manage periodontal disease, has been well vetted and now commercially available in the form of PreViser (4). However, the three major contributing factors (microbial analysis, genetic testing and risk assessment) are rarely assessed, yet they are fundamental and critical for diagnosis and treatment of periodontal disease.
Within ten to 20 years, dentists and/or their auxiliaries will be required to perform genetic and bacteriologic testing for adult patients when submitting predeterminations and seeking reimbursement for periodontal treatment. Data from these tests will be collated with risk management data and all interconnected to their electronic patient records. Artificial intelligence providing diagnostic trees for diagnosis and treatment planning will be delivered based on the data. With the constant flow of data along with patient outcomes, the algorithms will continuously be upgraded based on determining clinical outcomes, cost and value. What will happen at the dentist’s chair will be a whole lot different than it is today.
Much of diagnosis and treatment planning for periodontal disease will move from the subjective to the objective. Today diagnosis and treatment planning is based on the eye of the individual practitioner. The variations between practitioners are vast (5). Hence, the cost and outcome variations are massive. Given the health care implications of untreated and unmanaged periodontal disease, and the inadequate job of the profession and political organizations to unify these emerging technologies consistently within their membership, outside agencies will exert increasing pressure for compliance to standards and protocols based on the data and protocol they design. Instead of taking the lead, the dental professionals will be left behind, complaining loudly as they are compelled to follow the mandates and dictates of third parties, academic committees, government and employers.
Imagine you are an employer with 100,000 employees. Obesity, diabetes, and cardiovascular disease exists within your workforce. Your medical insurance has a heavy co-pay component in order for you to afford health care insurance. A healthier workforce is a strategic advantage in so many ways – time, money, performance levels and employee satisfaction. You seek third parties that will reduce health-care costs and severity of disease. You are now very aware that periodontal disease is a contributing factor to the severity of chronic diseases. You now actively search for an established dental insurer contractor with a large dentist network, dentists who use every tool available to prevent or control periodontal disease in your workforce.
References
- Genetic Test and Periodontal Disease, Abstract; Europe PMC, J. Khahill
- Quick Detection of Periodontitis Pathogens; Science Daily, Fraunhofer-Gesellschaft
- The Interleukin-1 Genotype as a Severity Factor in Adult Periodontal Disease; Journal of Clinical Periodontology, K. Kornman, et. al.
- PreViser; Scientific Papers.
- Variations in Dentists’ Clinical Decisions; Journal of Public Health, 55m, No 3, 1995, J. Bader and D. Shugars
