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Community Dental Health May 2019To collate the body of evidence in economic studies of different dental interventions.
OBJECTIVE
To collate the body of evidence in economic studies of different dental interventions.
METHODS
Eligible English studies after 1980 were sourced from MEDLINE using MeSH terms and reviewed independently by 4 teams. Studies were grouped according to the type of dental intervention and their quality appraised using Drummond's Checklist.
RESULTS
The number of dental economic studies increased from 1980 to 2016. A total of 91 studies were identified following the search strategy. Most studies were conducted in the United States (n=23), followed by Germany (n=14), Australia (n=10) and the United Kingdom (n=9). Preventative dental interventions comprised 37% of included studies (n=34), followed by restorative (n=14), prosthodontic (n=13) and periodontal interventions (n=12). Cost effectiveness analyses (n=68) comprise 75% of full economic evaluation (EE) studies, followed by cost-utility (n=17) and cost-benefit (n=6). Quality assessment checklists identified 60 studies as good, 23 as moderate and 8 as poor. Common methodological limitations were identified in EE studies. Comparison of studies identified trends and common findings within each dental intervention.
CONCLUSION
High quality economic studies are important in directing resources and funding by policy makers. Standardisation of reporting outcome measures will improve the potential for interpretation and comparison between studies. Research adhering to recommended quality assessment checklists will improve the overall quality of evidence to better identify cost-effective treatments for different dental interventions.
Topics: Australia; Cost-Benefit Analysis; Dental Care; Germany; Humans; United Kingdom
PubMed: 31070875
DOI: 10.1922/CDH_4426Eow08 -
Australian Dental Journal Dec 2013Cervicofacial subcutaneous emphysema is a rare complication of dental procedures. Although most cases of emphysema occur incidentally with the use of a high-speed air... (Review)
Review
Cervicofacial subcutaneous emphysema is a rare complication of dental procedures. Although most cases of emphysema occur incidentally with the use of a high-speed air turbine handpiece, there have been some reports over the past decade of cases caused by dental laser treatment. Emphysema as a complication caused by the air cooling spray of a dental laser is not well known, even though dental lasers utilize compressed air just as air turbines and syringes do. In this study, we comprehensively reviewed cases of emphysema attributed to dental laser treatment that appeared in the literature between January 2001 and September 2012, and we included three such cases referred to us. Among 13 cases identified in total, nine had cervicofacial subcutaneous and mediastinal emphysema. Compared with past reviews, the incidence of mediastinal emphysema caused by dental laser treatment was higher than emphysema caused by dental procedure without dental laser use. Eight patients underwent CO2 laser treatment and two underwent Er:YAG laser treatment. Nine patients had emphysema following laser irradiation for soft tissue incision. Dentists and oral surgeons should be cognizant of the potential risk for iatrogenic emphysema caused by the air cooling spray during dental laser treatment and ensure proper usage of lasers.
Topics: Dental Care; Face; Humans; Laser Therapy; Lasers, Gas; Lasers, Solid-State; Male; Mediastinal Emphysema; Middle Aged; Neck; Subcutaneous Emphysema
PubMed: 24320897
DOI: 10.1111/adj.12119 -
BMC Oral Health Nov 2023There are few contemporary studies on the time taken to complete dental procedures, those most heavily relied on in the United Kingdom date back to 1999.
BACKGROUND
There are few contemporary studies on the time taken to complete dental procedures, those most heavily relied on in the United Kingdom date back to 1999.
OBJECTIVES
This work aimed to establish how long members of the dental team took to complete specific dental procedures, relevant to their scope of practice.
METHODS
Data were collected via a purposive sample of 96 dentists, dental hygienists/therapists and dental nurses. Via an online survey, participants were asked to state the mean, minimum and maximum time they estimated that they took to complete individual dental procedures.
RESULTS
The mean time taken to complete procedures common to both dentists and dental hygienists/therapists ranged from 3.7 to 4 min respectively for clinical note reading prior to seeing patients to 30.1 and 28 min to undertake root surface debridement. There were no significant differences between the time taken by dentists and dental hygienists/therapists to treat adult patients. However, in all but one procedure, dental hygienists/therapists reported taking longer (p = 0.04) to treat child patients.
CONCLUSIONS
The data provided here represent an up to date assessment of the time taken to complete specific tasks by different members of the dental team. These data will be of value to service planners and commissioners interested in evolving a dental care system that employs a greater degree of skill-mix and preventively oriented care.
Topics: Adult; Child; Humans; Cross-Sectional Studies; Dental Hygienists; Dental Care; United Kingdom; Surveys and Questionnaires; Dentists
PubMed: 38007437
DOI: 10.1186/s12903-023-03671-y -
BMC Oral Health 2015Population health needs are changing. The levels of dental caries and periodontal disease across the population as a whole is falling. The proportion of adults with a... (Review)
Review
BACKGROUND
Population health needs are changing. The levels of dental caries and periodontal disease across the population as a whole is falling. The proportion of adults with a functional dentition in many developed countries has increased substantially and edentulous rates have dropped to some of their lowest levels. Despite this, a pronounced social gradient still exists, many adults do not attend dental services regularly and disease in young children remains intransigent amongst the poorest. New challenges are emerging too as the growing number of older people, above sixty-five years of age, retain their teeth.
METHODS
Ensuring "the right number of people with the right skills are in the right place at the right time to provide the right services to the right people" is critical for future dental service provision, both to meet the new challenges ahead and to ensure future services are cost-effective, efficient and reduce health-inequalities. Greater use of "skill-mix" models could have a substantial role in the future, as dentistry moves from a "cure" to a "care" culture.
DISCUSSION
The provision of dental services in many countries currently adopts a "one-size-fits-all", where the dentist is the main care-giver and the emphasis is on intervention. As needs change in the future, the whole of the dental team should be utilised to deliver primary, secondary and tertiary prevention in an integrated model. Growing evidence suggests that other members of the dental team are effective in providing care, but introducing this paradigm shift is not without its challenges. The provision of incentives within funding systems and social acceptability are amongst the key determinants in producing a service that is responsive to need, improves access and delivers equity.
Topics: Dental Care; Dentists; Humans; Mouth Diseases; Oral Health; Preventive Dentistry; Workforce
PubMed: 26391730
DOI: 10.1186/1472-6831-15-S1-S10 -
BMC Oral Health Aug 2023An accurate impression is an essential procedure for fabricating indirect fixed restorations. To achieve a precise final impression, the management of gingival tissue is...
INTRODUCTION
An accurate impression is an essential procedure for fabricating indirect fixed restorations. To achieve a precise final impression, the management of gingival tissue is without doubt a crucial.
AIM
To evaluate the use of different gingival displacement techniques among dental clinicians and to assess their associated knowledge and technique preferences.
METHODS
A self-designed survey was created electronically and sent to a list of dentists. The survey was composed of multiple sections. Participants who stated that they do not use GD methods were asked to answer the survey questions based on their knowledge. Descriptive statistics were generated, andChi-square test was used to examine the association between the different variables.
RESULTS
A total of 188 dentists participated in this study. The majority 144 (76.6%) use GD in their practice. When asked which technique yields a more accurate impression with lower incidence of repeating the impression, 93 (64.6%) reported retraction cord technique with a hemostatic agent results in a higher impression accuracy, while only 14 (9.7%) declared the retraction paste technique as being more accurate.
CONCLUSION
The cordless GD technique is believed to be easier, faster, and less traumatic to the gingival tissues, nevertheless, the outcome of dental impressions is believed to be more predictable with the use of conventional retraction cords and hemostatic medicaments.
Topics: Humans; Dental Care; Emotions; Gingiva; Hemostatics; Dentists
PubMed: 37587482
DOI: 10.1186/s12903-023-03218-1 -
Journal of Adolescent and Young Adult... Jun 2016Oral health is important for quality of life, but may be undermanaged for survivors of cancer. We examine dental care use and barriers among long-term survivors of...
PURPOSE
Oral health is important for quality of life, but may be undermanaged for survivors of cancer. We examine dental care use and barriers among long-term survivors of adolescent and young adult (AYA) cancer in comparison to individuals without a history of cancer.
METHODS
The 2008-2012 Medical Expenditure Panel Survey (MEPS) identified 1216 individuals diagnosed with cancer at AYA ages (15-39 years), who were at least 5 years from diagnosis. A comparison group was matched using age, sex, and other factors. We evaluated self-reported dental visits in the previous 12 months, and inability and delay in receiving necessary dental care among survivors and the comparison group. Furthermore, individual factors associated with dental care use were identified using multivariable logistic regressions.
RESULTS
Of survivors, 60.86% reported no dental visits in the previous year compared to 51.96% of the comparison individuals (p < 0.001). Survivors were more likely to report inability (10.71% vs. 6.29%, p = 0.001) and delay (8.12% vs. 4.45%, p = 0.001) in getting necessary dental care than the comparison group. Notably, survivors without dental insurance were more likely to report inability and delay. Female survivors were more likely to use dental care than males (odds ratio = 1.76, 95% confidence interval 1.15-2.71, p = 0.01). Hispanic survivors, those diagnosed at younger ages, and uninsured survivors were less likely to have at least one dental visit.
CONCLUSION
Survivors of AYA cancer need timely surveillance to manage late effects, including dental complications. Yet, these survivors, particularly those who are uninsured, delay dental care more often than individuals from the general population. Survivor-specific interventions are needed to reduce dental care barriers.
Topics: Adolescent; Adult; Cancer Survivors; Dental Care; Female; Humans; Male; Quality of Life; Young Adult
PubMed: 27028878
DOI: 10.1089/jayao.2015.0064 -
BMJ (Clinical Research Ed.) Sep 2017To assess the relation between invasive dental procedures and infective endocarditis associated with oral streptococci among people with prosthetic heart...
To assess the relation between invasive dental procedures and infective endocarditis associated with oral streptococci among people with prosthetic heart valves. Nationwide population based cohort and a case crossover study. French national health insurance administrative data linked with the national hospital discharge database. All adults aged more than 18 years, living in France, with medical procedure codes for positioning or replacement of prosthetic heart valves between July 2008 and July 2014. Oral streptococcal infective endocarditis was identified using primary discharge diagnosis codes. In the cohort study, Poisson regression models were performed to estimate the rate of oral streptococcal infective endocarditis during the three month period after invasive dental procedures compared with non-exposure periods. In the case crossover study, conditional logistic regression models calculated the odds ratio and 95% confidence intervals comparing exposure to invasive dental procedures during the three month period preceding oral streptococcal infective endocarditis (case period) with three earlier control periods. The cohort included 138 876 adults with prosthetic heart valves (285 034 person years); 69 303 (49.9%) underwent at least one dental procedure. Among the 396 615 dental procedures performed, 103 463 (26.0%) were invasive and therefore presented an indication for antibiotic prophylaxis, which was performed in 52 280 (50.1%). With a median follow-up of 1.7 years, 267 people developed infective endocarditis associated with oral streptococci (incidence rate 93.7 per 100 000 person years, 95% confidence interval 82.4 to 104.9). Compared with non-exposure periods, no statistically significant increased rate of oral streptococcal infective endocarditis was observed during the three months after an invasive dental procedure (relative rate 1.25, 95% confidence interval 0.82 to 1.82; P=0.26) and after an invasive dental procedure without antibiotic prophylaxis (1.57, 0.90 to 2.53; P=0.08). In the case crossover analysis, exposure to invasive dental procedures was more frequent during case periods than during matched control periods (5.1% 3.2%; odds ratio 1.66, 95% confidence interval 1.05 to 2.63; P=0.03). Invasive dental procedures may contribute to the development of infective endocarditis in adults with prosthetic heart valves.
Topics: Adult; Aged; Aged, 80 and over; Antibiotic Prophylaxis; Cohort Studies; Cross-Over Studies; Dental Care; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Regression Analysis; Streptococcal Infections
PubMed: 28882817
DOI: 10.1136/bmj.j3776 -
Caries Research 2018Despite the fact that dental care attendance during pregnancy has been recommended by guidelines and institutions, the demand for dental services is still low among...
Despite the fact that dental care attendance during pregnancy has been recommended by guidelines and institutions, the demand for dental services is still low among pregnant women. The aim of this study was to identify and analyze the determinants of dental care attendance during pregnancy. We performed a systematic literature search in the electronic databases PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, Brazilian Library in Dentistry, Cumulative Index to Nursing and Allied Health Literature, and Medline using relevant keywords. Studies were filtered by publication year (2000-2016) and language (English, Portuguese, Spanish, and French). The included studies were assessed for quality. Their characteristics and statistically significant factors were reported. Fourteen papers were included in the review. The prevalence of dental service usage during pregnancy ranged from 16 to 83%. Demographic factors included women's age, marital status, parity, and nationality. The socioeconomic factors were income, educational level, and type of health insurance. Many psychological and behavioral factors played a role, including oral health practices, oral health and pregnancy beliefs, and health care maintenance. Referred symptoms of gingivitis, dental pain, or dental problems were perceived need. Demographic, socioeconomic, psychological, behavioral factors and perceived need were associated with the utilization of dental services during pregnancy. More well-designed studies with reliable outcomes are required to confirm the framework described in this review.
Topics: Dental Care; Female; Humans; Patient Acceptance of Health Care; Pregnancy; Pregnancy Complications
PubMed: 29316548
DOI: 10.1159/000481407 -
British Dental Journal Nov 2022Patients treated for head and neck cancer may be susceptible to a higher incidence of dental disease due to long-term sequelae of treatment for head and neck cancer....
Patients treated for head and neck cancer may be susceptible to a higher incidence of dental disease due to long-term sequelae of treatment for head and neck cancer. Most patients with head and neck cancer are discharged from a hospital environment and responsibility for long-term dental care is transferred back from the restorative dentistry team to the dentist and dental care professionals in primary care. Treatment of these patients should be undertaken in a supportive environment, taking into account the physical and psychological repercussions of previous treatment. With the exception of some surgical procedures, routine dental care is not contraindicated in patients after head and neck cancer treatment and it is expected that the dentist and dental care professionals will be responsible for long-term routine dental treatment. Primary dental care practitioners should be aware of the process to refer patients back to the head and neck cancer multidisciplinary team if they note a suspicious change during their routine clinical examinations. Referral to a restorative dentistry consultant for planning and carrying out complex items of care may sometimes be necessary, but patients should always remain under the long-term care of their primary dental care practitioner.
Topics: Humans; Head and Neck Neoplasms; Referral and Consultation; Dental Care
PubMed: 36369558
DOI: 10.1038/s41415-022-5148-z -
Southern Medical Journal Sep 2016Poor oral health can have a negative impact on overall health. This is especially concerning for individuals with sickle cell disease (SCD), an inherited blood disorder...
OBJECTIVES
Poor oral health can have a negative impact on overall health. This is especially concerning for individuals with sickle cell disease (SCD), an inherited blood disorder that affects hemoglobin and can lead to an increased risk of infection and hyperalgesia. Because the majority of individuals with SCD have Medicaid insurance and no dental coverage, we provided free basic dental care to individuals with SCD to determine whether it decreased overall healthcare utilization.
METHODS
Through a contract with a private dental office, we provided free basic dental care (eg, cleanings, fillings, x-rays) to individuals with SCD. We reviewed medical records for the 12 months before and after their initial dental visit to determine whether there were any changes in acute care visits (defined as a visit to the emergency department, sickle cell infusion center, or visits to both in the same day), hospitalizations, and total days hospitalized. We conducted a negative binomial regression to determine any differences in the pre-post periods.
RESULTS
In our multivariable analysis, there was a statistically significant decrease in hospital admissions. In addition, there was a significant decrease in total days hospitalized if dental work was completed, but an increase in days hospitalized in men.
CONCLUSIONS
Providing dental care to individuals with SCD who did not have dental insurance did not greatly alter acute care visits. A larger sample size may be necessary to observe an effect.
Topics: Adult; Anemia, Sickle Cell; Controlled Before-After Studies; Delivery of Health Care; Dental Care; Female; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Stomatognathic Diseases; Young Adult
PubMed: 27598367
DOI: 10.14423/SMJ.0000000000000510