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Win with perio biofilm management

Sept. 1, 2006
Practitioners with the ability to treat and help patients manage biofilms are positioned to be rewarded professionally and financially.
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Practitioners with the ability to treat and help patients manage biofilms are positioned to be rewarded professionally and financially.

Biofilms cause both periodontal disease and decay. Practitioners with the ability to treat and help patients manage biofilms are positioned to be rewarded both professionally and financially.

Of these biofilm diseases, periodontal disease has historically been the more difficult to manage because it is more inaccessible beneath the gingiva. A new treatment method is now available to deliver doctor-prescribed medications into the gingival sulcus or periodontal pocket. These medications can modify the biofilm to manage the disease. After the medications modify the biofilm matrix, it is possible to arrest the pathogens and allow the patient to heal. This article briefly discusses both the treatment and home-care maintenance method and the financial aspects involved.

Epidemic of disease

A large number of patients are afflicted with periodontal disease because existing treatments have not been effective in managing the biofilm and bacteria. In addition, the vast majority of adults do not follow an adequate home-care routine. Average brushing times are low, and only a minority of patients regularly floss. In addition, in those patients who do regularly brush and floss, a deterioration of plaque control occurs over time. The inadequate treatment and failure of existing home care have resulted in an epidemic of disease that can now be treated and contained.

These advances in treatment and home care with the Perio Protect Method are in accord with the Center of Clinical Research at the National Institute of Dental and Cranial Research. Their research documents show that periodontal disease can affect up to 90 percent of the worldwide population. The Center recommends that the primary direction of professional treatment and patient home care must be directed toward controlling the bacterial biofilm, arresting the disease deterioration, and restoring lost tooth support.

The Perio Protect Method meets the Center’s ideal treatment requirements. This new method of biofilm treatment delivers doctor-selected medications to the gingival sulcus or periodontal pocket deeper than is possible with other conventional tray methods. These medications have been demonstrated to significantly reduce periodontal pockets and decrease gingival bleeding.

The Perio Protect Method uses the patented Perio Tray, an FDA-cleared medical device capable of delivering antimicrobial agents or solutions of the dentist’s choosing to the gingival crevice (sulcus) or periodontal pocket. Doctors are instructed in the system’s usage through seminars or a home-study certification program by Perio Protect, LLC, and are licensed to use the method and medical device in accordance with FDA rules and regulations.

Proper system utilization requires a thorough examination and an individualized treatment program that coincides with the scope and magnitude of the biofilm disease. The Perio Protect Method addresses these needs, adapts as healing occurs, and has been demonstrated to be effective in pilot studies.

The medications delivered to the periodontal pocket perform a variety of actions. These include:Modifying the biofilm by altering the amino acids. This changes the biofilm matrix configuration.
a. Cleaving hyaluronic acid
b. Converting histidine to alanine
c. Modifying asparagine to aspartate
Suppressing the tissue inflammatory response by inhibiting the IL-8 mRNA, thus decreasing the IL-8 production.Generating a minor electrical potential that appears to improve antibiotic effectiveness.Reducing gingival inflammation by providing chemotherapeutic agents which possess antioxidative properties.Inhibiting bone inflammation by inhibiting the matrix metalloproteinases and decreasing collagen breakdown.Decreasing bone loss by attenuating the osteoclastic signal response associated with bone loss.Abrogating the formation of new osteoclasts after 20 days of continuous medicament application.Promoting the development of new bone by fostering osteoblastic action in place of osteoclastic action.

This may help explain the clinically observed bone regeneration that occurs with the Perio Protect Method.

Before treatment
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The medical device comes in a kit which includes instructions for usage and all of the accessory instruments to evenly distribute the medication. The Perio Protect Kit (Figure 1) placed on the bathroom vanity also serves as a constant reminder that the method needs to be used in accordance with the doctor’s prescription. The prescribed usage is modified as healing occurs.

After Treatment
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Patient usage has demonstrated dramatic improvements as is evident when comparing the initial probing results (Figure 2) with the after treatment results (Figure 3). The patient was a juvenile diabetic and suffered from periodontal disease for a number of years. The cost to the patient was substantially less than the cost of comparable conventional method and the results have been maintained.

Figure 1: The Perio Protect Kit is a visible reminder for patient usage and contains all of the necessary elements for patient homecare.
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Determining the fee for the medical device is an individual practitioner’s prerogative and is determined in the same manner as most laboratory-prepared items. Most offices multiply the laboratory’s cost by some integer to determine the cost to the patient. For example, if the laboratory cost for a crown was $200 and the office integer was 4, the cost to the patient would be $800. Likewise, for two crowns, the cost would be $1,600.

For demonstration purposes, we will assume the cost for the kit is $200 for both arches. The integer will remain 4 for this demonstration, so the cost to the patient would be $800 for the medical devices, the bathroom vanity kit, medications, instrumentation, and wearing instructions. We will further assume the patient will only require one set of medical devices in the course of the treatment, although severe cases may require more than one medical device. We will further assume that periodontal surgery won’t be necessary.

The cost for this method will vary from office to office. We will assume the cost to be $1,000 for the entire six-month gingivitis treatment and $2,000 for the six-month periodontitis treatment. Assuming the demonstration charge is $1,000 and $2,000, the economics of the Perio Protect Method for an office open 48 weeks a year and seeing one gingivitis and one periodontitis patient per week are:

48 gingivitis patients x $1,000 = $48,000 real income
48 periodontitis patients x $2,000 = $96,000 real income
Total is $144,000 in real income

In most states, a significant advantage of the Perio Protect Method is that the management of the method can be delegated to a qualified staff member under the dentist’s supervision. This scenario would require very little of the dentist’s time, while providing a recurring source of revenue. This would maximize treatment usage and further increase the office income without requiring new staff or equipment.

Figure 2: Pretreatment pocket-depth analysis demonstrates the severity of the periodontal pockets, as 132 pocket-probing depths were greater than normal (3 mm) and 132 bleeding sites were discovered.
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Patients with a biofilm periodontal disease are faced with two alternatives: conventional treatments or the Perio Protect Method. Conventional treatment methods have been shown to be ineffective in affecting the prevalence of target species at one-year post-treatment. The prevalence of the microbial pathogens negatively affects the outcome of periodontal surgery and conventional nonsurgical therapy. The Perio Protect Method offers a second alternative. If patients elect not to receive the Perio Protect treatment, they should be referred to a periodontist immediately. Faced with these alternatives, patients must select the treatment they feel will provide them with the best and most appropriate care.

Figure 3: The six-month re-evaluation indicated a significant reduction in pocket-probing depths. Some 128 of the initial 132 sites were found to respond to therapy, and one site required root planing (tooth No. 25) to return to normal pocket-probing depths. All regions were then normal as a result of long-term management with the Perio Protect Method.
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Good insurance policies will cover much of the necessary treatments. Patients need to be informed of their options, the cost of treatment, and all reasonable alternatives. How the cost of treatment is presented to the patient also is important. This discussion should be managed just like any other dental procedure that is medically necessary. It is not in the patient’s interest to allow a situation to “fester” when it should be treated. Likewise, whether or not insurance will pay for treatment should not be the determining factor, but rather what is best for the patient.

Pluses of Perio Protect Method

The Perio Protect Method has been demonstrated to be an effective method of treating gingivitis and periodontitis. The cost for the entire treatment approximates the cost of one-to-two-crowns, which is affordable for most patients. Generally, costs for the Perio Protect Method are substantially less than the cost for periodontal surgery, and the patient does not have the complications or constraints that accompany many other procedures. Many of the Perio Protect procedures are covered by medical and dental insurance, and the process is comfortable, easy, simple ... and it works!

Patient compliance is excellent because patients feel the difference almost immediately. The medications delivered by the medical device denature the protein biofilm, making brushing and flossing more effective. Tissue inflammation is inhibited by the medications delivered to the source of the infection, and bleeding and discomfort cease within a matter of days. Collagen breakdown is inhibited, bone loss is controlled, and bone regeneration is promoted.

The economic impact on the office is substantial and immediate. The cost to implement the system is low because no new equipment is needed and no new personnel are required. The staff generally manages the Perio Protect Method under the supervision of the dentist. This increases the office income through staff-generated charges for the Perio Protect Method, while the dentist is free to provide other necessary treatments.

Most offices will exceed the figures presented in this article, due to the extremely large number of patients with periodontal disease and the effectiveness of the Perio Protect Method. Patients who fail to maintain their periodontal health with prior conventional means may need to receive treatment by a periodontal specialist. The Perio Protect Method is still recommended as the home-care system for these patients referred to the periodontist after the disease is managed. This is done to maintain the results long-term.

Duane Keller, DMD, is a general dentist practicing in St. Louis, Mo. Dr. Keller holds eight United States and 63 foreign patents (pending). He is a diplomat with the IBO and a fellow with the AGD. His primary practice emphasis is on TMJ and orthodontics and periodontal treatments. He is currently involved with six research projects in periodontal research and TMJ-related issues. Contact Dr. Keller by phone at (866) 693-3400 or e-mail him at [email protected].

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