J.J.M. Bruers

Patient safety in dental care: A challenging quality issue? An exploratory cohort study

Abstract Objective. Little is known about patient safety in primary oral healthcare. The aim of this study was to describe and analyze patient safety incidents in primary oral health care. Materials and methods. A random sample of 1000 patient records from 20 dental practices was reviewed retrospectively over 60 months. All adverse events (AEs) were noted: unintended events happening during treatment that resulted or could have resulted in harm to the patient. Results. A total of 46 (95% CI = 33–59) AEs was identified, of which 18 (95% CI = 10–26) were considered preventable. From these, 15 related to treatment, 10 to diagnostics and one to communication. Conclusions. The low incidence of AEs and absence of major harm to patients suggests that primary oral care is safe for patients. However, the low quality of record keeping may imply underestimation.

[Evidence-based clinical practice guidelines in oral care 2: process and content of evidence-based guideline development]

In 2014, an advisory report was published by a national working committee concerning how the current, applied method of evidence-based guideline development in healthcare can be used in oral care in a national guideline programme. In an independent Institute of Knowledge Translation in Oral Care, as yet to be established, primary and secondary oral care providers will participate in the programme in order to improve the quality of oral care in the Netherlands. With the launching of the Institute of Knowledge Translation in Oral Care, clinical guideline development will have the benefit of a structural approach, in which 3 successive steps can be distinguished: preparation, development and authorisation. In each of these steps, oral care providers and associations will be actively involved. In this way the aim is to give as much consideration as possible to the needs of those in the field of oral care in the choice of topics for guideline development and to secure the specific character of oral care in the actual establishment of guidelines for clinical practice.

Minimally Invasive Intervention for Primary Caries Lesions: Are Dentists Implementing This Concept?

Contemporary minimally invasive treatment concepts for restorative treatment of primary caries lesions include both delayed intervention and smaller-sized preparations restricted to removal of carious tissue. The aim of this study was to investigate whether these concepts have resulted in a trend towards a more conservative choice made by dentists regarding treatment thresholds and restorative techniques. The results from previously conducted, precoded questionnaires developed by Espelid and Tveit, as well as from a recent Dutch questionnaire, were collected and analysed. A worldwide trend towards more minimally invasive strategies in the operative treatment of caries lesions could not be observed, neither for the initiation of operative treatment nor for the preparation techniques. However, in some countries, changes over time could be assessed, especially in Norway, where a reduction in the proportion of interventions is visible for both occlusal and approximal lesions, indicating that more dentists are postponing interventions until the lesions have progressed to a deeper level. From the Dutch national survey, it could be concluded that operators that intervene at an earlier stage of approximal lesioning (stage ≤4) also intervene at an earlier stage of occlusal caries (stage ≤3) (p = 0.012; OR = 2.52; 95% CI: 1.22–5.22). Generally, it can be concluded that dentists worldwide still tend to operatively intervene at a too early stage of caries, although variations exist between countries. A worldwide shift could be observed in the restorative material applied, since composite resin has almost completely replaced amalgam for restoring primary caries lesions.

Outcome measures for oral health based on clinical assessments and claims data: feasibility evaluation in practice

BackgroundIt is well known that treatment variation exists in oral healthcare, but the consequences for oral health are unknown as the development of outcome measures is still in its infancy. The aim of this study was to identify and develop outcome measures for oral health and explore their performance using health insurance claims records and clinical data from general dental practices.MethodsThe Dutch healthcare insurance company Achmea collaborated with researchers, oral health experts, and general dental practitioners (GDPs) in a proof of practice study to test the feasibility of measures in general dental practices. A literature search identified previously described outcome measures for oral healthcare. Using a structured approach, identified measures were (i) prioritized, adjusted and added to after discussion and then (ii) tested for feasibility of data collection, their face validity and discriminative validity. Data sources were claims records from Achmea, clinical records from dental practices, and prospective, pre-determined clinical assessment data obtained during routine consultations.ResultsIn total eight measures (four on dental caries, one on tooth wear, two on periodontal health, one on retreatment) were identified, prioritized and tested. The retreatment measure and three measures for dental caries were found promising as data collection was feasible, they had face validity and discriminative validity. Deployment of these measures demonstrated variation in clinical practices of GDPs. Feedback of this data to GDPs led to vivid discussions on best practices and quality of care. The measure ‘tooth wear’ was not considered sufficiently responsive; ‘changes in periodontal health score’ was considered a controversial measure. The available data for the measures ‘percentage of 18-year-olds with no tooth decay’ and ‘improvement in gingival bleeding index at reassessment’ was too limited to provide accurate estimates per dental practice.ConclusionsThe evaluated measures ‘time to first restoration’, ‘distribution of risk categories for dental caries’, ‘filled-and-missing score’ and ‘retreatment after restoration’, were considered valid and relevant measures and a proxy for oral health status. As such, they improve the transparency of oral health services delivery that can be related to oral health outcomes, and with time may serve to improve these oral health outcomes.

50 jaar GVO en Gezondheidsbevordering.Tandheelkundige Voorlichting: toen en nu

In dit artikel wordt een overzicht gegeven van 60 jaar Tandheelkundige Gezondheidsvoorlichting en -Opvoeding (TGVO).In die periode is de gebitsbewustheid en de mondgezondheid van de bevolking aanzienlijk toegenomen. Intensieve individuele en collectieve voorlichting lijken hieraan te hebben bijgedragen. In de laatste twee decennia worden, met uitzondering van enkele (regionale)stimuleringsprojecten, wetenschappelijk verantwoorde grootschalige TGVO-projecten niet meer uitgevoerd. De bestrijding van de meest voorkomende mondziekten, cariës en parodontale aandoeningen, blijkt echter nog steeds hoogst noodzakelijk; vooral bij de jeugd, de kwetsbare ouderen en de lagere SES-groepen. Een algemeen probleem is dat er betrekkelijk weinig (regionaal) epidemiologisch onderzoek wordt gedaan naar de ondgezondheidssituatie, de kennis en het gedrag van de bevolking. Collectieve voorlichtingsinitiatieven op het gebied van de mondzorg blijven gewenst. In de individuele patiëntenvoorlichting is echter de belangrijkste rol weggelegd voor tandartsen, mondhygiënisten en andere medewerkers.AbstractDental health promotion: then and nowThis article presents a review of 60 years dental health promotion in the Netherlands. The consciousness of the importance of dental heath did strongly increase during these years. Intensive individual and collective educationdid contribute to this development. Rigorous scientific research projects on dental health promotion were not performed during the last two decennia, except the evaluation of some regional stimulation projects. However, the prevention of dental health, caries, and periodontal diseases is still important, especially among the youth, frail elderly, and lower SES groups. Only limited epidemiological data about the dental health are available about the Dutchpopulation. Collective education on dental care will be strongly needed. The practicing dentists and their coworkers play an important role in the patient education and health promotion.