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Biomedical subjects

P Milgrom

Publications and source records attributed to P Milgrom.

At least 19 recordsLinked to original sources
PubMed1992

Adolescent dental fear and control: prevalence and theoretical implications.

This study examined the prevalence and etiology of dental fear in a large, representative sample of Singapore adolescents. Participants completed a questionnaire regarding fear of the dentist, dental beliefs and their most recent dental visit. The population prevalence of high dental fear was 115 fearful children per 1000 population (SE = 0.02). Children who reported painful treatment and perceived lack of control at the dentist were 13.7 times more likely to report high fear and 15.9 times less likely to be willing to return to the dentist or dental nurse. The etiology of severe clinical fear appears strongly related to direct conditioning in the presence of pain and vulnerability.

Adaptation, Psychological↗
PubMed1992

Experience with triazolam in preschool children.

Triazolam (0.125 to 0.25 mg) was administered preoperatively to 17 unmanageable children aged 22 to 65 months. The children were monitored visually and by pulse oximeter. No child experienced any airway obstruction and none had oxygen saturation below 90%. Older children had lower SaO2 values than younger children. There was no relationship between the mg/kg dose and SaO2 values.

Anesthesia, Dental↗
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

A cross-cultural cross validation of the Dental Fear Survey in South East Asia.

This study was designed as a cross-cultural replication and cross validation of the Dental Fear Survey (DFS) in two groups of Singapore adults: university students and military conscripts. Factor analysis of the DFS in each of these dissimilar samples revealed factor structures that were highly comparable to one another as well as to those obtained in the U.S.A. Behavioral and physiological fear assessment during exposure to simulated dental treatment also showed results comparable to those found in Western cultures. Self report measures were more likely to correlate with other self reports than with physiologic or behavioral measures. Among university students, those who had visited a dentist within the past year had significantly lower DFS scores than those who had avoided dentistry. The fear-avoidance relationship did not hold for military subjects who reported less dental fear overall. It was concluded that the DFS was factorially stable; and therefore, generalizable to this South East Asia culture.

Adolescent↗
PubMed1990

Prevalence of dental anxiety and fear in children in Singapore.

505 primary school children in Singapore aged 10-14 were surveyed regarding fear of the dentist. Sixty-eight children were classified as having high fear, giving a sex and race adjusted population prevalence rate of 177 fearful children per 1000 population. Females were 2.64 times more fearful than males. There were no significant racial differences in the prevalence rate. Children with high state anxiety are almost three times as likely to report dental fear as those with low state anxiety. Children with trait anxiety scores above the population mean were just as likely as those reporting below the mean to be fearful. Access to dental care is an important intervening variable in dental fear.

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↗
PubMed1990

Prevalence of dental fear in young adult Singaporeans.

One-hundred-and-fifteen male military recruits and 176 mostly female first- and second-year students in the National University of Singapore were surveyed regarding their fear of the dentist. Nine of 115 recruits and 36 of 176 university students were classified as having high fear, giving a population prevalence rate between 78 and 208 fearful young adults per 1000 population. Higher educational levels were associated with fear of the dentist. There were no significant racial differences in the prevalence rate in either sample. Higher fear scores were associated with longer intervals between dental visits for the university but not the military population. Efforts are needed to prevent and ameliorate the development of dental fears. Trust and control appear to be major factors associated with dental fears.

Adolescent↗
PubMed1989

Oral hygiene instruction and health risk assessment in dental practice.

We studied oral hygiene instruction given to 109 patients in 19 Washington State dental practices to investigate the extent to which therapists targeted their efforts toward patients with high disease risk. Patients were examined prior to instruction and prophylaxes. Therapists' instructions were tape-recorded and their content analyzed: therapists' expectations were scored. There were no statistically significant associations between patients' initial plaque levels and the process/content of the oral hygiene instructions delivered. On average, therapists spent 9.4 minutes of each prophylaxis session discussing oral hygiene. Therapists were judged more genuine with those patients for whom they had higher expectations of compliance, i.e., those with less plaque and low disease risk. We conclude that dental practitioners were not employing effective risk assessment strategies in selection of patients most in need of intensive instructional efforts.

Attitude of Health Personnel↗
PubMed1989

How effective is oral hygiene instruction? Results after 6 and 24 weeks.

We studied the clinical effectiveness of oral hygiene instruction given to 71 "high" plaque patients in 19 Washington State dental practices to determine the extent of plaque reduction. Patients were examined prior to instruction and prophylaxis. Therapist instructions were tape-recorded and content analyzed, and therapists' expectations were scored. Patients were surveyed as to oral health behaviors and general health habit characteristics. Only 20 of 71 (28%) initially "high" plaque patients had reduced mean plaque scores to 1.0 or less at six weeks. An additional 13 percent had deteriorated plaque levels at 24 weeks. We concluded that therapists did not consistently follow principles of effective instruction and often overestimated their effectiveness. Determinants of relapse involve the educational process, the patients' oral status, and patients' life situations.

Adult↗
PubMed1988

The structure and function of dental-care markets. A review and agenda for research.

The growth of dental health services over the past 15 years has produced several issues in dentistry. Because economic markets are the cornerstone of dental delivery in the US, informed responses to these issues require a thorough understanding of dental-care markets. The empirical literature is reviewed to examine the structure of dental markets, to assess the major determinants of market equilibrium, and to examine the social and health consequences of dental-care markets. Results reveal that while dental markets are imperfectly competitive, it is unclear whether prices exceed competitive levels. Little is known about the effects of dental markets on public oral health and society. Future research is proposed in two broad areas: 1) updating early studies conducted when few Americans had dental insurance benefits; and 2) path-breaking research to advance our knowledge of dental-care markets in particular and medical-care markets in general.

Community Participation↗
PubMed1988

The influence of dentist supply on the relationship between fluoridation and restorative care among children.

Because fluoridation effectively reduces dental caries among children, it may also reduce their demand for dental care. The authors tested this proposition among 985 insureds aged 9 to 14 in Washington State using dental claims from 1982 to 1985. In the sample almost two thirds of the children with continuous fluoridation exposure lived in markets with the smallest number of persons per dentist. Relative to other children, these children received more diagnostic and preventive services and had the highest probability of receiving restorative care. Among children who received restorations, children in this group had the fewest restorations. While the last result reflects expected reductions in caries due to fluoridation, the others may reflect providers' response to less tooth decay and increased competition for patients.

Adolescent↗
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↗