Civil Rights Litigation Involving the Dental Care of Incarcerated Persons.

Individuals incarcerated in jails, prisons, and detention centers are unique because they have an entitlement to health care under the U.S. constitution; however, the dental care they receive is highly variable in scope and quality. We identified federal civil rights lawsuits related to dental care by incarcerated individuals that were decided in federal district courts in 2018 and courts of appeals since 1976. Judges dismissed or denied the majority of dental claims. Courts have little guidance to inform decisions relating to dental care because cases rarely have a dental expert and the dental profession has not set forth recommendations about the scope of correctional dental care. In the absence of guidance from the dental profession, oral health policy decisions have been left to the discretion of the courts and correctional administrators (nondentists), yielding inconsistent and often detrimental results.

Videoscope Assisted Minimally Invasive Surgery (VMIS): 36-Month Results.

BACKGROUND: Clinical outcomes from videoscope assisted minimally invasive surgery (VMIS) at 36 to 58 months are reported. METHODS: Fourteen patients having sites with residual probing depth (PD) of at least 5 mm and 2 mm loss of clinical attachment level (CAL) after initial non-surgical therapy were treated with VMIS. RESULTS: At 36 months or greater post-surgery there was a statistically significant improvement (P <0.001) in mean PD and CAL (PD: 3.80 ± 1.18 mm, CAL: 4.16 ± 1.18 mm) in all surgical sites compared with baseline. There was a mean improvement in soft tissue height (0.36 ± 0.64 mm, P = 0.03). In most cases, patients reported no postoperative discomfort. CONCLUSIONS: Improvements from VMIS appear to be favorable when compared with previously reported results of periodontal regenerative surgery. All improvements were stable over time. The lack of post-surgical recession after VMIS has not been reported with traditional regenerative surgery.

Videoscope-Assisted Minimally Invasive Periodontal Surgery: One-Year Outcome and Patient Morbidity.

The aim of this study was to report the 1-year clinical outcomes from videoscope-assisted minimally invasive surgery (V-MIS). A sample of 18 patients having sites with residual pocket probing depth (PPD) of at least 5 mm and 2 mm loss in clinical attachment level (CAL) following initial nonsurgical therapy were treated with V-MIS. At 12 months postsurgery, there was a statistically significant improvement (P < .001) in mean PPD (4.11 ± 0.98 mm) and CAL (4.58 ± 1.19 mm) in all surgical sites. A mean improvement in soft tissue height (0.48 ± 0.65 mm, P = .006) was also observed. In most cases, patients reported no postoperative discomfort. The improvements associated with V-MIS appear to be favorable when compared with previously reported results of periodontal regenerative surgery. The lack of postsurgical recession following V-MIS has not been reported with traditional regenerative surgery.

Videoscope-assisted minimally invasive periodontal surgery (V-MIS).

AIM: Small incision surgery has become routine in many areas of medicine but has not been widely accepted in periodontal therapy. A videoscope to assist minimally invasive surgery (MIS) has been developed. The clinical outcomes from MIS performed using this videoscope (V-MIS) are reported. MATERIALS AND METHODS: Patients were evaluated for residual defects following non-surgical therapy consisting of root planing with local anaesthetic. Thirty patients having 110 sites with residual pocket probing depth (PPD) of at least 5 mm, 2 mm loss of clinical attachment level (CAL), and radiographic evidence of bone loss were surgically treated. V-MIS was performed utilizing the videoscope for surgical visualization. RESULTS: At re-evaluation 6 months post surgery, there was a statistically significant improvement (p < .001) in mean PPD and CAL (PPD 3.88 ± 1.02 mm, CAL 4.04 ± 1.38 mm) in 1, 2, and 3 wall defects. All PPD at re-evaluation were 3 mm or less. There was a mean post-surgical increase in soft tissue height (0.13 ± 0.61 mm, p = 0.168) with a decrease in recession. CONCLUSIONS: The improvement in PPD and CAL from V-MIS, in the authors' opinion, appears to be favourable when compared to previously reported results of periodontal regenerative surgery. The lack of post-surgical recession following V-MIS has not been reported with traditional regenerative surgery.

Knowledge, attitude and use of fluorides among dentists in Texas.

AIM: The centers for disease control and prevention (CDC) recommendations on fluoride use were published in 2001. This study examines how this information has diffused to practicing dentists and the level of fluoride knowledge and use among Texas dentists. MATERIALS AND METHODS: A questionnaire was sent to dentists who self-identified as being in pediatric (343), dental public health (72), and general practices (980); a 12% sample of registered dentists in Texas. RESULTS: Response rate was 42.9%. About 90% of surveyed dentists reported using fluorides routinely. Only 18.8% reported fluoride varnish as the topical fluoride most often used. About 57% incorrectly identified primary effect of fluoride. 'Makes enamel stronger while tooth is developing prior to eruption' was the most commonly cited wrong answer (44%). Only 5% identified that posteruptive effect exceeds any preeruptive effect. CONCLUSION: Despite the evidence for fluoride varnish preventing and controlling dental caries being Grade I, its use is still uncommon. Dentists are expected to be knowledgeable about products they use, but this study reflects lack of understanding about fluoride's predominant mode of action. More accurate understanding enables dentists to make informed and appropriate judgment on treatment options and effective use of fluoride based on risk assessment of dental caries. CLINICAL SIGNIFICANCE: Lack of knowledge of, or failure of adherence to evidence based guidelines in caries prevention by use of appropriate fluoride regimens may adversely affect caries incidence in the population.

Treatment of odontogenic pain in a correctional setting.

Odontogenic pain, or toothache, is highly prevalent in correctional facilities. When there is no dental sick call because the dental clinic is closed or the facility has no dental clinic, it is critical that midlevel providers and physicians triage and manage these patients until a dentist can resolve the problem. This article explores the etiology and diagnosis of toothache, presents the authors' opinion of the standard of care for managing these patients, and makes three recommendations: (a) access to timely and definitive dental treatment should be available to all inmates experiencing dental pain, (b) antibiotic use should be limited to patients with frank infection, and (c) progress of patients awaiting a dental appointment should be monitored with frequency consistent with the differential diagnosis.

Is there a relationship between asthma and dental caries?: a critical review of the literature.

BACKGROUND: The authors conducted a critical review of the literature to ascertain the strength of the scientific and professional evidence supporting an association between dental caries and the experience and severity of asthma. TYPES OF STUDIES REVIEWED: In March 2010, the authors searched Medline (1976-2010) by using the Ovid Web Gateway for the terms "asthma" and ["dental caries" or "dental caries susceptibility"] appearing in studies of humans published in English. The authors eliminated conference proceedings and abstracts, opinion pieces and unpublished studies; they included case series, cross-sectional, case-control and cohort studies and clinical trials. RESULTS: The review yielded 27 studies described in 29 articles. The authors found that researchers have investigated the hypothesized relationship between asthma and caries by means of diverse strategies, often using asthma cases clustered in pools of patients seeking clinical care. The strongest methodological designs were more likely to reveal little support for a positive association. The authors found no strong evidence suggesting that a causal link exists. Future research incorporating better-defined covariates and longitudinal designs is needed. CLINICAL IMPLICATIONS: Asthma per se may not be a risk factor for caries. Patients who have extreme dryness of the mouth, whose use of nebulizers is persistent, whose consumption of carbohydrates is frequent, and who have used multiple medications or have used medications over the long term necessitate cautious dental health care.

A comparative study of root coverage using two different acellular dermal matrix products.

BACKGROUND: Gingival recession remains an important problem in dental esthetics. A new dermal matrix material has been introduced, but its effectiveness has not been studied and compared to current dermal matrix material. The aim of this study is to compare the healing associated with a coronally advanced flap for root coverage in areas of localized tissue recession when using Alloderm (ADM) and Puros Dermis (PDM). METHODS: A split-mouth design was used for this study, with 52 contralateral sites in 14 patients with Miller Class I or III facial tissue recession. Twenty-six sites were treated with coronally advanced flap using PDM, and 26 sites were treated with coronally advanced flap using ADM, all followed for 6 months. Clinical measurements of vertical recession, keratinized tissue, probing depths, and attachment levels were made initially, at 3 months, and at 6 months. RESULTS: Both groups had significant improvement in the amount of recession coverage with means of 2.83 mm for the PDM and 3.13 mm for the ADM. The percentage of root coverage was 81.4% for the PDM and 83.4% for the ADM; differences between the materials were not statistically significant. CONCLUSIONS: Based on the results of this study, there was no statistical or clinical difference in the amount of root coverage, probing depth, or keratinized tissue in coronally advanced flaps for root coverage with either of the two acellular dermal matrix materials. Both materials were successful in achieving root coverage.

Sample infection control needs assessment survey data from eight countries.

OBJECTIVES: To compare knowledge, attitudes and practice of standard methods in infection control by dentists in eight countries using a standardised questionnaire. METHODS: Self-administered questionnaires on dental infection control and safety (IC&S) knowledge, attitudes and practice were distributed to a convenience sample of dentists in India, Pakistan, Thailand, Philippines, Taiwan, China, South Korea and the United States of America. RESULTS: Knowledge and practice of infection control among the Asian dentists lagged behind the levels of US dentists. Availability and affordability of equipment and materials were some of the reasons for the practice of infection control and safety. Attitude towards universal/standard precautions in controlling bloodborne pathogens was comparable between groups surveyed. Tested knowledge and practice of infection control was acceptable but the attitude and understanding of universal/standard precautions was ambiguous among both Asian and USA dental practitioners. Education in dental infection control should focus on improving the attitudes of practitioners towards universal precautions. CONCLUSIONS: Knowledge and practice of dental IC&S was high among the USA respondents. Immunisation and IC & S should be stressed in Asia. Information obtained through this study could be used to plan and implement policies in improving dental infection control and occupational safety in individual countries.

Comparative assessment of ActiV GP/glass ionomer sealer, Resilon/Epiphany, and gutta-percha/AH plus obturation: a bacterial leakage study.

The objective of this study was to compare the sealing ability of ActiV GP/glass ionomer (GI) sealer (Brasseler USA, Savannah, GA), Resilon/Epiphany (Pentron Clinical Technologies, Wallingford, CT), and gutta-percha (GP)/AH Plus (Dentsply Maillefer, Tulsa, OK). Seventy-three human single-rooted teeth were randomly divided into three test groups (20 canals each) and two control groups (5 positive and 8 negative). Using Enterococcus faecalis, a split-chamber bacterial leakage model was developed to evaluate the sealing ability of the three obturation systems. Samples were monitored every 24 hours for 65 days. Thirteen teeth leaked in both the Resilon/Epiphany and GP/AH Plus groups, whereas 17 teeth leaked in the ActiV GP/GI group at the end of the observation period. There were no statistically significant differences in the resistance to leakage between the three obturation systems (p > 0.05).

Assessing the viability of the independent practice of dental hygiene--a brief communication.

BACKGROUND: This paper deals with the economics of the independent dental hygiene practice. METHODS: Using historical data from dental practices in Cincinnati, Ohio, we developed a business model for an independent hygiene practice. We tested the sensitivity of the model to variations in key assumptions (initial capitalization, interest, employee salary, and owner's draw). We described the profitability on the basis of the breakeven point. RESULTS: Under the most permissive regulatory and financial environment, the practice would breakeven after 26 months. However, the owner would not equal the earnings of a salaried hygienist until the initial loan is paid off after 7 years. The model was not sensitive to 20 percent changes in the key assumptions. CONCLUSIONS: Under ideal circumstances, an independent hygiene practice could be profitable.

Texas dentists' attitudes toward the Dental Medicaid program.

PURPOSE: The purpose of this study was to report the attitudes of Texas dentists toward the Dental Medicaid program. METHODS: A self-administered survey was mailed to all pediatric dentists and a random sample of general dentists. RESULTS: Surveys from 347 (69%) of 500 dentists (171 of 295 general dentists [58%] and 169 of 205 pediatric dentists [82%]) were returned. 57% of pediatric dentists and 29% of general dentists (P<.0001) treated at least 1 Medicaid patient in the past year. The major areas of dissatisfaction were: (1) broken appointments; (2) low reimbursement levels; and (3) patient noncompliance. This mirrors results from studies in Iowa, Louisiana, Ohio, Washington, and California. Both pediatric and general practitioners identified the following barriers to core for the Medicaid population: (1) low dental IQ; (2) few providers; and (3) no transportation. CONCLUSIONS: The major areas of dissatisfaction included both programmatic and patient-related factors. Attributes of the system (eg, lower reimbursement levels) are more modifiable than attributes of the patient population (eg, patient noncompliance and low dental IQ). Underfunding of dental Medicaid is endemic to all states studied in the literature. Providers, legislators, and government programs should target the programmatic problems with future efforts and funding.

Acute ethanol toxicity from ingesting mouthwash in children younger than age 6, 1989-2003.

PURPOSE: The purpose of this study was to analyze American Association of Poison Control Centers (AAPCC) reports of suspected overingestion of mouthwash by children under age 6 and examine the effect of a 1995 Consumer Product Safety Commission (CPSC) rule requiring child-resistant packaging for mouthwashes containing at least 3 g (0.11 oz) of ethanol per package. METHODS: The volume of ethanol ingested per kg of body weight was computed for children at the 5th, 50th, and 95th percentiles. The potentially toxic and potentially lethal volumes of 100% ethanol at each weight were also determined. The authors used segmented regression to test the difference in slopes between 1989 to 1996 (preintervention) and 1996 to 2003 (postintervention). RESULTS: Incidence of overingestion rose from a low of 12.7 per 100,000 (1991) to 20.7 (1996). The increase ended with the adoption of the CPSC rule, declining to 16.8 per 100,000 in 2001 and rising to 17.9 in 2003. CONCLUSIONS: This study's analysis suggests that the CPSC rule requiring child-resistant packaging on containers of mouthwash containing 3 g or more of ethanol has been successful in reducing AAPCC's reports of mouthwash overingestion. Health care providers should take a more active role by informing parents of the dangers associated with accidental ingestion of ethanol-containing mouthwash. Manufacturers should print warnings about the potential hazard of high ethanol concentrations on labels more prominent and they should stop producing mouthwashes with such high concentrations of ethanol. Moreover, they should also consider discontinuing packaging mouthwash in large containers.

Changes in dental fluorosis following the cessation of water fluoridation.

OBJECTIVES: To determine changes in the prevalence of dental fluorosis, and in perceptions of aesthetic concerns due to dental fluorosis after water fluoridation ceased. METHODS: Schoolchildren in second and third grades were examined in 1993-94, 1996-97 and 2002-03 to determine changes in the prevalence of dental fluorosis following fluoridation cessation of the public water supplies in 1992. The Thylstrup-Fejerskov Index (TFI) was used to quantify dental fluorosis. Perceptions of aesthetics were assessed by questionnaires which were sent home to parents. Residence and dental histories were confirmed on all children to determine the extent of exposure to all types of fluorides. Comparisons between the three surveys were used to establish the influence of fluoridated water and other fluoride sources on the occurrence and severity of dental fluorosis. Aesthetic ratings from parents were used to assess the aesthetic conditions of maxillary anterior teeth across the three surveys. RESULTS: When fluoride was removed from the water supply in 1992, the prevalence and severity of TFI scores decreased significantly from the 1993-94 survey cycle when compared with the 1996-97 and 2002-03 survey cycles. The use of fluoride supplements and fluoride dentifrice also decreased during this study period. Analyses were unable to determine the influence of these different fluoride exposures on the changes in TFI scores over time. Comparisons of aesthetic ratings from parents between survey cycles failed to show any significant differences.

Reports to the National Practitioner Data Bank involving dentists, 1990-2004.

BACKGROUND: While the National Practitioner Data Bank (NPDB) contains reports relating to dentists, an analysis of these data has not been published. METHODS: The authors analyze 47,441 reports to the NPDB relating to malpractice payments, licensure actions and adverse actions against dentists from Sept. 1, 1990, to Sept. 30, 2004. RESULTS: A total of 13.2 percent of all NPDB reports were related to dentists. Of these, 73.7 percent resulted from malpractice actions and the remaining 26.3 percent were from adverse actions. While the number of large payments increased over this period, the median payment remained relatively stable. CONCLUSIONS: Dental malpractice settlements and judgments generally have kept pace with inflation over the past decade. PRACTICE IMPLICATIONS: Dentists should be aware that the NPDB retains reports of adverse actions and malpractice settlements and judgments indefinitely. These reports are available to hospitals evaluating their credentials, state licensing boards and certain health care entities (for example, health maintenance organizations and preferred provider organizations) entering into an employment or other relationship with them.

Use of computer technology to modify objective structured clinical examinations.

Objective structured clinical examinations (OSCEs) are multistationed clinical examinations that have been shown to be effective in testing students' ability to integrate the knowledge, skills, and attitudes acquired during their preclinical and clinical training and experiences. The original OSCE for the third-year Preventive Dentistry course at Baylor College of Dentistry was based on the traditional format consisting of four sections of twelve stations with a group of twelve students rotating through each of the sections simultaneously. This arrangement allowed for examination of one-half of the class. The other half of the class took the exam on an alternate date. To reduce the disruption caused by the students' moving from station to station and to allow for examination of the entire class in one setting, the traditional concept was modified using computer technology, and the twelve stations "moved" via a PowerPoint presentation while students remained stationary. Questions on both exams provided a means for testing data interpretation, diagnostic skills, and, to some extent, interpersonal skills. The overall atmosphere during the computer-based examination was less chaotic. Each student received identical instructions, explanations, and time allotments to respond to the information presented. The ratio of faculty to students required to monitor the exam was less than required for the traditional format. Additionally, since there was no need to allow time for student transition, the total time required to administer the exam was reduced. Thus, objective assessment of the entire class was accomplished using fewer faculty members and less class time and with less disruption for the students.

Inclusion of tobacco exposure as a predictive factor for decreased bone mineral content.

Tobacco exposure has been implicated as a risk factor for decreased bone density, which might result in osteoporosis. Cotinine, a metabolite of nicotine, is commonly used as a marker for tobacco exposure (active or passive). The objective of the present study was to compare tobacco exposure with other predictive factors for low bone mineral content (BMC), as determined by dual photon bone absorptiometry (DXA) in a national U.S. sample. Publicly available interview and clinical examination data from the Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES-III) were used. Our data included 14,060 subjects from 19,528 randomly selected representative U.S. households. Clinical laboratory data included serum values for calcium and cotinine. BMC was assessed radiologically by DXA at five proximal femur sites. BMC values were adjusted for age, as well as height, weight, and bone area to correct for bone and body size. We used t tests to compare continuous variables and chi-square tests to explore associations between categorical variables. Multivariate regression models were developed for each gender with appropriate covariates. Intertrochanter BMC explained the most variation (highest R2) and was selected as the basis of the comparison. Serum cotinine had a significant inverse relationship to BMC in both males (p = .0069) and females (p = .0063). Serum cotinine, as a marker for tobacco exposure, is a statistically significant risk factor for decreased BMC in both genders and should be included in multivariate regression models to predict low BMC.

Nationwide survey of work environment perceptions and dentists' salaries in community health centers.

BACKGROUND: Experienced private practitioners make up a significant proportion of dentists entering community health center (CHC) practices. The authors conducted a study to identify sources of dissatisfaction that affect the retention of these dentists and to determine current CHC dentist salaries. METHODS: CHC dentists nationwide were surveyed regarding salary and job satisfaction indicators. The authors mailed 569 surveys, and the response rate was 73.8 percent. The authors explored associations between job satisfaction indicators, salaries and dentists' intentions to leave the CHCs. RESULTS: Practitioners in private practice are the largest group of dentists recruited by CHCs (54.5 percent). However, 31.2 percent of currently employed dentists do not intend to remain in CHC dental practices. Salary was not associated significantly with the intention to leave. Years of experience, freedom of professional judgment, altruistic motivation, importance placed on loan repayment and amount of administrative time allowed were associated significantly with career change intentions. CONCLUSIONS: Periodic salary surveys can monitor factors associated with recruitment and retention of dentists in community and migrant health centers, and standardized exit surveys can identify factors causing dissatisfaction among dentists who leave. PRACTICE IMPLICATIONS: Employment opportunities in public nonprofit practices are increasing under current federal grant programs. However, unless job satisfaction issues are addressed adequately with dentists in social safety net programs, additional work force needs will not be met.