Translating periodontal data to knowledge in a learning health system.

BACKGROUND: A learning health system (LHS) is a health system in which patients and clinicians work together to choose care on the basis of best evidence and to drive discovery as a natural outgrowth of every clinical encounter to ensure the right care at the right time. An LHS for dentistry is now feasible, as an increased number of oral health care encounters are captured in electronic health records (EHRs). METHODS: The authors used EHRs data to track periodontal health outcomes at 3 large dental institutions. The 2 outcomes of interest were a new periodontitis case (for patients who had not received a diagnosis of periodontitis previously) and tooth loss due to progression of periodontal disease. RESULTS: The authors assessed a total of 494,272 examinations (new periodontitis outcome: n = 168,442; new tooth loss outcome: n = 325,830), representing a total of 194,984 patients. Dynamic dashboards displaying performance on both measures over time allow users to compare demographic and risk factors for patients. The incidence of new periodontitis and tooth loss was 4.3% and 1.2%, respectively. CONCLUSIONS: Periodontal disease, diagnosis, prevention, and treatment are particularly well suited for an LHS model. The results showed the feasibility of automated extraction and interpretation of critical data elements from the EHRs. The 2 outcome measures are being implemented as part of a dental LHS. The authors are using this knowledge to target the main drivers of poorer periodontal outcomes in a specific patient population, and they continue to use clinical health data for the purpose of learning and improvement. PRACTICAL IMPLICATIONS: Dental institutions of any size can conduct contemporaneous self-evaluation and immediately implement targeted strategies to improve oral health outcomes.

Current state of dental informatics in the field of health information systems: a scoping review.

BACKGROUND: Over the past 50 years, dental informatics has developed significantly in the field of health information systems. Accordingly, several studies have been conducted on standardized clinical coding systems, data capture, and clinical data reuse in dentistry. METHODS: Based on the definition of health information systems, the literature search was divided into three specific sub-searches: "standardized clinical coding systems," "data capture," and "reuse of routine patient care data." PubMed and Web of Science were searched for peer-reviewed articles. The review was conducted following the PRISMA-ScR protocol. RESULTS: A total of 44 articles were identified for inclusion in the review. Of these, 15 were related to "standardized clinical coding systems," 15 to "data capture," and 14 to "reuse of routine patient care data." Articles related to standardized clinical coding systems focused on the design and/or development of proposed systems, on their evaluation and validation, on their adoption in academic settings, and on user perception. Articles related to data capture addressed the issue of data completeness, evaluated user interfaces and workflow integration, and proposed technical solutions. Finally, articles related to reuse of routine patient care data focused on clinical decision support systems centered on patient care, institutional or population-based health monitoring support systems, and clinical research. CONCLUSIONS: While the development of health information systems, and especially standardized clinical coding systems, has led to significant progress in research and quality measures, most reviewed articles were published in the US. Clinical decision support systems that reuse EDR data have been little studied. Likewise, few studies have examined the working environment of dental practitioners or the pedagogical value of using health information systems in dentistry.

The Development of Dental Informatics of Oral Cancer Screening for Prevention in Community Level: A Prototype Study in Thailand.

OBJECTIVE: The purpose of this study is to identify general dentists' information needs for oral cancer screening in community and the information sources they use to meet those needs in clinical settings so as to inform the design of dental information systems. METHODS: A semi-structured interview was conducted with a convenience sample of 8 general dentists and 5 dental assistant in the Public Health Region 9 area during clinical hours. One hundred and five patient cases were reported by these dentists. Interview transcripts were coded and analyzed using thematic analysis with a constant comparative method to identify categories and themes regarding information needs and information source use patterns. RESULTS: Two top-level categories of information needs were identified: foreground and background information needs. To meet these needs, dentists used four types of information sources: clinical information/tasks, risk factor of oral cancer in general people, surveillance in community and referral to oral cancer treatment. Major themes of dentists' unmet information needs include: (1) timely access to information on various subjects; (2) better visual representations of dental problems; (3) access to patient-specific evidence-based information; and (4) accurate, complete and consistent documentation of patient records. Resource use patterns include: (1) dentists information needs matched information source use; (2) little use of electronic sources took place during treatment; (3) source use depended on the nature and complexity of the dental problems; and (4) dentists and dental nurse routinely practiced cross-referencing to verify patient information. CONCLUSIONS: Dentists have various information needs of oral cancer at the point of care. For future development of dental information or clinical decision support systems, developers should consider integrating high-quality, up-to-date clinical evidence into comprehensive and easily accessible EDRs as well as supporting dentists' resource use patterns as identified in the study.

El acceso digital a la bibliografía científica / Digital access to scientific literature

Se considera la importancia del acceso digital a la bibliografía necesaria para la formación profesional y sus principales herramientas: revistas de publicación únicamente electrónica y acceso a bases de datos como BIREME, SciELO y PubMed. Se analizan los fundamentos del movimiento hacia el acceso abierto de las publicaciones de trabajos de investigación, sus motivaciones, ventajas y consecuencias positivas y negativas (AU)

The importance of digital access to the necessary scientific literature that is a must for professional training is considered. The most useful tools are on line only journals and access to databases such as BIREME, SciELO and PubMed. The trend towards the Open Access to research publications, its motivations, advantages and positive and negative consequences are analyzed (AU)

Glossary of Oral and Maxillofacial Implants.

No abstract available.

Study and analysis of information technology in dentistry in Latin American countries.

Dentistry increasingly uses Information and Communication Technology (ICT), which has impact on teaching, research, the profession and dental care in general. However, there is a lack of valid information on ICT resources and use in Latin America. This was a descriptive, cross-sectional, multi-center, interdisciplinary study, the aim of which was to conduct a survey on how extensively ICT is used in Dentistry in Latin American countries by enquiring into two primary components: 1) use of ICT in student training and 2) use of ICT by professionals in consulting rooms and services. Two questionnaires on ICT were prepared: one for teachers/researchers and another for students/professionals. We received 94 answers from teachers/researchers at universities in the region providing information on ICT resources for teaching (type and implementation) and 221 answers from professionals (personal use and use in healthcare). Data are presented as absolute relative frequencies and analyzed quantitatively as percentages. RESULTS: 1) Teachers highlight ICT as an instrument for development, democratization and fairness in access to knowledge for higher education. 2) ICT supports collaborative learning and generates other innovative resources (e.g. simulators). 3) Innovations in telemedicine and experiences with electronic clinical history were identified in Brazil, Uruguay and Colombia. These results are a basis upon which to reach a consensus regarding a set of ICT indicators which are comparable at regional level and serve as input to unify the design and implementation of ICTs experiences in both teaching and dental care in Latin America.

La Odontología utiliza en forma creciente las Tecnologías de la Información y la Comunicación (TIC) impactando en la enseñanza, la investigación, la profesión y la atención odontológica en general. Sin embargo, no se cuenta con información válida sobre los recursos e utilización de las TIC en latinoamérica. La investigación representó un estudio descriptivo, de corte transversal, multicéntrico e interdisciplinario, cuyo objetivo fue realizar un relevamiento del grado de informatización en Odontología en países latinoamericanos indagando dos componentes principales en el empleo de las TIC: 1) en la formación de estudiantes y 2) por parte de los profesionales en consultorios y servicios. Se realizaron cuestionarios a referentes TIC: uno para docentes/investigadores y otro para estudiantes/profesionales. Se recibieron 94 respuestas de docentes/investigadores de universidades de la región dando cuenta de los recursos TIC para la enseñanza (tipo e implementación) y 221 de profesionales (personal y en la asistencia clínica). Los datos recogidos fueron analizados cuantitativamente con tabulación en porcentaje y se presentan en frecuencia relativa absoluta. Resultados: 1) Los docentes enfatizan a las TIC como instrumento de desarrollo, democra tiza ción y equidad en el acceso al conocimiento en educación superior. 2) Las TIC apoyan el aprendizaje colaborativo y generan otros recursos innovadores (ej: simuladores). 3) Se identificaron innovaciones en telemedicina y experiencias con historia clínica electrónica en Brasil, Uruguay y Colombia. Los resultados constituyen una base para consensuar un conjunto de indicadores TIC comparables a nivel regional y sirven como insumo para unificar el diseño e implementación de las experiencias TIC tanto en enseñanza como en la asistencia odontológica en Latinoamérica.

Aplicações da impressão 3D na Ortodontia e Cirurgia bucomaxilofacial / Applications of 3D printing technology in Orthodontics and Oral and Maxillofacial Surgery

Ao longo da última década, avanços na prototipagem rápida vêm acontecendo, resultando no desenvolvimento de novas técnicas e abordagens. É o resultado de tecnologias de fabricação em 3D, como a estereolitografia (SLA), modelagem fundida (FDM) e, mais recentemente, a sinterização seletiva a laser (SLS). Entre suas aplicações, os guias cirúrgicos são gerados via computador e posteriormente fabricados por uma impressora 3D, sendo utilizado durante a cirurgia, possibilitando assim, posicionar de forma precisa os segmentos ósseos. A prototipagem também pode ser usada associada à tecnologia CAD/CAM (desenho assistido por computador) na Ortodontia, para personalizar a posição de braquetes e preparar guias personalizados para colagem ortodôntica indireta. Também, pode ser aplicada na customização e fabricação da aparatologia ortodôntica, através da fusão de imagens de modelos 3D. É notório que cada vez mais a prototipagem rápida vai se tornar uma rotina no dia a dia do ortodontista e do cirurgião, pois facilitam sobremaneira os procedimentos clínicos e possibilitam ao profissional ter maior previsibilidade dos seus resultados.

During the last decade, advances in rapid prototyping have resulted in the development of new techniques and approaches including 3D manufacturing technologies such as stereolithography (SLA), molten modeling (FDM), and more recently, selective laser sintering (SLS). Among its applications, the surgical guides are computer-generated, and then manufactured by a 3D printer for use during surgery, thus enabling precisely positioning of bone segments. Prototyping can be also used with CAD/CAM technology (computer aided design) in orthodontic brackets to customize its position and prepare customized guides for indirect orthodontic bonding. It’s also applied for customization and manufacturing of orthodontic appliance by the 3D model image fusion. It is clear that rapid prototyping will become a routine for the orthodontist and surgeon. It will facilitate the clinical procedures in such a way that professionals with have more predictable outcomes.

Prontuário eletrônico do paciente: mapeamento dos fluxos de trabalho / Electronic patient record: mapping workflows

OBJETIVO: mapear os fluxos de trabalho (processos) da FO-UFG relativos ao atendimento ao paciente, incluindo aspectos administrativos, atendimento clínico, ensino, pesquisa e extensão, identificando onde e quais recursos computacionais seriam introduzidos. MÉTODO: Entrevistas exploratórias/ouvidoria com informantes-chave foram realizadas. Essas informações foram registradas utilizando a notação BPMN (Bussines Process Modeling Notation). RESULTADOS: Foram obtidos 15 fluxos de trabalho, distribuídos em 4 categorias: disponibilização de vagas, agendamento, movimentação de prontuários e faturamento. Três módulos de um sistema computacional do Hospital das Clínicas-UFG foram adaptados e utilizados para otimizar a realização dos fluxos mapeados, bem como o sistema de regulação da Secretaria Municipal de Saúde de Goiânia-GO. CONCLUSÃO: Apesar da incipiente implementação desses processos não permitir uma avaliação dos impactos, acreditamos num aprimoramento da gestão da informação, integração com SUS, melhoria da qualidade da assistência à saúde e reorientação da formação do estudante da FO-UFG, segundo as Diretrizes Curriculares Nacionais.

OBJECTIVE: to map the workflows (processes) of the FO-UFG relating to patient care, including administrative aspects, clinical care, teaching, research and extension, identifying where and what computer resources would be introduced. METLHOD: Exploratory interviews / ombudsman with key informants was held. These data were recordedusing BPMN (Bussines Process Modeling Notation). RESULTS: We obtained 15 workflows, distributed in four categories: availability of jobs, scheduling, handling of patient records and billing. Three modules of a computer system at the Hospital das Clinicas-UFG have been adapted and used to optimize the performance of flows mapped, and the systemof regulation of the Secretariat of Health of Goiânia-GO. CONCLUSION: Despite the incipient implementation of these processes do not allow an assessment of impacts, we believe in improvement of information management, integration with SUS, improving the quality of health care, reorientation of the educational experience of the FO-UFG, accordingto National Curriculum Guidelines.

Study and analysis of information technology in dentistry in Latin American countries / Estudio y análisis de la informática odontológica en países de Latinoamérica

Dentistry increasingly uses Information and CommunicationTechnology (ICT), which has impact on teaching, research, the profession and dental care in general. However, there is alack of valid information on ICT resources and use in LatinAmerica. This was a descriptive, cross-sectional, multi-center,interdisciplinary study, the aim of which was to conduct asurvey on how extensively ICT is used in Dentistry in LatinAmerican countries by enquiring into two primary components:1) use of ICT in student training and 2) use of ICT by professionalsin consulting rooms and services. Two questionnaires on ICTwere prepared: one for teachers/researchers and another for students/professionals. We received 94 answers fromteachers/researchers at universities in the region providinginformation on ICT resources for teaching (type andimplementation) and 221 answers from professionals (personaluse and use in healthcare). Data are presented as absoluterelative frequencies and analyzed quantitatively as percentages.Results: 1) Teachers highlight ICT as an instrument fordevelopment, democratization and fairness in access toknowledge for higher education. 2) ICT supports collaborativelearning and generates other innovative resources (e.g.simulators). 3) Innovations in telemedicine and experienceswith electronic clinical history were identified in Brazil,Uruguay and Colombia. These results are a basis upon whichto reach a consensus regarding a set of ICT indicators whichare comparable at regional level and serve as input to unifythe design and implementation of ICTs experiences in bothteaching and dental care in Latin America.

La Odontología utiliza en forma creciente las Tecnologías de la Información y la Comunicación (TIC) impactando en la enseñanza, la investigación, la profesión y la atenciónodontológica en general. Sin embargo, no se cuenta con información válida sobre los recursos e utilización de las TIC en latinoamérica. La investigación representó un estudio descriptivo, de corte transversal, multicéntrico e interdisciplinario, cuyo objetivo fue realizar un relevamiento del gradode informatización en Odontología en países latinoamericanos indagando dos componentes principales en el empleo de las TIC: 1) en la formación de estudiantes y 2) por parte de losprofesionales en consultorios y servicios. Se realizaron cuestionarios a referentes TIC: uno para docentes/investigadores y otro para estudiantes /profesionales. Se recibieron 94 respuestas de docentes /investigadores de universidades de la región dando cuenta de los recursos TIC para la enseñanza (tipo e implementación) y 221 de profesionales (personal y en la asistencia clínica). Los datos recogidos fueron analizados cuantitativamente con tabulación en porcentaje y se presentan en frecuencia relativa absoluta. Resultados: 1) Los docentes enfatizan a las TIC como instrumento de desarrollo, democra tiza ción y equidad en el acceso al conocimiento en educación superior. 2) Las TIC apoyan el aprendizaje colaborativo y generan otros recursos innovadores (ej: simuladores). 3) Se identificaron innovaciones en telemedicina y experiencias con historia clínica electrónica en Brasil, Uruguay y Colombia. Los resultados constituyenuna base para consensuar un conjunto de indicadores TIC comparables a nivel regional y sirven como insumo paraunificar el diseño e implementación de las experiencias TIC tanto en enseñanza como en la asistencia odontológica enLatinoamérica.

Consultório hi-tech. Tecnologias não odontológicas no consultório ortodôntico / High-tech office: no dental technologies in orthodontic office

Diante da grande oferta de ortodontistas no mercado, a diferenciação é almejada por todos. Essa diferenciação passa por altas cargas horárias em cursos de especialização e atualização, até a estruturação e design do consultório. A modernização dos processos internos da clínica pode reduzir o tempo gasto com atividades repetitivas, além de auxiliar no marketing positivo. No entanto, a aquisição de equipamentos tecnológicos sem o adequado planejamento pode gerar custos extras sem o retorno esperado, uma vez que toda mudança requer comprometimento e motivação da equipe. Muitos serviços estão disponíveis na internet para ajudar na melhoria dos serviços prestados e automatização das atividades. Desta forma, este artigo objetivou apresentar alguns desses serviços, bem como discutir a necessidade de equipamentos para um investimento consciente no consultório...

Faced with the wide range of orthodontists, differentiation is desired by everyone and goes through high workloads of specialization and refresher courses to the structuring and office design. The modernization of internal processes of the clinic can reduce the time spent on repetitive activities, and assist in the positive marketing. However, the acquisition of technological equipment without proper planning can generate extra costs without the expected return, since every change requires commitment and motivation of the team. Many services are available online to help improve services and automation of activities. This article presents some of these services, as well as discusses the need for equipment for conscious investment in the office...

World Workshop on Oral Medicine VI: Utilization of Oral Medicine-specific software for support of clinical care, research, and education: current status and strategy for broader implementation.

OBJECTIVES: To assess the current scope and status of Oral Medicine-specific software (OMSS) utilized to support clinical care, research, and education in Oral Medicine and to propose a strategy for broader implementation of OMSS within the global Oral Medicine community. STUDY DESIGN: An invitation letter explaining the objectives was sent to the global Oral Medicine community. Respondents were interviewed to obtain information about different aspects of OMSS functionality. RESULTS: Ten OMSS tools were identified. Four were being used for clinical care, one was being used for research, two were being used for education, and three were multipurpose. Clinical software was being utilized as databases developed to integrate of different type of clinical information. Research software was designed to facilitate multicenter research. Educational software represented interactive, case-orientated technology designed for clinical training in Oral Medicine. Easy access to patient data was the most commonly reported advantage. Difficulty of use and poor integration with other software was the most commonly reported disadvantage. CONCLUSIONS: The OMSS presented in this paper demonstrate how information technology (IT) can have an impact on the quality of patient care, research, and education in the field of Oral Medicine. A strategy for broader implementation of OMSS is proposed.

Understanding dental CAD/CAM for restorations--the digital workflow from a mechanical engineering viewpoint.

As digital technology infiltrates every area of daily life, including the field of medicine, so it is increasingly being introduced into dental practice. Apart from chairside practice, computer-aided design/computer-aided manufacturing (CAD/CAM) solutions are available for creating inlays, crowns, fixed partial dentures (FPDs), implant abutments, and other dental prostheses. CAD/CAM dental solutions can be considered a chain of digital devices and software for the almost automatic design and creation of dental restorations. However, dentists who want to use the technology often do not have the time or knowledge to understand it. A basic knowledge of the CAD/CAM digital workflow for dental restorations can help dentists to grasp the technology and purchase a CAM/CAM system that meets the needs of their office. This article provides a computer-science and mechanical-engineering approach to the CAD/CAM digital workflow to help dentists understand the technology.

Methodological challenges when performing a systematic review.

Well-conducted systematic reviews can provide a foundation upon which to base educational curricula, practice guidelines and healthcare policy. We aim to provide an overview of important methodological issues that need to be addressed during the five phases of performing a systematic review. 1. The specific problems to be addressed by the systematic review need to be formulated as clear, unambiguous and structured question/s. 2. Literature from multiple resources should be searched to avoid publication biases, as positive outcomes are more likely to be published than null/negative results. 3. The quality of selected articles should be assessed using a checklist, while the reliability of graders, as well as the quality of the checklist, needs to be established a priori. 4. Statistical heterogeneity needs to be assessed to determine if a meta-analysis is appropriate to pool the data. If not, a narrative synthesis of the evidence/overall findings needs to be performed within a clinical context.

Are Electronic Health Records the Future of Dental Practice?

This article explores the opportunities and challenges for dentists in the transition to electronic health records (EHRs). Dentists have been slowed in the digital transition by lack of federal incentives and technical assistance. Now, however, changes in the practice of dentistry, including more integration with other health care providers, may propel them forward.

Legal Considerations for Electronic Health Records.

Electronic health record (EHR) solutions provide many potential benefits for dental practices, whether those programs run internally on a dental practice's computers or are cloud-based solutions. However, these programs also create new risks for a dental practice, which may be mitigated through due diligence and adequate contractual provisions to ensure protection for dentists. This article addresses the legal considerations associated with a dentist entering into a service contract with an EHR vendor.

How a modified approach to dental coding can benefit personal and professional development with improved clinical outcomes.

BACKGROUND: One disadvantage of the remarkable achievements in dentistry is that treatment options have never been more varied or confusing. This has made the concept of Evidenced Based Dentistry more applicable to modern dental practice. Despite merit in the concept whereby clinical decisions are guided by scientific evidence, there are problems with establishing a scientific base. This is no more challenging than in modern dentistry where the gap between rapidly developing products/procedures and its evidence base are widening. Furthermore, the burden of oral disease continues to remain high at the population level. These problems have prompted new approaches to enhancing research. AIM: The aim of this paper is to outline how a modified approach to dental coding may benefit clinical and population level research. METHODS AND MATERIALS: Using publically assessable data obtained from the Australian Chronic Disease Dental Scheme and item codes contained within the Australian Schedule of Dental Services and Glossary, a suggested approach to dental informatics is illustrated. RESULTS: A selection of item codes have been selected and expanded with the addition of suffixes. These suffixes provided circumstantial information that will assist in assessing clinical outcomes such as success rates and prognosis. CONCLUSION: The use of item codes in administering the CDDS yielded a large database of item codes. These codes are amenable to dental informatics which has been shown to enhance research at both the clinical and population level. This is a cost effective method to supplement existing research methods.