Determinants of Demand in the Public Dental Emergency Service

Effectiveness of and Patient’s Satisfaction with Dental Emergency Unit in Pitié Salpêtrière Hospital (Paris), Focusing on Pain and Anxiety

Background

The Dental Emergency Unit (DEU) of the Pitié Salpêtrière Hospital receives mainly painful emergencies. This study aimed at evaluating the suppression of pain and anxiety as well as the patient's satisfaction after a visit to the DEU. Patients and Methods. A prospective study was carried out in 2019 (NCT03819036) in adult patients. Data was collected on D0 on site and then on D1, D3, and D7 by phone, during daytime. The main objective and secondary objectives were, respectively, to assess the intensity of pain on D1; the intensity of pain on D3 and D7; the evolution of anxiety on D1, D3, and D7; and the patients' satisfaction. They were evaluated with a 0–10 numeric scale (NS) on D1, D3 and D7; mean scores were compared with nonparametric statistics (ANOVA, Dunn's test).

Results

814 patients were contacted and 581 patients included; 87 were lost to follow-up. 376 patients completed all the questionnaires. In the final sample (59% men, 40 ± 16 y.o.), 86% had health insurance. The mean pain scores were as follows: D0: 6.36 ± 0.12; D1: 3.49 ± 0.13; D3: 2.23 ± 0.13; D7: 1.07 ± 0.11—indicating a significant decrease of 45%, 65%, and 93% on D1, D3, and D7, respectively, compared to D0 (p < 0.0001) between D0 and D1, D3, D7. The mean NS anxiety scores were as follows: D0: 3.32 ± 0.15; D1: 3.69 ± 0.16; D3: 2.75 ± 0.16; D7: 1.98 ± 0.15. The decrease was significant between D0 and D7 (p < 0.0001). The perception of general heath improved between D1 and D7. The overall score of satisfaction was 8.64 ± 0.06.

Conclusion

DEU enabled a significant reduction in pain and anxiety with high overall satisfaction.

The Influence of Dentists' Profile and Health Work Management in the Performance of Brazilian Dental Teams

To evaluate the association between dentists' profile and health work management with the performance of primary care dental teams in the Brazilian National Health System, both nationally and regionally. Secondary data analysis from a Brazilian National Programme that evaluated 18,114 Brazilian dental teams, working in the public sector, between 2013 and 2014. Twenty-four independent variables taken from dentists' profile and dental team management characteristics were analysed to assess their influence on reported “dental team performance.” An estimated score was generated from their performance on 20 dental procedures by an item response theory model. Multiple linear regression models were performed for each Brazilian geographical region, separately and for the whole of Brazil. p values ≤ 0.05 were considered significant. Two variables related to dentists' profile, “having graduate studies” (β = 0.151) and “undertaking continuing professional development training” (β = 0.101), were associated with enhanced dental team performance in all five Brazilian geographical regions and nationally. The dental team management variables of “having a flexible dental appointment list” (β = 0.218) and “monitoring oral health indicators” (β = 0.132) also contributed to improve team performance in each of the regions and nationally. Dentists' profile influenced the performance of dental teams from south region more than the other regions. The findings suggest that continuing professional development, including postgraduate education, and strategic management characteristics are important for primary dental care performance and should be reflected in health policy initiatives in support of quality care. Regional factors could be considered for health care management.

Dental emergency: Scoping review

Part of the oral health care in the care network encompasses users in emergency cases. This study proposed mapping the determinants of the use of dental care services within the health care network to address dental emergencies within the Brazilian Unified Health System (UHS) and to verify the main gaps in the research in this area. This is a scoping review that took place in 2018 using Andersen's behavioral model as a reference. A total of 16 studies, out of 3786 original articles identified, were included and reviewed. Two reviewers independently conducted the selection process and the decision was consensually made. The mapping of the determinants revealed a greater number of enabling factors and a larger gap in the results. Greater use of the emergency service was registered by people in pain, women, adults, those from an urban area, people with a lower income, and those with less education. In future studies, primary surveys are recommended, which include all ages, and analyze different groups of needs and users that take into account the country's northern region and the different subjects pointed out by this review.

Sociodemographic Determinants and Common Reasons for Visiting the Emergency Dental Service in the City of Zagreb

Objective

The objective of the study was to determine the sociodemographic and clinical parameters of patients who visit the emergency dental service and their most common diagnoses.

Materials and Methods

The data were collected on the basis of a survey filled out by patients. A total of 1730 out of 6732 patients (26%) were surveyed using a questionnaire to analyze sociodemographic status, dental visits, the description and dynamics of the symptoms. After the data collection, methods of descriptive data presentation and of inferential statistics were made in SPSS.

Results

Survey results show that most subjects (60.4%) came during the weekends and holidays. The subjects, 73.1% of them, stated that they had already used this type of service, and 65.8% did not visit their dentist beforehand. The largest number of subjects (62.2%) reported that they needed emergency service within a week after their problems had begun. The most common diagnoses included face and jaw abscesses (27.3%). There is a statistically significant difference between the number of patients who went to the emergency dental service and completed the questionnaire over the course of several months contrary to patients who were there in May and June (59.7%) compared to July and August (40.3%).

Conclusions

Most subjects had clear indications for being referred to an emergency dental service. Most of the emergency conditions were mainly due to irregular visits to the dentist. Patient education and preventive programs would probably have reduced the number of visits.