Assessing periodontal disease risk: a comparison of clinicians' assessment versus a computerized tool

BACKGROUND: The authors conducted a study to compare risk scores assigned by subjective expert clinician opinion with quantitative scores generated for the same subjects using the Periodontal Risk Calculator, or PRC. METHODS: The authors assembled a group of 107 subjects and performed standard periodontal examinations. The authors entered the resulting information into the PRC and calculated risk scores for two and four years, assuming no treatment would be performed. Using the same subject records, three groups of expert clinicians assigned risk scores for years 2 and 4. The authors analyzed the data to reveal the extent of interevaluator variation and the level of agreement between expert clinician scores and PRC scores. RESULTS: The extent of variation among scores assigned by individual expert clinicians was greater than the authors had expected. Expert clinicians consistently assigned more subjects to PRC risk group 2 and fewer to risk group 5 than did the PRC. The authors observed very high heterogeneity in the risk scores expert clinicians assigned to patients in each of the PRC-assigned groups. Thus, expert clinicians varied greatly in evaluating risk and, relative to the PRC, they appeared to underestimate periodontitis risk, especially for high-risk patients. CONCLUSIONS AND PRACTICE IMPLICATIONS: The authors' observations suggest that use of risk scores generated for individual patients by subjective expert clinician opinion about risk in periodontal clinical decision making could result in the misapplication of treatment for some patients and support the use of an objective tool such as the PRC. Use of the PRC over time may be expected to result in more uniform and accurate periodontal clinical decision making, improved oral health, reduction in the need for complex therapy and reduction in health care costs.     

Relative efficacy of oral analgesics after third molar extraction--a 2011 update

This article provides a summary of the efficacy, and relative efficacy, of 38 different drugs or drug combinations tested in standard postoperative pain trials. It will help clinicians and patients make informed choices about analgesia based on pain relief, duration of action, and adverse events, which can then be put into context for the individual patient, depending on local availability. This article highlights the fact that no single drug is effective in all patients--even the best drugs fail to provide good levels of pain relief in at least 30%. These patients should try a different analgesic.     

Current implant usage

The types of dental implants in current use are described with comments on the various designs, the materials of which the implants are made, the patient situations for which they are used, and the age range of patients treated. The training background of the various clinicians involved is mentioned and comparisons are made between the United States, Japan and Central Europe. Predictions for the future use of implants are made and areas for future research are indicated, based upon deficiencies in our present knowledge.     

Computer-aided individual prognoses of squamous cell carcinomas of the lips, oral cavity and oropharynx.

Computer-aided individual prognoses (CIP) is a software-package developed on the basis of an empirical study and can be installed on any IBM-compatible personal computer. The project which went into the making of CIP was called "Prospective DOSAK-study on squamous cell carcinomas of the lips, oral cavity and oropharynx". In the course of the study 1485 patients were treated between 1977 and 1982, and followed up through 1985. CIP facilitates individual prognoses and comparisons of independent patient groups with parallel groups from the data of the above-mentioned study. In practical clinical work individual prognoses allow exact and reliable judgements on individual patients. In clinical cancer research it provides the information about prognostic factors required for controlled clinical studies. The comparison of independent patient populations allows for an ongoing qualitative control of the patients in each clinical institution. In clinical cancer research such a comparison means that certain characteristics of the patient, the tumor and of the disease can be given higher prognostic value. The same is true of the clinical testing of therapeutic measures which is typically carried out during phase-II-studies. Due to its menu-based organization CIP does not presuppose any specialist knowledge on the part of its users and can be regarded as particularly user-friendly.     

Evaluation of remote OMFS assessments in the era of pandemic COVID-19 control measures

Pandemic COVID-19 has put unprecedented pressure on NHS providers to offer non face-to-face consultation. This study aims to assess acceptability of patients and clinicians towards teleconsultation in oral and maxillofacial surgery compared with an expected face-to-face assessment. 340 telephone clinic patient episodes were surveyed over the initial 7-week period of pandemic-related service restriction. Appointment outcomes from a further 420 telephone consultations were additionally scrutinised. A total of 59.1% of patients expressed a strong preference for teleconsultation with only 13.1% stating a moderate or strong preference for face-to-face assessment. Diagnostic accuracy was highlighted as a concern for both clinicians and patients due to inherent inability to conduct a traditional clinical examination, notable in 43.5% of qualitative comments. Logistical concerns, communications needs and other individual circumstances formed the other emerging themes. The majority of remote consultations (59.5%) were outcomed as requiring further review. A total of 29.3% of patients were discharged. These findings suggest that the increasing use of remote follow-up in carefully selected subgroups can facilitate efficient and acceptable healthcare delivery. Although ‘in-person’ clinical appointments will continue to be regarded as the default safe and gold standard management modality, OMFS departments should consider significant upscaling of teleconsultation services.     

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提要：种植义齿修复牙齿缺失、牙列缺损越来越受到广大临床医生和缺失牙患者的青睐，由于种植义齿美观、舒适、最大限度地恢复咀嚼功能，又不损伤健康邻牙的优点，已成为缺牙患者的最佳选择。目前开展种植义齿修复的医疗机构和个体诊所迅猛增加。然而，有些医疗单位缺乏开展种植的必要条件和设备，医生又没有接受过正规的培训，对种植义齿修复的适应证选择、种植体植入过程中操作原则以及上部结构修复时的操作要点等方面的知识掌握不足，在临床上经常会出现一些问题。本文通过查阅了大量的国内、外相关文献，并结合自己多年的临床工作经验，对种植义齿修复过程中各个阶段常见问题的原因进行分析，并提出自己的解决方案，为临床医生提供参考。     

Situational awareness – what it means for clinicians,its recognition and importance in patient safety

A thorough understanding of the role of human factors in error in health care for improving patient safely is paramount. One area particularly crucial for optimising clinical performance is the recognising the importance of situational awareness. Loss of situation awareness can occur in many different settings, particularly during stressful and unexpected situations. Tunnel vision is a classic example where clinicians focus on one aspect of care, often to the detriment of overall patient management. Loss of situational awareness can result in serious compromise to patient safety if it is not recognised by either the individual or clinical team. We provide an introduction to situational awareness for those not familiar with it, including some important theory which explains how awareness can be lost, and discuss the important approaches we use in our day‐to‐day practice to safeguard both patients and clinicians in the workplace environment.     

The bone-added osteotome sinus floor elevation technique: multicenter retrospective report of consecutively treated patients

A retrospective clinical evaluation of patients consecutively treated from multiple centers was performed. The treatment of these patients utilized the bone-added osteotome sinus floor elevation (BAOSFE) procedure with immediate implant fixation. The BAOSFE method employs a specific set of osteotome instruments to tent the sinus membrane with bone graft material placed through the osteotomy site. A total of 174 implants was placed in 101 patients. Implants were of both screw and cylinder shapes with machined, titanium plasma-sprayed, and hydroxyapatite surfaces from various manufacturers. The 9 participating clinicians used autografts, allografts, and xenografts alone or in various combinations, and the type of graft was selected by the individual clinicians. The choice of graft material did not appear to influence survival rates. Loading periods varied from 6 to 66 months. The survival rate was 96% or higher when pretreatment bone height was 5 mm or more and dropped to 85.7% when pretreatment bone height was 4 mm or less. The most important factor influencing implant survival with the BAOSFE was the preexisting bone height between the sinus floor and crest. This short-term retrospective investigation suggests that the BAOSFE can be a successful procedure with a wide variety of implant types and grafting procedures.     

Use of risk assessment in attaining and maintaining oral health

The cost of health care is increasing rapidly. A transition from the "repair" to a "wellness" model of oral health care that minimizes the occurrence of disease and the need for complex treatment may reduce costs and improve oral health. Quantification of risk is essential for successful use of the wellness model. Subjective risk assessment by expert clinicians is too variable to be useful in clinical decision making. However, user-friendly Internet-based technology has been developed that provides a consistently accurate and valid quantified risk assessment for periodontitis, as well as a quantified measure of disease severity and extent. The numeric information helps clinicians and patients make diagnoses and generate individual, needs-based treatment plans. This technology enables successful application of the wellness model of care in day-to-day dental practice. Use of the wellness model may result in more uniform and accurate periodontal clinical decision making, improved oral health, less need for complex periodontal therapy, lower oral health care costs, and improved clinician productivity and income.     

An implant versus a conventional fixed prosthesis: a case report

The success of endosseous implant dentistry is widely acknowledged. Clinical research and subsequent innovations with both surgical and restorative techniques--as well as improved surface features and restorative components--have made endosseous dental implants a routinely accepted dental treatment modality. Patients and referring clinicians often specifically request dental implant therapy. This article presents an example of such a patient; however, in this case, a surgical ridge augmentation and fabrication of a conventional fixed prosthesis was selected as the treatment modality. The authors believe that all therapeutic modalities should be considered when adapting appropriate treatment plans for individual patients.     

Australian population norms for the Index of Dental Anxiety and Fear (IDAF-4C)

Background: The Index of Dental Anxiety and Fear (IDAF‐4C) is a theoretically derived test developed to allow clinicians and researchers to measure a person’s level of dental fear. Population norms have not previously been made available for the IDAF‐4C. The aim of this study was to provide Australian norms for the IDAF‐4C using percentile ranks and to examine associations between scores and individual‐level characteristics, dental avoidance and fear of pain. Methods: A stratified random sample of 1511 Australian adults yielded complete questionnaire data for 1063 individuals (70.4%). Percentile ranks were calculated for IDAF‐4C full scale scores stratified by age and gender. Results: IDAF‐4C mean scores varied significantly by age, gender, income, and speaking a language other than English at home. Tables to convert raw scores to percentiles showed that full scale scores varied by age and gender. Scores on the IDAF‐4C had strong and significant associations with avoidance of the dentist due to fear, average dental visiting frequency and anxiety about pain when going to the dentist. Conclusions: Population norms allow clinicians or researchers to compare results for an individual or subgroup to the Australian population. It is recommended that a dental fear scale be used to screen all dental patients for dental fear to enable a more tailored and effective dental treatment experience.     

Adult orthodontic therapy: extraction versus non-extraction.

This study addresses the problem of randomization of subjects with respect to an irreversible aspect of treatment strategy, namely, the extraction of teeth. The investigation includes both prospective and retrospective components. The data presented focus on clinician decision-making. Of the 1321 potential subjects for whom records were taken, 250 met the inclusion criteria. Of these subjects, 82 declined to participate and 20 were dropped because of difficulty in obtaining five independent evaluations of their records within a reasonable time frame. Thus, the final sample contained 148 subjects. Approximately one-third of the subjects in the sample are adult, somewhat more than half are female, and Class I malocclusions outnumber Class II malocclusions by a count of 95 to 53. Patterns of agreement and disagreement among five clinicians include: a) agreement/disagreement on the primary decision whether or not to extract: the data reveal a strong tendency towards consensus among the clinicians; b) agreement/disagreement on extraction pattern in patients in whom the clinician believes that extraction is indicated: the clinicians tended strongly to agree on extraction pattern; c) agreement/disagreement on the need for adjunctive orthognathic surgery: decisions favoring surgery were more common and more 'definite' than 'probable' in the adult cohort than in the adolescent cohort but this tendency was not as strong as had been anticipated; d) agreement/disagreement concerning Angle classification: disagreements were more common than had been anticipated; and e) differences among the individual clinicians as to their ratios of extraction/non-extraction decisions: overall, clinicians opted for extraction less frequently in the adolescent cohort than in the adult cohort (55 vs. 66%). Because the data are drawn from actual clinical experience, the conclusions involve a number of assumptions and their generalizability should be evaluated.     

Adult orthodontic therapy: extraction versus non-extraction

This study addresses the problem of randomization of subjects with respect to an irreversible aspect of treatment strategy, namely, the extraction of teeth. The investigation includes both prospective and retrospective components. The data presented focus on clinician decision-making. Of the 1321 potential subjects for whom records were taken, 250 met the inclusion criteria. Of these subjects, 82 declined to participate and 20 were dropped because of difficulty in obtaining five independent evaluations of their records within a reasonable time frame. Thus, the final sample contained 148 subjects. Approximately one-third of the subjects in the sample are adult, somewhat more than half are female, and Class I malocclusions outnumber Class II malocclusions by a count of 95 to 53. Patterns of agreement and disagreement among five clinicians include: a) agreement/disagreement on the primary decision whether or not to extract: the data reveal a strong tendency towards consensus among the clinicians; b) agreement/disagreement on extraction pattern in patients in whom the clinician believes that extraction is indicated: the clinicians tended strongly to agree on extraction pattern; c) agreement/ disagreement on the need for adjunctive orthognathic surgery: decisions favoring surgery were more common and more ‘definite’ than ‘probable’ in the adult cohort than in the adolescent cohort but this tendency was not as strong as had been anticipated; d) agreement/disagreement concerning Angle classification: disagreements were more common than had been anticipated; and e) differences among the individual clinicians as to their ratios of extraction/non-extraction decisions: overall, clinicians opted for extraction less frequently in the adolescent cohort than in the adult cohort (55 vs. 66%). Because the data are drawn from actual clinical experience, the conclusions involve a number of assumptions and their generalizability should be evaluated.     

Relevance of the water flosser: 50 years of data

A review of the literature answers many questions related to the use of water flossers, the first of which was introduced in 1962. Numerous studies suggest that water flossers remove biofilm from tooth surfaces and bacteria from periodontal pockets better than string flossing and manual toothbrushing-together or alone. Clinicians should review these findings and consider recommending water flossers for appropriate patients to improve their oral health. As different irrigation or water-flossing devices now on the market offer different features, designs, and combinations of pulsation and pressure, clinicians must consider the needs of individual patients and supporting research in selecting a model that the patient will like and use, and that will provide improved oral health.     

Influence of clinical experience on accuracy of virtual orthodontic attachment bonding in comparison with the direct procedure

Objectives:To compare the accuracy of bonding orthodontic attachments in a digital environment with the direct bonding procedure depending on the level of the orthodontist''s clinical experience.Materials and Methods:A total of 1120 artificial teeth of 40 identical models (20 solid sets + 20 digital sets) were divided into four groups: (1) direct bonding (experienced clinicians). (2) direct bonding (postgraduate students), (3) virtual bonding (experienced clinicians), and (4) virtual bonding (postgraduate students). The differences in individual position of the placed attachments were measured after three-dimensional superimposition of the models using customized software.Results:In the interoperator comparison, experienced clinicians were more exact than postgraduate students in virtual bonding in the angular dimension. Between the bonding techniques, virtual bonding was more accurate than the direct technique. The prevalence of errors was higher in the direct procedure than virtual bonding, and the errors were more significant in the premolar and molar teeth.Conclusions:Clinical experience had a positive influence in achieving a higher rate of correctness/accuracy in the angular dimension only during virtual bonding. Virtual bonding was more accurate than direct bonding in the vertical and horizontal dimensions. Early diagnosis of errors in the bonding positions of attachments could be of benefit to both clinicians and patients by predicting discrepancies that may lead to undesirable orthodontic movements.     

The role of competence and capacity in relation to consent for treatment in adult patients

Obtaining informed consent for dental and medical treatment is a fundamental ethical and legal responsibility for all clinicians. It is an opportunity for patients to have healthcare that is based on their informed choice. The assessment of a patient's competence is an essential part of the consent process and clinicians need to be aware that patients can be misunderstood and wrongly deemed incompetent. This paper aims to aid the clinician to better understand the concept of patient competency and capacity in relation to obtaining valid consent.     

Cathepsin B/L-, elastase-, tryptase-, trypsin- and dipeptidyl peptidase IV-like activities in gingival crevicular fluid: a comparison of levels before and after periodontal surgery in chronic periodontitis patients.

Gingival crevicular fluid (GCF) was collected from the deepest probing site of each tooth of 10 chronic periodontitis patients prior to treatment, after scaling and hygiene treatment, and after periodontal surgery. Surgery was carried out at sites which had persistent probing depths in excess of 5 mm. The patients were given a full periodontal examination, including measurements of probing depth, gingival index, bleeding index, and plaque index before each GCF collection. Cathepsin B/L-, elastase-, tryptase-, trypsin-, and dipeptidyl peptidase IV-like activities in the GCF samples were determined by fluorimetric assay with peptidyl derivatives of 7-amino-4-trifluoromethyl coumarin. There were reductions in all clinical parameters and all protease activities after scaling and hygiene treatment and further reductions after periodontal surgery. Decreases were recorded for both total enzyme activities and concentrations. The reductions were statistically significant in inter-patient comparisons using mean patient values and also in most intra-patient comparisons using site data from individual patients. GCF protease levels appear to reflect the clinical status of periodontal lesions and may prove to be of value in monitoring disease activity.     

Attitudes toward the shortened dental arch concept among Swedish general dental practitioners

PURPOSE: The purpose of this investigation was to obtain the opinions and assess the attitudes of Swedish general dental practitioners in private practice versus a public health care setting regarding management of patients with a shortened dental arch (SDA). MATERIALS AND METHODS: A questionnaire containing different statements regarding the SDA concept was sent to a random sample of 189 clinicians. Differences between male and female practitioners and between private practitioners (PPs) and those employed by the Public Dental Health Service (PDHS) were tested for statistical significance by the Student t test. RESULTS: The response rate was 54% (102 clinicians). Among the respondents, 62% were men and 38% were women. Fifty-six percent were PPs and 44% were employed by the PDHS. The results showed small differences in attitudes between various groups of practitioners but large individual variations. In general, Swedish general practitioners had a positive attitude toward the SDA concept with respect to oral function and oral comfort. They recognized few risks with a dentition lacking molar support, although female clinicians were more risk conscious. PPs expressed fewer advantages in using the SDA concept than PDHS practitioners with respect to the reduced risk for overtreatment, better patient economy, and the ability for older patients to keep their teeth. CONCLUSION: The results from this questionnaire study indicate that, overall, Swedish general practitioners have an affirmative opinion toward the SDA concept.