Alleviation of acute dental pain from localised apical periodontitis: A prospective randomised study comparing two emergency treatment procedures.

OBJECTIVE: To compare the outcomes of two emergency treatment procedures to alleviate pain from localised symptomatic apical periodontitis: complete chemo-mechanical disinfection (CMD) of the root canal system, or removal of necrotic tissue from the pulp chamber (RNT), that is without instrumentation of the root canals. METHODS: Fifty-seven consecutive patients from the emergency clinic at Malmö University met the inclusion criteria: spontaneous pain and/or pain on percussion and palpation, non-bleeding pulp in the canal orifice, pain ≥4 on a Numeric Rating Scale and ≥18 years of age. The diagnosis was symptomatic apical periodontitis, in the absence of swelling and/or fever. Pre-operative pain levels and intake of analgesics were registered. The patients were randomised to one of the two treatment groups. Three to five days post-operatively, the patients were contacted by telephone and asked to grade their current pain level and report any post-operative intake of analgesics and antibiotics. RESULTS: Of the patients treated with CMD of the root canal system, 26/30 (87%) reported satisfactory pain relief, compared with 22/27 (81%) of those treated by RNT. There was no mean difference in pain relief between the two groups (P = 0.879). Post-operatively, 37% in each group reported using analgesics and one in each group reported using antibiotics. CONCLUSION: Three to five days after treatment, a majority (>80%) in both groups reported adequate pain relief, in some cases in combination with analgesics. Removal of necrotic and infected tissue from the pulp chamber might therefore be a cost-effective emergency treatment alternative to complete chemo-mechanical disinfection.

A new dental insurance scheme--effects on the treatment provided and costs.

The aim of this study was to investigate whether the revenues cover the costs in a pilot capitation plan, a dental insurance scheme, and to compare this capitation plan (CP) with the original fee-for-service system (FFS), in terms of the amount and type of dental care provided. Data was collected longitudinally over a period of three years from 1,650 CP patients in five risk groups at a test clinic, and from 1,609 (from the test clinic) and 3,434 (from a matched control clinic) FFS patients, in Göteborg, Sweden. The care investigated was the number of total treatments provided and the number of examinations by dentists and dental hygienists, together with preventive, restorative and emergency treatments. The economic outcome was positive from the administrator's perspective, in all risk groups for the three-year period. The amount and type of care provided differed between the payment models, as CP patients received more preventive treatments, less restorative treatments, and more examinations by dental hygienists than the FFS patients. Emergency treatment was performed more often on CP patients, and the difference was due to a higher frequency of such treatments among women in the CP group. The difference between clinics concerning certain treatment measures was sometimes greater than the difference between payment models. The results from this study indicate a net positive economic outcome for the pilot CP system over three years. The payment model and the clinic affiliation had impact on what type and amount of dental care the patients received. This might suggest that the risk of skewed selection and its consequences as well as the influence of clinic-specific practice need further investigation, to ensure economic sustainability in a longer perspective.

Affording unavoidable emergency surgical care - The lived experiences and payment coping strategies of households in Ibadan metropolis, Southwestern Nigeria.

BACKGROUND: Pre-payment and risk pooling schemes, central to the idea of universal health coverage, should protect households from catastrophic health expenditure and impoverishment; particularly when emergency care is required. Inadequate financial protection consequent on surgical emergencies occurs despite the existence of risk-pooling schemes. This study documented the experiences and coping strategies of slum and non-slum dwellers in a southwestern metropolis of Nigeria who had undergone emergency surgery. METHODS: In-depth interviews were conducted with 31 participants (13 slums dwellers, 18 non-slum dwellers) who had recently paid for emergency surgical care in Ibadan. Patients who had experienced catastrophic health expenditure from the use of emergency surgical care were identified and people who paid for the care were purposively selected for the interviews. Using an in-depth interview guide, information on the experiences and overall coping strategies during and after the hospitalization was collected. Data were analyzed inductively using the thematic approach. RESULTS: The mean age of the 31 participants (consisting of 7 men and 24 women) was 31 ± 5.6years. Apathy to savings limited the preparation for unplanned healthcare needs. Choice of hospital was determined by word of mouth, perceptions of good quality or prompt care and availability of staff. Social networks were relied on widely as a coping mechanism before and during the admission. Patients that were unable to pay experienced poor and humiliating treatment (in severe cases, incarceration). Inability to afford care was exacerbated by double billing and extraneous charges. It was opined that health care should be more affordable for all and that the current National Health Insurance Scheme, that was operating sub-optimally, should be strengthened appropriately for all to benefit. CONCLUSION: The study highlights households' poor attitude to health-related savings and pre-payment into a social solidarity fund to cover the costs of emergency surgical care. It also highlights the factors influencing costs of emergency surgical care and the role of social networks in mitigating the high costs of care. Improving financial protection from emergency surgical care would entail promoting a positive attitude to health-related savings, social solidarity and extending the benefits of social health insurance.

Out-of-hours emergency dental services--evaluation of the first year of a pilot project in Fife.

The Scottish Executive Health Department approved funding in 2001 for Fife NHS Board to pilot an integrated model of out-of-hours dental services based upon a dental nurse-led triage system during the evenings, weekends and some public holidays. After one year of the pilot project the activity was evaluated by analysing the triage database. Nearly 4,000 calls were received--Fridays and Saturdays were the most popular days to telephone which resulted in nearly half of all callers being referred to an emergency weekend clinic. Thirty-nine percent of callers received advice only or were advised to contact their own dentist during working hours. A further 12% who were not registered with a dentist (n=479) were offered a next-day appointment with a dentist in their area--around half of these callers subsequently attended for an appointment. Only two out of every 100 callers were deemed to require emergency out-of-hours attention and were referred to oral surgery staff in a local hospital.

What is the economic burden of sports injuries?

Despite the health benefits of sports activities, sports injury and fear of injury are important barriers to participation in sport. The incidence, prevalence and type of sports injuries vary among men and women as well as age groups. It is usually difficult to examine these different aspects of sports injuries due to insufficient data. This study argues that sport injuries can be considered as an important economic burden in terms of the direct and indirect costs it bears. As a result, strong and effective strategies are needed to prevent sports injuries. Sports medicine has also been attracted increasing attention in recent years, particularly. In this article, the importance of sports injuries and their economic costs as well as the role of sport medicine as a prevention method for sports injuries were discussed.