The Morning Drill: March 28, 2012

Good Wednesday morning!

On to today's dentistry headlines:

Study Shows Invisalign More Profitable Than Braces

Invisalign clear plastic orthodontic aligners cost more in materials than conventional edgewise braces, but they require fewer patient visits and a shorter duration of treatment, researchers reported here at the American Association for Dental Research 2012 Annual Meeting.

Both approaches to moving teeth are useful, first author Michael Ross, a dental student at the Baylor College of Dentistry in Dallas, Texas, told Medscape Medical News. "It's weighing the time cost against the material costs," he said.

In the Invisalign system, practitioners fit their patients with a series of plastic aligners fabricated in a laboratory that incrementally adjust the teeth in the desired direction. The system has allowed some general dentists to do what only orthodontists could do before. But few studies have measured which approach is more efficient in time or money.

To explore this question, Rossi and his colleagues evaluated the records of 150 patients with mild to moderate class I malocclusion. The 2 groups were matched for the amount of initial malocclusion and the number of rotated teeth.

The researchers measured the time taken by appointments for both types of treatment with a stopwatch.

They found that conventional braces required a median of 13.6 minutes for a routine visit, whereas Invisalign required 9.9 minutes. Emergency, initial, and final appointments were all longer than regular visits.

Conventional braces required about 2.6 more visits than Invisalign, treatment for 2.4 months longer, 1.1 more emergency visits, 9.7 minutes more in chair time, 1.2 minutes more emergency doctor time, and 86.2 minutes more in total chair time (P < .01 for all).

However, Invisalign cost $500 to $1441 more in materials and required 5.9 minutes more doctor time than conventional braces (P < .01).

Measuring profitability as fees minus the cost of materials, Invisalign was more profitable than conventional braces, the researchers found, especially for Invisalign providers who are charged $899 in lab costs, a discount that the appliance maker, Align, offers to doctors who do more cases.

For these doctors, Invisalign provided about $1000 of profit per hour of chair time with the first $2750 in fees to the patient, rising to $3250 with $6000 in fees. Doctors who are charged $1549 in lab costs by Align had a profit of about $500 with the first $2750 in fees, rising to $3000 with $6000 in fees.

Braces were less profitable overall, starting at $750 per hour of chair time with the first $2750 in fees, but reaching only $2000 with $6000 in fees.

Asked to comment, Allen Firestone, DDS, MS, professor of orthodontics at Ohio State University in Columbus, told Medscape Medical News that doctor time could vary a lot from doctor to doctor; all the records in this study were obtained from one orthodontist's office.

Periodontal Treatment Cost Effective for Diabetics

Patients with diabetes who are treated for periodontal disease are less likely to see a physician and less likely to be hospitalized. Furthermore, they cost the healthcare system $1800 less per patient per year, researchers reported here at the American Association for Dental Research 2012 Annual Meeting.

"The biggest surprise was the tremendous decrease in doctor visits," lead investigator Marjorie Jeffcoat, DMD, professor of periodontics at the University of Pennsylvania, Philadelphia, told Medscape Medical News. "The doctors felt they did not need to see these patients."

Dr. Jeffcoat and her colleagues looked at data from patients who had Highmark medical insurance and United Concordia dental insurance. United Concordia, a subsidiary of Highmark, funded the study.

The researchers identified 91,454 patients with diabetes, making this study the largest in a series suggesting that periodontal care can improve the health of these patients.

Is toothpaste as good as varnish for white-spot lesions?

Two types of fluoride varnish that are frequently prescribed to ameliorate white spot lesions (WSL) did not provide a significantly better result than normal home care in a study presented last week at the American Association for Dental Research (AADR) annual session in Tampa, FL.

Over an eight-week period, MI Paste Plus (GC America) and PreviDent
(Colgate Professional) fluoride varnish did not outperform the control group using no active agent, the researchers concluded.

"On average, Colgate or Crest (toothpaste) is as good as anything," said Greg Huang, DMD, chair of the department of orthodontics at the University of Washington's School of Dentistry.

The study was created in response to the frustration experienced by many orthodontists: seeing that WSL have developed while the patient wore his or her dental appliance.

"Speaking as an orthodontist, I believe there's a failure of treatment when there's aesthetic compromise," Dr. Huang said.

Mom: Son's Teeth Extracted At School Without Consent

A local mother is outraged after her 9-year-old son came home from school with four fewer teeth.

"I was livid," said Tina Richardson, mother of 9-year-old Alexander Henry. "I jumped out of my car. I ran back to the school. They were all, 'What's wrong? What's wrong?' I was shaking."

Alexander, a student at Freese Elementary School in Lomita, currently takes part in the Big Smiles Program, an organization that is contracted by the San Diego Unified School District to provide dental care at no cost to hundreds of local children.

Richardson said she signed a form in September, which she believed authorized Big Smiles to examine her son's mouth. Two months later, she received a separate "Exatraction Authorization Form" that indicated Alexander had several teeth with cavities. Richardson said she never signed or returned the form.

"I still have the form here in my hand," she said. "I did not return it to the Big Smiles Corporation. I did not give them permission to pull my son's teeth."

Four of Alexander's teeth -- three on the bottom left, one on the top left -- were pulled at the school by a dentist because two were allegedly loose and the others had cavities in them. The teeth were removed in an empty classroom, instead of in a sterile room or at the nurse's office.

"I hope this isn't going on all over the district somewhere, where they're just going into classrooms and extracting teeth out of children's heads," Richardson said.

A representative for Big Smiles told 10News the original form Richardson signed in September gave Big Smiles permission to extract the teeth.

Enjoy your morning!