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Background. The prevalence of dental erosion is rising especially among children and adolescents and its grading needs further investigation. Aims. To determine the prevalence and severity of dental erosion in groups of Yemeni children and adolescents, and to clinically compare an erosion partial recording system (EPRS) with a proposed modified–simplified version (EPRS-M). Design. Of 6163 individuals aged 5–6, 13–14 and 18–19 years, 911 were randomly selected, of which 668 participated in the study. Dental erosion was graded using EPRS. EPRS-M was proposed, and its sensitivity and specificity was calculated in relation to EPRS. Results. Prevalence of erosion extending into dentine on at least one tooth was 6.8% among 5- to 6-year-olds, 3.0% among 13- to 14-year-olds and 14.6% among 18- to 19-year olds. The highest prevalence was 19.2% among girls aged 18– 19 years which was significantly higher than boys (10.4%) in the same age group (P = 0.044). Sensitivity and specificity for EPRS-M in relation to EPRS were 85.7% and 100% for primary teeth, and 84.1% and 100% for permanent teeth. Conclusions. Dental erosion was common among children and older teenagers and highest among older girls but less common among younger teenagers. The tested accuracy of EPRS-M qualifies it to be used as an initial quick detection tool in future dental erosion research. publishedVersion

Background Dental case notes record clinical diagnoses and treatments, as well as providing continuity of patient care. They are also used for dento-legal litigation and forensic purposes. Maintaining accurate and comprehensive dental patient records is a dental worker's ethical and legal obligation. Methods Australian registered specialist forensic odontologists were surveyed to determine the relevance of recorded case note items for dental identification. A dental case notes sample was assessed for adherence with odontologist nominated forensic value and compiled professional record keeping guidelines of forensic relevance. Frequency of item recording, confidence interval, examiner agreement and statistical significance were determined. Results Broad agreement existed between forensic odontologists as to which recorded dental items have most forensic relevance. Inclusion frequency of these items in sampled case notes varied widely (e.g. single area radiographic view present in 75%, CI = 65.65–82.50; completed odontogram in 56%, CI = 46.23–65.33). Recording of information specified by professional record keeping guidelines also varied, although overall inclusion was higher than for forensically desired items (e.g. patient's full name in 99%, CI = 94.01 – >99.99; named treating practitioner in 23%, CI = 15.78–32.31). Conclusions Many sampled dental case notes lacked details identified as being valuable by forensic specialists and as specified by professional record keeping guidelines.

Background When a dental practitioner is brought before a disciplinary body, a common finding is that dental records were poorly kept and inadequate to establish issues of consent for treatment or the nature of the treatment undertaken. Often this finding may be incidental to the actual issue that brought the practitioner before a regulatory body or the Courts. The aim of this study was to examine recent cases reported in the State of Victoria involving dental practitioners, specifically seeking those cases where the record keeping was found to be inadequate as an incidental finding. Methods Published rulings of formal complaints and notification cases brought before disciplinary hearings in the State of Victoria for the period January 2000 to June 2014 were analysed with regards to orders made in respect to record keeping. Results Complaints and notifications specific to dental record keeping accounted for less than 2% of formal complaints. And yet up to 75% of cases have made a finding of unprofessional conduct against a dental practitioner on the basis of inadequate record keeping, most often in combination with other breaches of conduct. Conclusions Adherence to the traditional format of handwriting or typing entries into patient records may contribute to the problem of poor record keeping in a clinical dental setting. Newer technologies such as digital intraoral and extraoral photography and audio-recording of patient interactions may offer a solution to the problems of record keeping.

During the Korean War, the Office of the Quartermaster General's Graves Registration Service (GRS) was responsible for the recovery, processing, identification, and repatriation of US remains. In January 1951, the GRS established a Central Identification Unit (CIU) at Kokura, Japan. At the Kokura CIU, postmortem dental examinations were performed by the dental technicians. Thirty-nine postmortem dental examinations performed at the CIU were compared to the findings documented in the Forensic Odontology Reports written at the JPAC Central Identification Laboratory (CIL). Differences were noted in 20 comparisons (51%). The majority of the discrepancies was considered negligible and would not alter the JPAC decision to disinter a set of unknown remains. Charting discrepancies that were considered significant included the occasional failure of the Kokura technicians to identify teeth with inter-proximal or esthetic restorations and the misidentification of a mechanically prepared tooth (i.e., tooth prepared for a restoration) as a carious surface.

The Consortium for Oral Health Research and Informatics (COHRI) is leading the way in use of the Dental Diagnostic System (DDS) terminology in the axiUm electronic health record (EHR). This collaborative pilot study had two aims: 1) to investigate whether use of the DDS terms positively impacted predoctoral dental students' critical thinking skills measured by the Health Sciences Reasoning Test (HSRT), and 2) to refine study protocols. The study design was a natural experiment with cross-sectional data collection using the HSRT for 15 classes (2013-17) of students at three dental schools. Characteristics of students who had been exposed to the DDS terms were compared with students who had not, and the differences were tested by t-tests or chi-square tests. Generalized linear models were used to evaluate the relationship between exposure and outcome on the overall critical thinking score. The results showed that exposure was significantly related to overall score (p=0.01), with not-exposed students having lower mean overall scores. This study thus demonstrated a positive impact of using the DDS terminology in an EHR on the critical thinking skills of predoctoral dental students in three COHRI schools as measured by their overall score on the HSRT. These preliminary findings support future research to further evaluate a proposed model of critical thinking in clinical dentistry.

Background: This study investigated the frequency, patterns and causes of dental trauma in patients seeking emergency treatment at a dental hospital, and evaluated the impact of an electronic structured injury history form to collect key information. Methods: A retrospective audit was undertaken of all emergency presentations at the Royal Dental Hospital of Melbourne from 2009 to 2012. Dental trauma and injury surveillance data were collected and evaluated with reference to the criteria of the Victorian Emergency Minimum Dataset. Statistical analysis included chi‐squared and Fisher's exact tests. Results: A total of 88 610 new emergency courses of care were created, with 3642 (4.1%) identified as new dental trauma cases in 3574 patients. A total of 6001 teeth were injured with a mean of 1.7 teeth per patient (range: 1–8 teeth). The improvement of injury surveillance information collected using the electronic form compared with the paper form was statistically significant (p < 0.001). Conclusions: The dental trauma findings of this study are consistent with other studies regarding age, gender, location, cause and injury type. This study also confirmed the benefits of electronic collection of dental injury surveillance data that can assist policy planners and health service providers in designing and delivering effective dental injury prevention and management services.

Background: Root caries stands to be a significant burden for Australia's ageing population. The objective of this study was to describe Queensland dental practitioners' perceptions of root caries prevalence, presentation and predisposing factors as well as diagnosis and recording practices. Methods: Using the Queensland Dental Board register, all 2 515 dentists and dental specialists practising in Queensland were invited to participate in a questionnaire-based postal survey. Results: Of the 660 responses received, 638 were included for final analysis. Use of diagnostic measures such as surface elasticity and contour were reported frequently. A majority of respondents (77%) reported not recording root caries in a way that could be distinguished from coronal caries. Dietary analysis was the most commonly reported adjunctive aid for risk assessment. Recommendations for use of remineralizing agents were frequently reported (home use 90%; in office use 71%). Salivary impairment was reported to be an important risk factor for root caries by 93% of respondents, but only 18% reported performing salivary analysis. A large proportion of respondents (32%) considered patients with diabetes to be of low or no risk of root caries. Conclusions: While the Queensland dental practitioners who participated in this survey demonstrated an awareness of root caries and its predisposing factors, clinical risk assessment particularly for patients with diabetes should be further examined.

Although standardized terminologies such as the International Classification of Diseases have been in use in medicine for over a century, efforts in the dental profession to standardize dental diagnostic terms have not achieved widespread acceptance. To address this gap, a standardized dental diagnostic terminology, the EZCodes, was developed in 2009. Fifteen dental education institutions in the United States and Europe have implemented the EZCodes dental diagnostic terminology. This article reports on the utilization and valid entry of the EZCodes at three of the dental schools that have adopted this standardized dental diagnostic terminology. Electronic data on the use of procedure codes with diagnostic terms from the three schools over a period from July 2010 to June 2011 were aggregated. The diagnostic term and procedure code pairs were adjudicated by three calibrated dentists. Analyses were conducted to gain insight into the utilization and valid entry of the EZCodes diagnostic terminology in the one-year period. Error proportions in the entry of diagnostic term (and by diagnostic category) were also computed. In the twelve-month period, 29,965 diagnostic terms and 249,411 procedure codes were entered at the three institutions resulting in a utilization proportion of 12 percent. Caries and periodontics were the most frequently used categories. More than 1,000 of the available 1,321 diagnostic terms were never used. Overall, 60.5 percent of the EZCodes entries were found to be valid. The results demonstrate low utilization of EZCodes in an electronic health record and raise the need for specific training of dental providers on the importance of using dental diagnostic terminology and specifically how to use the terms in the electronic record. These findings will serve to increase the use/correct use of the EZCodes dental diagnostic terminology and ultimately create a reliable platform for undertaking clinical, outcomes, and quality improvement-related research.

The purpose of this study was to illustrate one method of tracking patients' tobacco use and monitoring cessation interventions with electronic dental records in an academic dental setting. Records from 465 tobacco users were analyzed to assess patients' tobacco use and providers' intervention techniques. The results indicate that 75 percent of the patients whose records were analyzed had used tobacco for more than ten years and the cold turkey approach was the most common cessation method. Ninety-seven percent of the patients whose records were analyzed used cigarettes. The most common pharmacotherapy recommended in combination with counseling for smoking cessation was the nicotine patch, followed by nicotine gum, varenicline (Chantix), the nicotine lozenge, bupropion SR (Zyban), and the nicotine oral inhaler. Incorporating tobacco use questions into the electronic dental record can ensure that tobacco use and intervention techniques are addressed and documented in dental records. Electronic dental records provide an opportunity to collect data related to tobacco use and intervention techniques for purposes of further evaluation and research.

OBJECTIVE The aim of our investigation was to review the implementation of a comprehensive tobacco dependence education (TDE) curriculum at the Medi School of Dental Hygiene (MSDH), Bern, Switzerland, 2001-2008. METHODS In 2001, new forms to record patients' tobacco use history and willingness to quit were created for all the MSDH patients. In 2002, a new theoretically based tobacco dependence treatment protocol was implemented into the MSDH curriculum. Students received instruction on how to provide brief tobacco use dependence interventions as well as maintain detailed records of patient tobacco use and cessation interventions for every smoker at all dental hygiene visits. RESULTS In 2002, 17 lecture hours were added to the following subjects: pathology, periodontology, preventive dentistry, pharmacology and psychology. During the same time period, 2213 patients (56.9% women) have visited the MSDH. Smoking status was recorded in 85.7% of all the patients (30.2% smokers). Brief tobacco use interventions were recorded in 36.8% of all smokers while 7.6% of these have reported to quit smoking. CONCLUSIONS Overall, the new TDE curriculum was successfully implemented and accepted by the MSDH faculty. Applications in the clinical practice, however, may still be improved to better identify smokers and increase initial and follow-up interventions potentially leading to higher quit rates.

Patient recall should be a tool to support prevention, allow early intervention, and ensure long-term dental health. Although the concept of patient-customized recall intervals has increased in popularity, recommendations vary significantly. Concepts of risk assessment-derived recalls are described in the literature separately for caries, periodontal disease, and edentulism, but no published guidelines exist for creating patient-centered recall systems that integrate all risks. Further, no recommendations exist regarding oral cancer risk assessment and recall intervals. The evidence shows that recall intervals of less than twelve months do not impact stage and tumor size at diagnosis although increasing this interval may significantly affect the outcome. The typical approach to recall scheduling is that the interval before the next oral health review should be chosen when no further treatment is indicated or on completion of a specific treatment journey. This article advocates a modified approach that supports individualized risk-based recall schedules not only after active therapy is completed but also during the course of treatment. The design of individualized recall schedules would address a patient's risk for caries and periodontal disease and the need to perform periodic oral cancer screenings. Evidence is also presented regarding the timing of recalls for edentulous patients. This article describes design principles for a Risk Assessment-Based Individualized Treatment (RABIT) system, presents an example of an electronic health record (EHR) recall module implemented at one dental school, and identifies barriers to implementation. As EHRs become more prevalent in dental practice, it is expected that the software industry and the profession will collaborate to include RABIT-like concepts in software management packages.

Problem-based learning (PBL) is a widely accepted educational method centered on the discussion and learning that emerge from a clinically based problem; however, little has been reported on the details of PBL case-writing in the dental education literature. This article outlines some principles of writing a PBL case as it is practiced at a Chinese dental school and presents, as an example, an actual case based on a clinical problem (ameloblastoma of the jaw) intended to provide a learning focus for predoctoral dental students. A good PBL case should allow for progressive, interdependent actions to be taken in the evaluation and overall management of the patient in context and should trigger inquiry and discussion among students in both the basic sciences (anatomy, physiology, biochemistry, pharmacology, pathophysiology, etc.) and related clinical sciences. The epidemiological, sociological, and ethical considerations related to each problem should also be emphasized as an essential component of effective health care provision.

Background: Associations between periodontitis and cardiovascular and autoimmune diseases are most often assessed in patients with a particular cardiovascular or autoimmune disease. To prevent selection bias, this study assesses the existence of associations between periodontitis and cardiovascular and autoimmune diseases in patients attending a dental or periodontal clinic.Methods: Data were collected from 1,276 randomly selected dental records from patients attending a dental (n = 588) or periodontal (n = 688) clinic. Data on the prevalence of cardiovascular and autoimmune diseases were obtained from a validated health questionnaire. Data on the presence of periodontitis were taken from patients' dental records.Results: In uncontrolled analyses, the prevalence of hypertension, diabetes mellitus (DM), and rheumatoid arthritis (RA) is significantly increased in patients with periodontitis. Controlled for confounding, periodontitis was associated with DM, with an odds ratio of 4 (1.03 to 15.3), in the dental clinic. DM was not associated with periodontitis in periodontal clinics. Hypertension does not seem to be associated with periodontitis when controlling for confounders. Periodontitis may be associated with RA in both clinic types.Conclusions: The increased prevalence of cardiovascular and autoimmune diseases among patients with periodontitis attending dental or periodontal clinics may, at least in part, be influenced by confounding. However, the increased prevalence of DM and RA in patients with periodontitis could not be explained by confounding. J Periodontol 2010;81:1622-1628.

The School Dental Service provides regular dental care to 98 per cent of 5–13-year-old school children and 68 per cent of pre-school children in New Zealand. Officially collected statistics are presented for the six main population areas showing: 1 the dental status of all 12- and 13-year-old patients completing their final year of treatment, and 1 the permanent tooth filling rates of all patients with permanent teeth (aged 6–13 years). These suggest that child dental decay differences are not closely related to the presence or absence of water fluoridation. Official census information on the above and other communities suggests that dental health differences could be related to demographic, especially socio-economic, factors.

Background. Since caries prevalence has decreased and become polarized, high-risk preventive strategies have been widely adopted. The underlying factors leading to assessment and management of caries risk are poorly understood. Aim. The aim of this study was to identify the factors forming the basis for dentist's caries risk assessment in dental care for children and adolescents. Design. From all 3372 children in a Swedish county identified as at high risk for developing caries, a sample of dental records from 432 children, aged 3–19 years, were randomly selected to be analysed in the study. Information about medical and social history, dental status, dietary habits, oral hygiene, and salivary data was obtained from the records. Results. The results show that the only data registered in the majority of the dental records were dental status from the clinical examination and bitewing radiographs. In approximately half of the dental records, medical history and data concerning oral hygiene were registered. Dental history and dietary habits were noted in approximately 25% of the dental records, whereas other risk factors/indicators were occasionally registered. Conclusions. Dentists mainly base their caries risk assessments on past caries experience, a reliable risk indicator for assessing the risk of being affected by caries again. In children with no experience of caries, knowledge of other risk factors/indicators needs to be available to perform a caries risk assessment. In this study, documentation of such knowledge was strongly limited.

– Objectives: The commonly used methods of chart review, billing data summaries and practitioner self-reporting have not been examined for their ability to validly and reliably represent time use and service delivery in routine dental practice. A more thorough investigation of these data sources would provide insight into the appropriateness of each approach for measuring various clinical behaviors. The aim of this study was to assess the validity of commonly used methods such as dental chart review, billing data, or practitioner self-report compared with a ‘gold standard’ of information derived from direct observation of routine dental visits. Methods: A team of trained dental hygienists directly observed 3751 patient visits in 120 dental practices and recorded the behaviors and procedures performed by dentists and hygienists during patient contact time. Following each visit, charts and billing records were reviewed for the performed and billed procedures. Dental providers characterized their frequency of preventive service delivery through self-administered surveys. We standardized the observation and abstraction methods to obtain optimal measures from each of the multiple data sources. Multi-rater kappa coefficients were computed to monitor standardization, while sensitivity, specificity, and kappa coefficients were calculated to compare the various data sources with direct observation. Results: Chart audits were more sensitive than billing data for all observed procedures and demonstrated higher agreement with directly observed data. Chart and billing records were not sensitive for several prevention-related tasks (oral cancer screening and oral hygiene instruction). Provider self-reports of preventive behaviors were always over-estimated compared with direct observation. Inter-method reliability kappa coefficients for 13 procedures ranged from 0.197 to 0.952. Conclusions: These concordance findings suggest that strengths and weaknesses of data collection sources should be considered when investigating delivery of dental services especially when using practitioner survey data. Future investigations can more fully rely on charted information rather than billing data and provider self-report for most dental procedures, but nonbillable procedures and most counseling interactions will not be captured with routine charting and billing practices.

Background Dental hygiene is becoming an increasingly important component of quality health care for laboratory animals, especially non-human primates (NHPs). One key to a successful health care program is an effective and efficient record-keeping system. Methods To standardize a dental hygiene program for a small colony of NHPs, we developed a dental recording chart specific for rhesus monkeys. This dental chart was developed using the modified Triadan system. This system numbers teeth across species according to location. Results An illustrative case report was presented to demonstrate the accurate record keeping and spatial relationship generated from this Old World NHP dental chart design. Conclusion The development and implementation of a standardized dental chart, as part of a dental hygiene program will help minimize variables that may affect research data.

Obtaining lifetime diagnostic radiation histories in head and neck cancer studies is often challenging due to the almost universal lack of centralized registries on X-ray utilization in medicine and dentistry. Both the common nature of orthodontics and the young age at which orthodontics typically occurs make it important to quantify what diagnostic radiographs are typically taken during orthodontic therapy. The aim of this study was to assess the number and type of radiographic films associated with one episode of orthodontic therapy in an educational setting. Charts stored in an orthodontic clinic at one academic setting were randomly sampled, and the type and number of radiographic examinations were tallied for the 325 individuals who were in orthodontic therapy for at least one year. Being under orthodontic therapy for one or more years was associated with a median number of seven extra-oral radiographs and twenty-four intra-oral radiographic films. The extra-oral radiographs included three panoramic radiographs and three cephalometric radiographs. Less than 10 percent of the variability was explained by factors such as age, gender, calendar year, surgical orthodontic therapy, and duration of therapy. Head and neck cancer etiology studies should take into account the ionizing radiation during episodes of orthodontic care. The substantial variability in radiographic practices in orthodontics could be reduced by research into clinical utility and by establishing guidelines.

Objectives: To determine changes in the prevalence of dental fluorosis, and in perceptions of aesthetic concerns due to dental fluorosis after water fluoridation ceased. Methods: Schoolchildren in second and third grades were examined in 1993-94, 1996-97 and 2002-03 to determine changes in the prevalence of dental fluorosis following fluoridation cessation of the public water supplies in 1992. The Thylstrup-Fejerskov Index (TFI) was used to quantify dental fluorosis. Perceptions of aesthetics were assessed by questionnaires which were sent home to parents. Residence and dental histories were confirmed on all children to determine the extent of exposure to all types of fluorides. Comparisons between the three surveys were used to establish the influence of fluoridated water and other fluoride sources on the occurrence and severity of dental fluorosis. Aesthetic ratings from parents were used to assess the aesthetic conditions of maxillary anterior teeth across the three surveys. Results: When fluoride was removed from the water supply in 1992, the prevalence and severity of TFI scores decreased significantly from the 1993-94 survey cycle when compared with the 1996-97 and 2002-03 survey cycles. The use of fluoride supplements and fluoride dentifrice also decreased during this study period. Analyses were unable to determine the influence of these different fluoride exposures on the changes in TFI scores over time. Comparisons of aesthetic ratings from parents between survey cycles failed to show any significant differences.

The subject of missing persons is of great concern to the community with numerous associated emotional, financial, and health costs. This paper examines the forensic medical issues raised by the delayed identification of individuals classified as "missing" and highlights the importance of including dental data in the investigation of missing persons. Focusing on Australia, the current approaches employed in missing persons investigations are outlined. Of particular significance is the fact that each of the eight Australian states and territories has its own Missing Persons Unit that operates within distinct state and territory legislation. Consequently, there is a lack of uniformity within Australia about the legal and procedural framework within which investigations of missing persons are conducted, and the interaction of that framework with coronial law procedures. One of the main investigative problems in missing persons investigations is the lack of forensic medical, particularly, odontological input. Forensic odontology has been employed in numerous cases in Australia where identity is unknown or uncertain because of remains being skeletonized, incinerated, or partly burnt. The routine employment of the forensic odontologist to assist in missing person inquiries, has however, been ignored. The failure to routinely employ forensic odontology in missing persons inquiries has resulted in numerous delays in identification. Three Australian cases are presented where the investigation of individuals whose identity was uncertain or unknown was prolonged due to the failure to utilize the appropriate (and available) dental resources. In light of the outcomes of these cases, we suggest that a national missing persons dental records database be established for future missing persons investigations. Such a database could be easily managed between a coronial system and a forensic medical institute. In Australia, a national missing persons dental records database could be incorporated into the National Coroners Information System (NCIS) managed, on behalf of Australia's Coroners, by the Victorian Institute of Forensic Medicine. The existence of the NCIS would ensure operational collaboration in the implementation of the system and cost savings to Australian policing agencies involved in missing person inquiries. The implementation of such a database would facilitate timely and efficient reconciliation of clinical and postmortem dental records and have subsequent social and financial benefits.

Forensic scientists are often expected to present the likelihood of DNA identifications in US courts based on comparative population data, yet forensic anthropologists tend not to quantify the strength of an osteological identification. Because forensic anthropologists are trained first and foremost as physical anthropologists, they emphasize estimation problems at the expense of evidentiary problems, but this approach must be reexamined. In this paper, the statistical bases for presenting osteological and dental evidence are outlined, using a forensic case as a motivating example. A brief overview of Bayesian statistics is provided, and methods to calculate likelihood ratios for five aspects of the biological profile are demonstrated. This paper emphasizes the definition of appropriate reference samples and of the "population at large," and points out the conceptual differences between them. Several databases are introduced for both reference information and to characterize the "population at large," and new data are compiled to calculate the frequency of specific characters, such as age or fractures, within the "population at large." Despite small individual likelihood ratios for age, sex, and stature in the case example, the power of this approach is that, assuming each likelihood ratio is independent, the product rule can be applied. In this particular example, it is over three million times more likely to obtain the observed osteological and dental data if the identification is correct than if the identification is incorrect. This likelihood ratio is a convincing statistic that can support the forensic anthropologist's opinion on personal identity in court.

Objective: We examined the potential for research using administrative databases containing dentists' claims to identify both the type of health services research questions addressed and the strength of the evidence that is achieved in such studies. Methods: We searched Medline (1966 to March, 2003), retrieved additional reports from personal files, reviewed the literature cited in the relevant articles and conducted electronic searches on investigators' surnames. Information from relevant articles was abstracted into tables and the strength of the evidence for each was classified. Results: Thirty-eight studies met our inclusion criteria. Researchers have used administrative databases of dental records to examine provider practices, the longevity or consequences of dental interventions, the prevalence of dental conditions, and patient factors that determined care, and to establish quality assurance criteria or standards of care. The strongest designs were prospective or case-control (Level 11–2). Conclusion: Studies analyzing administrative databases have the advantage of size and economy but are subject to several threats to their validity and are seldom population-based. The strongest designs occurred with investigation of the longevity or consequences of care. Several studies demonstrated the benefit of linking the service data to patient or provider characteristics. The study of dentists' claims data appears under exploited, especially in the area of identifying and recommending changes in dental health care policies.

Background: Healthy periodontal tissues are essential to overall dental health. Therefore, the detection and management of periodontal disease is an integral part of general dental practice. The aim of this study was to investigate confidence in diagnosis and management of periodontal disease by general dental practitioners (GDPs), assess if the Dental Practice Board guidelines on periodontal record keeping are being addressed, and, if necessary, try to find ways of improving the periodontal knowledge of GDPs. Methods: A survey assessing practitioner confidence in diagnosing and treating periodontal disease was sent to a random selection of 550 dental care providers registered with the Dental Practice Board of Victoria. Results: Two hundred and eighty five (51.8 per cent) of questionnaires were returned completed. It was found that 79.7 per cent of the sampled population screened all new patients for periodontal disease. The majority of respondents felt confident to diagnose and treat gingivitis and initial periodontitis. However, only 61.9 per cent felt confident to diagnose aggressive/early onset periodontitis, and many were not confident in treating advanced periodontitis (36.3 per cent) or aggressive periodontitis (51.6 per cent). The majority of dentists reported that they provided most of the non surgical periodontal therapy to their patients, while most surgical treatments were referred to specialist periodontists. Factors deemed to be important in influencing the decision to provide periodontal treatment included level of training and ability to motivate patients to improve oral hygiene. Many responents requested periodontic continuing education (CE) courses be run. Conclusions: Most of the dentists surveyed were confident to diagnose periodontal disease and to treat the more common presentations of periodontal disease. There is some evidence to suggest that some practitioners are not following the minimum requirements set by the Dental Practice Board of Victoria in relation to periodontal record keeping. The results also indicate a need for more periodontic CE courses in Victoria.

Certain health care organizations, including dental schools, should be readying themselves to comply with the numerous requirements described within the administrative simplification section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The intent of administrative simplification is to streamline the management of health care transactions while protecting the privacy of certain written, oral, and electronic patient information. There are no field-tested plans for implementing the law because only recently has the health care industry begun to respond to the multitude of requirements. It is essential that each organization create a customized compliance plan that best fits its structure and needs. The purpose of this paper is to propose a five-stage theoretical strategy that could assist a dental school in achieving HIPAA compliance. The first stage involves the selection of a HIPAA task force. The second stage selects the applicable HIPAA requirements, determines the current states of confidentiality and security, manages the electronic transactions standards, and composes a gap analysis. The third stage examines risk analysis and management. The fourth stage encompasses technical modifications, policies and procedures, legal input, and training. The fifth stage addresses the maintenance of the implementation.

The identification of different dental implants and restorative components is difficult when dental records do not include an inventory of implant components. An implant record form is described. The form should be filled out and retained in the patient's chart for future use and implant maintenance visits.

Child abuse is a disturbingly common finding in society today. In view of the high proportion of orofacial injuries seen in victims of child abuse, dentists are in a strategic position to recognize and report suspected cases. The present study of 347 dentists in Victoria, Australia, assessed the level of knowledge and attitudes among dental professionals on the important issue of child abuse. While a high level of interest was shown by the participants towards this issue, a need for further information and training in the recognition and reporting of child abuse was seen in the survey findings. While dentists at present are not legally mandated in all states of Australia to report suspected cases of child abuse, the dental profession is in a key position to play an active role in the identification and reporting of this substantial community problem.

A new teaching aid to assist undergraduate dental students to learn charting methods was developed. The aim of this study was to evaluate the effectiveness of the aid. Baseline charting tests were completed by 58 inexperienced clinical students at the start of a weekly half-day attachment at 3 community dental service (CDS) teaching clinics. These students were randomly assigned, in their tutor groups, to act as either test or control groups. The test group was actively taught charting with the new aid over their first 5-week attachment and control students were taught in the traditional way. Final charting tests were completed at the end of the attachments by all students and their results compared with baseline test results. The test group improved their mean scores from 20 out of a possible 50 marks at baseline to 36 at final test, a mean increase of 15 marks and an improvement of 71%. The control group scored a mean of 18 marks at baseline and improved this to 25, an increase of 7 marks, an improvement of 39%. It is concluded that the new teaching aid is more effective in assisting the students to learn charting than the traditional method.

In this exploratory case-control study, somatic and psychological factors are used for exploring whether the anamnestic information gives support to the hypothesis of a relationship between therapy-resistant periodontitis and stress factors. From retrospective comparisons of pocket probing depth charts, we classified 22 patients as either non-responding or responding to periodontal treatment. The non-responding patient group, in comparison with the responding patient group, showed a profile over time of less pocket probing depth (PPD) reduction in response to periodontal treatment. Information registered in each patient's file regarding periodontal registrations and dental status was gathered, and an interview was conducted aiming at collecting information on dental experiences and attitudes. Bivariate and logistic multivariate regression analyses were performed. The NR-group patients experienced significantly more unpleasant feelings towards dental procedures and a higher tendency to experience pain in connection with dental procedures. This group was found to start smoking at an older age than the R-group. One reason for this may be that smoking debut at an older age is more related to stress conditions than debut at a younger age. The report highlights the possible contribution of stress factors in periodontal disease.

The aim of this study was to evaluate the clinical criteria for classification of 2 different patient groups. From retrospective comparisons of pocket probing depth (PPD) charts, we classified 22 patients as either non-responding or responding to periodontal treatment. The non-responding patient group, in comparison with the responding patient group, showed a profile over time of less PPD reduction in response to periodontal treatment. Information registered in each patient's file regarding clinical periodontal conditions, as well as treatment procedure characteristics, was gathered. Bivariate analyses were performed. 3 clinical variables (frequency of mean PPD > or = 6 mm during the treatment period; at final registration; and the mobility score at the final registration) indicated that 2 separate patient groups had been identified. Although the patient groups exhibited advanced periodontitis at the beginning of treatment, both groups at the end of treatment had lost very few (1-2) teeth, probably as a result of regular supportive treatment. The characteristics of the selected clinical criteria warrant the use of these 2 patient groups in further analysis of the relation of psychosocial stress and microbiological characteristics of therapy-resistant periodontitis.

Objectives: This case-control study characterized factors related to loss of root canal filled (RCF) teeth among members of the Kaiser Permanente Dental Care Program, a dental health maintenance organization based in Portland, Oregon. Methods: Individuals were identified who were enrolled continuously from January 1, 1987, through December 31, 1994, underwent initial root canal therapy on a permanent tooth (excluding third molars) in 1987 or 1988, had a clinical examination within two years after endodontic access, and were at least 21 years old at access. Patients who lost the RCF tooth by December 31, 1994, were defined as cases (n=96); those who did not were defined as controls (n=120). Computerized data, dental radiographs, and chart entries were reviewed to ascertain variables of interest, and multivariable logistic regression was used to describe differences between the groups. Results: RCF teeth of cases had fewer proximal contacts at access than RCF teeth of controls (odds ratio=2.7; 95% Cl=1.4, 5.1). Cases were older (odds ratio=1.4; 95% Cl=1.1, 1.9 per 10-year increase) and more likely to have had a facial injury than controls (odds ratio=3.6; 95% Cl=1.2, 10.5). Cases also had more missing teeth (odds ratio=1.5; 95% Cl=1.0, 2.1) and more plaque (odds ratio=1.7; 95% Cl=1.0, 2.6). Conclusion: Conditions evident during treatment planning may help dentists assess patients' chances of losing an RCF tooth.

Implementation of caries preventive treatment in relation to the risk of caries was studied among 13-year-olds (n = 132) in two groups treated in the same public dental clinics in Helsinki: caries patients (n = 100) had the greatest numbers of decayed teeth (DT+dt), 5.5 on average, whereas cavity-free patients (n = 32) had intact teeth. Data taken from patients' personal oral health records served for evaluation of individual need for caries prevention, risk of caries, and preventive treatment given to each patient. Patients with any caries lesions or erupting teeth or poor oral hygiene were considered to be at risk of caries and in need of preventive treatment. The more caries lesions a patient had, the more prevention was expected to have been given. Preventive treatment of caries was weakly or only moderately in accordance with patients' individual needs and risk of developing caries, although patients with more caries lesions tended to have been given more preventive treatment than did those with none or only a few lesions. The majority of preventive measures given were applications of fluoride varnish, whereas motivation of and instruction in oral health care habits remained weak. However, patients whom their dentists had judged to be at high risk of caries received more intensified preventive treatment than did other caries patients. As a conclusion, intensification of caries prevention among high-risk patients is still needed. Dentists should always consider each patient's risk of developing caries to improve quality of preventive treatment.

Computer-based, electronic dental record keeping involves complex issues of patient privacy and the dental practitioner's ethical duty of confidentiality. Federal and state law is responding to the new legal issues presented by computer technology. Authenticating the electronic record in terms of ensuring its reliability and accuracy is essential in order to protect its admissibility as evidence in legal actions. Security systems must be carefully planned to limit access and provide for back-up and storage of dental records. Carefully planned security systems protect the patient from disclosure without the patient's consent and also protect the practitioner from the liability that would arise from such disclosure. Human errors account for the majority of data security problems. Personnel security is assured through pre-employment screening, employment contracts, policies, and staff education. Contracts for health information systems should include provisions for indemnification and ensure the confidentiality of the system by the vendor.

It is widely accepted that the age of a horse can be determined from an examination of its teeth, but there is no evidence that the accuracy of the systems of ageing used has been validated. A dental record was made of 80 horses of known age. There was a good correlation between the actual and apparent age of the horses up to five years, but older horses showed much greater variability and accuracy declined markedly after 11 years of age. The disappearance of the 'cup', but not the 'mark', proved to be one of the more reliable features. The average age at which the dental star appeared was one to two years earlier than usually stated. The occlusal angle of the incisors and Galvayne's groove were useful indicators of age, but the caudal upper incisor hook was observed in horses of practically any age over six years.

Automated probing systems have been developed to provide a more precise method of evaluating periodontal pocket depths and attachment levels. The purpose of this study was to assess the clinical performance (reproducibility, time, and comfort) of a new electronic probe (E.P.) compared to the UNC 15 conventional probe (C.P.). Paired measurements 2 hours apart were performed by one examiner on 20 patients with moderate to advanced localized or generalized adult periodontitis. Both the E.P. and C.P. were used on each patient in a random manner. Overall reproducibility (+/- 1.5 mm) was: E.P. 94% (n = 1181); C.P. 96.5% (n = 1254); E.P./C.P. used interchangeably 82.4% (n = 830). In assessing the reproducibility of bleeding on probing, using the Wilcoxon matched pairs signed ranks test, only the mid-facial surface, when using the C.P. exhibited differences between measurements (P0.017). Paired t test revealed E.P. took significantly longer per exam (4 minutes, 46 seconds). Comfort levels, evaluated with a visual analog scale, were not significantly different between probes as shown by the Mann Whitney U test. The data suggest that, in general, there was no major significant difference in reproducibility measurements between the E.P. and the C.P. The E.P. took more time. Comfort levels were similar for both probes.

– 4505 Swedish children aged 4-11 yr were surveyed regarding dental behavior management problems (BMP) and dental health. Dental charts were retrieved from clinics in the Public Dental Service in Goteborg. and data were then compiled regarding BMP, action against BMP, caries, fillings, use of local anesthetics, and number of missed appointments. Behavior management problems were found in 10.5% of the children, and were more common in the younger children, among children who missed appointments, and in children who received restorative treatment without local anesthetics. The BMP children had more carious and fewer filled surfaces. In 43.4% of the cases with BMP the strategy chosen was postponement of dental treatment or no measure taken.

This study centers on the general health of dental patients, evaluated on the basis of the physical status classification system of the American Society of Anesthesiologists (ASA). A total of 4,087 patients completed a risk-related, patient-administered questionnaire. On the basis of their medical data, a computerized ASA classification was determined for each patient: 63.3 percent were in ASA class I, 25.7 percent in class II, 8.9 percent in class III, and 2.1 percent in class IV. After verification and/or consultation with the physician, the dentist also determined the ASA class, and this was compared with the computerized outcome. The agreement expressed as a kappa value was 0.64; the computer result generally placed the patient in a higher category of medical risk. The computer-determined ASA classes differed among the various dental practices (chi 2 = 262.9; df = 138; P < .01). It is possible to estimate the risk class of dental patients on the basis of standardized medical information only; however, the definitive ASA class can only be determined after verification of the patient's reply or, in some cases, after consultation with a physician.

Attendance compliance of patients presenting for periodontal therapy during one calendar year at two practice locations (Perth, Western Australia and Darwin, Northern Territory) was observed over a period of three to four years, depending on whether the patients were seen in the earlier or latter part of the initial year. Both venues (full-time practice and visiting practice every quarter) gave very similar results, of around 10 per cent of patients who dropped out after initial consultation, without commencing treatment. As well, both venues showed a similar trend of subsequent patient 'attrition' after the initial phase of treatment, with the retention of approximately 40 per cent of the original group of patients after three to four years. Of these, a very high proportion (90 per cent) were totally compliant with maintenance recall appointments.

This article reviews the history of bleaching teeth to lighten tooth color. The last 2 years have seen a dramatic increase in new bleaching methods and bleaching chemicals. The following categorizes bleaching chemicals and methods in relation to their use in treating common tooth discolorations. Special attention is given to home bleaching methods.

Interviews were carried out on 61 formal carers from 41 residential homes and 379 elderly residents from 35 homes. Formal carers were questioned about their own dental health and arrangements made to maintain the dental health of the residents. Only 46% of carers attended a dentist regularly although the majority knew that teeth and dentures should be examined regularly. Carers arranged most of the dental treatment received by residents. The percentage of residents from each home receiving treatment ranged from 0% to 52%. Residents judged by formal carers to be capable of participation were interviewed and a 40% stratified random sub-sample was examined. 96% of residents stated that they would only attend a dentist if they were experiencing problems. However, among residents reporting problems (25% of the sample), only a third wished to see a dentist. This proportion rose to half when treatment was offered. The reported barriers to seeking dental treatment included the resident's belief that he or she was coping satisfactorily, transport difficulties and ill health. Denture and oral hygiene were poor and dentures cleaned by staff were no cleaner than those cleaned by residents. A random sample of residents judged by formal carers to be confused were also examined. The condition of their teeth and dentures was similar to that of non-confused residents.

— After the bushfires in Victoria on 16 February 1983, the remains of twenty-two unidentified people were brought to the Melbourne Coroner's Court for identification. This paper presents the methods adopted by the dental team of the Disaster Victim Identification Task Force. The dental records provided evidence of identity of 14 victims and this highlights the value of dental records in the identification of victims in mass disasters.

The records of 400 patients treated for luxation injuries of the permanent dentition from 1965 to 1980 at the Dental Department of University Hospital, Copenhagen, were studied with respect to the development of post-traumatic complications. Data from the time of injury were collected on a standardized questionnaire and completed by the treating oral surgeon as lie interviewed the patient. Standardized forms for follow-up clinical data were also used. The present investigation was aimed at comparing the quality of information collected from the time of injury on a standaradized questionnaire vs. from a non-standardized form. The precision of radiographic techniques with or without film holders was also studied, as well as the value of photographic documentation of luxations vs. radiographs alone. Moreover, the number of radiographs needed to diagnose displacement was checked. It was found that when a standardized questionnaire was not used for collection of data, concerning the injury, an average of 53.3% of the information on the standardized questionnaire was recorded. It was also found that the variation of tooth length from one radiographic examination to the next was more than 3 times greater when film holders were not used than when they were (6.9% average error in measurement vs. 2.0%, respectively). Moreover, an occlusal radiograph was found to be the best exposure for disclosing extrusions and lateral luxations, while occlusal and periapical exposures were equally good for disclosing intrusions. A combination of an occlusal radiograph plus an eccentric (i.e. mesio- or distoradial) periapical radiograph could disclose almost all displacements. It was also found that photographic registration was necessary to precisely diagnose luxation type retrospectively, as radiographs were often misleading in indicating the direction and extent of displacement. It is concluded that standardized techniques (e.g. questionnaires and radiographic film holders) are necessary to provide reliable information in clinical investigations and that photographic registration adds important information about I lie-extent and direction of displacement, a factor to be considered in retrospective studies.

A dental team-care concept that incorporates the problem-oriented system has been instituted at The Medical College of Pennsylvania. The program, as described, is designed to achieve the following goals: 1) to enhance communication between doctors and auxiliaries and thus maintain continuity in patient care and improve the quality of care; 2) to identify all problems related to the care of a patient; 3) to evaluate the educational and technical ability of the residents and students; 4) to achieve an effective dental auxiliary utilization program; 5) to increase faculty involvement in the delivery of patient care; 6) to organize an effective system of peer review; 7) to maintain complete, accurate and systematic medical-dental records; and 8) to encourage an interdisciplinary approach to health care delivery.

The purpose of this research was to develop further information relevant to the problem of utilization of dental services at neighborhood health centers. The research objectives were: (1) A descriptive assessment of the utilization trends of the population served by a neighborhood health center; (2) Some determination of any possible correlation between failed appointments and patients' satisfaction with dental care; and, (3) Some exploration of possible reasons for non-utilization of scheduled dental appointments by a sample of patients from the neighborhood health center who report a history of previous dental treatment. From dental clinic daily appointment sheets, an assessment of utilization trends of a neighborhood health center population for a seven-month period (jon trends of a neighborhood health center population for a seven-month period (June 1, 1973 to December 31,1973) was obtained. In addition, analyses of patient treatment records and information obtained from personal interviews with 40 individuals from the health center population facilitated the completion of the second and third research objectives. The results indicated: (1) Compared to the findings of earlier research,-3 the reported ratio of broken to total appointments scheduled for this study population was substantially lower; (2) There is a rather strong relation between satisfaction with care and the utilization of dental services at the neighborhood health center studied; (3) Satisfaction with care is dependent upon a number of factors; and (4) Reasons given for nonutilization of scheduled dental services are practical ones, of which some are also reflected in the reasons given ofr dissatisfaction with dental care.