Time trends and determinants of acute odontogenic maxillofacial infections in Lithuania: a retrospective national 2009-2013 treatment data audit.

OBJECTIVES: To examine the distribution of treatment facilities accepting patients with acute odontogenic maxillofacial infections (AOMIs), time trends in incidence and relate these infections with a number of determinants. METHODS: A national Lithuanian retrospective study gathered data on all patients treated in outpatient/inpatient treatment facilities. Adjusted Incidence Ratios (AIRs) of AOMIs were calculated separately for each type of infection and for each year. Administrative districts (ADs) were grouped into low, medium, and high thirds based on the regional determinants: socio-economic index (R-SEI), access to basic (R-BDCI) or specialized dental care (R-SDCI) and index of systemic diseases (R-ISD). RESULTS: There were no statistically significant geographical differences in the distribution of TFs providing care for patients with AOMIs. Numbers of treatment facilities consistently increased from 2009 to 2013, but there was no consistent increase/decrease in the incidence of AOMIs (-1%). Regions with the highest R-SEI tended to have a higher incidence of AOMIs as compared to regions with medium or low R-SEI. When controlled for other determinants, lower R-BDCI/R-SDCI scores were associated with a higher incidence of AOMIs. CONCLUSIONS: High annual incidences (-1% of a total population) were diagnosed and treated for AOMIs, but there was no consistent time trend for these infections.

Balancing the role of the dental school in teaching, research and patient care; including care for underserved areas.

Inequalities within dentistry are common and are reflected in wide differences in the levels of oral health and the standard of care available both within and between countries and communities. Furthermore there are patients, particularly those with special treatment needs, who do not have the same access to dental services as the general public. The dental school should aim to recruit students from varied backgrounds into all areas covered by the oral healthcare team and to train students to treat the full spectrum of patients including those with special needs. It is essential, however, that the dental student achieves a high standard of clinical competence and this cannot be gained by treating only those patients with low expectations for care. Balancing these aspects of clinical education is difficult. Research is an important stimulus to better teaching and better clinical care. It is recognized that dental school staff should be active in research, teaching, clinical work and frequently administration. Maintaining a balance between the commitments to clinical care, teaching and research while also taking account of underserved areas in each of these categories is a difficult challenge but one that has to be met to a high degree in a successful, modern dental school.

Variations in crevicular fluid elastase levels in periodontitis patients on long-term maintenance.

Granulocyte elastase was determined in the gingival crevicular fluid (GCF) of 18 periodontitis patients. They initially had similar severity of disease but had responded differently to 5-yr maintenance, 13 responders and 5 non-responders. A total of 102 sites were investigated and categorized as: i) consistently healthy, ii) healthy after treatment, iii) gingivitis, and iv) periodontitis, according to clinical criteria. GCF elastase activity was determined with a granulocyte-specific substrate. The sites from non-responders had consistently higher elastase levels than the corresponding category of sites from responders, despite similar gingival inflammation and periodontal destruction, with the exception of consistently healthy sites. Within the non-responders, the periodontitis sites had higher elastase levels than the gingivitis sites commensurate with probing depth, while no difference existed between gingivitis sites and sites healthy after treatment, despite a difference in probing depth. In contrast, in the responders similar elastase levels were found at the periodontitis sites and gingivitis sites despite difference in probing depth, while both diseased sites had higher elastase levels than the sites healthy after treatment, commensurate with probing depth. This study suggests that increased granulocyte-specific elastase levels in GCF may serve as a diagnostic marker for refractory periodontitis patients.