Texas dental journal最新文献

Background There has been increasing concern by the American Dental Association, state dental boards, regional legislators, and specialty groups about the current state of dental anesthesia. Specific interest has surrounded methods to improve patient safety during parental sedation and anesthesia. Many times in the history of dental anesthesia, monitoring advances begin in the hospital for general anesthesia, then downscale, become smaller, and find utility in outpatient anesthesia. Monitoring advances ultimately have been shown to improve patient safety and are subsequently universally adopted. Practitioners should be aware that an anesthetic spectrum exists in parenteral sedation and anesthesia. For instance, there is data suggesting that a large number of patients planned for moderate sedation, may progress to deep sedation during which ventilation is impaired. With each individual patient responding differently to the administration of oral sedatives, intravenous anesthesia agents, or inhalational agents, anesthetics can have the effect of sedation, analgesia, hypertension, hypotension, combativeness, amnesia, apnea, or any one of many other more life-threatening events. It is incumbent upon all dental anesthesia providers to offer the highest spectrum of anesthesia monitoring and care currently available to prevent sedation effects from progressing to more serious situations. The most recent advance in anesthesia monitoring is capnography. It has been used in the operating room for many years to verify endotracheal tube placement. The capnogram provides information about respiratory rate and effectiveness, as well as end-tidal carbon dioxide values. Since 2011, the American Society of Anesthesiologists, and other prominent anesthesia organizations, have mandated capnography for use in moderate sedation. Most recently, the Oregon Board of Dentistry mandated capnography for all licensees performing moderate sedation effective Jan. 1, 2016. Capnography is also used in cardiopulmonary resuscitation and is advocated by the American Heart Association as an indicator of return of spontaneous circulation. Conclusions: Given the current regulatory environment concerning patient safety and monitoring during dental anesthesia, capnography should be a mandatory monitoring requirement for any dentist performing moderate sedation in the office. This instrumentation is easily added to any dental sedation monitoring armamentarium as a stand-alone unit or as a vital signs monitor upgrade and will demonstrate to the public and legislators that the dental profession is in alignment with monitoring recommendations of other anesthesia organizations.

Background: A prospective cohort study that included dentists in The National Dental Practice-Based Research Network was conducted to quantify 12-month failures of restorations that were repaired or replaced at baseline. The study tested the hypothesis that no significant differences exist in failure percentages between repaired and replaced restorations after 12 months. It also tested the hypothesis that certain dentist, patient, and restoration characteristics are significantly associated with the incidence of restoration failure.

Methods: Dentists recorded data for 50 or more consecutive defective restorations. The restorations that were either - repaired or replaced were recalled after 12 months and characterized for developing defects.

Results: Dentists (N = 195) recorded data on 5,889 restorations; 378 restorations required additional treatment (74 repaired, 171 replaced, 84 teeth received endodontic treatment, and 49 were extracted). Multivariable logistic regression analysis indicated that additional treatment was more likely to occur if the original restoration had been repaired (7%) compared with replaced (5%) (odds ratio [OR], 1.6; P < .001; 95% confidence interval [CI], 1.2-2.1), if a molar was restored (7%) compared with premolars or anterior teeth (5% and 6%, respectively) (OR, 1.4; P = .010; 95% CI, 1.1-1.7), and if the primary reason was a fracture (8%) compared with other reasons (6%) (OR, 1.3; P = .033; 95% CI, 1.1-1.6).

Conclusions: An additional treatment was more likely to occur within the first year if the original restoration had been repaired (7%) compared with being replaced (5%). However, repaired restorations were less likely to need an aggressive treatment (replacement, endodontic treatment, or extraction) than replaced restorations.

Practical implications: One year after repair or replacement of a defective restoration, the failure rate was low. However, repaired restorations were less likely to need an aggressive treatment than replaced restorations.

Background: Objectives were to: (1) determine whether and how often general dentists (GDs) provide specific dental procedures; and (2) test the hypothesis that provision is associated with key dentist, practice, and patient characteristics.

Methods: GDs (n = 2,367) in the United States National Dental Practice-Based Research Network completed an Enrollment Questionnaire that included: (1) dentist; (2) practice; and (3) patient characteristics, and how commonly they provide each of 10 dental procedures. We determined how commonly procedures were provided and tested the hypothesis that provision was substantively related to the 3 sets of characteristics.

Results: Two procedure categories were classified as "uncommon" (orthodontics, periodontal surgery), 3 were "common" (molar endodontics; implants; non-surgical periodontics), and 5 were "very common" (restorative; esthetic procedures; extractions; removable prosthetics; non-molar endodontics). Dentist, practice, and patient characteristics were substantively related to procedure provision; several characteristics seemed to have pervasive effects, such as dentist gender, training after dental school, full-time/part- time status, private practice vs. institutional practice, presence of a specialist in the same practice, and insurance status of patients.

Conclusions: As a group, GDs provide a comprehensive range of procedures. However, provision by individual dentists is substantively related to certain dentist, practice, and patient characteristics. A large number and broad range of factors seem to influence which procedures GDs provide. This may have implications for how GDs respond to the ever-changing landscape of dental care utilization, patient population demography, scope of practice, delivery models and GDs' evolving role in primary care.