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PubMed1997

A survey of general dentists in Ontario, Part II: Knowledge and use of topical fluoride and dental prophylaxis practices.

A mail questionnaire was used to assess variations in the knowledge and practices of Ontario dentists with respect to topical fluoride and prophylaxis procedures. The questionnaire was answered by 1,276 general dentists. A high percentage (72 to 83 per cent) of respondents identified six months as the optimal time interval at which both procedures should be repeated for all patients under 19 years of age. Relatively few dentists (< 10 per cent) indicated that there should be no specific time interval for re-treatment (i.e. that it should be individually selected). The respondents' preventive knowledge was found to be deficient in two areas: few dentists (16 per cent) knew that it is not necessary to provide a prophylaxis prior to topical fluoride application to achieve maximum caries protection; and most dentists overestimated the speed of caries progress from outer enamel to the dentinoenamel junction (DEJ) in both primary (83 per cent) and permanent (82 per cent) approximal tooth surfaces. In bivariate analysis, three variables were found to be consistently and significantly related to optimal time intervals selected for both topical fluoride application and prophylaxis procedures: year of graduation from dental school; level of hygienist employment; and percentage of patients with private insurance. Multivariate analysis also identified three significant variables: year of graduation from dental school; level of dental hygienist employment; and practice business. Continuing education courses are suggested as a means of updating dentists' knowledge regarding preventive services. Studies are needed to determine the extent to which recent recommendations regarding the professional application of topical fluorides have been followed.

Adolescent↗

PubMed1997

Restorative treatments received by children covered by a universal, publicly financed, dental insurance plan.

OBJECTIVES: This study sought to identify risk markers associated with the provision of new restorations in children and to investigate whether the carious status of a tooth surface is associated with the restorative decisions of dentists. METHODS: A total of 911 schoolchildren in grades one, two, and three were randomly selected from the island of Montreal, Quebec, Canada. Dental examinations were carried out in 1990, 1991, and 1992. Tooth surfaces of first permanent molars were classified as sound, noncavitated, and cavitated. The carious status of a tooth was matched with restorative decisions reported to the insurance board. RESULTS: The presence of a carious cavity was a strong risk marker for placement of new restorations (odds rations > or = 4.11). After one year, less than 2 percent of sound tooth surfaces of first permanent molars were restored and about 21 percent of noncavitated tooth surfaces were restored. When new class I restorations placed in maxillary first permanent molars within 3-6 months after the baseline examination were evaluated, we found that between 73 percent and 86 percent of these new restorations were placed in sound or noncavitated tooth surfaces. A similar trend also was observed in mandibular first permanent molars. Poor agreement between epidemiologic diagnosis and restorative decisions was found. The restorative profile of dentists was a significant risk marker for placement of new restorations. CONCLUSION: The majority of new restorations in first permanent molars were placed in sound and noncavitated tooth surfaces because of the ubiquitous prevalence of these tooth surfaces and the validity problems of current caries diagnosis methods.

Child↗

PubMed1996

Using crowns to prevent tooth fracture.

Placing crowns to prevent tooth fracture is thought to be a common but infrequently documented treatment procedure. Two studies are described that provide information about dentists' use of crowns to prevent tooth fracture. North Carolina general dentists indicated that 44% of the crowns they placed were for the principal reason of fracture prevention. However, when groups of dentists examined the same patients, there was little agreement about which teeth should be crowned due to risk of fracture. These results suggest that the placing of crowns to prevent fracture merits a careful determination of effectiveness and appropriateness.

Age Factors↗

PubMed2006

Knowledge of prescribing antimicrobials among Yemeni general dentists.

OBJECTIVE: Overuse of antimicrobial agents is closely related to an increase in bacterial resistance. A sound knowledge of appropriate prescribing of antimicrobials among health professionals is thus critical in combating the resistance. The objectives of this study were to assess the rationale for and patterns of antimicrobial prescriptions by general dental practitioners in Yemen. MATERIAL AND METHODS: A questionnaire containing 65 closed questions was used for this cross-sectional study and distributed to 280 dentists in the three major governorates in Yemen. The anonymously completed questionnaires sought answers to demographic questions and to questions on the therapeutic and prophylactic use of antimicrobial agents in dentistry. Correct and incorrect answers were defined according to information available in the current authoritative literature. Each correct answer was given a score of 1 while an incorrect answer scored 0. Thus, the total score had an attainable range from 0 to 65. Frequencies, means, and associations were assessed statistically. RESULTS: Out of 181 collected forms (response rate 64.6%), 150 were appropriately completed and used for data analyses. Penicillins were the most frequently prescribed drugs (72%), followed by spiramycin (10%). It was found that up to 84% of practitioners were likely to prescribe an antimicrobial agent when there was no clinical indication for such a medication. Many respondents (70%) would consider antibiotics for at least one of the given non-clinical factors. CONCLUSIONS: The results suggest that dental practitioners in Yemen lack uniformity in the rationale for appropriate prescribing of antimicrobials to their patients. Consequently, to reduce overuse, there is an urgent need for the dental community in the country to be informed about evidence-based guidelines and the appropriate use of antimicrobial agents in clinical dental practice.

Adult↗

PubMed1996

New assumptions concerning IPAs and cost of dental care.

OBJECTIVES: Previous studies suggest that fee-for-service (FFS) patients receive more treatment and at a greater cost than capitation patients. In this study treatment plans of dentists who are members of an independent practice association (IPA), a preferred provider organization (PPO), or who are paid their usual fee for service are compared. METHODS: A carefully selected and trained professional actor, with actual dental disease and recent radiographs, was sent to the offices of general practice dentists for an examination and treatment plan. To one group of dentists (n = 21) the patient said he was a member of a PPO plan served by that dentist, to a second group (n = 15) he said he was a member of an IPA plan served by that dentist, and to the third group (n = 19) he said he would pay by the traditional FFS method. RESULTS: IPA dentists recommended more restorations (mean = 9.60) than those in the PPO program (mean = 5.95) or those paid by the traditional FFS method (mean = 5.58). The anticipated mean cost to the patient was higher for the IPA dentists ($1,815.20) compared to the other two types (PPO = $1,186.24, FFS = $1,470.42). CONCLUSIONS: The IPA models studied in this investigation permitted dentists to charge copayments for most treatments beyond basic services. This type of IPA might be similar to a fee-for-service model that provides practitioners with an incentive to do more rather than less treatment.

Adult↗

PubMed2006

[Decision making of Hebrew University and Tel Aviv University Dental Schools graduates in every day dentistry--is there a difference?].

This study was designed to evaluate decision-making among Jerusalem Hebrew-University and Tel Aviv University dental schools graduates in various restorative dentistry, endodontics and oral surgery issues. A survey was conducted among 52 dentists during a dental military convention. Most of the dentists stated they will not recommend of re-treatment of endodontic-treated tooth with asymptomatic peri-apical pathology that does not need further rehabilitation. The study reveals over treatment and over-medication in restorative and surgery decisions. More than half of the dentists decided to treat caries lesions that extend to the dentino enamel junction, in low and moderate caries risk patients. More Hebrew University graduates than Tel Aviv University graduates recommend of removal of asymptomatic horizontal fully impacted mandibular third molar and disease-free maxillary third molar antagonist. Most of Tel Aviv graduates routinely prescribe antibiotic coverage after complicated tooth extraction. This study supports the need for continuing education on daily performed dental procedures.

Antibiotic Prophylaxis↗

PubMed2005

Factors influencing the diagnosis and treatment of periodontal disease by dental practitioners in Victoria.

BACKGROUND: Healthy periodontal tissues are essential to overall dental health. Therefore, the detection and management of periodontal disease is an integral part of general dental practice. The aim of this study was to investigate confidence in diagnosis and management of periodontal disease by general dental practitioners (GDPs), assess if the Dental Practice Board guidelines on periodontal record keeping are being addressed, and, if necessary, try to find ways of improving the periodontal knowledge of GDPs. METHODS: A survey assessing practitioner confidence in diagnosing and treating periodontal disease was sent to a random selection of 550 dental care providers registered with the Dental Practice Board of Victoria. RESULTS: Two hundred and eighty five (51.8 per cent) of questionnaires were returned completed. It was found that 79.7 per cent of the sampled population screened all new patients for periodontal disease. The majority of respondents felt confident to diagnose and treat gingivitis and initial periodontitis. However, only 61.9 per cent felt confident to diagnose aggressive/early onset periodontitis, and many were not confident in treating advanced periodontitis (36.3 per cent) or aggressive periodontitis (51.6 per cent). The majority of dentists reported that they provided most of the non surgical periodontal therapy to their patients, while most surgical treatments were referred to specialist periodontists. Factors deemed to be important in influencing the decision to provide periodontal treatment included level of training and ability to motivate patients to improve oral hygiene. Many responents requested periodontic continuing education (CE) courses be run. CONCLUSIONS: Most of the dentists surveyed were confident to diagnose periodontal disease and to treat the more common presentations of periodontal disease. There is some evidence to suggest that some practitioners are not following the minimum requirements set by the Dental Practice Board of Victoria in relation to periodontal record keeping. The results also indicate a need for more periodontic CE courses in Victoria.

Clinical Competence↗

PubMed2003

Dental care of a child in pain -- a comparison of treatment planning options offered by GDPs in California and the North-west of England.

OBJECTIVE: To compare the treatment plans offered by general dental practitioners (GDPs) in the North-west of England (UK) and California (USA) in dealing with a child in pain. METHODS: A cross-sectional postal survey of a convenience sample of 135 UK and 170 USA GDP. These GDPs were asked to consider a case scenario of a 5-year-old child with pain from a lower first primary molar and to offer a treatment plan. The plan was to have three phases: immediate care, follow-up care and longer term preventive strategy. The influence of cost on treatment plans was also recorded. RESULTS: Response rates for the GDPs were 117 (86.6%) from the UK and 139 (81.8%) from the USA. The major differences in immediate care were as follows: 98% of Americans would take a radiograph, 41% would consider extraction, 37% would place a space maintainer and 4% would use general anaesthesia to extract a tooth. Comparable proportions for the English dentists were 20%, 21%, 2% and 40%. Later clinical options also showed differences: 39% of UK dentists would extract all first primary molars compared to only 1% of Americans. Eighty-eight per cent of USA dentists would place a nickel chrome crown compared to 4% of UK respondents. There were also differences in the longer term preventive measures. Greater proportions of American dentists would offer fluoride varnish (30%) and fluoride mouthrinse (37%). Comparable UK responses were 13% and 28%. Cost of care was only mentioned by 3% of UK dentists, whereas 70% of USA dentists mentioned cost as a factor in treatment planning. CONCLUSION: There were marked differences in the treatment of a child in pain between general practitioners in the UK and the USA. Further investigations are required to elucidate the reasons for these differences.

Anesthesia, General↗

PubMed1997

The use of lignocaine in dental practice: results of a survey of a group of general and hospital dental practitioners.

OBJECTIVES: This survey investigated whether dentists using lignocaine with adrenaline used aspiration syringes or warming and assessed their knowledge of appropriate doses of these drugs. METHODS: Sixty-two general dental practitioners (GDPs) and 26 hospital dental practitioners (HDPs) responded to a series of questions asked via telephone or direct interview. RESULTS: Only 3% of dentists interviewed correctly calculated the amount of lignocaine (mg) in 2 ml of 2% lignocaine solution and none knew the safe dose expressed as mg/kg body wt. All dentists were using a cartridge system and had an easily remembered maximum number of cartridges that they would administer. This number varied, but in all cases was within the safe maximum dose recommended by the British National Formulary. The survey also showed that 63% of the GDPs were using self aspirating syringe systems and approximately 50% considered warming the anaesthetic solution prior to injection to be beneficial. CONCLUSION: The results indicate that dentists may be found to be poor at calculating doses but are nevertheless unlikely to give inappropriate amounts of lignocaine to healthy adults. This indicates the relative safety of the cartridge system. The use of the self aspirating syringe is not universal in spite of recommendations for its use. Warming of the anaesthetic solution is popular.

Adult↗

PubMed1998

Consistency across panels of ratings of appropriateness of dental care treatment procedures.

OBJECTIVE: To report on a study investigating the consistency across different consensus panels of ratings of appropriateness for dental procedures. RESEARCH DESIGN: The study conducted four consensus panels to determine, under various conditions, the appropriateness of five options for patients: no treatment; filling; crown; root canal with a filling or crown; extraction. The patients were categorised according to age; regular versus irregular use of dental care; degree of caries; degree of pain; degree of periodontal disease. PARTICIPANTS: The panellists were dentists enrolled in a continuing education programme on assessing the quality of dental care. The panellists were all individuals employed by various dental plans to evaluate the quality of care plans operating in California. RESULTS: The results indicate that the method does distinguish the dimensions of appropriateness used by the panellists in making their decisions, and that it is possible to substantially increase consensus among a diverse group of dentists and across separate panels on some procedures. However, it also showed that the process is sensitive to varying panels and that different variables had different outcomes in the ratings from the various panels. CONCLUSION: The consensus panel method holds some promise for determining the appropriateness of dental care. However the results of this study question whether it results in consistent ratings across different panels.

Adult↗

PubMedDate not supplied

[Dental practice in the camps of the Third Reich].

In the Concentration Camps, the Nazis made a mixing of National Socialism ideology, anti-Semitism and war effort. After the arrival of trains in the camps the Nazis selected the weakest inmates for the gas chambers, as far as they considered them to be "useless mouths". The heathly grownups were kept for productive use. However a person suffering from bad tooth was not profitable. Thus some inmate dentists were in position to give dental cares to a few prisoners as they had been allowed by the Nazis to work in precarious circumstances. On the 23rd of September 1940 Himmler ordered to pull out the dental gold from the alive prisoners or at their exit of gas chambers. The decree was reinforced on the 23rd December 1942. The product of gold became a mean to support war effort. On the other hand few dental experiments have been performed by the SS doctors.

Concentration Camps↗

PubMed1999

Selection of restorative materials in permanent teeth in general dental practice.

In this study, we recorded the type of restoration and the materials used in 24,429 restorations in permanent teeth by 243 Norwegian clinicians in general practice. Demographic information included patient's gender and age, and clinician's gender, years since graduation, and practice setting (private or salaried). The overall recorded use of restorative materials in permanent teeth shows that 32% are amalgams, just over 40% composites, and about 25% glass ionomer type materials. Three percent are "other" materials. A marked shift away from amalgam restorations is noted both in the clinician's estimated use during the last 2 decades and by comparing the present use of materials with that in failed restorations. Tooth-colored materials are more commonly used in adolescents, especially glass ionomer materials, and in female patients. In patients < or = 18 years, amalgam is used in 25% of all restorations. The use of amalgam is similar in private practice and in public health service practice, but private practitioners use more composites and salaried dentists more glass ionomers. The clinician's gender does not have any effect on the selection of restorative materials. The change from amalgam to tooth-colored material is particularly noticeable for Class I and Class V restorations. Amalgam is the predominant material in 2- and 3-surface Class II restorations.

Adolescent↗

PubMed1992

Dentists, malpractice and not knowing enough: legal liability for failing to keep up with the profession.

The law imposes an obligation on you to keep current with the developments of your profession, particularly those developments which directly affect the health of your patients. From a legal perspective, you risk liability when your professional inquisitiveness and awareness falls below that of the reasonable specialist. While there is a substantial risk of being overwhelmed by the explosion of new dental knowledge, the alternative of being sued for malpractice is less attractive.

British Columbia↗

PubMed2004

A cross-sectional survey of clinicians performing periodontal surgical crown lengthening.

The aim of this study was to conduct a survey of surgical crown lengthening practice performed by dental specialists and general dental practitioners using a cross-sectional questionnaire. One hundred general dental practitioners and 100 specialists from each of the following specialties: prosthodontics, periodontics, restorative dentistry and surgical dentistry. There were fewer surgical dentists performing surgical crown lengthening than the other specialists. The specialists in periodontics were significantly more likely to perform surgical crown lengthening than not. The respondents predominantly considered that periodontal surgical crown lengthening is within the remit of periodontics. 33% of the respondents performing more than 50 PSCL procedures in one year thought that the gingival margin was stable after three months. 33% thought that it was stable after six months and 33% declined to state a post-operative marginal stability time period.

Cross-Sectional Studies↗

PubMed2003

An evaluation of the usefulness of two endodontic case assessment forms by general dentists.

AIM: To evaluate the use of two forms to assess the risks and difficulty of root-canal treatment. METHODOLOGY: Two criterion-based forms, containing 15 and 16 items, respectively, were distributed to 83 general dentists to evaluate the potential difficulty of root-canal treatment. The participants were asked to assess the difficulty of 15 endodontic cases using the Dutch Endodontic Treatment Index (DETI) and the Endodontic Treatment Classification (ETC) forms. A questionnaire was also provided to evaluate the time needed to complete the two forms, their ease of use, the clarity and/or appropriateness of the criteria and any other comments. The outcomes of the assessment were compared with the assessment of each case as carried out by the authors. RESULTS: The response rate was 53%. The DETI was an easy and rapid way to differentiate between uncomplicated and complicated cases. In 13 of the 15 cases, 88-100% of the dentists scored the cases in agreement with the authors. Use of the ETC form was more complicated, as a result of the larger number of variables. However, most respondents recognized the complicated cases, and 91% found the ETC form valuable to help in assessing the difficulty of endodontic cases. CONCLUSIONS: These two forms may help general practitioners to assess the difficulty of endodontic problems and to decide whether to treat the case or to refer it to a specialist.

Decision Making↗

PubMed2000

Dental health promotion and preventive dentistry practices of U.S. Army dentists.

In May 1997, all Army dentists assigned full-time to clinical duties (1,100) were sent a mail survey that queried how often they deliver dental health promotion and preventive dentistry services and the type and source of their patient educational materials. By August, 606 dentists had responded. Simple frequencies were generated using SPSS. Results show that tobacco, oral hygiene, and periodontal counseling and oral cancer and blood pressure screening are delivered frequently, whereas nursing caries, mouthguard, sealant, and nutrition services are delivered infrequently. Army dentists relied almost exclusively on oral presentations to deliver health promotion messages. Few used more than one source for health promotion materials. These results suggest that the delivery of dental health promotion and preventive dentistry services in the Army is suboptimal. A campaign to heighten provider awareness of the importance of delivering these services should be launched. The campaign should also teach providers how to make their health promotion efforts maximally effective through the application of proven health marketing techniques.

Health Education, Dental↗

PubMedDate not supplied

Prosthodontic decision making among general dentists in Sweden. II: The choice between fixed and removable partial dentures.

PURPOSE: The purpose of this study was to describe how dentists evaluated various items related to a treatment choice between fixed partial dentures (FPD) and removable partial dentures (RPD), and to determine if the differences could be explained by dentist-related variables ("social and demographic attributes," "job situation," and "attitudes"). MATERIALS AND METHODS: Questionnaires were sent to a random sample of 2,059 Swedish general dentists, with a response rate of 76%. In the questionnaire, the choice between FPDs and RPDs in a clinical situation was presented. The dentists were asked to mark on 14-item visual analogue scales the relative importance he or she gave the different items. The items were analyzed through principal components analysis, where a 3-factor solution was obtained; the factors were labeled as "time," "health," and "comfort." The factors were run as dependent variables in multiple regression analyses. RESULTS: Great individual variations were seen, but the differences between groups of dentists were small. The items evaluated as most important were "patient's wish," "condition of possible abutment teeth," and "prognosis for delivered treatment." Male dentists gave significantly greater importance to the "health" factor compared to female dentists. The attitudinal variable "patient information" showed significant associations with all 3 factors in the multivariate models. CONCLUSION: Great individual differences were seen regarding the importance of the various items. In multiple regression models, several independent variables showed significant associations, most interestingly the attitudinal variable "patient information." Low explanatory (R2) values indicate that it is necessary to capture more variables of importance for the prosthodontic decision-making process.

Age Factors↗

PubMed1999

Retain or extract: the decision process.

It is difficult to give up attempts to save a tooth and decide to extract. Sometimes the decision is easy because experience allows the dentist to evaluate the patient and the situation and make an educated prognosis for the tooth. The thought process is extremely involved and many variables must be taken into consideration, some of which the dentist has very little control over. The process was much less involved when there were fewer options available to the patient and the dentist. Teeth in themselves are very rarely hopeless; it is the desires of the patient, the expertise of the dentist, and the conditions of the oral environment that lead to a hopeless prognosis. A tooth can be moved to another place in the mouth or even into another patient's mouth, and the treatment decision changes, making it not as hopeless. The wish of the patient is usually the final, determining factor for how treatment is carried out. Patients make the decision whether to spend their time and money to save the tooth with extraordinary effort or whether to cut their losses and give up on the tooth.

Decision Making↗