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PubMed2005

On the primary care frontlines: the role of the general practitioner in smoking-cessation activities and diabetes management.

BACKGROUND: Advances in understanding the relationship between oral disease and systemic conditions need to be translated into clinical practice. Relevant here is assessing dentists' active involvement in in-office smoking-cessation activities and management of the patient with type 1 or type 2 diabetes. METHODS: The authors mailed a survey to a net sample of 132 active general practitioners (GPs) in the northeastern United States during fall 2002. They drew a random sample of GPs listed in the designated states from the 2001 American Dental Association directory. They received 105 responses, for a response rate of 80 percent. RESULTS: With regard to smoking-cessation activities and management of diabetic patients, a majority of GPs reported having a lack of knowledge, viewed such activities as peripheral to their role and disagreed that colleagues and/or patients expected them to perform such activities. More GPs performed both activities on an assessing/advising basis than on an active management basis. CONCLUSION: Results suggest that approaches to changing dentists' behavior should aim not only at increasing knowledge but at overcoming attitudes and orientations associated with actively managing patients who smoke and patients who have diabetes. PRACTICE IMPLICATIONS: The profession's growing evidence base supports an increased primary and preventive care role for dentists. This role affords them opportunities to expand the bounds of dental practice, improve therapeutic outcomes and promote patients' overall health.

Attitude of Health Personnel↗

PubMed1998

Levels of restorative care under capitation.

OBJECTIVES: 1. To compare the prevalences of fissure sealants in similar groups of 14-15-year-old, regularly-attending patients treated under fee-for-service in 1989 and capitation in 1994. 2. To calculate the effect of including sealants in the restorative index on estimates of interventional treatment carried out on 14-15-year-old regularly attending patients treated by general dental practitioners in 1994. DESIGN: A randomised epidemiological study. SETTING: Secondary schools in the Wycombe, Doncaster and Hereford/Worcester areas. METHOD: Random samples of 14-15-year-old, regularly attending patients treated by dentists practising under capitation in three contrasting areas of England were examined in 1994 for the presence of decayed, missing and filled teeth and fissure sealants. Restorative indices were calculated with and without the inclusion of sealants. The latter were compared with restorative indices calculated without the inclusion of sealants on regularly attending patients of the same age group when the dentists in the same three areas were working under fee-for-service in 1989. RESULTS: The prevalence of fissure sealants increased between 1989 and 1994 from 16% to 30% in Wycombe, from 13% to 50% in Doncaster and from 25% to 47% in Hereford/Worcester. Without fissure sealants the restorative indices fell between 1989 and 1994 from a range of 76.5-94.4 to 63.3-87.1. When sealants were included in the restorative indices for 1994, they ranged from 79.5-92.9. CONCLUSIONS: There were increases in the prevalences of fissure sealants between 1989-1994. When these sealants were included in the calculation of restorative indices for 1994, the level of restorative care provided by general dental practitioners remained relatively high since the introduction of capitation. Although there has been some increase in the level of untreated disease, if the restorative index is calculated without the inclusion of sealants then there is a risk of underestimating the treatment provided by general dental practitioners to control the carious process. Dentists appear to be redirecting their efforts into newer treatment/preventive items.

Adolescent↗

PubMed1998

A practice-based study on stepwise excavation of deep carious lesions in permanent teeth: a 1-year follow-up study.

This study reports results from a practice-based study in which deep carious lesions were treated by general dental practitioners using stepwise excavation. The material comprised 94 teeth with deep carious lesions which the clinicians considered would result in pulp perforation if treated by a single and terminal excavation. At the first visit excavation of the peripheral dentine was completed. The outermost part of the central and necrotic dentine was gently removed with a sharp excavator. Standardized assessments of the dentine colour and consistency were made before application of a calcium hydroxide-containing base material and temporary filling. The final excavation was completed after a treatment interval ranging from 2 to 19 months, with a median of 6 months. Reassessments of the dentine colour and consistency were made before complete removal of demineralized dentine. The central dentine was significantly browner and less softened after the sealing period. After removal of the dark-brownish dentine during the final excavation, the colour and consistency of the exposed central dentine was found to resemble that of the completely excavated peripheral dentine. Only five cases resulted in pulp perforation during the final excavation. The high success rate of teeth surviving the final treatment without pulp exposure after 1 year of observation shows that it was possible for dentists in general practice to administer and manage the treatment of deep carious lesions, a process which may prolong tooth survival compared with conventional endodontic techniques.

Adolescent↗

PubMed2004

The impact of course attendance on the practice of dentists.

INTRODUCTION: This paper reports the impact of course attendance on the practice of dentists. METHOD: Phase One: A survey sent to all general dental practitioners (GDPs) in three deaneries in England. The survey included self-ratings of the impact of course attendance on practice. Phase Two: Interviews with 20 dentists before and two to three months after they had participated in a self-selected course. The response rate to the survey was 54% (n = 2082). Comparisons with national data showed no notable bias in the sample for gender, owners/partners and age/experience. An ordered logit model was used to explore the net effect of factors (including years' experience in general dental practice and gender) on dentists' ratings of course impact. RESULTS: Course attendance was judged to impact on practice. Impact rating was affected by participation rate and years' experience. Barriers to implementation included cost, time, NHS constraints and personal or staff issues. Impact was enhanced when selection of courses was based on learning needs although courses may also serve usefully to confirm current practice. CONCLUSION: There is much that dentists themselves can do to enhance the impact of courses, principally by reflecting on learning needs. They should be supported in the development of personal learning plans.

Education, Dental, Continuing↗

PubMed2000

Oral pharyngeal cancer prevention and early detection. Dentists' opinions and practices.

BACKGROUND: The five-year survival rate for patients in the United States diagnosed with oral pharyngeal cancer is 52 percent, which suggests that these cancers are diagnosed at late stages. The authors conducted this study to determine U.S. dentists' opinions and practices regarding oral cancer prevention and early detection. METHODS: The authors mailed a pretested survey to 7,000 randomly selected general practitioners. A total of 3,200 dentists provided information on how they conduct oral cancer examinations, their use of health history questions to assess patients' oral cancer risks and their oral cancer training and practices. The authors carried out analyses using unweighted data; both bivariate and logistic analytical techniques at a P < or = .01 level of significance were used. RESULTS: On average, dentists assessed about five of the eight health history items on the survey. Eighty-six percent indicated that they did not conduct oral cancer examinations on edentulous patients 18 years of age or older; 81 percent, however, reported that they conducted oral cancer examinations for 100 percent of their patients 40 years of age or older on their initial appointment. CONCLUSIONS: The reported practices of these dentists regarding oral cancer, in conjunction with their opinions about key aspects of these practices and their training, point to a need for systematic educational updates in oral cancer prevention and early detection. CLINICAL IMPLICATIONS: Dentists need to determine their patients' risks for oral cancers and provide routine and comprehensive oral cancer examinations.

Age Factors↗

PubMed2005

Evaluation of the personal dental services (wave 1) for Lambeth, Southwark and Lewisham primary care trusts--Part 2: Retrospective analyses of treatment and other dental record data.

AIM/OBJECTIVE: The purpose of the study was to undertake analyses of treatment data for the Personal Dental Services (PDS) of Lambeth, Southwark and Lewisham Primary Care Trusts and relate the analyses to the PDS goals of supporting practitioners deliver appropriate quality dental care and ensuring that appropriate quality safety net services are available for all residents. METHOD: Analyses of treatment data provided by the Dental Practice Board were undertaken for the post-PDS period (February 1999-March 2003, based on data availability). Analyses of the clinic notes for 1500 patients were also undertaken for the 1 year pre-PDS period (October 1997-September 1998) and post-introduction of the PDS (October 1998-June 2003). Two sets of analyses were undertaken to evaluate trends in treatment claims for the Dental Practice Board data, absolute numbers of each type of treatment claimed each month and change in numbers of types of treatments claimed over time. The clinic notes were used to undertake post-PDS, pre-PDS comparisons of the number of treatment items and grouped treatment item categories undertaken and the number of courses and percentages of private treatment items provided. The following sociodemographic characteristics of the patients were also analysed, age, gender, exemption status and attendance status. RESULTS: Overall it was identified that the percentage reduction in the number of treatment items undertaken was 13% (95% CI -19%, -7%), post- as compared to the pre-PDS introduction period. On an annual basis it was identified that the percentage reduction in the number of treatment items undertaken per year per patient post-PDS was 4% (95% CI -6%, -2%). There were significant variations in the impact of the PDS on the number of treatment items undertaken for different types of patients. A limited number of treatment types changed significantly post- as compared to pre-PDS. The proportion of exempt patients treated did not increase post-PDS. CONCLUSIONS: It is possible that a less invasive style of dental treatment was provided during the course of the PDS, however, there was only limited evidence to indicate that dentists practice style changed based on types of treatment categories provided. The PDS provided a limited safety net service for local residents. In setting program goals the nature of quality dental practice requires definition and evaluation should be undertaken on a prospective basis.

Adult↗

PubMed2005

Brazilian dentists' restorative treatment decisions.

PURPOSE: To investigate the pattern of decision-making by southern Brazilian dentists regarding the use of restorations in the treatment of dental caries. MATERIALS AND METHODS: A cross-sectional survey involving 840 dentists, randomly selected in three southern Brazilian states, was performed. Telephone interviews were conducted by three previously trained dentists, in which clinical situations with different-depth radiolucencies, based upon bitewing radiographs, were described. Two other situations, including dark fissures and white spots, were also described. The main outcome measures were the tendency in clinical decision-making in comparison with the number of years elapsed since qualification and attendance on postgraduate courses. RESULTS: The overall response rate was 89.4%: 31.5% of dentists would restore cavities in the outer half of the enamel; 54.5% when the cavity reached the inner half of the enamel, but not the enamel-dentine junction (EDJ); 79.0% when cavities reached the EDJ; and 96.9% when cavities reached the outer half of the dentine. Furthermore, 21.8% of dentists would restore dark fissures without signs of demineralization. Dentists qualified for less than 10 years and those who had attended postgraduate courses were less interventionist. CONCLUSION: It was concluded that dentists have an interventionist attitude in the making of treatment decisions for dental caries and may be over-treating in several situations.

Adult↗

PubMed2001

The use of dental anxiety questionnaires: a survey of a group of UK dental practitioners.

AIM: To determine the frequency of use of dental anxiety assessment questionnaires and factors associated with their use in a group of UK dental practitioners. METHOD: A postal questionnaire to all 328 dentists whose names appear in the British Society for Behavioural Sciences in Dentistry Directory. Information collected for each practitioner included gender, year of qualification, type of practice in which anxious dental patients were treated, treatment used to manage anxious dental patients, type and frequency of use of dental anxiety assessment indices. RESULTS: Questionnaires were returned from 275 (84%) practitioners. 269 were analyzed. Only 54 practitioners (20%) used adult dental anxiety assessment questionnaires and only 46 (17%) used child dental anxiety assessment questionnaires. Male practitioners were more likely to report questionnaire use in comparison with females (P< 0.05), when treating dentally anxious adults (26% v 14%). In addition, practitioners providing intravenous sedation were more likely to use an adult dental anxiety questionnaire (P < 0.04) than those who did not use intravenous sedation (29% v 15%). The type of treatment provided had a significant association with the use of child dental anxiety. Those providing general anaesthesia (P = 0.03) and hypnosis (P = 0.01) for dentally anxious children were more inclined to use a questionnaire. CONCLUSION: The use of pre-treatment dental anxiety assessment questionnaires was low in this group of dentists. Male practitioners and those providing intravenous sedation, general anaesthesia or hypnosis seem more likely to use dental anxiety assessment questionnaires.

Adult↗

PubMed2004

Dental nomograms for benchmarking based on the study of health in Pomerania data set.

AIM: Benchmarking is a means of setting goals or targets. On an oral health level, it denotes retaining more teeth and/or improving the quality of life. The goal of this pilot investigation was to assess whether the data generated by a population-based study (SHIP 0) can be used as a benchmark data set to characterize different practice profiles. MATERIAL AND METHODS: The data collected in the population-based study SHIP (n=4310) in eastern Germany were used to generate nomograms of tooth loss, attachment loss, and probing depth. The nomograms included twelve 5-year age strata (20-79 years) presented as quartiles, and additional percentiles of the dental parameters for each age group. Cross-sectional data from a conventional dental office (n=186) and from a periodontology unit (n=130, Greifswald) in the study region as well as longitudinal data set of a another periodontology unit (n=135, Kiel) were utilized in order to verify whether the given practice profile was accurately reflected by the nomogram. RESULTS: In terms of tooth loss, the data from the conventional dental office agree with the median from the nomogram. For attachment loss and probing depth, some age groups yielded slight but not uniform deviations from the median. Cross-sectional data from the periodontology unit Greifswald showed attachment loss higher than the median in younger but not in older age groups. The probing depth was uniformly less than the median and tended toward the 25th percentile with increasing age. The longitudinal data of the Unit of Periodontology in Kiel showed a pronounced trend towards higher percentiles of residual teeth, meaning that the patients retained more teeth. CONCLUSION: The profile of the Pomeranian dental office does not deviate noticeably from the population-based nomograms. The higher attachment loss of the Unit of Periodontology in Greifswald in younger age strata clearly reflects their selection because of periodontal disease; the combination of higher attachment loss and decreased probing depth may reflect the success of the treatment. The tendency of attachment loss towards the median with increasing age may indicate that the Unit of Periodontology in Greifswald does not fulfill its function as a special care unit in the older subjects. The longitudinal data set of the Unit of Periodontology in Kiel impressively reflects the potential of population-based data sets as a means for benchmarking. Thus, nomograms can help to determine the practice profile, potentially yielding benefits for the dentist, health insurance company, or--as in the case of the special care unit--public health research.

Adult↗

PubMed1999

[Prescription of drugs of systemic use by dentists].

OBJECTIVE: The study of the prescription pattern of antibacterial and analgesic/antiinflammatory systemic medication by dentists. METHODS: Observational study based in questionnaires answered by a representative, randomly selected sample of 163 general dentists from the Metropolitan Region of Belo Horizonte, Southeastern Brazil. Some of the topics verified were: the most frequently prescribed drugs in the fortnight prior to the study, the use of generic names of drugs in the prescriptions, attendance at refresher courses on pharmacology, self-assessment of degree of knowledge on pharmacology, the importance given to this subject in the dentist's professional career, and the filling out of the clinical chart and the registration of the drugs prescribed on it. RESULTS: It was observed that the drugs were usually prescribed by their commercial name. There were a trend to prescribe more antiinflamatory than analgesics drugs. A small, but worrying, 13% of dentists didnot fill out the clinical chart for all the patients and 43% of the sample didnot register the drugs prescribed on it. The courses on pharmacology seemed to produce no significant alteration in self valuation as to the degree of knowledge in pharmacology and the use of the generic names of drugs.

Analgesics↗

PubMed2000

A survey of antibiotic use in dentistry.

BACKGROUND: Antibiotics are important in the management and prophylaxis of infection in patients at risk of experiencing microbial disease. As a result of the increase in antimicrobial resistance, the authors conducted a survey to assess current antibiotic use in dental practice. METHODS: The authors mailed a two-page, pretested survey to all licensed dental practitioners in British Columbia, Canada. A total of 2,542 surveys were mailed; 19.9 percent were returned by fax or mail. The authors examined an association between factors analyzed using a chi 2 test. RESULTS: Respondents were demographically consistent with all registered dentists in British Columbia. They reported writing an average of 4.45 prescriptions per week. Antibiotics prescribed after treatment primarily were penicillin and its derivatives. Recommended adult doses of penicillin were prescribed by 59.2 percent of respondents; recommended daily doses of amoxicillin were prescribed by 72.2 percent of respondents. The average prescription duration was 6.92 days. Respondents prescribed prophylactic antibiotics an average of 1.15 times per week for prophylaxis of bacterial endocarditis; 17.5 percent reported postoperative dosing for prophylaxis, ranging from a one- to seven-day prescription with an average of 6.91 postoperative doses. Preoperative antibiotics were prescribed for patients with a history of rheumatic fever or any heart murmur or prosthetic hip. Antibiotics were prescribed more frequently for surgical procedures and patients with acquired immunodeficiency syndrome than for other circumstances. CONCLUSIONS: More than 80 percent of respondents reported that they followed current American Heart Association prophylaxis guidelines. The authors, however, noted discrepancies in prophylactic use of antibiotics for bacterial endocarditis and for patients with large joint prostheses, as well as in prescribing antibiotics in the presence of clinical infection. In therapeutic use, approximately 85 percent of respondents followed appropriate prescription guidelines for dosing and duration of therapy. CLINICAL IMPLICATIONS: Appropriate and correct use of antibiotics is essential to ensure that effective and safe treatment is available and that practices that may enhance microbial resistance are avoided. To improve standards of care, dentists need up-to-date pharmacology in dental education, as well as continuing education, further outcome studies and continuous assessment of dental practices.

Adult↗

PubMed2001

Dentists' decisions on prophylactic removal of mandibular third molars: a 10-year follow-up study.

OBJECTIVES: In recent years, several critical outcome studies concerning the prophylactic removal of mandibular third molars have been published. These would appear to motivate a more restrictive approach today as compared with 10 years ago. The aim of the present study was to examine dentists' decisions on the prophylactic removal of impacted mandibular third molars over a 10-year period. METHODS: Thirty-six cases were selected so as to represent an equal distribution of males and females, ages, angular position and degree of impaction of the molar. Twenty-six general dental practitioners (GDPs) and 10 oral surgeons judged the same cases on two occasions 10 years apart. RESULTS: Calculated for each category of dentists, there was no significant difference in the mean number of molars designated for removal between the two occasions. Two GDPs and three oral surgeons presented a higher removal rate, whereas five GDPs presented a lower removal rate on the second occasion as compared to the first one. The dentists presented a considerable interindividual variation in removal rate, between 0 and 22 molars on the first occasion and between 0 and 25 molars on the second occasion. CONCLUSION: In the decisions on prophylactic removal of mandibular third molars, there has been no change over the last 10 years towards a more noninterventionist attitude. Thus, the dentists seem not to have been influenced by the evidence that this intervention is not cost-effective.

Adult↗

PubMed2004

French dentists' restorative treatment decisions.

PURPOSE: Variations in decision-making about restorative treatments have been demonstrated among dentists in several countries. This study sought to assess the restorative treatment philosophies based on a representative sample of French dentists. MATERIALS AND METHODS: A sample (n = 2000) was randomly extracted from a national list (n = 42,000). Each dentist received a questionnaire, illustrations of carious conditions, and a reply-paid envelope. The questionnaire assessed the stage of lesion progression at which the respondents considered restorative treatment appropriate, their choice of restorative technique and dental material. For all questions, an imaginary 20-year-old patient with low caries activity was described. RESULTS: After one reminder, the response rate was 40%. Almost half of the respondents would restore an occlusal lesion confined to enamel and 88% would have prepared a cavity for a proximal lesion at the amelo-dentinal junction. The majority of the respondents would not use the Black concepts for cavity preparation. Their preferred restorative material was composite. CONCLUSIONS: Answers indicated a tendency towards early restorative intervention and showed large variations between the treatment decisions of French dentists.

Adult↗

PubMed2005

Medicolegal aspects of replanting permanent teeth.

Replantation of a permanent tooth is an intervention that carries the same responsibilities in terms of informed consent as a surgical procedure. Unlike many procedures that can be planned in advance, an avulsion requires decision-making shortly after the injury, often by a distraught patient or parent. Under these circumstances, patients or parents prefer, or may even pressure, clinicians to make the replantation decision for them.Later, the parents may seek advice of other professionals or be confronted by lay opinions or Internet information that may lead them to doubt the decision or even feel betrayed by the dentist who provided the acute care. This article uses an actual parent complaint to illustrate the medicolegal aspects of the replantation decision and describe measures to be taken by the clinician faced with this situation.

Child↗

PubMed2006

Sedation in Wales: a questionnaire.

AIM: To identify the current provision of sedation in primary dental care in Wales. DESIGN: Postal questionnaire survey. SETTING: Wales 2003. SUBJECTS AND MATERIALS: Questionnaires were sent to all dentists appearing on the Dentists Register with addresses in Wales (n = 1374). The questionnaires sought details on personal status, use of and training in conscious sedation techniques. RESULTS: In total 951 (69%) questionnaires were returned, 720 (90%) respondents worked in a primary dental care setting. Only 87 (12.1%) primary care dentists offered some form of sedation. CONCLUSIONS: The provision of conscious sedation services in primary dental care in Wales is poor.

Administration, Inhalation↗

PubMed2005

Uptake of rotary NiTi technology within Australia.

BACKGROUND: Rotary NiTi technology was introduced into Australia approximately 10 years ago. Little information is available in the dental literature to explain the adoption of new technology in dentistry. The aim of this paper is to identify and describe demographic features in the uptake of rotary NiTi technology within Australia. METHODS: In 2001, a questionnaire survey was mailed to a stratified systematic sample of general dentists and endodontists in Australia. The numbers of dentists in each state adopting the new technology were recorded and the results tabulated and graphed. RESULTS: The response rate for the survey was 87 per cent. Overall, 26 per cent of responders used rotary NiTi instruments with a significantly higher proportion of endodontists (64 per cent) than general dentists (22 per cent). A significantly lower proportion of South Australian metropolitan general dentists used rotary NiTi compared with metropolitan dentists in all other states combined. The rate of uptake by South Australian dentists was lower than the other states. A significantly higher proportion of Queensland endodontists were using rotary NiTi compared with endodontists in New South Wales. A significantly greater proportion of rural dentists had tried and abandoned the new technology than metropolitan dentists. CONCLUSIONS: The adoption of rotary NiTi in Australia appears to conform to diffusion of innovation theory and has reached a critical mass making it self-sustaining.

Attitude of Health Personnel↗

PubMed2005

An audit of study casts used to monitor tooth wear in general practice.

OBJECTIVE: To assess the outcome of compliance of advice sent to patients and dentists about monitoring tooth wear in general practice. METHOD: Postal questionnaires were sent to 70 patients and their dentists requesting information on the outcome of letters of advice sent to general dental practitioners regarding monitoring tooth wear with study casts. They also requested information about the reasons for the patients' referral, the outcome of treatment and whether study models had been taken. RESULTS: Replies were received from 60 dentists (87%) and 53 patients (75%). Of these, 16 patients and 16 dentists had moved from their recorded address. Study casts were reported as having been taken by 23 dentists (38%) and reported by 18 patients (34%). The most common reason for referral was advice about monitoring the wear and the appearance of their teeth. CONCLUSIONS: The compliance of the patients and dentists in monitoring tooth wear by using study casts in general practice was not successful. It raises issues regarding the value of consultant advice letters to this common clinical problem.

Adult↗

PubMed2000

Dentists' judgment strategies on prophylactic removal of mandibular third molars.

The number of molars selected for prophylactic removal varies widely among general dental practitioners and oral surgeons. To understand the basis for such variations, we investigated two hypotheses: (1) Individual judgment strategies will differ concerning the use of cues (items of information), and (2) few dentists will integrate the cues according to evidence in the literature. To analyze 30 general dental practitioners' (GDPs) and 10 oral surgeons' use of cues in the judgment preceding the treatment decision, we used the Brunwik's lens as a conceptual model. The cues were the patient's age, and the angular position and the degree of impaction of the molar. The clinical situation was simulated by written case descriptions. The proportion of variation explained by the cues and their combinations (total model) varied between 61% and 100% and between 4% and 76% as main effects. Two GDPs and one oral surgeon integrated the cues additively, i.e., any of the cues is independent of the other cues in the judgment. In general, the dentists integrated the cues interactively, i.e., the impact of one cue depends on the levels of some other cues. Even though most variations in judgments were accounted for by the cues, the dentists did not integrate the cues according to evidence in the literature and lacked insight into their decision-making thought processes.

Adult↗