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INTRODUCTION: Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through the systematic review of care against explicit criteria and the implementation of change. The objective of this audit was to evaluate the quality of orthodontic chart documentation by dental undergraduates against established guidelines. MATERIALS AND METHODS: An audit checklist with 13 criteria for good documentation was adapted from guidelines proposed by the American Association of Orthodontists and British Orthodontic Society. Orthodontic chart documentation in 103 removable appliance therapy patients under 4th and 5th year dental undergraduates' care was retrieved from the electronic record of the University dental clinic and audited. The audit exercise explored in detail the thirteen criteria for good documentation and eight assessment attributes of the first criterion, namely, basic orthodontic examination. The level of compliance was measured as the percentage records meeting the criteria. The data were statistically analysed using SPSS 26.0 (SPSS, Inc., Chicago, IL, USA). RESULTS: There was no complete compliance for any of the criteria. Thirty-five (33.9%) patient charts reported basic orthodontic examination documentation adequately. Compliance was the highest for documentation of treatment modality (77.6%), appliance delivery encounters (77.6%), and appliance adjustment appointments (83.5%). About 51.4% of the 68 patient charts (treatment of 35 patients of the total 103 were in the progress stage) stated adequately the outcome of treatment. Only 22% of the 68 patient charts had the details for retention protocol. There was statistically significant difference in chart documentation between male and female students for basic orthodontic assessment and appliance delivery and patient instructions attributes. CONCLUSION: The clinical audit demonstrated poor compliance with the criteria for orthodontic chart documentation. The audit should be repeated after the provision of learning opportunities and self-critical analysis.
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Educación en Odontología , Sociedades Odontológicas , Auditoría Clínica , Auditoría Odontológica , Documentación , Femenino , Humanos , Masculino , EstudiantesRESUMEN
AIM: To evaluate the effectiveness of clinical audit-feedback cycle as an educational tool in improving the technical quality of root canal therapy (RCT) and compliance with record keeping performed by dental undergraduates. METHODS: Clinical audit learning was introduced in Year 3 of a 5-year curriculum for dental undergraduates. During classroom activities, students were briefed on clinical audit, selected their audit topics in groups of 5 or 6 students, and prepared and presented their audit protocols. One chosen topic was RCT, in which 3 different cohorts of Year 3 students conducted retrospective audits of patients' records in 2012, 2014 and 2015 for their compliance with recommended record keeping criteria and their performance in RCT. Students were trained by and calibrated against an endodontist (κ ≥ 0.8). After each audit, the findings were reported in class, and recommendations were made for improvement in performance of RCT and record keeping. Students' compliance with published guidelines was presented and their RCT performances in each year were compared using the chi-square test. RESULTS: Overall compliance with of record keeping guidelines was 44.1% in 2012, 79.6% in 2014 and 94.6% in 2015 (P = .001). In the 2012 audit, acceptable extension, condensation and the absence of mishap were observed in 72.4, 75.7% and 91.5%; in the 2014 audit, 95.1%, 64.8% and 51.4%; and in 2015 audit, 96.4%, 82.1% and 92.8% of cases, respectively. In 2015, 76.8% of root canal fillings met all 3 technical quality criteria when compared to 48.6% in 2014 and 44.7% in 2012 (P = .001). CONCLUSION: Clinical audit-feedback cycle is an effective educational tool for improving dental undergraduates' compliance with record keeping and performance in the technical quality of RCT.
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Competencia Clínica/normas , Adaptabilidad , Curriculum , Auditoría Odontológica , Educación en Odontología/métodos , Retroalimentación Formativa , Tratamiento del Conducto Radicular/normas , Estudiantes de Odontología/psicología , Endodoncia/educación , HumanosRESUMEN
OBJECTIVE: The purpose of this study was to perform a comprehensive audit of dental treatment provided to special needs patients (SNP) under general anesthesia (GA) over a ten-year period. STUDY DESIGN: Special needs patients who received dental treatment under GA as an in-patient at Queen Mary Hospital, Hong Kong SAR during the time period January 2002 and December 2011 were included in the study. The study population was divided into three groups, based on age (<6years, 6-12 years, >12 years). One-way ANOVA was used to evaluate the effect of "age group" on duration of treatment, post-recovery time, treatment procedures and utilization of different restorative materials. Kappa statistics were used for intra-examiner reliability. RESULTS: A total of 275 patients (174 males and 101 females) were included in the study. The mean age of the patients at the time they received GA was 12.37±10.18 years. Dental procedures performed were mostly restorative in nature (47%). The >12 years group had significantly shorter treatment duration (p<0.05). No significant difference in post-operative recovery time was observed among the three age groups (p>0.05). The <6 years group received significantly less preventive, but more restorative procedures (p<0.05). Significantly fewer extractions were performed in the 6-12 years group (p<0.05). The use of composite restorations was significantly higher in the <6 years group; while amalgam restorations were more frequently used in the >12 years group (P<0.05). Stainless steel crowns were more frequently employed in SNP under 12 years of age (p<0.05). Intra-examiner reliability was good (k=0.94). CONCLUSIONS: Most of the dental procedures performed under GA on SNP were restorative procedures. For children less than 6 years of age, had longer treatment time under GA. Composite restorations and stainless steel crowns were more frequently used in the primary dentition and amalgam restorations were more frequently employed in the permanent dentition.
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Anestesia General , Auditoría Odontológica , Atención Dental para Niños , Atención Dental para la Persona con Discapacidad , Preescolar , Femenino , Humanos , Lactante , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de TiempoRESUMEN
Fourteen dentists at different practices in the UK assessed the dental charts of 1128 patients who were new to the dentist but not new to the practice; 44% of the dental charts were found to be inaccurate. Inaccuracy of the individual practice-based charts ranged between 16% for the best performing practices to 83% for the worst: 5% of dental charts had too many teeth charted and 5% had too few teeth charted; 13% of charts had missed amalgam restorations and 18% had missed tooth-coloured restorations; 5% of charts had amalgam restorations recorded but with the surfaces incorrect (eg an MO restoration charted but a DO restoration actually present); 9% of charts had tooth-coloured restoration surfaces incorrectly recorded. For 7.5% of charts, amalgams were charted but not actually present. Other inaccuracies were also noted. The authors reinforce the requirements of the GDC, the advice of defence organizations, and the forensic importance of accurate dental charts. Clinical relevance: Dental charting forms part of the patient's dental records, and the GDC requires dentists to maintain complete and accurate dental records.
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Auditoría Odontológica , Registros Odontológicos/normas , Odontología General , HumanosRESUMEN
THE OBJECTIVE: To examine whether audit and feedback could improve the quality of the application of dental sealant in rural Thai school children. RESEARCH DESIGN: A single blind, cluster randomized controlled trial was conducted. CLINICAL SETTING: Hospital-based and school-based school sealant applied by dental nurses in Southern province of Thailand. PARTICIPANTS: Dental nurses and school children who received dental sealant were involved. INTERVENTION: The intervention consisted of confidential feedback of data and tailor-made problem-solving workshops. MAIN OUTCOME MEASURES: Sealant quality was measured by sealant retention and caries on sealed surfaces at six-month after sealing. The teeth examinations were done among different groups of children prior and after the intervention. RESULTS: After the intervention, the sealant retention rate increased dramatically in the intervention group, whereas in the control group the rate was similar to that found at baseline. The rate of caries after the intervention was stable in the intervention group and increased slightly in the control group. At the beginning of the study, the adjusted odds ratio of complete sealant retention between the intervention and control group was 0.47 which increased to 1.99 at the end of the study. However, no effect on caries on sealed surfaces was observed. CONCLUSIONS: The intensive focus on actual problems during the audit and feedback improved the dental nurses' performance and the quality of the dental service, although it had no statistical impact on the incidence of caries.
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Auditoría Odontológica , Atención Odontológica/normas , Retroalimentación , Selladores de Fosas y Fisuras/normas , Servicios de Salud Rural/normas , Niño , Índice CPO , Asistentes Dentales/educación , Asistentes Dentales/normas , Recubrimiento Dental Adhesivo/normas , Caries Dental/prevención & control , Femenino , Humanos , Masculino , Mejoramiento de la Calidad , Método Simple Ciego , TailandiaRESUMEN
This paper describes and discusses a review of adult special care dentistry day cases in a UK hospital over a two year period and makes recommendations for other such reviews and for practice. Dental public health competencies illustrated: oral health needs assessment and evaluation of dental health services.
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Atención Ambulatoria/estadística & datos numéricos , Anestesia Dental/estadística & datos numéricos , Anestesia General/estadística & datos numéricos , Atención Dental para la Persona con Discapacidad/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Odontología Comunitaria/estadística & datos numéricos , Continuidad de la Atención al Paciente/estadística & datos numéricos , Auditoría Odontológica/estadística & datos numéricos , Restauración Dental Permanente/estadística & datos numéricos , Inglaterra , Estudios de Seguimiento , Odontología General/estadística & datos numéricos , Estado de Salud , Humanos , Consentimiento Informado/estadística & datos numéricos , Competencia Mental , Persona de Mediana Edad , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Extracción Dental/estadística & datos numéricos , Adulto JovenRESUMEN
AIM: To evaluate current level of safety under the care of an escort following intravenous sedation, post-sedation arrangements and to identify potential risk levels. BACKGROUND: Information and post-sedation arrangements are important to patients'safety following surgery but although there is a general consensus over what is recommended for patients and their escorts, there is little, if any, literature on the escorts' awareness of sedation and accordance to post-sedation arrangement and recommendations. METHOD: Escorts of 113 consecutive patients treated in oral surgery under sedation (midazolam) completed a questionnaire composed of 27 questions divided into seven sections including demographics, awareness of sedation, source of information and post-operative arrangement. From the data collected, two scores were calculated representative of the escorts' Safety and Reliability. Data were then analysed by ANOVA. RESULTS: Safety scores were statistically correlated with instruction source while Reliability correlated to a wider variety of parameters including gender, age as well as information source. CONCLUSION: Provision of clear written information to escorts is recommended as likely to improve patients' safety. Assessment of escorts' Safety and Reliability could provide a means for improving quality and safety of sedation service.
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Anestesia Dental/métodos , Cuidadores , Sedación Consciente/métodos , Auditoría Odontológica , Conocimientos, Actitudes y Práctica en Salud , Procedimientos Quirúrgicos Orales/métodos , Seguridad del Paciente , Adolescente , Adulto , Anciano , Anestésicos Intravenosos/administración & dosificación , Actitud Frente a la Salud , Estudios de Cohortes , Femenino , Adhesión a Directriz , Humanos , Hipnóticos y Sedantes/administración & dosificación , Masculino , Midazolam/administración & dosificación , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
The National Health Service anaesthesia annual activity (2013) was recently reported by the Fifth National Audit Program of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. Within a large dataset were 620 dental cases. Here, we describe this data subset. The estimated annual dental caseload was 111,600:60% were children (< 16 y), 38.5% adults (16 - 65y) and 1.5% the elderly (> 65y). Almost all were elective day procedures (97%) and ASA 1 or 2 patients (95%).The most senior anaesthetist present was a Consultant in 82% and a non-career grade doctor in 14%.Virtually all (98%) cases were conducted during GA. Propofol was used to induce anaesthesia in almost all adults compared with 60% of children. Propofol maintenance was used in 5% of both children and adults. Almost all adults received an opioid (including remifentanil) compared with only 40% of children. Thirty one per cent of children had a GA for a dental procedure without either opioid or LA supplementation. Approximately 50% of adults and 16% of children received a tracheal tube: 20% of children needed only anaesthesia by face mask. These data show that anaesthetists almost always use general anaesthesia for dental procedures and this exposes difficulties in training of anaesthetists in sedation techniques. Dentists, however, are well known to use sedation when operating alone and our report provides encouragement for a comprehensive survey of dental sedation and anaesthesia practice in both NHS and non-NHS hospitals and clinics in the UK.
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Anestesia Dental/estadística & datos numéricos , Auditoría Odontológica , Adolescente , Adulto , Anciano , Atención Ambulatoria/estadística & datos numéricos , Analgésicos Opioides/administración & dosificación , Anestesia General/estadística & datos numéricos , Anestesia por Inhalación/estadística & datos numéricos , Anestesia Local/estadística & datos numéricos , Anestésicos Intravenosos/administración & dosificación , Niño , Sedación Consciente/estadística & datos numéricos , Atención Odontológica/estadística & datos numéricos , Femenino , Humanos , Intubación Intratraqueal/estadística & datos numéricos , Irlanda , Masculino , Persona de Mediana Edad , Piperidinas/administración & dosificación , Propofol/administración & dosificación , Remifentanilo , Odontología Estatal/estadística & datos numéricos , Reino Unido , Adulto JovenRESUMEN
Clinical audit is a tool that may be used to improve the quality of care and outcomes for patients in a health care setting as well as a mechanism for clinicians to reflect on their performance. The audit described in this short report involved the collection and analysis of data related to the administration of 1,756 conscious sedations, categorised as standard techniques, by clinicians employed by an NHS Trust-based dental service during the year 2014. Data collected included gender, age and medical status of subject, the type of care delivered, the dose of drug administered and the quality of the achieved sedation and any sedation-related complications. This was the first time that a service-wide clinical audit had been undertaken with the objective of determining the safety and effectiveness of this aspect of care provision. Evaluation of the analysed data supported the perceived view that such care was being delivered satisfactorily. This on-going audit will collect data during year 2016 on the abandonment of clinical sessions, in which successful sedation had been achieved, due to the failure to obtain adequate local anaesthesia.
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Anestesia Dental/estadística & datos numéricos , Sedación Consciente/estadística & datos numéricos , Auditoría Odontológica , Odontología Estatal/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Anestésicos por Inhalación/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Niño , Preescolar , Atención Odontológica/estadística & datos numéricos , Grupos Diagnósticos Relacionados/estadística & datos numéricos , Inglaterra , Femenino , Estado de Salud , Humanos , Hipnóticos y Sedantes/administración & dosificación , Masculino , Midazolam/administración & dosificación , Persona de Mediana Edad , Óxido Nitroso/administración & dosificación , Seguridad del Paciente/estadística & datos numéricos , Mejoramiento de la Calidad , Factores SexualesRESUMEN
BACKGROUND: The first line approach to managing healthy anxious children requiring dental extractions should include behavioural management and treatment under local anaesthetic. This can be coupled with conscious sedation. AIM: To evaluate alternative methods attempted prior to treatment under general anaesthesia (GA), to establish the incidence of repeat GA procedures. METHOD: Paediatric cases requiring dental extractions under GA were audited from October 2014 - December 2014 in the Oral and Maxillofacial Department, Great Western Hospital, Swindon. RESULTS: 78 paediatric cases requiring dental extractions were carried out during the study period. 91% of referrals came from local general dental practitioners (GDPs). The indication for the GA was included in 59% of the referral letters. The number of teeth extracted per case ranged from 1 - 14. In 18% of cases treatment under local anaesthetic had been attempted previously. Conscious sedation had not been attempted in any of the cases. There were 5 cases (6.4%) of repeat general anaesthetic procedures. CONCLUSION: Local guidance regarding appropriate paediatric referrals should be distributed to primary care referrers. Treatment under conscious sedation should be considered for paediatric cases and an improved referral pathway to the community dental service should be developed. Preventative advice should be reinforced to the referrer and to the patient.
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Anestesia Dental/estadística & datos numéricos , Anestesia General/estadística & datos numéricos , Extracción Dental/estadística & datos numéricos , Adolescente , Anestesia Local/estadística & datos numéricos , Niño , Preescolar , Sedación Consciente/estadística & datos numéricos , Auditoría Odontológica , Atención Dental para Niños/estadística & datos numéricos , Inglaterra , Femenino , Odontología General/estadística & datos numéricos , Hospitales de Distrito/estadística & datos numéricos , Hospitales Generales/estadística & datos numéricos , Humanos , Incidencia , Masculino , Estudios Prospectivos , Derivación y Consulta/estadística & datos numéricosRESUMEN
The effect of a radiation positioning stent (RPS) in radiation dosage reduction to the opposing jaw and maintenance of mouth opening was audited. 55 Head and Neck cancer patients who received radiotherapy were reviewed. Radiation dosages at similar points in the primary/opposing jaws were measured along with the mouth opening. Results showed a significant reduction in the radiation dosage to the opposing jaw in patients given the RPS. Mouth opening was generally maintained in patients given the RPS (77.7% improvement in mouth opening) compared to patients without RPS. Patients undergoing radiotherapy who had an RPS showed a significant reduction in radiation dosage to the opposing jaw and maintained their mouth opening in the short-term.
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Neoplasias de Cabeza y Cuello/radioterapia , Mandíbula/efectos de la radiación , Maxilar/efectos de la radiación , Boca/fisiología , Dosis de Radiación , Protección Radiológica/instrumentación , Stents , Carcinoma de Células Escamosas/radioterapia , Estudios de Cohortes , Auditoría Odontológica , Diseño de Equipo , Humanos , Registro de la Relación Maxilomandibular/instrumentación , Neoplasias de la Boca/radioterapia , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada/métodos , Estudios RetrospectivosRESUMEN
Intrinsic discolouration of teeth often requires bleaching to improve the aesthetics. There are three techniques available for non-vital bleaching: chairside; walking; and, inside/outside. Before the 2012 Cosmetic Directive was released, an audit of non-vital bleaching practice in the Belfast and Cork restorative departments was undertaken (Part 1). Results showed a variation in clinical procedures from the gold standard and therefore the latter was used to develop a clinical protocol and pro forma for use in the restorative departments. These were designed to be useful in the hospital and general dental practice settings, and should hopefully increase compliance with the gold standard and therefore improve both the consent process and record keeping. With the change in the European Cosmetic Directive Guidelines on October 31, 2012, dentists were confined to using a maximum of 6% hydrogen peroxide in tooth bleaching products provided the first application was by a dentist or under their direct supervision. A high proportion of audit responses in Part 1 involved concentrations of hydrogen peroxide, in both the walking and chairside techniques, that no longer complied with the new Directive. This suggested that the new Cosmetic Directive could significantly impact the practice of non-vital bleaching in the Belfast and Cork restorative departments. This in turn prompted an evaluation on the perceived clinical impact of the European Cosmetic Directive since its release in 2012 (Part 2). Surprisingly, clinicians found similar clinical outcomes following the restriction in the concentration of bleach, although 50% felt that more treatment visits were required to achieve an acceptable result. Moreover, the results of the audit revealed that clinicians were most concerned that the introduction of a ban on treating patients under 18 years of age might exacerbate psychological issues in this vulnerable age group if discoloured teeth were left untreated.
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Blanqueamiento de Dientes/normas , Auditoría Odontológica , Humanos , Blanqueamiento de Dientes/métodosRESUMEN
STATEMENT OF THE PROBLEM: Concerns were expressed that postoperative written instructions following endodontic treatment are not available in the Dublin Dental University Hospital. MATERIALS AND METHODS: Data was collected in three phases: retrospective analysis of clinical notes for evidence of the delivery of postoperative instructions; a randomly distributed questionnaire to patients undergoing root canal treatment prior to the introduction of a written postoperative advice sheet; and, another survey following introduction of the advice sheet. RESULTS: Some 56% of patients' charts documented that postoperative advice was given. Analysis of phase two revealed that patients were not consistently informed of any key postoperative messages. In phase 3 analysis, the proposed benchmarks were met in four out of six categories. CONCLUSIONS: Postoperative advice after root canal treatment in the DDUH is both poorly recorded and inconsistently delivered. A combination of oral postoperative instructions and written postoperative advice provided the most effective delivery of patient information.
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Auditoría Odontológica , Folletos , Educación del Paciente como Asunto/métodos , Cuidados Posoperatorios , Tratamiento del Conducto Radicular , Adolescente , Adulto , Anciano , Benchmarking , Comunicación , Estudios Controlados Antes y Después , Registros Odontológicos , Restauración Dental Permanente , Restauración Dental Provisional , Edema/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias , Estudios Prospectivos , Estudios Retrospectivos , Escritura , Adulto JovenRESUMEN
OBJECTIVES: To examine the distribution of treatment facilities accepting patients with acute odontogenic maxillofacial infections (AOMIs), time trends in incidence and relate these infections with a number of determinants. METHODS: A national Lithuanian retrospective study gathered data on all patients treated in outpatient/inpatient treatment facilities. Adjusted Incidence Ratios (AIRs) of AOMIs were calculated separately for each type of infection and for each year. Administrative districts (ADs) were grouped into low, medium, and high thirds based on the regional determinants: socio-economic index (R-SEI), access to basic (R-BDCI) or specialized dental care (R-SDCI) and index of systemic diseases (R-ISD). RESULTS: There were no statistically significant geographical differences in the distribution of TFs providing care for patients with AOMIs. Numbers of treatment facilities consistently increased from 2009 to 2013, but there was no consistent increase/decrease in the incidence of AOMIs (-1%). Regions with the highest R-SEI tended to have a higher incidence of AOMIs as compared to regions with medium or low R-SEI. When controlled for other determinants, lower R-BDCI/R-SDCI scores were associated with a higher incidence of AOMIs. CONCLUSIONS: High annual incidences (-1% of a total population) were diagnosed and treated for AOMIs, but there was no consistent time trend for these infections.
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Enfermedades Maxilomandibulares/epidemiología , Enfermedades de la Boca/epidemiología , Periodontitis/epidemiología , Absceso/epidemiología , Atención Ambulatoria/estadística & datos numéricos , Celulitis (Flemón)/epidemiología , Enfermedad Crónica , Auditoría Odontológica , Atención Odontológica/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Lituania/epidemiología , Osteítis/epidemiología , Sector Privado/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Estudios Retrospectivos , Clase Social , Factores SocioeconómicosRESUMEN
UNLABELLED: Population prevalence of orofacial clefts (OFCs) is well documented but the service utilisation patterns of these patients have received limited consideration. OBJECTIVE: To analyse 10-year trends in the utilisation of subsidised OFC related services in Australia. DESIGN: Retrospective audit of service utilisation and claims datasets. METHODS: Using state-wide hospital admission data, all persons treated for Cleft Palate Only (CPO) and Cleft Lip Only (CLO) as their primary diagnosis from 1999 to 2009 in Western Australia were included in the data frameset. Additionally, National Medicare out-of-hospital claims from 2003 to 2013 were added to the data frameset. The socioeconomic status and accessibility to services were analysed as effectors of service-mix such as age group, gender and geographic location. RESULTS: Of 721 in-hospital care episodes in Western Australia, 69% had CPO and 31% CLO as their principal diagnosis. Hospitalisations occurred from 0-69 years of age, but three quarters of all episodes occurred from 0-4 years of age (averaging one to two episodes per child). Whilst total hospitalisations were about four times higher for patients resident in high access areas, adjustment for population found the poorest 20% of the population having substantially lower hospital admission rates than the rest of the population. In Australia, claims for out-of-hospital cleft-related services varied between States. The overall pattern of out-of-hospital Medicare claims nationwide showed orthodontic services having the highest number of claims, followed by prosthodontic then oral surgical services. CONCLUSION: These data provide a picture of diverse service utilisation and leads to some interesting conclusions about geographic and economic access as well as cost-shifts between State and Commonwealth.
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Labio Leporino/terapia , Fisura del Paladar/terapia , Auditoría Odontológica , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Atención Ambulatoria/estadística & datos numéricos , Niño , Preescolar , Prótesis Dental/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Formulario de Reclamación de Seguro/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Orales/estadística & datos numéricos , Ortodoncia Correctiva/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Estudios Retrospectivos , Factores Sexuales , Clase Social , Australia OccidentalRESUMEN
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.
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Anestesia Dental/estadística & datos numéricos , Sedación Consciente/estadística & datos numéricos , Auditoría Odontológica , Procedimientos Quirúrgicos Orales/estadística & datos numéricos , Administración Intravenosa/economía , Administración Intravenosa/estadística & datos numéricos , Adulto , Anestesia Dental/economía , Anestésicos Generales/administración & dosificación , Anestésicos Locales/administración & dosificación , Citas y Horarios , Cateterismo Periférico , Sedación Consciente/economía , Ahorro de Costo , Servicio Odontológico Hospitalario/economía , Servicio Odontológico Hospitalario/estadística & datos numéricos , Humanos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/economía , Procedimientos Quirúrgicos Orales/economía , Estudios Prospectivos , Negativa del Paciente al TratamientoRESUMEN
OBJECTIVE: To provide data from the British Orthodontic Society (BOS) national clinical audit on temporary anchorage device (TAD) use following the recommendations of the National Institute for Health and Clinical Excellence (NIHCE) Design and setting: The Audit commenced on 1 January 2008 and is still ongoing. This article reports the data for TADs placed from 1 January 2008 to 1 November 2013. MATERIALS AND METHODS: Audit data was collected from participants using a system of both on-line data entry and hard copy forms. The criteria and standards for the audit were set following the NIHCE report in conjunction with the Development and Standards Committee of the BOS. Virtually all participants used the on-line data entry available on the BOS website. The data submitted was checked and entered manually into an Excel spreadsheet, and transferred to SPSS for analysis. RESULTS: Written information and documented discussion of risks were provided in over 90% of TADs placed, but 17.4% were placed without a specific signed consent form. Temporary anchorage device failure rate was 24.2% overall. Among failed TADs, 93.1% were lost or removed due to excess mobility. Infection or inflammation resulting in loss or removal was reported in 6% of TADs. CONCLUSIONS: The only audit standard that was met was failures due to infection of inflammation. The rest of the audit standards were not met. Recommendations are made to address these issues.
Asunto(s)
Auditoría Odontológica , Métodos de Anclaje en Ortodoncia/instrumentación , Remoción de Dispositivos/estadística & datos numéricos , Falla de Equipo/estadística & datos numéricos , Humanos , Consentimiento Informado/estadística & datos numéricos , Métodos de Anclaje en Ortodoncia/estadística & datos numéricos , Diseño de Aparato Ortodóncico/estadística & datos numéricos , Ortodoncia , Educación del Paciente como Asunto/estadística & datos numéricos , Factores de Riesgo , Sociedades Odontológicas , Factores de Tiempo , Reino UnidoRESUMEN
This article explores the potential implications of the Francis Report for members of the dental team from a dento-legal perspective. It looks at the broad recommendations in light of the existing ethical environment in which dental registrants work and asks what is new and what the recommendations will actually mean for dental professionals in practical terms. Clinical Relevance: The fundamental recommendations of the Francis Report, namely, that those who provide care should put patients' interests first and be open about outcomes and performance, are not new concepts. A breach of these ethically based expectations may, however, create grounds for legal proceedings, which is clearly a significant point for all members of the dental team. It is therefore important to be aware of what is expected of those providing clinical care.
Asunto(s)
Atención Odontológica/normas , Odontólogos/legislación & jurisprudencia , Ética Odontológica , Nivel de Atención/normas , Odontología Estatal/normas , Gestión Clínica , Auditoría Odontológica , Atención Odontológica/ética , Atención Odontológica/legislación & jurisprudencia , Odontólogos/ética , Humanos , Responsabilidad Legal , Atención Dirigida al Paciente , Nivel de Atención/ética , Nivel de Atención/legislación & jurisprudencia , Odontología Estatal/ética , Odontología Estatal/legislación & jurisprudencia , Reino UnidoRESUMEN
OBJECTIVES: To compare patient-reported outcome measures (PROMs) after different dental surgical procedures over a 1-week post-surgical period and in relation to duration of the surgery, and periosteal releasing incisions. To evaluate the prevalence of post-surgical complications. MATERIAL & METHODS: Four hundred and sixty-eight healthy dental patients requiring surgeries, such as crown lengthening (CL), open flap debridement (OFD) and implant installation (IMP) in the National Dental Centre, Singapore (2009-2011), were consecutively recruited. PROMs on bleeding, swelling, pain and bruising were obtained using Visual Analogue Scales (VAS) on days 0, 3, 5 and 7 post-operatively. RESULTS: On the day of surgery, the IMP procedure gave the lowest median VAS for all four PROM parameters. After a week, OFD still had a significantly higher VAS for swelling, pain and bruising. Patients who underwent procedures lasting more than 60 min. had higher VAS for all parameters except bleeding. After considering other important confounders, type of surgery procedure was no longer associated with the VAS score for any of the parameters. Time after surgery, male gender and shorter surgery duration reduced post-operative VAS for one or more of the parameters. Longer surgeon experience helps reduce VAS scores only for bleeding. Prevalence for tenderness to palpation was 11.6%, 8.9% and 12.2% for IMP, CL and OFD, respectively, 1-week post-operatively. Swelling and suppuration occurred rarely. CONCLUSIONS: The median VAS scores for all PROM parameters were generally low and reduced to near zero over a week following all three surgical procedures tested. Time after surgery and shorter surgery duration were associated with lower VAS scores in all the PROM parameters in this cohort of patients. Surgery type was not associated significantly with VAS after adjustment with other important confounders. Low prevalences of post-surgical complications were reported.
Asunto(s)
Implantación Dental Endoósea , Procedimientos Quirúrgicos Orales , Evaluación del Resultado de la Atención al Paciente , Estudios de Cohortes , Contusiones/etiología , Alargamiento de Corona , Desbridamiento/métodos , Auditoría Odontológica , Edema/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Tempo Operativo , Dolor Postoperatorio/etiología , Periostio/cirugía , Complicaciones Posoperatorias , Hemorragia Posoperatoria/etiología , Factores Sexuales , Colgajos Quirúrgicos/cirugía , Escala Visual AnalógicaRESUMEN
OBJECTIVES: To determine the frequency and correlates associations of post-extraction complications at a dental school. DESIGN: Retrospective review of patient records. SETTING: Exodontia clinic at the School of Dentistry, University of Otago, Dunedin. MAIN OUTCOME MEASURES: Provider characteristics, patient demographic characteristics, patient medical history, teeth extracted and occurrence of postoperative complications. RESULTS: Of the 598 extractions (540 routine and 58 surgical) which were undertaken in the audit period, 74 (12.4%) resulted in post-operative complications. Dry socket and post-operative pain were the major complications. A higher complication rate was found among patients treated by fourth-year undergraduate students than among those treated by more senior students or staff. Post-operative complications were not significantly associated with patients' ethnicity or medical history. CONCLUSION: The rate of postoperative complications at the Univeristy of Otago's Faculty of Dentistry is consistent with reports in existing literature and inversely associated with operators' experience.