Dissertations / Theses on the topic 'Dentistry, State'

There is poor oral health awareness in Nigeria. This is mainly attributed to limited access to correct information on oral health as well as a lack of oral health care providers. The impact of the poor oral health awareness is worse in Northern Nigeria due to the uneven distribution of oral health care workers and training facilities. The purpose of this cross-sectional study was to describe the roles of community pharmacists (CPs) in Plateau State, Nigeria as sources of oral health information. Theoretical framework for this study was the theory of planned behavior (TPB). Background knowledge and practices of oral health care by CPs were assessed as related to their demographic characteristics. A 1 sample t-test was used to assess CPs' knowledge of oral health. A binary logistic regression model was conducted to evaluate if some demographic variables could predict Plateau State CPs' interest in becoming more involved in provision of services on oral health problems. According to the study findings, the CPs had a good disposition towards engaging in oral health prevention services by providing some oral health services to patients with oral health problems. In addition, 94.7% of the CPs were willing to advance the cause of oral health care. The disposition of CPs towards oral health could serve as a platform to help propagate oral health care and awareness in their communities. Engaging the CPs might help reduce oral health disparities by increasing oral health awareness, improving oral health-seeking behavior and oral hygiene practices, and improving quality of life via cost effective delivery of pharmacy-based oral health care services.

Nutrition education is an integral part of dental education as well as a variety of other healthcare professions1, but interprofessional education (IPE) between the fields of dietetics and dental hygiene is limited. The purpose of this pilot study was to define areas of opportunity to establish a foundation for the implementation of complimentary curriculum between the dietetics and dental hygiene programs at ETSU. A 76-question survey was developed and administered to dietetic interns (n=26), dental hygiene students (n=49), dietetic faculty (n=23), and dental hygiene faculty (n=19) at ETSU and Baylor College of Dentistry at Texas A&M Health Science Center. Data analysis reveals a knowledge proficiency deficit in dental hygiene students related to nutrition and oral health as well as significant findings in perceived roles of the ‘other’ profession. The potential for interdisciplinary education and training between dietetic and dental hygiene students at ETSU is promising, potentially leading to improved patient care.

Professional associations must have a significant level of membership to be effective. Georgia membership is increasingly low; therefore, ADHA cannot represent dental hygienists’ interests. This study determined factors that caused dental hygienists to continue to forgo membership in the ADHA. Several theoretical views of professional membership were considered. The sample was acquired from an unbiased systematic sampling of 50% (3,270) of registered dental hygienists and a convenience sampling of ADHA nonmembers at 2 continuing education seminars in Georgia. Data collection procedures included an electronic cover letter, consent form, and survey via Survey Monkey or hard copies for seminars. Three hundred sixteen participated yielded a 9.6% return rate. Participants were primarily women, holding associate degrees, and graduates of programs in Georgia. Participants worked full time in private practice, were satisfied with their working hours, and did not join GDHA because membership fee is too high or not sure of benefits offered. Twenty-one percent stated that lowering membership fee would entice them to join, and participants indicated they obtained their continuing education hours at the Hinman (52%) convention and online (27%).

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Dissertacao (Mestrado)
IPEN/D
Instituto de Pesquisas Energeticas e Nucleares, IPEN/CNEN-SP

Thesis (D. Tech. (Biomedical Technology)) -- Central University of Technology, Free State, 2015
This study reviewed national and international literature to develop an audit-feedback instrument (AFI) to monitor adherence of South African oral health care facilities with compliance to infection prevention and control precautions. In a multi-phased literature search, existing infection prevention and control recommendations, guidelines and audit-feedback instruments were reviewed and broadened to include “dental audit tools”, as well as audit tools from other health care disciplines. Audit-feedback instruments were scrutinised for user friendliness, the use of simple language, electronic calculations and feedback possibilities. A new South African AFI was proposed, considering the differences between public and private oral health care facilities and also the diversity of training levels of oral health care personnel employed. Eleven focus areas supporting all aspects of infection prevention and control in oral health care facilities, including administrative controls; personnel protection controls; environmental- and work controls; surface contamination management; equipment maintenance, service or repair; air- and waterline management; personal protective equipment usage; personal and hand hygiene practices; sterilisation practices; safe sharps handling and waste management were included. The AFI was tested in a sample of 50 oral health care facilities. None of the participating facilities demonstrated 100% compliance. Personal- and hand hygiene practices and waste management performed the best, at respectively 75% and 63%, while administrative controls and air- and waterline management scored the lowest mean values; 31% and 36% respectively The general lack of compliance with infection prevention and control precautions in the participating oral health care facilities clearly poses a safety hazard to both patients and oral health care workers. Results indicate that adherence of South African oral health care facilities with compliance to infection prevention and control precautions need to be improved. The AFI should go a long way towards improving safety and the high expectations about providing quality infection prevention and control outcomes in oral health care.

A atenção odontológica tem sido tradicionalmente realizada em consultórios. Aos hospitais a prática mais comum é reservada ao atendimento cirúrgico bucomaxilofacial ou procedimentos que necessitam de anestesia geral. Entretanto, a atuação do Cirurgião-Dentista em âmbito hospitalar vai além. O Odontólogo deve ter foco no cuidado ao paciente cuja doença sistêmica possa ser fator de risco para agravamento e ou instalação de doença bucal, ou cuja doença bucal possa ser fator de risco para agravamento e ou instalação de doença sistêmica. (Silva-Lovato et al., 2009; Manual de Odontologia Hospitalar, 2012). O Estado de São Paulo conta com uma ampla rede de serviços hospitalares próprios. Embora os resultados dos últimos anos comprovem o maior acesso da população a rede hospitalar pública do Estado de São Paulo, com aumento no número de atendimentos a pacientes internados, maior quantidade de cirurgias e de procedimentos complexos realizados (Mendes, Bittar, 2010), não há dados públicos concretos comprovando a atuação do Cirurgião- Dentista nesse contexto. Por outro lado, estudos e experiências em hospitais têm mostrado que a inserção do Cirurgião-Dentista na equipe multiprofissional de atendimento ao paciente sob internação contribui para minimizar o risco de infecção, melhorar a qualidade de vida, reduzir o tempo de internação, diminuir a quantidade de prescrição de medicamentos e a indicação de nutrição parenteral, além de promover um atendimento completo ao paciente. (Sonis et al., 2001; Sonis et al., 2004; Morais et al., 2006; Vera-Llonch et al., 2007; Eduardo et al., 2008; Bezinelli et al., 2013). Nosso trabalho trata-se de um estudo transversal com o objetivo de caracterizar o serviço de Odontologia dentro dos hospitais públicos veiculados a Secretaria do Estado da Saúde de São Paulo. Para tanto foram coletados dados do Programa Sorria Mais São Paulo e do CNES de 62 hospitais de diferentes formatos de gestão: direta, indireta e autarquia e/ou fundação. Os resultados mostraram que dos hospitais de administração indireta (n=30), 9 possuem o Cirurgião-Dentista na equipe multiprofissional, sendo 33% desses voltados ao atendimento odontológico dos funcionários do Hospital, 33% pertencem ao serviço de Cirurgia Buco Maxilo Facial e 44% apresentam um serviço de odontologia ao paciente com comprometimento sistêmico, tanto internado como em âmbito ambulatorial. Nos hospitais de administração direta (n=24), 20 apresentam no corpo clínico o Cirurgião-Dentista, sendo que 25% estão no atendimento do funcionário do hospital, 65% no serviço de Cirurgia Buco Maxilo Facial e 45% no atendimento ao paciente internado ou em âmbito ambulatorial que apresenta comprometimento sistêmico. Nos hospitais ligados as universidades estaduais (n=8), 75% possuem o serviço de Buco Maxilo Facial e 75% o de atendimento ao paciente internado ou em âmbito ambulatorial que apresenta comprometimento sistêmico. Os resultados mostram também que há 36% menos Cirurgiões-Dentistas atuando nos hospitais quando comparado os dados coletados in loco (Programa Sorria Mais São Paulo) com os disponíveis no CNES. No presente trabalho o investimento para a montagem do serviço de odontologia hospitalar é cerca de R$ 98.626,00 e o custeio mensal é de R$ 29.540,00. Pelo trabalho desenvolvido é possível concluir: que hospitais veiculados a SES são heterogênos. Há diferenças quanto ao formato de gestão e administração, tamanho, complexidade, especialidades médicas presentes, demanda atendida. A maioria dos serviços de odontologia dentro do hospital é de Cirurgia e Traumatologia Buco Maxilo Facial e não possuem atendimento odontológico ao paciente no leito que apresenta comprometimento sistêmico. O CNES não apresenta a realidade da atuação do Cirurgião-Dentista dentro do hospital e o custo não é fator limitante para a para implantação e manutenção de um serviço de Odontologia Hospitalar.
Dental care has traditionally been performed in dental offices. It is more common practice for oral and maxillofacial surgery care or procedures that require general anesthesia to be reserved for treatment at hospitals. However, the work of the Dental Surgeon in the hospital environment goes beyond this. The Dentist must be focused on care of the patient whose systemic disease may be a risk for aggravation and or onset of oral disease, or whose oral disease may be a risk factor for aggravation or onset of systemic disease. (Silva-Lovato et al., 2009; Manual de Odontologia Hospitalar, 2012). The State of São Paulo has a wide network of its own hospital services. Although the results of the last few years have proved that there is greater access by the population to the public hospital network of the State of São Paulo, with an increasing number of attendances of hospitalized patients, larger number of surgeries and complex procedures performed (Mendes, Bittar, 2010), there are no concrete public data proving the activities of the Dental Surgeon in this context. On the other hand, studies and experiences in hospitals have shown that the inclusion of the Dental Surgeon in the multiprofessional team of hospitalized patient care contributes to minimizing the risk of infection, improving quality of life, reducing time of hospitalization, diminishing the amount of medication prescribed and indication of parenteral nutrition, in addition to promoting complete care of the patient. (Sonis et al., 2001; Sonis et al., 2004; Morais et al., 2006; Vera-Llonch et al., 2007; Eduardo et al., 2008; Bezinelli et al., 2013). Ours is a cross-sectional study with the aim of characterizing the Dental Service within public hospitals linked to the State Secretary of Health of São Paulo. For this purpose data were collected from the Smile More Often São Paulo Program (Sorria Mais São Paulo) and of the national register of health establishments (Cadastro Nacional de Estabelecimentos de Saúde CNES of 62 hospitals with different management formats: direct, indirect, municipal and/or foundation. The results showed that of the hospitals with indirect administration (n=30), 9 have a Dental Surgeon in the multiprofessional team, with 33% of them being directed to dental care of the Hospital Staff, 33% belong to the Oral and Maxillofacial Surgery service and 44% provide dental service for systemically compromised patients, both those who are hospitalized and those in the outpatient clinics. In the hospitals with direct administration (n=24), 20 have a Dental Surgeon on the clinical staff, with 25% being engaged in dental care of the hospital staff, 65% in the Oral Maxillofacial Surgery service and 45% in caring for hospitalized patients or those in the outpatient clinics, who are systemically compromised. In the hospitals linked to the state universities (n=8), 75% have an Oral Maxillofacial service and 75% a service caring for the hospitalized patient, or those in the outpatient clinic, who are systemically compromised. The results also showed that there are 36% fewer Dental Surgeons working in hospitals when the data collected in loco (Programa Sorria Mais São Paulo) are compared with those available in CNES. In the present study the investment for setting up the hospital dental service is around R$ 98.626,00 and the monthly cost is R$ 29.540,00. From the work develop it was possible to conclude: That the hospitals linked to SES are heterogeneous. There are differences with regard to the management and administration format, size, complexity, medical specialties present, and demand served. The majority of the dental services within the hospital are provided in Surgery and Oral Maxillofacial Traumatology, and they do not have dental care for the patient in a hospital bed, who is systemically compromised. The CNES does not present the reality of the Dental Surgeons activity in the hospital, and the cost is not a limiting factor for the implementation and maintenance of a Hospital Dental Service.

Inflammation is a central component of the immune response. In its acute form it aids the transition from disease to health via the activation of numerous immune cells, enabling them to reach the site of infection/injury and orchestrate themselves to combat pathogens, facilitating resolution and repair to restore the host to health. However, chronic inflammation is deleterious to the host and differs from the “classical” acute inflammatory process in that the inflammation is not necessarily so readily obvious and is not self-limiting; rather, the immune system is in a constant state of low-grade activation and when challenged by pathogenic or sterile injury the response is heightened, resulting in prolonged tissue damage and a failure of efficient resolution mechanisms. Neutrophils are important mediators of acquired innate immune responses but may also contribute to the pathogenesis of chronic inflammatory diseases. Neutrophils are heavily involved in antimicrobial defence; their primary role is the localisation and elimination of pathogenic microorganisms. This, combined with their relatively short lifespan, has resulted in a traditional view of them as limited “kamikaze” cells. However, as detailed here, neutrophils have been shown to act with complexity and sophistication, orchestrating the immune/inflammatory response but also inadvertently contributing to tissue damage in different disease states. This thesis includes the study of neutrophil function in acute inflammatory episodes such as gingivitis and more chronic long-term health conditions such as obesity, chronic periodontitis and Papillon-Lefèvre Syndrome. The findings outlined here support the role of neutrophils as important contributors to both acute and chronic disease, showing these cells to be far more sophisticated than previously regarded.

>Magister Scientiae - MSc
The aim of the present study was to determine the knowledge, attitude and practice of dentists related to oral cancer prevention and early detection in public dental clinics in Khartoum State, Sudan

Purpose: The aims of this study were to: (1) evaluate the prevalence of compliance of Postgraduate Pediatric Dentistry Programs (PPDPs) in the United States with the current American Academy of Pediatric Dentistry (AAPD) sedation guidelines and Commission On Dental Accreditation (CODA) sedation curriculum requirements and identify barriers to and facilitators for implementation of such guidelines; (2) identify changes to-date in sedation practices of PPDP since the previously published AAPD sedation guidelines (2011); and (3) determine the independent association of compliance of PPDP with program setting.

Methods: A 40-item questionnaire was emailed to all postgraduate pediatric dentistry program directors (PPDPDs) of CODA accredited programs in the U.S. (n=74). Bivariate analysis, chi-square, Monte Carlo simulation and Kruskal-Wallis tests were used to analyze the data.

Results: 70% of surveyed participants responded (n=52). On average, PPDPs were found to be compliant with both AAPD and CODA sedation standards. The bivariate analysis showed that both current setting of PPDPs and PPDPDs training setting did not affect the compliance of the program with the AAPD and the CODA sedation guidelines. Directors that stated receiving an “excellent sedation training” were more likely to be compliant with the CODA sedation standards (p=0.01). In this study, a major perceived barrier for increasing the number of non-IV conscious sedation cases per residents was a lack of patient pool (37%). When comparing changes in the sedation practice of PPDPs between 2009 and 2011, more sedation emergency drills were found to be performed in 2015 (p=0.05).

Conclusion: Most PPDPs were compliant with both the AAPD and CODA sedation standards. Most PPDPDs were in favor of the 2013 increase number of sedation required by CODA. Both PPDPD training setting and PPDP setting did not affect the compliance of the programs with the AAPD sedation guidelines and the CODA sedation standards. PPDPs with PPDPDs who reported an excellent sedation training were more likely to be more compliant with the CODA sedation guidelines. Finally, PPDP setting did not affect the number of patients receiving non-IV conscious sedation or the number of sedation ER experienced per year.

Purpose: The aims of this study were to: (1) evaluate the prevalence of compliance of Postgraduate Pediatric Dentistry Programs (PPDPs) in the United States with the current American Academy of Pediatric Dentistry (AAPD) sedation guidelines and Commission On Dental Accreditation (CODA) sedation curriculum requirements and identify barriers to and facilitators for implementation of such guidelines; (2) identify changes to-date in sedation practices of PPDP since the previously published AAPD sedation guidelines (2011); and (3) determine the independent association of compliance of PPDP with program setting. Methods: A 40-item questionnaire was emailed to all postgraduate pediatric dentistry program directors (PPDPDs) of CODA accredited programs in the U.S. (n=74). Bivariate analysis, chi-square, Monte Carlo simulation and Kruskal-Wallis tests were used to analyze the data. Results: 70% of surveyed participants responded (n=52). On average, PPDPs were found to be compliant with both AAPD and CODA sedation standards. The bivariate analysis showed that both current setting of PPDPs and PPDPDs training setting did not affect the compliance of the program with the AAPD and the CODA sedation guidelines. Directors that stated receiving an “excellent sedation training” were more likely to be compliant with the CODA sedation standards (p=0.01). In this study, a major perceived barrier for increasing the number of non-IV conscious sedation cases per residents was a lack of patient pool (37%). When comparing changes in the sedation practice of PPDPs between 2009 and 2011, more sedation emergency drills were found to be performed in 2015 (p=0.05). Conclusion: Most PPDPs were compliant with both the AAPD and CODA sedation standards. Most PPDPDs were in favor of the 2013 increase number of sedation required by CODA. Both PPDPD training setting and PPDP setting did not affect the compliance of the programs with the AAPD sedation guidelines and the CODA sedation standards. PPDPs with PPDPDs who reported an excellent sedation training were more likely to be more compliant with the CODA sedation guidelines. Finally, PPDP setting did not affect the number of patients receiving non-IV conscious sedation or the number of sedation ER experienced per year.

Background: Individuals with developmental disabilities (DD) experience poorer dental health than the general population. They have limited access to health care services and face barriers to maintaining good oral health. Dental schools provide minimal didactic and clinical training to prepare their students to manage individuals with disabilities. As a result, future dentists may not feel well prepared to provide dental care to these individuals.

Objective: This study was conducted to compare the attitudes of senior dental students at the Faculty of Dentistry at King Abdulaziz University (KAU), in Jeddah, in Saudi Arabia, and students at Tufts University School of Dental Medicine (TUSDM) in Boston, in the United States. The authors also aimed to determine if there was an association between pre-doctoral training in treating individuals with special needs, and having positive attitudes toward providing dental care to individuals with DD.

Methods: The authors surveyed 617 senior dental students at both schools using a 40-item online survey questionnaire. The questionnaire asked students about their experiences with individuals with DD, their pre-doctoral education in managing these individuals, and their attitudes toward these individuals. Data was analyzed using Chi-square tests, Independent Sample t-tests, Mann-Whitney U tests, and Spearman's rank correlation coefficient tests.

Results: Only 214 students responded to the online survey, with a response rate of 34.6%. Seventy six respondents (36.7%) were TUSDM students with a response rate of 21.2%, and 131 respondents (63.3%) were KAU students with a response rate of 50.8%. Only 15 (11.6%) of KAU students, compared to 64 (86.5%) of TUSDM students (p<0.001), reported treating an individual with a DD. Seventy one (58.2%) of KAU students, compared to only 10 (13.5%) of TUSDM (p<0.001), reported not receiving any training in treating individuals with DD. Fifty six (57.1%) of KAU students, compared to only 15 (20.3%) of TUSDM students (p<0.001), reported that their education had not prepared them effectively to treat individuals with DD. There was a significant difference in the attitudes between students at KAU and students at TUSDM. Students at TUSDM had more positive attitudes, compared to students at KAU. Fifty six (45.9%) of the KAU students, compared to 47 (67.2%) of the TUSDM students (p=0.047), "strongly disagreed" or "disagreed" that they would not desire individuals with DD in their practice. Forty two (34.4%) of the KAU students, compared to 60 (85.7%) of the TUSDM students (p<0.001), "strongly disagreed" or "disagreed" that dental services for individuals with DD should only be provided in a hospital.

Discussion: Students at TUSDM had more positive attitudes toward individuals with DD, compared to KAU students. These differences in the attitudes may be attributed to the significant differences in students' experiences, education, and training in treating individuals with DD at both schools.

Conclusions: There is a significant difference in the attitudes between students at TUSDM and students at KAU. There is an association between pre-doctoral training in treating individuals with special needs, and having positive attitudes toward providing dental care to individuals with DD.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
Os EstÃgios Supervisionados em ServiÃos do Sistema Ãnico de SaÃde I, II e III sÃo disciplinas que integram a matriz curricular do curso de GraduaÃÃo Odontologia da Faculdade de FarmÃcia, Odontologia e Enfermagem da Universidade Federal do Cearà (UFC) instituÃda em 2005. Acontecem no 9 e 10 semestres do curso, seguem as orientaÃÃes das Diretrizes Curriculares Nacionais e tÃm como objetivo fazer com que o aluno conheÃa as polÃticas pÃblicas de saÃde, as formas de organizaÃÃo dos serviÃos e suas aÃÃes prÃticas em todos os nÃveis de atenÃÃo à saÃde. Considerando o tempo transcorrido desde a implantaÃÃo da atual grade curricular e a necessidade de acompanhamento permanente desta, foi idealizada uma pesquisa para avaliar os estÃgios curriculares com suporte na percepÃÃo dos egressos do citado curso de Odontologia da UFC. Para tanto, foi realizado um estudo descritivo e investigativo com abordagem qualitativa por meio de entrevista semiestruturada, aplicada junto aos ex-alunos da UFC, formados em 2010. Os aspectos investigados relacionaram-se a duraÃÃo dos estÃgios, infraestrutura dos locais de estÃgio, atuaÃÃo dos orientadores, correlaÃÃo entre as experiÃncias vivenciadas e os conteÃdos estudados durante o curso, a contribuiÃÃo dos estÃgios para a formaÃÃo do egresso e as sugestÃes para o seu aperfeiÃoamento. O mÃtodo preconizado para a anÃlise de dados foi aquele descrito por Bardin â AnÃlise de ConteÃdo. Os resultados foram agrupados em quatro categorias de anÃlise que nortearam as discussÃes: Categoria 1 â O conhecimento acadÃmico e a realidade; Categoria 2 â AvaliaÃÃo dos orientadores; Categoria 3 â Infraestrutura e Categoria 4 â InfluÃncia do EstÃgio na escolha profissional. Concluiu-se que, apesar das deficiÃncias relatadas sobre a infra-estrutura dos locais de estÃgio, eles contribuÃram para a formaÃÃo do egresso, por propiciarem uma aproximaÃÃo com a realidade social e dos serviÃos de saÃde. A atuaÃÃo dos orientadores foi avaliada de forma positiva, porque eles auxiliaram na obtenÃÃo de novos conhecimentos e prÃticas, que nÃo haviam sido privilegiados durante as disciplinas intramuros. Os estÃgios funcionaram como uma oportunidade de aprofundamento da vivÃncia em algumas especialidades, fazendo com que o aluno escolhesse essa Ãrea para sua atuaÃÃo profissional, sendo observado, ainda, o fato de que a maioria dos entrevistados relatou interesse em atuar em SaÃde PÃblica futuramente. As sugestÃes expressas durante o estudo poderÃo apoiar a realizaÃÃo dos ajustes que forem necessÃrios para o aprimoramento da matriz curricular, sendo imprescindÃveis outros estudos que avaliem os estÃgios ao longo do tempo e que busquem investigar a opiniÃo dos outros agentes envolvidos: usuÃrios, orientadores de estÃgio e gestores dos serviÃos de saÃde.
The Supervised Internship in Services of the Health System I, II and III are disciplines that integrate the curriculum of the course of Dentistry, Faculty of Pharmacy, Dentistry and Nursing on Federal University of Cearà (UFC) established in 2005. Occur in the 9th and 10th semesters of the course and follow the guidelines of the National Curriculum Guidelines, they aim to make students learn about the public health policies, forms of organization of services and practical actions at all levels of health care. Considering the time passed since the implementation of new curriculum and the need for continuous monitoring of this, a study was idealized to evaluate the internships from the perception of students who graduated from Dentistry at the UFC. Therefore, it was a descriptive and investigative study with qualitative approach through semi-structured interviews with former students of the UFC, formed in 2010. The aspects investigated were related to duration of stages, the infrastructure of local stage, the performance of supervisors, the correlation between the experiences and content studied during the course, the contribution of the stages for the formation of egress and their suggestions for improvement of them. The method recommended for data analysis was that described by Bardin - Content Analysis. The results were grouped into four categories as follows: Category 1 - The academic knowledge and reality, Category 2 - Performance of advisors, Category 3 - Infrastructure and Category 4 - Stage helped their career choice - which guided the discussions. It was concluded that despite the deficiencies reported on the infrastructure of the local stage, they contributed to the training of graduates, for they promoted a rapprochement with the social reality and the reality of health services. The role of the advisors was evaluated as positive, because assisted in the construction of new knowledge and practices, which were not contemplated during the disciplines intra-mural. The stages functioned as an opportunity to deepen the experience in some specialties, making the student chose this area for their professional practice, and also observed that the majority of respondents reported interest in future work in Public Health. Suggestions scored during the study will support the achievement of adjustments that are necessary to improve the curriculum, it is indispensable that other studies to avaluate the stages over time and who seek to investigate the opinions of others involved in the process: users, guiding stage and managers of health services.

Endodontic residents must keep current with clinical information to practice evidence- based dentistry. To do so, endodontic residents must access research papers and interpret results. This requires a knowledge of biostatistics. However, the biostatistical knowledge of endodontic residents is relatively unknown. The purpose of the study was to assess the biostatistical knowledge of endodontic residents using a survey instrument to prove or reject the hypothesis that there exists a lack of understanding of biostatistic principles among endodontic residents. A survey consisting of 29 questions querying attitudes and biostatistical knowledge was distributed to 230 endodontic residents and returned with a 32% response rate. The overall mean resident knowledge score was 42.3% (SD, 17.5%; range, 10% to 90%). Only 39% stated they understood all of the statistical terms encountered in journal articles. This data supports the hypothesis that there exists a lack of understanding of biostatistical principles and would suggest that more effective training in biostatistics in residency education is desirable.

Objectives To provide contemporary, national population-based estimates of complete tooth loss of older adults by English language proficiency. Methods We conducted a cross-sectional analysis of the 2017 Medical Expenditure Panel Survey among participants ≥50 years of age (n=10,452, weighted=111,895,290). Results The prevalence of complete tooth loss was higher among those with limited English proficiency (Spanish speaking: 13.7%; Other languages: 16.9%) than those proficient in English (Spanish speaking: 5.0%; Other languages: 6.0%). After adjusting for education, complete tooth loss was less common among participants for whom Spanish was their primary, with limited English proficiency relative to English only (adjusted odds ratio: 0.56; 95% confidence interval: 0.42-0.76). Among those without complete tooth loss, dental visit in the past year were less common among participants with primary languages other than English as compared to those who only speak English. Discussion Research is needed to examine the relationship of aging, oral health, and access to care.

Oral Biology
M.S.
Objectives: The presence of sinus septa may cause complications in maxillary sinus elevation surgery such as perforations. CBCT is important for planning the size, shape, and position of the sinus septa, and help separation of the sinus membrane from the bony septum. The purpose of this study is to determine the prevalence, location and morphology of maxillary sinus septa in patients of Temple University Kornberg School of Dentistry.  Materials and Methods: Eight hundred and twenty one scans taken in Temple University Kornberg School of Dentistry between 2009 to July 31, 2013 were evaluated by use of the iCAT software. Age, gender, ethnicity, and dentition status were also evaluated to determine potential relationship of the presence of sinus septa. Results: This study included 680 patients subdivided by gender into 360 female and 320 male, and subdivided by ethnicity into 408 Caucasian, 61 Asian, 51 Hispanic, and 160 African Americans. Septa were present in 303 of 680 patients (44.56%) and 485 of 1360 sinuses (35.7%) evaluated. 26.76% of patients with one or multiple sinus septa were present on both sides of the sinus, and 17.79% of patients with one or multiple septa were present on either right or left side only. Septa height has a mean of 5.26 mm (range of 1.2 to 22.30 mm). Septa were located in premolar, molar, and retromolar regions in 43.4%, 42.03% and 14.6 % respectively. The most common location of the septa is the second premolar region. Orientation of septa was vertical in 67.8 %, transverse 31.68 %, and horizontal 0.005% of cases. Complete septa were found in only 0.01 % of patients evaluated.  Conclusions: Incidence of septa was found in 44.56% of the scans. The age, gender, and ethnicity factors are not statistically significant. However, according to the Wald test, the prevalence of septa in Caucasian and Hispanic groups are statistically significant (p< 0.05) from African Americans. Prior to sinus augmentation surgery, CBCT scans should be carefully evaluated for the septa location and height to prevent surgical complication such as perforations.
Temple University--Theses

Objective: This study was conducted to determine how oral health-related quality of life (OHQoL) changes during the late stage of comprehensive fixed orthodontic treatment in adolescents and what factors may be involved. Background: Completion of orthodontic treatment has been shown to improve patients’ OHQoL due to the changes in esthetics, function and emotional well-being. The levels of OHQoL fluctuate throughout treatment where an initial decrease within the first 6 months occurs followed by an improvement towards patients’ pre-treatment levels. At 18 months of fixed orthodontic treatment, the level is unclear. The aims of this study were to clarify the changes of OHQoL during this late stage of fixed orthodontic treatment beyond 18 months in adolescents and to identify factors, including dental extractions, patient compliance, use of adjunctive appliances, and patient demographics, which may contribute to the OHQoL. Methods: This case-control study consisted of 154 adolescent patients undergoing comprehensive fixed orthodontic treatment from the Nova Southeastern University orthodontic department. Subjects were selected based upon the number of months in comprehensive fixed orthodontic treatment. Completion of the Oral Health Impact Profile short form (OHIP-14) as well as occurrence of dental extraction during orthodontic treatment, use of adjunctive appliances, frequency of emergency and failed appointments, level of oral hygiene, and subjects’ age and gender were all recorded. Statistical analysis using structural equation modeling was used to determine the direct and indirect effects to subjects’ OHQoL. Results: The model accounted for 35% of the variance in OHQoL. There were no significant differences in average OHIP-14 scores between the initial stage of 5-7 months and final stage of 18 months and over in orthodontic treatment. The analysis of direct factors showed that females and subjects with adjunctive appliances possessed higher OHIP-14 scores. Conclusions: Treatment time beyond 18 months of treatment was not a significant factor affecting adolescents’ OHQoL. Female patients and those with adjunctive appliances expressed poorer levels of OHQoL. These factors may be attributed to the scores within the physical and psychological domains as these patients experienced pain and discomfort from appliance wear as well as negative impact on their self-esteem during comprehensive fixed orthodontics.

OBJECTIVES: This study has three aims: 1) to determine the trends and prevalence of dental fluorosis and caries among persons aged 6-19; 2) to examine the association between dental fluorosis and caries among persons of the same age group; and 3) to investigate the influence of dental fluorosis and caries on oral health-related quality of life (OHRQoL) among people aged 16-49 in the United States. METHODS: The data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 and 2011-2012 were analyzed. For aims 1) and 2), individuals aged 6-19 years, who completed the home interview and oral health examination were included (n=9,493, n=2,411, respectively). For aim 3, the data from NHANES 2003-2004 were analyzed including only people aged 16-49, who completed the home interview and both conditions examination (n=3,035). The reason behind age restriction is that people aged 16-49 were targeted to answer OHRQoL questions. Dental fluorosis was measured by Dean’s Index (6-categories of severity), where classification was based on the two teeth most affected by fluorosis. Dental caries experience was measured by DMFS score (overall caries experience and untreated decay). OHRQoL was calculated as sum of 7 items out of the 14 items NHANES Oral Health Impact Profile (OHIP-14). OHRQoL score can range 6-28 (lower score indicates better oral health). Other covariates were socio-demographic characteristics, self-perceived mouth/teeth condition (1-item), and previous dental visit (time and reason). Bivariate and multivariate analyses were conducted with caries and OHRQoL as outcomes. All analyses were weighted and adjusted for the complex design of the NHANES survey, using SAS 9.3 survey procedures. RESULTS: For aim 1, dental fluorosis prevalence among persons aged 6-19 was increasing (37% vs. 57%) from 1999-2004 to 2011-2012. There was a significant increase in caries experience and a significant decrease in untreated tooth decay from 1999-2004 to 2011-2012 among persons aged 6-19. For aim 2, the crude association between the severity of fluorosis and DMFS was significantly inversely proportional except for the moderate/severe categories of fluorosis where the relationship was linear. For aim 3, the bivariate all teeth analysis showed that OHRQoL was significantly decreased with higher level of fluorosis severity (p-value=0.05). Severity of fluorosis was significantly inversely associated with DMFS score (β-coefficient=-4.8, p-value <0.0001). The lower DMFS scores explain the better perception of oral health (lower OHRQoL scores) in higher fluorosis severity groups. However, after controlling of DMFS and covariates in a multiple regression model, fluorosis severity was not significantly associated with lower OHRQoL score. CONCLUSIONS: Overall, the findings of this study suggest that the prevalence of dental fluorosis is increasing while untreated decay is decreasing among persons aged 6-19. The results demonstrated a clear inverse relationship between dental fluorosis and caries. The findings also suggest that the benefit of fluorides outweighs the esthetic impact of fluorosis among the U.S children and adolescents.
2018-09-28T00:00:00Z

OBJECTIVE: To evaluate access and utilization of both preventive and other dental care services among Children with Special Health Care Needs (CSHCN) in the US in 2005 and 2009. METHODS: We analyzed data for 81,082 CSHCN from the National Survey of Children with Special Health Care Needs (NS-CSHCN) 2005 and 2009. The three main dependent variables were: access to and utilization of dental care, and health insurance status. The independent variables were: gender, age, race/ethnicity, type of insurance, number of criteria met on the screener tool, federal poverty level (FPL), family structure, language, family work life, financial burden and out-of-pocket expenses. Bivariate and multivariate weighted analyses were conducted to evaluate the study outcomes. RESULTS: We found that CSHCN had a high degree of access and utilization of the dental care system in the US. In 2005, 98.2% and 99.03% of CSHCN had “very good to good” access to preventive dental care and other dental care, respectively, and in 2009, the access was 98.1% and 98.7% for both services, respectively. Further, in 2005, 92.9% and 90.4% “fully utilized” preventive dental care services and other dental care, respectively, while 91.9% and 84.7% of CSHCN “fully utilized” both services respectively in 2009. Barriers to access dental care were commonly seen among CSHCN of an older age (5-17 years old), other Non-Hispanics, those from low-income families, with complicated health conditions, living with single mothers, who were uninsured or publically insured, and having family out-of-pocket expenses of more than $250 for their health services. Low levels of utilization were found among non-Hispanic Blacks, Hispanics and other Non-Hispanics CSHCN, from low-income families, with complicated health conditions, who were uninsured or publically insured, having family out-of-pocket expenses of more than $250 for their health services and had other unmet specialist care needs. Hispanic CSHCN from low-income families were more likely to be uninsured. Family work life and family financial status were both significantly associated with access and utilization of dental care services in 2005 and 2009. CONCLUSION: Although the results of this study show that, in 2005 and 2009, CSHCN accessed and utilized both preventive and other dental care services at a high level, disparities still exist among some CSHCN.

Indiana University-Purdue University Indianapolis (IUPUI)
Oral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1986.
Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 170-185).

In the United States, prescription opioids have been a major problem that contributed to the opioid crisis in the country. As dentists prescribe analgesics routinely for dental pain management, further investigation into opioid and non-opioid prescription patterns by dentists on a national level is needed. This research project aimed to examine 1) the trends in opioid and non-opioid analgesic prescriptions by dentists in the US,2) to examine the racial-ethnic disparities in receiving an opioid and non-opioid prescription from a dental professional, 3) the effect of federal Rescheduling of hydrocodone combination on opioid prescription patterns by dentists in a school setting. Data on analgesic prescriptions by dentists were obtained using medical panel survey MEPS (1996- 2015), and Boston University Henry M. Goldman School of Dental Medicine clinical repository (2010 -2019). On average about 31,206 individuals of all ages were interviewed for MEPS each year. The trend in analgesics prescription was reported weighted numbers and proportions of total and dental analgesics prescriptions were reported. Kendall tau correlation test was used to examine trends in the rate of opioid prescriptions per 100 persons over survey years. Racial differences were examined using MEPS data (2002-2015) on dental analgesic prescriptions, dental care utilization, patients’ race, and other demographic information. The outcome was analgesic prescription received. The main independent variable was the patients’ race/ethnicity. Covariates included in the analysis were gender, age, marital status, income, geographical region, and survey year. Using BUSDM data (2010-2019) we examined 12,807 patients who received an opioid prescription from a dentist. The primary outcome variables were opioid prescriptions and opioid morphine milligram equivalent (MME). The primary predictor used is the date of opioid prescription (Time before and after the intervention). To assess the effect of hydrocodone medication reclassification on the outcome variables we used an interrupted time series (ITS) analysis with a segmented regression model. Our results showed a decrease in the proportion of dental opioids out of total opioids from 9.76% in 1996 to 4.5% in 2015. Kendall tau correlation indicated an increase in prescribing rate over the years in total opioids but not in dental opioids. Racial differences were found in opioid prescriptions by dentists with whites having a lower risk of receiving an opioid analgesic compared to other racial minorities. The effect of federal rescheduling of hydrocodone combination on opioid prescription patterns by dentists showed specifically a reduction in non-hydrocodone opioids prescribing rate by morphine milligram equivalent (MME). In conclusion dentists’ contribution to the increase in prescription opioids in the United States seem to be limited compared to other health care professionals. Nevertheless, racial differences were found in whites when compared to other racial minorities. Efforts to curb the use of opioids should be encouraged even more so with evidence supporting the effectiveness of non-opioids analgesics in control of dental pain.
2022-12-09T00:00:00Z

Dental health is an important aspect of one’s health and well-being (American Dental Association, 2015). This research analyzes six factors (income level, weather, sales tax, population density, dentist density, and water quality) to examine their relationship with oral health conditions based on 2015 state-level data in the United States. The results show that these factors indeed affect oral health conditions. The analysis results clearly show that income level, dentist density, temperature, and water quality have significant positive effects while temperature has a negative effect effects on oral health at state level.

Furthermore, this study uses a multilinear regression algorithm stepwise method to build three predictive models on different income groups, using the above factors to predict oral health. These models can be a helpful reference for further research in related areas, including but not limited to insurance companies, research institutes that work on improving public oral health, and government agencies.

Background: Several studies have suggested that the likelihood of paraesthesia may depend on the local anaesthetic (LA) used. The purpose of this study was to analyze reports of paraesthesia among dental LAs used in the U.S. Methods: Reports of paraesthesia involving LAs between November 1997 through August 2008 were obtained from the U.S. Food and Drug Administration Adverse Event Reporting System. Chi-Square analysis compared expected frequencies, based on U.S. LA sales data, to observed reports of oral paraesthesia. Results: During the study period 248 cases of paraesthesia following dental procedures were reported. Most (94.5%) cases involved mandibular nerve block. The lingual nerve was affected in 89.0% of cases. Reports involving 4%-prilocaine and 4%-articaine were 7.3-times and 3.6-times, respectively, greater than expected (χ2, p<0.0001) based on LA usage by U.S. dentists. Conclusions: Consistent with previous reports, these data suggest that paraesthesia is more common following use of 4% LA formulations.

The objective of this study was to explore a possible association between infant mortality rate (IMR) and Medicaid dental benefit payouts per state, as well as propose an expansion of the dental benefits provided through Medicaid. Data was obtained from the Vital Statistics report 2012 and the Center for Medicare & Medicaid Services (CMS) Medicaid coverage database for fiscal year 2011. Population and demographic data was also collected for further comparison. The states observed were Alabama, Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee. The IMR data was ranked in ascending order and then the dental payments were compared between the seven southern states. There did not appear to be an association between the two variables. It was hypothesized that the state with the highest IMR would have the least amount of Medicaid dental payments; possibly indicating limited benefits and a need for expansion. The data did not support the hypothesis. Although Mississippi had the highest IMR at 9.9 per 1,000 live births, the amount dental benefits paid through Medicaid was not the lowest. Kentucky had the lowest IMR at 6.9 per 1,000 live births, and North Carolina had the highest amount of dental payments with $352,602 being paid by the state. However, the comparing variable in each state did not reflect an association. Limitations of the study were addressed and suggested improvements were made for future studies that would possibly yield significant findings. In conclusion, the data collected and observed did not provide evidence that the expansion of Medicaid dental benefits would combat infant mortality rates across the country.