Integralidade do atendimento odontológico à mulher em situação de violência: revisão narrativa da conduta profissional / Dental care integrality for women in violent situations: a narrative review of professional conduct

O desempenho de atributos profissionais de integralidade do atendimento de mulheres em situação de violência depende de como os cirurgiões-dentistas (CDs)estruturam suas práticas de cuidado e como compreendem a violência. Por isso, o objetivo desta revisão foi acumular evidências da responsabilidade profissional e obrigações sociais do CDe sua imprescindibilidade no enfrentamento da violência contra a mulher. Foram selecionados artigos nas bases de dados PubMed, SciELOe LILACS, a partir de Descritores emCiências da Saúde, para fundamentar e aprofundar as perspectivas sobre a integralidade do atendimento odontológico, considerando os conflitos sociais subentendidos na queixa principal. Constatou-se que a violência contra a mulher é resultante de processoshistóricos-sociais de desigualdade entre os gêneros; a agressão física sobressai-se entre as principais queixas e mulheres agredidas por seu parceiro têm alta prevalência de sofrer injúrias na cabeça e na face. As sequelas da violência vão além dos vestígios físicos e difundem-se a inúmeros problemas orais. Verificou-se pouca aptidão dos cirurgiões-dentistas para identificar, conduzir e propor alternativas de tratamento global à paciente, mesmo com protocolos para naturalização da investigação por meio da anamnese. A ampliação do conhecimento e discussão das políticas de ensino são oportunidades para consolidar a humanização e a integralidade de saúde, evitando exames e tratamentos mecânicos, sem afeto ou respeito. Essa estratégia faz parte da construção coletiva para o estabelecimento e manutenção do compromisso ético e social do Ensino em Odontologia, em que o CD compreende a magnitude de sua profissão e presta seus serviços articulado com a realidade social (AU).

Improving integrality on dental care for women in a violent situation depends on how the dentist conducts the care practices and how to comprehend the violence. For that reason, the goal of this review was to gather evidence and concerns about the role of dentists in addressing violence against women, professional responsibilities, and social obligation. At PubMed, SciELO, and LILACS were selected research and studies to substantiate and deepen perspectives about integrality on dental care attendance considering the social conflicts implied in the main complaint. Violence against women is produced in gender inequality arising from historical and social processes. Physical aggression is the main complaint. Women assaulted by their partners have a high prevalence of suffering head and face injuries. The violence's sequelae spread to countless problems beyond the physical traces. Dentists do not be able to identify, conduct, and purpose alternatives of global treatment even though with protocols of investigationthrough the anamnesis. Multiprofessional discussion expands the knowledge and it is an opportunity to reinforce oral health inclusive criteria avoiding mechanicaltreatment with no respect or affect. Thus, this is a collective construction strategy to establish and maintenance of the ethical and social commitment of Dentistry, on what dentists improve the dental care screening, intervening, and changing behavior according to the real demand of our society (AU).

Effect of length of dental resident clinical rotations on patient behavior.

AIM: The purpose of this retrospective chart review study was to determine if the length of residents' comprehensive dental care rotations in a general practice residency affected late cancellations, broken appointments, completion of treatment, timeliness of recall visits, emergency visits, and the need for redo of restorations and prostheses. METHODS: Patients who presented for comprehensive care from 2010 to 2013, during which residents had 3- to 4-month dental clinic rotations, comprised Group 1, and patients who presented for comprehensive care from 2013 to 2016, during which residents had 11-month dental clinic rotations, comprised Group 2. Subjects were excluded if they only presented for emergency care, they had only one visit, or their care was delivered in both time periods. There were 105 patients in Group 1 and 55 patients in Group 2. RESULTS: The statistically significant results were that Group 1 patients had more late cancellations and broken appointments and failed to reach recall status more often than Group 2 patients, and that Group 1 patients had fewer emergency visits. CONCLUSION: Within the limitations of this retrospective study, the results suggest that short block rotations have an adverse effect on resident experience and outcomes of patient care in a hospital outpatient setting.

The Role of Self- and Peer Assessment in Dental Students' Reflective Practice Using Standardized Patient Encounters.

The aim of this study was to gain insight into the nature of the role played by self- and peer assessment in the development of dental students' reflective practice skills and the value gained through structured encounters with standardized patients. Four standardized patient encounters in an objective structured clinical exam (OSCE) format served as a learning experience for students to demonstrate decision making and communication skills in complex scenarios regarding issues of ethics. Self- and peer assessment and peer-to-peer discourse were used to enhance student reflection. A sample of 16 peer pairs was randomly selected from the population of 108 fourth-year students who participated in the 2014 Clinical Dental Ethics OSCE. Data were collected from self- and peer assessment forms. Five overall performance themes (personal affect, verbal communication, professional demeanor, relationship-building, and patient management) and three student learning themes (application and knowledge, ways to change, and impressed with peer/increased confidence in self) were identified. The results showed that peer assessment ratings were consistently higher than those in the self-assessments, but overall the students deemed both their peers' and their own decision making and communication skills to be quite good. These students rated their experience with the OSCE and self- and peer assessments as positive, appreciating the importance of reflection and learning from their peers. These results provide support for the continued formative use of standardized patient OSCEs and self- and peer assessment to help students develop skills in decision making, communication, professionalism, and reflection.

La sala lúdica: un complemento de la Clínica Dental Pediátrica Universitaria / The playroom: a complement of the University Pediatric Dental Clinic

El presente artículo muestra las diferentes actividades que realiza la salalúdica SALPEP (Especialidad en Estomatología Pediátrica, Facultad deEstomatología, Universidad Autónoma de San Luis Potosí), tanto educativascomo de preparación conductual antes de ingresar a la consulta dental, en los pacientes pediátricos así como en sus padres que acuden a la Clínica Dental Pediátrica del Posgrado. Además, se resaltan los resultados obtenidos en sus primeros doce meses de labor, los beneficios y experiencias logradas que se han refl ejado en el aumento de la calidad de la atención odontológica, en todos los aspectos...

[Dentists' judgement of the complaint procedure of the Royal Dutch Dental Association]. / De KNMT-klachtenregeling beoordeeld door tandartsen.

In 2013, to evaluate the functioning of the complaint procedure of the Royal Dutch Dental Association (KNMT), an anonymous, written survey was conducted among 955 dentists and dental specialists, for whom in the period mid-2008 to mid-2013 a complaint was handled. 413 (43%) participated in the study. 51% of them reported that the complaint was successfully mediated by the Regional Mediation Boards and the Specialist Mediation Board and 17% that the patient had withdrawn the complaint. For the remaining 32% the complaint was handled by the Central Complaint Committee, who determined that 13% was (partially) substantiated, 17% was not substantiated and 2% was settled. Generally, 79% of the dentists are (mostly) positive about the procedure of mediation, while 8% are neutral and 13% are dissatisfied about it. With regard to the complaints procedure this was 60%, 11% and 29% respectively. The judgment of the dentists about the Regional Mediation Boards and the Specialist Mediation Board and about the Central Complaints Committee is influenced by the success of the complaints procedure and by the impact of the complaint that was experienced. The emotional support of dentists during the complaints trajectory is one of the points requiring attention.

A clinical guide to needle desensitization for the paediatric patient.

Needle phobia is a common problem encountered by dental practitioners and it can pose a challenge, especially in the paediatric patient. Needle desensitization can be used for patients who have needle fear or phobia and help them overcome this by repeated, non-threatening and controlled contacts. This paper will describe an accepted technique of needle desensitization and work through the steps required to achieve a successful outcome of local anaesthesia being delivered in a calm, safe and controlled manner. Clinical Relevance: Needle desensitization is an effective technique which can be used to enable a needle phobic patient to receive a dental injection.

Iatrosedation: a holistic tool in the armamentarium of anxiety control.

Identifying the causes of dental anxiety by taking a history and carrying out investigations for patients attending for any type of dental procedure, can be time consuming. Common causative factors of dental anxiety can be previous adverse dental experiences, age, temperament or socioeconomic factors. These factors can lead to patients falling into a cycle of dental avoidance and greater treatment need with attendance for symptomatic relief only. Treatment using pharmacological methods such as conscious sedation or general anaesthesia can help overcome these obstacles, however, although a successful treatment outcome may result, how is the patient to gain trust and overcome their anxiety or fear, if they do not learn from the experience? In 1967 Nathan Friedman described a method he termed 'Iatrosedation' consisting of two components, the interview and the clinical encounter. His method relies on the communication skills and behaviour of the practitioner to identify the causes of anxiety or fear and then to provide a bespoke approach to help overcome them. The result can be that the patient not only has successful treatment, but also learns and gains confidence from their experience, as well as gains increased faith in their practitioner.

Dentists' use of behavioural management techniques and their attitudes towards treating paediatric patients with dental anxiety.

PURPOSE: The purpose of this study was to explore the relationship between dentists' education in treatment of dental anxiety (DA), dentists' attitudes towards patients with DA and dentists' use of BMT. METHODS: An anonymous questionnaire was sent electronically to 611 dentists in the Public Dental Service in Norway. Statistical evaluation was done using cross tabulation with Chi square and logistic regression analyses. RESULTS: The response rate was 65 % (n = 391). About half of the respondents (53 %, n = 208) had followed postgraduate courses in treating patients with DA. The following were the most common attitudes towards treating young patients with DA: it feels like making a contribution (72 %, n = 286), it is difficult or tiresome (54 %, n = 215) and it is a positive challenge (51 %, n = 203). Dentists who had taken postgraduate courses in DA more often reported anxious patients as a positive challenge (60 vs. 42 %, p < 0.001) and were less reluctant to treat these patients (5 vs. 15 %, p = 0.002). The most frequently used BMT was tell-show-do (87 %, n = 340), followed by relaxation (35 %, n = 132), distraction (25 %, n = 94), systematic cognitive behaviour therapy (22 %, n = 84) and conscious sedation (18 %, n = 69). Dentists without postgraduate courses in DA used fewer techniques when treating these patients (OR 2.1, 95 % CI 1.3-3.3, p = 0.001) compared with dentists who had taken these courses. CONCLUSION: Country of graduation and postgraduate courses in DA had a strong relationship with dentists' use of BMT and dentists' attitudes towards young patients with DA.

Perception of 'comprehensiveness of care': a qualitative study amongst dentists in the Brazilian Health System.

Comprehensiveness relates both to the scope of services offered and to a holistic clinical approach. The aim of this study was to identify the perception of Brazilian dentists regarding key concepts of comprehensiveness and its importance in primary health care oral health services performed in the public sector. Focus groups were conducted to explore three main concepts, 'patient welcoming', 'bonding' and 'quality of care', as well as their aspects. In total, there were four focus groups comprising seven general dentists, all of whom had at least two years of experience in primary care, from municipalities of varying sizes. Discussions of approximately 60 minutes were conducted, audio-recorded and transcribed. The data were analysed by qualitative thematic analysis, in line with the framework approach. The general dentists reported that they are aware that in the Brazilian Health System, the onset of patient care by primary health care services must happen through 'patient welcoming.' Nevertheless, they suggested that this action is often performed poorly due to the large volume of patients. Although they knew the importance of 'bonding', they realised that there is a lack of education preparing professionals to address interpersonal and social issues. They were aware that 'quality of care' is related to multiple factors. Comprehensiveness, as an approach in dental public health practices, needs to be enhanced, and there is evidence that primary care dentists are aware of the need for such an approach.

The information exchange.

This article has been written to highlight the importance of unconscious communication in the dental environment using Neuro-Linguistic Programming (NLP) principles. A single aspect of unconscious communication is described to demonstrate the value to dental team members of studying NLP in order to improve their communication skills.

Teaching dental students to interact with survivors of traumatic events: development of a two-day module.

Dentists are likely to treat patients who have experienced a wide range of traumatic life events, including child abuse and neglect, domestic violence, sexual assault, elder abuse, and exposure to combat. In order to effectively treat survivors of traumatic events, dentists must understand how these patients may present in oral health settings, the basic mandated reporting requirements related to abuse and neglect, and communication strategies to help engage trauma survivors in dental treatment. A traditional lecture-format educational module on trauma-informed care was developed and implemented for second-year dental students (N=92) at one U.S. dental school, after which a needs assessment was performed (all 92 students participated). This assessment then informed development of an enhanced module for the subsequent group of second-year dental students (N=102) at the same school. The revised (final) module was more interactive in nature, expanded to multiple sessions, and included more discussion of mandated reporting and appropriate dentist-patient communication in relation to traumatic events. All 102 students participated in assessments of the revised module. Comparison of pre and post tests and needs assessments between the initial and final modules indicated that the extended, more interactive final module was more effective in meeting the educational objectives. Results showed that the final module increased the students' knowledge in the health-related manifestations of traumatic events and slightly improved their confidence levels in treating survivors of trauma. Dentists who are prepared to deliver trauma-informed care may help individual patients feel more at ease and increase engagement in regular preventive care. Suggestions for future educational efforts in this area are discussed.

Widening horizons through alternative and augmentative communication systems for managing children with special health care needs in a pediatric dental setup.

PURPOSE: This study compared and evaluated the efficacy of conventional low-tech and improvised high-tech alternative and augmentative communication (AAC) software in behavior management in the dental environment and oral hygiene activities performance of children with special health care needs as well as improving their communication skills with the dentist and caretakers. METHODS: A total of 60 institutionalized children with special health care needs were divided into two groups of 30 each to be exposed to low-tech AAC and high-tech AAC systems (special smiles for special children material). Assessment of knowledge as well as behavior modification achieved before and after training was carried out on the basis of pretested proformas formatted through various peer reviewed articles. RESULTS AND CONCLUSION: Rapid and enhanced assimilation of knowledge was observed in group 2 exposed to high-tech AAC improvised software after intergroup comparison of total scores at baseline, first, second, third, sixth, and ninth month of training. Oral hygiene performance was compared using PHP (Patient Hygiene Performance) index and after training results revealed highly significant change in both groups. The subjects benefitted immensely from the programme as group 1 and group 2 children demonstrated good behavior after training compared to none at baseline. On the whole, this programme had a positive motivational impact.

[To finish with fear of dental care]. / Pour en finir avec la peur des soins dentaires.

The patient facing the dentist knows fear, anxiety. The symbolism of the mouth and teeth from childhood is an entirely specific nature of the human body. The terrifying image of dental treatment and dentist that has long been stigmatized through painting, literature, theater and cinema can change today. Many therapeutic options to the management of anxiety in dental phobia; anesthesia, conscious sedation, combined with a soothing cabinet, a caring dentist, targeted use of medications or milder alternative methods; homeopathy, herbal medicine, acupuncture, psychotherapy, places the patient's interests at the center of the caregiving relationship. But this treatment panel is also offered him the difficulty of the choice. This exercise without systematization, according to the patient with competence and kindness. Some patients may be sent or processed in collaboration with other health professionals.

Perception of 'Comprehensiveness of Care': a qualitative study amongst dentists in the Brazilian Health System

Comprehensiveness relates both to the scope of services offered and to a holistic clinical approach. The aim of this study was to identify the perception of Brazilian dentists regarding key concepts of comprehensiveness and its importance in primary health care oral health services performed in the public sector. Focus groups were conducted to explore three main concepts, ‘patient welcoming’, ‘bonding’ and ‘quality of care’, as well as their aspects. In total, there were four focus groups comprising seven general dentists, all of whom had at least two years of experience in primary care, from municipalities of varying sizes. Discussions of approximately 60 minutes were conducted, audio-recorded and transcribed. The data were analysed by qualitative thematic analysis, in line with the framework approach. The general dentists reported that they are aware that in the Brazilian Health System, the onset of patient care by primary health care services must happen through ‘patient welcoming.’ Nevertheless, they suggested that this action is often performed poorly due to the large volume of patients. Although they knew the importance of ‘bonding’, they realised that there is a lack of education preparing professionals to address interpersonal and social issues. They were aware that ‘quality of care’ is related to multiple factors. Comprehensiveness, as an approach in dental public health practices, needs to be enhanced, and there is evidence that primary care dentists are aware of the need for such an approach.

Parental attitudes and experiences of dental care in children and adolescents with ADHD--a questionnaire study.

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition characterized by age-inappropriate levels of inattention, hyperactivity-impulsiveness or a combination of these. The aim of this study was to analyze parental attitudes to and experience of dental care, oral hygiene and dietary habits in children/adolescents with ADHD. Twenty- six parents of 31 subjects, 20 boys and 11 girls, aged 5-19 years with ADHD registered at the Gothenburg Child Neuropsychiatric Clinic, were invited. The parents answered a questionnaire regarding different oral problems when visiting the Clinic of Pediatric Dentistry, Gothenburg, for an oral examination of their child. The parents felt the dental care at the Public Dental Service was good, but noted a lack of knowledge regarding child neuropsychiatry among the dental staff which may influence the dental treatment. Fifteen parents reported their children had experienced mouth pain and 15 reported their child had suffered from both discomfort and pain from local anesthesia. Thirteen of the children had a dental trauma and 12 parents reported pain in connection to the dental treatment. Pain related to filling therapy was stated by 11 parents. According to the parents, five children suffered from dental fear but 15 reported the child had a general fear. Pursuant to the parents, the beverage for dinner was mainly milk or water, while sweet drinks were more frequent when thirsty. Seventeen parents reported their children had poor oral hygiene or could not manage to brush their teeth and 14 of the 31 children only brushed once a day or less. The results show that the parents experience a lack of child neuropsychiatric knowledge, care and patience from the dental staff, which may influence the treatment. Oral hygiene/tooth brushing is neglected and the frequent consumption of sugar is difficult for the parents to handle.