Legislation in Hospital Dentistry: Gaps, Perspectives and Desires

Abstract Objective: To analyze the existing state legislation, including not only the ordinary laws, but also their infralegal regulation and the state legislation on Hospital Dentistry. Material and Methods: A survey was carried out in the databases of the Legislative Assemblies of the Brazilian States and the Federal District, as well as the Regional and Federal Councils of Dentistry in Brazil. Subsequently, a survey was carried out in the databases of the Ministry of Health, State Dental Councils and Federal Dental Council in Brazil. Results: Only 8 Brazilian states have legislation in force regarding hospital dentistry, which represents 29.63% of the federative units. Among the Brazilian regions, the Midwest presented the highest prevalence of the laws found (37.50%), followed by the North (25%) and the other regions with the same coverage (12.50%). Also, an orientation and an ordinance from the Ministry of Health, six resolutions from the Federal Council of Dentistry, and a technical note from the National Health Surveillance Agency were found. Conclusion: Several States do not have rules on the subject, making it imperative to create a federal rule that not only imposes the presence of the dentist, but also regulates the proportion of the team, workload, and availability.

Retrospective study to determine the change in referral pattern to St George's Hospital Orthodontic Department before and after the 2006 NHS Dental Contract changes.

AIM: The aim of this study was to determine the possible effects of the 2006 National Health Service General Dental Services contract changes on the referral pattern to the orthodontic department at St George's Hospital, South West London. METHOD: This study was carried out on a retrospective basis. The notes of consecutive patients referred between 1st May and 30th September in 2005 and 2008 were assessed, and the patient's Index of Orthodontic Treatment Need (IOTN) and the source of referral noted. RESULTS: The total numbers of referrals increased from 260 in 2005 to 405 in 2008. The number of referrals from general dental practitioners decreased slightly from 165 to 156, as did the numbers of referrals from other sources, such as tertiary referrals. The number of referrals made by specialist practitioners increased from 41 in 2005 to 207 in 2008, representing an increase from 16% to 51% of overall referrals. Overall, the number of patients being referred with an IOTN dental health component grade of 5 increased from 27% to 55%. CONCLUSION: The increase in referrals from specialist practitioners may be partly due to the changes brought to the commissioning of orthodontic services for specialist practitioners. Overall, the number of cases being referred with IOTN grades 4 and 5 remains high at St George's Hospital, indicating that appropriate referrals are being made.

[Third molar surgery under general anesthesia: a review of 180 patients]. / Extraction des dents de sagesse sous anesthésie générale : à propos de 180 patients.

BACKGROUND: Third molar surgery is an important part of the activity in a maxillofacial surgery department. This common activity is often under-evaluated by patients who forget its surgical aspect. The aim of this study was to evaluate our practice, and especially complications, with special consideration given to medicolegal aspects. MATERIALS AND METHODS: All the patients operated between September 2004 and July 2006 were enrolled in a retrospective study. This population is described, with the indications, follow-up, and complications. RESULTS: One hundred and eighty patients were reviewed (sex-ratio 1, mean age 27 years). The most frequent indications were impaction and pain. The mean duration of hospitalization was 1.7 days and temporary disability, one week. Local infection occurred in 8%; there was neurological complication in 2% for the inferior alveolar nerve, and 1% for the lingual nerve. These were all transient cases. DISCUSSION: Third molar surgery is an important and profitable part of the activity in a maxillofacial surgery department. Standardized information is necessary even if the rate of complications remains low.

The provision of general anaesthesia in dental practice, an end which had to come?

31 December 2001 was the final day on which a general anaesthetic could be given in a dental practice in UK. Henceforth all dental treatment requiring a general anaesthetic will have to take place in a hospital setting, which has immediate access to critical care facilities. This will mark the end of the association between dental practice and general anaesthesia which dates back to the very first recorded clinical procedure performed under general anaesthesia, when in 1844, Horace Wells an American dentist, had a tooth removed by his assistant using nitrous oxide in Hartford, Connecticut, USA.

EMTALA: impact on hospital dentistry emergency services.

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospital-based dental residency programs and hospital dentists to meet Federal standards when patients come to a hospital emergency department and need emergency dental services. EMTALA (42 U.S.C. 1395dd) has three key provisions which must be understood because of its impact on hospital emergency dental services: Medical Screening Requirements, Necessary Stabilizing Treatment for Emergency Medical Conditions, and Restricting Transfers Until the Individual is Stabilized. This article reviews the relevant Federal statutes, codes of Federal regulation, and published court cases to help practitioners understand the issues. An understanding of the informed consent process, including the "informed refusal" doctrine, as well as the dentist's obligation when patients refuse recommended diagnostic tests, treatment, or transfer, is important. Immunity for failure to obtain informed consent is sometimes appropriate under state law. Under EMTALA, the term "physician" applies to dentists. Recent changes clarify distinctions between the terms "on campus" and "off campus" related to hospital property emanating from the "Ravenswood" tragedy. Hospital dentists must be familiar with these requirements when caring for patients seeking emergency services.

Storage of orthodontic study models in hospital units in the U.K.

Orthodontic study models form an essential part of the dental records of patients undergoing diagnosis and treatment. In order to ascertain the problems encountered by hospital orthodontic units in the utilization and storage of study models, a questionnaire was circulated in February 1991 to members of the Consultant Orthodontists Group. All respondents took pretreatment study models, while 9 per cent took their final study models at some time other than the end of active treatment; 85.5 per cent of respondents stored their study models in their units, but most were beginning to experience difficulties in this regard. There was a wide range for storage times, and only 10 per cent of employing authorities had a stated policy on the storage of study models. There was a highly significant difference (P much less than 0.001) between the time that models are stored at present, and the desired storage times. Most respondents appeared to be rather uncertain about the precise medico-legal requirements concerning model storage. The implications for audit and medico-legal matters are discussed in the light of these findings.

HIV-testing of dental students and faculty: benefits, detriment and implications.

Many medical and legal problems have been raised by the acquired immunodeficiency disease. While there is a large volume of literature which addresses these problems, scant attention has been paid to problems which arise when health care faculty and students are affected by this disease. Some health care administrators have discussed the propriety the routine testing of faculty and students for HIV disease, especially when invasive procedures are involved: This article discusses some of the legal issues which attend routine HIV testing in this context. Arguments for and against routine testing are presented. In addition, routine testing is distinguished from targeted testing in response to the reasonable belief that a health care worker is HIV-positive. It is argued that routine testing of health care workers is legally unwarranted. There are arguments, however, that testing of those believed to be HIV-positive is legally sound. Targeted HIV testing may be especially useful and permissible when the worker performs invasive procedures.