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PubMed2002

[25 years of INAMI data in dentistry].

The author presents 25 years of social security data about expenses and the number of medical acts in dentistry using lists and diagrams. By relating these expenses per year to the number of dentists per year, the average expenses per dentist are compared to the evolution of the index of consumption. In the same manner the average number of medical acts per dentist are calculated. By this method the author emphasizes the changes in average dental practice profile over 25 years.

Belgium↗
PubMed2004

[The routine oral examination in The Netherlands. An orientation from the perspective of general dental practitioners].

In The Netherlands the routine oral examination (ROE) can be characterized as an important tool in dental care. As a result of the changing prevalence of oral diseases of the Dutch population the content of the routine oral examination has changed over time. A representative survey among general dental practitioners has been carried out to investigate the professional performance in the routine oral examination. Participants consisted of a random, stratified sample of 619 dentists, of whom 521 (85%) responded. The Dutch general dental practitioners use the routine oral examination mainly for detecting dental caries and to asses the status of the restorations. About 50% of the responders use a standard recall interval for all patients whereas the other half takes individual patient factors into consideration when determining the recall interval. Both groups differ significantly on the variables: 'time spend on the routine oral examination', 'the amount of diagnostic activities', 'the registration in patient dental records' and 'the frequency of using bitewing radiographs'. In the perspective of quality of dental care a national reconsideration of the routine oral examination by professionals and patients is advocated. The instrument of choice would be the use of evidence-based clinical practice guideline development procedures.

Dental Care↗
PubMed1996

Washington's teeth: patients' rights and dentists' rights--where are we heading?

Throughout its history in Australia the dental profession has operated primarily as a self-regulating profession. In recent years this paradigm has come under challenge from a number of quarters. Among these sources of challenge are Australia's various anti-discrimination laws, together with a more consumer-oriented approach to the development of broad public policies. This paper seeks to explore the issues in anti-discrimination law as they relate to the balance between the rights of patients and the rights of dentists. The particular problems dealing with the treatment of patients with HIV/AIDS is explored before consideration is given to other issues of social justice and equity within the dental profession. The responsibilities of dentists as health care providers and as employers are considered. Some final observations are offered on the future developments of public policy in relation to this question.

Australia↗
PubMed2004

Knowledge, opinions, and clinical experience of general practice dentists toward obstructive sleep apnea and oral appliances.

Undiagnosed obstructive sleep apnea (OSA) can contribute to hypertension, cardiovascular disease, stroke, and detract from overall quality of life. Dentists can play an important role in detecting, making recommendations for, and treating OSA with oral appliances (OAs). A survey of 18 questions of knowledge and opinion of, educational background for, and clinical experience with OSA and OAs was mailed to 500 general practice dentists in Indiana, United States. Two hundred survey returns produced 192 valid responses. Responders reported strong positive opinions toward OSA and OAs. However, 58% of dentists could not identify common signs and symptoms of OSA, and 55% of dentists did not know the mechanism for mandibular advance devices. Only 39% of dentists could identify snoring, mild OSA, and intolerance to continuous positive airway pressure as possible indications for OA treatment. Respondents reported a general lack of education about both OSA and OAs. Only 31 (16%) were taught about this issue in dental school; 77 (40%) knew little or nothing about OA treatment for OSA patients; 57 (30%) learned from postgraduate training. Cooperation and referrals between dentists and physicians were rated as "poor." Of the responders, 54% never consulted with physicians for a suspected OSA patient in their practice; 75% of dentists reported they have never been referred patients by physicians; and 80% of dentists never or less than five times prescribed OAs to OSA patients. Results suggest a need for increased education and training regarding OSA and OAs in dental school, as well as increased cooperation between dentists and physicians for better patient care.

Attitude of Health Personnel↗
PubMed1996

Productivity among Australian private general dental practitioners across a ten year period.

Historical trends in Australia have shown declining levels of dentists' annual productivity from the 1960s to the 1980s. In a period of changing population demographics and oral health status appropriate levels of supply of dental services remains a key issue. Changes in practice patterns of dentists, through variables such as productivity, may influence the capacity to supply services. The aim of this study was to investigate time trends in productivity for private general practitioners at three points in time across a ten year period. A weighted, stratified random sample of Australian dentists was surveyed in 1983-84 (response rate 73 per cent), 1988 (response rate 75 per cent) and 1993-94 (response rate 74 per cent). The data were re-weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988 and 1993. Analysis of variance showed that the number of patient visits per year declined across the ten year period, related to parallel decreases in the number of patients treated per hour, while there was no significant difference during the period in the number of hours per year devoted to work.

Adult↗
PubMed2006

Opinions and attitudes of the UK's GDPs and specialists in oral surgery, oral medicine and surgical dentistry on oral cancer screening.

OBJECTIVE: To survey two broad areas of oral cancer awareness and management of patients at risk of oral cancer by specialists in oral surgery, oral medicine, surgical dentistry and general dental practitioners (GDPs) in the UK. The first of these included knowledge and awareness of aetiological factors, changing patterns of disease, and screening/detection programmes including their effectiveness. The second included oral cancer detection methods, advice on avoidance of high-risk activity and self-examination, and referral pattern of GDPs. DESIGN AND METHOD: A pretested, 44-item questionnaire, a covering letter, a brief outline of the research protocol and return, stamped envelope were mailed in March 2003. A sample of 200 GDPs whose names were obtained from the General Dental Council's main list and 305 dental specialist names obtained from specialist's list in surgical dentistry, oral medicine and oral surgery were selected randomly. Information on oral cancer awareness and practice, screening practice and education was obtained. RESULTS: The response rate was 66.9%. The knowledge of the dental specialists was consistent with that in reports of current aetiological studies on oral cancer. However there were gaps in the GDP's knowledge and ascertainment of oral cancer risk factors. Over 70% of the dental specialists provided counselling advice on the risks of tobacco and alcohol habits compared with 41.2% of GDPs. More GDPs (52.4%) than specialists (35.4%) believed that oral cancer screening on a national basis would be effective in decreasing the mortality of oral cancer. Over 95% of all respondents used a visual examination for oral cancer screening and 89.9% of all respondents strongly believed that visual screening is effective in the early detection of oral cancer. CONCLUSION: The results showed that GDPs had knowledge gaps in their awareness of oral cancer risk factors and the application of preventive measures. Most dental health providers in the UK perform visual screening of the oral mucosa for their patients. Opinion was equivocal as to whether a nationally based screening programme similar to cervical cancer would be effective in improving the mortality and morbidity of oral cancer.

Adolescent↗
PubMed2003

Perceived risk of deteriorating periodontal conditions.

BACKGROUND: Interpretation of risk for periodontitis is critical for treatment planning. How periodontists assess risk for periodontitis is unclear. PURPOSE: To study (1) what factors periodontists use when assessing the risks for worsening periodontal conditions anticipating that no treatment would be provided, and (2) if risk assessment is consistent and independent of specialty background training. MATERIAL AND METHODS: Medical history, clinical dental data, full-mouth intra-oral radiographs, and slide pictures were obtained from each of 51 subjects, and the information was provided to 23 examiners. RESULTS: The mean age of the study subjects was 51.5 years (SD +/- 17.7, range 23-81), with 28 women included. In 10 of the subjects, only gingivitis was identified, while 22 subjects had advanced chronic periodontitis. Risk scores assigned for 2 and 4 years differed significantly between European- and US-trained periodontists (p < 0.001) and between graduate students in training and periodontists from either the US or Europe (p < 0.01) (Wilcoxon n-pair test), with European periodontists scoring the lowest risks. Risk scores were correlated between groups (p < 0.01 with rho range 0.82-0.89) (Spearman's rank correlation). The best-fit model (r2 = 0.86) to assess perceived risk for worsening periodontal conditions based on data from all examiners combined included the following variables: (1) overall horizontal alveolar bone loss (p < 0.000), (2) age-adjusted proportional radiographic bone height score for the worst site (p < 0.000), and (3) proportion of pocket probing depths > or = 6.0 mm. CONCLUSIONS: Differences exist on the scale of risk values based on specialty training. Consistency in scoring patterns exists. The examiners based their assigned risk scores almost exclusively on measures of existing disease severity, including radiographic bone loss and numbers of periodontal pockets > or = 6.0 mm, and excluding most known risk factors such as smoking, diabetes, and poor oral hygiene.

Adult↗
PubMed2005

A quality assurance program in dental radiographic units in western Greece.

OBJECTIVE: This survey reports on successful efforts to establish a quality assurance (QA) program for 50 intraoral x-ray units in the public and private sectors in the region of Achaia, Greece. It was conducted in 2 phases, in 1996 and in 2003, including on-site inspections, QA tests, and standard questionnaires. The aim of the study was to assess equipment conditions, knowledge, and adoption of radiographic QA guidelines by general dentists and, more importantly, the impact of the recommendations and training provided. STUDY DESIGN: The tested parameters focused on radiation protection, equipment maintenance, film speed used, film processing conditions, and radiologic characteristics such as voltage, radiation leakage, type of collimation, source-to-skin distance, timer accuracy, and entrance dose. RESULTS: The data gathered in 1996 demonstrate minimal compliance with equipment function requirements and radiation safety measures. 1 The comparative evaluation of all the parameters gathered from the 2 surveys, indicated that in 2003 the vast majority of the dentists followed the recommendations given in 1996. Only 2 dentists persisted in neglecting the guidelines.

Filtration↗
PubMed2002

Development of clinical practice guidelines for dentists: methods for topic selection.

OBJECTIVES: The aim of this study was to compare four methods for assessing the preferences of the dental profession for topics to be considered for the development of clinical practice guidelines. METHODS: The methods were: (1) a survey among dentists, (2) an analysis of topics discussed in dental peer groups, and (3) screening of dental journals. A fourth method was obtained from method number 3. The frequencies of the reported topics were calculated for each of the methods. For the fourth method, the number of publications per topic were plotted against the year of publication, and the slope of the linear regression line was used as an indicator. Within each of the four methods, the topics were ranked according to the frequency in which they were reported, and to the slope value. The reliability of the methods was tested by the "item-rest sum correlation", which is the correlation of the rank positions of one method with the sum of the rank positions obtained by the remaining three methods. RESULTS: In using all methods, a total of 1027 topics were obtained. Reclassification resulted in 34 topics. Moderate item-rest sum correlations ranging from 0.34 to 0.48 were found for all methods, indicating that the rank order of every method moderately predicts the sum of the rank orders obtained by all other methods. The topic 'prevention of cross-infection' had the highest overall rank position. CONCLUSION: It is concluded that the four applied methods appeared to provide a consistent ranking of potential topics. In view of the fact that the questionnaire method is generally applicable, this method should be preferred for assessing dentists' preferences for topics to be considered for the development of clinical practice guidelines.

Data Collection↗
PubMed2004

Dentists interacting and working with female dental nurses: a qualitative investigation of gender differences in primary dental care.

OBJECTIVES: To investigate if women compared with men dentists experience deferential treatment from their female nurses, what workplace strategies women use to manage chair-side assistance and to examine if these were country related. METHOD: A convenience sample of 22 male and female dentists of different ages working in general dental practice in The Netherlands and Northern Ireland participated. The sample framework was determined by saturation of the concepts. All informants were interviewed in a clinical setting. The data was subjected to rigorous line by line coding in order to identify clusters of codes, themes and concepts. RESULTS: Three themes were identified. These were: experiencing deferential nursing assistance; adopting 'friendly-like' working strategies and adopting business-like, hierarchical working strategies. Gender differences were shown for each of the themes. Women rather than men made friends with their nurses and attempted to reduce status inequalities. This led to workplace strategy inconsistencies. This suggested that it was not the type of strategy adopted but the inconsistency with which it was implemented that caused difficulties between younger women dentists and their nurses. CONCLUSIONS: Training dental students and young graduates how to interact appropriately in the clinical situation and to appreciate the nurses' work status will assist in improving working relationships.

Adult↗
PubMed1998

Quality evaluation of oral health record-keeping for Finnish young adults.

The objective of this study was to assess the quality of oral health record-keeping in public oral health care in relation to dentists' characteristics. A random computerized selection of 239 subjects, born in 1966-71 and clinically examined during 1994 in an administrative unit of the public oral health service in southern Finland, included 4-5 cases per dentist, the number of dentists being 50. Data concerning actual clinical examinations and treatment courses carried out in public dental clinics came from original oral health records. Criteria for assessment of oral health record entries were based on Finnish health legislation and detailed instructions of health authorities. The results showed that each patient's identity was available in 90% of documents. Recordings concerning continuity of comprehensive care were infrequent; a questionnaire concerning each patient's up-to-date health history was in only 26% of the oral health records. Notes concerning each patient's bite and function of the temporomandibular joint were in 37% of the records, notes about oral soft tissues were in 11%, and the check-up interval was recorded in 21%. Recording of indices on periodontal and dental status varied greatly; the community periodontal index of treatment need was found in 93% and the index of incipient lesions in 16% of the records. Female dentists and dentists younger than 37 years tended to record more information. Dentists should be encouraged to better utilize the options offered by oral health records for individual treatment schemes.

Adult↗
PubMed1999

The hopeless tooth: when is treatment futile?

The decision to place a tooth in the hopeless category is by no means a simple one. There is always the possibility of being wrong, the possibility that this tooth may prove to be the exception and, against all odds, survive as a functioning component of the masticatory apparatus. These are the decisions that make us dentists rather than technicians.

Decision Making↗
PubMedDate not supplied

Survey of Iowa general dentists regarding the age 1 dental visit.

PURPOSE: The purpose of this study was to assess Iowa general dentists regarding the age 1 dental visit. METHODS: A 15-item survey was mailed to 1,521 licensed dentists to address their knowledge, attitudes, and behavior regarding the age 1 dental visit. Chi-square statistics and logistic regression models were used to analyze data. RESULTS: Seven hundred fifteen (47%) useable surveys were returned from 2 mailings. Five hundred forty (76%) general dentists were familiar with the American Academy of Pediatric Dentistry (AAPD) age 1 dental visit recommendation. Most reported obtaining this information through continuing education (37%). Eleven percent believed the first dental visit should occur between 0 and 11 months of age, and 66% reported seeing children younger than 2. "Prefer to refer infants to a pediatric dentist" (20%) was the most common reason for not seeing children 0 to 23 months old. Bivariate and multivariate logistic regression analyses indicated that dentists who believed children should have their first dental visit at 0 to 23 months and those willing to see children at age 0 to 23 months were younger, more recent graduates, more likely to be female, aware of the AAPD recommendations, and were already seeing children 0 to 23 months. CONCLUSIONS: The majority of Iowa general dentists are aware of the AAPD age 1 dental visit recommendation.

Adult↗
PubMedDate not supplied

If dentists lack virtue.

Explore the source record for details and available documents.

American Dental Association↗
PubMed2005

Using tablet PC's in dental practice research: technology, cost savings, and direct data entry "on the go".

Recent technological developments have greatly simplified data collection, recording, and transfer in studies relying on direct observation or survey methodology, reducing both cost of data collection and the time necessary to prepare data for analysis. The purpose of this communication is to describe how tablet PC computers can be used in data collection, thereby eliminating intermediate data collection steps and chances for error, and thus reducing overall cost. The data collection procedure used to illustrate this technology is a direct observation study of the factors associated with the delivery of preventive services by dentists and hygienists in their daily practice.

Data Collection↗
PubMed2005

Interest in periodontology and preferences for treatment of localized gingival recessions.

OBJECTIVES: The purpose of this study was to evaluate the views, knowledge and preferences of a large sample of practising dentists in periodontics, focusing specifically on the treatment of gingival recessions, and to compare the findings with the current evidence available in the dental literature. METHODS: We conducted a cross-sectional postal survey of 3780 dentists, representing the majority of all dentists working in Switzerland. The questionnaire consisted of 17 questions, most of them giving the possibility of multiple choices of answers. The demographic profile, interests and satisfaction in periodontics were associated with the choice of treatment options offered for the management of six clinical situations. RESULTS: One thousand two hundred and one dentists sent back the questionnaire within three months and were thus included in the analysis. In general, the interest and the satisfaction in periodontics were moderate to high (6-7 on an analogue scale from 1 to 10). Specialists in periodontics indicated a significantly higher interest and satisfaction in periodontics than the general dentists (p<0.001), and practitioners working in urban areas indicated a slightly higher interest (p=0.027) and satisfaction (0.047) than their colleagues established in a rural setting. The predominant indication of root coverage procedures was aesthetics (90.7%). The region in which dentists worked was the only significant predictor for choosing "no treatment" of buccal recessions: dentists from the German-speaking part were significantly less inclined to surgically treat gingival recessions than their colleagues from the French or Italian part. For those who opted for therapy, a free tissue graft was generally the favourite option, followed by a connective tissue graft and a coronally advanced flap. Throughout, only a small fraction of the dentists considered using a guided tissue regeneration procedure. The relative odds for not extracting teeth with severe periodontal disease were higher if the dentist was a specialist than a generalist. Satisfaction in practicing periodontics also positively strengthened the inclination towards keeping severely compromised teeth. CONCLUSIONS: Aesthetic concerns were the predominant indication for root coverage procedures. Further research should therefore include aesthetic aspects as primary clinical outcome variables. Specific training of dentists and their satisfaction in periodontics influenced treatment decisions. Specialists involved in continuing education should inform practicing dentists more efficiently on the potential and usefulness of periodontal therapy for saving and maintaining periodontally compromised teeth.

Adult↗
PubMed2004

General dentists' perceptions of educational and treatment issues affecting access to care for children with special health care needs.

This study analyzed a data subset of a national survey of general dentists conducted in 2001 to determine their overall care of children with special health care needs (CSHCN). In the survey, dentists were asked to respond to questions in the following areas: did they provide care for CSHCN (children with cerebral palsy, mental retardation, and those who are medically compromised); what were their perceptions of the training they received in dental school related to CSHCN; what was their interest in additional training for CSHCN; and what factors influenced their willingness to provide care for CSHCN? Only about 10 percent see CSHCN often or very often, and only one in four respondents had hands-on experience with these patients in dental school. Postgraduate education in general practice or advanced general dentistry residency had no effect on willingness to care for CSHCN. Older dentists, those accepting Medicaid for all children, and those practicing in small communities were more likely to see CSHCN. Dentists willing to see CSHCN also were more likely to perform procedures associated with special needs and underserved child populations including pharmacologic management and stainless steel crowns. Dentists with hands-on educational experiences in dental schools with CSHCN were less likely to consider such factors as level of disability and patient behavior as obstacles to care and were more likely to desire additional education in care of CSHCN.

Adolescent↗