Dentists’ Attitudes Toward Dental Implant Maintenance in Thailand

Introduction: As implant therapy is a widely applied treatment modality, general dentists are in the frontline of maintaining health in patients with implants. It is however unknown to what extent general dentists are competent and feel prepared to deliver maintenance of implants to patients. Objectives: The aim of this study was to investigate the attitudes and self-reported and objectively assessed competences of general dentists with maintenance of dental implants in patients. Methods: A questionnaire designed and validated for the purpose of the study, including attitudes and self-reported and objectively assessed competences, was distributed by means of an online platform. Results: Data from 429 questionnaires were included in the study. Half of the participants were 28 to 33 y old and 78% had been working <10 y. Seventy-eight percent believed that dental implant maintenance should be performed by general dentists, but only 51% were prepared to do this, citing obstacles such as insufficient knowledge and limitations of their working environment. The mean ± SD objectively assessed competence score was 8.97 ± 2.74 of 17. There were significant differences (P < 0.001, 1-way analysis of variance) in the scores among dentists who offered the full range of maintenance and management of complications (10.83 ± 2.45) with those willing to provide comprehensive oral examination and implant maintenance only (9.31 ± 2.73), those offering comprehensive examination but unwilling to conduct maintenance (8.22 ± 2.28), and those who refer all dental implant patients elsewhere (7.2 ± 2.66). Around half of the dentists believed that implants last for life. Conclusions: While general dentists appeared to largely acknowledge the importance of providing implant maintenance care and present with positive attitudes, a large portion was unwilling to engage with maintenance of implants in patients and appeared to lack essential competences to this end. The main obstacles for providing implant maintenance care included insufficient knowledge and lack of a properly equipped clinical environment. Knowledge Transfer Statement: The results of this study can identify deficiencies in the currently available maintenance competences and schemes for patients with implants. These results can also help dental professionals, scientific bodies, and associations to design appropriate education and professional development strategies that can strengthen the confidence and competences of general dentists, thus offering better service to the public.

Peri-Implantitis Revisited

Dental implants have become a well-accepted treatment option for patients with partial or complete edentulism. The long-term success of the endosseous dental implant depends not only on osseointegration, but on the healthy soft tissue interface that surrounds the implant. Peri-implantitis is defined as an inflammatory process affecting the supporting hard and soft tissue around an implant in function, leading to loss of supporting bone. Peri-implant mucositis has been defined as a reversible inflammatory reaction in the peri-implant mucosa surrounding an osseointegrated dental implant. Peri-implant mucositis is assumed to precede peri-implantitis. Data indicate that patients diagnosed with peri-implant mucositis may develop peri-implantitis, especially in the absence of regular maintenance care. However, the features or conditions characterizing the progression from peri-implant mucositis to peri-implantitis in susceptible patients have not been identified. The most common etiological factors associated with the development of peri-implantitis are the presence of bacterial plaque and host response. The risk factors associated with peri-implant bone loss include smoking combined with IL-1 genotype polymorphism, a history of periodontitis, poor compliance with treatment and oral hygiene practices, the presence of systemic diseases affecting healing, cement left behind following cementation of the crowns, lack of keratinized gingiva, and previous history of implant failure There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of severe periodontitis, poor plaque control, and no regular maintenance care after implant therapy. Management of peri-implantitis generally works on the assumption that there is a primary microbial etiology. Furthermore, it is assumed that micro-organisms and/or their by-products lead to infection of the surrounding tissues and subsequent destruction of the alveolar bone surrounding an implant. A combination of surgical, open debridement, and antimicrobial treatment has been advocated for the treatment of peri-implantitis. Surgical intervention is required once a patient has bleeding on probing, greater than 5 mm of probing depth, and severe bone loss beyond that expected with remodeling. Access flaps require full-thickness elevation of the mucoperiosteum, facilitating debridement and decontamination of the implant surface via hand instruments, ultrasonic tips, or lasers. When necessary, surgical procedures may be used in conjunction with detoxification of the implant surface by mechanical devices, such as high-pressure air powder abrasion or laser.

Development and Evaluation of the MAINTAIN Instrument, Selecting Patients Suitable for Secondary or Tertiary Preventive Manual Care – The Nordic Maintenance Care Program

BackgroundChiropractic Maintenance Care (MC) has been found to be effective for patients classified as dysfunctional (high pain severity, marked interference with everyday life due to pain, high affective distress, low perception of life control, and low activity levels) by the Swedish equivalent of the West Haven-Yale Multidimensional Pain Inventory (MPI-S). Although displaying good psychometric properties such as validity and reliability, the instrument was not designed to be used in clinical practice to screen patients for stratified care pathways. To effectively be able to screen for individuals suitable for MC, the aim was to develop a clinical instrument with the intent of identifying dysfunctional patients with acceptable sensitivity, specificity, and discriminant ability.MethodsData from 249 patients with a complete MPI dataset from an RCT that investigated the effect and cost-effectiveness of MC with a 12-month follow-up was used in this cross-sectional analysis. The MPI’s data was used to develop a short screening instrument to identify dysfunctional patients, with a summary measure, based on the original instrument. Different cutoffs were considered with regards to sensitivity, specificity, and discriminant ability and compared to the original instrument’s classification of dysfunctional patients. The instrument was then tested in 3 other existing datasets to assess validity across populations.ResultsUsing an explorative approach, the MAINTAIN instrument with 10 questions (0-6 Likert responses) with 5 dimensions (pain severity, interference, life control, affective distress, and support) was developed, generating an algorithm-based score ranging from -12 to 48. Reporting a MAINTAIN score of 18 or higher, 146 out of the 249 patients were classified as dysfunctional with 95.8% sensitivity and 64.3% specificity. At a score of 22 or higher, 109/249 were classified as dysfunctional with 81.1% sensitivity and 79.2% specificity. Discriminant ability (area under the curve (AUC)) was estimated to 0.87 (95% CI: 0.83, 0.92; p <0.001) and Youden’s index was highest (0.70) at a score of 20. The discriminant ability is similar and acceptable across populations with minor differences in optimal thresholds for identifying dysfunctional individuals.ConclusionThe MAINTAIN instrument had an acceptable performance with regards to identifying dysfunctional patients and may be used as a decision aid in clinical practice. By using 2 thresholds, patients can be categorized into “low probability (-12 to 17)”, “moderate probability (18 to 21)”, and “high probability (22 to 48)” of having a good outcome from maintenance care for Low Back Pain (LBP).Trial registrationClinical trials.gov; NCT01539863; registered February 28, 2012; https://clinicaltrials.gov/ct2/show/NCT01539863

The nordic maintenance care program: patient experience of maintenance care—a qualitative study

Background Low back pain is one of the major causes of disability world-wide. Most back pain sufferers experience pain that is recurrent or persistent, making management of this condition a priority. In a series of previous studies, chiropractic maintenance care has been found to be an effective way of reducing the number of days with pain, particularly for patients with a certain psychological profile. However, little is known about patients’ experience of this kind of management plan. This study aimed to explore patient experiences and preferences by looking at barriers to and facilitators of engaging in and maintaining a care plan, and to contrast the data using psychological sub-groups. Methods In this qualitative study we performed semi-structured interviews with 24 patients who had previously participated in a Swedish trial evaluating maintenance care. They were purposefully selected to obtain richness, variation and breadth of data. The data were analyzed using inductive qualitative manifest and latent content analysis. We used the theory of planned behavior to deepen our understanding of the constructed themes. Results The analysis resulted in two overarching dimensions: “when maintenance care is of high value” and “when maintenance care is of low value”. Four factors were jointly identified as obstacles to maintenance care by patients in all the psychological subgroups. These factors were: Cost demanding, A sense of low value, Perceived as unavailable and Fear of treatment. The one factor seen as facilitating maintenance care by patients in all the subgroups was Care that is patient-centered. Conclusions The findings reveal a variance of both positive and negative experiences of MC in the psychological subgroups. These findings can deepen our understanding of how patients experience MC and can help clinicians to understand when patients might regard maintenance care as being of high value.

The Nordic Maintenance Care Program: Patient Experience of Maintenance Care - A Qualitative Study

Background:Low back pain is one of the major causes of disability world-wide. Most back pain sufferers experience pain that is recurrent or persistent, making management of this condition a priority. In a series of previous studies, chiropractic maintenance care has been found to be an effective way of reducing the number of days with pain, particularly for patients with a certain psychological profile. However, little is known about patients’ experience of this kind of management plan.This study aimed to explore patient experiences and preferences by looking at barriers to and facilitators of engaging in and maintaining a care plan, and to contrast the data using psychological sub-groups.Methods:In this qualitative study we performed semi-structured interviews with 24 patients who had previously participated in a Swedish trial evaluating maintenance care. They were purposefully selected to obtain richness, variation and breadth of data. The data were analyzed using inductive qualitative manifest and latent content analysis. We used the theory of planned behavior to deepen our understanding of the constructed themes. Results:The analysis resulted in two overarching dimensions: “when maintenance care is of high value” and “when maintenance care is of low value”. Four factors were jointly identified as obstacles to maintenance care by patients in all the psychological subgroups. These factors were: Cost demanding, A sense of low value, Perceived as unavailable and Fear of treatment. The one factor seen as facilitating maintenance care by patients in all the subgroups was Care that is patient-centered.Conclusions:The findings reveal a variance of both positive and negative experiences of MC in the psychological subgroups. These findings can deepen our understanding of how patients experience MC and can help clinicians to understand when patients might regard maintenance care as being of high value.

Exploring the Influences of Continuous Self-Management Education on the Self-Care Skills and Health Behavior of Patients with PICC Intubation

Objective: To analyze the effects of continuous self-management education on the self-care ability and health behavior of patients with tumor through peripherally inserted central venous catheters (PICC). Methods: The period from August 2018 to August 2020 was used as the research time range, and the random number table method was used as the basis for grouping. 80 patients with malignant tumors who regularly performed fixed catheter maintenance care in the PICC clinic of our hospital were admitted in the experimental group (given PICC specialist nursing, and implemented continuous self-management education), and 80 patients with PICC tube malignant tumors discharged from the superior hospital during this time range served as the control group (return to the original catheterization hospital from time to time or perform catheter maintenance care in the nursing clinic of our hospital). The self-care ability scores, health behavior scores, and complications during intubation between both groups were analyzed. Results: (1) There was no significant difference in self-care ability score and healthy behavior score between groups before the intervention, P>0.05; the self-care ability score and health behavior score of the research group were better than the control group after intervention, P<0.05; (2) After investigation, the incidence of complications in the research group (2.50%) was lower than that of the control group (10.00%), but there was no difference between the groups, P>0.05. Conclusion: Continuous self-management education has good effects on improving the self-care ability of tumor patients with PICC intubation. It can urge patients to maintain good health behaviors and reduce complications. It is worthy of promotion.

Predicting the Cost of Dental Care Using a Probability Model

This paper uses survey data to present a probability model that allows dental offices to predict patient costs. The quantitative model is useful for developing and accepting capitation rates. It accounts for whether the care is initial care or maintenance care, the type of dental care (such as operative, prosthetics, or periodontics), and different age groups, all of which affect the cost of dental treatment.