- Email: [email protected]
Rheumatoid arthritis and implants
sum of economic resources being used to pay for pulpal and periapical disease treatment delivered in a hospital setting. Either early prevention or interventions delivered in a nonhospital setting would have incurred lower costs.
Clinical Significance.—The population most commonly using the ED for their acute dental care tended to have incomes of less than $47,000. The costs for this care are much higher than costs for care delivered in a nonhospital setting. Significant resources are being used to pay for care that has been shown to often be
inappropriate, problematic, and too expensive. Changes in this pattern could save money and result in better, more appropriate care.
Nalliah RP, Allareddy V, Elangovan S, et al: Hospital emergency department visits attributed to pulpal and periapical disease in the United States in 2006. J Endod 37:6-9, 2011 Reprints available from V Allareddy, Dept of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115; e-mail: [email protected]
Implants Rheumatoid arthritis and implants Background.—Failure of osseointegration is attributable to multiple factors such as anatomic conditions, systemic health, genetic disposition, immune function, and behavioral factors. Sometimes implants are contraindicated in patients because of the increased risk for implant failure. Special care is needed for patients who have autoimmune diseases such as rheumatoid arthritis (RA) and connective tissue disease (CTD), both of which can affect hard- and soft-tissue structures. The effect of systemic autoimmune bone and soft-tissue disease on the survival and success rates of osseointegrated implants was explored, focusing on whether the presence of such disease should be an absolute contraindication for dental implant placement. Methods.—In all, 34 women (126 implants) were studied retrospectively, including 25 with isolated RA and nine with RA plus CTD. Assessments included implant survival/ success rates; peri-implant indicators such as marginal bone loss, pocket depth, plaque index, gingival index, and bleeding index; and the incidence of prosthodontic maintenance required. Results.—All 34 patients were assessed after a mean period of 47.6 months (range: 19 to 96 months overall). A total of 85 of the implants were in patients with RA and 41 in patients with RA plus CTD. The success rate for the implants was 100% after 1 year and 93.8% after 3.5 years. Three implants in the RA group and four in the RA plus CTD group did not meet the criteria for success. The difference in 3.5-year success rates between the two groups was not significant.
266
Dental Abstracts
Patients’ underlying disease significantly influenced some peri-implant parameters. Plaque index, gingival index, and pocket depth did not differ significantly between the two groups, but there were significant differences in bleeding index and marginal bone loss. However, the prostheses were maintained with no major revisions. Only 17 postinsertion interventions were required for the implant and prosthodontic components. The most common postinsertion maintenance performed was repair of fractured prosthesis teeth, and no denture type was predominant. All of the patients reported high levels of satisfaction with their implant prosthodontics. State of manual dexterity for the patients with RA versus those with RA plus CTD was not significantly correlated with denture handling and/or cleaning. Discussion.—Patients with RA plus CTD had pronounced marginal bone loss and bleeding as compared with those with RA alone. The patients’ underlying disease seemed to affect these two parameters.
Clinical Significance.—Most of the implant prosthodontic rehabilitation involved fixed prostheses, which help avoid soft-tissue trauma and keep prosthodontic maintenance to a minimum. This not only made the patients happy but also helped those patients who may have had compromised manual dexterity. It seems reasonable to use screw-type implant
placement for patients with specific autoimmune diseases when regular professional support and advice for optimal aftercare are available.
Krennmair G, Seemann R, Piehslinger E: Dental implants in patients with rheumatoid arthritis: Clinical outcome and peri-implant findings. J Clin Periodontol 37:928-936, 2010 Reprints available from G Krennmair, Austria 4600 Wels, Trauneggsiedlung 8, Austria; e-mail: [email protected]
Job Satisfaction Burnout risk Background.—Professional burnout can result from chronic work-related stress. It includes three defining dimensions: emotional exhaustion (EE), development of a negative or cynical attitude toward patients or clients called depersonalization (DP), and the tendency to assess oneself negatively, termed diminished personal accomplishment (PA). Physical exhaustion may also occur, but the key aspect of professional burnout involves the depleted emotional component. Various investigations in several countries have found high levels of burnout among 11% to 16% of dentists, making it a serious risk for the dental profession. Workrelated stressors for dentists include difficult patient contacts, organizational management, time pressure, government or insurance restrictions, and lack of clinical challenge. A way to avoid burnout in dentists and dental staff is to create enough time and space for satisfying and stimulating work activities that promote engagement. Job aspects identified as providing an interesting and stimulating work environment include acknowledging the immediate and long-term results of work, patient care, craftsmanship, idealism/pride of work, entrepreneurship, material benefits, and professional craftsmanship (Fig 1). In Northern Ireland, high numbers of general dental practitioners are leaving the profession, often taking early retirement and citing work-related stress. The levels of burnout and engagement, job demands, job resources, and general psychological distress of dental staff in Northern Ireland were investigated. Methods.—All the dental offices in the western part of Northern Ireland were provided with questionnaires consisting of the Maslach Burnout Inventory, the Job Demands in Dentistry measure, the Utrecht Work Engagement Scale, the Job Resources in dentistry measure, and the General Health Questionnaire (GHQ). Results.—The 135 questionnaires that were analyzed represented a response rate of 45%, including 71 dentists and 64 dental care professionals (DCPs). Half of the dentists were between 40 and 55 years of age. All of the DCPs were women. Nineteen percent of the dentists worked in a solo general dental practice and 86% worked in a mixed National
Health Service (NHS)/private general practice. Sixty-three percent of respondents indicated they averaged over 100 patients per week and worked a mean of 26.34 clinical hours per week. They also reported spending an average of 8.35 hours per week doing administrative work. The Maslach Burnout Inventory instrument indicated high mean scores in both EE and DP and low mean scores for PA for 16% of the dentists, indicating a severe risk for burnout (Table 1). Ten percent of dentists had high scores in both EE and DP but no low PA score. In total, about one-fourth of the dentists were at risk for serious burnout. Characteristics of these dentists included older age than average. DCPs with higher EE scores were significantly older than those with average or low EE scores. Mean total work demand score was 2.98 (Table 2), with the highest mean scores on measures of time pressure, financial worries, and risk of mistakes and dissatisfied patients. Time pressure was the most significant stressor for women; financial worries and time pressure were high for men. Dentists had higher mean scores on all measures than DCPs. The mean total scores for dentists and DCPs differed significantly in work demands. Dentists had significantly higher mean scores than DCPs for time pressure, risk of mistakes and dissatisfied patients, financial worries,
Work demands
Burnout
Work resources
Engagement
Fig 1.—Work demands-resources model. (Courtesy of Gorter RC, Freeman F: Burnout and engagement in relation with job demands and resources among dental staff in Northern Ireland. Community Dent Oral Epidemiol 39:87-95, 2011.)
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2011
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Clinical Significance.—The population most commonly using the ED for their acute dental care tended to have incomes of less than $47,000. The costs for this care are much higher than costs for care delivered in a nonhospital setting. Significant resources are being used to pay for care that has been shown to often be
inappropriate, problematic, and too expensive. Changes in this pattern could save money and result in better, more appropriate care.
Nalliah RP, Allareddy V, Elangovan S, et al: Hospital emergency department visits attributed to pulpal and periapical disease in the United States in 2006. J Endod 37:6-9, 2011 Reprints available from V Allareddy, Dept of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115; e-mail: [email protected]
Implants Rheumatoid arthritis and implants Background.—Failure of osseointegration is attributable to multiple factors such as anatomic conditions, systemic health, genetic disposition, immune function, and behavioral factors. Sometimes implants are contraindicated in patients because of the increased risk for implant failure. Special care is needed for patients who have autoimmune diseases such as rheumatoid arthritis (RA) and connective tissue disease (CTD), both of which can affect hard- and soft-tissue structures. The effect of systemic autoimmune bone and soft-tissue disease on the survival and success rates of osseointegrated implants was explored, focusing on whether the presence of such disease should be an absolute contraindication for dental implant placement. Methods.—In all, 34 women (126 implants) were studied retrospectively, including 25 with isolated RA and nine with RA plus CTD. Assessments included implant survival/ success rates; peri-implant indicators such as marginal bone loss, pocket depth, plaque index, gingival index, and bleeding index; and the incidence of prosthodontic maintenance required. Results.—All 34 patients were assessed after a mean period of 47.6 months (range: 19 to 96 months overall). A total of 85 of the implants were in patients with RA and 41 in patients with RA plus CTD. The success rate for the implants was 100% after 1 year and 93.8% after 3.5 years. Three implants in the RA group and four in the RA plus CTD group did not meet the criteria for success. The difference in 3.5-year success rates between the two groups was not significant.
266
Dental Abstracts
Patients’ underlying disease significantly influenced some peri-implant parameters. Plaque index, gingival index, and pocket depth did not differ significantly between the two groups, but there were significant differences in bleeding index and marginal bone loss. However, the prostheses were maintained with no major revisions. Only 17 postinsertion interventions were required for the implant and prosthodontic components. The most common postinsertion maintenance performed was repair of fractured prosthesis teeth, and no denture type was predominant. All of the patients reported high levels of satisfaction with their implant prosthodontics. State of manual dexterity for the patients with RA versus those with RA plus CTD was not significantly correlated with denture handling and/or cleaning. Discussion.—Patients with RA plus CTD had pronounced marginal bone loss and bleeding as compared with those with RA alone. The patients’ underlying disease seemed to affect these two parameters.
Clinical Significance.—Most of the implant prosthodontic rehabilitation involved fixed prostheses, which help avoid soft-tissue trauma and keep prosthodontic maintenance to a minimum. This not only made the patients happy but also helped those patients who may have had compromised manual dexterity. It seems reasonable to use screw-type implant
placement for patients with specific autoimmune diseases when regular professional support and advice for optimal aftercare are available.
Krennmair G, Seemann R, Piehslinger E: Dental implants in patients with rheumatoid arthritis: Clinical outcome and peri-implant findings. J Clin Periodontol 37:928-936, 2010 Reprints available from G Krennmair, Austria 4600 Wels, Trauneggsiedlung 8, Austria; e-mail: [email protected]
Job Satisfaction Burnout risk Background.—Professional burnout can result from chronic work-related stress. It includes three defining dimensions: emotional exhaustion (EE), development of a negative or cynical attitude toward patients or clients called depersonalization (DP), and the tendency to assess oneself negatively, termed diminished personal accomplishment (PA). Physical exhaustion may also occur, but the key aspect of professional burnout involves the depleted emotional component. Various investigations in several countries have found high levels of burnout among 11% to 16% of dentists, making it a serious risk for the dental profession. Workrelated stressors for dentists include difficult patient contacts, organizational management, time pressure, government or insurance restrictions, and lack of clinical challenge. A way to avoid burnout in dentists and dental staff is to create enough time and space for satisfying and stimulating work activities that promote engagement. Job aspects identified as providing an interesting and stimulating work environment include acknowledging the immediate and long-term results of work, patient care, craftsmanship, idealism/pride of work, entrepreneurship, material benefits, and professional craftsmanship (Fig 1). In Northern Ireland, high numbers of general dental practitioners are leaving the profession, often taking early retirement and citing work-related stress. The levels of burnout and engagement, job demands, job resources, and general psychological distress of dental staff in Northern Ireland were investigated. Methods.—All the dental offices in the western part of Northern Ireland were provided with questionnaires consisting of the Maslach Burnout Inventory, the Job Demands in Dentistry measure, the Utrecht Work Engagement Scale, the Job Resources in dentistry measure, and the General Health Questionnaire (GHQ). Results.—The 135 questionnaires that were analyzed represented a response rate of 45%, including 71 dentists and 64 dental care professionals (DCPs). Half of the dentists were between 40 and 55 years of age. All of the DCPs were women. Nineteen percent of the dentists worked in a solo general dental practice and 86% worked in a mixed National
Health Service (NHS)/private general practice. Sixty-three percent of respondents indicated they averaged over 100 patients per week and worked a mean of 26.34 clinical hours per week. They also reported spending an average of 8.35 hours per week doing administrative work. The Maslach Burnout Inventory instrument indicated high mean scores in both EE and DP and low mean scores for PA for 16% of the dentists, indicating a severe risk for burnout (Table 1). Ten percent of dentists had high scores in both EE and DP but no low PA score. In total, about one-fourth of the dentists were at risk for serious burnout. Characteristics of these dentists included older age than average. DCPs with higher EE scores were significantly older than those with average or low EE scores. Mean total work demand score was 2.98 (Table 2), with the highest mean scores on measures of time pressure, financial worries, and risk of mistakes and dissatisfied patients. Time pressure was the most significant stressor for women; financial worries and time pressure were high for men. Dentists had higher mean scores on all measures than DCPs. The mean total scores for dentists and DCPs differed significantly in work demands. Dentists had significantly higher mean scores than DCPs for time pressure, risk of mistakes and dissatisfied patients, financial worries,
Work demands
Burnout
Work resources
Engagement
Fig 1.—Work demands-resources model. (Courtesy of Gorter RC, Freeman F: Burnout and engagement in relation with job demands and resources among dental staff in Northern Ireland. Community Dent Oral Epidemiol 39:87-95, 2011.)
Volume 56
Issue 5
2011
267