Prevalence and factors associated with suicide among medical professionals in low/middle-income countries: a systematic review protocol.

INTRODUCTION: A number of studies in low/middle-income countries (LMICs) have reported varying prevalence of suicide among medical professionals with low rates. This may be because of the methods used in suicide assessment and the stigma associated with it. For this study, the prevalence of suicidal ideation, attempt and completed suicide, as well as the factors associated with suicidality and methods used during suicidal acts, will be documented. METHODS AND ANALYSIS: Studies published in peer-reviewed journals in which the prevalence and factors associated with suicidal ideation, attempt and completion among medical professionals in LMICs will be included. The Cochrane Library (CENTRAL), PsychINFO, PubMed and Embase will be systematically searched. We will search for all the papers available in the databases up to March 31 2019. Methodological quality of the articles will be assessed using the quality in prognostic studies tool. The risk of bias of the articles will be assessed using Cochrane risk of bias assessment tool for non-randomised studies. In the event of no statistical heterogeneity, a meta-analysis of the findings will be conducted. ETHICS AND DISSEMINATION: Ethical permission will not be required since this work does not involve the use of participant data that can be used to identify individuals. Findings from this study will be available for clinicians and other medical professionals, scientists and policy makers. On request, a data set of the study can be provided. TRIAL REGISTRATION NUMBER: CRD42018095990.

Diagnostic Pathway of Oral Cavity Cancer in an Integrated Health Care System.

CONTEXT: Survival for patients with oral cavity squamous cell carcinoma (OCSCC) has remained relatively stagnant despite advances in treatment. Few studies have examined why advanced-stage disease is diagnosed in 40% of patients with OCSCC nationally. OBJECTIVE: To characterize the diagnostic pathway of OCSCC in an integrated health care system. DESIGN: Retrospective study of patients with OCSCC (2007-2010). MAIN OUTCOME MEASURES: Referral patterns and demographic, clinical, and tumor characteristics associated with time to diagnosis (diagnostic interval). RESULTS: Of 247 patients, 167 (68%) had early-stage (I/II) disease, 86 (35%) were referred by dentists, and 70 (28%) had a history of premalignancy. The median time (interquartile range) from symptom onset to care sought from a primary care physician (patient interval), from primary care physician to otolaryngologist, and from otolaryngologist to diagnosis was 8.6 (4.0-25.8), 1.0 (0.6-3.1), 0.0 (0.0-3.0) weeks, respectively. These intervals did not differ by demographic characteristics, clinical factors, or tumor stage. Prolonged diagnostic intervals were observed among patients with premalignant lesions. CONCLUSION: The patient interval was the largest component of the total diagnostic interval. The subsequent professional workup proceeded relatively efficiently. Prolonged diagnostic interval in patients with premalignant lesions may reflect the natural history of malignant transformation rather than a delay in diagnosis. However, nearly one-fourth of these cases were diagnosed at an advanced stage; closer surveillance may represent an opportunity for diagnosis at an earlier stage. Surveillance for premalignant lesions and facilitating referrals from dentists may expedite the diagnosis and treatment of OCSCC. Further investigation is warranted.

The healthcare system and the provision of oral healthcare in European Union member states. Part 9: Sweden.

Equally accessible and affordable dental services for all population groups have been a political goal in Sweden for almost a century. All political parties have shared the idea that a person's social background should not have consequences for his or her dental status. Strategic tools to achieve this ambitious goal have been the wide use of publicly provided oral healthcare services, covering even sparsely populated areas, focusing on preventive care and significant subsidies for necessary treatments. Besides free care for children and young adults, oral healthcare is reimbursed from public funds. The public subsidy was particularly generous in 1975-1999 when a 'full clearance' of adults' dentitions was undertaken both by the public and private providers under fixed prices and high reimbursement levels for all treatment measures. Today, preventive oral healthcare for the elderly is given higher priority as most Swedes have been able to keep their natural teeth.

Development and evaluation of the Jönköping Dental Fear Coping Model: a health professional perspective.

OBJECTIVE: The purpose of this study was to design a structured treatment model focusing on all levels of adult's dental fear, the Jönköping Dental Fear Coping Model (DFCM). The aim was to study the DFCM from a dental health professional perspective. MATERIAL AND METHODS: The DFCM was studied by means of quantitative and qualitative analyses. Nine dental clinics participated in Period I (pre-intervention/standard care), and 133 dental health professionals (dentists, dental hygienists, dental assistants) and 3088 patients were included. After completion of Period I, four of the clinics were randomized to Period II (intervention), beginning with the professionals undergoing DFCM training. Following that, 51 dental health professionals treated 1417 patients according to the DFCM. The other five clinics served as controls. RESULTS: Half or more of the dental health professionals assessed the model as better than standard care, regarding anamnesis and diagnostics, communication and contact, and understanding of patients and dental fear. The dental health professionals reported higher tension in their fearful patients in Period II compared with Period I, possibly due to their increased awareness of dental fear. CONCLUSIONS: The qualitative data suggest that dental health professionals find the DFCM beneficial in routine dental care. The model promotes a holistic approach to the treatment of adult patients. However, stress among the professionals was not reduced when measured, neither quantitatively nor qualitatively. It is important to evaluate the model in further studies to make it possible to draw generalizable conclusions.

Prescribing patterns of analgesics and other medicines by dental practitioners in Australia from 2001 to 2012.

OBJECTIVES: Dental practitioners are able to prescribe a variety of medicines subsidized on the Pharmaceutical Benefits Schedule (PBS), the main categories of which are analgesics and antibiotics. We aimed to investigate the patterns of PBS prescribing of non-antimicrobial medicines by dental practitioners in Australia from 2001 to 2012. METHODS: Data were collected from Medicare Australia on prescriptions from dental practitioners dispensed to concessional beneficiaries between 2001 and 2012. We examined patterns of use over time. RESULTS: There was an overall increase in number of prescriptions and in dispensed use (standardized by dose and population) of analgesic medicines for the concessional population over the 12-years period. The use of dentally prescribed analgesics increased 15%, with use of nonsteroidal anti-inflammatory drugs increasing by 41% and opioid analgesics by 12%. Prescribing of the oxycodone 5-mg tablet increased 344% between 2005 and 2012, and dental prescription of the benzodiazepines diazepam and temazepam increased by 51% and 229%, respectively, over the observation period. Injectable corticosteroid use increased by 19%. Conversely, use of carbamazepine and anti-emetics decreased by 39% and 10%, respectively. CONCLUSIONS: Dental prescribing of analgesics, anti-inflammatories and benzodiazepines in the concessional population has increased significantly over the past decade. These data can form the baseline to further examine appropriate medicine use in the management of dental conditions.

Usage of complementary and alternative medicine: A survey among Indian dental professionals.

OBJECTIVE: CAM therapies are used along with standard medical care. Though there are various medical evidences to prove the effectiveness of CAM therapies in managing medical problems, the evidence for the dental application are still lacking in India. This could be attributed to the non-availability or the insufficient knowledge regarding the use of CAM in dentistry. Hence it is necessary to obtain the baseline knowledge regarding the use of CAM therapies among dentists. METHOD: Cross sectional questionnaire based survey. RESULTS: There were mixed attitudes towards CAM approaches in dental practices. Lack of clinical knowledge and exposure during their graduation and inadequate scientific evidence can be attributed to their hesitation in practicing the CAM. CONCLUSION: Though interested, dental practitioners were still cautious in putting CAM into clinical practice. Only very few dentist used CAM therapies and they limited their use to topical application for oral problems.

Musculoskeletal Pain Management Among Dentists: An Alternative Approach.

Musculoskeletal disorders (MSDs) are one of the most important occupational health issues in health care workers. Musculoskeletal pain is an occupational health problem for dental professionals, particularly dentists. Complementary and alternative medicine (CAM) can be helpful in managing and preventing these MSDs. The purpose of this study was to determine the prevalence of MSDs among dentists residing in east India and the use of CAM therapies for the management of MSDs among dentists. Dentists (N = 1082) residing in east India, registered under the Dental Council of India, were surveyed. A questionnaire comprising demographic profile, questions related to MSD among dentists, use of CAM therapies for MSD management, source of CAM information. Data analysis was done using SPSS (version 17), and data were presented in tabular and graphic forms. Univariate and bivariate analyses were done, with P < .05 considered as significant. A response rate of 81% (n = 877) was obtained, revealing that 71% (n = 623) of dentists suffered from MSD. The use of CAM was reported among 83% (n = 517) and conventional therapy among 15% (n = 94) of dentists, and 2% (n = 12) of dentists with MSD do not use any type of treatment modality. Complementary and alternative medicine represents a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional medicine. CAM therapies have improved quality of life and have given a new meaning to it, especially to dentists who suffer from MSD.

Use of complementary and alternative medicine for work related musculoskeletal disorders associated with job contentment in dental professionals: Indian outlook.

BACKGROUND: High prevalence rates of work-related musculoskeletal disorders (WRMSD) among dentists have been reported. Complementary and alternative medicine (CAM) therapies can be helpful in managing and preventing work-related musculoskeletal disorders. The purpose of this study was to determine if dental professionals are using CAM for work-related musculoskeletal disorders. Who have greater job satisfaction: dentist who uses Complementary and alternative medicine (CAM) or conventional therapy (CT) as a treatment modality for WRMSD. METHOD: Dentists who registered in Uttar Pradesh state, India under Indian Dental Council, Uttar Pradesh branch (n=1134) were surveyed. Data were analyzed using univariate and bivariate analyses and logistic regression. RESULT: A response rate of 53% (n=601) was obtained, revealing that 82% (n=487) of the respondents suffered from work-related musculoskeletal disorders. The use of complementary and alternative medicine or conventional therapy was reported among 80% (n=390) of the dentists with work-related musculoskeletal disorders. Complementary and alternative medicine users reported greater overall health compared to conventional therapy users (P<0.001). Of those with work-related musculoskeletal disorders, 35.5% (n=172) considered a career change for once, and 4.0% (n=19) reported having left dentistry. CONCLUSION: Complementary and alternative medicine therapies may improve quality of life, reduce work disruptions and enhance job satisfaction for dentists who suffer from work-related musculoskeletal disorders. It is important that dentists incorporate complementary and alternative medicine strategies into practice to facilitate musculoskeletal health that will enable longer and healthier careers, increase productivity, provide safer workplace and prevent musculoskeletal disorders.

What motivates professionals to learn and use hypnosis in clinical practice?

The authors devised and validated a questionnaire assessing the various possible motivations for learning and using hypnosis and administered it to 125 Israeli psychologists, physicians, and dentists who study and/or use hypnosis in their clinical work. The results suggest that most professionals were motivated by a desire to improve their professional performance and that a majority of professionals were primarily influenced in their desire to learn hypnosis by colleagues in academically or clinically oriented settings.

Habilitação e uso das práticas integrativas e complementares na odontologia / Habilitation and use of complementary and integrative practices in dentistry

Resumo: A Resolução CFO-82/2008 divulgada em 1º de Outubro de 2008 baixou normas para habilitação de Cirurgiões-Dentistas (CD) nas Práticas Integrativas e Complementares (PIC) no Brasil. Os objetivos do trabalho foram: identificar e analisar as evidências científicas disponíveis no campo das PIC na odontologia, bem como conhecer as motivações que desencadearam a busca de CD pela habilitação em PIC. Os resultados da pesquisa encontram-se disponibilizados nesta tese em oito capítulos (artigos). Os três primeiros capítulos abordam revisões sistemáticas que contemplem dimensões além de parâmetros clínicos e as evidências do uso clínico das PIC em saúde bucal. No quarto capítulo são abordadas as percepções de estudantes do curso de odontologia sobre a incorporação do ensino das PIC durante o período de graduação. O quinto e o sexto capítulo apresentam os resultados de duas revisões sistemáticas da literatura referentes à captação de dados qualitativos por meio de entrevistas telefônicas e por meio de outros tipos de entrevistas conduzidas à distância. No sétimo capitulo, apresenta-se a distribuição geográfica dos CD habilitados em 2009 para o exercício das PIC no Brasil. O oitavo e último capítulo consiste de um estudo qualitativo sobe as motivações que desencadearam a busca dos CD pela habilitação em PIC. Com o desenvolvimento da pesquisa foi possível: a) expor à comunidade científica uma proposta de metodologia que extrapola a compilação de dados clínicos e quantitativos, que não alcançam informações além das intervenções e desfechos clínicos (capítulo 1); b) identificar que a literatura analisada revelou maior volume de publicação de estudos sobre laserterapia odontológica e que embora existam evidências positivas do uso das PIC na odontologia, os artigos avaliados apresentaram limitações referentes à qualidade e consistência de seus resultados (capítulo 2); c) identificar o predomínio de evidências positivas decorrentes do uso das PIC em diferentes contextos de saúde bucal (capítulo 3); d) identificar que os estudantes de odontologia, nas instituições pesquisadas, consideram importante a incorporação do ensino das PIC durante o curso de graduação (capítulo 4); e) verificar que os artigos analisados apresentam superficialmente o modo como as entrevistas telefônicas (ET) foram planejadas e conduzidas sendo que o baixo custo e a necessidade de pequena infra-estrutura foram às principais justificativas para a opção da utilização das ET na coleta de dados qualitativos (capítulo 5); f) verificar que o assunto mais estudado foi à comparação de ED com outras técnicas de coleta de dados seguido de estudos sobre a viabilidade das ED e de estudos avaliativos de instrumentos para captação de dados por telefone (capítulo 6); g) verificar a existência da concentração de profissionais habilitados no Estado de São Paulo, identificar que a maioria desses pertence ao sexo feminino e que possui habilitação em Laserterpia (capítulo 7); h) identificar que a principal motivação para a busca das habilitações em PIC aplicadas a saúde bucal foi à curiosidade despertada por diferentes estímulos, sobretudo aqueles compreendidos nas demandas pessoais e profissionais (capítulo 8).(AU)

Abstract: The Resolution CFO-82/2008 released on 1 October 2008 lowered standards for habilitation of Dental Surgeons (DS) in Complementary and Integrative Practices (CIP) in Brazil. The aim of this study were to identify and analyze the available scientific evidence in the field of CIP in dentistry, as well as knowing the motivations of CD that led to the search for vetting in PIC. The research results were available in this thesis in eight chapters (articles). The first three chapters cover the elaboration process of systematic reviews that include dimensions beyond of clinical parameters and of clinical evidence of the use of CIP in buccal health. The fourth chapter deals with the perceptions of students of dentistry about the incorporation of the teaching of CIP during graduation. The fifth and sixth chapter presents the results of two systematic reviews of the literature concerning the capture of qualitative data through telephone interviews and through other types of interviews conducted at a distance. The seventh chapter presents the geographical distribution of DS habilitated in 2009 to exercise the CIP in Brazil. The eighth and final chapter consists of a qualitative study about the motivations of DS to get its habilitation in CIP. With the development of research was possible: a) expose to the scientific community a proposed methodology that goes beyond the compilation of clinical data and quantitative information that does not reach beyond the interventions and clinical outcomes (Chapter 1); b) identify that literature analyzed revealed higher number of published studies on dental laser therapy furthermore there is positive evidence of the use of CIP in dentistry, but the articles evaluated showed limitations regarding the quality and consistency of their results (Chapter 2); c) identify the prevalence of positive evidence from the use of CIP in different contexts of oral health (Chapter 3); d) identify that dental students in the institutions studied, considers important the incorporation of the teaching of the CIP during the undergraduate course (Chapter 4); e) verify that the analyzed articles presents superficially how the telephone interviews (TI) were planned and conducted thus the low cost and the need for small infrastructure were the main reasons for the choice of the use of TI in qualitative data collection (Chapter 5); f) verify that the most studied subject was the comparation of distance interviews (DI) with other techniques of data collection, followed by studies on the feasibility of DI and evaluative studies of instruments for data collection by phone (Chapter 6); g) verify the existence of the concentration of professionals in the State of Sao Paulo, identify the most of DS are female and has habilitation in Dental Laser therapy (Chapter 7); h) identify that the main motivation for the pursuit of habilitations in CIP applied to buccal health was curiosity aroused by different stimuli, especially those included in the personal and professional demands (Chapter 8).(AU)

Status of the dental health care workforce in Shanghai, China.

OBJECTIVES: The status of the dental health care workforce in Shanghai was investigated in order to support and improve regional planning of this workforce. METHODS: Questionnaires were used to survey all dental medical units in Shanghai. Data were collected on the quantity, structure and levels of dental health personnel. RESULTS: A total of 852 dental medical units and 3,218 dentists were identified in Shanghai. The ratio of dentists to population is 1 : 5,201. CONCLUSIONS: Presently, the total dental health workforce in Shanghai is relatively sufficient, but its distribution is inequitable because there are fewer dental health personnel employed in the suburbs. Moreover, the structure of the dental health workforce in Shanghai is inequitable and specialists in preventive dentistry are lacking. The results of this study can be applied to help Shanghai achieve the rational distribution and efficient utilisation of the dental health workforce available.

Comparing the treatment provided by UK and non-UK trained health professionals: dentists in Scotland.

OBJECTIVES: To examine differences in the amount of treatment provided by UK and non-UK trained dentists in the Scottish National Health Service. METHODS: Using a unique administrative data set, we utilize multivariate fixed effects regression models that control for patient characteristics and unobserved heterogeneity across dentists to explore the extent of treatment delivered. RESULTS: Non-UK trained dentists initially provide more treatment than UK-trained dentists, but over approximately two years of practice their treatment converge. CONCLUSIONS: As with many OECD countries, the UK relies on foreign-trained health professionals to address workforce shortages and one concern is whether they provide equivalent health care to their domestically trained counterparts. Whilst there is a difference in the amount of treatment provided by UK and non-UK trained dentists, the effect is modest and transitory.

Dentists’ knowledge about anaphylaxis caused by local anaesthetics

Background: IgE-mediated systemic reactions to local anaesthetics may be seen- althoughrarely- by dentists. However, it is not known whether dentists are familiar with symptoms,signs and management of anaphylaxis.Methods: In this study we aimed to evaluate knowledge of dentists of the symptoms and signsand current treatment of anaphylaxis. For this, some dentists working in their private officesin Istanbul were asked to complete an anonymous questionnaire with 15 questions related toanaphylaxis.Results: A total of 86 dentists agreed to participate in the study. None of the attendants werecompletely aware of the symptoms and signs of anaphylaxis. About half of the attendants(48.8%) knew epinephrine as the first drug in the treatment of anaphylaxis and keep it in theiroffices (55.6%), but only one third of the dentists (31.5%) preferred intramuscular route as themost effective route for epinephrine injection.Conclusion: Our data show that the level of dentists’ knowledge of local anaesthetics allergyand anaphylaxis is inadequate. This may endanger patients’ lives. An educational programmethat may improve general dentists’ knowledge about local anaesthetics allergy and anaphylaxisis urgently necessary(AU)

A multilevel analysis of factors affecting the difference in dental patients' and caregivers' evaluation of oral quality of life.

In a previous study, we observed that the concordance between patients' and caregivers' evaluation of oral health-related quality of life (OHRQoL) was low. The aim of this study was to use multilevel analysis to investigate the possible determinants of the low concordance, taking into account different patients' demographic and clinical variables, the financial system used by patients to pay for dental treatment, and the role of the different caregivers and clinics. The OHRQoL of patients was assessed both by the patients and by their caregivers, using the Oral Health Impact Profile (OHIP)-14. Data were collected in four clinics, and patients were evaluated by one of 27 caregivers. We tested eight multilevel models, using the difference (caregivers OHIP - patients OHIP) as the dependent variable. Data were complete for 432 patients. The mean difference was 4.4 (standard deviation = 8.2; higher scores indicated a higher impact on OHRQoL). The variance due to patients was partly explained by their age, gender, and number of teeth, with a greater OHIP difference for older vs. younger patients, for women than for men, and in patients with fewer teeth. Almost 30% of the variance was due to caregivers, while the effect of clinics was not significant. It is important to study the possible causes of the different judgments concerning patients' OHRQoL by patients and caregivers, in order to improve the patients' satisfaction with care.

Factors influencing the career aspirations and preferred modes of working in recent dental graduates in Wales.

INTRODUCTION: In England and Wales, National Health Service (NHS) primary dental care services are now commissioned on a local basis. In planning for the future, it is important that commissioning authorities have a clear understanding of the perspectives of recent dental graduates: vocational dental practitioners (VDPs). OBJECTIVES: This study investigated the career aspirations and preferred modes of working of VDPs in Wales. METHODOLOGY: Data were collected via a postal questionnaire, comprising 37 closed and open questions, mailed to all 59 VDPs in Wales. RESULTS: A total of 53 (90%) VDPs participated, of whom 47 saw their future in general dental practice: 5, 35, and 7 indicating a preference to work in the NHS, mixed (NHS and private), and private sector, respectively. None selected the Community Dental Service as their preferred vocation. More than half of all respondents intended to undertake a postgraduate qualification within the next five years and 22 wished to specialise. Of the 53 VDPs, 44 were concerned that lack of NHS contracts would limit where they could practise, and agreed that family and other social commitments were a significant influence on choice of practice location. Access to high-quality premises and continuing professional development were agreed as important by 41 VDPs. A majority (37) agreed that private dentistry was an attractive alternative to NHS dentistry. Of the respondents, 38 (22 females, 16 males) expected to work part-time at some point in the future and 14 said they would consider a career outside dentistry. Only nine VDPs agreed that they would be happy working in a single-handed practice and even fewer (six) indicated they would be happy working for a corporate body. CONCLUSIONS: Numerous factors impact on the career aspirations of VDPs. These factors have been quantified in this study, and healthcare-commissioning bodies need to be aware of them when planning future dental care provision in Wales.

Outcomes from homeopathic prescribing in dental practice: a prospective, research-targeted, pilot study.

BACKGROUND AND AIMS: A base for targeted research development in dental homeopathy can be founded on systematic collection and analysis of relevant data obtained by dentists in clinical practice. With these longer-term aims in mind, we conducted a pilot data collection study, in which 14 homeopathic dentists collected clinical and outcome data over a 6-month period in their practice setting. METHODS: A specifically designed Excel spreadsheet enabled recording of consecutive dental appointments under the following main headings: date; patient identity (anonymised), age and gender; dental condition/complaint treated; whether chronic or acute, new or follow-up case; patient-assessed outcome (7-point Likert scale: -3 to +3) compared with first appointment; homeopathic medicine/s prescribed; whether any other medication/s being taken for the condition. Spreadsheets were submitted monthly via e-mail to the project co-ordinator for data synthesis and analysis. RESULTS: Practitioners typically submitted data regularly and punctually, and most data cells were completed as required, enabling substantial data analysis. The mean age of patients was 46.2 years. A total of 726 individual patient conditions were treated overall. There was opportunity to follow-up 496 individual cases (positive outcome in 90.1%; negative in 1.8%; no change in 7.9%; outcome not recorded in 0.2%). Sixty-four of these 496 patients reported their outcome assessment before the end of the homeopathic appointment. Strongly positive outcomes (scores of +2 or +3) were achieved most notably in the frequently treated conditions of pericoronitis, periodontal abscess, periodontal infection, reversible pulpitis, sensitive cementum, and toothache with decay. CONCLUSIONS: This multi-practitioner pilot study has indicated that systematic recording of practice data in dental homeopathy is both feasible and capable of informing future research. A refined version of the spreadsheet can be employed in larger-scale research-targeted data collection in the dental practice setting.

Fatty acid intake and incident nephrolithiasis.

BACKGROUND: Elevated levels of arachidonic acid in cell membranes may promote the hypercalciuria and hyperoxaluria that are characteristic of idiopathic calcium nephrolithiasis. The intake of n-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may decrease the arachidonic acid content of cell membranes and reduce urinary excretion of calcium and oxalate. It has been proposed that greater intake of EPA and DHA (through dietary sources or fish oil supplementation) may reduce the risk for kidney stone formation. METHODS: After excluding subjects with a prior history of kidney stones, we prospectively examined the relation between fatty acid intake (including fish oil supplements) and incident symptomatic kidney stones in 3 large cohorts: the Health Professionals Follow-Up Study (N = 46,043), the Nurses' Health Study I (NHS I; N = 92,079), and the Nurses' Health Study II (N = 96,304). Self-administered food-frequency questionnaires were used to assess fatty acid intake every 4 years. Cox proportional hazards regression was used to adjust simultaneously for a variety of risk factors. RESULTS: We documented 3,956 incident kidney stones during a combined 36 years of follow-up. After adjustment for intake of other dietary factors, no association was detected between the intake of arachidonic acid or linoleic acid (a metabolic precursor to arachidonic acid) and the risk for incident kidney stones. Older women (NHS I) in the highest quintile of EPA and DHA intake had a multivariate relative risk of 1.28 (95% confidence interval, 1.04 to 1.56; P for trend = 0.04) of stone formation compared with women in the lowest quintile. However, this relation was not observed in the other 2 cohorts. CONCLUSION: Fatty acid intake is not consistently associated with the development of kidney stones. Greater levels of arachidonic and linoleic acid intake do not increase the risk for developing a kidney stone, and greater intake of n-3 fatty acids does not reduce the risk.

Michigan Medicaid's Healthy Kids Dental program: an assessment of the first 12 months.

BACKGROUND: In 2000, Michigan's Medicaid dental program initiated Healthy Kids Dental, or HKD, a demonstration program offering dental coverage to Medicaid-enrolled children in selected counties. The program was administered through a private dental carrier at private reimbursement levels. The authors undertook a study to determine the effect of these changes. METHODS: The authors obtained enrollment and utilization data for four groups: children covered in the first 12 months of HKD in 22 counties, children with private dental coverage in the same 22 counties in the same 12 months, Medicaid-enrolled children in the same 22 counties for 12 prior months, and Medicaid-enrolled children in 46 counties who were not included in the HKD program at any time. The authors compared access to care, dentists' participation, treatment patterns, patient travel distances and program cost. RESULTS: Under HKD, dental care utilization increased 31.4 percent overall and 39 percent among children continuously enrolled for 12 months, compared with the previous year under Medicaid. Dentists' participation increased substantially, and the distance traveled by patients for appointments was cut in half. Costs were 2.5 times higher, attributable to more children's receiving care, the mix of services shifting to more comprehensive care and payment at customary reimbursement levels. CONCLUSIONS: By increasing reimbursement levels and streamlining administration, the HKD demonstration program has shown that substantial improvements can be made to dental access for the Medicaid-enrolled population. PRACTICE IMPLICATIONS: The findings of this assessment suggest that appropriate attention to administration and payment levels can rapidly improve access for Medicaid-enrolled patients using existing dental personnel. By cooperating with state officials to design a program that addresses multiple issues, dental providers can help create a Medicaid dental program that is attractive to both providers and patients.

[Complications after third molar extractions: retrospective analysis of 1,213 teeth]. / Complications après extraction de dents de sagesse. Etude retrospective de 1 213 cas.

BACKGROUND: This retrospective study was conducted to analyze per and postoperative complications associated with third molar extraction. Our objective was to determine the appropriate moment for extraction. MATERIAL AND METHODS: The study included 367 patients, selected randomly among the population treated between January 1992 and December 1996. A total of 1213 third molars were extracted: 603 under local anesthesia in 83 men and 136 women, mean age 24.9 years (range 11-70); 610 under general anesthesia in 44 men and 104 women, mean age 19.9 years (range 12-62 years). The patients were divided into three groups by age: 11-18 years, 19-30 years, and 31 years and over. Extractions were performed by senior (n=4) and junior (n=7) surgeons who used the same standard operative technique for all patients. RESULTS: The overall complication rate for extractions conducted under local anesthesia was 12.6% for lower third molars and 2% for upper third molars. The most frequent complication was secondary infection (3.6%) for the mandible and fracture of the tuberosity and bucco-sinus communication for the maxillary. The overall complication rate for extractions conducted under general anesthesia was 8.2% for lower third molars and 1.5% for upper third molars. Complications were more frequent, for the entire cohort, when the operator was less experienced, the subject was older, and the tooth was deeply embedded. DISCUSSION: These results are in agreement with data in the literature. Based on our experience, we propose extraction of third molars during adolescence when the x-ray indicates normal eruption cannot be expected due to lack of space or an abnormal position.