Longevity of 2-and 3-surface restorations in posterior teeth of 25-to 30-year-olds attending Public Dental Service-A 13-year observation

Peer reviewe

e-Oral Health and Teledentistry in Finland - an Overview

Despite universal health coverage and a strong public health system, the oral health profile of Finland falls behind in an international age-matched prevalence of oral diseases. The oral healthcare system is organised and funded mainly by municipalities. Other stakeholders include the Finnish Student Health Service foundation (FSHS), government and private practices, where the Social Insurance Institution of Finland plays a major role in funding. Rise in the treatment need in recent years due to the increasing dentulous ageing population has challenged the healthcare system. Governmental response to the demand is an ongoing social and healthcare reform and increase of oral health professional education since 2004. However, the current and future treatment need is not met only by conventional prevention strategies and physical service provision. Finland has over the years supported a determined policy of building a digital healthcare architecture. This applies also to all fields of oral healthcare: virtual education, digital diagnostics, digital clinical workflow, national electronic patient records, patient-generated data registers, electronic prescriptions, remote consultation, digital service  management, as well as research and big data mining. These tools could play an important role in improving national oral health and increasing equity. This is an overview of the above-mentioned fields of e-Oral health and teledentistry in Finland based on current scientific literature, national reports, strategies and legislation.     &nbsp

E-Oral Health and Teledentistry in Finland; An Overview

Suun terveydenhuolto on osa suomalaista kansallista yleiskattavaa terveydenhuoltojärjestelmää. Valtaosa terveyspalvelujen järjestämis- ja rahoitusvastuusta Suomessa kuuluu kunnille. Kuntien vastuulla on erityisesti lasten suun terveydenhuolto. Valtaosa aikuisista käyttää kunnallisten palveluiden ohella yksityisiä palveluntarjoajia, joiden tuottamista palveluista potilas voi hakea osittaista korvausta Kansaneläkelaitokselta (KELA). Muita suun terveydenhuollon toimijoita ovat korkeakouluopiskelijoiden terveyspalveluista vastaava Ylioppilaiden terveydenhoitosäätiö (YTHS) ja valtio. Yleiskattavasta terveydenhuoltojärjestelmästä huolimatta suomalaisten suunterveys on kansainvälisessä vertailussa heikko. Valtaosan sairaustaakasta muodostavat hampaiden reikiintyminen ja kiinnityskudoksen sairaudet. Sairauksista huolimatta yhä useammalla suomalaisella ikääntyneellä on suussaan omia hampaita. Tämä yhdistettynä lisääntyvään väestön ikääntymiseen aiheuttaa lisääntynyttä hoidon tarvetta ja kuormittaa nykyistä suun terveydenhuoltojärjestelmää. Kasvavien terveyspalveluiden kysynnän vuoksi Suomen hallitus on valmistellut sosiaali- ja terveydenhuollon uudistusta vuodesta 2004 lähtien. Kasvava hoidontarve vaatii kuitenkin rahoitusmallin muutoksen lisäksi myös toiminnallisia muutoksia ja terveydenhuollon digitalisaation kehitystä. Suomessa onkin pitkään ajettu digitaalisen terveydenhuollon toimintamallia. Tämän katsauksen tarkoituksena on tarkastella elektronisen suun terveydenhuollon ja etähammaslääketieteen osa-alueiden nykytilaa ja tulevaisuuden näkymiä. Katsaus on laadittu vuoden 2018 lopulla. Kansallinen digitalisaatiostrategia koskettaa kaikkia suun terveydenhuollon toiminta-alueita. Palveluiden selkärangan muodostavat Kanta-palvelut, johon suun terveydenhuolto liittyi vuonna 2016. Nämä käsittävät potilastiedon arkiston, potilaan OmaKanta-palvelun, sähköisen reseptin, lääketietokannan ja terveydenhuollon todistuspalvelun. Näiden rinnalle kehitetään potilaiden tuottamia sähköisiä terveystietoja hyödyntäviä työkaluja, kuten OmaOlo-palvelua, jotka täydentävät terveydenhuollon ammattilaisen tuottamaa dataa. Kansallisten palveluiden lisäksi digitaalinen työnkulku vastaanotolla on ollut mahdollista tietokoneavusteisen suunnittelun ja valmistuksen (CAD/CAM) ja digiröntgenin yleistymisen myötä. Suomi on ollut digitaalisen röntgenteknologian ja telekonsultaatioiden edelläkävijä jo vuoden 2004 Thaimaan tsunamista saakka, jolloin mobiiliverkon kautta siirrettyjä hammasröntgenkuvia käytettiin uhrien tunnistamiseen katastrofipaikalla. Virtuaalisia ympäristöjä ammattilaisten koulutuksen tarpeisiin on kehitetty muun muassa MEDigi- ja VIRSU-hankkeissa. Näiden osa-alueiden kehitys ja käytännön toimintaan jalkauttaminen ovat keskeisessä osassa kansallisen suun terveyden tukemisessa, sekä hoidon saatavuuden ja oikeudenmukaisuuden lisäämisessä. Suun terveydenhuollon kohdalla vaaditaan ajatusmallin muutos, sillä alan on pitkään ajateltu vaativan fyysisen potilaskontaktin. Kuitenkin monien toimintojen, kuten esimerkiksi potilasneuvonnan, etäkonsultaatioiden, etädiagnostiikan ja moniammatillisen yhteistyön toteuttamiseen digitaaliset alustat voivat tarjota saavutettavia ja kustannustehokkaita ratkaisuja. Digitalisaation mahdollisuudet ovat moniulotteiset ja kehitystyön tulisi ennen kaikkea palvella potilaan etua

Management of defective dental Amalgam restorations-a mixed-methods study

Philosophiae Doctor - PhD (Community Oral Health)Much variation exists in the practice of dentistry with regard to the diagnosis of caries and the recommendations for treatment. Even though criteria for the selection of 'faulty' restorations often appear ill-defined, subjective and/or variable restoration replacement is a major component of dental practice in developed countries (Brennan and Spencer, 2006). While the prevalence of caries is decreasing in developed countries, low- and middle-income countries are experiencing an increase. The investigation of factors influencing the clinical decision-making process has identified and compared the roles of technical (e.g. oral health factors), patient and dentist factors (Brennan and Spencer, 2006; Bader and Shugars, 1995a; 1995b). A recent trend for a more conservative approach to restorative dentistry has led to the alternative management of defective dental restorations. Repair and refurbishment of defective dental restorations have been established as viable options. The purpose of this study was to provide information regarding the practices, knowledge and attitudes of South African dentists with regard to the management of defective dental amalgam restorations

Applying Process-Oriented Data Science to Dentistry

Background: Healthcare services now often follow evidence-based principles, so technologies such as process and data mining will help inform their drive towards optimal service delivery. Process mining (PM) can help the monitoring and reporting of this service delivery, measure compliance with guidelines, and assess effectiveness. In this research, PM extracts information about clinical activity recorded in dental electronic health records (EHRs) converts this into process-models providing stakeholders with unique insights to the dental treatment process. This thesis addresses a gap in prior research by demonstrating how process analytics can enhance our understanding of these processes and the effects of changes in strategy and policy over time. It also emphasises the importance of a rigorous and documented methodological approach often missing from the published literature. Aim: Apply the emerging technology of PM to an oral health dataset, illustrating the value of the data in the dental repository, and demonstrating how it can be presented in a useful and actionable manner to address public health questions. A subsidiary aim is to present the methodology used in this research in a way that provides useful guidance to future applications of dental PM. Objectives: Review dental and healthcare PM literature establishing state-of-the-art. Evaluate existing PM methods and their applicability to this research’s dataset. Extend existing PM methods achieving the aims of this research. Apply PM methods to the research dataset addressing public health questions. Document and present this research’s methodology. Apply data-mining, PM, and data-visualisation to provide insights into the variable pathways leading to different outcomes. Identify the data needed for PM of a dental EHR. Identify challenges to PM of dental EHR data. Methods: Extend existing PM methods to facilitate PM research in public health by detailing how data extracts from a dental EHR can be effectively managed, prepared, and used for PM. Use existing dental EHR and PM standards to generate a data reference model for effective PM. Develop a data-quality management framework. Results: Comparing the outputs of PM to established care-pathways showed that the dataset facilitated generation of high-level pathways but was less suitable for detailed guidelines. Used PM to identify the care pathway preceding a dental extraction under general anaesthetic and provided unique insights into this and the effects of policy decisions around school dental screenings. Conclusions: Research showed that PM and data-mining techniques can be applied to dental EHR data leading to fresh insights about dental treatment processes. This emerging technology along with established data mining techniques, should provide valuable insights to policy makers such as principal and chief dental officers to inform care pathways and policy decisions

Remineralising composites with improved cytocompatibility and containing antimicrobial agents for conservative treatment of caries

Objectives: To develop a remineralising dental composite with high strength, conversion and cytocompatibility and antimicrobial potential for more conservative treatment of dental caries. / Methods: The effect of glass filler particle size distributions and glass fibres on wetpoint, handling and mechanical properties was assessed. The effect of two photoinitiators at varying concentrations and four co-initiators on conversion, cytocompatibility and mechanical properties was determined. The conversion, depth of cure, shrinkage, mechanical properties, water sorption and cytocompatibility of composites containing varying bulk (urethane dimethacrylate (UDMA), bisphenol A glycidyl methacrylate (Bis-GMA)) and diluent monomers (poly(propylene glycol) dimethacrylate (PPGDMA), tri(ethylene glycol) dimethacrylate (TEGDMA)) were characterised. The conversion, water sorption, calcium precipitation, mechanical properties and shear bond strength of composites containing remineralising and antimicrobial agents (monocalcium phosphate (MCP), tricalcium phosphate (TCP), ε- poly-L-lysine (εPL)) were assessed (storage in water, simulated body fluid (SBF), artificial saliva (AS)). Techniques included Fourier transform infrared spectroscopy, mass and volume determination, biaxial flexural testing, shear bond testing, scanning electron microscopy, energy-dispersive X-ray spectroscopy, Raman spectroscopy, resazurin, WST-8 and MTS assays. / Results: An optimal combination of fillers was established. Conversion was affected by co-initiator to a greater extent than photoinitiator. Composites containing UDMA and PPGDMA had the optimal balance of conversion, mechanical properties, depth of cure and cytocompatibility without increased shrinkage. Composites containing MCP with either TCP or εPL induced rapid hydroxyapatite formation on the surface of the composite within one week in SBF but not in AS or water. / Significance: Composites containing the newly developed liquid phase had high conversion and strength, slightly improved cytocompatibility and acceptable shrinkage. Whilst composites containing MCP and TCP were stronger, the added possible antimicrobial action of those containing MCP and εPL have great potential to defend against recurrent caries by preventing microbial microleakage

Human experience in the natural and built environment : implications for research policy and practice

22nd IAPS conference. Edited book of abstracts. 427 pp. University of Strathclyde, Sheffield and West of Scotland Publication. ISBN: 978-0-94-764988-3

Public Health

Public health can be thought of as a series of complex systems. Many things that individual living in high income countries take for granted like the control of infectious disease, clean, potable water, low infant mortality rates require a high functioning systems comprised of numerous actors, locations and interactions to work. Many people only notice public health when that system fails. This book explores several systems in public health including aspects of the food system, health care system and emerging issues including waste minimization in nanosilver. Several chapters address global health concerns including non-communicable disease prevention, poverty and health-longevity medicine. The book also presents several novel methodologies for better modeling and assessment of essential public health issues