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The current program of continuing education is unnecessarily restricted by outdated conceptions of professionalism and learning; thus it fails to serve the needs of dentists today. A new model--professional development--is proposed, based on new ideas about what it means to be a professional and what professionals learn. The central role of practice is emphasized.
PURPOSE: This study surveyed board-certified pediatric dentists on their opinions about changes in U.S. parenting styles and the effects on the practice of pediatric dentistry. METHODS: A questionnaire was developed, piloted, and mailed to 1,129 members of the College of Diplomates of the American Board of Pediatric Dentistry during the summer of 2000. RESULTS: A total of 577 respondents (51%) returned questionnaires, equally distributed across AAPD districts, with male:female ratio of 4:1 and 90% married. A majority perceived parenting styles had changed during their practice lifetime (88% "absolutely or probably changed"), with older practitioners significantly more likely to say so. Ninety-two percent felt changes were "probably or definitely bad" and 85% felt that these changes had resulted in "somewhat or much worse" patient behavior. Practitioners report performing less assertive behavior management techniques than in the past due to these changes. CONCLUSIONS: Diplomates report that parenting changes have occurred and they believe these are negative (bad) and have adversely influenced behavior and caused changes in pediatric dentists' behavior management.
By conducting an oral examination, during radiographic examination and in treatment planning procedures dentists make numerous decisions. A dentist will be required to make his decisions explicit. Decision trees and decision analyses may play an important role. In a decision analysis, the probability of correct and incorrect decisions are multiplied by the utility of the decision outcomes. The treatment outcome with the highest expected utility should be selected. Complex decision tasks such as the estimation of an individual's caries risk or the diagnosis of bone disorders are currently available as computer applications. Also, a preliminary version of a computer programme which detects caries lesions from bitewing radiographs independent from the dentist has become available. It is expected that the applicability of decision analyses will increase when implemented in the dental practice software packages.
Evidence-based dental practice is defined in terms of systematically collected and analyzed data on treatment outcome. By making this the common ground among dentists, patients, insurers, and others, it is possible to improve both the effectiveness and cost-efficiency of oral health care.
OBJECTIVE: The purpose of this study was to evaluate the frequency of the use of gloves and to assess the prevalence of glove-related symptoms in a sample of Italian dentists with a high occupational exposure to latex gloves. METHOD AND MATERIALS: A 31-question instrument was mailed to all dentists (n = 550) practicing in the town of Bologna during 1994 to determine the type of procedures for which gloves were worn by dentists and the prevalence of self-reported glove-related symptoms. RESULTS: Of the dentists who replied to the items (n = 160), 94% reported that they usually wear nonsterile latex examination gloves; and 46% reported that they wear surgical gloves, even if not exclusively. About 98% reported changing gloves after contact with each patient, and 14% reported using disinfectants to treat examination gloves. Of the 106 respondents claiming to use examination gloves for surgical activities, 79 (74%) reported wearing them for extractions. Sterile surgical gloves were reported to be mostly worn for implant placement (47%) and periodontal surgery (42%). There were 46 (29%) responses indicating glove-related problems; of those subjects, 14 (30%) reported having other allergies. CONCLUSION: The use of gloves is common in the sample of Italian dentists, and the choice between nonsterile examination gloves and sterile surgical gloves seems to be made appropriately.
Dental practices are under scrutiny every day. The dynamics of the public, the media, the lawmakers, the regulators, and other special-interest groups create endless possibilities for influence over a practice and continue to challenge a dentist's ability to provide quality dental care to patients. This article describes examples of laws and regulations affecting dentistry and the impetus for them, whether real or perceived.
This study investigated provincial and territorial differences in dentists' compliance with recommended infection control practices in Canada (1995). Questionnaires were mailed to a stratified random sample of 6,444 dentists, of whom 66.4% responded. Weighted analyses included Pearson's chi-square test and multiple logistic regression. Significant provincial and territorial differences included testing for immune response after hepatitis B virus (HBV) vaccination, HBV vaccination for all clinical staff, use of infection control manuals and post-exposure protocols, biological monitoring of heat sterilizers, handwashing before treating patients, using gloves and changing them after each patient, heat-sterilizing handpieces between patients, and using masks and uniforms to protect against splatter of blood and saliva. Excellent compliance (compliance with a combination of 18 recommended infection control procedures) ranged from 0% to 10%; the best predictors were more hours of continuing education on infection control in the last two years, practice location in larger cities (> 500,000) and sex (female). Clearly, improvements in infection control are desirable for dentists in all provinces and territories. Extending mandatory continuing education initiatives to include infection control may promote better compliance with current recommendations.
Gaps exist in the extent to which technology has been fully integrated into dental practices. This is partially the result of continuously emerging technologies and partially attributable to different attitudes among dentists toward innovation. Further development of Evidence-Based Dentistry is needed before it becomes a productive and widely used part of practice.
To achieve local anesthesia, dentists may need to administer a second injection. One widely used textbook advocates removing the needle before replacing the used cartridge. To determine the extent to which practicing dentists follow this recommendation, the author surveyed 144 practicing dentists in an upstate New York community and found that only 3 percent use this method. The rest leave the needle on to minimize their risk of a needlestick.
In a relatively brief time, the dental profession has evolved into one of the most recognized and respected professions. There still is, however, a lack of public knowledge about dentistry and the procedures dentists can accomplish in addition to restoring teeth. Life-enhancing, dramatically significant oral procedures now are available to the public. The diverse nature of the professional activities in which dentists may involve themselves needs to be made public knowledge. This education of the public should come from the individual members of the profession and from organized dental groups.
The Community Dental Service (CDS) has increasingly become associated with providing primary dental care for those people who are unable to access care by the usual means. The work reported here examines the provision of primary dental care by using the notion of a dental service continuum to demonstrate that in the treatment of patients with special needs the CDS acts as a safety net service. One hundred and twenty-four General Dental Service (GDS) practices and 33 CDS practices took part in the survey. The results suggest that both services provide primary dental care for a wide range of patients with special needs. Dentists in the GDS and CDS treat and care for different populations of patients with special needs. It is proposed that a continuum of service provision exists.
In order to map variations in the operative treatment threshold for occlusal caries, a pre-coded questionnaire was sent to a random sample of 759 dentists in Norway, 923 in Sweden, and 173 in the Danish Public Dental Health Service inquiring about caries and treatment strategies. A further intention was to explore the type of operative treatment and filling material dentists in Scandinavia would use given an occlusal lesion in the lower 2nd molar in a 20-year-old. It is found that close to 70% of dentists in the 3 countries would put off carrying out operative treatment of occlusal caries until they registered a moderately sized cavity and/or any radiolucency in dentin. In Sweden, 26.7% of dentists and in Denmark 24.3% would postpone operative treatment until the lesion had a large cavity and/or until radiolucency could be observed in the middle third of the dentin; in Norway, only 11.5% of dentists indicated this. The majority of dentists in all 3 countries preferred to drill only the carious part of the fissure, though in Norway more dentists (30.9%) would tend to drill the whole fissure compared to their Swedish (23.4%) and Danish (9.5%) colleagues. The majority of Danish dentists (52.4%) suggested amalgam for restoring the occlusal surface, while 19.9% of Norwegian and 2.9% of Swedish dentists would use amalgam. Composite was the first material of choice for 71.5% of the Swedish dentists, the remaining 25.6% suggesting conventional glass ionomer cement, light-cured 'glass ionomer cement', or a combination of glass ionomer cement and composite. The corresponding values for the Norwegian dentists were 39.1% and 41.0%, respectively, and for the Danish dentists 29.2% and 18.4%. In Scandinavia, the leading strategy for occlusal caries seems to be to postpone operative treatment until a definite cavity or radiolucency in the outer third of dentin can be observed, and to carry out operative treatment only of the part of the fissure that is carious. Composite resin is the predominant material of choice in Sweden, while in Denmark the majority of dentists preferred amalgam. Composite, or composite in combination with glass ionomer cement material, was the choice of almost 80% of Norwegian dentists.
The incidence of malignant tumors of the buccal mucosa and stages of carcinoma were analyzed in 565 primary patients for a period of 10 years. The study showed social and organization problems in the disease diagnosis: refusal of patients from medical consultation, unjustified omitting of examination of the oral cavity aimed at cancer detection during preventive examinations of the population and treatment of odontogenic diseases, erroneous interpretation of pathological changes in the buccal mucosa, unjustified long observation and treatment by non-oncological specialists, incompetence of physicians, etc. Approaches to optimization of diagnosis are outlined: improvement of the efficiency of preventive examinations by non-oncological specialists, specialized upgrading of dentists and increase of their professional responsibility, and early use of morphological methods of examination of pathological processes in the buccal mucosa.
OBJECTIVES: To compare the knowledge of tooth erosion in a sample of 12 year old children with that of the dentists responsible for their care and also to compare the giving and receiving of advice concerning erosion. METHOD: A random sample of 1753 children from all 62 state maintained schools in Leicestershire completed questionnaires. Questionnaires were also sent to the 257 General Dental Practitioners in Leicestershire. RESULTS: 1686 (96.2%) of children and 227 (82.5%) of dentists returned forms that could be analysed. 36% of dentists reported that they frequently noticed erosion on the teeth of their patients but 67.7% of dentists believed that less than 25% of 12 year olds had any erosion. 67.5% of dentists advised their patients about erosion only occasionally or rarely. Only 34.2% of the children had heard of tooth erosion and only 8.4% could recall their dentist mentioning the condition. 40% of children believed that the best way to avoid erosion was regular tooth brushing. CONCLUSION: The levels of awareness were low for both dentists and patients and the messages that were given by dentists were either forgotten or misunderstood by the children, or they were incorrect. Better communication and understanding is needed in this important area.
AIM: To gather information on root canal treatment carried out by dentists working in Flanders (Belgium). METHODOLOGY: A questionnaire was handed to 312 dentists attending peer review sessions organized by the Flemish Universities. Basic information (age, gender, year of graduation, practice profile) and information on various issues relating to the cleaning and shaping of root canals was collected. RESULTS: A total of 310 questionnaires were returned. The majority (85.7%) of respondents categorized themselves as general practitioners; 25.7% mentioned a clinical interest or speciality in practice. Most practitioners (64.5%) did not use rubber dam routinely during root canal treatment and performed treatment over two visits irrespective of the number of root canals. The majority of respondents (82.4%) used sodium hypochlorite as an irrigant, but 10.6% did not know the concentration they used; EDTA was used by 61.6%. The vast majority exposed a radiograph with an instrument of known length in situ to gauge the working length; only 3.6% relied on tactile sense; electronic root canal length determination was seldom used. Amongst the root canal instruments, K-files were used solely or in combination with other instruments by 60.3% of the respondents, reamers were used solely or in combination with other instruments by 55.4%. The stepback technique was used by 31.2% of the participants, a combination of stepdown and stepback by 26.4%, a reaming technique by 26.1% and the step-down technique by 14.7%. The majority were familiar with mechanical root canal Instruments. Almost half of the practitioners believed their preparation technique could be improved: only 1.3% felt that their procedures were poor. CONCLUSIONS: The results of this study indicate that the theoretical knowledge of dentists working in Flanders is good. However, the use of rubber dam remained low, half believed their preparation technique could be improved.
Using dentist characteristics, our aim was to evaluate the reasons for replacements of fillings, the age of failed restorations in the posterior teeth of young adults, and replacement rates. Altogether 205 patient records from the Public Oral Health Service of the City of Vantaa, Finland were evaluated. Patient age was restricted to between 25 and 30 years and type of tooth to posterior teeth only (third molars excluded). Information collected from the records included the patient's date of birth, latest DMFS and DMF, and the code for background data on the dentist. Details of each filled premolar and molar included the restorative material, location, and surface coverage of filling(s). The age of replacement of filling in premolar(s) or molar(s) was screened retrospectively from patient records. The total number of filled premolars and molars was 1873, with 1969 fillings. Forty percent of the patients had undergone replacement of filling in premolar(s) or molar(s). In all, 140 replacements had been made, accounting for 6.9% of amalgam fillings and 8.5% of tooth-colored fillings. Secondary caries, along with fractures, overhangs, and marginal discrepancy, was the most common reason for replacement. The mean age of failed amalgam fillings was 8.9 years (SD 5.2) and of failed tooth-colored fillings 2.4 years (SD 1.6). In the public sector, female dentists form the majority and their replacement rate for amalgam fillings was twice that of male dentists (7.6% vs 3.2%; P = 0.01).
OBJECTIVES: To identify the relationship between the preventive and restorative care provided to children who frequently attend the General Dental Service in the UK after taking into account socio-economic status, gender and dental caries experience. SETTING: General dental practices in the North West of England. SUBJECTS AND MATERIALS: The study design involved a retrospective investigation of case notes of 677 children who regularly attended 50 general dental practitioners. The complete history of the dental care received by each child during the primary dentition period was recorded. Analyses took place at the patient level. Information was recorded on the total number of carious teeth and restorative and preventive care provided to the children. Preventive care was categorised as dietary advice, oral hygiene instruction, prescription of fluoride tablets and application of fluoride varnish. Socio-economic status was measured using the Townsend score of the electoral ward of residence of each subject. Logistic regression models, taking into account the clustering of the subjects within dental practices were fitted to identify whether or not socio-economic status was significantly associated with provision of each category of preventive care, after controlling for gender, the total number of teeth affected by caries and the proportion of carious teeth which were restored. RESULTS: Children from poorer backgrounds were significantly more likely to receive oral hygiene instruction than their more affluent peers. Socio-economic status did not influence dentists' decisions to prescribe fluoride tablets, but children from affluent backgrounds were significantly more likely to have fluoride varnish applied to their teeth than children from deprived backgrounds after controlling for other factors. The more teeth affected by decay significantly increased the odds of giving dietary advice, prescription of fluoride tablets and application of fluoride varnish, but had no effect on whether or not oral hygiene instruction was given. As the percentage of decayed but filled teeth decreased the odds of giving dietary advice or applying fluoride varnish increased significantly. Conclusion It would appear that dentists are providing appropriate preventive care according to the aetiological causes of dental disease. They also look to be providing preventive care in compensation for decisions not to restore carious primary teeth. However the preventive care provided seems to be reactive to disease patterns, and in this high risk group of patients does not seem to be particularly effective.
When confronting a defiant or pre-co-operative young patient with extensive dental decay the dentist must decide between treatment under conscious sedation with passive restraint or general anaesthesia. Although some practitioners prefer to attempt and exhaust sedative techniques in most cases and use general anaesthesia as a last resort, many others do not mandate that alternate approaches first be attempted before treating under general anaesthesia and routinely recommend it as their first choice. What are the considerations involved in this decision-making process? Should the use of conscious sedation with restraint be revisited and perhaps even be considered the preferred method? What is the role of the dentist in the decision-making process? The purpose of this opinion-based paper is to present to the UK dentist a dilemma that paediatric dentists face in the US and in other countries as well and allow the reader to establish an opinion.