Predetermination as a Cost-containment Mechanism in a Social Allowances Dental Program in Manitoba

Objectives: A review of dental consultant actions during predetermination of benefits in the publicly insured indemnity program in Manitoba under which Social Allowances Health Services certificate holders receive dental care was under-taken to determine the value of this process as a cost-containment mechanism. Methods : Dollar amounts of services denied by a dental consultant during eight predetermination sessions selected to represent the 96 sessions during the 1990–91 fiscal year were determined and grouped according to category of service. Results : Approximately one-third of average total expenditures each month were reviewed by the dental consultant through the predetermination process. Of the requested dollar amount reviewed, 26 percent was denied, a savings of 8.5 percent of average total monthly expenditures. The categories of services that made up the denied requests were: prosthodontics (30%); endodontics (32%); restorative (5%); periodontics (12%); and miscellaneous (21%), including diagnostic, surgical, preventive, orthodontic, and adjunctive. Conclusions : A properly administered predetermination process can save a third party 8.5 percent of total plan expenditures; dollar changes to altered treatment plans amount to a 26 percent reduction of expenditures relating to these requests. A predetermination process with an unbiased appeal mechanism provides a system to advise and protect providers regarding what treatment is covered.     

Possible foetotoxic effects of mercury vapour: a case report

A thirty-year-old dental surgeon who worked until the 35th week of pregnancy in a surgery in which mercury vapour concentrations in excess of the threshold limit value (TLV) had been detected, gave birth at 42 weeks to a small-for-dates baby with severe brain damage. The possibility that this baby's development might have been harmed by mercury is discussed and the literature relevant to teratogenicity of mercury reviewed. Attention is drawn to the need for further research into the effects on health and pregnancy outcome of mercury vapour in dental surgeries.     

An Epidemiologic Estimate of the Critical Period during which Human Maxillary Central Incisors Are Most Susceptible to Fluorosis

The temporal relation between a declining fluorosis gradient and an abrupt downward shift in community drinking water fluoride concentration was evaluated through multiple correlation analysis to determine the critical time frame during which developing maxillary central incisors are most susceptible to fluoride challenge. Fluorosis data were scrutinized through a time-related series of epidemiologic "windows" or time frames of varying lengths. The placement of these time frames was in turn related to the presumed start of enamel mineralization (at birth), and ranged from zero to 60 months later. In this way, the susceptibility of developing enamel to changes in water fluoride concentration was localized. The greatest risk was associated with a four-month critical period commencing at 22 months following birth. The risk of fluorosis from exposures to a fluoride challenge acting during shorter periods was better localized than risk associated with longer exposures. We concluded (1) that human maxillary central incisors are most susceptible to fluorosis during a critical period of as little as four months' duration, commencing at 22 months of age; and (2) that for these incisors, fluoride exposure during the months prior to this period carries less risk than continued exposure for up to 36 months beyond this critical time.     

The Effect of Engaging the Screw Access Channel of an Implant Abutment with a Cement-Retained Restoration

Purpose: Factors affecting the retention of fixed prostheses to natural abutments are well understood. In contrast, little is known concerning the factors influencing the retention of fixed prostheses cemented to implant abutments. The purpose of this study was to investigate the effect that extending a casting into the screw access channel of an implant abutment has on the retention when cemented using Temp Bond.
Materials and Methods: Replace Select Straight abutments received set modifications (buccal wall removal at 15°, 22°, and 30°) using a milling machine; controls were unmodified. Two castings were fabricated for each of the modified abutments, one with and one without an extension into the screw access channel. Following cementation with Temp Bond under standardized conditions, the castings were removed from the abutments using an Instron machine, and the peak removal force was recorded.
Results: Extending the casting into the screw access channel significantly ( p < 0.001) increased the peak load of removal. Significant differences ( p < 0.05) were found between no modification and 30° modification, 15° and 30° modification, and 22° and 30° modification in the groups when the casting extended into the abutment. In the group where the casting did not extend into the abutment, all groups were significantly different ( p < 0.001) with the exception of 22° and 30° modification.
Conclusions: The increased load required to remove a casting that extends into the screw access channel of an implant abutment may compensate for loss in retention, which occurs through unfavorable modification of the abutment.     

Changing Inequalities in the Distribution of Caries Associated with Improving Child Oral Health in Australia

Objectives: This study aimed to document the changing distribution of and inequalities in dental caries in Australian children across the 25-year period from 1977 to 2002. Methods: Oral health data were obtained from Australia's national Child Dental Health Survey. Measures of caries distribution included the Significant Caries Index and the proportions of children with high caries experience [decayed, missing and filled teeth (DMFT) ≥ 4], while inequality was assessed by using Gini coefficients calculated from Lorenz curves. Changes in caries distribution were compared with changes in child dmft/DMFT. Results: While appreciable reductions occurred in child caries experience, in terms of both mean dmft/DMFT and for those children with the poorest oral health, inequalities in the distribution of caries experience increased across the 25-year period. Inequalities in the distribution of decayed and filled teeth differed for the deciduous and permanent dentition and, in the permanent dentition, became increasingly similar in the 1990s. Conclusions: Increasing inequalities in child dental caries in Australia must be interpreted in the context of declines in both mean caries experience and in the caries experience of those children with the poorest oral health. The Gini coefficient documents that the majority of the caries experience is increasingly being confined to a smaller percentage of the child population; however, this is a consequence of population-wide child oral health improvements.     

Recent Dental Caries and Treatment Patterns in US Children

This report presents dental caries and treatment patterns found in a longitudinal study of US children between 1978 and 1982 who were geographically dispersed across several fluoridated and nonfluoridated sites. The analyses include first- and fifth-grade children examined annually for four years in the National Preventive Dentistry Demonstration Program and who did not receive effective preventive procedures. The results indicate that in association with the caries decline in US children, treatment ratios increased by over 20 percent during the study period. FS/DFS ratios averaged 79 percent for the four grade/fluoridation status cohorts analyzed and were significantly higher in fluoridated than in nonfluoridated sites. The single-fissured surface was the dominant treatment or disease area observed and these surfaces tended to be restored early. In assessing tooth-surface status changes annually, tooth surfaces were more than twice as likely to change from sound to filled than from sound to decayed between yearly examinations at fluoridated sites. The lower levels of decay and higher degree of restorative care observed were not observed in lower SES and black children nearly to the extent as those for higher SES and white children in the population. The dental profession should shift its emphasis from the early restoration of fissured-surface defects to an expanded use of sealants for those with reduced decay and focus resources on a minority of the population with high caries levels who receive limited care.     

The accessibility of dental treatment to adults with physical disabilities in northeast England

The study was carried out to gain information about the availability and the accessibility of dental services to adults with physical disabilities in Gateshead, an industrial town with a population of 199, 588¹ situated in northeast England. Questionnaires were sent to all general dental practices to ascertain the dental staffs perceptions of the accessibility of their premises, their willingness to treat people with disabilities, and the types of treatment offered. The main problem for access was caused by stairs and other physical barriers within buildings. Lack of portable equipment limited the scope of domiciliary treatment offered.     

The University of North Carolina Caries Risk Assessment Study. II. Baseline Caries Prevalence

Baseline clinical dental examinations were conducted on 5,233 children in grades 1 or 5 from the areas surrounding Aiken, SC, and Portland, ME, as part of a longitudinal study being conducted to predict children at high risk to dental caries. Mean caries levels in the Aiken area were nearly twice those of the Portland area. Black children experienced slightly more disease than whites. In addition to lower levels of caries experience, Portland children also had more treatment needs met, as indicated by higher filled ratio scores.