RESUMO
Dentistry is represented to the US public in large part by the various professional associations, which speak for the interests of general and specialized dentists, mostly in private proprietary practice. Unfortunately, the interests of dental professional associations may often be in conflict with those of the public. To resolve this continued disparity, it behooves the dental leadership to become more involved with the overall health care system than continuing to enhance the economic interests of the profession without sufficient regard for the world-wide burden of unmet dental needs. An assessment of policy failures is provided with some recommendations for greater involvement of organized dentistry in the integration of oral and general health care. Dentistry must recommit itself to being a health profession rather focusing on the business aspects of health care. Another aspect to be considered is a reorganization of the American Dental Association to better represent the oral health care workforce.
Assuntos
Reforma dos Serviços de Saúde , Licenciamento , Saúde Bucal , Serviços Preventivos de Saúde/organização & administração , Sociedades , Atitude do Pessoal de Saúde , Odontólogos/organização & administração , Política de Saúde , Humanos , Estados UnidosRESUMO
The United States is currently experiencing a primary care shortage. One solution to improving health care is to increase the utilization of existing health care providers, particularly dentists, an opportunity that has been largely ignored. By employing mid-level providers for less complex procedures to deliver more accessible dental care at lower cost, dentists can redistribute tasks to their office workforce. They can then serve as oral physicians who can provide limited preventive primary care, including screening for chronic diseases, while continuing to oversee all dental care, whether provided by dentists or non-dentists. Thus, they could improve the health of the US population as well as increase access to dental care at lower cost, while partially alleviating the primary care shortage by filling a need for the screening aspects of primary care.
Assuntos
Odontólogos , Atenção Primária à Saúde/métodos , Papel Profissional , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Diagnóstico Precoce , Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Acessibilidade aos Serviços de Saúde , Humanos , Programas de Rastreamento/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Medicina Preventiva/métodos , Fatores de Risco , Recursos HumanosRESUMO
We evaluated the Oral Physician Program, a dental residency sponsored by Harvard Medical School, Harvard School of Dental Medicine, and the Cambridge Health Alliance that offers an innovative model for training dentists to provide limited primary care. The didactic and clinical experiences increased residents' medical knowledge and interviewing skills, and faculty assessments supported their role as oral physicians. Oral physicians could increase patients'-especially patients from underserved groups-access to integrated oral and primary care services.
Assuntos
Internato e Residência , Medicina Bucal/educação , Atenção Primária à Saúde , Comportamento Cooperativo , Avaliação Educacional , Humanos , Internato e Residência/organização & administração , Faculdades de Odontologia/organização & administração , Faculdades de Medicina/organização & administraçãoRESUMO
Although the Doctor of Dental Surgery (DDS) evolved from the surgical and the Doctor of Medicine in Dentistry (DMD) from the medical (DMD) roots of the dental profession, dental schools in the US currently award both degrees, verified as equivalent by finding no differences between them in standards of admissions, accreditation, or state licensure requirements while continuing to be subjectively perceived as different enough to create professional and public confusion. In contrast, Doctors of Osteopathy (DOs) and Doctors of Medicine (MDs) are both objectively and subjectively perceived as different in philosophy and healthcare training while objectively passing similar examinations to be licensed as physicians. Following from the history of both dental degrees and their implications for training and dental practice, the objective of this manuscript is to update the scientific, socio-political, and professional reasons for awarding only the DMD for future graduates while continuing to recognize the contributions of DDS graduates to oral healthcare. Working with the American Dental Association (ADA), American Dental Education Association (ADEA), and dental school librarians, a historical review was undertaken of the establishment of two doctoral degrees for dentists in the United States, including beliefs and attitudes of faculty and local dentists at the times of initiation or change in degrees awarded. Among the current 68 dental schools in the United States, there are approximately equal numbers of DDS- and DMD-granting schools. Except for some Harvard physicians, some of whom practiced dentistry, who wanted dentistry to be a specialty of medicine and the unexpected, serendipitous substitution of "medicine" for "surgery" which could not be translated into required Latin in 1867, all dental schools would have awarded only the DDS degree. Now, with the ongoing reorganization of the healthcare workforce in the United States, a single degree with broader healthcare connotations of the DMD will facilitate the integration of dentistry with overall healthcare, without changing the fundamental oral healthcare responsibilities of both DDS and DMD graduates.
Assuntos
Educação em Odontologia , Estados UnidosRESUMO
BACKGROUND: Beginning with the biobehavioral bases of esthetic experiences, this article presents a quantitative analytic review of the motives and methods of providers and consumers of orthodontic treatment. METHOD: A primary focus is determining the anthropometric bases of self and others' perceived preference and satisfaction with changes in facial appearance. These quantitative analyses have been based on determining the frequency and magnitude of reliability and validity measures of diagnosis, treatment, and satisfaction outcome. Socioeconomic considerations are also quantitated regarding the discrepancy between objective need for treatment as determined for example by the Index of Orthodontic Treatment Need and the subjective demand for treatment. RESULTS: The major contribution of this article is the quantitation of the components of esthetic experience from sensation of perception using psycho physical methods, such as Perceptometrics, for determining the morphological basis of perceived facial attractiveness adjusted for ethnocultural differences updated by 3-dimensional and artificial intelligence technology. Recent quantitation of smile components has also added to the measures of esthetically successful treatment. Further contribution of orthodontists to mental and physical health is demonstrated by the differences between perceived personality attributes in profile and full-frontal views of symmetric and asymmetric faces. Such information can facilitate the clinician's ability to determine the ideational representation of the patients' perceived pre- and post-treatment outcome. CONCLUSION: The quantitative analysis of the motives and methods involved in the orthodontic treatment process has been combined with the neurophysiological correlates of producing and observing/evaluation of the esthetic experiences of both patients and orthodontists/dentists.
Assuntos
Inteligência Artificial , Estética Dentária , Atitude do Pessoal de Saúde , Estética , Humanos , Reprodutibilidade dos TestesRESUMO
Chronic pain and depression are two frequently co-occurring and debilitating conditions. Even though the former is treated as a physical affliction, and the latter as a mental illness, both disorders closely share neural substrates. Here, we review the association of pain with depression, especially when symptoms are lateralized on either side of the body. We also explore the overlapping regions in the forebrain implicated in these conditions. Finally, we synthesize these findings into a model, which addresses gaps in our understanding of comorbid pain and depression. Our lateralized pain-depression dyad model suggests that individuals diagnosed with depression should be closely monitored for pain symptoms in the left hemibody. Conversely, for patients in pain, with the exception of acute pain with a known source, referrals in today's pain centers for psychological evaluation should be part of standard practice, within the framework of an interdisciplinary approach to pain treatment.
Assuntos
Dor Crônica , Depressão , HumanosRESUMO
OBJECTIVE: To determine pain levels, function, and psychological symptoms in relation to predominant sidedness of pain (right or left) and gender in patients being treated for chronic spinal pain. DESIGN: Prospective cohort study. PATIENTS: Patients with chronic neck or low back pain undergoing a nerve block procedure in a specialty pain medicine clinic. INTERVENTIONS/OUTCOMES: Patients completed the Hospital Anxiety and Depression Scale and the Brief Pain Inventory just prior to the procedure. Pain history and demographic variables were collected from a chart review. Chi-square, Pearson correlations, and multivariate statistics were used to characterize the relationships between side of pain, gender, pain levels, pain interference, and psychological symptoms. RESULTS: Among 519 subjects, men with left-sided pain (N = 98) were found to have significantly greater depression and anxiety symptoms and worse pain-related quality of life (P < 0.01), despite having similar pain levels as men with right-sided pain (N = 91) or women with left- or right-sided pain (N = 289). In men, psychological symptoms had a significantly greater correlation with pain levels than in women (P < 0.01). CONCLUSION: In this sample, men with left-sided spinal pain report worse quality of life and more psychological symptoms than women. These data provide clinical evidence corroborating basic neuroscience findings indicating that the right cerebral hemisphere is preferentially involved in the processing of pain and negative affect. These data suggest that men appear more right hemisphere dominant in pain and affect processing. These findings have implications for multidisciplinary assessment and treatment planning in men.
Assuntos
Doença Crônica/psicologia , Dor/fisiopatologia , Dor/psicologia , Fatores Sexuais , Coluna Vertebral/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Adulto JovemRESUMO
OBJECTIVE: Based on a series of clinical observations that a thicker mandibular splint than that commonly used to treat bruxism and related craniomandibular myofascial pain reduced post-traumatic stress disorder (PTSD) nocturnal symptomatology (sleep disruptions, headaches, and nightmares), this study of 100 PTSD participants was undertaken to systematically establish 'proof of concept' of the therapeutic effectiveness of this modified splinting procedure. METHODS: Following the fabrication of splints thicker than those conventionally used, the effectiveness of this new procedure used by dentists was determined by comparing the self-reported frequency and intensity/severity of PTSD symptomatology during a seven-night pretreatment baseline period without the splint with a second seven-night period in which the modified splint was inserted. The scoring for the three dependent measures (sleep disruptions, headaches, and nightmares) was based on the frequencies on a scale from 0-7 multiplied by the intensity/severity on a scale of 1-10. RESULTS: Compared with the pre-splint baseline period, the insertion of the thickened splint resulted in a highly significant reduction of sleep disruption, nocturnal headaches, and nightmares. A second seven-night control period without the splint was followed by a second seven-night period with the splint, reproducing the effectiveness of the first splinting period. CONCLUSION: The results of this study provide the first systematic, documented proof of concept of the effectiveness of a modified splinting procedure in reducing key nocturnal symptoms in PTSD patients.
RESUMO
OBJECTIVE: To demonstrate the usefulness of a new imaging system for comparing the morphometric bases of children's self-perception of their facial profile with the perceptions of their mothers and treating clinicians. MATERIALS AND METHODS: Rather than choosing among a series of static images, a computer imaging program was developed to elicit a range of acceptable responses or tolerance for change from which a midpoint of acceptability was derived. Using the method of Giddon et al, three profile features (upper and lower lips and mandible) from standardized images of 24 patients aged 8- 15 years were distorted and presented to patients, parents, and clinicians in random order as slowly moving images (four frames per second) from retrusive and protrusive extremes. Subjects clicked the mouse when the image became acceptable and released it when it was no longer acceptable. Subjects responded similarly to a neutral facial profile. RESULTS: Patients and their mothers overestimated the protrusiveness of the mandible of the actual pretreatment profile. Consistent with related studies, mothers had a smaller tolerance for change in the soft tissue profile than the children or clinicians. The magnitudes of the children's self-preference and preferred change in a neutral face were also significantly correlated. Both patients and mothers preferred a more protrusive profile than that of the actual or neutral face for the patient and neutral face. CONCLUSION: Imaging software can be used with children to compare their preferences with those of parents and clinicians to facilitate treatment planning and patient satisfaction.
Assuntos
Estética Dentária/psicologia , Face/anatomia & histologia , Mães/psicologia , Adolescente , Adulto , Fatores Etários , Análise de Variância , Cefalometria , Criança , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Lábio/anatomia & histologia , Masculino , Má Oclusão/psicologia , Mandíbula/anatomia & histologia , Satisfação do Paciente , Autoimagem , Fatores SexuaisRESUMO
This Point/Counterpoint acknowledges the transformation of dental practice from a predominantly technically based profession with primary emphasis on restoration of the tooth and its supporting structures to that of a more medically based specialty focusing on the oral and maxillofacial complex. While both viewpoints accept the importance of this transformation, they differ on the ultimate desired outcome and how changes should be implemented during training of dentists as oral health professionals. Viewpoint 1 argues that, in response to a shortage of both primary care providers and access to affordable oral health care, dentists need to be able and willing to provide limited preventive primary care (LPPC), and dental educators should develop and implement training models to prepare them. Among changes proposed are consideration of three types of practitioners: oral physicians with sufficient training to provide LPPC; dentists with excellent technical proficiency but minimal medical and surgical training; and mid-level providers to provide simple restorative and uncomplicated surgical care. Viewpoint 2 argues that the objective of dentists' education in primary care medicine is to help them safely and effectively provide all aspects of oral health care, including appropriate preventive medical care, that already fall within their scope of knowledge and practice. Dental educators should encourage students to use this knowledge to take full ownership of non-tooth-related pathologic conditions of the oral and maxillofacial complex not currently managed in the dental setting, but encouraging graduates to expand into non-dental LPPC outside the recognized scope of practice will only further exacerbate fragmentation of care.
Assuntos
Assistência Odontológica/tendências , Educação em Odontologia , Serviços Preventivos de Saúde , Atenção Primária à Saúde , Humanos , Estados UnidosRESUMO
INTRODUCTION: Facial profile disharmonies in the anteroposterior (AP) position of the mandible are among the most frequent reasons that patients seek orthodontic treatment. Various methods are available for assessing profile preferences, and differences between them could affect treatment decisions. The purposes of this study were to compare and contrast 3 methods of evaluating profile preferences for the AP position of the mandible. METHODS: Facial profile preferences of white orthodontists (n = 28) and white (n = 56) and Japanese-American (n = 55) laypeople were evaluated. The esthetic significance of variations in the AP position of the mandible was investigated by using 3 methods: a traditional semantic differential scale, the Perceptometrics method (Health Programs Intl, Wellesley, Mass), and the implicit association test (IAT). RESULTS: Findings from the semantic differential scale show that, overall, there is a general preference among orthodontists and laypeople for an orthognathic profile (P <.001). Findings from the Perceptometrics method indicate that orthodontists consider the most pleasing profile to be more forward than do lay subjects (P <.001). The IAT results show a positive bias among all 3 groups toward orthognathic profiles and a negative bias toward profiles with mandibular retrognathism or prognathism. The IAT suggested that laypeople were more tolerant of mandibular prognathism in men than in women (P <.01), and more tolerant of mandibular retrognathia in white women than in men (P = .03). CONCLUSIONS: These results support the benefits of using both implicit and explicit methods to assess facial profile preferences.
Assuntos
Estética Dentária/psicologia , Face/anatomia & histologia , Mandíbula/anatomia & histologia , Prognatismo/psicologia , Retrognatismo/psicologia , Adulto , Povo Asiático/psicologia , Atitude , Beleza , Cefalometria , Gráficos por Computador , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Mandíbula/anormalidades , Opinião Pública , Diferencial Semântico , População Branca/psicologiaRESUMO
AIM: The purpose of this study was to determine differences in preference for Korean American facial profiles among Korean American orthodontic patients with 2 levels of acculturation, Asian American orthodontists, and Caucasian orthodontists. METHODS: Images of 1 male and 1 female Korean American adult were animated to move parts of the faces from an extreme retrusive position to an extreme protrusive position by using the Perceptometrics computer program. Three movies were created of the nose, lips, and chin for each image. Three groups of judges, ie, 18 Korean American orthodontic patients, 17 Asian orthodontists, and 18 Caucasian orthodontists selected the most pleasing position and the zone of acceptability as a measure of tolerance. RESULTS: Statistically significant differences were found between Caucasian orthodontists and Korean American orthodontic patients for the most pleasing and midpoint of acceptability positions of female nose and male chin, with no differences in the zone of acceptability position among the groups. CONCLUSION: In general, the Korean American orthodontic patients preferred a more protrusive nose on the female image and more retrusive chin on the male image than Caucasian orthodontists for the most pleasing and midpoint of acceptability positions, with similar zone of acceptability for all 3 groups.
Assuntos
Asiático/psicologia , Imagem Corporal , Estética Dentária/psicologia , Face/anatomia & histologia , Aculturação , Adulto , Gráficos por Computador , Comparação Transcultural , Odontólogos/psicologia , Feminino , Humanos , Coreia (Geográfico)/etnologia , Masculino , Estados Unidos , População Branca/psicologiaRESUMO
To determine the influence of boarding school on self-perceived body and facial morphology, the Body Shape Questionnaire (BSQ) and exploratory questions about the orofacial area (OFA) were administered to female boarding (B) and nonboarding (NB) students at two Catholic schools in Taiwan. The mean total BSQ scores of Bs were significantly higher than NBs, with both being significantly higher than the published normative score but lower than probable bulimics with no significant B vs. NB difference in mean total OFA scores. Because the Bs were significantly taller and reported more orthodontic treatment than NBs, the possible confounding by the higher economic status of the Bs was minimized by finding similar significantly higher BSQ scores for the small number of Bs (5%) than the remaining NBs (95%) in the documented lower socio-economic school. In summary, the experience of boarding in religion-dominated schools significantly increases body image concerns of adolescent females.
Assuntos
Imagem Corporal/psicologia , Habitação , Instituições Acadêmicas , Classe Social , Adolescente , Feminino , Humanos , Taiwan/etnologiaRESUMO
In response to the shortage of primary care physicians and the need for greater intercollaboration among health professionals, dentists with sufficient medical and surgical training are an untapped resource to provide limited preventive primary care (LPPC), such as chairside screening for chronic diseases. The objective of this study was to determine attitudes of Rhode Island dentists toward becoming more involved in the overall health of their patients. Using a 5-point scale (1 being highest), a pretested survey was administered to 92 respondent RI dentists who were asked to indicate their willingness to become more involved in patients' overall health, and undergo additional training to provide LPPC. Their moderate level of willingness was offset by great concern for liability, with older dentists being significantly more willing to assume these additional responsibilities than younger dentists (p< .05). Rank order of designation of oral health providers among dentist, dental physician, oral physician, odontologist, stomatologist, and stomiatrist was still dentist first, but with no significant difference between the mean ranks of dentist and oral physician.[Full article available at http://rimed.org/rimedicaljournal-2016-07.asp, free with no login].