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PubMed2004

Direct restorative materials use in Australia in 2002.

BACKGROUND: This study aimed to determine the reasons for dentists' choice of materials, in particular amalgam and resin composite, in Australia. METHOD: A questionnaire was developed to elicit this information. The names and addresses of 1000 dentists in Australia were selected at random. The questionnaire was mailed to these dentists with an explanatory letter and reply-paid envelope. RESULTS: A total of 560 replies were received. Regarding choice of material, 99 per cent of respondents cited clinical indication as an influencing factor, although patients' aesthetic demands (99 per cent of respondents), patients' wish (96 per cent), patients' financial situation (82 per cent), and lecturers' suggestions (72 per cent) were also reported to influence respondents' choice of materials. Twelve per cent of respondents used composite 'always', 29 per cent 'often', 32 per cent 'sometimes', 23 per cent 'seldom' and 4 per cent 'never' in extensive load-bearing cavities in molar teeth. For composite restorations in posterior teeth, 84 per cent 'always', 'often' or 'sometimes' used the total etch technique, 84 per cent used a thick glass-ionomer layer and 36 per cent never used rubber dam. Fifty-nine per cent of respondents reported a decreased use of amalgam over the previous five years. Sixty-eight per cent of respondents agreed with the statement 'discontinuation of amalgam restricts a dentist's ability to adequately treat patients'. Seventy-five per cent considered that the growth in the use of composites increased the total cost of oral health care. CONCLUSIONS: Of the respondents from Australia 73 per cent place large composite restorations in molar teeth and their choice of material is influenced greatly by clinical indications, and patients' aesthetic demands.

Acid Etching, Dental↗

PubMed2002

Factors influencing choice of dental treatment by private general practitioners.

Service rate variations have focused attention on treatment decisions. The aims of this study were to examine factors considered in choosing treatments, to classify dentists in terms of clinical decision making, and to investigate the association of decision making with services provided. From a random sample of dentists (response rate 60.3%) treatment constraints (15.0%), periodontal status (12.1%), tooth status (11.3%), mouth status (10.1%), and patient factors (9.8%) were considered important factors across six alternative treatment pair choice scenarios. Cluster analysis of the treatment choice scenarios produced one cluster that reflected patient preferences, another that reflected treatment constraints such as cost, and a third that reflected oral health factors. Compared with the oral health cluster, dentists in the constraints cluster had higher rates (p < .05) of extractions (rate ratio [RR] = 1.49), bridge work (RR = 1.77), and dentures (RR = 1.32), whereas dentists in the patient cluster had higher restoration rates for two-surface ionomers (RR = 2.45) and resins on three or more surfaces (RR = 1.50) and other preventive services (RR = 1.78) such as oral hygiene instruction. Although a range of factors influenced treatment choice, a limited set accounted for the majority of responses, with cost a major determinant, ahead of oral health status and patient preference. Decision-making style was associated with service provision.

Adult↗

PubMed2005

Patient-active prevention in primary dental care: a characterisation of general practices in Northern Ireland.

AIM: To investigate the preventive orientation of general dental practices by examining their patient-active prevention activities, practice policies for prevention and employment strategies. METHOD: All general dental practices located within the region of the Eastern Health and Social Services Board (EHSSB) in Northern Ireland were contacted and invited to participate. A questionnaire assessed practice characteristics, patient-active prevention, practice policies and employment strategies. The principal general dental practitioner (GDP) was invited to complete the questionnaire. RESULTS: Seventy-seven per cent of practices participated. Nearly all the practices provided patient-active prevention; however, lower proportions of dentists provided advice on diet for dental caries (3%), oral hygiene instruction, fluoride toothpaste use and interdental cleaning (7%) with each new course of dental treatment. 'Patient-active' prevention practices were 5.8 times more likely to employ a hygienist and 5.3 times more likely to have a practice policy to screen for oral cancer. CONCLUSIONS: These findings suggest that the employment of a hygienist is central to the reorientation of primary dental care. The Government must be encouraged to provide the financial means to allow primary care to shift from being disease-centred to health-focused.

Dental Hygienists↗

PubMed2003

General dental practitioners' perception of their role within child protection: a qualitative study.

AIM: This was to assess general dental practitioners' knowledge, attitudes and practice regarding their role within child protection in relation to child abuse. METHODS: Structured interviews with seven key informants from general dental practice (2), local dental committees (1), social services (2), paediatric dentistry (1) and community child health (1), together with five focus groups comprising 23 general dental practitioners (GDPs) on Health Authority Lists in Tyne and Wear and Northumberland (UK). RESULTS: GDPs reported feelings of isolation with little communication with other health professionals or local authority services. The majority had scarcely considered child protection issues in their clinical practice although those qualified for less than 15 years were more aware. GDPs acknowledged a lack of awareness of signs and symptoms of physical abuse and even less confidence in dealing with emotional or sexual abuse. Dentists expressed concern, even fear, about the outcomes of reporting suspicions, and had little knowledge of the local Child Protection mechanisms. CONCLUSION: GDPs in Tyne and Wear and Northumberland feel unprepared to undertake a role in the child protection process with confidence. National and local initiatives may be required to address existing barriers.

Attitude of Health Personnel↗

PubMed2006

[The changing picture of practicing dentistry].

Originally, dentists were particularly technical and curative practitioners. Nowadays, patient care is brought into focus, directed at maintaining oral health permanently by prevention and necessary curative treatments as a contribution to general health and well-being. The changing picture of praccising does not develop as a matter-of-course since many factors have an effect on dental practice. Effecting factors are: content concerning developments, technological advancements, legislation, government policies, organizational aspects, and typical characteristics of dental practitioners. The changing picture of practising dentistry is connected with uncertainty, proves to be hard to control, and some adjustments occur around practising.

Dental Assistants↗

PubMedDate not supplied

A survey of failure modes in composite resin restorations.

This study was undertaken as a first step in identifying opportunities to decrease the need for replacement of class 3, 4, and 5 composite resin restorations. Data regarding the reasons for original placement or replacement of a restoration, the age of restorations at the time of replacement, and patient/doctor factors that may be associated with a decision to place or replace a restoration were recorded by use of a cross-sectional survey. During a 2-week period 108 dentists recorded reasons for placing or replacing 1360 restorations. Of the 1360 restorations, 42.8% were classified as primary placement and 57.2% as replacement restorations. Of the primary placements 80% were categorized as being due to caries; 9.1% fracture of tooth; 8.4% other (erosion lesions were specified 94% of the time). By class, caries was the dominant cause for class 3 (96.2%); caries and other (erosion) for class 5 (77.3% and 16.4%); fracture of tooth and caries (48.9% and 40.2%) for class 4 restorations.

Chi-Square Distribution↗

PubMed1998

Knowledge, opinions and practices of general dentists regarding oral cancer: a pilot survey.

The authors mailed a pilot survey to 500 randomly selected general dentists. Although most dentists reported their knowledge of oral cancer to be current, their actual knowledge of oral cancer risk factors and signs and symptoms was inconsistent. Conflicting data were also found between their level of knowledge and their provision of oral cancer examinations. Most respondents agreed that patients should undergo an oral cancer examination annually, yet many do not provide this service.

Adolescent↗

PubMed2002

Endodontics and new graduates: Part I, Practice vs training.

Surveys have demonstrated that many dentists, even the recently qualified, do not carry out endodontics using currently recommended materials and techniques. To assess the scale and nature of this finding among young graduates, a questionnaire was sent to all graduates from the mainland United Kingdom dental schools qualified for either one or four years. Widespread reduction in the number of radiographs taken and rubber dam use was found. A minority had adopted techniques and materials without published guidelines. It is suggested that alterations are required in undergraduate teaching, vocational training and the United Kingdom National Health Service remuneration system in order to improve the standard of endodontics in general practice.

Clinical Competence↗

PubMed2005

General dental practitioners' views on the use of stainless steel crowns to restore primary molars.

AIM: To ascertain general dental practitioners' views on the use of stainless steel (pre-formed metal) crowns to restore carious primary molars. METHOD: Ninety-three general dental practitioners were selected at random from those practising in Lancashire, Cheshire and Greater Manchester in 2003 and interviewed separately about the clinical care they provide to the primary dentition. Before the interview participants recorded the care they would provide for a case scenario, describing a child with a carious lesion that the British Society of Paediatric Dentistry (BSPD) guidelines indicate should be treated with a stainless steel crown. RESULTS: In answering the case scenario only six (7%) of the dentists reported that they would fit a stainless steel crown. Of the 93 dentists interviewed 71% knew of the BSPD guidelines, but only 18% had ever fitted a stainless steel crown in general practice. Reasons given for not using stainless steel crowns were they are inappropriate for many children, time consuming to fit, difficult to manipulate, expensive, and ugly. CONCLUSION: The BSPD guidelines on the use of stainless steel crowns do not reflect the views of the majority of general dental practitioners who consider these crowns unsuitable for most children and an impractical restorative technique in busy daily practice.

Attitude of Health Personnel↗

PubMed2000

Professionally applied topical fluoride and restorative care in insured children.

OBJECTIVES: This study evaluates the association between use of professionally applied topical fluoride and use of interproximal restorations in primary and permanent teeth of children. METHODS: Insurance claims from 15,190 children, for treatment provided by 1,556 different dentists, were analyzed to look for associations between frequency of use of professionally applied topical fluoride and use of interproximal restorations. The average follow-up period for the children included in the analysis was 5.3 years, with the range from 3.0 to 7.9 years. RESULTS: Both tabular and regression results failed to demonstrate an association between frequency of use of professionally applied topical fluoride and use of interproximal restorations in either the primary or permanent dentition. The most powerful predictor of restorative care for these children was the overall propensity of the dentist to place restorations in children. CONCLUSIONS: In this group of insured children, we were unable to find an association between the frequency of use of professionally applied topical fluoride and restorative care. Further, despite numerous recommendations that professionally applied topical fluorides should be used only in moderate- and high-caries children, approximately two-thirds of these children received topical fluoride at every recall visit, nearly two times per year.

Adolescent↗

PubMed2003

Amalgam and composite use in UK general dental practice in 2001.

OBJECTIVE: This study determined the reasons for dentists' choice of materials, in particular amalgam and resin composite, in Great Britain. METHOD: A questionnaire was developed to elicit this information. The names and addresses of 1,000 UK-based dentists were selected at random. The questionnaire was mailed to these dentists with an explanatory letter and reply-paid envelope. RESULTS: Six hundred and fifty four replies were received. Regarding choice of material, 100% of respondents cited clinical indication as the most influential factor, although patients' aesthetic demands (99%), patients' choice (95%) and patients' financial situation (92%) were also reported to influence respondents' choice. Thirty-five per cent of respondents used composite 'sometimes', 15% 'often', and 1% 'always' in extensive load-bearing cavities in molar teeth. For composite restorations in posterior teeth, 92% 'always', 'often' or 'sometimes' used the total etch technique and 53% never used rubber dam. Seventy per cent of respondents agreed with the statement 'discontinuation of amalgam restricts a dentist's ability to adequately treat patients'. Eighty-one per cent considered that the growth in the use of composites increased the total cost of oral healthcare. CONCLUSIONS: Forty nine per cent of the respondents from England and Wales seldom or never place large composite restorations in molar teeth. Their choice of material is influenced greatly by clinical indications, and patients' aesthetic demands.

Acid Etching, Dental↗

PubMedDate not supplied

Antimicrobial management of third molars: survey results for military dentists.

In a survey of military dentists to examine use of antimicrobial agents in the management of third molars, questions addressed use of antibiotics and an antimicrobial rinse in treating pericoronitis and third molar extractions. Results were compared with information from a literature review. According to the survey, a majority of clinicians use antibiotics to treat pericoronitis but not surgical extraction of asymptomatic dental impactions. About 60 percent of respondents use a preoperative rinse with chlorhexidine in treating the third molar conditions discussed. A postoperative rinse with chlorhexidine was used less frequently. Half the respondents listed medicolegal factors in their decisions.

Anti-Infective Agents, Local↗

PubMedDate not supplied

Infant oral health education for pediatric and family practice residents.

PURPOSE: The purpose of this study was to investigate whether an infant oral health curriculum implemented in pediatric and family medicine residency programs could improve physicians' oral health knowledge and practice behaviors and promote the age 1 dental visit. METHODS: Residents and faculty members completed a baseline current practices survey and knowledge test before receiving a 1- or 2-hour training session followed by a knowledge post-test. Existing well child care forms were updated with oral health prompts to reinforce newly learned skills. At 1-year follow-up (1 YFU), participants completed a current practices survey and knowledge test. In addition to the residency programs, medical students and advanced practice registered nurses participated in baseline data collection, training, and immediate posttest data collection. RESULTS: A total of 245 people participated, with 78% trained in person and 22% trained via the Web. Of these, 120 were the targeted residents and faculty-of whom 82% completed the 1 YFU. Practice behaviors improved from baseline to 1 YFU, with only 28% of practitioners at baseline referring children to the dentist at age 1, compared to 73% at 1 YFU (P<.05). Knowledge scores were greater at 1 YFU than at baseline (P<.05), and the mode of training showed no difference in knowledge outcomes. Knowledge and prescribing practices regarding fluoride were poor at baseline and showed limited improvement at 1 YFU. CONCLUSIONS: An infant oral health education program can improve physicians' oral health knowledge and behaviors, particularly regarding promoting the age 1 dental visit. Behavior changes regarding fluoride prescribing, however, appear harder to achieve. Web-based training had similar success to in-person training.

Chi-Square Distribution↗

PubMed2000

A survey of Scottish primary care dental practitioners' oral cancer-related practices and training requirements.

OBJECTIVE: The study sought to investigate current examination habits and preventive practices of Scottish dental primary care professionals, with respect to oral cancer, and to determine any training needs of these practitioners in relation to the disease. BASIC RESEARCH DESIGN: A questionnaire was sent to a random sample of 331 general dental practitioners and community dental officers throughout Scotland, achieving an overall response rate of 68%. MAIN OUTCOME MEASURES: The study investigated examination and health promotion practices in relation to oral cancer. Confidence in, and barriers to, participating in these activities were studied, and information sought both on past training and future education needs regarding oral cancer. RESULTS: Although 58% of respondents reported examining regularly for signs of oral cancer in those aged >16 years, 63% indicated they felt less than confident in detecting oral cancer, with only 43% expressing confidence about discussing suspicious findings with patients. Practitioners were well aware of the importance of smoking and alcohol as risk factors, but had mixed views on the health-promoting role of the dentist regarding these issues. Furthermore, while only 3% reported training on these topics, over half expressed a desire to develop appropriate counselling skills. Overall, 87% and 79% of respondents wanted further training in oral cancer detection and prevention, respectively. CONCLUSION: The study indicated a need for continuing education programmes for dental primary care practitioners in oral cancer-related activities. Postgraduate education, utilising a variety of media formats, should aim to improve diagnostic skills and seek to increase practitioners' participation in both smoking and alcohol counselling.

Alcohol Drinking↗

PubMed1995

Provision of domiciliary care in a UK urban area: results of a survey.

A proportion of the population is unable to attend a dentist for treatment and it is therefore essential that an adequate domiciliary service is available. The availability of such a service was evaluated by means of a postal questionnaire distributed to 180 dentists practising in Manchester. The response rate was 57.8%. The results indicated that domiciliary care was provided by 84.6% of respondents, with the mean number of domiciliary patients treated per month being 2.9. Appointments for domiciliary care were arranged outside normal working hours by 65.9% of respondents and by arranging specific time periods by 43.2% of respondents. In general, domiciliary care was limited to prosthetic treatment, extractions, scaling and polishing, and simple restorations. A statistical association was found between number of years since graduation and the provision of domiciliary care.

Age Factors↗

PubMedDate not supplied

A survey of local and topical anesthesia use by pediatric dentists in the United States.

PURPOSE: The purpose of this survey is to evaluate current usage of local and topical anesthesia by Pediatric Dentist to evaluate the current practices. METHODS: Surveys were sent to 3051 pediatric dentists asking about types of anesthetics, considerations in determining local anesthetic dosage, time used to inject a cartridge and shortcomings of topical preparations. Data were computed for percentage responses. RESULTS: The response rate was 55%. Only 49% used exact body weight to determine local anesthetic dosage. The mostly commonly used needles for infiltrations were 30-gauge short and blocks were 27-gauge short. Only 11% of the respondents were using > or = 60 seconds to inject a full cartridge. Topical anesthetics were used by most, with the most commonly used brand being Hurricaine [correction of Hurricane]. A third waited 60 seconds before injecting after the application of the topical anesthetic. Most patients (89%) disliked the taste of topical anesthetics and adverse drug reactions were rarely seen. CONCLUSIONS: The findings of this study demonstrate that Pediatric Dentists are most commonly using Lidocaine as the preferred type of local anesthetic using 30 gauge short needle for infiltrations and 27 gauge short needle for blocks. Most were taking anywhere from 11-> 60 seconds to inject a cartridge. Topical anesthetic was used by most and the preferred brand was Hurricaine, however their perception of the effectiveness of topical anesthetics varied. There also appears to be a need to develop newer and better mode of topical anesthetic delivery system in the pediatric dental population.

Administration, Topical↗

PubMed2003

Keeping up appearances: using qualitative research to enhance knowledge of dental practice.

Current issues in dentistry including a focus on patients' wishes for outcomes and dentists' role in that process raise important questions that cannot be addressed by quantitative, statistical study alone. The intriguing complexities and ambiguities that are emerging with ever-improving techniques and materials in dentistry, as well as competing demands for attention in dental health, require a range of research methodologies to address important existing and future research questions. Qualitative research, much like what a dentist does in an office visit, can seem intuitive and almost common sense in nature. Yet behind that research, when it is done well, lie years of training and practice, rules of evidence, guidelines for rigor, and various subspecializations in its pursuit. Qualitative research begins with a clearly defined problem; identifies the appropriate strategy to gather data from people, existing documents, and other sources of information that will help address the problem; uses a multifaceted tool kit of analytic methods to work with those data; and proceeds to investigate the data for their insight into the research problem and interpretation of the findings. This article provides an overview of common approaches to qualitative methods and resources to explore their potential for dental research.

Anthropology, Cultural↗

PubMed2006

Reasons for third molar teeth extraction in Jordanian adults.

AIMS: To assess reasons for third molar teeth extractions in a sample of Jordanian dental patients and to evaluate the association of extractions with other independent variables. METHODS AND MATERIALS: The study sample was comprised of dental patients in North Jordan who had third molar extractions. Data were collected from 36 dentists who were instructed to administer questionnaires to their adult patients undergoing third molar extractions and then to record the primary reason for those extractions. The data in this study was analyzed using a descriptive summary and chi square statistics. RESULTS: Dentists performed 810 extractions for 648 patients. The reasons for the extractions were: dental caries and its consequences about 42%, eruption problems 39%, periodontal diseases about 7%, and approximately 9% of extractions were a result of the dentist's choice. The percentage of extractions due to dental caries significantly increased with increasing age. However, significant numbers of teeth were extracted due to eruption problems (51%-69%) in young adults. For 46+ year olds, 23% of extractions were caused by periodontal diseases. Extraction due to dental caries was distributed equally among the sexes. Persons with irregular tooth brushing and fewer dental visits had significantly more third molar teeth extracted due to caries and periodontal diseases compared to persons with regular tooth brushing and dental visits.

Adolescent↗