Patients' perspectives on the use of artificial intelligence in dentistry: a regional survey.

The use of artificial intelligence (AI) in dentistry is rapidly evolving and could play a major role in a variety of dental fields. This study assessed patients' perceptions and expectations regarding AI use in dentistry. An 18-item questionnaire survey focused on demographics, expectancy, accountability, trust, interaction, advantages and disadvantages was responded to by 330 patients; 265 completed questionnaires were included in this study. Frequencies and differences between age groups were analysed using a two-sided chi-squared or Fisher's exact tests with Monte Carlo approximation. Patients' perceived top three disadvantages of AI use in dentistry were (1) the impact on workforce needs (37.7%), (2) new challenges on doctor-patient relationships (36.2%) and (3) increased dental care costs (31.7%). Major expected advantages were improved diagnostic confidence (60.8%), time reduction (48.3%) and more personalised and evidencebased disease management (43.0%). Most patients expected AI to be part of the dental workflow in 1-5 (42.3%) or 5-10 (46.8%) years. Older patients (> 35 years) expected higher AI performance standards than younger patients (18-35 years) (p < 0.05). Overall, patients showed a positive attitude towards AI in dentistry. Understanding patients' perceptions may allow professionals to shape AI-driven dentistry in the future.

[Innovative methods and developments in oral care. 3D planning in oral and maxillofacial surgery]. / Serie: Innovatieve technieken en ontwikkelingen in de mondzorg. 3D-planning in de mka-chirurgie.

With the use of cone beam computed tomography, intraoral scanning and 3D stereophotogrammetry, a virtual 3D head model of a patient can be reconstructed with image fusion. In this way, the malposition, deficiency and other anomalies at the level of bone, dentition and soft tissue can be quantified objectively. The desired position of the dentition, occlusion and soft tissue in the facial profile can be virtually drawn in and used as a guideline for treatment planning. Based on the principle of backward planning, it is possible to determine what repositioning of the jaw is required, where there is a need for bone augmentation and how many dental implants are necessary to obtain the desired treatment outcome. From this perspective, 3D treatment planning has become a treatment standard for the 4 clinical pillars supporting oral and maxillofacial surgery, specifically orthognathic surgery, implantology, craniofacial surgery and head & neck oncology. 3D planning has influenced today's workflow, planning of complex surgery and contributed to useful further innovations and efficient healthcare.

Série temporal da produção odontológica no Sistema Único de Saúde, Brasil, 2008-2018 / Serie temporal de producción dental en el Sistema Único de Salud de Brasil, 2008-2018 / Time series of the production of dental procedures in the Brazilian National Health System, Brazil, 2008-2018

Objetivo: Analisar a realização de procedimentos odontológicos pelo Sistema Único de Saúde (SUS), no Brasil e suas regiões geopolíticas, entre 2008 e 2018. Métodos: Estudo de série temporal, com dados do Sistema de Informações Ambulatoriais dos SUS. Foram calculadas taxas anuais de procedimentos odontológicos (por 100 mil habitantes), globais e por categorias de procedimentos e regiões. Utilizou-se a regressão de Prais-Winsten para analisar as tendências temporais e foram calculadas variações percentuais anuais (VPA). Resultados: Tendências decrescentes foram encontradas para o Brasil, em ações coletivas (VPA= -13,5%; IC95% -21,1;-5,2), ações preventivas individuais (VPA= -6,2%; - IC95% -7,7;-4,8), restaurações (VPA= -7,3%; IC95% -10,5;-3,9) e exodontias (VPA= -6,9; IC95% -10,5;-3,1). Endodontia e periodontia apresentaram tendências estacionárias para a maioria das regiões e o Brasil. Procedimentos protéticos apresentaram tendência ascendente em todas as regiões e no Brasil (VPA= 16,9%; IC95% 9,1;25,2). Conclusão: A produção odontológica no SUS apresentou decréscimo no período 2008-2018; à exceção de procedimentos protéticos, cuja produção aumentou.

Objetivo: Analizar el desempeño de procedimientos dentales en el Sistema Único de Salud (SUS) en Brasil y regiones, 2008 - 2018. Métodos: Estudio de series temporales con datos del Sistema de Información Ambulatoria. Se calcularon tasas anuales de procedimientos dentales por 100 mil habitantes, globales y según categorías de procedimientos y regiones brasileñas de 2008 a 2018. Se utilizó la regresión de Prais-Winsten para analizar tendencias temporales y se calcularon los cambios porcentuales anuales. Resultados: Hubo tendencia decreciente en Brasil para acciones colectivas -13,5%; IC95% -21,1;-5,2), acciones preventivas individuales (-6,2%; IC95% -7,7;-4,8), restauraciones (-7,3%; IC95% -10,5;-3,9) y extracciones (-6,9; IC95% -10,5;-3,1%). Endodoncia y periodoncia mostraron tendencias estacionarias para la mayoría de las regiones y Brasil. Procedimientos protésicos mostraron tendencia ascendente en todas las regiones y Brasil (16,9%; IC95% 9,1;25,2). Conclusión: La producción dental en el SUS disminuyó entre 2008 y 2018, a excepción de los procedimientos protésicos cuya producción aumentó.

Objective: To analyze dental procedures provided by the Brazilian National Health System (SUS) in Brazil and its macro-regions, between 2008 and 2018. Methods: This was a time series study using data from SUS Outpatient Information System. Annual and overall rates of dental procedures (per 100,000 inhabitants), according to the categories of dental procedures and regions were calculated. Prais-Winsten regression was used to analyze time trends, while annual percentage change (APC) was calculated. Results: Decreasing trends were found in Brazil, in collective measures (APC= -13.5%; 95%CI -21.1;-5.2), individual preventive measures (APC= -6.2%; 95%CI -7.7;-4.8), dental restoration (APC= -7.3%; 95%CI -10.5;-3.9) and tooth extraction procedures (APC= -6.9; 95%CI -10,5;-3,1). Endodontics and periodontics showed stationary trend in most regions and Brazil. Prosthetic procedures showed an upward trend in all regions and Brazil (APC= 16.9%; 95%CI 9.1;25.2). Conclusion: Dental procedures in the SUS decreased between 2008-2018; with the exception of prosthetic procedures, which showed a rising trend.

Dental Trauma in Children with Autistic Disorder: A Retrospective Study.

BACKGROUND: The oral health care of autistic children is elaborated; they often fail to define dental problems, and a family-centered approach can be useful to improve and intercept these disorders. AIM: To assess the oral status of autistic children, comparing it with no autistic patients. MATERIALS AND METHODS: A retrospective study analyzed the oral health status of 70 children, 35 with autism and 35 without the disorder. Conditions assessed were dental trauma type, periodontal tissue injuries, soft tissue lip injuries, different treatments carried out, associated soft tissue findings and disorders, and the long-term management. All patients (≤15 years of age) were chosen consecutively. RESULTS: Females (57%) suffered more traumatic injuries than males (43%) in the autistic group, whereas males affected by dental trauma (54%) are predominant in the control group. The enamel fracture was the main finding among the dental trauma types in both groups followed by enamel/dentin/pulp fracture (31%), root fracture (11%), and avulsions (3%) in the autistic group and by avulsions (20%), root fracture (11%), and enamel/dentin/pulp fracture (6%) in the control group. The comparison of all variables of the two groups showed a statistically significant difference (P < 0.012). The lower lip was statistically more injured than the upper lip (P < 0.005). CONCLUSIONS: The composite restorative technique was the most common approach carried out; the long-term evaluation, when possible, was predominantly managed through root canal therapy in the control group (81%), and root canal therapy (50%) and tooth extraction (50%) in the sample group.

Dental Therapists in the United States: Health Equity, Advancing.

BACKGROUND: Dental therapists (DTs) are primary care dental providers, used globally, and were introduced in the United States (US) in 2005. DTs have now been adopted in 13 states and several Tribal nations. OBJECTIVES: The objective of this study is to qualitatively examine the drivers and outcomes of the US dental therapy movement through a health equity lens, including community engagement, implementation and dissemination, and access to oral health care. METHODS: The study compiled a comprehensive document library on the dental therapy movement including literature, grant documents, media and press, and gray literature. Key stakeholder interviews were conducted across the spectrum of engagement in the movement. Dedoose software was used for qualitative coding. Themes were assessed within a holistic model of oral health equity. FINDINGS: Health equity is a driving force for dental therapy adoption. Community engagement has been evident in diverse statewide coalitions. National accreditation standards for education programs that can be deployed in 3 years without an advanced degree reduces educational barriers for improving workforce diversity. Safe, high-quality care, improvements in access, and patient acceptability have been well documented for DTs in practice. CONCLUSION: Having firmly taken root politically, the impact of the dental therapy movement in the US, and the long-term health impacts, will depend on the path of implementation and a sustained commitment to the health equity principle.

Trends in Health Care Utilization and Expenditures in the United States Across 5 Decades: 1977-2017.

BACKGROUND: Health care expenditures in the United States are high and rising, with significant increases over the decades. The delivery, organization, and financing of the health care system has evolved over time due to technological innovation, policy changes, patient preferences, altering payment mechanisms, shifting demographics, and other factors. OBJECTIVE: The objective of this study was to examine trends over time in health care utilization and expenditures in the United States. RESEARCH DESIGN: This analysis employs descriptive statistics to examine 5 decades of health care utilization and expenditure data from the Agency for Healthcare Research and Quality (AHRQ) for 1977-2017. MEASURES: Measures include utilization and expenditures (not charges) for inpatient, emergency department, outpatient physician, outpatient nonphysician, office-based physician, dental, and out-of-pocket retail prescription drugs. RESULTS: We demonstrate that while health care expenditures have increased significantly overall and by type of care, utilization trends are less pronounced. The population of the United States grew 53% between 1977 and 2017, while annual total expenditures on health care increased by 208%. Amidst attention to out-of-pocket exposure for unexpected medical care bills, out-of-pocket payments for care have declined from 32% in 1977 to 12% in 2017 but increased in amount. CONCLUSIONS: This article provides the first extended snapshot of the dynamics of health care utilization and expenditures in the United States. Aspects of health care are much different today than in previous decades, yet the inpatient setting still dominates the expenditures.

COVID-19: Exploring the Repercussions on Federally Qualified Health Center Service Delivery and Quality.

The COVID-19 pandemic has brought about a precipitous transformation in health care delivery in the nation's safety-net, primary care system of federally qualified health centers (FQHCs). This study uses electronic health record data to quantify the extent of changes to visit volume in 36 FQHCs across 19 states as well as changes in quality metrics. We found a steep decline in in-person visits in March 2020 accompanied by a sharp increase in telehealth visits; however, combined volume remained 23% below pre-pandemic levels. The implications for public health are significant, as preventive and chronic care deferral could lead to exacerbations of health disparities. Our examination of the impact on quality measures suggests that gaps in care are already emerging. Services that cannot be readily performed virtually are most affected. As FQHC visit numbers recover, concerted efforts are needed to encourage access and re-engage at-risk groups that fell out of care.

Evaluation of Dental Practices Changes During the COVID-19 Pandemic in Brazil.

Dentists are healthcare professionals who are at high risk of infection and transmission of the coronavirus disease-19 (COVID-19). The primary objective of the present study was to evaluate the changes in clinical practice made by Brazilian dentists during the COVID-19 pandemic. From June 22 to July 13, 2020, an online questionnaire was sent to dentists using Google Forms. After providing consent, 1,178 dentists answered questions regarding their knowledge and clinical experiences related to COVID-19. Data were analyzed using Chi-square, Fisher's exact, or Kruskal-Wallis tests, with a significance level of 5%. Brazilian dentists significantly changed their routine dental practices. Biosafety measures were added in their offices by 98% of the dentists, increasing operating costs for 88.3% of dentists. Greater discomfort due to the increase in personal protection equipment (PPE) worn during the pandemic was reported by 58.6%. Furthermore, 84.2% reduced heir hours of service. It was found that the dentists decreased their workload, used additional PPE, and took additional biosafety measures.

Repercussões da epidemia de COVID-19 nos atendimentos odontológicos de urgência do Sistema Único de Saúde em Piracicaba, 2020 / Repercusiones de la epidemia de COVID-19 en la atención odontológica de emergencia del Sistema Único de Salud en Piracicaba, Brasil, 2020 / Repercussions of the COVID-19 epidemic on Brazilian National Health System urgent dental care in Piracicaba, Brazil, 2020

Objetivo: Avaliar as repercussões da pandemia de COVID-19 nos procedimentos realizados por um serviço público odontológico de urgência (SPOU). Métodos: Estudo transversal, utilizando-se dados do SPOU de Piracicaba, SP, Brasil, relativos a dois períodos, anterior (fevereiro e março de 2020) e durante a pandemia (março e abril de 2020). Diferenças no perfil de atendimentos, entre os períodos pré-COVID-19 e COVID-19 selecionados, de acordo com sexo, idade e procedimentos odontológicos, foram analisadas pelo teste qui-quadrado de Pearson. Também foi calculado o tamanho do efeito Cramer's V. Resultados: Houve redução de 51% no número de atendimentos, entre o período anterior (n=824) e o período da pandemia de COVID-19 observado (n=404). O percentual de exodontias reduziu-se, de 14,7 para 8,9%, enquanto o de selamento provisório de cavidades aumentou de 22,9 para 33,2%, entre ambos períodos. Conclusão: A pandemia de COVID-19 repercutiu na quantidade e no padrão de procedimentos realizados pelo serviço odontológico de urgência do município.

Objetivo: Evaluar el impacto de la pandemia COVID-19 en los procedimientos realizados por un servicio de odontología pública de emergencia (SOPE). Métodos: Estudio transversal, utilizando datos del SOPE de Piracicaba, SP, Brasil, para los períodos anteriores (febrero y marzo 2020) y durante la pandemia (marzo y abril 2020). Las diferencias en el perfil de atención entre los períodos Pre-COVID-19 y COVID-19, según sexo, edad y procedimientos dentales, se analizaron mediante la prueba Chi-cuadrado de Pearson. También se calculó el tamaño del efecto de Cramer V. Resultados: Hubo una reducción del 51% en el número de visitas entre el período anterior (n=824) y el período de la pandemia de COVID-19 (n=404). El porcentaje de extracciones se redujo del 14,7% al 8,9%, mientras que el porcentaje de sellado provisional de cavidades aumentó del 22,9% al 33,2%, entre estos períodos. Conclusión: La pandemia de COVID-19 afectó la cantidad y patrón de procedimientos realizados en el servicio de odontología de emergencia de la ciudad.

Objective: To evaluate the repercussions of the COVID-19 pandemic on procedures performed by a public urgent dental care service (PUDS). Methods: This was a cross-sectional study, using data from the PUDS in Piracicaba, SP, Brazil, prior to the pandemic (February-March 2020) and during the pandemic (March-April 2020). Differences in the care profile between the pre-COVID-19 period and the COVID-19 period, according to sex, age and dental procedures were analyzed using Pearson's Chi-square test. Effect size was also measured using Cramer's V. Results: There was a 51% reduction in the number of visits between the pre-COVID-19 period (n=824) and the COVID-19 period (n=404). The percentage of extractions reduced from 14.7% to 8.9%, while the percentage of temporary cavity fillings increased from 22.9% to 33.2%, between the two periods. Conclusion: The COVID-19 pandemic had repercussions on the amount and pattern of procedures performed at the city's urgent dental care service.

Emergency and urgent dental visits among Medicaid enrollees from 2013 to 2017.

BACKGROUND: Better understanding of the frequency of dental emergencies and the procedures performed during those emergency visits can help providers, insurers, and policymakers understand workforce and care provision needs. METHODS: Procedures performed at an emergency dental encounter and in the encounter following that encounter are assessed. Emergency dental encounters are those with a CDT code of D0140, D0160, or D0170. Data was analyzed from the IBM Watson Medicaid Marketscan data from 2013 to 2017, a nationally representative dental and medical claims database from 13 deidentified states in the United States. RESULT: Consistently over time, about 10% of all dental encounters are due to a dental emergency. 28% of emergency dental encounters had no other procedure performed during those encounters. When other procedures were performed during the encounter, the majority were diagnostic in nature, primarily radiographs. Among patients who returned to the dentists following an emergency visit, 43% returned for more definitive dental treatment, most within 30 days. CONCLUSIONS: The majority of dental emergency encounters do not result in definitive treatment, rather patients often return to the dentist at a later date for that treatment. Where possible, dental providers could utilize teledental services to triage patients to appropriate care.

Repercusiones de la pandemia de COVID 19 en la atención odontológica, una perspectiva de los odontólogos clínicos / Implications of COVID-19 pandemic for dental care: a perspective for clinical dentists

RESUMEN: Introducción: La atención odontológica va a cambiar rotundamente debido a la pandemia de COVID-19. En el futuro cobrará mayor importancia, surgirán transformaciones rotundas y necesarias, pero mejorará. Objetivo: Conocer las perspectivas de los odontólogos clínicos peruanos sobre los cambios y repercusiones que tiene y tendrá la pandemia COVID-19 en la atención odontológica. Materiales y métodos: Estudio cualitativo con enfoque fenomenográfico que utilizó la técnica de la entrevista a profundidad a dentistas clínicos en el contexto de la cuarentena en el mes de abril de 2020 en Lima (Perú). La entrevista se efectuó de forma digital y las categorías incluyeron: rol del odontólogo, inconvenientes en la práctica asistencial, soluciones y estrategias frente a la pandemia, apreciaciones sobre las medidas del gobierno, medidas de prevención, atención odontológica en el futuro, y protocolos de atención frente a un paciente con diagnóstico de coronavirus. Resultados: Los odontólogos tienen claro que tanto la indumentaria como los equipos en el consultorio deben estar condicionados a las medidas de protección para proteger tanto al paciente como al personal de salud presente; esto incluye que los ambientes deban estar distanciados, espaciar la atención entre paciente y paciente. Conclusiones: Existe una gran preocupación en los dentistas por el cierre repentino de las clínicas dentales y aumento de personas infectadas, ya que son la primera línea de contagio al tener contacto directo con los pacientes. Los servicios dentales van a tener que adaptarse a los nuevos lineamientos y protocolos dados. Cambiará el modo de atención odontológica priorizando a las urgencias y emergencias, para aminorar la difusión de la enfermedad y lograr una atención más segura y adecuada(AU)

ABSTRACT: Introduction: Dental care is going to change dramatically due to the COVID-19 pandemic. In the future, it will become more important; resounding and necessary changes will emerge, but it will improve for good. Objective: To know the perspectives of Peruvian clinical dentists on the changes and repercussions that the COVID-19 pandemic has and will have in dental care. Materials and methods: Qualitative study with a phenomenographic approach that used the technique of in-depth interview with clinical dentists in the context of quarantine in April 2020 in Lima (Peru). The interview was carried out digitally and the categories included: role of the dentist, inconveniences in healthcare practice, solutions and strategies in the face of the pandemic, insights from government measures, prevention measures, future dental care, and protocols for care in front of a patient diagnosed with coronavirus. Results: Dentists are clear that both clothing and equipment in the office must be subject to protective measures to protect the patient and health personnel present; this includes that environments must be spaced, spacing patient-patient care. Conclusions: There is great concern among dentists over the sudden closure of dental clinics and the increase of infected people since they are on the first line of contagion when having direct contact with patients. Dental services will have to adapt to the new guidelines and protocols given. The way of dental care will change, prioritizing urgencies and emergencies to lessen the spread of the disease and achieve safer and more adequate care(AU)

Developments in oral health care in the Netherlands between 1995 and 2018.

BACKGROUND: Over the past several decades, changes in legislation and regulations have been implemented in oral health care in the Netherlands. In 1995, for example, a major transformation in the funding of oral health care was implemented, after which most oral health care for adults was no longer covered by national insurance. In 1997, the Individual Healthcare Professions Act, in which the authorizations of care providers were described, was established. The Healthcare Quality, Complaints and Disputes Act, established in 2016, concerns the accountability of professional behavior. Regulations concerning employment have changed several times since 1995. These changes have affected the work and practice situation of oral health care providers. METHODS: Data from many publicly available sources were gathered and combined with internal reports mainly derived from the Data Stations project of the Royal Dutch Dental Association. This project was established in 1995 and, since its initiation, 6716 dentists have participated an average of 6.7 times. RESULTS: Between 1995 and 2018, nearly all professional groups in oral health care increased, particularly those of dental hygienists and prevention assistants. The number of dental practices decreased, but practices got larger in terms of dental units, number of patients, and personnel. The percentage of inhabitants visiting oral health care professionals remained unchanged, but the type of care provided moved towards more prevention. Oral health care providers exploited new opportunities to enhance and express their professional behavior. CONCLUSIONS: Oral health care in the Netherlands has evolved in recent years toward more collaboration in teams, and professions have established institutions to promote the quality and safety of care. Greater emphasis has been placed on prevention of dental diseases. These processes were influenced by new legislation and regulations, demographic changes within professional groups, and other social developments.

Dental Care Provision during Coronavirus Disease 2019 (COVID-19) Pandemic: The Importance of Continuous Support for Vulnerable Patients.

As a result of the ongoing 2019 coronavirus disease (COVID-19) pandemic, the medical and dental services across the world have to tackle unprecedented situations, providing essential care and professional support. The global health care crisis caused directly by the vast number of severe COVID-19 cases, and indirectly by reduced access to health care, as well as by limited secondary care provision, had a major impact on specialist services, and subsequently the deterioration of medical and dental conditions, particularly in vulnerable persons. In particular, at present, special care dentistry seems to play a unique role, dealing with a wide range of patients with underlying medical conditions and co-morbidities, phobic individuals, and persons with learning/physical disabilities. The effective adaptation of health services to the current new reality, based on an empathetic approach and recent guidelines, would allow us to maintain an adequate care provision, minimizing the long-term impact of the pandemic.

COVID-19: Present and Future Challenges for Dental Practice.

COVID-19 was declared a pandemic by the World Health Organization, with a high fatality rate that may reach 8%. The disease is caused by SARS-CoV-2 which is one of the coronaviruses. Realizing the severity of outcomes associated with this disease and its high rate of transmission, dentists were instructed by regulatory authorities, such as the American Dental Association, to stop providing treatment to dental patients except those who have emergency complaints. This was mainly for protection of dental healthcare personnel, their families, contacts, and their patients from the transmission of virus, and also to preserve the much-needed supplies of personal protective equipment (PPE). Dentists at all times should competently follow cross-infection control protocols, but particularly during this critical time, they should do their best to decide on the emergency cases that are indicated for dental treatment. Dentists should also be updated on how this pandemic is related to their profession in order to be well oriented and prepared. This overview will address several issues concerned with the COVID-19 pandemic that directly relate to dental practice in terms of prevention, treatment, and orofacial clinical manifestations.

Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care.

The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease has gripped the entire international community and caused widespread public health concerns. Despite global efforts to contain the disease spread, the outbreak is still on a rise because of the community spread pattern of this infection. This is a zoonotic infection, similar to other coronavirus infections, that is believed to have originated in bats and pangolins and later transmitted to humans. Once in the human body, this coronavirus (SARS-CoV-2) is abundantly present in nasopharyngeal and salivary secretions of affected patients, and its spread is predominantly thought to be respiratory droplet/contact in nature. Dental professionals, including endodontists, may encounter patients with suspected or confirmed SARS-CoV-2 infection and will have to act diligently not only to provide care but at the same time prevent nosocomial spread of infection. Thus, the aim of this article is to provide a brief overview of the epidemiology, symptoms, and routes of transmission of this novel infection. In addition, specific recommendations for dental practice are suggested for patient screening, infection control strategies, and patient management protocol.

Dental care during the coronavirus disease 2019 (COVID-19) outbreak: operatory considerations and clinical aspects.

OBJECTIVES: This paper is aimed at addressing the urgent need to develop a protocol that will address the operatory and clinical aspects of dental care during the Coronavirus disease 2019 (COVID-19) outbreak. DATA SOURCES: The epidemiology, clinical signs and symptoms, and modes of transmission of COVID-19 are presented. This protocol was established as an international collaboration of three dental universities: Hadassah School of Dental Medicine, Israel; University of Rochester Medical Center, USA; and the University of Pennsylvania, USA. This protocol is based on a detailed review of the existing English language literature as well on the logistic and clinical experience of each facility and the opinion of the authors. The protocol is designed for a hospital setting and includes considerations related to dental treatment in both healthy subjects and those suspected or diagnosed with COVID-19. The first part of this review discusses operatory considerations; the second part discusses general dental clinical aspects; the third part discusses endodontic considerations; and the fourth part discusses surgical aspects. This protocol may be applicable to other future similar pandemics. CONCLUSION: Logistic and clinical steps are required to provide dental care during the COVID-19 outbreak while preventing cross-contamination and protecting the dental team during the provision of care.

Access to Dental Visits and Correlates of Preventive Dental Care in Children with Autism Spectrum Disorder.

Dental care received by children in the Autism Speaks Autism Treatment Network (ATN) was compared to National Survey of Children's Health (NSCH) data for children without special healthcare needs and children with parent-reported ASD. Correlates of obtained preventive dental services were examined within the ATN sample. Participants included 375 families of children ages 4 to 17 enrolled in the ATN. ATN families reported levels of preventive dental care that were similar to, or exceeded, NSCH-reported care. However, disparities in obtained preventive dental services emerged within the ATN sample. Lower intellectual functioning was the most consistent correlate of reduced access to and completion of preventive dental care. Implications for developing system-wide supports and targeted interventions are discussed.

Teledentistry as a novel pathway to improve dental health in school children: a research protocol for a randomised controlled trial.

BACKGROUND: Despite great improvement in child oral health, some children subgroups still suffer from higher levels of dental caries. Geographic and socioeconomic barriers and the lack of access to dental care services are among common reasons for poor oral health in children. Historically in Australia, oral health therapists or dental therapists have been responsible for providing dental care for school children through the School Dental Services (SDS). The current SDS has been unable to provide sustainable dental care to all school children due to a reduction in workforce participation and limited resources. We propose a paradigm shift in the current service through the introduction of user-friendly technology to provide a foundation for sustainable dental care for school children. METHODS/DESIGN: We describe an ongoing parallel, two-armed, non-inferiority randomised controlled trial that compares routine and teledental pathway of dental care in children aged 4-15 years (n = 250). Participating schools in Western Australia will be randomly assigned to the control or teledental group, approximately three schools in each group with a maximum of 45 children in each school. All participants will first receive a standard dental examination to identify those who require urgent referrals and then their teeth will be photographed using a smartphone camera. At the baseline, children in the control group will receive screening results and advice on the pathway of dental care based on the visual dental screening while children in the teledental group will receive screening results based on the assessment of dental images. At 9 months follow-up, all participants will undergo a final visual dental screening. The primary outcomes include decay experience and proportion of children become caries active. The secondary outcomes include the diagnostic performance of photographic dental assessment and costs comparison of two pathways of dental care. DISCUSSION: The current project seeks to take advantage of mobile technology to acquire dental images from a child's mouth at school settings and forwarding images electronically to an offsite dental practitioner to assess and prepare dental recommendations remotely. Such an approach will help to prioritise high-risk children and provide them with a quick treatment pathway and avoid unnecessary referrals or travel. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12619001233112. Registered 06 September 2019.

Tendencia de actividades odontológicas realizadas en atención primaria del Servicio de Salud Valparaíso - San Antonio, chile: 2008 a 2018 / The evolution of dental services carried out in primary health care centers of the valparaíso - san antonio health service in chile: 2008-2018

INTRODUCCIÓN: La actual Política de Salud Bucal chilena indica que la atención odontológica está orientada a la promoción y prevención, reforzando la atención odontológica en Atención Primaria de Salud (APS). Se desconoce cómo esta política se ha materializado en el tiempo, pues, a la fecha, no existen estudios que analicen la tendencia de este tipo de actividades. El objetivo de este estudio fue analizar la tendencia de las actividades odontológicas, realizadas en adultos y adultos mayores, en APS del Servicio de Salud Valparaíso - San Antonio (SSVSA). MATERIAL Y MÉTODOS: Se realizó un estudio ecológico de tipo mixto entre los años 2008-2018, en 8 de las 9 comunas del SSVSA. Se analizó la tendencia del porcentaje de actividades promocionales-preventivas (APP) y de exodoncias utilizando las bases de datos "Resúmenes Estadísticos Mensuales-A09" (REM-A09). RESULTADOS: El 24,53% y 11,36% de las actividades realizadas correspondieron a APP y a exodoncias, respectivamente. El grupo de 20-64 años presentó un mayor porcentaje de APP y un menor porcentaje de exodoncias que el grupo de 65 y más años, en cada una de las comunas. Hubo una tendencia al aumento del porcentaje de APP y a la disminución del porcentaje de exodoncia en la mayoría de las comunas estudiadas. DISCUSIÓN: La tendencia de las actividades odontológicas realizadas en APS ha evolucionado a lo largo de los años, con diferencias entre comunas del SSVSA. Para poder determinar cuáles son los motivos que explican los resultados encontrados, se sugiere realizar otros estudios enfocados a la gestión odontológica local de APS. (AU)

BACKGROUND: The current Chilean Oral Health Policy indicates that dental care is aimed at promotion and prevention, thus reinforcing the presence of dental programs in Primary Health Care (PHC) Centers. It is unknown how this policy has materialized over time, since no studies to date have analyzed the trend of dental services carried out in PHC. The objective of this study was to analyze the evolution of dental services carried out in adults in PHC of the Valpa-raíso - San Antonio Health Service (VSAHS). MATERIALS AND METHODS: A mixed ecological study was carried out between 2008 and 2018, in 8 of the 9 municipalities of the VSAHS. The per-centage trends of promotional-preventive services (PPS) and extractions were analyzed, using the databases "Resúmenes Estadísticos Mensuales-A09" (REM-A09). RESULTS: The percentage of dental services dedicated to PPS and extractions were 24.53% and 11.36%, respectively. The group of adults between 20 and 64 years of age presented a higher percentage of PPS and a lower percentage of extractions than the 65 and over group in each municipality. There was also a trend of the percentage of PPS services increasing over time, while the percentage of extractions decreased in most of the municipalities studied. DISCUSSION: The type of den-tal services carried out in PHC has evolved over time, and differences were found between municipalities of the VSAHS. To explain these results, future studies should focus on the local management of dental services in PHC. (AU)