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PubMed2001

Cross infection control measures and the treatment of patients at risk of Creutzfeldt Jakob disease in UK general dental practice.

AIMS: To determine the suitability of key infection control measures currently employed in UK dental practice for delivery of dental care to patients at risk of prion diseases. MATERIALS AND METHODS SUBJECTS: Five hundred dental surgeons currently registered with the General Dental Council of the UK. DATA COLLECTION: Structured postal questionnaire. ANALYSIS: Frequencies, cross-tabulations and chi-squared analysis. RESULTS: The valid response rate to the questionnaire was 69%. 33% of practices had no policy on general disinfection and sterilisation procedures. Only 10 of the 327 responding practices (3%) possessed a vacuum autoclave. 49% of dentists reported using the BDA medical history form but less than 25% asked the specific questions recommended by the BDA to identify patients at risk of iatrogenic or familial CJD. However, 63% of practitioners would refer such patients, if identified, to a secondary care facility. Of the 107 practitioners who were prepared to provide dental treatment, 75 (70%) would do so using routine infection control procedures. CONCLUSIONS: Most of the dental practices surveyed were not actively seeking to identify patients at risk of prion diseases. In many cases, recommended procedures for providing safe dental care for such patients were not in place.

Adult↗

PubMed2002

Influence of patient, visit, and oral health factors on dental service provision.

OBJECTIVES: Service provision should reflect the oral health of the patient. However, patient and visit factors may influence service patterns and the appropriateness of care delivered. The aim of this study was to examine factors associated with variation in dental services and to assess whether variation by patient and visit characteristics persisted after controlling for oral health status. METHODS: A random sample of Australian dentists was surveyed during 1997-98 (response rate = 60.3%). Private general practitioners (n = 345) provided data on service provision, as well as patient, visit and oral health variables from a log of a typical clinical day (n = 4,115 patients). Multivariate Poisson regression models were run for eight service areas (e.g., diagnostic, preventive, and restorative). RESULTS: Significant effects (P < .05) were observed for oral health factors in all eight models, visit factors in all eight models, patient demographics in four models, dental knowledge/behavior in one model, and area-based socioeconomic status in one model. CONCLUSIONS: After controlling for oral health, visit characteristics persisted as significant predictors of services, with nonemergency visits, insurance, and capital city location associated with more favorable service mix patterns. Higher socioeconomic status areas and payment scale ratings also were associated with a better service pattern in particular service areas. These findings show that a wide range of factors, in addition to oral health, contribute to variation in service provision.

Adolescent↗

PubMed1997

General dental practitioners' opinions on orthodontics in primary and secondary care.

A survey of 232 general dental practitioners was undertaken by the purchasing authorities in Hereford and Worcester, England, in 1993, to establish local practitioners' views on primary and secondary care orthodontics. The response rate was 90.1%. The dentists overestimated their orthodontic case-load: 66.6% of contract holders submitted no claims for upper removable appliances (URA) treatment, but 70.8% claimed they undertook removable appliance therapy. Dentists believed orthodontics should be a feature of the General Dental Services (GDS) but did not seem inclined to commit themselves to providing it. A majority of GDPs (54.9%) felt orthodontics was uneconomic under the GDS. There was support for the treatment planning role of hospitals, but although this was available locally it did not appear to have stimulated primary care provision. Consultant outreach clinics were not generally supported but there was a desire for more opportunities for hospital clinical attachments in orthodontics. The implications for the policies of National Health Service (NHS) purchasers are considered: purchasing health authorities need to carry out systematic assessment of the views of their general dental practitioners and take account of their desired patterns of specialist provision. Policies encouraging the shift of orthodontics into primary care are called into question by this study. If demand for orthodontics is to be met, policy should concentrate on the development of hospital services and specialist practitioners.

Adult↗

PubMed2001

From amalgam to composite: selection of restorative materials and restoration longevity in Finland.

The aim of this study was to obtain information on restorative dental care in Finland and to analyze the changes in treatment over a 5-year period. A random sample of dentists was drawn from the registers of the health authorities and the dental association in Finland, and in the spring of 1997 a questionnaire was sent requesting the dentists to record information for each restoration placed during a given period. A total of 1,229 dentists were contacted, and 659 responded. The dentists treated 5,305 adults during the study period and placed 6,322 restorations. The most common restorative material was composite resin, which was used in 74.9% of the restorations, whereas amalgam was used in 4.8% and glass ionomers in 9.4% of the restorations. The median ages of failed restorations were nearly 12 years for amalgam, slightly less than 5 years for composite, and slightly more than 4 years for glass ionomer. The results indicate that clinical dentistry in Finland has made a definite step towards the post-amalgam era. However, the functional periods of the failed tooth-colored restorations were disappointingly short and warrant some serious consideration.

Adolescent↗

PubMed1998

Illinois Dental Anesthesia and Sedation Survey for 1996.

Dentists in the state of Illinois who possess a permit to administer sedation or general anesthesia were surveyed. A 71% response rate was achieved. Of the respondents, 86% held permits for deep sedation/general anesthesia and 14% held permits for parenteral conscious sedation. By practice specialty, 84% were oral and maxillofacial surgeons, 11% were general dentists, 5% were periodontists, and fewer than 1% were dental anesthesiologists. Advanced Cardiac Life Support training was possessed by 85% of the respondents. The most common anesthesia team configuration (82%) was a single operator-anesthetist and two additional assistants. Only 4% reported use of a nurse anesthetist, and 2% used an additional MD or DDS anesthesiologist. The vast majority (97%) of the practitioners do not intubate in the office on a routine basis. Supplemental oxygen was used by 81% of the respondents whenever intravenous agents were used. A total of 151,335 anesthetics were administered during the year. One mortality occurred in a patient with an undisclosed pre-existing cardiac condition. Four other events were reported that required medical intervention or hospital evaluation; however, no permanent injuries were reported. Other practice characteristics were described.

Anesthesia, Dental↗

PubMedDate not supplied

Dental care for special needs patients: a survey of Texas pediatric dentists.

The purpose of this study was to determine the amount of time Texas pediatric dentists spent, as both residents and in their professional position, in the treatment of special needs patients. In addition, an attempt was made to determine the dental services offered to these patients along with the barriers to obtaining care. A survey was mailed to the 334 members of the Texas Academy of Pediatric Dentistry. From the returned surveys (61.9% or 207/334) the following conclusions were drawn: 1) Most respondents had a significant portion of their training program devoted to special patient care, 2) Virtually all reported treating some special needs patients in their professional position, 3) Most provided conscious sedation and general anesthesia and adjuncts to behavior management for these patients, 4) Insufficient financial reimbursement was a major reason cited for not providing dental services to more of these patients.

Anesthesia, Dental↗

PubMed2003

A web-based survey of odontologist's opinions concerning bitemark analyses.

Within the field of forensic dentistry, the detection, collection, and analysis of bitemarks remains one of the most contentious areas. Attempts at the production of consensus documents have produced documents such as the ABFO's Guidelines for Bitemark Evidence Collection. Despite this, the range of differing analysis techniques, allied with a varied opinion base on the robustness of bitemark conclusions has led to polarized views within the profession. The purpose of this study was to survey forensic dentists to obtain their views on a number of crucial components of bitemark theory and contentious areas within the discipline. Using a web-based survey, 14 questions were asked of respondents. Seventy-two odontologists completed the survey, with 38% being of Diplomate status, 10% had completed 20 or more bitemark cases, and 20% between 10 and 20 cases, 91% of respondents believed that the human dentition was unique, with 78% believing that this uniqueness could be represented on human skin during the biting process. Seventy percent believed that they could positively identify an individual from a bitemark, and 22% stated that the statistical tool, the product rule, should be applied to bitemark conclusions. Over half of the odontologists used overlays for bitemark analysis. with a digital method of production the most popular. The implications of these and other findings are discussed.

Bites, Human↗

PubMedDate not supplied

Diagnostic codes in dentistry--definition, utility and developments to date.

Diagnostic codes are computer-readable descriptors of patients' conditions contained in computerized patient records. The codes uniquely identify the diagnoses or conditions identified at initial or follow-up examinations that are otherwise written in English or French on the patient chart. Dental diagnostic codes would allow dentists to access information on the types and range of conditions they encounter in their practices, enhance patient communication, track clinical outcomes and monitor best practices. For the profession, system-wide use of the codes could provide information helpful in understanding the oral health of Canadians, demonstrate improvements in oral health, track best practices system-wide, and identify and monitor the progress of high-need groups in Canada. Different systems of diagnostic codes have been implemented by program managers in Germany, the United Kingdom and North America. In Toronto, the former North York Community Dental Services developed and implemented a system that follows the logic used by the Canadian Dental Association for its procedure codes. The American Dental Association is now preparing for the release of SNODENT codes. The addition of diagnostic codes to the service codes already contained in computerized patient records could allow easier analysis of the rich evidence available on the oral health and oral health care of Canadians, thereby enhancing our ability to continuously improve patient care.

Abstracting and Indexing↗

PubMed2004

A survey of preprocedural antiseptic mouth rinse use in Army dental clinics.

OBJECTIVE: The objective of this project was to evaluate the use of preprocedural mouth rinses in Army dental clinics. MATERIALS AND METHODS: Three hundred six-question surveys were distributed to 10 Army dental organizations throughout the United States and Germany during the period from March 2001 to March 2002. Two hundred fifty-four surveys were completed and returned. Simple mathematics were used to evaluate answers to the questionnaires. RESULTS: The 254 respondents included military dentists (n = 190), civilian dentists used by the military (n = 27), registered dental hygienists (n = 20), and military-trained dental hygiene technicians (n = 17). Eighty-four and one-tenth percent of respondents (n = 216) use preprocedural rinses in their practices to prevent possible disease transmission (n = 85) or to decrease chances of postoperative infection (n = 167). Chlorhexidine gluconate (n = 170) and phenol-based essential oil preparations (n = 84) are the most commonly used products. The perceived greatest benefits of preprocedural rinsing are to decrease oral bacterial load (38%), to decrease incidence of postoperative infection (21%), and to decrease aerosolization of bacteria (8.66%). CONCLUSIONS: Army dental clinics make extensive use of antimicrobial preprocedural rinses. Chlorhexidine and Listerine (Warner-Lambert Consumer Healthcare, Morris Plains, NJ) are the most commonly used products. Currently available literature appears to support the use of these products in preventing or diminishing the chances of postoperative infection.

Anti-Infective Agents, Local↗

PubMed2001

Comparison of decisions regarding prophylactic removal of mandibular third molars in Sweden and Wales.

OBJECTIVE: To test the hypothesis that Swedish dentists schedule more mandibular third molars for prophylactic removal compared with UK dentists and oral surgeons. DESIGN: Clinical and radiographic information relating to a stratified sample of 36 disease-free mandibular third molars (equal distribution of males and females, patients' age, angular position and degree of impaction) was presented to 26 general dental practitioners (GDPs) and 10 oral surgeons in Sweden and 18 GDPs and 10 oral surgeons in Wales who were asked to decide whether or not the third molars should be removed. RESULTS: There was no evidence of any difference in mean number of molars scheduled for removal by the GDPs, but the Swedish oral surgeons scheduled significantly more third molars for removal than oral surgeons in Wales. CONCLUSION: The less interventionist approach among oral surgeons in the UK may reflect the development and application of authoritative guidelines in the UK and an extensive debate concerning appropriateness of prophylactic removal there.

Adult↗

PubMedDate not supplied

Placement and replacement of amalgam restorations in Germany.

From 15 September to 15 October 1991, 102 dentists practicing in a rural area of Germany provided information on 5240 amalgam restorations. The aim of the present cross-sectional study was to investigate the reasons for placement and replacement of amalgam fillings and to register the age of the failed restorations. First placements because of primary caries were made in 47.1% of all cases; 52.9% were replacements of failed restorations. The most frequently recorded reason for replacement was secondary caries, irrespective of size of the filling, dentition, and age group. The second most frequently recorded reasons for replacement depended on the size of the filling, the age and the dentition of the patient: Bulk fractures were predominant in primary teeth and in fillings with three or four surfaces, primary caries in permanent teeth of patients 16 years old or younger and marginal gaps in adults and in fillings with one or two surfaces. The median age of replaced amalgam restorations in adults was 60 months.

Adolescent↗

PubMed2004

The evolving impact of aging America on dental practice.

American dentistry has recognized for a quarter century that the growth in the proportion of elderly in the population is impacting on the profession. Multiple articles in the professional literature have speculated on the ways in which this change will be manifested. Data and projections from earlier articles are revisited and five trends are offered to guide professionals as they position their practices for the coming years. The increase in number and proportion of elderly in dental practices stems from successes in preventing and controlling infectious diseases during the last century. The trend has not peaked but will continue for at least two more decades. Retention of teeth into advanced age has resulted from emerging and improved preventive and restorative dental advances directed at children and adults beginning mid-century, and dental utilization studies confirm the elderly are seeking dental care at an unprecedented and growing rate. Chronic disease and infirmity that accompany advanced age make dental care more challenging for this group. Dentists and their staff will need to continuously undertake educational opportunities that will foster and maintain their facility in providing care to the elderly. They will need to do this because Americans of advanced age are becoming the dominant age group seeking, and able to pay for, sophisticated dental services. The blend of those services is shifting away from removable prostheses to a rising demand for restorative, periodontic, and endodontic care. Root caries, in particular, will be a growing challenge to both providers and patients. There is mounting evidence oral disease impacts endocrine, cardiovascular, and pulmonary health, particularly in frail elders, and will likely provide many elderly additional stimuli to seek dental care. Providers who seek an alternative approach for delivering their services will find growing demand for and satisfaction with traveling to patients, rather than the other way around.

Aged↗

PubMed2005

Routine oral examination: differences in characteristics of Dutch general dental practitioners related to type of recall interval.

OBJECTIVES: The aim of this study was to explore differences in behaviour (characteristics and opinions) among general dental practitioners (GDPs), using either a fixed (Fx) or an individualized recall interval (Iv) between successive routine oral examinations (ROEs). METHODS: In the year 2000, data were collected by means of a written questionnaire sent to a random stratified sample of 610 dentists of whom 521 responded, of which 508 (83%) were used for analysis. RESULTS: Two groups of GDPs were distinguished based on their answer to the question: 'Do you apply for all patients a fixed recall interval between two successive ROEs?' Fifty-one per cent of the GDPs (n=257) applied Fxs for all patients, generally for a period of 6 months. Ivs were applied by 49% (n=251) of GDPs, depending on the determination of specific patient characteristics. Logistic regression analysis showed that GDPs applying Fxs also used fixed periods between successive bitewing radiographs for all patients. Furthermore, dentists applying Ivs required more time to conduct an ROE, partly because of a more extensive periodontal screening. GDPs applying Fxs, adhered more to the opinion that a fixed recall regime (every 6 months, as existed before 1995) should be re-introduced, whereas the GDPs in support of Ivs were more in favour to support the opinion that the ROE is 'an excellent instrument for effective, individualized oral care'. CONCLUSIONS: Dutch GDPs differ in the way they deal with the determination of recall interval frequency. These are also specific differences in performance and opinions regarding ROE. With the changing prevalence of oral diseases and the skewed distribution within populations, further research is advocated on consistent decision making to determine the most appropriate recall policy in preventing oral disease.

Appointments and Schedules↗

PubMed1998

Endodontic retreatment behaviour: the influence of disease concepts and personal values.

To explain dentists' variation in endodontic retreatment decision making a praxis concept (PC) has been generated. PC assumes that practitioners operate along a health continuum. Various periapical conditions are then perceived as different stages on a continuous health scale, based on their radiographic appearance. PC suggests that an individual's placement of a cut-off point for retreatment on the health continuum to a large extent is dependent on the agent's personal values. In the present study value judgements (utilities) concerning two periapical health states in endodontically treated teeth were investigated among 82 dental students. The two methods used to elicit utilities, a Visual Analogue Scale (VAS) and the Standard Gamble (SG), produced large inter- and intra-individual variations. VAS frequently generated lower utility values. The results obtained in the study satisfy a necessary criterion for the validity of PC and strengthen the position of the theory.

Attitude of Health Personnel↗

PubMed2002

Radiographic practices of dentists undertaking endodontics in New Zealand.

OBJECTIVES: To determine the radiographic practices of New Zealand dentists undertaking root canal treatment, and to investigate the relationship between radiographic practices and educational and clinical factors. METHODS: A questionnaire was sent to all 1200 general dental practitioners and five specialist endodontists in New Zealand. Data were subjected to descriptive and analytical statistics. RESULTS: The response rate was 79%. The mean number of root canal treatments done by general dentists in the previous 12 months was 103, and for the specialists 938. Pre-operative views were taken by 57.1% of respondents all the time and by 34.8% in most cases. The long cone paralleling and bisecting angle techniques were in regular use by similar numbers of respondents, and over one half of the practitioners regularly used film holders and electronic apex locators. Working length films were taken by 67% of practitioners all the time and by 18% in most cases. One-quarter of practitioners took a master point view all the time, and 15% did this for most cases. Almost 65% always took a film of the completed root filling and 21% did for most cases. Twenty-three per cent of practitioners did not follow up their work. CONCLUSIONS: The majority of respondents used radiographs pre-operatively, for working length assessment and to assess the final root filling. There was a general improvement in radiographic practices compared with data from a previous national survey held in 1980.

Dental Pulp Cavity↗

PubMed2002

Investigation of previously reported mucosal swellings after injection with Citanest Forte.

The purpose of this study was to determine the reason for an apparent increase in the number of mucosal swellings after maxillary infiltration with Citanest Forte (prilocaine HCl 4% solution with epinephrine 1:200,000), 2 years after its introduction in 1971 by Astra Pharmaceutical Co (now AstraZeneca) in the United States. Approximately 70% of these reported reactions were from California, where less than 11% of all cartridges were sold. Comparison with New York State, with 27% of total sales but less than 1% of the reactions, suggested that possible differences in practice characteristics were responsible for the swellings. On the basis of the Bureau of Economic Research and Statistics Survey of Dental Practice, dentists in the Far West (eg, California) were found to schedule appointments with a median length of approximately twice that of their Mid-East colleagues, the implication being that more anesthetic solution was injected per office visit. Follow-up telephone interviews of dentists reporting such reactions at that time verified that they administered more than the recommended 1.8-mL dose. The most important epidemiologic information was that prilocaine HCl 4% solution with epinephrine 1:200,000 had been on sale in Canada 4 years before it was introduced in the US market, with little or no evidence of drug-related effects. Comparison of the US and Canadian prilocaine HCl with epinephrine 1:200,000 specifications revealed that NaCl was added to an already hypertonic prilocaine solution in the US but not in Canada. Comparison of the responses to intradermal injection of US and Canadian prilocaine solutions into the backs of rabbits with follow-up studies of dose-related NaCl injections demonstrated that the added NaCl was responsible for the onset and duration of irritation from the initially marketed US Citanest solutions.

Adverse Drug Reaction Reporting Systems↗

PubMed2006

General dentists and pediatric dental patients: the role of dental education.

The objective of this study was to investigate whether undergraduate dental education affects general dentists' practice characteristics, attitudes, and professional behavior concerning the treatment of pediatric patients. Data were collected with a self-administered mailed survey from 241 general dentists who were members of the Michigan Dental Association (response rate=48.2 percent). While 40.4 percent of the respondents reported that their dental education had prepared them well to treat child patients, only 33.4 percent indicated that their clinical education had prepared them well. The level of educational preparedness was significantly correlated with a) practice characteristics such as how well the practice was set up to treat children and how knowledgeable and comfortable the staff was concerning providing care for children, b) attitudes concerning the treatment of child patients, and c) professional behavior such as the types of services provided for child patients versus the number of referrals made. The findings strongly suggest that educational experiences concerning the treatment of pediatric dental patients will shape future dental care providers' attitudes and professional behavior. Given the lack of access to dental care for children, it seems crucial to carefully evaluate undergraduate dental curricula to ensure that future dental care providers receive sufficient educational and especially clinical experiences concerning the treatment of child patients.

Adult↗

PubMedDate not supplied

Are we ready to move from operative to non-operative/preventive treatment of dental caries in clinical practice?

This review focuses on the clinical interactions between patients and the dental team, not on caries prevention at a public health level. Many dentists no longer take a narrow surgical view seeking to apply interventive treatment as a one-off event at a certain trigger point of disease severity and the evidence that caries is an initially reversible, chronic disease with a known multi-factorial aetiology is being appreciated more widely. The caries process should be managed over time in an individualized way for each patient. Very few individuals can be considered to be truly 'caries free' when initial lesions as well as more advanced dentine lesions are considered. It is now very clear that, by itself, restorative treatment of the disease does not 'cure' caries. The caries process needs to be managed, in partnership with patients, over the changing challenges of a lifetime. The answer to the question posed in the title should be, in many cases, that we are ready to move to non-operative/preventive care (if we have not done so already). However, this should be for appropriate stages of lesion extent and in patients who respond to advice on recall frequency and preventive behaviours.

Consensus↗