Medical emergencies in the dental surgery. Part 1: Preparation of the office and basic management.

STATEMENT OF THE PROBLEM: Medical emergencies can and do happen in the dental surgery. In the 20- to 30-year practice lifetime of the typical dentist, he/she will encounter between five and seven emergency situations. Being prepared in advance of the emergency increases the likelihood of a successful outcome. PURPOSE OF THE PAPER: To prepare members of the dental office staff to be able to promptly recognize and efficiently manage those medical emergency situations that can occur in the dental office environment. MATERIALS AND METHODS: Preparation of the dental office to promptly recognize and efficiently manage medical emergencies is predicated on successful implementation of the following four steps: basic life support for ALL members of the dental office staff; creation of a dental office emergency team; activation of emergency medial services (EMS) when indicated; and basic emergency drugs and equipment. The basic emergency algorithm (P->C->A->B->D) is designed for implementation in all emergency situations. RESULTS AND CONCLUSIONS: Prompt implementation of the basic emergency management protocol can significantly increase the likelihood of a successful result when medical emergencies occur in the dental office environment.

The relationship between access to and use of dental services following expansion of a primary care service to embrace dental team training.

OBJECTIVES: To investigate changes in the patient population and treatment case-mix within an expanded primary care dental training facility in Southern England. STUDY DESIGN: Cross-sectional analysis of patient management system data. METHOD: Electronic data for patients with a closed/completed treatment plan in the 12-month period prior to, and following, dental service expansion were extracted for analysis (n = 4343). Descriptive analysis involved age, sex, payment status, deprivation status and treatment activity. Logistic regression was used to model the likelihood of treatment involving laboratory constructed devices (crowns, bridges, dentures), in relation to demography and deprivation in each time period. RESULTS: The volume of patients using the service increased by 48.3% (1749 cf 2594). The average age increased from 31.97 (95%CI: 30.8, 32.5) to 36.4 years (95%CI: 35.6, 37.1); greatest increase was in the over 75 years age-group (96%). The patient base became less deprived: patients exempt from payment reduced from 43.2% (n = 755) to 28.6% (n = 741) (P = 0.001) and the mean population deprivation score (IMD) reduced from 24.5 (95%CI: 23.8, 25.2) to 22.3 (95%CI: 21.7, 22.8). The volume and proportion of care involving laboratory constructed devices increased from 8.3% (n = 145) to 15.8% (n = 411) whilst assessments without interventive care decreased (34.5%-26.3%). On a logistic regression, the odds of having treatment involving laboratory constructed devices, increased with increasing age in both time periods 7% (95% CI: 1.06-1.08) and 6% (95% CI: 1.05-1.07) respectively. Furthermore, the odds increased by 38% OR: 1.38 (95% CI: 1.01-1.89) in period 2, for white patients. After adjusting for these effects, the odds of having care that involved laboratory constructed devices were less in period 2 than period 1 (100% cf 43%) for those who were technically exempt from payment (OR = 2.0; 95% CI 1.34 to 2.90 cf, OR = 1.43; 95% CI 1.13-1.81). CONCLUSION: The patient population altered in relation to age and socio-economic status. The expanded service had greater uptake by older people while users were less likely to be deprived. The expanded service, free at the point of delivery, attracted a higher proportion of patients who would normally have to pay health service charges. The service also showed an increase in treatment case-mix that involved laboratory constructed dental devices.

Training and the dental team--or how to get the best from your staff.

UNLABELLED: This article explores the benefits and methods of training in dental practice based on current accepted educational theories. CLINICAL RELEVANCE: Effective delivery of any service or clinical activity is dependent on having the right resources delivered at the right time, in the right place and in the right way. This can only happen if every person involved in the delivery knows what to do, when and how; this requires training.

A questionnaire study to derive information on the working environment, clinical training, use of ancillary staff and optimization of patient radiation dose within UK dental practice.

AIM: To evaluate the working environment of GDPs and Endodontists and the methods used to optimize patient radiation dose. METHODOLOGY: A total of 857 GDPs and 170 specialist Endodontists were contacted. The responders, 603 of the former and 132 of the latter, completed a questionnaire covering practitioner demographics, pattern of practice, the use of radiographic techniques and the optimization of dose. Chi-squared tests were used to compare groups at the P=0.05 level of significance. For nonparametric data, the Mann-Whitney U-test was employed. RESULTS: A response rate of 73% was achieved. Overall, 79.5% of endodontic specialists used film holders compared with 65.9% of GDPs (P=0.001). One hundred and thirty (98.5%) endodontists and 581 (96.3%) GDPs reported that they were well prepared or adequately prepared in radiographically assessing the presence of apical pathosis. The study found significant differences (P<0.001) between the use of digital radiography by specialist endodontists 93 (70.5%) compared with general dental practitioners 167 (27.7%). Significant differences (P=0.004) were also observed in the use of rectangular collimation between endodontic specialists 55 (42%) and GDPs 223 (37%). With regard to the use of film holders in diagnostic radiography, 105 (79.5%) of endodontic specialists employed these devices compared with 396 (65.7%) GDPs; this finding was significant (P=0.005). For working length estimation, significant differences (P=0.001) were noted in the use of a film holder between endodontic specialists 105 (79.5%) and GDPs 386 (64%). CONCLUSIONS: Both Endodontists and GDPs demonstrated compliance with guidelines relating to radiation protection being more significant amongst those clinicians working within specialist clinical practice.

Lonizing radiation regulations and the dental practitioner: 3. Quality assurance in dental radiography.

UNLABELLED: This is the last in a series of three articles on X-ray dose reduction and covers aspects of quality assurance. The first outlined radiation physics and protection and the second the legislation relating to radiation safety. CLINICAL RELEVANCE: Quality assurance is an essential part of dental radiography and is required to produce images of a consistently high standard, necessary for accurate diagnosis.

Domiciliary oral healthcare.

UNLABELLED: There is increasing demand for Domiciliary Oral Healthcare (DOHC) and the skills and equipment required to provide a quality, patient-centred service with careful assessment and management in a sometimes compromised situation. Commissioning of DOHC needs to be set in the context and current agenda of equality, diversity and human rights in both health and social care. Effective marketing and community engagement are required to promote awareness of how to access services amongst people confined to home and their families and carers. Training for the whole dental team should be available in order to address the concerns and problems encountered regarding the provision of DOHC. CLINICAL RELEVANCE: Members of the dental team should be aware of the skills required for DOHC and be familiar with using effective care pathways in relation to the provision of DOHC.

Induction of staff and team training.

Good training is vital for the safe and effective integration of a new team member. This training will be made easier if a deliberate, structured approach is taken, which takes due account of the need to safeguard their health, safety and welfare, from the moment they start.

Medical emergencies: are you prepared?

Billy Tyne sailed ill-equipped directly into a "perfect storm" at the cost of his boat, his crew, and his life. As a profession, we must not allow our own hubris to ignore the challenges that we are now facing: increasingly complex medical histories, more patients desiring sedation treatment, and more dentists expanding their scope of clinical services. Sadly, a nationally recognized set of guidelines has yet to be adopted. In the meantime, each member of the profession must be prepared to properly respond to any medical crisis that may occur in the dental office. The 6 links of survival provides a solid basis to meet that need.

Will your clinic be in compliance with the safe patient handling law by July 1, 2010?

Clinical settings have been added to the Minnesota Safe Patient Handling law. Even though previously dentists may not have considered manual assisting of patients to be a safety hazard, studies have clearly shown the risk for injury to staff and patients. By being the first state to address patient handling in clinics, Minnesota is acknowledging that patient movement can occur in all clinical settings and is demonstrating its desire to ensure staff safety at those previously overlooked facilities. SPH and the SPH law requirements may seem a bit foreign and confusing at first, but hopefully, by reading this article dentists and their staffs have gained the understanding and knowledge they will need to make sure each individual clinic meets the compliance deadline.

Impact of teleconsultations on the conduct of oral health teams in the Telehealth Brazil Networks Programme.

Telehealth has been applied in the Unified Health System (SUS) as a tool for qualifying professionals and improving the healthcare provided to the population served by the system. The aim of the present study was to evaluate the impact of teleconsultations on the qualifications of the clinical approach of the oral health teams involved in primary health care (PHC) in the state of Rio Grande do Sul under the Telehealth Brazil Networks Programme. The sample population of the study was composed of 285 dentists and 132 oral health assistants belonging to the Family Health Teams. A chi-square test was used to investigate possible associations between the absolute number of teleconsultations performed and several independent variables, namely, gender, age, dental specialty, time since graduation, time working in the Family Health Strategy (FHS), employment status, type of training institution, familiarity with information technology, and work satisfaction at the health facility. The level of significance was p < 0.05. Use of the oral health teleconsultation service led to a reduction of more than 45% in the number of referrals to other levels of care. However, no significant association was found between the number of teleconsultations and the independent variables analysed. The use of teleconsultations proved to be a powerful tool for professional training, for increasing the effectiveness of PHC, and for improving the oral healthcare provided.

Education for the dental team: make your practice a centre of learning excellence.

This paper discusses the future educational needs of the changing dental team, the potential for new institutions and teachers to deliver and assess that education, including outreach-based teaching and learning, and interchangeability of educational credits between institutions. The author's opinion is that primary care practices can become 'centres of learning' where all members of the dental team can interact to teach and learn together at the same time. The development of a career pathway for dental care professionals (DCPs), a more unified pan-Europe approach to integrated dental education and the development of further roles for senior dental students are proposed. The importance of dentistry acting upon sound, innovative concepts, and of not resisting educational change, is stressed.

The learning practice: 1. The learning practice concept.

UNLABELLED: This first article of two explores the concept, benefits and stages in developing a learning practice, which is applicable to all branches of dentistry. The second article will consider building a learning practice. CLINICAL RELEVANCE: Developing a learning practice will ultimately be of value to patients.