Oral health outcomes in an adult dental population: the impact of payment systems.

This study compared the effect of payment systems on recall visits and oral health outcomes for four patient payer groups. The authors reviewed recall audit data obtained over a 4-year period. Dental payer groups in the study population differed with respect to dental outcomes. Patients who had recall visits at 1 year or longer had worse outcomes than patients seen more frequently. A Medicaid subgroup with the greatest number of risk factors displayed improved oral health outcomes when seen on a more frequent recall schedule. Study findings suggest that, given the increased risks to maintaining oral health, patients being supported by public-funded programs would benefit from more frequent recalls. Such an emphasis would appear to provide the opportunity to improve outcomes in disadvantaged populations and increase the quality of care offered.

The state of the art in evaluating the performance of assistant and associate deans as seen by deans and assistant and associate deans.

This study explores the little-understood process of evaluating the performance of assistant and associate deans at dental colleges in the United States and Canada. Specifically, this research aimed to identify the methods, processes, and outcomes related to the performance appraisals of assistant/associate deans. Both deans and assistant/associate deans were surveyed. Forty-four of sixty-six deans (66.7 percent) and 227 of 315 assistant/associate deans (72.1 percent) completed surveys with both close-ended and open-ended questions. In addition, ten individuals from each group were interviewed. Results indicate that 75-89 percent of assistant/associate deans are formally evaluated, although as many as 27 percent may lack formal job descriptions. Some recommended best practices for performance appraisal are being used in a majority of colleges. Examples of these best practices are having at least yearly appraisals, holding face-to-face meetings, and setting specific, personal performance objectives/benchmarks for assistant/associate deans. Still, there is much room to improve appraisals by incorporating other recommended practices. Relatively high levels of overall satisfaction were reported by both assistant/associate deans and deans for the process and outcomes of appraisals. Assistant/associate deans rated the value of appraisals to overall development lower than did deans. Qualitative data revealed definite opinions about what constitutes effective and ineffective appraisals, including the use of goal-setting, timeliness, and necessary commitment. Several critical issues related to the results are discussed: differences in perspectives on performance reviews, the importance of informal feedback and job descriptions, the influence of an assistant/associate deans' lack of tenure, and the length of service of deans. Lastly, recommendations for enhancing performance evaluations are offered.

Dental injury associated with anesthesia: a report of 161,687 anesthetics given over 14 years.

STUDY OBJECTIVE: To determine the frequency, outcomes, and risk factors for dental injury related to anesthesia. DESIGN: Case-control study. SETTING: Tertiary-care university hospital. PATIENTS: Patients who had a perianesthetic dental injury between August of 1989 and December 31, 2003. MEASUREMENTS: A 1:2 case control study was done to identify the frequency, outcomes, and risk factors for dental injury. Perianesthetic dental injuries were defined as any notable change to the patient's dentition during the perianesthetic period that may or may not have required dental consultation or treatment. MAIN RESULTS: Seventy-eight patients with perianesthetic dental injury were identified. The incidence of dental injury was one per 2,073 anesthetics. Eighty-six percent of dental injuries were discovered by the anesthesia provider. Maxillary incisors were the most frequently injured teeth. The most commonly reported injuries were enamel fracture, loosened or subluxated teeth, tooth avulsion, and crown or root fracture. Patients with poor dentition or reconstructive work, whose tracheas were moderately difficult or difficult to intubate, were at much higher risk (approximately 20-fold) of dental injury than those with good dentition and found to be easy to intubate. Among those whose tracheas were easy to intubate, patients with poor dentition or reconstructive work were 3.4 times more likely to have dental injuries related to anesthesia. CONCLUSIONS: Dental injury is one of the most common adverse events reported in association with anesthesia. Risk factors include preexisting poor dentition or reconstructive work and moderately difficult to difficult intubation.

The state of the art in evaluating the performance of department chairs and division heads.

This study explores the little understood process of evaluating the performance of department chairs/division heads in dental schools. Specifically, this research aimed to elucidate the methods, processes, and outcomes related to the job performance of department chairs/division heads. Forty-three deans and 306 chairs completed surveys with both close-ended and open-ended questions. In addition, ten deans and ten chairs were interviewed. Results indicate that 80 to 90 percent of department chairs are formally evaluated, although as many as 50 percent may lack job descriptions. Recommended best practices for performance appraisal--such as having at least yearly appraisals, holding face-to-face meetings, and setting specific, personal performance objectives/benchmarks for chairs--are being used in most schools. Still, there is much room to improve appraisals by incorporating other recommended practices. Overall high levels of satisfaction were reported by both chairs and deans for the process and outcomes of appraisals. Qualitative data showed some convergence of opinions about appraisals with the notable exception of informal feedback. We explore some implications of these results, especially as they relate to improving performance appraisals.

Dental implants in edentulous adults with cognitive disabilities: report of a pilot project.

Individuals with cognitive disabilities face many barriers to oral care, often suffering from partial or complete edentulism. While the use of implant reconstruction is becoming more common in the general population, such care is still being used infrequently in individuals with intellectual impairment. A pilot project in 1995 surgically placed and restored implant-supported prostheses in six edentulous adults who had varying degrees of cognitive impairment. This report presents the dentists' reconstruction experiences and the patients' follow-up care, and discusses the results in relationship to current literature. Experiences from these patients suggest that behavior during the restorative process, prosthetic complications post placement, and patients' oral hygiene practices should influence patient selection and prosthetic design. Anteriorly placed fixtures and removable designs, which make self-care and repair easier, can be used to treat an edentulous population.

The work covenant: a management strategy for department chairs and program directors.

Learning contracts have been used in adult education to ensure a positive and successful learning process. By means of a learning contract, the instructor can support the learner in a manner that best suits the learner's individual requirements. Like the learning environment, the workplace finds individuals with varying skill sets, areas of interest, and degrees of motivation. Understanding and applying the skills of the worker to appropriate tasks and interests have important ramifications for how workers perceive their jobs and the ultimate effectiveness of the organization. Studies show that the quality of the work environment is critical for the job satisfaction and retention of employees in the public and private sector as well as for the dental academician. Recent literature on faculty development has focused on adapting business-based motivation, mentoring, and performance counseling strategies to the academic setting. By leading and managing faculty development through the use of such strategies, the quality of the work environment can be improved. This article briefly summarizes the commonality between retention strategies and learning contracts within a human resource context and provides a model document that can be used by chairs and program directors to organize and focus their faculty development efforts.

Gainsharing in a general practice residency: report of an experience.

Postgraduate general dentistry programs are facing critical problems with funding, resident recruitment and viability. Recent federal actions reduced and eliminated graduate medical education (GME) support for some programs, and rising student debt and increasingly lucrative private practice opportunities reduce the value of postgraduate general dentistry experiences. Faced with these complex and interlinked challenges, the University of Nebraska Medical Center College of Dentistry General Practice Residency implemented a gainshare plan. The first 12 months of the plan produced a 44% increase in production and a concomitant 42% increase in actual collections resulting in enough funds to provide remuneration over base salary for residents, staff and faculty. The plan also compensated the Dean, the host department and the College of Dentistry while also funding the development of a reserve account for program enhancement and future stipend support. Gainshare concepts, rationale and details of the pilot plan are presented along with a discussion of key outcomes and experiences.

Rapid forced eruption: a case report and review of forced eruption techniques.

This article reviews the infrequently utilized treatment method of forced eruption and how it can serve as an alternative to the sacrifice of the natural root system. Forced eruption can preserve the natural root system and related periodontal architecture, resulting in years of additional service for the patient. It also can maintain adjacent tooth structure while retaining the option for future implant reconstruction. Given the reported success of forced eruption, the technique requires greater attention and increased application among dentists. A case of forced eruption in the anterior maxilla utilizing a removable device is described. An overview of forced eruption technique also is provided.

The posterior superior alveolar injection technique: a report on technique variations and complications.

The posterior superior alveolar (PSA) injection technique has varied over time with respect to the depth and angle of penetration, the location for deposition of anesthetic agent, and the number of injections necessary to assure adequate anesthesia to the maxillary molars. Of the standard intraoral injections, the PSA carries with it the second highest risk for anesthesia complications. With changes in armamentarium and technique, the complication rates have declined and more often are associated with anatomical considerations with respect to neurovascular compromise and/or anesthetic solution. In this study, the PSA injection technique and complication histories were investigated. Seventeen variations to the technique are reported along with 12 injection complications. A historic injection complication classification system is presented along with a management strategy based upon a review of reported provider experiences and treatment suggestions.

The triangle of safety: a modified posterior superior alveolar injection technique based on the anatomy of the PSA artery.

The posterior superior alveolar (PSA) injection technique is commonly used to anesthetize soft and hard tissues of the posterior maxilla. As with all injections, complications arise, including hematoma formation secondary to needle-induced vascular trauma. In an attempt to develop a hemorrhage-free PSA injection technique, 361 infratemporal dissections were completed on human cadaver specimens. Three distribution patterns were identified for the external branch of the PSA artery. Regardless of distribution pattern, an anatomical Triangle of Safety was found superior to the maxillary second molar that was free of neurovascular tissues in more than 99% of individuals. Injection into this area appears to meet anesthetic needs while reducing the risk of hematoma formation. The combination of this anatomical triangle with newer anesthetic agents and computerized delivery systems holds promise for continued improvement of the PSA injection technique.

Strategic management and organizational behavior in dental education: reflections on key issues in an environment of change.

With issues such as shrinking revenue, access to care, faculty workloads, and graying faculty, dental schools are faced with difficult challenges that fall to dental school deans to manage. Do dental school deans have the organizational skill sets and ethical frameworks necessary to address the challenges now facing dental schools? The purpose of this article is to pose questions and suggestions regarding some of the key issues in dental colleges today and to stimulate discussion in the dental community about needed changes in dental education.

Anatomical variations and clinical implications of the artery to the lingual nerve.

The pterygomandibular space is a critical anatomic area for the delivery of local anesthesia in the practice of dentistry. The neurovascular contents of this area are subject to trauma and its resultant local and systemic complications. This study of 202 cadaveric specimens reaffirms the literature as to the percent distributions of the superficial and deep routes of the maxillary artery and details for the first time the anatomic variations of the artery to the lingual nerve. This artery courses through the pterygomandibular space placing it at risk for injection trauma along with the other neurovascular contents. It has been uncommonly identified and referred to in the literature, yet it may be the first artery encountered when entering the space with a needle or during surgical intervention in the area.