The Influence of Dentists' Profile and Health Work Management in the Performance of Brazilian Dental Teams.

To evaluate the association between dentists' profile and health work management with the performance of primary care dental teams in the Brazilian National Health System, both nationally and regionally. Secondary data analysis from a Brazilian National Programme that evaluated 18,114 Brazilian dental teams, working in the public sector, between 2013 and 2014. Twenty-four independent variables taken from dentists' profile and dental team management characteristics were analysed to assess their influence on reported "dental team performance." An estimated score was generated from their performance on 20 dental procedures by an item response theory model. Multiple linear regression models were performed for each Brazilian geographical region, separately and for the whole of Brazil. p values ≤ 0.05 were considered significant. Two variables related to dentists' profile, "having graduate studies" (ß = 0.151) and "undertaking continuing professional development training" (ß = 0.101), were associated with enhanced dental team performance in all five Brazilian geographical regions and nationally. The dental team management variables of "having a flexible dental appointment list" (ß = 0.218) and "monitoring oral health indicators" (ß = 0.132) also contributed to improve team performance in each of the regions and nationally. Dentists' profile influenced the performance of dental teams from south region more than the other regions. The findings suggest that continuing professional development, including postgraduate education, and strategic management characteristics are important for primary dental care performance and should be reflected in health policy initiatives in support of quality care. Regional factors could be considered for health care management.

The Challenge of Dental Education After COVID-19 Pandemic - Present and Future Innovation Study Design.

The present work suggests research and innovation on the topic of dental education after the COVID-19 pandemic, is highly justified and could lead to a step change in dental practice. The challenge for the future in dentistry education should be revised with the COVID-19 and the possibility for future pandemics, since in most countries dental students stopped attending the dental faculties as there was a general lockdown of the population. The dental teaching has an important curriculum in the clinic where patients attend general dentistry practice. However, with SARS-CoV-2 virus, people may be reluctant having a dental treatment were airborne transmission can occur in some dental procedures. In preclinical dental education, the acquisition of clinical, technical skills, and the transfer of these skills to the clinic are extremely important. Therefore, dental education has to adapt the curriculum to embrace new technology devices, instrumentations systems, haptic systems, simulation based training, 3D printer machines, to permit validation and calibration of the technical skills of dental students.

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.

Perception of Dental Students of COMS-TH regarding Future of Dentistry in Nepal amid COVID-19 Pandemic.

INTRODUCTION: There is a global crisis which has been led by COVID-19. The patients undergoingdental procedures and dental professionals are at higher risk of contracting this disease owing toaerosols generated and a lot of face to face contact during the procedures. The aim of this study was to know the perceptions of dental students of COMS-TH regarding future of dentistry in Nepal amidCOVID-19 pandemic. METHODS: The present cross-sectional descriptive study was conducted at COMS-TH, Bharatpur by sending an online e-survey questionnaire to 146 dental students out of which 99 responded. The e-survey questionnaire consisted of three parts which consisted of questions about demographics, knowledge about COVID-19 and their perceptions about future of dentistry. RESULTS: The results of the study depicted that most of the students thought dentistry is good and noble profession and will recommend it to young medical aspirants. Most of them wanted to pursue post graduation courses in future giving preference to Oral and Maxillofacial Surgery. CONCLUSIONS: The study concluded that most of the dental students were satisfied with dentistry as their profession and wanted National Dental Association to fix the minimum charges of each dental procedure. Also there is a need to start more post graduation courses in existing institutions providing dental education as most of the students want to pursue it in future.

COVID-19 pandemic and dental practice in Ghana.

With the advent of the COVID-19 pandemic, healthcare systems and their provision of care has globally been challenged, including the delivery of Oral healthcare. In Ghana, it has become imperative that healthcare delivery including the practice of Dentistry and its sub-specialties be re-oriented in our peculiar setting to ensure minimal risk of spread of the infection. This article discusses the impact of COVID-19 on the practice of Dentistry in the country.

How Brazilian dentists work within a new community care context? A qualitative study.

The aim of this study was to analyze the value and meanings that dental surgeons attribute to the Primary Health Care setting, where health promotion is encouraged over a mechanistic performance of procedures. A qualitative study, involving ten Brazilian dental surgeons working in Primary Care in 2016, was designed. In-depth semi-structured interviews were performed, with all interviews recorded, transcribed and subsequently submitted to Qualitative Content Analysis. Despite the Healthcare Promotion model proposed by the Brazilian oral health policy, dental surgeons demonstrated preferences for private and traditional dental practices. These characteristics are counterproductive in public oral health services, which aim to achieve collective health benefits. Traditional practice is based upon a specific and restricted focus, as opposed to overall patient care, hence maintaining the original professional identity, ruled by manual procedures, while demonstrating scientifically fragile understanding of disease processes. Despite the implementation of public service models that aim at change, counterproductive characteristics associated with the deeply rooted traditional management strategies were evidenced.

Antibiotic resistance and antibiotic prescribing by dentists in England 2007-2016.

The early prescribers of penicillin realised that antibiotics should be used wisely and as an adjunct to traditional surgical provision. They predicted that inappropriate use would increase sensitisation to the drug. National Health Service dentists prescribed almost 10% of antibiotics issued in NHS general practice in 2016 and an audit shows that many of these may have been prescribed inappropriately. One of the causes of antimicrobial resistance is over prescription of the drugs. This paper recalls the recommendations of some early users of penicillin, reports on the current prescription patterns of dentists in England, describes the mechanism of acquisition of anti-microbial resistance and discusses dentists' role in attempting to reduce the problem.

Usage of Behavior Guidance Techniques Differs by Provider and Practice Characteristics.

PURPOSE: The purpose of this study was to determine provider and practice characteristics influencing usage of behavior guidance techniques (BGTs). METHODS: A 24-item survey was emailed to 4,117 active AAPD members to identify factors influencing pediatric dentists' use of BGTs. RESULTS: A total of 1,081 surveys were returned, for a 26 percent response rate. The mean age of respondents was 44.7 years old, with recent graduates comprising the largest group (30.5 percent). Usage of voice control, nitrous oxide, sedation, and general anesthesia (GA) differed significantly, according to experience. Respondents with at least 30 years of experience reported changes in usage. Tell-show-do, nitrous oxide, oral sedation, and passive restraint were significantly more frequent among female respondents. Parental absence, oral sedation, and GA were significantly more frequent in respondents serving low income populations. Parental absence, pharmacologic techniques, and restraint were significantly different in frequencies among the different geographic regions. CONCLUSIONS: Usage of behavior guidance techniques has changed over the past three decades, with more recent graduates and experienced practitioners now emphasizing pharmacologic techniques. More assertive behavior guidance techniques are used more frequently by experienced providers and those in practices in the southwest or serving lower income populations. Pharmacologic techniques are used at a higher prevalence by recent graduates and providers who are female or serving lower income populations.

Tratamiento del liquen plano oral. Revisión sistemática y protocolo de actuación / Treatment of oral lichen planus. Systematic review and therapeutic guide

En la presente revisión sistemática se analizaron 55 artículos estructurados sobre la eficacia terapéutica frente al dolor y a los signos clínicos del liquen plano oral (LPO). La búsqueda bibliográfica se elaboró siguiendo los criterios del sistema PRISMA, seleccionando los ensayos realizados mediante alguno de los siguientes diseños metodológicos: entre fármaco (principio activo) vs. mismo fármaco en diferente excipiente o concentración, fármaco vs. diferente principio activo, fármaco vs. fitoterapia y fármaco vs. tratamiento con fototerapia. Basándonos en los resultados se propone un algoritmo que sirva de guía para establecer el tratamiento del LPO en sus formas clínicas atrófica y erosiva. Se destaca el empleo del propionato de clobetasol al 0,025-0,05% de aplicación tópica como primera alternativa terapéutica. En segundo lugar, el tacrolimús al 0,1% y pimecrolimús al 1% también formulado para su pauta tópica. Y, finalmente, se aborda el empleo de corticosteroide sistémico y la aplicación de láser de diodo (AU)

In this systematic review, 55 structured articles on the therapeutic efficacy against pain and clinical signs of oral lichen planus (OLP) were analysed. The literature search was developed according to the criteria of the PRISMA system, selecting the tests performed using one of the following methodological designs: drug (active ingredient) vs. drug in different excipient or concentration, drug vs. different active principle, drug vs. phytotherapy and drug vs. treatment with phototherapy. Based on the results, an algorithm is proposed to guide the treatment of OLP in its atrophic and erosive clinical forms. The use of clobetasol propionate at 0.025-0.05% of topical application as the first therapeutic alternative is highlighted. Secondly, 0.1% tacrolimus and 1% pimecrolimus also formulated for its topical regimen. And finally, we address the use of systemic corticosteroids and the application of diode lasers (AU)

Dental Education Required for the Changing Health Care Environment.

To be able to meet the demands for care in 2040, dental graduates will need to address challenges resulting from the rapidly changing health care environment with knowledge and sets of skills to build on current standards and adapt to the future. The purposes of this article are to 1) analyze key challenges likely to evolve considerably between now and 2040 that will impact dental education and practice and 2) propose several sets of skills and educational outcomes necessary to address these challenges. The challenges discussed include changes in prevalence of oral diseases, dental practice patterns, materials and technologies, integrated medical-dental care, role of electronic health records, cultural competence, integrated curricula, interprofessional education, specialty-general balance, and web/cloud-based collaborations. To meet these challenges, the dental graduate will need skills such as core knowledge in basic and clinical dentistry, technical proficiency, critical thinking skills for lifelong learning, ethical and professional values, ability to manage a practice, social responsibility, and ability to function in a collegial intra- and interprofessional setting. Beyond the skills of the individual dentist will be the need for leadership in academia and the practice community. Academic and professional leaders will need to engage key constituencies to develop strategic directions and agendas with all parties pointed toward high standards for individual patients and the public at large. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Assessing the impact of the extended-release/long-acting opioid an-algesics risk evaluation and mitigation strategies on opioid prescrip-tion volume.

OBJECTIVE: The Food and Drug Administration approved the extended-release/long-acting (ER/LA) opioid analgesics risk evaluation and mitigation strategies (REMS) in July 2012 to educate healthcare providers and patients about safe and appropriate opioid analgesic use. The authors evaluated the impact of the REMS on ER/LA opioid analgesic utilization, overall and stratified by patient characteristics and prescriber type associated with greater expected need for analgesia. DESIGN: Retrospective repeated cross-sectional study. QuintilesIMS's National Prescription Audit™ and LifeLink™ patient-level longitudinal prescription databases measured prescription volumes, projected to national estimates. MAIN OUTCOME MEASURES: Changes were assessed in ER/LA opioid analgesic prescriptions dispensed from the 2-year pre-REMS implementation (July 2010 to June 2012) to the 18-month post-REMS implementation (July 2013 to December 2014) periods (with 12-month transitional implementation period in between). RESULTS: Average quarterly ER/LA opioid prescription volume significantly decreased by 4.3 percent from Preimple-mentation to the Active Period (5.58 vs 5.34 million, p < 0.001). Differences in prescription volume change were observed between age, gender, and payer types. Prescription volume either significantly decreased or remained stable from Preimplementation to the Active Period among most provider specialties evaluated. The largest volume decreases were observed for dentists (-48.5 percent) and emergency medicine specialists (-25.5 percent) (both p < 0.001). The largest increases were observed for nurse practitioners (+33.7 percent) and physician assistants (+31.2 percent; both p < 0.001), whose overall prescribing of nonopioid medications also increased. CONCLUSIONS: A significant decrease in dispensed ER/LA opioid prescriptions was observed following REMS implementation compared to Preimplementation. The impact on volume varied by patient characteristics and prescriber specialty. The REMS program, in conjunction with other healthcare policies and initiatives, likely influenced these observations.

Change of attitude in Spanish professional dentists as regards risk of HIV/Aids infection / Cambio actitudinal en dentistas españoles ante el riesgo de VIH

Objective: The aim is to estimate the changes in attitude arising after eighteen years in the perception of the risk of contracting HIV/Aids among Spanish dental health workers and the general public. Design: We performed a cross-sectional comparative investigation with the data collected from a survey in 1996 and 2014. Method: two experimental random samples have been selected which make up both groups of dental health workers and general population. Participants were provided with the Global AIDS Attitudes questionnaire and form a B Eysenck Personality Inventory. The data was subsequently subjected to statistical analysis in order to find any significant differences in both years’ samples. Results: The general public of 1996 perceived greater risk in situations like ‘surgery with risk for the patient’ and ‘donating blood’ than dentists. That trend was inverted in 2014. In 1996, male dentists perceived more risk in general terms than women, but in 2014 women assigned more risk (mainly in dental surgery or sharing a syringe). According to age, only in 1996 data showed that dentists over forty perceived more risk than those under twenty-five. Conclusion: After 18 years, positive changes in the general public’s attitudes have taken place but dental health workers have increased their perception of risk of contagion. In the 1996 survey male dentists perceived greater risk while in 2014 it was women who perceived this

Objetivo: estimar los cambios actitudinales producidos en los dentistas españoles y la población general ante la percepción de riesgo de contagio del VIH/Sida dieciocho años después. Diseño: se ha realizado un estudio comparativo transversal de los datos obtenidos por una encuesta realizada en 1996 y otra en el año 2014. Método: se han seleccionado dos muestras aleatorias experimentales que conforman los grupos de profesionales dentistas y población general. A los participantes se les ha administrado el Cuestionario Global de Actitudes del SIDA y la forma B del Inventario de Personalidad de Eysenck. Posteriormente los resultados se han sometido a análisis estadístico para comprobar si existen diferencias significativas entre los resultados de ambos años. Resultados: En 1996 la Población General (PG) percibió más riesgo de contagio que los Dentistas (DT) en la ‘intervención quirúrgica con riesgo para el paciente’ y en la donación de sangre y en el año 2014 son los dentistas los que perciben mayor riesgo. Según sexo, en 1996 son los dentistas varones los que perciben más riesgo, pero en 2014 son las mujeres las que lo perciben (en intervención dental o quirúrgica o al compartir jeringuilla). En relación con la edad solo en 1996 se encontró más percepción de riesgo en dentista mayores de 40 años y menores de 25 años. Conclusiones: Tras 18 años se ha producido un cambio favorable en la percepción de riesgo de contagio en la población general pero los dentistas han aumentado su percepción de riesgo de contagio. En la encuesta de 1996 los hombres dentistas percibían más riesgo y en el 2014 las mujeres

Prescribing patterns of dental practitioners in Australia from 2001 to 2012. Antimicrobials.

BACKGROUND: The development of antibiotic resistance by bacteria is of global concern. Inappropriate prescribing has the potential to exacerbate this issue. We aimed to examine the patterns of prescribing of antimicrobial medicines by dental practitioners in Australia from 2001 to 2012. METHODS: Data were collected from Medicare Australia on prescriptions from dental practitioners dispensed to concessional beneficiaries between 2001 and 2012. We examined patterns of use over time. RESULTS: There was an overall increase in number of prescriptions and in dispensed use (standardized by dose and population) of antibiotics and antifungals for the concessional population over the 12-year period. The use of dentally prescribed antibiotics increased 50%. Amoxicillin was the most commonly prescribed antibiotic accounting for 66% of all prescriptions in 2012. Generally, there was preferential prescribing of the highest dose formulations. The use of the two antifungals increased 30% over the study period with a preference for amphotericin B (74%) rather than nystatin. CONCLUSIONS: These data show a concerning increase in prescribing of antibiotics and antifungals by dentists in Australia. It would appear that Australian dentists may not be prescribing these medicines appropriately; however, further research is needed to understand prescribing behaviours and decision-making by dentists.

SPECIAL FEATURE. PEDIATRIC DENTISTRY.

There are approximately 2 million children living in the state of Michigan who will receive dental care with one of more than 5,500 MDA member dentists. Of these 5,500 MDA members, only approximately 100 are pediatric dentists.(1-3) Thus, it's safe to say that most children will find their dental homes in general dental offices. These general dentists will be providing preventive, diagnostic, and restorative care to most children under most circumstances. And with that in mind, it's of great importance that all dentists be comfortable providing high quality care to the majority of children, referring only a select group for care by a pediatric dentist.

A comparative evaluation of endodontic practice trends in India: "the Mumbai study".

INTRODUCTION: Multiple treatment protocols are available to the Indian endodontist. Hence a survey is required to recognize the common trends in endodontics and set a basic standard of treatment. AIMS AND OBJECTIVES: The aim of this article is to present practice trends among Indian endodontists and compare the same with established practice trends internationally through various surveys that have been conducted respectively. MATERIALS AND METHODS: Questionnaires were mailed to 1085 endodontists in dental schools and private practice in India. A response rate of 42% was observed. The data was analyzed and compared with other studies. RESULTS: Most of the endodontists in India follow the basic protocols and techniques in their practices. 40% of the Endodontists preferred digital radiography technique. 2.5% NaOCl is the most preferred irrigant of choice for primary root canal treatment and 2% chlorhexidine in retreatment cases. Calcium hydroxide was the most preferred intracanal medicament in all clinical situations. Lateral compaction (70.8%) was the most widely used method. AH Plus was the most preferred root canal sealer (46.6%). CONCLUSION: Indian endodontists are following the basic protocol but when compared to other studies there were concepts like, the use of rubber dam and microscope which need to be improved and raised to a level that ensures international standards in clinical practice.

Antibiotic prescription pattern among Indian oral healthcare providers: a cross-sectional survey.

OBJECTIVES: Inappropriate prescribing of antibiotics by healthcare professionals is a worldwide concern. The purpose of this study was to determine the pattern of antibiotic prescription among oral healthcare providers in India. METHODS: A one-page questionnaire was sent to 1600 oral healthcare practitioners registered under the Indian Dental Association by using multistage sampling; 552 (34.5%) responded to the survey. The data were analysed using the χ(2) test and multiple logistic regression analysis. RESULTS: Of 552 questionnaire respondents, 405 (73.4%) chose amoxicillin in non-allergic patients, alone [279 (50.5%)] or associated with clavulanic acid [126 (22.8%)]. The average duration of antibiotic therapy was 4.26 ±â€Š1.26 days. The drug of first choice for patients with an allergy to penicillin was erythromycin [242 (43.8%) of respondents]. A majority prescribed antibiotics for irreversible pulpitis and acute apical periodontitis [395 (71.6%)] and necrotic pulp, acute apical periodontitis and no swelling [326 (59.1%)]. Five hundred and ten (92.4%) of the oral healthcare providers overprescribed antibiotics. CONCLUSIONS: Oral healthcare providers in India are overprescribing, which could be a major contributor to the world problem of antimicrobial resistance. As there is overprescription of antibiotics by Indian oral healthcare providers, there is an urgent need to raise public and professional awareness regarding the risks of antibiotic use.