Swedish quality registry for caries and periodontal diseases (SKaPa): validation of data on dental caries in 6- and 12-year-old children

Background The Swedish Quality Registry for caries and periodontal disease (SKaPa) automatically collects data on caries and periodontitis from patients’ electronic dental records. Provided the data entries are reliable and accurate, the registry has potential value as a data source for registry-based research. The aim of this study was to evaluate the reliability and accuracy of the SKaPa registry information on dental caries in 6- and 12-year-old children. Method This diagnostic accuracy study compared dental caries data registered at an examination with dental health status registered in the patient’s electronic dental records, and with corresponding data retrieved from the SKaPa registry. Clinical examinations of 170 6- and 12-year-old children were undertaken by one of the researchers in conjunction with the children’s regular annual dental examinations where the number of teeth were registered, and dental caries was diagnosed using ICDAS II. Teeth with fillings were defined as filled and were added to the ICDAS II score and subsequently dft/DFT was calculated for each individual. Cohen’s Kappa, the intraclass correlation coefficient (ICC), and sensitivity and specificity were calculated to test the agreement of the ‘decayed and filled teeth’ in deciduous and permanent teeth (dft/DFT) from the three sources. Results Cohen’s Kappa of the dft/DFT-values was calculated to 0.79 between the researcher and the patient record, to 0.95 between patient dental record and SKaPa, and to 0.76 between the researcher and SKaPa. Intraclass correlation coefficient (ICC) was calculated to 0.96 between the researcher and the patient journal, to 0.99 between the patient dental record vs. SKaPa, and to 0.95 between the researcher and SKaPa. Conclusion The SKaPa registry information demonstrated satisfactory reliability and accuracy on dental caries in 6- and 12-year-old children and is a reliable source for registry-based research. Trial registration The study was registered in Clinical Trials (www.ClinicalTrials.gov, NCT03039010)

Structuring electronic dental records through deep learning for a clinical decision support system

Extracting information from unstructured clinical text is a fundamental and challenging task in medical informatics. Our study aims to construct a natural language processing (NLP) workflow to extract information from Chinese electronic dental records (EDRs) for clinical decision support systems (CDSSs). We extracted attributes, attribute values, and tooth positions based on an existing ontology from EDRs. A workflow integrating deep learning with keywords was constructed, in which vectors representing texts were unsupervised learned. Specifically, we implemented Sentence2vec to learn sentence vectors and Word2vec to learn word vectors. For attribute recognition, we calculated similarity values among sentence vectors and extracted attributes based on our selection strategy. For attribute value recognition, we expanded the keyword database by calculating similarity values among word vectors to select keywords. Performance of our workflow with the hybrid method was evaluated and compared with keyword-based method and deep learning method. In both attribute and value recognition, the hybrid method outperforms the other two methods in achieving high precision (0.94, 0.94), recall (0.74, 0.82), and F score (0.83, 0.88). Our NLP workflow can efficiently structure narrative text from EDRs, providing accurate input information and a solid foundation for further data-based CDSSs.

A Survey of the Implementation and Usage of Electronic Dental Records in Private Dental Practices in Mississippi

Implementation of electronic health records by the Health Information Technology for Economic and Clinical Health has led to the implementation of electronic dental records in dental offices. The study was conducted to determine the state of implementation and usage of electronic dental records by the private general and pediatric dental practices in Mississippi as well as reasons why the dental practices are not moving forward with the advanced technology. A survey consisting of six research questions was emailed via SurveyMonkey to 712 private general and pediatric dental practices in Mississippi with an invitation to participate in the study: 116 responded (16% response rate) and 104 consented to participate (89.66%). The data collection process transpired over a six-week period (September 18 – October 29, 2017). Results of the survey indicated dental practices in Mississippi using electronic dental records were 46.07%, electronic dental records with paper records were 42.70%, and only paper records were 11.24%. Dissemination of the study results among medical and dental practitioners may raise awareness and thus encourage more dentists to embrace EDRs. The response rate was affected by the number of dental practices that chose not to participate or did not open the survey email as well as the number of emails that were undeliverable. A second limitation was the lack of certainty of collecting all email addresses through the collection method. Third, there was no certainty that the person who responded knew the correct answers.

Evaluation of Accuracy and Completeness of Electronic Dental Records in a Dental School Setting

Background: High-quality data in Electronic Dental Records (EDR) is essential for dental schools to provide high-quality patient care, improve dental students’ professionalism, and support a platform for research. Therefore, ensuring data quality in EDRs is extremely important. Objective: To perform a quality appraisal of EDRs by evaluating their accuracy and completeness. Methods: This was a Cross-sectional Observational Study conducted over four consecutive years in a dental school setting. Manual chart reviews were performed on an annual basis. EDR data were audited for accuracy and completeness. Accuracy was evaluated by comparing the entered data with an external source, where possible. An EDR data field was considered complete if it was not missing. Results: A total of 1,720 de-identified chart reviews were studied. The accuracy of the data to identify the patient was 93%. The completeness of the essential components of EDRs was 48-94%. Completeness was highest for documenting the patient’s chief complaint (94%) and the lowest for recall plan (48%). Completeness of data documenting social and behavioral determinants of health in EDRs was 36-77%, with the highest proportion of completeness in this domain being for oral hygiene habits, smoking habits, and social history. Conclusion: The quality appraisal of EDRs varied according to the data field. Understanding patterns of accuracy and completeness in EDRs will guide training and quality enforcement activities.

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.

Multiple Socioeconomic Factors and Dental Caries in Swedish Children and Adolescents

The study aimed to explore associations between multiple socioeconomic factors and dental caries experience in Swedish children and adolescents (3-19 years old). Electronic dental records from 300,988, in a Swedish region (97.3% coverage) were collected using the DMFT indices (decayed, missing, filled teeth: dependent variables). Socioeconomic status (SES) data (ethnicity, wealth, parental education, and employment) for individuals, parents, and families were obtained from official registers. Principal component analysis was used to explore SES data. Scores based on the first factor were used as an independent aggregated socioeconomic variable in logistic regression analyses. Dental caries experience was low in the participants: 16% in 3- to 6-year-olds (deft index: decayed, extracted, filled teeth) and 47% in 7- to 19-year-olds (DFT index). Both separate and aggregated socioeconomic variables were consistently associated with the dental caries experience irrespective of the caries index used: the crude odds ratio (OR) for having at least 1 caries lesion in 3- to 6-year-olds (deft index) in the lowest SES quintile was 3.26 (95% confidence interval [CI] 3.09-3.43) and in ≥7-year-olds (DFT index) OR 1.80 (95% CI 1.75-1.84) compared with children in the 4 higher SES quintiles. Overall, associations were stronger in the primary dentition than in the permanent dentition. Large SES models contributed more to explaining the caries experience than slim models including fewer SES indicators. In conclusion, socioeconomic factors were consistently associated with dental caries experience in the children and adolescents both as single factors and as multiple factors combined in an index. Socioeconomic inequalities had stronger associations to caries experience in young children than in older children and adolescents.