Evaluation of Change in Quality of Life, Dental Fear and Dental Anxiety in Young Children Following Full-mouth Dental Rehabilitation under General Anesthesia for Early Childhood Caries.

AIM: To evaluate the change in quality of life, dental fear, and dental anxiety in young children following full-mouth dental rehabilitation under general anesthesia for early childhood caries. MATERIALS AND METHODS: About 200 children who were diagnosed with early childhood caries requiring full-mouth rehabilitation under general anesthesia were recruited after obtaining parental consent. Oral health-related quality of life (OHRQoL) was measured using the Early Childhood Oral Health Impact Scale (ECOHIS). Dental fear was evaluated using Children's Fear Survey Schedule-Dental Subscale and dental anxiety was evaluated using the Facial Image Scale. Scores were taken on the day of intervention, and after 14 days when the child reported for posttreatment follow-up. RESULTS: All 200 participants returned for a follow-up visit after 2 weeks. The child impact section was reduced from 15.7 ± 4.1 to 7.7 ± 1.9 after treatment. The family impact section was reduced from 9.6 ± 2.7 to 3.5 ± 2.6 after treatment. A statistically significant difference was seen in both sections when pre-and posttreatment values were compared (p < 0.001). The total ECOHIS showed statistically significant improvement as the pretreatment score of 21.6 ± 9.5 reduced to 11.2 ± 4.2 showing 51.9% improvement in OHRQoL after full-mouth rehabilitation under general anesthesia was done (p < 0.001). Dental fear and anxiety among the participants showed a statistically significant reduction after treatment was done and most participants were found to be less fearful of doctors, dentists, and injections after treatment. CONCLUSION: Full-mouth rehabilitation was found to be a reliable treatment modality to improve the OHRQoL of children suffering from early childhood caries. CLINICAL SIGNIFICANCE: Significant improvement was seen in the OHRQoL within 2 weeks after treatment and most participants were found to be less anxious and fearful toward dentists and dental treatment. Comprehensive dental rehabilitation under general anesthesia has been proven to be an effective treatment modality for early childhood caries and a productive treatment technique to reduce dental fear and anxiety.

How do dental practitioners, educators and students diagnose and manage caries risk and caries lesions? A COM-B analysis.

OBJECTIVE: The International Caries Classification and Management System (ICCMS™), a comprehensive, evidence-informed, best clinical practice system, comprises a 4D cycle: 1D-Determine risk; 2D-Detect and assess lesions; 3D-Decide on a personalized care plan; and 4D-Do preventive and tooth-preserving care. The aim of this study was to establish how Colombian dental practitioners, educators and students diagnose and manage caries risk and caries lesions using the COM-B model and the ICCMS™ system. METHODS: A total of 1094 participants (practitioners: n = 277; educators: n = 212; students: n = 605) completed a previously validated 79-item questionnaire which explores, based on the COM-B model, the practitioners' self-reported caries diagnosis and management behaviours. Descriptive statistics, Welch's ANOVAs and multiple linear regressions were computed. RESULTS: All groups generally performed the behaviours within the 4-D categories 'Most of the time' to 'Always' (students: 4.06 ± 0.95; educators: 3.94 ± 0.98; practitioners: 3.86 ± 1.01). The most frequently performed diagnosis behaviours (1D/2D) were for practitioners assessing initial/moderate lesions (4.09 ± 1.01) and for educators and students cleaning teeth before lesion assessment (4.41 ± 0.80 and 4.38 ± 0.77 respectively). The least frequently performed decision/management (3D/4D) behaviour was non-operative care for moderate-caries lesions (when applicable) (practitioners: 2.64 ± 1.23; educators: 2.68 ± 1.17; students: 3.22 ± 1.41). Opportunity (Resources and Relevance) was the best COM-B predictor for diagnostic behaviours, whereas capability and opportunity (Relevance) were the strongest predictors for management behaviours. CONCLUSION: Colombian practitioners, educators and students diagnose and manage caries risk and caries lesions implementing best practice with a high to very high frequency.

Evaluación de la calidad del Servicio de Estomatología General Integral. Policlínico Camilo Cienfuegos de Sancti Spíritus / Assessment of the comprehensive General Stomatology quality service. Camilo Cienfuegos Polyclinic of Sancti Spiritus

RESUMEN Fundamento: La calidad de la atención estomatológica se ha convertido actualmente en una necesidad. En Cuba, el Programa Nacional de Atención Estomatológica Integral a la Población tiene como propósito incrementar y perfeccionar la atención estomatológica. Objetivo: Evaluar la calidad del Servicio de Estomatología General Integral del policlínico Camilo Cienfuegos de Sancti Spíritus. Metodología: Se realizó una investigación observacional descriptiva de corte transversal en el Policlínico Camilo Cienfuegos de Sancti Spíritus en el período comprendido de septiembre de 2019 a enero de 2020. Se seleccionaron 19 estomatólogos de la unidad y 368 pacientes pertenecientes a los consultorios 8 y 9 del área de salud que cumplieron con los criterios de inclusión. Se utilizó la calidad como variable, la cual se operacionalizó en las dimensiones: estructura, proceso y resultados y sus criterios de medida. Se utilizaron métodos teóricos, empíricos y estadísticos y técnicas de recolección y análisis de datos. Se realizaron encuestas de satisfacción a pacientes y profesionales. Resultados: Las dimensiones estructura y proceso, con 20 y 10 puntos respectivamente, fueron evaluadas de regular, la dimensión resultado de bien por un valor alcanzado de 8 puntos. Conclusión: La calidad del Servicio de Estomatología General Integral del policlínico Camilo Cienfuegos de Sancti Spíritus fue evaluada de regular.

ABSTRACT Background: Dental care quality has become a necessity. In Cuba, the National Program for the People´s Comprehensive Stomatology Care aims to increase and improve dental care. Objective: To assess the Comprehensive General Stomatology quality service at Camilo Cienfuegos polyclinic in Sancti Spíritus. Methodology: A cross-sectional descriptive observational research was conducted at Camilo Cienfuegos Polyclinic in Sancti Spíritus from September 2019 to January 2020. 19 stomatologists from the unit and 368 patients belonging to clinics 8 and 9 of the area were selected who met the inclusion criteria. Quality was used as a variable, and operationalized in the dimensions: structure, process and results and their measurement criteria. Theoretical, empirical and statistical methods and data collection also analysis techniques were used. Satisfaction surveys were conducted on patients and professionals. Results: Structure and process dimensions, with 20 and 10 points respectively, were evaluated as regular, the result dimension as good for an 8-point value. Conclusion: Comprehensive General Stomatology quality service at Camilo Cienfuegos polyclinic in Sancti Spíritus was evaluated as regular.

Dental management of patients with haemophilia / Haemophiliás betegek fogorvosi ellátása

Haemophilia A and B are one of the most common inherited bleeding disorders. Nevertheless, people with congenital haemorrhagic diatheses comprise a small proportion of the total population. Therefore, treating such patients can be a challenge for dentists, as most of them have no experience in the dental management of these cases. As a result, dental care is often neglected in this cohort of patients. Despite the potential bleeding risk of the dental procedures, the most routine, non-surgical interventions can be performed in a general dental practice after consultation with a haematologist and in adherence to protocols. A guideline on the possibilities of comprehensive dental treatment of patients with congenital bleeding disorders has not been published in Hungary. Therefore, the purpose of this paper is to review the literature on dental management of patients with haemophilia and to summarize treatment options in all fields of dentistry. This systematic review of the literature may be useful for dentists to treat patients with haemophilia more confidently and to overcome the difficulties in dental care. The article also provides professionals involved in the management of haemophilia with a practical summary of dental interventions.

Oral Health and Academic Achievement of Children in Low-Income Families.

Low-income children have higher rates of unmet oral health needs. Prior research suggests that poor oral health is associated with lower academic performance but uses cross-sectional and mostly parent-reported measures. This study examined the association between oral health during the first 5 y of life and subsequent academic achievement for low-income children. Birth certificates of children born in Iowa in 1999-2009 were linked to Medicaid enrollment and dental claims data in 1999-2014 and reading and math standardized school test scores for grades 2 through 11. The following oral health measures were examined: having minor dental treatments (mostly surface fillings), major dental treatments (mostly crowns and pulpotomy) or extractions, and comprehensive dental exams during the first 5 y of life. Regression models were estimated adjusting for sociodemographic factors, early infant health, and school district effects. The sample included 28,859 children and 127,464 child-grade observations. In total, 21%, 12%, and 62% of children had at least 1 minor dental treatment, 1 major treatment or extraction, and 1 comprehensive dental exam in the first 5 y of life, respectively. Children who received a minor dental treatment had higher reading and math scores by 1 percentile (95% CI, 0.09-1.9) and 0.9 percentiles (95% CI, 0.02-1.8), respectively. Children who had a major dental treatment or extraction had lower reading and math scores by 2.4 (95% CI, -3.5 to -1.4) and 1.8 (95% CI, -2.8 to -0.8) percentiles. Children who had a comprehensive oral exam had higher reading and math scores by 0.7 (95% CI, 0.06-1.4) and 1.2 (95% CI, 0.6-1.9) percentiles. The findings suggest that children's oral health before school age is associated with academic achievement later during school years.

The Impact of Contemplative Practice in Dental Education: A Qualitative Study in General Dentistry.

Aim: This study explored perceptions of dental postgraduates regarding the impact of contemplative practice in a patient care aspect. Materials and Methods: The qualitative research approach using semi-structured interview was employed. Postgraduate students from the General Dentistry Residency Training Program were selected by purposive sampling by considering sex and working experience. The retrieved data were transcribed using a verbatim technique and analyzed using framework analysis. Results: There were 12 students participating in this research. The retrieved data were analyzed and categorized into two main themes, which were mindfulness and humanized patient-centered care paradigm. Mindfulness can be categorized into four subthemes to represent its required skills, including concentration, deep listening, emotional regulation, as well as critical thinking and problem-solving skill. There were six subthemes for humanized patient-centered care paradigm, which were understanding in patients' context, development of individualized comprehensive treatment planning, treatment with humanization and compassion, management with phycological integrated care, rapport establishment with patients, and good attitudes toward special care needs patients. These skills are considered necessary for patient-centered dental practice, which could be expected from the learning process through contemplative practice. Conclusion: This research supports the implementation of contemplative practice in dental education, as the data demonstrated the positive impact of contemplative practice in both personal and professional perspectives. These included the cultivation of mindfulness and other relevant skills, which were required for humanized patient-centered care in dental practice.

Effectiveness of the ICCMS caries management system for children: a 3-year multicentre randomised controlled trial.

OBJECTIVE: This 3-year multicentre randomised controlled trial compared, in 6-7-year-old Colombian children, the effectiveness of the ICCMS (International Caries Classification and Management System) with a conventional caries-management system (CCMS) in terms of individual caries-risk, caries lesions, and secondarily, oral-health-related knowledge/attitudes/practices, and number of appointments. MATERIAL AND METHODS: With ethical approval, 240 6-7-year olds from six Colombian clinics were recruited. Trained examiners conducted the following baseline/follow-up assessments: Caries risk (Cariogram-ICCMS); caries severity/activity staging (ICDAS-merged combined radiographic/visual); sealants/fillings/missing teeth, and oral-health-related knowledge, attitudes and practices. Children received their randomly allocated (ICCMS/CCMS) care from dental practitioners. Outcomes: caries-risk control (children); caries-progression control (tooth surfaces); oral-health-related knowledge/attitudes/practices improvement (parents/children), and appointments' number (children). Descriptive and non-parametric/parametric bivariate analyses were performed. RESULTS: Three-year-follow-up: n = 187 (77.9%; ICCMS: n = 92; CCMS: n = 95) disclosed a baseline-to-3-year overall high-caries-risk children decrease (ICCMS: 60.9-0%, p < .001; CCMS: 54.7-5.3%, p < .001) (p > .05). ICCMS versus CCMS showed: fewer tooth-surface caries progression (6.2% vs 7.1%, p = .010) and fewer active-caries lesions (49.8% vs. 59.1%, p < .05); higher proportion of children with ≥2/day fluoride-toothpaste tooth-brushing practice (p < .05); similar mean number of appointments (10.9 ± 5.9 vs. 10.0 ± 3.8, p = .15). CONCLUSION: Both caries-management systems showed similar effectiveness in caries-risk control, with ICCMS more effectively controlling tooth-surface caries progression and improving toothbrushing practices.

Implementation and analysis of an enhanced screening and testing protocol for prediabetes in a dental school patient population.

OBJECTIVES: This project aimed to enhance the identification of patients at-risk for prediabetes or diabetes within a dental school patient population by introduction of a modified screening tool and related training of dental residents and students. METHODS: The American Diabetes Association Risk Tool (ADART) was modified by addition of three diabetes-linked oral health questions. Of the 1477 dental patients screened, 551 (37.3%) indicated an at-risk status using the modified tool. A subset of 138 patients received follow-up chairside HbA1c blood testing conducted by dental residents and students. Data was analysed to determine a) the influence of the modifications on the tool's discrimination strength and b) change in the tool's predictive value. RESULTS: The addition of the 3 oral health questions to the 7-item ADART resulted in a 9.4% increase in identification of patients at-risk for pre-diabetes/diabetes. The predictive value of the tool remained stable. Residents and students successfully incorporated the new screening activities within their assigned clinics. CONCLUSIONS: This project demonstrates that screening for risk for prediabetes/diabetes is both prudent and practical in the dental setting. Dental personnel, including trainees, can successfully incorporate enhanced screening methods within their traditional activities. Further, screening tools used in the dental setting might be enhanced by inclusion of certain oral health variables associated with diabetes. These findings add to emerging knowledge on the importance of screening for prediabetes/diabetes in dental settings and have particular relevance and application to institutional practice.

O olhar de usuários, residentes e trabalhadores sobre uma intervenção em saúde bucal de abordagem comunitária na ESFdo campo / Perspective of users, residents and workers on a community-based oral health intervention in the rural FHS

Objetivou-se analisar uma intervenção de cuidado integral em saúde bucal de abordagem comunitária protagonizada por residentes de Odontologia em Saúde da Família inseridos em duas unidades de saúde do campo de Caruaru/PE, segundo o olhar de profissionais, residentes e usuários. A intervenção englobou diagnóstico e levantamento das necessidades odontológicas, ações coletivas em saúde bucal e ações assistenciais para cárie com tratamento restaurador atraumático. Os grupos-alvo formam escolares e moradores de áreas mais remotas nas unidades de Lagoa de Pedra e de Xicuru. O estudo qualitativo utilizou técnica do grupo focal para coleta dos dados. Três grupos foram constituídos: nove profissionais, seis residentes e oito usuários. As entrevistas seguiram um roteiro com perguntas abertas sobre o cuidado e as tecnologias em saúde bucal empregadas no contexto das populações campesinas e acesso/acessibilidade às unidades de saúde. Os dados foram submetidos à análise de conteúdo. Emergiram duas categorias temáticas: dificuldades de acesso aos cuidados em saúde bucal e satisfação com as ações implementadas. Os participantes dos três grupos avaliaram positivamente a iniciativa de estabelecer relação educativa/assistencial participativa abrindo-se a espaços comunitários e valorizaram o enfoque adotado pela intervenção de saúde bucal no enfrentamento dos problemas limitadores do acesso aos serviços odontológicos e às ações coletivas que relataram. Contudo, desinteresse na continuidade das ações realizadas e contrários às práticas comunitárias em saúde bucal foram relatadas no grupo focal dos profissionais. Considera-se persistir fatores profissionais e de estrutura limitadores à garantia dos direitos de acesso à saúde aos usuários de áreas mais remotas às unidades de saúde (AU).

The aimof this study was to analyze a comprehensivecommunity-basedoral health care intervention carried out by residents of Dentistry in Family Health inserted in two health units in the rural area of the municipalityof Caruaru/PE, according to the perspective of professionals, residents and users. The intervention included diagnosis and assessment of dental needs, collective actions in oral health and actions for caries treatment with atraumatic restorative treatment. Target groupswere composed of schoolchildren and users frommore remote areas included in the health units of Lagoa de Pedra and Xicuru. The qualitative study used the focus group technique for data collection. Three groups were formed: nine professionals, six residents and eight users. Interviews followed a script with open questions about oral health care and technologies used in the context of ruralpopulations and access/accessibility to health units. Data were submitted to content analysis. Two thematic categories emerged: difficulties in accessing oral health care and satisfaction with implemented actions. Participants in the three groups positively evaluated the initiative ofestablishinga participatory educational/care relationship by opening up to community spaces and valued the approach adopted by the oral health intervention in dealing with problems that limit access to dental services and the reported collective actions. However, lack of interest in the continuity of actions carried out and contrary to community practices in oral health were reported in the focus group of professionals. There ispersistent presence of professional and structural factors that limit the guarantee of access to health ofusers frommore remote areas included inhealth units.

Patterns of Paediatric Dental Treatment Under General Anaesthesia: A Retrospective Study

ABSTRACT@#This retrospective study aimed to evaluate patterns of comprehensive dental treatment under general anaesthesia (GA) for healthy children in Universiti Teknologi MARA, Malaysia. The treatment records of healthy paediatric patients who received dental treatment under GA from February 2017 to January 2021 were reviewed. The patients were divided into two groups: (1) less than 6 years old and (2) 6 to 16 years old. Patients’ characteristics were summarised using descriptive statistics while an independent t-test was applied to investigate the influence of “age group” on treatment duration, number of procedures and use of various restorative materials. A total of 125 paediatric patients (67 boys and 58 girls) were included. The patients’ mean age at the time they underwent GA was 5.77 ± 1.94 years old and the average duration of dental treatment was 62.58 minutes. There was a significant difference in the duration of treatment between the two age groups (p < 0.05). Tooth extraction was the most dental procedure performed (63.31%). The 6 to 16 years old group had a significantly shorter treatment duration (p < 0.05). However, no significant differences were found in all procedures (extraction, restoration, preventive and pulp therapy) and the utilisation of composite, glass ionomer cement (GIC) and compomer in both groups. The use of stainless steel crown (SSC) restorations was significantly higher in the less than six years old group (p < 0.05). Most of the dental procedures performed under GA on healthy children were extraction procedures. Children less than six years of old had a longer treatment duration under GA. Composite restorations and SSC were more frequently used in primary dentition.

Superación profesional del tecnólogo sobre el protocolo de bioseguridad en Estomatología en tiempos de COVID-19 / Professional improvement of the technologist on the biosafety protocol in Dentistry in times of COVID-19

RESUMEN Fundamento: los altos niveles de propagación y contagio del SARS-CoV-2 han impuesto modificaciones a los protocolos de bioseguridad en Estomatología; de aquí la necesidad de identificar tales cambios y diagnosticar la preparación del tecnólogo de atención estomatológica para su aplicación. Objetivo: identificar las necesidades de superación profesional del tecnólogo sobre el protocolo de bioseguridad en Estomatología en tiempos de COVID-19. Métodos: se realizó un estudio descriptivo en las clínicas estomatológicas de las áreas de salud del municipio Santa Clara durante el mes de febrero de 2021. Se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción: para los referentes teóricos del tema y empíricos: análisis documental, cuestionario y observación. Resultados: más del 50 % de los tecnólogos tenían un nivel medio de conocimientos sobre el protocolo de bioseguridad; una vez identificadas las necesidades de superación estas se agruparon en 10 indicadores o temas a desarrollar en las diferentes formas del posgrado. En la formación del tecnólogo en atención estomatológica, por su naturaleza clínica, los cursos usualmente son presenciales y prácticos; sin embargo, para esta experiencia y a tenor de las condiciones generadas por la pandemia, se propuso incluir algunas actividades virtuales que promovieron el uso de recursos digitales, a fin de que fueran interactivas y motivaran al estudiante a realizarlas. Conclusiones: emergieron carencias que evidenciaron la necesidad de superación de los tecnólogos en atención estomatológica dadas en lo fundamental por los cambios en los protocolos de bioseguridad y las dificultades detectadas en su cumplimento.

ABSTRACT Background: the high levels of spreading and contagion of SARS-CoV-2 have imposed modifications to biosafety protocols in Stomatology; hence the need to identify such changes and diagnose the preparation of the dental care technologist for their application. Objective: to identify the professional improvement needs of the technologist on the biosafety protocol in Dentistry in times of COVID-19. Methods: a descriptive study was carried out in the Dentistry clinics of the health areas of the Santa Clara municipality during the month of February 2021. Theoretical methods were used: analysis-synthesis and induction-deduction: for the theoretical references of the subject and empirical ones: documentary analysis, questionnaire and observation. Results: more than 50% of the technologists had an average level of knowledge about the biosafety protocol; once the needs for improvement were identified, these were grouped into 10 indicators or topics to be developed in the different forms of the postgraduate course. In the training of the technologist in dental care, due to its clinical nature, the courses are usually face-to-face and practical; however, for this experience and in light of the conditions generated by the pandemic, it was proposed to include some virtual activities that promoted the use of electronic resources, so that they were interactive and motivated the student to carry them out. Conclusions: shortcomings emerged that evidenced the need for overcoming technologists in dental care, mainly due to the changes in biosafety protocols and the difficulties detected in their compliance.

Etnografía sobre el dolor dental en población Pijao de Ortega, Tolima / Ethnography on dental pain in Pijao population in Ortega, Tolima

RESUMEN Introducción: desde una mirada biológica, el dolor dental es un síntoma que indica daño en la pulpa dental. Sin embargo, desde una perspectiva centrada en el ser humano, se considera un proceso en donde se expresan elementos sustanciales de la cultura de la salud; en particular, las representaciones simbólicas sobre la boca y los dientes, y las diferentes estrategias que utiliza la población para solventar esta dolencia. El objetivo comprender la manera en que la población Pijao entiende y atiende sus dolores dentales. Método: estudio etnográfico. Uso de herramientas como análisis documental, observación participante, entrevistas semi-estructuradas y diario de campo. Resultados: este dolor es común en la población, y se relaciona con la presencia de caries dental e indica el inicio de la pérdida dental. La manera en que se entiende y atiende se relaciona con las representaciones simbólicas sobre la boca y los dientes, y sobre sus enfermedades y su atención. Su tratamiento inicial se da en el ámbito familiar a través de recursos herbolarios y farmacéuticos. Debido a su intensidad, las personas acuden a la atención odontológica por su eficacia terapéutica. Es el principal motivo de consulta odontológica. Conclusiones: el dolor dental es un proceso en donde los sujetos instituyen una conciencia sobre su cuerpo. Igualmente, indica malas condiciones de salud bucal, dificultades en la implementación de políticas de Atención Primaria en Salud Bucal, y la existencia de barreras económicas y culturales de acceso a las instituciones sanitarias.

Abstract Introduction: from a biological perspective, dental pain is a symptom that indicates damage to the dental pulp. Nevertheless, from a human-centered perspective, it is considered a process where substantial elements of the health culture are expressed, in this case, the symbolic representations about the mouth and teeth, and the different strategies that the population uses to solve this ailment. The objective was to understand the way in which the Pijao population understands and cares about their dental pain Method: ethnographic study. Use of tools such as documentary analysis, participant observation, semi-structured interviews and field diary. Results: this kind of pain is common in the population, and is related to the presence of dental caries, and indicates the appearance of dental loss. Furthermore, the way in which it is understood and cared for is related to the symbolic representations about the mouth and teeth, and about their diseases and their care. Its initial treatment is given to the family through herbal and pharmaceutical resources. Considering its intensity, people turn to dental care for its therapeutic efficacy. This is the main reason to visit the dentist. Conclusions: dental pain is a process where subjects establish an awareness of their body. Likewise, it indicates poor oral health conditions, difficulties in the implementation of policies for Primary Oral Health Care, and the existence of economic and cultural barriers to access to health institutions.

Perceptions of a comprehensive dental care teaching clinic among stakeholders in a dental teaching hospital in South India: A baseline assessment.

BACKGROUND: When the dentist starts practicing independently, they need to plan and treat comprehensively and prioritise the procedures accordingly. This contrasts with dental students learning years where they deal with only a clinical subject during a fixed period. To improve this scenario a comprehensive dental care teaching clinic was introduced, and baseline assessment was performed. METHODS: The perceptions of patients, dental undergraduate students, clinical instructors, and clinic co-ordinators regarding Comprehensive Dental Care was evaluated by a cross sectional survey. The questionnaire was developed through a focus group discussion and content validation was performed by experts. Three domains including orientation to the clinics, clinical training of undergraduates and clinic management were assessed. Descriptive statistics were performed using SPSS. RESULTS: The results reveal, 53.5% of undergraduate students and 61.3% of clinic instructors agreeing that students trained under comprehensive system can confidently manage patients independently. Good collaboration (80%) among the dental team and regular monitoring of the clinic management (80%) were reported by clinic co-ordinators. The challenges ahead for this teaching clinic includes instrument and facilities availability, which has found to higher disagreement percentages by undergraduate students (43.7%), clinic instructors (38.7%) as well as clinic co-ordinators (50%). Patient satisfaction for all three domains were noted to be high. CONCLUSION: With the introduction of the comprehensive dental care teaching clinic better patient management and improved clinical training of undergraduate students were reported by the stakeholders. This new system is a major shift in dental service delivery and can be adopted to similar settings to improve patient care and dental education.

Aspects of dental care for patients hospitalized in a medical clinic from a university hospital / Aspectos da assistência odontológica a pacientes internados em clínica médica de um hospital universitário

INTRODUCTION: The current context of multiprofessional approach in health is based on quality of care and patient safety, with the key contribution of the dentist in the hospital team to improve the health of hospitalized patients. OBJECTIVE: To characterize the systemic and buccal profile of patients treated in a medical clinic of a University Hospital from the Brazilian Public Health System, aiming to provide information for guiding dental care in the multidisciplinary attendance in the hospital setting. METHODS: Retrospective observational study carried out on 104 clinical records with data collection about general characteristics, systemic alterations, habits, oral situation and dental treatments of hospitalized patients attended by the dentist. RESULTS: There was a high frequency of hypertensive patients (36.5%) and with cardiac problems (33.6%). A significant association between diabetes (60%) and hypertension (50%) in the age group from 60 to 75 years of age was observed. For most patients, the frequency of oral hygiene was less than three times a day (54.3%), without flossing (85.7%). Biofilm (73.3%), dental calculus (70.5%), prosthesis use (25.7%), with poor hygiene (14.3%) and prosthetic stomatitis (8.6%) were recorded. Among the treatments performed by dentist, basic periodontal therapy (71.4%) and exodontia (39%) were noteworthy. CONCLUSION: The high frequency of biofilm presence, dental calculus, prosthesis with poor hygiene and basic periodontal therapy performed during the hospitalization denote the need for dental care with preventive activities.

INTRODUÇÃO: O contexto atual de abordagem multiprofissional em saúde fundamenta-se na qualidade do atendimento e segurança ao paciente, com contribuição importante do cirurgião-dentista na equipe hospitalar para melhoria de saúde dos hospitalizados. OBJETIVO: Caracterizar o perfil sistêmico e bucal de pacientes atendidos em clínica médica de um Hospital Universitário do Sistema de Saúde Pública do Brasil, visando fornecer subsídios no direcionamento da assistência odontológica ao atendimento multidisciplinar em âmbito hospitalar. MÉTODOS: Foi realizado estudo observacional retrospectivo em 104 fichas clínicas com coleta de dados sobre características gerais, alterações sistêmicas, hábitos, situação bucal e tratamentos odontológicos de pacientes internados, atendidos pelo odontólogo. RESULTADOS: Verificou-se alta frequência de pacientes hipertensos (36,5%) e com problemas cardíacos (33,6%). Observou-se associação significativa de diabetes (60%) e hipertensão (50%) na faixa etária de 60 a 75 anos de idade. Para a maioria dos pacientes, a higiene bucal foi realizada menos que três vezes ao dia (54,3%), sem uso de fio dental (85,7%). Biofilme (73,3%), cálculo dental (70,5%), uso de próteses (25,7%), com higiene deficiente (14,3%), e estomatite protética (8,6%) foram registradas. Dentre os tratamentos realizados, destacam-se a terapia básica periodontal (71,4%) e exodontias (39%). CONCLUSÃO: A alta frequência de presença de biofilme, cálculo dental, próteses com higiene deficiente e a terapia básica periodontal executada durante o período de internação denotam a necessidade de atuação odontológica com atividades preventivas.

Assessment of Patient Satisfaction Level to Dental Health Care Services in Indonesia

Abstract Objective: To know the level of patient satisfaction with dental healthcare services in Bantaeng, Indonesia. Material and Methods: This pilot pathfinder survey was conducted at Dental and Oral Health Services in Bantaeng and Pa'jukukang Sub-districts of Bantaeng Regency of South Sulawesi Indonesia. The Short-Form Patient Satisfaction Questionnaire (PSQ-18) scaled was used and it consists of 18 questions and seven subscales. The t-test and ANOVA were used with a significance level set at 5% (p<0.05). Results: The female participation (72.8%) was greater than the male (27.2). Regarding age, 74.6% were <40 years, 21.1% were between 40-60 years old and 4.4% were over 60 years old. On the subscale of technical quality, there was significant value in the age variable (p=0.45), education level (p=0.031), job (p=0.026), waiting time (p=0.46), distance to dentist=0.026), and location (p=0.007). There were significant values on the interpersonal aspect subscale that were present at age (p=0.016), education level (p=0.038), and occupation (p=0.007). The highest satisfaction score was found on the technical quality subscale (13.04 ± 1.75) and the lowest satisfaction score was seen on the general satisfaction subscale (4.11 ± 1.75). There was a significant difference between the value of patient satisfaction with age, education, and occupation. Conclusion: Patients from the District Bantaeng and Pa'jukukang Bantaeng regency of South Sulawesi were more satisfied with the service provided. The highest satisfaction score was found on the technical quality subscale and the lowest satisfaction score was found in the general satisfaction subscale (AU).

Ferramenta digital para organização da logística dos atendimentos nas clínicas da Faculdade de Odontologia da UFRJ / Digital tool for the organization of the logistics of dental care at the dental school of UFRJ

A logística de atendimentos nas clínicas odontológicas da FO-UFRJ é baseada no ensino do aluno de graduação por meio de disciplinas teórico-práticas que visam a formação integral dos futuros cirurgiões-dentistas. Durante o processo prático da educação verifica-se a interação entre três usuários com diferentes papéis na dinâmica dos atendimentos clínicos: alunos, pacientes e professores. Por meio da observação da rotina clínica o objetivo desse estudo foi organizar e otimizar a logística dos atendimentos da FO-UFRJ, na tentativa de humanizar o atendimento oferecido. Com o foco na percepção dos pacientes sobre os benefícios recebidos, foi desenvolvido um aplicativo web (AppClin), baseado na metodologia do Design Thinking, com funções individualizadas para cada usuário. Estimou-se que o benefício para o paciente será sua participação efetiva durante o atendimento odontológico, ao ter acesso ao seu plano de tratamento, à visualização de agendamentos futuros e à avaliação do serviço recebido. Para o aluno, o App poderá proporcionar o estreitamento da relação paciente/profissional, aprimorando seu aprendizado e desenvolvimento como cirurgião-dentista, além de possibilitar o acompanhamento da sua produção clínica nas disciplinas e, também, facilitar o gerenciamento das consultas. Para o professor, a função de supervisionar os atendimentos na clínica, tanto individualmente por aluno ou no conjunto da turma, poderá ser acessível, a partir dos relatórios de dados de produção clínica e de satisfação do paciente, ambos gerados em cada atendimento. (AU)

The logistic of dental care at FO-UFRJ is based on the instruction of undergraduation students through theoretical-practical disciplines aiming the whole formation process of the future dentists. During the pratice of education process, the interaction between three users is verified with differents role in the dynamic of the clinical care: students, patients and professors. Based on the observation of the clinical routine, the objective of this study was to organize and optimize the logistics of dental care at FO-UFRJ, aiming to humanize the clinical care offered. With the focus on the perception of patients about the benefits received, a web app was developed (AppClin), based on design thinking methodology, containing individual functions for each user. The benefits for the patient will be the effective participation during the dental care with the access of his treatment plan, the checking of future schedules and the evaluating of the service received. For the student, the app provide a closer patient/professional relationship, improving the learning and their growth as a dentist, allowing him to monitore his clinical production and the management of the dental care. For the professor, the function of supervising the dental care in the clinics is available, either individually per student or by the whole class, throughout the student´s clinical production and the patient satisfaction data reported, both generated in each clinical attendances. (AU)

Curative procedures of oral health and structural characteristics of primary dental care

ABSTRACT OBJECTIVE To evaluate if the provision of clinical dental care, by means of the main curative procedures recommended in Primary Health Care, is associated with team structural characteristics, considering the presence of a minimum set of equipment, instrument, and supplies in Brazil's primary health care services. METHODS A cross-sectional exploratory study based on data collected from 18,114 primary healthcare services with dental health teams in Brazil, in 2014. The outcome was created from the confirmation of five clinical procedures performed by the dentist, accounting for the presence of minimum equipment, instrument, and supplies to carry them out. Covariables were related to structural characteristics. Poisson regression with robust variance was used to obtain crude and adjusted prevalence ratios, with 95% confidence intervals. RESULTS A total of 1,190 (6.5%) dental health teams did not present the minimum equipment to provide clinical dental care and only 2,498 (14.8%) had all the instrument and supplies needed and provided the five curative procedures assessed. There was a positive association between the outcome and the composition of dental health teams, higher workload, performing analysis of health condition, and monitoring of oral health indicators. Additionally, the dental health teams that planned and programmed oral health actions with the primary care team monthly provided the procedures more frequently. Dentists with better employment status, career plans, graduation in public health or those who underwent permanent education activities provided the procedures more frequently. CONCLUSIONS A relevant number of Primary Health Care services did not have the infrastructure to provide clinical dental care. However, better results were found in dental health teams with oral health technicians, with higher workload and that plan their activities, as well as in those that employed dentists with better working relationships, who had dentists with degrees in public health and who underwent permanent education activities.

Development and Testing of a Cognitive Behavioral Therapy Resource for Children's Dental Anxiety.

Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for dental anxiety; however, access to therapy is limited. The current study aimed to develop a self-help CBT resource for reducing dental anxiety in children, and to assess the feasibility of conducting a trial to evaluate the treatment efficacy and cost-effectiveness of such an intervention. A mixed methods design was employed. Within phase 1, a qualitative "person-based" approach informed the development of the self-help CBT resource. This also employed guidelines for the development and evaluation of complex interventions. Within phase 2, children, aged between 9 and 16 y, who had elevated self-reported dental anxiety and were attending a community dental service or dental hospital, were invited to use the CBT resource. Children completed questionnaires, which assessed their dental anxiety and health-related quality of life (HRQoL) prior to and following their use of the resource. Recruitment and completion rates were recorded. Acceptability of the CBT resource was explored using interviews and focus groups with children, parents/carers and dental professionals. For this analysis, the authors adhered to the Mixed Methods Appraisal Tool criteria. There were 24 families and 25 dental professionals participating in the development and qualitative evaluation of the CBT resource for children with dental anxiety. A total of 56 children agreed to trial the CBT resource (66% response rate) and 48 of these children completed the study (86% completion rate). There was a significant reduction in dental anxiety (mean score difference = 7.7, t = 7.9, df = 45, P < 0.001, Cohen's d ES = 1.2) and an increase in HRQoL following the use of the CBT resource (mean score difference = -0.03, t = 2.14, df = 46, P < 0.05, Cohen's d ES = 0.3). The self-help approach had high levels of acceptability to stakeholders. These findings provide preliminary evidence for the effectiveness and acceptability of the resource in reducing dental anxiety in children and support the further evaluation of this approach in a randomized control trial. Knowledge Transfer Statement: This study details the development of a guided self-help Cognitive Behavioral Therapy resource for the management of dental anxiety in children and provides preliminary evidence for the feasibility and acceptability of this approach with children aged between 9 and 16 y. The results of this study will inform the design of a definitive trial to examine the treatment- and cost-effectiveness of the resource for reducing dental anxiety in children.

Randomized Controlled Trial of Postoperative Sensitivity with Warm and Room Temperature Composite.

Physical properties of composite improve when it is preheated prior to polymerization. However, postoperative sensitivity may be considered a potential complication. A review of the literature revealed no reported randomized controlled trials (RCTs) of postoperative sensitivity when using preheated composite resin. The objective of the study was to determine if preheating composite leads to changes in postoperative sensitivity in a parallel RCT. In total, 120 eligible, consenting adults were recruited in private dental practice and randomized into 2 groups of 60 patients. One group had room temperature composite restorations placed and the second had composite preheated to 39°C. The primary outcome was sensitivity after 24 h by the visual analog scale (VAS), recorded blind by patients. Secondary outcomes were VAS scores recorded over a month. Blind statistical analysis used the Mann-Whitney U test to compare the 24-h VAS score between groups and repeated-measures analysis of variance to assess the change over time. Potential confounders were tested using regression models. A total of 115 patients completed the trial: 57 in the heated composite group and 58 in the room temperature group. Analysis of 24-h VAS scores found no statistically significant difference between the 2 groups ( P = 0.162). Examining the potential confounders confirmed the nonsignificant difference between heated and room temperature groups on the 24-h VAS score, after controlling teeth type and preoperative pulp test (effect size = 0.173, P = 0.317). Analysis of the secondary outcomes found significant changes (within-subject effect) in VAS scores over the review period ( F statistic = 4.7, P = 0.002) but not a significant (between-subject effect) difference between heated and room temperature groups over time (effect size = 0.102, P = 0.197). There was a significant correlation between preoperative VAS score and postoperative VAS score ( P < 0.001). For the restorations in this study, there was no detectable difference in postoperative VAS score between preheated and room temperature composite. Postoperative sensitivity decreased throughout the first month. Postoperative sensitivity was correlated to preoperative sensitivity (ISRCTN 76727312). Knowledge Transfer Statement: The results of this study can be used by clinicians when considering the advantages and disadvantages of preheated composite. The study found no evidence of any change in postoperative sensitivity when using preheated composite. Since preheated composite has superior physical properties, its use for routine care can be considered good practice.

Planning oral health and clinical discharge in primary care: the comprehensive dental care protocol outcome.

INTRODUCTION: The dental care must be driven by preventive and curative measures that can contribute to the population's oral health promotion. OBJECTIVE: To evaluate the impact of the actions proposed by a comprehensive dental care protocol (CDCP) on the oral health condition of primary care users. MATERIALS AND METHODS: The sample consisted of 32 volunteers, assisted throughout the six phases proposed by the CDCP: diagnosis of dental needs; resolution of urgencies; restorative interventions; application of promotional measures; evaluation of the achieved health level; and periodic controls. Data were collected through clinical exams, which measured the simplified oral hygiene index (OHI-S), gingival bleeding index (GBI) and the decayed, missing and filled teeth (DMFT) Index, before and after the CDCP was implemented. Statistical analysis consisted of the Wilcoxon test, at 5% significance level (α = 0.05). RESULTS: The OHI-S and GBI indices showed a significant reduction (p < 0.05) from the initial (1.4 ± 0.6 and 46.3 ± 19.9) to final condition (0.9 ± 0.3 and 21.5 ± 7.5). The decayed, missing and filled teeth and the missing teeth component were not significantly altered (p > 0.05), showing final values equal to 12.7 ± 9.6 and 5.6 ± 7.8, respectively. Decayed elements were fully converted into filled elements, and the final values of the decayed and filled elements were, respectively, 0.0 ± 0.0 and 7.3 ± 5.7 (p < 0.05). CONCLUSIONS: The enactment of the CDCP had a beneficial effect on the oral health of the population assisted by the dental services offered in primary care and this protocol seems to ft the public dental service demands. CLINICAL SIGNIFICANCE: The CDCP can be useful to public dental service planning since it showed an efficient clinical outcome to the patients. We consider that this protocol should be employed in primary care oral health services in order to achieve overall upgrade, access enlargement and public oral health promotion.