Parental perceptions of dental visits and access to dental care among disabled schoolchildren in Kuwait.

The objective of this study was to describe dental visiting habits and access to dental care among the disabled schoolchildren in Kuwait. A total of 308 parents of children with a physical disability (n = 211), Down syndrome (n = 97) and teachers, who had normal children (n = 112) participated in the study. Less than one-fourth (21%) of the disabled children and 37% of the normal children had never visited a dentist (p = 0.003). Majority of Down syndrome (72%) and physically disabled children (59%) received curative dental care compared to 47% of normal children (p = 0.016). A bigger proportion of disabled children (42%) visited the dentist due to tooth ache than the normal ones (25%) (p < 0.01). Only 9.6% of Down syndrome children perceived no barriers to seek the dental care compared to 26.2% of physically disabled and 32.2% of normal children (p = 0.008). Difficulty to get an appointment was the most common perceived barrier to dental care by parents of Down syndrome children and the normal children (37.3%). Parents of disabled children considered difficulty in cooperation as a more important barrier to treatment (34.7%) than the parents of normal children (20.3%). Larger proportion of parents of normal children (82%) rated the present dental services as excellent/good compared to 52% of the parents of disabled children (p < 0.001). Toothache and curative treatment need were the main reasons for dental visits among disabled children. Regular dental check-ups and preventive oral health care should be encouraged for comprehensive coverage of the national school oral health program for the disabled in Kuwait.

Pediatric dentistry clinical education venues evaluation by pre and post-doctoral students.

OBJECTIVE: To evaluate dental students' perspectives about pre- and post-doctoral pediatric dentistry education venues. STUDY DESIGN: Surveys with visual analog scales (from 0 to 100) measuring the educational contribution of pediatric dentistry venues were conducted. The pre-doctoral venues included a 3rd year university twilight clinic (UTC), a 3rd year urban community based clinic (CBC) and 4th year mobile clinics (MCs). The post-doctoral venues included treatment of children under general anesthesia, oral sedations, a regular clinic (no sedations), seminars, journal club, case conferences and studding for the American Board of Pediatric Dentistry. RESULTS: Analyses of variance between the scores indicated that the 3rd year CBC score (68.2 ± 4.5) was statistically significant higher (p= .007) than the one for the 3rd year UTC score (44.9 ± 6.1). The 4th year students' MCs score (61.4 ± 4.0) was statistically significant higher than their retrospective scores for the 3rd year CBC (56.4 ± 4.4) or UTC (42.2 ± 4.9) scores (p= .03 and .004 respectively). Among the didactic or clinical post-doctoral venues, the regular clinic and the seminars received the highest scores (84.3 ± 1.7 and 71.6 ± 2.8 respectively). CONCLUSION: pre-doctoral community-based clinical education and post-doctoral regular university based clinic are considered by students to provide the main contribution to pediatric dental education.

Assessing the community clinic replacement effect on private Medicaid practices in oral health care within rural environments.

OBJECTIVES: Children in Medicaid/CHIP public coverage programs who reside in rural counties have limited access to dental care services. Shortages of dental professionals in rural areas impede utilization of dental care. Public and private initiatives are attempting to address this crisis. Missourians instituted deregulatory policies and invested in community-based initiatives. METHODS: Using a Medicaid/CHIP claims administrative dataset from 2004 to 2007, this research explored patterns of utilization to assess the impact of these efforts. RESULTS: The number of participating private dental office providers declined over the study period, and the number of children utilizing clinics increased. Trends are being observed within the public health dental care market demonstrating clinics are replacing private dentists as providers of Medicaid/CHIP dental services. CONCLUSIONS: Allowing greater market entry through deregulation could provide states with greater improvements to their public dental health infrastructure.

Quality and contents of referral letters from peripheral health centers to the dental centre of a teaching hospital, southwestern Nigeria.

OBJECTIVE: Referral letters are deficient in quality and content, which may prevent ideal treatment of patients. Therefore, this study assessed the quality and contents of referral letters from peripheral health centers to the dental center of a teaching hospital in southwestern Nigeria. MATERIALS AND METHODS: All consecutive referral letters received at the dental center of a teaching hospital in southwestern Nigeria from various peripheral health centers over a period of 1 year were prospectively reviewed using a structured questionnaire. The information extracted were patient's demographic data, addresses of referral persons, dates of referral, reasons for referral, medical and dental history, examination findings, investigations done, diagnosis and treatment given. Descriptive analyses of frequencies were done for all variables. RESULTS: One hundred and thirty-four referral letters were received and reviewed, comprising letters from 75 (60.0%) males and 59 (40.0%) females. The patient's age ranged from 2-74 years, with a median age of 25 years. The majority, 91 (85.4%), of the letters were written by medical doctors. An appreciable number of referral letters had no name or signature of the referring health care worker. Information on reasons for referral were not available in 27 (20.1%) of the letters. A significant proportion of referral letters lacked vital information on the patient age, past medical history, past dental history, investigations done and treatment given. CONCLUSION: This study has shown that referral letters written from various peripheral healthcare centers to the dental centre of a teaching hospital is generally of unacceptable quality and the content could be improved upon.

Dental education about patients with special needs: a survey of U.S. and Canadian dental schools.

The objectives of this study were to explore how U.S. and Canadian dental schools educate students about special needs patients and which challenges and intentions for curricular changes they perceive. Data were collected from twenty-two dental schools in the United States and Canada with a web-based survey. While 91 percent of the programs covered this topic in their clinical education, only 64 percent offered a separate course about special needs patients. The clinical education varied widely. Thirty-seven percent of the responding schools had a special clinical area in their school for treating these patients. These areas had between three and twenty-two chairs and were funded and staffed quite differently. Most programs covered the treatment of patients with more prevalent impairments such as Down syndrome (91 percent), autism spectrum disorders (91 percent), and motion impairments (86 percent). Written exams were the most common outcome assessments (91 percent), while objective structured clinical examinations (18 percent) and standardized patient experiences (9 percent) were used less frequently. The most commonly reported challenge was curriculum overload (55 percent). The majority (77 percent) planned educational changes over the next three years, with 36 percent of schools planning to increase clinical and 27 percent extramural experiences. The findings showed that the responding U.S. and Canadian dental schools had a wide range of approaches to educating predoctoral students about treating special needs patients. In order to eliminate oral health disparities and access to care issues for these patients, future research should focus on developing best practices for educational efforts in this context.

Contamination level of alginate impressions arriving at a dental laboratory.

The contamination level of alginate impressions delivered to a large dental laboratory in Sweden was determined. One hundred and seven consecutive alginate impressions were included during 7 days. Samples were taken and transferred into sterile physiological saline and analysed microbiologically for colony-forming units (cfu) as well as nonhemolytic, alpha-hemolytic, and beta-hemolytic colonies. After sampling, the clinics were contacted and asked to fill in simple questionnaires about their routines of disinfecting impressions. The questionnaire study revealed that about half of the clinics had some kind of disinfection routine, while the others rinsed in running water only. Seventy-two percent of the impressions yielded growth of bacteria, with a median number of 1.3x10(2) cfu. Thirteen per cent of the samples yielded >10(3) cfu, with a maximum number of 3.4x10(4) cfu. The majority of isolates were non- and alpha-hemolytic bacteria. Growth was recorded in 61.3% of disinfected impressions, and the numbers of bacteria in disinfected and nondisinfected impressions were similar. These findings raise the question of whether impressions need to be disinfected or if proper handling and hygienic procedures are sufficient to block the possible route of infection.

Morphological, functional and aesthetic criteria of acceptable mature occlusion.

At present, there are no generally accepted criteria that could easily be applied to the evaluation of occlusal acceptability in clinical examinations at population level. The present study analyses the opinions of Finnish orthodontists and general practitioners on the characteristics required for acceptable occlusion in the full permanent dentition. A questionnaire was sent to all 37 health centres where at least one orthodontist was employed, 31 regionally comparable health centres without an orthodontist, 12 private orthodontists, and 13 orthodontists working at university dental clinics. Seventy-four orthodontists returned the questionnaire giving a response rate of 80 per cent. They were asked to give their views on the importance of morphology, function, long-term stability, and dental appearance as elements of acceptable occlusion. They were also encouraged to indicate other significant characteristics and requested to assess the relative significance of these features. In general, the respondents expressed the need to assess morphological, functional and aesthetic aspects of occlusion as a whole. Good function, rather than morphology, was considered to be the most important feature of an acceptable occlusion, with a relative significance of 40 per cent (range 20-90 per cent). According to the respondents, the acceptability of occlusion is determined not only by morphological features, but also by the functional status and long-term stability, as well as by the patient's opinion of the dental appearance.

ADEA annual survey of clinic fees and revenue: 1998-1999 academic year.

The American Dental Education Association's 1998-1999 Survey of Clinic Fees and Revenue obtained data by which to report, by school, clinic revenue information per undergraduate student. Fifty of the fifty-five U.S. dental schools responded to the survey. The median revenue per third-year student was $6,313. It was $11,680 for fourth-year students. Clinic revenue data was also obtained by type of postdoctoral program. The postdoctoral general dentistry programs had the highest per student clinic revenues, at over $59,000 per AEGD student and almost $35,000 per student of GPR programs. Other areas of the survey provided information regarding clinic fees by type of program, levels of uncompensated care by type of program, clinic revenue by source of payment, and dental school fees as a percent of usual and customary private practice fees.

O desenvolvimento da disciplina de Clínica Integrada nas instituiçöes de ensino odontológico no Brasil / The devolopment of integrated clinics in Brazillian dental schools

O trabalho estuda o desenvolvimento da Clínica Integrada nas Instituiçöes de Ensino Odontológico (IEOs) no Brasil. A partir da revisäo bibliográfica, foram elaboradas proposiçöes visando identificar a situaçäo da Clínica Integrada nos Currículos Plenos: obter conceitos, filosofias, relacionar os objetivos educacionais e, finalmente, verificar se a Clínica Integrada cumpre as diretrizes estabelecidas pelo Conselho Federal de Educaçäo (CFE) e pela Associaçäo Brasileira de Ensino Odontológico (ABENO). Os dados foram obtidos através de questionário do tipo misto, enviado a todas as IEOs no Brasil, das quais 23 (33,30 por cento) compuseram a amostra. Os resultados indicaram, em relaçäo aos aspectos normativos, a presença da Clínica Integrada nos Currículos Plenos, no último semestre, sob forma de disciplina, havendo variaçöes em relaçäo à denominaçäo utilizada e à carga horária. Para os aspectos conceituais, os resultados mostraram uma diversificaçäo de conceitos, orientaçöes filosóficas e objetivos terminais. Verificou-se que a Clínica Integrada nas IEOs pesquisadas näo atinge os objetivos preconizados pela literatura, pela ABENO e pelo CFE, sendo satisfatória apenas em relaçäo aos aspectos normativos. Entendendo-se que a näo consecuçäo dos objetivos da Clínica Integrada compromete o processo de formaçäo do cirurgiäo-dentista clínico geral, sugere-se aqui uma reavaliaçäo de conceitos, objetivos e estratégias inerentes à Clínica Integrada, de modo a obter-se a viabilizaçäo desta