Sedação consciente com óxido nitroso em clínica odontológica: principais indicações e segurança / Concious sedation with nitrous oxide in dental clinics: main indications and safety

A ansiedade desempenha um papel significativo na experiência de tratamentos odontológicos e pode resultar em evasão por parte dos pacientes. Isso é especialmente relevante para grupos como pacientes pediátricos e aqueles com necessidades especiais, que muitas vezes requerem técnicas de controle de comportamento ou sedação devido à ansiedade. No entanto, a ansiedade não deve ser negligenciada mesmo em pacientes sem odontofobia grave, pois está relacionada à percepção da dor durante os procedimentos odontológicos. A sedação consciente com óxido nitroso surge como uma alternativa valiosa para reduzir a ansiedade e melhorar o conforto do paciente. Ao contrário dos benzodiazepínicos e da anestesia geral, o óxido nitroso atua no sistema nervoso de uma forma que deprime levemente o córtex cerebral, sem afetar o centro respiratório. Isso permite o uso de concentrações subanestésicas do gás, administradas com oxigênio por meio de uma máscara nasal. O óxido nitroso é de rápida ação, pouco solúvel e tem um período de recuperação breve, permitindo que os pacientes retornem rapidamente às atividades normais. Este estudo, uma revisão de literatura, explora o mecanismo de ação do óxido nitroso, suas indicações na prática odontológica e examina possíveis riscos e contraindicações associados ao seu uso. Em resumo, a sedação consciente com óxido nitroso se mostra como uma opção promissora para aliviar a ansiedade e melhorar a experiência de tratamentos odontológicos, beneficiando uma ampla gama de pacientes, não apenas aqueles com fobias graves.

Anxiety, in an outpatient dental environment, plays a fundamental role in pain and discomfort expectation, resulting in increase of treatment evasion. The groups that present greater difficulty in cooperation are children and special needs patients, with behavioral control and sedation being often necessary. Nevertheless, literature emphasizes that anxiety must be evaluated as a critical stage and its management done not only in patients with elevated anxiety levels, but being crucial on pain control of every dental patient, since higher grades of restlessness equals higher pain perception. It is known that the use of nitrous oxide in conscious sedation proves to be an useful tool on reducing anxiety and enabling comfortable interventions, indicating that it is an alternative to the use of benzodiazepines and general anesthesia. The drug acts on the nervous system, promoting a slight depression of the cerebral cortex and, unlike benzodiazepines, which act at the medulla level, it does not depress the respiratory center. The technique uses sub-anesthetic concentrations of nitrous oxide delivered with oxygen through a nasal mask. Nitrous oxide is poorly soluble and has a rapid onset of action, being therefore associated with a rapid recovery period. The duration of sedation is controlled and the patient can quickly return to normal activities. This paper is a narrative review with the objective of exploring the mechanism of action of this gas, evaluating its indications for use in dental clinic and verifying possible risks and contraindications.

Virtual clinics in oral surgery: an equitable service for all?

Introduction Teledentistry has become more prevalent in the provision of oral healthcare since the COVID-19 pandemic. Virtual consultation clinics were introduced at Birmingham Dental Hospital as an adjunct to face-to-face (F2F) consultation clinics. This service evaluation compares virtual and F2F consultation clinics in oral surgery, with particular focus on 'did not attend' (DNA) rates.Methodology Data were collected retrospectively from all clinics conducted within the oral surgery service in April 2021. Information collected included attendance, patient demographics and complications impeding the consultation, including technical difficulties. Patients' postcodes were used to generate deprivation deciles. All data were handled sensitively in line with the Caldicott principles.Results Binomial regression analysis showed that DNA rates were more likely to occur in virtual consultation clinics compared to F2F clinics (p <0.00). DNAs were less likely to occur at review appointments (p <0.00). Lower deprivation decile ratings were associated with higher rates of DNAs, independent of clinic type (eg review or new patient) or method of consultation (virtual versus F2F) (p <0.01).Conclusion While virtual clinics are advantageous for some patient demographics and have shown promising results in other studies, it is important that the delivery of these virtual services does not continue to marginalise vulnerable patient groups and enhance pre-existing oral health inequalities.

An Investigation Into Contaminated Waste Composition in a University Dental Clinic: Opportunities for Sustainability in Dentistry.

OBJECTIVES: Many international dental organizations have been advocating for sustainable practices in dentistry, whereby significant reductions in environmental impacts are needed. The aim of this study was to analyze dental clinical waste in a university clinic setting to explore opportunities for sustainable practices. MATERIAL AND METHODS: Fifty dental units (chairs) that are routinely used in delivery of dental treatment and involved supervising clinicians, dental students, and patients were randomly selected, and the clinical waste generated was collected, segregated, and weighed. Statistical analysis was performed to analyze differences in waste production based on treatment performed. RESULTS: The mean waste production generated by each chair was 81.4 g of aprons, 56.2 g of gloves, 17.2 g of masks, 24.0 g of sterile wrappings, 48.8 g of other plastics, 100.8 g of cellulose-based items, and 25.8 g of miscellaneous items. Higher waste was generated from the chairs performing endodontic procedures when compared with examinations. A potential annual greenhouse gas saving of approximately 10 kg CO2e per year (when one patient is treated daily) can be achieved if sterile wrapping plastics were to be recycled. CONCLUSIONS: Simple yet achievable opportunities for efficient clinical waste management at university clinics exist, which in turn will increase environmental sustainability in the post-COVID-19 era. Increased awareness and incentives for sustainable measures could potentially enhance the possibility of wider adoption of ecofriendly approaches.

Strategic changes and challenges of private dental clinics and practitioners in Israel: adapting to a competitive environment.

BACKGROUND: In the 21st century's digital age, health organizations face challenges from reduced public healthcare spending, creating a competitive market that impacts healthcare management. The struggle is hardest for small organizations, such as private clinics. Competing under unfavorable conditions, these small businesses must run as independent, profitable units in a government-regulated market where they are subject to numerous restrictions yet receive no financial support. In a world of increasing dependence on digital technologies, these small businesses must adopt competitive business models and be adaptive and flexible in embracing change. METHODS: This qualitative study is based on a thematic qualitative analysis of 20 in-depth, 45-minute-long interviews with dentists and owners of private dental clinics in various specialties. The study employs the strategic change model to examine how dentists who run private dental clinics implement new strategies and technologies to adjust to changes and create a competitive edge. RESULTS: Six main categories emerged from the analysis of the interviews: changes in the organization's environment; instituting and assimilating changes; obstacles in embracing change; added value obtained from embracing the change; quality of care and service; and cost-benefit considerations. The categories were map and evaluated in light of the strategic change model. The analysis indicated that digital strategies have been only partially adopted, suggesting an absence of a cohesive, long-term strategic vision for the organizations. CONCLUSIONS: The study explored the actions, perceptions, and challenges of adapting to a competitive digital market in dental private clinics. Based on these insights, recommendations have been provided for global change management, aiming for a sustainable and stable healthcare system that benefits the broader community.

Waste management from dental clinics: A case study in Belo Horizonte, Brazil.

Healthcare waste management is a critical aspect of public health and environmental protection, particularly in establishments such as dental clinics. This study examined the dental clinic waste (DCW) management processes in clinics within the city of Belo Horizonte, Brazil. Utilizing data from Healthcare Waste Management Plans (HCWMP) provided by the Urban Cleaning Superintendence, the study investigated waste generation, segregation, storage, collection, treatment, and final disposal practices. The results revealed that hazardous DCW represented a significant portion (26.5 %) of waste generated in dental clinics, exceeding the World Health Organization's recommended threshold. Biological waste (22.9 %), mainly consisting of cotton, gauze, and gloves contaminated with blood or body fluids, was the most generated hazardous waste group, followed by chemical (2.2 %) and sharps waste (1.3 %). Incineration was the predominant treatment method for hazardous DCW, raising concerns about environmental impacts and greenhouse gas emissions. Non-hazardous waste, primarily destined for landfills, had limited recycling rates (2.4 %), emphasizing the need for improved waste management strategies to minimize environmental impacts and increase circular economy. Challenges in DCW management included inadequate segregation practices, limited recycling initiatives, and incomplete HCWMPs lacking descriptions of waste management beyond establishment boundaries. Addressing these challenges requires comprehensive training programs, strengthened regulations, and increased environmental awareness among healthcare professionals. In conclusion, improving DCW management in dental clinics is crucial for mitigating occupational and environmental risks. Collective efforts are needed to enhance waste segregation, promote recycling, and ensure compliance with regulations, ultimately safeguarding public health and the environment.

Predictors of Medical and Dental Clinic Closure by Machine Learning Methods: Cross-Sectional Study Using Empirical Data.

BACKGROUND: Small clinics are important in providing health care in local communities. Accurately predicting their closure would help manage health care resource allocation. There have been few studies on the prediction of clinic closure using machine learning techniques. OBJECTIVE: This study aims to test the feasibility of predicting the closure of medical and dental clinics (MCs and DCs, respectively) and investigate important factors associated with their closure using machine running techniques. METHODS: The units of analysis were MCs and DCs. This study used health insurance administrative data. The participants of this study ran and closed clinics between January 1, 2020, and December 31, 2021. Using all closed clinics, closed and run clinics were selected at a ratio of 1:2 based on the locality of study participants using the propensity matching score of logistic regression. This study used 23 and 19 variables to predict the closure of MCs and DCs, respectively. Key variables were extracted using permutation importance and the sequential feature selection technique. Finally, this study used 5 and 6 variables of MCs and DCs, respectively, for model learning. Furthermore, four machine learning techniques were used: (1) logistic regression, (2) support vector machine, (3) random forest (RF), and (4) Extreme Gradient Boost. This study evaluated the modeling accuracy using the area under curve (AUC) method and presented important factors critically affecting closures. This study used SAS (version 9.4; SAS Institute Inc) and Python (version 3.7.9; Python Software Foundation). RESULTS: The best-fit model for the closure of MCs with cross-validation was the support vector machine (AUC 0.762, 95% CI 0.746-0.777; P<.001) followed by RF (AUC 0.736, 95% CI 0.720-0.752; P<.001). The best-fit model for DCs was Extreme Gradient Boost (AUC 0.700, 95% CI 0.675-0.725; P<.001) followed by RF (AUC 0.687, 95% CI 0.661-0.712; P<.001). The most significant factor associated with the closure of MCs was years of operation, followed by population growth, population, and percentage of medical specialties. In contrast, the main factor affecting the closure of DCs was the number of patients, followed by annual variation in the number of patients, year of operation, and percentage of dental specialists. CONCLUSIONS: This study showed that machine running methods are useful tools for predicting the closure of small medical facilities with a moderate level of accuracy. Essential factors affecting medical facility closure also differed between MCs and DCs. Developing good models would prevent unnecessary medical facility closures at the national level.

Chairside learning on undergraduate clinics: general dental and human disease themes.

Introduction Chairside teaching is an important part of dental undergraduate clinical education. Bedside teaching is well-reported in relation to undergraduate medicine but few publications relate to undergraduate dentistry.Aims and objectives To investigate the experience and benefits from chairside teaching/learning in the clinical years of a five-year dental programme in a UK university. We asked about general dental topic learning as well as human disease (HD) learning.Materials and methods An online survey gathered dental students' opinions on their recognition, knowledge and experience of chairside teaching/learning. We asked about clinics and clinicians and where they gained most from chairside teaching/learning. We encouraged free-text responses.Results Altogether, 127 students took part (62% response). Response rates approximated 60% for all three years. In total, 93% felt that chairside teaching/learning helped to a moderate/great extent for general dental topics and 73% felt that chairside teaching/learning helped to a moderate/great extent for HD topics. Free-text comments revealed students valued chairside teaching/learning and from which grade/level of staff they learned most.Discussion and conclusion Chairside teaching/learning is largely unreported and unrecognised in undergraduate education. Although not formally timetabled, enthusiastic staff with enough time to engage in chairside teaching can have a positive impact on student learning.

Air disinfection performance of upper-room ultraviolet germicidal irradiation (UR-UVGI) system in a multi-compartment dental clinic.

Multi-compartment dental clinics present significant airborne cross-infection risks. Upper-room ultraviolet germicidal irradiation (UR-UVGI) system have shown promise in preventing airborne pathogens, but its available application data are insufficient in multi-compartment dental clinics. Therefore, the UR-UVGI system's performance in a multi-compartment dental clinic was comprehensively evaluated in this study. The accuracy of the turbulence and drift flux models was verified by experimental data from ultrasonic scaling. The effects of the ventilation rate, irradiation zone volume, and irradiation flux on UR-UVGI performance were analyzed using computational fluid dynamics coupled with a UV inactivation model. Different patient numbers were considered. The results showed that UR-UVGI significantly reduced virus concentrations and outperformed increased ventilation rates alone. At a ventilation rate of six air changes per hour (ACH), UR-UVGI with an irradiation zone volume of 20% and irradiation flux of 5 µW/cm2 achieved a 70.44% average virus reduction in the whole room (WR), outperforming the impact of doubling the ventilation rate from 6 to 12 ACH without UR-UVGI. The highest disinfection efficiency of UR-UVGI decreased for WRs with more patients. The compartment treating patients exhibited significantly lower disinfection efficiency than others. Moreover, optimal UR-UVGI performance occurs at lower ventilation rates, achieving over 80% virus disinfection in WR. Additionally, exceeding an irradiation zone volume of 20% or an irradiation flux of 5 µW/cm2 notably reduces the improvement rates of UR-UVGI performance. These findings provide a scientific reference for strategically applying UR-UVGI in multi-compartment dental clinics.

Exploring the usability of simulated patient methodology in dental clinics in Western Australia: A pilot survey.

OBJECTIVES: This study aimed to explore the dental staff knowledge of simulated patient methodology and support for its use to investigate dental staffs' triaging ability. MATERIAL AND METHODS: Staff at dental practices in Western Australia were invited to participate in a cross-sectional online questionnaire, consisting of demographic questions, questions on triaging, and knowledge of simulated patient methodology. Descriptive and parametric tests were undertaken for quantitative data; qualitative responses were thematically analyzed. RESULTS: Of the 100 participants, most were female (71%), aged 25-39 years (57%), dentists (46%), and worked in private practices (60%). While 82% of participants triaged dental appointment enquiries, only 26% had heard of simulated patient studies. The majority (66%) of participants spent 1-5 min when triaging appointments and less than half (29%) asked about medical history, aggravating or alleviating factors. Although there was a general positive attitude toward use of simulated patient methodology to investigate practice, some concerns were identified. CONCLUSIONS: The findings of our exploratory study suggests that there may be a potential for utilizing simulated patient studies to improve the care of patients by dental receptionists in general dental practices.

Factors associated with dental clinic use by clients in Nigeria during the COVID-19 pandemic.

BACKGROUND: Nigeria, like many other countries, faced challenges in dental care provision during the COVID-19 pandemic, necessitating limited care to emergencies only. However, the impact of restricted access to dental services on oral health remains a concern, particularly with preventive maintenance care. This study aims to identify the factors associated with dental service utilization during the COVID-19 pandemic among patients attending dental clinics in Nigeria, and their sources of information about COVID-19. METHODS: This cross-sectional study recruited 500 participants who had visited dental clinics before and during the pandemic. Data were collected through telephone interviews and online questionnaires between September and December 2021. Inferential analyses were conducted using ordered logistic regression models to assess the association between the independent (awareness of emergency dental treatments, knowledge of COVID-19 transmission routes in dentistry, awareness of required preparations in dental practice settings, fear of COVID-19 infection in dental settings), and dependent (utilization of dental services during the pandemic) variables after adjusting for confounding variables (age, sex, educational status, COVID-19 vaccinations status and COVID-19 status of live-in residents). The sources of COVID-19 information by dental patients was also identified. Statistical significance was established at 95% confidence level with a p value < 0.05. RESULTS: Many participants were males (51.2%) and had tertiary education (61.6%). Fear of COVID-19 infection in dental settings was significantly associated with lower odds of utilizing dental care services during the pandemic (Adjusted Odds Ratio: -0.06, 95% Confidence Interval: -0.08, -0.01). The main sources of COVID-19 information were mass media and social networks, with only 42% receiving information from dental professionals. CONCLUSION: Fear of COVID-19 infection in dental settings significantly influenced dental service utilization during the pandemic. Strategies to address fear and improve communication channels between dental professionals and patients are essential for promoting oral health during similar crises.

Comparison of Implant-Retained Overdenture and Conventional Complete Denture: A Survey Study to Measure Patients' Satisfaction and Quality of Life in Dental School Clinics.

Patient satisfaction and quality of life are integral to assessing oral health care quality. For many Americans still using conventional complete dentures (CDs) or implant-retained mandibular overdentures (IODs), it remains essential to consider improving their oral health outcomes and quality of life. Due to inexperienced student dentists providing dental care to dental school patients, patient grievances are generally considered a problem. Patient feedback and satisfaction have proven valuable resources for monitoring and improving patient safety. While CDs and IODs are the 2 leading treatment options for edentulism, more comparative studies in the literature need to compare their outcomes in a school setting. The research question that guided this comparative analysis was, "Is patient satisfaction and quality of life affected by the type of prostheses and provider?" A validated questionnaire was mailed to 520 individuals selected from records of patients who had received treatment for edentulous mandible at a student prosthodontic clinic at the University of Kentucky College of Dentistry from 2014 to 2016 with at least 1 year of follow-up time. A validated questionnaire for edentulous patients based on the Oral Health Impact Profile (OHIP-19) was used. In addition, information on patients' oral health-related quality of life, including questions related to the edentulous patients' satisfaction with their dentures, was collected. The response rate was 33% (N = 171). The study's findings confirm previous findings, suggesting that IODs may significantly impact oral health-related quality of life. Data show that 76% of the IOD group reported improvement in experience when using the implants to retain the mandibular denture. However, there were no statistically significant differences in the OHIP scores between overall CD and IOD patient groups. Males with IODs had lower physical pain, limitations, and disability scores than males with CD. However, females with IODs reported more significant concerns associated with a social disability and handicap domains. Comparing users who had experiences with both treatment options, this study discerned essential characteristics that contribute to increased patient satisfaction with IODs and identified significance in outcomes by gender. These findings guide prosthodontic practitioners' patient care practices and identify a continuing need to discuss CD and IOD treatment protocols within dental school curricula.

Community Oral Health Initiative: Driving value-based transformation in North Carolina.

CareQuest Institute for Oral Health's mission is to improve the oral health of all. One way to achieve this is through programmatic initiatives, which train dental clinics to provide equitable, integrated and accessible care for their communities. The Community Oral Health Transformation (COrHT) Initiative, allowed CareQuest Institute to collaborate with the North Carolina Oral Health Collaboration (NCOHC) and Blue Cross Blue Shield (BCBS) of North Carolina Foundation to implement and support the initiative in North Carolina. This mixed methods study was designed to collect quantitative and qualitative data while 11 dental clinics and a control clinic participated in the program through the end of the program. Quantitative data included patient demographics, claims data, and financial and data measures. Descriptive statistics of participating clinics and the control clinic were analyzed, and aggregated clinic data showed improvements in patient care delivery measures. Qualitative interviews were also conducted at midpoint and conclusion, and an outcome evaluation was completed. This short report will provide readers with results from the COrHT Initiative, with an emphasis on medical-dental integration (MDI) as an integral component of comprehensive, person-centered care. The evaluation of programmatic strengths and weaknesses has been included to identify the potential for future implementation, sustainability, and policy making.

Microbial Contamination of Dental Unit Waterlines among Dental Clinics of India- An In vitro Study.

BACKGROUND: Dental Unit Water Line (DUWL) deliver water to different handpieces in a dental unit. The water in DUWL circulates in a closed system, where it is taken from a container. The quality of dental water is of considerable importance since patients and dental staff are regularly exposed to water and aerosols generated from dental equipment. Output water from DUWLs may be a potential source of infection for both dental health care personnel and patients. AIM: To assess the microbial contamination in the DUWL among dental clinics in Chennai. MATERIALS AND METHODS: An in vitro study was conducted on 60 water samples from 20 dental clinics in Chennai in December 2019. Water samples were collected from three different sources of the Dental unit according to ADA guidelines. The collected samples were assessed for the presence of Aspergillus, Acinetobacter, Pseudomonas aeruginosa, and Legionella by agar plate method. The data were analysed using SPSS software version 20. RESULTS: Legionella was the most prevalent microorganism with 70% prevalence in a three-way syringe and 50% in scaler and airotor, followed by Pseudomonas aeruginosa and Acinetobacter with 10% prevalence in scaler and airotor and Aspergillus with a prevalence of 10% in the three-way syringe. CONCLUSION: Most of the dental units were contaminated with Aspergillus, Legionella, Pseudomonas aeruginosa and Acinetobacter which pose a serious threat to the patients as well as the dentists.

SARS-CoV-2 detection in pediatric dental clinic wastewater reflects the number of local COVID-19 cases in children under 10 years old.

This was the first longitudinal study to analyze dental clinic wastewater to estimate asymptomatic SARS-CoV-2 infection trends in children. We monitored wastewater over a 14-month period, spanning three major COVID-19 waves driven by the Alpha, Delta, and Omicron variants. Each Saturday, wastewater was sampled at the Pediatric Dental Clinic of the only dental hospital in Japan's Saitama Prefecture. The relationship between the weekly number of cases in Saitama Prefecture among residents aged < 10 years (exposure) and wastewater SARS-CoV-2 RNA detection (outcome) was examined. The number of cases was significantly associated with wastewater SARS-CoV-2 RNA positivity (risk ratio, 5.36; 95% confidence interval, 1.72-16.67; Fisher's exact test, p = 0.0005). A sample from Week 8 of 2022 harbored the Omicron variant. Compared to sporadic individual testing, this approach allows continuous population-level surveillance, which is less affected by healthcare seeking and test availability. Since wastewater from pediatric dental clinics originates from the oral cavities of asymptomatic children, such testing can provide important information regarding asymptomatic COVID-19 in children, complementing clinical pediatric data.

ERGONOMIC PRACTICE IN DENTAL CLINICS AND MUSCULOSKELETAL DISORDERS AMONG DENTISTS IN GEORGIA.

The dental profession is associated with occupational health problems. The working environment of a dentist is associated with ergonomic risk factors that can significantly reduce the dentist's working ability and even cause the termination of his/her professional activity. Numerous studies have been conducted in different countries (Sweden, Denmark, Germany, Poland, Australia, etc.) to assess the prevalence of musculoskeletal disorders in dentists, though no studies related to the principles of ergonomics in dentistry have been carried out in Georgia. The study aimed to assess the ergonomics of the working environment of dentists in Tbilisi (capital city of Georgia) clinics and to identify the prevalence of musculoskeletal disorders among them. An observational descriptive study was conducted in April-July 2023 in Tbilisi. A special questionnaire of 40 questions was designed based on international experience. The survey was conducted by random sampling in selected dental clinics. Dentists were asked to fill out the questionnaire during their free time between patient appointments. Those who agreed to participate were provided with electronic versions of the questionnaire. Five hundred dentists were invited to participate in the survey, of whom 314 (62.8%) agreed to fill out the questionnaire. A total of 291 fully completed questionnaires were used for the descriptive statistical analysis. Our study shows that in Tbilisi clinics dentists work on average for 5-6 days (48.8% - 6 days, 37.1% - 5 days) or 40-48 hours a week. A majority of respondents said their workplace met the requirements of ergonomics (it had a good lighting, the chair had a back, instruments could be easily reached), yet most of them rarely lean on the backrest, never or rarely use the hand rest method, and never or rarely do light physical exercise during breaks. The survey shows that 53.6% of dentists most frequently suffer from pain in the back, followed by pain in the neck (50.9%), shoulders (47.9%) and lower back (47.1%). Most of them said they had to work less because of the pain. Introduction of the principles of ergonomics in dental profession is vital for preventing occupational musculoskeletal disorders. It is important to provide continuing professional development programs and information booklets for dentists and thematic online webinars for the management of dental clinics in Georgia.

Retrospective assessment of an intentional interprofessional experiential education experience involving pharmacy students in a dental clinic.

BACKGROUND: Our objective was to create an intentional Interprofessional Education Experience (IEE) that satisfied the requirements set forth by the Center for the Advancement of Pharmacy Education (CAPE 2013), the Accreditation Council for Pharmacy Education (ACPE) Standard 11, and the Interprofessional Education Collaborative (IPEC) Competencies. These frameworks elevate the importance of interprofessional education in pharmacy. They not only guide educational standards but also emphasize the crucial role of collaborative healthcare practices in ensuring comprehensive patient care and improving health outcomes. Our evaluation of PharmD students' attainment of Interprofessional Education (IPE) learning outcomes employed both quantitative and qualitative assessment methods to provide a comprehensive understanding of their achievements. INTERPROFESSIONAL EDUCATION ACTIVITY: Fourteen PharmD students participated in an intentional IEE experience in a community dental clinic, collaborating with the dental clinic team and patients. Assessment methods combined quantitative data from SPICE-R2 with qualitative insights from daily reflections and an IPE Field Encounter based on IPEC Competencies. This approach ensured a thorough evaluation across individual experiences. DISCUSSION: Quantitative analysis revealed a statistically increase in mean scores for four out of ten questions on the SPICE-R2 instrument. Qualitative data analysis utilized grounded theory to analyze emerging themes. IMPLICATIONS: Employing both quantitative and qualitative assessment methods in this intentional IEE environment has proved beneficial in assessing IPE learning outcomes. The PharmD students were able to deliver patient-centered care as valuable members of an interprofessional healthcare team.

Traumatic dental injuries among children attending the public after-hours emergency dental clinic in Bergen, Norway.

OBJECTIVES: To investigate traumatic dental injuries (TDIs) among children who for 1 year attended a Norwegian public after-hours emergency public dental (EPD) clinic. MATERIALS AND METHODS: The study included 7-18-year-olds (n = 312) who presented at the EPD clinic, underwent a clinical dental examination, and consented to the disclosure of clinical information. Recording of TDIs was restricted to anterior permanent teeth. Potential TDI predictors were also analysed. RESULTS: Almost half (n = 148) of the children were assessed with TDIs in permanent teeth, showing a mean age of 11.0 (standard deviation [SD]: 3.5) years. Males constituted 54.7%. The children experienced TDIs often outside school hours (43.9%), and the majority (58.1%) were caused by falls/accidents. Sixty of them experienced only one TDI. The most common location was the maxillary central incisors. Assessment of TDIs according to severity, could only be done in 131 individuals, involving 253 TDIs. Of these, 81.8% were mild. The odds of visiting the emergency clinic for a TDI were higher (odds ratio [OR] = 2.64, confidence interval [CI]: 1.61-4.31) among children with previous TDIs and lower (OR = 0.28, CI: 0.12-0.68) among those with poor dental attendance. CONCLUSIONS: Traumatic dental injuries were a common reason for seeking emergency care. Milder injuries dominated and involved mostly one maxillary central incisor. Previous episodes of TDIs and attendance patterns seemed to be associated with seeking care for TDIs.

Implementation of a 4Ms approach in age-friendly oral health care at an Academic Specialty Care Dental Clinic.

BACKGROUND: Implementing the Age-Friendly Health System (AFHS) framework into dental care provides a significant opportunity to link oral health to healthy aging. This project aimed to implement the AFHS 4Ms (what matters, medications, mentation, and mobility) in the provision of oral health care. This article describes the planning, integration, training development, and outcome measurements supporting a 4Ms approach at an academic dental clinic. METHODS: The Eastman Institute for Oral Health (EIOH) implemented screening instruments based on the 4Ms framework recommended for ambulatory care clinics by the Institute for Health Care Improvement (IHI). These ambulatory instruments were integrated into the workflows of a Specialty Care Clinic through the development of a plan-do-study-act cycle, utilization of available clinic resources, and creation of interdisciplinary collaborations. RESULTS: This project demonstrated the feasibility of implementing an AFHS checklist and tracking forms in dental practice by integrating available resources and prioritizing the 4Ms elements. This effort necessitated interdisciplinary collaborations between dental, medical, and social service professionals. It also created a new age-friendly focused education and training curriculum for dental residents and faculty. CONCLUSIONS: This pilot project is the first to establish dental standards for AFHS implementation, adapting the 4Ms assessment and metrics to oral health. This AFHS underscores key oral health processes, including assessment, planning, and personalized oral health care, adapted to the unique needs of the older adult population, especially those with cognitive impairment.