An Experience of Public Dental Care during the COVID-19 Pandemic: Reflection and Analysis

Since its emergence in China, the COVID-19 pandemic has become the number 1 health challenge in the world with all affected countries trying to learn from each other’s experiences. When it comes to health services, dental care does not seem to be a priority area, despite the fact that it is among the highest risk medical specialisations in terms of spreading the infection. Using the Department of Community Dentistry of Semmelweis University as a case study, the objective of this paper is to introduce and analyze the system and organizational level measures, which have been implemented in dental care in Hungary during the first months of the COVID-19 outbreak. The system level measures to promote social distancing, to reduce the use of health services and to protect high risk health professionals, together with the deployment of protective equipment and the reorganization of patient pathways at the organizational level proved to be effective in keeping the outbreak in control. There are two, less frequently mentioned ingredients of successful coping with the COVID-19 challenge. First, mental health support is at least as important as physical protection. Second, most of the interventions do not require big financial investments, but behavioural change, which in turn requires leadership and change management skills.

Virtual Reality Relaxation to Decrease Dental Anxiety: Immediate Effect Randomized Clinical Trial

Introduction: Dental anxiety is common and causes symptomatic use of oral health services. Objectives: The aim was to study if a short-term virtual reality intervention reduced preoperative dental anxiety. Methods: A randomized controlled single-center trial was conducted with 2 parallel arms in a public oral health care unit: virtual reality relaxation (VRR) and treatment as usual (TAU). The VRR group received a 1- to 3.5-min 360° immersion video of a peaceful virtual landscape with audio features and sound supporting the experience. TAU groups remained seated for 3 min. Of the powered sample of 280 participants, 255 consented and had complete data. Total and secondary sex-specific mixed effects linear regression models were completed for posttest dental anxiety (Modified Dental Anxiety Scale [MDAS] total score) and its 2 factors (anticipatory and treatment-related dental anxiety) adjusted for baseline (pretest) MDAS total and factor scores and age, taking into account the effect of blocking. Results: Total and anticipatory dental anxiety decreased more in the VRR group than the TAU group (β = −0.75, P < .001, for MDAS total score; β = −0.43, P < .001, for anticipatory anxiety score) in patients of a primary dental care clinic. In women, dental anxiety decreased more in VRR than TAU for total MDAS score (β = −1.08, P < .001) and treatment-related dental anxiety (β = −0.597, P = .011). Anticipatory dental anxiety decreased more in VRR than TAU in both men (β = −0.217, P < .026) and women (β = −0.498, P < .001). Conclusion: Short application of VRR is both feasible and effective to reduce preoperative dental anxiety in public dental care settings (ClinicalTrials.gov NCT03993080). Knowledge Transfer Statement: Dental anxiety, which is a common problem, can be reduced with short application of virtual reality relaxation applied preoperatively in the waiting room. Findings of this study indicate that it is a feasible and effective procedure to help patients with dental anxiety in normal public dental care settings.

Conhecimento do cirurgião-dentista sobre o manejo e tratamento de fratura radicular horizontal em Curitiba, Brasil Knowledge of dental practitioners on the management and treatment of horizontal root fracture in Curitiba, Brazil

Introdução: A fratura radicular ocorre em uma frequência que varia de 2,5 a 8,7% dos traumas dentários. Objetivo: Avaliar o conhecimento do cirurgião dentista clínico geral da rede municipal de saúde de Curitiba (PR) a respeito de fratura radicular horizontal e comparar os resultados obtidos nesta investigação (grupo 2) com um estudo desenvolvido em 2009 (grupo 1). Material e métodos: Para a realização deste trabalho, um questionário (utilizado no estudo de 2009) sobre conduta e manejo da fratura radicular horizontal foi aplicado aos cirurgiões-dentistas. Os dados foram analisados por meio do teste χ2 e teste Z de diferença entre duas proporções. A amostra foi composta de 81 cirurgiões-dentistas (grupo 2) e 59 cirurgiões-dentistas (grupo 1). Resultados: Houve maior porcentagem de acerto para o grupo 1 quando comparado ao grupo 2, em relação à conduta na fratura radicular horizontal com ou sem deslocamento do terço coronário e quanto ao prognóstico do dente no que tange à posição da fratura. Não houve diferença estatisticamente significante entre grupos a respeito do tecido pulpar, com ou sem deslocamento dos terços. Sobre a permanência da contenção, houve maior acerto entre o grupo 2. AbstractIntroduction: The frequency of tooth fractures ranges from 2.5 to 8.7% in dental injuries. Objective: The objectives of this study were to evaluated the knowledge of general dental practitioners (GD), at the public dental care system, about the correct management of horizontal tooth fractures, in Curitiba (PR, Brazil) (group 2), and to compare the results with a preview study (group 1). Material and methods: The same questionnaire was applied to GD: in 2009 (group 1) and in the actual study (group 2). The data was analyzed using the χ2 test and the Z test for different proportions. The samples were 81 GDs (group 2) and 59 GDs (group 1). Results: Group 1 had more correct answers than group 2, concerning horizontal root fracture with or without crowded displacement, and prognosis related to the position of the fracture line. About the pulp tissue, with our without displacement, there was no statistic significant difference between both groups. When it comes to the splint permanence, group 2 had more correct answers.

National dental waitlists: what would it take to reset to zero?

Objective Over the years, long public dental waitlists across Australia have received much attention from the media. The issue for eligible patients, namely a further deterioration of dental health because of not being able to address dental concerns relatively quickly, has been the subject of several state and Federal initiatives. The present study provides a cost model for eliminating public dental waitlists across Australia and compares these results with the cost of contracting out public dental care to private clinics. Methods Waitlist data from across Australia were collected from publicly available sources and confirmed through direct communication with each individual State or Territory Dental Health body. Average costs associated with employing key dental personnel and performance figures were used from previously published data to estimate the potential financial commitment and probable public benefits. Results The cost model suggests that, on average, it would be more than twice as expensive to contract the work out to private dental clinics as to treat eligible patients within public dental clinics. It is estimated that the cost of eliminating the legacy dental waiting lists (over 12 months) would be between A$50 and A$100 million depending on the method adopted. The effort would require some 360 dental teams. Conclusion The design of the Australian public dental care system that is targeted at meeting the needs of eligible patients into the future, in addition to being effective and sustainable, must also offer a level of protection to the taxpayer. The ability to address waitlist backlog identified in the present study clearly would require a mix of service models depending on service availability at different locations. Further research is needed to optimise the mix of service providers to address community needs. What is known about the topic? Long public dental waitlists across Australia have received much attention from the media. The topic has been the subject of debate at the government level and, over the years, has seen an increase in allocation of public funds in an effort to address the policy needs. What does this paper add? This study calculates the actual number of people on the public dental waitlist, provides a detailed analysis of the distribution of the demand for the services and offers a cost model for resetting public dental waitlists across Australia. What are the implications for practitioners? This study carries no implications for individual practitioners at the clinical level. However, at the state and national levels, this model offers direction to a more cost-effective allocation of public funds and human resources.