RESUMEN
OBJECTIVES: Anti-resorptive agents have been linked to the development of MRONJ in patients undergoing dental surgical procedures. This survey aims to explore the level of knowledge and experience of Italian Society of Periodontology and Implantology members in the management of patients treated with anti-resorptive agents and with the risk of developing MRONJ. MATERIALS AND METHODS: An 18-item questionnaire was submitted by e-mail to the SIdP members. Statistical analyses were carried out. Continuous variables were described as mean ± standard deviation (SD) or median, and first and third quartile according to distribution's normality. Normality of data was checked with Shapiro-Wilk test. RESULTS: Four hundred and fifty-one questionnaires were returned by e-mail (32%). Most of the respondents were private practitioners (81.8%). Only 47.7% declared to be highly confident in managing patients on anti-resorptive therapy while 92.5% reported to have performed tooth extractions and 52.3% implant surgery in patients under anti-resorptive therapy for osteometabolic disorders. One or more MRONJ-affected patients were encountered by 63.2% of the respondents. CONCLUSIONS: This survey highlights the need to develop a "dedicated" program both for dentists and prescribers to improve the level of cooperation and to increase the level of awareness of patients treated with anti-resorptive agents.
Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos , Conservadores de la Densidad Ósea , Periodoncia , Humanos , Italia , Conservadores de la Densidad Ósea/uso terapéutico , Encuestas y Cuestionarios , Femenino , Masculino , Sociedades Odontológicas , Extracción Dental , Implantación Dental , Pautas de la Práctica en Odontología/estadística & datos numéricos , Persona de Mediana EdadRESUMEN
BACKGROUND: The importance of good oral hygiene for patients in Intensive Care Units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. AIM: This study aimed to provide a national picture of oral care practices in adult ICUs in the United Kingdom (UK) to identify areas for improvement. STUDY DESIGN: A national one-day point prevalence study was undertaken in adult ICUs in the UK in the period from 30th September to 14th October 2021. Data were collected on all patients in the ICU on the date of data collection. Using a validated electronic data collection form, anonymised data were collected on methods and frequency of oral care provided, and the use of oral care protocols within the ICU. Data were analysed using descriptive analysis. RESULTS: Data from 195 patients in 15 ICUs in England, Wales and Northern Ireland were collected. Written oral care protocols were available for use in the care of 65% (n = 127) of patients. 73% (n = 142) of patients received oral care within the 24-h period. Oral care methods included toothbrushing 41% (n = 79), foam sticks 3% (n = 5), moisturizing the oral cavity 10% (n = 19) and mouth rinse with chlorhexidine 3% (n = 5) and other oral care methods not specified 12% (n = 23). 44% (n = 85) of patients had an oral assessment within the 24-h period and variable assessment methods were used. CONCLUSION: There is large variability in oral care provision and methods for intubated ICU patients and a lack of consensus was revealed in the study. Oral assessment is conducted less frequently using multiple tools. Optimal oral care standards and further research into oral care provision is pivotal to address this important patient-relevant practice. RELEVANCE TO CLINICAL PRACTICE: Oral care is a fundamental part of care for ICU patients, however, there is a large degree of variability, and oral care is often not based upon oral assessment. The use of an oral care protocol and oral assessments would help to improve patient care, ease of use for staff and provide a tailored oral care plan for patients, improving efficiency and preventing wasted resources.
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Higiene Bucal , Neumonía Asociada al Ventilador , Humanos , Adulto , Higiene Bucal/métodos , Salud Bucal , Prevalencia , Neumonía Asociada al Ventilador/prevención & control , Unidades de Cuidados Intensivos , Atención a la SaludRESUMEN
Hospital-acquired pneumonia is a preventable complication. The primary source of pneumonia among hospitalized and long-term care residents is aspiration of bacteria present in the oral biofilm. Reducing the bacterial burden in the mouth through consistent oral care is associated with a reduction in the incidence of hospital-acquired pneumonia. Following a significant reduction in pneumonia among non-ventilated patients in the research pilots, the Veterans Health Administration deployed the evidence-based, nurse-led oral care intervention called Hospital Acquired Pneumonia Prevention by Engaging Nurses as quality improvement nationwide. In this article, nursing informatics experts on the team describe the design and implementation of process and outcome measures of Hospital-Acquired Pneumonia Prevention by Engaging Nurses and outline lessons learned. The team used standardized terms and observations embedded within the EHR documentation templates to measure the oral care intervention in acute care areas. They also developed a tracking system for hospital-acquired pneumonia cases among non-ventilated patients. In addition to improving patient safety and care quality, Hospital-Acquired Pneumonia Prevention by Engaging Nurses links evidence-based practice with nursing informatics principles to generate numerous opportunities to measure the value of nursing at the point of care. This initiative was reported using SQUIRE 2.0: Standards for QUality Improvement Reporting Excellence.
Asunto(s)
Neumonía Asociada a la Atención Médica , Neumonía , Atención a la Salud , Hospitales , Humanos , Estados Unidos , United States Department of Veterans AffairsRESUMEN
OBJECTIVE: Dental insurance may be a protective factor in reducing unnecessary emergency department (ED) use for nontraumatic dental pain. The purpose of this study was to 1) characterize patient demographics and identify risk factors associated with ED utilization for dental problems among individuals dually enrolled in medical and dental insurance and 2) investigate antibiotic and opioid prescription patterns among these patients following discharge. Further study of this unique population may provide insight into other causes of unmet dental need beyond lack of dental insurance. METHODS: Claims data from a large national managed health care plan from 2015 to 2018 were used to evaluate ED use for dental problems in patients with synchronous medical and dental insurance. National counts for ED visits, total visit costs, primary diagnoses, and outpatient treatments for antibiotics and opioids were assessed. Multivariable regression was used to assess any associated demographic and health-related variables. RESULTS: 1492 unique patients were admitted to the ED for dental pain and 429,376 unique patients presented for other symptoms. Utilization rates for nontraumatic dental pain were estimated to be 0.4% of all ED visits, with an average cost of $1487 per visit. Within three days following discharge from the ED, 58% of patients filled an opioid prescription and 38% filled an antibiotic prescription. Patients who presented for dental ED pain were more likely to be younger, live in a ZIP code with a lower median household income, have more medical comorbidities, and receive fewer preventive dental procedures within the prior year. CONCLUSION: Our findings demonstrate a low rate of ED utilization for nontraumatic dental pain among dentally insured patients and highlight the protective value of prior dental visits for reducing ED use. Given high rates of antibiotic and opioid prescription fill following discharge, comprehensive ED guidelines regarding appropriate antibiotic and opioid treatment pathways may be helpful to provide more definitive care to patients with dental insurance.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Seguro Odontológico , Enfermedades de la Boca/diagnóstico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Analgésicos Opioides/uso terapéutico , Antibacterianos/uso terapéutico , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Retrospectivos , Factores de Riesgo , Estados UnidosRESUMEN
OBJECTIVE: General medical and dental practitioner and pharmacists all encounter patients on bisphosphonates and as such require adequate knowledge regarding osteonecrosis of the jaw, a potential complication associated with its use. The cross-sectional study investigated perceived implications of and attitudes towards bisphosphonate use in oral health among general medical and dental practitioners and pharmacists. MATERIALS AND METHODS: Medical and dental practitioners and pharmacists registered in Victoria, Australia, completed an online survey (SurveyMonkey©). Data analysis consisted of chi-square tests with significance as p < 0.05. RESULTS: One hundred and thirty six doctors (general medical practitioners, GMPs), 283 dentists (GDPs) and 26 pharmacists (PHs) participated. 70, 38 and 80%, respectively, reviewed patients prescribed bisphosphonates (BPs). GMPs (88%), GDPs (76%) and PHs (85%) were aware of osteonecrosis of the jaws (ONJ). GMPs (76%) and PHs (100%) advised patients to inform dentists. GMPs (45%) referred patients for dental assessments prior to commencing BPs with 71.9% of GDPs received such referrals. In terms of available information on oral health and BPs, GMPs (56%), GDPs (50%) and PH (53.8%) were either unsure any existed or reported receiving sufficient information. CONCLUSIONS: Discrepancies exist amongst different healthcare professionals in terms of BP use and oral health, and common consensus guidelines are warranted.
Asunto(s)
Actitud del Personal de Salud , Atención a la Salud , Difosfonatos/uso terapéutico , Salud Bucal , Adulto , Australia , Osteonecrosis de los Maxilares Asociada a Difosfonatos/prevención & control , Distribución de Chi-Cuadrado , Estudios Transversales , Odontólogos/psicología , Difosfonatos/efectos adversos , Educación en Odontología , Femenino , Médicos Generales/psicología , Adhesión a Directriz/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Osteonecrosis/tratamiento farmacológico , Osteonecrosis/prevención & control , Osteoporosis/tratamiento farmacológico , Osteoporosis/prevención & control , Farmacéuticos/psicología , Pautas de la Práctica en Odontología , Derivación y Consulta , Encuestas y CuestionariosRESUMEN
PURPOSE: Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe but extremely rare complication of prolonged treatment with bisphosphonates (BPs). Improper treatment or misdiagnosis can have serious repercussions. In some cases, the treatment of BRONJ can require jaw resection, prolonged use of antibiotics, and long hospitalizations. This study aimed to measure the awareness of dentists in the Province of Ontario, Canada about BRONJ and to identify any gaps in their knowledge of the condition and its treatment. In particular, the study aimed to answer questions about the dentists' knowledge of the current guidelines and their opinions and practices related to performing surgical dental procedures in patients taking BPs. MATERIALS AND METHODS: The study involved sending a Web-based questionnaire to a random sample of dentists in Ontario, Canada (n = 1,579). Information about their awareness of BPs, their experiences treating patients presenting with ONJ, their experiences with different surgical procedures in patients taking intravenous or oral BPs, and their awareness of the BRONJ guidelines suggested by the American Association of Oral and Maxillofacial Surgeons was collected. RESULTS: A response rate of 30% was achieved. Sixty percent of responding dentists had a good knowledge of BP and BRONJ; however, only 23% followed the guidelines for surgical treatment of a patient taking BPs, and 63% would refer patients if they were taking BPs. Approximately 50% of responding Ontario dentists were not comfortable treating patients with BRONJ at their current knowledge. CONCLUSION: The finding shows that although 60% of Ontario general dentists and specialists have a good knowledge about BRONJ, most are not comfortable performing oral surgery in patients taking BPs. Those who are comfortable have higher knowledge scores, suggesting greater educational efforts should be made to promote the knowledge of dentists regarding BP, ONJ, and BRONJ.
Asunto(s)
Actitud del Personal de Salud , Osteonecrosis de los Maxilares Asociada a Difosfonatos/prevención & control , Conservadores de la Densidad Ósea/uso terapéutico , Odontólogos/psicología , Difosfonatos/uso terapéutico , Educación en Odontología , Adulto , Anciano , Osteonecrosis de los Maxilares Asociada a Difosfonatos/terapia , Neoplasias Óseas/prevención & control , Neoplasias Óseas/secundario , Estudios Transversales , Atención Dental para Enfermos Crónicos , Educación Continua en Odontología , Femenino , Adhesión a Directriz , Humanos , Masculino , Persona de Mediana Edad , Ontario , Procedimientos Quirúrgicos Orales/métodos , Osteoporosis/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Odontología , Derivación y ConsultaRESUMEN
Current demographic data clearly show that the North American population is aging, and projections suggest that the percentage of older people will increase. The elderly often suffer from multiple chronic conditions that affect their quality of life, use of health services, morbidity and mortality. Also, in those of advanced age, the pharmacokinetics and pharmacodynamics of many drugs are altered. Polypharmacy increases the incidence of adverse drug reactions and drug interactions in this population. Thus, the dentist must be continually aware of the pharmacologic status of each patient and consider the likelihood of interactions between drugs prescribed by the dentist, drugs prescribed by the physician and drugs that are self-administered, including over-the-counter medications and natural supplements. In this article, we discuss pharmacokinetic and pharmacodynamic changes in the elderly patient, polypharmacy and the changes in prescribing for our dental patients. Specific emphasis is placed on the drugs commonly prescribed by dentists: local anesthetics, analgesics and antibiotics.
Asunto(s)
Analgésicos/farmacología , Anestésicos Locales/farmacología , Antibacterianos/farmacología , Cuidado Dental para Ancianos , Pautas de la Práctica en Odontología/estadística & datos numéricos , Factores de Edad , Anciano , Analgésicos/farmacocinética , Anestésicos Locales/farmacocinética , Antibacterianos/farmacocinética , Enfermedad Crónica , Comorbilidad , Interacciones Farmacológicas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Humanos , América del Norte , PolifarmaciaRESUMEN
Bisphosphonate-induced osteonecrosis of the jaw (BONJ) represents a growing concern for dentists and patients in that it may alter clinical care. This study assessed the knowledge and perceptions of practicing dentists in relation to the risk of BONJ and how their knowledge and perceptions influence their decisions when developing treatment plans. For this study, a sample of dentists (n = 93) in South Texas completed a 38-item survey about BONJ knowledge and perception and their current clinical practices for patients undergoing bisphosphonate therapy. Knowledge score groupings reflected differences between low knowledge and high knowledge dentists in terms of their behavior concerning medical history, alternative treatments offered, and routine blood testing for patients on bisphosphonate therapy.
Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/terapia , Pautas de la Práctica en Odontología/estadística & datos numéricos , Actitud del Personal de Salud , Osteonecrosis de los Maxilares Asociada a Difosfonatos/epidemiología , Odontólogos/psicología , Odontólogos/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Encuestas y Cuestionarios , Texas/epidemiologíaRESUMEN
We investigated awareness in dental hygienists of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients with osteoporosis and cancer and assessed the situation in systemic history investigations to broaden the scope of the dental hygienists' BRONJ awareness as a basis for contributing to preventing this disease. The study was carried out through a survey; 217 dental hygienists responded to the survey. They worked at 12 university and general hospitals, 10 dental hospitals and 35 dental clinics, for a total of 57 institutions in Seoul. The survey consisted of 37 questions: general characteristics (J Oral Maxillofac Surg 65: 2007; 369), systemic history investigations (Ruggiero et al. J Oral Maxillofac Surg 62: 2004; 527) and awareness of BRONJ (Park et al. J Korean Dent Assoc 49: 2011; 389). Among them, 79.7% were aware of BRONJ. Recognition was highest among those from 25 to 35 years old (P < 0.05). In terms of work experience, those with 5-10 years experience showed the highest awareness (P < 0.05). In terms of institutions type, dental clinics showed lower awareness than general and dental hospitals (P < 0.05). It was found that 55.3% of the dental hygienists had been educated about BRONJ. Those aged 25-35 years were the most educated. In terms of institutions, dental clinic staff were the least educated. The degree of understanding about BRONJ was analysed with the average score of 6.14 points. According to these results, dental hygienists working in university hospitals and general hospitals had more opportunity to receive training than those working in dental clinics. Thus, it is considered that the development of professional training programs about BRONJ for all dental hygienists is necessary.
Asunto(s)
Actitud del Personal de Salud , Osteonecrosis de los Maxilares Asociada a Difosfonatos/fisiopatología , Higienistas Dentales/educación , Adulto , Clínicas Odontológicas , Higienistas Dentales/psicología , Servicio Odontológico Hospitalario , Educación Continua , Hospitales Generales , Hospitales Especializados , Hospitales de Enseñanza , Humanos , Consentimiento Informado , Capacitación en Servicio , Relaciones Interprofesionales , Anamnesis , Práctica Profesional , República de Corea , Factores de Tiempo , Lugar de TrabajoRESUMEN
In the quest to understand the implications of separating management and treatment, we must first examine the forces driving management decisions. By defining ownership and equity interest, we are able to isolate a critical factor in the decision-making process. Evaluating the spectrum of the different models of dentistry gives us insight into potential advantages as well as disadvantages that can arise. In private practice, an owner typically wants to see the business grow over a lifetime, while, on the other end of the spectrum, corporate dental companies may be prioritizing dividends, investment returns through speedy packaged sales, or other means of reporting progress to investors. Interestingly, each model of dentistry has shown strength and growth, but there is no clear path to what is deemed ideal.
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Administración de la Práctica Odontológica/organización & administración , Rol Profesional , Servicios Contratados , Toma de Decisiones , Práctica Odontológica de Grupo/organización & administración , Humanos , Modelos Organizacionales , Propiedad , Práctica Odontológica Asociada/organización & administraciónRESUMEN
Strategies for management of patients with, or at risk for, medication-related osteonecrosis of the jaw (MRONJ) were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) position papers in 2007 and 2009. The position papers were developed by a special committee appointed by the board and composed of clinicians with extensive experience in caring for these patients and basic science researchers. The knowledge base and experience in addressing MRONJ has expanded, necessitating modifications and refinements to the previous position paper. This special committee met in September 2013 to appraise the current literature and revise the guidelines as indicated to reflect current knowledge in this field. This update contains revisions to diagnosis, staging, and management strategies and highlights current research status. The AAOMS considers it vitally important that this information be disseminated to other relevant health care professionals and organizations.
Asunto(s)
Inhibidores de la Angiogénesis/efectos adversos , Osteonecrosis de los Maxilares Asociada a Difosfonatos/etiología , Conservadores de la Densidad Ósea/efectos adversos , Enfermedades Maxilomandibulares/inducido químicamente , Osteonecrosis/inducido químicamente , Antineoplásicos/efectos adversos , Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico , Osteonecrosis de los Maxilares Asociada a Difosfonatos/terapia , Remodelación Ósea/efectos de los fármacos , Resorción Ósea/prevención & control , Diagnóstico Diferencial , Humanos , Enfermedades Maxilomandibulares/diagnóstico , Enfermedades Maxilomandibulares/terapia , Neoplasias/tratamiento farmacológico , Neovascularización Fisiológica/efectos de los fármacos , Procedimientos Quirúrgicos Orales/efectos adversos , Osteonecrosis/diagnóstico , Osteonecrosis/terapia , Osteoporosis/tratamiento farmacológico , Planificación de Atención al Paciente , Medición de Riesgo , Factores de Riesgo , Terminología como Asunto , Factores de TiempoRESUMEN
PURPOSE: The purpose of this article is to review data and results from past surveys of prosthodontists sponsored and conducted by the American College of Prosthodontists. Surveys were conducted in 2002, 2005, 2008, and 2011. Selected survey results are examined for prosthodontists in private practice. MATERIALS AND METHODS: Results from past surveys of prosthodontists were statistically examined and used to estimate several characteristics of the current population of practicing prosthodontists. The selected characteristics included age, gender, number of patient visits, hours in the practice, employment of staff, referral sources, and financial conditions (e.g., gross receipts, expenses in the practice, and net income of prosthodontists). While the most recent survey was conducted in 2011, the results reported by respondents are for the previous year, 2010. RESULTS: The average age of a private practicing prosthodontist in 2010 reached 53 years; 26 years since graduation from dental school and 20 years since completion of residency; an average of 13 years in their current practice. Sixty percent were in solo practice. The mean number of hours per week in the practice was 35 hours, and practicing prosthodontists treated an average of 35 patient visits per week. The patient was the single largest source of referrals, while general practitioners were a close second. The largest percentage of time spent treating patients was for fixed prosthodontics (21%), which declined from a mean of 24.1% in 2007. The mean amount of gross billings in 2010 was $721,970, which was a decline from 2007. Average total practice expenses were $538,230, and the mean net earnings of prosthodontists in private practice were $238,010. CONCLUSION: Changes have occurred since the last survey of prosthodontists in 2008 (with results for the year 2007). The prosthodontist private practice industry, not unlike dentistry as a whole, has undergone economic challenges that have affected the private practice of prosthodontists.
Asunto(s)
Odontólogos/estadística & datos numéricos , Práctica Privada/estadística & datos numéricos , Prostodoncia/estadística & datos numéricos , Contabilidad de Pagos y Cobros , Adulto , Factores de Edad , Anciano , Citas y Horarios , Personal de Odontología/estadística & datos numéricos , Femenino , Administración Financiera/estadística & datos numéricos , Odontología General/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico/estadística & datos numéricos , Práctica Odontológica Asociada/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Salarios y Beneficios/estadística & datos numéricos , Factores de Tiempo , Estados UnidosRESUMEN
It has been passed 10 years since the first article of bisphosphonate-related osteonecrosis of the jaw (BRONJ) was reported in 2003. During this period of time, turmoil and confusion initially seen in physicians, dentists and patients in the management of BRONJ have been gradually and significantly settling and preventive methods for BRONJ have been developed to some extent due to the accumulation of substantial amounts of information and clinical experience. Further, Japanese version of position paper for BRONJ that suggests unified view of the pathophysiology of BRONJ and consistent treatments of BRONJ was published in 2010 and 2012. However, the mechanism and pathophysiology of BRONJ still remain elusive. The recognition for BRONJ is still inconsistent between physicians and dentists. It is also noted that a new anti-resorptive drug denosumab is associated with ONJ. Thus, there are still lots to learn and study. In this chapter current our understanding of BRONJ will be described.
Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/etiología , Osteonecrosis de los Maxilares Asociada a Difosfonatos/terapia , Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Guías de Práctica Clínica como Asunto , Anticuerpos Monoclonales Humanizados/efectos adversos , Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico , Osteonecrosis de los Maxilares Asociada a Difosfonatos/prevención & control , Denosumab , Atención Odontológica , Diagnóstico Diferencial , Humanos , Grupo de Atención al Paciente , Factores de Riesgo , Factores de TiempoRESUMEN
Viable practices change with the professional and personal needs of dentists and with trends in society. There is no single way for transitioning out of practice--concluding a direct sale, remaining as an associate, and even purchasing a new practice to better match one's more mature lifestyle and practiced preferences. Changing ratios of dentists to patients currently favor a seller's market and emergence of corporate models provide new options. An analysis is given of the Canadian practice market. Planning advice is also offered.
Asunto(s)
Odontólogos , Jubilación , Acreditación , Canadá , Atención Odontológica , Humanos , Relaciones Interprofesionales , Alquiler de Propiedad , Licencia en Odontología , Estilo de Vida , Práctica Odontológica Asociada , Administración de la Práctica Odontológica , Valorización y Adquisición Práctica , Corporaciones Profesionales , Servicios de Salud RuralRESUMEN
Until the 1960s, the value of a practice upon the retirement of the dentist was considered to be nil. In the next several decades, the value of a practice as a going business concern was recognized and formulas based on productivity were used to establish the sales price of "walkaway" practice transitions. Increasingly creative means, such as pre-sale, deferred pre-sale, shareholder process, incremental practice sale, and practice mergers have been created to make practice transitions more flexible, thereby maximizing the financial value of transitions. Dentists at the beginning of their careers will have an increasing range of opportunities in the future, with various combinations of financial security, freedom from manage- ment concerns, control over the practice, and accumulation of equity. Those in the 45- to 55-year age range should be planning in detail for their transition. Those older than 55 should begin exercising their plans since the future will involve much longer transitions.
Asunto(s)
Odontólogos , Valorización y Adquisición Práctica/tendencias , Jubilación/tendencias , Administración Financiera/economía , Administración Financiera/organización & administración , Instituciones Asociadas de Salud/economía , Humanos , Renta , Inversiones en Salud , Organizaciones de Gestión de Servicios , Práctica Odontológica Asociada , Administración de la Práctica Odontológica/economía , Administración de la Práctica Odontológica/tendencias , Valorización y Adquisición Práctica/clasificación , Valorización y Adquisición Práctica/economía , Jubilación/economíaRESUMEN
There is much more to transitioning well out of dentistry than maximizing the economic value of the practice. The full spectrum of professional and personal values, and where each dentist is in his or her life, must be considered. The same is true for the staff and the patients, especially for mature family-oriented practices. A case is worked out in detail, showing that the wisest thing to do in some cases is to gradually wind down a practice and stop without selling at all.
Asunto(s)
Odontólogos , Jubilación , Toma de Decisiones , Personal de Odontología , Relaciones Dentista-Paciente , Administración Financiera , Humanos , Relaciones Interprofesionales , Práctica Odontológica Asociada , Valorización y Adquisición PrácticaRESUMEN
BACKGROUND: Atopic dermatitis (AD) is associated with multiple comorbid conditions, such as asthma and food allergy. We sought to determine the impact of eczema severity on the development of these disorders and other non-atopic comorbidities in AD. METHODS: We used the 2007 National Survey of Children's Health, a prospective questionnaire-based study of a nationally representative sample of 91,642 children aged 0-17 yr. Prevalence and severity of eczema, asthma, hay fever and food allergy, sleep impairment, healthcare utilization, recurrent ear infections, and visual and dental problems were determined. RESULTS: In general, more severe eczema is correlated with poorer overall health, impaired sleep, and increased healthcare utilization, including seeing a specialist, compared with children with mild or moderate disease (Rao-Scott chi-squared test, p < 0.0001). Severe eczema was associated with a higher prevalence of comorbid chronic health disorders, including asthma, hay fever, and food allergies (p < 0.0001). In addition, the severity of eczema was directly related to the severity of the comorbidities. These associations remained significant in multivariate logistic regression models that included age, sex, and race/ethnicity. Severe eczema was also associated with recent dental problems, including bleeding gums (p < 0.0001), toothache (p = 0.0004), but not broken teeth (p = 0.04) or tooth decay (p = 0.13). CONCLUSIONS: These data indicate that severe eczema is associated with multiple comorbid chronic health disorders, impaired overall health, and increased healthcare utilization. Further, these data suggest that children with eczema are at risk of decreased oral health. Future studies are warranted to verify this novel association.
Asunto(s)
Asma/epidemiología , Eccema/epidemiología , Hipersensibilidad a los Alimentos/epidemiología , Rinitis Alérgica Estacional/epidemiología , Odontalgia/epidemiología , Adolescente , Asma/inmunología , Niño , Preescolar , Comorbilidad , Atención a la Salud , Progresión de la Enfermedad , Eccema/inmunología , Femenino , Hipersensibilidad a los Alimentos/inmunología , Humanos , Lactante , Recién Nacido , Masculino , Prevalencia , Estudios Prospectivos , Rinitis Alérgica Estacional/inmunología , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Up to 48% of ventilated coronavirus disease 2019 (COVID-19) patients develop ventilator-associated pneumonia (VAP) during hospitalization in an ICU. Dysbiotic oral microbiota can colonize the lower respiratory tract and lead to VAP. It is recommended to introduce oral care strategies in the ICU to prevent VAP. In this study, we observed the impact of an oral hygienic protocol with tooth brushing on cultivable oral bacteriota, the incidence of HAI and patient safety among mechanically ventilated COVID-19 patients in an ICU setting. METHODS: In this prospective cohort study, we recruited 56 adult COVID-19 patients who qualified for mechanical ventilation. Patients were divided into 2 groups depending on the oral care procedure: standard and extended oral procedures with tooth brushing. Oral bacteriota samples were taken first within 36 h and after 7 days of intubation. Microorganisms were identified by MALDI/TOF mass spectrometry. bacterial health care-associated infection (HAI) cases were retrospectively analyzed by etiology. A PFGE study was performed for Klebsiella pneumoniae to check for clonal spreading of strains from oral bacteriota samples and HAI cases. RESULTS: We observed significant dysbiosis and a decrease in cultivable oral bacteriota diversity, with a high frequency of potentially pathogenic species, including Acinetobacter baumannii and K. pneumoniae. The HAI incidence rate was high (55.2/1000 patient-days), most commonly of K. pneumoniae and A. baumannii etiologies, which correlated with the presence of A. baumannii and K. pneumoniae in the oral samples. Strains isolated from VAP cases were the same as oral isolates in 8 cases. The procedure with tooth brushing led to less frequent identification of A. baumannii in oral samples (55.6% vs. 5.3%, p = 0.001); however, it did not decrease the incidence of HAIs. CONCLUSIONS: Dysbiotic oral bacteriota is an important source of respiratory pathogens. The introduction of tooth brushing in oral hygiene protocols in an ICU setting was effective in decreasing the extent of oral bacteriota dysbiosis; however, it did not reduce the risk of HAIs or mortality. TRIAL REGISTRATION: 1072.6120.333.2020.
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COVID-19 , Infección Hospitalaria , Neumonía Asociada al Ventilador , Adulto , Humanos , Cepillado Dental/efectos adversos , Estudios Prospectivos , Disbiosis , Estudios Retrospectivos , Unidades de Cuidados Intensivos , COVID-19/epidemiología , COVID-19/complicaciones , Neumonía Asociada al Ventilador/microbiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Klebsiella pneumoniae , Atención a la SaludRESUMEN
PURPOSE: The goal of the survey was to identify the desired characteristics of recently graduated oral surgeons entering private practice in Connecticut and compare these results to a similar study conducted earlier in New Jersey. MATERIALS AND METHODS: An anonymous survey was mailed to all active members of the Connecticut Society of Oral and Maxillofacial Surgeons in February 2010. The response rate for the survey was 63%, with 69 of 110 surveys returned. CONCLUSIONS: The most valued characteristics of a new associate included board certification; clinical competence in dentoalveolar surgery, anesthesia, and implant surgery; and personal character. These results paralleled the results of the New Jersey survey.
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Práctica Privada , Cirugía Bucal , Anestesia Dental , Actitud del Personal de Salud , Carácter , Competencia Clínica , Connecticut , Implantación Dental Endoósea , Empleo , Humanos , Procedimientos Quirúrgicos Orales , Práctica Odontológica Asociada , Consejos de Especialidades , Cirugía Bucal/educaciónRESUMEN
The orthodontic treatment of patients on bisphosphonates is becoming an increasing aspect of contemporary practice. This article will draw attention to the chemical structure and effects of these drugs on bone and will provide the latest recommendations to avoid potential sequelae.