A multidisciplinary treatment of congenitally missing maxillary lateral incisors: a 14-year follow-up case report

Absence of the maxillary lateral incisor creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and the teeth, including the presentation of malocclusion and the effect on the occlusion must be considered. The objective of this study was to describe the etiology, prevalence and alternative treatment modalities for dental agenesis and to present a clinical case of agenesis of the maxillary lateral incisors treated by the closure of excessive spaces and canine re-anatomization. A clinical case is presented to illustrate the interdisciplinary approach between orthodontics and restorative dentistry for improved esthetic results. In this report, the treatment of a girl with a Class II malocclusion of molars and canines with missing maxillary lateral incisors and convex facial profile is shown. Treatment was successfully achieved and included the space closure of the areas corresponding to the missing upper lateral incisors, through movement of the canines and the posterior teeth to mesial by fixed appliances as well as the canines transformation in the maxillary lateral incisors. This is a 14-year follow-up case report involving orthodontics and restorative dentistry in which pretreatment, posttreatment, and long-term follow-up records for the patient are presented

Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach

<p>Abstract</p> <p>Background</p> <p>Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level.</p> <p>Objectives</p> <p>To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics.</p> <p>Methods</p> <p>The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed.</p> <p>Results</p> <p>Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics.</p> <p>Conclusions</p> <p>Girls, students whose parents have low schooling, those with low <it>per capita </it>income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.</p

Dental skill mix: a cross-sectional analysis of delegation practices between dental and dental hygiene-therapy students involved in team training in the South of England

BACKGROUND: Research suggests that health professionals who have trained together have a better understanding of one another’s scope of practice and are thus equipped for teamwork during their professional careers. Dental hygiene-therapists (DHTs) are mid-level providers that can deliver routine care working alongside dentists. This study examines patterns of delegation (selected tasks and patients) by dental students to DHT students training together in an integrated team. METHODS: A retrospective sample of patient data (n = 2,063) was extracted from a patient management system showing the treatment activities of two student cohorts (dental and DHT) involved in team training in a primary care setting in the South of England over two academic years. The data extracted included key procedures delegated by dental students to DHT students coded by skill-mix of operator (e.g., fissure sealants, restorations, paediatric extractions) and patient demography. χ(2) tests were conducted to investigate the relationship between delegation and patient age group, gender, smoking status, payment-exemption status, and social deprivation. RESULTS: A total of 2,063 patients managed during this period received treatments that could be undertaken by either student type; in total, they received 14,996 treatment procedures. The treatments most commonly delegated were fissure sealants (90%) and restorations (51%); whilst the least delegated were paediatric extractions (2%). Over half of these patients (55%) had at least one instance of delegation from a dental to a DHT student. Associations were found between delegation and patient age group and smoking status (P <0.001). Children under 18 years old had a higher level of delegation (86%) compared with adults of working age (50%) and patients aged 65 years and over (56%). A higher proportion of smokers had been delegated compared with non-smokers (45% cf. 26%; P <0.001). CONCLUSIONS: The findings suggest that delegation of care to DHT students training as a team with dental students, involved significantly greater experience in treating children and adult smokers, and providing preventive rather than invasive care in this integrated educational and primary care setting. The implications for their contribution to dentistry and the dental team are discussed, along with recommendations for primary care data recording

Is there really a beauty premium or an ugliness penalty on earnings?

Purpose Economists have widely documented the “beauty premium” and “ugliness penalty” on earnings. Explanations based on employer and client discrimination would predict a monotonic association between physical attractiveness and earnings; explanations based on occupational self-selection would explain the beauty premium as a function of workers’ occupations; and explanations based on individual differences would predict that the beauty premium would disappear once appropriate individual differences are controlled. In this paper, we empirically tested the three competing hypotheses about the “beauty premium”. Design/Methodology/Approach We analyzed a nationally representative and prospectively longitudinal sample from the National Longitudinal Survey of Adolescent Health (Add Health). Findings Findings The results contradicted the discrimination and self-selection explanations and strongly supported the individual differences explanation. Very unattractive respondents always earned significantly more than unattractive respondents, sometimes more than average-looking or attractive respondents. Multiple regression analyses showed that there was very weak evidence for the beauty premium, and it disappeared completely once individual differences, such as health, intelligence, and Big Five personality factors, were statistically controlled. Implications Past findings of beauty premium and ugliness penalty may possibly be due to the fact that: 1) “very unattractive” and “unattractive” categories are usually collapsed into “below average” category; and 2) health, intelligence (as opposed to education) and Big Five personality factors are not controlled. It appears that more beautiful workers earn more, not because they are beautiful, but because they are healthier, more intelligent, and have better (more Conscientious and Extraverted, and less Neurotic) personality. Originality/Value This is the first study to show that: 1) very unattractive workers have extremely high earnings and earn more than physically more attractive workers, suggesting evidence for the potential ugliness premium; and 2) the apparent beauty premium and ugliness penalty may be a function of unmeasured traits correlated with physical attractiveness, such as health, intelligence, and personality

Patient-Centered Research: Disenrollment From Medicare Managed Care Plans in Connecticut

PURPOSE: Disenrollment behavior has important implications for the cost, quality, and continuity of care under Medicare Managed Care (MMC). Although disenrollment data are sometimes used as a quality indicator, uncertainty about how personal and plan characteristics influence disenrollment decisions complicates their use as a valid quality measure. METHODS: To determine how personal characteristics influence MMC disenrollment decisions, we analyzed data from the Medicare Beneficiary File, the US Census, and MMC plans. The study population consisted of MBs enrolled in one of 9 MMC Risk plans during a 6 month period, January through June 1998. We estimated logistic regression models with disenrollment (i.e. leaving a plan during the study period) as the dependent variable, and individual MB characteristics (age, gender, race, education, economic indicators) as independent variables, adjusting for plan characteristics. For disenrolling MBs we also estimated models using rapid disenrollment and disenrollment to fee-for-service (FFS) as dependent variables. RESULTS: Of 84,443 Medicare Beneficiaries (MBs) enrolled in one of 9 MMC risk plans in Connecticut, 4,102 (4.9%) disenrolled at least once during the 6 month study period, January through June, 1998. Of 4,022 MBs who disenrolled only once, 2,661 (66.2%) joined another MMC plan, while 1,361 (33.8%) returned to fee-for-service (FFS). 948 (23.6%) disenrolled "rapidly" (<90 days after joining). MBs who switched to another MMC plan had been enrolled longer than those who went back to FFS (Median 303 vs. 120 days, p < .001). In logistic regression analysis, adjusting for plan characteristics, disenrollment was associated with non-White race/ethnicity, age <75, and residence in areas with higher poverty rates and lower education levels. Among disenrollees, rapid disenrollment and disenrollment to FFS were associated with female gender, age ≥75, and residence in areas with higher poverty rates. CONCLUSION: Higher disenrollment among poorer, minority MBs suggests that these groups may have more problematic experiences with MMC, or may be more severely affected by coverage limitations. The higher rate of rapid disenrollment and return to FFS among older, poor, female disenrollees may be related to inadequate plan information at enrollment. Further research is needed do determine how patient characteristics influence disenrollment decisions, and whether MMC plans can improve member retention by paying more attention to the medical needs of specific groups and the information provided to enrollees