Orthodontic therapy and third party in Europe

This paper is an attempt to individuate some principles and guidelines apt to regulate the relationship between orthodontists and financing third parties, applicable to most western European Countries. The concepts of orthodontic treatment need, orthodontic treatment request and orthodontic screening are discussed, alongside with a short overview of some of the most common indexes to assess the severity of the malocclusion and/or the treatment priority. The screening method introduced by the Danish Ministry of Health is presented; its importance lies in the fact that for the first time a direct correlation between health risk and individual malocclusions is recognized and assessed. In the discussion, it is stressed how the screening system tightly depends on the chosen general model for orthodontic care. Different models of orthodontic care organization as presently used in many European countries are presented and shortly discussed; among these, the Norwegian model is described more in details, because of its simplicity. Eventually, some guidelines considered necessary in order to achieve satisfactory standards of quality and efficiency are presented and discussed.     

Oral health-related quality of life in patients seeking care for dentin hypersensitivity

Summary  The aim of the present study was to evaluate oral health-related quality of life (OHRQoL) impairment in patients seeking care for their hypersensitive teeth in comparison with general population subjects and to investigate the influence of gender and age on OHRQoL in these populations. Study participants were 656 patients without removable prosthodontics who sought treatment for their hypersensitive teeth in German dental offices. These patients were asked to complete the German form of the Oral Health Impact Profile (OHIP-G) prior to treatment. The sum of OHIP-G item responses (OHIP-G49, 0–196) characterized the OHRQoL impairment. Patients' OHIP summary scores were compared with those in a sample of the German general population ( n  = 1541). The influence of population (patients vs. general population subjects), gender and age was investigated using a multivariable linear regression model. Age presented a curvilinear association with OHRQoL, with lower OHIP scores associated with younger and older adults and higher OHIP scores (indicating impaired OHRQoL) associated with middle-aged adults in both the patient and general populations. Gender influence depended on the population, i.e. female general population subjects had lower OHIP scores than male general population subjects and female patients had higher OHIP scores than male patients. Mean OHIP summary scores indicated that patients with hypersensitive teeth reported considerably more impaired OHRQoL (approximately 22 OHIP units) than subjects in the general population. The present study suggests that the oral condition of hypersensitive teeth is significantly associated with impaired OHRQoL.     

Individual prediction of treatment outcome in patients with temporomandibular disorders. A quality improvement model

The general aim of this thesis was to create and evaluate a quality improvement model for prediction of treatment outcome in patients diagnosed with Temporomandibular Disorders (TMD) of either Muscle or Mainly TMJ (Temporomandibular Joint) origin, treated with interocclusal appliances and/or occlusal adjustment. The model was assumed to generate negative predictors of treatment outcome through evaluating all patients predicted Good reaching an objective treatment goal but not having an improvement of 50% or more. The model was created and evaluated by one TMD specialist. The questions were: (I) Was it possible for the TMD specialist to predict treatment outcome individually in patients diagnosed with TMD and, from the results, create a quality improvement model? (II) Was it possible for eight TMD-trained general dental practitioners, under the supervision of the TMD specialist, to treat TMD patients with similar results to the TMD specialist if the TMD specialist had examined, treatment planned, and individually predicted the treatment outcome? (III) Was it possible for the TMD specialist to improve the possibility to predict individual treatment outcome overtime? (IV) Was it possible for one TMD-trained general dental practitioner to copy the clinical part of the model and achieve the same results as the TMD specialist, in patients selected by the TMD specialist? Out of 5165 patients subjected to a functional examination of the masticatory system, 3602 were diagnosed with TMD and subgrouped as either Muscle or Mainly TMJ symptoms. The patients were predicted to have a Good, Dubious, or Poor possibility to have an improvement of 50% or more after treatment. Patients predicted Poor were not offered any treatment. A correct prediction of actual treatment outcome Good was defined as an improvement of 50% or more for muscle and/or TMJ symptoms. A total of 2625 patients began treatment at the specialist clinic for TMD and 2128 completed the full course of treatment. The patients were treated with counseling, interocclusal appliances and/or occlusal adjustment. Treatment outcome was evaluated at an objective treatment goal as improvement in percent using a verbal Numeric Rating Scale ranging from 0 to 100. The results suggest that (I) individual treatment outcome can be predicted in patients with TMD treated by one specialist in TMD and a quality improvement model could be created, (II) eight TMD-trained general dental practitioners could, under the supervision of the TMD specialist, treat TMD patients with similar results to the TMD specialist, (III) the TMD specialist could improve the possibility to predict individual treatment outcome over time, and (IV) the clinical part of the model could be copied by one TMD-trained general dental practitioner with similar results to the TMD specialist. In conclusion, the model works in the hand of one TMD specialist and the clinical part for one general dental practitioner, but it needs to be evaluated by other clinics/clinicians before it can be claimed to be generalizable. The model has identified new negative predictors for treatment outcome in patients with TMD. These predictors need to be investigated further in well controlled clinical trials. The created model is a PDSA cycle.     

口腔临床综合实习模式的建立

口腔临床实习是口腔医学教育的重要阶段,第四军医大学口腔医院经过5年的实践和探索,以树立整体诊疗观、提高实习生综合素质为目标,改变传统的以内、外、修复分科轮转的"三段式"临床实习模式,实行通科与专科实习相结合,建立了口腔临床综合实习模式,提高了临床实习质量。     

Oral disease and psychosocial risk determinants in relation to self-assessments of general health in persons with chronic whiplash-related disorders

The aim of this study was to analyse how self-assessed general health was related to oral health among persons afflicted with whiplash-associated disorders (WAD), controlling for relevant background factors, confounders and other risk factors. Questionnaires included the SF-36 Health Survey, self-assessed oral health and relevant risk factors, in total 49 questions. Multivariable regression modelling was performed. Members of a nationwide Swedish association enlisting persons who have problems concerning a whiplash injury (n = 1,928) were included. A total of 979 persons participated in the study, a response rate of 50.8%. A multivariable regression model is presented, with general health as the dependent variable, and the independent variables inserted en-bloc. The model was highly significant with an explained variance of 28%. Among background factors, only older age appeared as significantly and strongly related to poorer general health. The strongest explanatory contributions came from the health related variables. Oral disease and extra-oral body pain were both strongly related to poorer general health, most obviously for the oral disease variable. Oral disease was significantly and to a clinically relevant degree associated with self-assessed general health. Several other psychosocial indicators of stress were also significantly related to the general health. These findings are consistent with the stress-behaviour-immune model for development of disease.     

Improving evaluation of amalgam restorations.

A predictive model of overall quality of performance is presented which might assist both dental students and dental faculty by increasing the reliability of clinical and laboratory evaluations. Training effectiveness can be improved by identification of those restorative skills which contribute most to the quality rating of restoration.     

Periodontal disease and quality of life: Umbrella review of systematic reviews

This umbrella review appraised existing systematic reviews and meta‐analysis to establish the impact of periodontal disease and therapy on general and oral health‐related quality of life. A systematic electronic literature search was carried out in accordance with the PRISMA guideline up to January 2020 using PubMed, LIVIVO, EMBASE and OpenGrey (PROSPERO CRD 42020163831). Hand searching was performed through the reference lists of periodontal textbooks and related journals. All English language‐based systematic reviews and meta‐analysis that assessed the impact of periodontal disease and treatment interventions on general and oral health‐related quality of life were included. Overall, eight articles met the inclusion criteria and their methodological quality was assessed using the AMSTAR2 criteria. Two systematic reviews showed a significant impact of oral conditions on general health‐related quality of life, although the specific impact of periodontal disease remains inconclusive. Three systematic reviews established a negative impact of periodontal disease on oral health‐related quality of life. Another three systematic reviews concluded that periodontal treatment can improve oral health‐related quality of life. Oral conditions, like periodontal disease, can impact the general health‐related quality of life. Periodontal disease is negatively correlated with oral health‐related quality of life, although treatment interventions can improve self‐reported quality of life. In view of the heterogeneity of generic instruments currently utilized to assess the self‐reported quality of life of periodontal patients, the development of a general and oral health‐related quality of life instrument specific for periodontal disease is strongly recommended.     

Dental implants placed in a patient with multiple myeloma: report of case

A 69-year-old male, under active treatment for multiple myeloma, fractured his left maxillary second premolar palatal abutment tooth and requested treatment because his upper partial denture no longer fit. Several other teeth were deemed hopeless, and construction of a maxillary complete denture presented problems. There are general contraindications regarding dental implant surgery in the terminally ill patient; however, in this case, the patient wished to maximize his quality of life and opted to undergo implant surgery. With close management, the treatment was successful.     

Correction of facial-skeletal deformities in two patients with facio-scapulo-humeral muscular dystrophy

The genetic etiology, pathophysiology, natural progression, prognosis, and complications of Landouzy-Dejerine facio-scapulo-humeral benign muscular dystrophy are presented, as well as the risks of anesthesia and surgery. Patients with relatively benign myopathies may be candidates for reconstructive orthognathic surgery to improve oral function, facial esthetics, social interchange, and general quality of life. The surgery can be a gratifying experience for the patient, the family, and the surgeon, but the procedure, the anesthesia, and the postoperative care must be carefully planned to minimize the genuine risks.     

Computer-assisted treatment planning and analysis

The Invisalign orthodontic system (Align Technology, Inc, Santa Clara, CA) is a series of clear removable appliances that is worn by a patient to correct malocclusions. Introduced in 1999, it has been applied to successfully correct an increasingly wide variety of malocclusions. Part of the success of the system is because of the innovative technologies inherent in the design of the appliances. During the development of the system, many challenges and issues needed to be overcome to realize the product. Many of these issues were not specific to Invisalign, and represented general problems in the area of computer-aided orthodontics. The general problems of developing a virtual model of a patient's dentition appropriate for use in orthodontics, performing a treatment plan on a virtual dentition model, and analyzing how accurately the virtual treatment plan executed in the patient's mouth are presented.     

A randomised trial of a simplified method for complete denture fabrication: patient perception and quality

Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones albeit the lesser use of time and resources, without disadvantage for the patient. This study compared a simplified method for complete denture fabrication to a conventional protocol in terms of oral health‐related quality of life (OHRQoL), patient satisfaction and denture quality. Forty‐two edentulous patients requesting treatment with complete dentures were randomly allocated into two study groups. Group S received dentures fabricated by a simplified method and Group C received conventionally fabricated dentures. Before interventions and after three and 6 months following insertion, OHRQoL and patient satisfaction were analysed by specific instruments. A prosthodontist assessed denture quality 3 months after delivery. Groups presented no difference for OHRQoL, denture quality and general satisfaction. Differences regarding patient satisfaction with some aspects of the dentures were found after 3 months (S > C), but were insignificant at 6 months. It was concluded that the simplified method is able to produce dentures of a quality comparable to those produced by the conventional method, influencing OHRQoL and patient satisfaction similarly.     

Obesity and Periodontal Outcomes: A Population‐Based Cohort Study in Brazil

Background: The aim of this study is to investigate the effects of abdominal and general obesity on periodontal outcomes in a population‐based cohort of Brazilian adults. Methods: Abdominal and general obesity were assessed in the years 2009 (n = 1,720) and 2012 (n = 1,222). For abdominal obesity, a dichotomous variable was created: 1) eutrophic/lost weight or 2) obese/gained weight. For general obesity, a categorical variable was created: 1) eutrophic/lost weight; 2) gained weight; or 3) obese. Periodontal outcomes were percentage of teeth with bleeding on probing (BOP) and combination of BOP and attachment loss (AL). Hypertension was set as the mediator. Marginal structural models (MSMs) were used to estimate the controlled direct effect of obesity on periodontal outcomes. Results: Periodontal data were presented from 1,066 participants. The total effect model showed those with general obesity in the cohort period presented higher risk of unfavorable periodontal outcomes (rate ratio [RR]: 1.45 for AL and BOP in different teeth; RR: 1.84 for AL and BOP in the same tooth). Estimates from MSMs revealed an effect of general obesity on AL and BOP in different teeth (RR: 1.44). No effect of general obesity was noted on the percentage of BOP. Total effect of abdominal obesity increased risk of AL and BOP in different teeth (RR: 1.47), AL and BOP in the same tooth (RR: 2.77), and percentage of BOP (RR: 1.49). In a MSM, those with abdominal obesity presented greater risk of AL and BOP in the same tooth (RR: 2.16) and percentage of BOP (RR: 1.37). Conclusion: Abdominal obesity has a direct effect on unfavorable periodontal outcomes in MSMs.     

Recommendations for improving the assessment of postgraduate dental education

This paper makes recommendations for the improvement of assessment in postgraduate dental education. The recommendations are based on a twelve-month study conducted in 1998/99 which evaluated the strengths and weaknesses of the existing assessment systems. Evidence was taken from examination syllabi, assessments and records. Semi-structured interviews were conducted with representatives from national bodies and with trainers and trainees in the West Midlands. Strengths in parts of the system include: commitment and professional experience; commissioned work; opportunity to share experience; a monitoring framework; procedures for maintaining standards and examples of broadbased assessments. Weaknesses include: lack of assessment of quality; existence of some forms of unregulated assessment; lack of transparency and lack of clarity between training and assessment. Development is recommended in three broad areas: a competence-based model of assessment; distinguishing assessment from the analysis of educational needs and quality assurance. The introduction of a competence-based model is the most significant and is addressed in some detail. Specific proposals for consideration by national regulatory bodies and education providers include: strengthening the management of assessment; national leadership in the development of a competence model of assessment; widening the assessment base; clearer criteria for inspection; revisions to how vocational training, HO/SHO training and general professional training are assessed and training for trainers.     

Quality Management in Orthodontics

The introduction of modern quality thinking to orthodontic care should be a continuing effort on the part of the orthodontic profession.The strategy for the development of a European quality management system in orthodontic care was developed from 1993 to 2000 during the EURO-QUAL project. During the project's first stage, the basic prerequisites were identified for a general model of quality management in orthodontic care. A supra-national agreement was reached on policy statements for orthodontic care in Europe.The essential components of an orthodontic quality management system are: linking orthodontic care to population need, patient partnership, clinical accountability, and containing costs.Value-based health care and "TQM", the philosophy of total quality management, are basic principles applied in accordance with the recommendations of the European Health Committee of September 1997 and the "Health-for-All" policy framework of the World Health Organization.     

Student evaluation of a problem-oriented module of clinical medicine within a revised dental curriculum

As part of a revised dental curriculum, a 3(rd) year module on medical subjects was developed based on a mixture of self-study and problem-oriented approach using cases. Pairs of students had to select a specific medical problem and solve a paper patient case using a problem-solving cycle. Results were presented in working groups and by writing an essay. The quality of the presentations was assessed by colleague students and by the teacher supervisor; the expert teacher in the field graded the essay. The results contributed for 40% to the overall grade of the module. A questionnaire filled out by 94% of the participating students showed that 85% of the students agreed in preferring this way of handling medical problems as compared with conventional, lecture-based education. Almost all of them enjoyed the provided opportunity to give a case presentation. The problem-oriented model was assessed as useful by 73% of the students. Knowledge concerning the topic chosen turned out to be higher than knowledge of other topics. Although this study cannot prove that this mode of education actually results in a better ability to cope with medical problems, it may contribute in several ways to the final competences in the area of general medicine in the undergraduate dental curriculum.     

Model curriculum for forensic dentistry in US dental schools.

A model curriculum for forensic dentistry in US dental schools has been presented. This curriculum follows guidelines that will provide the dental student with practical training in specific forensic techniques, knowledge of general principles of forensic dentistry, and an appreciation for the dentist's responsibility within the legal community.     

Assessing the impact of oral health on the life quality of children: implications for research and practice

Traditionally, child oral health has been assessed using clinical parameters of disease and deformity. However, there is a growing interest in the psychosocial impact of oral health among children. This commentary outlines the value and need for assessing child oral health-related quality of life (COHQoL). COHQoL has implications for oral health needs assessment (at an individual and population level) and for evaluating outcomes from specific treatments, initiatives and dental services overall. In addition, it could prove to be a useful adjunct tool for evidence-based dentistry research and practice. Theoretical and practical considerations in assessing the complex psychosocial construct of oral health among children are discussed: the use of general versus oral health-specific measures, the development of tools for children, the use of generic versus condition-specific measures, and the measurement of 'positive' oral health. Recommendations for research and practice are presented.     

Oral health promotion for our ageing Australian population

The ageing Australian population living in the new millennium has dental needs that are very different and more complex than those experienced by previous older adult cohorts during the twentieth century. A summary of the oral health status of older Australians is presented, together with a review of the important relationships between general health and oral health. The key to maintaining and improving older adults' oral health status is the use of oral health promotion strategies that focus not only on dental characteristics, but also on the life characteristics of older adults, and on their quality of life issues. Traditionally, there has been very limited geriatric oral health promotion, with several myths contributing to this situation. Contemporary geriatric oral health promotion in the new millenium has an evidence-based and planned approach. It encompasses not only the treatment of oral diseases and conditions, but has an increased focus on the prevention of oral diseases and conditions to enhance oral health status and older adults' quality of life. Using the Ottawa Charter and a functional dependence classification, a geriatric oral health promotion matrix is presented, using a specific example of Australian residential care.     

Comparative study of two digital radiographic storage phosphor systems

The objective of this study was to evaluate the image quality and dynamic range of two digital radiographic storage phosphor systems: Digora (Soredex, Finland) and DenOptix (Gendex, USA). Four objects were analyzed and eight exposure times employed, totaling 64 images that were analyzed by 5 examiners using a scale from 1 to 4 to classify the images. The scores were submitted to analysis of variance and the results showed statistical differences among the averages attributed to the systems, to the exposition times and to the objects (p 0.01 Pound). Digora presented a larger dynamic range and, in general, a better image quality. Although these 2 systems present the same photon detector, they present different results in relation to the evaluated items.     

A cross sectional study of water quality from dental unit water lines in dental practices in the West of Scotland

OBJECTIVE: To determine the microbiological quality of water from dental units in a general practice setting and current practice for disinfection of units. DESIGN: A cross-sectional study of the water quality from 40 dental units in 39 general practices and a questionnaire of the disinfection protocols used in those practices. SETTING: NHS practices in primarydental care. SUBJECTS: Thirty-nine general practices from the West of Scotland. METHODS: Water samples were collected on two separate occasions from dental units and analysed for microbiological quality by the total viable count (TVC) method. Water specimens were collected from the triple syringe, high speed outlet, cup filler and surgery tap. Each participating practitioner was asked to complete a questionnaire. Results Microbial contamination was highest from the high speed outlet followed by the triple syringe and cup filler. On average, the TVC counts from the high speed water lines at 37 degrees C and for the high speed lines, triple syringe and cup filler at 22 degrees C were significantly higher than that from the control tap water specimens. The study included units from 11 different manufacturers with ages ranging from under one year to over eight years. The age of the dental unit analysed did not appear to influence the level of microbial contamination. Five of the practices surveyed used disinfectants to clean the dental units but these had no significant effect on the microbiological quality of the water. The majority of dental units (25 out of 40) were never flushed with water between patients. A number of different non-sterile irrigants were used for surgical procedures. CONCLUSION: The microbiological quality of water from dental units in general dental practice is poor compared with that from drinking water sources. Suitable sterile irrigants should be used for surgical procedures in dental practice. Further work is required for pragmatic decontamination regimens of dental unit water lines in a general dental practice setting