Dental Care Clinic Research Articles

Ton Hoek: Trailblazer of international pharmacy

A.J.M. "Ton" Hoek, CEO and General Secretary of the International Pharmacy Federation (FIP), died July 28 in his home in Huizen, Netherlands. Hoek was 56.

Parâmetros assistenciais em saúde bucal: comparação entre duas programações do atendimento clínico no serviço público

To compare two forms of scheduling clinical dental care for the oral health teams (OHT) included in the strategy of family health, regarding productive aspects of assistance. Methods: Two OHT worked concurrently, using two methods of clinical care: the parameter recommended by the Ministry of Health Ordinance No. 1101, 2002, which establishes 03 dental visits per hour (c/h) per team, and a Testing model, with 02 c/h, being each method applied for a period of 615 hours. The quantitative data was collected in OHTs’ daily production spreadsheets, covering the following items: the number of dental visits (initial, for maintenance and for emergency procedures), procedures performed, consumption of material and sterilization cycles. Data was compared and statistically analyzed through the BioStat 5.0 by applying the paired t-test (p <0.05). Results: Under the Ministerial method and the Testing model, were performed, respectively, 288 and 365 first dental visits, 921 and 686 return dental visits, 167 and 172 emergency dental attendances, with 469 and 110 fouls, 212 and 327 treatments were finished and 2501 and 3046 dental procedures were realized. Among eleven analyzed consumables, five were consumed in smaller quantities in the Testing model: gloves (9%), anesthesia (38%), anesthetic needle (34%), suture material (24%) and aspirators (11%), while the six remaining items presented similar consumption rates between the two models. Conclusions: The testing model revealed to be more productive and economical

Medical conditions and body pain in patients presenting orofacial pain

To verify the frequency of self-reported medical conditions and pain areas in orofacial pain patients, comparing them with patients from the routine dental care. Data were collected from archives of the Orofacial Pain Clinic (Group A, n=319) and of the routine dental care clinics (Group B, n=84) at Faculdade de Odontologia de Araraquara, São Paulo, in Brazil. All individuals answered a standardized clinical questionnaire and completed a body map indicating their pain areas. The Mann-Whitney's test demonstrated that Group A presented a higher mean number of medical reports than Group B (p=0.004). In both groups, Pearson's correlation test showed that the highest frequencies of medical conditions were positively correlated to highest frequencies of painful areas (0.478, p=0.001 and 0.246, p=0.000, respectively). Group A tended to report more medical conditions and there was a positive correlation between the number of medical conditions and the one of pain areas for both groups.

Delivering free healthcare to rural Central Appalachia population: the case of the Health Wagon

Central Appalachia residents present unique healthcare challenges. This vulnerable population faces poor health status and low access to health care. 'The Health Wagon' was established to innovatively enhance access to health care for the poor and marginalized rural population of Central Appalachia. This article describes the operations of the Health Wagon, a full mobile medical clinic, in delivering free health care to those in rural Southwest Virginia in Central Appalachia. The Health Wagon provides a wide range of comprehensive healthcare services, such as acute and chronic disease management, laboratory and diagnostic services, medication assistance, dental and eye care and specialty clinics for marginalized, poor and disenfranchised patients living in the mountains of that region. In 2009, a total of 157 clinics were provided and 2900 patients were seen (3165 patient encounters) in addition to 268 telemedicine specialty consultations at no cost to the patients. The work of the Health Wagon has broken down a financial barrier to healthcare access and offers unique and profound opportunities to improve health and expand health care in rural Central Appalachia.

Influence of parental presence on the child’s perception of, and behaviour, during dental treatment

To analyse the influence of the presence of the parent in the dental operatory on their child's behaviour during dental treatment. This study was a randomised controlled trial performed in a secondary paediatric dental care clinic. The child's perception of the dental treatment and its behaviour during treatment according to the parent and dentist were compared with parental presence in the operatory as independent variable. Age and dental anxiety were also calculated as co-variable. The child's perception of the treatment was assessed using the Wong-Baker Faces Rating Scale. The behaviour of the child according to parent and dentist was measured using Venham`s (modified) clinical rating of anxiety and cooperative behaviour. Statistical analysis was performed using Mann Whitney U tests and Independent Samples T Test. 90 children participated (50% girls, mean age 6.21 years old, SD ± 1.56). During the habituation session child's behaviour was better according to the dentist when the parents were not present in the operatory during treatment (p<0.01). There were no significant differences in a child's perception of the treatment in relation to parental presence or absence. Dentally anxious children behaved better according to the parent (treatment session 2) and the dentist (habituation session and treatment session 2) when the parent was not present in the operatory (p<0.05). Relying on a child's perception of dental treatment, a made no difference whether the child was treated with or without the parent(s) in the dental operatory. For anxious children it was mainly the dentist who was aware of the disadvantages of the parental presence.

Essential steps in performing a risk assessment in dental practice

Control of infection should be viewed as an integral part of clinical governance and routine dental care and is subject to legislation under the Health and Safety at Work Act 1974, and the Control of Substances Hazardous to Health Regulations 1999 (COSHH). This article outlines the procedure for performing a risk assessment.

Clinical dental care: An integrated multidisciplinary approach

Clinical dental care: An integrated multidisciplinary approach

Asymptomatic pebbly lesions

A 28-year-old African-American woman visited an urgent care dental school clinic for evaluation of a painful right mandibular molar. Her medical history was unremarkable. The remainder of her intraoral and extraoral examination findings were within normal limits except for the presence of multiple small asymptomatic lesions on the right buccal mucosa, of which the patient was unaware (Figure 1). The lesions could not be “wiped off.” Further questioning of the patient did not reveal any parafunctional habits, allergies, history of trauma, medication use or medical conditions that seemed relevant to the source of the lesions. The attending dentist (M.J.K.) referred the patient to the Department of Oral and Maxillofacial Surgery, University of Maryland Dental School, Baltimore, for removal of the molar and a biopsy of the mucosal lesions.

Custos para implantação e operação de serviço de saúde bucal na perspectiva do serviço e da sociedade

The aim of this study was to assess the costs of setting up and maintaining dental care in the public sector. Costs were updated or depreciated according to the service's lifespan and were analyzed from the perspective of the service itself and society. According to the findings, for the service the total cost of setting up a dental care unit with seven rooms was BRL$860.643.67 in the first year, plus BRL$545,419.23 for maintenance, and clinical dental care was the most expensive specialty. For society, the total cost was BRL$990,065.06 (implementation) and BRL$668,369.55 (maintenance), and the most expensive specialty was prevention (US$1.00 = BRL$1.62). Capital costs represented a small percentage of total costs for a dental care unit, but they need to be considered, since they can modify the results. Due to the high costs, preventive and promotional interventions should not be performed in the clinical setting, but should be replaced by broader and less expansive population-based interventions, since considerable sums need to be spent by the low-income population to participate in free public programs.

Child rearing styles, dental anxiety and disruptive behaviour; an exploratory study

This was to explore the relation between children's dental anxiety, their behaviour during treatment and their parent's rearing style. Also the parents' preparation of the child for dental treatment was related to behaviour and parental rearing style. The parents of 100 children, referred to a secondary dental care clinic were asked to fill out the Child Rearing Practices Report (CRPR), the Child Fear Survey Schedule (CFSS) on behalf of their children and an additional questionnaire on child preparation prior to dental treatment. Four rearing styles were constructed by using the results of the Nurturance and the Restrictiveness domain of the CRPR. Dentists were asked to assess the behaviour of the child during dental habituation and dental treatment using the Venham scale. The dentists were unaware of the child's CFSS score. Parents were not present during actual dental treatment. Each child's dental anxiety was related to their behaviour displayed during dental treatment. Highly anxious children showed more disruptive behaviour than their low anxious counterparts did, especially during familiarisation. Parental rearing style was neither related to child dental anxiety prior to or to behaviour during dental treatment. Parents who use a permissive rearing style were less likely to tell their children that the dentist will not hurt them compared with authoritarian parents. Parents with an authoritative rearing style were more convinced that the behaviour of their child could be managed by the dentist than parents with a permissive and neglectful rearing style. After their children's dental rehabilitation parents were less inclined to accompany their child during treatment. Dental anxiety correlated positively with the behaviour displayed during treatment. No relation was found between parenting style and dental anxiety and behaviour during treatment. Parents showed more confidence in the child-dentist dyad after the rehabilitation of their child's teeth.

Mouth Preparation Pada Anak Dengan Kelainan Jantung Kongenital Tetralogi of Fallot, Pre-operatif Kardiovaskuler

Teeth dimension is the factor influenced the incidence of toothimpaction. The most The congenital figure of the heart defect incidentin several educational hospitals in Indonesia almost reached 9 per1,000 born babies who survive to live (0.8-1.2%). Tetralogi of Fallotwas one of the cyanotic congenital heart defects that were often foundto children. This situation had four forms of the deviation: defect of theventricle septum, overriding aorta, stenosis infundibuler, andhypertrophy of the right ventricle. As in the case of other congenitalheart defect, in Tetralogi Fallot often happened fatal complication suchas endocarditis bacterialis that had tight relationship to the infection inteeth. In dentistry, the treatment for children with cardiovasculardisease needs holistic handling to prevent the occurrence endocarditisbacterialis. This paper discussed the teeth and the mouth conditionsas well as the therapy in two cases of the child with tetralogi of Fallot.Two female patients came to the Special Dental Care clinic, RSHSBandung with the congenital Tetralogi of Fallot heart defect to undergomouth preparation prior to the heart operation in Jakarta. Theconclusion is as in the case of the congenital heart other defectcyanotic, in Tetralogi Fallot fatal complications such as endocarditisbacterialis could happen. Endocarditis bacterialis was caused by the '':bacterial infection in the heart valve or endocardium.

Portable Digital Assistants (PDAs) in dentistry: Part II - Pilot study of PDA use in the dental clinic

To describe a simple technical evaluation of the access, security issues and uses of wireless networked PDAs in a dental clinic and report a pilot study investigating students' educational use of PDAs to access a Virtual Learning Environment (VLE) in a dental clinic. To undertake a technical evaluation of wireless networking to PDAs focusing on security issues, robustness of the system and accessibility particularly to educational resources. To evaluate the impact of using a PDA on undergraduate students in the dental clinic and at home. Part II describes the technical and educational evaluation of PDAs used by one group of 12 undergraduate fourth year students in the Primary Dental Care clinic. A cross over trial of six students with PDAs and six without was carried out during one semester of 12 weeks. Technical issues such as secure internet access using wireless connectivity were addressed. An assessment of the general and educational use and the students' attitudes towards using PDAs was undertaken using online questionnaires and focus group discussions. Over 90% of participants wanted PDAs as part of their dental kit. The potential of PDA use in dental training was demonstrated by a good to excellent response by over 75% of participants to having access to online support materials, particularly videos, being able to make notes for individual study and to keep a diary of their commitments to teaching sessions. Recreational use included a 100% good to excellent response to playing games and keeping a diary. The PDA proved to be a convenient and versatile mode of access to online education. Technical solutions enabled a substantial proportion of the functionality of WebCT (Web Course Tools) to be accessed by the students in a clinical environment. Both novice and experienced users were able to appreciate the use of the PDA and the less able considered that their ICT skills had improved. However, further research is needed to determine how students use a range of new technologies in their undergraduate programmes. The Dental Institute plans to recommend that all students will use this device in the future throughout their five-year curriculum, and the scoping of the implications of this recommendation is underway.

Clinical features, dental findings and dental care management in osteogenesis imperfecta

This article reports the case of a child diagnosed with type III osteogenesis imperfecta, assessing the clinical features observed, with emphasis on the craniofacial, oral and dental findings, and describes the dental care management rendered for this special needs patient. The issues addressed and discussed throughout the paper shows that, as far as the oral health professionals are familiarized with the disease-specific clinical manifestations and the possible implications of this condition, there are no hindrances for a successful, high-quality dental and behavioural management.

An audit of single drug (propofol) dental general anaesthesia in children

The aim of this study was to evaluate and describe the (dis)advantages of intravenous single drug anaesthesia (IVA) using the target- controlled infusion of propofol in order to validate a protocol. The treatments were performed in two secondary dental care clinics in Amsterdam. Retrospective study of the anaesthetic reports and medical history of 950 patients treated were screened for any irregularities and medical problems. Most children treated were in the age group 2-5 years, time needed to wake up decreased significantly with age. Fourteen children dropped out of the planned IVA treatment because of medical reasons, 12 of whom were treated under general anaesthesia (GA). A further 26 were treated under GA because of convenience reasons. Total number of medical problems prior to treatment was 45 and mild complications were 42. There was a low morbidity in patients treated. The method seems to be successful in young children and creates an increase of treatment capacity in the field of special dental care. Preoperative screening is necessary, on paper and after consultation of a specialist. However blood test screening for allergies seem to be questionable. The treatment method is not possible without the presence of the anaesthesiologist and his team.

GDC registration unravelled

Statutory registration for dental nurses is almost here. The General Dental Council (GDC) expects to start registering dental nurses, and other new groups of dental care professionals (DCPs), in July 2006. For patients, this will bring the assurance that all the people directly involved in their clinical dental care are regulated and bound by professional standards. For the DCP groups registering with the GDC for the first time, it will bring greater recognition of their important contribution to dentistry and more opportunity to develop their skills.

A resource guide for practice development through technology

A resource guide for practice development through technology

New product developments

Background: Facing the coronavirus disease 2019 (COVID-19) challenge on a global level, dental care professionals are encouraged to optimize universal precautions and adopt measures that ensure protection against infection by contaminated aerosols and droplets. Although aerosol transmission is possible, direct contact through large droplets is probably responsible for the vast majority of transmissions. Methods: This paper is the second of a series of 3 on the management of COVID-19 in clinical dental care settings and aims to describe the selection and use of personal protection equipment (PPE) by dental care professionals (DCP), with consideration of the level of risk associated with the planned procedures. PPE selection depends directly on the local epidemiological setting, the patient's characteristics, and the level of risk of the planned procedures. The procedures performed in the office environment are classified as low-, moderate-, or high-risk. Moderate risk includes 2 further sublevels associated with the cleaning, disinfection, and sterilization of materials for clinical procedures that do not generate aerosols. The training of DCP on how to properly don (put on) and doff (remove) PPE is as important as choosing the appropriate PPE because it can be associated with a risk of infection. Discussion: When there is limited availability of PPE, measures should be adjusted to the risk associated with the intervention. Assuming that an effective COVID-19 vaccine will be developed, once it becomes widely available for DCP, PPE requirements will likely be different. Conclusion: The proper use of PPE, together with the adoption of other operational procedures, can provide effective protection against microorganisms being transmitted via body fluids or in the air.

Changes in dental health and dental health habits from 3 to 5 years of age.

This study sought to determine how dental health and dental health habits change from 3 to 5 years of age and to consider whether preventive dental health care helped in preventing or halting caries in children. The study included 67 maternity health care clinics, 72 well-baby clinics, and 69 dental health care clinics. Of the 1,292 newborn children, 1,003 (90.8%) were included in this study. Preventive dental health care contributed to dental caries being halted in only 13.2 percent of those children who had enamel caries at 3 years of age. The dmft index did not increase in 22.6 percent of those children who had dentinal caries at 3 years of age. For all others, the disease became more severe. Toothbrushing habits of 3-year-old children were very consistent over the two years studied. Children were at a risk for caries when their mothers had nine years of basic education, when they already had plaque and caries at 3 years of age, and when the frequency of eating sweets increased the most during the two-year study period. Among 3-year-old children, plaque is an indicator of caries risk and therefore should be a key element in health education. Those children who already have evidence of caries at 3 years of age should be the target of preventive dental services because of their increased risk.

Methods of evaluating dental care costs in the Swedish public dental health care sector.

Twenty-six Swedish dental health care clinics participating in the intervention study "Evaluation of caries preventive measures" have been analysed with focus on costs, with the aim of demonstrating techniques suitable for evaluating direct dental care costs and also finding out whether charges are acceptable as a proxy for real costs. Three different approaches to calculating unit costs are discussed: average treatment time cost and two methods of different allocation of overhead cost. Average treatment time cost shows treatment time cost regardless of who (dentist, dental hygienist or nurse) provides the dental care. The other two methods reflect both the differences of treatment costs depending on practitioners' skill level and competence (salary) and the methods of handling overhead cost allocation. Our conclusions are that the proposed methods seem useful for evaluating costs in cost-effectiveness and cost-benefit analysis. The alternative to average treatment time cost or unit time cost depends on what data is available and the perspective of the analysis. This study also concludes that charges are not sufficient as an alternative to a more detailed cost evaluation, at least not in Swedish public dental health care, since charges do not cover costs.

Dental health habits of 3-year-old Finnish children.

The aim was to study whether 3-yr-old children's toothbrushing habits are associated with the child's other dental health habits and whether the mother's background influences the child's toothbrushing frequency. The survey used stratified randomized cluster sampling, confidential questionnaires and clinical dental examinations. A random sample of 1443 (91.2%) of a Finnish province's 1582 primiparous women participated in the study at the onset of their pregnancy. Dental health care clinics of the public health care system carried out dental examinations in 1018 (83.5%) 3-yr-old children born of these pregnancies. The variables used in the study included consumption of juice at night and sugar at the age of 1.5 yr and the use of fluoride tablets and sweets at the age of 3. The mother's background factors included age, basic education and occupation. Daily toothbrushing was practised by 78.2% of the children. Addition of sugar to the diet and frequent use of sweets at the age 3 were more common in those who brushed their teeth only occasionally, whereas the use of fluoride tablets was less frequent in them than in those brushing their teeth every day. Of the mothers' background factors, age was the most significant. The youngest mothers paid the least attention to their children's toothbrushing habits. The proportion of those brushing their teeth was 67.9% in rural areas, 78.6% in semi-urban population centers and 80.1% in towns (P = 0.02). The results indicate that the health education provided by dental health care clinics should be focussed on young mothers and rural families.(ABSTRACT TRUNCATED AT 250 WORDS)