Provision of orthodontic care to adolescents in South Australia: The type, the provider, and the place of treatment

There are many pathways involving different providers and locations that individuals may take in obtaining orthodontic services. The aim of this study was to document the provision of orthodontic services and establish the pathways taken toward fixed orthodontic treatment by adolescents in South Australia. Data were collected on the use of orthodontic services by a cohort of adolescents enrolled in the School Dental Service at age 13 years and again at age 15 years. By age 15 years, 83.2 per cent of the adolescents had received orthodontic consultations, 27.3 per cent had received fixed orthodontic treatment and 41.4 per cent had received other forms of orthodontic treatment (extractions, space retainers or removable appliances). The majority of fixed orthodontic treatment was supplied by orthodontists in the private sector, while extractions and removable appliances were provided mainly by public sector general dentists. Most individuals used services in both the public and private sectors and the most frequent pathway taken by the adolescents receiving fixed orthodontic treatment involved consultation in both the public and private sectors, non-fixed orthodontic treatment in the public sector and fixed orthodontic treatment in the private sector. The findings indicate wide access to orthodontic consultation and a high uptake of fixed orthodontic treatment once the adolescent sought private sector orthodontic consultation. Orthodontic care was seen to be an interactive process between public sector general dentists and private sector orthodontists.     

A study on moral hazard in dentistry: costs of care in the private and the public sector

Tuominen R, Eriksson A‐L. A study on moral hazard in dentistry: costs of care in the private and the public sector. Community Dent Oral Epidemiol 2011; 39: 458–464. © 2011 John Wiley & Sons A/S Abstract – Objectives: The aim of this study was to evaluate the costs of subsidized care for an adult population provided by private and public sector dentists. Methods: A sample of 210 patients was drawn systematically from the waiting list for nonemergency dental treatment in the city of Turku. Questionnaire data covering sociodemographic background, dental care utilization and marginal time cost estimates were combined with data from patient registers on treatment given. Information was available on 104 patients (52 from each of the public and the private sectors). Results: The overall time taken to provide treatment was 181 days in the public sector and 80 days in the private sector (P < 0.002). On average, public sector patients had significantly (P < 0.01) more dental visits (5.33) than private sector patients (3.47), which caused higher visiting fees. In addition, patients in the public sector also had higher other out‐of‐pocket costs than in the private sector. Those who needed emergency dental treatment during the waiting time for comprehensive care had significantly more costly treatment and higher total costs than the other patients. Overall time required for dental visits significantly increased total costs. The total cost of dental care in the public sector was slightly higher (P < 0.05) than in the private sector. Conclusions: There is no direct evidence of moral hazard on the provider side from this study. The observed cost differences between the two sectors may indicate that private practitioners could manage their publicly funded patients more quickly than their private paying patients. On the other hand, private dentists providing more treatment per visit could be explained by private dentists providing more than is needed by increasing the content per visit.     

The place of radiography in endodontic treatment carried out in general practice in Dakar]

An investigation conducted over dental surgeons of 52 dental offices in Dakar and it's near suburb (40 from private sector and 12 from public and quasi-public) has shown that the use of retro-alveolar radiography during endodontic treatment was not systematic, due to the price of retro-alveolar film, waste of time and relative facility of the endodontic treatment of monoradicular teeth. The preparatory negative is favored (32.70%) particularly by private dental surgeons, who use two retro-alveolar films for endodontic treatment: pre and post operative radiography (30%). The immediate post operator control is executed only in case of post-operator pains by public and quasi-public dental surgeons (16.67%) with one retro-alveolar film on average for the endodontic treatment; at term any radiographic control is done. Three retro-alveolar films per endodontic treatment were exceptionally used (9.61%) and offset incidences (15%) are not much used as well as support-films (angulators). The retro-alveolar radiography is still a reliable guide for a clinical success in endodontic treatment with a minimum of three retro-alveolar films and offset incidences.     

Systems for the provision of oral health care in the Black Sea countries. Part 11: Serbia

This paper gives an overview of the provision of health care in the Republic of Serbia. It then gives details of the system for the provision of oral health care, the education of dentists and dental staff, epidemiological data, and costs. It includes details of the state (public) and private sectors of health and dental care in Serbia. Private health and oral health care is based mainly on a number of practices that provide medical and dental care to the population. The state sector has a wider range of types of provision, including complex health care institutions. The number of employees in the private health and dental sector is much smaller than the number of employees in the public sector. Far fewer patients seek private medical and dental care than visit a doctor and dentist in the state sector, which still provides the bedrock for the health system in Serbia.     

Retreatment in endodontics: treatment decisions by general practitioners and dental teachers in Finland

OBJECTIVE: To evaluate treatment decisions of general practitioners (GPs) and dental teachers (DTs) in cases of endodontically treated teeth and to test the hypothesis that dentists' treatment decisions are independent of their working sector and other practice characteristics. DESIGN: A questionnaire based on four endodontic cases was mailed to 400 GPs and 47 DTs. The GPs were selected by stratified randomisation by gender, and main occupation (public and private sector). Others were all full-time DTs, representing clinical disciplines other than surgery and orthodontics. The endodontic cases were described in detail: one with a radiograph enclosed, three with statements on radiographic examinations. For each case, respondents chose the optimal treatment from alternatives, later reclassified as 'no therapy now' (further examination within 3-12 months), and 'active treatment' (immediate retreatment or periapical surgery). RESULTS: For Case 1 (tooth 25, asymptomatic, in normal occlusion, the radiograph revealed an underfilled root canal and a crown with a post, widened periodontal ligament space around the apex but no radiolucency), active treatment was chosen more frequently by private than by public dentists (11% vs. 4%, P=0.01), but neither sector differed (P>0.05) from DTs (6%). Decisions in favour of active treatment were associated with higher share of adult patients (OR=2.8; 95%CI: 0.3, 1.0; P=0.01). Cases 2-4 showed no difference in treatment decisions by practice characteristics. CONCLUSION: Treatment decisions by GPs and DTs were quite similar for each case and in most cases independent of the dentist's work and practice related characteristics.     

Private practicing endodontists: production of endodontic services and implications for workforce policy

The methods and techniques used by private practicing endodontists to provide patient care are at the core of endodontic workforce policy. Productivity influences both the amount of care provided and the required number of practicing endodontists in the future. Data was collected from practicing endodontists in order to characterize the technical methods of producing endodontic services. This data was then used to develop a statistical model for use in assessing the national endodontic workforce conditions in the United States. A survey was mailed to a random sample of 2,075 private practicing endodontists in the United States based on membership files from the American Association of Endodontists and the American Dental Association. The overall survey consisted of three means of data collection: (1) a survey about the endodontic practice as a whole; (2) a survey about the endodontist; and (3) patient encounter forms used when collecting detailed endodontic procedure data for a single day in the practice. The model was used to obtain a projection of 4,016 endodontists in the year 2005 and 4,671 practicing endodontists in 2010 required to meet the projected demand for endodontic care. The model and survey data provide valuable information to practicing endodontists for use in identifying critical elements used to render care, how the elements are combined in the practice of endodontics, and the minimum number of endodontists required to provide a given volume of endodontic care.     

Accuracy of Cone-beam Computed Tomographic Image Interpretation by Endodontists and Endodontic Residents

Introduction

Limited field cone-beam computed tomography (CBCT) imaging has become a modality frequently used by endodontists to evaluate the teeth and surrounding tissues of their patients. Accurate image interpretation is vital to obtain needed treatment information as well as to discern coincidental findings that could be present. The goal of this study was to determine the accuracy of CBCT volume interpretation when performed by endodontists and endodontic residents.

Clinical endodontic management during the COVID-19 pandemic: a literature review and clinical recommendations

The spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in millions of confirmed cases and hundreds of thousands of deaths. Despite all efforts to contain the spread of the disease, the number of infections and deaths continue to rise, particularly in some regions. Given its presence in the salivary secretions of affected patients, and the presence of many reported asymptomatic cases that have tested positive for COVID-19, dental professionals, including Endodontists, are at high risk of becoming infected if they do not take appropriate precautions. As of today, there are no predictable treatments or approved vaccines that can protect the public and healthcare professionals from the virus; however, there is speculation that a vaccine might be available sometime in 2021. Until then, general dentists and Endodontist will need to be able to treat emergency patients in order to relieve pressure on emergency clinics in hospitals or local community hubs. In addition, as the pandemic continues, strategies to manage patients will need to evolve from a palliative to a more permanent/definitive treatment approach. In this article, an update on the treatment considerations for dental care in general is provided, as well as a discussion on the available endodontic guidelines reported in the literature. Recommendations on clinical management of endodontic emergencies are proposed.     

Operator-related aspects in endodontic malpractice claims in Finland

Objective: We analyzed operator-related differences in endodontic malpractice claims in Finland.

Materials and methods: Data comprised the endodontic malpractice claims handled at the Patient Insurance Centre (PIC) in 2002–2006 and 2011–2013. Two dental advisors at the PIC scrutinized the original documents of the cases (n?=?1271). The case-related information included patient’s age and gender, type of tooth, presence of radiographs, and methods of instrumentation and apex location. As injuries, we recorded broken instrument, perforation, injuries due to root canal irrigants/medicaments, and miscellaneous injuries. We categorized the injuries according to the PIC decisions as avoidable, unavoidable, or no injury. Operator-related information included dentist’s age, gender, specialization, and service sector. We assessed level of patient documentation as adequate, moderate, or poor. Chi-squared tests, t-tests, and logistic regression modelling served in statistical analyses.

Results: Patients’ mean age was 44.7 (range 8–85) years, and 71% were women. The private sector constituted 54% of claim cases. Younger patients, female dentists, and general practitioners predominated in the public sector. We found no sector differences in patients’ gender, dentists’ age, or type of injured tooth. PIC advisors confirmed no injury in 24% of claim cases; the advisors considered 65% of injury cases (n?=?970) as avoidable and 35% as unavoidable. We found no operator-related differences in these figures. Working methods differed by operator’s age and gender. Adequate patient documentation predominated in the public sector and among female, younger, or specialized dentists.

Conclusions: Operator-related factors had no impact on endodontic malpractice claims.     

Recommendations for endodontic referral among practitioners in a dental HMO.

This study assessed the effect of patients' presenting conditions on general practitioners' (GPs') self-reported endodontic referral patterns, and compared GPs' perceived indications for referral with those of endodontists. The study was based on a self-administered, confidential survey distributed to 79 GPs and 7 endodontists who provide care to members of one Dental HMO in the Pacific Northwest. GPs were most likely to recommend referral for teeth they felt needed surgical retreatment, but GPs and endodontists did not always agree on indications for referral. Compared with GPs, endodontists were more likely to recommend referral for patients with complex problems, but not necessarily technically difficult teeth. Compared with those with less experience, GPs with more than 10 yr both in dentistry and at this HMO were more likely to recommend (a) referring difficult cases rather than performing endodontic therapy themselves and (b) extracting perforated or root-fractured teeth prior to obturation rather than continuing treatment. Indications for referral that maximize favorable dental outcomes need to be identified.     

Factors influencing recent dental graduates' location and sector of employment in Victoria

BACKGROUND: Recruitment and retention of dentists in the public sector and rural areas in Victoria has become increasingly difficult in recent years. There are little available data on the factors that influence the sector and location of practice of new dental graduates. The objective of this study was to investigate the factors considered by new graduates in determining the location and sector of employment after graduation, and influencing any early changes in career path. METHODS: Questionnaires were sent to dentists who Mgraduated from The Univrersity of Melbourne from graduated from The University of Melbourne from 2000-2003 who were currently practising in Victoria. There were 154 subjects to whom questionnaires were sent and 109 useable questionnaires were returned, a response rate of 74 per cent. RESULTS: Upon graduation, 53 per cent of the new graduates chose to work in the private sector only, compared to 15 per cent in public sector only and 33 per cent in both. At present, 71 per cent work in the private sector only, 17 per cent in the public sector only and 12 per cent in both. The most important factors for choosing to work in the private sector were receiving broad range of clinical experience, opportunities to familiarize with practice management and providing a continuity of care. The principal factors for practising in the public sector were clinical mentoring and advice, consolidating clinical skills and work environment. Initially, 48 per cent of the sample chose to work in metropolitan areas only, 39 per cent in rural areas only and 13 per cent in both. Factors that influenced the decision to work in rural areas were the broad range of clinical experience and remuneration, while the main factors for choosing to work in metropolitan areas were lifestyle and proximity to family and friends. CONCLUSIONS: This study found that a large proportion of new dental graduates initially chose to work in the public sector and rural areas on graduation primarily as a means of consolidating their clinical skills. However, retention of dentists in both these areas appears to be a problem, with less than 10 per cent of 2000-2001 graduates still than 10 per cent of 2000-2001 graduates still working in the public sector and only 20 per cent of 2000-2001 graduates still working in rural areas.     

The effect of public or private management on patients with temporomandibular joint pain dysfunction

Australians may receive free dental treatment via the public sector if they have a health care card but otherwise must seek treatment via the private sector. These two modes of dental delivery have different objectives, facilities, and patient populations. Two groups of patients, one public and one private, who presented to the same clinicians with temporomandibular joint dysfunction were studied. There were differences in age, numbers of natural teeth and some psychological features. However, the outcome to simple non-surgical management resulted in similar levels of successful treatment.     

Enhanced visualization with microscopy and digital radiography

The ability to visualize the three-dimensional anatomy of the root canal system is essential in both surgical and nonsurgical endodontic procedures. Endodontists have adopted two new technologies to enhance visualization: the surgical operating microscope and digital radiographic imaging. This review article discusses the uses and benefits of these technologies and how they have advanced the art and science of modern endodontic treatment.     

Knowledge and practices of decontamination during root canal treatment by dentists in Jeddah

BackgroundThe periapical area is healed through disinfection of root canal system and reduction of microbial infection after root canal.PurposeTo assess the knowledge of dental practitioners about decontamination during root canal treatment and the techniques used in the government and private sectors of Jeddah, Saudi Arabia.Methods103 dental practitioners and interns from private and governmental sectors performing root canal treatment were included. To extract information, a questionnaire assessing knowledge and preferred techniques used in decontamination during root canals treatment was distributed. The association of variables was investigated using chi-square tests.ResultsThe findings reflected that 82.5% of subjects used rubber dam for isolation with significantly more practitioner in the governmental (95.2%) as compared to the private sector (27.8%). Chelating agents were used by 13.3% of the practitioners in government sector and 1% practitioners in private sector (1%). The most commonly used irrigant was sodium hypochlorite. Calcium hydroxide was used more frequently in the governmental sector (29.8%) than in the private sector (11.8%), as intracanal medicament. Mechanical irrigation devices were used by 2.4% of practitioners in the governmental sector only.ConclusionsThere is a significant difference in practicing root canal disinfection techniques among dentists in governmental and private sectors but no difference in degree of knowledge.     

Treatment choices for negative outcomes with non‐surgical root canal treatment: non‐surgical retreatment vs. surgical retreatment vs. implants

The revision of negative treatment outcomes is a significant part of current endodontic practice. Both non‐surgical and surgical retreatment procedures share the problem of a significant negative outcome in the presence of apical periodontitis. More positive results may be achieved in certain teeth with a combination of both procedures rather than either alone. However, there are pressures to replace these ‘failed’ endodontically treated teeth with implants. When comparable criteria are applied to outcomes, the survival rates of endodontic treatment and implant placement are the same. Time, cost, and more flexible clinical management indicate that endodontic retreatment procedures should always be performed first unless the tooth is judged to be untreatable. Endodontists should be trained in implantology to assist patients and referring colleagues in making informed treatment decisions.     

Why intravenous moderate sedation should be taught in graduate endodontic programs

The purpose of this opinion article is to present reasons why intravenous moderate sedation should be taught in graduate endodontic programs. Access to oral health care is an area of much interest and concern, but some patients are unable to get endodontic care because they have special needs. Special needs can refer to patients who fear dentistry itself and other aspects of dental treatment. A variety of phobias and medical, developmental, and physical conditions can make it difficult for some patients to tolerate the endodontic care they need and want. Moderate sedation can help many of these patients. Endodontists in general are not trained to provide intravenous moderate sedation. By incorporating intravenous moderate sedation into endodontic practice, many of these patients can be treated. The first step in achieving this goal is to add intravenous moderate sedation training to graduate endodontic programs. The long-term effect will be to make specialty endodontic care available to more people.     

Revascularization-associated Intracanal Calcification: A Case Report with an 8-year Review

Revascularization-associated intracanal calcification (RAIC) is a common finding in immature teeth managed with regenerative endodontic treatment (RET). The aim of this report was to illustrate a case in which 2 mandibular premolar teeth developed complete canal obliteration and have been reviewed for 8 years. The 3 primary outcome goals as defined by the American Association of Endodontists after RET are resolution of signs and symptoms of pulp necrosis, further root maturation, and achievement of responses to pulp vitality testing. The teeth had been included in an earlier quantitative study in which an increase in root canal width of 72.1% and 39.6% and an increase in root length of 1.7% and 0% were reported for teeth #20 and #29, respectively. Qualitative assessments over the 8-year review period showed no pathosis and a response to electric pulp testing at the final review. A quantitative assessment at the 8-year review showed an increase of 100% for canal width because complete calcification had occurred and no substantive change in root length (?0.17% and 0.68% for teeth #20 and #29, respectively). In this report, complete RAIC occurred in both teeth over time. RAIC has the potential to complicate future endodontic or prosthodontic treatment if necessary. Therefore, it is recommended that the American Association of Endodontists clinical considerations for a regenerative endodontic procedure be updated to include the incidence of RAIC after RET.