Treatment needs and skill mix workforce requirements for prosthodontic care: a comparison of estimates using normative and sociodental approaches.

BACKGROUND: The traditional measure for assessing dental treatment needs and workforce requirements based solely on normative need (NN) has major shortcomings. The sociodental approach (SDA) to assess needs overcomes some of the shortcomings as it combines normative and subjective needs assessments and also incorporates behavioural propensity (Sheiham and Tsakos 2007). The objective of this study was to estimate and compare prosthodontic treatment needs and workforce requirements, using the normative and the sociodental approaches for different skill mix models. METHODS: A cross-sectional study was conducted on 732 university employees aged 30-54 years. Normative prosthodontic need was assessed using the WHO (1997) method. The SDA includes NN and also considers oral impacts, measured through the OIDP index, and behavioural propensity. Estimates of prosthodontic need and dental workforce requirements using the two methods were compared using McNemar and Wilcoxon Signed Rank test respectively. The dental workforce required for prosthodontic treatment based on NN and SDA approaches were then compared using different workforce skill mix models. RESULTS: The proportion of subjects needing prosthodontic treatment was lower by more than 90% when the SDA was used compared to NN. The number of dentists required for prosthodontic treatment per 100,000 people were 98.8 using NN compared to 2.49 using SDA. Using a skill mix approach, the requirements for dentists per 100,000 people decreased slightly when more denture procedures were delegated to dental therapists. CONCLUSION: There were very much lower levels of prosthodontic treatment needs and workforce requirements when using the sociodental approach compared to normative methods.

Benefits of the simplified edentulous treatment (SET) method in communicating with the laboratory.

AIM: According to the literature, a high quality prosthetic rehabilitation consists of physical and psychological acceptance of the denture by the patient, an empathic relationship between the clinician and the patient and correct application of complete denture construction principles. To apply these principles correctly, it is important to establish excellent communication with the technician. Interactions between dentists and technical laboratories is typically characterised by minimal communication, which is considered to be the most significant problem for achieving a qualitatively elevated prosthetic manufacture. The aim of the simplified edentulous treatment (SET) method is to correctly transmit clinical data to the laboratory and maintain these data throughout the entire treatment period. METHODS: One hundred twenty-three completely edentulous, Caucasian patients (71 men and 52 women; medium age: 66 years; range 27 to 85 years) were recruited for this study. The inclusion criteria were total edentulism, both maxillary and mandibular, both in patients wearing and not wearing a complete denture. To complete the denture, the patients were entrusted to 65 teams of two students each, attending the fifth year of their degree course in dentistry and performing their first rehabilitation of an edentulous patient, under the supervision of six skilled tutors. The denture manufacturing was performed by 12 technical laboratories. RESULTS: In the rehabilitation of an edentulous patient, transmission of clinical data to the technical laboratory is effective and reliable. CONCLUSION: The data transfer block allows one to transfer all of the necessary information to the laboratory at one time.

Removable prosthodontic services, including implant-supported overdentures, provided by dentists and denturists.

The aim of this study was to evaluate the provision of removable prosthodontic services, including implant-supported overdentures, by dentists and denturists. A structured questionnaire was mailed to 474 randomly chosen dentists and 156 denturists registered to practise in New Zealand. Information was sought on the range of removable prosthodontic services provided (including implant-supported overdentures) and the professional fees charged for them. From 410 respondents, there was an overall response rate of 67.43%; 290 came from the dentists (males 78.6%, n = 228; females 21.48%, n = 62) and 120 from denturists (males 91.7%, n = 110; females 8.3%, n = 10). Most respondents were over 40 years of age, with one in three denturists (but only one in seven dentists) over 60 years of age. The extent of removable prosthodontic services varied. One-third of dentists referred complete denture patients and denturists referred a similar number of immediate denture cases. Denturists' complete denture, immediate denture and single reline prices were generally lower than those from dentists. Removable partial denture prices were similar. Implant-supported overdentures were recommended for edentulous patients by one-third of the dentists and three out of four denturists. Forty per cent of denturists (but only 10% of dentists) charged

Propuesta del curso optativo Protectores Bucales en el Deporte / Proposal of the optional course Mouth Guards in Sports

Introducción: La protección de las estructuras dentomaxilofaciales durante las actividades deportivas y el ejercicio físico se hace cada vez más necesaria, por lo que el Técnico Superior en Prótesis Estomatológica debe saber confeccionar protectores bucales y dominar el conocimiento en estos temas. Objetivo: Diseñar un curso optativo en primer año del Técnico Superior en Prótesis Estomatológica que contribuya a la formación de un profesional capaz de elaborar protectores bucales personalizados. Métodos: Se realizó un estudio cualitativo con carácter descriptivo. Se emplearon métodos del nivel teórico: (histórico-lógico, inductivo-deductivo, analítico-sintético, sistémico-estructural y la modelación) y empírico: (revisión documental, criterios de especialistas). Resultados: Se diseñó un curso optativo de 20 horas de duración, con carácter presencial y estructurado en tres temas. El curso optativo Protectores Bucales en el Deporte contribuye a potenciar actividades curriculares que tributen al desarrollo de una cultura para la protección bucodental. Conclusiones: El diseño del curso optativo se corresponde con las necesidades de aprendizaje de los Técnicos Superiores en Prótesis Estomatológica para confeccionar protectores bucales.

Introduction: The protection of the dentomaxillofacial structures during sports activities and physical exercise is increasingly necessary, so the Superior Technician in Stomatological Prosthesis must know how to make mouth guards, and develop knowledge on these topics. Objective: To design an optional course in the first year of the speciality Superior Technician in Stomatological Prosthesis that contributes to the training of a more qualified professional to make mouth guards. Methods: A qualitative descriptive study was carried out. Theoretical methods: (historical-logical, inductive-deductive, analytical-synthetic, systemic-structural and modeling), and empirical methods: (documentary review, specialist criteria) were used. Results: An optional face-to-face and structured in three topics course of 20 hours was designed. The optional course Mouth Guards in Sports contributes to promoting curricular activities which support the development of a culture on oral protection. Conclusions: The design of the optional course corresponds to the learning needs of the Superior Technician in Stomatological Prosthesis to make mouth guards.

[The registration of false teeth and the others].

The quality control of false teeth should include the control for designing and processing. The registration of false teeth should emphasize particularly on the qualification of the makers, technology management, quality control and the labeling.

Occupational exposure and health problems among Polish denturists: a population-based study in Lódz province.

OBJECTIVE: The aim of this study was to analyse the potential health effects of occupational exposure of denturists in the Lódz province. METHODS: The survey was performed among 103 denturists working in 24 dental laboratories in the Lódz province using the questionnaire prepared by the authors. RESULTS: The most common health problems associated with work (occurring daily or at least once a week) were: back pain (69.8%); chronic fatigue syndrome (61.6%); irritation, itching and rashes on the hands (51.2%); restlessness and aggression (43.0%); and watery and itchy eyes (41.9%). Psychosocial and ergonomic hazards associated with work organisation (72.2%) were the most common work environment factors related to the denturist profession. CONCLUSIONS: Analyses of denturists' occupational exposure in the Lódz province and epidemiological estimates of the health effects suggest the need for preventive measures.

Dental services in Quebec: issues and changes.

This paper describes the dental care delivery system in the province of Quebec (Canada) and shows that it has failed on two counts: the geographical maldistribution of dental manpower and the lack of development of preventive services. The paper discusses these issues in relation to recent changes which have occurred in the last decade, particularly the recognition of dental hygienists and denturists as legitimate providers of dental care in 1973 and the inception of Denticare in 1974.

The denturism initiative.

Denturism, an organized movement by dental laboratory technicians to increase their control over the provision of denture services to the public, has generated a great deal of controversy among members of organized dentistry, the National Denturist Association, the Federal Trade Commission, consumer groups, and prepaid dental plans.Denturism is currently legal in Arizona, Colorado, Maine, and Oregon. In the first three States, the denturist must practice under the supervision of a dentist, but in Oregon the denturist is able to enter independent practice.The American Dental Association has held that a denturist is educationally unqualified to provide denture services directly to the consumer, Representatives of organized dentistry have characterized denturists as untrained and unskilled persons who would endanger the public's health and return one phase of dentistry to the apprentice system. They see denturism as constituting a major step backward in health care delivery and having an adverse effect on preventive dental care.The National Denturist Association, however, defines a denturist as a highly skilled person who specializes in the making of full and partial dentures. Denturists maintain that the dentist is an unnecessary middleman in the provision of denture services and is the primary cause of the high cost of dental prostheses. They contend that State dental laws providing that only dentists may render denture services have led to the high cost of these services without contributing significantly to the health and safety of the public.Organized dentistry in the United States has been fighting denturism in a number of ways. One that has met with considerable success has been the establishment of programs to provide people access to dental care, especially denture services, at lower costs. A second alternative under consideration is to license denturists but require them to practice under the supervision of a dentist. A third alternative under discussion is to expand the duties of existing dental auxiliary personnel.The final decision on denturism, however, will not be made by the dental profession or the denturists, but by the voting public and their elected representatives, based on the evidence they have before them.

Determinants of AIDS preventive behaviour among dental professionals.

This study was conducted to assess concerns regarding AIDS and to identify determinants of poor preventive behaviour among dentists. Questionnaires were distributed to a random sample of 342 professionals. Respondents showed the lowest knowledge scores on topics dealing with symptoms, epidemiology and AIDS control. The predictors of poor AIDS knowledge were: more than ten years of practice and a strong belief to be professionally susceptible to HIV infection. Sterilization of high speed drills was disappointing; only 14.2% of dentists reported using heat sterilization. Predictors of poor preventive behaviour were: poor ability in clinical AIDS identification, more than ten years of practice and poor knowledge of AIDS prevention and control. Dental burs were the major cause of occupational injury. Professionals who recap needles are three times more likely to sustain needlesticks than those who do not. Our results suggest the need to increase AIDS knowledge and to improve compliance to infection control measures among dentists.

Utilization in Alberta's universal dental plan for the elderly, 1974-91.

Since 1973 the government of Alberta, a Canadian province of 2.4 million people, has funded a dental care plan for all residents over 64 years old and their dependents. It is the only dental plan in North America that covers all seniors and their dependents residing in a state or province. Under this plan, just over 270,000 persons (in 1990-91) are eligible for comprehensive, premium-free dental services provided by dentists and denturists in private practice on a fee-for-service basis. The plan's design, administration, utilization, and costs are reviewed. Utilization increased from 27 percent of eligibles using the plan in 1974-75 to 44 percent in 1990-91, and the mean number of services per user rose from 4.9 to 6.9 during the same time period. Although the cost per eligible person has increased about 200 percent, from Canadian (C) $42 to C $131, these costs only began to exceed the rate of inflation in 1986-87. Even though just 12 percent of the two main providers participating in the plan are denturists, nearly 22 percent of plan patients attended denturists rather than dentists for their complete dentures. Fees paid to dentists by the plan have decreased over time relative to the standard fees for the various services listed annually in the Alberta Dental Association fee guide. The apparent growth of direct additional billing by dentists of plan users to recover the difference between their usual fees and those paid by the plan and the effects of greater plan utilization are discussed, as are future potential difficulties in the plan's administration.

The Postgraduate Diploma in Clinical Dental Technology.

The Dental Act 1988 included requirements for the registration of clinical dental technicians, a new category of dental health worker. Despite the Act containing provision for a course of training in clinical dental technology, 11 years elapsed before the first candidates would graduate in this discipline. This paper describes the development and implementation of the new Postgraduate Diploma in Clinical Dental Technology, PGDipCDTech(Otago). Diplomates of the inaugural course in 1999 were the first students, other than students of dentistry, to obtain a clinical qualification from the School of Dentistry. Overall the course was very successful, but the provisions of the Dental Act inhibit flexible approaches to the teaching of clinical dental technology.

Quackery, fraud, and denturists.

Denturism is questionable dental practice, even in those few states where it is licensed. Incomplete or incompetent care is quackery. In the early 1980s a few states liberalized their laws to allow denturism to those who were educationally qualified. This experiment has generally failed because all accredited training programs have closed, because prices charged by denturists have about reached parity with dentists' fees, and because of limited demand for denturists' services. Because of the complexity of the message about scientifically-grounded oral health care and the populism of stories about the poor and underserved, dentists must be vigilant regarding their interactions with the media.

[Denturists and the Occupations in Individual Health Care Law]. / Tandprothetici in de Wet-BIG.

The legal position of denturists in the Netherlands will be discussed again in the near future. At the moment it is uncertain what the legal basis will be. It is important for denturists and other dental professionals to investigate the different possibilities in the legislation. Historical research and research of sources of law concerning the development of denturism learned that denturists have a lot of arguments to obtain a solid position in future legislation.

Dental prosthetist experience with oral mucosal screening and referral.

OBJECTIVES: This study aimed to investigate dental prosthetists' experiences with screening and referral for suspicious oral mucosal pathology. METHOD AND MATERIALS: Questionnaires regarding oral mucosal screening and referral were mailed to 300 randomly selected dental prosthetists in Australia for selfcompletion. Non-responders were sent replacement questionnaires up to three times, according to the Dillman method. RESULTS: A total of 179 prosthetists returned completed questionnaires resulting in a response rate of 64.9% after excluding 24 due to incorrectly listed addresses. Most participants reported that they checked all new patients for oral mucosal pathology (99.4%) and most reported that they checked all recall patients for mucosal pathology (86%). Most participants had detected a suspicious lesion (86%) and most had referred for a suspicious lesion (77.3%). CONCLUSION: Australian dental prosthetists appear motivated to perform oral mucosal screening and will refer suspicious oral mucosal pathology when detected.

Avaliação da estabilidade dimensional da silicona de condensação em diferentes tempos de vazamento em moldagens para prótese fixa / Evaluation of the dimensional stability of the condensation silico-ne in different leakage times in moldings for fixed prosthesis

Introdução: O envelhecimento da população aumenta a necessidade de reabilitação protética e o custo do atendimento odontológico. Para reabilitar com qualidade e baixo custo é necessário conhecer os materiais odontológicos desse processo, como os materiais de moldagem. O mais utilizado no Brasil é a silicona de condensação, que possui limitações. Porém, o fabricante modificou a fórmula com o intuito de melhorar a estabilidade dimensional. Objetivo: avaliar a estabilidade dimensional da silicona de condensação Speedex com a nova tecnologia DCP, em diferentes tempos de vazamento nas moldagens para prótese fixa. Material e métodos: Foi confeccionado um modelo padrão metálico com dois cilindros de mesmos diâmetros e mesma altura para simular uma prótese fixa. Foi elaborada uma moldeira metálica padronizada com retenções e guias de inserção. A partir dessa, outras quatro, em acrílico incolor, foram reproduzidas pelo alginato reversível. No total, foram realizadas 20 impressões, sendo 5 impressões por grupo. Os grupos foram vazados com o gesso tipo IV em diferentes tempos: grupo 1 (n=5): imediato; grupo 2 (n=5): 30 min; grupo 3 (n=5): 36h; grupo 4 (n=5): 72h. O modelo padrão e todos os modelos de gesso do grupo 1, 2, 3 e 4 foram medidos por dois pesquisadores de forma cega com auxílio de um paquímetro digital. Foram analisadas as distâncias externas e internas entre os pontos de referência dos cilindros. Os grupos foram comparados pelo teste t de Student, o nível de significância considerado foi p<0,05. Resultados: não se observou diferença estatística entre as medidas do pesquisador 1 e 2 (p>0,05). Não houveram diferenças entre os grupos 1 e 2 e 1 e 3; porém houve diferença significativa entre o 1 e 4. Conclusão: A silicona de condensação Speedex, não altera a estabilidade dimensional com o vazamento em até 36 horas.

Introduction: The aging of the population increases the need for prosthetic rehabilitation and the cost of dental care. To rehabilitate with quality and low cost is necessary to know the dental materials of this process, such as impression materials. The most used in Brazil is condensation silicon, which has limitations. However, the manufacturer modified the formula to improve dimensional stability. Objective: To evaluate the dimensional stability of Speedex condensation silicon with the new DCP technology at different casting times in fixed prosthesis moldings. Material and methods: A standard metal model with two cylinders of the same diameters and the same height was made to simulate a fixed prosthesis. A standard metal tray with drawers and insertion guides was developed. This metal tray was duplicated using reversible alginate. From this, four colorless acrylic trays were reproduced. In total, 20 impressions were made, with 5 impressions per group. The groups were cast with type IV gypsum at different times: group 1 (n=5): immediate; Group 2 (n=5): 30 min; group 3 (n=5): 36h; group 4 (n=5): 72h. The standard model and all gypsum models of groups 1, 2, 3 and 4 were measured by two researchers blindly using a digital caliper. The external and internal distances between the reference points of the cylinders were analyzed. The groups were compared by Student's t test, the significance level considered was p<0.05. Results: no statistically significant difference was found between researcher 1 and 2 by (p<0.05). There were no differences between groups 1 and 2 and 1 and 3; however, there was a significant difference between 1 and 4. Conclusion: Speedex condensing silicone does not change dimensional stability with leakage within 36 hours. Key-words: Dental Impression Materials, Dental Prosthesis, Silicone Elastomers. Submetido: 14/06/2019Aceito: 16/08/2019 Rebeca Vidal Capelupi1,2,Viviam Salvato de Souza1,2,Marcelo Tarcísio Martins1,Júlio Marcos Gouvêa Chagas1,Rogério Teodoro de Aquino3,Thalyta dos Reis Furlani Zouain-Ferreira1,Fabiana Aparecida Mayrink de Oliveira1,21Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Curso de Odontologia ­ Juiz de Fora, MG. 2Programa Institucional de Bolsas de Iniciação Científica (PIBIC) ­ FCMS/JF 2018.2 3Usinagem Mecânica Industrial, SENAI, Juiz de Fora, MG. Avaliação da estabilidade dimensional da silicona de condensação em diferentes tempos de vazamento em moldagens para prótese fixaEvaluation of the dimensional stability of the condensation silico-ne in different leakage times in moldings for fixed prosthesis * Fabiana de OliveiraAvenida Barão do Rio Branco, 1871/1105, CentroJuiz de Fora ­ MG CEP: 36013-020 8 fabsmay@hotmail.com

Osteotomia segmentar posterior da maxila para reabilitação protética: caso clínico / Posterior maxillary segmental osteotomy for prosthetic rehabilitation: clinical case

O edentulismo pode causar a extrusão do processo alveolar, especialmente em pacientes que não utilizam nenhum tipo de prótese no arco antagonista. Uma opção de tratamento bastante viável e rápida é a cirurgia de impacção do segmento dentoalveolar posterior por meio de osteotomia alveolar. O objetivo é descrever a técnica cirúrgica de impacção de bloco alveolar por meio de um relato de caso clínico. Paciente sexo feminino, 36 anos, faioderma procurou atendimento para reabilitação com prótese sobre implante. Ao exame, notou-se a ausência de diversas unidades dentárias, bem como extrusão do bloco alveolar superior do lado direito e mesialização dos dentes da região fechando o espaço dos pré-molares. Foi planejada a realização de cirurgia de impacção da região posterior de maxila do lado direito, a fim de criar espaço para reabilitação com implantes osseointegráveis e, consequentemente, permitir também abertura de espaço para colocação de um pré-molar no 1o quadrante. A cirurgia de osteotomia alveolar para impacção do bloco posterior de maxila é um procedimento cirúrgico comum da prática do cirurgião bucomaxilofacial, que permite restabelecer a distância entre os arcos, possibilitando, assim, a reabilitação protética... (AU)

Edentulism can result the extrusion of the alveolar process, especially in patients who do not use any type of prosthesis in the antagonist arch. A very feasible and rapid treatment option is the surgery of impaction of the posterior dentoalveolar segment by means of alveolar osteotomy. The objective is describe the surgical technique of alveolar block. Female patient, age 36, light-skinned black, sought dental care for oral. The examination revealed the absence of several dental units as well as extrusion of the upper alveolar block of the right side and mesialization of the teeth of the region closing the space of premolars. It was proposed the impaction surgery of the posterior maxillary region on the right side to create space for placement of osteointegrated implants and, consequently, when performing the block correction, it also allows opening of space for placement of a pre molar in the 1st quadrant. Alveolar osteotomy surgery for impaction of the posterior maxilla block is a common surgical procedure of the bucomaxillofacial surgeon practice that allows restoring the distance between the arches; thus enabling prosthetic rehabilitation... (AU)