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PubMed1996

[Defensive behavior? Also in dentistry?].

The objective of this pilot-study was to investigate if defensive behaviour of dental practitioners occurs just as in the general practice of family physicians. On the basis of a survey, developed in the Department of General Practice of the University of Amsterdam, 38 dentists (mainly general-practitioners with an average of 20.9 years in practice), were interviewed. The dentists mention defensive practices, but the reasons are unrelated to fear of law-suits. They recommend unnecessary treatments, based on the wishes of their patients. The financial situation of the patient and defensive behaviour are closely related. The respondents avoid to give treatments because of dentally unmotivated patients or deviant behaviour of their visitors. Unnecessary referrals to specialists are also cited. Defensive behaviour was found to play a role in 3.5% of all patient encounters.

Adult↗
PubMedDate not supplied

Oral and pharyngeal cancer: practices and opinions of dentists in British Columbia and Nova Scotia.

Oral and pharyngeal cancers are associated with high mortality rates, a situation usually attributed to late-stage diagnosis. Dentists in British Columbia and Nova Scotia were surveyed regarding their practices and opinions related to oral and pharyngeal cancer. In February 1998 a pretested, 41-item survey was mailed to a random sample of dentists in British Columbia (n = 817) and the population of dentists in Nova Scotia (N = 423). A reminder postcard and one additional mailing were sent to nonrespondents. Of the 670 dentists supplying usable responses (response rate 55.2%), only 56.7% agreed that their knowledge of the subject was current. Of 8 health history items, dentists assessed 5 on average, with most (88.0%) asking about the patients' current use of tobacco. A total of 72.7% of the responding dentists performed an oral cancer examination for all edentulous patients at every appointment, but 10.9% never did so. Similarly, 70.7% of the dentists always provided an oral cancer examination at the initial appointment for patients 40 years of age and older, but 9.8% never did so. Undergraduate training related to oral cancer examination was reported as good by only 52.2% of the dentists. About three-quarters of all dentists (77.0%) were interested in taking continuing education courses on this subject. Differences between the 2 provinces were not statistically significant (p > 0.01). Dentists in British Columbia and Nova Scotia could benefit from undergraduate and continuing education courses to increase their knowledge of health history assessment, examination for oral and pharyngeal cancers, and risk reduction strategies, such as counselling about tobacco cessation.

Adult↗
PubMed2004

Caries-preventive measures applied by Mongolian dentists to their own children.

PURPOSE: To investigate caries-preventive measures (CPMs) applied by dentists in Mongolia to their own children in relation to the dentist-parents' professional and preventive care-related backgrounds and the children's dental health. MATERIALS AND METHODS: A questionnaire distributed to Mongolian dentists in 2000 surveyed their professional and preventive care-related backgrounds. The dentists filled in a dental chart for their own children aged 3 to 13 years and indicated which of seven listed CPMs were applied to each child. Of the dentists surveyed, 245 replied (98%); with 146 having children (n = 208) of the target age. Statistical evaluation included chi-square test, one-way ANOVA, linear regression analysis, and odds ratios based on 2X2 tables. RESULTS: Of the seven CPMs, the following were applied on average per child: 3.7 (SD = 1.6) to 3- to 5-year-olds; 4.4 (SD = 1.3) to 6- to 11-year-olds; 4.3 (SD = 1.4) to 12- to 13-year-olds; with the youngest children receiving the fewest CPMs (p = 0.02). Demonstrating toothbrushing techniques and taking children for regular preventive check-ups were the most frequently reported measures applied to the children. Conversely, pit and fissure sealants and restriction of sugar were the least reported. The number of CPMs was unrelated to any factors connected with the dentist-parents' backgrounds among the youngest group; correlated negatively to dentist-parents' work experience (p = 0.002) among the middle group; and positively to dentist-parents' preventive knowledge (p = 0.04) and self-reported competency (p = 0.005) among the oldest group. Among the middle group, more CPMs were applied to those with greater DMFT/dmft scores. CONCLUSION: Caries-preventive measures applied to dentists' children should be improved, especially in regard to sugar consumption. Comprehensive efforts are called for, stressing modern CPMs.

Adolescent↗
PubMed2006

The challenges of transferring evidence-based dentistry into practice.

The goal of evidence-based dentistry is to help practitioners provide their patients with optimal care. This is achieved by integrating sound research evidence with personal clinical expertise and patient values to determine the best course of treatment. Although clinicians embrace this concept, its implementation in clinical practice has been slow. In this article, barriers against the implementation of evidence-based care are examined and possible solutions are offered. The dental profession is committed to providing the best possible dental care for patients. This is proving to be more complex due to a virtual "information explosion" on new therapies, techniques, and materials; increased consumer understanding of treatment possibilities and therapeutic outcomes; and changing sociodemographic patterns. Although the profession advocates the importance of evidence-based dental disease prevention and treatment, practitioners have been slow to implement this concept. In 2003, the California Dental Association (CDA) formulated an evidence-based dentistry (EBD) action plan that included the formation of a task force to monitor EBD efforts and implement programs to educate CDA members on this methodology. The challenges of transferring EBD into clinical practice were key issues addressed by the task force, and much of their deliberations and perspectives are reflected in this article. Possible solutions for eliminating barriers against evidence-based care will also be explored.

Attitude of Health Personnel↗
PubMed2003

Opinions about oral cancer prevention and early detection among dentists practising along the Texas-Mexico border.

OBJECTIVES: The purpose of this study was to assess dentists' opinions about oral cancer (OC) prevention and early detection. METHODS: Data were collected by a self-administered mail questionnaire sent to all 398 registered dentists practising along the Texas-Mexico border. RESULTS: The effective response rate to the survey was 40%. While 90% of respondents agreed that oral cancer examinations (OCE) should be provided annually for patients 40 years of age and older, only 59% of respondents believed their OC knowledge was current. While 99% agreed that dentists were qualified to perform OCE, only 54 and 68% respectively, agreed that dental hygienists and physicians were similarly qualified. Dentists who rated their undergraduate OC training favorably (OR = 2.68, 1.23-5.81, P = 0.011), had attended their last oral cancer continuing education (OCCE) course within the past 5 years (OR = 2.46, 1.25-4.86, P = 0.009), and those who performed OCE on all patients 40 years and older (OR = 2.64, 1.32-5.26, P = 0.005), were more likely to agree their OC knowledge was current. CONCLUSIONS: Respondents expressed diverse opinions about OC prevention and early detection. Positive opinion on currency of OC knowledge was associated with performance of OCE. Results indicate a need for OCCE targeting the study population as well as increased emphasis on OC curriculum in dental schools.

Analysis of Variance↗
PubMed2002

Addressing tobacco in managed care: a survey of dentists' knowledge, attitudes, and behaviors.

OBJECTIVES: This study assessed the tobacco cessation knowledge, attitudes, and behaviors of dentists participating in a large managed care dental plan. METHODS: Participating dentists in 4 states were surveyed via mail. RESULTS: Dentists' perceived success in helping patients quit using tobacco was highly correlated with discussion of specific strategies for quitting, advice about the use of nicotine gum, and time spent counseling patients. Dentists who were confident about their smoking cessation knowledge frequently advised patients to quit and spent more time counseling patients about tobacco cessation. CONCLUSIONS: Tobacco cessation is not a routine part of dental practice. Knowledge, time spent counseling patients, and specific strategies for quitting were associated with dentists' perceptions of success.

Attitude of Health Personnel↗
PubMed2004

Improving quality and speed in providing fixed prosthodontics.

American dentists should be pleased with the level of care they provide to their patients in the area of fixed prosthodontics. The American public is served with good, competent care at a moderate cost. However, this article has addressed the potential for increasing the quality level of care, increasing the speed of treatment and maintaining the moderate cost by delegating some of the clinical tasks to qualified staff members. In my opinion and experience, these results are achievable by delegating up to one-half of the time involved in fixed prosthodontic clinical tasks to qualified, educated, supervised non-dentist staff members, where such delegation is legal.

Crowns↗
PubMed1997

Dental caries treatment pattern in 14-15-year-old school pupils attending high caries schools in north & west Belfast and their ability to recognise untreated disease.

The study examined the dental caries treatment profile of 186 14-15-year-old children in schools known previously to have a high overall caries experience, the schools being located in a high caries area of Northern Ireland. The children had a high mean number of decayed and untreated teeth. The majority of children who had untreated decay were unaware of this status and had a mean D value of 3.85. There was a significantly higher number of untreated carious teeth for children who had not attended a dentist within the past year when compared with those who had attended (mean values 4.08 and 2.54 respectively). While there were high levels of unmet needs overall it is concluded that children who had not attended the dentist for the past year had very high levels of untreated decay.

Adolescent↗
PubMed2006

A comparison of the perceived effects on Scottish general dental practitioners of peer review and other continuing professional development.

AIM: To produce evidence to inform future provision of continuing professional development (CPD). METHOD: A postal questionnaire survey of 268 dentists who had participated in the pilot peer review scheme in Scotland. RESULTS: Courses, both Section 63 and privately run, were both seen as highly effective in changing both knowledge and practising behaviour. Most of the free form comments invited were positive about the effects and acceptability of peer review as a mode of CPD. Courses and reading journals were felt to be better at changing knowledge while all the other modes (vide intra) were felt to be better at changing practice, except computer assisted learning (CAL). CONCLUSIONS: Peer review in Scotland is perceived as an acceptable and effective CPD mode for changing knowledge and practice. It is not felt to be superior to the established classical modes of courses and reading of journals.

Adult↗
PubMed2003

Continuing dental care for Highlands elderly: current practice and attitudes of dental practitioners and home supervisors.

OBJECTIVE: To investigate current practice and attitudes of Highland dentists and home supervisors to continued dental care of elderly residents. METHODS: A cross-sectional questionnaire was designed to survey the current practice and attitudes of Highland dentists and residential care supervisors in their provision of dental care for the elderly at home and in long stay accommodation. RESULTS: The response rate was 94% of dentists and 79% of homes. Despite 86% of dentists providing domiciliary care and 93% of homes transport to a surgery, no more than a quarter of residents had had contact with a dentist in the previous year. The distribution of residents varied with dependant individuals living in nursing units and the least dependant in residential homes. Only 1% of all residents were totally bed bound. Domiciliary patients were less likely to receive continuing care compared with those seen in a surgery and 75% of homes had to initiate dental care. In terms of patient referral, the majority of GDPs would refer uncooperative patients, salaried dentists would refer those with complex medical histories and community dentists would refer those requiring complex treatments. A dental assessment was undertaken in 46% of homes and 81% of these kept a record of dental care. CONCLUSION: This study highlights the need for a co-ordinated, seamless continuing dental care service, tailored to the actual needs of the elderly individuals it is designed to serve, particularly in a remote and rural area.

Adult↗
PubMed1998

Sedation in primary dental care: an investigation in two districts of northern England.

OBJECTIVE: To determine the current provision of sedation in primary dental care and investigate the knowledge and attitudes of dental practitioners and others on the use of sedation. DESIGN: Qualitative interviews and postal questionnaire survey. SETTING: Health districts of Bradford (West Yorkshire) and South Durham, UK in 1996. SUBJECTS AND MATERIALS: 15 key individuals associated with NHS primary dental services were interviewed. Questionnaires were sent to all 260 NHS general dental practitioners and community dental service clinicians. RESULTS: 208 questionnaires (80%) were returned. 42% of respondents reported current sedation use, with oral administration the favoured technique (26%). Significant differences were found between districts for intravenous sedation use (7% Bradford, 41% South Durham, P < 0.001). Almost all participants agreed the value of sedation in dental care for adults and children, for nervous, phobic patients or in association with unpleasant forms of treatment and 45% of dentists felt that provision should be expanded. Training, availability of referral services, finance and patient demand were seen as encouraging factors. CONCLUSIONS: Substantial variations in sedation provision between the two districts were associated with teaching at the nearest dental schools. Innovative use of resources could help the expansion of provision supported in this study.

Administration, Oral↗
PubMed2001

Variation, certainty, evidence, and change in dental education: employing evidence-based dentistry in dental education.

Variation in health care, and more particularly in dental care, was recently chronicled in a Readers Digest investigative report. The conclusions of this report are consistent with sound scientific studies conducted in various areas of health care, including dental care, which demonstrate substantial variation in the care provided to patients. This variation in care parallels the certainty with which clinicians and faculty members often articulate strongly held, but very different opinions. Using a case-based dental scenario, we present systematic evidence-based methods for accessing dental health care information, evaluating this information for validity and importance, and using this information to make informed curricular and clinical decisions. We also discuss barriers inhibiting these systematic approaches to evidence-based clinical decision making and methods for effectively promoting behavior change in health care professionals.

Attitude of Health Personnel↗
PubMed2002

Debt and practice profiles of beginning dental practitioners.

Escalating student debt for dental education has led some to speculate that beginning practitioners may undertake procedures that are beyond their competence in an effort to augment practice income. This hypothesis was tested directLy using a data set containing self-reports of practice profiles across a wide range of procedures and debt for education, practice, and personal purposes. Respondents were 113 individuals who had graduated from a private dental school from 1986 to 1997. Conservative dental practice was measured by comparing frequency of commonly and uncommonly performed procedures in the group as a whole against the profile for each respondent. There was no association between educationaL debt and propensity to engage in unconventional procedures. Older dentists and those who felt more competent at the time of graduation were less conservative. Amount of practice debt was a better predictor of unconventional practice than was educational debt.

California↗
PubMed1996

Orthodontists' perceptions of need for jaw surgery.

Treatment recommendations in borderline orthognathic surgery cases were examined for influence of orthodontists' traits and orthodontist's perceptions of patients', surgeons', and psychologists' traits. A mail questionnaire consisted of 23 case vignettes describing borderline surgical candidates with certain physical, psychological, attitudinal, and support system traits, as well as demographic and attitudinal items. The response rate from 512 licensed Canadian orthodontists was 65%. Seventy-four percent of orthodontists preferred camouflage for themselves. Recommendation of camouflage predominated in 12 of 23 vignettes and surgery in only four, although the cost of surgery was considered justified. Psychological referral was recommended highly for certain patients: those hoping to improve negative life events through positive facial change, those having low self-esteem, and those wanting to opl out of surgery in the middle of orthodontic treatment. Certain patient traits appeared to influence orthodontists' treatment recommendations. The availability, expertise, and receptiveness to case discussion of oral surgeons and psychologists did not influence orthodontists' treatment recommendations.

Adult↗