Feasibility of Utilizing Electronic Dental Record Data and Periodontitis Case Definition to Automate Diagnosis

Periodontitis is an irreversible disease leading to tooth loss, and 42% U.S. population suffers from periodontitis. Hence, diagnosing, monitoring, and determining its prevalence is critical to develop preventive strategies. However, a nationwide epidemiological study estimating the prevalence reported a concern about the discontinuation of such studies due to cost and ethical reasons. Therefore, this study determined the feasibility of utilizing electronic dental record (EDR) data and periodontitis case definition to automate periodontitis diagnosis. We utilized EDR data from the Indiana University School of Dentistry of 28,908 unique patients. We developed and tested a computer algorithm to diagnose periodontitis using the case definition. We found 44%, 22%, and 1% of patients with moderate, severe, and mild periodontitis, respectively. The algorithm worked with 100% sensitivity, specificity, and accuracy because of the excellent quality of the EDR data. We concluded the feasibility of providing automated periodontitis diagnosis from EDR data to conduct epidemiological studies across the US.

Utilizing Electronic Dental Records to Predict Neuro-Degenerative Diseases in a Dental Setting: A Pilot Study

Limited research demonstrates the possible correlations between dental diseases and neurodegenerative diseases like Alzheimer's disease (AD) and Parkinson's disease (PD). Nevertheless, dental diseases are often overlooked while assessing the risk of AD and PD in clinical settings. It is unknown whether AD/PD risk can be predicted using electronic dental record (EDR) data collected in a routine dental setting. This pilot study determined the feasibility of predicting AD/PD using 84 features routinely captured in the EDR. We utilized the Temple University School of Dentistry clinic data of 27,138 patients. Using a natural language processing (NLP) approach (accuracy=97%), we identified patients with AD/PD and their matched controls (matched by age and gender). XGBoost machine learning model with 10-fold cross-validation was applied for prediction. With 77% accuracy, we found 53 features significantly associated with AD/PD that could be utilized to predict the risk of AD/PD. Further studies are warned to confirm these findings.

Use GPT-J Prompt Generation with RoBERTa for NER Models on Diagnosis Extraction of Periodontal Diagnosis from Electronic Dental Records

This study explored the usability of prompt generation on named entity recognition (NER) tasks and the performance in different settings of the prompt. The prompt generation by GPT-J models was utilized to directly test the gold standard as well as to generate the seed and further fed to the RoBERTa model with the spaCy package. In the direct test, a lower ratio of negative examples with higher numbers of examples in prompt achieved the best results with a F1 score of 0.72. The performance revealed consistency, 0.92-0.97 in the F1 score, in all settings after training with the RoBERTa model. The study highlighted the importance of seed quality rather than quantity in feeding NER models. This research reports on an efficient and accurate way to mine clinical notes for periodontal diagnoses, allowing researchers to easily and quickly build a NER model with the prompt generation approach.

Predicting sequenced dental treatment plans from electronic dental records using deep learning

BACKGROUND

Designing appropriate clinical dental treatment plans is an urgent need because a growing number of dental patients are suffering from partial edentulism with the population getting older.

OBJECTIVES

The aim of this study is to predict sequential treatment plans from electronic dental records.

METHODS

We construct a clinical decision support model, MultiTP, explores the unique topology of teeth information and the variation of complicated treatments, integrates deep learning models (convolutional neural network and recurrent neural network) adaptively, and embeds the attention mechanism to produce optimal treatment plans.

RESULTS

MultiTP shows its promising performance with an AUC of 0.9079 and an F score of 0.8472 over five treatment plans. The interpretability analysis also indicates its capability in mining clinical knowledge from the textual data.

CONCLUSIONS

MultiTP's novel problem formulation, neural network framework, and interpretability analysis techniques allow for broad applications of deep learning in dental healthcare, providing valuable support for predicting dental treatment plans in the clinic and benefiting dental patients.

CLINICAL IMPLICATIONS

The MultiTP is an efficient tool that can be implemented in clinical practice and integrated into the existing EDR system. By predicting treatment plans for partial edentulism, the model will help dentists improve their clinical decisions.

Maintenance of dental records and awareness of forensic odontology among pakistani dentists: a mixed-method study with implications for dental data repository

OBJECTIVE

Dental records and forensic odontology play an important role in both healthcare and the legal system, aiding in personalized patient care, human identification, and legal proceedings. This study aims to investigate dental record-keeping practices and assess the awareness of forensic odontology among Pakistani dentists over 12 months. This study aims to collect data from 500 dentists, identify areas for enhancement, and develop a strategic action plan to improve record-keeping quality and forensic odontology application, culminating in a comprehensive dental data repository to support legal and criminal investigations in Pakistan.

METHODOLOGY

This study employed a mixed-method approach conducted at Hamdard Dental College from January to March 2023. The quantitative phase involved distributing questionnaires to 463 dentists, chosen through stratified random sampling. Out of these, 413 responded, yielding an 86% response rate. These questionnaires focused on dental record-keeping practices and dentists' awareness of forensic odontology. Subsequently, based on the questionnaire results, face-to-face interviews were conducted with 20 purposively selected dentists to gain deeper insight into the challenges and potential solutions. Data from both phases were integrated and analyzed accordingly.

RESULTS

The study included 413 participants, mainly females (79%), with ages ranging from 27 to 65 years and an average age of 46.4 years. Most dentists had 5-20 years of work experience (53%), and most (87.4%) were practicing in private clinical settings. All the dentists generated medical and dental records, but the duration of their record-keeping varied, with some maintaining them for up to a year and others for two years or longer. Five themes were generated from the qualitative content analysis. These themes were dentists' perceptions, barriers and challenges, knowledge and awareness, and improvement strategies.

CONCLUSION

Our study revealed that local practitioners in Pakistan exhibit subpar practices in dental record-keeping and maintenance of patient history, irrespective of whether they use a digital or traditional file-based system. Even though dentists are cognizant of the importance of record-keeping, they do not actively maintain comprehensive records. This suggests the need for improved training and system improvements to address the gaps in record-keeping practices.

Comparing gingivitis diagnoses by bleeding on probing (BOP) exclusively versus BOP combined with visual signs using large electronic dental records

The major significance of the 2018 gingivitis classification criteria is utilizing a simple, objective, and reliable clinical sign, bleeding on probing score (BOP%), to diagnose gingivitis. However, studies report variations in gingivitis diagnoses with the potential to under- or over-estimating disease occurrence. This study determined the agreement between gingivitis diagnoses generated using the 2018 criteria (BOP%) versus diagnoses using BOP% and other gingival visual assessments. We conducted a retrospective study of 28,908 patients' electronic dental records (EDR) from January-2009 to December-2014, at the Indiana University School of Dentistry. Computational and natural language processing (NLP) approaches were developed to diagnose gingivitis cases from BOP% and retrieve diagnoses from clinical notes. Subsequently, we determined the agreement between BOP%-generated diagnoses and clinician-recorded diagnoses. A thirty-four percent agreement was present between BOP%-generated diagnoses and clinician-recorded diagnoses for disease status (no gingivitis/gingivitis) and a 9% agreement for the disease extent (localized/generalized gingivitis). The computational program and NLP performed excellently with 99.5% and 98% f-1 measures, respectively. Sixty-six percent of patients diagnosed with gingivitis were reclassified as having healthy gingiva based on the 2018 diagnostic classification. The results indicate potential challenges with clinicians adopting the new diagnostic criterion as they transition to using the BOP% alone and not considering the visual signs of inflammation. Periodic training and calibration could facilitate clinicians' and researchers' adoption of the 2018 diagnostic system. The informatics approaches developed could be utilized to automate diagnostic findings from EDR charting and clinical notes.

Using electronic dental records to establish a surveillance system for dental decay in rural Western Alaska

OBJECTIVES

Previous surveys have demonstrated high rates of early childhood caries (ECC) in the Alaska Native (AN) population of western Alaska. There are many challenges to providing dental care in this road-less Yukon-Kuskokwim Delta region. The regional Tribal Health Organization implemented an electronic dental record (EDR) system in the late 1990s. We explored use of the EDR to establish an oral health surveillance system in children.

METHODS

We contracted with EDR software developers to implement calculation of a summary count of decayed (d), missing (m) or filled (f) primary (dmft) score for each individual. We calculated the yearly average dmft scores for 2011-2019 for children aged 3 and 5 years with a comprehensive exam in a given year. We also assessed the number of children undergoing full mouth dental rehabilitation (FMDR). We used US census data population estimates for these age groups to calculate rates.

RESULTS

Over the 9-year period, 2,427 3-year-old children (47 percent of all 3-year olds over this period), received a comprehensive exam; increasing from 24 percent in 2011 to 62 percent in 2019. Their average dmft score over the 9-years was 6.4 with a significant annual decline over this period. Seventy percent of AN children who turned 6 between 2015 and 2019 had received at least one FMDR.

CONCLUSIONS

An oral health surveillance system has been established in western Alaska using the Electronic Dental Record. High rates of ECC and FMDR were observed. This surveillance system will allow assessments of ECC prevalence and impact of dental interventions.

Accuracy of Parental Self-Report of Medical History in a Dental Setting: Integrated Electronic Health Record and Nonintegrated Dental Record

Purpose: The purpose of this study was to evaluate the extent of concordance and significance of inaccuracies between a parent-reported medical history in a nonintegrated electronic dental record (EDR) and an integrated electronic health record (EHR). Methods: In a retrospective institutional review board chart review, a single trained examiner compared medical histories in an EDR with the same patient's history from an EHR for concordance in sociodemographic, medical condition, allergy, and medication variables deemed significant to dental care. Of 4,282 possible patient comparisons, 291 patients were randomly sampled and compared. Concordance between record types was generated for each variable using the EHR as the ideal standard. Data were analyzed using percent match comparison and logistic regression. Results: Only 10 of 45 variables (22 percent) met the standard to match. Present conditions were more likely to be unreported than falsely reported in the EDR (58 percent). Logistic regression revealed multiple significant associations between sociodemographic variables and concordance between the EDR and EHR on specific medical conditions and medications. Conclusions: Discrepancies exist between parent-reported medical histories (EDR) and composite health histories (EHR), with the potential to compromise patient safety and create an opportunity for medical error. Social determinants of health are associated with true-positive and true-negative reporting of medications and medical conditions. EHRs allow clinicians access to a greater depth of health history information in real time compared to nonintegrated health records, but medical history-taking skills should remain at the forefront of dental education and dental practice.

Perceptions towards Use of Electronic Dental Record at a Dental College, University of Hail, Kingdom of Saudi Arabia

AIM

This study highlights the use of electronic dental record (EDR) of a dental college at the University of Hail. This study has examined the perceptions of the stakeholders in regard to the objective mentioned above.

MATERIALS AND METHODS

It was a cross-sectional survey. The present study collected data from participants working in the dental clinics at the University of Hail. Face- and content-validated questionnaire was used as a study tool. The data were displayed in numbers and percentages. A Chi-squared test was used to measure the statistical significance. The p value < 0.05 was considered significant.

RESULTS

There were 166 respondents, out of which 92 (55.4%) were male and 74 (44.6%) were female participants. A highly significant result recorded for age group and rank/position for a variable that says using EDR will add to the skills of the dentists. Results showed that using EDR would not slow down the work. A need for a comprehensive training and the interference with the performance of dentists found as two main barriers towards the use of EDR.

CONCLUSION

This study has pioneered the idea of checking on the perceptions of stakeholders to enquire about the use of EDR in clinics in the Kingdom of Saudi Arabia. It has been reiterated by all the participants that EDR is a need for the clinics in the kingdom but some have reservations about the tedious nature of its use while some were worried about the excessive training they will need to overcome the difficulty of using it. It is observed from the stakeholders' replies that the use of EDR will slow down the work nature in clinics.

CLINICAL SIGNIFICANCE

The EDR is commonly used in many developed countries. The proficiency of its use is quite acceptable. The use of EDR in Kingdom of Saudi Arabia is relatively new. The present study measures the perception of its easiness and efficiency in dental practice.

Pakistan's position in the world of forensic odontology and dental records

BACKGROUND

Forensic Odontology (FO) still strives for recognition in some countries such as Pakistan. Natural and man-made disasters, along with child abuse cases and age estimation for child marriages and juvenile imprisonments in Pakistan justify its applicability.

AIMS

This study investigated the awareness, information, training, practice and interest in FO in dental professionals in Pakistan. Another aim was to design tools to deliver primary knowledge about FO and emphasize the importance of dental records.

METHODOLOGY

A 10 question paper-based survey was distributed among 560 dental professionals and postgraduates of 14 public dental institutes/hospitals in Pakistan. The results were quantitatively analyzed by graphs using Microsoft Excel (version 16.22). An educational video and an information leaflet were produced after the survey was undertaken to explain the scope of FO and the importance of dental records respectively.

RESULTS

476 dentists (51%♀, 49 %♂) aged 20 - 50+ years responded and 98.53% confirmed that FO was not taught in the dental schools. 66% were aware of the field and 62% were only informed. 99% were not trained and 89.7% were not working in this field; however, 89% were interested in training within Pakistan. Considering dental charts, 60.92% do not produce detailed charts but 55% maintain them and the majority do so manually. Radiographs were the most stored type.

CONCLUSIONS

Most dentists are aware of the existence of FO, but they need to acknowledge the significance of dental record keeping and encourage implementation of FO. Regardless of the absence of any governing body for FO and negligible education, training and implementation in Pakistan, this field is gradually progressing. The authorities should introduce detailed guidelines for recording, managing and storing dental records. They should ensure the future acknowledgement of this subject in the education system and assign forensic odontologists to the Disaster Victim Identification (DVI) team.

Postmortem Dental Records Identification by Dental Hygiene Students: A pilot study

Purpose: Dental hygienists have the potential for filling critical roles in multidisciplinary victim identification teams. The purpose of this pilot study was to evaluate the accuracy of dental hygiene students utilizing dental charting, bitewings, and skull dentitions for the purpose of making identification matches.Methods: Thirty senior dental hygiene students (n=30) independently viewed an asynchronous online multimedia-based presentation on the procedures used for collecting and recording forensic dental evidence. Following the presentation participants attempted to chart and match three bitewing radiograph sets to three human skull dentitions by correlating matches/exclusions. Immediately following the activity, each student completed a questionnaire rating the difficulty of the exercise, as well as their confidence, and willingness to volunteer as a forensics team member. Descriptive statistics were used to analyze the data.Results: Of the total sample 36.7% (n=11) reported having prior experiences with dental radiography; while the majority (63.33%, n=19) reported no prior experience. Participants' accuracy scores for dental charting ranged from 91.23% (SD=9.42) to 99.06% (SD=3.60), with no statistically significant difference based on prior experience (p>0.05). The average interrater reliability was 86% (p<0.0001), indicating a high level of agreement with charting skulls and radiographs. No statistically significant differences were found for charting time, perceived difficulty, or level of confidence when comparing experience among the participants (p>0.05).Conclusions: Regardless of previous experience, dental hygiene students were able to match postmortem dentitions and radiographs with good interrater reliability and did not differ statistically for charting time, perceived difficulty, or confidence. Results suggest dental hygienists can work as effective victim identification team members when educational programs are implemented.

A Review of Proposed Positive Dental Identifications from the World War II Era

In 1949, the American Graves Registration Service Pacific Zone proposed the identification of 27 sets of remains (skulls/crania/mandibles) based on comparisons with written dental records. All were denied, and the remains were buried as unknowns. In 2003 and 2015, the remains were exhumed by the DPAA. Currently, 26 individuals previously recommended for identification have been positively identified. The DPAA Science Director's opinion corresponded with 24 of their recommendations, while DNA excluded three. Caution should be taken by the forensic scientist when building assemblages through skeletal and dental articulation. The forensic odontologist must always consider variations in restorative care/extraction patterns and the possibility of documentation errors when reviewing/interpreting historical and current day dental records used for AM/PM comparisons. The odontologist should base their opinion on the strength of the antemortem/postmortem comparison, number and type of concordances, and distinct dental care and extraction patterns.

Need for diagnostic-centric care in dentistry: A case study from the Marshfield Clinic Health System

BACKGROUND

The study objective was to evaluate the workflow of dental providers who use the existing electronic dental record (EDR) system at a large regional health care system to establish a diagnostic-centric culture as part of their dental practice. A further goal focused on identifying when improvements to the workflow and design of the EDR may be indicated.

METHODS

Dental procedures performed on patients and corresponding International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses were retrospectively mined from Marshfield Clinic's enterprise data warehouse. All dental procedures performed were selected and paired with corresponding diagnostic codes documented by dental providers. Frequency of documented diagnosis was further analyzed by characterizing correspondence with their ranking order in the diagnosis column with and without a scroll bar within the EDR user interface (UI). Accuracy of selecting appropriate ICD-9-CM for the corresponding Code on Dental Procedure and Nomenclature (CDT) was checked for 10% (n = 6,187) of the procedure-diagnosis pairs.

RESULTS

Of the 61,511 unique procedures documented using 147 CDTs, 11% (6,914 procedures) had a corresponding "not available" option associated under the diagnoses column, whereas 89% (54,597) of dental procedures were associated with a corresponding ICD-9-CM diagnostic code. Overall tendency of dental providers to select the first or last options from the diagnostic list with a scroll bar was noted. Appropriateness of documenting corresponding ICD-9-CM to CDT procedures indicated 98% accuracy.

CONCLUSION

EDR UI design greatly affected documentation process. Redesigning the EDR UI from the results will increase both the quality and utility of clinical documentation.

'If it Ain't in the Notes . . .' Dental Record-Keeping in Adversity

There are some dento-legal mantras that have, by default, come to be understood as the truth, for example: "if it ain't in the notes, it didn't happen" and "Good records, good defence; poor records, poor defence; no records, no defence." the opposite view was offered by the trial judge in a dental clinical negligence case in recent years. the judge's view can be summed up as: "if you don't make a note of something that has happened, you leave yourself at risk of proceedings like these."

Assessing Information Congruence of Documented Cardiovascular Disease between Electronic Dental and Medical Records

Dentists are more often treating patients with Cardiovascular Diseases (CVD) in their clinics; therefore, dentists may need to alter treatment plans in the presence of CVD. However, it's unclear to what extent patient-reported CVD information is accurately captured in Electronic Dental Records (EDRs). In this pilot study, we aimed to measure the reliability of patient-reported CVD conditions in EDRs. We assessed information congruence by comparing patients' self-reported dental histories to their original diagnosis assigned by their medical providers in the Electronic Medical Record (EMR). To enable this comparison, we encoded patients CVD information from the free-text data of EDRs into a structured format using natural language processing (NLP). Overall, our NLP approach achieved promising performance extracting patients' CVD-related information. We observed disagreement between self-reported EDR data and physician-diagnosed EMR data.

Adoption of Electronic Dental Records: Examining the Influence of Practice Characteristics on Adoption in One State

OBJECTIVE

Compared with medicine, less research has focused on adoption rates and factors contributing to the adoption of electronic dental records (EDRs) and certified electronic health records (EHRs) in the field of dentistry. We ran two multivariate models on EDR adoption and certification-capable EHR adoption to determine environmental and organizational factors associated with adoption.

METHODS

We conducted telephone survey of a 10-item questionnaire using disproportionate stratified sampling procedure of 149 dental clinics in Tennessee in 2017 measuring adoption of dental information technology (IT) (EDRs and certification-capable EHRs) and practice characteristics, including region, rurality, specialty, and practice size. We used binomial logistic regression models to determine associations of adoption with predictor variables.

RESULTS

A total of 77% of surveyed dental clinics in Tennessee had adopted some type of EDR system. When the definitions of certification capable were applied, the adoption rates in dental clinics dropped to 58%. A binomial logistic regression model for the effects of rurality, specialization, and practice size on the likelihood that a clinic would adopt an EHR product was statistically significant (chi-square (3) = 12.41, p = 0.0061). Of the three predictor variables, specialization and practice size were significant: Odds of adopting an EHR is 67% lower for specialists than for general dentists; and clinics with two or more practicing dentists were associated with a much greater likelihood of adopting an EHR-capable system (adjusted odds ratio = 3.09, p = 0.009).

CONCLUSION

Findings from this study indicate moderate to high levels of overall dental IT adoption. However, adoption rates in dental clinics do remain lower than those observed in office-based physician practices in medicine. Specialization and practice size were significant predictors of EHR-capable system adoption. Efforts to increase EHR adoption in dentistry should be mindful of potential disparities in smaller practices and between dental specialties and generalists.

An Electronic Screening System for Oral Health Examination and Collection of Critical Data in a Nonclinical Setting: Validation Trial

OBJECTIVE

To evaluate the reliability, ease, and efficiency of data entry for an oral health screening app that allows iPad® entry of data, including permanent versus deciduous teeth present, visual image comparison grading of demineralization/caries, fluorosis, periodontal inflammation, oral hygiene status, identification of sealants/restorations, dental trauma, orthodontic malocclusion, mandibular joint dysfunction, and early childhood caries.

METHODS

89 consented children were examined first by a public health dental hygienist in a dental office reception area and then by a dentist in a treatment operatory. The same research associate was used to prompt and record both examinations.

RESULTS

The screenings prompted by the electronic oral health screening system were completed in 2 to 3 minutes each with favorable levels of comparison between examiners as assessed by weighted Kappa scores measuring 0.531 for all teeth examined, with the lower back teeth showing the greatest agreement (K = 0.601) and the upper back and upper front demonstrating less agreement (K = 0.446 and 0.468, respectively). Neither examiner identified any carious lesions among the lower front teeth.

CONCLUSIONS

This study provides the first description of an oral health screening entry app with visual image comparisons and touchscreen data entry for efficient collection of oral health information.

Dynamic Documentation of the Smile and the 2D/3D Digital Smile Design Process

Medical and dental histories, clinical examination, study models, and photographs provide the data for a proper diagnosis and the treatment plan for esthetic dentistry. However, they do not offer all the information necessary to analyze the smile and create harmony with the lips and face without excessive intraoral adjustments. Dentolabial parameters vary according to lip dynamics and are influenced by both a static posed smile and a smile in motion as captured in video. This article describes a documentation protocol using smartphone videos to improve the analysis, smile design decisions, and elaboration of a 2D smile frame that will guide the 3D digital smile design project. The use of dynamic documentation of the smile (DDS) allows esthetic rehabilitative planning from a facial perspective, improvement of communication with the patient, integration between the specialists, and the predictable quality of the treatments.

Primary Fused Teeth and Findings in Permanent Dentition

OBJECTIVE

The aim of this study was to investigate the characteristics of primary fused teeth (PFT) and their effect on permanent dentition in a group of Turkish children.

SUBJECTS AND METHODS

Dental records of 13,450 pediatric patients who attended the Pediatric Dental Clinic in northern Turkey between 2015 and 2017 were reviewed. Forty patients had been diagnosed with PFT and were included in the study. Clinical and radiographic examinations were conducted, and the distribution of PFT was calculated by type, sex, affected jaw, associated dental anomalies, and clinical complications. Data analysis involved descriptive statistics.

RESULTS

A total of 50 PFT were detected in the 40 patients. The mean age of patients was 6.7 ± 0.3 years (range 3-10 years). The most common PFT were the mandibular lateral incisors and canines (34, 68%). The most prevalent type of PFT was type III (20, 40%). Of the 40 patients with PFT, 34 (85%) also ex-hibited other dental anomalies such as tooth aplasia, peg-shaped incisors, talon cusps, ectopic eruption, and delayed eruption in both related and unrelated areas. The most common complications of PFT were fusion-related tooth aplasia (n = 26 [76%]) and caries formation in the affected teeth (24 [48%]).

CONCLUSION

In this study, PFT were frequently observed in the mandibular anterior region. Caries formation and dental anomalies, especially permanent tooth aplasia, were often encountered in areas where PFT were seen. Hence, parents should be informed about possible dental problems associated with PFT and be encouraged to schedule regular follow-up appointments.

Epidemiological profile of patients utilising public oral health services in Limpopo province, South Africa

BACKGROUND

Despite the impact of oral diseases on the quality of life, there is limited updated evidence on oral health status in Limpopo province.

OBJECTIVES

To determine the epidemiological profile of patients utilising public oral health services in Limpopo province.

METHOD

This was a descriptive retrospective clinical chart review conducted in five purposively selected district hospitals in Limpopo province. The collected data included the patient's sociodemographic information, reasons for dental consultation, information on the dental or oral diseases and the treatment received. Five hundred clinical files were systematically selected (100 from each district hospital) for the period 01 January 1995 to 31 December 2013. Data were collected using the World Health Organization's indicator age groups, namely 6-year-olds, 12-year-olds, 18-year-olds and 35-44-year-old groups. A data capturing sheet was used to record the collected information. Data were analysed using the statistical software package for social sciences SPSS version 23.0.

RESULTS

The majority of patients were in the age group of 6 to 20 years (n = 375, 75%). The majority were male patients (n = 309; 62%). Dental caries was the most common complaint (n = 298, 60%). The second most common main complaint in this age group was retained primary or deciduous teeth (n = 60, 12%) affecting children mainly in the age group of 6 to 12 years. The most common clinical procedure across all five districts was dental extractions (n = 324, 64%). Other clinical interventions included scaling and polishing (n = 33, 12%) and dental restorative care (n = 20, 3%).

CONCLUSION

There is an urgent need to reorient oral health service delivery in Limpopo province to focus more on preventive oral health programmes.

Forensic Medicine and the Military Population: International Dental Records and Personal Identification Concerns

INTRODUCTION

The first goal of this research was to perceive the global commitment towards the organization and archiving of dental records and to compare it with each country's security risk rating. The second one was to study dental records in a sample of the Portuguese military population, using the available national dental records.

MATERIAL AND METHODS

An e-mail was sent to representative dentistry associations in several countries, requesting some information concerning the professionals' awareness of this issue. After obtaining permission from the Ethics Committee, the information was collected through the Forensic Dental Symbols® system into the Dental Encoder®, as an extension of a Spanish study, and a generic codification was used (unrestored, restored, missing and crowned teeth).

RESULTS

The most common dental record retention period is ten years after treatment. Observing the samples' dental records (595 files), we found a total of 19 040 analyzed teeth, with the following frequencies: unrestored (89.6%), restored (7.0%), missing (2.2%) and crowned (1.1%).

DISCUSSION

There is a wide range of guidelines on how long dentists should keep dental records. Especially for the military population, dental records must include detailed information concerning each tooth situation, in order to support the process of human identification.

CONCLUSION

This article reinforces the need for mandatory quality dental records in all countries, which must be efficiently stored and easily accessible in case dental identification is necessary. For the military population, these requirements are especially important, due to the added risks to which this group is subject.

Interpretation of cone beam computed tomography volumetric data: How to report findings?

Cone beam computed tomography (CBCT) was introduced to the dental profession at the beginning of the new millennium and has become an integral part of dental practice, especially within the surgical specialties. With advances in technology and the introduction of new-generation digital detectors, the concomitant increase in pixel resolution provided the ability to discern fine details of the anatomy. This article focuses on the methodology of CBCT interpretation and reporting. Details of reviewing the volume thoroughly are described with relevant citations. The article summarizes the overall methodical interpretation of CBCT data that is essential to every dentist who uses the technology.

Identifying Patients' Smoking Status from Electronic Dental Records Data

Smoking is a significant risk factor for initiation and progression of oral diseases. A patient's current smoking status and tobacco dependency can aid clinical decision making and treatment planning. The free-text nature of this data limits accessibility causing obstacles during the time of care and research utility. No studies exist on extracting patient's smoking status automatically from the Electronic Dental Record. This study reports the development and evaluation of an NLP system for this purpose.

Characterizing Restorative Dental Treatments of Sjögren's Syndrome Patients Using Electronic Dental Records Data

Scant knowledge exists on the type of restorative treatments Sjögren's syndrome patients (SSP) receive in spite of their high dental disease burden due to hyposalivation. Increased adoption of electronic dental records (EDR) could help in leveraging information from these records to assess dental treatment outcomes in SSP. In this study, we evaluated the feasibility of using EDR to characterize the dental treatments SSP received and assess the longevity of implants in these patients. We identified 180 SSP in ten years of patients' data at the Indiana University School of Dentistry clinics. A total of 104 (57.77%) patients received restorative or endodontic treatments. Eleven patients received 23 implants with a survival rate of 87% at 40 months follow-up. We conclude that EDR data could be used for characterizing the treatments received by SSP and for assessing treatment outcomes.

Extraction and Evaluation of Medication Data from Electronic Dental Records

With an increase in the geriatric population, dental care professionals are presented with older patients who are managing their comorbidities using multiple medications. In this study, we developed a system to extract medication information from electronic dental records (EDRs) and provided patient distribution by the number of medications.

Health Services Research

The major barriers to the collection of primary population-based dental services data are: (1) Dentists do not use standard record systems; (2) few dentists use electronic records; and (3) it is costly to abstract paper dental records. The value of secondary data from paid insurance claims is limited, because dentists code only services delivered and not diagnoses, and it is difficult to obtain and merge claims from multiple insurance carriers. In a national demonstration project on the impact of community-based dental education programs on the care provided to underserved populations, we have developed a simplified dental visit encounter system. Senior students and residents from 15 dental schools (approximately 200 to 300 community delivery sites) will use computers or scannable paper forms to collect basic patient demographic and service data on several hundred thousand patient visits. Within the next 10 years, more dentists will use electronic records. To be of value to researchers, these data need to be collected according to a standardized record format and to be available regionally from public or private insurers.

Dental Informatics: A Work in Progress

Dental informatics is a young scientific discipline that is undergoing continual maturation. Its literature is estimated to consist of approximately 600 papers published between 1975 and 2003, and it is currently growing at a rate of about 50 papers annually. While interest in the discipline is growing, the number of core contributors to dental informatics research remains relatively small. Two major questions for the discipline are: What are the research challenges that dental informatics faces today? and How can the discipline be strengthened and positioned to maximize its success in addressing those challenges? Progress toward research challenges formulated more than ten years ago has been varied. While many new technologies have become available for clinical dental practice, research, and education, many fundamental problems remain to be addressed with informatics research. Recommendations to augment the research capacity in dental informatics include creating a stronger worldwide dental informatics research community, drawing more biomedical informatics researchers to dental research areas, providing career opportunities for dental informatics researchers, addressing grand challenges together as a community, and recruiting subsequent generations of dental informaticians.

Grand Challenges in Dental Informatics

When truly significant scientific challenges are overcome, it profoundly changes the daily activities, as well as the future research activities, of everyone involved in the related field. By identifying and describing the grand challenges facing a scientific field, we can help funding agencies identify and prioritize projects for support, stimulate and encourage new investigators to work on these intellectual and technological challenges, and help define the field itself. In this article, we present an informatics-oriented, future-patient-care scenario, then describe a series of applications and the related informatics grand challenges facing the dental field today. New techniques and technologies to help us overcome these challenges would facilitate the development of truly monumental applications, such as a comprehensive electronic oral health record, an automated dental treatment planning system for all diagnoses, or a system to profile patient risk for chronic oral diseases.

Retrospective Study of the Survival Rates of Indirect Pulp Therapy Versus Different Pulpotomy Medicaments

PURPOSE

The purposes of this retrospective chart review were to determine: (1) how primary molars in need of vital pulp therapy (VPT) have been treated over a period of four years at a university-based pediatric dental practice (UBP); and which treatments-indirect pulp therapy (IPT), formocresol pulpotomy (FCP), and ferric sulfate pulpotomy (FSP)-have been successful.

METHODS

Electronic patient records (axiUm) that contained the procedure codes D3120 (pulp cap-indirect) or D3220 (therapeutic pulpotomy) were totaled by year. Visit records were queried again to identify treatment failures (i.e., extractions [D7140] or pulpectomy [D3221/D3240]). A total of 2,001 primary molar teeth were included in the study. Success was compared using a Kaplan-Meier analysis.

RESULTS

At the three-year follow-up, IPT had a 96.2 percent survival rate, FCP had a 65.8 percent survival rate, and FSP had a 62.9 percent survival rate (P<.0001).

CONCLUSIONS

Over a four-year period of time, IPT became the more commonly used vital pulp therapy treatment at a university-based pediatric dental practice and had a significantly better survival rate than FCP or FSP.

The use of intraoral radiographs for identification of edentulous patients rehabilitated with implants

The aims of this study were; i) to determine the accuracy by which two intra-oral radiographic examinations performed on patients with edentulous mandibles treated with dental implants can be matched. ii) to determine whether prosthodontic supra-construction is important for matching. iii) to investigate whether there is a difference between oral and maxilla-facial radiologists (OMR) and dental practitioners, not specialized in oral and maxillofacial radiology (NOMR), regarding their ability to match. The specific features of the radiographs used by the operators to acquire a match were also investigated. Intra-oral radiographic examinations from 59 patients were utilized. Radiographic examinations from 47 patients carried out at placement of the supra-construction and at subsequent follow-up examinations were used as "ante-mortem" and "post-mortem" records respectively. Examinations from 12 patients were added to the "post-mortem" records without "ante-mortem" records being available. The study was divided into two parts. In Part One all "ante"- and "post-mortem" records had the supra-construction masked and in Part Two it was visible. Seven dentists (4 OMR, 3 NOMR) were instructed to specify on what basis each matching was made on the confidence of a three-graded scale OMR had 93.2 % and 98.5 % accuracy in Parts One and Two respectively. NOMR had 63.8 % and 87.9 %. Bone anatomy was the most commonly used feature by OMR to obtain a match. For NOMR it was the appearance of the fixtures. OMR reported higher confidence in their ability to match the examinations. This study indicates that OMR could be a valuable resource in cases of identification where dental implants are a feature of the post-mortem dental records.

Identifying Multilevel Barriers to Tobacco Intervention in Postdoctoral Dental Education

The aims of this mixed-methods study were to assess tobacco treatment behaviors among residents and faculty in dental specialty postdoctoral programs and to explore factors in training and practice related to tobacco treatment education. Surveys and focus groups were conducted with a convenience sample of participants at three postdoctoral residency programs in New York City. Surveys assessed tobacco cessation training and behaviors. Focus groups explored barriers to implementing tobacco cessation treatment in educational settings. Data were collected between May and December 2013. Among the 160 faculty and residents identified as potentially eligible for the study, 60 were invited by program directors to participate, and 50 subsequently completed the survey and participated in a focus group (response rate of 31.3%). Survey results indicated high levels of asking patients about tobacco use and advising patients to quit. In contrast, specific tobacco cessation assistance and follow-up care occurred less frequently. There were statistically significant differences in tobacco cessation intervention across the specialties surveyed, but not between residents and faculty. Focus group comments were grouped into three broad areas: clinician factors, organizational support, and structural and contextual factors. Focus group results indicated that participants experienced significant organizational and structural barriers to learning about and providing tobacco treatment. Participants from each specialty indicated that multi-level barriers impeded their provision of evidence-based tobacco cessation interventions in postdoctoral educational settings. They suggested that didactic education should be reinforced by organizational- and systems-level changes to facilitate comprehensive tobacco education and effective cessation treatment in future dental practice.

Quality Improvement Efforts in Pediatric Oral Health

Quality improvement (QI) and measurement are increasingly used in health care to improve patient care and outcomes. Despite current barriers in oral health measurement, there are nascent QI and measurement efforts emerging. This paper describes the role that QI and measurement can play in improving oral health care delivery in clinical practice by presenting a QI initiative that aimed to test and implement a chronic disease management approach to address early childhood caries.

Prospective audit of postoperative instructions to patients undergoing root canal treatment in the DDUH and re-audit following introduction of a written patient information sheet

STATEMENT OF THE PROBLEM

Concerns were expressed that postoperative written instructions following endodontic treatment are not available in the Dublin Dental University Hospital.

MATERIALS AND METHODS

Data was collected in three phases: retrospective analysis of clinical notes for evidence of the delivery of postoperative instructions; a randomly distributed questionnaire to patients undergoing root canal treatment prior to the introduction of a written postoperative advice sheet; and, another survey following introduction of the advice sheet.

RESULTS

Some 56% of patients' charts documented that postoperative advice was given. Analysis of phase two revealed that patients were not consistently informed of any key postoperative messages. In phase 3 analysis, the proposed benchmarks were met in four out of six categories.

CONCLUSIONS

Postoperative advice after root canal treatment in the DDUH is both poorly recorded and inconsistently delivered. A combination of oral postoperative instructions and written postoperative advice provided the most effective delivery of patient information.

Forensic Odontology: A Boon to Community in Medico-legal Affairs

Forensic odontology is a sub-discipline of dental science which involves the relationship between dentistry and the law. The specialty of forensic odontology is applied in radiographic investigation, human bite marks analysis, anthropologic examination and during mass disasters. Besides the fact that radiographs require pretentious laboratory, it is still claimed to be a facile, rapid, non-invasive method of age identification in the deceased. The budding DNA technology has conquered the traditional procedures and currently being contemplated as chief investigating tool in revealing the hidden mysteries of victims and suspects, especially in hopeless circumstances. Forensic odontology has played a chief role in solving cold cases and proved to be strong evidence in the court of law. Systematic collection of dental records and preservation of the same would marshal the legal officials in identification of the deceased. To serve the forensic operation and legal authorities, dental professionals need to be familiar with the basics of forensic odontology, which would create a consciousness to preserve the dental data. The aim of this paper is to emphasize the vital applications of forensic odontology in medico-legal issues. Conjointly the recent advancements applied in forensic human identification have been updated.

Policies and Procedures That Facilitate Implementation of Evidence-Based Clinical Guidelines in U.S. Dental Schools

The aim of this study was to determine the degree to which dental schools in the United States have policies and procedures in place that facilitate the implementation of evidence-based clinical guidelines. The authors sent surveys to all 65 U.S. dental schools in 2014; responses were obtained from 38 (58%). The results showed that, of the nine policies and procedures examined, only two were fully implemented by 50% or more of the responding schools: guidelines supported through clinical faculty education or available chairside (50%), and students informed of guidelines in both the classroom and clinic (65.8%). Although 92% of the respondents reported having an electronic health record, 80% of those were not using it to track compliance with guidelines. Five schools reported implementing more policies than the rest of the schools. The study found that the approach to implementing guidelines at most of the responding schools did not follow best practices although five schools had an exemplary set of policies and procedures to support guideline implementation. These results suggest that most dental schools are currently not implementing guidelines effectively and efficiently, but that the goal of schools' having a comprehensive implementation program for clinical guidelines is achievable since some are doing so. Future studies should determine whether interventions to improve implementation in dental schools are needed.