Perfil de utilização de anestésicos locais de uma cidade brasileira com ênfase em diabéticos / Profile of use of local anesthetics in a Brazilian city with emphasis on diabetics

Objetivo: avaliar o conhecimento de cirurgiões-dentistas que trabalham em consultórios particulares de Palmas, Tocantins, quanto à utilização de anestésicos locais em pacientes portadores de diabetes mellitus. Materiais e método: trata-se de um estudo descritivo qualitativo, aprovado pelo Comitê de Ética em Pesquisa da FAMERP de São José do Rio Preto, sob o protocolo 032/2007 e CAAE: 0065.0.000.140-07, respeitando-se a Resolução 466/12, do Conselho Nacional de Saúde. A coleta de dados foi realizada por meio da aplicação de um questionário, utilizando um formulário estruturado. Resultados: de 113 participantes, 47 (41,6%) eram do sexo masculino e 66 (58,4%) do sexo feminino, com idade média de 35 anos. O anestésico mais utilizado pelos cirurgiões-dentistas avaliados foi a lidocaína 2% + adrenalina 1:100.000 (53,1%), o qual também é o mais utilizado para pacientes diabéticos controlados (64,6%). Quanto à variedade de anestésicos, 47,8% dos avaliados relataram possuir somente 3 tipos de anestésicos no consultório e que 83,2% nunca presenciaram nenhum problema decorrente do uso de anestésico. Além disso, 65,5% relataram não participar de cursos para atualização de conhecimentos, sendo que 53,1% mostraram-se insatisfeitos com o ensino de anestesiologia que receberam na graduação. Conclusão: observou-se que os cirurgiões-dentistas do atendimento odontológico particular de Palmas precisam de uma reciclagem profissional, a fim de atualizarem conhecimentos adquiridos na graduação sobre indicação e utilização de anestésicos locais em tratamentos odontológicos de pacientes com necessidades especiais, com ênfase em pacientes portadores de diabetes mellitus.(AU)

Objective: to evaluate the knowledge of dentists who work in private offices in Palmas, Tocantins, regarding the use of local anesthetics in patients with diabetes mellitus. Materials and method: this research is a qualitative descriptive study, approved by the Research Ethics Committee of FAMERP from São José do Rio Preto, under protocol number 032/2007 and CAAE: 0065.0.000.140-07 in compliance with the Resolution 466/12 of the National Health Council. Data collection was performed through the application of a questionnaire, using a structured form. Results: 47 (41.6%) out of 113 participants were male and 66 (58.4%) female, with an average age of 35 years old. The anesthetic most used by the dentists evaluated was lidocaine 2% + adrenaline 1: 100,000 (53.1%) which is also the most used for controlled diabetic patients (64.6%). As for the variety of anesthetics, 47.8% of those evaluated reported having only 3 types of anesthetics in the office and that 83.2% never saw any problems resulting from the use of anesthetics. Furthermore, 65.5% reported not participating in courses to update knowledge and 53.1% were dissatisfied with the teaching of anesthesiology they received during graduation. Conclusion: it was observed that dentists who work in private dental offices in Palmas need a professional retraining in order to update knowledge acquired during graduation on the indication and use of local anesthetics in dental treatments for patients with special needs, with an emphasis on patients with diabetes mellitus.(AU)

Práticas de higiene bucal de pacientes em hemodiálise / Practices of bucal hygiene of patients in hemodialysis

Introdução: os hábitos de higiene bucal de pacientes em hemodiálise podem melhorar sua qualidade de vida e possibilitar o sucesso do transplante renal, entretanto, esse é um assunto pouco evidenciado nas clínicas de terapia substitutiva (hemodiálise) atualmente. Objetivo: avaliar a higiene bucal dos pacientes renais crônicos em tratamento de hemodiálise. Materiais e método: tra¬ta-se de um estudo observacional transversal analítico, cuja população de estudo foram pacientes com doença renal crônica no serviço de referência para tratamento hemodialítico da 13ª Coordenadoria Regional de Saú¬de, localizado no município de Santa Cruz do Sul, RS. As técnicas utilizadas para coleta dos dados foram a entrevista interpessoal padronizada e exames clínicos intrabucais, juntamente com a análise do histórico mé¬dico digital da instituição. Resultados: a amostra teve predomínio de homens (59,21%), com faixa etária de 22 a 89 anos; dos 76 pacientes participantes da pes¬quisa, 39,47% utilizam prótese total; a média de pre¬valência do índice de placa visível foi de 54,137%, e a do índice de sangramento gengival de 16,765%. Os resultados do estudo foram analisados por meio de esta¬tística descritiva e testes de hipóteses. O nível de signifi¬cância utilizado como critério de aceitação ou rejeição nos testes estatísticos foi de 5% (p<0,05). Conclusão: os pacientes em hemodiálise avaliados possuem um per¬fil de higiene bucal precário, com alta prevalência de placa e cálculo dental, o que comprova a necessidade de maior atenção odontológica diversificada e integral para conscientização e melhoria da saúde bucal.

Introdução: os hábitos de higiene bucal de pacientes em hemodiálise podem melhorar sua qualidade de vida e possibilitar o sucesso do transplante renal, entretanto, esse é um assunto pouco evidenciado nas clínicas de terapia substitutiva (hemodiálise) atualmente. Objetivo: avaliar a higiene bucal dos pacientes renais crônicos em tratamento de hemodiálise. Materiais e método: trata- se de um estudo observacional transversal analítico, cuja população de estudo foram pacientes com doença renal crônica no serviço de referência para tratamento hemodialítico da 13ª Coordenadoria Regional de Saúde, localizado no município de Santa Cruz do Sul, RS. As técnicas utilizadas para coleta dos dados foram a entrevista interpessoal padronizada e exames clínicos intrabucais, juntamente com a análise do histórico médico digital da instituição. Resultados: a amostra teve predomínio de homens (59,21%), com faixa etária de 22 a 89 anos; dos 76 pacientes participantes da pesquisa, 39,47% utilizam prótese total; a média de prevalência do índice de placa visível foi de 54,137%, e a do índice de sangramento gengival de 16,765%. Os resultados do estudo foram analisados por meio de estatística descritiva e testes de hipóteses. O nível de significância utilizado como critério de aceitação ou rejeição nos testes estatísticos foi de 5% (p<0,05). Conclusão: os pacientes em hemodiálise avaliados possuem um perfil de higiene bucal precário, com alta prevalência de placa e cálculo dental, o que comprova a necessidade de maior atenção odontológica diversificada e integral para conscientização e melhoria da saúde bucal. (AU)

Transgender HIV status, self-perceived dental care barriers, and residents' stigma, willingness to treat them in a community dental outreach program: Cross-sectional study.

AIM: Assess the association between high risk transgender (TG) HIV status, self-perceived barriers toward oral care, and the residents' stigma and willingness to treat during community dental outreach. METHODS: Demographics, tobacco habits, HIV status, willingness for rapid HIV testing, and self- perceived oral health, barriers toward oral care were assessed in a cross-sectional study among 212 transgender in South India. Further, the residents' stigma across three subscales and residents' willingness to treat the transgender was evaluated. RESULTS: Overall, 88% had begging as the sole income, and 93% lived in slums and used some form of tobacco. Oral health was perceived to be poor by more than half, and the mean probing pocket depth (PPD) and decayed, missing, or filled teeth (DMFT) was 4.2 mm and 3.67, respectively. The residents reported significantly low regard and willingness to treat TG irrespective of high/low stigma and when the transgender HIV status was positive/do not know. Residents with greater fear of exposure expressed least regard and willingness to treat TG (P < 0.05). CONCLUSION: The self-perceived oral health of transgender' was poor corresponding to the clinical examination findings. Moreover, the stigmatizing attitude and low regard to provide oral care is rampant among the dental residents, which further frustrates dental care.

Oral Health Status, Health Behaviour and Treatment Needs of Patients Undergoing Cardiovascular Surgery.

OBJECTIVE: The aim of the present study was to assess the oral health status and treatment needs of cardiovascular surgery patients. Second, the awareness of cardiovascular surgery patients regarding the association between oral health and heart disease was considered. METHODS: Assessment of oral health status, oral hygiene practices and treatment needs of 106 hospitalized patients in preparation for cardiovascular surgery. Patients were interviewed using a structured questionnaire designed for this study and oral examination was carried out by a dentist. RESULTS: The oral hygiene practices of the study cohort were not up to the standard. Patients' awareness of infective endocarditis was poor. Approximately 68% patients experienced dental caries as decayed teeth or missing teeth due to caries and filled teeth. The mean plaque index in the study group was 1.25. In this study cohort, the mean probing depth of periodontal pockets was 5.7±1.3, whereas the mean number of teeth with periodontal pockets > 6 mm was 0.5±0.9. A total of 84 (74.2%) of the patients required dental treatment. CONCLUSION: The principal finding in this study was that patients with heart disease had poor oral health. This study also highlights the importance of better interaction among all healthcare professionals to integrate oral health as part of comprehensive inpatient healthcare.

Oral health status, health behaviour and treatment needs of patients undergoing cardiovascular surgery

Abstract Objective: The aim of the present study was to assess the oral health status and treatment needs of cardiovascular surgery patients. Second, the awareness of cardiovascular surgery patients regarding the association between oral health and heart disease was considered. Methods: Assessment of oral health status, oral hygiene practices and treatment needs of 106 hospitalized patients in preparation for cardiovascular surgery. Patients were interviewed using a structured questionnaire designed for this study and oral examination was carried out by a dentist. Results: The oral hygiene practices of the study cohort were not up to the standard. Patients' awareness of infective endocarditis was poor. Approximately 68% patients experienced dental caries as decayed teeth or missing teeth due to caries and filled teeth. The mean plaque index in the study group was 1.25. In this study cohort, the mean probing depth of periodontal pockets was 5.7±1.3, whereas the mean number of teeth with periodontal pockets > 6 mm was 0.5±0.9. A total of 84 (74.2%) of the patients required dental treatment. Conclusion: The principal finding in this study was that patients with heart disease had poor oral health. This study also highlights the importance of better interaction among all healthcare professionals to integrate oral health as part of comprehensive inpatient healthcare.

Utilization of oral health services network among children and adolescents with leukemia.

AIM: To evaluate the use of the network of oral health services by children and adolescents with leukemia, according to the phase of cancer treatment, type of dental treatment received, and access barriers. METHODS AND RESULTS: An exploratory cross-sectional study carried out in a referral hospital in cancer in northeast of Brazil, with all children and adolescents (3-16 years old) with leukemia who used dental services and who attended the medical consultation in the outpatient clinic between March and August 2016. The analysis of the medical records and a structured interview with caregivers were performed. The majority who used only the specialized network were in a single phase of cancer treatment (49.1%), had oral mucositis treatment (79.2%), and had a time of displacement for oral health services greater than 40 minutes (92.6%). In addition, dental care was centered in the specialized network (76.8%) and during hospitalization (37.7%). CONCLUSIONS: The findings suggest that the oral health care of these individuals is centered on tertiary care, reflecting a deficiency in communication between the network services, as well as the nonrecognition of the basic network as a caregiver source by its users. Despite this, more research is needed.

The need for endodontic treatment and systemic characteristics of hematopoietic stem cell transplantation patients.

The aim of this study is to investigate the relationship between the epidemiological and clinical profiles of patients before and after hematopoietic stem cell transplantation (HSCT) and the need for endodontic treatment. The subjects included 188 individuals enrolled in the dental care program for transplanted patients of the School of Dentistry, Federal University of Minas Gerais (Faculdade de Odontologia da Universidade Federal de Minas Gerais, FO-UFMG) from March 2011 through March 2016. The patients were subjected to an HSCT conditioning dental regimen based on a thorough clinical and radiographic evaluation. Intraoral periapical and bite-wing X-rays were obtained, and after evaluation, specific dental treatment was planned and performed. The following demographic and clinical data were collected from the patients' medical records: age, gender, transplantation stage, primary disease, transplant type, medication used, complete blood count at the time of visit, and need for endodontic treatment. The Kolmogorov-Smirnov and the chi-square tests were used. Leukemia (31.3%) and multiple myeloma (17.9%) were the most prevalent primary diseases. Most patients were subjected to allogeneic-related transplantation (83.6%). Most patients exhibited platelet counts and hemoglobin concentrations below the reference values in the pre-transplantation stage, while the neutrophil and platelet counts and the hemoglobin levels were within the reference ranges in the post-transplantation stage. The proportions of individuals requiring endodontic treatment were similar between the pre- and post-transplantation groups: 24.3% and 24.7%, respectively. The systemic conditions of the patients referred for dental treatment were compromised.

The need for endodontic treatment and systemic characteristics of hematopoietic stem cell transplantation patients

Abstract The aim of this study is to investigate the relationship between the epidemiological and clinical profiles of patients before and after hematopoietic stem cell transplantation (HSCT) and the need for endodontic treatment. The subjects included 188 individuals enrolled in the dental care program for transplanted patients of the School of Dentistry, Federal University of Minas Gerais (Faculdade de Odontologia da Universidade Federal de Minas Gerais, FO-UFMG) from March 2011 through March 2016. The patients were subjected to an HSCT conditioning dental regimen based on a thorough clinical and radiographic evaluation. Intraoral periapical and bite-wing X-rays were obtained, and after evaluation, specific dental treatment was planned and performed. The following demographic and clinical data were collected from the patients' medical records: age, gender, transplantation stage, primary disease, transplant type, medication used, complete blood count at the time of visit, and need for endodontic treatment. The Kolmogorov-Smirnov and the chi-square tests were used. Leukemia (31.3%) and multiple myeloma (17.9%) were the most prevalent primary diseases. Most patients were subjected to allogeneic-related transplantation (83.6%). Most patients exhibited platelet counts and hemoglobin concentrations below the reference values in the pre-transplantation stage, while the neutrophil and platelet counts and the hemoglobin levels were within the reference ranges in the post-transplantation stage. The proportions of individuals requiring endodontic treatment were similar between the pre- and post-transplantation groups: 24.3% and 24.7%, respectively. The systemic conditions of the patients referred for dental treatment were compromised.

The Association between the History of HIV Diagnosis and Oral Health.

Unmet oral care needs are high among people living with human immunodeficiency virus (HIV)/AIDS (PLWH). Oral health care is of increasing importance as life expectancy is being prolonged extensively among PLWH. The benefit of oral health care in relation to time since HIV diagnosis has not previously been assessed. A retrospective multivariable analysis of the Special Project of National Significance Oral Health Initiative observational cohort study ( N = 2,178) was performed to estimate the odds ratios (ORs) of oral health outcomes comparing historically diagnosed subjects (>1 y since HIV diagnosis) to newly diagnosed subjects (≤1 y since HIV diagnosis). ORs were adjusted for age, study site, language, income, last dental care visit, and dental insurance. Historically diagnosed subjects were more likely to report oral problems than newly HIV-diagnosed subjects (OR, 2.10). Historically diagnosed subjects were more likely to require oral surgery (OR, 1.52), restorative treatment (OR, 1.35), endodontic treatment (OR, 1.63), and more than 10 oral clinic visits over the 24-mo study period (OR, 2.02). The crude cumulative 2-y risk of requiring prosthetic (risk difference [RD], 0.21) and endodontic (RD, 0.11) treatment was higher among historically than newly diagnosed subjects, despite no significance postadjustment. Furthermore, poor oral health outcomes were exacerbated among non-highly active antiretroviral therapy users. Summarizing, the authors found that historically diagnosed subjects were more likely to report oral problems and require dental procedures compared with newly diagnosed subjects, suggesting that oral health among PLWH declines over time since HIV diagnosis. Hence, newly diagnosed PLWH may benefit from the implementation of early oral interventions.

Dental utilization for Medicaid-enrolled children with cystic fibrosis.

OBJECTIVES: Despite a multitude of risk factors, children with cystic fibrosis (CF) have lower reported dental caries prevalence. A potential explanation is preventive dental care use, but no studies to date have examined dental use for children with CF. METHODOLOGY: Iowa Medicaid data were analyzed for children age 3 to 17 years (N = 156,268). Poisson regression models were used to compare utilization rates for any dental care and also for specific categories of dental care, by CF status. RESULTS: Children with CF were significantly less likely to use any dental care than children without CF (incident rate ratio: 0.819, 95% CI: 0.80 to 0.84, p < .001). There were no significant differences in use across specific categories of dental care. CONCLUSIONS: Medicaid-enrolled children with CF are less likely to use dental care than children without CF. These findings suggest that use of dental care use is an unlikely explanation for lower purported caries rates among children with CF.

Learning from a Special Care Dentistry Needs Assessment.

UNLABELLED: The General Dental Council recognised special care dentistry (SCD) as a speciality in 2008 and local service reviews have been carried out in order to develop SCD services. A needs assessment was completed to inform the implementation of recommendations from a 2010 review of SCD in Wales. AIM: The aim of this paper is to outline the process, findings and learning from the needs assessment and the implications for SCD. METHOD: A focused needs assessment approach was used. Stakeholder consultations were used to develop a working definition for the needs assessment. Data were collected from existing health and social care sources and analysed using descriptives and geographic information system (GIS) mapping. RESULTS: Data sources for needs assessment were limited. Analysis showed that health conditions were common in the population and increased with age. The majority of people who reported seeing a dentist were seen in general dental practice. Older people with health conditions were less likely to report seeing a dentist. Patients often needed to travel for specialist care services. CONCLUSION: General dental practice teams have a significant role in caring for SCD patients. Careful planning of specialist care, joint working and enhancing skills across the general practice team will reduce the burden of care and enhance patient safety. Improvements in data for assessment of SCD needs are required to help this process.

Medically compromised conditions among Dental patients: A prospective study of the attitude of patients toward medication and medical recall visits.

BACKGROUND: A significant proportion of patients seeking dental care may present with one or more medical conditions. Information on medical history, drug used and attitude to medical recall visit is vital for planning dental treatment in this group of patients. OBJECTIVES: To study the attitude of dental patients with medical condition toward their medication and medical recall visits. METHODS: This prospective study was conducted among consecutive new patients presenting to the Dental centre, UMTH, Maiduguri, between January and December 2012. The data were collected through a structured questionnaire. RESULTS: Of 566 new patients seen during the study period, 92 patients (16.3%) had medically compromised conditions. Male Female ratio was 1:1.4 and a mean age 43.3 +/- 16.1 years. Hypertension 91(5.7%) was the most prevalent medical problem. Forty-four (47.8%) kept regular medical recall appointments while 15 (16.3%) only visited their physician when they have perceived symptoms of their ailment. Fifty-three (57.6%) take their medications regularly as prescribed by their physician while 14.1% of the patients had on their own stopped their medication. CONCLUSION: Appreciable number of the patients showed good drug compliance and regular recall visit to their physician, however there is still some level of poor drug compliance and irregular observance of medical recall appointments among the subjects. Oral health awareness instructions should include counselling and motivation on drug compliance and adherence to medical visit.

Survey on choice of intravenous sedative agent at department of dental anesthesiology, Tokyo Dental College Chiba Hospital between 2010 and 2011.

Use of intravenous sedation is increasing in the management of dental patients in consideration of accompanying diseases and patient demand for comfort and safety. We surveyed choice of sedative agent and dosage on the basis of accompanying diseases or conditions in patients receiving treatment at the Department of Dental Anesthesiology, Tokyo Dental College Chiba Hospital between 2010 and 2011. A total of 5,256 patients were reviewed and divided into the following categories: 1) medically compromised patients (MC); 2) minor oral surgery (OS); 3) cerebral palsy (CP); 4) mental retardation (MR); 5) mental disorder (MD); and 6) dental phobia with/without gag reflex. The investigated variables were sex, age, weight, duration of sedation, and dosage of agent. Dosage of midazolam (M), M plus propofol (MP), and P alone was investigated. A total of 2,336 patients were managed by intravenous sedation during the study period. The combination of MP was used in approximately 63-79% of patients in all categories, except MC. Midazolam was used in approximately 47% in the MC group. Propofol was used in approximately 32% of patients in the MR group. Other agents (minor tranquilizers, analgesics, and so on) were used in approximately 12% in the OS group. The dose of M was approximately 0.05-0.06 mg/kg. When MP was administered, the dose of M showed no difference among groups. The dose of P, however, tended to be lower in the MC and CP groups than in the other groups. These results suggest that MP is chosen for intravenous sedation in most types of dental treatment.

Analysis of dental care of children receiving comprehensive care under general anaesthesia at a teaching hospital in England.

OBJECTIVES: This study aimed to analyse the characteristics of comprehensive dental care provided under general anaesthesia (CDGA) and to review the additional treatment required by children over the 6 years subsequent to CDGA. METHOD: Information collected from hospital records for the 6-year period following the first CDGA included the types of dental treatment performed at CDGA, the return rates for follow-up appointments, further treatment required subsequent to CDGA and the types of dental treatment performed at repeat DGA. RESULTS: The study population consisted of 263 children, of whom 129 had a significant medical history, with mean age of 6.7 years. The results revealed that the waiting time for CDGA was significantly shorter in children who had a significant medical history, with 49% being admitted for CDGA within 3 months of pre-GA assessment, as compared to 29% of healthy children. 67% of children had follow-up care recorded, with a slightly higher proportion of children with significant medical history returning for follow-up [70% (90/129)] compared with 65% (87/134) of healthy children. Re-treatment rates were 34% (88/263), the majority of cases being treated under local analgesia (42/88). 34 of 263 children had repeat DGA (12.9%). Of these 71% (24/34) were children with significant medical history. The mean age at repeat DGA was 9 years. In 25 of 34 children (74%), repeat DGA was due to trauma, oral pathology, supernumerary removal, hypomineralized teeth or new caries of previously sound or un-erupted teeth at CDGA. The ratio of extraction over restoration (excluding fissure sealants) performed at repeat DGA was 2.8, compared with the ratio of 1.3 in the initial CDGA. CONCLUSIONS: There was a higher ratio of extraction over restorations at the repeat DGA. This suggests that the prescribed treatments at repeat DGA were more aggressive as compared to the initial CDGA in 1997. The majority of the treatment required at repeat DGA was to treat new disease.

Antibiotic prophylaxis prescribing practices of dentists in Singapore.

BACKGROUND: Infective endocarditis is a serious complication that results in significant morbidity and mortality in susceptible patients. The guidelines for antibiotic prophylaxis have been updated by the American Heart Association and National Institute for Health and Clinical Excellence. The antibiotic prophylaxis prescribing practices among dentists in Singapore are unknown. AIM: To determine the specific infective endocarditis antibiotic prophylaxis prescribing practices of dentists in Singapore. METHODS: A questionnaire survey was sent through an email link and by postal mail. Statistical analysis was carried out using SPSS 19.0. RESULTS: Responses were received from 458 dentists (34.3% response rate), of which 278 (65.9%) were general practitioners. The majority of respondents (39.8%) followed the American Heart Association 2007 guidelines and 30.2% followed cardiologists' recommendations. The accuracy of prescriptions for 13 cardiac conditions and 12 dental procedures were evaluated. The median number of accurate answers for cardiac conditions was eight for the American Heart Association 1999 guidelines, and four for the American Heart Association 2007 and National Institute for Health and Clinical Excellence guidelines, respectively. The median number of accurate answers for dental procedures was generally high, both for dentists who followed the American Heart Association 1999 guidelines (median = 10) and American Heart Association 2007 (median = 9) guidelines. Majority of respondents (82.8%) felt that developing a local guideline would be beneficial to the local dental community. CONCLUSION: Dentists were accurate in their prescriptions of antibiotic prophylaxis for dental procedures, but not for cardiac conditions. It may be helpful to attain a consensus among local cardiologists and dentists to unify the antibiotic prophylaxis prescription practices in Singapore.

Dental management of children with special healthcare needs.

INTRODUCTION: Dental caries is a common condition amongst young children that negatively impacts on their quality of life, It is an added burden on children with special healthcare needs (CSHCN) who have an increased risk of developing caries due to the high sugar contents in their medications, regular consumption of cariogenic foods and a poor salivary flow. AIMS AND OBJECTIVES: to analyse the management of dental caries in CSHCN at a tertiary public hospital in South Africa. METHODS: A retrospective analysis was conducted of the dental and medical records of 374 medically compromised children presenting with dental caries. Dental treatment and anaesthetic techniques used were reviewed. RESULTS: Results indicated that the majority of CSHCN presenting with caries were managed by extractions (96.5%) under either local anaesthesia (73.3%) or general anaesthesia (26.7%). There was a lack of restorative care provided to these compromised children, CONCLUSIONS: Treatment by extractions may relieve discomfort and pain; however, early loss of teeth leads to functional, psychological, aesthetic and orthodontic problems, which can result in a further decline in the quality of life of these already compromised patients, Restorative treatment and prevention strategies are critical in managing caries in CSHCN in order to improve their quality of life,

Increasing use of dental services by children, but many are unable to secure needed care.

National studies indicate that an increasing proportion of children are receiving needed oral health care. However, this increase is not uniform throughout all populations of youngsters. Overall national study findings regarding the use of dental services mask the fact that, a significant subset of low-income, minority, medically and developmentally compromised and socially vulnerable children continue to lack access to care and suffer significant and consequential dental and oral disease. In addition, these same children will face continued difficulties in securing needed care as they reach their early adult years.

Dental case manager encounters: the association with retention in dental care and treatment plan completion.

Little is known about dental case managers as few programs have been scientifically evaluated. The goal of this study was to explore the impact of dental case manager on retention in dental care and completion of treatment plans, while specifically exploring the number of dental case manager encounters. Fourteen programs enrolled people with HIV/AIDS (PLWHA) in dental care and a longitudinal study between 2007 and 2009. The 758 participants had a total of 2715 encounters with a dental case manager over twelve months: 29% had a single encounter; 21% had two; 27% had 3-4 and; 23% had 5-29 encounters. Adjusting for baseline characteristics, participants receiving more encounters were significantly more likely to complete their Phase 1 treatment plan, be retained in dental care, and experience improvements in overall oral health status. Organizations considering efforts to improve the oral health of vulnerable, hard-to-engage populations should consider these findings when planning interventions.

Retention of people living with HIV/AIDS in oral health care.

OBJECTIVE: We identified factors associated with retention in oral health care for people living with HIV/AIDS (PLWHA) and the impact of care retention on oral health-related outcomes. METHODS: We collected interview, laboratory value, clinic visit, and service utilization data from 1,237 HIV-positive patients entering dental care from May 2007 to August 2009, with at least an 18-month observation period. Retention in care was defined as two or more dental visits at least 12 months apart. We conducted multivariate regression using generalized estimating equations to explore factors associated with retention in care. RESULTS: In multivariate analysis, patients who received oral health education were 5.91 times as likely (95% confidence interval 3.73, 9.39) as those who did not receive this education to be retained in oral health care. Other factors associated with care retention included older age, taking antiretroviral medications, better physical health status, and having had a dental visit in the past two years. Patients retained in care were more likely to complete their treatment plans and attend a recall visit. Those retained in care experienced fewer oral health symptoms and less pain, and better overall health of teeth and gums. CONCLUSIONS: Retention in oral health care was associated with positive oral health outcomes for this sample of PLWHA. The strongest predictor of retention was the receipt of oral health education, suggesting that training in oral health education is an important factor when considering competencies for new dental professionals, and that patient education is central to the development of dental homes, which are designed to engage and retain people in oral health care over the long term.