Дисертації з теми "Orthodontic services"

Tillgänglighet till ortodontisk vård behövde förbättras. Förbättringsarbetet fokuserade på processen för ortodontisk diagnostik och behandling i allmäntandvården. Syftet med förbättringsarbetet var att på ett mer resurseffektivt sätt identifiera och behandla patienter med ett ortodontiskt behandlingsbehov för att öka tillgänglighet och erbjuda patienterna optimal behandling. Studiens syfte var att utifrån berörda tandläkares erfarenheter utvärdera vad som har betydelse för att insatser för bättre ortodontisk vård fungerar som de gör. Förbättringsarbetet utgick från strukturen i förbättringsrampen. I fallstudien användes data från enkäter, intervjuer och förbättringsarbetet. Gemensam tolkning genomfördes med triangulering. Riktlinjer och förändrade ortodontikonsultationer infördes. Tiden för konsultationer för ortodontisten minskade trots bibehållen mängd patienter. I fallstudien identifierades stödjande och hindrande faktorer av betydelse för utfallet av förbättringsinsatserna.  Förändringar i processen för ortodontisk diagnostik och behandling i allmäntandvården bidrog till att frigöra tid för ortodontisten och därmed förbättrad tillgänglighet till specialisttandvård för patienterna. Stödjande och hindrande faktorer av betydelse för insatser för bättre ortodontisk vård kan komma till nytta vid spridning av arbetssättet.
Access to orthodontic care needed to be improved. The improvement project focused on the process for orthodontic diagnosis and treatment in general practice. The aim of the improvement project was to make the process for orthodontic diagnosis and treatment planning more efficient, to improve accessibility and offer patients optimal treatment. The study aimed to explore the experience of dentists in general practice related to the impact of changes on orthodontic care. The improvement project followed the steps of the improvement ramp. In the case study data from questionnaires, interviews and the improvement project were used. Triangulation was used for interpretation. Guidelines and alterations in orthodontic consultations were introduced. Scheduled time for consultations was reduced, despite no change in the number of patients. The case study identified constraining and enabling factors to be considered in relation to the improvement project. Changes in the process contributed to making consultations less time consuming and thereby useful to improve accessibility to care. The impact of constraining and enabling factors in relation to the improvement efforts can promote transfer of learning to other caregivers in adopting improvement activities.

Background: The National Health Service (NHS) aims to achieve maximum health gains with its limited resources, while also ensuring that it provides services according to need, irrespective of factors such as socioeconomic position (SEP). Aim: The aim of this thesis is to explore the relationships between SEP and various aspects of the NHS orthodontic service, including need, demand, supply, and outcomes. Methods: Three main data sources were used: two population-based surveys (the 2003 United Kingdom (UK) Children’s Dental Health Survey (CDHS) and the 2008-2009 NHS Dental Epidemiology Programme for England Oral Health Survey (OHS) in the North West) and an administrative data set (containing 2008-2012 North West NHS orthodontic activity data). The data were used to investigate levels of need and willingness to have orthodontic treatment, treatment utilisation, assessment procedures, and treatment outcomes, and the costs associated with the service. Subsequently, regression analyses were carried out to explore the associations between SEP and the various orthodontic variables. Results: Over a third of 12-year-olds had normative need for orthodontic treatment and over half had patient-defined need. Those in the most deprived groups in the North West tended to have lower levels of treatment compared to those in the least deprived group (despite the fact that normative need was not shown to vary by SEP), and they were more likely to discontinue treatment and have residual post-treatment need (RPTN). There was a great deal of variation among practices/orthodontic clinicians in terms of the percentages of patients with repeated assessments, treatment discontinuations, and RPTN. The major sources of potential inefficiency costs in the NHS orthodontic service in the North West are treatments that result in discontinuations (which cost £2.4 million per year), RPTN (which cost £1.8 million per year), and unreported treatment outcomes (which cost £13.0 million per year). Discussion: The NHS is not delivering orthodontic care equitably between SEP groups in the North West, as those from more deprived groups are more likely to fail to receive treatment, and to have poor outcomes if they do receive treatment. In addition, the wide range of process and outcome indicators between practices/orthodontic clinicians raises issues about quality of the overall service. In particular, treatment outcomes are frequently unreported, which highlights the need to improve the outcome monitoring systems in the NHS orthodontic service.

Thesis (M.Med. (Orthodontics))--University of Limpopo, 2010
Introduction: Orthodontic services in South Africa are mainly offered by the private sector and to a lesser extent by the four government funded training institutions which are plagued by limited resources. The majority of patients cannot afford private fees and seek treatment at these training institutions. The growing number of patients on waiting lists is a problem. Prioritization of orthodontic services would assist to ensure that these services are preferentially provided to those patients most likely to derive the greatest benefit. The Dental Aesthetic Index (DAI) is used to estimate orthodontic treatment need and can also be used as a screening tool to determine treatment priority (Cons, Jenny & Kohout, 1986). The DAI focuses on aesthetics and therefore omits other malocclusion traits thereby limiting its comprehensiveness as an assessment tool. To date no published study has been found that identified other malocclusion traits not included in the DAI and examined the influence that these malocclusion traits have in the prioritization of orthodontic service needs whilst using the DAI. Thus the aim of this research was to assess the application of the DAI to prioritize orthodontic services needs within a government funded institution. The objectives were: 1) To identify other malocclusion traits not included in the DAI. 2) To evaluate how much influence other malocclusion traits not included in DAI have in the prioritization of orthodontic service needs. 3) To compare the mean DAI scores according to age and gender. Materials and methods: One hundred and twenty (120) pre-treatment study models of patients in the permanent dentition stage were collected from the records archive of the Department of Orthodontics, University of Limpopo (Medunsa campus) using a systematic sampling method. The study models were assessed using the DAI by two calibrated examiners. Other malocclusion traits were identified and recorded according to the basic method for recording occlusal traits (Bezroukov et al., 1979). Specific codes were assigned to each identified malocclusion trait from code 01 to 09. The traits were recorded once, by marking the respective code/malocclusion trait with an x when present on each study model. Descriptive statistics, Pearson correlation coefficient, Chi-square values and t-tests were employed to analyze the data and p values of less than or equal to 0.05 (p < 0.05) were considered statistical significant. Results: The sample consisted of 58 females and 62 males, aged 10-45 years with a mean age of 17.9 years and a SD of 6.2 years. The DAI scores showed that 19.1% had normal or minor malocclusion, 17.5% had definitive malocclusion, 21.7% had severe malocclusion and 41.7% had handicapping malocclusion. The mean DAI score was 35.2 with a SD of 10.3. A statistical significant difference was found between mean DAI score of adults and adolescence (p < 0.05), while no statistical significant difference was found between males and females (p > 0.05). The study identified the following other malocclusion traits: crowded and rotated posterior teeth (27.5%), posterior crossbite (22.8%), retained primary teeth (13.4%), missing molars (10.7%), partially erupted teeth (9.4%), deep overbite (8.1%), transposition (3.4%), peg lateral (3.4%) and supernumerary teeth (1.3%). These malocclusion traits accounted for 21.1% of the total malocclusion traits of the sample whilst the DAI accounted for 78.9%. About 47.6% of these other malocclusion traits were found in handicapping category of the DAI, 19.5% in the severe category, 18.1% in the definitive category and 14.8% in the normal or minor category. The distribution of subjects over the four DAI categories and the distribution of subjects with other malocclusion traits over the same DAI categories did not differ significantly (Chi-square test, p = 0.917). The intra and inter examiner reliability was tested using the Pearson correlation coefficient and found to be highly correlated (r = 0.9). Conclusions: The study showed that the DAI is a valid and reliable index that can be applied to prioritize orthodontic service needs in a financially constrained situations without any modification as two thirds of other malocclusion traits were found in categories which the DAI had already prioritized for treatment.

Thesis (M.S.)--University of North Carolina at Chapel Hill, 2008.
Title from electronic title page (viewed Sep. 16, 2008). "... in partial fulfillment of the requirements for the degree of Master of Science in the School of Dentistry Orthodontics." Discipline: Orthodontics; Department/School: Dentistry.

Significant efforts have been undertaken in medicine to identify hospital and primary care service areas (eg, the Dartmouth Atlas of Health Care) using patient origin information. Similar research in dentistry is nonexistent. The goal of this dissertation was to develop and refine methods of defining dentist service areas (DSAs) using dental insurance claims. These service areas were then used as spatial units of analysis in studies that examined relationships between utilization of oral health services, dentist workforce supply, and service area characteristics. Enrollment and claims data were obtained from the Iowa Medicaid program for children and adolescents ages 3-18 years during calendar years 2008 through 2010. The first study described rates of treatment by orthodontists in children ages 6-18 years. Orthodontic DSAs were identified by small area analysis in order to examine regional variability in utilization. The overall rate of utilization was approximately 3%; 19 DSAs were delineated. Interestingly, children living in small towns and rural areas were significantly more likely to have received orthodontic services than those living in metropolitan and micropolitan areas. The second study identified 113 DSAs using claims submitted by primary care dentists (ie, general and pediatric dentists). Characteristics of these primary care DSAs were then compared with counties. Localization of care was used as a measure of how well each region approximated a dental market area. Approximately 59% of care received by Medicaid-enrolled children took place within their assigned service area versus 52% of care within their county of residence. Hierarchical logistic regression was used in the final study to examine the influence of spatial accessibility and the importance of place on the receipt of preventive dental visits among Medicaid-enrolled children. Children living in urban areas were more likely to have received a visit than those living in more rural areas. Spatial accessibility assessed using measures of dentist workforce supply and travel cost did not appear to be a major barrier to care in this population. More studies are needed to explore the importance of spatial accessibility and other geographic barriers on access to oral health services. The methods used in this dissertation to identify service areas can be applied to other populations and offer an appropriate method for examining revealed patient preferences for oral health care.

Orientador: Marcelo de Castro Meneghim
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
Made available in DSpace on 2018-08-17T18:03:15Z (GMT). No. of bitstreams: 1 Brandao_GustavoAntonioMartins_D.pdf: 1551670 bytes, checksum: 01a11ec08c02fb063fbd07523f53a5d7 (MD5) Previous issue date: 2011
Resumo: Este estudo foi composto por dois artigos cujo objetivo principal foi determinar as necessidades de tratamento ortodôntico em adolescentes e avaliar o impacto que as más oclusões possuem nas atividades diárias desses indivíduos. A amostra probabilística por conglomerados contou com 528 escolares de 15 anos selecionados em 10 escolas públicas de Piracicaba no ano de 2010. Os exames foram realizados por dois examinadores calibrados seguindo recomendações da OMS. Um questionário semi-estruturado foi enviado aos pais para a obtenção das informações socioeconômicas e obtenção do TCLE. A avaliação dos impactos orais nas atividades diárias (Oral Impacts on Daily Performances - OIDP) foi avaliada através de medida de condição específica (CS-OIDP). Os índices DAI (Dental Aesthetic Index), IOTN (Index of Orthodontic Treatment Need) e ICON (Index of Complexity, Outcome and Need) foram utilizados para a obtenção das características específicas da oclusão e categorização das necessidades de tratamento ortodôntico. A auto-percepção da estética dental foi avaliada através do Oral Aesthetic Subjective Impact Scale (OASIS) e a auto-estima através do Global Self-evaluation (GSE). O interesse em realizar tratamento ortodôntico foi avaliado através de ferramenta específica. Artigo 1: Avaliou a concordância diagnóstica dos índices DAI, IOTN e ICON na determinação das necessidades de tratamento ortodôntico em saúde pública e avaliou a relação entre as necessidades normativas e a presença de impacto nas atividades diárias atribuídos à má oclusão . A comparação das proporções das necessidades de tratamento ortodôntico foi realizada através do teste qui-quadrado. Os índices foram dicotomizados em categorias "com necessidade" e "sem necessidade de tratamento ortodôntico. A concordância diagnóstica foi avaliada através de estatística Kappa. Análise bivariada foi realizada para avaliação da relação existente entre as necessidades normativas e a presença de impactos nas atividades diárias. As necessidades de tratamento de acordo com os critérios adotados foram: 20,65% (n=109) DAI; 19,79% (n=104) IOTN (DHC); 4,73% (n=25) IOTN (AC) and 21,78% (n=115) ICON. A concordância diagnóstica dos índices foi fraca (Kappa variando 0,018-0,235; p=0.00). Apenas a concordância IOTN (DHC)-ICON foi boa (Kappa 0.499; p=0.00). As necessidades normativas apresentaram relação estatisticamente significante com a presença de impactos nas atividades diárias. Artigo 2: Avaliou os indicadores de risco para a presença de impactos nas atividades diárias atribuídos à má oclusão . O índice OIDP foi utilizado como variável dependente para a classificação da presença de impacto e o índice DAI utilizado para avaliação da oclusão. As demais variáveis independentes, auto estima, auto-avaliação estética, interesse ortodôntico e condições sócio-econômicas foram incluídas no modelo. Para análise estatística utilizou-se teste de qui-quadrado e regressão logística uni e multivariada (? = 5%). A presença de má oclusão , necessidade normativa de tratamento, presença de apinhamento, apinhamento maxilar, auto-estima, auto-percepção estética e interesse ortodôntico apresentaram relação estatisticamente significativa com a presença de impactos nas atividades diárias. Um terço dos indivíduos apresentaram impactos nas suas atividades diárias atribuídos as más oclusões. Necessidade de tratamento obrigatória, apinhamento em um ou mais segmentos, apinhamento maxilar ? 2 mm, baixa auto-estima, auto-percepção negativa e ausência de interesse ortodôntico foram considerados indicadores de risco.
Abstract: The present study was composed by 2 articles which aims were evaluate the orthodontic treatment needs in adolescents and to evaluate the presence of impacts on daily performances attribute to malocclusion on daily activities. Adolescents were selected, using two-stage cluster sampling. 528 15-year old students were selected from 10 public schools in Piracicaba, SP, Brazil. The exams were carried out by two previously calibrated examiners in accordance with WHO recommendations. A semi-structured questionnaire was sent to the parents to collect information on socioeconomic level. Face-to-face structured interview was used to collect the data about the condition-specific feature of oral impact on daily performances attributed to malocclusions (CS-OIDP) in the past six months. Intraoral examinations were conducted to register all the necessary malocclusion features and to obtain the DAI, IOTN and ICON indices and to determine the normative orthodontic treatment. The subjects were evaluated to their self-esteem (global self-evaluation) and self-perception of oral esthetics (oral aesthetic subjective impact scale). Orthodontic concern was also assessed through questionnaires. Article 1: the aim of this study was to estimate the diagnostic agreement between dental aesthetic index (DAI), index of orthodontic treatment need (IOTN) and index of complexity outcome and need (ICON) assessments of orthodontic treatment needs and test the association between the normative needs and the presence of impacts on daily performances attributed to malocclusion. DAI, IOTN and ICON were dichotomized into 'yes' or 'no' categories of treatment need and agreement was calculated using Kappa statistics. The results indicate that orthodontic treatment needs according to the criteria adopted were: 20.65% (n=109) DAI; 19.79% (n=104) IOTN (DHC); 4.73% (n=25) IOTN (AC) and 21.78% (n=115) ICON. Agreement of the indices was weak (Kappa ranging 0.018-0.235; p=0.00). Only the comparison IOTN (DHC)-ICON presented a good relationship (Kappa 0.499; p=0.00). Normative needs showed significant relation to oral impacts on daily performances attributed to malocclusions. Article 2: The second study aimed to evaluate the risk indicators of impacts on daily performances attributed to malocclusion. The dental aesthetic index (DAI) was considered for clinical assessment. The (CS-OIDP) instrument was used to assess the presence of impact, as de dependent variable. The self-esteem (global self-evaluation), self-perception of oral esthetics (oral aesthetic subjective impact scale), orthodontic concern and socioeconomic variables were the independent variables. Multiple logistic regressions were used in the data analysis. The results indicated that presence of malocclusion (p = 0.00), normative need (p = 0.00), anterior crowding (p = 0.00), maxillary anterior crowding (p = 0.00), self-esteem (p = 0.03), esthetic self perception (p = 0.00) and orthodontic interest (p = 0.00) were significantly associated with the presence of impacts. Logistic regression indicates that mandatory normative need, anterior crowding in one or more segments, maxillary anterior crowding ? 2 mm, low self esteem, negative esthetic self perception, no orthodontic concern are risk indicators to oral impacts. 1/3 of 15-year old adolescents sample presented impacts on daily performances attributed to malocclusion on the past six months.
Doutorado
Saude Coletiva
Doutor em Odontologia

QUALITY EVALUATION OF DENTAL SERVICE FOR CHILDREN FROM THE PARENTS' POINT OF VIEW Aistė Kavaliauskienė Supervisor Antanas Šidlauskas, Assoc. Prof., D.D.S., PhD., Department of Social Medicine, faculty of Public Health, Kaunas University of Medicine. – Kaunas, 2005. �� P.74 Aim of the study – to evaluate the quality of dental services for children from the parents’ point of view. Methods. The anonymous questionnaire survey was performed among 280 parents of children visiting their pediatric dentists or orthodontists in four Kaunas public health care institutions. The research methodology used the questionnaire based upon SERVQUAL instrument. Two sets of questions, one relating to the respondents’ expectations, the other relating to the respondents’ perceptions of a particular aspect of service quality, comprised the questionnaire. The perceived gaps between expectations and perceptions were analysed regarding five service quality dimensions (tangibles, responsiveness, reliability, assurance, empathy). Likert-type scales were used for the evaluation of the examined characteristics. The statistical package SPSS version 11.0 for Windows was used to conduct data analysis. Results. There was a statistically significant difference between the parents’ expectations (mean score 4,31±0,36) compared with their perceptions (mean score 3,86±0,46) of the dental service provided. The largest quality gap was observed in characteristic regarding reliability while the smallest gap concerned... [to full text]

碩士
國立臺灣大學
臺大-復旦EMBA境外專班
107
Orthodontic Treatment has flourished in Taiwan in recent years and has largely expanded the turnover of clinics. Different from the functional-purposed general dental treatment, the orthodontic treatment requires good occlusion of teeth, aesthetics of face and dentition, and the care of patients’ mind and health at the same time. Therefore, the dentist needs to communicate with the patients, so the patients get the medical services with the most appropriate treatment. Orthodontic Treatment has generally been self-paid and oftentimes high-priced, patients hence have higher expectation and criteria toward Orthodontic Treatment medical service quality. The main purpose of this study is to explore the factors that influence the cognitions of patients and dentists’ orthodontic treatment service quality. The result of this study would provide specific recommendations for dentists and dental clinic managers to improve the service quality of Orthodontic Treatment. The results of the study infer that more than half of the dentists are under the age of 40. The education levels are mainly bachelor''s degrees. More than half of dentists practice in general dental clinics. Furthermore, Taiwan''s orthodontic treatment industry is at the stage of vigorous development, young dentists are willing to engage in this paticular field. However, there is still room for further development in the characteristics and norms for the orthodontic treatment to be a special medical division. As for the patients, highly educated people are the main customers of orthodontic treatment, or have higher willingness to let their children receive orthodontic treatment. Patients with orthodontic treatment gathered the information mainly from relatives and friends (72.1%), dentists’ advice (42.3%), and only 1% from dental health education information. The result indicates that Orthodontic Treatment has a high correlation with interpersonal networks. In the choice of doctors and clinics, doctors'' medical ethics, family and friends’ advice, service attitudes in the clinic, and transportation convenience are the main considerations. In terms of brace materials, 74.1% use economical metal materials, and 13.4% lack of knowledge about which materials they use. It is inferred that patients care about the curative effect instead of appearances during the treatment, and their decision-making rely on dentists’ advice. In addition, in this study, only 1/4 patients are children, which is very different from the research studies in America and Japan. This result may be caused by the sampling limitation. However, we found the parents’ decision-making is important in their child’s orthodontic treatment decision. Hence, further investigation is needed to understand the parents-child behavior in orthodontic treatment in the future studies.

碩士
國立陽明大學
科技與社會研究所
99
From the perspective of utilizers of medical service, this study investigates orthodontic practices from three aspects: the coproduction of technology and human society, the gap between medical advises on malocclusion and how utilizers conceive them, and their continuous reflections as orthodontics appears as an option to refigure their body/lives This study has three findings. First, thanks to recent advancement in orthodontic technology, utilizers of medical service are able to find what might meet their needs. Meanwhile, celebrities facilited the urge for orthodontics by openly sharing their experiences. Second, despite experts generally agree that teenage is the best time for orthodontic treatment, this study reveals that it was in fact the adults that contributed as the majority to the increasing population who seek for the treatment. It also finds that the flexibility of payment methods, as well as the Taiwanese dentists’ technology preference, are responsible for this phenomenon. Finally, although there have been in place a set of criteria for malocclusion, by which almost all people are classified as “abnormal”, this study concludes that these criteria are by no means primary concerns for people who decide to be engaged in an orthodontic treatment. Non-medical considerations, such as cosmetic ones, play a crucial role in their decisions. By tracking these factors as they are woven into the utilizers’ life stories, this thesis argues that these factors are not just factors per se; they arouse utilizers’ body awareness and skills to cope it. They also affect, upon these body reflections, whether medical interventions are allowed to enter their lives.