Does use of an electronic health record with dental diagnostic system terminology promote dental students' critical thinking?

The Consortium for Oral Health Research and Informatics (COHRI) is leading the way in use of the Dental Diagnostic System (DDS) terminology in the axiUm electronic health record (EHR). This collaborative pilot study had two aims: 1) to investigate whether use of the DDS terms positively impacted predoctoral dental students' critical thinking skills measured by the Health Sciences Reasoning Test (HSRT), and 2) to refine study protocols. The study design was a natural experiment with cross-sectional data collection using the HSRT for 15 classes (2013-17) of students at three dental schools. Characteristics of students who had been exposed to the DDS terms were compared with students who had not, and the differences were tested by t-tests or chi-square tests. Generalized linear models were used to evaluate the relationship between exposure and outcome on the overall critical thinking score. The results showed that exposure was significantly related to overall score (p=0.01), with not-exposed students having lower mean overall scores. This study thus demonstrated a positive impact of using the DDS terminology in an EHR on the critical thinking skills of predoctoral dental students in three COHRI schools as measured by their overall score on the HSRT. These preliminary findings support future research to further evaluate a proposed model of critical thinking in clinical dentistry.

Saúde bucal de indivíduos brasileiros com mucopolissacaridose: um estudo transversal pareado / Oral health of brazilian individuals with Mucopolysaccharidosis: a paired crosssectional study

A mucopolissacaridose (MPS) é uma doença genética metabólica causada por erros inatos do metabolismo. Acarreta diversas alterações físicas, motoras e intelectuais. Dentre as alterações físicas, muitas estão presentes na face e na cavidade bucal. Na área odontológica ainda são poucos os estudos dedicados a MPS, sendo insuficientes as informações sobre as características dentárias presentes nas pessoas diagnosticadas com a doença. Este estudo objetivou comparar as características bucais de indivíduos brasileiros com MPS e sem MPS. O mesmo sera apresentado na forma de artigo científico. Foi realizado um estudo transversal, pareado, com 29 pacientes com MPS e 29 sem MPS, na faixa etária de 2 a 25 anos. A coleta de dados foi realizada em uma das clínicas da Faculdade de Odontologia da Universidade Federal de Minas Gerais (UFMG), na cidade de Belo Horizonte, região sudeste do Brasil. Foram convidados a participar do estudo todos os pacientes diagnosticados com MPS atendidos pelo Ambulatório de Erros Inatos do Metabolismo do Hospital das Clínicas da UFMG e pelo Hospital João Paulo II, bem como os respectivos pais/responsáveis. Os pacientes sem MPS foram selecionados nos Ambulatórios Bias Fortes (setor de pediatria) e São Vicente de Paula (setor de adolescentes). Aqueles pais/responsáveis que concordaram em participar do estudo responderam um questionário abordando aspectos individuais, socioeconômicos e comportamentais relacionados aos filhos. Foi realizado o exame da cavidade bucal dos pacientes com MPS e sem MPS. Aconteceu sob luz artificial, na cadeira odontológica, maca ou cadeira de rodas. Foram analisadas as seguintes condições: cárie dentária, gengivite, má oclusão (alterações de overbite e/ou overjet), anomalias dentárias e defeitos de desenvolvimento de esmalte (DDE). A examinadora foi previamente calibrada. Os valores de kappa e coeficiente de correlação intraclasse variaram de 0,76 a 0,98. Após as fases de calibração e estudo piloto, foi iniciado o estudo principal. Os dados foram analisados por meio do software Statistical Package for Social Science - SPSS® (versão 22.0). Foi realizada a análise univariada e bivariada. Por meio da análise bivariada (teste X2) verificou-se possíveis associações entre os grupos e as variáveis independentes (p<0,05). Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG. Este estudo será apresentado em formato de artigo científico. A média de idade dos pacientes foi de 13,9 anos (+7,2). A maioria deles foi de homens (58,6%), pretos ou pardos (70,7%) e de classe econômica favorecida ou mais favorecida (89,7%). As variáveis gengivite, má oclusão e anomalias dentárias foram estatisticamente significativas quando associadas ao grupo dos pacientes. A chance de ser diagnosticado com alguma má oclusão, anomalia dentária e/ou gengivite foi maior no grupo de pacientes com MPS. As anomalias identificadas foram giroversão, agenesia e outras (dente conóide e microdontia). Os resultados deste estudo pareado mostraram que existe uma prevalência maior de má oclusão, anomalias dentárias e gengivite entre os indivíduos com MPS do que entre aqueles sem MPS

Mucopolysaccharidosis (MPS) is a metabolic genetic disease caused by inborn errors of metabolism. It involves a number of physical, motor and intellectual disorders. Many of the physical disorders are present on the face and in the mouth. There are few studies devoted to MPS in the area of dentistry, and a lack of information on the dental characteristics of individuals with the disease. This study aimed to compare the oral characteristics of Brazilian individuals with MPS and without MPS. It will be presented into one manuscript. A paired cross-sectional study of 29 patients with MPS and 29 patients without MPS, aged between two and 25 years, was performed. Data was collected at a clinic of the School of Dentistry of the Universidade Federal de Minas Gerais (UFMG), in the city of Belo Horizonte, in the southeast of Brazil. Patients diagnosed with MPS at the Inborn Errors of Metabolism Clinic of the Clinical Hospital of UFMG and Hospital João Paulo II, together with their respective parents/guardians, were invited to participate in the study. The patients without MPS were selected from the Bias Fortes outpatient clinic (pediatric sector) and São Vicente de Paula outpatient clinic (adolescent sector). Parents/guardians who agreed to participate completed a questionnaire about the individual, socioeconomic and behavioral aspects of their children. The oral cavity of patients with and without MPS was examined under artificial light, in a dental chair, stretcher or wheelchair. The following conditions were analyzed: dental caries, gingivitis, malocclusion (overbite and/or overjet), dental anomalies and developmental enamel defects (DED). The examiner had been previously calibrated. Kappa values and intraclass correlation coefficients ranged from 0.76 to 0.98. Following calibration and a pilot study, the main study was performed. The data obtained was analyzed using the Statistical Package for Social Science - SPSS® (version 22.0) software. Univariate and bivariate analysis was performed. Bivariate analysis (X2 test) identified possible associations between the groups and the independent variables (p<0.05). The study was approved by the Human Research Ethics Committee of the UFMG. The mean age of the patients was 13.9 years (+7.2). The majority of them was male (58.6%), black/brown skin color (70.7%) and from favored or more favored economic classes (89.7%). There was a statistically significant association between the group of MPS patients and the variables gingivitis, malocclusion and dental anomalies. The chance of being diagnosed with a malocclusion, dental anomaly and/or gingivitis was higher in patients with MPS. The anomalies identified were giroversion, agenesis and others (conoid teeth and microdontia). The results of this paired study revealed a greater prevalence of malocclusion, dental anomalies and gingivitis among individuals with MPS than those without MPS

Assessing use of a standardized dental diagnostic terminology in an electronic health record.

Although standardized terminologies such as the International Classification of Diseases have been in use in medicine for over a century, efforts in the dental profession to standardize dental diagnostic terms have not achieved widespread acceptance. To address this gap, a standardized dental diagnostic terminology, the EZCodes, was developed in 2009. Fifteen dental education institutions in the United States and Europe have implemented the EZCodes dental diagnostic terminology. This article reports on the utilization and valid entry of the EZCodes at three of the dental schools that have adopted this standardized dental diagnostic terminology. Electronic data on the use of procedure codes with diagnostic terms from the three schools over a period from July 2010 to June 2011 were aggregated. The diagnostic term and procedure code pairs were adjudicated by three calibrated dentists. Analyses were conducted to gain insight into the utilization and valid entry of the EZCodes diagnostic terminology in the one-year period. Error proportions in the entry of diagnostic term (and by diagnostic category) were also computed. In the twelve-month period, 29,965 diagnostic terms and 249,411 procedure codes were entered at the three institutions resulting in a utilization proportion of 12 percent. Caries and periodontics were the most frequently used categories. More than 1,000 of the available 1,321 diagnostic terms were never used. Overall, 60.5 percent of the EZCodes entries were found to be valid. The results demonstrate low utilization of EZCodes in an electronic health record and raise the need for specific training of dental providers on the importance of using dental diagnostic terminology and specifically how to use the terms in the electronic record. These findings will serve to increase the use/correct use of the EZCodes dental diagnostic terminology and ultimately create a reliable platform for undertaking clinical, outcomes, and quality improvement-related research.

Evaluating a dental diagnostic terminology in an electronic health record.

Standardized treatment procedure codes and terms are routinely used in dentistry. Utilization of a diagnostic terminology is common in medicine, but there is not a satisfactory or commonly standardized dental diagnostic terminology available at this time. Recent advances in dental informatics have provided an opportunity for inclusion of diagnostic codes and terms as part of treatment planning and documentation in the patient treatment history. This article reports the results of the use of a diagnostic coding system in a large dental school's predoctoral clinical practice. A list of diagnostic codes and terms, called Z codes, was developed by dental faculty members. The diagnostic codes and terms were implemented into an electronic health record (EHR) for use in a predoctoral dental clinic. The utilization of diagnostic terms was quantified. The validity of Z code entry was evaluated by comparing the diagnostic term entered to the procedure performed, where valid diagnosis-procedure associations were determined by consensus among three calibrated academically based dentists. A total of 115,004 dental procedures were entered into the EHR during the year sampled. Of those, 43,053 were excluded from this analysis because they represent diagnosis or other procedures unrelated to treatments. Among the 71,951 treatment procedures, 27,973 had diagnoses assigned to them with an overall utilization of 38.9 percent. Of the 147 available Z codes, ninety-three were used (63.3 percent). There were 335 unique procedures provided and 2,127 procedure/diagnosis pairs captured in the EHR. Overall, 76.7 percent of the diagnoses entered were valid. We conclude that dental diagnostic terminology can be incorporated within an electronic health record and utilized in an academic clinical environment. Challenges remain in the development of terms and implementation and ease of use that, if resolved, would improve the utilization.

The development of a dental diagnostic terminology.

There is no commonly accepted standardized terminology for oral diagnoses. The purpose of this article is to report the development of a standardized dental diagnostic terminology by a work group of dental faculty members. The work group developed guiding principles for decision making and adhered to principles of terminology development. The members used an iterative process to develop a terminology incorporating concepts represented in the Toronto/University of California, San Francisco/Creighton University and International Classification of Diseases (ICD)-9/10 codes and periodontal and endodontic diagnoses. Domain experts were consulted to develop a final list of diagnostic terms. A structure was developed, consisting of thirteen categories, seventy-eight subcategories, and 1,158 diagnostic terms, hierarchically organized and mappable to other terminologies and ontologies. Use of this standardized diagnostic terminology will reinforce the diagnosis-treatment link and will facilitate clinical research, quality assurance, and patient communication. Future work will focus on implementation and approaches to enhance the validity and reliability of diagnostic term utilization.

Incisivos laterales superiores en forma de barril. Reporte de un caso / Upper lateral incisors in barrel morphology: A case report

Se reporta un caso de incisivos en forma de barril en un individuo de género masculino, perteneciente al grupo poblacional mestizo con biotipo facial predominantemente mongoloide. El rasgo morfológico se observa de forma bilateral en los incisivos laterales superiores...(AU)

A case of barrel-shape incisors is reported in a male individual, belonging to mixed population ethnicity with predominantly mongoloid facial biotype. This morphologic trait is observed bilaterally in upper central incisors...(AU)

Divergence in prevalence of mesiocclusion caused by different diagnostic criteria.

INTRODUCTION: The divergence in prevalence of a specific malocclusion is often striking. In addition to differences in ethnic background, sex, and age, inconsistency in diagnostic criteria might be important. Our aim was to investigate the prevalence of mesiocclusion in the same group by modifying the diagnostic criteria. METHODS: We examined clinically 3358 young white men. The prevalence of mesiocclusion was determined by applying diagnostic criteria based on the sagittal relationship of the anterior teeth. Correlations to the molar sagittal relationship were calculated. RESULTS: When the diagnosis was based on anterior crossbite, the prevalences were 9.0% for 1 incisor, 4.7% for 2 incisors, and 1.3% for 4 incisors involved. The prevalence decreased when teeth in edge-to-edge positions were excluded (5.2%, 1.9%, and 0.5%, respectively). When canine relationship was used, the prevalences varied from 5.2% to 0.2%, with mesiocclusion increasing from a quarter to 1 cusp width on average. When incisors and canines were combined, prevalences ranged from 0.2% to 3.0 %. The sagittal relationship of the anterior teeth was moderately correlated to the molars. CONCLUSIONS: Subtle differences in diagnostic criteria lead to varying prevalence values for mesiocclusion. The diagnostic criteria of at least 2 incisors in crossbite or edge-to-edge and a mean canine mesiocclusion of at least a half cusp width are recommended for future epidemiologic studies as the anterior tooth relationship that correlates relatively highly to the sagittal molar relationship.

Making a comprehensive diagnosis in a comprehensive care curriculum.

Comprehensive care models in dental education encourage students to deliver patient-centered care. But to deliver effective comprehensive care, a clinician must first make a comprehensive diagnosis. Students of general dentistry are taught to make one or more diagnoses as defined by the dental specialties, and to direct patient care accordingly. Without a comprehensive diagnosis, patients may receive fragmented, poorly prioritized care that is inappropriate to their overall oral health. This paper presents a simple diagnostic classification that can be used to make a comprehensive diagnosis with which to guide the student of general dentistry in planning comprehensive care.

Use of dental services: an analysis of visits, procedures and providers, 1996.

BACKGROUND: While many studies have provided data on Americans' access to dental care, few have provided a detailed understanding of what specific treatments patients receive. This article provides detailed information about the types of dental services that Americans receive and the types of providers who render them. METHODS: The authors provide national estimates for the U.S. civilian noninstitutionalized population in several socioeconomic and demographic categories regarding dental visits, procedures performed and the types of providers who performed them, using household data from the 1996 Medical Expenditure Panel Survey, or MEPS. RESULTS: Data show that while the combination of diagnostic and preventive services adds up to 65 percent of all dental procedures, the combination of periodontal and endodontic procedures represents only 3 percent. Additionally, while 81 percent of all dental visits were reported as visits to general dentists, approximately 7 percent and 5 percent of respondents who had had a dental visit reported having visited orthodontists or oral surgeons, respectively. CONCLUSION: MEPS data show the magnitude and nature of dental visits in aggregate and for each of several demographic and socioeconomic categories. This information establishes a nationally representative baseline for the U.S. population in terms of rates of utilization, number and types of procedures and variations in types of providers performing the procedures. These nationally representative estimates include data elements that describe specific dental visits, dental procedures and type of provider, and they offer details that are useful, important and not found elsewhere. PRACTICE IMPLICATIONS: By understanding these analyses, U.S. dentists will be better positioned to provide care and better meet the dental care needs of all Americans.

Avaliaçäo do exame visual, visual-tátil e radiográfico no diagnóstico de lesöes de cáries dentinárias em superfície oclusal de molares decíduos / The visual, visual with probing and radiographic diagnosis of occlusal dentine caries in primary molars

Avaliou-se a eficácia dos exames visuais, visual-tátil e radiográfico para diagnosticar a presença de lesöes dentinárias em superfície oclusal de 50 molares decíduos humanos. Os exames foram realizados por três pós-graduandos, sendo utilizada a análise microscópica (estereomicroscópio, 40 x) para validaçäo dos dados (gold standart). Os valores de sensibilidade, ao comparar-se todos os métodos, demonstraram näo haver diferenças estatisticamente significantes; a especificidade do método radiográfico, comparada a dos demais, revelou diferenças. A concordância inter e intra-examinadores foi determinada pela estatística Kappa e, em média, considerada substancial a quase perfeita