Level Of Treatment Need Research Articles

Prevalence and determinants of oral health conditions and treatment needs among slum and non-slum urban residents: Evidence from Nigeria.

Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An understanding of its distribution and severity in different settings can aid the planning of preventive and therapeutic services. This study assessed the oral health conditions, risk factors, and treatment needs among adult residents in the slum and compared findings with non-slum urban residents in Ibadan, Nigeria. The Multistage sampling was used to select adult (≥18-years) residents from a slum and a non-slum urban sites. Information sought from participants included dietary habits, oral hygiene practices, and the use of dental services. Oral examinations were performed in line with WHO guidelines. Associations were examined using logistic regression. Mediation analysis was undertaken using generalized structural equation modeling. The sample comprised 678 slum and 679 non-slum residents. Median age in slum vs non-slum was 45 (IQR:32-50) versus 38 (IQR:29-50) years. Male: female ratio was 1:2 in both sites. Prevalence of oral diseases (slum vs non-slum sites): dental caries (27% vs 23%), gingival bleeding (75% vs 53%) and periodontal pocket (23% vs 16%). The odds of having dental caries were 21% higher for the slum dwellers compared to non-slum residents (OR = 1.21, 95% CI:0.94 to 1.56); and 50% higher for periodontal pocket (OR = 1.50, 95%CI: 1.13 to 1.98), after adjusting for age and sex. There was little evidence that tooth cleaning frequency mediated the relationship between place of residence and caries (OR = 0.95, 95%CI: 0.87 to 1.03 [indirect effect], 38% mediated) or periodontal pocket (OR = 0.95, 95%CI: 0.86 to 1.04, 15% mediated). Thirty-five percent and 27% of residents in the slum and non-slum sites respectively required the "prompt and urgent" levels of treatment need. Oral diseases prevalence in both settings are high and the prevalence was generally higher in the slum with correspondingly higher levels of prompt and urgent treatment needs. Participants may benefit from targeted therapeutic and health promotion intervention services.

A general dental practitioner's role in treating patients with a cleft lip and/or palate.

The publication of the Five Year Forward View promoted a drive within the NHS to improve access to care for all patients, across all specialties. This article describes what would be expected of a general dental practitioner (GDP) when treating patients with a cleft lip and/or palate in primary care and when it would be appropriate to refer and work alongside specialist services at the hospital. The inspiration for this article began after an audit investigating the complexity level of treatment need of patients with a cleft lip and/or palate referred into the Adult Restorative Clinic at Guy's Hospital. The results of the audit suggested that access to GDPs for this cohort of patients may be difficult and there may be a lack of confidence amongst GDPs with regards to what treatment they can or should provide. The article also discusses the potential of dentists with enhanced skills (DES) bridging the gap between primary and secondary care. The aim of the article is to increase the knowledge and understanding of GDPs with regards to treating patients with a cleft lip and/or palate and ultimately to improve the level of care these patients receive.

The prevalence of orthodontic treatment need and malocclusion problems in 8–9-year-old schoolchildren: A study in the south of Thailand

Aims This study aims to find the prevalence of orthodontic treatment need and malocclusion problems in 8–9-year-old schoolchildren in the south of Thailand. Materials and Methods A number of 202 children (100 boys and 102 girls) samples were randomly selected from all schools in Hat Yai District, Songkhla Province, Thailand. A cross-sectional survey of dental health component (DHC) of the Index of Orthodontic Treatment Need (IOTN) and malocclusion problems was investigated by clinical examination and dental model. Results Levels 4 and 5 of orthodontic treatment need according to DHC of IOTN of the sample were presented in 18.8% and 1.49%, respectively. Children who need orthodontic treatment (Grade 2–4) showed more than one highest DHC problem that indicated the level of treatment need (39.68%). Normal occlusion was found at 6.43%. Malocclusions such as Class I, Class II division 1, Class II division 2, and Class III malocclusion were observed in 78.71%, 7.92%, 3.47%, and 3.47%, respectively. Reversed overjet and overjet >9 mm were detected in 5.64% and 1.58%, respectively. Approximately half of the children (46.67%) had overbite >3.5 mm. Conclusions High percentage of children in mixed dentition period who need orthodontic treatment was found in this study. Some children who presented with the orthodontic treatment need Grade 2–4 had more than one DHC problem which identified the grade of treatment need. Class I malocclusion was most frequently found in this group of children.

Patterns of Use and Reasons for Discontinuation of Prophylactic Medications for Episodic Migraine and Chronic Migraine: Results From the Second International Burden of Migraine Study (IBMS‐II)

Our objective was to characterize patterns of preventive medication use in persons with episodic migraine (EM) and chronic migraine (CM). Several classes of medications are used both on- and off-label for the prevention of migraine, including β-blockers (eg, propranolol, timolol), tricyclic antidepressants (eg, amitriptyline), anti-epileptic drugs (eg, topiramate, valproic acid), and neurotoxins (eg, onabotulinumtoxinA). Preventive medication use and reasons for discontinuation were collected in an international, Web-based, cross-sectional survey of adults with migraine during 2010. Descriptive analyses were conducted on demographics and headache-related disability as measured by the Migraine Disability Assessment Scale, stratified by use of preventive medication, and EM or CM. Univariate and multivariate logistic regression models were constructed to assess predictors of preventive medication use. One thousand one hundred and sixty-five respondents completed the survey. Only 28.3% of EM and 44.8% of CM respondents were currently using preventive medication; any use of prophylaxis (prior or current) was reported by 43.4% of those with EM and 65.9% with CM. The mean number of prophylactic medications ever used was 2.92 for EM and 3.94 for CM. Antidepressants were used most frequently (EM 60.9%; CM 54.7%), followed by β-blockers (EM 35.4%; CM 36.8%) and anti-epileptics (EM 28.6%; CM 36.3%). Odds of preventive medication use were higher among CM than EM, adjusting for age, gender, race, years of daily headache, and country (odds ratio 2.72; 95% confidence interval 2.15 to 3.57). Greater headache-related disability and older age were also associated with greater odds of ever having used prophylaxis, regardless of headache frequency. Less than half the persons with EM and CM were currently using preventive medication for migraine, with treatment rates being higher for CM, as expected. Those with CM tried more medications than those with EM, possibly reflecting higher levels of treatment need.

Psychosocial impact of dental aesthetics among university undergraduates

The aim of this study was to assess the impact of dental appearance on the psychosocial well-being of young adults in a university community. The participants were a sample (165) of first year University undergraduates who completed the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), a condition-specific Oral-Health-Related Quality of Life (OHRQoL) measure and another self-rating instrument, the Perception of Occlusion Scale (POS). Self- and examiner-perceived dental aesthetics were determined using the Aesthetic Component (AC) scale of the Index of Orthodontic Treatment Need (IOTN) and a modification of the Dental Aesthetic Index (DAI). Results were analysed using non-parametric tests (Kruskall Wallis). Statistical significance was set as p<0.05. Participants with varying degrees of self- and examiner-perceived dental aesthetics according to the AC of IOTN and the POS demonstrated statistically significant differences in well-being based on the PIDAQ subscale scores (p<0.05), with the dental self-confidence subscale demonstrating the strongest difference. No significant differences were observed between the modified DAI groups. Differences in the quality of life of individuals with varying degrees of dental aesthetics and different levels of treatment need were identified by the PIDAQ. The most significant impact of impaired aesthetics being on dental self-confidence.

Long-term management of hospital orthodontic services

This study sought to monitor longitudinally the service provided in two district general hospital (DGH) units. Monthly data were collected from January 1989 to December 2009 for: patient referral, attendance and DNA rates, waiting lists, treatment completion rate, appliance types used, proportion of multidisciplinary work, level of treatment need and quality of outcomes. Variations in these parameters were analysed in the light of changes imposed by government, purchaser and provider policies. Departmental policies to improve treatment outcomes were evaluated.

Brief anger interventions with offenders may be ineffective: A replication and extension

Anger-management interventions are widely delivered in the criminal justice and forensic mental health systems. Whilst previous research has generally supported the thesis that anger management is an effective intervention for anger problems in general there remains a need to determine its effectiveness with offender populations. This paper reports the results of a controlled outcome study of a 20 h anger-management program offered to offenders. Those receiving treatment showed improvements in their knowledge about anger, but showed little change on measures of anger and anger expression when compared to waiting-list controls. Scores on measures of treatment readiness and level of need for treatment were however, correlated with post-treatment improvement. These findings are discussed in terms of their implications for the assessment and selection of appropriate participants for offender anger-management programs.

A Multisite Evaluation of Prison-Based Therapeutic Community Drug Treatment

A quasi-experimental study examined multiple postrelease outcomes up to 2 years for inmates who participated in therapeutic community (TC) drug treatment programs ( n = 217) or comparison groups ( n = 491) at five state prisons. Statistical controls included level of need for treatment, current and prior criminal history, and postrelease employment. Prison TC was effective even without mandatory community aftercare, although main effects and interactions varied somewhat across different outcome measures and sites. TC significantly reduced rearrest and reincarceration rates but not drug relapse rates. Postrelease employment predicted drug relapse and reincarceration, and employment interacted with age to predict rearrest. Two sites had higher drug relapse rates than the other three. Implications for research and policy are discussed.

Substance Dependence and Level of Treatment Need Among Recently-Incarcerated Prisoners

This study assessed both prevalence rates of substance dependence and level of treatment need among recently-incarcerated prisoners in a southeastern state. Participants were 752 consecutive admissions to the state prison system in 2002. They were administered the 93-item Substance Abuse Subtle Screening Inventory (SASSI). The results indicated that approximately 72% of participants met criteria for substance dependence and 46% of participants met criteria for prison-based residential treatment. The results of this study can be used to inform allocation of prison-based treatment resources.

Normative and self-perceived orthodontic treatment need of a Peruvian university population

BackgroundPrevious studies on orthodontic treatment need in young adults have shown that up to 50% had malocclusions that needed orthodontic treatment. The aims of this study were to assess the normative and self-perceived need for orthodontic treatment using the Index of Orthodontic Treatment Need (IOTN) and to determine if the treatment need levels were influenced by sex, age and socio-economic status (SES) in a sample of Peruvian young adults.Methods281 first-year students (157 male and 124 female students) with a mean age of 18.1 +/- 1.6 years were randomly selected and evaluated through the Dental Health Component (DHC) and Aesthetic Component (AC) of the IOTN. Structured interview and clinical examination were used to assess the students. Descriptive statistics and Chi-square tests were used for data analysis with statistical significance set at P < 0.05.ResultsAn intra-examiner reliability of 0.89 was obtained (weighted Kappa). The percentage of students according to SES was 51.2%, 40.6% and 8.2% corresponding to low, medium and high SES respectively. The percentage of students with DHC grades 4–5 was 29.9% whereas the percentage of students with AC grades 8–10 was 1.8%. There were no significant differences in the distribution of normative and self-perceived orthodontic treatment need based on sex, age and SES comparisons.ConclusionNormative orthodontic treatment need was not matched by a similar level of self-perceived treatment need in these young adults. Sex, age and SES were non-significant factors associated with levels of treatment need.

The development of the Sex Offender Psychometric Scoring System (SOPSSys) for use in the Probation Service

Within the probation service for England and Wales, a number of psychometric assessments are typically administered to offenders who attend structured group-based interventions. These assessments help to measure the offenders’ progress in treatment. The assessments that are used with the sex offender treatment programmes can also help to determine the offenders’ level of treatment need, and consequently the length of treatment that would be appropriate. The time taken to manually score these assessments is therefore significant, and consequently highly resource intensive. The current article describes a computer-based scoring system that has been developed to make this process quicker and more efficient. The processes and considerations involved in designing the system are discussed, as are the benefits and the implications of using it.

A cultural comparison of treatment need

The aims of this study were two-fold. First to compare the perceptions of African dental aesthetics as determined by a panel of black African Senegalese and French Caucasian judges, and second to compare the sensitivity and specificity of both components of the Index of Orthodontic Treatment Need (IOTN) and the Index of Complexity, Outcome and Need (ICON) in relation to the opinions of African and Caucasian judges. Ninety-eight colour digital dental images of black adolescents and adults were scored for attractiveness on a 100 mm visual analogue scale (VAS) by 45 Caucasian and 41 black African judges. In addition the judges were asked to classify the level of treatment need. Both components of the IOTN and ICON were recorded for the 98 cases. The results indicated that Caucasian judges perceived the majority of images to be less attractive than African judges. African and Caucasian judges showed similar levels in the estimation of treatment need. The aesthetic component (AC) of the IOTN and ICON showed similar levels of sensitivity. Taking all factors into account, it would appear that the ICON is marginally better at identifying those individuals who are perceived to need orthodontic treatment.

Orthodontic treatment need in Asian adult males.

Orthodontic treatment in adults has gained social and professional acceptance in recent years. An assessment of orthodontic treatment need helps to identify individuals who will benefit from treatment and safeguard their interest. The purpose of this study was to assess the objective and subjective levels of orthodontic treatment need in a sample of orthodontically untreated adult Asian males. A sample of male army recruits (n = 339, age 17-22 years, Chinese = 258, Malay = 60, Indian = 21) with no history of orthodontic treatment or craniofacial anomalies participated in the study on a voluntary basis with informed consent. Impressions for study models were taken. Objective treatment need was assessed based on study model analysis using the Index of Orthodontic Treatment Need (IOTN). Questionnaires were used to assess subjective treatment need based on subjective esthetic component (EC) ratings. Fifty percentage of the sample had a definite need for orthodontic treatment (dental health component [DHC] grades 4 and 5), whereas 29.2% had a moderate need for treatment (DHC grades 3). The occlusal trait most commonly identified was dental crossbite. Malay males had the highest percentage with a definite need for treatment for both dental health and esthetic reasons in comparison with Chinese and Indian males. However, there was no difference in the level of treatment need among the ethnic groups (P > .05). No correlation between objective and subjective EC scores was found (P > .05). A high level of investigator-identified treatment need was not supported by a similar level of subject awareness among the adult sample.

Estimating drug treatment needs among state prison inmates

Growing prison populations in the U.S. are largely due to drug-related crime and drug abuse. Yet, relatively few inmates receive treatment, existing interventions tend to be short-term or non-clinical, and better methods are needed to match drug-involved inmates to level of care. Using data from the 1997 Survey of Inmates in State Correctional Facilities, a nationally representative sample of 14,285 inmates from 275 state prisons, we present a framework for estimating their levels of treatment need. The framework is drawn partly from the American Society of Addiction Medicine Patient Placement Criteria and other client matching protocols, incorporating drug use severity, drug-related behavioral consequences, and other social and health problems. The results indicate high levels of drug involvement, but considerable variation in severity/recency of use and health and social consequences. We estimate that one-third of male and half of female inmates need residential treatment, but that half of male and one-third of female inmates may need no treatment or short-term interventions. Treatment capacity in state prisons is quite inadequate relative to need, and improvements in assessment, treatment matching, and inmate incentives are needed to conserve scarce treatment resources and facilitate inmate access to different levels of care.

Modifying the process of treatment to meet the threat of AIDS.

Treatment for drug users is unlikely to receive sufficient resources to expand to the level of treatment need. Moreover, there is indication that a substantial minority of injection drug users have never initiated needed treatment in spite of long histories of injecting drugs. Given the potential for that population to contract and spread AIDS, it is important that we explore street-based treatment alternatives derived from findings regarding the efficacy of outreach/intervention programs. Those programs were found both to reduce drug-taking behaviors of injecting drug users and to prepare those users for clienthood. Additional strategies that need to be explored include: aftercare, behavioral counseling for sex partners of drug treatment clients, and partial (i.e., survival) treatment services for clients who cannot be accommodated within existing treatment capacity.

Demand and need for treatment of craniomandibular dysfunction in the Dutch adult population.

A nationwide survey of oral conditions, treatment needs, and attitudes toward dental health care in Dutch adults was carried out in 1986. One of the aims of the study was to investigate the perceived need and demand for treatment of craniomandibular dysfunction (CMD). A sample of 6577 persons (15-74 yrs of age), stratified for gender, age, region, and socio-economic status, was contacted. Of this sample, 4496 persons participated in the behavioral part of the study, of which 3526 were examined clinically. The CMD-treatment demand was based on (1) CMD complaints in the past, (2) CMD complaints at present, and (3) an anticipated increase of the present complaints. CMD was both anamnestically and clinically assessed, independently by different examiners. A total of 21.5% of the Dutch adult population reported dysfunction, but 85% of these perceived no need for treatment. With most of the remaining 15% either seeking or intending to seek treatment (or having had it before), a figure of 3.1% can be used to summarize the actual level of treatment need for CMD in the Dutch adult population.