Public Dental Health Service Research Articles

Evaluation of Patient Satisfaction on Quality of Public Dental Health Service from Different Dimensions in Indonesia

Objective: To verify user satisfaction with oral public health services in different treatment dimensions and relate them to demographic conditions. Material and Methods: This study using pilot pathfinder design, conducted in Bantaeng Regency in January 2018. Patient was obtained for 114 people. Data were collected using structured questionnaires, which have been designed according to this survey which has eighteen questions corresponding to the object, with response patterns: satisfied, more or less and dissatisfied. Satisfaction was analyzed by using chi-square test. Questions about satisfaction with services are grouped into five domains - 'physical structure', 'relationships and communication', 'information and support', 'health care' and 'service organization'. Results: The results showed that in dental and oral health centers in Bantaeng District the physical structure dimension showed the highest level of satisfaction, while the dimensions of dental and oral health care showed the lowest satisfaction. Conclusion: Communities in Bantaeng and Pa'jukukang Sub-districts of Bantaeng Regency are mostly satisfied with dental and oral health services based on health service dimensions. On the physical structure dimension shows the highest level of satisfaction, whereas the dimension of dental and oral health care shows the lowest satisfaction.

Diagnosis, Risk Assessment, and Treatment Decisions for Occlusal Caries: A Survey from the Danish Public Dental Health Service

This study validates a case-based survey method and analyzes the extent to which Danish dental professionals apply current concepts and strategies for occlusal caries management in children, adolescents, and young adults. A case-based, precoded questionnaire consisting of 10 clinical cases/patients with 26 teeth/occlusal surfaces was developed. The cases were set up in a PowerPoint presentation and color printed as a booklet illustrating patients with different patterns of caries activity, severity, and risk. A total of 69 dental professionals participated. Content and face validity of the survey method was established using a panel of experts. The panel also assessed the reliability of the method using a test-retest procedure (κ ≥ 0.80) and acting as benchmark. Measurements of agreement between dental professional and benchmark assessments showed substantial agreement for overall caries activity and risk assessment of patients and for clinical and radiographic severity of occlusal lesions (κ = 0.61-0.67). For assessment of caries lesion activity on occlusal surfaces, the agreement was moderate (κ = 0.50). Regarding treatment decisions, dental professionals showed substantial agreement when indicating restorative treatments (κ = 0.68). Multivariate logistic regression analysis showed a significant influence of various patient-, lesion-, and participant-related variables in the assessment of caries risk, caries activity and severity, and treatment decision. In conclusion, Danish dental professionals participating in the study apply reasonably well current concepts on overall caries activity and risk assessment, clinical and radiographic severity of occlusal lesions, and, to a certain extent, assessment of caries lesion activity on occlusal surfaces. Nonoperative treatment decisions had a high priority among Danish professionals.

Quality of oral surgery referrals and how to improve them.

AimTo assess the quality of routine oral surgery referrals received at Halmstad Hospital and Växjö Hospital and to emphasize areas for improvement.MethodA retrospective study was performed on all routine oral surgery referrals received between 2014 and 2015 at both Halmstad Hospital and Växjö Hospital. A total of 1,891 referral letters were assessed for their quality against a predetermined checklist of basic requirements of a satisfactory referral. The referrals were also categorized according to if it was sent by a male, female, private dental service, or the Swedish Public Dental Health service.ResultsA diagnosis was missing in 30% of all referrals. Radiographs and information about previous radiographic examinations were not included in 10% of the referrals. Of those referrals that included radiographs, only around half were deemed adequate for diagnostic purposes. The presenting complaint was missing in 40% of all referrals. Current medical history was absent in 40% and current medication was omitted in 60% of the referrals. Information about tobacco use was only included in 10% of all referrals. Overall, female referrers performed better than male colleagues. Private referrals more regularly included information about diagnosis, previous treatment, and current medication. On the other hand, referrals from the public dental health service more frequently included radiographs, tobacco use, and current medical history.ConclusionThere is plenty of room for improving the standards of oral surgery referrals. We suggest that future electronic referral systems should only allow for submission once all of the essential information has been considered.

Treatment of Cracked Teeth

Although many options are proposed for the treatment of cracked posterior teeth, most treatment decisions are not evidence based. Thus, considerable individual variation can occur regarding treatment recommendations for the same scenario. To our knowledge, there are no studies in the literature assessing practitioners' attitudes toward the treatment of cracked teeth. This research recorded variations between general practitioners and specialist groups regarding the treatment approaches of cracked teeth. In a cross-sectional structured questionnaire survey, 32 prosthodontists, 34 endodontists, and 29 general practitioners working in public and private dental health services in Kuwait were assessed regarding their treatment approach to 5 different clinical cracked tooth scenarios. Chosen treatment options varied greatly. Within each scenario, there was a wide range in treatment preferences across all groups and within each group, especially with respect to asymptomatic cracked teeth. Overall, treatment approaches did not relate to specialty training. Statistically significant differences were noticed between endodontists and general practitioners, in case of crowning teeth, in scenario 3 (P = .032), and in extracting teeth for scenario 5 (P = .048). This study highlights that, despite suggested guidelines, there are large differences in the approach to treatment planning for cracked teeth by practitioners and specialists, both as a whole and within each group. Further multicountry studies involving larger dental populations are needed to determine factors that influence practitioners' treatment choices and/or whether better or more widely accepted guidelines need to be established. More prospective well-controlled clinical case-based research with long-term follow-ups is required.

Outcome of three screening questions for temporomandibular disorders (3Q/TMD) on clinical decision-making.

Patients with temporomandibular disorders (TMD) seem to go undetected and not adequately managed within dentistry. To identify these patients, three screening questions (3Q/TMD) have been introduced within dentistry in parts of Sweden. It is not known whether 3Q/TMD affects the clinical decision-making for these patients. The aim of this study was to evaluate the outcome of 3Q/TMD on the clinical decision-making and to analyse whether gender, age and the fee system the individual was assigned to were related to prescribed TMD treatment. This cohort study was carried out within the Public Dental Health service in Västerbotten, Sweden. As part of the routine dental check-up, a health declaration including 3Q/TMD was completed. The study population was randomly selected based on their 3Q/TMD answers. In total, 300 individuals with an affirmative answer to any of the 3Q/TMD, and 500 individuals with all negative answers were selected. The 3Q/TMD includes questions on weekly jaw-face-temple pain (Q1), pain on function (Q2) and catching/locking of the jaw (Q3). The 3Q/TMD was analysed in relation to prescribed treatment assessed from dental records. There was significantly more treatment performed or recommended for 3Q-positives (21·5%), compared to 3Q-negatives (2·2%) (P < 0·001). The odds ratio for TMD-related treatment for 3Q-positives versus 3Q-negatives was 12·1 (95% CI: 6·3-23·4). Although affirmative answers to the 3Q/TMD was related to TMD treatment, the majority of individuals with a screen positive still did not, according to dental records, receive assessment or treatment. Further studies are needed to better understand the clinical decision-making process for patients with TMD.

'It's good enough': Swedish general dental practitioners on reasons for accepting substandard root filling quality.

The concept of 'good enough' is central and necessary in the assessment of root filling quality. The aim was to explore the concept by analysing reasons and arguments for the acceptance or rejection of substandard root filling quality as reported by general dental practitioners (GDPs) in Sweden. The study was designed as a qualitative and exploratory study based on seven videotaped focus group interviews analysed by means of qualitative content analysis. Thirty-three GDPs employed in the Public Dental Health Service in Gothenburg, Sweden, participated (4-6GDPs/interview). In all, nine predetermined questions were followed. Before each focus group, the participants received radiographs of 37 root fillings and were asked to assess the root filling quality. The three cases representing the most divergent assessments served as a basis for the discussion. The cases were presented without clinical information; the dentists would relate to the cases as being just root filled by themselves. The radiographs did not provide a sufficient basis for decisions on whether or not to accept the root filling. This study emphasized that dentists did not primarily look for these arguments in the technical details of the root filling per se, but instead, they considered selected features of the contextual situation. The GDPs constantly introduced relevant 'ad hoc considerations' to account for the decisions they made. These contextual considerations were related to aspects of pulpal and periapical disease, risks (e.g. technical complications) or to consumed resources (personal and/or economic). It was obvious that the concept of 'good enough' does not exist as a general formula ready to be applied in particular situations. Instead, it is necessarily and irremediably tied to contextual properties that emerge from case to case.

Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey

Objective: Detecting and responding to child-maltreatment is a serious challenge and public health concern. In Norway, public dental health personnel (PDHP) have a mandatory obligation to report to child welfare services (CWS) if they suspect child-maltreatment. This study aimed to assess PDHP’s frequency of reporting and failing to report to CWS and whether the frequencies varied according to personal, organizational and external characteristics.Material and methods: An electronic questionnaire was sent to 1542 public dental hygienists and dentists in Norway, 1200 of who responded (77.8%).Results: The majority 60.0%, reported having sent reports of concern to CWS throughout their career, 32.6% had suspected child-maltreatment but failed to report it in their career and 42.5% had sent reports during the three-year period from 2012 to 2014. The reporting frequency to CWS was influenced by PDHP’s personal, organizational and external characteristics, while failure to report was influenced by personal characteristics.Conclusions: Compared to international studies, PDHP in Norway sends reports of concern and fails to report to CWS at relatively high rates. PDHP's likelihood of reporting was influenced by age, working experience, number of patients treated, size of the municipality and geographical region, while failure to report to CWS was influenced by working experience.

Validity of three screening questions (3Q/TMD) in relation to the DC/TMD

Temporomandibular disorders (TMD) are common but seem to be largely undetected within general dental care. To improve dentists' awareness of these symptoms, three screening questions (3Q/TMD) have been introduced. Our aim was to validate 3Q/TMD in relation to the diagnostic criteria for TMD (DC/TMD), while taking into account the severity level of the symptoms. The study population consisted of 7831 individuals 20-69years old, who had their routine dental check-up at the Public Dental Health Service in Västerbotten, Sweden. All patients answered a health declaration, including the 3Q/TMD regarding frequent temporomandibular pain, pain on movement and catching/locking of the jaw. All 3Q-positives (at least one affirmative) were invited for examination in randomised order. For each 3Q-positive, a matched 3Q-negative was invited. In total, 152 3Q-positives and 148 3Q-negatives participated. At examination, participants answered 3Q/TMD a second time, before they were examined and diagnosed according to DC/TMD. To determine symptom's severity, the Graded Chronic Pain Scale and Jaw Functional Limitation Scale-20 (JFLS-20) were used. In total, 74% of 3Q-positives and 16% of 3Q-negatives met the criteria for DC/TMD pain or dysfunction (disc displacements with reduction and degenerative joint disorder were excluded). Fifty-five per cent of 3Q-positives had a TMD diagnosis and CPI score ≥3 or a JFLS-20 score ≥5, compared to 4% of 3Q-negatives. The results show that the 3Q/TMD is an applicable, cost-effective and valid tool for screening a general adult population to recognise patients in need of further TMD examination and management.

‘Working in the dark’: Swedish general dental practitioners on the complexity of root canal treatment

To explore elements of reasoning and understanding that might obstruct the performance of good-quality root canal treatment (RCT) and make general dental practitioners (GDPs) produce and accept root fillings of inferior quality. The study was designed as a qualitative and explorative study based on seven videotaped focus group interviews analysed by means of qualitative content analysis. Nine predetermined questions were followed. Thirty-three GDPs (4-6 dentists/interview), employed in the Public Dental Health Service in Gothenburg, Sweden, participated. Feelings such as anxiety, frustration, stress or exhaustion were associated with RCT. In general, RCT was regarded as complex, mysterious and embedded in uncertainty. A feeling of loss of control was frequently described in relation to all procedural steps from negotiating the canal to prognostic deliberations. Reasons could include challenging canals, complicated instruments and the fact that treatment had to be performed in a concealed space without visible insight. Several dentists questioned the requirements for correctly performing RCT, and some indicated that striving towards optimal technical root filling quality should not be expected in each case in general practice. Most of the GDPs were unable to complete a case within the remuneration system, and they therefore either spent more time than the set fee allowed for or accepted a suboptimal root filling when the time limit was reached. High levels of stress and frustration in relation to RCT were reported by the GDPs. RCT was regarded as complex and was often performed with an overall sense of lack of control.

Treatment of temporomandibular disorders – knowledge, attitudes and clinical experience among general practising dentists in Sweden

Objective: The aim of the study was to investigate the self-perceived level of knowledge, attitudes and clinical experience in treatment of temporomandibular disorders (TMD) among general practising dentists (GPDs).Material and methods: A web-based questionnaire was sent to all GPDs in the public dental health service in the County of Uppsala in 2010 (n = 128) and 2014 (n = 113). The GPDs were asked to answer questions in the following categories: Demographic information, Quality assurance, Clinical experience and treatment, Need for specialist resources in the field of TMD and Attitudes. Between the two questionnaires, the GPDs were offered TMD education and an examination template including three TMD questions was introduced in the computer case files. The results were also compared with a previous questionnaire from 2001.Results: The response rate was 71% (2010) and 73% (2014). The majority of the GPDs were women (70% in 2010 and 72% in 2014). The reported frequency of taking a case history of facial pain and headache increased between 2010 and 2014. In 2014, the GPDs were more secure and reported higher frequency of good clinical routines in treatment with jaw exercises and pharmacological intervention compared to 2001. Interocclusal appliance was the treatment with which most dentists felt confident and reported good clinical routines.Conclusions: The GPDs felt more insecure concerning TMD diagnostics, therapy decisions and treatment in children/adolescents compared to adults. There is a high need for orofacial pain/TMD specialists and a majority of the GPDs wants the specialists to offer continuing education in TMD.

Posterior composites and new caries on adjacent surfaces - any association? Longitudinal study with a split-mouth design.

BackgroundThe aim of this longitudinal study was to compare caries incidence in sound approximal surfaces adjacent to newly placed composite restorations with the caries incidence in corresponding surfaces in contralateral teeth without any restorations in contact; and to assess risk factors for dentine caries development on adjacent and control surfaces.MethodsData from a practice-based study, where 4030 posterior approximal restorations placed in permanent teeth by clinicians working in a Public Dental Health Service in Norway, were used. The study was approved by the Regional Committee for Medical Research Ethics. The present study is based on a subsample of patients with a sound surface adjacent to a newly placed composite posterior approximal restoration. All individuals who had intact corresponding contralateral pairs of teeth in the same jaw, were included.At the end of the follow-up period, the study restorations and their adjacent surfaces were evaluated clinically and radiographically. Status of the contralateral tooth pair at baseline and end point was based on recordings from routine dental examinations, retrospectively extracted from the electronic dental records.ResultsOne hundred and ninety three patients (mean age 15.0 years, SD = 3.4) met the inclusion criteria. The surfaces were followed on average for 4.8 years. Follow-up observations revealed that 41 % of adjacent surfaces remained sound, compared with 67 % of the control surfaces (p < 0.001). Restorations were placed in 17 % of adjacent surfaces, compared with 3 % of the control surfaces (p < 0.001). In multivariate logistic regression analysis adjacent surfaces in maxillary teeth had increased risk for dentine caries development (OR 3.1, CI 1.3–7.3).ConclusionsCaries incidence in intact approximal surfaces adjacent to newly placed composite posterior approximal restorations was significantly higher compared with the contralateral control surface without a restoration in contact. Adjacent surfaces in maxillary teeth had increased risk for dentine caries development.

Local government and public dental health services: an analysis of inequality in use

The aim of this study was to identify factors associated with the use of primary and specialized public dental health services and private services. A population-based household survey was conducted in two cities of Bahia State, Brazil. Key informants provided data on socioeconomic variables and use of dental health services. Organization of the local public dental health service was ranked as worse versus better. Univariate and multivariate polytomous logistic regression was performed. Of the total of 1,290 individuals, 38.76% used private services, 33.80% used public primary care, and 17.29% used both primary care and the Center for Dental Specialties. Less use of both primary care and specialized public services was associated with lower education (OR = 1.47; 95%CI: 1.03-2.10) and worse organization of services (OR = 1.74; 95%CI: 1.22-2.48), when compared to the exclusive use of primary care. The study showed inequality in the use of dental services, even when comparing more homogeneous groups, namely users of public services.

Reimbursement systems influence prosthodontic treatment of adult patients

Objective. To evaluate the influence of reimbursement system and organizational structure on oral rehabilitation of adult patients with tooth loss. Materials and methods. Patient data were retrieved from the databases of the Swedish Social Insurance Agency. The data consisted of treatment records of patients aged 19 years and above claiming reimbursement for dental care from July 1, 2007 until June 30, 2009. Before July 1, 2008, a proportionately higher level of subsidy was available for dental care in patients 65 years and above, but thereafter the system was changed, so that the subsidy was the same, regardless of the patient’s age. Prosthodontic treatment in patients 65 years and above was compared with that in younger patients before and after the change of the reimbursement system. Prosthodontic treatment carried out in the Public Dental Health Service and the private sector was also analyzed. Results. Data were retrieved for 722,842 adult patients, covering a total of 1,339,915 reimbursed treatment items. After the change of the reimbursement system, there was a decrease in the proportion of items in patients 65 years and above in relation to those under 65. Overall, there was a minimal change in the proportion of treatment items provided by the private sector compared to the public sector following the change of the reimbursement system. Conclusions. Irrespective of service provider, private or public, financial incentive such as the reimbursement system may influence the provision of prosthodontic treatment, in terms of volume of treatment.

Deep carious lesions and other consequences of caries among 18-year-olds at Public Dental Health Service in Northern Norway: A cross-sectional age cohort study

Objectives. To document deep carious lesions and other consequences of caries (DCL-CC) in molars of 18-year olds leaving the free-of-charge Public Dental Health Service (PDHS). To explore the association between background factors and DCL-CC. Materials and methods. The final study sample (n = 1876) comprised 95% of individuals born in 1993 and registered in the PDHS in Troms County, Northern Norway. The most recent digital bitewing radiographs of each subject were examined for DCL-CC (deep untreated carious lesions, deep restorations, root canal obturations or extractions due to caries). Inter- and intra-observer kappa scores were 0.62 and 0.87, respectively. Information on background factors (gender, clinic location, history of medical problems, bitewing examination interval, DMFT score and planned recalls) were retrieved from dental records. Results. About one-quarter of subjects (488) had at least one molar with DCL-CC. There were 848 molars in total with DCL-CC; the majority were deep restorations (70%), but 4% were deep untreated carious lesions. More than a quarter of DCL-CC were either root canal obturations (14%) or extractions (12%). Multivariable logistic regression analyses showed that a 1-unit increase in DMFT score was associated with deep untreated carious lesions and extractions due to caries. There was no association between urban/rural clinic location, which indicated socio-economic status, and either DMFT score or DCL-CC. Conclusions. Despite the existence of a free-of-charge dental service, more than one-quarter of the subjects in the present study had at least one molar with DCL-CC.

Caries and background factors in Swedish 4-year-old children with special reference to immigrant status

Objective. This study assesses the prevalence of caries and some background factors in 4-year-old children in the city of Umeå, northern Sweden, and compares this with data from earlier studies to reveal changes over time. Materials and methods. Children from the catchment areas of three Public Dental Health Service clinics in Umeå (n = 224) born during the third quarter of 2008 were invited to undergo a clinical dental examination. Decayed surfaces (including both dentine and enamel, except for enamel lesions on buccal and lingual surfaces), missing and filled surfaces (dmfs) were recorded using the same methods and criteria as in a series of earlier studies performed between 1980–2007. Background data were collected in a case-history and a questionnaire. Results. The proportion of children with caries significantly decreased from 2007 (38%) to 2012 (22%) (p < 0.05). In addition, the distribution of dmfs differed significantly between these years (p < 0.05). More immigrant children had caries (42%) than non-immigrant children (15%) (p < 0.05). For children with caries, there were no significant changes in the distribution of dmfs between 1980–2012 (p > 0.05). An immigrant background was associated with a lower frequency of tooth brushing and a higher intake of ice cream, sweets and chocolate drinks (p < 0.05). Conclusion. Although the proportion of children with caries declined between 2007–2012, this decline was limited to non-immigrant children. Since 1980 the distribution of dmfs remained unchanged among children with caries. More research on interventions for changing oral health behaviours is needed, specifically for immigrant children.

Treatment effect of ozone and fluoride varnish application on occlusal caries in primary molars: a 12-month study

The aim of this study is to evaluate the effect of ozone and fluoride varnish on occlusal caries in primary molars in a split-mouth study. Caries risk was estimated by treating Public Dental Health Service dentists. Children with occlusal caries with Ekstrand index scores ≤3 (VI ≤3) were included. Selection of caries lesions was discontinued for ethical reasons due to non-acceptable clinical results during the follow-up. In the continued evaluation pairs of teeth with non-cavitated caries lesions, Ekstrand score ≤2a (VI ≤2) were selected. Fifty pairs of carious primary molars were included, 18 boys and 15 girls (mean 4.7 years, range 3-8). At baseline, the lesions were assessed by visual inspection (VI) and laser-induced fluorescence (LF), in each pair to treatment with 40 s ozone (HealOzone(TM), 2,100 ppm) or fluoride varnish Duraphat®. The treatments and evaluations were repeated at 3, 6 9 months and evaluations only at 12 months. Medium-high caries risk was observed in VI ≤3 children and low-medium risk in VI ≤2a children. In the 15 pairs VI ≤3 lesions, 8 treated with ozone and 9 with fluoride progressed to failure. In the 35 pairs VI ≤2a lesions, one lesion failed. Median baseline LF values in the VI ≤3 group were 76 and 69, for ozone and fluoride lesions, respectively, and 21 and 19 in the VI ≤2a group. At 12 months, LF values in the VI ≤2a group were 15 and 18. No improvement or difference in LF values was found over time between the caries lesions treated with ozone or fluoride. Neither ozone nor fluoride varnish treatments stopped the progression of caries in cavitated lesions. In low and medium caries risk children, non-cavitated lesions following both treatments showed slight or no progression. The use of ozone or fluoride varnish treatments in this regime as caries preventive method, added to the daily use of fluoridated toothpaste, to arrest caries progression in primary molars must therefore be questioned.

Gender differences, facial profile and treatment need of malocclusion for a sample of Al-Muthanna governorate students aged 15 years

Background: Survey of the occlusion in population groups usually include in their objections the academic assessment of occlusal feature, the planning resources for public health treatment programmers, the comparison of different population and the screening of groups for orthodontic treatment. Likewise a thorough investigation of the occurrence of malocclusions among school–students would be of major importance in the planning of orthodontic treatment in the public dental health services. For this purpose it is necessary to have detailed information on the prevalence of individual malocclusion among boys and girls at different ages distributed regionally, and moreover, an analysis of the need for orthodontic treatment in the different school classes. Materials and methods: This study was conducted from 20th October 2011 to 9th May 2013 on (3424 ) students (1712 males and 1712 females); from which 62 students (1.8%) were excluded because of incomplete information (no molar relation can be attended) giving a valid sample of 3362 (1681 males and 1681 females) aged (15) years old were studied with respect to facial profile ,sagittal occlusion according to Angle's classification, overjet, overbite, anterior crossbite , posterior crossbite, scissorsbite, rotation and displacement spacing and crowding. Results: The normal profile were presented in (73.76%) students (74%) males and (73.53%) females. Convex profiles were presented (20.34%) students (20.46%) males and (20.23%) females. A concave profile were presented in (5.9%) students (5.54%) males and (6.24%) females), The malocclusion were presented (73.05%) students (73.46%) males and (72.64%) females, According to the Dental health component of index of the orthodontic treatment subjects with no need for treatment were about 44.11% , the subjects who need little treatment were about 26.82%, 13.06% of the subjects who need moderate treatment, 10.03% great treatment need and about 5.98% very greatly treatment

Gerenciamento de resíduos odontológicos no serviço público

OBJETIVO: Verificar o processo de gerenciamento dos resíduos odontológicos do serviço público de saúde em 11 municípios brasileiros. MATERIAL E MÉTODO: Uma única pesquisadora realizou as visitas e as observações foram anotadas em um roteiro previamente elaborado e testado. RESULTADO: Foram visitadas 50 unidades de saúde, sendo que nenhuma apresentou cópia do plano de gerenciamento de resíduos. Do total de estabelecimentos, 62% realizavam a correta segregação dos resíduos no momento da sua geração. A presença de recipientes adequados a cada tipo de resíduo gerado no consultório odontológico foi observada em 74% dos estabelecimentos e, destes, 94% apresentavam capacidade adequada ao tipo de resíduo gerado. A identificação do tipo de resíduo nas embalagens plásticas bem como anotações identificando o estabelecimento gerador dos resíduos foram encontradas em 8% e 6%, respectivamente. Somente 21% dos estabelecimentos apresentavam locais apropriados, de acordo com as normas vigentes, para o armazenamento dos resíduos até que fosse feita a coleta externa. CONCLUSÃO: Constatou-se na presente pesquisa que a rotina adotada pela rede pública de saúde bucal, no que tange ao gerenciamento de resíduos de saúde, apresentou falhas.

A prospective 8-year follow-up of posterior resin composite restorations in permanent teeth of children and adolescents in Public Dental Health Service: reasons for replacement

The aim of the study was to investigate reasons for replacement and repair of posterior resin composite (RC) restorations placed in permanent teeth of children and adolescents attending Public Dental Health Service in Denmark. All posterior RC placed consecutively by 115 dentists over a period of 4 years were evaluated at baseline and up to 8 years later. The endpoint of each restoration was defined when repair or replacement was performed. The influence of patient, dentist and material factors on reasons for repair or replacement was investigated. A total of 4,355 restorations were placed. Replacements comprised 406 and repairs 125 restorations. The cumulative survival rate at 8 years was 84 %. Failed restorations were most frequently seen due to secondary caries (57 %), post-operative sensitivity (POS) (10 %) and RC fracture (6 %). POS was observed in 1.5 % of the evaluations and reported more often in girls and from teeth restored with a base material. Older dentists showed lower proportion of replaced restorations due to secondary caries than younger dentists. Posterior RC restorations in children and adolescents performed in general practice showed a good durability with annual failure rates of 2 %. The main reason for failure was secondary caries followed by post-operative sensitivity and resin composite fracture. A high proportion of replaced/repaired RC restorations were caused by primary caries in a non-filled surface. Secondary caries was the main reason for failure of RC in children and young adults. More teeth with post-operative sensitivity and a shorter longevity of restorations were observed when a base material was used.

Treatment preferences of deep carious lesions in mature teeth: Questionnaire study among dentists in Northern Norway

Objective. To investigate preferred treatment methods of deep carious lesions in mature permanent teeth among dentists in Northern Norway. Materials and methods. The survey included all 437 general dental practitioners in Northern Norway working in the private or the public dental health service. The participants received an invitation with a radiograph and a clinical picture of a deep carious lesion in a mature permanent tooth and a questionnaire asking about demographic characteristics and their preferred treatment methods related to different clinical deep caries diagnoses. Results. The response rate was 56%. There was an over-representation of publicly employed dentists among the respondents; otherwise no systematic bias related to non-responders was detected. In the absence of carious exposure and no symptoms, total caries excavation was the preferred treatment method (49%) followed by stepwise excavation (45%). In cases of deep caries and no exposure with symptoms, the preferences were equally distributed between root canal treatment (39%) and stepwise excavation (38%). In the presence of carious exposure but no symptoms, the preferred treatment method was direct pulp capping (51%) and in carious exposure with symptoms root canal treatment was the preferred treatment method (91%). Conclusions. There is no uniform treatment method of deep carious lesions among dentists in Northern Norway.