Quality management in healthcare: The pivotal desideratum.

Health care is very complex sector and delivery of service is the fragmented care. Quality can be a common paradigm to address the need of all groups in health care. Quality improvement is the process approach to the organization's operational challenges. The initiative to address the quality in health care has become a global phenomenon. A quality revolution for delivery of service with patient at the center and services around it is the demand of the time. This article comprehensively reviews the quality management in health care service and aims to sensitize the health care professionals towards achieving total quality.

Oral Health & Quality of Life in preadolescents with hearing impairment in Uttarakhand, India.

BACKGROUND: "Better teeth better health" is a guiding dictum for the 21st century that has been well adopted by WHO and emulated world over by numerous health care agencies. Hence its of paramount importance to assess the impact of oral health on the quality of life. Keeping this in mind the present study was done to gauge the impact of prevalence of dental diseases amongst 9-15 year old institutionalized hearing impaired children in districts of Uttarakhand, India. MATERIALS & METHODOLOGY: 250 hearing impaired institutionalized 9-15 year old children were examined using WHO type III clinical examination for DMFT/dmft, Traumatic dental injuries using TDI index and dentofacial anomalies using Angle's classification of malocclusion. The Hindi version of the C-OIDP questionnaire was used in this study. RESULTS: There was a high dental caries prevalence of 56% with significant male predilection. TDI index was 40.8% and the most common molar relation was class I with 90.4%. With 49.6% crowding was the most common dentofacial anomaly. Deformity of face or mouth has maximum impact on the daily life of these children. The overall oral health related quality of life was less favorable in this group. CONCLUSION: Oral health has a significant impact on daily life of these children with hearing impairment and those children having dental diseases showed unfavorable OHRQoL.

Psychometric properties of Hindi version of child oral impact on daily performances (C-OIDP) index amongst school children in North India.

AIM: To assess validity and reliability of Hindi version of Child Oral impact on daily performances (C-OIDP) index among school children in North India. MATERIAL AND METHODOLOGY: Descriptive cross sectional study was conducted amongst 250, 11-12 year old school children in primary schools of Rishikesh, Uttarakhand, India. The study was done in two phases: first phase included assessment of Psychometric and linguistic properties of hindi version of C-OIDP index which was then pilot tested on study subjects. Phase two comprised of the actual main study which included the re-assessment of Hindi C-OIDP index on the entire study population. The pilot study comprised of 40 school children while the main study was conducted on 250 school children. RESULTS: The inter-item correlation coefficient ranged from 0.1 to 0.786 while corrected item total correlation coefficient ranged from 0.176 (smiling) to 0.843 ((cleaning). The standardised Cronbach's Alpha coefficient was 0.88. Moreover, the alpha coefficients didn't increase upon deleting any of the items. Weighted kappa was 0.85 & ICC was 0.9. Children with higher scores were less satisfied with their mouth (p- 0.001) in case of concurrent validity. CONCLUSION: Hindi Child Oral Impact on Daily Performances index can be used as a valid and reliable instrument in measuring OHRQoL. of Paediatric North Indian population.

Radix mesiolingualis and radix distolingualis: a case report of a tooth with an unusual morphology.

Variation in the root and canal morphology of the maxillary first molars is quite common. The most common configuration is 3 roots and 3 or 4 canals. Nonetheless, other possibilities still exist. The presence of an additional palatal root is rather uncommon and has been reported to have an incidence of 0.06 - 1.6% in varying populations studied. Whenever two palatal roots exist, one of them is the normal palatal root, the other is a supernumerary structure which can be located either mesiolingually (radix mesiolingualis) or distolingually (radix distolingualis). This case report describes successful endodontic treatment of a maxillary first molar with radix mesiolingualis and radix distolingualis. Identification of this variation was done through clinical examination along with the aid of multiangled radiographs, and an accurate assessment of this morphology was made with the help of a cone-beam computed tomography imaging. In addition to the literature review, this article also discusses the epidemiology, classifications, morphometric features, guidelines for diagnosis, and endodontic management of a maxillary first molar with extra-palatal root.

Nanodentistry: Is just a fiction or future.

Nanotechnology creates incredibly useful structures from individual atoms or molecules, which provides a new alternative and a possibly superior approach for the identification of oral health related problems and also in designing of more biocompatible dental materials with better properties and anticaries potential. Nanodentistry is striving its best to apply new advances in dental practice. The present article discusses the use of nanotechnology in dentistry and also the latest innovations in oral health care, nanoincorporated products, and issues of patient safety and occupational health.

Use of Clinical UV Chamber to Disinfect Dental Impressions: A Comparative Study.

INTRODUCTION: Dental impressions are potential source of infection in a prosthodontic practice. Risk of transmission of infection through saliva, blood etc is considered as hazard for both dentist as well as dental auxiliary staff. A number of methods are currently employed for disinfecting the impressions which are technique sensitive and time consuming. This study focuses on disinfecting impression using dental UV chamber which is commonly employed for storing sterilized instruments. AIM: The aim of this invitro study was to evaluate the use of clinical UV chamber to disinfect various impression materials at different time intervals and its comparison with 2% glutaraldehyde using standard immersion technique. MATERIALS AND METHODS: Total sample size of 180 specimens was taken from three different impression materials. The impressions were made from 30 dentulous subjects. A total of ten impressions were made for each impression material i.e. alginate, addition silicone and polyether impression material. Six punch samples were taken from each impression. Out of 6 punch sample, one was kept as control, second was disinfected by immersing in freshly prepared 2% glutaraldehyde solution for 10 minutes and remaining four were exposed to UV rays for 3 minutes, 6 minutes, 10 minutes and 15 minutes using dental UV chamber. Amount of disinfection achieved was evaluated by counting the colonies over the culture plates with the help of digital colony. RESULTS: The results showed that the mean CFUs for alginate were found to be i.e. 11797.40 ± 5989.73 (mean ± SD). The mean CFUs for addition silicone impression material was found 7095.40 with a standard deviation of 4268.83 and the mean CFUs for polyether impression material was found to be 2168.92 ± 1676 (mean ± SD). CONCLUSION: For alginate and addition silicone impression material, disinfection was achieved on exposure to UV rays for a period of 10 minutes. However, for polyether impression material 3 minutes of exposure to UV rays was sufficient to cause complete disinfection.

Implant supported overdenture in the patients with history of radio and chemotherapy for the prostate malignancy.

The success of dental implants in patients that have undergone chemo and radiotherapy for a region other than head and neck remain unclear, although some local and systemic factors could be contraindications to dental implant treatment. As there are very few absolute medical contraindications to dental implant treatment, but a number of conditions may increase the risk of treatment failure or complications. The case report describes the successful survival of dental implants placed in maxilla and mandible of a patient who had undergone radio and chemotherapy for prostate cancer.

Flexible thermoplastic denture base materials for aesthetical removable partial denture framework.

Conventional fixed partial dentures, implant supported Fixed Partial Dentures (FDPs) and removable partial dentures are the most common treatment modalities for the aesthetic and functional rehabilitation of partially edentulous patients. Although implants and FDP have certain advantages over removable partial dentures, in some cases, removable partial dentures may be the only choice which is available. Removable cast partial dentures are used as definitive removable prostheses when indicated, but location of clasps may affect aesthetics. So, when patient is concerned about aesthetics, flexible partial dentures which is aesthetically superior to flipper and cast partial dentures, may be considered. But for the success of flexible removable partial denture, proper diagnosis, treatment planning and insertion technique of this prosthesis is very important, which have been thoroughly described in this article.

Evaluation of stress patterns in bone around dental implant for different abutment angulations under axial and oblique loading: A finite element analysis.

INTRODUCTION: The replacement of missing anterior teeth presents peculiar challenges to the Prosthodontist. Implants are increasingly gaining favour for the same. The morphology of existing bone in the premaxilla often dictates that implants are placed at angles that are difficult to restore with conventional abutments. However, the angulated abutments might transfer unfavourable forces to the implant or bone, thereby compromising the prognosis of the treatment. Because, it is difficult to assess the generated forces clinically, a finite element analysis was chosen for the present study as it is useful tool in estimating stress distribution in the contact area of the implant with the bone. MATERIALS AND METHODS: In this study, the frontal region of the maxilla was modelled with a cortical layer 1.5 mm thick containing an inner cancellous core. The implant was cylindrical, round ended, with length 13 mm and diameter 4.1 mm. The abutment was modelled as 7 mm in height with a 5 degree occlusal taper. The different abutment angulations used were 0°, 10°, 15° and 20°. The amount of loads used were 100, 125, 150, 175 and 200 N axially, and 50 N in oblique direction, to approximate the kind of loads seen in clinical situations. RESULT: It was seen that, as the abutment angulation changes from 0° to 20° both the compressive as well as tensile stresses increased; but, it is within the tolerance limit of the bone. CONCLUSION: It seems reasonably safe to use angled abutments in anterior implant supported prostheses, in the maxillary arch.

Interim palatal lift prosthesis as a constituent of multidisciplinary approach in the treatment of velopharyngeal incompetence.

The velopharynx is a tridimensional muscular valve located between the oral and nasal cavities, consisting of the lateral and posterior pharyngeal walls and the soft palate, and controls the passage of air. Velopharyngeal insufficiency may take place when the velopharyngeal valve is unable to perform its own closing, due to a lack of tissue or lack of proper movement. Treatment options include surgical correction, prosthetic rehabilitation, and speech therapy; though optimal results often require a multidisciplinary approach for the restoration of both anatomical and physiological defect. We report a case of 56 year old male patient presenting with hypernasal speech pattern and velopharyngeal insufficiency secondary to cleft palate which had been surgically corrected 18 years ago. The patient was treated with a combination of speech therapy and palatal lift prosthesis employing interim prostheses in various phases before the insertion of definitive appliance. This phase-wise treatment plan helped to improve patient's compliance and final outcome.

Prevention of trauma to edentulous ridge from opposing natural teeth.

OBJECTIVE: To suggest a technique to prevent trauma of the edentulous ridge from opposing natural or restored teeth. BACKGROUND: The prevalence of the condition where one edentulous arch opposes a natural or restored dentition is quite common. In most of cases, the maxillary arch is completely edentulous and either all teeth or only anterior teeth are present in the mandibular arch. These remaining teeth may continuously cause trauma to the opposing edentulous ridge during the night when a removable prosthesis is kept out of the mouth. MATERIALS AND METHODS: A thermoplastic acrylic resin mouthguard was fabricated on a cast of the remaining teeth dentition. CONCLUSION: This article presents a simple and inexpensive procedure to prevent self-induced trauma of the edentulous ridge from opposing natural teeth by using a thermoplastic acrylic resin mouthguard.

Evaluation of effect of tray space on the accuracy of condensation silicone, addition silicone and polyether impression materials: an in vitro study.

Optimal thickness of impression materials in the custom tray in order to get the most accurate impression. To investigate the effect of different tray spacer thickness on the accuracy and the dimensional stability of impressions made from monophasic condensation silicone, addition silicone and polyether impression materials. Three different types of elastomeric monophasic impression materials were used for making the impression of a master die with tray having tray spacer thickness of 2, 4 and 6 mm. Each type of impression was poured in die stone after 1 h. Each cast was analyzed by a travelling microscope and compared with the master die. The data was tabulated and subjected to statistical evaluation. The results of the study indicated that the impressions made from 2 to 4 mm spaced trays produced more accurate stone casts when compared to 6 mm spaced tray. No statistical significant differences were observed between the accuracy and dimensional stability of the three materials tested. Minimum changes were observed when the cast was poured after 1 h and the tray space was 2 mm for all the materials tested. It is therefore advisable not to exceed tray space of 2 mm.

Canine tip marker: a simplified tool for measuring intercanine distance.

PURPOSE: Appropriate selection of anterior teeth is considered to be of paramount importance in the success of denture prostheses. This study was undertaken to evaluate the correlation between the intercanthal width and interalar width with intercanine distance, in North Indian male and female patients for predicting the mesiodistal width of the maxillary anterior teeth during tooth selection. MATERIALS AND METHODS: The study was conducted with 100 North Indian patients (50 men, 50 women) ranging in age from 17 to 21 years. A digital caliper with an accuracy of 0.01 mm was used to measure the intercanthal and interalar width. A T-shaped flat metal plate (canine tip marker) was used to mark the intercanine distance, which was then measured with the digital caliper. These measurements were interpreted and subjected to statistical analysis. Student's t-test was applied to test the correlation between intercanthal width and interalar width with intercanine distance. RESULTS: Calculated t-values between intercanine distances with interalar width in both male and female groups were 3.14 and 3.56, respectively, greater than the standard value taken at a 5% level of significance with 48 degree of freedom, showing a higher correlation of interalar width with the intercanine distance. Values obtained between intercanthal width and intercanine distance were lower than the standard value in both groups. CONCLUSIONS: A significant correlation was found between interalar width and intercanine distance in both men and women, suggesting that interalar width can be used as a reliable guide for maxillary anterior teeth selection.