RESUMEN
INTRODUCTION: This study aimed to investigate access to care and financial considerations associated with the endodontic treatment of immature permanent teeth. METHODS: Surveys were distributed to endodontists (n = 2,457) and pediatric dentists (n = 3,974) in the United States. Data were analyzed using X2 analysis and logistic regression. The level of significance was set to 0.05. RESULTS: The response rate was 13% (n = 840). Respondent specialist groups were similar by age and years since specialty residency completion, but significantly different with regard to primary practice setting (eg private practice, Federally Qualified Health Center, hospital), (P = .001). The majority (91%) of respondents reported participation with dental insurance. Pediatric dentists (69%) were significantly more likely than endodontists (17%) to participate with public-payer dental insurance (P < .001). The majority of respondents (82%) indicated that patients reported economic factors (time or money) as a barrier to accessing endodontic treatment. Pediatric dentists were significantly more likely to consider economic factors when planning for treatment (P < .001). Pediatric dentists were more likely than endodontists to have the opinion that endodontic procedures for treatment of necrotic immature permanent teeth should cost less than root canal therapy (apexification, P < .001; regenerative endodontic procedures, P = .002). Pediatric dentists (33%) reported encountering barriers when attempting to refer their patients to an endodontist. Inability to find an endodontist that participates with dental insurance was the most frequently cited barrier. CONCLUSIONS: Limited clinician participation with dental insurance and gaps in insurance coverage for endodontic procedures appear to contribute to access to care barriers for pediatric patients.
Asunto(s)
Endodoncistas , Accesibilidad a los Servicios de Salud , Humanos , Estados Unidos , Endodoncistas/estadística & datos numéricos , Masculino , Femenino , Odontología Pediátrica , Tratamiento del Conducto Radicular/economía , Tratamiento del Conducto Radicular/estadística & datos numéricos , Niño , Encuestas y Cuestionarios , Endodoncia , Adulto , Persona de Mediana Edad , Dentición Permanente , OdontólogosRESUMEN
BACKGROUND: The final pathway of tooth mortality lies between tooth extraction, and the more expensive and less accessible root canal treatment (RCT). AIM: To determine the extent to which individuals' financial resources as measured by socioeconomic status and dental insurance coverage affects their access to RCT. METHODS: A hospital-based study that used a 15-item questionnaire to collect data among patients scheduled for RCT. All scheduled subjects (N = 291) over a one-year period constituted the sample for the study. Using the SPSS software, associations between the subjects' variables, and the dental insurance status were carried out with Chi square and independent t test respectively at 95% confidence interval. RESULTS: Two hundred and ninety-one subjects were to have 353 RCTs within the study period. A high proportion (79.7%, p < 0.001) of the subjects had dental health insurance, majority (95.3%) of which was government funded. 20.9% of those with previous tooth loss was due to inability to afford cost of RCT. The lowest socioeconomic group had the highest proportion (90%, p = 0.421) of insured that visited for RCT. CONCLUSION: Dental insurance increased access to RCT. Socioeconomic status did not affect dental insurance status and dental visit for RCT.
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Atención Odontológica/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Seguro Odontológico/estadística & datos numéricos , Seguro de Salud , Tratamiento del Conducto Radicular/economía , Adulto , Estudios Transversales , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Tratamiento del Conducto Radicular/estadística & datos numéricos , Factores Sexuales , Clase Social , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: To contribute with information on cost-effectiveness of pulp capping and root canal treatment of posterior permanent vital teeth in children and adolescents with pulp exposures due to caries. MATERIAL AND METHODS: Cost-effectiveness by means of a Markov simulation model was studied in a Scandinavian setting. In a simulated 12-year-old patient, treatment of pulpal exposure of a permanent tooth, either by the initial treatment pulp capping or root canal treatment, was followed for 9 years until the patient was 21. The model was based on outcome data obtained from published literature and cost data based on reference prices. RESULTS: In the simulated case, with the annual failure probalility (AFP) of 0.034 for pulp capping, the total cost for an initial treatment with pulp capping and any anticipated following treatments during the 9 years, was 367 EUR lower than for a root canal treatment as the initial treatment. After an initial treatment with pulp capping 10.4% fewer teeth, compared with initial root canal treatment, were anticipated to be extracted. Pulp capping was thus considered to be the cost-effective alternative. The sensitivity analyses showed that the AFP of a tooth requiring a root canal treatment after an initial pulp capping needed to be 0.2 before root canal treatment may be considered being the cost-effective treatment. CONCLUSIONS: This model analysis indicated initial treatment by pulp capping to be cost-effective compared to root canal treatment in children and adolescents with pulp exposures due to caries.
Asunto(s)
Apicectomía/economía , Caries Dental/economía , Recubrimiento de la Pulpa Dental/economía , Exposición de la Pulpa Dental/economía , Tratamiento del Conducto Radicular/economía , Adolescente , Niño , Análisis Costo-Beneficio , Caries Dental/terapia , Exposición de la Pulpa Dental/terapia , Dentición Permanente , Femenino , Costos de la Atención en Salud , Humanos , Tratamiento del Conducto Radicular/métodos , Diente no Vital/economía , Resultado del TratamientoRESUMEN
BACKGROUND: After root canal treatment, a choice is made between different coronal restorations which in the long run could affect the survival of the tooth. OBJECTIVE: To compare demographic characteristics between individuals choosing an indirect coronal restoration (crown, inlay/onlay) and individuals choosing other restorations after completion of a root filling. METHODS: The cohort consisted of all root-filled upper first molars that were reported to the tax-funded Swedish Social Insurance Agency (SSIA) during 2009. After registration of the root filling, any subsequent coronal restorations within 2 years were identified. The crown group consisted of individuals registered with an indirect coronal restoration and the restoration group was the remaining individuals with a direct coronal restoration or lacking registration. Demographic data (gender, disposable income, age, educational level, civil status and country of birth) were received from Statistics Sweden or the SSIA. Statistical analyses included chi-square test, t test and logistic regression analysis. P < 0.05 was considered statistically significant. RESULTS: An indirect coronal restoration was received by 7806 individuals (21.9%), and 27 886 individuals (78.1%) received a direct restoration. All demographic variables except gender differed significantly between groups. Logistic regression analysis found significant associations for all demographic variables and the registration of an indirect restoration except for country of birth and gender. CONCLUSIONS: The identified demographic differences between individuals choosing to restore their newly root-filled teeth with an indirect restoration compared to those receiving other restorations may indicate that the tax-funded Swedish dental insurance fails to provide dental care on equal terms for Swedish citizens.
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Conducta de Elección , Restauración Dental Permanente/métodos , Seguro Odontológico/estadística & datos numéricos , Tratamiento del Conducto Radicular , Adulto , Demografía , Restauración Dental Permanente/economía , Escolaridad , Femenino , Humanos , Modelos Logísticos , Masculino , Estado Civil/estadística & datos numéricos , Persona de Mediana Edad , Diente Molar , Tratamiento del Conducto Radicular/economía , Clase Social , Suecia/epidemiologíaRESUMEN
OBJECTIVE: To compare the outcomes of two emergency treatment procedures to alleviate pain from localised symptomatic apical periodontitis: complete chemo-mechanical disinfection (CMD) of the root canal system, or removal of necrotic tissue from the pulp chamber (RNT), that is without instrumentation of the root canals. METHODS: Fifty-seven consecutive patients from the emergency clinic at Malmö University met the inclusion criteria: spontaneous pain and/or pain on percussion and palpation, non-bleeding pulp in the canal orifice, pain ≥4 on a Numeric Rating Scale and ≥18 years of age. The diagnosis was symptomatic apical periodontitis, in the absence of swelling and/or fever. Pre-operative pain levels and intake of analgesics were registered. The patients were randomised to one of the two treatment groups. Three to five days post-operatively, the patients were contacted by telephone and asked to grade their current pain level and report any post-operative intake of analgesics and antibiotics. RESULTS: Of the patients treated with CMD of the root canal system, 26/30 (87%) reported satisfactory pain relief, compared with 22/27 (81%) of those treated by RNT. There was no mean difference in pain relief between the two groups (P = 0.879). Post-operatively, 37% in each group reported using analgesics and one in each group reported using antibiotics. CONCLUSION: Three to five days after treatment, a majority (>80%) in both groups reported adequate pain relief, in some cases in combination with analgesics. Removal of necrotic and infected tissue from the pulp chamber might therefore be a cost-effective emergency treatment alternative to complete chemo-mechanical disinfection.
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Antibacterianos/uso terapéutico , Tratamiento de Urgencia , Dolor Facial/patología , Dolor Facial/terapia , Periodontitis Periapical/patología , Periodontitis Periapical/terapia , Pulpectomía , Tratamiento del Conducto Radicular , Adulto , Análisis Costo-Beneficio , Tratamiento de Urgencia/economía , Dolor Facial/etiología , Femenino , Humanos , Masculino , Dimensión del Dolor , Satisfacción del Paciente , Periodontitis Periapical/complicaciones , Periodontitis Periapical/economía , Estudios Prospectivos , Pulpectomía/economía , Tratamiento del Conducto Radicular/economía , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Objective: To conduct economic evaluation of treatments under dental general anesthesia (DGA) and protective stabilization (PS), in order to compare the cost and the final therapeutic effect of these two treatments. Methods: Retrospectively studied twenty-six 2 to 4 years old patients treated under DGA and twenty-seven treated under PS in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. The general information, treatment information and total treatment cost information of patients were collected. The cost and cost-survival time ratio of the two groups were compared in units of people and tooth respectively. When compared in unit of people, patients were divided into two groups depending on the number of teeth treated, when compared in unit of tooth, teeth were divided into two groups depending on the treatment received, i.e. restoration or root canal treatment. In addition, we recalculated and compared two groups under the assumption that the treatment charges of DGA was consistent with common outpatient charges. Results: The tooth average cost and cost-survival time ratio of each patient in DGA group which were [(1 133.87±87.37) yuan] and [3.51 (1.30, 5.72) yuan/d] respectively were significantly higher than those in PS group which were [(303.81±155.34) yuan] and [1.54 (0.95, 2.13) yuan/d] respectively (P<0.01). The number of teeth and the way of treatments wouldn't change the result. The recalculated result of the cost-survival time ratio of each patient in DGA group [1.63 (0.72, 2.55) yuan/d] and PS group [1.54 (0.95, 2.13) yuan/d] showed no significant difference (P=0.455). Conclusions: Patients treated in Peking University School and Hospital of Stomatology showed a significant higher cost and cost-survival time radio in DGA group than that in PS group. If the treatment charges of DGA group was consistent with common outpatient charges, PS group will no longer have economic advantage.
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Anestesia Dental/economía , Anestesia General/economía , Restauración Dental Permanente/economía , Tratamiento del Conducto Radicular/economía , Preescolar , China , Análisis Costo-Beneficio , Implantación Endodóntica Endoósea/economía , Humanos , Odontología Pediátrica , Estudios RetrospectivosRESUMEN
AIM: To investigate the fees charged by Swedish dentists for root fillings, coronal restorations and further dental interventions during a follow-up period of 5-6 years. METHODOLOGY: A total of 248 299 root fillings were linked with the tooth, the patient and the provider and entered into the Swedish Social Insurance Agency register in 2009. The data register also recorded the subsidy-based (scheduled) fee and the fee actually charged for the root fillings. Fees charged for direct or indirect coronal restorations and additional interventions during the follow-up period were also recorded. One-way anova and t-test were used for statistical analysis. RESULTS: The mean overall fee charged for a root filling was approximately 332 Euro and differed only marginally (13 Euro) from the scheduled fee. The total mean fee for preservation of a root filled tooth was 717 Euro, which included the root canal treatment, the coronal restoration and any additional interventions during the follow-up period. The fees for indirectly restored root filled teeth were significantly higher (1105 Euro) than for directly restored teeth (610 Euro), despite further additional treatment (P < 0.001). The mean fee for teeth which were subsequently extracted was higher (769 Euro) than for the retained teeth (711 Euro) (P < 0.001). CONCLUSIONS: Fees charged by Swedish dentists for root canal treatment were in accordance with the scheduled fees. The overall mean fee was significantly higher for root filled teeth with indirect restorations than for teeth with direct coronal restorations. However, prospective clinical cost-effectiveness studies are needed to analyse the total costs.
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Coronas/economía , Restauración Dental Permanente/economía , Honorarios y Precios , Odontología General , Tratamiento del Conducto Radicular/economía , Adulto , Anciano , Anciano de 80 o más Años , Fracaso de la Restauración Dental , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Sistema de Registros , Suecia , Factores de Tiempo , Adulto JovenRESUMEN
'...scheduling treatments as well as patients' and dentists' preferences' although trivial, are factors that influence treatment modality.
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Cavidad Pulpar , Pautas de la Práctica en Odontología , Tratamiento del Conducto Radicular/economía , Análisis Costo-Beneficio , Odontólogos , Humanos , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Single-visit root canal treatment requires fewer visits and reduces treatment time and material use compared with multiple-visit treatment. However, it might result in a higher risk of complications. We aimed to assess the long-term cost-effectiveness of single- versus multivisit root canal treatment using a model-based approach. METHODS: A mixed public-private-payer perspective in German health care was adopted. Permanent teeth were simulated over the lifetime of 40-year-old patients. Different tooth types and preoperative conditions were modeled. Teeth could experience endodontic and nonendodontic complications. The risk of endodontic complications after single- versus multiple-visit treatment was estimated based on systematically collected data and adjusted depending on the preoperative conditions. The health outcome was tooth retention time. Costs were calculated based on the German dental fee catalogs and the Monte Carlo microsimulations were performed for analysis. RESULTS: For nonvital molars without periapical lesions, single-visit treatment was minimally less costly (1703 Euro vs 1729 Euro) and more effective (19.9 vs 19.8 years) than multiple-visit treatment. This cost-effectiveness ranking also applied to vital molars or those with periapical lesions. In single-rooted teeth, multiple-visit treatment was less costly (1667 vs 1770 Euro) and more effective (18.9 vs 15.1 years). CONCLUSIONS: The overall cost-effectiveness difference between treatments seems limited. The resulting cost-effectiveness differs in subgroups of teeth, whereas data supporting such subgroup analyses are scarce. Practical aspects in scheduling treatments as well as patients' and dentists' preferences should be considered for decision making.
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Tratamiento del Conducto Radicular/economía , Tratamiento del Conducto Radicular/métodos , Adulto , Análisis Costo-Beneficio , Alemania , Costos de la Atención en Salud , Humanos , Masculino , Metaanálisis como Asunto , Método de Montecarlo , Visita a Consultorio Médico/economía , Resultado del TratamientoRESUMEN
Endodontic retreatment often involves remaking restorations. The total cost may steer the treatment towards surgery. The aim of this study was to retrospectively record the reasons for performing apical surgery in an economically deprived patient population. The clinical reasons (59%) for apical surgery were most common, but the nonclinical (financial) reasons (41%) emerged as a major cause. The finding that 41% of the apicoectomies were performed because of nonclinical constraints is a high figure and may not reflect the situation generally. Still, economic factors potentially play a major role in the selection of surgical versus nonsurgical endodontic retreatment.
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Apicectomía/estadística & datos numéricos , Poblaciones Vulnerables/estadística & datos numéricos , Adulto , Apicectomía/economía , Calcificaciones de la Pulpa Dental/epidemiología , Cavidad Pulpar/lesiones , Falla de Equipo , Etnicidad , Femenino , Cuerpos Extraños/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Enfermedades Periapicales/epidemiología , Técnica de Perno Muñón/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Retratamiento , Estudios Retrospectivos , Materiales de Obturación del Conducto Radicular/efectos adversos , Preparación del Conducto Radicular/instrumentación , Tratamiento del Conducto Radicular/economía , Tratamiento del Conducto Radicular/estadística & datos numéricos , Ápice del Diente/lesionesRESUMEN
OBJECTIVES: Despite increasing evidence supporting selective caries tissue removal, the technique is not adopted by most dentists, one possible reason being that patients might reject it. We aimed to assess patients' preferences for selective versus complete excavation, and to identify predictors of this preference. METHODS: A sequential mixed-methods approach was taken. First, semi-structured focus group discussions on two convenience samples were performed. Verbatim transcripts were evaluated using content-analysis to inform quantitative study design. The subsequent survey employed convenience, snow-ball and deviant-case sampling, yielding 150 respondents. The relevance of treatment attributes (risks of nerve damage, root-canal treatment, recurrent caries, restorative complications, treatment costs, aesthetic consequences) on patients' treatment preferences was measured using case-vignettes. Dental experience and anxiety as well as patients' personality and socio-demographic details were recorded. Association of predictor variables (age, gender, education, partnership status, personality items, dental experience, anxiety) with treatment preference was assessed using regression analysis. RESULTS: Focus group participants perceived complete excavation as reliable, but feared endodontic treatment. The vast majority of survey respondents (82.7%) preferred complete over selective excavation. The preference for selective excavation was significantly increased in patients with an emotionally stable personality (p<0.001), university entrance degree (p<0.001), none or little dental anxiety (p=0.044), few dentist changes in the past (p=0.025), and who accepted that sealed lesions could progress (p<0.002). CONCLUSION: Treatment attributes, socio-demographic characteristics, personality and dental experiences shape patients' preference towards caries excavation. CLINICAL SIGNIFICANCE: Clinical decision-making regarding carious tissue removal might be affected by dentists on both an informative and an empathic level.
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Caries Dental/terapia , Preparación de la Cavidad Dental/métodos , Prioridad del Paciente , Adulto , Preparación de la Cavidad Dental/efectos adversos , Preparación de la Cavidad Dental/economía , Exposición de la Pulpa Dental/prevención & control , Restauración Dental Permanente , Estética Dental/economía , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Tratamiento del Conducto Radicular/economía , Tratamiento del Conducto Radicular/métodos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
AIM: To study the 20-year survival rate and periapical status of root filled teeth in a Swedish population requiring high-cost dental care and to identify factors related to survival and normal periapical status at follow-up. METHODOLOGY: The study population comprised 104 patients selected from four local health insurance districts with treatment plans including radiographs submitted for approval for reimbursement from the Swedish National Dental Insurance in 1977. In 1998, a clinical and radiographic follow-up examination was conducted, to register the status of 449 teeth identified as root filled at baseline. Differences in tooth survival and periapical status at follow-up, with reference to periapical status and quality of root filling at baseline, were analysed by chi-square tests. Multiple regression analysis was used to describe tooth survival and normal periapical status at follow-up, with the explanatory baseline variables: tooth type, type of restoration, type of post, quality of root filling, periapical status, marginal bone loss and caries. Differences were considered significant at a 5% level. RESULTS: Two hundred and ninety (65%) of the root filled teeth survived at follow-up. Baseline variables associated with low odds for tooth survival were mandibular molar, maxillary premolar, prefabricated posts other than screw posts, severe marginal bone loss, caries and apical periodontitis (AP). Normal periapical status at follow-up was registered in 49% of the root filled teeth. Baseline variables associated with low odds for normal periapical status (high risk for AP) at follow-up were mandibular molar, maxillary premolar, AP, severe marginal bone loss and inadequate root filling quality. Of the root filled teeth with AP at baseline, 42% had been left untreated during the observation period, and at follow-up, the AP persisted in 57% of these teeth. CONCLUSIONS: After 20 years, 65% of the root filled teeth had survived and one-third remained with a sound periapical condition, without any further treatment. Almost half of the APs registered at baseline were left without treatment, and more than half of them persisted after 20 years.
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Seguro Odontológico/economía , Tratamiento del Conducto Radicular/economía , Adulto , Anciano , Anciano de 80 o más Años , Fracaso de la Restauración Dental/economía , Fracaso de la Restauración Dental/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Costos de la Atención en Salud , Humanos , Seguro Odontológico/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Suecia , Adulto JovenRESUMEN
PURPOSE: To assess and compare the outcomes and economic complication burden of three-unit tooth-supported fixed dental prostheses (TFDPs) and implant-supported single crowns (ISCs) provided to a sequential cohort in a specialist prosthodontic practice over a 15-year period. MATERIALS AND METHODS: Sequential patients requiring replacement of a single missing tooth between 1996 and 2010 with a metal-ceramic three-unit TFDP (n = 145 patients, n = 174 prostheses) or ISC (n = 174 patients, n = 220 prostheses) were included. Prostheses subjectively judged at insertion to have an unfavorable 10-year prognosis (17 TFDPs, 0 ISCs) were removed from statistical analyses. The estimated cumulative survival (ECS) was calculated with the life table actuarial method and standard errors calculated with the Greenwood formula. Differences in outcomes between all prostheses and those replacing only anterior or only posterior teeth were assessed with the log rank test. Complication incidence, severity, and economic burden, measured in time/cost accounting units (TAUs), were tallied and compared descriptively. RESULTS: The 15-year ECS did not differ for 112 TFDPs (92.75% ± 3.28%) and 81 ISCs (95.95% ± 2.92%) replacing posterior teeth. However, the 15-year ECS was significantly greater for 139 ISCs (93.33% ± 6.44%) than for 45 TFDPs (82.82% ± 6.50%) replacing anterior teeth. The economic burden of nonterminal complications for both prostheses was low (mean = 0.3 and 0.2 TAUs per prosthesis for TFDPs and ISCs, respectively). This equated to 3 TAUs/100 years in clinical service and 4 TAUs/100 years in clinical service for the TFDPs and ISCs, respectively. CONCLUSION: The survival of three-unit TFDPs and ISCs over 15 years was not statistically different when replacing posterior teeth, but ISCs survived significantly better when replacing anterior teeth. The complication rates of the TFDPs and ISCs were similar, but the economic burden for the TFDPs was greater.
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Coronas/estadística & datos numéricos , Implantes Dentales de Diente Único/estadística & datos numéricos , Prótesis Dental de Soporte Implantado/estadística & datos numéricos , Dentadura Parcial Fija/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Costo de Enfermedad , Coronas/economía , Implantes Dentales de Diente Único/economía , Prótesis Dental de Soporte Implantado/economía , Fracaso de la Restauración Dental/economía , Fracaso de la Restauración Dental/estadística & datos numéricos , Dentadura Parcial Fija/economía , Femenino , Estudios de Seguimiento , Humanos , Tablas de Vida , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Periimplantitis/economía , Estudios Prospectivos , Tratamiento del Conducto Radicular/economía , Tratamiento del Conducto Radicular/estadística & datos numéricos , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Patient charges and availability of dental services influence utilization of dental services. There is little available information on the cost of dental services and availability of materials and equipment in public dental facilities in Africa. This study aimed to determine the relative cost and availability of dental services, materials and equipment in public oral care facilities in Tanzania. The local factors affecting availability were also studied. METHODS: A survey of all district and regional dental clinics in selected regions was conducted in 2014. A total of 28/30 facilities participated in the study. A structured interview was undertaken amongst practitioners and clinic managers within the facilities. Daily resources for consumption (DRC) were used for estimation of patients' relative cost. DRC are the quantified average financial resources required for an adult Tanzanian's overall consumption per day. RESULTS: Tooth extractions were found to cost four times the DRC whereas restorations were 9-10 times the DRC. Studied facilities provided tooth extractions (100%), scaling (86%), fillings (79%), root canal treatment (46%) and fabrication of removable partial dentures (32%). The ratio of tooth fillings to extractions in the facilities was 1:16. Less than 50% of the facilities had any of the investigated dental materials consistently available throughout the year, and just three facilities had all the investigated equipment functional and in use. CONCLUSIONS: Dental materials and equipment availability, skills of the practitioners and the cost of services all play major roles in provision and utilization of comprehensive oral care. These factors are likely to be interlinked and should be taken into consideration when studying any of the factors individually.
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Clínicas Odontológicas , Equipo Dental , Servicios de Salud Dental/economía , Materiales Dentales , Honorarios Odontológicos , Accesibilidad a los Servicios de Salud , Sector Público , Adulto , Clínicas Odontológicas/economía , Clínicas Odontológicas/organización & administración , Equipo Dental/economía , Servicios de Salud Dental/organización & administración , Materiales Dentales/economía , Restauración Dental Permanente/economía , Raspado Dental/economía , Servicio Odontológico Hospitalario/economía , Servicio Odontológico Hospitalario/organización & administración , Diseño de Dentadura/economía , Dentadura Parcial Removible/economía , Recursos en Salud/economía , Recursos en Salud/organización & administración , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Sector Público/economía , Tratamiento del Conducto Radicular/economía , Tanzanía , Extracción Dental/economíaRESUMEN
OBJECTIVE: There are various alternatives for the management of oral conditions that may lead to or already have lead to partial or full edentulism. Economic evaluations measure the efficiency of alternative healthcare interventions and provide useful information for decision-making and the allocation of scarce resources. MATERIAL AND METHODS: The current English literature dealing with "cost-effectiveness" of dental implant therapy versus different alternative treatment modalities, that is, complete and fixed partial dentures, root canal, and periodontal treatment, has been included in this narrative review. Due to the high heterogeneity within the literature, a meta-analysis could not be conducted. RESULTS: The available evidence from economic evaluations indicated that for the treatment of central incisors with irreversible pulpitis and coronal lesions, root canal treatments were most cost-effective initial treatment options. When initial root canal treatments failed, orthograde retreatments were most cost-effective. When root canal retreatments failed, extractions and replacement with single implant-supported crowns were more cost-effective compared to fixed or removable partial dentures. In the treatment of periodontitis in molars with Class I furcation invasion, non-surgical periodontal therapy was more effective and costed less than implant-supported single crowns. For the replacement of single missing teeth, two evaluations indicated that implant-supported single crowns provided better outcomes in terms of greater quality-adjusted tooth years or survival rates at lower costs compared to fixed partial prostheses. Another economic evaluation found that implant-supported crowns costed more, but provided greater survival rates compared to fixed partial dentures. For the restoration of edentulous mandibles, two evaluations indicated that overdentures retained by two or four implants improved oral health-related quality of life outcomes, but costed more than complete dentures. CONCLUSIONS: To better assess the efficiency of implant-supported prostheses in various clinical conditions, more economic evaluations are needed that follow well-established methodologies in health economics.
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Análisis Costo-Beneficio , Implantación Dental Endoósea/economía , Prótesis Dental de Soporte Implantado/economía , Economía en Odontología , Coronas/economía , Dentadura Completa/economía , Dentadura Parcial Fija/economía , Humanos , Enfermedades Periodontales/terapia , Calidad de Vida , Retratamiento/economía , Tratamiento del Conducto Radicular/economíaRESUMEN
INTRODUCTION: When faced with a clinically asymptomatic root canal treated tooth with certain radiographic findings (e.g., underextended or overextended root fillings or persistent periapical lesions), clinicians need to decide between endodontically retreating the tooth before restoration or not retreating it now but possibly later on. The present study compared the cost-effectiveness of both strategies. METHODS: A Markov model was constructed following a root canal treated, clinically asymptomatic molar with one of the described radiographic findings in a 50-year-old patient during his lifetime. Hazard functions were derived from systematically and non-systematically assessed literature, and costs were estimated for German health care. Monte Carlo microsimulations were performed for teeth with composite restorations, crowns, or post-core crowns, and costs per year of tooth retention were calculated. RESULTS: Regardless of the radiographic findings, not performing immediate retreatment was found to be significantly less costly (589-954 Euro) and more effective (retention time, 25-29 years) than immediately performing secondary root canal treatment (1163-1359 Euro, 25-27 years). Both strategies had similar effectiveness only for teeth that received post-core crowns, whereas immediate retreatment remained more expensive. The uncertainty around the obtained strategy ranking was low. CONCLUSIONS: The high costs for secondary root canal treatment do not seem to be outweighed by the increased risks associated with certain radiographic findings in asymptomatic teeth. Our results should be interpreted with caution because the quality of the underlying data is limited.
Asunto(s)
Restauración Dental Permanente/economía , Tratamiento del Conducto Radicular/economía , Análisis Costo-Beneficio , Coronas , Humanos , Cadenas de Markov , Persona de Mediana Edad , Diente Molar/diagnóstico por imagen , Diente Molar/cirugía , Radiografía Dental , RetratamientoRESUMEN
INTRODUCTION: With the recent advancement in dental treatment modalities, patients are increasingly faced with the dilemma of selecting between root canal treatment (RCT) and implant placement (IP). Data on the influence of demographics on the aforementioned choice appear to be limited. The purpose of this retrospective cohort study was to investigate any association between demographic attributes and patients' receipt of RCT or IP. METHODS: The study sample for this computerized retrospective cohort study included 4084 dental school patients who received RCT and/or IP between 2006 and 2011. The following data were abstracted for each patient: age, sex, ethnicity, insurance status, and zip codes; the last variable was the proxy for socioeconomic status (SES). Statistical analysis included descriptive, chi-square test, and computation of odds ratios. RESULTS: Patient age, sex, race, insurance status, and SES were significantly associated with the choice of endodontic or implant therapy. Older patients were 6 times more likely as younger ones to receive IP. Males were 1.3 times more likely as females to have received IP; whites were twice as likely as blacks for the same treatment. Insured patients were 1.6 times more likely to have received RCT compared with uninsured patients The odds of patients from high SES receiving IP was 2.4 times greater than those from low SES. CONCLUSIONS: Demographic attributes and insurance status significantly affected the receipt of RCT or IP. Clinicians need to be aware that patient demographics and/or dental insurance status play a role in treatment decisions.
Asunto(s)
Demografía , Implantes Dentales , Tratamiento del Conducto Radicular , Adulto , Estudios de Cohortes , Implantes Dentales/economía , Etnicidad , Femenino , Humanos , Seguro Odontológico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tratamiento del Conducto Radicular/economía , Factores Sexuales , Extracción Dental/economía , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: Adolescents and emerging adults can provide dentists with many challenges. Little information is available on their perceptions of dental costs once they turn 18 and dentistry is no longer State-funded. The aim of this study was to explore the use of dental care by Southland students in years 12 and 13, their perceptions of the cost of four common dental procedures, self-related oral health and dental self-care habits, time off school related to dental problems, and knowledge and views regarding fluoride. METHODS: After ethical approval, a 26-question survey was conducted of all Southland students in years 12 and 13. Data were statistically analysed in SPSS version 20 with the alpha value set at 0.05. RESULTS: The participation rate was 49.6%. Regular attendance for examinations was reported by 77.5% with non-attendance mainly related to attitudes around lack of importance or necessity. Reported dental attendance varied according to gender, ethnicity and decile rating of school attended. Although some were accurate in their estimations of dental costs, the standard deviation for all procedures was large. The majority thought that costs put people off going to the dentist. While 74.8% brushed their teeth at least twice daily, only 26.6% flossed regularly. Knowledge regarding fluoride was lacking. CONCLUSIONS: It may be advantageous to include education regarding costs of dental care with patients of this age. This may motivate them to improve their self-care and ensure that their oral health is of a high standard before their dental needs are no longer State-funded.
Asunto(s)
Actitud Frente a la Salud , Atención Odontológica/psicología , Costos de la Atención en Salud , Autocuidado/psicología , Absentismo , Adolescente , Cariostáticos/uso terapéutico , Coronas/economía , Ansiedad al Tratamiento Odontológico/psicología , Atención Odontológica/economía , Dispositivos para el Autocuidado Bucal , Restauración Dental Permanente/economía , Etnicidad/psicología , Femenino , Fluoruración/psicología , Fluoruros/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Nueva Zelanda , Salud Bucal , Tratamiento del Conducto Radicular/economía , Factores Sexuales , Clase Social , Cepillado Dental/psicología , Adulto JovenRESUMEN
Overbearing regulators with their various labyrinthine regulations have had adverse impacts on dentists and their teams' behaviours. This has produced the perverse outcomes of demoralizing dental teams as well as reducing their capacity and/or desire to deliver compassionate oral healthcare. These adverse outcomes do not seem to have benefited patients, or dentists, or their teams, in any sensible or measurable way. CPD/CLINICAL RELEVANCE: The vastly increased burdens on the UK dental profession of intrusive, bullying regulations, emanating from the various UK agencies, such as the supposedly fair and independent GDC, but including the increasingly politically controlled NHS and the CQC, have had unfortunate, perverse, effects on many dentists' clinical practices and affected dental teams' desires, or willingness, to be as compassionate as they used to be about helping to solve some patients' dental or oral problems.
Asunto(s)
Regulación Gubernamental , Odontología Estatal/legislación & jurisprudencia , Comportamiento del Consumidor , Costos y Análisis de Costo , Atención Odontológica/legislación & jurisprudencia , Odontólogos/legislación & jurisprudencia , Dentaduras/economía , Disentimientos y Disputas , Eficiencia Organizacional/economía , Ética Odontológica , Conductas Relacionadas con la Salud , Costos de la Atención en Salud , Humanos , Legislación en Odontología , Licencia en Odontología/legislación & jurisprudencia , Grupo de Atención al Paciente/legislación & jurisprudencia , Mecanismo de Reembolso/economía , Tratamiento del Conducto Radicular/economía , Tratamiento del Conducto Radicular/normas , Nivel de Atención , Odontología Estatal/economía , Reino UnidoRESUMEN
AIM: To elicit the factors affecting willingness to pay (WTP) values for the preferred options of participants for dealing with a molar tooth with a nonvital pulp, a common but difficult problem. METHODOLOGY: A total of 503 patients were recruited from dental practices in the North East of England and interviewed. Their preferred treatment option for a molar tooth with a nonvital pulp (endodontics, extraction and various prosthetic restorative options) and WTP for this preferred option were elicited. Factors affecting preferred option and WTP were analysed using econometric modelling. RESULTS: Overall, 53% of the sample wished to save the tooth with a mean WTP of £373. The variance in WTP was high. Of those opting for extraction, the majority chose to leave a gap or have an implant. The preferred option was influenced by previous treatment experience. WTP was only influenced by having a low income. CONCLUSIONS: The high level of variance in WTP and its relatively unpredictable nature pose difficult questions for policy makers trying to ensure the delivery of an equitable service. For dentists, it is important not to make assumptions about patient preference and strength of preference when making decisions. Ideally, WTP values should be considered alongside effectiveness data, and those on costs, in policy making.