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PubMed2006

Implementing evidence-based decision making in the private practice setting: the 4-step process.

An important goal of EBDM is to improve outcomes where it matters the most: at the point of care. All dental clinicians need practical tools that facilitate access to the clinical information needed to enable our patients to make better-informed choices. This article provides a 4-step guide for practical implementation of EBDM in the private practice setting. Step 1 is defining your practice purpose. Step 2 describes the use of Ethical Practice Parameters to guide clinical decision-making. Step 3 illustrates how to implement Ethical Practice Parameters. Step 4 describes a simple process for searching for scientific evidence. Online resources are provided and the benefits of the 4-step process are elucidated.

Crowns↗
PubMed2006

An analysis of current analgesic preferences for endodontic pain management.

A descriptive, cross sectional survey was developed to determine the preferences of endodontists when prescribing analgesics. Eleven clinical scenarios describing common endodontic diagnoses or procedures with specified severity of pain were provided. A survey was sent to 310 AAE members and 63 responded, providing a 20% response rate. Respondents were given various choices for analgesic prescription including various dosages of ibuprofen or acetaminophen (APAP), or combination narcotic medications. Data were analyzed by chi2 tests. Non-narcotics were preferred over narcotics for all clinical situations. Significantly more respondents selected ibuprofen 600 mg (4x a day) regardless of the severity of preoperative or postoperative pain (p<0.001). Educators and board-certified AAE members were less likely than nonboard certified AAE members to manage their patient's perceived severe pain with narcotic analgesics.

Analgesics↗
PubMed2005

The diffusion of innovation in dentistry: a review using rotary nickel-titanium technology as an example.

Technological innovations are crucial for the advancement of the art and science of clinical dentistry. While some innovations suffer a lack of support, resulting in general nonacceptance, others are gradually adopted and supersede previous techniques and/or materials. Very little has been published in the dental literature concerning the reasons for the adoption, nonadoption, or rejection of new technology in dentistry. This paper reviews the diffusion of innovation in dentistry, with an emphasis on the adoption of rotary nickel-titanium endodontic instruments. Factors affecting adoption of new technology include a complex interplay of perceived benefits and advantages, and psychosocial and behavioral factors, in decision making. The importance of both dental school teaching and continuing education in dentistry is highlighted, emphasizing that such courses must be of a very high caliber.

Attitude of Health Personnel↗
PubMed2000

Need for evidence-based practice in prosthodontics.

STATEMENT OF PROBLEM: Patients, their insurers, the courts, and the scientific community are demanding more evidence to support the effectiveness of health care strategies. PURPOSE: This article describes evidence-based practice, its origins, and value as a way of addressing the demand for evidence of treatment effectiveness in maxillofacial prosthetics. MATERIAL AND METHODS: A limited review of maxillofacial prosthetics literature was performed using Medline over the years 1966 to 1998. The retrieved articles were classified by methodologic design and assessed for the strength of their evidence. RESULTS: Focused and speedy (but not necessarily comprehensive) literature searching methods are available. Critical appraisal skills are available and needed to assess the quality of evidence in support of a treatment and to maintain clinical skills. CONCLUSION: With appropriate skills and the availability of literature searching hardware and software, evidence-based practice is a powerful means for the practitioner to establish the effectiveness of individual patient treatment, and to prevent the diminution of clinical skills over the course of a career. These skills should be included in training programs.

Evidence-Based Medicine↗
PubMed2004

[Sporadic transmission of hepatitis C in dental practice].

Percutaneous contact with contaminated blood is the principal mode of transmission of the hepatitis C virus (HCV). However, the diagnosis of infection in patients in whom no parenteral risk factor can be identified allows speculation on the existence of other routes of transmission. In the field of dentistry, the role of saliva has still not been defined as a potential vehicle for infection nor the role of dental treatment as a possible occult factor in the sporadic transmission of hepatitis C. HVC-RNA is detectable in the saliva of over 50% of patients with chronic hepatitis C. The infectivity of the HVC particles detected in the saliva has not been determined, though it may be deduced from epidemiological studies that their potential for transmission, if it exists, is extremely limited. There has been no documented case of HVC transmission in a dental clinic. Studies which propose a history of dental treatment as a risk factor for HVC infection have not achieved conclusive results. The age distribution of the prevalence of HVC could indicate that a risk of iatrogenic transmission existed in the past, before the systematic application of universal barriers. The transmission of HVC in dental clinics may be considered a very infrequent occurrence as long as the norms for the control of cross-infection are respected.

Dentistry↗
PubMed1998

Endodontic patient recall procedures: a national survey of endodontic practices.

A survey was conducted to measure the extent of patient recall procedures and perceived success and failure in treatment from a sample of endodontists. A comparison to the accepted Quality Assurance Guidelines set forth by the American Association of Endodontists was conducted. Three hundred surveys were mailed to as many active members of the American Association of Endodontics. Two hundred thirty-three responses were returned for a response rate of 77.6%. The only statistically significant finding was that military practitioners in general do not have an active recall system. This was significant at the p < 0.008 level.

Appointments and Schedules↗
PubMed2002

Appropriateness of referrals for removal of wisdom teeth.

A 6-month prospective study of 166 patients was undertaken to assess whether general dental practitioners who referred patients for removal of wisdom teeth were following current national guidelines. It was found that 92% of referrals followed the guidelines of the Faculty of Dental Surgery of the Royal College of Surgeons of England and the National Institute for Clinical Excellence. There were 13 inappropriate referrals - 3 patients were asymptomatic, 9 patients had a single episode of pericoronitis and 1 had crowding of the lower anterior incisors. General dental practitioners in this study seem to be following current guidelines consistently. No teeth were removed prophylactically.

Adolescent↗
PubMed2002

Current practice of British oral and maxillofacial surgeons: advice regarding length of time to refrain from contact sports after treatment of zygomatic fractures.

OBJECTIVE: To find out the current practice of consultant maxillofacial surgeons in the United Kingdom regarding the advice that they give to patients after the treatment of zygomatic fractures. MATERIALS AND METHODS: We sent a postal questionnaire to 261 consultant maxillofacial surgeons in the United Kingdom. They were asked what advice they gave to patients about the length of time that they should refrain from contact sports after a zygomatic fracture. RESULTS: A total of 184 replies were received (70%). Advice about the length of time to refrain from contact sports ranged from none to 13 weeks; 165 (90%) of respondents based their advice on common sense and traditional practice. CONCLUSIONS: Advice given to the patients after the treatment of zygomatic fractures varies widely. Most consultants base their advice on traditional practice and common sense. No widely accepted evidence-based guidelines exist about post-operative advice concerning duration of avoidance of contact sports after zygomatic fractures.

Attitude of Health Personnel↗
PubMed1996

Management of asymptomatic impacted wisdom teeth: a multicentre comparison.

This study was carried out to assess the opinions of clinicians (general practitioners and oral and maxillofacial surgeons) regarding the management of unerupted Mandibular Asymptomatic Impacted Wisdom Teeth (MAIWT) at two centres: Glasgow Dental Hospital and School and its affiliated institutions and Prince Philip Dental Hospital and its affiliated institutions in Hong Kong. Twenty four clinicians, twelve from each centre, of whom six were oral and maxillofacial surgeons (OMS) and six general dental practitioners (GDP) participated in this investigation. The orthopantomographs of 21 cases were used in the study and were examined by each clinician to investigate the management of unerupted MAIWT was recorded using a custom written questionnaire. Hong Kong clinicians showed a greater tendency towards extraction of MAIWT in comparison to Glasgow clinicians. The difference was statistically significant. The data indicates a significant difference between Hong Kong OMS and Glasgow OMS and between Hong Kong OMS and Hong Kong GDP, with Hong Kong OMS showing a greater tendency towards extraction. This study proved the diversity of opinions in one of the most common dento-alveolar procedures. The dilemma to extract or retain MAIWT still exists and controversy is likely to remain. The difference in the rationale of management regimes between the centres are discussed. The medico-legal and financial issues are investigated.

General Practice, Dental↗
PubMed1996

The referral practice of general medical practitioners to the surgical specialties: implications for the future.

With increasing numbers of general medical practitioners (GMPs) becoming purchasers of health care, providers of surgical services need to understand factors influencing GMP referrals. Using an anonymous postal questionnaire, criteria used by 400 randomly selected general medical practitioners to make referral decisions were assessed. Issues regarding the importance of waiting lists, cost, distance and communication were assessed, along with previous training and fundholding status. The findings of this study reveal that waiting list times for consultation and treatment, along with communication, are the most important criteria influencing referral. Cost, travel and literature from each specialty were the least important factors. General medical practitioners are shown, in the majority, to remain unaware of the range of conditions managed by oral and maxillofacial surgeons. A series of strategies are outlined, which might be used to broaden the referral base for maxillofacial surgery. The need for active education of practitioners is emphasised and the possible effects of regionalisation of the service is discussed.

Attitude of Health Personnel↗
PubMed1997

Controversies in third molar surgery--the national view on review strategies.

A national survey was conducted to establish the current practice of postoperative review of third molar surgery by the 255 fellows of the British Association of Oral and Maxillofacial Surgeons. Of the 216 complete responses, 134 say that they routinely reviewed all patients, while 67 did not. A further 15 fellows (7%) are currently considering their practice. Five (2%) stated that routine review should be compulsory and failure to do so was medically negligent. We conclude that a policy of selective rather than routine review is safe for most patients, but if a patient is under age, mentally retarded, taking psychoactive drugs, or has any other associated condition, then routine follow-up should be undertaken.

Age Factors↗
PubMed1997

An audit of antibiotic prescribing in third molar surgery.

The use of antibiotics as a prophylactic measure against infection is widespread following the removal of impacted third molars. The advantages of using such prophylaxis appear to be marginal and there is little substantial evidence to support the use of second and third generation antibiotics for routine prophylaxis. An audit of antibiotic prescribing practices in the University Dental Hospital National Health Service Trust (Cardiff) was undertaken and demonstrated the potential for saving large sums of money whilst apparently incurring no clinical disadvantage. The value of such audit process in oral and maxillofacial surgery is in identifying best practice followed by measuring and, where possible, improving standards.

Adult↗