Developmental dental anomalies and their potential role in establishing identity in post-mortem cases: a review

Teeth may provide useful forensic evidence owing to features like uniqueness, stability and comparability. Moreover, the human dentition is heterodont, i.e. all the teeth have different morphology - incisors, canines, premolars and molars. There are sometimes deviations from normal morphology, such as the presence of extra teeth, variation in their shape and size eg the presence of an extra cusp, fractured crown/root, Carabelli's cusp, peg laterals, transpositions, fusion, etc. These differences can help forensic personnel identify bodies, especially where other methods of identification like facial features, fingerprints or DNA typing cannot yield satisfactory results as in cases of badly decomposed bodies, burnt remains, mass disasters, etc. Identification from dentition is based on the direct comparison of post-mortem dental profiles with ante-mortem dental records of the deceased. This article aims to review these developmental and morphological dental traits and their role in post-mortem identification.

Update on Electronic Dental Record and Clinical Computing Adoption Among Dental Practices in the United States

This study sought to re-characterize trends and factors affecting electronic dental record (EDR) and technologies adoption by dental practices and the impact of the Health Information Technology for Economic and Clinical Health (HITECH) act on adoption rates through 2012. A 39-question survey was disseminated nationally over 3 months using a novel, statistically-modeled approach informed by early response rates to achieve a predetermined sample. EDR adoption rate for clinical support was 52%. Adoption rates were higher among: (1) younger dentists; (2) dentists ≤ 15 years in practice; (3) females; and (4) group practices. Top barriers to adoption were EDR cost/expense, cost-benefit ratio, electronic format conversion, and poor EDR usability. Awareness of the Federal HITECH incentive program was low. The rate of chairside computer implementation was 72%. Adoption of EDR in dental offices in the United States was higher in 2012 than electronic health record adoption rates in medical offices and was not driven by the HITECH program. Patient portal adoption among dental practices in the United States remained low.

Linking medical and dental health record data: a partnership with the Rochester Epidemiology Project

PURPOSE

The purpose of this project was to expand the Rochester Epidemiology Project (REP) medical records linkage infrastructure to include data from oral healthcare providers. The goal of this linkage is to facilitate research studies examining the role of oral health in overall health and quality of life.

PARTICIPANTS

Eight dental practices joined the REP between 2011 and 2015. The REP study team has linked oral healthcare information with medical record information from local healthcare providers for 31 750 participants who have resided in Olmsted County, Minnesota. Overall, 17 718 (56%) participants are women, 14 318 (45%) are 40 years of age or older and 26 090 (82%) are white.

FINDINGS TO DATE

A first study using this new information was recently completed. This resource was used to determine whether the 2007 guidelines from the American Heart Association affected prescription rates of antibiotics to patients with moderate-risk cardiac conditions prior to dental procedures. The REP infrastructure was used to identify a series of patients diagnosed with moderate-risk cardiac conditions by the local healthcare providers (n=1351), and to abstract antibiotic prescriptions from dental records both pre-2007 and post-2007. Antibiotic prescriptions prior to dental procedures declined from 62% to 7% following the change in guidelines.

FUTURE PLANS

Dental data from participating practitioners will be updated on an annual basis, and new dental data will be linked to patient medical records. In addition, we will continue to invite new dental practices to participate in the REP. Finally, we will continue to use this research infrastructure to investigate associations between oral and medical health, and will present findings at conferences and in the scientific literature.

Demographic factors and dental health of Swedish children and adolescents

OBJECTIVE

To investigate the dental health of Swedish children and adolescents with reference to age, gender and residence.

MATERIAL AND METHODS

Electronic dental records from 300,988 3-19-year-olds in one Swedish region were derived in a cross-sectional study in years 2007-2009. The DMFT system was used. Age was categorized into 3-6/7-9/10-12/13-15/16-17/18-19-year-olds and residence into 'metropolitan', 'urban' and 'rural' areas. ANOVA, generalized linear regression models and Fisher's exact test were used.

RESULTS

Among 7-9-year-old children, nine out of 10 were free from fillings and manifest caries, while for 18-19-year-olds; this proportion was one third. Girls (18-19-year-olds) had a significantly lower risk of caries compared to boys of the same age, RR for the DT index = 0.83 (95% CI = 0.81-0.85). This pattern was reversed in 7-12-year-old children. Children and adolescents in metropolitan and urban areas had significantly more caries than subjects in rural areas, for instance the RR for the DT index in metropolitan 7-9-year-olds was 2.26 (95% CI = 2.11-2.42) compared to their rural counterparts.

CONCLUSIONS

In the permanent dentition, the overall pattern revealed that girls ≤ 12 years had a higher risk of caries, while adolescent girls had a lower risk of caries, both compared with boys of corresponding ages. Living in an urban or metropolitan area entailed a higher risk of caries than living in a rural area. A greater occurrence of dental caries in adolescents than in children was confirmed. The findings should have implications for planning and evaluation of oral health promotion and disease prevention activities.

Electronic Dental Records System Adoption

The use of Electronic Dental Records (EDRs) and management software has become more frequent, following the increase in prevelance of new technologies and computers in dental offices. The purpose of this study is to identify and evaluate the use of EDRs by the dental community in the São Paulo city area. A quantitative case study was performed using a survey on the phone. A total of 54 offices were contacted and only one declinedparticipation in this study. Only one office did not have a computer. EDRs were used in 28 offices and only four were paperless. The lack of studies in this area suggests the need for more usability and implementation studies on EDRs so that we can improve EDR adoption by the dental community.

Utilizing Dental Electronic Health Records Data to Predict Risk for Periodontal Disease

Periodontal disease is a major cause for tooth loss and adversely affects individuals' oral health and quality of life. Research shows its potential association with systemic diseases like diabetes and cardiovascular disease, and social habits such as smoking. This study explores mining potential risk factors from dental electronic health records to predict and display patients' contextualized risk for periodontal disease. We retrieved relevant risk factors from structured and unstructured data on 2,370 patients who underwent comprehensive oral examinations at the Indiana University School of Dentistry, Indianapolis, IN, USA. Predicting overall risk and displaying relationships between risk factors and their influence on the patient's oral and general health can be a powerful educational and disease management tool for patients and clinicians at the point of care.

Electronic Dental Record (EDR) Use in Saudi Arabia: An Exploratory Study

The purpose of this exploratory study is to provide an overview of the electronic dental records (EDR) systems used at National Guard Health Affair (NGHA) hospitals in the Kingdom of Saudi Arabia (KSA). Different sources of data were collected between February 18 and March 16, 2014. Sources of data included interviews with key informants. Key informants interviews included one 30 minute interview with an information technology specialist working at NGHA; seven 30-40 minute interview with dentists working in both the NGHA hospital and affiliated NGHA Primary Healthcare Clinics (PHCs). Two dental ward clerks were interviewed for 30 minutes and two dental directors were interviewed for 1 hour each. Four main themes emerged as a result of the analysis of the data. The main themes that emerged centered on staff satisfaction and workload, incomplete information, missing files, and adoption of EDRs. There were several challenges identified with the use of EDRs in Saudi Arabia. The challenges related to resistance to use the EDRs by clinical staff; lack of computer skills by clinical staff; usability of the systems; lack of interest in using EDRs; and lack of a clear management change strategy. Moving forward, these issues should be addressed so that more EDRs are implemented in all healthcare institutions in Saudi Arabia.

Adverse events in Public Dental Service in a Swedish county--a survey of reported cases over two years

Adverse events cause suffering and increased costs in health care. The main way of registering adverse event is through dental personnel's reports, but reports from patients can also contribute to the knowledge of such occurrences. This study aimed to analyse the adverse events reported by dental personnel and patients in public dental service (PDS) in a Swedish county. The PDS has an electronic system for reporting and processing adverse events and, in addition, patients can report shortcomings, as regards to reception and treatment, to a patient committee or to an insurance company. The study material consisted of all adverse events reported in 2010 and 2011, including 273 events reported by dental personnel, 53 events reported by patients to the insurance company and 53 events reported by patients to the patient committee. Data concerning patients' age and gender, the nature, severity and cause of the event and the dental personnel's age gender and profession were collected and analysed. Furthermore the records describing the dental personnel's reports from 2011 were studied to investigate if the event had been documented and the patient informed. Age groups 0 to 9 and 20 to 39 years were underrepresented while those between the ages 10 to 19 and 60 to 69 years were overrepresented in dental personnel's reports. Among young patients delayed diagnosis and therapy dominated and among patients over 20 years the most frequent reports dealt with inadequate treatments, especially endodontic treatments. In 29% of the events there was no documentation of the adverse event in the records and 49% of cases had no report about patient information. The majority of the reports from dental personnel were made by dentists (69%). Reporting adverse events can be seen as a reactive way of working with patient safety, but knowledge about frequencies and causes of incidents is the basis of proactive patient safety work.

Dental caries in older adults in the last year of life

OBJECTIVES

To examine dental caries severity (measured by number of carious teeth) in older adults in the last year of life.

DESIGN

Cross-sectional study based on dental records.

SETTING

Community-based geriatric dental clinic.

PARTICIPANTS

One thousand two hundred sixteen individuals aged 65 and older, including 168 individuals in the last year of life (e.g., individuals died within 1 year after their new-patient examinations).

MEASUREMENTS

Information on socioeconomic, medical history, medication, functional status, and oral health measures, including number of carious teeth, was abstracted from dental records. End-of-life status was determined using the National Death Index. Propensities of death were calculated using a logistic regression and then adjusted together with mobility and oral care function in the multivariable regression model to examine the effect of end-of-life status on dental caries.

RESULTS

Caries severity differed in end-of-life participants with different oral care function. Of those needing help with oral care, end-of-life participants had only a slightly higher and nonstatistically significant risk (7.5 vs 6.1, adjusted incidence density ratio (IDR) = 1.12, 95% confidence interval (CI) = 0.85-1.48) of having more carious teeth than those not in the last year of life. On the other hand, caries severity was lower in end-of-life participants without impaired oral care function (IDR = 0.53, 95% CI = 0.30-0.92).

CONCLUSION

Oral care function modifies the association between caries severity and end-of-life status. Individuals who could maintain oral hygiene independently had a low level of caries at the end of life, however, dental caries had increased before functionally dependent individuals entered their last year of life.

North Cork HSE orthodontic treatment waiting list 2009-2010: retrospective audit of patient records

PURPOSE OF THE STUDY

To evaluate the case profile and verify the treatment eligibility (based on the modified IOTN) from written case records, of patients accepted for orthodontic treatment from the North Cork area of HSE South.

MATERIALS AND METHODS

A data collection form was designed and applied to the written case records of 200 consecutive patients accepted for orthodontic treatment in 2009/2010. Data relating to the IOTN (DHC and AC, where relevant) were provided by a calibrated examiner.

RESULTS

Based on the written case records, most (57%) of the treatment cohort were female and had an average age of 14 years and two months. The predominant malocclusion was Class II division 1 (40%). The prevalence of Class III malocclusion was high at 18%. A total of 61% of patients were in grade 5 and 36% in grade 4. The majority of patients in each of these grades fell into DHC 5a (32%), followed by 5i (24%) and 4d AC > 8 (16%).

CONCLUSIONS

Written case records conclude that patients accepted for orthodontic treatment from the North Cork area of HSE South were predominantly female. Class II division 1 malocclusion was the most common accepted for treatment. These records verify that those patients accepted for orthodontic treatment satisfy the eligibility criteria for HSE treatment.

Use of electronic dental records in Brazil

This study aims to provide both a quantitative and a qualitative analysis of the usability of the most popular electronic dental records in Brazil regarding its clinical and administrative features. The softwares not only will be evaluated regarding their usage among the Brazilian dental professionals but also regarding their functionalities (present, used and desired) and the difficulties encountered by the dentists during their use.

Health-oriented electronic oral health record for health surveillance

Public health surveillance of oral health might benefit from increased access to and analysis of electronically available data including systematic collection, analysis, interpretation, and dissemination of outcome-specific data for use in public health action to improve oral health. This study aimed to develop and evaluate a new Health-oriented Electronic Oral Health Record (Health-EOHR) that integrated new oral health status graphical user interface, the health-oriented status and intervention model to facilitate oral health surveillance. We designed an experiment using focus groups and a Delphi process to develop health-oriented status and intervention model and graphical user interface. The Health-EOHR was implemented and integrated into the existing Electronic Health Record widely used in community hospitals. The study on usefulness for oral health surveillance was conducted. Overall, the dentists were significantly satisfied with the Health-EOHR compared to the existing EOHR (p < 0.001). The dentists found it easy to use and were generally satisfied with the function and the impact on their work, oral health services and surveillance.

Qualities of dental chart recording and coding

Chart recording and coding are the important processes in the healthcare informatics system, but there were only a few reports in the dentistry field. The objectives of this study are to study the qualities of dental chart recording and coding, as well as the achievement of lecture/workshop on this topic. The study was performed by auditing the patient's charts at the TU Dental Student Clinic from July 2011-August 2012. The chart recording mean scores ranged from 51.0-55.7%, whereas the errors in the coding process were presented in the coder part more than the doctor part. The lecture/workshop could improve the scores only in some topics.

Tracking dental patient tobacco use and intervention in the academic clinical setting

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.

Analysis of demographic data obtained from pathology records

INTRODUCTION

Pathologists commonly analyse patient data obtained from pathology records. Such information is useful in that it might provide an indication of changing patterns of disease, or of the aetio-pathogenesis of a disease process, but such data is seldom standardised.

AIM

To determine to what extent the lack of standardisation may influence the resultant data and the conclusions drawn.

MATERIALS AND METHODS

Pathology reports of all cysts diagnosed from 1994 to 2004 were retrieved. The diagnosis and site of the cyst, and the age, gender and race of patient were analysed. Comparative data from 1958 to 1992 was obtained from the text "Cysts of the oral regions". The data from the different periods was statistically compared. Only the four most common cysts were included: radicular, dentigerous, odontogenic keratocyst and nasopalatine duct cysts.

RESULTS

There was no difference in frequency and site of cysts or in age of patients. Statistically significant differences were found in the gender and race comparisons.

CONCLUSION

Do the differences reflect a changing pattern of disease or are they due to changes in the demographics of the patient pool from which the surgical specimens were obtained? We favour the latter. Awareness of the fact that data from either survey is not reliable due to lack of standardisation is pertinent to avoid drawing fundamental conclusions from such data.

Short communications published online in the British Journal of Oral and Maxillofacial Surgery during 2010-2011

The British Journal of Oral and Maxillofacial Surgery (BJOMS) publishes many types of papers including original articles, review articles, and short communications. Many of the latter are isolated case reports of rare or interesting diseases or of difficult or unexpected complications. While case reports are sometimes considered to be of little educational or clinical value, and as such do little to advance medical knowledge, they do have an important role, and many trainees begin their publishing careers writing such papers. There is increasing pressure for space in paper medical journals and, for this reason, some journals either limit or do not publish short publications in print copy but instead put them online. Using established criteria, we previously evaluated all 142 short communications published in the BJOMS during 2008-2009 and found that 48% of them had little or no educational value. As a result, the editorial board of BJOMS took the decision to publish most short communications online only. We have now analysed 48 short communications that were published online only during 2010-2011. Most (80%) were single case reports that covered virtually the whole remit of the specialty, and over half (56%) were published by authors based in the UK. While many of these papers did not add important new information to existing knowledge, these types of article are clearly of value both for trainees and for experienced surgeons. We think that these should continue to be supported as, in addition to their educational value, they are an excellent way for trainees to start to write.

Comparison between two methods for periodontal risk assessment

AIM

Risk assessment is increasingly important in periodontology. The aim of this article was to propose a new objective method (UniFe) in order to simplify the risk assessment procedures. UniFe was compared with a computer-based risk assessment tool (PAT(R)).

METHODS

Risk scores for both UniFe and PAT(R) were calculated for 107 patients, randomly selected among patients seeking care at a specialist periodontal clinic. For UniFe risk calculation, the ''parameter scores'' assigned to smoking status, diabetic status, number of sites with probing depth 5 mm, bleeding on probing score (BoP) and bone loss/age, were added and the sum was referred to a ''risk score'', ranging from 1 (low risk) to 5 (high risk). PAT(R) generated a risk score on a scale from 1 (lowest risk) to 5 (highest risk).

RESULTS

The mean UniFe and PAT(R) risk scores were 4.5+/-0.9 and 4.6+/-0.7, respectively. Cohen k-statistics amounted to 0.7, suggesting a good agreement between methods. Difference in risk score between methods was significantly explained by the parameter scores of BoP and bone loss/age (adjusted R2=0.378).

CONCLUSION

The comparison between UniFe and PAT(R) demonstrated a good level of agreement between methods in a randomly selected population referred to a periodontal clinic.

Computed online determination of life-long mean index values for carious, extracted, and/or filled permanent teeth

OBJECTIVE

The purpose of this study was to develop and test a data-mining system for the online determination of mean DS, M, and FS or DMFS values per subject at different ages from electronic patient records at two health centers to see if there are north-south differences in oral health in Finland.

MATERIAL AND METHODS

The mean index values were determined at two health centers using the codes of dental charts and progress notes of electronic dental records during the digital era of more than 10 years in a total of 153,619 subjects of all ages. Extracted teeth, as well as sound, carious, and restored tooth surfaces, were recorded from the dental charts. Treatments were then additionally registered from progress notes of the records when performed.

RESULTS

The cumulative DS and FS values were similar in subjects under the age of 20 years at both health centers. In adults, caries was more abundant in northern Finland, where there was a higher number of restored surfaces (>40) registered, compared to only 30 in southern Finland at the age of 40 years. A high increase in the number of extractions began at age 45 in the north compared to age 70 in the south. These changes were clearly reflected in the DMFS index.

CONCLUSIONS

Online determination of health parameters is a feasible methodology. The results revealed that north-south regional differences in dental health still occur in adults in Finland, but not in subjects younger than 20 years of age.

Radiographs associated with one episode of orthodontic therapy

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.

Dental records: a Belgium study

The aim of this study was to deduce the quality of the average dental record kept by Belgian dentists and to evaluate its potential use for forensic dental casework. The evaluated material originated from 598 Dutch speaking and 124 French speaking Belgian dentists who completed a questionnaire and returned it by mail or through the internet. The age of the participating dentists ranged from 22 to 72 years of age. The results of the inquiry were statistically analysed taking parameters such as language, gender, age, university and ZIP code into account. In general there was a tendency for the young dentists from the age category 22 to 34 years of age, especially those living in larger cities, to perform better on several of the questions asked such as completion of the dental record, storage of x-rays, working with digital x-rays and a digital dental record.

The Use of Administrative Databases to Assess Oral Health Care

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 II-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.

Effect of Partial Recording Protocols on Estimates of Prevalence of Periodontal Disease

BACKGROUND

The aim of this study was to assess the degree of underreporting in the estimates of prevalence of periodontal attachment loss due to different partial recording protocols (PRP) in epidemiological studies, and to derive a correction factor to adjust for this bias.

METHODS

The study sample included 1,460 dentate persons 14 to 103 years old who were examined clinically to assess the clinical attachment loss at six sites per tooth. Seven PRP based on full-mouth or half-mouth designs were assessed, and the bias and sensitivity in the assessment of attachment loss prevalence for these protocols were assessed.

RESULTS

All partial protocols underestimated the prevalence of attachment loss. Bias estimates for any full-mouth PRP were smaller than those for the corresponding site-combination PRP for the half-mouth design. The PRP using the mesio-buccal (MB), mid-buccal (B), and disto-lingual (DL) sites of teeth in all four quadrants showed the smallest bias and highest sensitivity of prevalence estimates among the seven PRP evaluated, uniformly across the range of attachment loss severity level. The three site PRP incorporating the DL site produced less bias than the three site PRP including the disto-buccal (DB) site. There was a 3% to 12% gain in sensitivity for 2 to 5 mm attachment loss thresholds for the three site half-mouth PRP compared with the two site MB, B half-mouth PRP.

CONCLUSIONS

The bias in the assessment of attachment loss is influenced by the partial recording design and the type and number of sites assessed, and is also influenced by the severity of attachment loss in the study population. These factors should be considered when selecting a partial recording method in large surveys. Furthermore, inflation factors designed to adjust for the bias due to the use of partial systems should be calculated and reported so that comparisons of results with other surveys are more meaningful.

Dental anomalies as a microsymptom of palatal canine displacement

AIM

A retrospective study was performed to investigate whether palatal canine displacement is associated with other dental features permitting early clinical diagnosis of the eruption disturbance.

PATIENTS AND METHODS

The study was based on the complete records of 235/8556 patients at the Department of Orthodontics, School of Dental Medicine, University of Freiburg i.Br. (mean age = 14.11 years) with at least one palatally displaced permanent canine. These patients were examined for ten different morphologic parameters, e.g. impaction and congenital absence of further teeth, hypoplastic, peg-shaped, rotated and congenitally missing upper lateral incisors, supernumerary teeth, Angle classification, and cover-bite (= "Deckbiss"). The data were compared with those of a control sample of the same size with physiologic upper canine eruption (mean-age = 10.0 years). Furthermore, in a right/left comparison the local influence of anomalies of the upper lateral incisors on palatal canine displacement was evaluated by multiple linear regression analysis.

RESULTS

The statistical analyses revealed that the risk of palatal canine displacement was significantly higher in patients with hypoplasia, peg shape or congenital aplasia of upper lateral incisors, further impacted and congenitally missing teeth and cover-bite. The intergroup differences in terms of gender, rotation of upper lateral incisors and Angle classification were not statistically significant. The right/left comparison revealed a significantly higher risk of palatal canine displacement in association with an adjacent hypoplastic or peg-shaped lateral incisor and with aplasia of the contralateral upper incisor.

CONCLUSION

The clinical significance of the study is that the occurrence of palatally displaced canines is often closely linked with other dental anomalies. In this context, anomalies of upper lateral incisors, aplasia or impaction of further teeth, and the anomaly of cover-bite may serve as indicators of palatal canine displacement. A retarded development of the upper lateral incisor seems to be more disturbing for physiologic canine eruption than aplasia. In patients exhibiting the stated microsymptoms, close clinical follow-up of the maxillary permanent canine eruption during the late exfoliation period is strongly recommended.

Caries data collected from public health records compared with data based on examinations by trained examiners

Collecting data for dental caries studies is costly. In countries where uniform patient records are available for virtually the whole population, it is tempting to use them as a data source. Our aim was to compare data collected from patient records to those obtained by trained examiners. In 1992 and 1995, dentists who were specially trained and calibrated examined random samples of 12- and 15-year-olds living in two towns in Finland. The dental record of each child was obtained from public dental clinics, the dental status was entered into a computer file, and the DMFS value was calculated. Data were available for 824 children. In the two data sets, 1.3% of the tooth surfaces were recorded differently (DMF vs. sound) with the related kappa value being 0.70. In two thirds of the discrepancies, the reason was that a filling was marked in only one of them, which confirms the known difficulty in discerning a white filling. For 48% of the subjects, the DMFS values calculated from the two sets of data were equal. The difference was 1 and 2 surfaces for 28 and 11%, respectively. Public health dentists had almost equally often registered more and less DMF surfaces compared to trained examiners. The results suggest that data collected from public health records are not decisively inferior to those obtained from examinations by trained examiners. In large enough settings, data obtained from patient records could possibly be used as a replacement for separate surveys.

Is there a relationship between rheumatoid arthritis and periodontal disease?

AIM

The aim of this study was to determine whether there is a relationship between disease experience of rheumatoid arthritis and periodontal disease.

METHODS

1,412 individuals attending the University of Queensland's School of Dentistry were assessed for the prevalence of periodontal disease and rheumatoid arthritis. Analysis of data obtained from a self-reported health questionnaire and dental records was carried out and included: number of individuals referred for advanced periodontal care (test group); number of individuals attending for routine dentistry; determination of rheumatoid arthritis, cardiovascular disease and diabetes mellitus through self-reporting and assessment of prescription medications; assessment of periodontal disease through assessment of existing oral radiographs.

RESULTS

In patients referred for periodontal treatment, the prevalence of self-reported rheumatoid arthritis was 3.95% which is significantly higher than that seen in patients not referred for periodontal treatment (0.66%) and also that reported in the general population (1%). Of those referred patients with rheumatoid arthritis, 62.5% had advanced forms of periodontal disease. These results were mirrored in the results of the self-reported prevalence of cardiovascular disease and diabetes mellitus which was consistent with the published higher prevalence in periodontal patients.

CONCLUSIONS

Based on data derived from self-reported health conditions, and not withstanding the limitations of such a study, we conclude that there is good evidence to suggest that individuals with moderate to severe periodontal disease are at higher risk of suffering from rheumatoid arthritis and vice versa.

Evaluation of three years of dental care of adolescents in the Public Dental Service in west Sweden

107 individuals, randomly selected from the County of Göteborg and Bohuslän, all born in 1970 were followed regarding the dental care received 1987-1989. The records of each individual from the actual time were collected and information on diagnosis and treatment measures was gathered. Radiographs from the actual time were studied by one of the authors. Sixty-two per cent of the adolescents had been examined and treated all 3 years. Six percent had not been seen at all. The sample was divided into three groups depending on the patient's DFSa value at the examination the first year. This classification appeared to correlate well with caries development in the following years. One-fourth of the sample was responsible for the major part of the non-attendance and late cancellations. The dental health of these subjects was below average, and non-attendance seemed to be a further risk factor. The preventive measures undertaken during the study appeared to correlate poorly with the actual situation of the patient and the presence or absence of potential risk factors.

Appraisal of a standardised periodontal referral proforma

AIM

The primary objective was to assess the standard of new-patient referral communications to the Periodontology Department of a teaching hospital and evaluate any differences in referral quality between referrals that used a standardised proforma and conventional letters. Secondary objectives were to evaluate the potential influence on referral performance of age, postgraduate qualifications and country of qualification of the referring practitioners.

DESIGN

A retrospective analysis of a randomised sample of all referral letters and proformae received during a nine-month period.

SETTING

Letters and referral proformae received by the Periodontal Department of the teaching hospital between 1 January and 30 September 1995 were surveyed.

METHODS

An objective Categorisation System for Periodontal Referral Quality (CSPRQ) was devised and tested for inter- and intra-examiner reproducibility. The referral communications in the random sample were then categorised for quality. The year, country of qualification (UK or non-UK) and possession or otherwise of postgraduate qualifications for each of the referring dentists was ascertained from the Dentists' Register. A Standard Normal Deviants (SND), or Z-test was applied to the resulting data.

OUTCOME MEASURES

Acceptability or unacceptability of referral letters and proformae, related to the age (assessed by year of qualification), country of qualification and possession or otherwise of postgraduate qualifications.

RESULTS

A random sample of 378 referral communications (from a total of 2663) was analysed. Sixty-three of the random sample were referral proformae. The use of the referral proforma was associated with a highly significantly better (P < 0.01) referral performance, than the use of referral letters. There was a trend for referrals from the small numbers of practitioners who were Fellows in Dental Surgery or Masters of Science to be better than those from other practitioners. There was also a trend for use of the referral proforma to enhance the referral performance of practitioners who had been qualified for more than 20 years. Use of the referral proforma highly significantly (P < 0.01) improved the quality of referrals from non-UK qualified practitioners.

CONCLUSIONS

In this study, the quality of periodontal referrals was associated for the better with the use of a referral proforma.

Correlation of dental-record medical histories with outpatient medical records

Medical history questionnaires and outpatient medical records of 115 patients were compared. All patients had a medical history of at least two years in both records. The dental records were initially reviewed, and patients' responses were compiled; when these were compared with the outpatient medical records, the overall discrepancy rate was > 86 percent. This overwhelming rate of error should make dentists aware that many routinely treated patients have medical conditions that are unknown to providers. Use of universal precautions, adequate medical-emergency training, and oral review of the dental health questionnaire are recommended.

The patient's health history form: how healthy is it?

An aging population, a more medically complex patient base and concerns about infectious diseases have complicated dentistry in the past decade--making a thorough health history more important than ever. A survey comparing dental university health history forms with those used by some general practitioners is presented.