Teledentistry: A Systematic Review of Clinical Outcomes, Utilization and Costs

Purpose: The purpose of this systematic review is to identify clinical outcomes, health care utilization and costs associated with teledentistry. Relevant databases were searched for articles on teledentistry published until March 2012, reference lists examined and key journals hand searched. Of a possible 58 articles, 19 studies met the inclusion criteria. Clinical outcomes were generally improved following a teledentistry intervention and satisfaction with teledentistry was consistently high. The few studies examining health care utilization reported mixed findings, but preliminary evidence suggests cost savings for health care facilities. There is a consistent trend in the literature supporting the efficacy and effectiveness of teledentistry. Further research is needed to identify the effectiveness, efficiency, utilization and costs of teledentistry as it could provide the key to improving access to care

Teleodontologia no diagnóstico de lesões de cárie e alterações da mucosa bucal em adolescentes privados de liberdade

Resumo: Objetivos: O objetivo do presente estudo foi avaliar um sistema de teleodontologia como ferramenta para o diagnóstico de lesões de cárie e alterações em mucosa bucal, em um grupo de 102 adolescentes brasileiros em conflito com a lei. Metodologia: O exame clínico foi realizado para avaliar o Índice CPO-D, de acordo com os critérios da Organização Mundial de Saúde (OMS) e a condição de saúde bucal de cada um dos adolescentes foi documentada, utilizando uma câmera fotográfica digital. A presente pesquisa contou com três avaliadores à distância, dois para o Índice CPO-D e um para as alterações em mucosa bucal. Para o telediagnóstico, foram testadas duas formas de transmissão de imagens. Na primeira delas, as imagens foram compactadas e postadas em um site para compartilhamento de arquivos (www.sendspace.com) e o link para download foi enviado por e-mail para os avaliadores. Na outra, as imagens foram salvas em um compact disc e enviadas para avaliação por meio de um serviço de orrespondência expressa. O Índice CPO-D foi calculado e as alterações em mucosa bucal foram identificadas em cada um dos casos transmitidos. Foram realizadas análises descritivas dos valores de CPO-D e das alterações em mucosa bucal. Para o CPOD, a concordância entre o exame presencial e as duas avaliações à distância foi mensurada pelo Coeficiente de Concordância Kappa. Sensibilidade e specificidade também foram calculadas, considerando o exame clínico presencial como padrãoouro. Resultados: A idade média da amostra foi de 16,84 anos (DP=0,94). De acordo com o exame clínico presencial, a prevalência de lesões de cárie foi de 93,1% e o CPO-D médio foi de 5,9. Os resultados obtidos com o Índice Kappa variaram de concordância “substancial” a “quase perfeita”. A sensibilidade variou de 48% a 73%, a especificidade de 97% a 98% e a acurácia de 93% a 95%. A prevalência de lesões bucais foi de 38,23%; 78,43% dos adolescentes apresentaram pelo menos uma variação de normalidade e 51% pelo menos uma alteração periodontal. Conclusões: Diante das dificuldades envolvidas na identificação das necessidades de tratamento de grupos vulneráveis, a aplicação da teleodontologia mostrou-se como uma alternativa ao exame clínico presencial no diagnóstico de lesões de cárie e um método adequado para auxiliar no rastreamento de alterações bucais em adolescentes que cumprem medida socioeducativa de rivação de liberdade

Dental Education

The dental curriculum is like a living organism—it has developed through time, manifesting regional, cultural, and scientific heritage, and reflecting modern trends. The undergraduate dental curriculum is periodically rebuilt to ensure the harmonization of higher education systems between countries, especially in Europe. Structure, content, learning, and assessment in undergraduate and postgraduate dental education and auxiliary dental personnel training are shaped based on professional consensus. Constant updates on recent technological innovations and evidence-based best practice are necessary.In modern times, ethical issues are raised more than ever. Can we teach our students how to be dedicated health professionals and manage a successful practice at the same time? Does the commercialization of our profession also affect the dental curriculum today?The COVID-19 pandemic has imposed new challenges, moving us from lecture rooms and clinics to an online environment.This Special Issue is dedicated to developing the understanding of dental education

Issues in Contemporary Orthodontics

Issues in Contemporary Orthodontics is a contribution to the ongoing debate in orthodontics, a discipline of continuous evolution, drawing from new technology and collective experience, to better meet the needs of students, residents, and practitioners of orthodontics. The book provides a comprehensive view of the major issues in orthodontics that have featured in recent debates. Abroad variety of topics is covered, including the impact of malocclusion, risk management and treatment, and innovation in orthodontics

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

Remote clinical consultations in restorative dentistry: A clinical service evaluation study

Introduction Specialist consultant services in the UK NHS provide a decision-making support service to other health professionals. There is a drive to deliver this service in a more patient-centred, cost-effective and efficient manner. Remote clinical consultations (RCC), using secure, live, super-fast internet connectivity and high-resolution, multi-channel audio-visual streaming, has the potential for the delivery of this service. Aim To conduct a clinical service evaluation to assess the viability and efficiency of conducting a RCC for the management of primary care referrals in restorative dentistry, compared to an in-person consultation. Design A RCC was conducted for every participating patient and immediately followed with a 'verification' in-person consultation. Materials and method Twenty-three patients of even gender distribution participated in this study across the three specialisms of restorative dentistry. A thematic questionnaire was completed by each member of the study intervention team and the patient after each consultation. Results In all the cases, the consultant was able to conduct an effective and safe clinical consultation, not inferior to an in-person process, regardless of gender and age. The GDP, the nurse and the patient were able to participate effectively in the process and with each other. Conclusion This proof-of-concept study suggests that the RCC concept is a feasible way of delivering specialist consultations in restorative dentistry with high levels of patient acceptability and that it can be delivered in a practical and simple manner

A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery

A systematic review of objective burn scar measurements

BackgroundProblematic scarring remains a challenging aspect to address in the treatment of burns and can significantly affect the quality of life of the burn survivor. At present, there are few treatments available in the clinic to control adverse scarring, but experimental pharmacological anti-scarring strategies are now beginning to emerge. Their comparative success must be based on objective measurements of scarring, yet currently the clinical assessment of scars is not carried out systematically and is mostly based on subjective review of patients. However, several techniques and devices are being introduced that allow objective analysis of the burn scar. The aim of this article is to evaluate various objective measurement tools currently available and recommend a useful panel that is suitable for use in clinical trials of anti-scarring therapies.MethodsA systematic literature search was done using the Web of Science, PubMed and Cochrane databases. The identified devices were then classified and grouped according to the parameters they measured.The tools were then compared and assessed in terms of inter- and intra-rater reproducibility, ease of use and cost.ResultsAfter duplicates were removed, 5062 articles were obtained in the search. After further screening, 157 articles which utilised objective burn scar measurement systems or tools were obtained. The scar measurement devices can be broadly classified into those measuring colour, metric variables, texture, biomechanical properties and pathophysiological disturbances.ConclusionsObjective scar measurement tools allow the accurate and reproducible evaluation of scars, which is important for both clinical and scientific use. However, studies to evaluate their relative performance and merits of these tools are scarce, and there remain factors, such as itch and pain, which cannot be measured objectively. On reviewing the available evidence, a panel of devices for objective scar measurement is recommended consisting of the 3D cameras (Eykona/Lifeviz/Vectra H1) for surface area and volume, DSM II colorimeter for colour, Dermascan high-frequency ultrasound for scar thickness and Cutometer for skin elasticity and pliability