A person's right to access his or her protected health information is a core feature of the U.S. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If the information is stored electronically, covered entities must be able to provide patients with some type of machine-readable, electronic copy of their data. The aim of this study was to understand how academic dental institutions execute the Privacy Rule's right of access in the context of electronic health records (EHRs). A validated electronic survey was distributed to the clinical deans of 62 U.S. dental schools during a two-month period in 2014. The response rate to the survey was 53.2% (N=33). However, three surveys were partially completed, and of the 30 completed surveys, the 24 respondents who reported using axiUm as the EHR at their dental school clinic were the ones on which the results were based (38.7% of total schools at the time). Of the responses analyzed, 86% agreed that clinical modules should be considered part of a patient's dental record, and all agreed that student teaching-related modules should not. Great variability existed among these clinical deans as to whether administrative and financial modules should be considered part of a patient record. When patients request their records, close to 50% of responding schools provide the information exclusively on paper. This study found variation among dental schools in their implementation of the Privacy Rule right of access, and although all the respondents had adopted EHRs, a large number return records in paper format.

Objective: Oral health is associated with the availability, accessibility, and utilization of food. The objective of this study is to investigate the physical and economic access to sufficient, safe and nutritious food among university students in Nigeria, and relate these to their oral health.Method: Extensive literature review was conducted using internet sources, journal publications and official reports. Cross-sectional stratified random sampling was conducted for undergraduate university students resident on campus at Obafemi Awolowo University. Data was collected using a modified format of the United States Household Food Security Survey Module of the USDA, with a section on oral health. Data was analysed using the SPSS Statistical package (Version 16) and differences were taken as significant at p<0.05.
Result:
Using the data collected, respondents were categorised into a “food secure” and “food insecure” groups. Food insecure individuals were more likely to have dental pathologies including toothache, gum bleeding, and oro-facial pain. They also had more
frequent history of tooth removal, irregular dental visit and less frequent tooth brush
Conclusion: Individuals challenged by the unavailability, inaccessibility, and poor utilization of safe and nutritious foods tend to have poorer oral health compared to those with better food security.

Objective: Over the past few decades, the world has experienced a gradual increase in the percentage of elderly people aged 65 years and over. As this elderly population increases, evidence suggests that their demand for dental services would increase. The increasing population of the elderly population in Spain has underlined the need for the dental profession to take pay particular attention to the oral health needs of older patients. The aim of this report is to present a preliminary assessment of the undergraduate Geriatric Dentistry programs in Spanish dental schools.Method: Study participants included all the dental schools in Spain (n=19). Using a simple, 12-item questionnaire, information was collected regarding the geriatric dental education programs from the official websites of all the schools.
Results: Only 42% (n=8) of schools offered a specific geriatric dentistry course. No significant differences were found in the proportion of public and private dental schools with geriatric dentistry departments (p=0.1312).
Conclusion: More studies on the curriculum content, design, implementation and evaluation of geriatric dentistry programs at the undergraduate level should be developed. Research must also focus on assessing the access and improvement to the oral care of the elderly population. Dental schools, organizations, local and state governments need to work together, using a multidisciplinary approach, in responding to the unmet needs of the elderly population.

Objective: Over the past few decades, the world has experienced a gradual increase in the percentage of elderly people aged 65 years and over. As this elderly population increases, evidence suggests that their demand for dental services would increase. The increasing population of the elderly population in Spain has underlined the need for the dental profession to take pay particular attention to the oral health needs of older patients. The aim of this report is to present a preliminary assessment of the undergraduate Geriatric Dentistry programs in Spanish dental schools.Method: Study participants included all the dental schools in Spain (n=19). Using a simple, 12-item questionnaire, information was collected regarding the geriatric dental education programs from the official websites of all the schools.
Results: Only 42% (n=8) of schools offered a specific geriatric dentistry course. No significant differences were found in the proportion of public and private dental schools with geriatric dentistry departments (p=0.1312).
Conclusion: More studies on the curriculum content, design, implementation and evaluation of geriatric dentistry programs at the undergraduate level should be developed. Research must also focus on assessing the access and improvement to the oral care of the elderly population. Dental schools, organizations, local and state governments need to work together, using a multidisciplinary approach, in responding to the unmet needs of the elderly population.

To determine the prevalence of problems associated with chewing and the relationship with body mass index, the self-reported rating of oral health and normative oral hygiene assessment among the elderly.This was a descriptive community based study carried out in three locations in Ife-Ijesa zone (south western Nigeria). Elderly persons of 55 years and above were recruited through the religious organisations. All elderly who volunteered were assisted in completing a questionnaire on their socio-demographic status, chewing ability, any quadrant associated with problems and self-rating of oral health. An oral examination under a natural daylight using sterile wooden spatulae and an upright chair was carried out. The Oral Hygiene Index of Greene and Vermillion [Journal of the American Dental Association (1964) 61, p. 172] was used to determine the oral hygiene status.
The lower right quadrant had the highest frequency of complaint on difficulty with chewing (15.6%), and 44.1% of the subjects had problems with chewing. Twenty-nine per cent rated their oral health as poor or very poor. There was a statistically significant association between the rating of oral health and the presence of calculus (p = 0.022). This was also true for oral hygiene and having any problem with chewing (p = 0.001). The self-rating of oral health was not in agreement with that of the normative finding.
Health promotion focusing on the oral health of the elderly is a significant requirement for the study population. Proper evaluation of the effectiveness of traditional dentifrices must be carried out and interventions designed to address the possibility of improper usage.

In many communities of South Africa, traditional healers are often the only means of health care delivery available. The level of knowledge and ability to recognize oral lesions of 32 traditional healers and 17 care-givers were assessed after a two-day workshop. The data collection instrument was a structured questionnaire, complimented by enlarged clinical photographs of the common oral manifestations of HIV/AIDS. Prior to the workshop, 46 (93.9%) of the 49 respondents had never had any formal information on oral health and 43 (87.8%) were unfamiliar with the symptoms of oral diseases. Thirty-five (71.4%) recognized bleeding gums from A4-size photographs and 11 (22.4%) recognized oral thrush. The recognition of other oral manifestations of HIV/AIDS were; oral hairy leukoplakia (41.0%), angular cheilitis (43.6%), herpes virus infection (56.4%), oral ulcerations (56.8%), and in children, parotid enlargement (27.3%), and moluscum contagiosum (56.8%). Traditional healers and caregivers constitute an untapped resource with enormous potential. A positive bridge should be built to link traditional healing with modem medicine in the struggle against HIV/AIDS.

In many communities of South Africa, traditional healers are often the only means of health care delivery available. The level of knowledge and ability to recognize oral lesions of 32 traditional healers and 17 care-givers were assessed after a two-day workshop. The data collection instrument was a structured questionnaire, complimented by enlarged clinical photographs of the common oral manifestations of HIV/AIDS. Prior to the workshop, 46 (93.9%) of the 49 respondents had never had any formal information on oral health and 43 (87.8%) were unfamiliar with the symptoms of oral diseases. Thirty-five (71.4%) recognized bleeding gums from A4-size photographs and 11 (22.4%) recognized oral thrush. The recognition of other oral manifestations of HIV/AIDS were; oral hairy leukoplakia (41.0%), angular cheilitis (43.6%), herpes virus infection (56.4%), oral ulcerations (56.8%), and in children, parotid enlargement (27.3%), and moluscum contagiosum (56.8%). Traditional healers and caregivers constitute an untapped resource with enormous potential. A positive bridge should be built to link traditional healing with modem medicine in the struggle against HIV/AIDS.

Oral diseases is still a major problem in most developing countries. Within the Republic of South Africa, there remains areas where few or no studies have been done on the oral health status. The emerging district health system with decentralisation of health services to address past inequity in health care in South Africa also provides compelling case for data collection at regional levels.To assess the prevalence and severity of dental caries of school children; determine the caries patterns of the study population and to provide useful data for the planning of oral health services in this region.
Descriptive analytical study.
School children in the Donald Fraser Health District, Venda in the Northern province, Republic of South Africa.
A total of 519 school children in the age groups 6, 12 and 15 years were examined by a calibrated examiner for dental caries using WHO diagnostic criteria. Both the schools, which were divided into rural and peri-urban locations and the children that participated were randomly selected.
A mean dmft(sd) of 2.68(3.29) in six year olds and a mean DMFT (sd) scores of 0.61(1.50) and 1.26 (2.18) were recorded in the 12 and 15 year olds respectively. In the six year olds the upper anterior teeth showed highest susceptibility to caries, clearly indicating that black children suffer from early infant caries. At ages of 12 and 15 the mandibular molars were the teeth most affected. The decayed component constituted the main part of the dmft and DMFT scores. Ninety-nine percent of these lesions were untreated and the restorative care was almost nil.
An important finding was the doubling of the mean DMFT from the 12-year-olds to 15-year olds and the caries levels for all age groups was higher than the provincial average. The treatment required were mostly extractions and simple fillings, the majority of which could be managed by dental auxiliaries using the Atraumatic Restorative Treatment Technique. This study indicates that preventive oral health measures should be implemented on the younger age groups in order to control dental caries.

A course in Public Oral Health is currently offered by the Division of Public Oral Health (POH) to students in their final (6th year) of study for the degree of Bachelor of Dental Science. A fundamental aspect of this project was to shift the teaching methods from didactic to a participatory, student-centred approach, based on current local and international trends in medical, dental and general education. In 1999 the course covering core Public Health topics was presented over a period of 20 weeks to 49 students who were divided into three groups. Staff members were trained in participatory, student-centred teaching methods. An evaluation of students and staff was conducted at the end of the course. Results show that students were satisfied with the teaching methods employed and commended the Division on the organisation of the course. Students were unhappy with the amount of reading required in preparation for weekly seminars. They felt that the course was inappropriately positioned in their final year of study, due to pressure of achieving quotas for the clinical courses. Nevertheless, the main objectives of the Public Oral Health course were achieved through the adoption of a participatory, student-centred teaching approach.

Human immunodeficiency virus (HIV) infection constitutes an unparalleled public health challenge. The unique nature of most oral health procedures, instrumentation and patient-care settings requires specific strategies and protocols aimed at preventing the transmission of HIV/AIDS between oral health care providers and patients, as well as between patients themselves. The present study investigated the level of information and training about protocols and policies for preventing the transmission of HIV/AIDS in oral health care settings in South Africa. The data collection techniques utilised available information, in-depth interviews and an open-ended questionnaire. The respondents were 20 purposively selected key informants who were senior officers for HIV/AIDS programmes and/or oral health organisations. Sixteen (80%) of the respondents reported that there were no existing oral health policies on HIV/AIDS in their health care institutions or organisations. None of the interviewees knew of any specific protocols on HIV/AIDS in the oral health care setting that emanated from South Africa. In addition, none of the dental professional associations had established an infection control committee or a support system for members who might become infected with HIV and develop AIDS. Territorial boundaries existed between sectors within the medical disciplines, as well as between the medical and oral health disciplines. Numerous general impediments were identified, such as prejudice, denial and fear, inadequate training and/or information about the infection, lack of representation and resources for policy planning, a lack of interest from the business sector, and approaching HIV/AIDS in the workplace as a 'one-time issue' Other obstacles identified included unemployment, poverty, illiteracy, disempowerment of women and inadequate communication of policies to service providers. Additional issues raised included the migrant labour systeM, complexities of language and culture, the large unstructured sex industry, high prevalence of sexually transmitted infections and lack of funding. All of these have an impact on oral health. Future policy directions identified included 'increasing access to HIV information and postexposure prophylaxis' 'shift towards care and support for those living with HIV/AIDS with emphasis on community and home-based care' and 'improving intersectoral co-ordination and collaboration'. The study demonstrated gaps in availability and access to policies and protocols on HIV/AIDS by managers and health workers. Specific strategic recommendations are made for oral health.

Presence of helicobacter pylori (H.Pylori) in the dental plaques may be associated with the presence of the same organism in gastric mucosa.To assess and compare the prevalence of H. pylori in dental plaques and gastric mucosa of dyspeptic Nigerians.
Sixty-six consecutive patients undergoing endoscopy for investigation of dyspepsia were included in the study. A predesigned questionnaire was used to collect information on socio-demographic and other factors. Each patient also had clinical dental examination. Dental plaque scrapping was collected before endoscopy for helicobacter pylori culture, and at endoscopy, two gastric biopsy specimens were taken for culture and histology.
The mean age (+/- SD) of the patients was 44.8 (+/- 17.4) years (range 5 to 80 years). The positivity rate of helicobacter pylori in gastric biopsy was 35 of 66 (53.0%) while the same for dental plaque was 46 of 66 (69.7%). The correlation (Spearman's) between gastric mucosa and dental plaque colonization with helicobactor pylori was significant (R = 0.30, P = 0.01). When concordant positivity of gastric biopsy culture and histology was taken as diagnostic, the sensitivity of dental plaque culture was found to be 82.9% and the specificity was 45.2%.
This study revealed that helicobactor pylori has a high prevalence in the dental plaque of the population that we have studied and may therefore be of potential relevance in screening for such infection.

Oral health programmes for refugees should emphasize a Primary Health Care approach focusing on prevention, based on appropriate technology, and promoting involvement of the refugee community in the provision of services. This report describes a unique programme at the Liberian refugee camp Gomoa Buduburam, Central Region, Ghana. The programme resulted in the effective participation of a refugee community in oral health promotion, and empowerment of members of the community to take care of their own oral health. A comprehensive primary oral health care programme is essential for refugee camps, especially when the camp has become stable. This programme represents an approach to oral health promotion in refugee situations characterized by full community participation. It is recommended that UNHCR should accommodate oral health within the major health framework for refugee populations, including provisions for Community Oral Health Worker remuneration as well as equipment and material supply.

In this study, 1,325 school children from 7 farm schools were examined. Their mean age (+/- SD) was 10.5 +/- 3.0 (range 6-11) years. At baseline, the mean DMFT score was 1.1 +/- 1.7 and 36.4% of the children had caries. The prevalence of fluorosis among the children was 12.6%. Curative treatment was offered to all the children. A total of 113 children (8.5%) with one-surface cavities on permanent teeth and without fluorosis were treated using the atraumatic restorative treatment (ART) approach. A total number of 163 cavities were included in the study, of which 82 were treated with Fuji IX glass-ionomer cement and 81 with Ketac-MOLAR (hand mix). One year after treatment, restoration and sealant parts of ART fillings were examined. Caries status was also determined. The placing of the ART fillings and their evaluation were performed by different practitioners. A total number of 108 restorations (58 with Fuji IX, 50 with Ketac-MOLAR) were evaluated. Results of ART fillings showed a survival rate of 93.1% with Fuji and 94.0% with Ketac-MOLAR. Retention of the sealant parts of ART fillings was observed in 81% of restorations with Fuji IX and 76% with Ketac-MOLAR, not connected to the filled cavity. Caries was absent on all teeth restored with Fuji IX and noted in only one tooth restored with Ketac-MOLAR, not connected to the filled cavity. The retention rate after a 12-month period was acceptable and ART approach proved to be an appropriate technique for restoring teeth in this population group. There were no statistically significant differences between the survival rates of the two glass-ionomer restorative materials (P > 0.05).

Managed health care (MHC) has emerged in South Africa as an alternative system to control the cost of health care. Fears, negative perceptions and much uncertainty have surrounded this issue since its introduction in South Africa. The purpose of this study was to assess the understanding, perceptions and opinions of dentists residing in the Gauteng province about the emergence, benefits, impact, and future of MHC in South Africa. Eighty-six dentists (21.5%) out of the sample population of 400 responded to the questionnaire. The majority (66.7%) of the respondents perceived MHC to be a threat to their practices, with most feeling that MHC will interfere with the doctor-patient relationship. Forty-two per cent of the respondents were of the opinion that MHC will not succeed in South Africa. The results suggest that this sample of dentists do not consider MHC to be an alternative to the existing fee-for-service system. The introduction of MHC in South Africa is mostly based on models used in the USA, which might not be appropriate in the unique South African environment.

This study determined the knowledge, attitude and practice of oral health care workers in public clinics in South Africa towards HIV/AIDS and investigated the implementation of infection control measures. A total of 727 questionnaires were distributed to dentists, dental therapists, oral hygienists and chairside assistants in the public dental clinics of 9 provinces, of which 276 were returned from 8 provinces, giving a response rate of 38%. The questionnaire covered demographic factors and assessed issues such as knowledge, infection control practices, continuing education, legal, ethical and psychosocial issues and available support for HIV/AIDS. The common oral manifestations seen by respondents were candidiasis, acute necrotising ulcerative gingivitis (ANUG), hairy leukoplakia and Kaposi's sarcoma. Of the 174 who had a previous HIV test, 48% were for insurance purposes and 21% for post-needle-stick injury. Over 10% of the respondents indicated that gloves were not available at all, that there was an inadequate supply of water, and that there was no autoclave in their clinic. Nearly 50% of the clinicians had not had hepatitis B vaccination in the last 3 years. Fifteen respondents (5.4%) were not willing to treat HIV-positive patients. Only 48% had access to a written post-exposure management protocol and post-exposure medication was available to only 36.6%. The vast majority of the respondents clearly expressed a need for additional education on HIV/AIDS. The study demonstrated a need to add knowledge, enhance personal skills and improve the application of universal precautions

A structured, 40-item, self-administered questionnaire was distributed to 290 nurses attending an international health care conference held in Pretoria, South Africa. The questionnaire focused on; personal and demographic details of the respondents, history of dental disease and dental attendance, exposure to oral health during and after basic nurse training, opinions on oral health and the nursing curriculum, perceptions on the relationship between nurses and oral health personnel, perceived ability to promote oral health and self-reported contributions to oral health. The 153 respondents were predominantly female (140, 93.3%) with a mean age (+/- Standard deviation) of 43.0 +/- 7.5 years. One hundred and twenty one (79.1%) had previously visited a dental clinic for personal care and 105 (68.6%) had suffered from dental disease, dental pain, bleeding gums or bad breadth. Only 71 (46.4%) were exposed to experiences in assessing and caring for clients with oral disease during their training. Significant positive correlation were found between exposure (during training) to experiences in assessing and caring for clients with oral diseases and some factors. One hundred and forty-eight (96.7%) agreed oral health should be integrated into the nursing curriculum. Forty-one (26.8%) indicated they have not been contributing to the oral health of their clients or community while 92 (60.1%) described their personal contributions as fair. One hundred and thirty six respondents (88.9%) wished to be able to do more for their clients in the area of oral health.

The changing profile of oral care rendered through the Mobile Dental System (MDS), after the introduction of the Atraumatic Restorative Treatment (ART) approach is described. During the first year of introduction of ART, the percentages of amalgam restorations and tooth extractions decreased significantly (P < 0.0001). This is partly ascribed to a change in choice of treatment by dental operators in favour of ART and also due to an increase in acceptance by patients because of the reduced fear, and the patient-friendly nature of the ART approach. The reduction in amalgam restorations was 16.0 per cent for permanent and 1.4 per cent for primary posterior teeth. Extraction of posterior teeth was reduced by 17.4 per cent in the permanent and 35.7 per cent in the primary dentitions. The restorative component of oral care increased by 33.4 per cent in the permanent and 37.1 per cent in primary posterior teeth. The one-year survival of one-surface ART restorations using Fuji IX and KetacMolar was 93.6 per cent. Full and partial (more than 90 per cent) retention of the sealant part of the ART restoration was obtained in 75 per cent of the cases after one-year. During the one-year period, infection control was made more simple and this facilitated easier maintenance of mobile dental equipment. The introduction of the ART approach reduced extraction, restored more teeth and made oral care in the MDS more preventive, less threatening and thus more patient-friendly.

To promote community involvement in the provision of oral health services.The project consisted of a four-week training course in oral health for selected refugees, an oral health survey based on WHO guidelines and conducted by the refugees themselves and the provision of oral health care services to the community by the trained refugees.
Liberian refugee camp, Gomoa Buduburam in Ghana.
Liberian refugees of all ages.
Twelve refugees were given short term training in oral health. In the oral health survey, 196 refugees were clinically examined for dental caries, periodontal disease and malocclusion.
DMFT (for dental caries), CPITN (for periodontal disease), and malocclusion scores for selected subjects. Also clinical services rendered.
Oral health survey revealed a mean age (+/- SD) of 25.7 (+/- 9.5) years. Only thirty nine (19.9%) of the subjects were caries-free, and total DMFT was 2.5 +/- 2.2. Based on the CPITN, 107 (54.6%) required oral hygiene instructions (OHI), and 41 (20.9%) required prophylactic scaling with OHI. Forty four (22.5%) of the subjects had normal occlusion and 152 (77.5%) mild to severe malocclusion. Periodontal (75.5%), prosthetic (52.5%) interventions and extractions (34.2%) constituted the bulk of the treatment needs required. Clinical treatment was rendered by the trained refugees to 846 patients over a twelve month period.
Relief programmes for refugees should emphasise a primary health care approach, focusing on prevention, based on appropriate technology, and promoting involvement by the refugee community in the provision of services.

As an institution of governance, the parliament is the soul of democratic societies. The parliament typifies the presence of the people in the running of governmental activity. It monitors the actions of public officials towards ensuring adherence to initiatives and measures that advance the people's well-being. Relations between parliamentarians and citizens are, thus, critical on two fronts. Parliament – citizen relations are important in ensuring that elected parliamentarians are responsive to the desires of their constituents; and enable the people to hold their elected representatives accountable. In bridging communication gaps between the people and lawmakers, the Internet, social media and mobile phones, as digital technologies, have prospects in enabling the desired level of citizen engagement critical to democratic practice. This chapter explores, in comparative terms, the use of digital technologies by the national parliaments in Africa's two largest economies, Nigeria and South Africa. It examines the extent to which digital technologies are used in facilitating parliament – citizen relations in the two countries and how this connects with citizens' demands of accountability on national parliaments, and links between elected representatives and their constituents. The paper draws on data obtained through measurement of the online resources, especially websites and social media pages, of the parliaments. The chapter contributes to frameworks on how digital technologies can enhance parliament – citizen relations and good governance in sub-Saharan Africa.

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