Odontologia hospitalar: uma análise crítica sobre a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil / Hospital dentistry: a critical analysis of the role of the dental surgeon in tertiary care in the state of Rio Grande do Sul, Brazil

Objetivo: analisar a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil. Método: estudo descritivo ecológico, com uso de dados secundários registrados pelo Cadastro Nacional de Estabelecimentos de Saúde no ano de 2023. A coleta de dados foi realizada em duas etapas. Na primeira etapa também foram coletados os dados do CNES referentes à presença do cirurgião dentista, tipo de vínculo contratual e especialidades ofertadas pelos serviços. Já na segunda etapa os dados coletados foram referentes aos indicadores sociodemográficos dos profissionais com habilitação em odontologia hospitalar utilizando as informações disponibilizadas pelo Sistema WSCFO do Conselho Federal de Odontologia. A análise dos dados foi realizada com o suporte do software TabWin, versão 3.6, e do software estatístico R v. 4.2.3. Os dados foram analisados por meio de análise descritiva. Resultados: apenas 6,11% das instituições são certificadas e consideradas Hospitais de Ensino. A maioria dos estabelecimentos (87,14%) oferece atendimento pelo SUS. Quanto à presença de cirurgiões dentistas nos estabelecimentos, 64,63% dos estabelecimentos relataram tê-los, enquanto 35,37% não possuem esse profissional em sua equipe. Neste estudo, constatamos que uma correlação positiva do cirurgião dentista com o número de leitos de UTI adulto e ao maior porte do hospital. Conclusão: observa-se que ainda há necessidade de estruturação da atenção terciária no Estado do Rio Grande do Sul, no que se refere à odontologia hospitalar. Há poucos os cirurgiões dentistas com uma carga horária dedicada exclusivamente ao atendimento hospitalar clínico a beira leito.(AU)

Objective: To analyze the inclusion of dental surgeons in tertiary care in the state of Rio Grande do Sul, Brazil. Method: a descriptive ecological study using secondary data recorded by the National Register of Health Establishments in 2023. Data was collected in two stages. In the first stage, data was also collected from the CNES regarding the presence of a dental surgeon, the type of contractual relationship and the specialties offered by the services. In the second stage, data was collected on the sociodemographic indicators of professionals qualified in hospital dentistry using the information provided by the WSCFO System of the Federal Council of Dentistry. The data was analyzed using TabWin software, version 3.6, and R v. 4.2.3 statistical software. The data was analyzed using descriptive analysis. Results: only 6.11% of institutions are certified and considered Teaching Hospitals. The majority of establishments (87.14%) provide care through the SUS. As for the presence of dental surgeons in the establishments, 64.63% of the establishments reported having them, while 35.37% did not have this professional on their team. In this study, we found a positive correlation between the number of adult ICU beds and the size of the hospital. Conclusion: There is still a need to structure tertiary care in the state of Rio Grande do Sul, in terms of hospital dentistry. There are few dental surgeons with a workload dedicated exclusively to bedside clinical hospital care.(AU)

Hallazgos en radiografías panorámicas de niños entre 6 y 15 años en un hospital odontológico en Argentina / Findings in panoramic radiographs of children between 6 and 15 years at a dental hospital in Argentina

Objetivo: Describir la frecuencia y localización de pato- logías y anomalías dentarias (anomalías de número, tumores, quistes y piezas retenidas) observadas en radiografías pa- norámicas de pacientes pediátricos de entre 6 y 15 años del Hospital Zonal Especializado en Odontología Infantil "Dr. A. Bollini" de la ciudad de La Plata. Materiales y métodos: Se realizó un estudio observa- cional descriptivo de 300 radiografías panorámicas, de niños (n=150) y niñas (n=150) de entre 6 y 15 años, seleccionadas aleatoriamente en el área de radiología del hospital, tomadas en el período comprendido entre marzo de 2018 y marzo de 2020. Los datos obtenidos se volcaron en planillas de cálculo y con ellos se realizó un análisis estadístico descriptivo. Se utilizaron las siguientes variables: edad, sexo, tipo de ano- malía o patología (anomalías de número, tumores, quistes y piezas retenidas), pieza dentaria y ubicación (maxilar o man- díbula). Resultados: Dentro de las anomalías registradas (n=147), se encontraron en mayor medida piezas dentarias retenidas, en un 44,22% de los casos (n=65), agenesias en un 42,18% de los casos (n=62) y supernumerarios en un 13,61% de los casos (n=20). No se hallaron quistes ni tumores. Conclusión: En un 24% de las radiografías panorámicas de niños entre 6 y 15 años se halló alguna anomalía dentaria. Las anomalías más frecuentes fueron piezas dentarias reteni- das y agenesias (AU)

Aim: To describe the frequency and location of dental pathologies and anomalies (number anomalies, tumors, cysts and retained dental pieces) observed in panoramic radio- graphs of pediatric patients between 6 and 15 years of age from the Hospital Especializado en Odontología Infantil "Dr. A. Bollini" from the city of La Plata. Materials and methods: A descriptive observational study was performed based on 300 panoramic radiographs of children (150 girls and 150 boys) between 6 and 15 years old, randomly selected in the Radiology area of the hospital, taken in the period between March 2018 and March 2020. The data obtained were entered into spreadsheets and a descriptive sta- tistical analysis was carried out. The following variables were evaluated: age, sex, type of anomaly or pathology (anomalies of number, tumor, cysts and retained dental pieces), dental piece and location (maxilla or mandible). Results: Among the registered anomalies (n=147), re- tained dental pieces were found to a greater extent, in 44.22% of the cases (n=65), agenesis in 42.18% of the cases (n=62) and supernumeraries in 13.61% of the cases (n=20). No cysts or tumors were found. Conclusion: In 24% of panoramic radiographs of chil- dren between 6 and 15 years old, some dental anomaly was found. The most frequent anomalies were retained dental pieces and agenesis (AU)

Medical Conditions, Oral Health Practices, and Barriers to Treatment among Patients Visiting a Teaching Dental Hospital in Eastern Saudi Arabia.

OBJECTIVE: To assess the prevalence of medical conditions, oral hygiene practices, and dental visits among patients who attended a teaching dental hospital in Dammam, Saudi Arabia. Materials & Methods. This retrospective cross-sectional study used patient records from 2009 to 2015 from the dental hospital of the College of Dentistry Imam Abdulrahman Bin Faisal University, Dammam. Patients' demographics, medical history, oral hygiene practices, reasons for attending the facility, attendance patterns, and smoking habits were studied. RESULTS: The study included 1502 records of patients with 65.1% of males and 34.9% of females. The prevalence of medical conditions was 25.7% in the study. The most common medical conditions included diabetes mellitus (7.2%), hypertension (6.5%), and anemia (4.7%). Only 21.8% reported visiting the dental hospital in the past one year. The prevalence of smoking was 16.7%, and this did not differ significantly between healthy and medically compromised patients (P=0.165). Fillings were the most common (21.6%) reason for visiting a dental hospital, followed by treatment for periodontal problems (12.9%) and oral lesions (12.6%), whereas treatment for braces (orthodontics) was the least common (5%) reason for visiting the hospital. The reasons for visiting the hospital did not differ significantly between healthy and medically compromised patients (P > 0.05). The three most common barriers to dental visits included long waiting time (18.1%), fear of dental treatment (14.4%), and difficulty in getting an appointment (11.3%). CONCLUSION: The study showed that dental patients had a high prevalence of medical conditions. Diabetes mellitus was the most prevalent problem. Most patients visited the dental hospital to receive restorative treatment, and a long waiting time was the most common barrier to dental visits. Public health measures should be taken to improve the general health and oral care of patients.

Manifestaciones bucales de pacientes con mucopolisacaridosis / Oral manifestations in patients with mucopolysaccharidosis

Objetivo: Describir las características bucales prevalentes de pacientes argentinos con mucopolisacaridosis (MPS) atendidos en el Servicio de Odontología del Hospital Nacional "Prof. Alejandro Posadas". Materiales y métodos: Se consideraron las historias clínicas de 19 pacientes con diagnóstico de MPS. Se registraron la edad, el sexo, el lugar de residencia, el tipo de MPS y la presencia de retraso madurativo. La muestra estuvo constituida por 13 niños (6,7±3 años) y 6 adultos (26±9 años): 2 eran mujeres (1 con MPS tipo I; 1 con MPS tipo IV A) y 17 eran hombres (15 con MPS tipo 2; 1 con MPS tipo 1; 1 con MPS tipo III); 13 de los pacientes presentaban discapacidad intelectual. Se evaluaron: tipo de dentición, oclusión, macroglosia, hipoplasias del esmalte, tipo de respiración predominante, clase molar y tratamiento realizado. Resultados: Ambos casos con MPS I presentaban mordida abierta anterior y giroversión dental, y solo uno de estos, diastemas, microdoncia, hipoplasias del esmalte, macroglosia y respiración bucal. De los 15 pacientes con MPS II, 11 presentaban mordida abierta anterior (73%), 3 mordida cruzada posterior (20%), 5 giroversión dental (33%), 11 diastemas (73%), 3 retraso en la erupción (20%), 4 hiperplasia gingival (26%), 13 macroglosia (87%), 7 hipoplasias del esmalte (47%), 2 microdoncia (13%), 9 respiración bucal (60%). Se registraron 5 pacientes con clase molar I (33%), 3 con clase molar II (20%), 3 con clase molar III (20%) y en 3 casos no se pudo evaluar (20%). En el paciente con MPS tipo III se halló mordida abierta anterior, diastemas, retraso en la erupción, macroglosia, respiración bucal y clase molar II; y en el caso de MPS tipo IV A, mordida abierta anterior, diastemas, hiperplasia gingival, macroglosia y clase molar II. El 90% de los pacientes requirió tratamiento odontológico (AU)

Aim: To identify the most prevalent oral manifestations of 19 Argentine patients with mucopolysaccharidos (MPS) attending the Dentistry Service of the National Posadas Hospital. Materials and methods: The medical records of 19 patients diagnosed with MPS were considered. Age, sex, place of residence, type of MPS, and presence of maturational delay were recorded. The sample consisted of 13 children (6.7 ± 3 years) and 6 adults (26 ± 9 years): 2 were women (1 with MPS type I; 1 with MPS type IV A) and 17 were men (15 with MPS type 2; 1 with MPS type 1; 1 with MPS type III); 13 of the patients had intellectual disabilities. The following were evaluated: type of dentition, occlusion, macroglossia, enamel hypoplasia, predominant type of respiration, molar class and treatment performed Results: Both cases with MPS I presented anterior open bite and dental gyroversion, and only one of these, diastemas, microdontia, enamel hypoplasia, macroglossia and mouth respiration. Of the 15 patients with MPS II, 11 presented anterior open bite (73%), 3 posterior crossbite (20%), 5 dental gyroversion (33%), 11 diastemas (73%), 3 delayed eruption (20%), 4 gingival hyperplasia (26%), 13 macroglossia (87%), 7 enamel hypoplasia (47%), 2 microdontia (13%), 9 mouth breathing (60%). 5 patients with molar class I (33%), 3 with molar class II (20%), 3 with molar class III (20%) and in 3 cases it could not be evaluated (20%). In the patient with type III MPS, anterior open bite, diastemas, delayed eruption, macroglossia, mouth breathing and molar class II were found; and in the case of type IV A MPS, anterior open bite, diastemas, gingival hyperplasia, macroglossia and molar class II. 90% of the patients required dental treatment. Conclusion: The most observed oral manifestations were macroglossia (84.2%) and anterior open bite (73%) (AU)

Diabetes y enfermedad periodontal / Diabetes and periodontal disease

El objetivo de este trabajo fue establecer la relación entre el grado de enfermedad periodontal y el control metabólico de la glucemia en pacientes que padecen diabetes tipo 2. Es un estudio de tipo observacional, descriptivo, transversal. Se seleccionaron 42 pacientes con diagnóstico de diabetes mellitus tipo 2 de ambos sexos, entre 25 y 75. Se realizó odontograma y se evaluó el grado de enfermedad periodontal para determinar el grado de compensación metabólica de los pacientes se tomaron muestras de sangre venosa y se midieron los valores de hemoglobina glicosilada. Un 23,55% de los pacientes no presentaron enfermedad periodontal y el resto se dividió en leve, moderada y severa presentándose la enfermedad leve en primer orden. Los pacientes con mayor grado de enfermedad periodontal presentaron mayor número de piezas dentarias perdidas (p 0,0334). La enfermedad periodontal se distribuye de la misma manera en ambos grupos de control glucémico (p=0,1211). En el grupo estudiado, el grado de enfermedad periodontal es independiente del control glucémico de los pacientes (AU)

The objective of this work was to establish the relationship between the degree of periodontal disease and the metabolic control of glycemia in patients with type 2 diabetes. It is an observational, descriptive, cross-sectional study. 42 patients with a diagnosis of type 2 diabetes mellitus of both sexes, between 25 and 75, were selected. An odontogram was performed and the degree of periodontal disease was evaluated; venous blood samples were taken and glycosylated hemoglobin values were measured to determine the degree of metabolic compensation of the patients. 23.55% of the patients did not present periodontal disease and the rest were divided into mild, moderate, and severe, with mild disease presenting in the first order. The patients with a higher degree of periodontal disease had a higher number of missing teeth (p 0.0334). Periodontal disease is distributed in the same way in both glycemic control groups (p = 0.1211). In the group studied, the degree of periodontal disease is independent of the glycemic control of the patients (AU)

Manifestaciones trombóticas en la neumonía viral por SARS-CoV-2 pacientes hospitalizados en el Hospital «Irma de Lourdes Tzanetatos¼, Panamá, Panamá. De marzo de 2020 a septiembre de 2020 / Thrombotic manifestations in viral neumonia by CoV-2-SARS hospitalized patients at «Irma Lourdes Tzanetatos¼ Hospital, Panama, Panama. March 2020 to September 2020

La respuesta a la infección viral produce un estado de trombosis o hipercoagulabilidad que, unido a la inflamación de las células endoteliales, puede generar disfunción plaquetaria y predisposición a la formación de trombos que, aunque con frecuencia son más venosos, también pueden aparecer en el sistema arterial y producir infartos a cualquier nivel así como tromboembolia e hipertensión pulmonar. Estas manifestaciones han sido captadas hospitalariamente y al egreso de los pacientes detectados por SARS-CoV-2 habiendo ya cumplido el tiempo establecido de virulencia. Los criterios diagnósticos de respuesta inmunológica trombótica asociada a COVID-19 (RITAC) ayudan a seleccionar al paciente que está predispuesto a esta condición; a esto se añade que el paciente ya tiene un diagnóstico de infección por SARS-CoV-2 (AU)

The response to viral infection produces a prothrombotic state of hypercoagulability , united with an inflammation of endothelial cells, It can generate platelet dysfunction and predisposition to the formation of thrombus, that, although, are more frequently venous, Also, it can appear in the arterial system and cause heart attacks at any level; thromboembolism and pulmonary hypertension, as well. These manifestations have been captured hospitably and with the egress of patients detected by SARS-CoV-2. The diagnostic criteria of RITAC (abbreviation in Spanish of Thrombotic Immune Response Associated to COVID-19), help to select the patient who is predisposed to this condition; adding that the patient already has a diagnosis of SARS-CoV-2 infection (AU)

The Impact of Title VII Dental Workforce Programs on Dentists' Practice Location: A Difference-in-Differences Analysis.

PURPOSE: To examine the potential impact of Health Resources and Services Administration (HRSA) funding (predoctoral [PD] and postdoctoral [PDD] programs) on dentists' practice location in the United States. METHOD: The authors linked 2011-2015 data from HRSA's Electronic Handbooks to 2015 data from the American Dental Association Masterfile, dental health professional shortage areas, and rural-urban commuting area codes. They examined the associations between PD and PDD funding and dentists' practice location between 2004 and 2015 using a difference-in-differences analysis and multiple logistic regressions, adjusting for covariates. RESULTS: From 2004 to 2015, 21.2% (1,588/7,506) of dentists graduated from institutions receiving PD funding and 26.8% (2,014/7,506) graduated from institutions receiving PDD funding. Among dentists graduating from institutions receiving PDD funding, after adjusting for covariates, those graduating between 2011 and 2015 were more likely to practice in a rural area than those graduating between 2004 and 2010 (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.04-3.76). The difference-in-differences approach showed that PD and PDD funding significantly increased the odds that a dentist would practice in a rural area (respectively, OR = 2.70; 95% CI = 1.31-5.79/OR = 2.84; 95% CI = 1.40-5.77). CONCLUSIONS: HRSA oral health training program funding had a positive effect on dentists choosing to practice in a rural area. By increasing the number of dentists practicing in rural communities, HRSA is improving access to, and the delivery of, oral health care services to underserved and vulnerable rural populations.

The Spectrum of Histological Findings in Oral Biopsies

Aim: To undertake a retrospective analysis of the use of a diagnostic pathology service, to determine the source of oral biopsies submitted for histological analysis, and to examine the range and frequencies of histologically diagnosed oral lesions in an Irish population. Methods: A retrospective analysis was carried out on all oral biopsies submitted for histological analysis to an oral and maxillofacial diagnostic pathology service from June to December 2015. Results: In total 724 oral biopsies were submitted. The majority of diagnoses were benign (80.3%) and the remaining diagnoses were made up of malignancies (6.7%) and potentially malignant disorders (PMDs), histologically characterised by epithelial dysplasia (13%). Less than 1% of biopsies were submitted from general dentists in primary care. Conclusion: This study showed that oral biopsies are not submitted from the primary care setting, but rather from hospital-based specialist units or referral-based specialist practitioners. There was a broad range of histological diagnoses, the majority of which were benign.

Desinfección del instrumental en las Unidades de Salud Bucodental del Servicio Gallego de Salud / Disinfection of dental instruments in dental settings of the Galician Health Service

No disponible

'I miss my family, it's been a while ' A qualitative study of clinicians who live and work in rural/remote Australian Aboriginal communities.

OBJECTIVES: Dental issues are more prevalent for Aboriginal Australians, especially those living in rural/remote locations, but distribution of clinicians is favoured towards metropolitan areas and are not always culturally competent. This study aimed to document the experiences of dental clinicians who relocated to rural/remote communities to provide dental services to Aboriginal communities in an effort to redress these gaps. SETTING: Clinicians working in a new rural/remote dental service strategy to Aboriginal communities in Northern NSW. DESIGN: Qualitative semi-structured face-to-face interviews and reflective diaries were analysed qualitatively. PARTICIPANTS: Relocating dental clinicians and their support team. RESULTS: Three major themes emerged: Theme one: Mastering the clinical environment through professional experiences: Increasing professional capabilities, clinical environment, valuing team work and gaining community respect. Theme two: Development and growth of the individual through personal and social experiences: culture shock, developing cultural competence, social impact, economic cost and personal adjustments and growth. Theme three: An overarching sense of achievement and advice to new clinicians. CONCLUSION: Relocation to rural and remote communities to provide health services is a complex but rewarding process. Providing personal and professional support, to relocating clinicians resulted in an overall positive experience for the participants, where they increased their professional skills and developed personally. Living and working in the community increased their cultural competence. Barriers were overcome through effective communication, flexibility and teamwork. Funding for rural placements, such as these, is critical for rural and remote health services and should include long-term appropriate funding for mentoring and support.

Does Restriction of Public Health Care Dental Benefits Affect the Volume, Severity, or Cost of Dental-Related Hospital Visits?

PURPOSE: On July 1, 2012, the Illinois legislature passed the Save Medicaid Access and Resources Together (SMART) Act, which restricts adult public dental insurance coverage to emergency-only treatment. The purpose of this study was to measure the effect of this restriction on the volume, severity, and treatment costs of odontogenic infections in an urban hospital. MATERIALS AND METHODS: A retrospective cohort study of patients presenting for odontogenic pain or infection at the University of Illinois Hospital was performed. Data were collected using related International Classification of Diseases, Ninth Revision codes from January 1, 2011 through December 31, 2013 and divided into 2 cohorts over consecutive 18-month periods. Outcome variables included age, gender, insurance status, oral and maxillofacial surgery (OMS) consultation, imaging, treatment, treatment location, number of hospital admission days, and inpatient care level. Severity was determined by the presence of OMS consultation, incision and drainage, hospital admission, and cost per encounter. Hospital charges were used to compare the cost of care between cohorts. Between-patients statistics were used to compare risk factors and outcomes between cohorts. RESULTS: Of 5,192 encounters identified, 1,405 met the inclusion criteria. There were no significant differences between cohorts for age (P = .28) or gender (P = .43). After passage of the SMART Act, emergency department visits increased 48%, surgical intervention increased 100%, and hospital admission days increased 128%. Patients were more likely to have an OMS consult (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.11-1.81), an incision and drainage (OR = 1.48; 95% CI, 1.13-1.94), and a longer hospital admission (P = .04). The average cost per encounter increased by 20% and the total cost of care increased by $1.6 million. CONCLUSION: After limitation of dental benefits, there was an increase in the volume and severity of odontogenic infections. In addition, there was an escalated health care cost. The negative public health effects and increased economic impact of eliminating basic dental care show the importance of affordable and accessible preventative oral health care.

Pacientes con fisura labio-alveolo-palatina: estudio descriptivo de pacientes atendidos en el Hospital Público Materno Infantil, Pcia. de Salta, entre los años 2010 y 2014 / A descriptive study of patients with FLAP at the Public Maternity Child Hospital in the province of Salta, between 2010 and 2014

La fisura labio-palatina (FLP) es una de las malformaciones congénitas más frecuentes. Si bien la fisura de labio y la fisura de paladar son distintas y pueden presentarse de manera individual o ambas en el mismo individuo, es útil estudiarlas en conjunto. La prevalencia en Argentina es menor que la media informada a nivel mundial. Esta patología requiere un tratamiento continuo y mutidisciplinario, con el fin de disminuir sus secuelas. El Hospital Público Materno Infantil (HPMI) de la provincia de Salta, es el principal centro de referencia que trabaja con niños fisurados de toda la provincia. Dada la diversidad de etnias y regiones geográficas de procedencia de los pacientes, se considera conveniente sistematizar la información. Para ello, se realizó un estudio descriptivo sobre 308 pacientes con FLAP: el sexo más afectado fue el masculino y la mayoría proviene de los Departamentos de Molinos y Los Andes. La fisura más frecuente es la unilateral izquierda completa. El 92,5 por ciento de los pacientes FLAP no presentaron asociación con síndromes y el 28,6 por ciento abandonó el tratamiento ortodóncico-ortopédico, la mayoría antes del primer año de vida. Si bien los datos aportados fueron similares a los de otros autores, ésta es la primera base de datos para la provincia de Salta. La misma permitirá realizar nuevas investigaciones y propone consignar una historia clínica estandarizada para la institución...

Oral health-related quality of life in the elderly population receiving health care at the Public Hospital Network in Medellin, Colombia, and its related factors

Metrosalud is the largest public hospital network in the city of Medellin and one of the most important in Colombia providing health care to the most vulnerable population. The objective of the study was to determine the Oral HealthRelated Quality of Life (OHRQoL) and its related factors in the elderly population receiving health care at the public hospital network in Medellin (Colombia). A crosssectional design was used. Men and women ≥ 65 years old were considered for this research, selected from first consultation records by the institution’s statistical unit for 2011, who accepted to participate after being contacted by telephone...

Metrosalud es la Empresa Social del Estado (E.S.E.) y red hospitalaria pública más grande de la ciudad de Medellín y una de las más importantes del país en materia de atención en salud a la población más vulnerable. El objetivo de este estudio fue determinar la calidad de vida relacionada con salud bucal (CVRSB) en la población adulta mayor atendida en la red hospitalaria pública de Medellín (Colombia) y sus factores relacionados. Se realizó un estudio descriptivo trasversal. La muestra fue constituida por población adulta mayor de la ESE Metrosalud. Hombres y mujeres mayores de 65 años fueron considerados para esta investigación y fueron seleccionados de los registros de consulta de la unidad de estadística de la institución (año 2011) e invitados a participar a través de contacto telefónico.

Tratamiento de las fracturas en mandíbulas atróficas: nuestra experiencia con la reducción abierta y fijación interna según el principio de carga soportada / Treatment of atrophic mandible fractures: our experience with open reduction and internal fixation according to the load-bearing principle

Objetivo: presentar los resultados terapéuticos obtenidos por medio de la reducción abierta y fijación interna, aplicando el principio de carga soportada, en el tratamiento de fracturas de mandíbulas atróficas. Casos clínicos: se llevaron a cabo tratamientos en 21 pacientes, con un total de 30 fracturas de mandíbula atrófica, sobre 410 pacientes ingresados por fracturas mandibulares, en un hospital municipal de tercer nivel y en la práctica privada, durante el período 1991-2014. Conclusión: la reducción abierta y fijación interna según el principio de carga soportada, es una terapéutica predecible y segura para el tratamiento de las fracturas en mandíbulas atróficas. La mayoría de las publicaciones recientes comparten resultados similares y lo consideran el procedimiento terapéutico de elección...

Does access to general dental treatment affect the number and complexity of patients presenting to the acute hospital service with severe dentofacial infections?

AIM: This is a retrospective study to review the treatment and management of patients presenting with odontogenic infections in a large urban teaching hospital over a four-year period, comparing the number and complexity of odontogenic infections presenting to an acute general hospital in two periods, as follows: Group A (January 2008 to March 2010) versus Group B (April 2010 to December 2011). The background to the study is 'An alteration in patient access to primary dental care instituted by the Department of Health in April 2010'. OBJECTIVES: a) to identify any alteration in the pattern and complexity of patients' presentation with odontogenic infections following recent changes in access to treatment via the Dental Treatment Services Scheme (DTSS) and the Dental Treatment Benefit Scheme (DTBS) in April 2010; and, b) to evaluate the management of severe odontogenic infections. METHOD: Data was collated by a combination of a comprehensive chart review and electronic patient record analysis based on the primary discharge diagnosis as recorded in the Hospital In-Patient Enquiry (HIPE) system. RESULTS: Fifty patients were admitted to the National Maxillofacial Unit, St James's Hospital, under the oral and maxillofacial service over a four-year period, with an odontogenic infection as the primary diagnosis. There was an increased number of patients presenting with odontogenic infections during Group B of the study. These patients showed an increased complexity and severity of infection. Although there was an upward trend in the numbers and complexity of infections, this trending did not reach statistical significance. CONCLUSIONS: The primary cause of infection was dental caries in all patients. Dental caries is a preventable and treatable disease. Increased resources should be made available to support access to dental care, and thereby lessen the potential for the morbidity and mortality associated with serious odontogenic infections. The study at present continues as a prospective study.

Epidemiology and Outcomes of Hospital-based Emergency Department Visits with Tooth Fractures.

PURPOSE: The purpose of this study was to identify characteristics of hospital-based emergency department (ED) visits for tooth fracture and subsequent dentally related hospital admissions. METHODS: This was a retrospective analysis of the Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project for the years 2008 to 2010. All children up to 21 years old, with a diagnosis of tooth fracture due to trauma, were selected. Hospital ED charges, occurrence of concurrent injuries, and hospitalization following ED visits were examined. RESULTS: A total of 199,061 ED visits were attributed to broken or fractured teeth; males comprised 63 percent of ED visits. Skull and facial fractures were present in seven percent and intracranial injuries in four percent of ED visits. The most frequent causes for ED visits and for subsequent hospitalization, respectively, were falls and motor vehicle accidents. The mean charge for each ED visit was $1,441. Total charges for the entire United States were $241.8 million. Following an ED visit, 7,233 patients were admitted as inpatients. CONCLUSIONS: Males comprised a majority of these emergency department visits. Occurrence of concomitant bodily injuries appears to be common and is a significant predictor of hospitalization and hospital ED charges.

Trends in paediatric maxillofacial trauma presenting to Dunedin Hospital, 2006 to 2012.

OBJECTIVES: The purpose of this study was to review the epidemiology, aetiology and management of maxillofacial injuries in the paediatric population seen in Dunedin, New Zealand from 2006 to 2012. MATERIALS AND METHODS: A retrospective descriptive analysis was conducted over a 7 year period. Data concerning demographics, injuries and management of patients between the ages of 0-17 years who presented to the oral and maxillofacial service in Dunedin were gathered and analysed. RESULTS: 340 incidents that excluded pure dental trauma were recorded. Falls were found to be the most common cause of injury; followed by contact with animate objects (other individuals and animals), contact with inanimate objects and road traffic accidents. Injuries in younger age groups were found to be caused by falls and contact with inanimate objects more often, receiving predominantly soft tissue injuries. In the older age group, a higher number of facial fractures were seen with a change in the most common causes to road traffic accidents and contact with animate objects. An increase in alcohol-related road traffic accidents was noted among females. For all injuries the male to female ratio was 2:1 which is similar to previous reports from New Zealand and overseas. For the sub group of facial fractures a much higher ratio of males were seen at a ratio of 8.5:1. CONCLUSIONS: Causes of injury and anatomical location followed similar patterns to reports worldwide, along with a similar male to female ratio. Although the incidence of road traffic accident related facial injuries is relatively low, the high proportion of these accidents involving paediatric patients and alcohol is of concern.

A study of the provision of hospital based dental general anaesthetic services for children in the northwest of England: part 1--a comparison of service delivery between six hospitals.

BACKGROUND: Extensive caries in children can result in a referral for tooth extraction under General Anaesthesia (GA). While there are guidelines for the use of GA within paediatric dentistry this process is ultimately dependent upon the decision making of the treating dentist. This decision can be influenced locally by the availability of services and their waiting list. GA services for paediatric extractions (DGA) have developed from different historical positions, including community dental services, maxillofacial services and paediatric led specialist services. METHODS: This article explores the differences between DGA services provided by 6 randomly selected hospitals across the North West of England. 456 patients who attended a routine DGA appointment in each hospital over a period of two months from 2012 to 2013 gave consent to allow access to their clinical notes and completed a questionnaire (93% consent rate). Data were entered onto SPSS and appropriate statistical tests undertaken. RESULTS: Differences between hospitals included the clinic structure, patient characteristics and the treatment provided. There was a significant difference in the number of previous child DGAs experienced within the family, ranging from 33% to 59% across hospitals. Hospital 1 attendees differed in a number of ways to other areas but notably in the stability of life time residency with 20% of patients having previously lived in another area and with just 58% of parents stating their child regularly attended the dentist (compared to an average of 9% and 81% respectively across other hospitals). CONCLUSION: Findings suggest services throughout the region face different obstacles in providing support and treatment for young children referred for DGA. There are, however common practices such as preventative treatment, which could impact on caries experience and subsequent DGA referral, a particular issue given the high DGA repeat rate observed. For many children a DGA may be their first dental experience. It is therefore vital to engage with both child and family at this stage, attempt to initiate a pattern of dental attendance and to ensure this experience does not create an on-going cycle of poor dental behaviour and health.

An audit into the reasons why treatment was not completed as planned under intravenous sedation in an adult oral surgery department, and the cost implications.

This audit aimed to identify the prevalence of, and reasons for failed intravenous conscious sedation in an adult oral surgery department, to develop recommendations to reduce such failures and to identify any cost implications. Data were collected prospectively for three months for all intravenous sedation appointments in the Oral Surgery department. Data were collected for 109 sedation appointments of which 83 were successful (76%). The failure rate (24%) was higher than the acceptable departmental failure rate (10%), and included reasons for failure that should have been avoided by a thorough patient assessment prior to treatment. Of the 26 failures, the most common reasons for failure were: cancellation: 8 patients (30.8%), failure to attend: 6 patients (23.1%), excessively late arrival of patient: 4 patients (15.4%) and failure to cannulate: 3 patients (11.6%). When sedation was unsuccessful, 13 of the 26 patients (50%) had their treatment successfully completed under local anaesthesia alone, 10 patients (38%) were rebooked for sedation and 3 patient. (12%) were rebooked for a general anaesthetic. Identifying and correcting the reasons for failure can result in vast savings in appointment time, clinical resources and cost. That 13 patients subsequently had their treatment completed under local anaesthesia alone opens the debate on how rigorous the patient assessment and allocation of sedation appointments was, and the potential to achieve savings.

What is the role of the oral and maxillofacial department in the preoperative management of patients awaiting cardiac operations?

There is limited evidence and guidance on best practice regarding preoperative dental assessments of patients awaiting cardiac operations. To analyse current practice in oral and maxillofacial units across the United Kingdom, we did a telephone survey to find out how these patients are managed. All maxillofacial departments in the United Kingdom were contacted, with a response rate of 77%. Those attached to dental schools were excluded. Most departments did extractions only, and in many, patients were assessed and treated within 7 days of being referred, although this varied. Most units did not offer antibiotic prophylaxis to patients at high risk of infective endocarditis, but some did after advice had been sought from a cardiologist. Respondents in 76% thought that preoperative dental assessments for cardiac patients were an appropriate use of resources. We propose a more integrated pathway for the management of these patients (particularly considering the pressure on time for treatment) that focuses primary and secondary resources accordingly.