COVID-19: ¿una oportunidad para la toma de conciencia sobre el cuidado integral del odontólogo? / COVID-19: An opportunity to raise awareness about dentists' holistic wellbeing?

La pandemia de COVID-19 generó en la comunidad odon- tológica argentina un profundo desconcierto e incertidumbre frente a su práctica profesional, su economía y su cuidado. Mediante un cuestionario difundido a través de redes so- ciales en octubre de 2020, se formularon preguntas vinculadas al ejercicio profesional en ese contexto y otras en las que se incluyeron variables referidas a signos de ansiedad, depresión y resiliencia. Los odontólogos presentaron signos de estrés, ansiedad, tensión emocional, dificultad para conciliar el sueño, senti- mientos de culpa y sensación de soledad. Manifestaron casi en su totalidad que su esfuerzo y el cuidado de su persona frente a este nuevo paradigma no son valorados por el sistema de salud y que se evidencia en la escasa retribución que perciben por sus prestaciones. Las conclusiones tienen el mandato del cambio pues los datos arrojados por la encuesta y el sentir manifestado con vehemencia y desolación ponen sobre la mesa la necesidad de iniciar una nueva etapa (AU)

The COVID-19 pandemic created a profound state of be- wilderment and uncertainty among dentists regarding their professional practice, economy and personal care. An online survey posted on social media in October 2020 asked ques- tions about professional practice in this context and other variables such as signs of anxiety, depression and resilience. Dentists reported signs of stress, anxiety, emotional tension, difficulty to get to sleep, and feelings of guilt and loneliness. Most of them felt that the efforts they made to do their job and ensure their personal care in this new paradigm were not valued by the healthcare system, as reflected by the low compensation for their services. From the data obtained through the survey and the feelings of vehemence and grief expressed by respondents, it is concluded there is a need for action and change (AU)

Dentistry at the crossroads.

The dental practice pattern is shifting from small dental office to large corporate dental groups. This article analyzes the powers behind this change, and discusses the choices dental practitioners are facing and the reasons why many may choose to work in a corporate practice setting. Dental associations and specialty groups need to reaffirm their mission to provide quality oral health care. Dental treatment should not be viewed as a commodity used to measure corporate profitability.

Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation.

Oral mucositis (OM) is one of the side effects of hematopoietic stem cell transplantation (HSCT), resulting in major morbidity. The aim of this study was to determine the cost-effectiveness of the introduction of a specialized oral care program including laser therapy in the care of patients receiving HSCT with regard to morbidity associated with OM. Clinical information was gathered on 167 patients undergoing HSCT and divided according to the presence (n = 91) or absence (n = 76) of laser therapy and oral care. Cost analysis included daily hospital fees, parenteral nutrition (PN) and prescription of opioids. It was observed that the group without laser therapy (group II) showed a higher frequency of severe degrees of OM (relative risk = 16.8, 95% confidence interval -5.8 to 48.9, p < 0.001), with a significant association between this severity and the use of PN (p = 0.001), prescription of opioids (p < 0.001), pain in the oral cavity (p = 0.003) and fever > 37.8°C (p = 0.005). Hospitalization costs in this group were up to 30% higher. The introduction of oral care by a multidisciplinary staff including laser therapy helps reduce morbidity resulting from OM and, consequently, helps minimize hospitalization costs associated with HSCT, even considering therapy costs.

Impact of educational intervention on implementation of tobacco counselling among oral health professionals: a cluster-randomized community trial.

OBJECTIVES: Tobacco use adversely affects oral health. Clinical guidelines recommend that oral health professionals promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented successfully. This study aimed to evaluate two interventions to enhance tobacco use prevention and cessation (TUPAC) counselling among oral health professionals in Finland. METHODS: We used a cluster-randomized community trial to test educational and fee-for-service interventions in enhancing TUPAC counselling among a sample of dentists (n=73) and dental hygienists (n=22) in Finland. Educational intervention consisted of 1 day of training, including lectures, interactive sessions, multimedia demonstrations and a role play session with standard patient cases. Fee-for-service intervention consisted of monetary compensation for providing tobacco use prevention or cessation counselling. TUPAC counselling procedures provided were reported and measured using an electronic dental records system. In data analysis, intent-to-treat principles were followed at both individual and cluster levels. Descriptive analysis included chi-square and t-tests. A general linear model for repeated measures was used to compare the outcome measures by intervention group. RESULTS: Of 95 providers, 73 participated (76.8%). In preventive counselling, there was no statistically significant time effect or group-by-time interaction. In cessation counselling, statistically significant group-by-time interaction was found after a 6-month follow-up (F=2.31; P=0.007), indicating that counselling activity increased significantly in intervention groups. On average, dental hygienists showed greater activity in tobacco prevention (F=12.13; P=0.001) and cessation counselling (F=30.19; P<0.001) than did dentists. In addition, cessation counselling showed a statistically significant provider-by-group-by-time interaction (F=5.95; P<0.001), indicating that interventions to enhance cessation counselling were more effective among dental hygienists. CONCLUSIONS: Educational intervention yielded positive short-term effects on cessation counselling, but not on preventive counselling. Adding a fee-for-service to education failed to significantly improve TUPAC counselling performance. Other approaches than monetary incentives may be needed to enhance the effectiveness of educational intervention. Further studies with focus on how to achieve long-term changes in TUPAC counselling activity among oral health professionals are needed.

Reimbursing dentists for smoking cessation treatment: views from dental insurers.

INTRODUCTION: Screening and delivery of evidence-based interventions by dentists is an effective way to reduce tobacco use. However, dental visits remain an underutilized opportunity for the treatment of tobacco dependence. This is, in part, because the current reimbursement structure does not support expansion of dental providers' role in this arena. The purpose of this study was to interview dental insurers to assess attitudes toward tobacco use treatment in dental practice, pros and cons of offering dental provider reimbursement, and barriers to instituting a tobacco use treatment-related payment policy for dental providers. METHODS: Semi-structured interviews were conducted with 11 dental insurance company executives. Participants were identified using a targeted sampling method and represented viewpoints from a significant share of companies within the dental insurance industry. RESULTS: All insurers believed that screening and intervention for tobacco use was an appropriate part of routine care during a dental visit. Several indicated a need for more evidence of clinical and cost-effectiveness before reimbursement for these services could be actualized. Lack of purchaser demand, questionable returns on investment, and segregation of the medical and dental insurance markets were cited as additional barriers to coverage. CONCLUSIONS: Dissemination of findings on efficacy and additional research on financial returns could help to promote uptake of coverage by insurers. Wider issues of integration between dental and medical care and payment systems must be addressed in order to expand opportunities for preventive services in dental care settings.

Community-based dental education and community clinic finances.

To develop a long-term, sustainable partnership with dental schools, federally qualified health centers (FQHCs) need to assess the financial impact of dental students on their financial operations. Primary concerns are that students will not cover their marginal costs and will reduce the productivity of clinic dentists. This study uses data from Asian Health Services, an FQHC in Oakland, California, to examine revenues generated by senior dental students and by FQHC dentists when students are and are not present. The analysis of ten months of electronic record data showed that two full-time equivalent students generated $420,549 in gross revenues and reduced dentist output by only $29,000. While the results are from just one FQHC, they strongly suggest that students make a significant contribution to clinic productivity and finances.

Measurement of attitudes of U.K. dental practitioners to core job constructs.

OBJECTIVES: To develop a measure to identify dental practitioner attitudes towards core job dimensions relating to job satisfaction and motivation and to test this against practice characteristics and provider attributes of U.K. practitioners. RESEARCH DESIGN: an 83-item questionnaire was developed from open-ended interviews with practitioners and use of items in previously used dentist job satisfaction questionnaires. This was subsequently sent to 684 practitioners. Item analysis reduced the item pool to 40 items and factor analysis (PCA) was undertaken. RESULTS: 440 (64%) dentists responded. Factor analysis resulted in six factors being identified as distinguishable job dimensions, overall Cronbach's alpha = 0.88. The factors were: 'restriction in being able to provide quality care (F1)', 'respect from being a dentist (F2)', 'control of work (F3)', 'running a practice (F4)', 'clinical skills (F5)', and 'caring for patients (F6)'. All six factors were correlated with a global job satisfaction score, although F1 was most strongly related (r = 0.60). Regression model analysis revealed that 'whether the dentist worked within the National Health Service or wholly or partly in the private sector' (p < 0.001), 'time since qualification' (p = 0.009), and the position of the dentist within the practice (whether a practice owner or associate dentist), (p = 0.047) were predictive of this factor. CONCLUSIONS: Six core job constructs of U.K. practitioners have been identified, together with several practice characteristics and practitioner attributes which predict these factors. The study demonstrates the importance of refining measures of dentists' job satisfaction to take account of the culture and the system in which the practitioner works.

[25 years of INAMI data in dentistry]. / 25 années de données INAMI en Médecine Dentaire.

The author presents 25 years of social security data about expenses and the number of medical acts in dentistry using lists and diagrams. By relating these expenses per year to the number of dentists per year, the average expenses per dentist are compared to the evolution of the index of consumption. In the same manner the average number of medical acts per dentist are calculated. By this method the author emphasizes the changes in average dental practice profile over 25 years.

The dash for dentures: the turbulent introduction of NHS dentistry.

With the formal launch of the National Health Service on the evening of Sunday, July 4, 1948, the pattern of dental treatment in Britain changed dramatically. This change altered the lives of everyone connected with the provision of this treatment and, for dentists in particular, working life would never be the same again. But how did they come about?