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1.
J World Fed Orthod ; 9(3): 123-128, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32768366

RESUMO

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has had far-reaching effects on orthodontic care delivery worldwide. This study aimed to assess the impacts of the pandemic on orthodontists and orthodontic residents in Nigeria. METHODS: This cross-sectional study was conducted among consenting orthodontists and orthodontic residents. The respondents were contacted through the WhatsApp group of the Nigerian Association of Orthodontists to fill the self-administered online questionnaires (Google forms). The questionnaire had two sections: A, Sociodemographics; B, Perceived impact of the COVID-19 pandemic. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were used to compute mean and standard deviation and chi-square for association. Level of significance was set at P < 0.05. RESULTS: This study population comprised 98 people; however, only 73 participants responded, which represented a response rate of 74.5%. Approximately 60% (44) of the respondents thought that the COVID-19 pandemic would lead to a reduction in the number of orthodontic patients in the future, whereas almost all the respondents reported that it would affect their future practice of orthodontics. Most of the respondents (63.0%) reported that the pandemic had recorded a moderate to severe negative economic impact on them. Significant gender differences were recorded, in the social life of respondents, in addition to economic and psychosocial effects. CONCLUSIONS: Almost all respondents reported that they would change their future practice of orthodontics, particularly with respect to placing a greater emphasis on infection control. Most of the respondents reported perceived economic, psychosocial, and social impacts due to the pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Ortodontistas , Pneumonia Viral/epidemiologia , Padrões de Prática Odontológica/estatística & dados numéricos , Adulto , Betacoronavirus , Estudos Transversais , Feminino , Humanos , Masculino , Nigéria/epidemiologia , Pandemias , Inquéritos e Questionários
2.
PLoS One ; 15(7): e0235671, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649689

RESUMO

BACKGROUND: Antibiotics are regularly prescribed by dental professionals in their practice, for the purpose of dental treatment as well as for the prevention of infection. The inappropriate use of antibiotics is a significant factor in the rise of antibiotic resistance. There is an immediate need for the advancement of prescribing guidelines and instructive polices to encourage the rational and appropriate utilization of medications especially antibiotics in dentistry. OBJECTIVE: The aim of this study was to identify the frequency of antibiotic prescription for treating dental infections in children among dentists in teaching institutions of Karachi, Pakistan and whether they are adhering to the prescribed international guidelines. METHODS: A cross-sectional study was conducted in three private and two public colleges of Karachi. After taking written informed consent and checking the inclusion criteria, a total of 380 participants were interviewed using a pre-designed validated questionnaire which included demographic profile and clinical case scenarios. Data were entered and analyzed on SPSS version 20. Inferential analysis was performed using chi-square test. The significance level was set at 0.05. RESULTS: Of the 380 subjects, a majority (71.3%) treated 15 or less children per month (n = 271) while 28.7% of dentists (n = 109) treated more than 15 children per month. Overall adherence to American Academy of Pediatric Dentistry guidelines was low from 26.1% to 44.2%. The difference between adherence of dentists with low and high volume of pediatric patients was significantly different for case scenarios 1, 3, 4 and 5 (p<0.001 for all) where dentists who treated 15 or less children per month were more likely to be adherent to standard antibiotic prescription guidelines than those who treated more than 15 children per month. CONCLUSIONS: This study shows that majority of dentists, particularly dentists with high volume of pediatric patients lacked adherence to professional guidelines for prescribing antibiotics for treating dental infection in children. There seem to be a lack of harmony between the recommended professional guidelines and the antibiotic prescribing pattern of dentists. Regular updates and continuing medical education for the health professionals regarding comprehensible and specific professional guidelines may lead to improved adherence of antibiotics prescription amongst dentists.


Assuntos
Antibacterianos/uso terapêutico , Odontólogos/psicologia , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Doenças Dentárias/tratamento farmacológico , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Humanos , Lactente , Entrevistas como Assunto , Masculino , Paquistão , Odontopediatria , Inquéritos e Questionários , Doenças Dentárias/microbiologia , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-32604906

RESUMO

SARS-CoV-2 is a member of the family of coronaviruses. The first cases were recorded in Wuhan, China, between December 2019 and January 2020. Italy is one of the most affected countries in Europe. COVID-19 is a new challenge in modern dentistry. New guidelines are required in dental clinics to avoid contagion caused by cross-infections. A narrative review was performed using both primary sources, such as scientific articles and secondary ones, such as bibliographic indexes, web pages, and databases. The main search engines were PubMed, SciELO, and Google Scholar. Twelve articles were selected to develop the bibliographic review by applying pre-established inclusion and exclusion criteria. Precautionary measures should be applied to control COVID-19 in clinical practice. Several authors have highlighted the importance of telephone triage and/or clinic questionnaires, body temperature measurement, usage of personal protective equipment, surface disinfection with ethanol between 62% and 71%, high-speed instruments equipped with an anti-retraction system, four-handed work, and large-volume cannulas for aspiration. Clinically, the use of a rubber dam is essential. FFP2 (or N95) and FFP3 respirators, if compared to surgical masks, provide greater protection for health workers against viral respiratory infections. Further accurate studies are needed to confirm this.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Odontologia , Controle de Infecções/normas , Saúde do Trabalhador , Pneumonia Viral/transmissão , Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde , Humanos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle , Padrões de Prática Odontológica/estatística & dados numéricos
4.
Artigo em Inglês | MEDLINE | ID: mdl-32570842

RESUMO

COVID-19 has severely impacted dentists, who are at a great risk of infection. This study aimed to investigate if dentists are anxious about returning to their daily activities, and what the perception of the risk is for dentists and orthodontists regarding orthodontic procedures. An online questionnaire, including the Patient Health Questionnaire-4 (PHQ-4), was sent to Italian dentists during the final days of the lockdown with items about anxiety, fear, distress, perceived risk for operators, and concerns about orthodontic patients caused by working during the COVID-19 outbreak. Data were analyzed with a chi-square test and logistic regression analysis. The level of significance was set as p < 0.05. A total of 349 dentists completed the survey, including 183 orthodontists. Returning to their daily work activity was a source of anxiety for 192 participants and this was associated with the level of distress (odds ratio (OR) = 3.7; p < 0.001). Most of the orthodontists (67.6%) thought that they would increase the number of working hours during the week (OR = 1.8; p = 0.007). Italian dentists were mostly scared to return to their daily activities because they considered their jobs a high risk to them and their families. Dentists with an exclusive/prevailing orthodontic activity were forced to increase their working day during the week.


Assuntos
Infecções por Coronavirus/transmissão , Odontólogos/psicologia , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador , Pneumonia Viral/transmissão , Padrões de Prática Odontológica/estatística & dados numéricos , Ansiedade/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Odontólogos/estatística & dados numéricos , Surtos de Doenças , Humanos , Itália/epidemiologia , Ortodontistas/psicologia , Ortodontistas/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
5.
Braz Oral Res ; 34: e054, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32490887

RESUMO

Currently, the whole world is under the threat of the COVID-19 pandemic, and dentists are at high risk. The aim of this study was to investigate what kind of precautions Turkish dentists take in dental clinics during the COVID-19 pandemic. The study population consisted of dentists in Turkey. An online questionnaire (23 questions-57 items) was sent to a sample of Turkish dentists from March 16 to March 20, 2020. The questionnaire comprised a series of questions about dentists' demographic characteristics, their concerns, and the measures taken in dental clinics against COVID-19. This study included a total of 1,958 Turkish dentists. A total of 1,274 (65.1%) were general dentists, and 684 (34.9%) were specialists. Five hundred twenty-two (26.7%) dentists attended an informational meeting on COVID-19. Of these dentists, 69.8% were aware of COVID-19 according to their self-assessed knowledge scores. More than 90% of the dentists were concerned about themselves and their families. Only 12% of the dentists wore an N95 mask. Although Turkish dentists took some precautionary measures, they did not take enough precautions to protect themselves, the dental staff, and other patients from COVID-19. As the number of COVID-19 cases increased, the measures taken slightly increased in dental clinics as well. Dentists are strongly recommended to take maximum precautions in the clinical setting. The guidelines about the COVID-19 pandemic should be sent to all dentists by the regional and national dental associations.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Odontólogos/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Odontológica/normas , Adulto , Idoso , Infecções por Coronavirus/epidemiologia , Clínicas Odontológicas , Odontólogos/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Padrões de Prática Odontológica/estatística & dados numéricos , Fatores de Risco , Distribuição por Sexo , Especialidades Odontológicas/normas , Especialidades Odontológicas/estatística & dados numéricos , Inquéritos e Questionários , Turquia/epidemiologia
6.
Sci Rep ; 10(1): 8463, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32439950

RESUMO

The misuse of pharmaceutical opioids is a major public health issue. In Australia, codeine was re-scheduled on 1 February 2018 to restrict access; it is now only available on prescription. The aim of this study was to measure the change in dental opioid prescriptions, one year before and after the codeine re-scheduling in Australia and to assess dental prescribing rates of opioids for 2018 by population and by clinician. Data was extracted for dental opioids for the year immediately prior and after the codeine up-schedule (1 February 2017-31 January 2019) from the publicly-available national prescription database (Pharmaceutical Benefits Scheme). Descriptive statistics, T-tests and odds ratios were used to identify significant prescribing differences. Codeine, codeine/paracetamol, oxycodone and tramadol use increased significantly the year after the codeine restriction than the previous year (13.8-101.1%). Australian dentists prescribed 8.6 prescriptions/1,000 population in 2018, with codeine/paracetamol accounting for most prescriptions (96%). The significant increase in opioid prescribing highlights that Australian dentists may be contributing to the misuse of pharmaceutical opioids. Educational efforts should be targeted at the appropriate use of opioids and patient selection. Dentists should be added to the prescription monitoring system SafeScript so they can make informed decisions for patients who are potentially misusing opioids.


Assuntos
Analgésicos Opioides/provisão & distribução , Codeína/provisão & distribução , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Programas de Monitoramento de Prescrição de Medicamentos/normas , Doenças Dentárias/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Codeína/administração & dosagem , Humanos
7.
BMC Oral Health ; 20(1): 23, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996198

RESUMO

BACKGROUND: This study, by using a variable-controlled survey model, sought to compare clinical decisions made by dentists with different clinical backgrounds in South Korea regarding teeth with apical periodontitis and to identify factors that influenced decision-making. METHODS: A questionnaire with 36 questions about identical patient information, clinical signs, and symptoms was filled out by participants. Each question referred to a radiograph that had been manipulated using computer software in order to control tooth-related factors. Participants were instructed to record their demographic information and choose the ideal treatment option related to each radiograph. Simple and multivariable logistic regression analyses (p < .05) were used to investigate factors related to the decision to extract the tooth. We divided factors into dentist-related factors (gender, years of experience, and professional registration) and tooth-related factors (tooth position, coronal status, root canal filling status, and size of the periapical radiolucency). Dentists were categorized into three groups, based on professional registration: general dental practitioners (GDPs), endodontists, and other specialists. Simple logistic regression analysis (p < .05) was used to evaluate the tooth-related factors influencing extraction, depending on the dentists' specialty. RESULTS: Participants mostly preferred saving the teeth over extraction. This preference was highest among the endodontists, followed by other specialists and GDPs. Extractions were significantly preferred for molars, teeth with previous root canal fillings, and those with apical lesions greater than 5 mm. CONCLUSIONS: This study suggests that dentists' decision-making regarding teeth with apical periodontitis was associated with their work experience and specialty and influenced by tooth position, root canal filling status, and size of the apical lesion. CLINICAL RELEVANCE: This survey revealed that clinical decision-making related to teeth with apical periodontitis was affected by dentists' specialty and work experience and by tooth-related factors, such as tooth position, root canal filling status, and size of the apical lesion.


Assuntos
Tomada de Decisão Clínica/métodos , Odontólogos/psicologia , Periodontite Periapical , Padrões de Prática Odontológica/estatística & dados numéricos , Tratamento do Canal Radicular , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Periodontite Periapical/diagnóstico , Periodontite Periapical/terapia , República da Coreia , Inquéritos e Questionários
8.
Braz Oral Res ; 33: e115, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939497

RESUMO

The aim of this study was to investigate how Brazilian dentists perceive and manage dentin hypersensitivity (DH) in their clinical routine. A 13-item questionnaire-based survey was developed and sent electronically to a convenience sample of dentists. The questionnaire assessed the personal and dental practice characteristics of the sample, the occurrence of DH in their daily clinical practice, and management strategies. The data were analyzed descriptively and together with the chi-square test (a = 0.05). A total of 353 responses were obtained from September 2017 to March 2018. Of all the respondents, 62% were females, 49.9% reported fewer than five years of dental practice, and 70.5% were self-identified as private practitioners. Most of the dentists reported an estimated frequency (30-60%) of patients with DH in their practice. The most frequently cited (91.79%) trigger of DH was air blast and/or scratching with a probe. The first-choice strategy to manage DH was a dentin desensitizer (48.16%). The number of years in clinical practice did not influence DH relapse frequency (p = 0.76) significantly, or consider DH treatment as a problem (p = 0.22). The present findings indicate that, regardless of clinical experience, dentists in Brazil still consider DH management a challenge in their daily dental practice. In addition, the results suggest that guidelines should be developed to disseminate the available knowledge regarding this condition in ways that may influence decision-making processes among practitioners.


Assuntos
Sensibilidade da Dentina/terapia , Gerenciamento Clínico , Padrões de Prática Odontológica/estatística & dados numéricos , Brasil , Tomada de Decisão Clínica , Dessensibilizantes Dentinários/uso terapêutico , Odontólogos/estatística & dados numéricos , Feminino , Humanos , Masculino , Inquéritos e Questionários
9.
Ann Surg ; 271(2): 290-295, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30048311

RESUMO

OBJECTIVE: To determine the proportion of initial opioid prescriptions for opioid-naive patients prescribed by surgeons, dentists, and emergency physicians. We hypothesized that the percentage of such prescriptions grew as scrutiny of primary care and pain medicine opioid prescribing increased and guidelines were developed. SUMMARY OF BACKGROUND DATA: Data regarding the types of care for which opioid-naive patients are provided initial opioid prescriptions are limited. METHODS: A retrospective cross-sectional study using a nationwide insurance claims dataset to study US adults aged 18 to 64 years. Our primary outcome was a change in opioid prescription share for opioid-naive patients undergoing surgical, emergency, and dental care from 2010 to 2016; we also examined the type and amounts of opioid filled. RESULTS: From 87,941,718 analyzed lives, we identified 16,292,018 opioid prescriptions filled by opioid-naive patients. The proportion of prescriptions for patients receiving surgery, emergency, and dental care increased by 15.8% from 2010 to 2016 (P < 0.001), with the greatest increases related to surgical (18.1%) and dental (67.8%) prescribing. In 2016, surgery patients filled 22.0% of initial prescriptions, emergency medicine patients 13.0%, and dental patients 4.2%. Surgical patients' mean total oral morphine equivalents per prescription increased from 240 mg (SD 509) in 2010 to 403 mg (SD 1369) in 2016 (P < 0.001). Over the study period, surgical patients received the highest proportion of potent opioids (90.2% received hydrocodone or oxycodone). CONCLUSIONS: Initial opioid prescribing attributable to surgical and dental care is increasing relative to primary and chronic pain care. Evidence-based guideline development for surgical and dental prescribing is warranted in order to curb iatrogenic opioid morbidity and mortality.


Assuntos
Analgésicos Opioides/uso terapêutico , Padrões de Prática Odontológica/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
10.
Am J Orthod Dentofacial Orthop ; 156(3): 312-325, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474261

RESUMO

INTRODUCTION: This aim of this paper is to describe and identify the practitioner and patient characteristics that are associated with treatment recommendations for adult anterior open bite patients across the United States. METHODS: Practitioners and patients were recruited within the framework of the National Dental Practice-Based Research Network. Practitioners were asked about their demographic characteristics and their treatment recommendations for these patients. The practitioners also reported on their patients' dentofacial characteristics and provided initial cephalometric scans and intraoral photographs. Patients were asked about their demographic characteristics, previous orthodontic treatment, and goals for treatment. Four main treatment groups were evaluated: aligners, fixed appliances, temporary anchorage devices (TADs), and orthognathic surgery. Extractions were also investigated. Predictive multivariable models were created comparing various categories of treatment as well as extraction/nonextraction decisions. RESULTS: Ninety-one practitioners (mostly orthodontists) and 347 patients were recruited from October 2015 to December 2016. Increased aligner recommendations were associated with white and Asian patients, the presence of tongue habits, and female practitioners. TADs were recommended more often in academic settings. Recommendations for orthognathic surgery were associated with demographic factors, such as availability of insurance coverage and practitioner race/ethnicity, and dentofacial characteristics, such as anteroposterior discrepancies, more severe open bites, and steeper mandibular plane angles. Extraction recommendations were largely associated with severe crowding and incisor proclination. CONCLUSIONS: Both doctor and patient demographic factors, as well as dentofacial characteristics, were significantly associated with treatment recommendations for adult anterior open bite patients.


Assuntos
Mordida Aberta/terapia , Ortodontia Corretiva/estatística & dados numéricos , Ortodontistas/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Idoso , Cefalometria , Feminino , Humanos , Incisivo , Masculino , Mandíbula , Pessoa de Meia-Idade , Mordida Aberta/diagnóstico por imagem , Mordida Aberta/epidemiologia , Aparelhos Ortodônticos/estatística & dados numéricos , Ortodontia Corretiva/instrumentação , Ortodontia Corretiva/métodos , Procedimentos Cirúrgicos Ortognáticos , Inquéritos e Questionários , Técnicas de Movimentação Dentária/instrumentação , Técnicas de Movimentação Dentária/métodos , Técnicas de Movimentação Dentária/estatística & dados numéricos , Estados Unidos/epidemiologia
11.
BMC Oral Health ; 19(1): 179, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387573

RESUMO

BACKGROUND: Screening for medical conditions (MCs) of public health importance is a first step in disease prevention and control. Prior studies in the United States found oral health care providers (OHCPS) embrace screening for increased risk of medical conditions in the dental setting. Our objectives were to assess Saudi Arabian (SA) dentist's attitudes, willingness and perceived barriers towards implementing screening for MCs into their dental practices. METHODS: A self-administered, 5-point Likert Scale (1 = very important/willing to 5 = very unimportant/unwilling) questionnaire was given to a convenience sample of 190 practicing dentists. Friedman nonparametric analysis of variance was used to compare responses within each question. RESULTS: Of the 143 responding dentists the mean age was 31 years; 102 (71%) were men. The majority felt it was important for a dentist to screen for cardiovascular disease (98.6%), hypertension (97.9%), diabetes (97.9%), human immunodeficiency virus (HIV) (97.9%), and hepatitis C virus (98.6%). Respondents were willing to refer a patient to a physician (97.9%); send samples to an outside laboratory (96.1%); conduct screening that yields immediate results (96.2%); and discuss results immediately with the patient (93.7%). Respondents were willing to measure/collect blood pressure (67.2%); weight and height (63.7%); and finger stick blood (54.6%). The whole responding dentists (100%) reported time as an important barrier. Respondents were significantly more willing to refer a patient for consultation than send samples to an outside laboratory (mean ranks: 2.32, 2.81, P < 0.001); significantly more willing to measure blood pressure than take oral fluids for salivary diagnostics (mean ranks 2.22, 2.75, p = 0.003). Insurance was significantly (P < 0.05) less important barrier than time, cost, patients' willingness or liability (mean ranks 3.56, 2.63, 3.00, 2.79, 3.02, respectively). CONCLUSIONS: The majority of dentists in this study reported positive attitudes towards and willingness to perform medical screenings in their practice. Time was an important factor.


Assuntos
Atitude do Pessoal de Saúde , Assistência Odontológica/métodos , Odontólogos/psicologia , Programas de Rastreamento/métodos , Padrões de Prática Odontológica/estatística & dados numéricos , Adulto , Estudos Transversais , Serviços de Saúde Bucal , Odontólogos/estatística & dados numéricos , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Arábia Saudita , Inquéritos e Questionários
12.
Clin Exp Dent Res ; 5(4): 365-376, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31452948

RESUMO

Objectives: From casual observation of our colleagues, only a few individuals use the dental dam for operative procedures in their faculty practice. The purpose of this study was to obtain faculty perceptions of the dental dam, quantify its utilization in their intramural faculty practice, and determine the factors that influence dental dam usage. Material and Methods: A survey containing 11 questions was sent to 19 faculty members who teach full time and maintain an intramural dental practice involving operative dentistry. Thirty electronic dental health records of the 19 providers were reviewed to gather the following information from restorative procedures they completed: isolation methods, tooth location and involved surfaces, and dental restorative material. Results: Overall, dental dam was utilized for 30% of all restorative procedures and was used less than 20% of the time for placement of class II and class III composite resins. Dental dam utilization rate by general dentists was 37% and 17.6% for prosthodontists. Those general dentists with prior history of military dental practice had a utilization rate of 78.6% and nonmilitary dentists only 7.6%. Eight faculty members responded to the questionnaire for a 42% return rate. Those who practiced dentistry in the military strongly agreed that the dental dam is the standard of care, improves their quality of restorative work, and should be documented in the dental record. Conclusions: There were significantly different dental dam utilization rates between general dentists and prosthodontists and between dentists with prior military experience and those without.


Assuntos
Dentística Operatória/instrumentação , Odontólogos/estatística & dados numéricos , Docentes/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Diques de Borracha/estatística & dados numéricos , Humanos , Inquéritos e Questionários/estatística & dados numéricos
13.
Braz Oral Res ; 33: e076, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31432927

RESUMO

The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.


Assuntos
Analgésicos Opioides/uso terapêutico , Assistência Odontológica/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Acetaminofen/uso terapêutico , Brasil , Codeína/uso terapêutico , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Humanos , Farmácias/estatística & dados numéricos , Valores de Referência , Fatores Socioeconômicos , Estatísticas não Paramétricas , Tramadol/uso terapêutico
14.
BMJ Open ; 9(8): e030934, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31420398

RESUMO

OBJECTIVES: The aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up. DESIGN AND OUTCOME MEASURES: Intervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5-8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (€) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio. SETTING: The study was conducted in dental clinics in Sweden. PARTICIPANTS: 294 smokers aged 19-71 years were included in the study. INTERVENTIONS: Behaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT). RESULTS: The more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5-8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to €918 and €3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden. CONCLUSION: CEA favours the more costly HIT if decision makers are willing to spend at least €4000/QALY for tobacco cessation treatment.


Assuntos
Aconselhamento/economia , Assistência Odontológica/economia , Padrões de Prática Odontológica/estatística & dados numéricos , Abandono do Hábito de Fumar/economia , Adulto , Idoso , Atitude do Pessoal de Saúde , Terapia Comportamental/economia , Análise Custo-Benefício , Assistência Odontológica/métodos , Serviços de Saúde Bucal/economia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Suécia , Adulto Jovem
15.
Acta Odontol Scand ; 77(8): 617-623, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31271077

RESUMO

Objectives: To collect information on endodontic treatment procedures among dentists in the public dental service (PDS) in Western Norway and relate this information to their work experience. Materials and methods: A survey comprised of 35 questions related to personal information, frequency of endodontic treatment, endodontic procedures and treatment principles was distributed electronically to 187 dentists in PDS in two counties of Western Norway. Results: The response rate was 74%, and 130 dentists participated. Among them, 57.0% had completed their education less than 13 years ago, and almost all were below 39 years old (95%). The majority (81.0%) had graduated in Norway. Stepwise caries excavation in primary and permanent teeth and direct pulp capping in primary teeth were more frequently performed by dentists with less than 13 years from graduation. Routine use of rubber dam was high among the responders (87%). However, use of rubber dam and master-cone radiograph uptakes were more frequent among the younger dentists. The majority used rotary instrumentation systems, and almost all participants followed the current guidelines for use of antibiotics in endodontics. Conclusions: In general, dentists in PDS follow the current endodontic treatment guidelines. However, it seems that the more recently graduated dentists perform more endodontic procedures and tend to adhere more to the taught principles regarding rubber dam use and radiograph uptakes.


Assuntos
Endodontia , Padrões de Prática Odontológica , Adulto , Odontólogos , Endodontia/estatística & dados numéricos , Humanos , Noruega , Padrões de Prática Odontológica/estatística & dados numéricos , Inquéritos e Questionários
16.
BMC Oral Health ; 19(1): 112, 2019 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200689

RESUMO

BACKGROUND: Few published reports have presented concordance between treatment choices selected by dentists in hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice. The aim of the current cross-sectional study, conducted within the Management of Dental Hypersensitivity (MDH) study, was to assess the potential value of practitioners' questionnaire responses regarding their typical treatment provided for management of dentin hypersensitivity (DH), by evaluating agreement between these responses and subsequently-observed recommendations recorded during actual clinical examinations. METHODS: A total of 171 practitioners enrolled in the National Dental Practice-Based Research Network completed both a questionnaire and a clinical study regarding methods they use to treat dental hypersensitivity. The questionnaire solicited first-, second- and third-choice products when prescribing or recommending management of dentin hypersensitivity. Agreement was calculated for first-choice products/recommendations and for inclusion in the top three choices, as identified by the practitioners, from 11 listed treatment options. Overall percent agreement and Cohen's kappa statistic were calculated, with associated 95% confidence intervals (CI). Associations between practitioner characteristics and agreement were also evaluated. RESULTS: For individual treatment modalities, percentage agreement ranged from 63 to 99%, depending on the specific item. Percentage agreement between typical treatment and actual treatment for each practitioner's top three treatment modalities, as a combined grouping, ranged from 61 to 100%. When these same agreement pairings were quantified to account for agreement above that expected by chance, kappa values were poor to low. CONCLUSIONS: Concordance between hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice showed moderate to high levels of percentage agreement, but Cohen's kappa values suggested relatively low levels of agreement beyond that expected by chance. This analysis adds to the larger work of the network which has now observed a wide range of agreement between hypothetical and actual care, depending upon the specific diagnosis or treatment under consideration. Questionnaire data for DH might serve as a useful adjunct to clinical data regarding treatment recommendations, but agreement was not sufficiently high to justify use of questionnaires alone to characterize patterns of treatment for this particular condition.


Assuntos
Sensibilidade da Dentina/diagnóstico , Sensibilidade da Dentina/prevenção & controle , Odontólogos , Padrões de Prática Odontológica/estatística & dados numéricos , Inquéritos e Questionários , Tomada de Decisão Clínica , Estudos Transversais , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
17.
Patient Educ Couns ; 102(11): 2068-2072, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31122817

RESUMO

OBJECTIVE: To assess socioeconomic inequalities in health advice provided in dental setting. METHODS: Data were from the Adult Dental Health Survey, 2009 of England, Wales and Northern Ireland. Index of Multiple Deprivation, occupational classification and education were used to assess differences in advice on diet, oral hygiene and dental visits using logistic regression. RESULTS: The analysis included 6279 participants with complete data. There were significant socioeconomic inequalities in all health advice provided in dental setting. Those with a higher level of education had significant odds ratios of 1.36 (1.06-1.75), 1.40 (1.15-1.70), and 1.82 (1.47-2.25) for having advice on diet, dental visits and oral hygiene, respectively compared to those with lower education. CONCLUSION: Inequalities in health advice in the dental setting resemble inequalities in oral health. This implies that those who are most likely to need behaviour-related advice do not receive it. Health policies should address the underpinning causes of inequalities in health advice. PRACTICE IMPLICATIONS: Growing evidence supports the importance of health advice given in dental practice. More time and greater resources should be allocated for comprehensive health advice particularly to the socially disadvantaged to reduce inequalities and subsequently promoting health-related behaviours.


Assuntos
Promoção da Saúde/métodos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Saúde Bucal , Padrões de Prática Odontológica/estatística & dados numéricos , Adolescente , Idoso , Aconselhamento , Estudos Transversais , Inglaterra , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Irlanda do Norte , Fatores Socioeconômicos , Populações Vulneráveis , País de Gales , Adulto Jovem
18.
JAMA Netw Open ; 2(5): e194303, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-31125102

RESUMO

Importance: The United States consumes most of the opioids worldwide despite representing a small portion of the world's population. Dentists are one of the most frequent US prescribers of opioids despite data suggesting that nonopioid analgesics are similarly effective for oral pain. While oral health and dentist use are generally similar between the United States and England, it is unclear how opioid prescribing by dentists varies between the 2 countries. Objective: To compare opioid prescribing by dentists in the United States and England. Design, Setting, and Participants: Cross-sectional study of prescriptions for opioids dispensed from outpatient pharmacies and health care settings between January 1 and December 31, 2016, by dentists in the United States and England. Data were analyzed from October 2018 to January 2019. Exposures: Opioids prescribed by dentists. Main Outcomes and Measures: Proportion and prescribing rates of opioid prescriptions. Results: In 2016, the proportion of prescriptions written by US dentists that were for opioids was 37 times greater than the proportion written by English dentists. In all, 22.3% of US dental prescriptions were opioids (11.4 million prescriptions) compared with 0.6% of English dental prescriptions (28 082 prescriptions) (difference, 21.7%; 95% CI, 13.8%-32.1%; P < .001). Dentists in the United States also had a higher number of opioid prescriptions per 1000 population (35.4 per 1000 US population [95% CI, 25.2-48.7 per 1000 population] vs 0.5 per 1000 England population [95% CI, 0.03-3.7 per 1000 population]) and number of opioid prescriptions per dentist (58.2 prescriptions per dentist [95% CI, 44.9-75.0 prescriptions per dentist] vs 1.2 prescriptions per dentist [95% CI, 0.2-5.6 prescriptions per dentist]). While the codeine derivative dihydrocodeine was the sole opioid prescribed by English dentists, US dentists prescribed a range of opioids containing hydrocodone (62.3%), codeine (23.2%), oxycodone (9.1%), and tramadol (4.8%). Dentists in the United States also prescribed long-acting opioids (0.06% of opioids prescribed by US dentists [6425 prescriptions]). Long-acting opioids were not prescribed by English dentists. Conclusions and Relevance: This study found that in 2016, dentists in the United States prescribed opioids with significantly greater frequency than their English counterparts. Opioids with a high potential for abuse, such as oxycodone, were frequently prescribed by US dentists but not prescribed in England. These results illustrate how 1 source of opioids differs substantially in the United States vs England. To reduce dental opioid prescribing in the United States, dentists could adopt measures similar to those used in England, including national guidelines for treating dental pain that emphasize prescribing opioids conservatively.


Assuntos
Analgésicos Opioides/administração & dosagem , Manejo da Dor/métodos , Padrões de Prática Odontológica/estatística & dados numéricos , Estudos Transversais , Inglaterra/epidemiologia , Humanos , Estados Unidos/epidemiologia
19.
Asian Pac J Cancer Prev ; 20(5): 1531-1536, 2019 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-31128059

RESUMO

Background: Oral cancer signifies a public health concern of international importance. Early detection of oral cancer can improve the prognosis and the 5-year survival rate. Objective: The aim of this study was to assess the level of oral cancer knowledge, opinion, attitudes and practices among dentists working at the primary oral health care centers in Kuwait. Methods: In this cross-sectional study, self-reported questionnaire was distributed to the dentists working at the primary oral health care centers in Kuwait. A total of 289 dentists participated in the present study. The questionnaire included 23- questions on oral cancer knowledge, opinion, attitudes and practices. Results: The mean age of the dentists was 35.2 ± 10.9 years. Approximately, all dentists (99.7%) were aware of the major risk factors that were most likely associated with oral cancer. Overall, majority of the participants knew the most common form of oral cancer (80.6%), most common site (80.3%) and the likely lesions associated with oral cancer occurrence (87.9%). A large number of dental practitioners (81%) would routinely refer a patient with a suspicious lesion to a specialist. Nearly one-third (32%) reviewed their patients' oral cancer risk factors. Approximately two-thirds (62%) assessed the use of tobacco in their practice. Almost, all (92.4%) were interested in attending continuing education courses on oral cancer. Conclusions: Majority of the participants presented good knowledge about various aspects of oral cancer. More continuing education programs on risk factors and diagnosis of oral cancer should be organized to train the dentists. Oral cancer screening should be a routine procedure for the high risk patients at the primary oral health care centers in Kuwait.


Assuntos
Odontólogos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias Bucais/diagnóstico , Padrões de Prática Odontológica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Kuweit , Masculino , Saúde Bucal , Fatores de Risco , Autorrelato , Inquéritos e Questionários
20.
Clin Exp Dent Res ; 5(2): 121-127, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31049214

RESUMO

The aims of this study were to investigate the knowledge, attitude, and practice of dentists in Upper Egypt with regard to oral cancer (OC). Out of 1,200 licensed dental practitioners list, 424 dentists were randomly selected from three governorates in Upper Egypt (Minia, Assuit, and Sohag). The sample size was calculated using the equation considering the knowledge of dentists about OC, confidence level, and margins of error; then, an additional number of dentists were added to guard against nonresponse. Data were collected by face-to-face interview using 44 items divided into four sections; first part demonstrates sociodemographic. The second part concerned with the knowledge about OC clinical presentation and diagnosis (12 multiple-choice questions) as well as its risk factors (17 close-end questions). The third part consists of six questions focused on the practice of participants, and finally, the last part measures attitude of dentists. The chi-square test was used to compare between the two or more proportions. A correlation was used for describing the relationship or association between two mutually numerical dependent variables. p < 0.05 was considered to indicate significance. Rate of response was 94.3%. The overall knowledge level in the current study was 31.8%. The awareness about OC risk factors was high especially, smoking tobacco and alcohol consumption. Also, over 80% of dentists identified family history and human papillomavirus (HPV) as risk factors. Only 37.5% of participants performed regular screening of oral mucosa, and 26.5% reported lymph-node examination. Regarding attitude, only one quarter of dentists attended continuing educating programs about OC. A statistically significant relation (p < 0.0001) between knowledge level and most demographic variables was detected. There was a fair positive correlation (r = 0.47) between practice and knowledge scores. A predominant trouble among dentists in Upper Egypt was regarding OC knowledge and practice. Continues education and training programs are highly recommended.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Odontólogos , Detecção Precoce de Câncer/estatística & dados numéricos , Educação Continuada em Odontologia/estatística & dados numéricos , Neoplasias Bucais , Padrões de Prática Odontológica/estatística & dados numéricos , Carcinoma de Células Escamosas de Cabeça e Pescoço , Adulto , Consumo de Bebidas Alcoólicas , Egito , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Linfonodos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal , Neoplasias Bucais/diagnóstico , Infecções por Papillomavirus , Exame Físico/estatística & dados numéricos , Fatores de Risco , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico , Fumar Tabaco , Adulto Jovem
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