Improving diagnostic specimen management systems in an oral medicine department.

Histological, haematological and microbiological investigations are essential in the field of oral medicine and are a crucial adjunct to clinical findings, often being relied on to obtain a definitive diagnosis. Importantly, in some cases, these investigations can help exclude or confirm the presence of malignancy. This project highlighted some problems regarding labelling and recording of specimens in an oral medicine department and a lack of clear specimen management processes. It aimed to improve specimen management by reducing reported incidents surrounding diagnostic tests. Quality improvement methods such as process mapping were key to understanding the journey of specimens and the departments involved at each stage of the system. Initiatives included a recording log book, staff training, information signage around the clinic and delegation of responsibilities, all of which were implemented over multiple plan, do, study, act (PDSA) cycles. The project was extremely successful and since implementation there has been a clear and sustained reduction in reported incidents. The small number of incidents which did occur all involved transportation of specimens and none involved labelling or recording. One can conclude that the change in test management systems in terms of recording and labelling of specimens in the department has been sustained. Ongoing engagement with stakeholders and senior leaders is the priority to ensure further reduction in incidents in the future and that the improvements are maintained. This project demonstrates how simple, realistic, cost-effective, quality improvement initiatives can have a significant positive impact on patient care and hospital management systems.

Oferta da disciplina de Estomatologia nos cursos de Odontologia do sudeste brasileiro / Offer of Stomatology discipline in the Dentistry courses of the Brazilian Southeast

Objetivo: oferecer um panorama sobre a presença da disciplina de Estomatologia nos projetos pedagógicos dos cursos de graduação em Odontologia da Região Sudeste do Brasil no ano de 2019. Métodos: estudo exploratório, quantitativo e transversal, no qual as grades curriculares dos cursos foram analisadas, totalizando uma amostra de 144 cursos, incluindo instituições públicas e privadas. As variáveis avaliadas foram oferta da disciplina, categoria administrativa e localização da instituição de ensino superior (IES), natureza do componente curricular, forma em que o conteúdo é ministrado e carga horária. Resultados: apenas 88 (61,11%) instituições ofertavam a disciplina em sua grade curricular, sendo que 82 (93,1%) ofertavam o conteúdo de forma obrigatória, e a maioria de forma teórico-prática. A carga horária variou de 33 a 285 horas, com média de 111,9 horas. Conclusão: o presente estudo evidenciou a dissonância com a qual a disciplina de Estomatologia é ministrada, bem como a deficiência de sua oferta por parte de muitas instituições averiguadas.(AU)

Objective: to provide an overview of the presence of the stomatology discipline in the pedagogical projects of undergraduate dentistry courses in the Southeast region of Brazil in 2019. Methods: exploratory, quantitative and cross-sectional study. The curriculums of the courses were analyzed, totaling a sample of 144 courses, from public and private ones. The variables evaluated were the offer of the subject, administrative category and location of the Higher Education Institution (HEI), nature of the curriculum component, form in which the content is taught and workload. Results: 88 (61.11%) institutions offered the discipline in their curriculum, 82 (93.1%) offer the content in a compulsory way, and most in a theoretical-practical way. The workload ranged from 33 to 285 hours, with an average of 111.95 hours. Conclusion: the present study showed the dissonance in which the discipline of stomatology is taught, as well as the deficiency of its offer by many investigated institutions.(AU)

A retrospective analysis of referral patterns to a university oral medicine clinic.

OBJECTIVES: The aim of this study was to analyze referral patterns to a university-based oral medicine (OM) clinic and to identify access issues to OM care. STUDY DESIGN: A retrospective patient chart review on all OM specialists at the University of Alberta (Edmonton, Alberta, Canada) over a 1-year period was performed. Data collected included patient age and gender, referring clinician training and experience, reason and urgency of referral, provisional and final diagnosis, and the referral times. Proportions for data points were collected by using a 95% Wilson Score confidence interval. Two-sided Fisher's exact tests were performed for significant differences. RESULTS: In total, 924 patients were included. Dentists referred 81.4% of the cases, with the remaining cases referred by physicians. Patients traveled, on average, 55.44 km to the OM clinic, with a mean wait time of 105.5 days. White/red lesions were the most common referral reason (38%), with the tongue (21.8%) being the most common site of concern. There was no significant difference in the accuracy of provisional diagnoses between clinician types. Immune-mediated conditions were the most common final diagnosis. CONCLUSIONS: The referral patterns of dental and medical practitioners are similar, with mucosal lesions being the most common referral reason. In our study population, access to care was compromised by wait times and travel distances.

Enfoque social de la tecnología en el campo de la Estomatología / Social approach of technology in the field of dentistry

Introducción: la situación de la Estomatología en el mundo contemporáneo exige a la sociedad el reconocimiento de las necesidades tecnológicas como un factor clave para su desarrollo. Durante mucho tiempo la tecnología ha sido analizada básicamente en su carácter artefactual. Objetivo: reflexionar sobre la concepción de la tecnología como proceso social, especialmente en el campo de la estomatología destacando la importancia del método clínico. Métodos: se realizó una revisión bibliográfica en seis libros impresos, y automatizada en Internet con el buscador Google, para lo que se utilizaron los descriptores ciencia, tecnología, método clínico; se consultaron 20 artículos y se seleccionaron los más actualizados y que más trabajaban el tema. Para el procesamiento de la información se utilizó la herramienta de Microsoft Office Word y un microprocesador Pentium IV, con ambiente de Windows XP. La búsqueda y selección de los materiales estuvo restringida a textos en español tanto para libros impresos como artículos de la búsqueda automatizada, estos últimos del período 2000-2015. Análisis e integración de la información: el proceso acelerado de la tecnificación de la práctica estomatológica no debe sustituir la experiencia práctica acumulada del estomatólogo, los valores y cualidades que caracterizan la esencia humanista de la profesión. El conocimiento y utilización de una tecnología puede mejorar resultados y logros en materia de salud; pero no debemos olvidar que ellos traen consigo otras consecuencias que debemos combatir, a través de la sólida formación de las nuevas generaciones, basada en principios éticos y valores cultivados durante su preparación como profesionales. Conclusiones: el desarrollo de la Estomatología como ciencia en el mundo contemporáneo exige el uso de la tecnología, como un eficaz instrumento de bienestar humano que complementa la clínica, lo cual permite mejorar los resultados en materia de salud bucal así como la calidad de vida de los pacientes(AU)

Introduction: the current situation of dentistry worldwide demands that the society know the technological needs as a key factor for its development. For so much time technology had been analyzed basically in regard of its character of items considered artifacts. Objective: to reflect about the conception of technology as a social process, especially in the field of dentistry, pointing out the importance of the clinical method. Methods: bibliographical review in six items of printed literature and automated online books with the Google search engine using descriptors such as science, technology, clinical method having consulted twenty issues and selected the most updated. In the analysis of the information we used the tool Microsoft Office Word and a microprocessor Pentium IV, with atmosphere of Windows XP. The search and selection of the materials was restricted to texts in Spanish for both printed books and articles of the automated search, these last the period from 2000 to 2015. Data analisys and integration: the fast process of dentistry practical technification shall not replace the doctor of dental surgery's accrued practical experience, nor the values and qualities that characterize the humanist essence of the profession. Technology knowledge and usage can improve the results and outcome in the health sphere, but we cannot forget that they bring about consequences we should fight, by strongly training the new generations, as based on ethical principles and values cultivated during the professional training. Conclusions: the development of deontology as a science in the contemporary world demands the use of technology as an effective instrument of human welfare which supplements clinics, allowing improving the results regarding mouth health as well as the quality of our patients' life(AU)

Urgencias estomatológicas en diabéticos, Policlínico Ángel Machaco Ameijeiras; (2011-2012) / Dental emergencies among diabetic patients at Angel Machaco Ameijeiras polyclinic, 2011-2012

Introducción: estudiar las urgencias estomatológicas en diabéticos permite el desarrollo de acciones para prevenirlas y tratarlas. Objetivo: describir el comportamiento demográfico y epidemiológico de las urgencias estomatológicas en individuos diabéticos en los registros de un año, y estimar la asociación de las cinco urgencias más frecuentes con el tiempo de evolución de la diabetes mellitus. Métodos: se realizó un estudio descriptivo transversal en la consulta de urgencias estomatológicas del Policlínico Ángel Machaco Ameijeiras de Guanabacoa, La Habana, Cuba (entre enero de 2011 y enero de 2012). De 4 975 pacientes atendidos, se identificaron 396 diabéticos. Las principales variables utilizadas fueron: edad, sexo, urgencias estomatológicas, tiempo de evolución. Los datos se recolectaron en un modelo confeccionado con este fin. Los resultados se expresaron mediante estadígrafos descriptivos y se estimó el riesgo relativo para identificar asociación. Se asumió que existía asociación cuando el valor obtenido era mayor que 1 con un intervalo de confianza de 95 por ciento (p< 0,05) que no incluyera la unidad. Resultados: al sexo femenino correspondió 52,02 por ciento de los pacientes estudiados; el 52,02 por ciento tenían 60 o más años. Las urgencias resultaron: absceso dentoalveolar agudo (27,27 por ciento), pulpitis aguda irreversible (21,71 por ciento), alveolitis (15,65 por ciento), pulpitis transitoria (9,34 por ciento) y absceso periodontal (5,30 por ciento). En la pulpitis transitorias el riesgo resultó muy bajo (RR= 0,50). Conclusiones: las urgencias estomatológicas predominaron en el sexo femenino y en pacientes mayores de 60 años. Las más frecuentes fueron: absceso dentoalveolar agudo, pulpitis aguda irreversible, alveolitis, pulpitis transitoria y absceso periodontal. El tiempo de evolución de la Diabetes Mellitus puede estar implicado como responsable de la enfermedad en los abscesos dentoalveolares agudos, las pulpitis agudas irreversibles, las alveolitis, y los abscesos periodontales(AU)

Introduction: the study of dental emergencies in diabetic patients leads to the development of preventive and therapeutic actions. Objective: describe the demographic and epidemiological behavior of dental emergencies among diabetic individuals based on the analysis of one-year records, and estimate the association between the five most common emergencies and the time of evolution of diabetes mellitus. Methods: a descriptive cross-sectional study was conducted at the dental emergency department of Angel Machaco Ameijeiras polyclinic in Guanabacoa, Havana, Cuba, from December 2011 to December 2012. Of the 4 975 patients cared for, 396 were diabetic. The main variables analyzed were age, sex, dental emergency and time of evolution. Data were collected onto a dedicated model. Results were expressed through descriptive statigrams, and relative risk was estimated to identify the association. An association was assumed to exist when the value obtained was greater than 1 with a confidence interval of 95 percent (p< 0.05) not including the unity. Results: of the patients studied, 52.02 percent were female and 52.02 percent were aged 60 or over. The emergencies recorded were acute dentoalveolar abscess (27.27 percent), acute irreversible pulpitis (21.71 percent), alveolitis (15.65 percent), transitory pulpitis (9.34 percent) and periodontal abscess (5.30 percent). In transitory pulpitis, risk was found to be very low (RR= 0.50). Conclusions: dental emergencies predominated in the female gender and the 60 and over age group. The most frequent were acute dentoalveolar abscess, acute irreversible pulpitis, alveolitis, transitory pulpitis and periodontal abscess. Time of evolution of diabetes mellitus may be involved as the cause of acute dentoalveolar abscess, acute irreversible pulpitis, alveolitis and periodontal abscess(AU)

Oral chronic GVHD outcomes and resource utilization: a subanalysis from the chronic GVHD consortium.

OBJECTIVES: This study evaluated the extent to which oral chronic graft-versus-host disease (cGVHD) consensus assessments are predictive of management across institutions with and without oral medicine (OM) centers, and whether ancillary care guidelines are followed within clinical practice. METHODS: Longitudinal oral cGVHD data were abstracted from the cGVHD Consortium, and additional mouth-specific management data were analyzed across five transplant centers. RESULTS: Seventy-nine patients with 656 visits were observed for a median of 7.1 months with one visit per follow-up month. Ancillary therapies for oral cGVHD were prescribed for 67% of patients for a median of 0.46 months (per follow-up month) at OM centers and 0.78 months at non-OM centers. Patients treated with ancillary therapy were more likely to have an National Institutes of Health (NIH) mouth score of ≥1 (P < 0.001, odds ratio: 5.1) and mouth pain (P = 0.01, odds ratio: 2.6). The odds ratios of receiving ancillary therapy from OM experts were higher than transplant physicians (53%; P = 0.03). CONCLUSIONS: Oral cGVHD consensus assessments corresponding with ancillary therapy use were mouth pain and NIH mouth score, with higher odds ratios of receiving therapy from OM experts. Ancillary care guidelines for oral cGVHD are reflected in academic clinical practice with respect to utilization of recommended prescriptions.

Evaluating the impact of a mobile oral telemedicine system on medical management and clinical outcomes of patients with complicated oral lesions in Botswana.

Mobile telemedicine, which involves the use of cellular phone telecommunications to facilitate exchange of information between parties in different locations to assist in the management of patients, has become increasingly popular, particularly in resource-limited settings. In Botswana, small studies of mobile telemedicine programs suggest access to these services positively affect patients, but these programs' impact is difficult to capture given limitations of baseline and comparative data. Our observational study uses each patient receiving mobile oral telemedicine services in Botswana as his/her own control to assess the impact of these services on his/her diagnosis and management plan. At month 5 of 12 total, preliminary analysis of eligible cases (n = 27) reveals management plan discordance between clinicians submitting cases and the specialist was 68.0% (17/25), suggesting that telemedicine can result in significant changes in management of patients.

Considerations for planning and designing meta-analysis in oral medicine.

Evidence to address a scientific question is generated through the design of research aiming to answer it. Probably the most often sought design in epidemiologic research is a randomized clinical trial that offers the advantage of controlling for confounders, which may influence the trial outcome. In contrast, observational study designs test hypotheses when clinical trials are difficult to implement. The interest in clinical trials has led to an explosion of manuscripts testing interventions in health care, often yielding interesting results albeit in statistically underpowered samples. Thus, the clinician faces the challenge of making sense of multiple studies that produce results of variable strength when attempting to assess the evidence supporting a treatment. Meta-analytic methods represent an alternative to assess the evidence by pooling the results from multiple studies to increase statistical power. This manuscript describes considerations for planning and implementing meta-analysis in oral medicine.

Provision of oral medicine in departments of oral and maxillofacial surgery in the UK: national postal questionnaire survey 2009.

We investigated the current provision of oral medicine in oral and maxillofacial (OMF) departments in the UK. We examined the number of specialists in oral medicine in OMF departments, the training given to OMF consultants in oral medicine, and the estimated time dedicated to treating patients with oral medical conditions in outpatient clinics. We also examined the pattern and reasons for onward referrals to departments of oral medicine. A postal questionnaire was sent to 300 OMF consultants and was returned by 183 (61%). Sixteen (9%) of the responding consultants had a registered specialist qualification in oral medicine with the General Dental Council (GDC), 15 (8%) had a degree in oral medicine, and 4 (2%) had a diploma. One hundred and eighteen (64%) consultants had been given formal training in oral medicine during their training as registrars. Time dedicated to oral medicine in outpatient clinics varied between less than 20% and more than 40% of total outpatient time. Sixteen surgeons (9%) referred 1-2 patients/week to departments of oral medicine, and 19 (10%) referred 2-4/month. Reasons for referral included need for specialist expertise, failure of treatment, and lack of time in outpatients. The proposal for a dentally qualified consultant-led oral medicine service was supported by 70 responding surgeons (38%).

British Association of Oral and Maxillofacial Surgeons first national audit in support of revalidation.

This is the first national audit of Fellows of the British Association of Oral and Maxillofacial Surgeon with the specific purpose of supporting consultant revalidation. The audit was performed online. There were 127 responses from 275 email invitations. The audit reflects the range of activity by consultants with over 90% being involved in dento-alveolar, trauma and oral medicine. 78% of consultants performing head and neck oncology had a database and 75% of cleft lip and palate surgeons. Contributions to audits in the last 3 years were least common in oral medicine (7%), skull base (7%), aesthetic surgery (8%), and paediatric maxillofacial surgery (12%). There were many different audits reflected in consultants responses and there is merit in focusing on specific audits suitable for national comparison and benchmarking.

Biopsy and diagnostic histopathology in dental practice in Brisbane: usage patterns and perceptions of usefulness.

BACKGROUND: Biopsy procedures and diagnostic histopathology are rarely used by general dental practitioners (GDPs) compared with dental specialists. The aim of this study was to investigate the usage patterns and views of GDPs and specialists in Brisbane on these procedures. METHODS: An analysis was carried out on 1027 oral biopsy accessions at a private pathology laboratory. A survey was distributed to 200 GDPs and dental specialists inquiring about their use of and views on biopsy and diagnostic histopathology. An analysis was carried out on 327 and 95 biopsies performed at a private oral medicine practice and at the University of Queensland School of Dentistry, respectively. RESULTS: The majority (76.2%) of GDPs surveyed referred all oral lesions requiring biopsy to a specialist, rather than undertaking biopsy themselves. Although most GDPs recognized the importance of biopsy, a large proportion (58.1%) did not feel competent in undertaking the procedure due to concerns of inadequate experience and practical skills. CONCLUSIONS: Many dental practitioners believe that GDPs should be able to undertake simple biopsies of benign lesions, however more undergraduate and postgraduate training in biopsy and diagnostic histopathology is necessary to promote a greater use of these procedures.

Ulceração aftosa recorrente no Ambulatório de Estomatologia da UNIFESP / Recurrent aphtous stomatitis in Stomatology Clinic UNIFESP (Universidade Federal de São Paulo)

Introdução e objetivo: A ulceração aftosa recorrente (UAR) é uma doença inflamatória bucal crônica de distribuição mundial, cuja prevalência varia entre 5% e 66%, com média de 30%, e continua representando problema clínico sem solução satisfatória. Apesar da etiopatogenia da UAR ainda ser desconhecida, ela é considerada doença multifatorial, na qual componentes genéticos, microbiológicos e imunológicos concorrem simultaneamente ou sequencialmente para o surgimento e evolução das lesões ulcerativas. Alguns fatores são apontados como modificadores ou desencadeantes das UAR, entre eles os mais estudados estão as alterações hormonais, estresse, traumatismos locais e nutricionais (deficiências de vitamina B12, ácido fólico e ferro). O objetivo deste artigo foi delinear o perfil dos pacientes com UAR acompanhados no Ambulatório de Estomatologia da UNIFESP, no período de 1999 a 2009. Foi elaborado um questionário, assim como um banco de dados para coletar e gerenciar as características clínicas da UAR dos pacientes. Resultados: O tipo mais comum de afta era o tipo minor (92%), o sítio de maior acometimento das lesões era a mucosa jugal (21%), seguida pela mucosa labial, 90% dos pacientes eram não fumantes, em 50% dos pacientes encontramos história familiar de UAR e apenas 28% dos pacientes relacionaram o estresse ao surto de aftas. Apenas 45% dos pacientes relataram piora com alimentação. Conclusões: Concluiu-se que os principais fatores associados à ocorrência da UAR foram predisposição familiar e alimentação e de forma negativa o uso do tabaco.

Avaliação das Condições Estomatológicas de Pacientes Portadores de Hidrocefalia Congênita / Evaluation of the Stomatological Conditions of Patients with Congenital

Objetivo: Avaliar as condições estomatológicas de crianças portadoras de hidrocefalia congênita (GPHC) atendidas no Hospital Governador João Alves Filho (HGJAF) e no Hospital Universitário (UFS), no município de Aracaju, estado de Sergipe. Método: Foram examinadas 30 crianças portadoras de hidrocefalia congênita e 34 crianças saudáveis (GC), na faixa etária de 2 a 7 anos de idade, de ambos os gêneros. Os dados a serem analisados durante o exame clínico foram relativos ao índice de sangramento gengival, de higiene oral, de ceo-d, anomalias dentárias, cronologia de erupção, alterações de tecidos moles e forma de palato. Foi realizada análise estatística através dos testes “t” de Student, Quiquadradoe de Fischer (p<0,05). Resultados: No GPHC, predominou a gengivite moderada, enquanto no GC apresentou ausência de gengivite; a higiene bucal foi regular no GPHC e boa no GC. A média de ceo-d foi de 1,53 para o GPHC e 1,44 para o GC, ressaltando-se que não foi observado nenhum dente obturado no GPHC. Não foram detectadas anomalias dentárias, mas a presença de língua saburrosa, língua fissurada, freio labial teto persistente e atraso de erupção dentária foram verificados apenas no GPHC. O palato atrésico foi mais freqüente nestas crianças em comparação com o GC. Conclusão: As crianças portadoras de hidrocefalia congênita apresentam condições de saúde bucal menos satisfatórias que as crianças saudáveis, sugerindo que as mesmas compõem um grupo de pacientes portadores de necessidades especiais, sendo, portanto, fundamental uma maior atenção à saúde bucal, com participação do cirurgião-dentista na equipe envolvida no atendimento destes pacientes.

Caracterización de la docencia estomatológica en el Municipio de Boyeros: Ciudad de La Habana 2008 / Characterization of estomatological docency in Boyeros Municipality. Havana City 2008

Con el propósito de caracterizar la composición de la fuerza técnica que se dedica a la atención estomatológica en el Municipio Boyeros en el 2008, se llevó a cabo este estudio descriptivo. A cada director de clínica o jefe de servicio estomatológico se le solicitó llenar una planilla que recogía nombre, categoría y nivel profesional, grado de los especialistas, categoría docente y grado de master. Se describe la situación de los servicios estomatológicos en nuestro municipio y cómo a partir de 2004, comienza a impartirse docencia de pregrado, en el 2005 de post grado y de tecnología de la salud, con los recursos humanos que tenemos .Hoy la docencia estomatológica está evolucionando de acuerdo con las necesidades de la atención estomatológica en función de brindar mejores servicios al pueblo. Todo esto puede servir de referencia para ulteriores comparaciones.

In order to characterize the manpower devoted to stomatological assistance and teaching, we performed a research that can serve as reference to further studies. Every director or head of service for stomatological units at Boyeros Municipality was given a form containing the main data of the staff: professional level, master degree, specialization level and teaching rank. We describe the conditions of our municipality and the teaching process that officially started for undergraduate level on 2004 and for postgraduate level and Technology of Health on 2005. We analyze that both assistance and teaching activities are evolving toward higher levels, and emphasis must be done on improving the academic condition of the staff.

Need and Demand for Oral Medicine Services in 1996. A report prepared by the Subcommittee on Need and Demand for Oral Medicine Services, a subcommittee of the Specialty Recognition Committee, American Academy of Oral Medicine.

The need and demand for oral medicine services in the United States and Canada was determined by a prospective survey of American Academy of Oral Medicine practitioners who attended the Academy's 1996 annual meeting. Of the 50 surveys returned from 149 eligible registrants, it was determined that, on the average, oral medicine practitioner respondents practiced 2.3 days per week and treated 8.7 patients per day; this amounts to more than 40,000 patient-care visits per year. Almost 90% of patients were treated because of medically compromising conditions, oral mucocutaneous disease, or chronic orofacial pain. Most of the care (52%) was provided in non-university settings. Most treatment involved the comprehensive evaluation of complex oral problems (36.7%), the prescription of medications (24.2%), or comprehensive dental treatment (21.8%) for patients with severe and life-threatening medical conditions. These results suggest that oral medicine services are needed and that demand for these services is high.