Simple Approaches for Establishing an Evidence-Based Dental Practice.

Constructing an evidence-based dental practice requires leadership, commitment, technology support, and time, as well as skill practice in searching, appraising, and organizing evidence. In mastering the skills of evidence-based dentistry, clinicians can implement high-quality science into practice through a variety of opportunities including the development of clinical care guidelines, procedural technique protocols, and electronic dental record auto-note templates, as well as treatment planning, care prioritization, and case presentation. The benefits of building an evidence-based dental practice are many, including improvements in patient care and satisfaction, increased treatment predictability and confidence in care approaches, as well as potential cost savings.

The impact of pharmacy services on opioid prescribing in dental practice.

OBJECTIVES: To compare rates of dental opioid prescribing between periods of full and partial integration of pharmacy services and periods of no integration. METHODS: This observational study used a retrospective chart review of opioid prescriptions written by dental providers practicing in a free dental clinic for the medically underserved over a period of 74 months. Pharmacy services were fully integrated into the practice model for 48 of the 74 months under study. During this time frame, all dental opioid orders required review by the pharmacy department before prescribing. Outcomes related to prescribing rates and errors were compared between groups, which were defined by the level of integrated pharmacy services. Demographic and prescription-specific data (drug name, dose, quantity, directions, professional designation of individual entering order) and clinic appointment data were collected and analyzed with the use of descriptive and inferential statistics. RESULTS: A total of 102 opioids were prescribed to 89 patients; hydrocodone-acetaminophen combination products were the most frequently used. Opioid prescribing rates were 5 times greater when pharmacy services were not integrated (P <0.001); and dentists were 81% less likely to prescribe opioids when pharmacy was fully integrated (odds ratio 0.19, 95% confidence interval 0.124-0.293; P <0.001). Frequency of hydrocodone use compared with other opioids did not decrease after the rescheduling of hydrocodone to a Schedule II controlled substance. The frequency of prescribing errors was not statistically different between groups, although there were numerically fewer errors with integrated pharmacy services. CONCLUSION: The literature reports that dentists are the third most frequent prescribers of opioids. The findings from this study suggest that collaboration between pharmacists and dentists has the potential to decrease opioid utilization in primary dental practice.

Use of clinical practice guidelines by dentists: findings from the Japanese dental practice-based research network.

RATIONALE, AIMS AND OBJECTIVES: The objectives of this study were to: (1) examine differences in the use of dental clinical practice guidelines among Japanese dentists, and (2) identify characteristics associated with the number of guidelines used by participating dentists. METHODS: We conducted a cross-sectional study consisting of a questionnaire survey in Japan between July 2014 and May 2015. The study queried dentists working in outpatient dental practices who are affiliated with the Dental Practice-Based Research Network Japan (n = 148). They were asked whether they have used each of 15 Japanese dental clinical guidelines. Associations between the number of guidelines used by participants and specific characteristics were analysed via negative binomial regression analysis. RESULTS: The mean number of guidelines used by participating dentists was 2.5 ± 2.9 [standard deviation (SD)]. Rate of use of guidelines showed substantial variation, from 5% to 34% among dentists. The proportion of dentists that used guidelines was the highest among oral medicine specialists, who had the highest proportion for 10 of 15 guidelines. Negative binomial regression analysis identified three factors significantly associated with the number of guidelines used: 'years since graduation from dental school', 'specialty practice' and 'practice busyness'. CONCLUSIONS: These results suggest that the use of clinical practice guidelines by Japanese dentists may still be inadequate. Training in the use of the guidelines could be given to dental students as undergraduate education and to young clinicians as continuing education.

Dental students' compliance with antibiotic prescribing guidelines for dental infections in children.

CONTEXT: To investigate the antibiotic prescribing training received by dental students, clinical experience in treating child patients, awareness of antibiotic prescribing guidelines, preparedness in antibiotic prescribing, and compliance with antibiotic prescribing guidelines for the management of dental infections in children. METHODS: This was a cross-sectional study involving final year dentals students from Malaysian and Asian dental schools. A self-administered questionnaire consisting of five clinical case scenarios was e-mailed to all final year students at selected dental schools. Students' responses were compared for each clinical case scenario with the prescribing guidelines of the American Academy of Pediatric Dentistry and the American Dental Association. Compliance in each scenario was tested for association with their preparedness in antibiotic prescribing, previous training on antibiotic prescribing and awareness of antibiotic prescribing guidelines using Chi-square test. Data collected were analyzed using SPSS statistics version 20. RESULTS: A total of 108 completed responses were received. About 74 (69%) students were from Malaysian dental schools. The compliance rate with prescribing guidelines ranged from 15.7% to 43.5%. Those attending Malaysian dental schools (47.3%) and those who had treated child patient more often (46.3%) were more likely (P < 0.05) to be aware of the guidelines. Those who had received antibiotic prescribing training (21.3%) were more likely to think they were well prepared in antibiotic prescribing (P < 0.05). CONCLUSIONS: Final year dental students had low awareness and compliance with antibiotic prescribing guidelines. Further research is needed to investigate how compliance with the guidelines may be enhanced.

An investigation into the numbers of dentists from 19 European Economic Area (EEA) member states currently registered to work in the United Kingdom and key differences between the practise of dentistry in the UK and their member states of origin.

The aim of this short communication is to highlight the numbers of non-UK EEA qualified dentists currently registered with the General Dental Council (GDC) and to present a brief overview of the systems for the provision of oral healthcare in the non-UK EEA member states identifying differences in practise. The relevant data were gathered for the National Clinical Assessment Service (NCAS) as part of a wider project. It was found that at 31 December 2010, 28% of dentists registered with the GDC had not qualified in the UK. Of these more than 6,300 were European Economic Area (EEA) dentists with non-UK qualifications. The nature of their practise varied widely from member state to member state. The implications of these findings are discussed briefly.

The assessment of infection control in dental practices in the municipality of São Paulo.

OBJECTIVE: The goal of this study was to evaluate the infection control measures actually implemented by dental surgeons during dental practice, as patients and professionals are exposed to high biological risk in dental care environments. METHOD: 614 questionnaires (90.69%) were answered by professionals registered in updating or in post-graduate courses in the Municipality of São Paulo. RESULTS: Out of surveyed professionals 30.62% admitted that surface protection barriers were not used, whereas 34.17% were using non ideal or outdated pre-disinfection practices. The autoclave was used by 69.38% of participants, although 33.80% were not monitoring control of the sterilization cycles. Chemical and biological indicators were not used simultaneously by 83.21% of respondents and were not employed on a daily or weekly basis by at least 81.75%. Dubious methods of sterilization were cited by 44.77%. Occupational accidents caused by cutting and piercing objects were reported by 47.88%; however, the biologic risk was underestimated by 74.15% of the professionals who suffered the accidents. Irritant solutions were used as an antiseptic agent by 18.55%. CONCLUSIONS: Infection control measures reported by dental surgeons during their practices are deficient. It is necessary to educate, raise awareness of professionals, and promote constant updating courses on procedures which aim at improving safety of dental care.

The assessment of infection control in dental practices in the municipality of São Paulo

OBJECTIVE: The goal of this study was to evaluate the infection control measures actually implemented by dental surgeons during dental practice, as patients and professionals are exposed to high biological risk in dental care environments. METHOD: 614 questionnaires (90.69 percent) were answered by professionals registered in updating or in post-graduate courses in the Municipality of São Paulo. RESULTS: Out of surveyed professionals 30.62 percent admitted that surface protection barriers were not used, whereas 34.17 percent were using non ideal or outdated pre-disinfection practices. The autoclave was used by 69.38 percent of participants, although 33.80 percent were not monitoring control of the sterilization cycles. Chemical and biological indicators were not used simultaneously by 83.21 percent of respondents and were not employed on a daily or weekly basis by at least 81.75 percent. Dubious methods of sterilization were cited by 44.77 percent. Occupational accidents caused by cutting and piercing objects were reported by 47.88 percent; however, the biologic risk was underestimated by 74.15 percent of the professionals who suffered the accidents. Irritant solutions were used as an antiseptic agent by 18.55 percent. CONCLUSIONS: Infection control measures reported by dental surgeons during their practices are deficient. It is necessary to educate, raise awareness of professionals, and promote constant updating courses on procedures which aim at improving safety of dental care.

Risk management in clinical practice. Part 10. Periodontology.

A sizeable proportion of patients in clinical practice will have some form of periodontal disease and most of these patients can be well managed in primary care. Unfortunately, dento-legal claims regarding inappropriate periodontal care are increasing rapidly and are now one of the most common reasons for litigation in dentistry. In this paper we will look at aspects of contemporary management of periodontal disease in clinical practice and offer guidance for examination, management and referral.

Pay for performance: will dentistry follow?

BACKGROUND: "Pay for performance" is an incentive system that has been gaining acceptance in medicine and is currently being considered for implementation in dentistry. However, it remains unclear whether pay for performance can effect significant and lasting changes in provider behavior and quality of care. Provider acceptance will likely increase if pay for performance programs reward true quality. Therefore, we adopted a quality-oriented approach in reviewing those factors which could influence whether it will be embraced by the dental profession. DISCUSSION: The factors contributing to the adoption of value-based purchasing were categorized according to the Donabedian quality of care framework. We identified the dental insurance market, the dental profession position, the organization of dental practice, and the dental patient involvement as structural factors influencing the way dental care is practiced and paid for. After considering variations in dental care and the early stage of development for evidence-based dentistry, the scarcity of outcome indicators, lack of clinical markers, inconsistent use of diagnostic codes and scarcity of electronic dental records, we concluded that, for pay for performance programs to be successfully implemented in dentistry, the dental profession and health services researchers should: 1) expand the knowledge base; 2) increase considerably evidence-based clinical guidelines; and 3) create evidence-based performance measures tied to existing clinical practice guidelines. SUMMARY: In this paper, we explored factors that would influence the adoption of value-based purchasing programs in dentistry. Although none of these factors were essential deterrents for the implementation of pay for performance programs in medicine, the aggregate seems to indicate that significant changes are needed before this type of program could be considered a realistic option in dentistry.

Meeting oral health needs to promote the well-being of the geriatric population: educational research issues.

This article reviews some of the more recent demographic changes affecting aging populations. The author expands the concept of aging to include persons who may be chronologically young but biologically old because they are medically compromised or developmentally disabled. It is not known how many persons can be included in this definition who will need care, and the question is what are their needs and how are we going to teach dental students and dentists to care for them. These problems are discussed, and some models of care are described.

[The stomatologic status of people of elderly and senile age].

This article presents the data of epidemiological inspection of 1000 persons of average, elderly and senile age. Prevalence and intensity of a current of the basic stomatologic diseases (caries, pathology of a paradont and a mucous membrane of an oral cavity, a temporal-mandibular joint and chewing muscles) have been studied. Indicators of need of people of various age groups in tooth prosthetics are established. Level of rendering the stomatologic help is defined to be insufficient in groups of people of elderly and senile age. Recommendations aimed at improvement of stomatologic help to people of elderly and senile age are made.

Occlusal tooth surface treatment plans and their possible effects on oral health care costs.

PURPOSE: The aim of this study was to evaluate decision making with regard to detection and treatment of carious lesions on occlusal tooth surfaces and to evaluate the possible costs related to the different treatment plans of a group of clinicians in private practice. MATERIALS AND METHODS: Forty extracted permanent teeth with no fillings or macroscopic carious cavitations were selected and radiographed, using a standard method similar to bitewing and then mounted in two models. A sample of 130 clinicians in private practice in Piracicaba, Brazil were asked to carry out combined visual-radiographic caries examination of the occlusal surfaces and to recommend possible treatment plans for each surface. Teeth were sectioned bucco-lingually and caries was assessed using a stereomicroscope and classified as either enamel or dentine lesions. The costs of treatments suggested by each examiner were calculated, using a fee scale reported by the Brazilian Federal Council of Dentistry. RESULTS: Most teeth (53.7%) that were found to be sound on histological examination were considered to have enamel lesions. In 85.7% of these cases, the clinicians recommended restorative treatments. There was about 14-fold difference among clinicians concerning the costs related to decision making. CONCLUSION: Not only did the clinicians overestimate the presence and depth of carious lesions, but they also tended to treat enamel lesions using invasive therapeutic procedures. Great disparities were observed with regard to treatment costs related to decision making. Assuming an in vivo situation, the clinicians may be performing overtreatments and consequently interfering in the quality of patients' oral health.

Assessment of the frequency of routine removal of dental plaque prior to caries diagnosis by dentists in three cities in southern Brazil.

The aim of this study was to assess the frequency of routine use of dental prophylaxis prior to visual inspection, in order to diagnose caries, by dentists with different lapses of time after graduating time. One hundred and fifty one Brazilian dentists were interviewed in 3 Brazilian cities to determine if they usually remove dental plaque prior to visual inspection for caries diagnosis. The dentists were stratified according to year of graduation. The association between the lapse of time after graduating and the practice of routinely removing dental plaque before clinical examination was tested using the chi-square test with a significance level of 5%. Only 28.5% of the dentists reported that they usually remove dental plaque prior to clinical examination. The dentists who graduated in the last 15 years presented the lowest percentages of plaque removal prior to clinical examination (15.1%), whereas the more experienced dentists reported that they perform prophylaxis more frequently. Of the professionals who graduated from 1960-1975, 23.9% reported that they performed dental plaque removal prior to diagnosis, whereas the figure for those graduating from 1976-1990 was 46.2%. Most of the dentists interviewed reported that they did not remove dental plaque prior to performing visual diagnosis of caries.

Oral health in the family health strategy: a change of practices or semantics diversionism / Saúde bucal na estratégia de saúde da família: mudança de práticas ou diversionismo semântico

OBJECTIVE:To evaluate public health dentistry practices of two different family health models. METHODS: Qualitative study conducted with data obtained from focus groups consisting of 58 dentists working in the Family Health Strategy for at least three years between August-October, 2006. The Paideia Family Health Approach was used in the city of Campinas and the Oral Health Initiative as part of the Family Health Strategy was implemented in the city of Curitiba, Southeastern and Southern Brazil, respectively. Data was analyzed using the hermeneutic-dialectic method. Analysis indicators were employed to indicate backwardness, stagnation or progress in oral health practices effective from the implementation of the strategies referred. The indicators used were: work process; interdisciplinary approach; territorialization; capacity building of human resources; health promotion practices; and responsiveness to users' demands. RESULTS: There was progress in user access to services, humanization of health care, patient welcoming and patient-provider relationship. The results related to health promotion practices, territorialization, interdisciplinary approach and resource capacity building indicated a need for technical and operational enhancements in both cities. CONCLUSIONS: Both models have brought about important advances in terms of increased access to services and humanization of health care. Universal access to oral health at all levels of complexity was not achieved in both cities studied. Local health managers and oral health program coordinators must bring more weight to bear in the arena that defines public policy priorities.

OBJETIVO: Avaliar práticas de saúde bucal coletiva de dois modelos de atenção à saúde familiar. MÉTODOS: Estudo qualitativo realizado por meio de grupos focais constituídos por 58 cirurgiões-dentistas atuantes em programa de saúde da família há pelo menos três anos. Foram adotados os modelos de atenção Método Paidéia em Saúde da Família (Campinas, SP, 34 profissionais) e Estratégia de Saúde da Família (Curitiba, PR, 24 profissionais). O estudo foi realizado entre os meses de agosto e outubro de 2006. O referencial teórico utilizado para análise dos dados foi a hermenêutica-dialética. Foram empregados indicadores analíticos visando a indicar retrocesso, estagnação ou progresso nas práticas de saúde bucal que tiveram efeito a partir da implantação das estratégias em estudo. Os indicadores utilizados foram: processo de trabalho, interdisciplinaridade, territorialização, qualificação dos trabalhadores, promoção da saúde, resolutividade às demandas dos usuários. RESULTADOS: Houve progresso no acesso dos usuários aos serviços, na humanização do cuidado em saúde, no acolhimento das pessoas e no vínculo entre os profissionais e os pacientes. Os resultados relativos às práticas de promoção de saúde, territorialização, abordagem interdisciplinar e qualificação das equipes indicaram a necessidade de avanços técnicos e operacionais nas duas cidades. CONCLUSÕES: Os dois modelos apresentam importantes avanços na qualificação do acesso e na humanização do cuidado em saúde. Não obstante, o direito universal ao acesso à saúde bucal, em todos os níveis de complexidade, mostrou-se deficiente nas duas cidades. Os gestores locais dos serviços de saúde e os coordenadores municipais de saúde bucal, devem atuar com maior intensidade ao definir prioridades em políticas públicas de saúde local.

OBJETIVO: Evaluar prácticas de salud bucal colectiva de dos modelos de atención a la salud familiar. MÉTODOS: Estudio cualitativo realizado por medio de grupos focales constituidos por 58 cirujanos-dentistas actuantes en programa de salud de la familia hace por lo menos tres años. Fueron adoptados los modelos de atención Método Paideia en Salud de la Familia (Campinas, Sureste de Brasil, 34 profesionales) y Estrategia de Salud de la Familia (Curitiba, Sur de Brasil, 24 profesionales). El estudio fue realizado entre los meses de agosto y octubre de 2006. El referencial teórico utilizado para análisis de los datos fue la hermenéutica-dialéctica. Fueron empleados indicadores analíticos con el objetivo de indicar retroceso, estancamiento o progreso en las prácticas de salud bucal que tuvieran efecto a partir de la implantación de las estrategias en estudio. Los indicadores utilizados fueron: proceso del trabajo, interdisciplinaridad, territorialidad, cualificación de los trabajadores, promoción de la salud, resolución a las demandas de los usuarios. RESULTADOS: Hubo progreso en el acceso de los usuarios a los servicios en la humanización del cuidado en salud, en el acogimiento de las personas y en el vínculo entre los profesionales y los pacientes. Los resultados relativos a las prácticas de promoción de salud, territorialidad, abordaje interdisciplinar y cualificación de los equipos indicaron la necesidad de avances técnicos y operacionales en las dos ciudades. CONCLUSIONES: Los dos modelos presentan importantes avances en la cualificación del acceso y en la humanización del cuidado en salud. Sin embargo, el derecho universal al acceso a la salud bucal, en todos los niveles de complejidad, se mostró deficiente en las dos ciudades. Los gestores locales de los servicios de salud y los coordinadores municipales de salud bucal, deben actuar con mayor intensidad al definir prioridades en políticas públicas de salud local.

Oral health in the family health strategy: a change of practices or semantics diversionism.

OBJECTIVE: To evaluate public health dentistry practices of two different family health models. METHODS: Qualitative study conducted with data obtained from focus groups consisting of 58 dentists working in the Family Health Strategy for at least three years between August-October, 2006. The Paideia Family Health Approach was used in the city of Campinas and the Oral Health Initiative as part of the Family Health Strategy was implemented in the city of Curitiba, Southeastern and Southern Brazil, respectively. Data was analyzed using the hermeneutic-dialectic method. Analysis indicators were employed to indicate backwardness, stagnation or progress in oral health practices effective from the implementation of the strategies referred. The indicators used were: work process; interdisciplinary approach; territorialization; capacity building of human resources; health promotion practices; and responsiveness to users' demands. RESULTS: There was progress in user access to services, humanization of health care, patient welcoming and patient-provider relationship. The results related to health promotion practices, territorialization, interdisciplinary approach and resource capacity building indicated a need for technical and operational enhancements in both cities. CONCLUSIONS: Both models have brought about important advances in terms of increased access to services and humanization of health care. Universal access to oral health at all levels of complexity was not achieved in both cities studied. Local health managers and oral health program coordinators must bring more weight to bear in the arena that defines public policy priorities.

Assessment of the frequency of routine removal of dental plaque prior to caries diagnosis by dentists in three cities in southern Brazil

The aim of this study was to assess the frequency of routine use of dental prophylaxis prior to visual inspection, in order to diagnose caries, by dentists with different lapses of time after graduating time. One hundred and fifty one Brazilian dentists were interviewed in 3 Brazilian cities to determine if they usually remove dental plaque prior to visual inspection for caries diagnosis. The dentists were stratified according to year of graduation. The association between the lapse of time after graduating and the practice of routinely removing dental plaque before clinical examination was tested using the chi-square test with a significance level of 5 percent. Only 28.5 percent of the dentists reported that they usually remove dental plaque prior to clinical examination. The dentists who graduated in the last 15 years presented the lowest percentages of plaque removal prior to clinical examination (15.1 percent), whereas the more experienced dentists reported that they perform prophylaxis more frequently. Of the professionals who graduated from 1960-1975, 23.9 percent reported that they performed dental plaque removal prior to diagnosis, whereas the figure for those graduating from 1976-1990 was 46.2 percent. Most of the dentists interviewed reported that they did not remove dental plaque prior to performing visual diagnosis of caries.

[Pastoral psychology, spiritual counseling in dentistry. Review of the literature]. / A pasztorálpszichológia, lelkigondozás fogászati vonatkozásai Irodalmi összefoglaló.

Although there were drastic changes in the XX-th century, still 70% of the Hungarian population believe in God, and 10-15% can be counted as active believer. A percentage of 44% of the hospitalised patients indicated a need of pastoral counseling during the treatment time. In the field of psychiatry and psychotherapy the percentage of the need of religious care (pastoral psychology, pastoral counseling) may be even higher. In the field of dentistry the increasing number of psychosomatic patients justify the introduction of such religious treatment methods into the dental care system as well. In this review authors try to collect the main points of this special, religious type of therapy to help dental professionals working in the field of psychosomatic dentistry in the orientation in this interesting and important field.