Cross-infection and infection control in dental clinics in Nablus and Tulkarm districts.

BACKGROUND: Infection control had many developments in the COVID 19 (Coronavirus Disease 2019) pandemic, despite this, there were many complications in different health care facilities as well as dentists' clinics due to the lack of infection control knowledge and compliance failure. This study aimed to assess the level of knowledge and compliance with the infection control measures in the dental clinics in the Nablus and Tulkarm districts. RESULTS: The results showed that the total positive response regard all infection control domains were (70.0 %). Whereas the participants gave the highest positive response for personnel protective equipment i.e. gloving was (96.10 %). They gave the instruments related to controls the lowest responses, i.e. instruments sterilization was (59.40 %). The analyzed data showed significant statistical differences in the compliance with infection control measures between Nablus and Tulkarm districts "p < 0.05" in the interest of dentists from Tulkarm. CONCLUSIONS: In conclusion, the findings of this study showed that there is moderate compliance to infection control protocol in Nablus and Tulkarm dental clinics. Thus, there is a need to strengthen adherence to infection control measures. METHOD: A universal sampling was used to assess the infection control program at the dental clinics in Nablus and Tulkarm Districts. The study sample involved 265 dentists. Data was collected using a questionnaire which has been sent via email between July and August 2020. Descriptive statistics, Chi-square test, One-way ANOVA and Post-Hock tests have been used. Statistical significance was set at ″P <0.05″. Cronbach's alpha has been conducted to ensure the reliability and validity of the questionnaire.

Nursing strategies for COVID-19 prevention and control in a selected dental clinic.

AIM: To comprehensively introduce the prevention and control measures that we can take in dental clinics during the pandemic period of coronavirus disease 2019 (COVID-19) and provide some practical experience for the development of nursing and health policies applicable to COVID-19. BACKGROUND: The outbreak of COVID-19 has placed the global health system under threat, which seriously influences the normal operations of human society. Safe and effective nursing measures should be taken to ensure the normal operation of dental clinics. SOURCES OF EVIDENCE: We searched and referenced many references on the PubMed database. Through the combination of related literatures and our experience, we describe various strategies, including personnel management, personal protection, disinfection and isolation, adopted in the dental clinic of our Chinese hospital during the pandemic of COVID-19. DISCUSSION/CONCLUSIONS: We introduced strategies for the nursing staff in dental clinics to assist them with the prevention and control of COVID-19. The successful implementation of the protective measures could ensure the safety of medical staff and patients, and contributed to the normal operation of dental clinics during the pandemic period. CONCLUSIONS FOR NURSING AND HEALTH POLICY: During the pandemic, frontline nurses are under physical and mental pressure facing the threat of infection while at work. In addition to pandemic prevention, we should also pay attention to the needs of nursing staff. More reasonable and effective nursing and health policies should be formulated to ensure their safety and protect their rights and interests. This is the only way that the prevention and control of COVID-19 can be achieved, and we can prepare for future public health events.

Factors affecting revisit intention for medical services at dental clinics.

Recent changes in the medical paradigm highlight the importance of patient-centered communication. However, because of the lack of awareness of dental clinics and competency of medical personnel, the quality of medical services in terms of the communication between doctors and patients has not improved. This study analyzed the impact of health communication and medical service quality, service value, and patient satisfaction on the intention to revisit dental clinics. The study participants were outpatients treated at 10 dental clinics in Seoul. The research data were collected using a questionnaire during visits to these dental clinics from December 1 to December 30, 2016. A total of 600 questionnaires were distributed (60 copies to each clinics) and 570 valid questionnaires were used for the analysis. The influence of the factors was determined using structural equation modeling. The factors influencing service value were reliability (ß = 0.364, p < 0.001), expertise (ß = 0.319, p < 0.001), communication by doctors (ß = 0.224, p < 0.001), and tangibility (ß = 0.136, p < 0.05). In addition, the factors influencing patient satisfaction were reliability (ß = 0.258, p < 0.001), tangibility (ß = 0.192, p < 0.001), communication by doctors (ß = 0.163, p < 0.001), and expertise (ß = 0.122, p < 0.01). Further, service value (ß = 0.438, p < 0.001) raised patient satisfaction, which was found to influence the intention to revisit dental clinics (ß = 0.383, p < 0.001). Providing accurate medical services to inpatients based on smooth communication between doctors and patients improves patient satisfaction. In addition, doctors can build long-term relations with patients by increasing patients' intention to revisit through patient-oriented communication.

Point-of-care characterization and risk-based management of oral lesions in primary dental clinics: A simulation model.

OBJECTIVES: Oral potentially malignant disorders (OPMDs) encompass histologically benign, dysplastic, and cancerous lesions that are often indistinguishable by appearance and inconsistently managed. We assessed the potential impact of test-and-treat pathways enabled by a point-of-care test for OPMD characterization. MATERIALS AND METHODS: We constructed a decision-analytic model to compare life expectancy of test-treat strategies for 60-year-old patients with OPMDs in the primary dental setting, based on a trial for a point-of-care cytopathology tool (POCOCT). Eight strategies of OPMD detection and evaluation were compared, involving deferred evaluation (no further characterization), prompt OPMD characterization using POCOCT measurements, or the commonly recommended usual care strategy of routine referral for scalpel biopsy. POCOCT pathways differed in threshold for additional intervention, including surgery for any dysplasia or malignancy, or for only moderate or severe dysplasia or cancer. Strategies with initial referral for biopsy also reflected varied treatment thresholds in current practice between surgery and surveillance of mild dysplasia. Sensitivity analysis was performed to assess the impact of variation in parameter values on model results. RESULTS: Requisite referral for scalpel biopsy offered the highest life expectancy of 20.92 life-years compared with deferred evaluation (+0.30 life-years), though this outcome was driven by baseline assumptions of limited patient adherence to surveillance using POCOCT. POCOCT characterization and surveillance offered only 0.02 life-years less than the most biopsy-intensive strategy, while resulting in 27% fewer biopsies. When the probability of adherence to surveillance and confirmatory biopsy was ≥ 0.88, or when metastasis rates were lower than reported, POCOCT characterization extended life-years (+0.04 life-years) than prompt specialist referral. CONCLUSION: Risk-based OPMD management through point-of-care cytology may offer a reasonable alternative to routine referral for specialist evaluation and scalpel biopsy, with far fewer biopsies. In patients who adhere to surveillance protocols, POCOCT surveillance may extend life expectancy beyond biopsy and follow up visual-tactile inspection.

Feasibility, Acceptability, and Short-term Behavioral Impact of the MySmileBuddy Intervention for Early Childhood Caries.

OBJECTIVES: To evaluate acceptability, feasibility, and short-term behavioral impact of an early childhood caries (ECC) intervention. METHODS: Predominantly low-income Hispanic parent/child (2-6 years) dyads attending a busy pediatric dental clinic in New York City completed a single administration of the iPad-based technology-assisted education, goal-setting, and behavior change MySmileBuddy program. Self-reported behavior change was assessed via telephone survey one month post-intervention. RESULTS: Of 113 parent/child dyads approached, 108 (95.6%) participated and all completed MySmileBuddy in its entirety. Over 96% (n = 76) of 79 parents reached for follow-up recalled MySmileBuddy; 63.3% (n = 50) recalled their diet-and/or oral hygiene-related behavioral goal; and 79.7% (n = 79) reported taking action to initiate behavior change. CONCLUSIONS: Findings suggest that MySmileBuddy was feasibly implemented in a busy clinic, acceptable to this high-risk population, and effectively promoted preliminary ECC-related behavior changes. Larger, long-term studies are warranted to further investigate the impact of the MySmileBuddy program.

Improving Dental School Clinic Operations Using Business Intelligence Data.

In dental school clinics, students spend a great deal of time waiting for faculty members to check and approve their work. Traditionally at the University of Michigan School of Dentistry, students have left their cubicles to form lines behind supervising faculty members, and this line of students would follow the faculty member around from patient to patient. To address this problem and improve the patient experience, the school computerized the approval-seeking process by building the Faculty Request System (FRS) to enable students to stay with their patients while seeking the necessary approvals. The FRS produced a large volume of time-stamped, business intelligence data that enabled further evaluation. The aim of this study was to assess the effects of this change, including the quality/process improvement interventions that were possible due to information revealed by the FRS. The results showed no change in the number of students or faculty members per clinic session across the three years of this evaluation. With the FRS, the amount of time students spent away from their patients was reduced from 40.6 minutes to 12.1 minutes. After the FRS was implemented, there was an eradication of appointments that ended 30 minutes late (from 0.03% to zero) and a reduction of appointments that ended 15 minutes late (from 0.25% to 0.01%). There were also increases in students' starting appointments on time (9.8% of start checks to 25.8%), 15 minutes late (16.6% to 35.2%), and 30 minutes late (13.2% to 22.2%). By critically analyzing data from the new system, the school's leadership can analyze trends and make data-driven decisions to alter operations. The results of this study suggest that this process can improve the patient and student experience and faculty utilization.

Dog-assisted therapy in the dental clinic. Part B. Hazards and assessment of potential risks to the health and safety of the dental therapy dog.

Background: A dental therapy dog may help anxious patients in the dental clinic overcome their fear and facilitate the completion of necessary dental care. Dental clinic activities are associated with hazards that may pose potential risks to the health and safety of the dental therapy dog. Objectives: To describe potential hazards associated with risks to health and safety to therapy dogs in dental clinics and to present suggestions for risk minimisation by adopting best practices in dental clinic settings. Materials and method: Literature searches in Medline, http://Clinicaltrials.gov, and Google Scholar for qualitative and quantitative assessments of occupational hazards and risks in dental clinics, in combination with a review of the reference list of the included studies. Identified hazards and risks were analysed relative to their relevance for the health and welfare of a therapy dog present in a dental clinic setting. Results: Workplace hazards in the dental clinic that apply to both humans and therapy dogs are allergies, sharps injury, eye injury, stress, rhinitis, hearing impairment, and other hazards. Additional concerns associated with risks for the dental therapy dog are situations involving erratic patient behaviour and threats if the patient is an undisclosed disease carrier. Risks to the health and safety of the dental therapy dog in the clinics are present but are low if the dental clinical staff and dog handlers comply with best practices. Conclusions: Best practice includes awareness amongst the clinic staff and the dog handler of all potential hazards in the dental clinic and on how to reduce these hazards as well as adverse events that may scare the dental therapy dog. The dental therapy dog team must be specially trained to work in a dental clinic. Each treatment session has to be exclusively tailored to that specific appointment and the individual patient.

Dog-assisted therapy in the dental clinic: Part A-Hazards and assessment of potential risks to the health and safety of humans.

Background: Dog-assisted therapy in the dental clinic may be an attractive alternative to sedation for anxious patients. Including a dental therapy dog in a clinical setting introduces new hazards and potential risks to health and safety for both humans and animal. Objectives: The study aims to describe potential hazards associated with risks to humans by having a therapy dog present in the dental clinic and to provide guidance on best practices to minimise and control risks for the patients, the dentist, and the dental clinic staff. Materials and Methods: Literature searches in Medline, http://Clinicaltrials.gov, and Google Scholar for qualitative and quantitative assessments of hazards and risks associated with the use of therapy dogs in health care settings, in combination with a review of the reference list of the included studies. Identified hazards and risks were analysed with respect for the health and welfare of humans in a dental clinic setting that involves the presence of a therapy dog. Results: Potential risks to health and safety for humans in dental clinics that offer dog-assisted therapy can be categorised within four general categories of hazards: the dog as a source of zoonotic pathogens and human diseases, exposure to canine allergens, adverse animal behaviour, and dangers associated with high activity in a congested dental clinic operatory. Risks to humans are reduced by maintaining awareness amongst the dental clinic staff and the dog handler of all potential hazards in the dental clinic, and on how to reduce these hazards as well as adverse events that may scare the dental therapy dog. Conclusions: Risks to the health and safety of humans in the presence of therapy dog in the clinics are present but are low if the dental clinical staff and dog handlers comply with best practices.

Evaluation of a community based dental clinic for youth experiencing homelessness in Brisbane.

The relationship between homelessness and ill health is complex, and many risk factors for homelessness such as unemployment, low income, and substance abuse are also risk factors for poor oral health. In order to overcome barriers to access dental care, previous studies have recommended integrating dental care, referral pathways, and information within the overall care provided by support services available to people at risk of homelessness. This study aimed to evaluate a dental service developed and implemented to improve access to oral health care of disadvantaged youth in Brisbane. A mobile dental clinic run by volunteer dental professionals was implemented into a community organisation for disadvantaged youth. Participants were clients of Brisbane Youth Services who were disadvantaged youth, ≤25 years and attended the dental clinic in a 1 year period. A questionnaire collected demographic information, a self-assessment of oral health and an evaluation of their experiences with the dental clinic. Clinical data including DMFT, appointment attendance and items of service provided were collected. One hundred and twelve clients participated in the four dental clinic weeks and its evaluation. Cost was the greatest reported barrier to accessing dental care among participants. More than half (57%) of participants who pre-booked an appointment failed to attend. A total of 640 services were delivered, with an estimated value of $48,000. The majority (69%, n = 444) of the services provided were preventative services. Almost all of the clients felt the service they received was suitable for them (97%, n = 98) and would use the service again (98%, n = 99). This dental clinic model is feasible and sustainable due to its integration into an existing homeless youth service, low running costs, acceptability to clients and an interest by dental practitioners to volunteer. It provides a useful model which could be scaled up and implemented in other regions.

Introducing and Evaluating Intraprofessional Team-Based Care Delivery in a Dental School Clinic: A Pilot Study.

There is growing interest in developing more efficient, patient-centered, and cost-effective models of dental care delivery using teams of professionals. The aims of this small pilot study were to assess the number of patient visits, type and number of procedures performed, and clinic revenues generated by an intraprofessional team of dental, dental hygiene, and dental therapy students and to determine the students' and patients' perceptions of this model of care. Sixteen senior students from three student cohorts (dental, dental hygiene, and dental therapy) at the University of Minnesota piloted a team-based dental delivery model from January to April 2015. The group was named the Team Care Clinic (TCC), and the team for each clinical session consisted of one dental student, three dental hygiene students, and one dental therapy student. Data were collected from the school's database to determine the number of patient visits, type and number of procedures performed, and clinic revenue generated by the TCC. Focus groups were used to assess student perceptions of the experience, and patient satisfaction surveys were administered to assess the patients' experience. The TCC students were given twice as many patients as non-TCC students, and they managed them effectively. Working as a team, the TCC student providers completed twice as many procedures per patient encounter as non-TCC students. Patients and students said their experiences in the TCC were positive, and students expressed a preference for team-based care delivery. The results of the study suggest the team-based dental care delivery model is promising. Team-based care delivery may allow providers to accomplish more during a patient appointment and increase provider satisfaction.

Evaluación del clima organizacional en la Clínica Docente Estomatológica 27 de Noviembre. Colón. 2017 / Assessment of the organizational climate in the Teaching Dental Clinic 27 de noviembre. Colon. 2017

Introducción: el clima organizacional es un fenómeno complejo y multifactorial, que involucra a factores relacionados con los estilos de dirección, la estructura y los comportamientos dentro de la organización, y tienen como sustento los conocimientos, actitudes y prácticas. Objetivo: evaluar el clima organizacional en la Clínica Docente Estomatológica "27 de Noviembre". Colón. Materiales y métodos: se realizó una investigación descriptiva de corte transversal, en el periodo de enero a mayo del 2017. El universo y muestra estuvo constituido por los 120 trabajadores que fueron organizados por estratos. Se estudiaron tres dimensiones básicas: comportamiento organizacional, estructura organizacional y estilo de dirección. Resultados: las dimensiones comportamiento organizacional; estructura organizacional y estilo de dirección, fueron percibidas como clima organizacional adecuado. Conclusiones: el clima organizacional en la Clínica Docente Estomatológica "27 de Noviembre" fue evaluado de adecuado para todas las dimensiones objeto del estudio. Todas las categorías investigadas fueron evaluadas de aceptable, excepto las condiciones de trabajo que fueron evaluadas en riesgo (AU).

Introduction: the organizational climate is a multifactorial, complex phenomenon involving factors related with managing styles, structure and behavior inside the organization, and have as a support knowledge, attitudes and practice. Objective: to assess the organizational climate in the Teaching Dental Clinic ¨27 de noviembre¨ of Colón. Materials and methods: a descriptive, cross-sectional research was carried out in the period from January to May of 2017. The universe and sample was formed by 120 workers who work in the institution organized by strata. Three basic dimensions were studied: organizational behavior, organizational structure and managing style. Results: the dimensions organizational behavior; organizational structure and managing style were perceived as adequate organizational climate. Conclusions: the organizational climate in the Teaching Dental Clinic ¨27 de noviembre¨ was assessed as adequate for all the dimensions that were object of study. All the investigated categories were evaluated as satisfactory, except for occupational conditions that were evaluated as at risk (AU).

Evaluación del clima organizacional en la Clínica Docente Estomatológica 27 de Noviembre. Colón. 2017 / Assessment of the organizational climate in the Teaching Dental Clinic 27 de noviembre. Colon. 2017

Introducción: el clima organizacional es un fenómeno complejo y multifactorial, que involucra a factores relacionados con los estilos de dirección, la estructura y los comportamientos dentro de la organización, y tienen como sustento los conocimientos, actitudes y prácticas. Objetivo: evaluar el clima organizacional en la Clínica Docente Estomatológica "27 de Noviembre". Colón. Materiales y métodos: se realizó una investigación descriptiva de corte transversal, en el periodo de enero a mayo del 2017. El universo y muestra estuvo constituido por los 120 trabajadores que fueron organizados por estratos. Se estudiaron tres dimensiones básicas: comportamiento organizacional, estructura organizacional y estilo de dirección. Resultados: las dimensiones comportamiento organizacional; estructura organizacional y estilo de dirección, fueron percibidas como clima organizacional adecuado. Conclusiones: el clima organizacional en la Clínica Docente Estomatológica "27 de Noviembre" fue evaluado de adecuado para todas las dimensiones objeto del estudio. Todas las categorías investigadas fueron evaluadas de aceptable, excepto las condiciones de trabajo que fueron evaluadas en riesgo (AU).

Introduction: the organizational climate is a multifactorial, complex phenomenon involving factors related with managing styles, structure and behavior inside the organization, and have as a support knowledge, attitudes and practice. Objective: to assess the organizational climate in the Teaching Dental Clinic ¨27 de noviembre¨ of Colón. Materials and methods: a descriptive, cross-sectional research was carried out in the period from January to May of 2017. The universe and sample was formed by 120 workers who work in the institution organized by strata. Three basic dimensions were studied: organizational behavior, organizational structure and managing style. Results: the dimensions organizational behavior; organizational structure and managing style were perceived as adequate organizational climate. Conclusions: the organizational climate in the Teaching Dental Clinic ¨27 de noviembre¨ was assessed as adequate for all the dimensions that were object of study. All the investigated categories were evaluated as satisfactory, except for occupational conditions that were evaluated as at risk (AU).

A Pilot Study on an Interprofessional Course Involving Pharmacy and Dental Students in a Dental Clinic.

Objective. To assess the effect of a dental clinical rotation program involving pharmacy students and dental students. Methods. An interprofessional education (IPE) course was offered as an elective to second-year pharmacy students and required for third-year dental students. The course included two in-class sessions, one online lecture, and five clinic sessions. Program evaluation analyses included a comparison of participating versus nonparticipating students on a knowledge survey of pharmacotherapy and IPE, and a descriptive analysis of IPE course evaluation results. Results. Among pharmacy students, mean scores were significantly higher for participants than nonparticipants on the 31-item pharmacy knowledge component of the survey. On the eight-item IPE component of the survey, scores were significantly higher for participants than for nonparticipants, both among pharmacy students and among dental students. Awareness and attitudes about IPE were generally high among course participants. Conclusion. An IPE course that integrates second-year pharmacy students with third-year dental students in the dental clinic to provide medication history, education, and identification of potential drug-related problems improved pharmacy students' knowledge of pharmacotherapy related to or associated with dental conditions and improved pharmacy and dental students' knowledge and attitudes about IPE.

Development and evaluation of the Jönköping Dental Fear Coping Model: a health professional perspective.

OBJECTIVE: The purpose of this study was to design a structured treatment model focusing on all levels of adult's dental fear, the Jönköping Dental Fear Coping Model (DFCM). The aim was to study the DFCM from a dental health professional perspective. MATERIAL AND METHODS: The DFCM was studied by means of quantitative and qualitative analyses. Nine dental clinics participated in Period I (pre-intervention/standard care), and 133 dental health professionals (dentists, dental hygienists, dental assistants) and 3088 patients were included. After completion of Period I, four of the clinics were randomized to Period II (intervention), beginning with the professionals undergoing DFCM training. Following that, 51 dental health professionals treated 1417 patients according to the DFCM. The other five clinics served as controls. RESULTS: Half or more of the dental health professionals assessed the model as better than standard care, regarding anamnesis and diagnostics, communication and contact, and understanding of patients and dental fear. The dental health professionals reported higher tension in their fearful patients in Period II compared with Period I, possibly due to their increased awareness of dental fear. CONCLUSIONS: The qualitative data suggest that dental health professionals find the DFCM beneficial in routine dental care. The model promotes a holistic approach to the treatment of adult patients. However, stress among the professionals was not reduced when measured, neither quantitatively nor qualitatively. It is important to evaluate the model in further studies to make it possible to draw generalizable conclusions.

El clima organizacional de la clínica estomatológica Fe Dora Beris, del municipio de Santiago de Cuba / Organizational environment at Fe Dora Beris Dental Clinic, of Santiago de Cuba municipality

Introducción: el clima organizacional, conocido como clima laboral, es el ambiente humano y físico donde se desarrolla el trabajo. Para medir el clima interno de la institución médica Fe Dora Beris, se aplicó una encuesta a los trabajadores. Objetivo: caracterizar el clima laboral en una clínica estomatológica y sus módulos, en el municipio de Santiago de Cuba, desde febrero hasta abril del 2013. Método: se realizó un estudio transversal, con un universo de 33 trabajadores, presentes físicamente en el momento de la ejecución del trabajo en la Clínica Estomatológica Fe Dora Beris, de Santiago de Cuba. Se tomaron como bases las propuestas de la OMS y de la Organización Panamericana de la Salud (OPS), con 80 ítems relacionados con el instrumento Inventario de Clima Organizacional, y un test de motivación confeccionado y validado por el Centro de Técnicas de Dirección de La Habana (CETED), y se incluyeron los trabajadores de los módulos estomatológicos. El informe primario fue introducido en una base de datos Excel.Resultados: en las dimensiones de Reciprocidad y Participación el liderazgo se comportó de forma satisfactoria en la clínica, no así en los módulos estomatológicos, donde en el ciento por ciento los trabajadores quedaron insatisfechos. El personal no está motivado debido a la falta de recursos en la unidad. No reciben capacitación para mejorar su trabajo y, en el caso de los módulos, existe una pobre atención por parte de los directivos. Conclusiones: en la dimensión Motivación, y por consecuencia en todas las dimensiones de los módulos estomatológicos correspondientes a dicha clínica, el clima laboral resultó inadecuado.(AU)

Introduction: organizational or work environment is the human and physical environment in which the daily work unfolds. In order to measure the internal climate of the institution a survey to staff was applied.Objective: to characterize the organizational climate in a dental clinic and its modules, at the Santiago de Cuba municipality, in Cuba, from February to April, 2013.Method: a cross-sectional descriptive study with a universe of 33 workers, physically working at the dental clinic “Fe Dora Beris” of Santiago of Cuba, at the time of research, was conducted. Proposals with 80 items, of the World Health Organization (WHO) and the Panamerican Health Organization (PAHO) related to organizational climate, and a test of motivation, produced and validated by the Centre for Management Techniques of Havana (CMT), were applied to the clinic and its modules´ workers. Primary data was stored in an Excel database.Results: at the clinic leadership behaved satisfactorily. On the other hand, in the dimensions of Reciprocity and Participation, workers at all modules were dissatisfied. They are not motivated due to the lack of resources at the unit, no training to improve their work and, in the case of the modules, poor attention from managers.Conclusions: organizational climate was unsatisfactory. Motivation dimension in modules corresponding to the clinic was proved unsatisfactory.(AU)

Management Models of Centers of Dental Specialties: Analysis from PMAQ-CEO

Objective: To identify and understand how management models are being institutionalized in Centers of Dental Specialties, specifically with regard to the publicprivate relationship. Material and Methods: A descriptive and quantitative study using database of the 1st cycle PMAQ/CEO External Evaluation, specific to the question directed to managers or Dentists working at CEO: what is the labor link of CEO professionals? It was considered an alternative model when at least one dentist had nonstatutory labor relationship. Statistical analyses performed were exploratory and descriptive. Results: Data were collected from 930 CEOs distributed throughout Brazil, of which 170 (18.3%) are under alternative management model, especially in the southeastern (37.6%) and northeastern regions (34.7%), distributed in 147 municipalities, 144 (85%) under municipal management, 22 (13%) under state management. Of CEOs with state management, 68% are in Ceará State and 27% in Paraná State. In 78.6% of CEOs, the labor link of dentists is exclusively via direct public administration. Other 10.1% are in direct public administration with new legal arrangements. Only alternative management models were identified in 8.2% of CEOs. Conclusion: A significant number of CEOs are under alternative management model, and its distribution to all regions indicates a consolidation trend.

Current Status of Operation and Management of Dental School Clinics.

This article summarizes the current status of the operation and management of dental school clinics as schools strive to provide excellent patient-centered care in an environment that is educationally sound, efficient, and financially strong. Clinical education is a large component of dental education and an area in which many dental schools have an opportunity to enhance revenue. Clinical efficiencies and alternative models of clinical education are evolving in U.S. dental schools, and this article describes some of those evolutionary changes. This article was written as part of the project "Advancing Dental Education in the 21st Century."