The effect of comprehensive oral care program on oral health and quality of life in patients undergoing radiotherapy for head and neck cancer: A quasi-experimental case-control study.

OBJECTIVES: The purpose of this study is to investigate the effect of the comprehensive oral care program on oral health status and symptoms in head and neck cancer (HNC) patients undergoing radiotherapy. METHODS: This was a quasi-experimental study using a non-equivalent control group in non-synchronized design. All participants including control and experimental group were asked for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire H&N35 (EORTC QLQ-H&N35) and given an oral health education 4 times at baseline, immediate postradiotherapy, 3 months after radiotherapy, and 6 months after radiotherapy. In each visit except for final, the experimental group was given fluoride varnish application and fluoride mouth rinsing solution for daily use. Oral health examination for dental caries, plaque score (PS), bleeding on probing (BOP), and salivary flow rate was performed in baseline and 6 months after radiotherapy. Statistical analyses were done by paired t-tests and mixed ANCOVA repeated-measures analysis. RESULTS: From November 1, 2013 to October 31, 2015, a total 61 patients undergoing radiotherapy for HNC cancer were enrolled (30 in control and 31 in experimental groups). Decrease in salivary flow rate was comparable between 2 groups. Dental caries increased in control group (P = .006); PS and BOP were decreased in experimental group (P < .001 and .004, respectively). Experimental group showed lower swallowing, speech problems, and less sexuality scores in EORTC QLQ-H&N35 than control group. CONCLUSION: We found improvement in oral health and the quality of life in HNC patients with comprehensive oral care intervention by dental professionals. Communicating and cooperating between the healthcare and dental professionals is needed to raise the quality of health care services for HNC patients receiving radiotherapy.

Atención odontológica a personas con discapacidad intelectual: una cuestión de derecho / Dental care for people with intellectual disabilities: a matter of law

En el planeta hay 100 millones de personas con alguna discapacidad yen México es el 6.2 por ciento de la población total. Estas personas son altamente vulnerables porque el entorno donde se desenvuelven no ofrece las condiciones para favorecer su integración y participación social, como el acceso a servicios médicos. De acuerdo con la Organización Mundialde la Salud, las personas con discapacidad son las menos atendidas en los Servicios Odontológicos, principalmente por inexperiencia del profesionista sobre el trato a estas personas, o bien por desconocimiento de los familiares-cuidadores de la importancia de mantener una boca sana. Las personas con discapacidad intelectual (PDI) constituyen un retopara el odontólogo, quien tiene que capacitarse para diseñar estrategiaspara su atención, ya que los tratamientos para este tipo de pacientes son específicos y poco convencionales. Adicionalmente conviene tomar precauciones en su atención dental, debido a que los PDI consumen diversos medicamentos, por lo que el odontólogo debe asegurarsecon otros especialistas para su manejo. Un punto medular sobre las características de la atención odontológica es que ésta tiene que generar confianza y enfrentar con paciencia y destreza a un PDI que cumpla con las expectativas del usuario, trato digno, calidez y confianza centrada en la prevención como principal criterio en la intervención odontológica, sobre todo en la supervisión de la higiene por parte de los familiares. Actualmente se habla de la relación médico-paciente participativa donde se define lo que corresponde a cada persona involucrada en el cuidado de la PDI, sin olvidar que esta atención conviene que sea en equipo. Así, ante este contexto, los odontólogos tendrían que formarseen el cuidado de la salud de las PDI quienes son sujetos de derecho,por tanto tienen que ser atendidos, respetados y tratados con dignidad.

On the planet, there are 100 million people with some disability andin Mexico; it is 6.2% of the total population. These people are highly vulnerable because the environment where they operate does not offer the conditions to favor their integration and social participation, such as access to medical services. According to the World Health Organization, people with disabilities are the least attended in the dental services, mainly because of the inexperience of the professional about the treatment of these people, or because the family/caregivers do notknow about the importance of maintaining a healthy mouth. People with intellectual disabilities (PIDs) are a challenge for the dentist,who has to be trained to design strategies for their care since the treatments for these types of patients are specific and unconventional.In addition, precautions should be taken in dental care, because PIDsconsume different medications, so the dentist must be sure with other specialists to handle them. A central point about the characteristicsof dental care is that it has to generate trust and face with patience and dexterity a PDIs that meets user expectations, dignified treatment, warmth, and confidence focused on prevention as the main criterion inthe intervention dental care, especially in the supervision of the hygieneby the relatives. At the moment we are talking about the participative doctor-patient relationship where it is defined that corresponds to eachperson involved in the care of the PDIs, without forgetting that this careshould be in a team. Thus in this context dentists should be trained inthe health care of the IDPs who are subjects of law, therefore have tobe attended, respected and treated with dignity.

Design and Outcomes of a Comprehensive Care Experience Level System to Evaluate and Monitor Dental Students' Clinical Progress.

A Comprehensive Care Experience Level (CCEL) system that is aligned with Commission on Dental Accreditation (CODA) standards, promotes comprehensive care and prevention, and addresses flaws observed in previous Relative Value Units (RVU)-based programs has been implemented at the School of Dental Medicine, Case Western Reserve University since 2011. The purpose of this article is to report on the design, implementation, and preliminary outcomes of this novel clinical evaluation system. With the development of the CCEL concept, it was decided not to award points for procedures performed on competency exams. The reason behind this decision was that exams are not learning opportunities and are evaluated with summative tools. To determine reasonable alternative requirements, production data from previous classes were gathered and translated into CCEL points. These RVU points had been granted selectively only for restorative procedures completed after the initial preparation stage of the treatment plan, and achievement of the required levels was checked at multiple points during the clinical curriculum. Results of the CCEL system showed that low performing students increased their productivity, overall production at graduation increased significantly, and fluoride utilization to prevent caries rose by an order of magnitude over the RVU system. The CCEL program also allowed early identification and remediation of students having difficulty in the clinic. This successful implementation suggests that the CCEL concept has the potential for widespread adoption by dental schools. This method also can be used as a behavior modification tool to achieve specific patient care or clinical educational goals as illustrated by the way caries prevention was promoted through the program.

La odontología restauradora integral y la estética / Comprehensive restorative dentistry and esthetics

La planificación es una de las etapas más importantes del tratamiento y también una de las más difíciles. Si lo hacemos de manera específica, parcial y no integral, no vamos a avanzar ni a terminarlo correctamente. Además, es preciso cumplir con las expectativas de los pacientes, quienes buscan restauraciones permanentes que duren toda la vida. Si tenemos en cuenta los estudios clínicos de cualquier tipo de tratamiento, veremos que la tasa de supervivencia a largo plazo nunca es del 100 por ciento. El plan de tratamiento es la base del éxito de la rehabilitación. Después de haber almacenado los datos necesarios de forma integral, el profesional tiene la capacidad de ejecutar un plan de trabajo en detalle, lo cual puede facilitar el desarrollo de las actuaciones y dar lugar a un tratamiento exitoso.

Comprehensive Oral Health Care to Reduce the Incidence of Severe Early Childhood Caries (s-ECC) in Urban China.

OBJECTIVE: To explore the effectiveness of comprehensive oral health care to reduce the caries incidence for children with severe early childhood caries (s-ECC) in an urban area in China. METHODS: A total of 357 children aged 3 to 4 years old and diagnosed with s-ECC were recruited in this randomised controlled, single-blinded clinical trial for 1 year. Children of two different kindergarten classes were enrolled in this study and randomly divided into a test group (205 children) and a control group (152 children). The test group received comprehensive oral health care, which included: oral health examination, oral health education, topical fluoride application and dental treatment, and the children in the control group only received the oral health examination. The evaluation of the oral health questionnaire for parents was also performed. An evaluation was carried out at the time of recruitment and 1 year later to explore the effectiveness of the comprehensive oral health care model. RESULTS: The differences in decayed teeth (dt), decayed tooth surfaces (ds), filled teeth (ft), filled tooth surfaces (fs) and the ratio of ft /(dt + ft) between the two groups were statistically significant (P < 0.001) at 1 year. The incidence of caries in the control group was higher than that of the test group (P = 0.02). The rate of awareness of oral health knowledge (P = 0.01) and the practice of good diet habits (P = 0.02) by parents in the test group were significantly higher than those in the control group. CONCLUSION: The present study demonstrated that the comprehensive oral health care program reduces and prevents caries amongst children with s-ECC.

Tratamiento interdisciplinario en la resolución de un caso clínico / Interdisciplinary treatment for the resolution of a clinical case

La resolución del caso clínico presentado, demuestra la importancia de la prevención como objetivo de toda acción odontológica. Los datos obtenidos a través de la anamnesis de la paciente tratada (hábito de succión del pulgar, antecedentes familiares, tabaquismo) no dejan lugar a dudas de cómo las anomalías que motivaron la consulta fueron consecuencias directas de este hábito que trajo aparejado, además, severos problemas periodontales, estéticos y funcionales asociados entre sí. La resolución obtenida debe ser considerada como bastante buena en relación al complejo problema que presentaba el caso clínico. El trabajo realizado fue muy valorado por el paciente y trajo como consecuencia una mejoría no solamente en su salud bucal, sino también en su bienestar personal y anímico. El enfoque multidisciplinario, por otra parte, permite la integración de varias ramas de nuestra profesión y los avances logrados en rehabilitación con el trabajo mancomunado de la ortodoncia, cirugía y la prótesis, brindan la posibilidad de resolver casos complejos, lo que hasta hace un tiempo era impensado. Queremos resaltar que la atención precoz de los pacientes, ya sea desde el punto de vista ortopédico-ortodóncico como desde el punto de vista periodontal, tendría que ser un objetivo primordial en nuestra salud. Este caso resume varios problemas odontológicos que podrían haberse resuelto solamente con prevención y atención precoz...

[Comprehensive dental treatment under general anaesthesia: implementation among patients with mouth opening limitation].

Patients unable to tolerate routine dental treatment in an ordinary dental setting may undergo a wide range of dental procedures under general anaesthesia. This report describes a practical protocol for providing comprehensive dental treatment under general anaesthesia. The importance and uniqueness of planning, treating and adopting safety measures is illustrated through the presentation of clinical cases of patients with mouth opening limitation. Complete treatment can thus be achieved in a single visit, thereby eliminating repetition of coping with anxiety associated with repeated treatment sessions.

Restorative dentistry productivity of senior students engaged in comprehensive care.

In dental education, various clinical delivery models are used to educate dental students. The quantitative and qualitative measures used to assess the outcomes of these models are varied. Georgia Health Sciences University College of Dental Medicine has adopted a version of a general dentistry comprehensive care dental education hybrid model. Outcome assessments were developed to evaluate the effectiveness of this delivery model. The aim of this study was to compare the number of restorative procedures performed by senior dental students under a discipline-based model versus senior student productivity engaged in comprehensive care as part of a hybrid model. The rate of senior students' productivity in performing various restorative procedures was tracked over four years, and a comparison was made. In the first two years, the seniors operated in a discipline-based model, while in the last two years the seniors operated in a comprehensive care hybrid model. The results showed that there was a significant increase in productivity by the students in terms of direct and indirect restorations. This increase in productivity may indicate that the comprehensive care model may be a more productive model, thereby enhancing clinical experiences for the students, improving operating efficiency for the schools, and ultimately increasing clinical income.

Estomatología en Cuba y su encargo social / The Cuban dentistry and its social responsibility

Encargo social es la responsabilidad de actuar en beneficio del bien público, la preocupación por satisfacerlo ha sido visible en la Estomatología cubana a partir de 1959 en que se inicia una etapa para la profesión que resalta por su accesibilidad, gratuidad y cobertura a toda la población, incluidas las comunidades más aisladas. La salud bucal de la población cubana ha mejorado considerablemente a nivel nacional, a consecuencia de ser considerada entre las áreas prioritarias del Ministerio de Salud Pública y a su conducción programática adecuada, acorde además a la situación de cada momento. El primer programa emprendido en los años 60, dio paso en los 80, a los programas orientados a grupos de población específicos como los menores de 15 años, adultos, población con retraso mental y al dirigido a la prevención precoz del cáncer bucal. Luego, para responder al modelo de atención de medicina familiar y satisfacer los nuevos requerimientos de la atención primaria de salud, los programas específicos se integraron en el Programa Nacional de Atención Estomatológica Integral en el año 1992, el que fuera revisado en el 2002 y en el 2009; en esta ocasión, en respuesta a la reorganización, las proyecciones para el 2015 y la incorporación de nuevos profesionales en la atención estomatológica, egresados de la Licenciatura en Tecnología de la Salud en los perfiles de atención estomatológica y prótesis dental...(AU)

Oral health in Brazil: the challenges for dental health care models.

This paper discusses adult oral health in Brazil according to three perspectives: 1) the available epidemiological evidence about the population's oral-health-related epidemiological situation, especially adults and the elderly population, in relation to two high prevalence oral injuries (dental caries and tooth loss), 2) the main health care models for dealing with this situation, by analyzing the related historical processes in order to reveal the likely social, political and epidemiological implications of the different models, and 3) lastly, the possible challenges to Brazilian dentistry or collective oral health in overcoming these obstacles. The main results of the study indicate that, from an epidemiological point of view, Brazil is undergoing a transition in dental caries and tooth loss, which is not yet reflected in the profile of the elderly, but which is tentatively evidenced in young adults. Tooth loss remains high. Certain aspects of society's economic and political superstructure have an important impact on oral health indicators and existing inequalities. Oral health care models have a relative importance and must not be neglected. Vestiges of ideological movements, like preventive medicine, may explain the current impasse in collective oral health practices, such as the preeminence of Finalized Treatment (FT) in clinics and of preventive care in schools fostered by community-based programs. It is therefore important to develop conceptual, theoretical reflections and to increase the objects of intervention, their purposes and their modus operandi. The practice of dentistry according to these alternative models is still being constructed. New studies related to the different formats of these new practices are recommended.

Oral health in Brazil: the challenges for dental health care models

This paper discusses adult oral health in Brazil according to three perspectives: 1) the available epidemiological evidence about the population's oral-health-related epidemiological situation, especially adults and the elderly population, in relation to two high prevalence oral injuries (dental caries and tooth loss), 2) the main health care models for dealing with this situation, by analyzing the related historical processes in order to reveal the likely social, political and epidemiological implications of the different models, and 3) lastly, the possible challenges to Brazilian dentistry or collective oral health in overcoming these obstacles. The main results of the study indicate that, from an epidemiological point of view, Brazil is undergoing a transition in dental caries and tooth loss, which is not yet reflected in the profile of the elderly, but which is tentatively evidenced in young adults. Tooth loss remains high. Certain aspects of society's economic and political superstructure have an important impact on oral health indicators and existing inequalities. Oral health care models have a relative importance and must not be neglected. Vestiges of ideological movements, like preventive medicine, may explain the current impasse in collective oral health practices, such as the preeminence of Finalized Treatment (FT) in clinics and of preventive care in schools fostered by community-based programs. It is therefore important to develop conceptual, theoretical reflections and to increase the objects of intervention, their purposes and their modus operandi. The practice of dentistry according to these alternative models is still being constructed. New studies related to the different formats of these new practices are recommended.