The Impending Oral Health Crisis.

Last May, the New York State Dental Association and the New York State Dental Foundation convened the first "Oral Health Stakeholders' Summit on the Future of Special Needs Dentistry, Hospital Dentistry and Dental Education." The summit was chaired by David J. Miller, then NYSDA President Elect, and Carl H. Tegtmeier, then chair of the NYSDA Council on Dental Health Planning and Hospital Dentistry. It brought together experts, called to frame the issues and provide information necessary for a reasoned response. And it sought input from attendees to develop recommendations to ensure that patients with intellectual and developmental disabilities, as well as an aging population with Alzheimer's disease and dementia, have access to appropriate oral health care in the years ahead. Over 100 participants, representing dentistry, hospital training programs, third-party payers, state government offices and related patient support associations, attended the two-day event in Albany. They focused on the impact of reductions in funding, the transition of Medicaid services into a managed care model, a loss of service providers and the need for expanded training programs. They heard from speakers epresenting a broad spectrum of those involved in he oral health care of patients with intellectual and evelopmental disabilities, the Alzheimer's Association, dental educators and researchers, hospital dentistry and the benefits industry, whose presentations focused on a looming oral health crisis threatening access to dental care for patients with disabilities.

Frequency and distribution of teeth treated by single- and multiple- visit root canal treatment in a Nigerian population by differently skilled operators.

BACKGROUND: Single visit root canal treatment (RCT) is being advocated around the world. This study profiles RCT in a Nigerian population and compares pattern of single versus multiple visit RCT to tooth type and skill level of the doctors. METHOD: A retrospective study was carried out on RCT performed in one year by fresh graduates and postgraduate dentists. Records retrieved included patients' sex and age, tooth type, location in the jaw and whether single- or multiple-visit RCT was done. RESULTS: Records of 705 teeth were reviewed, 54.6% belonged to females. Age range was 18-87 years, mean of 31.76 (± 12.31) years. Majority (70.1%) belonged to 20-39 years' age group. Most teeth were located in the maxilla (60.8%) and in posterior regions (73.6%). The most frequently root filled tooth was the mandibular first molar (20.7%) followed by maxillary central incisor (18.4%) then maxillary premolar (12.8%). However, all molars accounted for 47.3%, premolars 26.3% and incisors 25.0%. Canines (1.45%) were least frequently root-filled. Incisors (54.8%) were the teeth most frequently treated in single-visit followed by premolars (28.8%). Most frequently treated by multiple-visit were molars (51.0%). All doctors performed multiple-visit RCT in an approximately equal proportion but a significant percentage of single-visit RCT was carried out by senior doctors (71.2%). CONCLUSION: The most frequently root filled teeth were mandibular first molars. Teeth most likely to be treated by single-visit RCT were incisors. Appropriate operator skill and experience is important in the decision to perform single-visit RCT. Single-visit RCT is advocated in the developing environment.

Analysis of Nigerian dentists' opinion and consequences on expanded function dental auxiliaries.

OBJECTIVE: To examine Nigerian dentists' opinion on expanded function dental auxiliaries. METHODS: This cross-sectional study of Nigerian dentists attending a dental conference was conducting in 2012 using self-administered questionnaire. The data were analyzed using Statistical Package for the Social Sciences version 16.0. P < 0.05 was considered statistically significant. RESULTS: The majority of the 82 dentists that participated in this study were male, aged 31-40 years, either specialist or specializing (residents), practiced for < 10 years, teaching hospital and urban practitioners. Of the participants, 22 (26.8%) reported favorable opinion towards expanded duty dental auxiliaries. The mean scores on consequences, of expanded function dental auxiliaries ranked redundancy of dentist as highest. Males and non-specialist significantly reported expanded function dental auxiliaries would lead to redundancy of dentists. Practitioners working in other hospitals other than teaching hospital significantly reported that appropriate legislation are necessary before expansion of duties of the dental auxiliaries can be done. The dentists with favorable opinion significantly reported that expanded duty dental auxiliaries would not cause redundancy of dentist and the task are not too difficult for dental auxiliaries with necessary training but will increase service delivery and efficiency, increase job satisfaction, lead to dental auxiliary specialization with legislation. CONCLUSION: Data from this study revealed overall unfavorable opinion of Nigerian dentists on the expanded duty dental auxiliaries. However, those with favorable opinion were significantly supportive of expanded function dental auxiliaries. This information would serve as a useful tool for Nigerian oral healthcare policy formulators.

Interviewers' and interviewees' perceptions of the changes in recruitment of orthodontic specialty registrars.

AIM: To assess interviewers' and interviewees' perceptions of the National Recruitment for Orthodontic Specialty Registrars in 2012. DESIGN: Cross-sectional survey. METHODS: Interviewers and interviewees completed an anonymous questionnaire comprising of 25 and 16 questions, respectively. Statistical analysis included descriptive statistics and frequency distributions. RESULTS: All interviewees (83/83) and 88% (36/41) of interviewers completed the questionnaires. Of the interviewees, 61% were female; their mean age was 28·9 years (95% CI: 28·2-29·6). The mean time since bachelor of dental science (BDS) was 5·6 years (95% CI: 4·9-6·3) with 78% qualifying from a UK university. The interviewees preferred the multi-station interview (MSI) format, considered the questions easy to understand and thought that MSI was fairer than traditional interviews. Of the interviewers, 56% were male; their mean age was 45·5 years (95% CI: 43·0-48·0). The mean time that they had been a consultant was 11·4 years (95% CI: 8·7-13·1). The interviewers thought that the interviews were fair, tested an appropriate range of competences, selected the best candidates to be appointed and would appoint the same people if repeated. CONCLUSIONS: Interviewees were very positive about the organization and perceived fairness of the MSI format. Interviewers were positive about the selection of candidates, fairness and conduct of the MSI format.

Occupational stress among dental house officers and students in a tertiary healthcare centre.

OBJECTIVE: To assess occupational stress among dental house officers and students treating patients in a tertiary healthcare centre in Nigeria. MATERIALS AND METHODS: This questionnaire-based cross-sectional study of dental officers and final year dental students at the University of Benin Teaching Hospital, Benin City was conducted in the second half of 2010. The questionnaire utilized was a modified form of stress screening questionnaire of International Stress Management Association. RESULTS: Out of the 100 questionnaires distributed, 88 questionnaires were returned, giving a response rate of 88.0%. A total of 53 (60.2%) the respondents were male and 35 (39.8%) were females. Dental students constituted 54 (61.4%) of the respondents while the remaining 34 (38.6%) were house officers. Amongst the respondents, 9 (10.2%), 68 (77.8%) and 11 (12.5%) reported severe, moderate and mild occupational stress respectively. The reported stress was significantly associated with gender (P = 0.032) as more female reported severe stress and more male reported moderate stress. The mean stress level was significantly higher among dental students than house officers (P = 0.007). CONCLUSION: One in every ten respondent reported severe occupational stress with a significant gender difference. Development of stress reduction strategies for dental house officers and students with gender bias is imperative.

Hospital dental staff attitudes to guide education and training in patient safety: a study with a focus on qualitative data.

Objectives This study aimed to determine attitudes of current NHS dental hospital trainees at dental core trainee and speciality registrar level, plus consultant trainers, to guide shaping the direction of education and training in patient safety. The study was a locally based project in a single dental hospital setting at an acute NHS London Trust.Methods This study employed a survey and interviews, with emphasis on qualitative data utilised. Interviews were aimed at hospital clinical dental staff. The survey and focus groups were aimed at trainees. The one-on-one interview sessions were aimed at trainers.Results Findings demonstrated that both trainers and trainees see patient safety as a priority and there are gaps in education and training. Four overarching themes were seen as important to trainees and trainers to support education and training in patient safety: culture, knowledge, time to train and engagement.Conclusions Recommendations in this dental hospital setting focused on culture change and dental-specific experiential learning based on spiral curricula. Education and training in patient safety should be introduced at undergraduate level, with regular team training acknowledging the need for consistent engagement of all key stakeholders.

Evaluation of knowledge and experience among oral and maxillofacial surgeons about cardiopulmonary resuscitation.

OBJECTIVE: This study was undertaken to assess the level knowledge and experience about CPR among oral and maxillofacial surgeons. MATERIALS AND METHODS: In a cross-sectional study, a total of 96 professionals (31-PGs, 65-MDS staff) were surveyed using a self-administered structured questionnaire pretested through a pilot survey. The data was analyzed using the SPSS version 15.0. The Student's t-test and ANOVA test were used as test of significance. The level of significance was set at p ≤ 0.05. RESULTS: In the present study, 78% of oral surgeons had received training about CPR but only 52.0% have proper practical knowledge of performing it. As there were some cases due to CPA in dental practice even then half of the participants take history of patients regarding this. A significant difference was found according to designation with PGs having lower mean scores. A positive linear correlation was found between years of experience and knowledge about CPR (Pearson's correlation, r = 0.613, p = 0.00). CLINICAL SIGNIFICANCE: The present findings showed that practical knowledge of performing CPR is still low and half of them still do not take history regarding this. So there is need for more knowledge about CPR through CDE programs.

Impact of occupational exposure to elemental mercury on some antioxidative enzymes among dental staff.

OBJECTIVES: The aim of this study is to investigate the effect of elemental mercury exposure on renal function and antioxidative enzymes activity as a possible mechanism of renal affection among dental staff. METHODS: This study was performed on a group of dental staff exposed to elemental mercury (N = 32) and matched control group (N = 37). Urinary and blood level of mercury, albumin α1 microgloblin in urine, glutathione peroxidase and superoxide dismutase blood level were measured for the exposed and control group. RESULTS: Compared to the control group, urinary and blood mercury were significantly higher in the exposed group. Glutathione peroxidase and superoxide dismutase activities in blood were significantly decreased and were negatively correlated with duration of work. CONCLUSION: Oxidative stress is an important molecular mechanism for renal dysfunction in mercury exposure, manifested by decreased activities of antioxidant enzymes.

A new style of orthognathic clinic.

The Orthognathic Team at the Eastman Dental Hospital has developed a new style of multidisciplinary clinic to supplement the traditional orthognathic consultation. The aim of the new clinic is to increase patient satisfaction and involvement in the consent and decision making process, as well as optimizing the information given to prospective patients regarding all aspects of this complex elective treatment. Results of a survey of patients attending the clinic found that 80% thought that the information given was 'just the right amount' and 96% were satisfied with the new structure. They particularly found it useful to meet a patient who had completed treatment. All of those who attended said that they understood the information given to them and would recommend the clinic to those considering orthognathic treatment. They also liked having other patients there with them on the clinic.

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.

Use of information and communication technology among dental students and registrars at the faculty of dental sciences, University of Lagos.

The aim of this study was to investigate the use of information technology amongst dental students, dental nursing students and resident doctors in training at the faculty of dental Surgery University of Lagos. A structured questionnaire was distributed to 58 clinical dental students in 4 th and 5 th years of training in the 2010/2011 academic year, 36 dental nursing students and 63 resident doctors undergoing specialist training. All participants have access to the computers, 2.5% within the University and 31% at home and internet cafes and about 50% have the basic skills required. A significant difference was observed between the resident doctors and clinical dental students (P = 0.003), between resident doctors and dental nursing students (P = 0.0001) when the use of computer for study was compared. Over 95% of participants have access to internet and about 50% of them use the internet for their studies. A significant difference (P = 0.005) was observed between clinical dental students and dental nursing students that use the internet and word processing. The resident doctors used the computers for multimedia and MedLine search tools more than clinical dental students (P = 0.004) and dental nursing students (0.0006). The findings of the study show that dental students and resident doctors in training have the requisite knowledge to operate the computer for use in their study and personal activities.

Work experiences, professional development and career prospects of New Zealand dental house surgeons.

OBJECTIVE: New dental graduates compete for house surgeon positions every year, despite little being known about the work experience gained from such posts. The main objectives of this study were to identify the nature of house surgeons' work experiences, their continued professional development (CPD) opportunities and the impact of hospital experience on their future career pathways. METHOD: A questionnaire was mailed to all 31 New Zealand dental house surgeons (response rate 100%). RESULTS: The majority of house surgeons (77.4%) found hospital work enjoyable, with nearly all (93.5%) perceiving themselves as better clinicians from their experience. Oral surgery, restorative dentistry, special needs dentistry and removable prosthodontics were the most commonly practised areas. The average weekly number of working hours was 42.3 hours for a normal week and 61.8 hours for an on-call week. Stress levels during on-call work were significantly higher than during day-to-day hospital work (p < 0.05). Departmental seminars were reported to be the most common form of CPD available at hospitals (74.2%), followed by hands-on clinical training (61.3%). More than half of the house surgeons (58.1%) planned to pursue a specialist career, with nearly 13% wishing to return to a New Zealand hospital in the future. CONCLUSIONS: A dental house surgeon position remains an attractive choice and offers an enjoyable experience for young graduates. Hospitals provide ample CPD opportunities and appear to play an influential role in a house surgeon's career pathway.

What is the role of senior house officer or dental foundation year two posts in professional careers? Exploring the motivations for, and perceived benefits of, undertaking SHO posts in two London hospitals.

AIMS: To investigate the motivations for, and perceived benefits of, undertaking senior house officer (SHO) posts, and to explore the career pathways of those who do, examining trends in successive cohorts. METHOD: Postal cross-sectional questionnaire survey of all dental and maxillofacial SHOs (DF2s) who had worked for two South London hospitals within the previous nine years (n=137). Respondents were grouped into three cohorts to enable responses to be examined in relation to respondents' entry to their first SHO post. RESULTS: There were responses from 83 (61%) potential participants. The most frequent motivation for carrying out SHO posts from 79 (95%) of the respondents was the desire to 'learn from experienced clinicians'. The most common perceived benefit reported by those who had completed posts at the time of the survey was 'an improved understanding of the role of the hospital dental service' from 68 (97%) of those who answered this question. Difficulty in securing a job in general dental practice was not reported as a notable motivating factor, either before or after the implementation of the new dental contract. 'Fulfil approved training post requirements for postgraduate examinations' reduced as a motivator from 28 (88%) for the earlier cohort of SHOs to nine (36%) for the more recent cohort. Fifty-four of 78 (69%) respondents declared a definite plan to seek admission to the General Dental Council Specialist Lists in future, 24 (83%) in the first cohort, compared with 11 (46%) in the last (P=0.05). Of the males, 13 (52%) were significantly more likely to report that they were currently working in general practice compared with 15 (27%) females (P=0.028). CONCLUSION: The findings suggest that multiple benefits are identified from undertaking SHO posts. However, some of the motivations for undertaking SHO posts may have changed over the nine-year period investigated. Possible influences are discussed. This paper highlights the perceived benefits of junior training posts at a time of significant transition within the profession.

An audit to assess the quality and efficiency of complete and partial dentures delivered by junior hospital staff.

The average number of visits for the construction of metal-based and acrylic dentures by junior hospital staff was 10 visits. Our hypothesis was that supervision would optimise the number of visits and reduce any need for remakes. The first audit cycle was retrospective and included all patients treated by SHOs in the Prosthodontics Department. The standard of care was compared to the British Society for the Study of Prosthetic Dentistry. The re-audit showed that the time taken to completion was reduced by 2 visits for both denture types and the average length of time was reduced from 31 weeks to 22 weeks. These improvements were directly related to improved supervision by senior staff.

Quality management and work environment in Swedish oral and maxillofacial surgery.

This thesis attempts to describe the opinion of the work with quality, quality management, and work environment among the employees at Oral and Maxillofacial Surgery (OMFS) clinics in Sweden. THIS THESIS AIMED TO: Analyse if the OMFS clinics in Sweden actively work with quality development and if so which systems they use. Explore the opinion of the employees about quality work. Describe how the employees of OMFS clinics in Sweden perceive good work, i.e., their image of the dimensions that the profession should contain to be really good work. Investigate whether there is a discrepancy between ideal and reality for this group. Describe how the employees of OMFS clinics in Sweden perceive their health. Analyse how work environment influenced attitudes to and knowledge of quality among employees of OMFS clinics in Sweden. The study was based on self-report questionnaires which in 2003 were sent to all OMFS clinics in Sweden. The response rate was 86%. Only at two clinics did all the respondents agree on their system. Surgeons rated intellectually stimulating work as most important, and the hazard-free work environment as least important. The nurses rated stimulating fellowship as most important, and the opportunity for career advancement as least important. The percentage unit differences between the ideal and the reality were largest for the item the work provides opportunities to have an influence on important decisions. There were significant differences between maxillofacial. surgeons and dental nurses and assistant nurses as to muscle- and joint trouble. The differences were also significant between men and women both as to muscle- and joint troubles and somatic trouble. Only work environment was significant for attitude towards quality work. Profession, gender, clinic size, and a factor for hard demand had significant associations to quality management system used or not. IN CONCLUSION: More than half of the respondents stated that they worked with a quality system. The dental nurses and assistant nurses had a much more positive view on the potential of quality work as a means to improve their work than had the maxillo-facial surgeons. For a majority of the dental nurses the working situation concerning the physical environment was more important than for the maxillo-facial surgeons. The employees emphasized free, influential, and intellectually stimulating work, but the dissonance between ideal and reality was rather wide concerning good work. OMFS employees are feeling unhealthy, but no worse than other high-risk-groups in human service working and better than female general practice dentists. The women of OMFS employees feel worse than the men.

Prevalence of HBV and Assessment of Hepatitis B Vaccine Response among Dental Health Care Workers in Dental Teaching Hospital, Umm Al-Qura University, Saudi Arabia.

Hepatitis-B Virus (HBV) infection is a serious health problem that can be prevented by vaccination. Dental Health Care Workers (DHCWs) are at-risk of occupational exposure to HBV infection. This study was aimed to assess the prevalence of HBV and evaluate the immune response to hepatitis B vaccine among DHCWs in Dental Teaching Hospital, Umm Al-Qura University, Saudi Arabia. A cross-sectional study was conducted on 139 DHCWs, 71 males and 68 females. Blood samples were collected and the levels of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) were measured by Chemiluminescent Microparticle Immunoassay. The prevalence of HBV among DHCWs was zero (0.0%). The hepatitis B vaccine was given to 95% of DHCWs. Among the vaccinated participants, 90.1% (n=119) have protective immunity to hepatitis B. An inverse correlation between anti-HBs levels and increasing the duration of vaccination (P < 0.0001) was found. We compared the anti-HBs levels in 28 students who received childhood vaccine and revaccinated at age of 21. The anti-HBs concentration was greater than 10mIU/mL (protected) in 17.9% of those who had childhood vaccine compared to 100% one-year after revaccination. The mean of anti-HBs levels for childhood vaccine was 5.6 mIU/mL and these levels increased significantly to 620 mIU/mL after recent revaccination (P < 0.0001). In conclusion, Hepatitis B vaccine is effective in prevention of HBV infection among DHCWs. Non-protected individuals should be identified and revaccinated.

Legislation in Hospital Dentistry: Gaps, Perspectives and Desires

Abstract Objective: To analyze the existing state legislation, including not only the ordinary laws, but also their infralegal regulation and the state legislation on Hospital Dentistry. Material and Methods: A survey was carried out in the databases of the Legislative Assemblies of the Brazilian States and the Federal District, as well as the Regional and Federal Councils of Dentistry in Brazil. Subsequently, a survey was carried out in the databases of the Ministry of Health, State Dental Councils and Federal Dental Council in Brazil. Results: Only 8 Brazilian states have legislation in force regarding hospital dentistry, which represents 29.63% of the federative units. Among the Brazilian regions, the Midwest presented the highest prevalence of the laws found (37.50%), followed by the North (25%) and the other regions with the same coverage (12.50%). Also, an orientation and an ordinance from the Ministry of Health, six resolutions from the Federal Council of Dentistry, and a technical note from the National Health Surveillance Agency were found. Conclusion: Several States do not have rules on the subject, making it imperative to create a federal rule that not only imposes the presence of the dentist, but also regulates the proportion of the team, workload, and availability.

Credentialing.

Credentialing is the administrative process for validating the qualifications of licensed professionals and appraising their background. It is used by hospitals and other health care facilities, educational institutions, and insurance companies to ensure the qualification of their clinicians and to grant privileges to provide specific services and perform different medical or dental procedures. This article familiarizes the reader with the credentialing process and the documentation that is needed to be credentialed by certain organizations.