Private Dentist Research Articles

Mandibular changes in a patient suspected with Thalassemia trait: A case report by radiograph finding

Thalassemia is an inherited hemolytic anemia characterized by abnormal synthesis the hemoglobin globin component. A forty-year-old woman presented to a private dentist complaining of a left-sided facial pain and headache that occurred out of the blue. Panoramic radiograph showed severe caries on several teeth, generalized reduction in the alveolar crest, thin lamina dura and changes in trabecular pattern of mandible and the inferior alveolar canal on each side was partially absent. Unmanaged anemia caused ineffective erythropoiesis resulting extensive bone marrow with sparse coarse trabecular. As the mean hemoglobin falls, enhanced osteoclastic bone resorption thus thinning lamina dura, reducing alveolar crest and lacking radiopaque line of inferior alveolar canal. Panoramic is widely used in dentistry, this case report presents a case of patient discovered thalassemia through radiological findings.

NON-HODGKIN'S LYMPHOMA VERSUS TOOTH ABSCESS: IMPORTANCE AND CHALLENGES OF A CORRECT DIAGNOSIS

A 41-year-old male patient reported pain and discomfort in the jaw for 2 months. A private dentist established the diagnosis of a tooth abscess and prescribed antibiotics for 2 weeks. On extraoral exam, slight facial asymmetry and an enlarged and firm right submandibular lymph node were noted. On intraoral exam, a lobulated, reddish, partially ulcerated, soft, and asymptomatic nodule in the maxillary ridge referring to tooth 16, measuring 2.5 cm, was observed. A differential diagnosis of lymphoma and fibrosarcoma was established, and an incisional biopsy was performed. Histopathologic examination revealed a proliferation of round and blue cells, compatible with lymphoma. The complementary immunohistochemical examination was positive for CD20 and BCL6. Dentists should consider lymphoma as a diagnostic hypothesis among lesions that grow rapidly and cause diffuse bone resorption. To avoid iatrogenesis and improper drug prescriptions, dentists should always make detailed anamnesis and complete physical examinations of patients. A 41-year-old male patient reported pain and discomfort in the jaw for 2 months. A private dentist established the diagnosis of a tooth abscess and prescribed antibiotics for 2 weeks. On extraoral exam, slight facial asymmetry and an enlarged and firm right submandibular lymph node were noted. On intraoral exam, a lobulated, reddish, partially ulcerated, soft, and asymptomatic nodule in the maxillary ridge referring to tooth 16, measuring 2.5 cm, was observed. A differential diagnosis of lymphoma and fibrosarcoma was established, and an incisional biopsy was performed. Histopathologic examination revealed a proliferation of round and blue cells, compatible with lymphoma. The complementary immunohistochemical examination was positive for CD20 and BCL6. Dentists should consider lymphoma as a diagnostic hypothesis among lesions that grow rapidly and cause diffuse bone resorption. To avoid iatrogenesis and improper drug prescriptions, dentists should always make detailed anamnesis and complete physical examinations of patients.

A retrospective study on the incidence of medication-related osteonecrosis of the jaws (MRONJ) associated with different preventive dental care modalities

PurposeTo assess the efficacy of different preventive dental visits and treatments in reducing the risk of medication-related osteonecrosis of the jaws (MRONJ).MethodsIn this retrospective study, patients diagnosed with MRONJ were divided into 5 groups based on available data: no preventive dental visits (group 0); dental visits and compliance with recommended treatments, at the university hospital’s dental clinic (group 1) or maxillofacial surgery unit (group 2), or at a private dentist’s (group 3); dental visits at one of the above and noncompliance with proposed treatments (group 4); patients judged eligible by the oncologist on panoramic radiography (group 5). Patients were classified on severity of MRONJ according to the Italian SIPMO/SICMF 2.0 staging system. A descriptive analysis was performed on the results. Fisher’s exact test was applied (p < 0.05).ResultsNinety-three patients diagnosed with MRONJ were considered for the study, but 22 were excluded due to a lack of data, leaving a sample of 71 cases. MRONJ staging was only 0 for some patients (26.92%) in group 0. In all groups, the majority of patients had stage 2 MRONJ. The proportions of cases in stage 3 were 7.69% in group 0, 18.18% in group 3, and 43.48% in group 5. Groups 0 and 3 were somewhat similar as regard MRONJ staging. Most patients in group 5 had MRONJ stage 2 or 3. No statistically significant differences emerged between the groups.ConclusionsPreventive dental care can reduce the risk of MRONJ providing patients comply with the specialist’s recommendations.

A Novel Surgical Approach for the Successful Removal of Overextruded Separated Endodontic Instruments

Endodontic procedures can result in various complications. Separation of the endodontic instrument is a common complication of incorrect use or overuse of the instrument. However, a separated endodontic instrument may hinder cleaning and shaping during endodontic treatment procedures, which can potentially impact prognosis. Therefore, it is necessary to manage this complication by removal of the separated instruments from inside the root canal. Although several devices are used, nonsurgical removal for retreatment remains difficult. We report the case of a failed attempt to manage a separated endodontic instrument nonsurgically by a private dentist, which resulted in extrusion of the instrument beyond the root apex and its migration into the mandible. We describe a novel surgical approach involving intentional tooth replantation combined with alveolar osteotomy. There have been few reports on the management of separated endodontic instruments that were pushed out beyond the root apex. Our novel surgical approach suggests a technique for the potential removal of a separated endodontic instrument extruded beyond the root apex.

Socioeconomic differences in utilization of public and private dental care in Finland: Register-based evidence on a population aged 25 and over.

Dental care utilization is known to have a strong socioeconomic gradient, with lower socioeconomic groups utilizing less of these services despite having poorer dental health. However, less is known about the utilization of dental services in the population concurrently in the public and private sectors in different socioeconomic groups. Additionally, evidence on how different sectors contribute to the overall socioeconomic gradient in dental care utilization is scarce. This study examines visits and absence of visits to public and private dentists in the years 2017–2018 by education, occupational class and income. Comprehensive register data was collected from the total population aged 25 and over in the city of Oulu, Finland (N = 118,397). The data were analyzed with descriptive methods and with multinomial logistic regressions for the probability of visits and with negative binomial regressions for the number of visits, adjusted for sociodemographic covariates. The results showed a clear socioeconomic gradient for the probability of visits according to income and education: the higher the income and the higher the education, the more likely was a visit to a dentist–especially a private dentist–during the two-year period. Similar results were obtained for the number of visits. Higher socioeconomic status was less associated with public dentist visits. While those with the lowest income visited public dentists more frequently than private dentists, their overall visits fell below that of others. Adjusted estimates by occupation did not show a clear socioeconomic gradient. The socioeconomic inequality in dentist visits in a country having a universally covered public dental care scheme puts a challenge for decision makers in designing an equal dental health care system. Experimenting with lower co-payments is a possible option.

Rationalisation and 'McDonaldisation' in dental care: private dentists' experiences working in corporate dentistry.

Introduction This study examines how dentists experience the corporatisation of dentistry and the impacts of rationalisation. The emergence of corporate dentistry in the early twenty-first century has introduced greater competition into the dental marketplace. Ritzer's theory of 'McDonaldisation' explores the rationalisation of services through corporatisation and provides an apt framework with which to understand the qualitative insights gathered through this project.Methods Semi-structured interviews and reflective journals were used to collect insights from dentists who were working in private practice. Data were then subjected to thematic analysis.Results A total of 20 private dentist participants provided 22 separate interviews and multiple reflective accounts. Following analysis, three key themes emerged: 1) opportunities provided by corporate dentistry; 2) balance between professionalism and commercialism in corporate dentistry; and 3) competition between independent and corporate dentistry.Conclusions The participants' insights demonstrate how Ritzer's four dimensions of rationalisation - efficiency, predictability, calculability and control - have been encapsulated by corporate dentistry in Australia. Corporate interests in Australian dentistry are perceived to improve competition and offer opportunities for younger and less experienced dentists, but the findings also suggest that those leading corporate dentistry need to ensure that rationalisation does not diminish the caring relationship between dentists and patients.

Conhecimento sobre cárie dentária entre docentes do ensino médio

O objetivo do estudo foi avaliar o conhecimento sobre cárie dentária entre docentes do ensino médio. Trata-se de um estudo exploratório transversal com abordagem quantitativa entre docentes do ensino médio de escolas públicas e privadas do município de Vitória/ES. O estudo utilizou um questionário autoaplicado validado, adaptado para população-alvo, com perguntas que versavam sobre o conhecimento da cárie. Os dados descritivos foram apresentados em frequências absolutas e relativas e houve o teste de associação utilizando o teste Exato de Fisher (p&lt;0,05). Um total de 38 professores participaram do estudo, sendo 25 (65,8%) de escolas públicas. A maioria dos professores não recebeu informações sobre cárie (60,5%) durante sua formação acadêmica e seus conhecimentos foram adquiridos nas visitas ao cirurgião-dentista particular (50,0%). A maior parte soube definir cárie como doença (71,1%), no entanto, com incertezas (39,5%) se a lesão era a principal consequência do seu desenvolvimento e obrigatoriedade de restauração (55,3%) para o seu tratamento. O tema cárie é abordado em sala de aula por 60,5% dos docentes, principalmente no segundo ano (60,9%) e nas escolas particulares (p=0,0285). Dos professores, a maior parte gostaria que o tema cárie fizesse parte da estrutura curricular do ensino médio (92,1%) por acreditaram na relevância do assunto (97,4%). A maioria dos docentes soube definir a cárie como uma doença, no entanto, houve relativo desconhecimento de suas consequências e formas de tratamento

Oral Health - Factors of Non-Adherence to Dental Vouchers: A Case-Control Study

A dental voucher was created to facilitate the access to oral health care, however the use of these vouchers, by students aged 7, 10 and 13 with dental caries from state schools within the geodemographic area covered by the Community Health Center Group of Western Lisbon and Oeiras, had a low uptake (23%, school year 2014/2015) The aim of this study was to examine the factors associated with this non-use. A case-control study was carried out involving 270 students (135 cases and 135 controls) from 35 state schools who agreed to participate in the study. A descriptive analysis of the reasons for non-adhesion to the voucher, and a study associating the variables and the use/non-use of the dental vouchers using bivariate and multivariate statistical analysis was made adopting a significance of 0.05. The main reasons for non-use (n = 135) were the use of private dentists outside the dental voucher scheme (23.7%) and forgetting to use the vouchers or exceeding the expiry date (21.5%). The main factor associated with the non-use was students having a private dentist (OR adjusted 2.004, p = 0.012; IC 95%: 1.176 - 3.413) and the main factor associated with the use was having information of dentists accepting dental vouchers (OR adjusted 0.096, p = < 0.001; IC 95%: 0.047 - 0.198). Our findings highlight the need to improve the accessibility to dental vouchers. It is hoped that the identification of these factors will contribute in the planning of strategies and activities to improve the use of dental vouchers.

The possibility of modification and improvement of dental services in Poland for children and adolescents with special emphasis on orthodontic service.

World Dental Federation reveals that dental caries is one of the most common diseases in the world, and as much as 90% of the population is facing oral cavity problems. About 28% of teenagers aged 10 and 15 absolutely needs orthodontic treatment and about another third of this age group represents very serious cases. The aim of this study is to verify the authorial model which modifies and facilitates the system of dental services in Poland with a special emphasis on orthodontic service. The research was carried out with the method of diagnostic survey through a survey questionnaire. For this study, 1159 people were questioned for the research. In order to check the reliance between the variables Pearson chi-square test and the test of the Highest Reliability were used. Average market prices and the "prices expected" by the Greater Poland Voivodship Department of National Healthcare System were used to price dental services. The research revealed that the highest percentage of people who used only private dental services is between 19 and 64 years of age and the lowest percentage is represented by the elderly, i.e. subjects over 65 years of age. As for the dental services offered by the National Health Fund, the highest percentage of patients are children and adolescents under 18 and the lowest percentage of patients is represented by people in the working age. The tendency towards private healthcare is in direct proportion to parents' increase in the level of education. The main reason why parents take their children to a private dentist is the long waiting time for the visit offered by the National Health Fund as well as better materials and equipment offered by private dentists. The costs connected with extending the basket of guaranteed services for children and youngsters are combined with the increase in National Health Fund expenditure reaching EUR 7,014,151. The lack of refunding dental services for patients aged 19-64 will generate savings reaching about EUR 34,756,765. The reduction of public funds allocated for dental treatment of patients aged 19-64 will generate savings which will satisfy the needs connected with the increase in the range of refunded orthodontic treatment with the use of orthodontic permanent braces for patients under 18 years of age. The solution suggested will only slightly affect people in the working age as they reveal a strong tendency for treatment financed with their private funds.

Comportamiento de los sellantes de vidrio ionomero de alta densidad. Estudio a 6 años.

Although high density glass ionomer cement (GICS) sealants have proved to be effective in pit and fissure caries prevention, there are very few studies with more than three years of duration and practically no discussions about resealing convenience and the correct moment to do it. The aim of this study is to carry out a six years observation study to evaluate the retention and caries prevention effect of GICS. During a three years previous study (2007 – 2010) performed by the authors comparing the effectiveness of resin based sealants and GICS, developed by odontology students during a community dental school program, only the partially or totally lost sealants of 6-8 year old children were resealed. A longitudinal and observational study during 2010 and 2013 completed the six year. 25 children participate in this experience, totaling 42 molars. Caries did not appear in any molar. Two molars (in same child) were sealed with resin by a private dentist. In the last year (2013) the total of present sealants have almost disappeared (2,6%). No significant association was found between the sealant performance and the number of resealing (Fisher test p-value = 0,3627). Fisher test does not detect association between age and resealing (p-value = 0,6261). The probability of a six years old needing a resealant was 2,450 times than an 8 year old child. CONCLUSIONS: High density GICS with digital pressure technique is an effective measure of pit and fissures caries prevention in permanent molars. The presence, partial or total absence of sealant is not a success or failure indicator. The study could not prove that the resealing influenced the final result but it might have collaborated in achieving the biological objective. More comparative studies are necessary to evaluate the effectiveness and moment of resealing.

Dental attendance among adult Finns after a major oral health care reform.

Between 2001 and 2002, all age limits restricting the availability of subsidized private dental care and Public Dental Services (PDS) were abolished in Finland. In addition, the reform aimed to address income- and residence-related disparities in access to subsidized oral health care services. The aim of this study was to analyse how dental attendance and factors associated with it changed after the reform. We carried out three consecutive surveys on the use of oral health care services and perceived oral health. The surveys were conducted in 2001 (n=2837), in 2004 (n=2420) and in 2007 (n=2296), and the study population comprised Finnish adults born in 1970 or earlier. Logistic regression analyses were used to examine factors associated with the use of the services. The percentage of respondents who attended dental care regularly or had used oral health care services over the past 12months rose between 2001 and 2007. In particular, there was an increase in the proportion of subjects who used PDS. The average number of visits to a private dentist decreased between 2001 and 2007. In the regression analyses, the use of services was associated with older age, perceived lack of need for care, perceived toothache during the past 12months, perceived good oral health, lower number of missing teeth and regular dental visiting habits. The use of private dental care services was associated with perceived good oral health and perceived lack of need for care, higher household income and older age in all three study years while the use of PDS was associated with younger age, perceived good oral health and perceived lack of need for care only in 2001. The use of oral health care services rose and age did not seem to be a barrier to the use of oral health care services after the reform, as was the aim of the reform. No change in the association of household income with the use of oral health care services was seen after the OHCR.

Dental abnormalities and preventive oral care in Schimke immuno-osseous dysplasia

Schimke immuno-osseous dysplasia (SIOD) is a rare, severe, autosomal recessive disorder that results in spondyloepiphyseal dysplasia, renal dysfunction, immunodeficiency, facial dysmorphism and growth failure. Little is known about oral features associated with SIOD. Some of the dental anomalies encountered are specific to SIOD and have only been reported in individuals with SIOD. This paper describes the clinical and radiographic dental manifestations of SIOD in two Caucasian brothers. Both lived to be about 10 years old. After a variety of symptoms were reported, a diagnosis of SIOD was finally made when the brothers were, respectively, 5 and 8 years old. At that time, dental anomalies, such as dyschromia, bulbous crowns, short and thin roots, had not been taken into account to establish the diagnosis. However, knowledge of the dental features characteristic of this disease could have helped make the diagnosis. Although both were caries- and periodontal disease-free, special attention was focused on prevention, including dietary counselling, plaque control, oral hygiene instructions and the use of fluoridated toothpaste. The two patients were followed every 6 months, for over 2 years (until their death), by both a private dentist and a university hospital dentist, which helped them maintain good oral health. Oral hygiene was assessed at each appointment and fissure sealants were placed by the private practitioner on their first permanent molars. This report describes dental anomalies specific to SIOD that could facilitate diagnosis. Clinicians and dentists should work in collaboration to diagnose and treat children with SIOD. These patients require regular and specific dental management because of their fragile health and their characteristic dental anomalies. Ideally, preventive visits should be scheduled every 6 months in addition to curative visits as needed.

Regional density of private dentists: empirical evidence from Austria

We investigated the determinants of disparities in the regional density of private dentists in Austria. Specifically, we focused on the relationship between the density of private dentists and their public counterparts, thereby controlling for other possible covariates of dentist density. Dentist density was measured at the district level. We used panel data of dentist density from 121 Austrian districts over the years 2001-2008. We applied a Hausman-Taylor framework to cope with possible endogeneity and to control for cross-district effects in the dentist density. A significant negative relationship was found between the density of private and public dentists, indicating a substitution effect between the two dentist groups. A significant positive spatial relationship also existed for private and public dentists in the neighboring regions. Dental capacities in public and private hospitals and dental laboratories run by the public health insurance system did not have a significant effect on private dentist density. Although a strong negative relationship existed between private and public dentists within the districts, one should not draw the conclusion that private dentists in Austria are close substitutes for public dentists. Such a conclusion would require further empirical analysis on the utilization patterns of dental services and their relationships with financing mechanisms.

Health care waste disposal among private dentist in an Indian city: It's time to act

The provision of healthcare generates waste which can be detrimental to health and environment. Staff that provide dental healthcare ought to be aware of the proper handling and the system of management of dental waste used by different dental hospitals. A survey was conducted to determine the awareness of dental practitioners on hospital generation and handling of waste. A self-administered questionnaire was used. Lack of awareness, ignorance of policy and procedure on the handling of dental healthcare waste and failure to attend educational activities were major defects found among practitioners in the study. There is a need for a plan to improve the awareness of dental healthcare workers about hospital generated waste and its proper handling.

Health care waste disposal among private dentist in an Indian city: It's time to act

Health care waste disposal among private dentist in an Indian city: It's time to act

BHPR: Audit and Clinical Evaluation * 103. Dental Health in Children and Young Adults with Inflammatory Arthritis: Access to Dental Care

Background: Children and young adults with JIA have increased levels of poor oral hygiene and dental decay [1]. Periodontitis and types of arthritis are linked by similar components of blood cytokine profiles. Good dental health can be directly affected in JIA patients due to physical limitations in upper limb movements making brushing and flossing teeth difficult. An important factor in oral care is good dental hygiene and access to dental health practitioners. NHS advice is that all children should be reviewed by a dentist annually and be offered both sealant of their teeth and fluoride varnish at the appropriate time. Our aim was to establish if our patients had any barriers to accessing dental care. Methods: All patients (age 18 and under) diagnosed with JIA in the paediatric rheumatology clinic over a period of 3 months were asked to complete a dental care questionnaire. Parents completed the questionnaire for their children if necessary. Data were analysed using Excel. Results: 30 questionnaires were completed. Demographics were M:F 1:1.3, all children were diagnosed with JIA, average age 10.5 years with range 2–18. 27 children were registered with an NHS dentist with the exception of one child with a private dentist. 26 children had seen a dentist at least annually and one child in the past 2 years. 2 children, one aged 16, were not registered with a dentist because their parents didn’t think it was important. 11 children had 25 fillings in total, 9 of these children were not supervised during dental hygiene. 13 children admitted to drinking sugary drinks daily and had 16 dental fillings. None of the children admitted to smoking. Conclusions: Whilst our audit showed that most children were registered with a dentist and were reviewed annually, only 1 child had been offered sealant and fluoride varnish. The NHS advises that children with chronic medical conditions can be seen either by their NHS dentist or by the local Community specialist dental service which can be accessed by referral from their rheumatology department or NHS dentist. None of the children were seen by the specialist dental service. We have developed an information leaflet informing parents and children with JIA of the importance of dental health explaining the benefits of both sealant and fluoride for teeth.

Gingival and localized alveolar bone necrosis related to the use of arsenic trioxide paste—Two case reports

The leakage of arsenic trioxide paste from tooth fillings has been associated with widespread necrosis of the supporting periodontal tissues. This report describes two cases of arsenic trioxide paste-induced gingival and localized alveolar bone necrosis in the mandible, following the use of arsenic trioxide paste as a pulp-devitalized agent. The first case was a 54-year-old female complaining of a painful white patch on the gingival tissue of the left mandibular second molar (tooth #37) after treatment by a private dentist. She underwent completely debridement of all necrotic soft tissue with physical saline irrigation. The gingival tissue was gradually replaced with vascular tissue and completely healed after 7 weeks. The second case was a 30-year-old female complaining of severe pain and continuous gingival bleeding from the right maxillary first bicuspid (tooth #14) following treatment by a private dentist. She finally accepted debridement of the sequestrum and necrotic alveolar bone with decortication to induce active bleeding. A partial thickness gingival flap was made to cover the wound. Four weeks later, the supporting tissues had completely healed. Arsenic trioxide paste is a cytotoxic agent and may cause harmful adverse effects on adjacent periodontium and supporting hard tissue if leakage occurs, or it is used carelessly. There is no indication for the use of arsenic trioxide paste in modern dental practice.

Slow Orthodontic Teeth Extrusion to Enhance Hard and Soft Periodontal Tissue Quality before Implant Positioning in Aesthetic Area

Approaching bone defects of jaws treatments, hard and soft tissue augmentation could be considered as a goal for clinicians when performing dental implant placement. The increase in patients who want cosmetic treatment puts practitioners in an awkward position when choosing the best therapy to obtain the most desirable results. A private dentist referred a young patient to the Department of Implantology in Milan in order to place implants in the upper jaw. Radiographic evaluation of the two upper anterior incisors confirmed that the teeth had a poor prognosis The anterior ridge volume was clinically analyzed and several therapeutic choices were evaluated. Rapid extractions and immediate implant positioning were not considered due to the vertical and horizontal components of the bone defect. Therefore, the surgical team decided on increasing the bone volume by using slow orthodontic teeth extrusion technique.After 3 months of orthodontic treatment, the angular intra-bony defects of 1.1 tooth was completely healed. Implant guided positioning, associated with a small bone graft, showed optimal results at the time of healing screw placement. The soft tissue conditioning was obtained by a provisional acrylic crown. The final application of two integral ceramic crowns showed excellent aesthetic results. Radiographic investigation at a 24 month follow-up confirmed the integration of the dental implants and the recovery of the bone defects. Several safe surgical techniques are available today for reconstructing atrophic jaws. However, the same technique applied on the posterior area did not give the same predictable results as in the anterior areas of the jaw.

Chronic disease and use of dental services in Australia

Chronic disease and use of dental services in Australia

Think twice before you book? Modelling the choice of public vs private dentist in a choice experiment

This study concerns the choice of primary dental service provider by consumers. If the health service delivery system allows individuals to choose between public-care providers or if complementary private services are available, it is typically assumed that utilisation is a three-stage decision process. The patient first makes a decision to seek care, and then chooses the service provider. The final stage, involving decisions over the amount and form of treatment, is not considered here. The paper reports a discrete choice experiment (DCE) designed to evaluate attributes affecting individuals' choice of dental-care provider. The feasibility of the DCE approach in modelling consumers' choice in the context of non-acute need for dental care is assessed. The aim is to test whether a separate two-stage logit, a multinomial logit, or a nested logit best fits the choice process of consumers. A nested logit model of indirect utility functions is estimated and inclusive value (IV) constraints are tested for modelling implications. The results show that non-trading behaviour has an impact on the choice of appropriate modelling technique, but is to some extent dependent on the choice of scenarios offered. It is concluded that for traders multinomial logit is appropriate, whereas for non-traders and on average the nested logit is the method supported by the analyses. The consistent finding in all subgroup analyses is that the traditional two-stage decision process is found to be implausible in the context of consumer's choice of dental-care provider.