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A study of "broken appointment" patients in a children's hospital dental clinic.

Part I of this study investigated possible variables determining "High Risk No Show" behavior on the part of patients in a dental clinic. Only "source of payment" seemed important; namely, that Medicaid patients were statistically more likely to be "High Risk No Show" patients (P less than .001). Race was associated but was found to be confounded with Medicaid. In an attempt to investigate the reasons for the Medicaid group being "High Risk No Show" patients, Part II of the study compared three distinct groups of patients at the Children's Hospital Medical Center Clinic. These included the self-paying group and the Medicaid group of the original sample of 90 in addition to the Union plan group (patients receiving free third-party payment care as an employee benefit). It was shown that both groups with third-party coverage were associated with "High Risk No Show" behavior. The type of "No Show" behavior, however, was different for the two groups. Union plan patients tended to cancel appointments or at least notify in advance of inability to keep an appointment. Medicaid patients, conversely, were just as likely to fail appointments and not file advance notice of inability to keep an appointment.

Appointments and Schedules↗

Noise levels encountered in dental clinical and laboratory practice.

PURPOSE: The aim of this study was to determine the noise levels made by different clinical hand-pieces, laboratory engines, and other significant equipment such as ultrasonic scalers, amalgamators, high-speed evacuation, and other items. MATERIALS AND METHODS: Sound levels were measured at four dental practices and three dental laboratories selected as representative of a variety of workplaces to reveal a range of noise. The noise levels were determined using a precision sound level meter, which was positioned at ear level and also at 2 meters distance from the operator. RESULTS: Virtually all noise levels at the dental clinics were below 85 dB(A). The noise levels in the dental laboratories had much higher maxima, with some cutting activities, steam cleaning, and sandblasting up to 90 dB(A), and compressed air blasts with a maximum of 96 dB(A). CONCLUSIONS: The noise levels in the dental clinics are considered to be below the limit of risk of hearing loss. However, technicians and other personnel who spend many hours in noisy dental laboratories may be at risk if they choose not to wear ear protection.

Dental High-Speed Equipment↗

An evaluation of image quality for the assessment of the marginal bone level in panoramic radiography. A comparison of radiographs from different dental clinics.

The diagnostic image quality of panoramic radiographs originating from different clinics was examined. Two samples of 98 and 100 radiographs, respectively, were from a department of oral radiology. The radiographs of one of these samples were checked using immediate subjective analysis of the image quality before inclusion in the study whereas the radiographs of the other sample were randomly selected. A third sample consisted of radiographs from 20 randomly selected dental clinics. The subjective overall image quality of the whole panoramic radiograph was classified as adequate, marginal or inadequate. The three observers also assessed the reason for inferior image quality. The overall image quality of the radiographs was better for the checked sample from the department of oral radiology compared to the sample form the 20 dental clinics. The main reason for unacceptable image quality of the radiographs was too low density and/or contrast irrespective of sample. Other faults were incorrect positioning of the patient but in the sample from the 20 clinics improper film handling was also frequent. We conclude that image quality in panoramic radiography can be improved. Improvement of the image quality is a prerequisite if panoramic radiography in the future is to replace the full-mouth examination.

Adolescent↗

Equivalence testing with dental clinical trials.

Clinical trials whose purpose are to show equivalence of two or more treatments have traditionally utilized methods for demonstrating superiority, and, if no statistical differences are found, the treatments are assumed to be equivalent. Methods for directly demonstrating equivalence have been developed by the pharmaceutical industry to establish the bioequivalence between drug formulations. This approach should have significant future implications for dental research. It is presently well-characterized in the statistical literature, but is virtually unknown within the dental literature and has had limited documented application with dental clinical trials. The purpose of this paper is to consider equivalence testing with dental clinical trials. Equivalence and superiority testing are contrasted, and comparisons between parallel and crossover designs with equivalence testing are discussed. To exemplify equivalency trial methodology for dental research application, several examples are proposed, including, in detail, an implant overdenture clinical trial to test the equivalence of treatment outcome between a two- and a four-implant overdenture treatment. Sample size calculations for otherwise-identical crossover and parallel equivalence studies are demonstrated. Results show that for a power of 0.90, a sample size of 24 is required for the crossover trial and over 150 subjects for the parallel design. For this dental research application, the equivalence/crossover design methodology is shown to be an efficient and appropriate approach.

Cross-Over Studies↗

Fee-paying systems and service patterns in a Hong Kong dental clinic.

OBJECTIVE: This study aimed to describe and compare patients' consumption of dental services and dentists' productivity in a university campus clinic before and after changing from a time-based to an item-based fee-paying system. METHOD: Data were collected from the University of Hong Kong dental clinic which serves all university students and staff. A time-based fee-paying system had been in use up to February 1999 when it was switched to an item-based system. Computerised records of all patients in two 1-year periods starting from February 1996 and February 1999 were analysed. RESULTS: The percentages of eligible users who attended the University dental clinic were similar in the two study periods (30% in 96/97 vs 29% in 99/00). However, on average, patients consumed more dental service items in a year after the switch in fee-paying system (3.2 vs 4.1). There was also an increase in the mean number of dental service items provided by a dentist per working week after the change in fee-paying system (71.5 vs 99.4). CONCLUSION: On switching from a time-based to an item-based fee-paying system, dentists in the UHS dental clinic became more productive and the consumption of dental services per patient also increased.

Dental Care↗

The satisfaction of men with HIV infection attending a dedicated dental clinic: a controlled study.

A self-complete questionnaire to assess satisfaction with dental care was administered to two groups of dental patients: men with asymptomatic HIV infection attending a dedicated dental clinic and men, presumed to be HIV negative, attending a general dental practice. Both settings were staffed by the same dentist. Men attending the dedicated clinic expressed satisfaction with the technical competence of their treatment and the affective behaviour of their dentist comparable with satisfaction expressed by participants at the general dental practice. However, men at the dedicated clinic expressed dissatisfaction with the availability of treatment. This may be related to the staffing level at the clinic. Men with asymptomatic HIV infection wanted more dentists who specialized in their needs and thought there was not enough information available on oral health.

Adolescent↗

Use of polymer materials in dental clinics, case study.

Dentistry uses a variety of different polymer materials. Dental polymer materials are based on methacrylate, its polymer, and polyelectrolytes. The setting of restorative materials and adhesives is initiated chemically by mixing two components or by light. In both cases, polymerisation is incomplete and monomers, not reacted, release. Studies have documented that monomers may cause a wide range of adverse health effects such as irritation to skin, eyes or mucous membranes, allergic dermatitis, asthma, parenthesise in the fingers, and disturbances from central nervous system such as; headache, pain in the extremities, nausea, loss of appetite, fatigue, sleep disturbances, irritability, loss of memory and changes in blood parameters. Dental personnel are occupationally exposed when handling the non reacted monomers. The use of gloves do not give enough protection as monomers, released from the material, easily penetrate all gloves used in dentistry. Face masks do not prevent inhalation of monomers. Ordinary glasses do not protect the eyes against vapor from monomers. The result from this study demonstrate the need for the development of ergonomic procedures and practices for safe handling of such materials in dental clinics.

Asthma↗

Emergency dental clinic patients in South Devon, their anxiety levels, expressed demand for treatment under sedation and suitability for management under sedation.

OBJECTIVE: To assess the anxiety levels of patients attending two salaried dental service emergency clinics, their expressed demand for treatment under sedation, and their medical suitability for dental sedation. DESIGN: A questionnaire survey, incorporating the Modified Dental Anxiety Scale (MDAS) and assessment of American Society of Anesthesiologists' (ASA) physical status classification, of all adult patients attending two emergency dental clinics in Torquay and Newton Abbot. RESULTS: 513 patients returned questionnaires. Only five declined to take part in the study. The mean MDAS for patients attending the two emergency dental clinics was 14.09 (SD 6.04) and 41.9% of patients were classified as dentally anxious (MDAS >15). A preference for treatment under sedation was expressed by 56.3%, of all patients, of whom 50.5% were classified as ASA 1 (without health problems) and would have been suitable for sedation in primary dental care. CONCLUSIONS: The reported dental anxiety levels of patients attending the two emergency dental clinics were found to be much higher than those found by previous studies in general dental practice and at dental school emergency clinics. There was a high expressed demand for treatment under sedation. Further studies are needed to assess the levels of dental anxiety seen at other dental emergency clinics and a health needs assessment to determine need as opposed to expressed demand.

Adolescent↗