'I miss my family, it's been a while ' A qualitative study of clinicians who live and work in rural/remote Australian Aboriginal communities.

OBJECTIVES: Dental issues are more prevalent for Aboriginal Australians, especially those living in rural/remote locations, but distribution of clinicians is favoured towards metropolitan areas and are not always culturally competent. This study aimed to document the experiences of dental clinicians who relocated to rural/remote communities to provide dental services to Aboriginal communities in an effort to redress these gaps. SETTING: Clinicians working in a new rural/remote dental service strategy to Aboriginal communities in Northern NSW. DESIGN: Qualitative semi-structured face-to-face interviews and reflective diaries were analysed qualitatively. PARTICIPANTS: Relocating dental clinicians and their support team. RESULTS: Three major themes emerged: Theme one: Mastering the clinical environment through professional experiences: Increasing professional capabilities, clinical environment, valuing team work and gaining community respect. Theme two: Development and growth of the individual through personal and social experiences: culture shock, developing cultural competence, social impact, economic cost and personal adjustments and growth. Theme three: An overarching sense of achievement and advice to new clinicians. CONCLUSION: Relocation to rural and remote communities to provide health services is a complex but rewarding process. Providing personal and professional support, to relocating clinicians resulted in an overall positive experience for the participants, where they increased their professional skills and developed personally. Living and working in the community increased their cultural competence. Barriers were overcome through effective communication, flexibility and teamwork. Funding for rural placements, such as these, is critical for rural and remote health services and should include long-term appropriate funding for mentoring and support.

Evaluación de la calidad de la información disponible en Internet sobre odontología y síndrome de Down / Evaluation of the quality of the information available on the Internet regarding dentistry and Down syndrome

No disponible

The relative patient costs and availability of dental services, materials and equipment in public oral care facilities in Tanzania.

BACKGROUND: Patient charges and availability of dental services influence utilization of dental services. There is little available information on the cost of dental services and availability of materials and equipment in public dental facilities in Africa. This study aimed to determine the relative cost and availability of dental services, materials and equipment in public oral care facilities in Tanzania. The local factors affecting availability were also studied. METHODS: A survey of all district and regional dental clinics in selected regions was conducted in 2014. A total of 28/30 facilities participated in the study. A structured interview was undertaken amongst practitioners and clinic managers within the facilities. Daily resources for consumption (DRC) were used for estimation of patients' relative cost. DRC are the quantified average financial resources required for an adult Tanzanian's overall consumption per day. RESULTS: Tooth extractions were found to cost four times the DRC whereas restorations were 9-10 times the DRC. Studied facilities provided tooth extractions (100%), scaling (86%), fillings (79%), root canal treatment (46%) and fabrication of removable partial dentures (32%). The ratio of tooth fillings to extractions in the facilities was 1:16. Less than 50% of the facilities had any of the investigated dental materials consistently available throughout the year, and just three facilities had all the investigated equipment functional and in use. CONCLUSIONS: Dental materials and equipment availability, skills of the practitioners and the cost of services all play major roles in provision and utilization of comprehensive oral care. These factors are likely to be interlinked and should be taken into consideration when studying any of the factors individually.

A study of the provision of hospital based dental general anaesthetic services for children in the northwest of England: part 1--a comparison of service delivery between six hospitals.

BACKGROUND: Extensive caries in children can result in a referral for tooth extraction under General Anaesthesia (GA). While there are guidelines for the use of GA within paediatric dentistry this process is ultimately dependent upon the decision making of the treating dentist. This decision can be influenced locally by the availability of services and their waiting list. GA services for paediatric extractions (DGA) have developed from different historical positions, including community dental services, maxillofacial services and paediatric led specialist services. METHODS: This article explores the differences between DGA services provided by 6 randomly selected hospitals across the North West of England. 456 patients who attended a routine DGA appointment in each hospital over a period of two months from 2012 to 2013 gave consent to allow access to their clinical notes and completed a questionnaire (93% consent rate). Data were entered onto SPSS and appropriate statistical tests undertaken. RESULTS: Differences between hospitals included the clinic structure, patient characteristics and the treatment provided. There was a significant difference in the number of previous child DGAs experienced within the family, ranging from 33% to 59% across hospitals. Hospital 1 attendees differed in a number of ways to other areas but notably in the stability of life time residency with 20% of patients having previously lived in another area and with just 58% of parents stating their child regularly attended the dentist (compared to an average of 9% and 81% respectively across other hospitals). CONCLUSION: Findings suggest services throughout the region face different obstacles in providing support and treatment for young children referred for DGA. There are, however common practices such as preventative treatment, which could impact on caries experience and subsequent DGA referral, a particular issue given the high DGA repeat rate observed. For many children a DGA may be their first dental experience. It is therefore vital to engage with both child and family at this stage, attempt to initiate a pattern of dental attendance and to ensure this experience does not create an on-going cycle of poor dental behaviour and health.

A study of the provision of hospital based dental General Anaesthetic services for children in the North West of England: Part 2--the views and experience of families and dentists regarding service needs, treatment and prevention.

BACKGROUND: Patterns of service delivery and the organisation of Dental General Anaesthesia (DGA) have been found to differ across hospitals. This paper reports on qualitative research aimed to understand the impact of such variation by exploring views and experiences of families receiving care in different hospital sites, as well as dentists involved in referral and delivery of care. METHOD: Qualitative semi-structured interviews were conducted with 26 people comprising parents (n = 15), dentists working in primary care (n = 6) and operating dentists (n = 5) in relation to DGA. Participants were recruited from areas across the North West of England to ensure a variety referral and treatment experiences were captured. Field notes were made during visits to all settings included in the study and explored alongside interview transcripts to elicit key themes. RESULTS: A variety of positive and negative impacts on children and parents throughout the referral process and operation day were apparent. Key themes established were clustered around three key topics: 1. Organisational and professional concerns regarding referrals, delivery of treatment and prevention. 2. The role of hospital environment and routine on the emotional experiences of children. 3. The influence of the wider social context on dental health. CONCLUSION: These findings suggest the need and perceived value of: tailored services for children (such as play specialists) and improved information, such as clear guidance regarding wait times and what is to be expected on the day of the procedure. These features were viewed to be helpful in alleviating the stress and anxiety often associated with DGA. While some elements will always be restricted in part to the hospital setting in which they occur, there are several aspects where best practice could be shared amongst hospitals and, where issues such as wait times have been acknowledged, alternative pathways can be explored in order to address areas which can impact negatively on children.

Prescrição de higiene bucal nos prontuários de pacientes internados em uma cidade da Amazônia / Oral hygiene prescription in medico records of patients in o city of Amazônia

O objetivo deste trabalho foi registrar os cuidados bucais prescritos nos prontuários dos pacientes internados no Hospital de Pronto-Socorro Municipal Mario Pinotti, tendo como me todologia a avaliação dos prontuários de pacientes que tiveram internação mínima durante 2 horas, pelo fato de que todo paciente deveria ter recebido higiene bucal independentemente de suas condições físicas e motoras, onde de 415 prontuários analisados, apenas 28,19% receberam prescrição de higiene bucal. Com relação ao tempo de internação, a maior parte, 52,29% permaneceu internada por período acima de 2 a 7 dias, e a maioria (56,63%) foi do gênero masculno. Observaram-se como motivos de internação mais frequentes: doenças bacterianas (4,34%) pneumonia/gripe (7,23%); apendicectomia (11 ,33%); traumatismos (16,14%); e acidente vascular encefálico (18,55%). Concluiu-se que não há uma efetiva importância dos cuidados bucas no âmbito hospitalar dos pacientes internados com a maioria deles não recebendo nenhuma prescrição de higiene bucal.

The purpose of this paper was to report prescribed oral care in the medical records of hos pitalized patients from Pronto Socorro Municipal Mario Pinotti Hospital. The methodology consists of evaluating the medical records of patients who were hospitalized for at least 24 hours assuming that every patient should have received oral hygiene regardless of their physical and motor conditions. According to the 415 analyzed records, oral hygiene was prescribed for just 28.19% of patients (117). Regarding hospitalization, the majority of patients (52.29% - 217) had a period of hospitalization between over 2 days and 7 days and most of them were male (56,63% - 235). The most frequent reasons for hospitalization were: bacterial diseases 4.34% (18 patients), pneumonia / flu symptoms 7.23% (30 patients), appendectomy 11.33% (47 patients); trauma 16.14% (67 patients); stroke 18.55% (77 patients) and others reasons represented 42,41% (176 patients). Data suggests that there is not much importance placed on oral care in hospitais for hospitalized patients, since most of them received no required care for ora hygiene.

Patients' expectations and online presence of Oral and Maxillofacial Surgery in the United Kingdom.

In patient-centred medical practice, consideration of the patients' expectations is vital to the planning and delivery of service. Modern medicine must use the continuing advances in information technology to disseminate knowledge and raise awareness among patients and the public. People increasingly use the Internet to search for information on health, and the online presence of an organisation or a profession is known to bring a wide range of benefits. We aimed to find out what patients expect from the website of an Oral and Maxillofacial Surgery (OMFS) unit and to assess the online presence of OMFS units in the United Kingdom. Results from 100 self-administered questionnaires showed that there were 18 common domains that patients would like to see on OMFS websites. When ranked according to the number of times they were mentioned, a map of the department was mentioned most and the complaints policy least. Of the 156 OMFS units in the UK, only 51% have websites and of these, 80% are in London. There were none in Wales and Northern Ireland. Only half of the websites contained information that related to patients' expectations. Strategies to improve the content of websites for OMFS units and to improve their online presence are urgently needed.

A Odontologia hospitalar nos hospitais públicos vinculados a secretaria do estado da saúde de São Paulo / Hospital dentistry in public hospitals linked the state secretary of health of São Paulo

A atenção odontológica tem sido tradicionalmente realizada em consultórios. Aos hospitais a prática mais comum é reservada ao atendimento cirúrgico bucomaxilofacial ou procedimentos que necessitam de anestesia geral. Entretanto, a atuação do Cirurgião-Dentista em âmbito hospitalar vai além. O Odontólogo deve ter foco no cuidado ao paciente cuja doença sistêmica possa ser fator de risco para agravamento e ou instalação de doença bucal, ou cuja doença bucal possa ser fator de risco para agravamento e ou instalação de doença sistêmica. (Silva-Lovato et al., 2009; Manual de Odontologia Hospitalar, 2012). O Estado de São Paulo conta com uma ampla rede de serviços hospitalares próprios. Embora os resultados dos últimos anos comprovem o maior acesso da população a rede hospitalar pública do Estado de São Paulo, com aumento no número de atendimentos a pacientes internados, maior quantidade de cirurgias e de procedimentos complexos realizados (Mendes, Bittar, 2010), não há dados públicos concretos comprovando a atuação do Cirurgião- Dentista nesse contexto. Por outro lado, estudos e experiências em hospitais têm mostrado que a inserção do Cirurgião-Dentista na equipe multiprofissional de atendimento ao paciente sob internação contribui para minimizar o risco de infecção, melhorar a qualidade de vida, reduzir o tempo de internação, diminuir a quantidade de prescrição de medicamentos e a indicação de nutrição parenteral, além de promover um atendimento completo ao paciente. (Sonis et al., 2001; Sonis et al., 2004; Morais et al., 2006; Vera-Llonch et al., 2007...

Dental care has traditionally been performed in dental offices. It is more common practice for oral and maxillofacial surgery care or procedures that require general anesthesia to be reserved for treatment at hospitals. However, the work of the Dental Surgeon in the hospital environment goes beyond this. The Dentist must be focused on care of the patient whose systemic disease may be a risk for aggravation and or onset of oral disease, or whose oral disease may be a risk factor for aggravation or onset of systemic disease. (Silva-Lovato et al., 2009; Manual de Odontologia Hospitalar, 2012). The State of São Paulo has a wide network of its own hospital services. Although the results of the last few years have proved that there is greater access by the population to the public hospital network of the State of São Paulo, with an increasing number of attendances of hospitalized patients, larger number of surgeries and complex procedures performed (Mendes, Bittar, 2010), there are no concrete public data proving the activities of the Dental Surgeon in this context. On the other hand, studies and experiences in hospitals have shown that the inclusion of the Dental Surgeon in the multiprofessional team of hospitalized patient care contributes to minimizing the risk of infection, improving quality of life, reducing time of hospitalization, diminishing the amount of medication prescribed and indication of parenteral nutrition, in addition to promoting complete care of the patient. (Sonis et al., 2001; Sonis et al., 2004; Morais et al., 2006; Vera-Llonch et al., 2007; Eduardo et al., 2008; Bezinelli et al., 2013). Ours is a cross-sectional study with the aim of characterizing the Dental Service within public hospitals linked to the State Secretary of Health of São Paulo...

Awareness of biomedical waste management among dental professionals and auxiliary staff in Amritsar, India.

AIM: The aim of this study was to determine awareness of biomedical waste (BMW) management policies and practices among dental professionals and auxiliary staff in a dental hospital/clinics in Amritsar, India, to inform the development of future policies for effective implementation of BMW rules. METHOD: The study involved 160 staff members at the Amritsar hospital/clinics (80 dentists and 80 auxiliary staff) to whom a questionnaire was distributed regarding policies, practices and awareness relating to BMW. The questionnaire was first piloted. Completed questionnaires were returned anonymously. The resulting data were statistically tested using the chi-square test for differences between the dentists and auxiliary staff. RESULTS: In respect of BMW management policies, there was a highly significant difference in the responses of the dentists, whose answers suggested far greater knowledge than that of the auxiliaries (P<0.001). Regarding BMW management practices, the dentists were significantly more aware (P<0.001) of the method of waste collection in the hospital and the disposal of various items into different colour-coded bags. As for employee education/awareness, there was a significant difference (P<0.05) between the dentists and the auxiliaries on the question regarding records of BMW maintained in the hospital and the other responses to questions on these topics had a highly significant (P<0.001) difference between the two groups in favour of the dentists. CONCLUSION: The results of this study have demonstrated a lack of awareness of most aspects of BMW management among dental auxiliary staff in the dental hospital/clinics in Amritsar and a lack of awareness of some aspects among dentists who work in the hospital/clinics. The results provide the hospital authorities with data upon which they can develop a strategy for improving BMW management.

Factors associated with the satisfaction of millennial generation dental residents.

Data from the 2010 Learners' Perceptions Survey (LPS) administered through the Office of Academic Affiliations, Department of Veterans Affairs (VA) were analyzed to identify factors associated with dental residents' satisfaction with the VA as a clinical training environment. Satisfaction scores were linked to clinic workloads, dental procedure complexity levels, staffing patterns, and facility infrastructure data to explore conditions that may improve residents' satisfaction. Findings supported the construct validity of the LPS survey data and underscored the importance of maintaining optimal ratios of attending dentists, dental assistants, and administrative staff to residents so that each trainee will have opportunities to perform an adequate level of dental workload. As programs strive to improve the quality of graduate dental education, findings from this study are vital for setting curriculum design guidelines and for providing infrastructure support for dental resident education.

A description of a specialist led primary care based oral surgery service.

AIM: To describe the establishment of a referral only oral surgery service in a primary care setting together with the challenges, benefits and successes of the service. PROBLEM: In 1994 waiting times for hospital for oral surgery and maxillofacial procedures were unacceptably long. A proposal to establish a primary care oral surgery service aimed to complement the hospital-based service, reduce treatment delays. OUTCOME: Referrals commenced immediately in response to a managed launch with local dentists recognising the service as a source of expedient and convenient treatment for their patients. The service now treats up to 1300 patients per year. LEARNING POINTS: New dental services to dentistry can encompass different specialities. Initial capital investment is needed to develop a more cost-effective service. Recruitment of suitable specialist staff is a critical for success. Staffing, organisation and funding must be sustained.

Aspectos odontolegaisda inserção do cirurgião-dentista no âmbito hospitalar: revista documental

O atendimento interdisciplinar no âmbito hospitalar com a inclusão de cirurgiões-dentistas objetivam, dentre outras variantes, a busca por um perfil de saúde mais completo e qualificado para os pacientes hospitalizados...

Three-level quality assessment of a dental hospital using EFQM.

PURPOSE: This article aims to measure quality by applying the European Foundation for Quality Management (EFQM) excellence model at three different participation levels, in a Karachi teaching university dental hospital. DESIGN/METHODOLOGY/APPROACH: The case study assessed the eight EFQM model excellence concepts as benchmarks for providing quality services: results orientation; customer focus; leadership and constancy of purpose; management by processes and facts; people development and involvement; continuous learning, innovation and improvement; partnership development; and corporate social responsibility. This study was conducted at Hamdard University Dental Hospital (HUDH), located in Karachi - part of the largest privately-owned university in Pakistan. Data were collected through in-depth interviews with internal stakeholders at three levels (management, faculty and student). FINDINGS: Continuous learning, innovation and improvement; partnership development; and corporate social responsibility were satisfactorily represented. RESEARCH LIMITATIONS/IMPLICATIONS: The EFQM assessment was limited to a single university dental hospital, hence findings cannot be generalized. ORIGINALITY/VALUE: The article highlights that it is envisaged that this exercise will bring about a positive change in attitude and will stimulate institute staff to kick start the self assessment process and implement measures leading to better quality practices, thus establishing a continuous quality improvement cycle.

[Experience of using a filmless system in dental practice at Hiroshima University Hospital, a former university dental hospital].

Our university hospital has had a policy of electronic patient recordkeeping, replacing paper-based recordkeeping, since September 1, 2008. Because the Department of Oral and Maxillofacial Radiology had already been using computed radiography for X-ray systems except for intraoral radiography and storing data in Digital Imaging and Communications in Medicine (DICOM) format, the following three conditions form the basis of the changes we made in relation to the introduction of this policy. We started 1. using imaging plates for intraoral radiography as well and storing the data in DICOM format; 2. diagnosed without the need for film; and 3. referred to past images displayed on the screen of our Radiology Information System (RIS). The introduction of digital intraoral radiography has many advantages: not only does it not require film and can all past images be referred to on the screen of the RIS, but radiation exposure times are also shorter, images can be saved electronically, and thus, film processing is redundant. The system improves efficiency and is also advantageous to patients and staff in other departments.

Characteristics of dental clinics in US children's hospitals.

PURPOSE: This study's purpose was to describe the workforce, patient, and service characteristics of dental clinics affiliated with US children's hospitals belonging to the National Association of Children's Hospital and Related Institutions (NACHRI). METHODS: A 2-stage survey mechanism using ad hoc questionnaires sought responses from hospital administrators and dental clinic administrators. Questionnaires asked about: (1) clinic purpose; (2) workforce; (3) patient population; (4) dental services provided; (5) community professional relations; and (5) relationships with medical services. RESULTS: Of the 222 NACHRI-affiliated hospitals, 87 reported comprehensive dental clinics (CDCs) and 64 (74%) of CDCs provided data. Provision of tertiary medical services was significantly related to presence of a CDC. Most CDCs were clustered east of the Mississippi River. Size, workload, and patient characteristics were variable across CDCs. Most were not profitable. Medical diagnosis was the primary criterion for eligibility, with all but 1 clinic treating special needs children. Most clinics (74%) had dental residencies. Over 75% reported providing dental care prior to major medical care (cardiac, oncology, transplantation), but follow-up care was variable. CONCLUSIONS: Many children's hospitals reported comprehensive dental clinics, but the characteristics were highly variable, suggesting this element of the pediatric oral health care safety net may be fragile.

Rapid treatment reduces hospitalization for pediatric patients with odontogenic-based cellulitis.

PURPOSE: The study aimed to assess characteristics of facial cellulitis admissions and their relationship to cost of hospitalization (COH) and length of stay (LOS) in children ages 0 to 20 years at an urban hospital and to compare outcomes of rapid management to published and national statistics for LOS and COH. METHODS: A retrospective review of 376 charts of facial cellulitis admissions between 2000 and 2006 revealed 63 of confirmed odontogenic cases from which cellulitis characteristics, COH, and LOS were gleaned. Variables were correlated to LOS and COH. Data on LOS and cost of admission were compared to published studies and 506 entries from the 2006 Kids' Inpatient Database (KID). RESULTS: Of 63 charts included, children included were 8.3 years (SD, +/-3.8 years) and equal in sex distribution. Treatment rendered and site of infection had no significant relationship to COH. Overall mean hospital LOS was 2.08 days and significantly less as compared to 3.97 days for published studies and 3.4 days for KID (P < .0001). The mean overall hospital COH was $4166 and significantly less compared to $3223 in the literature and $8998.43 for KID. CONCLUSION: In the management of pediatric facial cellulitis of odontogenic origin, rapid treatment had a significant positive impact on length of stay and total cost of treatment compared to published studies and nationally reflective data.

An audit to assess the quality and efficiency of complete and partial dentures delivered by junior hospital staff.

The average number of visits for the construction of metal-based and acrylic dentures by junior hospital staff was 10 visits. Our hypothesis was that supervision would optimise the number of visits and reduce any need for remakes. The first audit cycle was retrospective and included all patients treated by SHOs in the Prosthodontics Department. The standard of care was compared to the British Society for the Study of Prosthetic Dentistry. The re-audit showed that the time taken to completion was reduced by 2 visits for both denture types and the average length of time was reduced from 31 weeks to 22 weeks. These improvements were directly related to improved supervision by senior staff.

A national study of cross infection control: 'are we clean enough?'.

OBJECTIVE: To establish what cross infection control policies and procedures are in place within UK orthodontic departments and how they compare with recommended guidelines. DESIGN: A hospital-based cross-sectional study investigating UK orthodontic departments between March 2007 and January 2008. SUBJECTS AND METHODS: The main outcome measure was a questionnaire constructed for the study, based on current cross infection control guidelines. All orthodontic departments within district general hospitals were invited to participate via email and the response rate was 48%. RESULTS: Five key areas were explored, which included a) training, education and personal protection, b) the clinical environment, c) decontamination of instruments, d) decontamination of appliances and impressions and e) disposal of waste. Ninety-eight percent of departments provided training in cross infection control and 98% also had a policy to check staff immunisation status. With respect to the clinical environment, 97% of the departments surveyed had separate 'clean' and 'dirty' zones. Half of all departments used central sterile services departments (CSSD) for instrument sterilisation. Seventy-eight percent of departments had a policy to decontaminate impressions/appliances at the chairside and all departments used 'yellow bags' for clinical waste and puncture-proof containers for sharps waste. CONCLUSIONS: UK orthodontic departments have implemented policies and procedures which would ensure a high standard of cross infection control. In particular, this related to the decontamination of surfaces and instruments, the use of personal protection and disposal of clinical waste. Most departments had policies and procedures in place for staff education and training in cross infection control and personal protection.

Impact of the systematic use of the informed consent form at public dental care units in Galicia (Spain)

Aim: To ascertain the impact of routine application of the informed consent form at the primary dental care units of the Galician Health Service. Study design: Non random selection of consecutive patients seeking tooth extraction between 9 January and 7 March 2007 at the dental care units of Burela, Praza do Ferrol and Viveiro (Lugo). The study included sociodemographic, clinical, utilization, behavioural and IC-related variables. Main results: A total of 462 patients, mainly males (n=249; 53.9%) entered the study. The mean age of the participants was 57.87±17.54 years. 93.7% of the patients gave their consent for tooth extraction, whereas 47.3% did not want to be informed. The average time employed for obtaining the informed consent was 3.40±1.87 minutes, with a median of 4 and thesame mode. The referred stress values did not differ before and after reading the informed consent form 3.28±2.52 vs 3.41±2.45 (p=0.661). Conclusion: Routine application of the informed consent form before tooth extraction under local anaesthesia did not impair clinical practice nor is it a barrier to dental care. The use of this form does not require changes beyond the allocation of the time necessary for its completion