RESUMO
Dentistry is represented to the US public in large part by the various professional associations, which speak for the interests of general and specialized dentists, mostly in private proprietary practice. Unfortunately, the interests of dental professional associations may often be in conflict with those of the public. To resolve this continued disparity, it behooves the dental leadership to become more involved with the overall health care system than continuing to enhance the economic interests of the profession without sufficient regard for the world-wide burden of unmet dental needs. An assessment of policy failures is provided with some recommendations for greater involvement of organized dentistry in the integration of oral and general health care. Dentistry must recommit itself to being a health profession rather focusing on the business aspects of health care. Another aspect to be considered is a reorganization of the American Dental Association to better represent the oral health care workforce.
Assuntos
Reforma dos Serviços de Saúde , Licenciamento , Saúde Bucal , Serviços Preventivos de Saúde/organização & administração , Sociedades , Atitude do Pessoal de Saúde , Odontólogos/organização & administração , Política de Saúde , Humanos , Estados UnidosRESUMO
Residency education in oral and maxillofacial surgery (OMS) exists in an environment of transformation unlike anything seen in the past. Changes in American society accelerated by the COVID-19 pandemic are impacting all of health-care education and demand a comprehensive response by OMS programs and in standards for education. The oral health in America report of the National Institutes of Health and actions of the American Council on Graduate Medical Education provides a new framework for structuring and adapting OMS programs. These include incorporating the Quadruple Aims and ACGME core competencies into OMS education. The evolution of clinical education is being adapted to changes in technology and the American higher education environment. A changing workforce and practice model combined with today's technology revolution are being incorporated into OMS residency education.
Assuntos
COVID-19 , Internato e Residência , Cirurgia Bucal , Humanos , COVID-19/epidemiologia , Currículo , Procedimentos Cirúrgicos Bucais/educação , Pandemias , Cirurgia Bucal/educação , Estados UnidosRESUMO
Objectives: To provide a nonbiased, complete assessment of what the evidence from meta-analyses informs us about complementary and nonpharmacological treatment options for the management of pain after third molar surgery, as well as highlight any discordancy, gaps, or lack of evidence among meta-analyses. Methods: The quality of the included systematic reviews was assessed using the ROBIS tool. Corrected covered area (CCA) was calculated for pairs of similar meta-analyses to identify the amount of overlap. Reviews that were the most recent, comprehensive, and had adequate quality were considered for analyses when reviews showed a high overlap. In cases with a low amount of overlap among meta-analyses, all eligible studies were included. Also, citation matrices were constructed to address overlap. A network meta-analytical approach was adopted to rank different interventions. Results: Ten meta-analyses were included for quantitative synthesis. The quantitative analysis revealed that platelet-rich fibrin and its derivatives as well as ozone therapy reduce early and late pain better than the other complementary interventions compared to control (no complementary intervention). Conclusions: Despite the shortcomings of included meta-analyses, consolidated evidence suggests that platelet-rich-fibrin and its derivatives as well as ozone therapy outperform the other nonpharmacological complementary interventions in reducing early and late postsurgical pain following third molar extraction. However, the results should be interpreted with caution due to an unclear risk of bias and lack of firm evidence in the included meta-analyses. Moreover, there is a need for a standard protocol for the application of nonpharmacological complementary interventions.
Assuntos
Dente Serotino , Ozônio , Humanos , Dente Serotino/cirurgia , Viés , DorRESUMO
Arbitrarily cordoning off the mouth from the rest of the body is the educational approach that, since 1840, has been responsible for the medical-dental schism that persists today, preventing oral health's integration with overall health. This divide has also thwarted oral disease prevention initiatives, access to services, and health equity. This article offers an educational plan for reunifying medicine and dentistry, which involves interprofessional education, dual degree training, integrating oral health into medical education, and integrated residency training.
Assuntos
Educação Médica , Internato e Residência , Currículo , Atenção à Saúde , Humanos , Saúde BucalAssuntos
Cirurgia Bucal/tendências , Centros Médicos Acadêmicos , Adulto , Criança , Assistência Odontológica/economia , Educação em Odontologia , Educação Médica , Previsões , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Seguro Odontológico/economia , Relação entre Gerações , Internato e Residência , Medicaid/economia , Cirurgiões Bucomaxilofaciais/estatística & dados numéricos , Prática Profissional , Encaminhamento e Consulta , Especialização , Cirurgia Bucal/economia , Cirurgia Bucal/educação , Tecnologia Odontológica/tendências , Estados UnidosRESUMO
Chromosome 4q deletion syndrome is a monosomy that comprises all interstitial and terminal deletions of the long arm of chromosome 4. It results in a variety of phenotypes characterized by various craniofacial and bodily abnormalities. The purpose of this study is to report a case of 4q deletion syndrome and describe its clinical manifestations, with particular attention to the craniofacial presentation and subsequent management of the syndrome, as well as its associated micrognathia and airway complications. Among treatment options, the investigators chose bilateral distraction osteogenesis of the mandible in order to increase the subject's posterior airway space. At follow-up, the subject was able to ventilate without any adjuncts or mechanical ventilation assistance.
Assuntos
Transtornos Cromossômicos/patologia , Anormalidades Craniofaciais/patologia , Deleção Cromossômica , Cromossomos Humanos Par 4 , Fissura Palatina/patologia , Seguimentos , Humanos , Imageamento Tridimensional/métodos , Recém-Nascido , Masculino , Mandíbula/anormalidades , Mandíbula/cirurgia , Micrognatismo/patologia , Micrognatismo/cirurgia , Osteogênese por Distração/métodos , Palato Mole/anormalidades , Insuficiência Respiratória/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: Oral bisphosphonates are known to have potentially profound effects on oral health. A review of the evidence supporting answers to key clinical questions is necessary to assist surgeons in the care of their patients who are receiving oral bisphosphonates. MATERIALS AND METHODS: The literature is reviewed to address several questions, ie, what is the risk of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in my patient on oral bisphosphonates? Why are so few cases of BRONJ attributable to oral bisphosphonate use? What is the importance of cofactors in the development of osteonecrosis? How major a clinical problem is BRONJ, typically, in the oral bisphosphonate patient? What dental procedures are associated with a risk of BRONJ? Are other findings apart from BRONJ of importance in the oral bisphosphonate patient? Are there proven strategies to prevent BRONJ in the oral bisphosphonate patient? Should my patient discontinue the use of oral bisphosphonates temporarily or permanently? RESULTS: A review of the evidence offers information that will help in clinical decision-making. In general, the risk of BRONJ is between 1 in 10,000 and 1 in 100,000, but may increase to 1 in 300 after dental extraction. The great majority of BRONJ cases will likely remain in the intravenous population. Cofactors have not been firmly established, although smoking, steroid use, anemia, hypoxemia, diabetes, infection, and immune deficiency may be important. Rarely does BRONJ in the oral bisphosphonate patient appear to progress beyond stage 2, and many cases reverse with discontinuation of oral medication. Extraction is the only dental procedure shown to increase the risk of BRONJ. Dental implant therapy should be used with caution in the oral bisphosphonate patient. The benefits and risks of oral bisphosphonate use must be weighed individually and in consultation with the prescribing physician, before determining the need for temporary or permanent cessation of medication. CONCLUSION: Emerging evidence supports clinical decisions in favor of the oral and maxillofacial surgery patient taking oral bisphosphonates.
Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Doenças Maxilomandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , Administração Oral , Conservadores da Densidade Óssea/administração & dosagem , Complicações do Diabetes , Difosfonatos/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Doenças Maxilomandibulares/patologia , Obesidade/complicações , Procedimentos Cirúrgicos Bucais/efeitos adversos , Osteonecrose/patologia , Medição de Risco , Fumar/efeitos adversosRESUMO
PURPOSE: Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a well-described clinical condition with consistent radiographic findings. The purpose of this report was to review these findings in an attempt to offer important diagnostic, prognostic, and therapeutic information associated with BRONJ. MATERIALS AND METHODS: The findings of studies assessing the radiographic landmarks on plain films, intraoral films, orthopantograph, computed tomography, magnetic resonance imaging, and nuclear bone scans in patients with BRONJ were analyzed. RESULTS: The radiographic findings in patients with BRONJ include osteosclerosis, osteolysis, dense woven bone, a thickened lamina dura, subperiosteal bone deposition, and failure of postsurgical remodeling. CONCLUSIONS: Consistent imaging findings are noted in the BRONJ patient. Imaging is an essential part of the clinical assessment of the BRONJ patient and might be an additional tool for tracking the progression of the disease.
Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Doenças Maxilomandibulares/induzido quimicamente , Doenças Maxilomandibulares/diagnóstico por imagem , Osteonecrose/induzido quimicamente , Osteonecrose/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Doenças Maxilomandibulares/patologia , Imageamento por Ressonância Magnética , Osteonecrose/patologia , Tomografia por Emissão de Pósitrons , Radiografia Panorâmica , Compostos Radiofarmacêuticos , Medronato de Tecnécio Tc 99m/análogos & derivados , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada por Raios XAssuntos
Odontologia/tendências , Assistência Odontológica/economia , Assistência Odontológica/organização & administração , Pesquisa em Odontologia , Educação em Odontologia , Previsões , Fundações , Custos de Cuidados de Saúde , Educação em Saúde Bucal , Acessibilidade aos Serviços de Saúde , Humanos , Higiene Bucal/educação , Cuidados de Saúde não RemuneradosRESUMO
This article discusses the risk for wrong-site surgery in oral and maxillofacial surgery and the development and utility of checklists. The intent of checklists and the specific applicability of each of them to ambulatory oral and maxillofacial surgery are presented. Checklists and other considerations to mitigate the risk of wrong-site surgery are evaluated. The role of interprofessional teams in improving patient care outcomes with the checklist as a vehicle is evaluated. Recommendations for the use of checklists and related methods in the ambulatory oral and maxillofacial surgery setting are made.
Assuntos
Lista de Checagem , Erros Médicos/prevenção & controle , Procedimentos Cirúrgicos Bucais , HumanosRESUMO
Care of female and gravid patients requires a detailed understanding of the unique issues inherent to quality treatment. Increasingly important data continue to accumulate about significant differences in the physiology of men and women and the way they express disease. Furthermore, the gravid patient requires specific alterations and considerations in clinical care that not only affect the mother but also the fetus. This article focuses on key elements that the treating surgeon should consider.