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PubMed2000

Dental service rates: age, period, and cohort effects.

OBJECTIVE: Variation in dental service provision over time has been related to changes in factors such as oral health and demographics. Dentist factors such as age and cohort effects are also potential sources of influence. The aim of the study was to examine the operation of age, period, and cohort factors on variation in service rates. BASIC RESEARCH DESIGN: data were collected by a mailed survey of a random sample of 10% of male and 40% of female dentists from each state/territory of Australia in 1983-84, 1988-89. and 1993-94 with response rates of 73, 75 and 74% respectively. MAIN OUTCOME MEASURES: Data on main areas of service were obtained from a log of service items provided on a typical day. RESULTS: Poisson regressions of rates for the 10 main areas of service over time showed increased rates over the study period for diagnostic, preventive, endodontic, crown and bridge, general/miscellaneous and orthodontic services, and decreased rates of prosthodontic services. Goodness-of-fit tests indicated that models for periodontal and endodontic services had a good fit. However, only endodontic services were readily interpretable in terms of descriptive trends. While the age-period-cohort model was preferred, age-period and age-cohort models were also examined because of problems of identification with age-period-cohort models. Endodontic rates were higher among younger dentist birth cohorts, and increased over the 10-year study period for most cohorts of dentists. CONCLUSIONS: If these effects for dentist cohorts were extrapolated over the next 10-year interval, the distribution of services would alter, with endodontic services emerging as a dominant area behind restorative, diagnostic, and preventive services.

Adult↗

PubMed2007

An audit to assess the outcome of a 1-day acupuncture course for dentists.

OBJECTIVE: The principal author has, during the last 4 years, given 45 1-day courses in acupuncture involving 450 dentists arranged under the umbrella of continuous post-graduate dental education. There is a paucity of evidence in the published dental literature regarding the outcomes after such courses, and the objective of this work was to analyse the outcome after a 1-day acupuncture course. MATERIALS AND METHODS: In co-operation with the individual post-graduate centres, a questionnaire was posted to all participants to ascertain whether; (a) the dentist has taken up acupuncture; (b) how often acupuncture was used; (c) any reasons for not incorporating acupuncture into the daily practice. To further evaluate the quality of the course, the following questions were addressed; (d) overall rating of the course; (e) the relevance of the course, assessed on a scale from 1 to 6 (1, highly unfavourable; 6, very high favourable). MAIN OUTCOME: A total of 209 (51.6%) questionnaires were returned, although 15 (3.7%) were subsequently excluded. The male:female ratio of respondents was 3:2, with an average age of 42 and 19 years of experience in dental practice. As many as 46% of respondents had incorporated acupuncture into their practice and 19% reported using acupuncture several times a month. The conditions treated were control of the gag reflex, stress management, sinusitis, headache and facial pain. The main reasons for not taking up acupuncture was 'the dentist never actually got round to starting' (83%) and lack of appropriate patients (60%). Regarding the evaluation of the course, the assessment forms were obtained from 47% of the participants. Participants from all centres rated the course in the top end, 5.3 of 6.0 possible.

Acupuncture↗

PubMed2002

Periodontal treatment practices of Finnish dentists.

OBJECTIVES: To evaluate the treatment practices of Finnish general practitioners (GPs) and dental teachers (DTs) regarding periodontal treatment modalities, and their knowledge of possible contraindications for periodontal surgery. MATERIAL AND METHODS: A questionnaire on two periodontal cases was mailed to 400 GPs, selected by stratified randomization from the public and private sector, and to 47 DTs. The response rate was 77%. Respondents were asked to choose the optimal treatment for a patient with a bleeding, 8-mm-deep periodontal pocket and to consider the influence on their treatment decision of the six possible contraindications for periodontal surgery presented, two of which were absolute (inadequate oral hygiene and poorly controlled diabetes) and four of which were relative contraindications. The respondents' treatment decisions were compared with recommendations from textbooks and the Consensus Report from the 1996 World Workshop of Periodontology. RESULTS: The majority of public (65%) and private (70%) dentists and almost all of the DTs chose treatment in agreement with recommendations. Correct answers from dentists were associated with a greater number of days in continuing education (OR = 1.5; p= 0.005). The two absolute contraindications were known by 38% of public and 31% of private sector dentists, and by 29% of DTs. The respective figures for relative contraindications were 40, 58 and 53%. CONCLUSION: The majority of Finnish dentists followed the recommendations, but elaboration of international guidelines for good clinical practice is still needed to help clinicians to make optimal treatment decisions.

Adult↗

PubMed1998

The effectiveness of equilibration in the improvement of signs and symptoms in the stomatognathic system.

Signs and symptoms of the breakdown of the various components of the stomatognathic system, in particular the TMJ structures, masticatory muscles, dental structures, and periodontium, can have a variety of causes. Occlusal interferences have been implicated as one contributing factor in these areas of breakdown. If this is indeed the case, then elimination of these interferences should improve these signs and symptoms. A retrospective study involving 30 practicing dentists who make up part of the visiting faculty of the Pankey Institute analyzed a variety of signs and symptoms both prior to equilibration and after equilibration to elucidate signs and symptom dynamics following treatment.

Age Factors↗

PubMedDate not supplied

Survey of general dentists regarding posterior restorations, selection criteria, and associated clinical problems.

This survey was designed to provide insight concerning the materials that general dentists use for direct and indirect posterior restorations. A stratified random sample of dentists (n = 2,880) from the Academy of General Dentistry's membership list received a questionnaire that elicited information on the clinician's current use of amalgam, direct, and indirect composite materials; reasons for material selection; and reported complications with composite restorations. Data were analyzed using descriptive statistics as well as t-test, Mann-Whitney, and chi square for group comparisons. A total of 714 dentists (26.3%) responded. Direct composite was the material used most commonly for posterior intracoronal restorations. Dentists in amalgam-free practices (31.6%) were significantly more likely (p = 0.001) to use direct composite than dentists whose practices used amalgam. Both groups weighed clinical decision factors and ranked perceived complications differently. Dentists in amalgam-free practices were less likely (p = 0.001) to consider caries rate, patient demand, and moisture control as important clinical decision factors and were more likely to report never experiencing complications.

Bicuspid↗

PubMed2003

Factors influencing referral for specialist endodontic treatment amongst a group of Dutch general practitioners.

AIM: To analyse the need for endodontic referral amongst a group of Dutch general practitioners and to examine the current referral patterns and factors influencing the decision to refer. METHODOLOGY: A questionnaire was designed to investigate the perceived need for endodontic referral, the factors that influenced the decision process, the specialist to whom the case was referred and the frequency of referring. The questionnaires were distributed amongst 500 dentists attending a scientific meeting of the Netherlands Society for Endodontology (NVvE) and to 83 members of 10 study groups responding to a request in a newsletter. These groups were chosen to represent those dentists who possessed a similar degree of general dental knowledge and were acquainted with the requirements that endodontic treatment should meet. RESULTS: The response rate was 41%. Of the respondents, 93% felt the need to refer cases to specialists. The majority of dentists preferred to refer to an endodontist rather than an oral surgeon. The major factors considered to be important or very important (37 and 54%, respectively) for endodontic referral were the presence of an obstruction in the canal, followed by the presence of a perforation or resorption (43 and 34%, respectively) and persistent signs and/or symptoms (39 and 32%, respectively). NVvE members referred significantly less to oral surgeons than nonmembers. CONCLUSIONS: Amongst a group of Dutch general practitioners there is a substantial perceived need for referring endodontic cases to specialists.

Decision Making↗

PubMed2003

A survey of radiographic prescription in dental implant assessment.

OBJECTIVES: To survey the current radiographic prescriptions in dental implant assessment amongst dentists in Brazil. METHODS: Sixty-nine dentists were interviewed during a dental implant meeting by two calibrated graduate students, using a 19-question questionnaire, considering imaging modality options both for pre-operative implant site assessment and for follow-up, particularly with respect to cost, patient radiation dose, and broad coverage of facial bones and teeth. Epi-Info 6.04 software was used to analyse the database file. RESULTS: Approximately 63.8% of the dentists prescribed only panoramic radiography for dental implant assessment and 28.9% ordered panoramic radiography plus periapical radiography and/or conventional tomography and/or computed tomography (CT). Only 7.2% of the dentists ordered conventional tomography or CT as a single examination, although 10.1% ordered it in combination with other imaging modalities. The main reasons given for prescribing panoramic radiography were broad coverage and cost (86.4%). CONCLUSIONS: This study has shown that most of the dentists in this study prescribe panoramic radiographs in dental implant assessment based on broad coverage and cost. They are not following the American Academy of Oral and Maxillofacial Radiology recommendations regarding cross-sectional imaging.

Anatomy, Cross-Sectional↗

PubMed2005

[Risk behavior associated with the manipulation of dental amalgam in Senegal].

Dental amalgam is a combination of mercury, silver, tin and copper used in the treatment of the dental decays. Amalgam is used in dentistry since many years. Actually a large discussion held according to environmental pollution and risk of intoxication for the patient and the dentist himself. The aim of our survey concerning 103 dentists was to determine the quantity of mercury used in a year, to see the risks linked with the equipment and the manipulation of amalgam and to study the incoming of the trashes of amalgam. Our results showed that among the dentists: 44.66% used 250 to 500 g of mercury by year, 14.56% used their hands for insertion of amalgam in the cavities, 10.68% used their hands for condensation of amalgam in the cavities, 87.38% throw their amalgam on the trash.

Dental Amalgam↗

PubMed2003

Radiographic equipment and techniques used in general dental practice: a survey of general dental practitioners in England and Wales.

OBJECTIVES: The aims of this study were to determine the self-reported use of panoramic radiography, D- and E-speed film, rectangular collimation, film holders, equipment fitted with a long spacer cone (>200 mm) and the bisecting angle and paralleling techniques by general dental practitioners and to see if use was related to the dentists' age and postgraduate qualifications. METHODS: Three mailings of a self-completion questionnaire were circulated to 800 general dental practitioners working in the National Health General Dental Service in England and Wales. RESULTS: A response rate of 74% was achieved. Sixty-one percent of general dental practitioners reported use of panoramic equipment. Fifty percent of dentists always used E-speed film and 18% always used rectangular collimation. Sixty-eight percent of dentists always used bitewing film holders though fewer (37%) used periapical film holders. Sixty-three percent of dentists always used a long cone. The bisecting angle technique was used by 70% of dentists with 22% always using this technique for periapical radiographs. Thirty-one percent always used the paralleling technique. Use of panoramic equipment, periapical film holders, bisecting angle and paralleling techniques were associated with the dentists' age. Use of periapical film holders, bisecting angle and paralleling techniques and rectangular collimation were associated with dentists' postgraduate qualifications. CONCLUSIONS: There are several features of radiographic equipment and techniques that can aid high quality imaging and reduce patient dose. Although a number of these are being used in general dental practice in England and Wales they have yet to achieve universal adoption.

Adult↗

PubMed1999

The consultant orthodontic service--1996 survey.

OBJECTIVE: To evaluate the working patterns and facilities of the consultant orthodontist service. DESIGN: A cross-sectional survey. SETTING: Consultant orthodontist departments in the UK. SUBJECTS AND METHODS: All consultant orthodontists in the UK were sent a questionnaire that gathered information on the individual consultant, the facilities available, the new patients referred and patients under current treatment. RESULTS: The consultant orthodontist service provided treatment to a high number of patients who were in definite need of orthodontic treatment. A marked reduction in the use of removable appliances suggests improving standards of care and provision of more complex treatment. The caseload was high and a fair proportion of patients were returned to their referring dentists with treatment plans. The consultant service has not completely evolved into a service that provides treatment at a super-specialist level alone. CONCLUSIONS: There has been little change in the consultant orthodontist service over the past ten years. Arguably, this is because of the wishes of the purchasers and the shortage of trained orthodontic manpower as a direct result of poor manpower planning and lack of funds for post-graduate training.

Cross-Sectional Studies↗

PubMed1997

The new commitment to patient satisfaction.

CheckUp helps dentists measure and increase patient satisfaction through easy, inexpensive patient surveys. The CheckUp survey is endorsed by the American Dental Association (ADA) and several state dental associations. This article discusses the importance of committing to and maintaining the highest possible level of patient satisfaction not only as a practice management strategy, but also as a source of pride in one's reputation as a professional.

Costs and Cost Analysis↗

PubMed1996

The role of caries recognition: treatment decisions from bitewing radiographs.

OBJECTIVE: To describe the effect of the ability to estimate caries depth from bitewing radiographs on restorative treatment decisions. METHODS: A 10% random sample of Dutch dental practitioners (n = 444) was sent a two-part questionnaire based on an analytic approach to radiographic caries diagnosis and restorative treatment decision making. In the second part the dentists were asked to diagnose radiographs of 105 tooth surfaces with and without dentine caries and then to make a treatment decision for each surface. A regression analysis was carried out using the negative predictive value (TN/[TN + FN]) of the restorative treatment decision for dentine caries as the dependent variable. RESULTS: The mean negative predictive value for the dentists' proposals from radiographs to leave surfaces untreated was 0.77 (SD 0.05; min. 0.60, max 0.87). Nine significant (P < 0.05) variables explained 65% (R2 = 0.65) of the variation in decision making. One diagnostic ability variable explained 48% of the variation found. CONCLUSIONS: Dentists appear to take the seriousness of errors in restorative decisions into account when deciding on treatment. The ability of dental practitioners to identify and discriminate between lesions in the inner half of the enamel and the outer half of the dentine, however, plays a dominant role in their treatment decision making.

Decision Making↗

PubMed2004

Use of the basic periodontal examination and radiographs in the assessment of periodontal diseases in general dental practice.

OBJECTIVES: The aims of this study were to investigate (1) the use of the basic periodontal examination (BPE) by general dental practitioners (GDPs) and their selection of radiographs for the assessment of periodontal disease and (2) whether this selection concurred with existing selection (referral) criteria. METHODS: Three mailings of a self-completion questionnaire were sent to 800 GDPs working in the National Health General Dental Service in England and Wales. Dentists were presented with six clinical scenarios for which they were asked to describe their use of radiographs. RESULTS: Ninety-one percent of dentists reported that they used the BPE in new patients, with 56% using it for all patients; 84% of dentists used BPE in recall patients. BPE use was related to the dentists' age and postgraduate qualifications. There was a wide variation in the radiographic views used for periodontal disease assessment. The choice of radiographs was not generally in line with the Faculty of General Dental Practitioners (UK) 1998 selection criteria, particularly for the clinical scenarios of pocketing >5 mm, irregular pocketing or pockets associated with teeth with heavy restorations. Sixty seven percent of dentists concurred with recommendations for radiographs for a suspected periodontal-endodontic lesion. CONCLUSIONS: A majority of dentists reported clinical screening for periodontal diseases using the BPE. There was considerable variation in the selection and use of radiographs and practice was not in line with existing guidelines for many clinical situations. Evidence-based referral criteria should be actively promoted to ensure high standards of radiographic practice in general dental practice.

Adult↗

PubMed2006

Treatment concepts for restoration of endodontically treated teeth: A nationwide survey of dentists in Germany.

STATEMENT OF PROBLEM: Opinions concerning proper restoration of endodontically treated teeth (ETT) vary. A variety of techniques and materials for post-and-core restorations are available. The rationale for post placement performed by German dentists was unknown. PURPOSE: The purpose of this study was to determine current opinions, applied techniques, and materials for the restoration of ETT in Germany. MATERIAL AND METHODS: A nationwide questionnaire-based survey containing 18 multiple choice questions regarding treatment philosophies, favored post type, and materials for core foundations was mailed to 36,500 German general dentists. A total of 6029 questionnaires (16.5%) were returned. Data were evaluated in terms of the dentists' occupational experience and the frequency of post placement. Descriptive statistics were used to analyze the data. RESULTS: Irrespective of their occupational experience, 52% of the surveyed dentists consider post placement for almost every postendodontic restoration of ETT. The majority of dentists (54%) believe that a post reinforces ETT. Cast posts and cores are used by 55% of all dentists, whereas 34% use prefabricated posts exclusively. Screw posts are the most popular prefabricated post type (47%). Composite resin (51%) is preferred for core foundation, followed by glass ionomer cements (GICs) (26%). Amalgam is seldom used (0.5%). Posts are placed primarily with zinc phosphate cement (51%), followed by GIC (38%). CONCLUSION: The treatment philosophy of German dentists is not in complete agreement with recommendations found in the literature. The belief that a post would reinforce an ETT might explain the high frequency of post placements. Due to the partially inconsistent responses, it is difficult to derive a generalized treatment concept.

Cementation↗

PubMed2004

Endodontic retreatment strategies used by general dental practitioners.

PURPOSE: Root-filled teeth with persistant periapical radiolucencies are often classified as endodontic failures. Studies have shown that general dental practitioners (GDP) do not consistantly suggest retreatment of "failures." The "Praxis Concept" (PC) theory hypothesizes that dentists conceive periapical health and disease as different states on a continuum. This study examined endodontic retreatment concepts among 157 GDPs from Värmland, Sweden. STUDY DESIGN: In 6 simulated cases the periapical condition, quality of root filling and presence of a root canal-retained post were systematically varied. Five options were offered: no therapy, wait and see, nonsurgical retreatment, surgical retreatment, and extraction. RESULTS: The investigation showed large interindividual variation in retreatment behavior among the GDPs. Only 9 dentists (6%) where found to repeatedly suggest retreatment of endodontic failures. A majority of GDPs (79%) performed in accordance with PC. CONCLUSIONS: The data indicate that several retreatment decision rules are used by Swedish GDPs, but PC-derived strategies attract the majority.

Adult↗

PubMed1996

Dentists' stated restorative treatment thresholds and their restorative and caries depth decisions.

OBJECTIVE: This study examines the relationships between stated restorative treatment thresholds of 16 dentists and both their restorative decisions and caries depth determinations for approximal tooth surfaces based on bitewing radiographs. METHODS: Sixteen dentists independently examined 15 pairs of experimental bitewing radiographs. They separately recorded restorative and dental caries depth decisions for 4,864 unrestored approximal tooth surfaces, 304 identical surfaces per dentist. In addition to caries depth and restorative decision data, these dentists provided their restorative thresholds using a five-point scale. RESULTS: Three dentists stated it would be appropriate to restore enamel lesions, nine would wait until caries had reached the dentinoenamel junction, and four would wait until caries extended into the dentine. Although dentists stating an enamel restorative threshold intended definitely or probably to restore relatively more surfaces and recorded relatively more surfaces with dentinal caries, ANOVA analyses revealed that the differences among the restorative and the depth means according to the restorative thresholds were not significant. Considerable variation existed in both the restorative and depth decisions among the dentists in each threshold group. CONCLUSION: Although interesting trends occurred in the restorative and depth decisions relative to the stated thresholds, this study suggests, like others in Europe, that these thresholds cannot be taken at face value to explain restorative decisions.

Analysis of Variance↗

PubMed1999

Evidence-based dentistry: a practitioner's perspective.

Basing practice decisions on evidence is neither contestable nor new. There are some concerns, however, that must be addressed. First, all published "evidence" is not of equal quality. Second, the practical experience of dentists must be recognized as constituting evidence. Additionally, third parties should not be allowed to use evidence if that use interferes with practitioners' judgment. Fourth, the call for more evidence may place a burden on dental schools already struggling to keep up with their demands of teaching basic dental skills. The Dental Practice Parameters developed by the ADA may provide a more realistic alternative because they preserve practitioner discretion.

Evidence-Based Medicine↗

PubMed1999

Factors influencing the selection of panoramic radiography in general dental practice.

OBJECTIVES: To identify factors influencing dentists' decisions to take panoramic radiographs and to determine dentists' perceptions of the value of panoramic radiographs in the diagnosis of common dental pathologies. METHODS: Questionnaire of dentists with access to panoramic radiography equipment in 22 randomly selected Family Health Service Authorities in England and Wales. Dentists were asked to score 17 factors for their influence upon panoramic use, compare the relative diagnostic value of panoramic and intraoral radiographs for diagnosis of common dental pathologies and state their principal reasons for taking panoramic radiographs. RESULTS: The response rate to the questionnaire was 73.3%. The factors most likely to influence dentists to take a panoramic radiograph were 'planning oral surgery', 'facial trauma', 'periodontal disease', 'heavily restored dentition' and 'patient first attendance'. Dentists' opinions on the diagnostic usefulness of panoramic radiographs were in broad agreement with those in the scientific literature. The main reasons for taking panoramic radiographs were as a 'general screen' and as a 'view for unerupted or impacted teeth'. CONCLUSIONS: There are areas where dentists' prescription of panoramic radiographs is in disagreement with recent guidelines. Successful implementation of these guidelines would be likely to lead to a substantial reduction in the numbers of panoramic radiographs taken by GDPs.

Adult↗