Health Data in Dentistry: An Attempt to Master the Digital Challenge

Abstract

a b s t r a c tBackground: The Strategic Advisory Group of Experts (SAGE) Working Group on rabies vaccines and immunoglobulins was established in 2016 to develop practical and feasible recommendations for prevention of human rabies. To support the SAGE agenda we developed models to compare the relative costs and potential benefits of rabies prevention strategies. Methods: We examined Post-Exposure Prophylaxis (PEP) regimens, protocols for administration of Rabies Immunoglobulin (RIG) and inclusion of rabies Pre-Exposure Prophylaxis (PrEP) within the Expanded Programme on Immunization (EPI). For different PEP regimens, clinic throughputs and consumables for vaccine administration, we evaluated the cost per patient treated, costs to patients and potential to treat more patients given limited vaccine availability. Results: We found that intradermal (ID) vaccination reduces the volume of vaccine used in all settings, is less costly and has potential to mitigate vaccine shortages. Specifically, the abridged 1-week 2-site ID regimen was the most cost-effective PEP regimen, even in settings with low numbers of bite patients presenting to clinics. We found advantages of administering RIG to the wound(s) only, using considerably less product than when the remaining dose is injected intramuscularly distant to the wound(s). We found that PrEP as part of the EPI programme would be substantially more expensive than use of PEP and dog vaccination in prevention of human rabies. Conclusions: These modeling insights inform WHO recommendations for use of human rabies vaccines and biologicals. Specifically, the 1-week 2-site ID regimen is recommended as it is less costly and treats many more patients when vaccine is in short supply. If available, RIG should be administered at the wound only. PrEP is highly unlikely to be an efficient use of resources and should therefore only be considered in extreme circumstances, where the incidence of rabies exposures is extremely high.

Digital Oral Medicine for the Elderly

“…It is true that large amounts of data can increase the reliability of answers to individual questions. Nevertheless, it remains to be hoped that big data will not lead to further commercialization or industrialization of medicine, and thus, neglect the healing power of a systemic doctor-patient relationship, but rather that it will nurture this relationship [22,23].…”

Using big data to promote precision oral health in the context of a learning healthcare system

“…To successfully integrate precision medicine into oral healthcare, three major challenges must be addressed: development of up‐to‐date evidence‐based guidelines, integration of large analytical data sets, and translation of new knowledge into routine clinical care delivery . In the fields of dentistry and oral health, implementation of these factors represents a major obstacle to the delivery of precision oral medicine …”

“…Improvements in data curation and aggregation in dentistry and oral medicine is a necessary step for the integration of precision medicine practices into oral healthcare. An urgent need for intelligent and harmonized aggregation of heterogeneous oral health data sets has been well articulated in several recent publications …”

“…6,7 In the fields of dentistry and oral health, implementation of these factors represents a major obstacle to the delivery of precision oral medicine. 8 In recent years, oral health sciences called for a greater emphasis on evidence-based practice, especially as advances in the field of healthcare and medicine have accelerated. [9][10][11] Without evidence, clinical practice is empirical, anecdotal, and experiential.…”

“…An urgent need for intelligent and harmonized aggregation of heterogeneous oral health data sets has been well articulated in several recent publications. 4,8 The third challenge is the slow translation from research to routine care delivery. A survey of clinical dental school faculty found that only 47 percent of faculty integrate evidence-based dentistry into their teaching.…”