The objective of the study was to compare the acceptability of occlusion among orthodontically treated and untreated adolescents in eight Finnish municipal health centres applying different timing of treatment. A random sample of 16- and 18-year olds (n = 2325) living in these municipalities was invited for a clinical examination, and 1109 adolescents participated. Two calibrated orthodontists blindly examined the participants for the acceptability of occlusion with the Occlusal Morphology and Function Index. The history of orthodontic treatment was elicited by questionnaire. The impact of the history and timing of treatment on the acceptability of occlusion was analysed with logistic regression analysis. The history of orthodontic treatment decreased the odds for acceptability of morphology [odds ratio (OR) = 0.719, 95 per cent confidence limit (CL), P = 0.016] and acceptability of function (OR = 0.724, 95 per cent CL, P = 0.018). The early timing of treatment increased the odds for acceptability of morphology (OR = 1.370, 95 per cent CL, P = 0.042) and of function (OR = 1.420, 95 per cent CL, P = 0.023). No substantial differences were observed in the acceptability of occlusion between the early and late timing health centres. However, the proportion of subjects with acceptable occlusion was slightly higher in the early than in the late timing group. These findings suggest that when examining the effect of timing on treatment outcome, factors other than acceptability of occlusion should be concomitantly evaluated. Consequently, in this context, the duration and cost of treatment need to be investigated.
The aim of this study was to investigate the accuracy of 17 forensic odontologists identifying individuals from two sets of radiographs, one regarded as ante- and the other as postmortem. Each case was observed twice and only one pair out of 31 did not match. The observers were asked to comment about each case, classifying it as easy, moderate or difficult. The results show that one observer was totally correct in the first analysis while four observers made no errors the second time. In the first evaluation 14 observers made between one and seven errors and two observers made 11 errors each. In the second evaluation 12 observers made between one and seven errors and one observer made 13 errors. At the first evaluation, the observers judged 18 of the cases as easy, eight as medium and five as difficult. At the second evaluation, the observers pronounced 13 of the cases as easy, 13 as medium and five as difficult. The corresponding values for the authors were 6, 12 and 13. Most of the mistakes were made on the cases with no restorations and the incorrect answers were found mostly among the difficult cases. In practical forensic work however additional dental chart information is usually available to the forensic odontologist.
To determine the applicability of SWOT analysis for measuring the quality of public oral health services from the adult client's perspective.
Data were collected using a structured questionnaire developed in an earlier study. The study group consisted of all adult (over 18 years of age) clients (n = 256) using public municipal oral health services in Kirkkonummi, Finland, during 2 weeks in 1995. Before treatment, patients filled out a questionnaire that measured the importance of their expectations in different aspects of oral care. After the appointment, they filled out a similar questionnaire that measured the enactment of these expectations in the treatment situation. The response rate was 51%. The difference between subjective importance and enactment of expectations was tested by Wilcoxon's signed rank test. Results were interpreted using both a conventional analysis of "expectation enacted or not" and SWOT analysis, which is used in strategic planning to identify areas of strengths (S), weaknesses (W), opportunities (O) and threats (T) in an organisation.
In 28 statements out of 35, the two analyses revealed similar interpretations. In most areas the patient-perceived quality of the services was good. Weaknesses were found in the following areas: communicating to patients the causes and risk of developing oral diseases, informing them about different treatment possibilities, and including patients in decision-making when choosing restorative materials.
SWOT analysis provided more structured interpretation of the results, and can be more easily transferred to development of services.
The objective was to identify dental professionals' attitudes and awareness on evidence based dentistry (EBD), and to elucidate perceived barriers and views on how to move towards EBD. A questionnaire was sent to 290 dental professionals (dental hygienists, general dentists, specialist dentists) in the county of Halland, Sweden. The questionnaire consisted of closed questions and free text sections, related to attitudes, awareness and skills on databases, EBD, and terms related to scientific publications, as well as perceived barriers towards EBD. A majority of the respondents had a welcoming attitude towards EBD. The respondents perceived their colleagues less positive towards EBD. The respondents considered EBD, at least partly, useful in daily dental practice. With the exception of general dentists in private practice, a vast majority of the dental professionals thought that EBD would improve the care of their patients. Dental professionals in the county of Halland, in Sweden, had a welcoming attitude towards EBD, and indicated an open attitude for learning more about interpretation of evidence from scientific publications. The most commonly perceived barriers towards EBD, were 'lack of time' and 'poor availability of evidence'.
The Swedish systems for complaints and supervision with many possibilities of claiming on different levels may lead to prevention of future problems in medical and dental care. The systems are corrective, preventive and compensatory, and are important in the process of quality assurance. However, some elements need improvement. The present paper gives as a background an overview of the Swedish systems and discusses a few cases. Comparisons with systems in other countries, especially the USA, are made, and new measures are discussed. There is a need for smooth, preventive measures as well as strong, punitive and corrective measures. Recidivist doctors/dentists must be stopped.
Discussions of quality assurance mechanisms for health professions are increasing in Canada. In their roles of protecting the public from incompetent or unsafe health care, and enhancing the quality of care provided by practitioners, provincial licensing organizations are taking an interest in quality assurance programmes. The paper reports the results from a national survey of five self-regulating health professions (dentistry, medicine, nursing, optometry and pharmacy) in Canada. The study found two types of activities in place--a complaints programme and a routine audit programme. Both programmes use a similar approach to identifying poor performers within a health profession. The paper discusses the results of the study, the advantages and disadvantages of the approach used, and suggests a second approach to quality assurance which could be used in conjunction with current activities.