Impression material lodged in the hypopharynx: A clinical report.

Ingestion or aspiration of foreign objects may present as a significant complication with various common dental procedures. The most reported ingested or aspirated dental materials have included endodontic instruments and metal restorative and prosthetic materials, which can often be identified clinically and radiographically from their relative radiodensities. The authors present an unusual report of lodged impression material in the hypopharynx, which was not detectable radiographically.

Rehearsal's effect on long-term recall and comprehension of orthodontic informed consent.

INTRODUCTION: The purpose of this study was to determine if written rehearsal of informed consent improved 6-month recall and comprehension compared with the current best practices. METHODS: A consultation was provided and subjects read the modified informed consent document. They were randomized to group A (received the core and up to 4 custom elements of treatment, wrote what each image displayed) or group B (presentation of the 18 elements with core elements chunked at the end followed by up to 4 custom elements). Interviews recording knowledge recall/comprehension occurred immediately and after months later. RESULTS: Overall, no significant differences in baseline or 6-month follow-up scores were found between groups. Initially, group A outperformed group B in some core domains. There were no significant differences between groups in the change of scores from initial to follow-up. Follow-up scores were significantly lower than baseline scores (P <0.05). Higher initial scores were associated with larger drops at follow-up. A decrease in knowledge >20% was common. CONCLUSIONS: Overall the methods are comparable at baseline and 6-months. Initial content retention was roughly 60+%, with 6%-9% deterioration. For areas of treatment methods, risk, discomfort, and resorption at 6-months, the current processes failed the patient and left the practitioner vulnerable to risk management issues. Results support the rehearsal method with immediate feedback for misunderstandings as the preferred method for informed consent.

Rehearsal's effect on recall and comprehension of orthodontic informed consent.

INTRODUCTION: Proper informed consent allows patients to take an active role in their own treatment decisions, and enhanced compliance might improve treatment outcomes. The objective of this research was to determine if handwritten rehearsal of core and custom consent items would increase short-term recall and comprehension. METHODS: A total of 90 patient-parent pairs were randomly assigned to 2 groups. After case presentation, each subject was provided 10 minutes to read a modified informed consent document. Group A received visual printouts containing the 4 core elements (root resorption, decalcification, pain, and relapse/retention) likely to be encountered by all patients and up to 4 custom elements (eg, impacted teeth, orthognathic surgery, or other case-specific treatment issues). Subjects identified and wrote what the image depicted and how it could affect treatment. Group B viewed a slideshow presentation on all 18 consent elements arranged from general to specific. All participants were interviewed, and each provided their sociodemographic data, as well as completed literacy, health literacy, and state anxiety questionnaires. The groups were compared for recall and comprehension through an analysis of covariance. RESULTS: The rehearsal intervention significantly improved recall and comprehension of the core elements (P = 0.001). Rehearsal also improved custom recall and comprehension, but not significantly. Group B performed significantly better on treatment questions (P = 0.001). Overall, as anxiety increased, correct responses decreased. CONCLUSIONS: The rehearsal group improved recall and comprehension of the core and custom elements of informed consent and proved a more efficient method than an audiovisual presentation to provide informed consent. It also improved meeting legal obligations.

Resistance of Mandibular Polyurethane Replicas to Fracture After Removal of Blocks From the Symphysis and Ramus.

BACKGROUND: When block grafts are harvested intraorally, the donor sites may act as stress concentrators and alter the structural integrity of the mandible. PURPOSE: The study aimed to compare displacement and load failure between intact polyurethane mandibular replicas and similar replicas from which blocks were taken at the symphysis or the ramus. It also aimed to identify trends of load failure. MATERIALS AND METHODS: Thirty-five mandibular replicas were tested to failure with an electromagnetic material testing unit. The variables evaluated in this investigation were maximal load, displacement at maximal load, and fracture location. RESULTS: Statistically significant differences in maximal load were detected between groups (P = 0.0008). Differences between fracture locations were also statistically significant (P < 0.0001). The mandibles from which blocks were removed at the symphysis were significantly more likely to break at a lower maximal load than were the control mandibles (P = 0.0010) or the mandibles from which blocks were removed at the ramus (P = 0.0162). They were also more likely than the control group to break at a lower displacement at maximal load (P = 0.0145). CONCLUSIONS: Location of the donor site significantly influences the structural integrity of mandibular replicas. In addition, the donor site significantly affects the location of mandibular fractures.

Osteoporosis and bisphosphonate-related osteonecrosis in a dental school implant patient population.

PURPOSE: Studies have demonstrated an inconsistent association between implant failure and bone mineral density. The prevalence of osteoporosis in US adults has been reported to range from 5% to 10% in women and from 2% to 4% in men. The prevalence of bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) has been reported to range from 0% to 4.3% of patients taking oral BPs. The purpose of this study was to calculate the risk of dental implant loss and the incidence of BRONJ in patients with osteoporosis at the University of Kentucky College of Dentistry (UKCD). MATERIALS AND METHODS: This study analyzed data collected from patients who had implants placed between 2000 and 2004 at UKCD. Data were gathered from patient interviews regarding implant survival and patient-satisfaction parameters, and interviews were conducted either chairside at a scheduled maintenance appointment or by telephone interview. RESULTS: Among 203 patients who received 515 implants, the prevalence of osteoporosis was 23.3% for women and 1.2% for men. None of the 20 patients who reported a history of oral BP use exhibited BRONJ, and there were no implant failures in patients with a history of osteoporosis. CONCLUSIONS: In this study, osteoporosis conferred no risk of implant failure, and oral BP therapy was not associated with BRONJ.

Outcomes of a contemporary credentialing and privileging program in a dental school.

The current credentialing and privileging (C&P) climate has evolved due to a risk reduction/management awareness of increased institutional legal liability. This recognition affects dental colleges and has caused the implementation of C&P processes. Contemporary best practices for methods, processes, and structure are reported here. Data reported from the process show how and what clinicians' red flags were discovered during the process. Conclusions include the following: C&P is a significant process to introduce in terms of institutional resources and commitment. This process includes increased clinician and administrative burden that needs to have a governor. Attention to experiences of other institutions can reduce but not eliminate challenges from the clinician and some administrators. A primary data-based verification process administered by a credentialing specialist can make the process valid and workable.

Oral rehabilitation of severe dentoalveolar trauma: a clinical report.

This clinical report describes the oral rehabilitation of an adult male who suffered severe dentoalveolar trauma as a result of a motor vehicle accident. The specific objectives of this treatment were to restore esthetics and masticatory function. Treatment included removal of fractured roots, placement of multiple endosseous implants, and placement of anterior and posterior metal-ceramic crowns and fixed partial dentures. Three year clinical examination revealed no pathology associated with the rehabilitation. The patient's esthetic and functional expectations were successfully achieved.

Programmatic effectiveness of a university-based implant training program: long-term, patient-centered outcomes.

The University of Kentucky College of Dentistry established a formal implant program in 1999. The program utilizes a single system (Straumann) and a team concept in which implants are placed by residents in period ontology or oral and maxillofacial surgery and restored by predoctoral dental students. The program features stringent patient inclusion and exclusion criteria, incremental structured learning experiences, formal standardized protocols, and hands-on preclinical learning experiences. The use of a single system simplified training protocols and inventory requirements. Complete and partially edentulous patients requiring single and multiple implants are eligible for the program, although maxillary anterior sites are excluded. There is a formal quality assurance program to assess patient-centered outcomes. The current report includes data for patients who had implants placed in the period from January 2000 through December 2002. During that period, 192 patients received dental implants, of which 116 patients (248 implants) were available for analysis. The mean follow-up was 7.05 years (median = 7.32 years). The implant survival rate was 98.4%, while the success rate was 93.15%. Success was determined by the absence of pain or mobility, as well as self-reported patient satisfaction with function, appearance, and surgical experience.

Clinical Integration in a Dental School Clinic Through an Enhanced Patient Intake Process.

Dental care in the U.S. is based on a general practice model of care delivery that can be enhanced by the integration of the dentists and allied dental professionals. There are 25 U.S. dental schools with associated dental hygiene programs, presenting distinctive opportunities for educating the dental health care team. Integrated educational clinical experiences are believed to positively influence teamwork and quality of care that parallels the authentic general practice environment. Lean management, developed by Toyota and used in a variety of types of organizations including health care, provides a distinctive blend of engineering principles and operations management to enhance business and operations processes. A fundamental principle of Lean management is the elimination of waste and preservation of only those value-added components of a process. The faculty and staff of The Ohio State University College of Dentistry, trained in Lean process improvement, applied techniques to enhance and integrate an inefficient patient intake (admissions) process. The aim of this initiative was to improve patient throughput in the patient intake process and to provide dental and dental hygiene students with enhanced educational experiences from improved clinical integration. These goals were achieved through streamlining patient flow and relocating major phases of the process. Although new patient retention and cancellation/no-show rates remained mostly unchanged, this enhancement project resulted in improved access to care, improved continuity of care, expanded scope of dental services offered, improved patient satisfaction, and enhanced dental and dental hygiene student collaboration and teamwork. These outcomes suggest that process improvement initiatives can serve as valuable opportunities for integration of the dental health care team.

Development and Implementation of a Uniform Dental School-Wide Electronic Treatment Consenting Process for Patients.

One approach to enhancing quality care outcomes and patient safety is through effective implementation of clinical risk reduction strategies. Clinical risk identification at The Ohio State University College of Dentistry revealed lack of a standardized informed consenting process for patients. The purpose of this project was to develop and implement a uniform college-wide informed consenting process. An operating procedure was also developed. The resulting consenting documents used a uniform approach in which clinics could use a basic readable and processable informed consent template. The template was edited for appropriate content suitable for an electronic health record. Implementing an operating procedure along with associated contemporary uniform electronic informed consent forms was realized through efforts of a core team with informed consenting experience. The core team developed the template and the majority of all documents before editing all division-based consents. This method relied on growing expertise and momentum. Outcomes of chart audits following implementation of the new electronic informed consent forms showed a transitory increase in missing consent forms. Subsequently, the number of missing consent forms decreased to near pre-implementation levels. Patient refunds related to missing informed consent issues dropped, and patient satisfaction remained high throughout the project. Other institutions can use this project as a guide for developing their own uniform consent forms and process.

Simplified impression technique for implant-supported crowns.

Dental implants have become a widely accepted method for replacing missing teeth. While many oral surgeons and periodontists are actively involved in the surgical placement of dental implants, many general dentists do not perform such placements because they are intimidated by the seeming complexity of the procedures and hardware. In response to perceived complexity, dental implant manufacturers have developed implant systems that facilitate and simplify impression taking. As such simplified protocols become more common, implant-borne restorations will become more widely used by the profession as a routine treatment modality. This article describes a simple technique for restoring a single-tooth posterior Straumann implant.

Determining the rate of follow-up after hospital emergency department visits for dental conditions.

BACKGROUND: Emergency department (ED) visits for dental reasons continue to impact EDs nationwide. This investigation determined the rate of follow-up in an emergency dental clinic (EDC) after hospital ED visits for nontraumatic dental conditions. METHODS: This prospective investigation reports the number of patients who presented to an ED for nontraumatic dental conditions and the rate of follow-up at an EDC. Upon ED discharge, patients were provided instructions to follow-up for low-cost care at the EDC. Telephone contact was attempted following failed referrals. Descriptive statistics were reported for comparing referral sources and demographic trends. RESULTS: Two hundred and forty-seven referrals were made and 31% followed up for definitive treatment at the EDC. More referrals were made on weekends than on weekdays. Failed referrals were unreachable by telephone in 75% of cases. Tooth extraction was the most common treatment rendered in the EDC. Of the ED patients who accessed EDC care, 14% became comprehensive patients in the EDC's regular dental clinic. CONCLUSION: Less than one-third of ED referrals to the EDC followed up for definitive care when provided an opportunity to do so, and 75% of referrals were unreachable by telephone in the week following the ED dental visit.

Improving a Dental School's Clinic Operations Using Lean Process Improvement.

The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes. One of the core concepts is relentless elimination of waste (non-value-added components of a process). Another key concept is utilization of individuals closest to the actual work to analyze and improve the process. When the medical center of the University of Kentucky adopted the Lean process for improving clinical operations, members of the College of Dentistry trained in the process applied the techniques to improve inefficient operations at the Walk-In Dental Clinic. The purpose of this project was to reduce patients' average in-the-door-to-out-the-door time from over four hours to three hours within 90 days. Achievement of this goal was realized by streamlining patient flow and strategically relocating key phases of the process. This initiative resulted in patient benefits such as shortening average in-the-door-to-out-the-door time by over an hour, improving satisfaction by 21%, and reducing negative comments by 24%, as well as providing opportunity to implement the electronic health record, improving teamwork, and enhancing educational experiences for students. These benefits were achieved while maintaining high-quality patient care with zero adverse outcomes during and two years following the process improvement project.

Did we push dental ceramics too far? A brief history of ceramic dental implants.

Humankind has developed and used ceramics throughout history. It currently has widespread industrial applications. Dental ceramics are used for fabricating highly esthetic prosthetic denture teeth, crowns, and inlays. However, ceramic's biocompatibility and compressive strength are offset by its hardness and brittleness. Nonetheless, a single crystal sapphire aluminum oxide endosseous implant was developed in 1972 as an alternative to metal. It was more esthetic than its metallic counterparts and was eventually produced in a variety of shapes and sizes. Clinical studies demonstrated its excellent soft and hard tissue biocompatibility, yet the range of problems included fractures during surgery, fractures after loading, mobility, infection, pain, bone loss, and lack of osseointegration. Ultimately, single crystal sapphire implants fell into irredeemable disfavor because of its poor impact strength, and dentists and surgeons eventually turned to other implant materials. However, bioactive ceramic coatings on metal implants have kept ceramics as a key component in dental implantology.

Perceptions of dental schools from within and outside the university.

Perceptions of dental schools held by high-level administrators of their parent institutions and officials in the local community have great potential to influence the future of dental education. The intent of this investigation was to gain a preliminary knowledge of such perceptions at seven institutions in the United States and to use this information to formulate hypotheses that can provide the basis for further targeted investigations that provide evidence useful in decision making and planning processes within dental schools. Interviews with university administrators, executive directors of state dental associations, and state government officials in seven areas of the United States were conducted. The hypotheses drawn from these interviews are: 1) dental schools are generally too insular and need to interact more with their parent institutions and external community; 2) dental schools need to systematically and continually get the message of the value of their services out to the public and political constituencies; and 3) multidisciplinarity and integration with other units are important to university administrators but largely outside the concerns of those external to the university. We suggest that these hypotheses form the basis of subsequent, more targeted, follow-up investigations with the intent of formulating specific recommendations for action.