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North Carolina Medical Journal 2012Emergency departments (EDs) act as the safety net and alternative care site for patients without insurance who have dental pain.
BACKGROUND
Emergency departments (EDs) act as the safety net and alternative care site for patients without insurance who have dental pain.
METHODS
We conducted a retrospective chart review of visits to an urban teaching hospital ED over a 12-month period, looking at patients who presented with a chief complaint or ICD code indicating dental pain, toothache, or dental abscess.
RESULTS
The number of visits to this ED by patients with a dental complaint was 1,013, representing approximately 1.3% of all visits to this ED. Dental patients had a mean age of 32 (+/- 13) years, and 60% of all dental visits were made by African Americans. Dental patients were more likely to be self-pay than all other ED patients (61% versus 22%, P < 0.001). At the vast majority of dental ED visits (97%), the patient was treated and discharged; at most visits (90%) no dental procedure was performed. ED treatment typically consisted of pain control and antibiotics; at 81% of visits, the patient received an opiate prescription on discharge, and at 69% of visits, the patient received an antibiotic prescription on discharge.
LIMITATIONS
This retrospective chart review covered a limited period of time, included only patients at a large urban academic medical center, and did not incorporate follow-up analysis.
CONCLUSION
Although they make up a small percentage of all ED visits, dental ED visits are more common among the uninsured, seldom result in definitive care or hospital admission, and often result in prescription of an opioid or antibiotic. These findings are cause for concern and have implications for public policy.
Topics: Adolescent; Adult; Child; Child, Preschool; Dental Care; Dental Health Services; Emergency Service, Hospital; Female; Humans; Insurance Coverage; Medicaid; Middle Aged; North Carolina; Retrospective Studies; United States; Young Adult
PubMed: 23189415
DOI: No ID Found -
Dental Clinics of North America Oct 1988Research on modeling indicates that this technique offers dentists a means of reducing fear in child patients of all ages. As a preventive measure used with children who... (Review)
Review
Research on modeling indicates that this technique offers dentists a means of reducing fear in child patients of all ages. As a preventive measure used with children who have had no prior exposure to dental treatment, it can be particularly efficacious. Based on the assumption that much of adult dental avoidance is based on dental fears acquired in childhood treatment, the reduction of children's dental fear would have a positive effect on the individual's tendency to seek out dental health care throughout his or her lifespan. For the dentist, there are also short- and long-term benefits. Dental management of the child is prerequisite to providing good dental care. Pedodontics as a specialty recognizes behavioral management of the child cannot be separated from the quality of the dentist's work. Fear has been identified as an important factor in disruptive behavior of school age children in the dental office. Practicing dentists consider the fearful, disruptive child to be among the most troublesome of problems in their clinical work. The child must cooperate or at least passively comply with the dentist's procedures in order to have the technical work completed. By reducing disruptive patient behavior (crying, screaming children whose peripheral and gross motor movements often make direct contact with the dentist or his equipment) the most unpalatable aspect of pediatric dentistry is minimized. Further, the actual time for treatment becomes shorter rather than longer. Although modeling is not restricted to videotape media, the emergence of current videotape technology provides the practitioner with the means for incorporating patient viewing of prerecorded modeling tapes as part of the usual waiting period. Such a procedure would mean that in the long run, the dentist will spend more time doing dentistry and less in behavioral management tasks.
Topics: Anxiety; Behavior Therapy; Child; Child Behavior; Dental Care; Dentist-Patient Relations; Fear; Humans; Imitative Behavior; Learning
PubMed: 3053265
DOI: No ID Found -
BMJ Military Health Nov 2020Health professionals working in the dental environment are potentially at risk of noise-induced hearing loss (NIHL) due to the use of clinical and laboratory equipment....
INTRODUCTION
Health professionals working in the dental environment are potentially at risk of noise-induced hearing loss (NIHL) due to the use of clinical and laboratory equipment. Workplaces engaging in the practice of dentistry within the UK are subject to legislation from the Control of Noise at Work (CNW) regulations 2005. Clinicians working in the military are at further increased risk of NIHL due to exposure from additional risk factors such as rifles or aircraft engines. To our knowledge, no authors have previously studied the noise levels experienced in a military dental setting or compared noise levels in a typical dental practice with current UK legislation.
METHOD
Measurements of noise levels experienced by a dentist, dental nurse and dental hygienist during a standard conservation procedure were assessed using wearable noise dose-badges. Furthermore, noise levels within a dental technician's work space were also assessed. Noise levels produced by representative clinical and laboratory equipment were assessed and compared with CNW legislation.
RESULTS
The highest level for clinical equipment was produced by the suction apparatus while aspirating up a cup of water at 76 dB. For laboratory equipment, the lower exposure action value (LEAV) of 80 dB would be exceeded in 2.1 hours' use of the trimmer, 3.6 hours' use of the vibrating table and 9 min use of the airline.
CONCLUSIONS
Noise levels experienced by clinicians within the dental surgery were well below the legislative LEAV thresholds for both peak and continuous noise. However, noise levels produced by laboratory equipment were far higher and there is clearly the potential for excessive noise exposure for dental professional in the everyday setting. Dental professionals responsible for dental laboratory settings must be familiar with the CNW regulations and measures put in place that control the inadvertent breach of legislation. Hearing protection must be mandated when using equipment that exceeds the LEAV and an educational programme is required to explain both their correct use and the rationale behind it. Methods of mitigating that risk further require exploration such as alternative methods of completing the tasks performed by the airline or reducing the noise generated by it, such as by reducing the supply pressure or using an alternative nozzle design.
Topics: Dental Care; Equipment Design; Hearing Loss, Noise-Induced; Humans; Military Medicine; Occupational Exposure; Risk Factors; United Kingdom
PubMed: 30992338
DOI: 10.1136/jramc-2018-001150 -
The Journal of the Michigan Dental... Jul 2004
Topics: Dental Care; Dental Care for Aged; Dental Care for Chronically Ill; Dental Care for Disabled; Humans; Michigan; Uncompensated Care
PubMed: 15382423
DOI: No ID Found -
Journal of Public Health Dentistry 1996This paper aims to develop and organize a set of variables that can be used to: (1) test the widely held but unproven assumption that lay risk perceptions can adversely... (Review)
Review
OBJECTIVE
This paper aims to develop and organize a set of variables that can be used to: (1) test the widely held but unproven assumption that lay risk perceptions can adversely affect dental care, (2) investigate the possible influence of lay risk perceptions on dental care and (3) permit the evaluation of risk communication strategies in dentistry.
METHODS
We reviewed the literature regarding risk perception and risk communication in health care and technology. We then selected a set of variables that could be measured in a study of the general public and organized these in a taxonomy to suggest likely relationships among the variables.
RESULTS
The central relationship of the proposed taxonomy is between a lay person's perception of dental risk and a set of measurable outcomes that could affect that person's dental care. The taxonomy lists three possible influences on the lay person's risk perception: attributes of the individual, attributes of the dental procedure or technology perceived as risky, and attributes of the dental practice.
CONCLUSIONS
Systematic testing of the proposed variables should demonstrate whether lay risk perceptions substantially influence dental care, and if so, which factors most strongly influence risk perceptions. A model of lay risk perceptions of dentistry then could be developed and strategies could be devised to minimize the detriment, if any, to dental care from risk perception.
Topics: Attitude to Health; Classification; Communication; Dental Care; Humans; Models, Theoretical; Oral Health; Outcome Assessment, Health Care; Practice Management, Dental; Public Opinion; Risk; Risk Assessment; Risk Management; Technology, Dental
PubMed: 8906705
DOI: 10.1111/j.1752-7325.1996.tb02438.x -
PloS One 2022This cross-sectional study aims to describe the primary dental care procedures performed by Oral Health Teams (OHTs), adhering to the third cycle of the "National...
This cross-sectional study aims to describe the primary dental care procedures performed by Oral Health Teams (OHTs), adhering to the third cycle of the "National Program for Improving Access and Quality of Primary Care" (PMAQ-AB) in Brazil. A descriptive analysis was performed through 26 dental procedures, including spontaneous, preventive, restorative/prosthetic and surgical procedures, and actions of cancer monitoring. Each conducted procedure assigned a score to the OHT, the final score being the sum of the number of procedures performed by the OHTs. These scores were then compared among the geographic regions of the country. Most OHTs perform basic dental procedures, such as supragingival scaling, root planning and coronal polishing (98.1%), composite filling (99.0%), and permanent tooth extraction (98.6%). The frequency related to dental prosthesis and monitoring of oral cancer decreased. Only 12.9% of the OHTs carries out biopsies, 30.9% monitor patients undergoing biopsy, 15.1% carry out impression for prostheses, and 13.6% carry out prostheses' installation. The scores reveal that OHT's performed, on average, 19.45 (±3.16) dental procedures. The OHTs in the South, Southeast, and Northeast had a higher number of primary dental procedures, while the teams in the North and Midwest performed, on average, fewer procedures. The Brazilian regions with the highest dental need have the lowest number of dental procedures. It is necessary to increase the range of procedures offered by OHT and reduce regional inequalities, adapting to the needs of the population in order to achieve comprehensive oral health.
Topics: Brazil; Dental Care; Geography; Humans; Oral Health; Primary Health Care
PubMed: 35089961
DOI: 10.1371/journal.pone.0263257 -
Cadernos de Saude Publica Feb 2008This article provides a literature review of dental care models in Brazil, with a specific focus on the Incremental System. Other models that appeared in the research... (Review)
Review
This article provides a literature review of dental care models in Brazil, with a specific focus on the Incremental System. Other models that appeared in the research were the Inversion of Care, Early Dental Care, and Family Health Programs. The various authors analyzed the pros and cons, origins, program principles, and evolution of the different dental care models. Finally, the authors observed a common deficiency that impeded access to dental care services: exclusion of the clientele.
Topics: Brazil; Dental Care; Health Services Accessibility; Humans; Models, Organizational; National Health Programs; State Dentistry
PubMed: 18278270
DOI: 10.1590/s0102-311x2008000200002 -
Oral Health & Preventive Dentistry 2014Infective endocarditis (IE) in high-risk patients is a potentially severe complication which justifies the administration of antibiotics before invasive dental... (Review)
Review
PURPOSE
Infective endocarditis (IE) in high-risk patients is a potentially severe complication which justifies the administration of antibiotics before invasive dental treatment. This literature review presents the current guidelines for antibiotic prophylaxis and discusses the controversial aspects related to the antibiotic administration for prevention of IE.
RESULTS
According to the guidelines of the American Heart Association, individuals who are at risk to develop IE following an invasive dental procedure still benefit from antibiotic prophylaxis. In contrast, the guidelines of the National Institute for Health and Clinical Excellence in England and Wales have recommended that prophylactic antibiotic treatment should no longer be performed in any at-risk patient. Bacteraemia following daily routines such as eating and toothbrushing may be a greater risk factor for the development of IE than the transient bacteraemia that follows an invasive dental procedure. However, a single administration of a penicillin derivate 30 to 60 minutes pre-operatively still represents the main prophylactic strategy to prevent bacteraemia.
CONCLUSIONS
Presently, there is not enough evidence that supports and defines the administration of antibiotics to prevent IE. The authors suggest performing a risk-benefit evaluation in light of the available guidelines before a decision is made about administration.
Topics: Antibiotic Prophylaxis; Bacteremia; Dental Care; Endocarditis, Bacterial; Humans; Practice Guidelines as Topic; Risk Factors; United Kingdom; United States
PubMed: 24914430
DOI: 10.3290/j.ohpd.a32133 -
Evidence-based Dentistry 2013Medline, CINAHL, PsycINFO, SCI, SSCI, Cochrane Database of Systematic Reviews, Business Source Premier, Google scholar. (Review)
Review
DATA SOURCES
Medline, CINAHL, PsycINFO, SCI, SSCI, Cochrane Database of Systematic Reviews, Business Source Premier, Google scholar.
STUDY SELECTION
Primary or secondary reports and studies, published in English, after 1993, likely to include data relevant to direct access, report on empirical data relating to the operation of that system.
DATA EXTRACTION AND SYNTHESIS
After initial screening, titles and abstracts were assessed by two reviewers, and disagreements resolved by the third. Full texts of these eligible ones were then assessed by the team until consensus reached. Data extraction by one reviewer was checked by a second and disagreements resolved by discussion with the third. Study quality was assessed through reference to CASP or SIGN checklists. Descriptive analyses and synthesis of findings were given.
RESULTS
From the 1,733 studies yielded from the search, over 100 research dental and other health-related papers were identified as relevant. Thirty-five studies were eligible for inclusion under dental health care direct access and 57 under non-dental health care direct access literature. The quality of the evidence was varied but on the whole assessed as moderately good quality.There was no evidence of increased risk to patient safety in any of the included seven studies. Four studies on appropriateness of DCP referrals reported a high proportion of over-referral, one study found under-referral and one good agreement regarding referral decisions.Six of the seven studies looking at DCPs' knowledge or support to patients for smoking cessation, diabetes, child abuse and domestic violence found deficiencies in DCPs' knowledge or support to patients, but these studies didn't have evidence to suggest how this compared to dentists.Increasing access to dental therapists and hygienists (whether indirect, general or without supervision of a dentist) according to ten studies, resulted in greater access to and use of dental services by underserved populations. Three studies suggested variable and, at most, modest cost savings to patients and service providers. High levels of patient satisfaction were found in all eight studies reporting this, and DCP job satisfaction was reported to be higher with direct access.
CONCLUSIONS
Although over-referral of patients to dentists was suggested and a need for training on assessment and referral skills, there was no evidence of significant issues of patient safety from the clinical activities of DCPs. There was strong evidence of improved access to dental care with direct access arrangements, cost benefits to patients/service providers and high levels of patient satisfaction.
Topics: Dental Care; Health Services Accessibility; Humans; Referral and Consultation; United Kingdom
PubMed: 23792392
DOI: 10.1038/sj.ebd.6400926 -
European Archives of Paediatric... Feb 2020To assess children's perception of pain during routine dental procedures and associated factors.
PURPOSE
To assess children's perception of pain during routine dental procedures and associated factors.
METHODS
A cross-sectional study was performed including 192 children aged 6-13 years, who visited a university paediatric dental clinic. Mothers were interviewed to obtain information about demographic and socioeconomic data, and psychosocial characteristics. During dental treatment, children's behaviour was assessed using Frankl's Behaviour Scale. Dental procedures were recorded according to complexity of treatment from dental records. Immediately after the dental procedure, perception of pain was assessed using the Faces Pain Scale-Revised. Poisson regression analysis was used to assess the association between potential predictor variables and perception of pain (P < 0.05 was considered significant).
RESULTS
Overall, the mean pain score was 1.5 (SD 2.4). Higher levels of pain were reported by children who demonstrated non-cooperative behaviour during the treatment (RR = 2.39, 95% CI = 1.23-4.64), who were administered local analgesia (RR = 2.36, 95% CI = 1.31-4.27), and who reported dental pain during the previous 4 weeks (RR = 1.60, 95% CI = 1.04-2.47).
CONCLUSION
Perception of pain may be influenced by pre-operative pain and use of local analgesia, and is associated with non-cooperative behaviour during treatment.
Topics: Adolescent; Child; Child Behavior; Cross-Sectional Studies; Dental Anxiety; Dental Care; Female; Humans; Toothache
PubMed: 31236833
DOI: 10.1007/s40368-019-00456-2