Gestión de la calidad en el servicio de Ortodoncia / Orthodontic quality management service

RESUMEN Fundamento: Un sistema de gestión de calidad es una valiosa herramienta para perfeccionar los servicios de salud pública. Objetivo: Caracterizar el estado actual de la gestión de la calidad en el servicio de Ortodoncia para contribuir a una atención de calidad en pacientes con anomalías dentomaxilofaciales. Metodología: Se realizó un estudio descriptivo transversal entre septiembre de 2020 y julio de 2021 en la Clínica Estomatológica Docente Provincial de Sancti Spíritus. Se seleccionaron 3 directivos y 12 miembros del equipo básico de ortodoncia. Se midieron las variables: nivel de información y prácticas sobre gestión de la calidad. Se utilizaron métodos del nivel teórico, empírico y de la estadística descriptiva. Resultados: El 50 % de los miembros del equipo básico presentó un nivel bajo de información sobre la gestión de la calidad en el servicio de Ortodoncia. El 100 % de estos y sus directivos, mostraron prácticas medianamente adecuadas en tres de los cinco aspectos evaluados. Conclusiones: El proceso de gestión de la calidad en el servicio Ortodoncia permitió determinar que, aunque existen directivos con experiencia laboral y un equipo básico con preparación científico-técnica, predominaron con el nivel bajo de información, así como las prácticas medianamente adecuadas sobre la gestión de la calidad.

ABSTRACT Background: A quality management system is a valuable tool for improving public health services. Objective: To describe the current state of orthodontic quality management service to contribute to the patients' quality care with dentofacial abnormalities. Methodology: A descriptive cross-sectional study was conducted between September 2020 and July 2021 at the Sancti Spíritus provincial and teaching stomatology center. Three managers and 12 members of the basic orthodontic team were selected. The following variables were measured: level of information and quality management practices. Theoretical, empirical and descriptive statistical methods were used. Results: 50 % of the basic team members had a low level of information on the orthodontic quality management service. 100 % of them also their managers, showed moderately adequate practices in three of the five aspects evaluated. Conclusions: The orthodontic quality management service allowed us to determine that, although there are managers with work experience and a basic team with scientific-technical preparation, a low level of information prevailed, as well as moderately adequate practices on quality management.

Systemic Management of Pandemic Risks in Dental Practice: A Consolidated Framework for COVID-19 Control in Dentistry.

Dental teams and their workplaces are among the most exposed to airborne and bloodborne infectious agents, and therefore at the forefront of pandemic-related changes to how dental care is organized and provided to patients. The increasing complexity of guidelines makes is challenging for clinicians to navigate the multitude of COVID-19 guidelines issued by different agencies. A comparative analysis of guidance issued for managing COVID-19 in dental settings leading U.S. agencies was conducted, including documents of the Occupational Safety and Health Administration (OSHA), an agency of the U.S. Secretary of Labor, and of the U.S. Centers for Disease Prevention and Control (CDC), an agency of the U.S. Secretary of Health and Human Services. Details of infection control and other risk mitigation measures were reviewed for consistency, overlaps and similarities, then clustered according to thematic areas covering all domains of managing a dental healthcare setting. The analysis revealed five distinct areas of pandemic control, comprising (1) planning and protocols, (2) patient screening, (3) preparation of facilities, (4) PPE and infection control, and (5) procedures and aerosol control; thereby covering systematically all aspects requiring adaptation in a pandemic context. The "Pandemic-5 Framework for COVID-19 Control in Dentistry" provides an opportunity to simplify comprehensive decision-making from a clinical practitioner perspective. The framework supports a comprehensive systems-driven approach by using dental clinics as a setting to integrate pandemic clinical responses with the implementation of appropriate infection control protocols. Traditionally these two aspects are addressed independently from each other in separate concepts.

Dental workers in front-line of COVID-19: an in silico evaluation targeting their prevention

Abstract SARS-CoV-2 has high human-human transmission rate. The aerosols and saliva droplets are the main contamination source. Thus, it is crucial to point out that dental practitioners become a high-risk group of contagion by SARS-CoV-2. Based on this, protocols have been recommended to avoid cross-contamination during dental care; however, appropriate evidence has not yet been established. Objective Our study sought to make a screening, by in silico analysis, of the potential of mouth rinses used in dental practices to prevent the dental workers' contamination by SARS-CoV-2. Methodology Multiple sequence comparisons and construction of the phylogenetic tree were conducted using the FASTA code. Therefore, molecular docking investigation between SARS-CoV-2 proteins (Main Protease, Spike Glycoprotein, Non-structure Protein, and Papain-like Protease) and molecules used in dental practices (chlorhexidine digluconate, hydrogen peroxide, cetylpyridinium chloride, povidone-iodine, gallic acid, β-cyclodextrin, catechin, and quercetin) was performed using AutoDock Vina. Moreover, 2D interactions of the complex protein-ligand structure were analyzed by Ligplot+. Results The obtained results showed a remarkable affinity between SARS-CoV-2 proteins and all tested compounds. The chlorhexidine digluconate, catechin, and quercetin presented a higher affinity with SARS-CoV-2. Conclusions The overall results allowed us to suggest that chlorhexidine is the most suitable active compound in reducing the SARS-CoV-2 salivary load due to its better binding energy. However, in vivo studies should be conducted to confirm their clinical use.

Head and neck cancer therapy-related oral manifestation management in the COVID-19 pandemic: a critical review

Abstract With the onset of the new coronavirus disease (COVID-19) pandemic, the dental treatment of patients at risk of infection has become quite challenging. In view of this, patients with head and neck cancer may present with oral complications due to anticancer therapy, making dental assistance necessary. Thus, the objective of the study was to review the literature and critically discuss important concerns about the treatment of patients with head and neck cancer during the COVID-19 pandemic. Because dental professionals are in close contact with the main viral transmission routes, this study presents recommendations for management and protection during clinical dental care. The main characteristics and transmission routes of COVID-19 are also discussed. Dental professionals should control pain and the side effects of antineoplastic treatment and use preventive measures for infection control. During this pandemic, patients with head and neck cancer should not undergo elective procedures, even if they do not have symptoms or a history of COVID-19; therefore, in asymptomatic or painless cases, only preventive actions are recommended. In symptomatic or painful cases, precautions for safe interventional treatments must be implemented by following the hygiene measures recommended by health agencies and using personal protective equipment. During health crises, new protocols emerge for cancer treatment, and professionals must act with greater attention toward biosafety and updated knowledge. It is important to offer adequate individualized treatment based on the recommendations of preventative and interventional treatments so that patients can face this difficult period with optimized quality of life.

Biological and social aspects of Coronavirus Disease 2019 (COVID-19) related to oral health

Abstract The expansion of coronavirus disease 2019 (COVID-19) throughout the world has alarmed all health professionals. Especially in dentistry, there is a growing concern due to it's high virulence and routes of transmission through saliva aerosols. The virus keeps viable on air for at least 3 hours and on plastic and stainless-steel surfaces up to 72 hours. In this sense, dental offices, both in the public and private sectors, are high-risk settings of cross infection among patients, dentists and health professionals in the clinical environment (including hospital's intensive dental care facilities). This manuscript aims to compile current available evidence on prevention strategies for dental professionals. Besides, we briefly describe promising treatment strategies recognized until this moment. The purpose is to clarify dental practitioners about the virus history and microbiology, besides guiding on how to proceed during emergency consultations based on international documents. Dentists should consider that a substantial number of individuals (including children) who do not show any signs and symptoms of COVID-19 may be infected and can disseminate the virus. Currently, there is no effective treatment and fast diagnosis is still a challenge. All elective dental treatments and non-essential procedures should be postponed, keeping only urgent and emergency visits to the dental office. The use of teledentistry (phone calls, text messages) is a very promising tool to keep contact with the patient without being at risk of infection.

Comparative Analysis of User-Generated Online Yelp Reviews for Periodontal Practices in Multiple Metropolitan Markets.

BACKGROUND: Previously published research for a single metropolitan market (Austin, Texas) found that periodontists fare poorly on the Yelp website for nearly all measured metrics, including average star ratings, number of reviews, review removal rate, and evaluations by "elite" Yelp users. The purpose of the current study is to confirm or refute these findings by expanding datasets to additional metropolitan markets of various sizes and geographic locations. METHODS: A total of 6,559 Yelp reviews were examined for general dentists, endodontists, pediatric dentists, oral surgeons, orthodontists, and periodontists in small (Austin, Texas), medium (Seattle, Washington), and large (New York City, New York) metropolitan markets. Numerous review characteristics were evaluated, including: 1) total number of reviews; 2) average star rating; 3) review filtering rate; and 4) number of reviews by Yelp members with elite status. Results were compared in multiple ways to determine whether statistically significant differences existed. RESULTS: In all metropolitan markets, periodontists were outperformed by all other dental specialties for all measured Yelp metrics in this study. Intermetropolitan comparisons of periodontal practices showed no statistically significant differences. CONCLUSIONS: Periodontists were outperformed consistently by all other dental specialties in every measured metric on the Yelp website. These results were consistent and repeated in all three metropolitan markets evaluated in this study. Poor performance of periodontists on Yelp may be related to the age profile of patients in the typical periodontal practice. This may result in inadvertently biased filtering of periodontal reviews and subsequently poor performance in multiple other categories.