Mapping Oral health and Local Area Resources (MOLAR): protocol for a randomised controlled trial connecting emergency department patients with social and dental resources.

INTRODUCTION: There are substantial inequities in oral health access and outcomes in the USA, including by income and racial and ethnic identity. People with adverse social determinants of health (aSDoH), such as housing or food insecurity, are also more likely to have unmet dental needs. Many patients with dental problems present to the emergency department (ED), where minimal dental care or referral is usually available. Nonetheless, the ED represents an important point of contact to facilitate screening and referral for unmet oral health needs and aSDoH, particularly for patients who may not otherwise have access to care. METHODS AND ANALYSIS: Mapping Oral health and Local Area Resources is a randomised controlled trial enrolling 2049 adult and paediatric ED patients with unmet oral health needs into one of three trial arms: (a) a standard handout of nearby dental and aSDoH resources; (b) a geographically matched listing of aSDoH resources and a search link for identification of geographically matched dental resources; or (c) geographically matched resources along with personalised care navigation. Follow-up at 3, 6, 9 and 12 months will evaluate oral health-related quality of life, linkage to resources and dental treatment, ED visits for dental problems and the association between linkage and neighbourhood resource density. ETHICS AND DISSEMINATION: All sites share a single human subjects review board protocol which has been fully approved by the Mass General Brigham Human Subjects Review Board. Informed consent will be obtained from all adults and adult caregivers, and assent will be obtained from age-appropriate child participants. Results will demonstrate the impact of addressing aSDoH on oral health access and the efficacy of various forms of resource navigation compared with enhanced standard care. Our findings will facilitate sustainable, scalable interventions to identify and address aSDoH in the ED to improve oral health and reduce oral health inequities. TRIAL REGISTRATION NUMBER: NCT05688982.

How Often Do Oral Maxillofacial Surgeons Lose Malpractice Cases and Why?

PURPOSE: Although oral maxillofacial surgeons (OMSs) carry high legal risk in malpractice lawsuits, data elucidating the reason behind those claims and their outcomes are scarce. The purpose of the present study was to characterize the trends, analyze the payouts, and determine the etiology of malpractice cases against OMSs. MATERIALS AND METHODS: A retrospective case series study was performed using the Westlaw database to access medical malpractice cases filed against OMSs from 1980 to 2017. The inclusion criterion was that the defendants had included an OMS. Two of us independently collected the demographic data, verdicts, payouts, and etiology of the litigation. RESULTS: The study sample included 183 cases adjudicated from 1980 to 2017. The results highlighted the temporal and geographic trends, payout information, and etiology of the cases. The total number of malpractice cases had decreased by 60% from 2011 to 2015 compared with the previous 5 years. The greatest incidence of malpractice cases filed per 100 practicing OMSs was in New York, followed by California and Massachusetts. Ruling in favor of the defendant OMS was noted in 55% of the cases, of the plaintiffs in 40% of the cases, and had reached a settlement before trial in 3% of the cases. In the cases in which the ruling had favored the plaintiff, the average payment was $812,449.08, with a median payment of $250,000.00 (range, $13,750.00 to $14,887,525.95). Extraction cases represented 53% of all malpractice litigations. Of these, 65% had been third molar extractions that had resulted in lingual nerve injury (26%), postoperative infection (17%), wrong site extractions (15%), and death or brain damage (10%), among other injuries. CONCLUSIONS: Approximately one half of the malpractice cases favored the defendant OMS. Most cases were third molar extractions resulting in injuries ranging from lingual nerve injury to death. Complementary data from insurance companies would be helpful to provide more specific analysis of the etiology and trends of the malpractice cases.

The Development of Dual-Degree Programs in Oral and Maxillofacial Surgery: Celebrating the 75th Anniversary of the Journal of Oral and Maxillofacial Surgery and the 100th Anniversary of Our Specialty.

The concept and history of dual-degree residency education and training are reviewed.

Massachusetts needs a PGY-1 option for licensure.

The American Dental Association (ADA) House of Delegates voted to eliminate live patient clinical exams in the year 2000. Canadian dental graduates take an objective structured clinical examination (OSCE) for licensure. Several states have changed their dental practice acts to permit licensure by mentored experience of a general residency or specialty Dental students have led the fight, with some results, to eliminate a practice--live patient exams--that perpetuates unprofessional and potentially illegal activity.

A faculty group practice-driven credentialing and privileging infrastructure in a school of dental medicine.

Credentialing and assigning clinical privileges are well-established practices in institutions that need to verify a clinician's ability to provide direct patient care services. The credentialing process verifies a provider's credentials to practice his or her profession, while privileging authorizes the individual to perform enumerated procedures within a specific scope of practice. All clinical faculty members at Harvard School of Dental Medicine (HSDM) practice in the Faculty Group Practice (FGP). Because of the number of practitioners in the FGP, the organization instituted a more formal process of credentialing that verifies that practitioners are not only licensed to practice, but also are competent to provide direct patient care. In contrast to other dental schools that have established similar protocols, HSDM approached the process not from the academic side, but rather from the clinical practice side, explicitly taking into account whether the FGP could accommodate another practitioner when an academic department wished to appoint a new faculty member. In doing so, we had to be careful to reconcile our educational and research needs with those of the FGP. In this article, we describe how, within this framework, we established a credentialing and privileging program in which all full- and part-time faculty members, as well as advanced graduate students, were included.

Using ultrasound to visualize the lingual nerve.

PURPOSE: The purpose of this study was to assess the effectiveness of ultrasonography in visualizing the lingual nerve, calculating its distance from the lingual cortex at the area of the third molar, and in detecting injuries. MATERIALS AND METHODS: Using a standardized protocol, lingual nerve dissections were performed in Yorkshire pig cadaver heads. After nerve isolation was confirmed, the nerve was left intact, fully transected, or partially transected. The dissection flap was repositioned and the pig heads were given to 3 blinded evaluators. Using a handheld ultrasound device, the evaluators were asked to determine the status of the nerve and categorize their finding as intact, fully transected, or partially transected. The recorded ultrasound images from the 9 study specimens were then analyzed and the distances of the lingual nerves from the alveolus were measured. RESULTS: After becoming familiar with the ultrasonographic appearance of the lingual nerve, all of the evaluators were able to visualize and identify the nerve using the ultrasound machine. Lingual nerve injuries were accurately categorized in 17 out of the 27 total attempts (success rate, 63%). The average distance of the nerve from the alveolar cortex was measured to be an average distance of 1 mm. CONCLUSION: The results of this study indicate that ultrasonography can be effectively used to visualize the lingual nerve.