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PubMed1983

Model for cost-containment planning in dental clinics.

Cost-containment possibilities in dental clinics present complex challenges to dental clinic management in the 1980s. A hypothetical model using mean cost components has been presented, together with strategies for cost reduction. Although clinical cost management is a complex task, these costs are the most significant and manageable in the dental school. Clinical cost containment is related to curriculum, faculty ego, staff morale, and many other factors separate from clinic operations. Rational cost containment requires a thorough understanding of the relative value of various costs and of the interrelation of costs, as well as firm commitment to control these costs by responsible faculty, particularly the dean. The escalating effect of uncontrolled clinical costs may result in the financial downfall of some schools in the 1980s. The observation that in the average dental school costs exceed income by a factor of approximately 3.5:1 (with an estimated range of 2:1 to 30:1) suggests that cutting costs in many schools may be more effective than raising clinic income. With inflation, the effect of the predominant cost factor versus income becomes more significant over time.

Cost Control↗

PubMed2001

Role of lateral cephalograms in assessing severity and difficulty of orthodontic cases.

To assess the role of lateral cephalometric films in the evaluation of orthodontic patients, 16 certified orthodontists examined 80 sets of dental casts and lateral cephalograms. The patients included 5 subgroups: Class I with mild crowding, Class II Division 2, Class III, open bites, and bimaxillary protrusion. A 5-point Visual Analogue Scale was used to assess the degree of severity and difficulty of each case. Severity was defined as the degree of deviation from ideal occlusion, while difficulty was defined as the probability of attaining an ideal occlusion when all treatment options were available. The examiner then chose one or more of the following treatment options: growth modification, extraction, nonextraction, and surgery. All examiners scored the degree of severity and difficulty of each case with casts only at Time 1 (T1), then with casts and cephalograms at Time 2 (T2). The observed ratings from the Visual Analogue Scale were scored by using the Rasch model, which transforms the nonlinear ordinal ratings to a linear interval scale. Intersubgroup differences and differences between T1 and T2 difficulty and severity were assessed by using a 5 x 2 repeated measures analysis of variance. A paired t test examined the amount and direction of the differences between T1 and T2 of each subgroup. Multiple contingency tables were used to compare treatment option changes between all subgroups at each time. Severity and difficulty scores highly correlated. Analysis of variance showed significant differences among subgroups for both severity and difficulty; however, there were significant time differences for severity only. Paired t tests revealed a small increase in severity for the bimaxillary protrusive group and small but significant decreases for the subgroups Class II Division 2 and Class III when cephalograms were added. The multicontingency table analysis demonstrated that a significant number of examiners did change their treatment options at T2 for bimaxillary protrusive, nonextraction, and Class II Division 2 patients. It was concluded that lateral cephalometric films showed a significant influence on a clinician's determination on severity of some types of orthodontic malocclusions.

Adolescent↗

PubMed2006

An audit of the laboratory service provided to the Health Service Executive Orthodontic Department, St James Hospital, Dublin.

PURPOSE OF THE STUDY: To evaluate the service purchased from contracted orthodontic laboratories used by HSE (SWA) regional orthodontic unit, St. James's Hospital, Dublin and identify deficiencies in the current service. MATERIALS AND METHODS: A data collection questionnaire was designed and distributed to the departmental orthodontists for a period of three months (October-December 2004). Gold standards, drawn up based on the authors' ideal requirements and published guidelines, were supplied to grade the work returned. RESULTS: During the study period 363 items of laboratory work were requested. 20% of the laboratory work arrived late and most of the delayed work was delayed for more than 24 hours. Most laboratory delays occurred with functional appliances, retainers and study models. Prior to fit, 20% of the appliances required adjustments for more than 30 seconds. 65% of laboratory work returned to the department met all of the gold standards. 10% of appliances were considered unsatisfactory. Functional appliances were most often ill fitting accounting for almost half of the unsatisfactory laboratory work. CONCLUSIONS: The majority of the laboratory work returned to the department met our gold standards and arrived on time. Forty six percent of the appliances required adjustments. Functional appliances required the most adjustments; one in five of all functional appliances ordered were considered unsatisfactory.

Dental Audit↗

PubMed1998

[A biomechanical study of dental implants using a method for 3-dimensional volumetric mathematical modelling].

Biomechanics of the dental implants introduced into alveoli immediately after tooth extraction has been investigated. The programme ANSYS has been used. Three-dimension volume mathematical models were calculated, with the help of which the tense-deformed state of the supportive biological tissues has been investigated in the area of direct implantation. On the grounds of the results obtained a conclusion has been made that there is an essential improvement of the load distribution under investigation of the inner bone modified biologically designed implants for direct implantation.

Alveolar Process↗

PubMed1989

Using demographic data for ambulatory health care planning: a dental health practice management model.

The use of sociodemographic data in planning ambulatory health services is discussed and illustrated. Five global indices are identified as important for establishing contours of need within local community areas: social class, population heterogeneity, resident mobility, family organization, and general stress factors. Knowledge of sociodemographic distributions within a given community can serve as an adjunct for rational decision making in planning and placement of ambulatory health care services. It can also establish a means for evaluating whether extant health services reach their intended targets via comparisons to the social demography of patients receiving care in private practices or public clinics. Such analyses are germane to ambulatory health care practitioners in both the public and private sector.

Ambulatory Care↗

PubMed1985

Symposium on semiprecision attachments in removable partial dentures. Laboratory procedures.

The fabrication of semiprecision rest systems will differ depending on whether a prefabricated rest system or milled-in rest system is indicated. In a prefabricated rest seat, a die-related model must be used and the rest seats must be waxed into the wax pattern. A means of fabricating both locking and nonlocking rests has been described. The instruments and tools necessary for the milled-in rest seat have been illustrated. The need for a stress-releasing attachment for distal-extension removable partial dentures is satisfied by the Thompson dowel rest. In fabricating the Thompson dowel rest prosthesis, both vertical parallelism and horizontal parallelism are essential for rotation. The use of a parallelometer and the parallel rule insures precise positioning of the Thompson dowel rest, which in turn, will enable the distal extension partial to rotate.

Dental Abutments↗

PubMed2006

How do genes make teeth to order through development?

This introduction to new patterning theories for the vertebrate dentition outlines the historical concepts to explain graded sequences in tooth shape in mammals (incisors, canines, premolars, molars) which change in evolution in a linked manner, constant for each region. The classic developmental models for shape regulation, known as the 'regional field' and 'dental clone' models, were inspired by the human dentition, where it is known that the last tooth in each series is the one commonly absent. The mouse, as a valuable experimental model, has provided data to test these models and more recently, based on spatial-temporal gene expression data, the 'dental homeobox code' was proposed to specify regions and regulate tooth shape. We have attempted to combine these hypotheses in a new model of the combinatorial homeobox gene expression pattern with the clone and field theories in one of 'co-operative genetic interaction'. This also explains the genetic absence of teeth in humans ascribed to point mutations in mesenchymally expressed genes, which affect tooth number in each series.

Animals↗

PubMed1994

Dental assistants' ability to select caries risk-children and to prevent caries.

A new model for dental care in children has been used since 1987 in a small-town clinic in the county of Blekinge in southern Sweden. The model is based on early screening of caries risk, performed by dental assistants. The purpose is to obtain an individual assessment of the need of preventive dental care among pre-school children, in order to prevent dental caries and gingivitis. The aim was to 1) evaluate the dental assistants' selection of caries risk children up to the age of three by comparing dental health variables in 4 yr olds in the test clinic with those for the whole county and 2) compare the time spent by the dentists and the dental assistants in the test clinic and in the whole county per child up to the age of four. 102 children participated. Specially trained dental assistants screened children likely to develop caries lesions using background factors combined with clinical examinations at ages 1, 2 and 3. A systematized form for questioning the parents was used. Individual caries prevention was given. Dental health and time spent were analyzed. The proportion of children with caries lesions at four years and a caries risk assessment up to the age of three was 11/19 = 0.58 (sensitivity). The proportion of children with no caries lesions at four years and no caries risk assessment up to the age of three was 82/83 = 0.99 (specificity). The proportion of children with no caries lesions at 4 yr of age in the test clinic was 81.4% compared to a county mean of 77.2%.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗

PubMed1968