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Biomedical subjects

L Fiset

Publications and source records attributed to L Fiset.

At least 37 records · Page 2Linked to original sources
PubMed1993

Fluoridation effects on periodontal disease among adults.

Numerous studies report that water fluoridation reduces caries in children, but little current evidence exists about fluoridation's effects on the periodontal health of adults. To address this issue, we estimated fluoridation effects on periodontal disease among 1066 Washington state employees and their spouses, aged 20 to 34, with current residences divided evenly between fluoridated and nonfluoridated communities. Subjects were interviewed by telephone to collect residence histories, personal characteristics and other data. Each subject's lifetime years of fluoridation exposure (YFE) was calculated from the person's residence history and the U.S. Centers for Disease Control's Fluoridation Census. Oral assessments were conducted to measure the extent of periodontal disease. Relative to adults with no exposure, continuous lifetime exposure reduced the probability of attachment loss from 0.87 to 0.72. Similar benefits were obtained for bleeding gingiva and calculus. The estimates of fluoridation's benefits were not influenced by selection bias due to subjects' nonparticipation in the oral assessments.

Adult↗
PubMed1993

The safety and efficacy of outpatient midazolam intravenous sedation for oral surgery with and without fentanyl.

This study examined midazolam and midazolam plus fentanyl in a placebo-controlled, double-blind clinical trial. It tested the hypothesis that combined drug therapy results in significantly poorer safety but no difference in efficacy compared to the single drug approach. Subjects were among 207 mildly anxious young adults having their third molars removed. Fentanyl had a significant depressant effect on respiration. Fifty of 79 (63%) subjects who received a midazolam-fentanyl combination became apneic, while only two of 78 (3%) who received midazolam alone were apneic (Fisher's Exact Test, P < 0.001). Two subjects (2.5%) in the combination group and none in the midazolam alone group had oxygen saturations drop below 90%. About twice as many subjects in the combination group had end-tidal carbon dioxide (EtCO2) levels greater than 25% above baseline. While these results are consistent with those for apnea, contingency analyses of the oxygen saturation and EtCO2 results were not statistically significant. Subjects in the combination group were more than four times as likely to have excellent versus good, fair, or poor sedation at a given level of intraoperative pain, and behavioral (movement and verbalization) but not cognitive measures of anxiety were attenuated.

Adolescent↗
PubMed1992

How fluoridation affects adult dental caries.

Oral assessments conducted to measure caries experience in adults reveal that, on average, each year of exposure to fluoridated water reduced DFS by 0.29 surfaces. Fluoridation appears to have both pre- and post-eruptive benefits.

Adult↗
PubMed1991

Dental decisionmaking and variation in dentist service rates.

Previous medical and dental studies report wide variations in service rates across small areas, regions and providers. A major source of this variation appears to be the pattern of clinical decisionmaking of the provider. This argument was tested using dentist service rates (the average number of services provided per patient) calculated from 1984-1985 claims data for a population of well-educated, middle-class patients in Washington state, U.S.A. (N = 23,153). Service rates were calculated for each dental procedure in the following pairs of alternative treatments: crown vs amalgam or crown build-up; root canal therapy vs extraction; and fixed bridge vs removable partial denture. For each pair, dentists identified patient (e.g. cost, patient preference) and technical (e.g. periodontal status, tooth damage) factors which they considered to be important in choosing therapy. Regression analysis revealed that the technical factors explained little variation in the rates, while at least one patient factor was significant across services, except prosthetics. Environmental characteristics, structural features of the practice, and the dentists' practice beliefs also explained variation in the rates.

Crowns↗
PubMed1991

Effect of a beta-adrenergic blocking agent on dental anxiety.

The effect of propranolol was studied on 23 dental phobics in a double-blind, placebo-controlled clinical trial involving actual dental treatment. The subjects were selected because they showed high physiological reactivity in the dental situation. Twelve subjects received the test drug and 11 subjects received the placebo at individualized doses of either 80 or 120 mg. A significant difference in self-reported anxiety at the injection phase of treatment and less overall pain intensity and aversiveness were observed for the propranolol as compared with the placebo group. No differences were detected for behavior ratings. Beta-adrenergic blocking agents may have utility for reducing anxiety in individuals fearful of dental treatment.

Adolescent↗
PubMed1990

Variation in dentist service rates in a homogeneous patient population.

Previous studies in medicine and dentistry document wide variations in service rates across small areas, large regions, and providers. The practice patterns of providers and underlying differences in patient need are thought to be important sources of this variation. To control for variation in patient needs, we calculated service rates of 200 general dentists in Washington state based on a homogeneous, well-educated, upper-middle-class population of patients. Wide variations were found in the rate for many dental services. Dentists' practice beliefs and characteristics of the practice were sources of variation in the rates. The evidence is insufficient to determine whether undertreatment of overtreatment occurred among dentists with the lowest and highest expenditures per patient, respectively. However, the perceived oral health status of adult patients was lower in practices with the lowest total expenditures per patient than in practices with the highest total expenditures per patient, suggesting the undertreatment of adult patients in the lowest-expenditure practices may have occurred.

Adult↗
PubMed1990

Factors influencing variation in dentist service rates.

In the previous article, we calculated dentist service rates for 200 general dentists based on a homogeneous, well-educated, upper-middle-class population of patients. Wide variations in the rates were detected. In this analysis, factors influencing variation in the rates were identified. Variation in rates for categories of dental services was explained by practice characteristics, patient exposure to fluoridated water supplies, and non-price competition in the dental market. Rates were greatest in large, busy practices in markets with high fees. Older practices consistently had lower rates across services. As a whole, these variables explained between 5 and 30 percent of the variation in the rates.

Attitude of Health Personnel↗
PubMed1988

Factors influencing dental decision making.

In clinical decision making, dentists routinely choose between alternative treatments such as crown vs amalgam/composite buildup, root canal vs extraction, fixed bridge vs removable partial denture, and prophylaxis vs subgingival curettage or periodontal scaling. A number of technical and patient factors can influence dentists' choice of treatment in these situations; however, little is known about their relative importance. To address this issue, a list of technical (e.g., periodontal status and caries rate) and patient (e.g., cost and patient preference) factors possibly influencing choice of treatment was developed for each pair of services. Responding to a mail questionnaire, 156 general dentists in Washington State listed the top three factors influencing their choice of service in each pair. Results revealed that dentists took different factors into account in choosing among alternative treatments. Technical factors dominated over patient concerns; only about 33 percent of the dentists considered patient factors important in choosing alternative therapies. The latter group was less preventively oriented, were solo practitioners, worked longer hours, and had lower prices. Results suggest patients may have little influence on prescriptions of therapy among experienced general dentists.

Attitude of Health Personnel↗
PubMed1988

The prevalence and practice management consequences of dental fear in a major US city.

In 1986, 1,019 residents of Seattle were surveyed about their dental fears, dental experiences, and perceived oral health status. High dental fear in Seattle was found to affect 204 per 1,000 people. More than 66% acquired their fear in early childhood. Females were 1.8 times more likely than males to report high fear (P less than .001). An individual was 1.6 times as likely to have high levels of dental fear if he or she had at least one oral problem such as bleeding gingiva (P = .004).

Adolescent↗
PubMed1986

Local anaesthetic adverse effects and other emergency problems in general dental practice.

This paper has three parts: local anaesthetic adverse effects, haemorrhage control and altered immune response. Primary emphasis is placed on the problems with anaesthetics since their use is widespread. Every day, nearly 2 million injections of local anaesthetic are given in dental practice. From 2.5 to 10 per cent of patients experience adverse reactions. This adverse effect rate is 10 times higher than that in medicine for the same drugs. Allergic, toxic, idiosyncratic and psychogenic effects are discussed. New data on the role of local anaesthetic agents, vasoconstrictors and preservatives is presented. In addition, the problem of anaesthetic failure (occurring in over 10 per cent of patients) is explained. Treatment (drug and psychological) for anaesthetic related emergencies such as panic attacks, shortness of breath, palpitations and nausea is recommended. Prevention and treatment of haemorrhage is explained. Medical and dental conditions may increase clotting time (e.g., systemic disease or local factors such as granulation tissue). Preventive strategies are outlined and laboratory tests discussed. Emphasis should be placed on the use of local anaesthetics with vasoconstrictors, haemostatic agents and pressure. The final aspect of the paper discussed new data on problems for dentists arising with patients who have altered immune function. In particular AIDS is discussed from the point of view of protection of the dentist and dental treatment for the patient.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Psychophysiological responses to dental injections.

Dentists frequently change local anesthetic formulations on the basis of a patient's experience of adverse effects. Frequently, less effective anesthetics are selected because a lack of understanding exists regarding the nature of untoward events. This may exacerbate the problem. Allergic reactions are overreported, whereas fear responses frequently are unrecognized. This article outlines the clinical problem of adverse reactions to local anesthetics in dental practice. Clinical recommendations based on proper diagnosis are provided to prevent recurrence of the problem.

Adult↗
PubMedDate not supplied

Dental fear of Japanese residents in the United States.

The purpose of this study was to investigate dental fear in a sample of Japanese adults and to make preliminary comparisons with a previously described US sample. The survey instrument was translated into Japanese and then translated back into English and was sent to 839 Japanese residing in the Seattle area. A total of 419 (49.9%) usable questionnaires were returned. Results indicate a level of fear higher than the US population (only 17.9% were not at all afraid). Fear level did not vary by age; most respondents (73.3%) acquired their fear in early childhood. While reported utilization was lower than the American sample, the percentage of Japanese respondents who reported being hurt at the last appointment was high (68.0%). Japanese respondents indicated that 35% of dentists appeared to be in a hurry, hurry being associated with being hurt. Japanese coping practices appeared to differ from the American sample. For example, 14.7% of the Japanese whereas 28.2% of the US sample requested the dentist to stop treatment.

Adolescent↗
PubMedDate not supplied

Common fears and their relationship to dental fear and utilization of the dentist.

Common fears were studied by household telephone interviews and mail survey in Seattle, Washington, to determine their relationship to dental fear and to utilization of the dentist. Dental fear was either the first or second most common fear, with a prevalence estimated between 183 and 226 persons per 1000 population. Dental fear was associated with fears of heights, flying, and enclosures. Respondents with multiple common fears other than fear of dentistry were more likely to delay or cancel dental appointments, report a longer period since their last visit to the dentist, and report poorer oral health and less satisfaction with oral appearance. Over 22 percent of the dentally fearful group reported two or more accompanying common fears.

Adult↗