Consommation de soins dentaires préventifs en région Centre-Val de Loire : une étude rétrospective.

CONTEXT: The demography of dentist-surgeons in the Centre-Val de Loire region is far inferior to the national average and characterized by many territorial inequalities of health. The aim of this study is to provide details concerning the dental hygienic care-seeking consumption habits in this region based on one dental care treatment, dental scaling, which allows for the mechanical elimination of dental plaque in order to prevent periodontal diseases. METHOD: This retrospective study is based on data from several databases of the National Health Insurance Cross-Schemes Information System (Sniiram) for the year 2016, analyzed by the Statistical Institute of Liberal Health Professionals. RESULTS: It can be observed that less scaling treatments have been sought out in this region in comparison with metropolitan France and certain territories which also face difficulties in terms of care treatment offers and scaling treatment inferior to the regional average. Although the care offer is unequally distributed, it seems to have little influence on the number of treatment acts consumed per patient and notably scaling treatments. Inversely, indicators of wealth or poverty do have an impact on treatment consumption HBJD001. CONCLUSION: This study suggests that the consumption of scaling treatment is independent from the dental care offers, but linked to the social gradient of the population. It points to the deficit in the consumption of this treatment in comparison to metropolitan France. The potential role of the HBJD001 treatment as a marker of the trajectory of preventive health care as well as the necessity of the adjustment of the zones determined by the ARS are put forward.

[Lack of medical or dental care: Impact on health expenditures for people with chronic disease]. / L'effet du non-recours aux soins médicaux et dentaires sur les dépenses de santé des personnes ayant une maladie chronique.

BACKGROUND: People with chronic disease often have dental (especially periodontal) disorders. Nevertheless, people with chronic disease seek dental care less often than others. We wanted to know if there is a relationship between the consumption of medical care and the consumption of dental care, and if so if the relationship is especially strong for people with chronic disease. METHODS: We conducted a longitudinal study that combined two data-sets: consumption data from the French National Health Insurance Fund and health and socioeconomic welfare data collected with a dedicated national survey. We studied healthcare expenditure and analyzed the association between healthcare consumption, health status and healthcare expenditure over a four-year period (2010-2013). RESULTS: People who did not seek medical or dental care in 2010 exhibited irregular consumer behavior thereafter. This pattern was particularly evident among those with chronic disease whose healthcare expenditures did not stabilize during the study period compared with the rest of the study population. Among people who did not seek medical care in 2010, variation in average dental care expenditure was 91% in people with chronic disease versus 42% for those without chronic disease. Lack of medical care during the first year of the study was also associated with greater expenditure-delay in people with chronic disease (77%) compared with 15% in people without chronic disease. CONCLUSION: The lack of medical or dental care in 2010 for people with chronic disease did not lead to an increase in medical and dental consumption in the following years. The catch-up delay was longer than four years. This highlights a problem of monitoring and identifies a marginalized population within the healthcare system.

Burden of dental caries and periodontal disease in South Korea: An analysis using the national health insurance claims database.

OBJECTIVES: It is essential to measure and monitor the burden of dental caries and periodontal disease (PD) in Korea's ageing population due to their potential impact on morbidity, quality of life and economic condition. This study aimed to quantify the size of burden of dental caries and PD using the disability-adjusted life years (DALYs), and their trends. METHODS: DALYs were estimated using incidence-based approaches to calculate the burden of dental caries and PD from 2013 to 2015 in Korea. Incidence and prevalence were estimated using medical claim data by specific algorithms. Additionally, sensitivity analysis was conducted to investigate possible weakness in the study methodology. To conduct the sensitivity analysis, we modified the algorithms to estimate prevalence and incidence. RESULTS: The burden of dental caries and PD increased by 39.2% and 57.0%, respectively, between 2013 and 2015. In 2015, dental caries and PD ranked 11th and 25th, respectively, in terms of the leading causes of DALYs. The burden of dental caries was the most substantial in children aged 0-9 years, while that of PD was the most substantial among those in their ages of 40 and 50 (per 100 000 population). After sensitivity analysis with a modified disease algorithm, the magnitude of disease burden changed considerably. CONCLUSIONS: Dental caries and PD constitute substantial burdens in South Korea. Despite the known limitations, medical claims data can be a powerful resource for conducting timely and cost-effective measurements of oral health. In countries, where universal dental schemes are available, there is need to estimate the burden of oral disease using claims data, for methodical advances in the research field.

Factors associated with the utilization of dental health services by the pediatric population: an integrative review. / Fatores associados à utilização dos serviços de saúde bucal pela população pediátrica: uma revisão integrativa.

This integrative literature review aimed to analyze studies about factors associated with the utilization of dental health services by the pediatric population between zero and 15 years old, published between 2006 and 2016 and available in Portuguese, English or Spanish. A survey of articles in the Lilacs and Medline databases was carried out, using the search strategy: ("dental care/utilization" OR "dental health services/utilization") AND ("child" OR "child, preschool") AND NOT adult. To analyze the methodological quality, the adapted Critical Appraisal Skill Programme (CASP) and the Agency for Healthcare and Research and Quality (AHRQ) were used. The following predictors of use of dental health services stood out: factors associated with children or adolescents (age, frequency of tooth brushing, chronic conditions), caregivers (schooling, perception of child's dental health, perceived oral health needs), dentists (availability at night and on the weekends) and follow up of oral health by the family health team. These are inherent factors for the planning of oral health policies or programs for the pediatric population. However, these factors vary according to the context, and therefore, a contextual analysis should be conducted.

O objetivo desta revisão integrativa da literatura foi analisar estudos publicados entre 2006-2016, disponibilizados em português, inglês ou espanhol, sobre fatores associados à utilização dos serviços de saúde bucal pela população pediátrica entre 0 e 15 anos. Foi realizado um levantamento nas bases de dados Lilacs e Medline, utilizando a estratégia de busca: ("dental care/utilization" OR "dental health services/utilization") AND (child OR "child, preschool") AND NOT adult. Para análise da qualidade metodológica, utilizou-se o Critical Appraisal Skill Programme (CASP) adaptado e o Agency for Healthcare and Research and Quality (AHRQ). Destacam-se como preditores do uso: fatores da criança ou adolescente (idade, frequência de escovação, condições crônicas), do cuidador (escolaridade, percepção da saúde bucal do filho, necessidades bucais referidas), do dentista (disponibilidade à noite e nos finais de semana) e o acompanhamento da saúde bucal pela equipe de saúde da família. Estes fatores são inerentes ao planejamento de políticas ou programas em saúde bucal na população pediátrica, entretanto, variam de acordo com o contexto em que se inserem. Portanto, uma análise contextual é necessária.

Fatores associados à utilização dos serviços de saúde bucal pela população pediátrica: uma revisão integrativa / Factors associated with the utilization of dental health services by the pediatric population: an integrative review

Resumo O objetivo desta revisão integrativa da literatura foi analisar estudos publicados entre 2006-2016, disponibilizados em português, inglês ou espanhol, sobre fatores associados à utilização dos serviços de saúde bucal pela população pediátrica entre 0 e 15 anos. Foi realizado um levantamento nas bases de dados Lilacs e Medline, utilizando a estratégia de busca: ("dental care/utilization" OR "dental health services/utilization") AND (child OR "child, preschool") AND NOT adult. Para análise da qualidade metodológica, utilizou-se o Critical Appraisal Skill Programme (CASP) adaptado e o Agency for Healthcare and Research and Quality (AHRQ). Destacam-se como preditores do uso: fatores da criança ou adolescente (idade, frequência de escovação, condições crônicas), do cuidador (escolaridade, percepção da saúde bucal do filho, necessidades bucais referidas), do dentista (disponibilidade à noite e nos finais de semana) e o acompanhamento da saúde bucal pela equipe de saúde da família. Estes fatores são inerentes ao planejamento de políticas ou programas em saúde bucal na população pediátrica, entretanto, variam de acordo com o contexto em que se inserem. Portanto, uma análise contextual é necessária.

Abstract This integrative literature review aimed to analyze studies about factors associated with the utilization of dental health services by the pediatric population between zero and 15 years old, published between 2006 and 2016 and available in Portuguese, English or Spanish. A survey of articles in the Lilacs and Medline databases was carried out, using the search strategy: ("dental care/utilization" OR "dental health services/utilization") AND ("child" OR "child, preschool") AND NOT adult. To analyze the methodological quality, the adapted Critical Appraisal Skill Programme (CASP) and the Agency for Healthcare and Research and Quality (AHRQ) were used. The following predictors of use of dental health services stood out: factors associated with children or adolescents (age, frequency of tooth brushing, chronic conditions), caregivers (schooling, perception of child's dental health, perceived oral health needs), dentists (availability at night and on the weekends) and follow up of oral health by the family health team. These are inherent factors for the planning of oral health policies or programs for the pediatric population. However, these factors vary according to the context, and therefore, a contextual analysis should be conducted.

[Oral health care in the Xingu Indigenous Park, Brazil, from 2004 to 2013: an analysis based on evaluation indicators]. / Atenção à saúde bucal no Parque Indígena do Xingu, Brasil, no período de 2004-2013: um olhar a partir de indicadores de avaliação.

In 2011, the Brazilian National Oral Health Policy redefined its model of care for indigenous peoples, recommending the use of epidemiology and follow-up of the impact of activities using adequate indicators. The current study aimed to analyze trends in these indicators, proposed by the Brazilian Ministry of Health, in the Xingu Indigenous Park, Brazil, from 2004 to 2013. This was a quantitative study using secondary data from the Xingu Special Indigenous Health District and the Xingu Project of the Federal University of São Paulo. The coverage rate for first dental visit exceeded 60% in all the years analyzed except 2009 and 2010 (44.7% and 53.4%, respectively). The basic dental treatment indicator showed a significant increase, from 44.9% to 79.9%, between 2006 and 2008. The proportion of tooth extractions decreased from 24.3% in 2004 to 3.8% in 2011. Mean coverage of supervised collective toothbrushing showed the highest variation (1.2 to 23.3%). Access to oral health showed good coverage, and the indicator for completed treatment showed a higher percentage when compared to other indigenous peoples during the same period. Better performance on the tooth extractions indicator may have been due to the change in focus of care through partnerships with universities, although the indicators for supervised toothbrushing suggest the need to prioritize preventive measures. Changes in indigenous healthcare management, with weakening or absence of partnerships, may have negatively influenced the program's indicators.

A Política Nacional de Saúde Bucal redefiniu em 2011 seu modelo de atenção para os povos indígenas, preconizando o subsídio da epidemiologia e o acompanhamento do impacto das ações por meio de indicadores adequados. O objetivo deste estudo foi analisar a evolução desses indicadores, propostos pelo Ministério da Saúde, no Parque Indígena do Xingu, Brasil, no período de 2004-2013. Trata-se de pesquisa de abordagem quantitativa, com o uso de dados secundários do Distrito Sanitário Especial Indígena Xingu e do Projeto Xingu, da Universidade Federal de São Paulo. Observou-se cobertura de primeira consulta odontológica programática maior que 60% em todos os anos analisados, exceto em 2009 e 2010, cujas coberturas foram de 44,7% e 53,4%, respectivamente. O indicador de tratamento odontológico básico concluído apresentou aumento significativo, de 44,9% para 79,9%, entre 2006 e 2008. A proporção de exodontias no conjunto dos procedimentos diminuiu de 24,3% em 2004 para 3,8% em 2011. A cobertura da média da ação coletiva de escovação dental supervisionada obteve a maior variabilidade (1,2 a 23,3%) no período analisado. O acesso à saúde bucal mostrou boa cobertura e o indicador de tratamento concluído apresentou percentual mais elevado em comparação com outros povos indígenas no mesmo período. O melhor desempenho do indicador de exodontias pode decorrer de mudança no enfoque assistencial possibilitado por parcerias com universidades, ainda que os indicadores de escovação supervisionada indiquem ser necessário priorizar ações preventivas. Mudanças na gestão da saúde indígena, com fragilização ou ausência de parcerias, podem ter influenciado negativamente os indicadores do programa.

La Política Nacional de Salud Bucal redefinió en 2011 su modelo de atención para los pueblos indígenas, preconizando el subsidio de la epidemiologia y el seguimiento del impacto de las acciones mediante indicadores adecuados. El objetivo de este estudio fue analizar la evolución de esos indicadores, propuestos por el Ministerio de la Salud, en el Parque Indígena de Xingu, Brasil, durante el período de 2004 a 2013. Se trata de una investigación de enfoque cuantitativo, con el uso de datos secundarios del Distrito Sanitario Especial Indígena Xingu y del Proyecto Xingu, de la Universidad Federal de São Paulo. Se observó una cobertura de primera consulta odontológica programática mayor que un 60% en todos los años analizados, excepto en 2009 y 2010, cuyas coberturas fueron de un 44,7% y un 53,4%, respectivamente. El indicador de tratamiento odontológico básico concluido presentó un aumento significativo, de un 44,9% a un 79,9%, entre 2006 y 2008. La proporción de exodoncias en el conjunto de los procedimientos disminuyó de un 24,3% en 2004 a un 3,8% en 2011. La cobertura de la media de la acción colectiva de cepillado dental supervisado obtuvo la mayor variabilidad (1,2 a 23,3%) durante el período analizado. El acceso a la salud bucal mostró una buena cobertura y el indicador de tratamiento concluido presentó un porcentaje más elevado, en comparación con otros pueblos indígenas durante el mismo período. El mejor desempeño del indicador de exodoncias puede producirse del cambio en el enfoque asistencial, posibilitado por colaboraciones con universidades, aunque los indicadores de cepillado supervisado indiquen que sea necesario priorizar acciones preventivas. Cambios en la gestión de la salud indígena, con fragilización o ausencia de colaboraciones, pueden haber influenciado negativamente los indicadores del programa.

Atenção à saúde bucal no Parque Indígena do Xingu, Brasil, no período de 2004-2013: um olhar a partir de indicadores de avaliação / Oral health care in the Xingu Indigenous Park, Brazil, from 2004 to 2013: an analysis based on evaluation indicators / Atención a la salud bucal en el Parque Indígena de Xingu, Brasil, durante el período de 2004 a 2013: una observación a partir de indicadores de evaluación

A Política Nacional de Saúde Bucal redefiniu em 2011 seu modelo de atenção para os povos indígenas, preconizando o subsídio da epidemiologia e o acompanhamento do impacto das ações por meio de indicadores adequados. O objetivo deste estudo foi analisar a evolução desses indicadores, propostos pelo Ministério da Saúde, no Parque Indígena do Xingu, Brasil, no período de 2004-2013. Trata-se de pesquisa de abordagem quantitativa, com o uso de dados secundários do Distrito Sanitário Especial Indígena Xingu e do Projeto Xingu, da Universidade Federal de São Paulo. Observou-se cobertura de primeira consulta odontológica programática maior que 60% em todos os anos analisados, exceto em 2009 e 2010, cujas coberturas foram de 44,7% e 53,4%, respectivamente. O indicador de tratamento odontológico básico concluído apresentou aumento significativo, de 44,9% para 79,9%, entre 2006 e 2008. A proporção de exodontias no conjunto dos procedimentos diminuiu de 24,3% em 2004 para 3,8% em 2011. A cobertura da média da ação coletiva de escovação dental supervisionada obteve a maior variabilidade (1,2 a 23,3%) no período analisado. O acesso à saúde bucal mostrou boa cobertura e o indicador de tratamento concluído apresentou percentual mais elevado em comparação com outros povos indígenas no mesmo período. O melhor desempenho do indicador de exodontias pode decorrer de mudança no enfoque assistencial possibilitado por parcerias com universidades, ainda que os indicadores de escovação supervisionada indiquem ser necessário priorizar ações preventivas. Mudanças na gestão da saúde indígena, com fragilização ou ausência de parcerias, podem ter influenciado negativamente os indicadores do programa.

In 2011, the Brazilian National Oral Health Policy redefined its model of care for indigenous peoples, recommending the use of epidemiology and follow-up of the impact of activities using adequate indicators. The current study aimed to analyze trends in these indicators, proposed by the Brazilian Ministry of Health, in the Xingu Indigenous Park, Brazil, from 2004 to 2013. This was a quantitative study using secondary data from the Xingu Special Indigenous Health District and the Xingu Project of the Federal University of São Paulo. The coverage rate for first dental visit exceeded 60% in all the years analyzed except 2009 and 2010 (44.7% and 53.4%, respectively). The basic dental treatment indicator showed a significant increase, from 44.9% to 79.9%, between 2006 and 2008. The proportion of tooth extractions decreased from 24.3% in 2004 to 3.8% in 2011. Mean coverage of supervised collective toothbrushing showed the highest variation (1.2 to 23.3%). Access to oral health showed good coverage, and the indicator for completed treatment showed a higher percentage when compared to other indigenous peoples during the same period. Better performance on the tooth extractions indicator may have been due to the change in focus of care through partnerships with universities, although the indicators for supervised toothbrushing suggest the need to prioritize preventive measures. Changes in indigenous healthcare management, with weakening or absence of partnerships, may have negatively influenced the program's indicators.

La Política Nacional de Salud Bucal redefinió en 2011 su modelo de atención para los pueblos indígenas, preconizando el subsidio de la epidemiologia y el seguimiento del impacto de las acciones mediante indicadores adecuados. El objetivo de este estudio fue analizar la evolución de esos indicadores, propuestos por el Ministerio de la Salud, en el Parque Indígena de Xingu, Brasil, durante el período de 2004 a 2013. Se trata de una investigación de enfoque cuantitativo, con el uso de datos secundarios del Distrito Sanitario Especial Indígena Xingu y del Proyecto Xingu, de la Universidad Federal de São Paulo. Se observó una cobertura de primera consulta odontológica programática mayor que un 60% en todos los años analizados, excepto en 2009 y 2010, cuyas coberturas fueron de un 44,7% y un 53,4%, respectivamente. El indicador de tratamiento odontológico básico concluido presentó un aumento significativo, de un 44,9% a un 79,9%, entre 2006 y 2008. La proporción de exodoncias en el conjunto de los procedimientos disminuyó de un 24,3% en 2004 a un 3,8% en 2011. La cobertura de la media de la acción colectiva de cepillado dental supervisado obtuvo la mayor variabilidad (1,2 a 23,3%) durante el período analizado. El acceso a la salud bucal mostró una buena cobertura y el indicador de tratamiento concluido presentó un porcentaje más elevado, en comparación con otros pueblos indígenas durante el mismo período. El mejor desempeño del indicador de exodoncias puede producirse del cambio en el enfoque asistencial, posibilitado por colaboraciones con universidades, aunque los indicadores de cepillado supervisado indiquen que sea necesario priorizar acciones preventivas. Cambios en la gestión de la salud indígena, con fragilización o ausencia de colaboraciones, pueden haber influenciado negativamente los indicadores del programa.

Dental Procedures in Primary Health Care of the Brazilian National Health System.

The aim of this study was to examine the procedures of primary dental health care performed by oral health teams (OHTs) adhering to the second cycle of the 'National Programme for Improving Access and Quality of Primary Care' (PMAQ-AB) in Brazil. A cross-sectional descriptive analysis was performed, across 23 dental procedures comprising preventive, restorative/prosthetic, surgical, endodontic and oral cancer monitoring. Descriptive analysis shows that most of the oral health teams carry out basic dental procedures. However, most of the time, they do not keep adequate records of suspected cases of oral cancer, diagnosis tests or follow-ups, and do not perform dental prosthetic procedures. Data also showed disparities in the average number of procedures performed in each Brazilian geographical region in 2013-2014, ranging from 13.9 in the northern to 16.5 in the southern and south-eastern regions, reinforcing the great social disparities between them. Brazilian regions with the highest volume of dental needs deliver the lowest number of dental procedures. The need to expand the supply of prostheses and the early diagnosis of oral cancer in primary health care (PHC) is evident.

Frequency of visits and examinations in the Public Dental Service in Finland - a retrospective analysis, 2001-2013.

BACKGROUND: This study aimed to investigate longitudinally examination and visiting patterns in the Finnish Public Dental Service (PDS) and to relate these to patients' treatment needs and international recommendations on examination intervals. METHODS: Data on patients and their dental visits in the period 2001-2013 were collected from five municipal PDS-units serving a total population of 320,000 inhabitants and using the same database system. Ethical approval was given by the National Institute for Health and Welfare (THL) and permissions to use local data by the directors of health services in each unit. For each year, the numbers of visitors, those examined and those in need of basic periodontal or caries treatment (CPI >2 and D + d > 0) were calculated separately for young people (< 18 years), the working-aged (18-64 years) and the elderly (65+ years). Each individual's examination and visiting intervals were counted. Multilevel modelling was used to study probabilities of being examined or in need of treatment and differences in examination and visiting intervals between groups and over time. RESULTS: From 2001 to 2013, the number of visitors increased by 39.3% and the working-aged became the biggest patient group rather than the young. Compared with adults, the young were five times more likely to be examined (OR = 4.97) and three times less likely to require treatment (OR = 0.31). On average, 37% of the young, 73% of the working-aged and 63% of the elderly needed basic treatment. Multi-level analysis showed that the young had the shortest examination intervals and the working aged the longest (0.50 years longer). Most examination intervals of the young and the elderly were 1 year (65.2 - 77.0%), but only half (49.5%) of the working-aged were re-examined within 1 year. Over time, the examination intervals increased slightly in all groups. Most visiting intervals remained at 1 year. CONCLUSION: Young patients had mostly annual or biannual examinations, in line with recommendations. The examination intervals of working aged adults were considerably longer, and more of them needed treatment. The share of elderly among visitors remained low. The PDS seems to have access barriers for adults.

Income-Related Inequalities in Access to Dental Care Services in Japan.

Background: This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods: The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results: Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions: There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system.

The healthcare system and the provision of oral healthcare in European Union member states. Part 8: Italy.

In Italy healthcare is provided for all Italian citizens and residents and it is delivered mainly by public providers, with some private or private-public entities. Italy's public healthcare system - the Servizio Sanitario Nazionale (SSN) - is organised by the Ministry of Health and administered on a devolved regional basis. It is financed by general taxation that provides universal coverage, largely free of charge at the point of service. The central government establishes the basic national health benefits package, which must be uniformly provided throughout the country, through services guaranteed under the NHS provision called LEA - (Livelli Essenziali di Assistenza [Essential Level of Assistance]) and allocates national funds to the regions. The regions, through their regional health departments, are responsible for organising, administering and delivering primary, secondary and tertiary healthcare services as well as preventive and health promotion services. Regions are allowed a large degree of autonomy in how they perform this role and regarding decisions about the local structure of the system. Complementary and supplementary private health insurance is also available. However, as in most other Mediterranean European countries, in Italy oral healthcare is mainly provided under private arrangements. The public healthcare system provides only 5-8% of oral healthcare services and this percentage varies from region to region. Oral healthcare is included in the Legislation on Essential levels of care (LEAs) for specific populations such as children, vulnerable people (medically compromised and those on low income) and individuals who need oral healthcare in some urgent/emergency cases. For other people, oral healthcare is generally not covered. Apart from the national benefits package, regions may also carry out their own initiatives autonomously, but must finance these themselves. The number of dentists working in Italy has grown rapidly in the last few years. In December 2014, there were 59,324 practicing dentists with a ratio of one dentist every 1025 inhabitants, about 90,000 dental chair-side assistants, about 26,000 dental technicians and about 4000 dental hygienists. To enrol in an Italian dental school a student must pass a competitive national entrance examination after obtaining a high school leaving certificate. For entry in the 2015-2016 cycle, there were 792 places for dentistry. In comparison with dental schools in other EU member states, the number of dental students per school is low with an average of 20 students per year, per school and a range of 10 to 60. The aims of this paper are to give a brief description of the organisation of healthcare in Italy, to outline the system for the provision of oral healthcare in Italy and to explain and discuss the latest changes.

Productivity of Senior Dental Students Engaged in Comprehensive Care: A Seven-Year Follow-Up Study.

The aims of this study were to determine the trend of senior dental students' rate of production of clinical procedures performed in the comprehensive care clinic at one U.S. dental school and to compare that trend to what was reported immediately following inception of that clinic. In addition, total clinic revenues collected were recorded and compared. The periods used for comparisons were 2005 and 2006 combined, the last years before introduction of comprehensive care (called "pre-comp care"); 2007 and 2008 combined, the first two years of comprehensive care (called "post-comp care"); and subsequent years through 2014. The number of procedures and total charges were tracked in the electronic health record, and the total number of student-hours was calculated by multiplying the number of students in the class by the total number of available clinic hours. The rate calculated in this way was then multiplied by a factor of 1,000 for ease of interpretation. The results showed a generally upward trend and a significant increase from post-comp care to 2014 for all procedures combined and for indirect restorations. There was a generally downward trend and a significant decrease from post-comp care to 2014 for direct restorations, extractions, and root planing. There was some up and down fluctuation but no significant change from post-comp care to 2014 for exams. In terms of all procedures, the rate per student/1,000 clinic hours increased from approximately 227 to 419, an 85% increase over seven years. These results show that implementation of the comprehensive care clinic model of clinical education has increased the total clinical productivity of senior dental students at this dental school. Additional studies are indicated to determine the proper balance between a quality education and the financial capabilities of the institution.

Oral Health Beliefs, Attitudes, and Practices of Albanian Immigrants in the United States.

Research indicates a high prevalence of oral disease among Albanians. There is a lack of evidence regarding oral health beliefs and practices among Albanian immigrants in the United States and abroad. This research seeks to better understand the oral health beliefs, attitudes, and practices among Albanian immigrants living in the United States. A descriptive study was employed with a purposive sample (n = 211) of Albanian adult immigrants. A cross-sectional validated questionnaire was provided in both English and Albanian, with a response rate of 66 %. Results revealed a high use of dental services among respondents, with 68 % reported as having a dental visit and cleaning within the past year. Although 25 % of participants stated their parents and grandparents have used folk remedies, 88 % of them stated that use of folk remedies did not influence their decision to seek professional dental care. Increasing age was inversely associated with the belief in the importance of retaining natural teeth, as older respondents were less likely to agree with the prior statement; older respondents were more likely to agree with the statement "bleeding gums are normal." Low oral health care access and utilization was not a factor among the majority of the Albanian immigrants studied. Focusing on providing age appropriate oral health education and behavioral strategies could increase oral health knowledge and potentially improve poor oral health status among this population.

Dental patients' self-reported use of dietary supplements on medical history questionnaires.

Dietary supplement effects and drug interactions can lead to significant adverse health events, thus potentially impacting the safe delivery of oral healthcare. This study sought to determine the frequency of, and factors impacting, dietary supplement use among 209 dental patients and whether the design of a medical history questionnaire influences reporting of supplement use. Patients were randomly allocated to 1 of 2 groups in which they completed either a standard medical history questionnaire (n = 107) or the same questionnaire with an additional item about dietary supplement use (n = 102). All patients were then administered a survey with questions about their demographics, their use and knowledge of dietary supplements, and the person or persons who recommended dietary supplement use to the patient. While 62% of the total population (130/209) reported supplement use, specific prompting nearly doubled the number of supplements reported (mean with prompting: 1.53; mean without prompting: 0.76; P < 0.0001). Patients younger than 30 years of age reported significantly less dietary supplement use than all other age groups except the 30-40 age group (P = 0.0003). An estimated 70% of all respondents were not aware of potentially detrimental side effects of dietary supplement use or possible interactions with conventional drug therapies. Since patients tended to report a greater use of dietary supplements when specifically asked about their use on a medical history questionnaire, a checklist or set of designated questions may be a suitable first step toward gathering this essential information.

The State of UK Dental Anaesthesia: Results From The NAP5 Activity Survey. A national survey by the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland.

The National Health Service anaesthesia annual activity (2013) was recently reported by the Fifth National Audit Program of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. Within a large dataset were 620 dental cases. Here, we describe this data subset. The estimated annual dental caseload was 111,600:60% were children (< 16 y), 38.5% adults (16 - 65y) and 1.5% the elderly (> 65y). Almost all were elective day procedures (97%) and ASA 1 or 2 patients (95%).The most senior anaesthetist present was a Consultant in 82% and a non-career grade doctor in 14%.Virtually all (98%) cases were conducted during GA. Propofol was used to induce anaesthesia in almost all adults compared with 60% of children. Propofol maintenance was used in 5% of both children and adults. Almost all adults received an opioid (including remifentanil) compared with only 40% of children. Thirty one per cent of children had a GA for a dental procedure without either opioid or LA supplementation. Approximately 50% of adults and 16% of children received a tracheal tube: 20% of children needed only anaesthesia by face mask. These data show that anaesthetists almost always use general anaesthesia for dental procedures and this exposes difficulties in training of anaesthetists in sedation techniques. Dentists, however, are well known to use sedation when operating alone and our report provides encouragement for a comprehensive survey of dental sedation and anaesthesia practice in both NHS and non-NHS hospitals and clinics in the UK.

Dental Homes for Children With Autism: A Longitudinal Analysis of Iowa Medicaid's I-Smile Program.

INTRODUCTION: Medicaid-enrolled children with autism spectrum disorder (ASD) encounter significant barriers to dental care. Iowa's I-Smile Program was implemented in 2006 to improve dental use for all children in Medicaid. This study compared dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and within three time periods (pre-implementation, initial implementation, maturation) and determined I-Smile's longitudinal influence on ASD-related dental use disparities. METHODS: Data from 2002-2011 were analyzed for newly Medicaid-enrolled children aged 3-17 years (N=30,059); identified each child's ASD status; and assessed whether the child had a dental home or utilized preventive dental care. Log-linear regression models were used to generate rate ratios. Analyses were conducted in 2015. RESULTS: In 2003-2011, 9.8% of children with ASD had dental homes compared with 8% of children without ASD; 36.3% of children with ASD utilized preventive care compared to 45.7% of children without ASD. There were no significant differences in dental home rates by ASD status during pre-implementation, initial implementation, or maturation. There were no significant differences in preventive dental utilization by ASD status during pre-implementation or initial implementation, but children with ASD were significantly less likely to utilize preventive care during maturation (rate ratio=0.79, p<0.001). Longitudinal trends in dental home and preventive dental utilization rates were not significant (p=0.54 and p=0.71, respectively). CONCLUSIONS: Among newly Medicaid-enrolled children in Iowa's I-Smile Program, those with ASDs were not less likely than those without ASD to have dental homes but were significantly less likely to utilize preventive dental care.

The midwifery initiated oral health-dental service protocol: an intervention to improve oral health outcomes for pregnant women.

BACKGROUND: Evidence is emerging that women's poor oral health and health practices during pregnancy are associated with poor oral health in their children and potentially an increased risk of pre-term or low-birth weight infants. METHODS/DESIGN: The Midwifery Initiated Oral Health-Dental Service (MIOH-DS) trial is a three arm multicentre randomised controlled trial which will recruit women from three metropolitan hospitals aimed at improving women's oral health and service access and indirectly reducing perinatal morbidity. All three arms of the trial will deliver oral health promotion material, although a midwife oral assessment and referral to private/public/health fund dental services pathway (Intervention Group 1) and the midwife oral assessment and referral to local free public dental services pathway (Intervention Group 2) will be compared to the control group of oral health promotional material only. Midwives will undergo specific oral health education and competency testing to undertake this novel intervention. DISCUSSION: This efficacy trial will promote a new partnership between midwives and dentists focused on enhancing the oral health of women and their infants. Should the intervention be found effective, this intervention, with existing on-line educational program for midwives, can be easily transferred into practice for large metropolitan health services within and beyond Australia. Further cost-benefit analysis is proposed to inform national health policy. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612001271897.

Type II diabetes and oral health: perceptions among adults with diabetes and oral/health care providers in Ghana.

OBJECTIVE: This study sought to examine oral health beliefs and attitudes, and utilisation of oral health care services among individuals with diabetes and health professionals who serve them in Ghana. BASIC RESEARCH DESIGN: A qualitative study using grounded theory was conducted. CLINICAL SETTING: University of Ghana Dental School at Korle Bu, University of Ghana School of Public Health, National Diabetes Research and Management Centre at Korle Bu, and New York University College of Dentistry. PARTICIPANTS: A convenience sample of 59 patients comprised 7 focus groups conducted in either Twi or English. Seven key informant interviews with healthcare professionals and one spiritual leader were completed. RESULTS: Data from the focus groups and interviews reveal: 1, half of the participants with diabetes have oral manifestations (e.g., bleeding gums) and participants are generally unaware of interrelationship between diabetes and oral health; 2, dental treatment utilisation is minimal and associated almost exclusively with reparative and emergency care; and 3, medical health providers do not acknowledge the interrelationship between oral health and diabetes nor do they incorporate oral health issues into diabetes screening/treatment. CONCLUSION: Oral health knowledge and practices are limited among patients with diabetes in Accra, Ghana. Collaborative efforts for in-service education and training for oral health and medical professionals may be beneficial in serving the oral and general health care needs as well as improving the oral health-related quality of life of Ghanaians with diabetes.

Survey of midwives' knowledge of caries prevention in perinatal care.

PURPOSE: To assess midwives' knowledge about oral health and early caries prevention during perinatal care for mothers and babies. STUDY DESIGN AND METHODS: A survey developed by the investigators was conducted among midwives to assess their knowledge about caries etiology, their attitude toward their role in early caries prevention, and prophylactic measures recommended during pregnancy, and after birth, for their babies. Self-administered questionnaires were sent to 180 midwives in hospitals and 323 midwives from a midwives' association in Hesse, Germany. RESULTS: Response rates were 46% (83/180) and 56% (181/323); a total of 264 questionnaires were evaluated. Most midwives were familiar with the term Early Childhood Caries (ECC), over 90% knew the role of acidic bacteria, carbohydrates, and insufficient oral hygiene in caries etiology. A vast majority of the midwives considered caries prophylaxis as essential, and saw this topic as part of their core area of competence. Only 60% informed the pregnant women in their care about pregnancy gingivitis. Almost all midwives gave recommendations about caries prophylaxis. The risk for developing ECC was explained to the pregnant women and mothers/parents by 92% of the midwives. Recommendations concerning regular dental visits for small children were given by 80% of the midwives. CLINICAL IMPLICATIONS: The time-intensive medical care of families through advanced practice nurses or midwives offers opportunities for better education about caries prophylaxis. A consensus of all the involved healthcare professional groups, including dentists, obstetricians, advanced practice nurses, midwives, pediatric nurses, and pediatricians, is needed to provide uniform recommendations for prophylaxis and prevention of ECC.

Prospective Study of Serum 25-hydroxy Vitamin D and Tooth Loss.

Vitamin D deficiency and oral diseases (periodontitis, caries, and tooth loss) are highly prevalent in Germany. Previous studies suggested that vitamin D might be a modifiable and protective factor for periodontitis, caries, and tooth loss. However, prospective studies investigating such associations are limited. We explored the association between the concentration of serum 25-hydroxy vitamin D (25OHD) and incidence of tooth loss, progression of clinical attachment loss (CAL) ≥ 3 mm, and progression of restorative and caries status in a population-based longitudinal study. We analyzed data from 1,904 participants from the Study of Health in Pomerania with a five-year follow-up. Generalized estimating equation models were applied to evaluate tooth-specific associations between serum 25OHD and incidence of tooth loss, progression of CAL ≥ 3 mm, and progression of restorative and caries status. Age, sex, education, smoking status, alcohol drinking, waist circumference, dental visit frequency, reasons of dental visit, vitamin D or calcium supplements, and season of blood draw were considered as confounders. Serum 25OHD was inversely associated with incidence of tooth loss. A significant dose-response relationship (p = .0022) was observed across the quintiles of serum 25OHD. After adjusting for multiple confounders, each 10-µg/L increase of serum 25OHD was associated with a 13% decreased risk of tooth loss (risk ratio: 0.87; 95% confidence interval: 0.79, 0.96). The association was attenuated for changes of CAL ≥ 3 mm when adjusting for multiple confounders. No significant association was found between serum 25OHD and caries progression. Vitamin D might be a protective factor for tooth loss. The effect might partially be mediated by its effect on periodontitis.