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.

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.

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.

'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.

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.

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.

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.

Trends in pediatric dental surgery for severe early childhood caries in Manitoba, Canada.

INTRODUCTION: Caries is the most common chronic disease of childhood, and severe forms may necessitate rehabilitative dental surgery. In this study, administrative data related to pediatric dental surgery performed under general anesthesia to treat severe early childhood caries in Manitoba, Canada, were reviewed to determine trends in pediatric dental surgery, as well as geographic, regional and socio-economic variations in surgical rates. METHODS: The total number of dental surgery cases performed under general anesthesia was obtained from provincial administrative databases for fiscal years from 1997-98 to 2006-07. Codes from the International Classification of Diseases and Related Health Problems (9th or 10th revision, as appropriate) were used to identify children who underwent extractions under general anesthesia for a slightly earlier fiscal year period (1996-97 to 2005-06). Each 10-year period was divided into two 5-year periods for comparisons over time. Analyses included descriptive and bivariate statistics, with the data being disaggregated by regional health authority (RHA) or by community area (for Winnipeg). Comparisons for which p ≤ 0.05 were defined as statistically significant. RESULTS: A total of 18,544 children had dental surgery under general anesthesia between 1997-98 and 2006-07 (mean age ± standard deviation 3.28 ± 1.02 years). Many of the children requiring surgery resided in one northern RHA (26.8%) or the Winnipeg RHA (23.8%). More than half of the RHAs (7/11) displayed significant increases in the rate of surgery, with northern RHAs having the highest rates. Within Winnipeg, 3 of the 12 community areas had significant increases in the rate of surgery. Two inner-city neighborhoods accounted for nearly 50% of surgical cases. The rate of extractions under general anesthesia increased significantly in 6 of the 11 RHAs, with northern RHAs having the highest rates. Four Winnipeg communities experienced significant increases in the extraction rate over time. CONCLUSION: Pediatric dental surgery under general anesthesia for treatment of severe early childhood caries is common in Manitoba, and the demand increased in several communities over the study period. These results are being shared with decision-makers and communities to identify regions where oral health promotion is needed.

Analysis of hospital dental care for patients with special needs in Brazil.

This analytical cross-sectional study aimed to analyze the access of patients with special needs (PSN) in Brazilian municipalities to hospital dental care of the Unified Health System (Sistema Único de Saúde - SUS), based on data from the Hospital Information System of the Unified Health System (Sistema de Informações Hospitalares do SUS- SIH/SUS - SIH), from 2010 to 2018. The Kolmogorov-Smirnov normality test was performed; the Poisson regression was used to verify factors associated with the variable total number of hospitalization authorizations with the main procedure of dental treatment for PSN ("Total de Autorizações de Internação Hospitalar" - AIH), the Spearman correlation test with a significance level of 5% was used to characterize the relationships between the Municipal Human Development Index per municipality - (Índice de Desenvolvimento Humano Municipal - HDI) and the Oral Health Coverage in the Family Health Strategy by municipality (Cobertura de saúde bucal na estratégia saúde da família por município - SBSF Coverage), and the relationship of the AIH with SBSF Coverage. A total of 127,691 procedures were performed, of which 71,517 (56%) were clinical procedures, such as restorations, endodontic treatments, supra and subgingival scaling, among others. Municipalities in the Midwest (PR=5.117) and Southeast (RP = 4.443) regions had more precedures than the others. A weak correlation was found between AIH and SBSF Coverage (r = -0.2, p < 0.001) and HDI and SBSF Coverage (r = -0.074, p < 0.001). Population size, region, health coverage, oral hygiene, and number of dentists in hospitals affected the availability of dental procedures in PSN.

Reducing the burden of dental patients on the busy hospital emergency department.

PURPOSE: Studies have shown that there is a current trend for many patients with dental problems to seek care in a hospital emergency department (ED). This may contribute to an already overcrowded and overburdened situation. The purpose of this study was to determine the volume and characteristics of the patients seeking care in the ED of a large metropolitan level I trauma center. PATIENTS AND METHODS: Using ICD-9 diagnosis codes for dental complaints, the following ED data were collected for the years 2007 through 2009: the number of patients, the age of patients, the day and time the patients presented, the number of visits patients made to the ED for a dental-related complaint, and the insurance status of the patients. This information was then used to develop a pilot program to divert these patients from the ED to a special Urgent Dental Care Clinic located in the hospital Oral and Maxillofacial Surgery Clinic, and data on number of patients treated in the following year were compared with the number treated in the ED the previous year. RESULTS: There were 173,648 emergency department visits between 2007 and 2009. Of these, 4.3% were dental-related. The majority of the patients presented between 7 am and 6 pm on Monday through Thursday, with the highest percentage on Monday. The insurance status showed that 39.7% had Medicaid or Medicare, 52.7% were uninsured, and only 7.6% had private insurance. Sixty-seven percent had tooth-related ailments. The treatment in most cases was limited to a prescription for pain medicine and an antibiotic. In the year prior to initiation of the pilot program there were 2,618 patients with dentally related problems managed in the ED. This decreased more than 52% during the first year of the pilot program. Return to the ED for a subsequent dental problem was also reduced by more than 66%. CONCLUSION: A diversion plan for dental patients can be effective in reducing their impact on the busy ED.

Effectiveness of a brief educational workshop intervention among primary care providers at 6 months: uptake of dental emergency supporting resources.

INTRODUCTION: Dental emergencies often present to primary care providers in general practice and Emergency Departments (ED), who may be unable to manage them effectively due to limited knowledge, skills and available resources. This may impact negatively on patient outcomes. Provision of a short educational workshop intervention in the management of such emergencies, including education in supporting resources, may provide a practical strategy for assisting clinicians to provide this aspect of comprehensive primary care. METHODS: This descriptive study used a validated questionnaire survey instrument to measure the effectiveness of a short multimodal educational intervention through the uptake and perceived usefulness of supporting resources at 6 months following the intervention. Between 2009 and 2010, 15 workshops, of which eight were for regional and rural hospital ED doctors, were conducted by the same presenter using the same educational materials and training techniques. A sample of 181 workshop participants, 63% of whom were in rural or remote practice and engaged in providing primary care medical services, returned responses at 6 months on the perceived usefulness of the dental emergencies resource. RESULTS: Thirty percent of clinicians had used the dental emergencies resource within the six-month follow-up period. Significance was demonstrated between professional category and use of the resource, with emergency registrars utilising this resource most and GPs the least. The Dental Handbook, specifically designed for ED use, and tooth-filling material contained within this resource, were deemed the most useful components. There were overall positive open-ended question responses regarding the usefulness of the resource, especially when it was made available to clinicians who had attended the education workshops. CONCLUSION: Utilisation and perceived usefulness of a supporting resource at 6 months are indicators of the effectiveness of a short workshop educational intervention in the management of dental emergencies by primary care providers. This education may have greater relevance to rural and remote practice where dental services may be limited.

What has been the United Kingdom's experience with retention of third molars?

BACKGROUND: In 2000, the first National Institute of Clinical Excellence (NICE) guidelines related to third molar (M3) surgery, a commonly performed operation in the United Kingdom, were published. This followed research publications and professional guidelines in the 1990 s that advised against prophylactic surgery and provided specific therapeutic indications for M3 surgery. The aim of the present report was to summarize the available evidence on the effects of guidelines on M3 surgery within the United Kingdom. MATERIALS AND METHODS: Data from primary care dental services and hospital admissions in England and Wales during a 20-year period (Hospital Episode Statistics 1989/1990 to 2009/2010), and from private medical insurance companies were analyzed. The volume and, where possible, the nature of the M3 surgery activity over time were assessed together, as were the collateral effects of the guidelines, including patient age at surgery and the indications for surgery. RESULTS: The volume of M3 removal decreased in all sectors during the 1990 s before the introduction of the NICE guidelines. During the 20-year period, the proportion of impacted M3 surgery decreased from 80% to 50% of admitted hospital cases. Furthermore, an increase occurred in the mean age for surgical admissions from 25.5 to 31.8 years. The change in age correlated with a change in the indications for M3 surgery during that period, with a reduction in "impaction," but an increase in "caries" and "pericoronitis" as etiologic factors, in accordance with the NICE guidelines. CONCLUSION: The significant decrease in M3 surgery activity occurred before the NICE guidelines. Thus, M3 surgery has been performed at a later age, with indications for surgery increasingly in accordance with the NICE guidelines. The importance of clinical monitoring of the retained M3s is discussed.

Status of the dental health care workforce in Shanghai, China.

OBJECTIVES: The status of the dental health care workforce in Shanghai was investigated in order to support and improve regional planning of this workforce. METHODS: Questionnaires were used to survey all dental medical units in Shanghai. Data were collected on the quantity, structure and levels of dental health personnel. RESULTS: A total of 852 dental medical units and 3,218 dentists were identified in Shanghai. The ratio of dentists to population is 1 : 5,201. CONCLUSIONS: Presently, the total dental health workforce in Shanghai is relatively sufficient, but its distribution is inequitable because there are fewer dental health personnel employed in the suburbs. Moreover, the structure of the dental health workforce in Shanghai is inequitable and specialists in preventive dentistry are lacking. The results of this study can be applied to help Shanghai achieve the rational distribution and efficient utilisation of the dental health workforce available.

Two audits of the diagnosis of oral cancer and the two-week rule following referrals from primary care practitioners in Newcastle.

AIM: The aim of the two audits was to evaluate the success of the two-week rule in the oral and maxillofacial surgery (OMFS) department at the Newcastle General Hospital (NGH) and then subsequently in the oral surgery and oral medicine departments at Newcastle Dental Hospital (NDH). METHODS: All two-week referrals seen at the NGH over a one-year period were examined retrospectively. An identical subsequent audit was carried out at the NDH over a second one-year period, also retrospectively. RESULTS: In the initial audit at the NGH, a total of 63 two-week referrals were received during the one-year period analysed. Of these, 57 (90%) were seen within the appropriate time period, and 60 (95%) conformed to the Department of Health guidelines. Seven (11%) of the 63 referred patients were diagnosed with head and neck cancer, indicating a positive oncology detection rate of 11%.In the later audit at the NDH, 49 urgent referrals were assessed. Forty-three of the 49 referrals (88%) were seen within the appropriate time period and thirty-nine (80%) were compliant with the referring guidelines. Forty-five patients attended for assessment and the resultant positive oncology detection rate for these patients was 7%. In both audits, the patients diagnosed as having positive oncology results all had referrals that were compliant with the Department of Health guidelines. CONCLUSIONS: Both of these audits indicated that the national guide- lines for two-week referrals were usually appropriately followed in the two departments that were audited. However, in the future, further education of referring practitioners should ensure that these guidelines are followed better, making the service provided more efficient for all concerned.

Demand in pediatric dentistry for sedation and general anesthesia by dentist anesthesiologists: a survey of directors of dentist anesthesiologist and pediatric dentistry residencies.

This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 10 anesthesiology training program directors was 9 of 10 or 90%. The response rate for the 79 pediatric dentistry training program directors was 46 of 79 or 58%. Thirty-seven percent of pediatric dentistry programs use clinic-based deep sedation/general anesthesia for dental treatment in addition to hospital-based deep sedation/general anesthesia. Eighty-eight percent of those programs use dentist anesthesiologists for administration of deep sedation/general anesthesia in a clinic-based setting. Pediatric dentistry residency directors perceive a future change in the need for deep sedation/general anesthesia services provided by dentist anesthesiologists to pediatric dentists: 64% anticipate an increase in need for dentist anesthesiologist services, while 36% anticipate no change. Dental anesthesiology directors compared to 2, 5, and 10 years ago have seen an increase in the requests for dentist anesthesiologist services by pediatric dentists reported by 56% of respondents (past 2 years), 63% of respondents (past 5 years), and 88% of respondents (past 10 years), respectively. Predicting the future need of dentist anesthesiologists is an uncertain task, but these results show pediatric dentistry directors and dental anesthesiology directors are considering the need, and they recognize a trend of increased need for dentist anesthesiologist services over the past decade.

A baseline audit of referral and treatment delivered to patients in the intermediate minor oral surgery service in Croydon PCT.

INTRODUCTION: Patients attending for primary dental care may require oral surgery procedures beyond the capability of a generalist and thus need to be treated by a dentist with greater expertise. In the United Kingdom, it is increasingly accepted that such care may be provided in primary care settings by specialists or dentists with a special interest. In response to local pressures, an intermediate minor oral surgery (IMOS) service has been established in Croydon, south west London, to provide oral surgery treatment for non-urgent patients on referral. AIM: To audit the appropriateness and quality of oral surgery referrals after triage to an IMOS service in Croydon and to set standards for future audits on this topic. METHODS: An audit tool was developed in line with the local referral guidelines and agreed with local stakeholders. Information on 501 (10%) triaged referrals to IMOS practices over a 24-month period was obtained through the referral management centre. A 10% sample of referrals per month to each practice was calculated and IMOS providers randomly selected the relevant patient records. Using an agreed audit pro forma, information on the indications for referral, treatment provided, and dates relating to patient management, in addition to the age and sex of patients, was collected from the IMOS providers by one investigator. Descriptive analysis of the data was performed. RESULTS: Of the 501 patient records that were examined, 99% of patients were treated in IMOS practices, with only three (less than 1%) patients being referred on to hospital consultant services. The largest proportion (237; 40%) of referrals was for the extraction of teeth considered to have special difficulty, followed by lower third molars (154; 26%). Almost one-third (159; 32%) of patients were referred for more than one procedure. One in eight (72; 13%) teeth removed by the IMOS providers were recorded as a simple extraction without medical complications. CONCLUSIONS: In general, patients were referred appropriately to the primary care oral surgery service in Croydon, with only a minority recorded as receiving simple care that should not have required referral. The clinician-led triage process using a referral management system worked well in selecting appropriate patients for treatment by IMOS providers in primary care and reduced referrals to hospital. Suggested standards for future audits of IMOS referrals have been set.

Survey of ambulatory surgery dentistry.

A telephone survey of New York State's most significant providers of Medicaid hospital ambulatory surgery dental treatment for special needs patients was conducted in June and July of 2011 to assess whether there had been changes in the availability of dental services following implementation of the Ambulatory Patient Groups (APG) Medicaid payment methodology and the April 2011 35% reduction in fee-for-service reimbursement to dentists who provide this dental care. With release of "Oral Health in America: A Report of the Surgeon General" in 2000, attention was focused on the link between oral health and general health, with the report highlighting the difficulties individuals with special needs experienced with respect to their oral health and accessing dental care. The New York State Department of Health in 2005 released its "Oral Health Plan for New York State." It had three stated objectives pertaining to those with special needs. None of these objectives has been met, and the response to this survey revealed waiting times for access to ambulatory surgery dental programs of up to two years and an overall probable 10% to 15% decrease in availability as a direct result of the APG payment methodology and reduction in fee-for-service reimbursements. New York is failing not only to meet the objectives of its own oral health plan, but also to adequately meet the dental health care needs of its most vulnerable citizens.

An international survey of oral medicine practice: proceedings from the 5th World Workshop in Oral Medicine.

OBJECTIVES: (i) To define the current state of oral medicine clinical practice internationally, and (ii) to make recommendations for future modeling of the practice of oral medicine. MATERIALS AND METHODS: A survey was designed by an international panel of oral medicine experts to assess the current state of oral medicine practice internationally. The survey was sent to oral medicine experts across the world, and responses were electronically stored and analyzed using descriptive statistics. RESULTS: Two hundred respondents completed the survey representing 40 countries from six continents. The two most common settings for an oral medicine practice were in a hospital and a dental school. More than 88% of respondents considered management of oral mucosal disease, salivary dysfunction, oral manifestations of systemic diseases, and facial pain in the definition of oral medicine. CONCLUSIONS: (i) Oral medicine clinicians diagnose and manage a wide variety of orofacial conditions; (ii) There are significant differences in the definition of oral medicine clinical practice from country to country; (iii) India has the largest expansion of oral medicine services as defined by escalating numbers of clinicians within the specialty as compared with other countries; (iv) oral medicine practitioners have a wide range of professional responsibilities.

Retrospective evaluation of the referral pattern to an oral medicine unit in Ireland.

OBJECTIVES: The aims of this study were firstly to examine patient demographics, lesion types and referral sources to Cork University Dental School and Hospital (CUDSH) for oral medicine services and secondly, to indicate factors that could improve the efficiency of the service provided. METHODS: A retrospective analysis of the clinical records for all new patients, both public and private, seen in the CUDSH oral medicine unit (n = 412) in the calendar year 2007 was undertaken. For each patient the following parameters were recorded: age, gender, residence, referral source and the reason for referral including site of lesion. RESULTS: The majority of patients were females and the majority of referrals came from general dental practitioners. The most common reason for referral was due to concern about white lesions. Raised soft tissue lesions including epuli and mucocoeles were second and ulceration, including recurrent aphthous and traumatic ulceration, was the third most common reason for referral. CONCLUSIONS: To our knowledge this is the first study to investigate factors influencing referrals to oral medicine clinics in Ireland. Based on the results presented there appears to be a considerable demand for an oral medicine service dealing with oral lesions and conditions which other practitioners consider to be outside the scope of their practice. Studies of this nature should prove to be valuable in maximising hospital resources at a time when economic factors are leading to increased financial pressure in health care funding.