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PubMedDate not supplied

Patient age and general dentists' treatment decisions.

To test whether a patient's age plays a role in dentists' treatment planning decisions, a convenience sample of 159 general dentists attending a state dental society annual meeting was presented a vignette including intra-oral photographs, a brief case history and clinical diagnosis of a patient. The patient was partially dentate, and was described as having irreversible pulpitis of tooth #19. Three versions of the vignette were developed, with identical materials and information except for the patient's age (either 44, 65, or 84 years), and were randomly assigned to the participating dentists who were asked to develop a treatment plan for the patient's mandibular arch. The dentists planned limited therapy for the 84 year old because of their assumptions about the patient's brief life expectancy, cost, concern about the inability of the patient to tolerate extensive treatment, and a low cost/benefit ratio. These findings suggest that a patient's age influences general dentists' treatment planning decisions, perhaps limiting the treatment options offered to older adults. Additional research is necessary to further test these associations.

Adult↗

PubMed2003

Dental materials used by general dental practitioners.

As a follow-up to previous surveys regarding materials used by dentists a total of 1500 questionnaires were distributed to general dental practitioners in private practice. A response rate of 11.8% was achieved. The most popular products used during 1999 were identified. Changes in the choices of materials were observed when compared to previous surveys. This may be attributed to the development of various new products.

Choice Behavior↗

PubMed2003

Revisiting the role of dentists in prescribing antibiotics.

The purpose of this paper is to review the principles of therapeutic and prophylactic prescribing in light of the increasing problem of antibiotic resistance and the evidence of inappropriate use of antibiotics in dentistry. Recommendations based on a review of the evidence and good practice for prescribing therapeutic and prophylactic antibiotics will be given.

Anti-Bacterial Agents↗

PubMed2005

Factors associated with implant recommendation for single-tooth replacement.

The use of dental implants for single-tooth replacement has been established as a predictable treatment option; yet, limited data are available as to how frequently this option is recommended to patients. The aim of the present study was to examine the frequency of implant recommendation by general dental practitioners after single-tooth extraction and factors influencing their decision to recommend an implant. All single-tooth extractions performed in 26 general dental practice clinics in Kuwait over a 30-day period were examined. Dentists in these centers used the study form to record demographic data, the type of tooth extracted, reason for extraction, and replacement options presented to the patients. Univariate and logistic regression analyses were used to examine associations between background factors and decisions to recommend implant therapy. A total of 1367 patients (mean age, 37.9 +/- 11.8 years) had an extraction of one tooth during the study period. Forty-three patients were offered implants as a replacement option (3.3% of the total sample; 8.6% of patients who were offered tooth replacement options). Factors associated significantly with the recommendation of an implant by Kuwaiti dentists to their patients included younger age, regular dental maintenance visits, and adequate oral hygiene practices (P < 0.05; binary logistic regression). Dental implant recommendation for single-tooth replacement in the present sample of dentists was low. Factors associated significantly with dentist recommendation of an implant for single-tooth replacement included age, history of dental maintenance, and oral hygiene practices.

Adolescent↗

PubMed1999

Is it better to leave or restore carious deciduous molar teeth? A preliminary study.

INTRODUCTION: The objective of this study was to compare the extraction and exfoliation experience of filled and unfilled carious deciduous molar teeth. METHOD: The study was carried out in 1997 in four general dental practices in south Cheshire, UK and involved a longitudinal retrospective review of case notes. A quota sample of 20 case notes of children from each practice was selected according to strict criteria. Subjects had to: Have had experience of approximal caries in one or more of the deciduous molar teeth. Have a date of birth between 1st January 1984 and 31st December 1985. Be a regular attender and in continuous contact with the practice. Data were collected on a common data abstraction form. Variables measured included: Base-line dmft. Site and number of filled teeth. Site and number of unfilled carious teeth. Number of courses of antibiotics. Site and number of pulp therapies. Site, number, method (local or general anaesthetic) of extractions. Reasons for extraction. All teeth not recorded as being extracted were assumed to have exfoliated. In addition, information was collected on the dentists' treatment philosophies. A series of group discussions revealed that the four dentists fitted into two groups according to treatment philosophies; two dentists shared a philosophy of minimal intervention, the other two shared the same views of treating more radically. RESULTS: There was no significant difference between the proportion of filled teeth and the proportion of carious unfilled teeth that were extracted (chi-square 0.05 P = 0.83). A logistic regression showed that for each course of antibiotics administered the odds of having an extraction was multiplied by 5.5 and children who were patients of the interventionist dentists were five times more likely to have an extraction than patients of non-interventionist dentists. CONCLUSION: Although the study was preliminary in nature no clear benefit could be found in filling deciduous molar teeth against leaving carious teeth unfilled, if avoidance of extraction was the desired outcome. The treatment philosophy of dentists was a major factor in determining extraction or exfoliation outcomes. This issue is complex with many interacting factors to be accounted for and will require multiple well-designed studies to provide an answer.

Anti-Bacterial Agents↗

PubMedDate not supplied

Analgesic prescribing patterns in a group of dentists.

Dentists have an increasing number of analgesic agents available to enable them to deal with pain relief. Each of these agents has advantages tempered by undesirable side effects. Five years ago the authors conducted a survey of dentists to compare analgesic prescribing habits. A follow-up study was conducted to ascertain any changes in analgesic therapy prescribing habits. It was determined that most dentists prefer to prescribe on an as-needed basis rather than by the clock. New drugs in the marketplace have not changed the approach of dental practitioners in handling pain management; similarly, prescription writing patterns have not changed appreciably in the last five years. More restraint probably could be used in prescribing narcotic agents.

Adolescent↗

PubMed2003

Does digital radiography increase the number of intraoral radiographs? A questionnaire study of Dutch dental practices.

OBJECTIVES: To compare the number of radiographs taken in general dental practices equipped with digital radiography vs conventional film-based radiography and to determine the reasons for any difference in numbers. METHODS: In a mail survey, 473 questionnaires were sent to Dutch General Dental Practitioners (GDPs) using digital radiography and 105 questionnaires were sent to GDPs using film. The questionnaire concerned the number of intraoral radiographs taken in the dental practice, as well as possible reasons to take more or fewer radiographs after conversion to digital radiography. RESULTS: The response rate was 73%. Users of a phosphor plate system on average take 42.8 radiographs per week and solid-state system users take 48.4 radiographs, whereas film users take on average only 32.5 radiographs per week. The need for more certainty about the planned or ongoing treatment as well as better diagnostics were the most important reasons for taking more radiographs. CONCLUSIONS: It seems that GDPs using a system for digital radiography are more inclined to take radiographs than dentists taking conventional radiographs. Although digital intraoral radiography requires 50-80% less radiation per exposure than film, it is likely that the effective dose reduction after converting from conventional to digital radiography is less than 25% owing to the greater numbers of radiographs taken.

Attitude of Health Personnel↗

PubMed2006

Sex differences among dentists regarding eating disorders and secondary prevention practices.

BACKGROUND: The purpose of this cross-sectional study was to assess sex differences among dentists pertaining to current behaviors and behavioral beliefs with regard to eating disorders. METHODS: The authors collected data via a self-administered paper-and-pencil questionnaire from a randomized sample of 350 practicing male and female dentists. RESULTS: The results showed a low level of practice regarding secondary prevention (that is, measures leading to early diagnosis and prompt intervention) of eating disorders. The authors found statistically significant differences, with more female than male dentists reporting that they assessed patients for oral cues (P < .001), more female dentists reporting that they provided specific dental care instructions (P = .038) and more female dentists referring patients who have oral signs of eating disorders (P = .028). They also found sex differences with regard to mediating factors. Female dentists had greater knowledge of oral manifestations of eating disorders (P = .001), greater knowledge of physical cues of anorexia nervosa (P < .001), greater perception of the severity of anorexia nervosa (P = .007) and greater knowledge of physical cues of bulimia nervosa (P < .001). CONCLUSIONS: Although the dentist may be the first health care provider to assess oral effects of eating disorders, his or her involvement may be influenced in part by sex and sex-related health beliefs. CLINICAL IMPLICATIONS: Female dentists may be more sensitive to oral cues related to women's health issues. Further research is warranted to explore the mediating factors regarding secondary prevention of eating disorders.

Adult↗

PubMed2005

Treatment policies among Israeli specialists in paediatric dentistry.

AIM: This was to evaluate some suggested diagnostic procedures, treatment policies and professional attitudes of specialists in paediatric dentistry, in light of the periodically published guidelines by The American Academy of Pediatric Dentistry, The European Academy of Paediatric Dentistry and The British Society of Paediatric Dentistry. METHODS: Using a structured questionnaire, 67% of the Israeli specialists in paediatric dentistry, who agreed to participate in this study, were personally interviewed. RESULTS: Only 7.5% of the participants reported that they carry out pulp capping of primary teeth in cases of pulp exposure. Over 50% reported restoring teeth after pulpotomy with preformed crowns. Most indicated sealing pit and fissures after considering depth and morphology of the fissures and correlation with the patient's risk to caries. Cleaning teeth after eruption of the first tooth was suggested by 75.5% of the participants. A striking majority (96%) claimed that they restored permanent anterior teeth with composite resins and most used these materials for occlusal restoration in both primary and permanent posterior teeth. Most specialists advocated the use of amalgam in proximal posterior restorations. The presence of a parent in the operatory/surgery was preferred by 85% of the dentists. CONCLUSIONS: Israeli specialists in paediatric dentistry mostly comply with the mentioned guidelines. Further studies of this nature should also be encouraged in other countries to emphasize the importance of monitoring compliance with established and evidence based guidelines.

Adult↗

PubMed1998

Investigation of the operative response of a group of general dental practitioners to varying extents of proximal caries.

The aim of this investigation was to assess the operative response of a representative sample of Irish General Dental Practitioners of various times since qualification to carious lesions of varying extent in both approximal surfaces of a lower left first molar tooth. 82 General Dental practitioners participated. The dentists were asked to treat 2 manikin teeth for minimal caries on both approximal surfaces extending to the enamel dentine junction, 2 teeth for caries extending approximately to half the thickness of the dentine and 2 teeth for caries extending more than 3/4 of the dentine thickness. Weight measurements were made of the tooth substance cut away. Mean volumes of tooth material removed ranged from 21 mm3 for minimal caries to 76 mm3 for the largest amount of caries. A two-factor analysis of variance revealed that the type of cavity preparation the dentist used had a significant effect on the volume of tooth material removed for all three extents of caries. Time since graduation had a significant effect on the volume of tooth material removed for the least extent of caries, but not for the other categories of carious involvement.

Age Factors↗

PubMed2000

The infinity of opportunity: breaking barriers to technological change in dentistry.

This essay characterizes the nature of the technologically current dental office and identifies challenges to be overcome in accelerating the introduction of technology. These challenges include dentists' preference for serial introduction of incremental change, lack of a network for communicating information on technology, the dental market of small and independent offices that make it difficult for manufacturers to finance innovative products, and the need to integrate technological change in dental education.

Attitude of Health Personnel↗

PubMed2006

Fluoride knowledge and prescription practices among dentists.

The purpose of this study was to assess dentists' knowledge about fluorides as well as their prescription practices. The study population consists of all general and pediatric dentists in Houston, and the sample consists of 360 general and forty-one pediatric dentists. Data were collected with a self-administered mail questionnaire, which consisted of thirteen open-ended and twenty-nine precoded items. After three mailings, the effective response rate was 46.4 percent. Respondents had been in practice on an average of 18.9 +/-6.6 years; the majority were male. More than 75 percent of respondents believed fluoride level in drinking water is an important determinant of fluoride supplement prescription, and 29 percent felt the same about a patient's weight. The correct ages at which to begin (six months) and to discontinue (sixteen years) the fluoride supplements to children were identified by 14.7 and 14.9 percent of the respondents, respectively. Only 6.7 percent of those prescribing fluoride supplements routinely tested the fluoride level in the patient's drinking water. Even though pediatric and general dentists differed in certain items, the two groups did not differ significantly in prescribing fluorides (OR=2.4, 95% CI=0.94, 6.27). Deficiencies and ambiguity in respondents' fluorides knowledge as well as prescription practices indicated a need for educational interventions.

Adolescent↗

PubMedDate not supplied

Blood pressure measurement by community dentists.

The benefit and implications of blood pressure (BP) measurement in dental patients are a standard curricular component of most physical evaluation courses in dental schools. However, previous research has indicated that preventive procedures such as oral cancer examinations frequently are not completed or documented. A survey of practicing dentists was conducted in a Midwest metropolitan area to determine the frequency of BP measurement and conditions under which this vital sign is likely to be measured. Two hundred four responses were obtained from a telephone survey which included questions characterizing BP measurement on the basis of patient age and medical diagnosis. The results of the survey indicated that 57.4% of respondents do not check the BP of new patients over the age of 65, while 74% do not check the BP of new patients under 30 years of age. Fourteen percent admitted never measuring BP. The results varied by graduation years and by dentist's completion of AEGD or GPR programs. The results suggest great variation in the recording of BP and the criteria which are applied to those decisions. Further study should investigate factors contributing to low compliance with screening procedures such as the clinical measurement of BP and other health-promotion measures.

Adult↗

PubMed2006

[Clinical evaluation of digital imaging].

The rapid progression of digital radiography makes us consider its role in different fields of dentistry. The aim of the present survey was to evaluate the advantages of digital imaging over the use of radiographic films in the diagnosis and therapy of common oral pathologic conditions. The underlying hypothesis was that RadioVisiograph (RVG, Trophy Radiology, Marne-la-Vallée, France)--provided that there is access to this digital network--is easily available. Thus it can provide options for specialists of different dental fields to obtain more detailed information in order to make better decisions. Immediately after the installation of the new system and then, ten months later we analysed the results of digital images and radiographic films in outpatients of different sections at our clinic. The quality of both diagnostic procedures was evaluated using a questionnaire. Digital imaging was used mainly by specialists of endodontics, followed by restorative and prosthetic dentistry in setting up the diagnosis. The application of this new technique in parodontology and paediatric dentistry was negligible. However, it is worth mentioning that the majority of dentists participating in the survey thought that conventional radiographic films gave more detailed imaging than the digital technology. To sum it up, currently, digital imaging systems may represent an efficient device in diagnostic and therapeutic procedures. Nevertheless owing to the technical sensitivity of the above systems, traditional radiographic techniques should also be used as an option due to their advantages.

Dental Caries↗

PubMed2001

The use of specific dental school-taught restorative techniques by practicing clinicians.

In 1995, a survey requesting information about the utilization of certain prosthodontic techniques was mailed to 3,544 graduates of a midwestern dental school. Responses were received from 1,455 alumni, representing a 41 percent return rate. In general, the results are consistent with international and national trends and show significant disparity in the utilization rates of certain procedures between general dentists and prosthodontists, as well as a disconnect between what is taught in the undergraduate dental educational program and what is applied in practice. For example, while prosthodontists typically apply what was taught in their educational program, utilization rates of general dentists for the facebow was 29.64 percent; the custom tray 68.48 percent; border molding 58.67 percent; altered casts 24.10 percent; custom posts 49.29 percent; prefabricated posts 67.54 percent; and semi-adjustable articulators 50.64 percent. While no solutions to this disconnect are offered the authors do pose important questions that must be addressed by the dental educational community.

Dental Articulators↗

PubMed2002

Orthodontics in 12-year old children. Demand, treatment motivating factors and treatment decisions.

Ninety-three per cent of all 12-year old patients at a clinic in western Sweden accepted an invitation to take part in a dental examination in order to evaluate early orthodontic treatment. Treatment in the primary or mixed dentition periods should aim at creating normal craniofacial, occlusal and dental development and, if possible, at reducing the need for later, more complicated treatment. The treatment success was low regarding overjet correction but fairly good with regard to diagnosis and treatment of crossbite/forced occlusion, ectopic eruption and congenitally missing teeth. Whether correction of crossbite had reduced crowding was impossible to evaluate in this study. However, relatively few subjects with a history of crossbite correction desired alignment of teeth. The study confirmed earlier observations that TMD prevention is not a major motivating factor for orthodontic treatment. The majority of the children, including those desiring treatment, judged their dental appearance to be fairly average. The dentists more often than the children regarded the subjects' appearance to be better than average. Prediction of later orthodontic treatment, recorded at the age of 14 years, turned out to have a weak association to evaluation of aesthetics both by the children and the dentists. Nor did recording of TMD improve prediction. The study confirms earlier observations that discussions about orthodontic treatment on mainly aesthetic grounds ought to be postponed well into the permanent dentition period, and by attempting to avoid "making the normal abnormal".

Age Factors↗

PubMed2001

Reasons for extraction by dental practitioners in England and Wales: a comparison with 1986 and variations between regions.

OBJECTIVES: To compare reasons for extraction in 1997 and 1986, and to consider regional variations for the 1997 data. METHODS: Random samples of general dental practitioners (GDPs) completed questionnaires for all extractions for 4 weeks in 1986 and in 1997. Reasons for extraction by region were compared for the 1997 data. RESULTS: 220 and 562 GDPs participated in 1986 and 1997, respectively, averaging 24 extractions in 1986 and 20 in 1997. 'Caries' remained the commonest reason for < or =50-year-olds (excluding 'ortho'), but peaked a decade later than in 1986. One-third of 'perio' extractions in both studies were for 51-60-year-olds, but in 1997 there were fewer such extractions for < or =40-year-olds and more for >70-year-olds than in 1986. In 1997 'caries' and 'perio' extractions remained equally common for patients >50 years, but there were far more extractions for both reasons for >80-year-olds. Patients < or =30 years in S. England and in the Midlands/E. Anglia had more 'ortho' than 'caries' extractions, whereas 'caries' predominated in N. England and in Wales. 'Caries' exceeded 'perio' for patients >40 years in Wales, whereas in the three English regions the two reasons were equally frequent. CONCLUSIONS: Comparisons of results of two studies conducted a decade apart indicate that there have been some changes in reasons for extraction. Overall, mean number of extractions per dentist has declined, and it appears that the trend is for extractions due to the common dental diseases to be carried out later in life. The 1997 data also suggest that young patients in Wales and N. England are relatively disadvantaged, having more caries and less orthodontic treatment than those in other parts of England.

Adolescent↗

PubMed1999

Practical approach to evidence-based management of caries.

This paper discusses evidence-based management of dental caries with regard to: (1) need to adopt new office methods, (2) potential barriers to change, and (3) possible practical solutions to aid change. The need for classifying individual patients into low-, medium-, and high-risk caries groups is justified from a review of the epidemiological characteristics of caries. In addition, a deficiency is identified in traditional caries recording methods since they are unable to grade the severity and activity of individual lesions. The traditional basis of six-monthly recall examinations for all patients is shown from the literature to have no scientific support. It is suggested a three-twelve month recall interval be used, depending on a patient's risk group classification. Some barriers to change are identified as: (1) the collection of more comprehensive history and clinical caries data, (2) the complexity of evidence-based decision-making, and (3) dentists' difficulty in standardizing decision-making. A new pictorial classification for caries severity and activity is described. A demonstration decision-support system is presented in terms of assisting collection of data, automatic identification of risk factors, patient risk classification, and generation of a suggested treatment plan. Evidence-based management may result in change of professional manpower levels.

Dental Caries↗