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June 1st, 2017

Rochester Epidemiology Project: Taking a bite out of poor health

By Elizabeth Zimmermann Young

The Rochester Epidemiology Project has added dental records to its database of linked medical records, making it more valuable as a medical research resource.

The Rochester Epidemiology Project is a collaboration of medical and dental care providers in Minnesota and Wisconsin. With patient agreement, the organizations link medical, dental, surgical procedures, prescriptions, and other health care data for medical research.

“We are very pleased by the interest of dental providers in participating in the Rochester Epidemiology Project,” says Alan Carr, D.M.D., chair of Dental Specialties at Mayo Clinic, and the lead champion for the inclusion of dental records in the Rochester Epidemiology Project.

“Considering oral care part of the continuum of health care is nothing new,” he says. “In fact, in 1928, Dr. Charlie Mayo told the American Dental Association: ‘The practice of medicine includes dentistry and dentistry is the practice of a special branch of medicine, as is ophthalmology. It may be going too far to say that all dentists should be doctors of medicine, but certainly all dentists should know much about the practice of medicine as a whole; and, conversely, all physicians should know more about dentistry, its importance and possibilities.’”

Thus far, nine dental practices in Olmsted County, Minnesota – the hub of the Rochester Epidemiology Project – have linked records of 31,750 patients. While only a fraction of the community is included, this database is sufficient to begin studies examining the impact of oral health on overall health and quality of life, says Dr. Carr.

In an article published in BMJ Open in March 2017, he and his co-authors describe the purpose of this addition to the Rochester Epidemiology Project data and state their intentions to grow the data, linking in other providers.

These dental practices participate in the Rochester Epidemiology Project:

  • 12th Street Dental
  • Apollo Dental
  • Calcagno Cosmetic and Family Dentistry
  • Lakeside Dentistry
  • Mayo Clinic Dental Specialties
  • Northwest Dental Group
  • Reeve Family Dentistry
  • Stewartville Family Dentistry
  • The Dental Doctors (Philip Wadkins, D.D.S.)

All are located in Rochester, except Stewartville Family Dentistry.

First findings

The first study to use these dental records was released May 23 in Mayo Clinic Proceedings.

The research team, led by Daniel DeSimone, M.D., infectious diseases and hospital internal medicine physician at Mayo Clinic, found that dentists and oral surgeons are in good compliance with updated guidelines issued by the American Heart Association (AHA) in 2007, describing the use of prophylactic antibiotics prior to invasive dental procedures.

Prior to 2007, the AHA guidelines recommended prescribing prophylactic antibiotics for patients with cardiac conditions at moderate- or high-risk of developing infective endocarditis—a potentially deadly infection of the heart valves. After 2007, AHA recommended that only high-risk patients receive the antibiotics. This group represents a very small fraction of the individuals receiving them before 2007, says Dr. DeSimone.

Earlier studies by Dr. DeSimone’s team determined the incidence of viridans group streptococci infective endocarditis in Olmsted County before and after 2007, using Rochester Epidemiology Project data. They found no significant increase in cases of infective endocarditis following the introduction of updated AHA guidelines.

However, “the major limitation of these studies was the lack of access to dental records,” says Dr. DeSimone.

“The inclusion of dental records in the Rochester Epidemiology Project provides a unique opportunity unlike any population health database in the United States,” he says.

“The primary criticism of the earlier studies was, ‘Are dentists actually following the 2007 AHA guidelines, or  do patients continue to receive antibiotics when no longer indicated?’” reports Dr. DeSimone. “How could we prove that dentists were actually following the guidelines, rather than assuming they were? Now we can.”

“There are a number of health risks for patients when taking antibiotics,” he says. “Plus overuse of antibiotics can result in increased bacterial resistance, which is a widespread public health problem.”

In addition, while the cost to patients might only be a few dollars a dose, Dr. DeSimone says that when added up, this group of moderate risk patients could be spending well over $100 million per year in the United States alone.

“Using the Rochester Epidemiology Project, we have shown that the new guidelines were very helpful in reducing unnecessary antibiotic use and related issues, without causing an increase in new cases of infective endocarditis.”

Although the first study using the newly linked dental records, this was just one of more than 2,600 medical research publications using the Rochester Epidemiology Project. Using medical and dental records, researchers can identify what causes diseases and how patients with certain diseases respond to surgery, medication or other interventions. They also can determine what the future is likely to include for patients with specific diseases or medical conditions.

For more information on the history and findings of the Rochester Epidemiology Project, view the new historic timeline.

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About the Rochester Epidemiology Project

The Rochester Epidemiology Project is a collaboration of clinics, hospitals, and other medical and dental care facilities in southern Minnesota and western Wisconsin. Founded by Mayo Clinic and Olmsted Medical Center in 1966 in Olmsted County, Minnesota, the collaboration now stretches across 27 counties, and includes Olmsted County Public Health Services as its first public health member. This collaboration and sharing of medical information makes this area of Minnesota and Wisconsin one of the few places where true population-based research can be accomplished. For more information visit rochesterproject.org.

Read the news release about the research on American Heart Association guidelines for prophylactic antibiotic use in dentistry.

Tags: About, Alan Carr, Daniel DeSimone, dental, dentist, Findings, Innovations, Kern Center, Mayo Clinic Proceedings, Olm, Olmsted Medical Center, oral health, population health, Progress Updates, public health, REP, research, Rochester Epidemiology Project, Science of health care delivery

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