Shade selection practices amongst clinical dental students in South Western Nigeria

Objective: Shade selection is crucial in satisfying aesthetic demands of patients during cosmetic dental treatment. It is important to nurture and evaluate this act in students as future dental professionals. This study aimed to evaluate the understanding and practice of tooth shade matching amongst dental students. Methods: A descriptive cross-sectional study was carried out in South-Western Nigeria. A structured, self-administered questionnaire was given to clinical dental students to garner information on socio-demographics, knowledge and practice of shade selection. The resulting data were statistically tested using chi-square with p-value ≤ 0.05 indicating significant level. Results: There was 76.5% response rate to the questionnaires with the male subjects accounting for 52.3%. The mean age of participants was 24.2 ± 2.4 years. Majority (40.9%) did not know the ideal time required for shade selection. Most (57.9%) students used visual/manual method in shade selection but 63.6% of these did not know the name of the shade guide used. Majority (80.8%) select the shade before commencing restorative procedure. Less than half (36.4%) of participants performed tooth shade matching in 3 segments (from incisal-third to cervical-third) while 54.5% considered tooth shade as a single uniform colour. Most students, 67.4% had a fair knowledge of shade matching while 13.6% practiced good shade matching technique for restorations/prosthesis. There was a statistically significant difference (p=0.022) between shade selection practice and the clinical training levels of students. Conclusion: The dental students had a fair knowledge about the principles of shade selection but lack the clinical know-how

Gestión del fracaso del tratamiento dental / Management of dental treatment failure

Desde la Bioética y empleando los principios de la calidad en salud y de la seguridad del paciente, se listan los diferentes argumentos que apoyan la necesidad de implementar de forma sólida los procedimientos de supervisión y auditoría interna en el centro dental para identificar, prevenir y manejar los diferentes niveles de fracaso que se dan en el ámbito terapéutico de la Odontología. (AU)

From bioethics and employing principles of quality in health and patients safety, different arguments are listed that support the need to solidly implement supervision and internal auditing procedures in the dental center to identify prevent and manage the different levels of failure that occur in the therapeutic field of dentistry. (AU)

Evaluation of dental record keeping at Hamdard university dental hospital

An audit was conducted at Hamdard University Dental Hospital to assess the standard of clinical record keeping by undergraduate dental students, house officers and faculty members. Objective of this audit was to improve the quality of care of patients treated by the staff and students

100 hospital notes were audited for this purpose. These records were randomly selected from the record room at HUDH. CRABEL score was used for assessing the quality of these notes

Ten variables were measured in our study. Data analysis was done on SPSS version 16. Descriptive statistics were performed. Mean CRABEL score was found to be 50

94% of the notes had readable writing. 87% of the clinical notes did not mention the chief complaint of the patient. 98% of the clinical notes had no mention of consent in them, while 43% of the clinical notes did not mention the investigations performed. These inferences clearly suggest that the current standards of clinical notes need considerable improvements. Further studies are planned in the future after addressing the present deficiencies

Evaluación de la calidad de los registros empleando la auditoría odontológica en una clínica dental docente / Quality evaluation of the records using dental audit in a teaching dental clinic

Objetivo: Evaluar la calidad de registro o llenado de historias clínicas de pacientes nuevos atendidos en una Clínica Dental Docente durante el período de enero a julio de 2012 empleando la auditoría odontológica como herramienta sistematizada. Material y métodos: Se tomaron como muestra 140 historias clínicas de pacientes nuevos de las cuales se evaluó la frecuencia y porcentaje de registro de los diferentes aspectos que componen la historia clínica. Resultados: Se encontró que el 78% de las historias no tenían completo el registro en los diferentes aspectos evaluados, encontrando que de los diecisiete aspectos evaluados, nueve registran entre 11% y 29%, quedando entre un 89% y un 71% de historias que no registran estos aspectos. Se identificaron tres aspectos que se registran entre 84% y 86% (número de historias, cuestionario de salud y examen estomatológico), cuatro aspectos resgistran entre 94% y 98% (fecha de ingreso, asignación de operador, odontograma y filiación) y sólo un aspecto se registra al 100% (evolución del tratamiento) del total de historias clínicas auditadas. conclusiones: más del 45% de las historias clínicas auditadas en la presente investigación tenían deficiencias en el registro o llenado de los datos que la historia clínica requiere como información de documento médico-legal.

Introduction: To assess the quality of registration or filling histories of new patients treated at a Teaching Dental Clinic during the period January to July 2012 using the Dental Audit as a tool systematized. Material and methods: Was sampled 140 medical records of new patients which assessed the frequency and percentage of recording various aspects that make up the medical record. Results: We found that 78% of the medical records do not have full registration in the different aspects evaluated, fi nding that of the seventeen aspects evaluated, nine recordedbetween 11% and 29 %, remaining between 89% and 71% of medical records that not record these aspects. Weidentifi ed three aspects that are recorded between 84% and 86% (medical record number, health questionnaire and dental examination), four points recorded between 94% and 98% (date of entry, operator assignment, odontogram and fi liation) and only one side is recorded 100% (treatment outcome) of the total audited medical records. Conclusions: Over 45% of medical records audited in this investigation are impaired in the registry or data fi lling medical history required as medico-legal document.

A auditoria odontológica nos serviços de saúde suplementar / Dental auditing in supplementary health care services

O sistema de saúde no Brasil vem sofrendo grandes transformações. Em virtude da saúde pública não ter condições de atender as necessidades da população, junto ao baixo poder aquisitivo da população para custear de forma direta seus tratamentos, foi institucionalizado o sistema de saúde suplementar, que complementa o serviço de saúde público. Com a crise no mercado odontológico provocada pelo excesso de profissionais, muitos cirurgiões-dentistas,passaram a trabalhar em parceria com as operadoras de planos de saúde (OPS), na expectativa de aumentar a clientela. Essa parceria promove reorganização acelerada e irreversível do setor, em que a relação entre paciente e cirurgião-dentista é intermediada pela OPS. Objetivo: demonstrar por meio de atualização de literatura a importância da auditoria nos serviços de saúde bucal oferecidos pelas OPS, destacando o papel do auditor técnico como gestor de saúde, exprimindo sua função educadora e não fiscalizadora ou punitiva. Considerações finais: devido ao crescimento das OPS, regulação do setor através da lei 9656/98 e código de defesa do consumidoras OPS passaram a desenvolver instrumentos de avaliação da qualidade dos serviços prestados, dentre eles, a auditoria odontológica. Entretanto, este novo modelo de exercer a prática odontológica, tem trazido conflitos para os profissionais que desconhecem a importância do auditor nos serviços de saúde bucal. As ações dos serviços de auditoria são pautadas por princípios éticos-legais e baseadas em evidências que fundamentam a prática odontológica, além disso representa segurança adicional para o beneficiário através do controle de qualidade a que seu tratamento é submetido...

The health care system in Brazil is undergoing large transformations. Due to the public health care system's inability to attend to the needs of the whole population, together with the general population's inability to pay for needed treatment out of pocket, the supplementary health care system was created to augment the public system. With the crisis in the dental industry caused by the excess of dental professionals, many dentists began partnering with health care plan operators (HPO) with the hope of expanding their clientele. These partnerships encourage an accelerated and irreversible reorganization in the industry, where the relationship between patient and dentist is mediated by the HPO. Objective: to demonstrate via a review of the most recent literature the importance of the practice of auditing the oral-health services offered by the HPOs, highlighting the role of the technical auditor as health manager, focusing on its educational function and not fiscal or punitive. Final remarks: due to the growth of the HPOs, regulation of the sector via the law 9656/98 and the consumer-defense code, the HPOs started to develop tools to evaluate the quality of the performed services, amongst them, the dental audit. Nevertheless, this new model for the dental industry has given rise to problems for dental professionals that are unaware of the importance of the auditor in relation to oral health services. The actions of the auditing services are regulated by legal and ethical principles and based on fundamental data from dental practice. Beyond that, they add additional assurance for patients via quality control and ensuring their treatment is submitted...

Auditoria no Sistema Único de Saúde: o papel do auditor no serviço odontológico / Auditing in the Brazilian National Health System: the auditor's role in oral health services

A auditoria, na saúde, verifica os processos e resultados da prestação de serviços, pressupondo o desenvolvimento de um modelo de atenção adequado, de acordo com as legislações vigentes. Nesta pesquisa, objetivou-se analisar as atividades da auditoria no Sistema Único de Saúde no serviço de saúde bucal, buscando demonstrar as ações e a sua inserção nas três esferas de governo. Foram realizadas análise documental e levantamentos bibliográficos sobre os sistemas de auditoria e o papel do auditor no serviço odontológico desde 1969. Os resultados mostraram que foram encontrados seis artigos sobre auditoria odontológica no SUS e que a atuação do auditor odontológico é abrangente no gerenciamento do sistema, consistindo no controle, na avaliação, na supervisão e na orientação, bem como na garantia da participação social e acesso aos serviços. Na saúde bucal o auditor analisa, monitora e fiscaliza o planejamento das estratégias e os procedimentos efetuados; realiza o cadastramento dos profissionais, das unidades de saúde e a programação física orçamentária; viabiliza os dados para o sistema de informação e o pagamento dos serviços prestados; examina o cumprimento das pactuações, dando um enfoque educativo e não mais policialesco à resolubilidade dos problemas. Conclui-se que existem poucos estudos sobre auditoria odontológica no SUS e que o sistema de auditoria é um instrumento administrativo confiável e essencial para os gestores no desenvolvimento das ações de saúde.

Análise comparativa entre os códigos de ética odontológica e médica brasileiros / Comparative analysis of Brazilian medical and dental ethics codes / Análisis comparativo de los códigos brasileros de ética médica y dental

Os códigos de ética profissional são normas jurídicas (resoluções de autarquias federais) elaboradas pelos membros das mais diversas categorias de trabalhadores com o intuito de orientar a condutas desses profissionais no que diz respeito à ética na relação com os pacientes, com seus pares e com a sociedade. O objetivo deste estudo foi realizar uma análise comparativa entre os Códigos de Ética Odontológica e Médica. Observou-se que as diferenças entre estes documentos deontológicos surgem muito mais em virtude das particularidades de cada profissão do que por abordagens distintas frente a problemas similares. Concluiu-se que os Códigos de Ética Odontológica e Médica apresentam muito mais pontos em comum do que diferenças, mas seria interessante que os Conselhos de classe ao propor atualizações e modificações dos seus atuais códigos observassem o que as outras profissões da saúde contemplam em suas normas deontológicas, com o intuito de levar em consideração aspectos que também poderiam ser importantes para sua classe profissional de modo a engrandecer os códigos tornando um pouco mais fácil para os médicos e cirurgiões-dentistas a tomada de decisões éticas no seu trabalho diário em benefício da saúde do ser humano e da coletividade.

Los códigos de ética profesional son normas (resoluciones de autoridades federales) preparadas por los miembros de las diferentes categorías de trabajadores con el fin de orientar la conducta ética de estos profesionales en la relación con pacientes, colegas y la sociedad. El objetivo de este estudio fue realizar un análisis comparativo de los códigos de ética en Odontología y Medicina. Se observó que las diferencias entre estos documentos se deben más a las particularidades de cada profesión que a enfoques distintos frente a problemas similares. Se concluyó que los códigos de ética en Odontología y Medicina presentan más puntos en común que diferencias, pero sería interesante que los Consejos de Clase, al proponer actualizaciones y cambios a sus actuales códigos, observaran lo que otras profesiones de la salud contemplan en sus normas deontológicas, con fin de tener en cuenta aspectos que también podrían ser importantes para su clase profesional, de modo de ampliar los códigos y hacer un poco más fácil para los médicos y cirujanos dentistas la toma de decisiones éticas en su trabajo diario en beneficio de la salud del ser humano y la comunidad.

Professional ethics codes are norms (federal authority resolutions) prepared by members of the different categories of workers with the goal to guide the ethical conduct of these professionals in relation to patients, colleagues and society. The aim of this study was to carry out a comparative analysis of ethical codes in Dentistry and Medicine. It was observed that differences between these documents were due more to the particularities of each profession than to different focus, facing similar problems. It was concluded that Dentistry and Medicine ethical codes have more points in common than differences, but it would be interesting that Class Advisory Committees, when proposing actualizations and changes to their current codes, they will look what other health care professions view as deontological norms, with the end to have into account aspects which may be important also for their professional class, in order to extend the codes and facilitate to physicians and dentists ethical decision making in their daily task in benefit to the health of human beings and community.

Auditoria na Saúde: justificativas de glosas no setor odontológico / Auditing in the service: glosses justification in the dental sector

Objetivo - Fazer o levantamento das principais justificativas de glosas e o percentual de perdas de produção dos procedimentos odontológicos. Métodos - É um estudo epidemiológico de série histórica, retrospectivo e quantitativo, baseado no levantamento dos dados do sistema de informação do DATASUS e relatórios do Sistema Municipal de Auditoria do município de Aquidauana-MS nos anos de 2001 a 2010. Resultados - Os resultados demonstram que foram apresentados 921.300 procedimentos odontológicos; sendo 223.226 (24,2%) procedimentos individuais e 698.074 (75,8%) coletivos. Ocorreram 23.881 glosas (2,6%), sendo 10.158 (42,5%) nos procedimentos coletivos e 13.723 (57,5%) nos individuais. A causa mais frequente de glosas referente aos procedimentos individuais foi a repetição de procedimento no mesmo paciente e no mesmo dente (42,4%). Nas atividades coletivas, foi a não realização do programa coletivo de saúde bucal (68,9%). Houve um aumento da perda dos procedimentos individuais passando de menos de 5% no período de 2001 a 2007; para 5,8% em 2008; 8,9% em 2009 e 14,1% em 2010 e nos procedimentos coletivos a perda atingiu 4% em 2010. Conclusão - Conclui-se que a causa mais frequente de justificativa de glosas foi a de repetição de procedimento no mesmo paciente e no mesmo dente nos procedimentos individuais e a não realização do programa preventivo de saúde bucal nas atividades coletivas. É importante o Sistema de Auditoria como um instrumento confiável aos gestores no planejamento e avaliação das ações de saúde.

Objective - To collecting data about the main explanations for glosses and demonstrating the percentage of production loss in the odontologic procedures. Methods - It is about an epidemiological study of historical series, retrospective and quantitative, based on the data collection of DATASUS information system and reports realized by the city of Aquidauana/MS audit system from 2001 to 2010. Results - The results show that in this period, 921.300 odontologic procedures were presented as production; being 223.226 (24,2%) individual procedures and 698.074 (75,8%) collective. There were 23.881 (2,6%) glosses, being 10.158 (42,5%) in the collective procedures and 13.723 (57,5%) in the individual ones. The main cause for glosses related to individual procedures was the repetition of procedures for the same patient and the same tooth (42,4%). In the collective activities, it was the non-accomplishment of the oral health collective program (68,9%). There was an increase of loss in the individual procedures going from less than 5% in the period of 2001 to 2007; to 5,8 % in 2008; 8,9% in 2009 and14,1 % in 2010 and in the collective procedures the loss reached 4% in 2010. Conclusion - It was concluded that the most frequent cause of glosses explanation was the repetition of procedures for the same patient and the same tooth in the individual cases and the non-accomplishment of the oral health collective program in the collective activities. The importance of the audit system as a trust-worthy instrument for the managers in the planning and evaluation of health actions with the intention of guarantee the solution of the services provided.

O papel do auditor odontológico / The role of dental auditor

O aumento do número de profissionais dentistas, a maior concorrência por pacientes e a queda no desembolso direto geram respostas estratégicas dos profissionais no formato de empresas cooperativas ou na criação das sociedades civis de natureza empresarial. Com base em revisão de literatura, este estudo apresenta o papel do auditor odontológico como ator indispensável a todas as modalidades assistenciais, definindo suas características, seu perfil, áreas de atuação, interfaces e conflitos, tendo como eixo de análise a abordagem de sua atuação junto ao sistema de atenção à saúde. Concluiu-se que o Dentista Auditor desempenha importante papel em todo o processo de auditoria e que necessita ser permanentemente treinado e capacitado.

Two years audit of maxillofacial surgery department at Khyber college of dentistry, Peshawar

This study was conducted to identify the potential problems in the quality of care provided to the community in oral and maxillofacial unit of Khyber College of Dentistry. 2764 patients admitted in this unit from January 2006 to December 2007 were included in the study irrespective of age and gender. Detailed analysis of the data showed, 1842 patients were males while 922 were females [2:1]. Majority of the patients were from Peshawar Division [65.42%] with the peak in the first decade of life. Maxillofacial injuries comprised 1004 patients [36.32%], of which mandibular fractures were the most common [69.72%]. The overall morbidity rate was 1.74% [n=48]. Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry is the busiest center in Pakistan and the procedures performed on patients vary from simple extraction under general anesthesia to resection and reconstruction. This institute not only caters the entire N.W.F.P but also FATA and Afghanistan

Hepatitis - control in dental practice

Hepatitis infection is a silent epidemic. It has high morbidity and mortality in different countries. It is a public health problem in developing countries with limited resources and health budgets. The aim of this review paper is to revisit the hepatitis infection, its epidemiology, its modes of spread, diagnosis, prevention, especially in relation to Pakistan. Special emphasis is laid on hepatitis infection in the dental, and medical practices. The recommendations have been highlighted in the light of latest developments, understanding of hepatitis infection, treatment modalities and need of cost effective preventive regimens to control the infectious disease. The observance and practice of "Universal Precautions" for infection control has been emphasized. It is hoped that the paper will be of great help to health care professionals, those who are active in rendering their services to improve the quality of life of their patients. Further, it would be helpful to dental practitioners to protect themselves, their team and the patients in general, and may minimize the risk with better understanding of the public health problem

Audit of hepatitis b and c viruses in patients attending dental clinics

This study was carried out to audit hepatitis B and C viruses, detected in the department of pathology, on the patients who visited the dental clinics of Lahore Medical and Dental College, Lahore. This was a retrospective study conducted between March 2006 and January 2008. A total of 575 patients visited the clinic during this period, [250 males and 325 females], of these 80[13.91%] were positive for heaptitis B or C viruses. HCV was positive in 49 and HBV in 31 patients. Majority of infected patients were females i.e., 45 [7.8%]. Maximum number of patients were seen in the age groups between 50 and 60 years and 10-20 years respectively

Radiographic prevalence of root canal ramifications in a sample of root canal treatments in a Brazilian Dental School

The aim of this study was to radiographically investigate the presence of root canal ramifications found after endodontic treatment, and to determine any relationship between their presence and the type of the auxiliary chemical substance used. The study evaluated 1,470 endodontic treatments performed by final year undergraduate students at the Dental School of Piracicaba, State University of Campinas (UNICAMP), SP, Brazil, during the period from 1998 to 2000. The X-rays taken during treatment were evaluated in order to establish the presence of ramifications of the root canal system. The initial X-ray did not show the presence of any canal ramifications. After filling, X-rays showed only 3 ramification types: 3.06 percent of lateral canals, 2.99 percent of apical deltas, and 0.1 percent of interradicular canals. The maxillary premolars showed the highest number of lateral canals (n = 13), followed by mandibular premolars (n = 10) and maxillary incisors (n = 10). Apical deltas were mostly found in mandibular molars (n = 14), followed by maxillary incisors (n = 9). Only mandibular molars had interradicular canals. The detection of ramifications increased with the use of EDTA. However, no statistically significant relationship was found between the type of auxiliary chemical substance used and the number of root canal ramifications detected after root canal filling. It was concluded that the frequency of root canal ramifications found radiographically was low in treatments performed by undergraduate students.

O objetivo deste estudo foi investigar radiograficamente a presença de ramificações do canal radicular encontrada depois do tratamento endodôntico, e determinar qualquer relação entre a presença destas e do tipo de substância química auxiliar usada. O estudo avaliou 1.470 tratamentos endodônticos executados pelos estudantes do último ano da Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), SP, Brasil, no período de 1998 a 2000. Foram avaliadas as radiografias feitas durante o tratamento para verificar a presença das ramificações dos sistemas de canais radiculares. A radiografia inicial não mostrou a presença de qualquer ramificação. Depois da obturação as radiografias mostraram apenas 3 tipos de ramificação: 3,06 por cento de canais laterais, 2,99 por cento de deltas apicais e 0,1 por cento de canais interradiculares. Os pré-molares superiores mostraram o maior número de canais laterais (n = 13), seguidos pelos pré-molares inferiores (n = 10) e incisivos superiores (n = 10). Deltas apicais foram encontrados principalmente em molares inferiores (n = 14), seguidos por incisivos superiores (n = 9). Apenas molares inferiores apresentaram canais interradiculares. A detecção de ramificações aumentou com o uso do EDTA. Entretanto, nenhuma relação estatisticamente significante foi encontrada entre o tipo de substância química auxiliar usada e o número de ramificações visualizadas após a obturação dos canais radiculares. Foi concluído que a freqüência de ramificações do canal radicular encontrada radiograficamente é baixa em tratamentos executados por estudantes universitários.