Oral health in children with Down syndrome: Parents' views on dental care in Flanders (Belgium).

AIM: Evaluate the views and knowledge, regarding dental care, of parents who have a child with Down syndrome (DS). MATERIALS AND METHODS: Parents of children with DS were invited to fill in a questionnaire. They were recruited by the Flemish Organization for DS, from schools for children with special needs and by four multidisciplinary medical DS teams at four University Hospitals. STATISTICS: Chi-square tests were used to test the correlation between different variables. Results were assessed in the 95% confidence interval with p<0.05. RESULTS: Mean age of the children was 10.1 years old (SD: 5.3). Oral health was indicated as rather good by 53% of the parents. Of the children, 66% went to a dentist within the last six months. Most of the children (64%) received a dental examination. In 53% of the cases, parents visited the same dentist for their child with DS as their other child(ren) without DS. Eighty-three percent of the parents are pleased with their dentist. They expect the dentist to be kind and reassuring. Children aged 10 years or younger get significantly more help with tooth brushing (79%) than children older than 10 years (36%). However 20% of the parents never received any oral hygiene instructions for their child with DS. CONCLUSION: Prevention is the most frequent service provided by the dentist. Parents seem to be pleased with the dentist who treats their child with DS.

Dental skill mix: a cross-sectional analysis of delegation practices between dental and dental hygiene-therapy students involved in team training in the South of England.

BACKGROUND: Research suggests that health professionals who have trained together have a better understanding of one another's scope of practice and are thus equipped for teamwork during their professional careers. Dental hygiene-therapists (DHTs) are mid-level providers that can deliver routine care working alongside dentists. This study examines patterns of delegation (selected tasks and patients) by dental students to DHT students training together in an integrated team. METHODS: A retrospective sample of patient data (n = 2,063) was extracted from a patient management system showing the treatment activities of two student cohorts (dental and DHT) involved in team training in a primary care setting in the South of England over two academic years. The data extracted included key procedures delegated by dental students to DHT students coded by skill-mix of operator (e.g., fissure sealants, restorations, paediatric extractions) and patient demography. χ2 tests were conducted to investigate the relationship between delegation and patient age group, gender, smoking status, payment-exemption status, and social deprivation. RESULTS: A total of 2,063 patients managed during this period received treatments that could be undertaken by either student type; in total, they received 14,996 treatment procedures. The treatments most commonly delegated were fissure sealants (90%) and restorations (51%); whilst the least delegated were paediatric extractions (2%). Over half of these patients (55%) had at least one instance of delegation from a dental to a DHT student. Associations were found between delegation and patient age group and smoking status (P <0.001). Children under 18 years old had a higher level of delegation (86%) compared with adults of working age (50%) and patients aged 65 years and over (56%). A higher proportion of smokers had been delegated compared with non-smokers (45% cf. 26%; P <0.001). CONCLUSIONS: The findings suggest that delegation of care to DHT students training as a team with dental students, involved significantly greater experience in treating children and adult smokers, and providing preventive rather than invasive care in this integrated educational and primary care setting. The implications for their contribution to dentistry and the dental team are discussed, along with recommendations for primary care data recording.

The potential oral health impact of cost barriers to dental care: findings from a Canadian population-based study.

BACKGROUND: Prior to the 2007/09 Canadian Health Measures Survey, there was no nationally representative clinical data on the oral health of Canadians experiencing cost barriers to dental care. The aim of this study was to determine the oral health status and dental treatment needs of Canadians reporting cost barriers to dental care. METHODS: A secondary data analysis of the 2007/09 Canadian Health Measures Survey was undertaken using a sample of 5,586 Canadians aged 6 to 79. Chi square tests were conducted to test the association between reporting cost barriers to care and oral health outcomes. Logistic regressions were conducted to identify predictors of reporting cost barriers. RESULTS: Individuals who reported cost barriers to dental care had poorer oral health and more treatment needs compared to their counterparts. CONCLUSIONS: Avoiding dental care and/or foregoing recommended treatment because of cost may contribute to poor oral health. This study substantiates the potential likelihood of progressive dental problems caused by an inability to treat existing conditions due to financial barriers.

[Satisfaction with dental care from the patient's perspective - the dental-ZAP-V1]. / Zufriedenheit mit der zahnärztlichen Versorgung aus Perspektive der Patienten - Der Zahn-ZAP-V1.

BACKGROUND: Patient satisfaction is a central topic in quality management in outpatient dental care. The ZAP questionnaire was validated to explore patient satisfaction in general and specialist outpatient settings. This study aims at assessing the psychometric properties of the ZAP in dental care. METHODS: A minimally modified version of the ZAP consisting of 4 domains (office organisation, cooperation, interaction, information) was administered in personal interviews to a population-based sample. Descriptive, exploratory and confirmatory psychometric analyses were conducted with random subsets of the study sample. RESULTS: The study population comprised 1 773 subjects with at least one dental visit during their lifetime (mean age=50 years, female=51.6%). The exploratory factor analysis identified 3 subscales (office organisation, interaction, information). Based on these results, items of the subscale "cooperation" were excluded from further analyses. The remaining items had a medium difficulty of 0.75, all item-total-correlations were above 0.4. Missing values ranged between 2.3% and 28.7%. Cronbach's alpha ranged between 0.79 and 0.95. After introduction of 3 residual correlations, the confirmatory factor analyses reached a good model fit (TLI: 0.97; CFI: 0.97, RMSEA: 0.06). Partial standardised factor loadings ranged between 0.77 and 0.87. The 3 latent factors were highly correlated. There was a positive correlation between the 3 subscales and global patient satisfaction with the dentist. CONCLUSION: The psychometric assessment can be used in the 3 modified subscales (office organisation, interaction, and information) to assess patient satisfaction with dental care. To assess dentist's competence in relation to dental anxiety and pain as well as shared decision making new scales specific to dental care should be explored.

The use of intravenous midazolam and ketamine in paediatric dental sedation.

In the UK, Dental General Anaesthesia (DGA) was removed from primary care at the end of 2001. Since then anxious and 'difficult' paediatric dental patients have been treated using local anaesthesia with or without conscious sedation. Evidence has been lacking as to the safety and efficacy of paediatric dental sedation in primary care. Various centres have presented evidence of good clinical practice when anaesthetist-led. This study describes an audit of 500 children treated using intravenous midazolam and ketamine, by an operator-sedationist in a primary care setting.

Role of the Chronic Dental Disease Scheme in Enhanced Primary Care: allied health or allied outlier?

This study aims to provide a comparative analysis of the Chronic Dental Disease Scheme (CDSS) and the Allied Health Profession (AHP) program as they related to the greater Enhanced Primary Care Scheme introduced by the Australian Government to manage patients with chronic and complex diseases. A retrospective analysis of data pertaining to Medicare items related to dentistry and the allied health professions were extracted from the Medicare Benefits Schedule database online, and formed the basis of this study. The highest proportion of services was provided in the state of New South Wales. There appears to be synergy in the utilisation of services with jurisdictions either overutilising or underutilising services. Costs to the Enhanced Primary Care Scheme under the CDSS model (fee for service) were up to 40 times more expensive compared with the AHP model (fee per visit). Costs and treatment associated with the CDSS experienced an increase of 13350% during the period 2007-08, coincident with an increase in subsidization. Reconstructive dentistry accounted for the majority of the increase. Gender disparities in dentistry were less distinct when compared with AHPs and were postulated to be due to males presenting with conditions that were more progressive requiring more invasive treatment. A comparative analysis indicates significant differences in costs, nature of treatment and the manner of remuneration between dentistry and the AHPs. A fee for service schedule as evidenced by the CDSS is dependent on the degree of financial incentive as indicated by patterns in utilisation over time. The amount of treatment considered necessary may be influenced by the level of subsidy with treatment that may not reflect disease management. The AHP model, which is based around a fee for visit schedule, is not without its deficiencies but has not experienced significant rises in cost compared with the CDSS.

Auricular acupuncture effectively reduces state anxiety before dental treatment--a randomised controlled trial.

OBJECTIVES: The objective of this study was to analyse whether auricular acupuncture, acupuncture at the outer ear, could reduce state anxiety before dental treatment. METHODS: This prospective, randomised patient-blinded study with 182 patients compared anxiety before dental treatment following auricular acupuncture at the relaxation-, tranquillizer- and master cerebral points (auricular acupuncture group) versus acupuncture at sham points (finger-, shoulder- and tonsil points; sham group) and a non-intervention control group. Anxiety was assessed using the Spielberger State Trait Anxiety Inventory (German version) before auricular acupuncture and 20 min thereafter, immediately before dental treatment. RESULTS: Auricular acupuncture reduced state anxiety score more effectively from 54.7 ± 10.8 to 46.9 ± 10.4 (mean ± SD) than sham acupuncture from 51.9 ± 10.2 to 48.4 ± 10.0. In contrast, state anxiety in the control group increased from 51.0 ± 11.7 to 54.0 ± 11.6 (mean increase +3.0; CI +4.7 to +1.2). The decrease in state anxiety in both intervention groups was statistically significant (p < 0.001) when compared to the non-intervention control group. After correcting for group differences in baseline state anxiety, the reduction in anxiety was -7.3 score points (CI -9.0 to -5.6) in the auricular acupuncture group and -3.7 score points (CI -5.4 to -1.9) in the sham group (p = 0.008). CONCLUSION: Auricular acupuncture, a minimally invasive method, effectively reduces state anxiety before dental treatment. CLINICAL RELEVANCE: Auricular acupuncture could be an option for patients scheduled for dental treatment, who experience an uncomfortable degree of anxiety and request an acute intervention for their anxiety.

Clinical use of an epinephrine-reduced (1/400,000) articaine solution in short-time dental routine treatments--a multicenter study.

The addition of epinephrine in dental local anaesthesia results in a longer and deeper anaesthesia under almost ischemic conditions. For short-time dental treatments, epinephrine-reduced anaesthetics may offer shorter and more individual anaesthesia with reduced potential side effects. The aim of this study was a clinical evaluation of anaesthetic potency and adverse effects of an epinephrine-reduced articaine formulation in dental patients undergoing short-time routine treatment. In a prospective clinical, not interventional, study between January 2008 and February 2009, 908 patients undergoing short-time dental treatment in five medical centers were anaesthetized with 4% articaine 1:400,000 epinephrine (Ubistesin, 3M/ESPE, Seefeld, Germany). Efficacy and safety in clinical use were evaluated. A follow-up after 1 day was conducted by telephone survey. A mean amount of 1.3-ml anaesthetic solution was needed to achieve a complete or sufficient anaesthesia in 97% (n = 876) of cases. A second injection had to be done in 3.7% (n = 34) before and in 11.9% (n = 108) during treatment. Here, the second injection had to be applied after a mean of 48.6 min. The mean duration of soft tissue anaesthesia after infiltration was 146.6 min, after nerve block 187.7 min. The painful treatment took a mean of 50.2 min and the total treatment time summed up to 68.8 min. In 1.7% cases (n = 15), unwanted side effects were observed. The results indicate that a lower concentration of epinephrine in combination with the 4% articaine solution leads to a high success rate of efficacy. The clinical use of a 4% articaine 1:400,000 epinephrine solution can be stated as safe and effective in short dental routine treatments. Reconsiderations concerning limitations of indication or additional contraindications are not necessary.

Initial University of Otago oral health graduates' employment pathways and preparedness for work.

OBJECTIVES: To examine University of Otago BOH graduates' post-graduation pathways and employment experiences; and graduate, employer and host therapist perspectives of the new BOH programme and student/ graduate preparedness for work. DESIGN: A survey-based qualitative research project. SETTING: Private and public oral healthcare settings. PARTICIPANTS AND METHODS: Open-ended questionnaires were used to conduct a 2010 survey of 2009 BOH graduates and consenting graduates' employers, and a 2011 survey of dental therapists who had hosted BOH students on clinical placement since 2009. Data were analysed inductively using a thematic content and analysis approach. MAIN OUTCOME MEASURES: 18 (60%) of the 30,2009 BOH graduates completed the online graduate questionnaire with 10 providing employer information. Six employers completed the 'graduate attribute' questionnaire, and 30 (45%) of the 66 eligible host therapists, the 'student attribute' questionnaire. Clear themes emerged from the three participant groups. RESULTS: Of the 18 graduate participants, 10 were working in dental therapy and dental hygiene, with the remaining eight working in only one area. Graduates' primary concern was with maintaining both scopes of practice. Graduates and host therapists stressed a need for students' exposure to complex cases, while employers indicated that graduates' clinical confidence had developed over time. CONCLUSION: Recommendations for improving BOH graduates' transition outcomes included (1) increasing students' exposure to complex clinical and placement experience; (2) improving continuing education opportunities for new graduates; and (3) promoting interaction between BOH and dental students with a view to improving (future) dentists' knowledge of BOH graduate skills and attributes.

The relationship between body system-based chronic conditions and dental utilization for Medicaid-enrolled children: a retrospective cohort study.

BACKGROUND: Dental care is the most common unmet health care need for children with chronic conditions. However, anecdotal evidence suggests that not all children with chronic conditions encounter difficulties accessing dental care. The goals of this study are to evaluate dental care use for Medicaid-enrolled children with chronic conditions and to identify the subgroups of children with chronic conditions that are the least likely to use dental care services. METHODS: This study focused on children with chronic conditions ages 3-14 enrolled in the Iowa Medicaid Program in 2005 and 2006. The independent variables were whether a child had each of the following 10 body system-based chronic conditions (no/yes): hematologic; cardiovascular; craniofacial; diabetes; endocrine; digestive; ear/nose/throat; respiratory; catastrophic neurological; or musculoskeletal. The primary outcome measure was use of any dental care in 2006. Secondary outcomes, also measured in 2006, were use of diagnostic dental care, preventive dental care, routine restorative dental care, and complex restorative dental care. We used Poisson regression models to estimate the relative risk (RR) associated with each of the five outcome measures across the 10 chronic conditions. RESULTS: Across the 10 chronic condition subgroups, unadjusted dental utilization rates ranged from 44.3% (children with catastrophic neurological conditions) to 60.2% (children with musculoskeletal conditions). After adjusting for model covariates, children with catastrophic neurological conditions were significantly less likely to use most types of dental care (RR: 0.48 to 0.73). When there were differences, children with endocrine or craniofacial conditions were less likely to use dental care whereas children with hematologic or digestive conditions were more likely to use dental care. Children with respiratory, musculoskeletal, or ear/nose/throat conditions were more likely to use most types of dental care compared to other children with chronic conditions but without these specific conditions (RR: 1.03 to 1.13; 1.0 to 1.08; 1.02 to 1.12; respectively). There was no difference in use across all types of dental care for children with diabetes or cardiovascular conditions compared to other children with chronic conditions who did not have these particular conditions. CONCLUSIONS: Dental utilization is not homogeneous across chronic condition subgroups. Nearly 42% of children in our study did not use any dental care in 2006. These findings support the development of multilevel clinical interventions that target subgroups of Medicaid-enrolled children with chronic conditions that are most likely to have problems accessing dental care.

Implementation of an international short-term dental mission.

Dental professionals serve across the globe, working to alleviate the pain and suffering caused by dental disease. Many dental professionals serve on international mission trips, yet little has been published in the professional literature to guide dentists in establishing and operating a volunteer dental clinic in an international mission setting on a short-term basis. This article reports on multiple aspects of planning a short-term dental mission trip, including considerations in the selection of an indigenous national partner, concerns regarding the safety of patients and participants, scope of care decision-making, and the requisite equipment and supplies.

Dentists demonstrating professionalism: Dentists in private practice settings provide free or reduced-fee care.

Access to oral health care is an issue that has received attention at the local, state, regional, and national levels. This study focuses on how dentists in private practice settings attempt to address problems regarding access to care through personal initiatives. These dentists donate or discount services in their own offices to individuals who face access barriers. These donated or discounted services may go unreported and unnoticed. The research question addressed in this study is: What was the amount and type of free and reduced-fee care that dentists in the community of Brookline, Massachusetts, provided during the 2008 calendar year.

Correlates of dental visits among community-residing Latino elders: a public health alert.

OBJECTIVES: To examine oral service utilisation in a probability sample of community-residing Latino elders. BACKGROUND: Older Latinos are at a potential increased risk of oral diseases, given their higher prevalence of co-morbidities and lower rate of dental service utilisation. METHODS: A prevalence survey was conducted among a random sample of Latino (largely Puerto Rican) elders (n = 205; mean age = 75.8; SD ± 5.3) in New York City during 2001-2002. A systematic random sample was drawn from the Centers for Medicare and Medicaid Services Beneficiary tape files. Current use of oral health services and self-reported health conditions was obtained. Functional and cognitive impairment were assessed. RESULTS: Less than half of the sample reported a dental visit in the previous year. The average time since the last dental visit was 54 months (SD ± 84.5). Last year dental visit compliers were more likely to be unmarried, living alone, with higher levels of education, fewer health conditions and less impairment with activities of daily living. In multivariate analyses, problem-oriented behaviour, Medicaid beneficiary, education, living alone, chronic health conditions and mobility impairment explained 14% of the 'time since last dental visit' variance. CONCLUSIONS: Given that socio-demographic and level of functioning determinants appear to influence the frequency of dental visits, a multilevel approach to oral health promotion is imperative.

Practices and opinions of Connecticut general dentists regarding dental treatment during pregnancy.

This study aimed to evaluate the opinions and practices of general dentists in Connecticut regarding dental care during pregnancy. A survey was mailed to Connecticut general dentists to acquire data regarding age, gender, training, type of practice, years in practice, payment types accepted, procedures provided for pregnant women according to trimester, provider comfort level with treating pregnant patients, reasons for not treating pregnant patients, and provider opinions about dental care during pregnancy. The response rate was 42%, yielding a sample of 116 dentists. The majority of respondents (97%) reported treating pregnant patients; however, only 45% felt "very comfortable" treating these patients. All dentists in the sample agreed that physicians need to include an oral health evaluation and appropriate referral for patients' prenatal care. However, 70% of respondents had never received a dental referral for a pregnant patient. The majority of dentists favored providing dental treatment during the second trimester of pregnancy. Most dentists (77%) would take a radiograph for a patient 10 weeks into the pregnancy seeking treatment for dental pain, but only 2% would take routine radiographs regardless of the pregnancy trimester. There was a lack of consensus about medications dentists reported acceptable to prescribe for pregnant patients, and female dentists were significantly less likely than males to prescribe ibuprofen (P < 0.05). At least half of the respondents reported not being completely comfortable treating pregnant patients. Further, many dentists appear to not follow medication prescribing guidelines for this population. While additional research is needed, these initial results indicate that additional education regarding the treatment of pregnant patients would be a beneficial addition to dental school and continued education course curricula.

Dentists' knowledge and attitude towards informed consent taking in a Nigerian teaching hospital.

BACKGROUND AND AIM: There has been an increase in medical and dental knowledge in the world today. More and more people are getting to know their rights and cases of medical and dental liability is on the increase. Hence a proper approach towards obtaining informed consent in dental practice has become necessary. This study assessed dentists' perception on informed consent taking for dental procedures. METHODOLOGY: Self administered questionnaires were given to all dentists working in one of the teaching hospitals in the south west region of Nigeria. The questionnaires assessed the doctors' ability to properly define informed consent, knowledge of aspects relevant to informed consent taking and procedures for which they felt informed consent should be taking routinely. RESULTS: The result revealed 10 out of 56 dentists (17.5%) were able to rightly and fully define informed consent. Almost all the dentists (98.4%) claimed to have taken informed consent at one time or the other, out of which 31 dentists (59.6%) claim that they always take verbal informed consent on routine dental treatment. However 21 (42%) of the dentists believed that informed consent scares patients, while 31 (54.5%) believed informed consent prepares patients better for the procedure. Generally the dentists agreed that the more invasive the dental treatment procedure was the more they felt informed consent should be taken. CONCLUSION: Dentists knowledge about informed consent seems to be inadequate as only few of them were able to define informed consent. However their attitude towards informed consent seems to be more positive as almost all claimed to have taken informed consent from patients at one time or the other. Therefore regular update about knowledge and significance of informed consent should be encouraged.

Dental treatment profile of New Zealand Defence Force personnel.

OBJECTIVE: To evaluate the dental treatment provided over one year to serving personnel and new entrants in the New Zealand Defence Force (NZDF). METHOD: Dental treatment data from 4,380 personnel in the 12 months following their last annual dental examination were retrieved and evaluated from electronic data archives. These included all treatment provided for 2000 randomly-selected regular serving personnel and for all 2380 new entrants entering the Service in the years 2005 and 2006. RESULTS: Treatment data were recorded for 1770 (88.5%) of the 2000 serving personnel in the year following their last dental examination. Excluding examinations and radiographs, treatments averaged 2.3 per person. Amalgam and composite restorations contributed 40%, preventive and oral hygiene services 44%, and tooth extractions 6% of treatments; the "other" category amounted to 10% of treatments. For the 2380 new entrants, treatment data were recorded for 1959 (82.3%) during their first year of service. Treatments averaged 3.6 per person; amalgam and composite restorations contributed 58%, preventive and oral hygiene services 25%, and extractions 10%. The remaining 10% of treatment items recorded comprised a diverse range of procedures. CONCLUSIONS: The level of treatment provided was low for both serving personnel and new entrants. Ninety percent of teeth were present and functional. Amalgam and composite restorations, preventive care and oral hygiene procedures made up the majority of treatment provided.

Dental service patterns among private and public adult patients in Australia.

BACKGROUND: While the majority of dental care in Australia is provided in the private sector those patients who attend for public care remain a public health focus due to their socioeconomic disadvantage. The aims of this study were to compare dental service profiles provided to patients at private and public clinics, controlling for age, sex, reason for visit and income. METHODS: Data were collected in 2004-06, using a three-stage, stratified clustered sample of Australians aged 15+ years, involving a computer-assisted telephone interview (CATI), oral examination and mailed questionnaire. Analysis was restricted to those who responded to the CATI. RESULTS: A total of 14,123 adults responded to the CATI (49% response) of whom 5,505 (44% of those interviewed) agreed to undergo an oral epidemiological examination. Multivariate analysis controlling for age, sex, reason for visit and income showed that persons attending public clinics had higher odds [Odds ratio, 95%CI] of extraction (1.69, 1.26-2.28), but lower odds of receiving oral prophylaxis (0.50, 0.38-0.66) and crown/bridge services (0.34, 0.13-0.91) compared to the reference category of private clinics. CONCLUSION: Socio-economically disadvantaged persons who face barriers to accessing dental care in the private sector suffer further oral health disadvantage from a pattern of services received at public clinics that has more emphasis on extraction of teeth and less emphasis on preventive and maintenance care.

Insurance billing and coding.

The purpose of this article is to highlight the importance of understanding various numeric and alpha-numeric codes for accurately billing dental and medically related services to private pay or third-party insurance carriers. In the United States, common dental terminology (CDT) codes are most commonly used by dentists to submit claims, whereas current procedural terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD.9.CM) codes are more commonly used by physicians to bill for their services. The CPT and ICD.9.CM coding systems complement each other in that CPT codes provide the procedure and service information and ICD.9.CM codes provide the reason or rationale for a particular procedure or service. These codes are more commonly used for "medical necessity" determinations, and general dentists and specialists who routinely perform care, including trauma-related care, biopsies, and dental treatment as a result of or in anticipation of a cancer-related treatment, are likely to use these codes. Claim submissions for care provided can be completed electronically or by means of paper forms.