International air medical transport. Part II: Results and discussion

International air medical transport requires reliable equipment, skilled personnel and precise planning. A report is presented of an experience with 31 international transports. Details concerning equipment, personnel and logistics are presented. Results and problem areas are discussed. This early experience demonstrates the capability for the repatriation of critically ill patients, and the evacuation of patients who require access to a level of care which may be unavailable outside the United States.     

Guidelines for developing a dental laboratory infection-control protocol.

Guidelines for developing a dental laboratory infection-control protocol are discussed. A detailed outline of infection-control protocol regarding universal precautions, personal protective equipment, hepatitis B vaccination, environmental and surface cleaning and disinfection, and personnel training is presented.     

Office emergencies: an outline of causes, symptoms, and treatment.

Conscientious dental practitioners are aware of the increasing chances for medical emergencies to arise in the dental office. New treatment modalities and drugs have increased potential life spans, but have also presented greater responsibilities to the dentist for properly managing these patients. Additionally, widely diversified sources are available to the dentist for acquiring and assembling all necessary information to train his personnel and organize equipment and drugs so he is constantly ready to handle any emergency. We have attempted to give a simple, thorough outline that provides basic information on causes, symptoms, and treatment of major medical emergencies, but that in no way reflects the only means of treating the specific emergency. We feel the manner presented allows one to regiment his diagnosis and treatment rapidly and make modifications to the list as needed.     

Endoscopic excision of forehead lipomas

Endoscopic surgery is a significant addition in the maxillofacial surgeon's armamentarium. Authors' experience of endoscopically assisted removal of forehead lipomas has been presented. The endoscopic technique permits to hide minimal scars in the hair. The magnification allows a good identification of anatomical structures and thus decreases the risk of numbness. The main disadvantages of this technique are the more expensive equipment and the steep learning curve. But with the expansion of endoscopic techniques, prices should decline and the duration of operations always lessens with experience. This technique might possibly appear to offer a new standard procedure for removal of forehead lipomas, notably in patients with keloid history or high aesthetic concerns.     

口腔专科医院急诊科建设与护理管理

口腔急诊医学是一门新兴的学科，在急性口腔疾病的应急处置以及口腔临床诊疗过程中突发全身性病症时的生命抢救中发挥着重要作用。目前，我国对于口腔急诊科的建设、管理、人员培训等方面尚缺乏成熟的经验，影响和制约了口腔急诊医学的发展。笔者结合自身工作经验，针对口腔专科医院的口腔急诊科建设包括布局、设备配置、制度建设以及护理管理（如培训工作、分级诊治、急救药品、设备流程化管理等）进行阐述，为国内口腔专科医院急诊科的规范化建设等提供参考。     

A suggested curriculum for teaching conscious sedation in advanced general practice programs: GPR and AEGD

Previously published national guidelines related to the teaching and performance of conscious sedation in dentistry have not included guidance in this area for program directors of General Practice Residency and Advanced Education in General Dentistry Programs. A suggested curriculum is presented here for use by program directors of such programs who wish to design training experiences in their own programs or as a reference for program directors who wish to compare their programs with experiences provided in other locations. Guidelines are provided for facilities, equipment, personnel, records and preparation necessary to perform conscious sedation procedures, as well as goals, objectives, and evaluation methodology for training residents in conscious sedation.     

Aspects of panoramic radiography in general dental practice.

OBJECTIVES: To gather information on the types of panoramic x-ray equipment used in NHS dental practice and whether dentists satisfy the legal requirements for safety, to determine which practice personnel take panoramic radiographs and to assess the prevalence of the practice of 'routine' panoramic radiography among NHS dentists. DESIGN: Postal questionnaire survey of general dental practitioners carried out during 1997 in selected FHSAs in England and Wales. RESULTS: 542 dentists returned the questionnaire, a 73.3% response. Panoramic x-ray equipment ranged in age from 27 years old to new, with 42.2% exceeding 10 years in age. The overwhelming majority of GDPs satisfied the requirement for regular maintenance and surveying of equipment. Almost all dentists (95.9%) performed a history and clinical examination prior to panoramic radiography but 42% practised 'routine screening' of new adult patients. A substantial proportion (36.7%) of dentists used unqualified personnel to take panoramic radiographs. CONCLUSIONS: While some aspects of this study give reassurance about the prevalence of good practice, widespread panoramic screening and using unqualified staff to take radiographs causes concern. These findings have implications for educators and for those involved in maintaining clinical standards.     

Kaposi's sarcoma in a patient with acquired immune deficiency syndrome

A case of Kaposi's sarcoma, which first appeared as an erythematous oral lesion, in a patient with AIDS is presented. Current concepts regarding these disease entities are reviewed, and recommendations for protection of personnel when providing care for AIDS patients are outlined.     

Design of dental equipment for remote rural and field areas

In the context of providing dental services, remote areas may be defined as those with overall low population densities; or isolated areas of low population density within more populous regions; or areas of high population density remote from dental services. The provision of equipment for remote areas is not simply a matter of extending the supply of conventional operatories to these regions. The particular needs of a region must be assessed first with equipment and instruments being selected to serve the skills of personnel who can be trained locally. The preventive-surface care operatory is the most basic yet most widely usable operatory. Staffed by auxiliary personnel it will facilitate communication, primary care procedures and the completion of non-invasive tasks. The design of operatories to a preferred work position will simplify the design of fixed installations and associated equipment and overall costs will be reduced. New educational methodologies will influence the design and manufacture of equipment more than in the past. For remote areas there are physical and practical limitations to equipment design but the preferred work position should not be compromised. If this is maintained the transfer of skills between different work places is simplified and mobilization of the operatory is facilitated.     

Skin lesions: mirror images of oral lesion infections

Skin lesions can be the presenting signs for HIV disease and are among the most prevalent manifestations throughout the course of HIV disease. Correlation of skin diseases and HIV disease staging has long been recognized and used to guide medical management in resource-limited settings. The purpose of this paper is to give a review of common skin infections presented in HIV-infected patients. Common skin infections presenting in HIV-infected patients include viral, fungal, mycobacterial, and bacterial infections, along with skin infestation. Key diagnostic points correlate with certain HIV disease staging for many skin diseases. These can help facilitate appropriate diagnosis and referral by health care personnel when treating HIV-infected patients who have skin lesions. Knowledge of common skin manifestations found in HIV-infected patients is essential for all health care personnel who work in the HIV field. Most skin infections presenting in HIV-infected patients can be treated effectively if the correct diagnosis and appropriate referral are made promptly.     

The provision of dental services in the Third World

The primary health care approach has been selected as the basic health care planning philosophy in the developing countries and as oral health is an integral part of general health, this approach could be applied for oral health promotion too. Sri Lanka shares most of the oral health problems common to other developing countries. Dental care is delivered free through hospital dental clinics to adults and school clinics to children. Field medical staff, village health volunteers, religious leaders, school-teachers, traditional medical practitioners and senior students in schools are deeply involved in oral health promotional activities. The traditional concept of health care delivery filtering through a number of layers has been replaced by an upward movement initiated by the people. Every effort is being made to strengthen the base of this structure where non-dental personnel are involved, the dental auxiliary personnel providing the services at the first referral level and the scarce professionals being concerned only with high quality oral care at the final referral level. In addition to preventive and educational services a certain amount of treatment has to be provided. These are supplied in static hospital clinics, in mobile clinics or portable equipment is used to set up temporary dental centres in remote areas. Highly sophisticated equipment imported from industrialized countries is used in the hospital service but this service is disrupted due to frequent breakdowns and lack of spares. Local production of dental equipment should be encouraged and research should be conducted to assess the most suitable equipment for third world countries.     

Basic principles of maximizing dental office productivity

To maximize office productivity, dentists should focus on performing tasks that only they can perform and not spend office hours performing tasks that can be delegated to non-dentist personnel. An important element of maximizing productivity is to arrange the schedule so that multiple patients are seated simultaneously in different operatories. Doing so allows the dentist to work on one patient in one operatory without needing to wait for local anesthetic to take effect on another patient in another operatory, or for assistants to perform tasks (such as cleaning up, taking radiographs, performing prophylaxis, or transporting and preparing equipment and supplies) in other operatories. Another way to improve productivity is to structure procedures so that fewer steps are needed to set up and implement them. In addition, during procedures, four-handed dental passing methods can be used to provide the dentist with supplies or equipment when needed. This article reviews basic principles of maximizing dental office productivity, based on the author's observations of business logistics used by various dental offices.     

Oral surgery management of the geriatric patient

Because the management of geriatric patients is accomplished with increased risk for morbidity and mortality compared to average patients, dentists who treat the medically compromised geriatric patient should be ready for any emergency. It is the dentisfs responsibility to know basic cardiopulmonary resuscitation, to have trained his ancillary personnel in emergency techniques, and to have the proper resuscitative equipment available. As the geriatric population increases, so will the demands on the dental profession to provide care for the patients in this category. Geriatric patients require more time, patience, attention to detail, and evaluation before treatment is begun. Clearly, these increasing requests for treatment must be met and the patients delivered the best care the dental profession can offer regardless of compromising medical status.     

Modifications of emergency dental clinic protocols to combat COVID-19 transmission

During the COVID-19 pandemic, incidence rates for dental diseases will continue unabated. However, the intent to prevent the spread of this lethal respiratory disease will likely lead to reduced treatment access due to restrictions on population movements. These changes have the potential to increase dental-related emergency department visits and subsequently contribute to greater viral transmission. Moreover, dentists experience unique challenges with preventing transmission due to frequent aerosol-producing procedures. This paper presents reviews and protocols implemented by directors and residents at the Dental College of Georgia to manage a dental emergency clinic during the COVID-19 pandemic. The methods presented include committee-based prioritization of dental patients, a multilayered screening process, team rotations with social and temporal spacing, and modified treatment room protocols. These efforts aid in the reduction of viral transmission, conservation of personal protective equipment, and expand provider availability. These protocols transcend a university and hospital-based models and are applicable to private and corporate models.     

Increasing productivity in dental practice: the role of ancillary personnel

Dentistry has achieved substantial improvements in productivity which have the effect of making more care available at reasonable cost. Data are presented documenting trends in productivity. These are analyzed with respect to number of dentists, hours worked by dentists, and the use of ancillary personal in dental offices. There is strong evidence linking increased productivity to the use of ancillary personnel. The history of creation, recognition, and integration of ancillary personnel into dental practice is also presented.     

Significance of infection control in dentistry: a review

Dental care is a field of high priority regarding the risk of infections. Since many carriers are not aware of their infection, it may happen that the dentist meets a patient, in whom an earlier infection can be proven by serology, but the patient is not aware of it and the clinical signs and symptoms are missing, as well. For this reason, the dentist has to consider every patient potentially infected. On the other hand, health-care workers are not only susceptible persons to infections but they can also be sources of infections. In order to prevent the nosocomial infections the dentist has to ensure the hygienic protection of both the patients and the health-care workers. All the health-occupational measures have to be known and have to be kept by the dental personnel. The health personnel has to be informed on the risk and how to prevent infections. The essential importance of hygiene, the role of protective equipment and all the duties connected with should be emphasized. Furthermore, the continuing education of health-care workers is indispensable regarding the infectious diseases. In order to reduce the risk of nosocomial infections the authors summarize the state-of-the-art knowledge of infection control.     

Methicillin-resistant Staphylococcus aureus and infection control for restorative dental treatment in nursing homes

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in nursing home residents now averages 20–35%. This includes both numerous asymptomatic mostly unidentified carriers, and the occasional patient with an active infection. Among the most common sites for positive MRSA colonization are the nares and mouth (saliva). Ohio State University (OSU) dental students perform routine restorative dental care onsite in local nursing homes using portable equipment including handpieces that can generate aerosols. Using a series of cultured test swabs and plates, this pilot study suggests that protection for both dental health care personnel and patients are provided by the following: I. universal barrier precautions (for example, gloves, gowns, masks, hats, facial shields, glasses), 2. surface disinfectants, 3. pre-op 0.12% chlorhexidene mouth rinses, 4. high volume evacuation, 5. perioral skin scrubs. Additional infection control methods, techniques and equipment were evaluated and compared including rubber dam isolation, hand excavation and bond technique, high-speed air turbine and electric "high" speed handpiece. There was no indication of a special tendency or heightened ability of MRSA to aerosolize.     

The roles of other dental personnel in the patient care provided by dental hygienists in traditional and nontraditional settings

The information presented in this paper was obtained as part of an ongoing longitudinal study of 1982 dental hygiene graduates. This portion of the study was contracted by the American Dental Hygienists' Association and investigated the roles of personnel other than the dental hygienist in dental hygiene patient care by collecting data on (1) the numbers of personnel by personnel category, (2) the activities that other personnel provide to assist the hygienist in providing care, (3) the frequency at which the dentist evaluates the hygienist's work and (4) the frequency at which the dentist examines the hygienist's patients. In September 1986, mail questionnaires were sent to a cohort of 1,008 dental hygienists who graduated in 1982. Responses were received from 766 subjects--a 76% response rate overall and 77% response rate from subjects with valid addresses. Data were analyzed for clinical dental hygienists working in traditional and nontraditional settings. The median numbers of personnel were similar in both traditional and nontraditional settings; however, the means and standard deviations were larger for nontraditional settings. The most common forms of assistance provided by other personnel were billing and scheduling patients; a greater percentage of hygienists in traditional settings had this type of help. Hygienists were more likely to report that dentists examined their patients rather than evaluated the hygienists' work, and hygienists in nontraditional settings reported less dentist involvement with dental hygiene patient care than did hygienists in traditional settings.     

The dental equipment needs and problems associated with the provision of dental services in remote areas

Dental services, facilities and equipment are inseparable and interdependent. The provision of all three is influenced by socio-economic factors. Prominent among these is the powerful competition for scarce resources to meet other health needs. In planning health programmes the perception of dentists, the community and health administrators will differ. In this competitive situation the planning of dental services, and hence the choice of equipment needed, must be based upon knowledge of the oral health status of the community to be served. The community's level of interest and likely cooperation is of great importance. Unsuitable services must not be imposed but at the same time the dental profession's educational role should be maintained. Establishing a balance between treatment needs and preventive programmes will influence the provision of equipment just as much as it will determine the choice of personnel. Standards of care should not be judged on the basis of elaborate facilities and exotic equipment. The choice of equipment must be related to the level of service to be provided at its site of use. Planners must consult with the dentists concerned if the provision of inappropriate equipment is to be avoided.