Ethics in the provision of removable partial dentures

Aim: To investigate the construction of cobalt-chromium removable partial dentures by commercial private dental laboratories. Methods: Ninety master casts for fabrication of cobalt-chromium removable partial dentures were obtained from three commercial laboratories randomly selected. Casts were assessed for dental arch treated, Kennedy classification, cast surveying, denture design information provided by the dentist, and mouth preparation (rest seat, guiding plane and retentive area). Dental technicians answered a questionnaire regarding qualification of assisted dentists, monthly number of framework castings, and use of dental surveyor. Mouth preparation was compared among laboratories using Kruskal-Wallis test (α=0.05). Results: The percentage of Kennedy class I was 16%, class II 19%, class III 56%, and class IV 9%. The majority of master cats (51%) examined was sent to dental laboratories without any design information and did not comply with ethical guidelines in the provision of RPD. Approximately half of the casts were considered “inappropriate” for guiding planes and retentive areas. One of the laboratories presented all casts “inappropriate” for rest seat distribution (p<0.001). Conclusions: Mouth preparation frequently failed for guiding planes, retentive areas and distribution of rest seats. It is necessary to provide students with adequate clinical experience at the dental school environment, which will actually be carried into the practice of dentistry.

Ethics in the provision of removable partial dentures

Aim: To investigate the construction of cobalt-chromium removable partial dentures by commercial private dental laboratories. Methods: Ninety master casts for fabrication of cobalt-chromium removable partial dentures were obtained from three commercial laboratories randomly selected. Casts were assessed for dental arch treated, Kennedy classification, cast surveying, denture design information provided by the dentist, and mouth preparation (rest seat, guiding plane and retentive area). Dental technicians answered a questionnaire regarding qualification of assisted dentists, monthly number of framework castings, and use of dental surveyor. Mouth preparation was compared among laboratories using Kruskal-Wallis test (α=0.05). Results: The percentage of Kennedy class I was 16%, class II 19%, class III 56%, and class IV 9%. The majority of master cats (51%) examined was sent to dental laboratories without any design information and did not comply with ethical guidelines in the provision of RPD. Approximately half of the casts were considered “inappropriate” for guiding planes and retentive areas. One of the laboratories presented all casts “inappropriate” for rest seat distribution (p<0.001). Conclusions: Mouth preparation frequently failed for guiding planes, retentive areas and distribution of rest seats. It is necessary to provide students with adequate clinical experience at the dental school environment, which will actually be carried into the practice of dentistry.

Referência e contra referência em saúde bucal: regulação do acesso aos centros de especialidades odontológicas

Objective Based on the system of reference and counter-reference and comprehensiveness in oral health care, we aimed to examine ways of refering users to Specialized Dental Care Centers (SDCC) and the interface between them and Primary Care. Methods This is a cross-sectional study carried out with users and dentists of SDCC in a metropolitan region of Northeast of Brazil. Analyses were descriptive, and the association test was done with chi-square. Results Six forms of entry to specialized service were identified: free demand (13.8 %) and reference by the Primary Care dentist (63.2 %) were most frequent. Users referred by the basic health unit dentist had more interest in making a counter-reference than the others (p<0.001, PR=4.65, 95 % CI: 2.74 to 7.91), while individuals without this referral had 1.49 times more difficulty obtaining care (95 % CI: 1.02 to 2.17). Referral procedures are a decisive factor for counter-references. However, the high demand for primary care services and the short supply these services can offer in the face of needs make SDCC performance difficult. Conclusion The analysis of oral health practices from the perspective of network modeling points to the service's need to establish protocols for regulation in a bid to improve access to and the quality of care provided.

Referência e contra referência em saúde bucal: regulação do acesso aos centros de especialidades odontológicas

Objective Based on the system of reference and counter-reference and comprehensiveness in oral health care, we aimed to examine ways of refering users to Specialized Dental Care Centers (SDCC) and the interface between them and Primary Care. Methods This is a cross-sectional study carried out with users and dentists of SDCC in a metropolitan region of Northeast of Brazil. Analyses were descriptive, and the association test was done with chi-square. Results Six forms of entry to specialized service were identified: free demand (13.8 %) and reference by the Primary Care dentist (63.2 %) were most frequent. Users referred by the basic health unit dentist had more interest in making a counter-reference than the others (p<0.001, PR=4.65, 95 % CI: 2.74 to 7.91), while individuals without this referral had 1.49 times more difficulty obtaining care (95 % CI: 1.02 to 2.17). Referral procedures are a decisive factor for counter-references. However, the high demand for primary care services and the short supply these services can offer in the face of needs make SDCC performance difficult. Conclusion The analysis of oral health practices from the perspective of network modeling points to the service's need to establish protocols for regulation in a bid to improve access to and the quality of care provided.

Estudo da Acessibilidade Organizacional aos Serviços de Saúde Bucal de um Município de Pequeno Porte do Nordeste Brasileiro

Objective: This study aimed to evaluate the accessibility to oral health services in Santa Cruz (RN), focusing on the organizational aspect which is characterized by variables like delay in getting consultation, waiting lines, difficulty scheduling appointments, lack of material, among others. Material and Methods: For such purpose, questionnaires were addressed to 194 users’ houses based on census tract. Results: It has been found that 12.9% of the population has never gone to the dentist’s office, and that the service demand has not been affected by users’ individual and socioeconomic characteristics, except for gender. Data have revealed that 36.1% of users went to the dentist’s in less than a year. In addition, the youngest users are among those who seek the dentist’s office more frequently (p<0.05). 63.3% of the interviewees have reported they find some kind of difficulty when seek for dental care, and 43.2% of users have waited three weeks or more for assistance. It is also noteworthy that 7.4% of the interviewees have been finding difficulties in getting access to urgency care, and that long wait for the consultation is the most frequently cited matter. Conclusion: It could be verified that accessibility to oral health services in the municipality of Santa Cruz (RN) has been hampered by factors related to public policies organization, especially with regards to the work process.

Estudo da Acessibilidade Organizacional aos Serviços de Saúde Bucal de um Município de Pequeno Porte do Nordeste Brasileiro

Objective: This study aimed to evaluate the accessibility to oral health services in Santa Cruz (RN), focusing on the organizational aspect which is characterized by variables like delay in getting consultation, waiting lines, difficulty scheduling appointments, lack of material, among others. Material and Methods: For such purpose, questionnaires were addressed to 194 users’ houses based on census tract. Results: It has been found that 12.9% of the population has never gone to the dentist’s office, and that the service demand has not been affected by users’ individual and socioeconomic characteristics, except for gender. Data have revealed that 36.1% of users went to the dentist’s in less than a year. In addition, the youngest users are among those who seek the dentist’s office more frequently (p<0.05). 63.3% of the interviewees have reported they find some kind of difficulty when seek for dental care, and 43.2% of users have waited three weeks or more for assistance. It is also noteworthy that 7.4% of the interviewees have been finding difficulties in getting access to urgency care, and that long wait for the consultation is the most frequently cited matter. Conclusion: It could be verified that accessibility to oral health services in the municipality of Santa Cruz (RN) has been hampered by factors related to public policies organization, especially with regards to the work process.

O processo ensino-aprendizagem e suas conseqüências na relação professor-aluno-paciente.

This study deals with the ethical and human aspects present in the teaching-learning process within the dentists' formation. It arises from the growing need for professionals involved with the quality of the services they provide for the population in health care centers. In this research a qualitative approach was used and data was obtained by means of focal groups, interviews and participative observation. The sample consisted of 28 dentistry students and 33 patients attended at the dentistry course. According to the results, it was shown that the main problems are the excess of authority in the teacher-student-patient relationship and the dissociation of the body-mind-spirit as seen in the biomedical model health practice. These findings show the future professionals' insufficient abilities for developing a satisfactory relationship with their patients and the need of considering these aspects during their formation.

O processo ensino-aprendizagem e suas conseqüências na relação professor-aluno-paciente.

This study deals with the ethical and human aspects present in the teaching-learning process within the dentists' formation. It arises from the growing need for professionals involved with the quality of the services they provide for the population in health care centers. In this research a qualitative approach was used and data was obtained by means of focal groups, interviews and participative observation. The sample consisted of 28 dentistry students and 33 patients attended at the dentistry course. According to the results, it was shown that the main problems are the excess of authority in the teacher-student-patient relationship and the dissociation of the body-mind-spirit as seen in the biomedical model health practice. These findings show the future professionals' insufficient abilities for developing a satisfactory relationship with their patients and the need of considering these aspects during their formation.

Sistema inteligente para o processamento de imagens digitais intrabucais oclusais

Several are the areas in which digital images are used in solving day-to-day problems. In medicine the use of computer systems have improved the diagnosis and medical interpretations. In dentistry it’s not different, increasingly procedures assisted by computers have support dentists in their tasks. Set in this context, an area of dentistry known as public oral health is responsible for diagnosis and oral health treatment of a population. To this end, oral visual inspections are held in order to obtain oral health status information of a given population. From this collection of information, also known as epidemiological survey, the dentist can plan and evaluate taken actions for the different problems identified. This procedure has limiting factors, such as a limited number of qualified professionals to perform these tasks, different diagnoses interpretations among other factors. Given this context came the ideia of using intelligent systems techniques in supporting carrying out these tasks. Thus, it was proposed in this paper the development of an intelligent system able to segment, count and classify teeth from occlusal intraoral digital photographic images. The proposed system makes combined use of machine learning techniques and digital image processing. We first carried out a color-based segmentation on regions of interest, teeth and non teeth, in the images through the use of Support Vector Machine. After identifying these regions were used techniques based on morphological operators such as erosion and transformed watershed for counting and detecting the boundaries of the teeth, respectively. With the border detection of teeth was possible to calculate the Fourier descriptors for their shape and the position descriptors. Then the teeth were classified according to their types through the use of the SVM from the method one-against-all used in multiclass problem. The multiclass classification problem has been approached in two different ways. In the first approach we have considered three class types: molar, premolar and non teeth, while the second approach were considered five class types: molar, premolar, canine, incisor and non teeth. The system presented a satisfactory performance in the segmenting, counting and classification of teeth present in the images.

Sistema inteligente para o processamento de imagens digitais intrabucais oclusais

Several are the areas in which digital images are used in solving day-to-day problems. In medicine the use of computer systems have improved the diagnosis and medical interpretations. In dentistry it’s not different, increasingly procedures assisted by computers have support dentists in their tasks. Set in this context, an area of dentistry known as public oral health is responsible for diagnosis and oral health treatment of a population. To this end, oral visual inspections are held in order to obtain oral health status information of a given population. From this collection of information, also known as epidemiological survey, the dentist can plan and evaluate taken actions for the different problems identified. This procedure has limiting factors, such as a limited number of qualified professionals to perform these tasks, different diagnoses interpretations among other factors. Given this context came the ideia of using intelligent systems techniques in supporting carrying out these tasks. Thus, it was proposed in this paper the development of an intelligent system able to segment, count and classify teeth from occlusal intraoral digital photographic images. The proposed system makes combined use of machine learning techniques and digital image processing. We first carried out a color-based segmentation on regions of interest, teeth and non teeth, in the images through the use of Support Vector Machine. After identifying these regions were used techniques based on morphological operators such as erosion and transformed watershed for counting and detecting the boundaries of the teeth, respectively. With the border detection of teeth was possible to calculate the Fourier descriptors for their shape and the position descriptors. Then the teeth were classified according to their types through the use of the SVM from the method one-against-all used in multiclass problem. The multiclass classification problem has been approached in two different ways. In the first approach we have considered three class types: molar, premolar and non teeth, while the second approach were considered five class types: molar, premolar, canine, incisor and non teeth. The system presented a satisfactory performance in the segmenting, counting and classification of teeth present in the images.

Educação ambiental como estratégia para inserção da sustentabilidade na formação em odontologia

This thesis proposes environmental education as a strategy for the inclusion of sustainability in the academic education of higher level. The dentistry course has been the object of study, which is justified by the recognition of the need for reflection on environmental issues in the dental academia, initially based on professional experience of the author as a dental surgeon. The aim of this study is to investigate the scientific production of dentistry and its content related to environmental issues, in addition to expanding discussions and reflections on the need to insert environmental education as academic content. With the specific purpose of verifying the amount and analyze the content of scientific articles involving issues related to sustainability in dentistry, Chapter 01 presents research in leading journals portals available on the internet. Works were surveyed where sustainability and related issues were present and placed in a theoretical framework that analyzes the dental service inclusion in the dominant economic model. These procedures are intended to prove the hypothesis that the dental profession does not produce significant scientific content that relates the profession to the environment and sustainability. A literature review was conducted with the statement of dentistry changes from its origins to the front position to the dominant development model and exemplification of the deleterious effects of this model on the environment. In addition, there was a scientific research in journals portals available on the internet and investigated the amount and content of scientific articles involving issues related to sustainability in dentistry. Chapter 02 has the specific purpose of providing content to expand discussions and reflections on the need to insert environmental education in undergraduate courses in dentistry, such as insertion strategy into a new development model guided by sustainability. In this, students questionnaires were given the 8th dentistry course of the period the Federal University of Rio Grande do Norte (UFRN), to be understood environmental perception of learners and were obtained grants for proof of the thesis that environmental education applied dentistry has the potential to make people aware and willing to act practicing and propagating sustainability in their conduct. The overall results indicate little scientific production, as the research and work that relates to dentistry to sustainability and the issues related to the environment have not significantly been present in the syllabus of the undergraduate courses in dentistry, despite the interest shown by survey respondents When such issues are addressed. In this context, it is proposed fostering actions to environmental education, so that dental professionals are engaged in the construction of a new development model based on sustainability, as despite the environmental theme seems to be little explored in the academic and scientific world of dentistry, there interest from students and great potential multiplier for appropriate environmental behavior. After proving the hypothesis that the environment-related content are poorly explored in the academic and scientific world of dentistry, the main conclusions were recognizing the importance of environmental education as an interdisciplinary tool for environmental thematic approach in undergraduate courses dentistry, in addition to implementing this new pedagogical proposal in the professional practice of dentists, given their potential multiplier for environmental knowledge.

Avaliação do AAM - Active Appearance Model para detecção de regiões de interesse em radiografias carpais na estimativa da idade óssea através do método TW

In several areas of health professionals (pediatricians, nutritionists, orthopedists, endocrinologists, dentists, etc.) are used in the assessment of bone age to diagnose growth disorders in children. Through interviews with specialists in diagnostic imaging and research done in the literature, we identified the TW method - Tanner and Whitehouse as the most efficient. Even achieving better results than other methods, it is still not the most used, due to the complexity of their use. This work presents the possibility of automation of this method and therefore that its use more widespread. Also in this work, they are met two important steps in the evaluation of bone age, identification and classification of regions of interest. Even in the radiography in which the positioning of the hands were not suitable for TW method, the identification algorithm of the fingers showed good results. As the use AAM - Active Appearance Models showed good results in the identification of regions of interest even in radiographs with high contrast and brightness variation. It has been shown through appearance, good results in the classification of the epiphysis in their stages of development, being chosen the average epiphysis finger III (middle) to show the performance. The final results show an average percentage of 90% hit and misclassified, it was found that the error went away just one stage of the correct stage.

Irish dental practitioners perceived barriers to the care of patients with special healthcare needs and the effect of postgraduate training

Inequalities in oral healthcare service provision to people with special health needs have been reported in the Republic of Ireland. These include higher unmet dental treatment needs and longer waiting period to access routine dental treatment than the general population. Aim: The aims of this study were to determine the groups of patients with special needs which pose a challenge to manage in the dental surgery and to examine perceived barriers to the care of these patients. We aimed to determine whether postgraduate training in the management of these patients increases the practitioners’ frequency of treatment and their desire for further training in this area. Methods: A questionnaire was used to survey 326 randomly selected dentists from the Dental Council’s register of dentists. Questionnaire and information sheets explaining the purpose of the survey, confidentiality and anonymity of the responses were posted to the dentists. Results: The results showed that children with intellectual disability posed the biggest challenge for dentists to manage in the dental surgery. Behaviour management issues and the degree of disability were perceived by many dentists as factors that would have high effects on their willingness to treat patients with special needs. Dentists who have postgraduate training in the management of patients with special needs were significantly more willing to treat these patients and to seek additional training in the future. Conclusion: There are links between the training and the willingness of practitioners to undertake dental treatment or patients with special healthcare needs.

Gerodontology teaching amongst European dental schools – A European College of Gerodontology survey.

Introduction: In 2009, the European College of Gerodontology (ECG) published the Gerodontology undergraduate teaching guidelines. Seven years later it conducted a survey to explore the current status of Gerodontology teaching amongst the European dental schools.
Methods: The ECG Education Committee developed an electronic questionnaire that was emailed to the Deans or other contact persons in 185 dental schools in 40 European countries. The questionnaire recorded the prevalence, contents and methodology of Gerodontology education. Two weeks later a reminder was sent to non-respondents.
Results: The first wave of responses included 70 dental schools from 28 European countries. Gerodontology was included in the undergraduate curricula of 77% of the respondents and was compulsory in 61% of them. The course was usually offered in senior students and was interdisciplinary; the educators included dentists, physicians, nurses and other care providers. Lecturing was the most common educational technique (75%), and the most common topics included medical problems in old age, pharmacology and polypharmacy, the association between general and oral health, nutritional and chewing problems, xerostomia and prosthodontic management. Clinical training was usually offered within the dental school clinics (50%) and less often in remote locations (nursing homes, geriatric hospitals, day centers).
Key Conclusions: An increasing number of European dental schools teach Gerodontology at the undergraduate curriculum. The study is still ongoing, but a "worst case scenario" has to be born in mind, where dental schools, who failed to participate in the survey, may not be teaching in Gerodontology.

Content and methodology of predoctoral Geriatric Dentistry teaching in Europe

Objectives: To explore the content and methodology of predoctoral Geriatric Dentistry teaching amongst European dental schools.
Methods: The study was conducted by the European College of Gerodontology (ECG) Education Committee. Αn electronic questionnaire has been developed with close and open-ended items, including information on the prevalence and institutional anchorage of Gerodontology programs, the educators, the content and the methodology of teaching. An electronic mail, including a hyperlink to the questionnaire, was sent to 216 dental schools in 39 European countries (Winter/ Spring 2016). The Deans were asked to either answer themselves, or forward the link to faculty members with knowledge on Gerodontology teaching at their respective schools. Repeated reminders or telephone calls were used for non-respondents and personal networks were exploited to identify potential contact persons.
Results: Until August 2016, 121 dental schools from 29 countries responded to the survey (response rate 56%, EU response rate: 60%). Gerodontology was included in the predoctoral curricula of 86% of the respondents and was compulsory in 68%. The course was mainly offered in senior students and was interdisciplinary in 30% of the schools, delivered mainly by dentists (79%), physicians (21%), psychologists (10%), and nurses (5%). It was conducted as an independent lecture series in 40% of the schools and a course director was assigned in 44% of the respondents. When embedded in other disciplines, these were mainly Prosthodontics (31%). The content included a large number of items, such as epidemiology of oral health, medical problems in old age, prosthodontic management, xerostomia, and caries risk assessment. Lectures were the most common teaching format (69%), followed by small group seminars (27%). The most common types of educational material used were scientific articles (48%), printed textbooks (44%), lecture notes (40%) and e-learning material (21%). Clinical training was offered by 64% of the respondents, within the dental school clinics (49%) and/or in outreach locations (40%).
Conclusion: Amongst the respondent European dental schools (66%) there is an increasing number that teach Gerodontology at a pre-doctoral level with significant variations in content and methodology. Official guidelines and the dissemination of the ECG pre-doctoral curriculum guidelines might help to increase the prevalence and improve the status of Gerodontology teaching in Europe.