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1.
Am J Orthod Dentofacial Orthop ; 159(5): e389-e397, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33931225

RESUMO

INTRODUCTION: Determination of improvement in orthodontic treatment may depend on the measurement method used and the purpose. METHODS: Improvement after orthodontic treatment (from T1 to T2 [beginning to end of treatment]) was assessed 3 ways from a set of 98 patient records: (1) calculated by subtracting judges' assessments at T2 from T1 for records presented in random order, (2) judged as a holistic impression viewing T1 and T2 records side by side, and (3) determined from proxies (American Board of Orthodontics Discrepancy Index, the American Board of Orthodontics Objective Grading System, and the Peer Assessment Rating index). RESULTS: High levels of intramethod consistency were observed, with intraclass correlation coefficient clustering around an intraclass correlation coefficient of 0.900, and distributions were normal. Calculated and judged improvements correlated at r = 0.606. Calculated or judged improvements were correlated at a lower level with proxies. Calculated improvement was significantly associated with "challenge" (T1) scores and judged improvement associated with "results" (T2) scores. Common method bias was observed, with higher correlations among similar indexes than among indexes at the same time that used various methods. Relative to differences in Peer Assessment Rating scores, calculated improvement overestimated low scores and underestimated high ones. The same effect, but statistically greater, was observed using direct judgment of improvement. CONCLUSIONS: These findings are consistent with decision science and measurement theory. In some circumstances, such as third-party reimbursement and research, operationally defined measures of occlusion are appropriate. In practice, the determination of occlusion and improvement are best performed by judgment that naturally corrects for biases in proxies and incorporates background information.


Assuntos
Má Oclusão , Ortodontia , Assistência Odontológica , Oclusão Dentária , Humanos , Julgamento , Má Oclusão/terapia , Ortodontia Corretiva , Resultado do Tratamento
2.
J Dent Educ ; 85(8): 1373-1378, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33870514

RESUMO

PURPOSE/OBJECTIVES: Identify barriers and opportunities regarding faculty participation in research. METHODS: Sixty-four faculty members of all ranks and days of employment completed a survey designed to reveal attitudes toward participation in research. RESULTS: Among those responding, three-quarters said they were actively engaged in research, and 45% of these identified no perceived barriers. Those reporting obstacles rank-ordered 10 barriers, but no consistent patterns emerged. A factor analysis revealed three clusters of concerns: (a) school barriers, (b) personal barriers, and (c) team opportunities. A large number of comments were offered, and these tended to group by the three quantitatively identified factors. CONCLUSION: These findings were consistent with the view that lack of time and formal training in standardized research skills were not major impediments to scholarship. Instead, assistance in navigating administrative hurdles and participation on multiskilled teams appeared to offer the best prospect for helping faculty interested in research.


Assuntos
Docentes , Faculdades de Odontologia , Atitude , Emprego , Docentes de Odontologia , Bolsas de Estudo , Humanos
3.
Community Dent Oral Epidemiol ; 49(2): 209-210, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33689196
4.
Am J Orthod Dentofacial Orthop ; 158(6): 777, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33250096
5.
Am J Orthod Dentofacial Orthop ; 158(4): 564-571.e2, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32829973

RESUMO

INTRODUCTION: The clinical choice of diagnostic tests or treatment options is determined by the probability that the value of their execution (called the warrant for the test) exceeds their cost, and by their usefulness. The purpose of this study was to determine the warrant and usefulness of STOP-Bang, an obstructive sleep apnea screening questionnaire, and cone-beam computed tomography (CBCT) information about the minimal cross-sectional area for referring a mouth-breathing patient to a sleep specialist and for modifying planned orthodontic treatment. METHODS: A branching survey was used to identify the prominence of paths between the presenting situation, 2 diagnostic tests, and 2 referral and/or treatment options. A description was given of a hypothetical patient: an overweight, mouth-breathing female teenager. Path analysis was used as a method for quantifying diagnostic warrant and usefulness. RESULTS: There was a wide variation among the 125 orthodontists who responded to the survey. All paths were chosen. The use of tests altered the referral (χ2 = 8.039; P = 0.03) and/or treatment decisions (χ2 = 12.636; P = 0.005). Ownership of a CBCT system significantly influenced the use of this diagnostic test, with owning a CBCT system resulting in greater use in-office (χ2 = 50.416; P <0.001) and greater use in the study (χ2 = 22.959; P <0.001). The usefulness of the diagnostic tests could not be determined directly because common values were used for each test, but the variation in the use of this standard stimulus was very large, indicating personal differences in the interpretation of actual data. CONCLUSIONS: Wide variation in the choice and interpretation of diagnostic tests for referral and orthodontic treatment modification relative to airway condition exists among orthodontists. Diagnostic path analysis is a potentially useful model for studying how practitioners make decisions independent of research evidence.


Assuntos
Respiração Bucal/diagnóstico por imagem , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Adolescente , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Boca , Inquéritos e Questionários
6.
Artigo em Inglês | MEDLINE | ID: mdl-31300373

RESUMO

OBJECTIVES: This study aimed to evaluate the clinical and histopathologic features of gingival lesions containing foreign material (GLFMs). In parallel, the composition of the foreign material and its effects in primary human gingival fibroblasts (HGFs) were investigated. STUDY DESIGN: Eighty-six GLFMs were retrieved from an oral pathology biopsy service. Clinical and microscopic data were analyzed, and the composition of the particles was identified by using energy-dispersive X-ray spectroscopy (EDX). Furthermore, HGFs were stimulated with silica (SiO2) microparticles to investigate the production of collagen type 1 (COL-1), matrix metalloproteinase 2 (MMP2), and inflammatory cytokines. RESULTS: GLFMs were most commonly found in women (60.5%) and most frequently described as white plaques. Histopathologic examination identified verrucous hyperplasia in 59% and epithelial dysplasia in 28% of the cases. EDX microanalysis revealed that Si (94%) was the most frequently detected foreign element. SiO2 microparticles induced higher COL-1 expression; higher levels of proinflammatory cytokines, such as interleukin-6 (IL-6), IL-8, and transforming growth factor-ß, and increased MMP-2 activity in HGFs. CONCLUSIONS: There was a strong association between the presence of foreign material in the gingiva and white verrucous clinical lesions. In addition, the most common element in the foreign material was Si, and our in vitro findings demonstrate the importance of silica-mediated effects on gingival fibroblasts.


Assuntos
Gengiva , Células Cultivadas , Feminino , Fibroblastos , Humanos , Interleucina-6 , Masculino , Metaloproteinase 2 da Matriz , Dióxido de Silício
7.
Am J Orthod Dentofacial Orthop ; 155(6): 826-831, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31153503

RESUMO

INTRODUCTION: "Upstream" decisions by patients are important in determining whether they seek orthodontic care for their children and for themselves and whether they seek care from general dentists or from orthodontists. Classic marketing theory suggests that purchase decisions naturally progress through a sequence beginning with awareness and proceeding to information, emotional preferences, and final purchase commitment. METHODS: A survey was used to assess patient demographics and care history, motives for seeking care for themselves and their children, perceived barriers to care, trust in various sources of information, and preference for treatment by a general dentist or by an orthodontist. Three hundred fifty-two responses were received from patients in all states in the United Sates attending their general dentists. RESULTS: Care for children was most often initiated in response to a suggestion from the family dentist, and traditional treatment with braces was expected. Adults were slightly more likely to make a decision for care themselves and for appearance reasons, often with "invisible" braces. Cost was the principal barrier to seeking care for either functional or appearance reasons. More personal and individualized sources of information, such as the family dentist or referral to a specialist were strongly more influential, with indirect sources, such as dentist Web pages or advertisements, being least influential. There was a preference for care by orthodontists compared with general dentists for functional reasons and when complications were anticipated. Orthodontists were seen as being better at identifying complications, managing complications, and delivering reliable results. Orthodontic care provided by general dentists was favored for convenience and based on established relationships. Patients with more education, higher incomes, and more preventive oral habits preferred treatment by orthodontists. Although it was expected that orthodontists would charge more, income and cost were not factors among those considering treatment. CONCLUSIONS: This study suggests that orthodontists should focus on educating potential patients about the functional health features of treatment for malocclusions, especially for children. Furthermore, orthodontists would benefit from working with general dentists, given their role as gatekeepers in the sequential process of reaching an upstream decision about seeking orthodontic care.


Assuntos
Tomada de Decisões , Ortodontia , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Atitude Frente a Saúde , Feminino , Humanos , Masculino , Motivação , Estados Unidos
8.
J Am Dent Assoc ; 149(10): 833-834, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30261948
9.
J Prosthodont ; 26(8): 682-687, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29243373

RESUMO

PURPOSE: To conduct an empirical investigation using qualitative techniques of the way dentists engage in the process of reading a technique-oriented journal article and what they pay attention to in the process. MATERIALS AND METHODS: Grounded theory was used to identify how dentists read an article describing the fabrication of an interim prosthesis in the esthetic zone. Twenty-one experienced practitioners were videotaped, and their verbatim reflections were coded. The sequence of attending to various features of the paper was noted. RESULTS: Ninety-five percent of readers voiced specific, multiple attempts to identify or refine the main purpose of the article as they processed the material. All readers engaged in various activities to navigate through the article, including skipping and backtracking, and none "read" the article straight through. All readers also made repeated observations about the relevance of the technique to their personal practice situation. Eighty percent used some form of "distancing," whereby the content and value of the article were accepted, but the reader reserved the privilege of not being bound by the results because of technical, sponsorship, or methodological issues that "might be present." The quality of photographs was accepted as a proxy for the quality of technical work performed. CONCLUSIONS: Dentists actively customized the reading of a journal article that described a technical procedure. They imposed a non-linear structure for absorbing information and a standard of personal relevance, and, while accepting the results, created reasons for not necessarily having to accept them as applicable. The approach clinicians use in reading a procedural article may be different from the structure writers use in preparing a paper.


Assuntos
Teoria Fundamentada , Publicações Periódicas como Assunto , Leitura , Pensamento , Odontólogos , Inquéritos e Questionários
10.
J Calif Dent Assoc ; 45(6): 275, 2017 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-29016079
11.
J Calif Dent Assoc ; 45(5): 221, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-29072409
12.
J Calif Dent Assoc ; 45(3): 117, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-29064215
13.
J Calif Dent Assoc ; 45(4): 169, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-29068613
16.
J Calif Dent Assoc ; 44(7): 401, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27514151
19.
J Calif Dent Assoc ; 44(5): 269, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27290821
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