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R G Stephens

Publications and source records attributed to R G Stephens.

At least 19 recordsLinked to original sources
PubMed1997

An analysis of the scientific basis for the radiographic guideline for new edentulous patients.

The FDA Radiology Guideline for the new edentulous patient recommends an initial survey of the arches. In the process of developing this recommendation, the expert panel reviewed the available literature and concluded that there was sufficient evidence to warrant screening radiography rather than selective radiography, which is the principle on which all the other recommendations are based. Our evaluation of the literature used by the panel for the edentulous recommendation identifies critical errors in the analysis of the data. Factors such as a vague definition of abnormality and a geographically diverse sample population might have led the expert panel to suggest a very conservative recommendation for this group of patients. The recommendation failed to consider the treatment impact of findings and was based simply on the large number of observations, regardless of their treatment or pathologic significance. However, in studies in which treatment is considered, it is clear that screening radiography for new edentulous patients does not yield sufficient clinically relevant information to support the guideline.

American Dental Association↗
PubMed1996

Current trends in guideline development: a cause for concern.

Although the development and use of practice-related guidelines as educational aids has a long history in the health professions, scientific assessment indicates that they have had limited success in changing practice patterns. This is principally due to the exclusion of practitioners from the development process, and the lack of a credible scientific basis for many guidelines. Past failures have led to new methods of guideline development based on a critical analysis of scientific data. These methods, which involve legitimate professional organizations at all stages of the development process, are clearly a step in the right direction. Unfortunately, there are signs that current guideline developers still fail to recognize the critical nature of the new methods or the need for an open and inclusive development process. It is even more disquieting that the objective of some guideline developers, such as licensing bodies, is the formulation of standards or review criteria, particularly when there are very few therapeutic practices with a sufficient scientific basis to justify such a designation. National and provincial societies, as well as dental educators, need to assume a leadership role to ensure that if guidelines are required, they will be developed as credible aids for the improvement of patient care. In this paper, the authors recount why the "traditional process" of guideline development resulted in guidelines that were mistrusted by the profession and, as a result, ineffective. They also outline the widely-documented current methodology, which should be followed if guidelines are to be accepted by the profession. Finally, they discuss the critical issue of who should develop guidelines, and examine their role in dental practice and education.

Canada↗
PubMed1996

Wall of fame.

Explore the source record for details and available documents.

Advertising↗
PubMed1995

Radiographic examination of children. A survey of prescribing practices of general dentists.

OBJECTIVE: The purpose of this article was to assess the radiographic prescribing practices of a sample of general practitioners for the pediatric dental patients in relation to current guidelines. STUDY DESIGN: Questionnaires were mailed to a sample of 963 dentists. The adjusted response was 80%. RESULTS: For the new patient under age 6, slightly more than two thirds of respondents reported the use of selective radiography. For ages 6 to 14 years, a slight majority chose a protocol of survey radiography. Of those who used a predetermined protocol, 69% chose "bite-wings only" for the child under 6 years, whereas for the child 6 to 14 years, the protocol of choice was a complete radiographic survey, predominantly the panoramic/bite-wing. For recall patients in both age groups, less than 1% of dentists used survey radiography. CONCLUSION: From our results, we concluded that the majority of dentists followed the guideline for children under 6 years. However, for children in the transitional dentition years, our respondents choices were divided between selective or survey radiography. The ambiguity in the wording or interpretation of the guideline for this age group may have contributed to this result.

Adolescent↗
PubMed1995

Survey of radiographic practices of general dentists for the dentate adult patient.

OBJECTIVE: The purpose of this study was to assess the radiographic practices of general dentists with emphasis on the influence of education on these practices. METHODS: Data were obtained from a mail survey of a stratified random sample of 963 general practitioners in Ontario, Canada, who graduated from the two provincial dental schools. Descriptive statistics were used, and associations were tested by Pearson's chi 2 analysis. RESULTS: The adjusted response rate was 80%. For the new patient, 62% of respondents chose a type of predetermined protocol with the panoramic/bite-wing survey as the predominant choice. Only 37% of respondents chose to prescribe selectively according to the patient's needs. For recall patients, 55% of dentists used selective radiography, and of those who chose a protocol, the vast majority preferred bite-wing radiographs only. CONCLUSIONS: Three influences on the dentists' choice of radiographic examination as suggested by the data were dental education, ownership of a panoramic unit, and who exposed the radiographs. These associations were statistically significant.

Adolescent↗
PubMed1994

A survey of radiographic techniques and equipment used by a sample of general dental practitioners.

A study of radiographic practices of general dentists was conducted by mail survey. Eighty percent of 963 dentists returned completed questionnaires. All participants resided in the province of Ontario, Canada, and were graduates of either of the two provincial dental schools. Fewer than one third of radiographs were taken by the dentist with only 10% of dentists taking three fourths or more of the radiographs in their practices. There was infrequent use of E speed film (11%) and rectangular collimation (8%). Automatic processing was used by 93% of dentists. Although the overwhelming majority of dentists used a film holder, 2% still have the patient hold the film. The type of film holder used was affected by dental school experience, whereas the use of E speed film was not.

Filtration↗
PubMed1992

A critical view of the rationale for routine, initial and periodic radiographic surveys.

Most dentists and dental faculties use an initial radiographic survey for the comprehensive-care patient rather than selective radiography, as recommended by professional organizations and radiation protection agencies. Survey or screening radiography has been justified in the belief that it is an essential health service designed to disclose serious occult disease and that failure to use such films might expose the dentist to successful malpractice litigation. However, incidence data indicate the chance of disclosing tumors, non-inflammatory cysts or other serious bone disease in the asymptomatic patient by screening jaw films is infinitesimal. On this basis, the practice is not justifiable as a public health measure, nor is the dentist who follows published national guidelines for prescription radiography vulnerable to successful litigation.

Canada↗
PubMed1991

A clinical study of radiographic selection criteria for edentulous patients.

This study was designed to determine if radiographic selection criteria could be developed and applied in the examination and treatment planning of edentulous patients. Fifty-one patients were examined and radiographs were prescribed for seven patients, where indicated by the selection criteria chosen. Previously-obtained screening panoramic films were interpreted first, for findings in the areas covered by the prescribed films, and then for occult findings in the remaining areas. Thirty-three patients showed occult positive findings, none of which had clinical significance. For this population, the prescription of radiographs provided the appropriate radiographic information for making treatment decisions. For the vast majority of patients (49), screening panoramic films were unproductive and therefore unnecessary.

Adult↗
PubMed1991

A study of the reasons for tooth extraction in a Canadian population sample.

The reasons for extraction of teeth were determined in a Canadian population sample of 909 patients, ranging in age from 14 to 91 years. Caries was the primary cause of extraction (63%), followed by periodontitis (34%). For the adult age groups, the percentages were approximately the same. While periodontitis was the cause of one-third of the extractions, these occurred in only one-fifth of the population. Although there is a commonly expressed belief that periodontitis is the major cause of tooth loss in adults, a review of both historical and contemporary literature does not support this position. According to the current concept of the natural history of periodontal disease, only about one-fifth of the population, or less, is likely to have periodontitis severe enough to cause tooth loss. This view is consistent with data from this and most other studies on the reasons for tooth extraction.

Adolescent↗
PubMed1990

New U.S. guidelines for prescribing dental radiographs--a critical review.

Most national dental organizations have approved recommendations which set out principles to guide the profession in its use of diagnostic radiation. In 1987, the Center for Device and Radiological Health (an agency of the United States government) published detailed guidelines. This significant initiative should encourage and accelerate the practical application of these principles. In this article, we identify and discuss what we determine to be a major flaw in the guidelines regarding radiography for children in the transitional dentition stage. As well, we have suggested revisions to the guidelines to eliminate some less serious flaws which we believe add unnecessary complexity to the chart.

Adolescent↗
PubMed1989

The unerupted or impacted third molar--a critical appraisal of its pathologic potential.

The prophylactic removal of asymptomatic unerupted or impacted third molars constitutes a major proportion of all oral surgical procedures. Patients are advised to have this preventive surgery on the basis that such teeth, if retained, are likely to cause certain pathologic lesions. The evidence in the scientific literature on the prevalence of dentigerous cysts, mural ameloblastoma, epidermoid carcinoma and root resorption indicates that this concern is exaggerated. The retrospective data on the reasons for extractions of third molars confirm this conclusion. Until there are prospective studies which demonstrate a significant patient benefit from surgery exceeding the risks of retention, the practice should be discontinued. Third molars should be removed only where there is a defined pathologic indication.

Dentigerous Cyst↗