Orthodontically Relevant Manifestations in People with Rare Diseases.

BACKGROUND: Approximately 15% of all rare diseases occur with orofacial manifestations. Symptoms and manifestations of relevance to orthodontists represent a considerable proportion of these diseases and require appropriate strategies for their treatment. This article provides an overview of the orthodontically relevant manifestations of rare diseases. MATERIAL AND METHODS: Overall, 3,639 rare diseases listed at the Orphanet, OMIM or Pubmed database were evaluated for orofacial manifestations. All rare diseases which were indicated with at least one orofacial manifestation were recorded in a database for rare diseases with orofacial manifestations called "ROMSE," which was developed by the authors. All the rare diseases were analysed with regard to orthodontically relevant orofacial manifestations, such as dysgnathia, changes in the number of teeth, failures of eruption, pathologies of bone metabolism or orofacial clefts. For all rare diseases with orthodontic relevance, an exact analysis was undertaken. RESULTS: The orthodontically relevant orofacial manifestation termed dysgnathia is described in 151 of 535 identified rare diseases (28.2%). In these 151 rare diseases, 15 different subforms of dysgnathia, in the sense of skeletal misdevelopments of the jaws but without dental abnormalities, were described. Also changes in the number of teeth (17.9%), orofacial clefts (27.6%), failures of eruption (8.4%) and pathologies of the bone (2.1%) were described. CONCLUSIONS: Orthodontics play an important role in the diagnosis and treatment of orofacial manifestations in rare diseases. Databases such as ROMSE are a first step toward providing valid information in publicly accessible databases.

Schedule for Rating Disabilities; Dental and Oral Conditions. Final rule.

This document amends the Department of Veterans Affairs (VA) Schedule for Rating Disabilities by revising the portion of the schedule that addresses dental and oral conditions. The effect of this action is to ensure that the rating schedule uses current medical terminology and to provide detailed and updated criteria for evaluation of dental and oral conditions for disability rating purposes.

Development and evaluation of a comprehensive screening for orofacial dysfunction.

The aim was to develop a comprehensive screening instrument for evaluation of orofacial dysfunction that was easy to perform for different health professionals without special equipment. The Nordic Orofacial Test--Screening (NOT-S), consisting of a structured interview and clinical examination,was developed with a picture manual illustrating the different tasks in the examination. It was first tested in a Swedish version, and later translated to other Nordic languages, and to English. The interview reflected six domains, (I) Sensory function, (II) Breathing, (III) Habits, (IV) Chewing and swallowing, (V) Drooling, and (VI) Dryness of the mouth, and the examination included six domains representing (1) The face at rest, and tasks regarding (2) Nose breathing, (3) Facial expression, (4) Masticatory muscle and jaw function, (5) Oral motor function, and (6) Speech. One or more "yes" for impairment in a domain resulted in one point (maximum NOT-S score 12 points). The mean NOT-S score (+/- SD) in 120 patients (3-86 yr), referred to five centers for specialized dental care or speech and language pathology in Sweden, Norway and Denmark, was 4.1 +/- 2.6, and 0.4 +/- 0.6 in 60 control subjects (3-78 yr). The screening was easy to administer and the time spent 5-13 min. The scores from the clinic-referred sample differed significantly from the controls, and the sensitivity of the screening was 0.96 and specificity 0.63. Repeated evaluations of videotapes of 200 patients by 3 examiners, speech-language pathologists and dentists, with at least two-week intervals, showed inter- and intraexaminer agreement on the points given in the domains at respectively 83% and 92-95% which increased after recalibration to 85% and 95-99%. Kappa values for interexaminer agreement on the NOT-S scores were 0.42-0.44 (i.e. fair), and the method error was 5.3%. To conclude, NOT-S gave a reliable and valid screening for orofacial dysfunction.

A prototype mobile application for triaging dental emergencies.

BACKGROUND: Evidence suggests that dental emergencies are likely to occur when preferred care is less accessible. Communication barriers often exist that cause patients to receive suboptimal treatment or experience discomfort for extended lengths of time. Furthermore, limitations in the conventional approach for managing dental emergencies prevent dentists from receiving critical information before patient visits. METHODS: The authors developed a mobile application to mediate the uncertainty of dental emergencies. The development and study consisted of a needs analysis and quality assessment of intraoral images captured by smartphones, prototype development, refining the prototype through usability inspection methods, and formative evaluation through usability testing with prospective users. RESULTS: The developed application successfully guided all users through a series of questions designed to capture clinically meaningful data by using familiar smartphone functions. All participants were able to complete a report within 4 minutes, and all clinical information was comprehended by the users. CONCLUSIONS: Patient-provided information accompanied by high-resolution images may help dentists substantially in predicting urgency or preparing necessary treatment resources. The results illustrate the feasibility of patients using smartphone applications to report dental emergencies. This technology allows dentists to assess care remotely when direct patient contact is less practical. PRACTICAL IMPLICATIONS: This study's results demonstrate that patients can use mobile applications to transmit clinical data to their dentists and suggest the possibility of expanding the use of mobile applications to enhance access to routine and emergency dental care. The authors addressed how to enable patients to communicate emergency needs directly to a dentist while obviating patient emergency department visits.

The accuracy of International Classification of Diseases coding for dental problems not associated with trauma in a hospital emergency department.

OBJECTIVES: Emergency department (ED) visits for nontraumatic dental conditions (NTDCs) may be a sign of unmet need for dental care. The objective of this study was to determine the accuracy of the International Classification of Diseases codes (ICD-10-CA) for ED visits for NTDC. METHODS: ED visits in 2008-2099 at one hospital in Toronto were identified if the discharge diagnosis in the administrative database system was an ICD-10-CA code for a NTDC (K00-K14). A random sample of 100 visits was selected, and the medical records for these visits were reviewed by a dentist. The description of the clinical signs and symptoms were evaluated, and a diagnosis was assigned. This diagnosis was compared with the diagnosis assigned by the physician and the code assigned to the visit. RESULTS: The 100 ED visits reviewed were associated with 16 different ICD-10-CA codes for NTDC. Only 2 percent of these visits were clearly caused by trauma. The code K0887 (toothache) was the most frequent diagnostic code (31 percent). We found 43.3 percent disagreement on the discharge diagnosis reported by the physician, and 58.0 percent disagreement on the code in the administrative database assigned by the abstractor, compared with what it was suggested by the dentist reviewing the chart. CONCLUSION: There are substantial discrepancies between the ICD-10-CA diagnosis assigned in administrative databases and the diagnosis assigned by a dentist reviewing the chart retrospectively. However, ICD-10-CA codes can be used to accurately identify ED visits for NTDC.

Costs of medically treated craniofacial conditions.

OBJECTIVES: Determining the magnitude of the burden of diseases and health disorders on the U.S. population is a high priority for health policy makers. Conditions such as malignant neoplasms and injuries from craniofacial trauma contribute to adverse oral health. This study estimates the number of cases of diseases and disorders relevant to oral health that are treated annually in the medical care, as opposed to the dental care, system and associated costs. Policy makers can use this cost model to compare the impact of different conditions, to target areas for reducing costs, and to allocate appropriate health resources. METHODS: Data from four national and two state data systems were used to estimate the number of cases of selected dental, oral, and craniofacial diseases and conditions treated in the medical system annually and associated medical and wage/household work loss costs. RESULTS: Per case, the most costly conditions were estimated to be malignant neoplasms at 83,080 US dollars annually (in 1999 dollars), diabetes-related oral conditions at 51,030 US dollars, endocarditis at 48,610 US dollars, and chlamydiae at 41,100 US dollars. Total estimated costs for oral conditions treated in the medical care system in 1996 were approximately 95.9 billion US dollars, including 21.4 billion US dollars in medical costs and 74.4 US dollars billion in wage/household work loss costs. CONCLUSIONS: Conditions treated outside the dental care system are major contributors to oral health costs. They should be an important focus for the National Institute of Dental and Craniofacial Research.

Diagnostic codes in dentistry--definition, utility and developments to date.

Diagnostic codes are computer-readable descriptors of patients' conditions contained in computerized patient records. The codes uniquely identify the diagnoses or conditions identified at initial or follow-up examinations that are otherwise written in English or French on the patient chart. Dental diagnostic codes would allow dentists to access information on the types and range of conditions they encounter in their practices, enhance patient communication, track clinical outcomes and monitor best practices. For the profession, system-wide use of the codes could provide information helpful in understanding the oral health of Canadians, demonstrate improvements in oral health, track best practices system-wide, and identify and monitor the progress of high-need groups in Canada. Different systems of diagnostic codes have been implemented by program managers in Germany, the United Kingdom and North America. In Toronto, the former North York Community Dental Services developed and implemented a system that follows the logic used by the Canadian Dental Association for its procedure codes. The American Dental Association is now preparing for the release of SNODENT codes. The addition of diagnostic codes to the service codes already contained in computerized patient records could allow easier analysis of the rich evidence available on the oral health and oral health care of Canadians, thereby enhancing our ability to continuously improve patient care.

Parameters of odontostomatognathic disability: guidelines for evaluation of impaired simple and complex human functions involving the odontostomatognathic functional system.

This paper explores the current status and the future of efforts to establish parameters of disability for the odontostomatognathic functional system ("the teeth, mouth, jaws and related structures as they subserve the functions of mastication, deglutition, digestion, speech, facial expression, respiration, sexual activity, appearance and posture"). Illness, disorders, disease or injuries involving this functional system include a broad spectrum of problems that affect the dental and paradental structures. The dentist is the primary healthcare provider (HP) in the diagnosis, treatment and impairment/disability/handicap status (IDH) decisions. The authors point out that the first stage of establishing parameters of odontostomatognathic disability was accomplished with recognition in the AMA Guides to Evaluation of Permanent Impairment of the temporomandibular joint and the masticatory musculature. The second stage will be the AMA Guides publishing of an objective rating system for functional impairment of the temporomandibular joint and the masticatory musculature. Prior to the third stage of actually establishing parameters of odontostomatognathic disability, the authors suggest that multiple objectives must be accomplished, including: 1. a change in current healthcare terminology; 2. an agreement on the organization of human physiological systems; 3. medical community acceptance of the integrated structures and functions of the odontostomatognathic functional system; and 4. an appreciation of both Level I (joint and muscle dysfunction) and Level II (complex odontostomatognathic dysfunction including problems with mastication, deglutition, digestion, speech, facial expression, respiration, sexual activity, appearance and posture). The authors conclude that once these objectives are met, parameters of odontostomatognathic disability can be established.

[An analysis of dental morbidity based on patient visits]. / Analiz stomatologicheskoi zabolevaemosti po obrashchaemosti.

The present-day system for assessment of the activities of dental clinics does not reflect their efficacy, for it does not take into consideration the population disease incidence and changes in this parameter. The author suggests that the incidence of dental diseases be assessed from the records of consultations at health institutions, as exemplified by a random sample of 2515 primary consultations at dental clinics. The cause of the consultation was classified in accordance with the International Disease Classification, 9th Revision. The author claims that such mode of assessment of the physicians' and clinics' work efficacy, will improve the quality of the diagnosis.

[The epidemiological correlations between mandibular dysfunctions and parafunctions]. / Untersuchungen über epidemiologische Zusammenhänge zwischen mandibulären Dysfunktionen und Parafunktionen.

In general as dominating aetiological parafunctions are considered to be the onset of mandibular dysfunctions. In general dental consulting hours this statement was checked and confirmed in patients who were not selected. According to the Helkimo index 20.8% of the patients showed subjective symptoms and 60.2% of the patients showed objective symptoms of mandibular dysfunctions. The rate of patients with parafunctions was growing with the increasing index of dysfunction.

[Two or three things about the PMSI in stomatology and maxillofacial surgery]. / Deux ou trois choses sur le PMSI en Stomatologie et Chirurgie Maxillo-Faciale.

The Information Systems Medicalization Program (PMSI in French) was created in 1985 for Public Health Service Hospitalisation Structures. It appeared to be directly derived from the North-American Diagnosis Related Groups (DRGs) system. Since them, the PMSI has been progressively developed in private structures as well. The authors have had the opportunity to use the latest version of the computer program which was elaborated in order to share the patients into more than 500 different groups of pathology. These groups were called "Homogeneous Patients Groups" (GHM in French). To each group corresponds a "Synthetic Activity Index" number (ISA in French). It is supposed to be representative of the average cost of the management of each kind of patients, based on the diagnosis and the surgery possibly done. Several astonishing findings have been made. Some of them can be summarized as mentioned below: In maxillofacial Surgery, each group (GHM) seems in fact to be extremely inhomogeneous: for example, total parotidectomy with preservation of the facial nerve belongs to the same group as accessory salivary gland exeresis. Total skin graft is in the same group as free composite osseous flap with vascular anastomosis. Coding a surgical procedure leads often to reduce the ISA number in comparison with the same patient without surgery: "impacted third molar" gives 754 points without surgery but only 658 if surgery is performed. Carcinologic surgery is wholly grouped in the same category, even for rather short procedures as isolated partial glossectomy. This group corresponds to a great number of ISA points (6486) while bimaxillary surgery or free flap transfer gives less than 2500 points. In conclusion, the use of the PMSI to allocate financial means can be extremely dangerous for maxillofacial surgery units and consequently for the quality of the medical care in our Specialty. Further studies are obviously necessary to complete a critical analysis of the current system and to improve it.