Risk Management for a Legally Valid Informed Consent.

ABSTRACT: Gelli-Bianco law (Law no. 24/2017) intervenes both in order to divide healthcare liability between the healthcare professional and the facility in which he/she exercises and to incentivize the latter to adopt an organizational model suitable for managing the risk associated with the provision of any healthcare service, including the information for consent. In fact, the healthcare facility must guarantee clear, complete and adequate information on the specific case, which, therefore, cannot consist of standard forms to be signed by the patient, under penalty of a flawed consent to treatment and consequent healthcare liability in the event of an adverse event. The regulation mandates that safety must be guaranteed through proper prevention tools and health care risk management, in con-junction with the most effective use of structural, technological and organizational resources available. It further spells out the obligation of health care professionals to contribute to risk prevention while administering health care procedures. For this reason, the consent information constitutes a source of risk for the responsibility of the healthcare provider and the Facility and it must necessarily be managed. Risk Management is the management tool that can allow the healthcare facility to improve the quality and safety of the services provided, optimizing the risk of adverse events through proper moni-toring of the same. This paper will be published, following a special agreement, on the two journals "Igiene e Sanità Pubblica" and "La Clinica Tera-peutica", in Italian and in English, in order to increase the diffusion to a wider audience.

Risk management and Healthcare responsibility. How to guarantee legal protection in Medicine.

Having regard to the increasing attention to the issue of safety and health of patients and workers by low, the hypothesis that this topic will be the growing trend in the next years does not seem to be manifestly unfounded. For this reason, it is wise for healthcare professionals to already be aware that any violation of the interests underlying the legislation in question entails a ruling on civil and/or criminal liability. It is therefore necessary to identify the most suitable means to prevent undue harm occurring, partly to exempt healthcare professionals and hospitals from compensation costs, thereby providing them with recourse to insurance coverage. Healthcare facility organisations must adopt Risk Management techniques as a tool to simultaneously guarantee the effectiveness of health services (in this case), the efficiency of the management economy, and finally compliance with all legally required precautions. This will relegate the occurrence of an adverse event to remote and unpredictable hypotheses, thus guaranteeing useful recourse to insurance coverage to compensate any harm that does occur.

Prevalence of oral disease and treatment types proposed to children affected by Autistic Spectrum Disorder in Pediatric Dentistry: a Systematic Review.

PURPOSE: To investigate the prevalence of dental caries and periodontal disease in children with ASD, and to analyse the necessity of treatment and the prevalence of using general anaesthesia in order to perform it. MATERIALS AND METHODS: A search was performed covering the last 10 years utilising the following databases: Pubmed, Scopus, Medline, BASE, Science Citation Index, Science Direct, Web of Science. Four reviewers evaluated each study. Review findings were summarised using the PRISMA Statement for reporting. Thirteen articles were included in this systematic review. RESULTS: When analysing the articles selected, the evidence turned out did not show a common DFMT and dmft for the groups of children affected by Autism Spectrum Disorder considered. When compared to group of unaffected children, groups of ASD children not always showed a higher prevalence of caries but always higher Periodontal Indexes (PI and GI), resulting in higher prevalence of periodontal disease. Where the treatment was performed and taken into consideration, there was a high incidence of necessity of General Anaesthesia due to the lack of collaboration of the children. CONCLUSION: The high prevalence of treatment under general anaesthesia and the often-reported negative behaviour evidence how there is a lack of protocols specifically designed for these patients, in order to better improve their collaboration and subsequently their oral health and so additional strategies for a preventive care should be applied for these patients.

Oral health in a cohort of individuals on a plant-based diet: a pilot study.

INTRODUCTION: Plant-based diets are associated with a lower: (i) body mass index, (ii) rates of death from ischemic heart disease, (iii) serum cholesterol, (iv) incidence of high blood pressure, (v) type II diabetes mellitus and cancer, with an overall longer life expectancy. However, little data concerning the oral health in individuals on a plant-based diet are available. AIM: The aim of the present study was to investigate the general and clinical oral health status in a cohort of adults who had been following a plant-based diet for a minimum of 24 months. MATERIAL AND METHODS: For this purpose, individuals were administered two questionnaires (a.Questionnaire investigating risk areas for oral diseases; b. Italian version of the Oral Health Impact Profile -14 (IOHIP-14)) by a dental hygienist and clinical examination of the oral cavity was carried out. RESULTS: Seventy-seven adult individuals were enrolled. On average, they followed a plant-based diet for the last four years, had four meals a day and brushed their teeth twice a day. Fruit was the most frequently consumed food at breakfast by 48 of the participants. Thirty-four responders did not drink beer or wine, 65 did not drink spirits, 57 avoided carbonated beverages and 62 (80.5%) did not consume any highly-sugared beverages. Different dental therapies in the previous three years were reported in 36 of the responders. Overall, answers "never and almost never" to the IOHIP-14 questionnaire were observed in 87% to 100% of the individuals. Multiple logistic regression analysis revealed that fresh fruit consumption at lunch had a protective effect against caries (p<0.05). CONCLUSIONS: In conclusion, this study showed that individuals on a plant-based diet have good overall oral health conditions. These features are in agreement with the behavior of these subjects towards an overall healthy life style.

School-age dental screening: oral health and eating habits.

AIM: the study has the purpose to evaluate the association between clinical data collected from dental screening carried out on children and their eating habits. Materials and methods: The dental screening was carried out on a sample of eight-year-old children attending the third grade of the elementary schools of Gaeta (Latina). Clinical data and periodontal status indexes were recorded. The descriptive statistics (mean, standard deviation, frequency) of all data were calculated and anova analysis and chi square test have been performed. RESULTS: On the sample of 70 children the results showed an average of 1.4 decayed teeth per child (sd ± 2.3) with a slightly higher average in females. More than 68% of the sample had poor or insufficient oral hygiene conditions with plaque presence in 64% of cases. Moreover, 57% of children had class II malocclusion with increased overjet and oral breathing respectively in 37% and 30% of cases. Only 24% were breastfed in the first months of life and more than 40% maintained a bad habit for over two years of age. About eating habits, more than 80% of the sample consumed sweets or sweet drinks every day. The analysis of the data showed as children consume several snacks throughout the day, and 47% eat them watching TV. CONCLUSIONS: The results of this study showed how prevention program carried out through the School is more effective on children for learning of content especially when the acquisition of knowledge follows the application and verification of theoretical and practical skills in terms of oral health.

Clinical comparison between an opaque and a clear pit and fissures sealants: a 12-month split-mouth, randomized controlled study.

TRIAL DESIGN: We design a clinical splith-mouth, randomized controlled study, in which the retention of an opaque and clear pit and fissures sealants were evaluated and their effectiveness compared at 6 and 12 months of follow up. A secondary aim was to evaluate the possibility of using a fluorescence based intra-oral camera through the clear sealant to monitor enamel demineralization. METHODS: Consecutive young adolescents with at least two molars with code 0, 1, 2 caries evidenced following the International Caries Detection and Assessment System (ICDAS II) were enrolled. A split-mouth randomized allocation was carried out. One skilled operator applied the sealant under 3.5 X magnification. A second operator evaluated clinical retention and performed the intra-oral camera assessments at 6 and 12 months follow up. RESULTS: A total of 42 patients, (20 males and 22 females, mean age 14.25) with 176 dental lesions were enrolled. Nine patients dropped out accounting for 26 teeth lost during follow up. Overall, a total of 150 sealed teeth were evaluated in the study. In 77 cases the clear sealant was used, while in 73 the opaque sealant was utilized. The opaque sealant rated 100% complete retention at 6 months, and 97.3% at 12 months, while the clear selant 91.8% and 85.9% respectively. Demineralization under clear selant was registered when sealant partial detachment occurred. CONCLUSIONS: The overall retention rate of an opaque sealant was higher than that of a clear sealant after 12 months of follow-up. This difference may partly be due to difficulty in clinical detection of clear sealants during follow-up. Fluorescence based intra-oral camera seems useful to monitor enamel demineralization in clear sealant.

[Knowledge, attitude and behavior towards oral health: gender differences between parents].

OBJECTIVES: The aim of this study is to compare the results of a survey carried out on a sample of mothers and fathers about the knowledge and personal attitudes towards their own oral health and in terms of attention to that of their children. Mutual analogy and cognitive and behavioral differences between parents have been evaluated; in particular as the early assumption of a healthy lifestyle can influence the proper development of their children. MATERIALS AND METHODS: This survey was conducted using a paper questionnaire distributed to a population of parents, men and women, in several private dental practices in Rome. The study lasted about three months. RESULTS: The results obtained from this study show that values obtained by mothers and fathers are essentially equivalent, there are no statistically significant differences (p> 0.05). CONCLUSIONS: This study has shown that there are no significant thinking and behavioral differences between parents regarding their oral hygiene and that of their children. Both parents have been shown to recognize the importance of continuous monitoring and to be aware of techniques and oral hygiene aids suitable for adults and children, although this knowledge is not always applied in daily lifestyles and oral hygiene.

Oral health sentinel-based surveillance: a pilot study on dentinal hypersensitivity pain.

Aim of the study is to assess the development of a structured sentinel system for oral health data collection at national level. Furthermore, this pilot study aims to investigate the prevalence data on dentinal sensitivity pain collected through a nationwide network of epidemiological sentinels (dental hygienists). Each sentinel was given a specific number of examinees and periodicity of data collection. Overall, 116 adults were recruited from 19 Regions, 42,24% male and 57,76% female, with a mean age of 26. DH result was consistent with literature data, being 45%. All sentinel completed the standard forms and assured a good compliance. The overall good customer satisfaction assures adhesion of the sentinels to the procedure, and the regular data collection. The pilot study proved the effectiveness of a structured nationwide network of epidemiological sentinels (dental hygienists) for oral health data collection at national level. This methodology can be an essential starting point for periodic comparative studies.

Oral Health Status and Oral Health-Related Quality of Life in Italian Deinstitutionalized Psychiatric Patients.

INTRODUCTION: The aim of this study is to investigate the oral health status and Oral Health-Related Quality of Life (OHRQoL, measured with OHIP- 14) in psychiatric patients assisted by the unique Italian mental health care system, in accordance to regulatory Law 180/78. MATERIALS AND METHODS: Demographic and medical variables were retrieved from institutional medical records. General health and oral health variables, oral health-related behavior and last dental contact were recorded. Clinical evaluation was performed on each patient. For oral health data collection, a standardized medical form was used. RESULTS: The study involved an overall number of 67 patients. Primary diagnosis of mental illness was at mean age of 29 years. The average number of teeth per patient was 25.45 ±6,55. The overall mean value of caries experience was 9.1 decayed, missing and/or filled teeth (DMFT Index). Among affected patients (60%, n=33) the mean value of DMFT for all age groups was 11.3 (range 2-27). The present study highlighted a direct linear relationship between caries experience and OHRQoL. As the caries level increased, pain, functional and psychological discomfort scores increased. DISCUSSION AND CONCLUSIONS: The overall caries experience value of 9.1 DMFT was lower than that reported in existing literature, which is usually related to traditionally institutionalized psychiatric patients, and most important of all, data on access to dental care is fairly good. These results, although derived from a pilot study on a limited sample, suggest that, where a psychosocial rehabilitative program is set out for psychiatric patients, as in the case of the Italian experience, the program can also determine an improvement in oral health status. It is important that programs for oral health promotion are developed in collaboration with mental health services and social measures are patient-centered as an integral part of the individual's rehabilitation program.

Awareness of complications and maintenance mode of oral piercing in a group of adolescents and young Italian adults with intraoral piercing

BACKGROUND: The aim of the study was to focus the awareness of complications of oral piercing among a group of adolescents and young Italian adults with intraoral piercings. MATERIAL AND METHODS: A total of 225 teenagers were asked to complete a questionnaire on the awareness of complications of oral piercing. An additional questionnaire was administered in case of oral piercing worn, based on site piercing, knowledge about piercer license, oral and systemic risks due to oral piercing, disinfection and sterilization of the material pierced, information by the piercer about piercing hygiene maintenance and post-piercing dentist check-up. After questionnaire all partecipants received a brochure with some information about risks and maintenance mode of piercing. RESULTS: Data revealed that more than 50% of teens surveyed was found to wear a piercing. Only 25.3% was aware of the risk of HCV cross-infection and only 17.3% reported of knowledge about risk of endocarditis. Only 17% checked the piercer license and only 18% sterilization and disinfection of the materials used. 53.7% did not received explanations about the risks associated with piercing. With regard to the maintenance mode of the piercing, it has been suggested to brush the piercing bar in 17% of cases. The post piercing specialist visits have been suggested only in 7% of cases. CONCLUSIONS: The general lack of awareness of complications and maintenance mode related to oral piercing needs to be addressed by some education programs performed at school and by dentists

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