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PubMed2000

Third-party reimbursement and use of fluoride varnish in adults among general dentists in Washington State.

BACKGROUND: Studies have indicated that a minority of dentists regularly use fluoride varnish to control caries. To increase the use of this new technology, Washington Dental Service, or WDS, began reimbursing dentists for providing fluoride varnish in January 1996. The aim of the authors' study was to determine whether reimbursement increased dentists' use of fluoride varnish. METHODS: In the fall of 1995, the authors asked a random sample of 532 general dentists in Washington state to complete a mail questionnaire on their use of caries control services. The survey was conducted before the institution of payment for fluoride varnish use, and dentists were unaware that fluoride varnish use would be a paid service in January 1996. In the fall of 1997 the same dentists were asked to complete a second questionnaire on the same topic. RESULTS: About 32 percent of dentists used fluoride varnish regularly before WDS started reimbursement for the service. Two years after reimbursement began, about 44 percent of dentists regularly used fluoride varnish (P = .004). Dentists' rates of use of other caries-control services (chlorhexidine rinses for caries control and adult pit-and-fissure sealants) did not change. Dentists' reasons for not using fluoride varnish included lack of awareness, lack of convincing evidence of a favorable cost:benefit ratio, patients' rejection of the service and low caries risk among adult patients. CONCLUSIONS: After fluoride varnish became a covered benefit, the use of fluoride varnish among general dentists increased after two years, but a majority of dentists still had not adopted the technology. The increase in use may be due to reimbursement, as well as other factors. PRACTICE IMPLICATIONS: Reimbursement by itself cannot increase dentists' use of caries control services.

Adult↗

PubMedDate not supplied

Project USAP 2000--use of sedative agents by pediatric dentists: a 15-year follow-up survey.

PURPOSE: A national survey of members of the American Academy of Pediatric Dentistry was conducted to provide a 15-year update of information regarding the use of sedative agents by pediatric dentists. METHODS: All 3,315 active members of the Academy were sent questionnaires regarding the frequency of their use of sedation and 1,778 responded. Practitioners were questioned regarding their use of sedative agents and the nature of their patients receiving sedation. In addition, they were questioned in regard to their use of restraints and reasons for change in their use of sedation during the past two years. RESULTS: In regard to the use of nitrous oxide alone, 47% of practitioners responded that they use nitrous oxide less than 11% of the time. In regard to other types of sedative agents, most practitioners use little, if any, sedation. Eighty-two percent use sedation for less than 11% of their patients. Of the 1,778 respondents, 1,224 used drugs other than nitrous oxide. In a typical three-month period, they performed 77,112 sedations. Of that number, 61,662 (80%) were administered by only 478 practitioners who use sedation on the average of once or greater each day. CONCLUSIONS: In comparison with previous surveys in 1985, 1991 and 1995, these results demonstrate an overall increased use of sedation by pediatric dentists. However, the increased use is due primarily to an increase in the numbers of practitioners who are heavier users of sedation (once or greater each day).

Anesthesia, Dental↗

PubMed2006

Attitudes, beliefs, and infection control practices of Iranian dentists associated with HIV-positive patients.

Of the 309 private dental practitioners in Fars, Iran, surveyed most, 77.7% believed they had a professional duty to treat HIV-positive patients, with 61.4% expressing some level of discomfort about treating these patients, and 75.1% believed they should be treated at a specialist practice. Gloves and masks were not always worn, 15.8% and 9.7%, respectively, and 70.2% of dentist washed their hands before treatment and 60.2% after treatment. Elementary standard precautions were not routinely implemented in private dental practices, despite high levels of concerns about transmission of infection.

Adult↗

PubMedDate not supplied

Report of practicing dentists' activities which serve older people residing in Kentucky's nursing homes.

This state-wide study of dental consultants to nursing homes provides a "first ever" profile of this small but important field in dentistry. As the number of older people continues to grow, particularly in the 85+ age group (which is most likely to be housed in nursing home facilities), the dental profession needs to understand and appreciate its professional obligations to this group of "special" patients. While the data is not absolutely clear, it does appear that perhaps 50% of all of the nursing homes in Kentucky do not have regular staff dentists working with them. Surprisingly, no dental hygienists seemed to be working with dentists, even though they could be quite useful for several types of clinical services and could be a big help with family and staff education projects. Nursing home consultants are dedicated individuals in the middle of their careers. Although gerontology in general and nursing home care, in particular, is primarily a women's field, women dentists in Kentucky are not yet very active in this aspect of dental practice. The list of problems and frustrations facing dentists seems long and difficult to resolve. In spite of this, the dentists working with nursing homes have continued their relationship for many years. While some dentists support more than one nursing home facility, the majority of the dental consultants do limit their efforts to a single nursing home.

Aged↗

PubMed2004

An investigation into the use of bitewing radiography in children in Greater Glasgow.

AIM: In recent years there have been a number of reviews and guidelines published with respect to the diagnosis and management of caries in children. Bitewing radiography remains the recommended method of choice for caries diagnosis in most circumstances. The aims of the study were to investigate the usage of bitewing radiography by general dental practitioners (GDPs) in Greater Glasgow, for the diagnosis of caries in children and to assess the usefulness of the technique as perceived by these dental practitioners. DESIGN: A questionnaire for self completion was sent to all GDPs with an NHS list number in the Greater Glasgow area. RESULTS: An 80% response rate was obtained with 303 GDPs responding. Less than half the dentists (44%) indicated that they always carried out caries risk assessments for all children, but 71% reported doing this for 6 and 7-year-old children. Approximately 60% of dentists stated they had read the recent radiation and caries management guidelines. Only 72% stated that they used radiography as a caries diagnostic tool in children, with 12 GDPs (4%) indicating they would never consider using bitewing radiography in children. Only 17% would consider taking bitewing radiographs in children under 6 years, and the majority of dentists (61%) reported that they would first consider taking radiographs in the 6-11-year-old age group. However, only a low proportion of children in this age band had dental x-rays taken. Bitewing radiography was considered to be more important for 12-year-olds than for 6-year-olds. Recommended methods for decreasing radiation exposure such as rectangular collimation and film holders were not being used universally, with 41% and 58% respectively using these devices. CONCLUSIONS: A significant proportion of dentists in Greater Glasgow are not complying with recent guidelines and recommendations and it would appear that the value of bitewing radiography as a diagnostic tool in children is not being fully exploited.

Adolescent↗

PubMed1999

Restorative treatment decisions on approximal caries in Norway.

A random sample of dentists in Norway were asked which radiographic criterion for assessing the initiation of restorative treatment of approximal caries they would use, and which type of cavity preparation and filling material they would prefer for a distal lesion on an upper second premolar. Only 19 per cent stated that they would treat approximal lesions confined to enamel, with 81 per cent opting to wait until lesions had reached dentine, compared with 66 per cent in a similar study performed in 1983. The tunnel preparation was cited most often as the preparation of choice (47.3 per cent), while 28.2 per cent preferred traditional class II preparations and 24.3 per cent a saucer shaped preparation. Only 15.5 per cent of the dentists chose amalgam as the restorative, 15.8 per cent composite, 22.3 per cent a conventional glass ionomer cement, 7.2 per cent a resin modified glass ionomer cement and 22.4 per cent a combination of glass ionomer and composite. There has been a shift in operative treatment criteria among the majority of dentists in Norway from 1983 to 1995, with most now waiting until the lesion is diagnosed in dentine radiographically before restoring. Most dentists prefer new preparation techniques for approximal caries using tooth coloured materials. Only every fifth dentist has amalgam as a first choice for approximal restorations in the posterior region.

Adult↗

PubMed2006

Oral health care for frail elderly people: actual state and opinions of dentists towards a well-organised community approach.

OBJECTIVE: This study was undertaken to provide an analysis of the actual oral heath care for frail elderly people living in different settings and to explore opinions of dentists towards new concepts in developing a community approach. METHOD: Data were collected from a sample of 101 dentists (15%) in the county of Antwerp using a self-administered 30-item questionnaire including questions about age, gender, education, organisational aspects of dental surgery, questions concerning dentists' own contribution to oral healthcare services for frail elderly people and statements concerning opinions and attitude toward the organisation of oral health care for frail elderly people. At the same time, qualitative data were collected from focus group sessions with all participating dentists. Non-parametric analysis was used to explore possible relationships between opinion and possible explanatory variables. RESULTS: Half of the dentists offered dental services to residential or nursing homes (mean number of treatments a year: 5.4) and at home (mean number of treatments a year: 2.4). Prosthetic treatments such as relieving denture pressure points, repairing, rebasing and making new dentures were carried out in 77.4% and 76.7% of the cases in residential or nursing homes and at home respectively. Extractions were carried out in 16% and 18.6% of the cases in both living situations respectively. The main reasons for dentists refusing domiciliary oral health care were the absence of dental equipment (63%), lack of time (19%), with 11% convincing the patients to be treated in their dental surgery. Analysis showed different opinions of dentists depending on age, gender and university of education; however, statistically significant differences were only found by age. CONCLUSION: The older the dentist, the greater the tendency to refuse domiciliary oral healthcare services. The younger dentists were reluctant to cooperate in the provision of oral health care in a structured community approach.

Adult↗

PubMed2000

Myths of dental surgery in patients receiving anticoagulant therapy.

BACKGROUND: Continuous anticoagulant therapy with warfarin is administered to prevent a variety of medical complications, including thromboembolisms and stroke. When patients receiving continuous anticoagulant therapy are scheduled for dental surgery, a decision must be made whether to continue or interrupt the anticoagulant therapy. METHODS: The author reviewed the literature, focusing on dental surgery in patients receiving continuous anticoagulant therapy and in patients whose anticoagulant therapy was withdrawn before they underwent dental procedures. RESULTS: Of more than 950 patients receiving continuous anticoagulant therapy (including many whose anticoagulation levels were well above currently recommended therapeutic levels) who underwent more than 2,400 surgical procedures, only 12 (< 1.3 percent) required more than local measures to control hemorrhage. Only three of these patients (< 0.31 percent) had anticoagulation levels within or below currently recommended therapeutic levels. Of 526 patients who experienced 575 interruptions of continuous anticoagulant therapy, five (0.95 percent) suffered serious embolic complications; four of these patients died. CONCLUSIONS: Serious embolic complications, including death, were three times more likely to occur in patients whose anticoagulant therapy was interrupted than were bleeding complications in patients whose anticoagulant therapy was continued (and whose anticoagulation levels were within or below therapeutic levels). Interrupting therapeutic levels of continuous anticoagulation for dental surgery is not based on scientific fact, but seems to be based on its own mythology. CLINICAL IMPLICATIONS: Dentists should recommend that therapeutic levels of anticoagulation be continued for patients undergoing dental surgery. Practitioners should consult with the patient's physician if necessary to determine his or her level of anticoagulation before performing dental surgery.

Anticoagulants↗

PubMedDate not supplied

Prosthodontic decision making among general dentists in Sweden. I: The choice between crown therapy and filling.

PURPOSE: The purpose of this study was to analyze dentists' evaluations of factors related to the choice between crown therapy and filling and to possibly explain this by social and demographic attributes, job situation, and dentists' attitudes. MATERIALS AND METHODS: Questionnaires were sent to a random sample of 2,059 Swedish dentists. The response rate was 76%. In the questionnaire the choice between crown therapy and filling in a clinical situation was presented. The dentists were asked to mark their assessments of the relative importance of the different items on 14-item visual analogue scales (VAS). Multiple regressions were run for all 14 items. RESULTS: Large individual variations were seen among the dentists regarding the stated importance of the various items. The items rated as the most important were "patient's wish" and "treatment prognosis," and the items rated as least important were "treatment time required" and "number of visits required for treatment." The differences between groups were small, and for no item exceeded 0.7 step on the 8-grade VAS scale. No data reduction was possible using principal components analysis. CONCLUSION: The study showed great variations among individual dentists. The dentist-related factors explained little of the variance. The results indicated that the questionnaire instrument did not fully capture the real influences on the treatment choice between a filling and an artificial crown.

Adult↗

PubMedDate not supplied

Rural versus urban analysis of dental procedures provided to Virginia Medicaid recipients.

PURPOSE: The purpose of this study was to report the distribution of procedures provided to Virginia Medicaid children by 3 types of dental providers in rural and urban areas. METHODS: Medicaid claims filed for dental patients less than 21 years old were obtained and analyzed for fiscal years 1994-1995. Dental providers were categorized according to their practice type: (1) general practice (GP); (2) pediatric (PD); and (3) public health (PH) dentists. Each type of practice was categorized as practicing in a metropolitan, urban, rural, or completely rural location and evaluated for percentages of preventive, diagnostic, and corrective services provided. RESULTS: Rural areas had a higher percentage of significant providers than did metropolitan or urban areas. General dentists performed more diagnostic and preventive but fewer corrective procedures than pediatric dentists. Pediatric dentists and general dentists in completely rural areas performed more corrective procedures than their counterparts in metropolitan or urban areas. CONCLUSIONS: General, pediatric, and public health dentists in metropolitan and urban areas perform slightly more diagnostic services and fewer corrective services than practitioners in more rural areas.

Adolescent↗

PubMed1998

Making a clinical decision for vital tooth bleaching: at-home or in-office?

The dramatic increase in public demand for esthetic dentistry and tooth bleaching has encouraged development and resulted in new products and eltasdeltaues. Vital tooth bleaching, including in-office bleaching and at-home bleaching, has been adopted as an effective and safe method for whitening natural dentition. Although most dentists prefer at-home bleaching, nearly one third use in-office bleaching. Continuous improvements in bleaching products and delivery systems have made in-office bleaching more practical and predictable. This article discusses the practical applications of vital tooth bleaching, as well as the advantages and disadvantages of each method.

Adult↗

PubMed2003

Factors associated with diagnostic delay of oral squamous cell carcinoma.

Shortening the diagnostic delay from the onset of symptoms to the final diagnosis leads to early cancer detection and a reduced incidence of advanced cases. To analyze factors contributing to delays in the diagnosis of oral cancer, information was collected from the medical charts of 152 consecutive patients with oral squamous cell carcinoma, and factors associated with diagnostic delay were examined retrospectively. No characteristic was significantly associated with delay caused by patients. Referral by a non-initial professional, initial visit to a dentist, T1 cancer, and the presence of an ulcerative lesion were significantly associated with delay caused by the initial professionals. Patients with N0 were significantly associated with diagnostic delay caused by the final professional. These results re-emphasize the important role of the initial professional, particularly the dentist, and the diagnostic difficulty posed by ulcerative lesions and small-sized or early-stage oral cancer.

Adult↗

PubMed2002

Management of impacted third molars among Nigerian dentists.

Seventy-five Nigerian dentists were interviewed on their approach to the management of impacted third molars. The mean age of the dentists was 34.8 years, with a male/female ratio of 3.4:1. Most of the female dentists were found in the training institutions (p = 0.005). More than half of the dentists (58.7%) practiced in institutions with dental schools (training institutions), majority preferred the buccal approach (92%), and all the dentists (100%) preferred third molar disimpaction under local analgesia. Most dentists (88%) prescribe antibiotics following third molar surgery. Fifty dentists (66.7%) routinely reviewed all patients postoperatively while 12 dentists (16%) were of the opinion that all impacted third molars should be extracted. Only 21 dentists (28%) were aware of any protocol on the management of impacted teeth. More dentists in the training institutions performed third molar surgery less frequently than dentists in other hospitals (p = 0.07) who tend to employ chisels/mallet for bone removal (p = 0.0004). The need for continuing education and the formulation of guidelines in order to assist dentists to make informed decisions is emphasised. This will help conserve scarce resources and enhance the operation of the newly introduced National Health Insurance Scheme.

Adult↗

PubMed2005

Categorisation of dental care provided in the Netherlands.

OBJECTIVE: To describe the dental care provided in the Netherlands and investigate to what extent variations can be explained in accordance with certain general characteristics of patients. METHOD: Besides the more usual classification of treatment into groups of dental procedures, in this study it is done using constructed categorisation of dental care based on characteristics such as 'preventive', 'curative', 'new', 'time-consuming', 'complicated' and 'lucrative' treatment. The data were collected from various groups of dentists. Two smaller groups of dentists-informants were asked to categorise dental procedures: 16 out of 55 (29%) and 57 out of 150 (38%). Finally this resulted in six type-scores for each procedure. From another larger group of dentists (n = 607) data were collected about the procedures they performed on a 25% random sample of their patients. Categorisations of dental care per patient were calculated by combining the data on the factual procedures performed with the six 'type-scores' for the procedures concerned. Furthermore, the financial returns dentists generated per patient were calculated from the care they provided. RESULTS: Multilevel analysis shows that considerable variation exists in the categorisations of dental care provided according to age, gender, insurance situation and income level of patients. In youths, for example, relatively more 'preventive' and less 'curative', 'complicated' and 'lucrative' treatment is done and 'older' adults receive relatively less 'preventive' and more 'curative', 'time-consuming' and 'complicated' treatment. CONCLUSIONS: By classifying the dental care provided in certain categories, a general view is obtained of the variations between patients in the care provided. The age of patients appears to be the most critical factor, but there are differences among dentists in the way the age of patients influences their conduct in the provision of dental care.

Adolescent↗

PubMedDate not supplied

Disinfection/sterilization in U.S. dental practices--practice behavior and attitudes.

In an era when we are experiencing an increased awareness of communicable infectious diseases such as tuberculosis and hepatitis B, and in which stories regarding the fear of the spread of the HIV virus receive almost nightly news coverage, all health care professionals are taking extra precautions when providing care to patients. The concern of occupational transmission of infectious diseases from the perspective of patient to health care worker is not new. However, the sensationalized singular instance of a dentist in Florida who reportedly transmitted the HIV virus to five of his patients raises questions about the possibility of health care worker to patient transmission and puts the spotlight on the dental community.

Attitude of Health Personnel↗

PubMed2002

Case selection for apical surgery: a retrospective evaluation of associated factors and rational.

Endodontic failures associated with poor quality of endodontics respond favorably to retreatment. Nevertheless, under certain clinical conditions, apicoectomy should be the preferred procedure. A retrospective survey of 200 roots that were referred for apical surgery revealed that 83% of the roots were inadequately obturated, including 8.5% with no root canal filling at all. In 49 of the roots in this group (24.5% of the referred cases) nonsurgical retreatment was judged by an endodontist as either impossible or improbable because it might jeopardize the root integrity. Retreatment should have been the preferred treatment modality for the rest of the group, provided that coronal restorations could be safely bypassed or removed. Posts were found in 63 of these teeth, however 35 of them were either short or loosely fitting and could safely be removed. The rest of the posts were longer than 5 mm, which might have presented a problem if their removal was attempted. In 45% of the 200 cases in the present study, surgical intervention was justified. The rest of the cases (55%) should have either been subjected to a follow-up (10.5%) or retreated nonsurgically by a skilled endodontist (44.5%). These results indicate that referring dentists may not appreciate the retreatment possibilities offered by modern endodontics, and they emphasize the need for a shift of concept: endodontists should be involved in the decision making before referring a patient to surgery.

Apicoectomy↗

PubMed2002

Influence of patient characteristics on Finnish dentists' decision-making in implant therapy.

The purpose of this survey was to evaluate the association of various patient characteristics or possible contraindications with dentists' treatment decisions in oral implantology among general practitioners (GPs) and dental teachers (DTs) in Finland. A questionnaire was mailed to 400 GPs, selected by stratified randomization by gender and main occupation (public vs private sector), and to all full-time DTs (n = 47) representing clinical disciplines other than surgery and orthodontics. The questionnaire included a clinical description of a situation optimal for implant therapy. The same situation was modified with 10 variations (cases) according to patient characteristics or possible contraindications, later classified into three categories: (1) oral factors, (2) medical factors, and (3) personal factors. Respondents were asked whether or not they would recommend implant therapy for each of the cases separately. For all 10 cases, the public sector dentists recommended implant therapy on average for 48%, the private sector dentists for 57% (P < 0.01), and the DTs for 50%. For cases with periodontal pockets or untreated caries lesions, the private sector dentists recommended implant therapy more frequently than did the public sector dentists (27 vs 16%, P = 0.01, 46 vs 26%, P = 0.000, respectively). In the case of a smoking patient, 15% of DTs, but almost half of the GPs, recommended implant therapy (P = 0.002). Because some treatment decisions in implant therapy varied so widely between the dentist groups surveyed, a national database of dental implants would offer an important forum for the sharing of information and evidence among clinicians in various countries.

Adult↗

PubMed1997

An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 2: Dentists' knowledge of management methods and their perceptions of barriers to providing care.

AIM: To assess dentists' knowledge of and perceived barriers to treatment of dental injuries. DESIGN: Cross-sectional postal questionnaire and personal interview. SUBJECTS AND METHODS: Questionnaires from 153 GDPs and 53 CDOs were received giving details of emergency options on 17 imaginary dental injuries and perceived barriers to treatment of trauma. Structured interviews with 21 of the GDPs and 19 CDOs seeking knowledge on diagnosis and long-term follow-up and treatment took place. Age and gender of dentist, type of practice and postgraduate courses attended were noted. MAIN OUTCOME MEASURES: Mean knowledge scores. RESULTS: Of a maximum of 14 correct responses on emergency treatment of injured teeth the mean was 7.5. Only 19% knew for how long avulsed teeth should be splinted. Of a maximum of 37 correct responses on long-term follow-up of treatment the mean was 15.4. Only 10% would correctly treat acute abscess on a traumatised tooth. 82% of dentists thought dental trauma should be treated in the primary care service, but 86% of GDPs thought fees for this type of treatment were too low. 72% of CDOs thought the treatment occupied too much clinic time and was not the responsibility of the CDS. CONCLUSIONS: Dentists in the primary care sector have insufficient knowledge to treat dental trauma.

Adolescent↗