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Clinical Oral Investigations Sep 2022This study evaluated particle spread associated with various common periodontal aerosol-generating procedures (AGPs) in simulated and clinical settings.
OBJECTIVES
This study evaluated particle spread associated with various common periodontal aerosol-generating procedures (AGPs) in simulated and clinical settings.
MATERIALS AND METHODS
A simulation study visualized the aerosols, droplets, and splatter spread with and without high-volume suction (HVS, 325 L/min) during common dental AGPs, namely ultrasonic scaling, air flow prophylaxis, and implant drilling after fluorescein dye was added to the water irrigant as a tracer. Each procedure was repeated 10 times. A complementary clinical study measured the spread of contaminated particles within the dental operatory and quantified airborne protein dispersion following 10 min of ultrasonic supragingival scaling of 19 participants during routine periodontal treatment.
RESULTS
The simulation study data showed that air flow produced the highest amount of splatters and the ultrasonic scaler generated the most aerosol and droplet particles at 1.2 m away from the source. The use of HVS effectively reduced 37.5-96% of splatter generation for all three dental AGPs, as well as 82-93% of aerosol and droplet particles at 1.2 m for the ultrasonic scaler and air polisher. In the clinical study, higher protein levels above background levels following ultrasonic supragingival scaling were detected in fewer than 20% of patients, indicating minimal particle spread.
CONCLUSIONS
While three common periodontal AGPs produce aerosols and droplet particles up to at least 1.2 m from the source, the use of HVS is of significant benefit. Routine ultrasonic supragingival scaling produced few detectable traces of salivary protein at various sites throughout the 10-min dental operatory.
CLINICAL RELEVANCE
The likelihood of aerosol spread to distant sites during common periodontal AGPs is greatly reduced by high-volume suction. Clinically, limited evidence of protein contaminants was found following routine ultrasonic scaling, suggesting that the the majority of the contamination consisits of the irrigant rather than organic matter from the oral cavity.
Topics: Aerosols; Dental Care; Dental Scaling; Fluorescein; Humans; Suction
PubMed: 35581347
DOI: 10.1007/s00784-022-04532-8 -
Journal of Dental Education May 2023A nurse-led rural practice, Archer Family Health Care, established a partnership with the University of Florida College of Dentistry to improve access to dental care for...
PURPOSE
A nurse-led rural practice, Archer Family Health Care, established a partnership with the University of Florida College of Dentistry to improve access to dental care for underserved rural populations. The purpose of this project was to evaluate the impact of this partnership on dental care access and identify perceived barriers patients' experience in this rural community.
METHODS
A qualitative design was used to evaluate if this partnership improved access to dental care and identify care barriers existing in this population. Outcome measures were 1) completed dental visits and 2) a qualitative analysis of patients' perceived barriers to accessing care if they did not complete their dental appointment.
RESULTS
As a result of this partnership, 118 direct dental referrals were placed. From those referrals, 45 (38%) patients completed their dental appointments, and 73 (62%) patients did not. Twenty-five patients provided a rationale for not presenting for their appointment. Cited barriers included cost (32%), time (24%), frustration with the referral process (20%), obtaining care at an alternate dental location (12%), fear (7%), and transportation issues (4%).
CONCLUSION
This project suggests that specific interventions may increase opportunities for dental care in rural areas however barriers continue to exist that may impact that access.
Topics: Humans; Health Services Accessibility; Rural Population; Medically Underserved Area; Dental Care
PubMed: 36691321
DOI: 10.1002/jdd.13176 -
Zhonghua Kou Qiang Yi Xue Za Zhi =... Feb 2023Oral diseases are highly prevalent in China, while oral health services are generally underutilized and public health resources are wasted. Lacking oral insurance may be...
Oral diseases are highly prevalent in China, while oral health services are generally underutilized and public health resources are wasted. Lacking oral insurance may be one of the leading causes. The basic medical insurance of China does not cover dental care in most cities, which is worthy to further discuss. To better understand the experience of dental insurance from international dental care practice, the dental coverage scope, content, co-pay ratio, and effects of oral insurance on oral health improvement from the abroad countries with typical health insurance systems were summarized by using scoping review. Then, we discussed the coverage scope for dental health of basic medical insurance and private insurance in China. We also analyzed the current issues of dental care coverage and cost-share. At last, we proposed thoughts and suggestions to establish and improve a multi-level oral health insurance system with Chinese characteristics under the basic medical insurance frame. In particular, we gave suggestions on increasing the coverage for high dental care xpenditure by ebasic medical insurance, supplying children and teenagers with preventive dental care, and encouraging private insurance companies to cover dental care expenditure.
Topics: Child; Adolescent; Humans; Insurance, Dental; Dental Care; China
PubMed: 36746454
DOI: 10.3760/cma.j.cn112144-20220601-00294 -
British Dental Journal Dec 2021The first Alliance for a Cavity-Free Future (ACFF)/King's College London Dental Policy Lab, held in 2017, identified the need for a review of dental payment systems in... (Review)
Review
The first Alliance for a Cavity-Free Future (ACFF)/King's College London Dental Policy Lab, held in 2017, identified the need for a review of dental payment systems in order to see progress towards achieving improvements in caries and cavities. The lack of incentivisation for preventive intervention and care has long been a barrier to progress. The second Dental Policy Lab, held in July 2018, focused on this issue with the overarching question: 'How can we create and implement acceptable prevention-based dental payment systems to achieve and maintain health outcomes?' Using a design approach and participatory research, 29 participants from five stakeholder categories developed a blueprint report that aims to serve as a framework to adapt or create remuneration systems that are compatible with evidence-based dentistry with a focus on preventive care. Aimed at policymakers and policy entrepreneurs, this blueprint provides guidance and potential solutions using several international examples. The report and accompanying infographic explored in this paper have been well received and have helped to frame discussions in several country settings, with a direct implementation which is being trialled in France in 2021.
Topics: Dental Care; Dental Caries; Evidence-Based Dentistry; France; Health Policy; Humans; London
PubMed: 34921273
DOI: 10.1038/s41415-021-3725-1 -
Journal of Public Health Management and...To describe the patterns of specific dental service utilization among the various sociodemographic groups in North Carolina served by the East Carolina University School...
OBJECTIVE
To describe the patterns of specific dental service utilization among the various sociodemographic groups in North Carolina served by the East Carolina University School of Dental Medicine (ECU SoDM).
DESIGN
This was a descriptive study utilizing self-reported patients' sociodemographic information, payment method history, and CDT codes of procedures performed. Deidentified clinical data recorded for 26 710 patients and 534 983 procedures from 2011 to 2020 were extracted from a centralized axiUm database. Data were analyzed using IBM SPSS Statistics, version 25.0. Cross-tabulations between dental service utilizations, patients' demographics, and payment method were performed using chi-square analysis.
SETTING
Nine dental clinic sites across the state of North Carolina.
PARTICIPANTS
In total, 26 710 adults 23 years to older than 65 years were included in the sample for this study.
MAIN OUTCOME MEASURES
In total, 534 983 procedure codes completed for the eligible patients were cross-tabulated with payment method.
RESULTS
Payment method was significantly related to individual characteristics including location of service, age, race, ethnicity, and untreated decay ( P < .001). Payment method is associated with the dental service type utilized by an individual ( P < .001). Patients who received Medicaid benefits were more likely to receive restorative procedures, removable prosthetics, or oral surgery. Despite NC Medicaid covering preventive procedures, patients who received Medicaid benefits showed lower utilization of preventive procedures than expected. Privately insured or self-paying individuals demonstrated a greater variety of service option utilization, as well as more frequent usage of more specialized procedure options such as endodontics, periodontics, fixed prosthodontics, and implants.
CONCLUSIONS
Payment method was found to be related to patients' demographics and type of dental service utilized. Adults older than 65 years demonstrated a higher proportion of self-payment for dental care, indicating a lack of payment options for this population. In the interest of providing care for underserved populations in North Carolina, policy makers should consider expanding dental coverage for adults older than 65 years.
Topics: Adult; United States; Humans; North Carolina; Self Report; Universities; Dental Care; Medicaid; Demography
PubMed: 37290126
DOI: 10.1097/PHH.0000000000001774 -
Journal of Dental Education Apr 2021While the numbers of oral maxillofacial surgery (OMFS) residents increased over time, women and residents from underrepresented minority backgrounds are still...
PURPOSE
While the numbers of oral maxillofacial surgery (OMFS) residents increased over time, women and residents from underrepresented minority backgrounds are still underrepresented. The objectives were to assess dental students' OMFS-related personal and educational experiences and attitudes and explore which factors correlate with their interest in future OMFS careers.
METHODS
Data were collected from 493 dental students in 1 dental school and 206 students from 15 other US and Canadian dental schools.
RESULTS
The students in the national sample were more likely to have experienced an OMFS procedure themselves (64.6% vs. 50.7%; P = 0.001), have shadowed an OMFS in an operating room (23.2% vs. 14.9%; P = 0.009) prior to coming to dental school and to be much/very much interested in an OMFS career (36.4% vs. 12%; P < 0.001) than the students at the home school. While the majority of both groups rated their experiences with rotations in the OMFS department in the dental school (68% vs. 62.5%) and in the hospital (80.3% vs. 85.7%) as very interesting, the students in the national sample were more likely to agree/strongly agree that they were satisfied with their OMFS experiences (68.1% vs. 36.3%; P < 0.001) and had learned a lot from the OMFS faculty (57.9% vs. 30.8%) than the students in the home school. For both groups, the degree of interest in an OMFS career correlated with having had more personal OMFS experiences (home: r = 0.28; P < 0.001/other: r = 0.39; P < 0.001), more interesting OMFS experiences in the dental school (r = 0.23; P < 0.05/r = 0.40; P < 0.001) and the hospital (0.33; P < 0.05/r = 0.50; P < 0.001) and more positive attitudes toward OMFS faculty (r = 0.26; P < 0.001/r = 0.37; P < 0.001).
CONCLUSIONS
Positive personal and educational OMFS experiences and positive attitudes toward OMFS faculty were associated with an interest in OMFS careers. These findings provide a basis for developing educational interventions aimed at increasing the percentage of women and residents from URM backgrounds in OMFS programs.
Topics: Canada; Career Choice; Dental Care; Female; Humans; Students, Dental; Surgery, Oral
PubMed: 33368261
DOI: 10.1002/jdd.12511 -
European Journal of Dental Education :... Feb 2021Graduating confident students who are able to flourish and develop in their future careers is an importance outcome of the dental education. This study aims to evaluate...
PURPOSE
Graduating confident students who are able to flourish and develop in their future careers is an importance outcome of the dental education. This study aims to evaluate self-perceived level of confidence of fifth-year dental students in different restorative-related tasks and the relationship between their clinical training and its corresponding confidence.
METHODS
Fifth-year graduate dental students (n = 202) were asked to fill a questionnaire that rated their level of confidence in different clinical restorative dentistry tasks. Additionally, they were asked about the number of times they performed tasks prior to attempting the equivalent competency and in which sub-specialty they felt the most confident.
RESULTS
Completed responses were received from 120 students giving a response rate of 59%. Students felt the most prepared and confident in direct restorations and simple endodontic treatment, and they seemed less confident in indirect restorations and complex endodontic treatment. Regarding the steps of indirect restorations, students expressed least confidence in crown preparation compared to impression making and try-in procedures (P < .05). Students rated their confidence highest in operative dentistry, followed by endodontics and lastly fixed prosthodontics.
CONCLUSION
The results highlight the areas in which students exhibit the least confidence. Enhancement of student clinical skills and directed exposure is necessary to raise the level of perceived confidence which will reflect positively on their current and future professional performance.
Topics: Clinical Competence; Dental Care; Dentistry, Operative; Education, Dental; Endodontics; Humans; Students, Dental
PubMed: 33245624
DOI: 10.1111/eje.12592 -
Orthodontics & Craniofacial Research Dec 2023Despite technological advances, challenges exist in US dental care, including variations in quality of care, access and untreated dental needs. The implementation of...
Despite technological advances, challenges exist in US dental care, including variations in quality of care, access and untreated dental needs. The implementation of learning health systems (LHSs) in dentistry can help to address these challenges. LHSs use robust informatics infrastructure including data and technology to continuously measure and improve the quality and safety of care and can help to reduce costs and improve patient outcomes. The use of EHRs and standardized diagnostic terminologies are highlighted, as they allow for the storage and sharing of patient data, providing a comprehensive view of a patient's medical and dental history, and can be used to identify patterns and trends to improve the delivery of care. The BigMouth Dental Data Repository is an example of an informatic platform that aggregates patient data from multiple institutions and is being used to for scientific inquiry to improve oral health.
Topics: Humans; Informatics; Oral Health; Dental Care
PubMed: 36919982
DOI: 10.1111/ocr.12655 -
Revista Medica de Chile Sep 2020We analyze the transmission routes, possible viral reservoirs in the oral cavity and considerations about dental care of SARS-CoV-2 virus infection. We also analyze the...
We analyze the transmission routes, possible viral reservoirs in the oral cavity and considerations about dental care of SARS-CoV-2 virus infection. We also analyze the protocols required before and after a dental procedure, aiming to increase the awareness of dentists about the importance of virus spread prevention among health care workers and patients. The evaluation of symptoms associated with SARS- CoV-2 such as fever, fatigue, dry cough, myalgia, dyspnea, and the inquiry about possible contacts with infected people is of utmost importance. The tongue and oral mucosa are important viral reservoirs and the transmission of the virus occurs primarily by saliva droplets. Therefore, elective dental care should be postponed, attending only dental emergencies during this period, incorporating the use of protective personal equipment (PPE) and using manual instruments to prevent the production of aerosols.
Topics: Aerosols; COVID-19; Dental Care; Humans; Infection Control; Pandemics; Personal Protective Equipment
PubMed: 33399706
DOI: 10.4067/S0034-98872020000901302 -
British Dental Journal Oct 2022This article discusses the different types of sensory impairments and their aetiology. It considers how the oral health status in patients with sensory impairments is...
This article discusses the different types of sensory impairments and their aetiology. It considers how the oral health status in patients with sensory impairments is impacted by their disability and the barriers these patients face in dental care. It also discusses legislation relevant to dental care professionals when caring for patients with disabilities, including the Mental Capacity Act (2005), the Equality Act (2010) and the Accessible Information Standard (2016). Finally, it provides recommendations to dental care professionals on how they can best manage patients with sensory impairments and communicate with them effectively in order to provide them with quality dental care.
Topics: Humans; Disabled Persons; Dental Care
PubMed: 36307700
DOI: 10.1038/s41415-022-5085-x