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PubMed2000

Practices of Maryland dentists: oral cancer prevention and early detection--baseline data from 1995.

OBJECTIVES: To investigate practices and opinions of general dentists in Maryland, USA, related to oral and pharyngeal cancer prevention and early detection. DESIGN AND METHODS: A pre-tested, 34-item questionnaire, cover letter and addressed, stamped envelope were mailed in the summer, 1995, to a simple random sample of 800 members and non-members of the American Dental Association practicing in Maryland. A reminder postcard was sent 3 weeks after initial mailing; a second complete mailing to all non-respondents 6 weeks after first mailing. RESULTS: Over 90% of dentists asked about patient's current use of tobacco but only 77% assessed patient's history of tobacco use and types and amounts used. Fewer (66%) asked about present use of alcohol. Ninety percent reported providing an oral cancer examination at the initial appointment for patients 40 years of age or older; only 6% provided the examination for edentulous patients and only 40% reported palpating lymph nodes of patients 80% or more of the time. CONCLUSIONS: Dentists' reporting on providing oral cancer examinations and taking appropriate health histories are disappointing. These results call for comprehensive educational interventions in terms of changes in dental curricula and as continuing education courses especially since most dentists were interested in continuing education courses on oral cancer prevention and early detection.

Adolescent↗

PubMed2004

Basic infection control procedures in dental practice in Khartoum-Sudan.

OBJECTIVES: To survey the infection control procedures used by dental practitioners in Khartoum, Sudan. METHODS: Questionnaires were distributed to150 randomly sampled dentists practising in Khartoum state. Each questionnaire comprised 17 questions about basic infection control procedures. RESULTS: A 100% response rate to the questionnaire showed that 92% of dentists routinely wore gloves when treating patients, 50% face masks, 61% a gown and 14.7% protective eye wear. Furthermore 52% of the practitioners had been immunised against Hepatitis B. The majority of practitioners (72%) used dry heat as their method of instrument sterilisation, 22% used an autoclave, 2% used boiling water and the remainder used chemical sterilisation. Safe disposal of clinical waste was undertaken by only 23% of dentists although 47% of practitioners stored sharp items in closed containers. All respondents used disposable dental needles, but only a few used other disposable items. There was a significant difference in the implementation of cross infection control procedures between salaried and private dental practitioners, especially with regard to handpiece sterilisation, use of disposables, the wearing of face masks and the availability of additional sets of instruments. CONCLUSION: There is a clear need to improve the existing situation particularly with regard to immunisation of dentists against Hepatitis B, the safe disposal of clinical waste and instrument sterilisation in Khartoum.

Cross Infection↗

PubMed2006

Demographic variables affecting patient referrals from general practice dentists to periodontists.

BACKGROUND: Within dentistry, a limited body of literature exists regarding the referral relationships between general practitioners (GPs) and specialists. The purpose of this study was to investigate the referral relationship between GPs and periodontists within the state of Virginia. METHODS: A survey was developed that focused on the demographic variables in the referral relationship between GPs and periodontists. The survey was mailed to 800 dentists throughout the state of Virginia. Descriptive statistics were completed along with multivariate logistic regression analysis comparing the responses with the number of patients referred per month to periodontists. RESULTS: Female respondents were more likely to refer three or more patients per month to a periodontist than a male respondent (P<0.02). Those dentists who practiced with one other dentist were twice as likely to refer more frequently when compared to solo practitioners or larger group practices (P<0.03). Dentists employing two hygienists were more likely to refer patients than those with fewer hygienists (P<0.02). Those whose practices were >5 miles from the nearest periodontist were more likely to refer patients compared to dentists geographically closer to a periodontist (P<0.02). No other variables had a significant effect on the referral of more patients per month to a periodontist. CONCLUSIONS: This study indicates that four demographic variables have a statistical influence on the number of referrals per month from a GP to a periodontist. These variables are as follows: female gender, practicing with one other dentist, employing two or more hygienists, and being >5 miles away from the nearest periodontist.

Adult↗

PubMed1999

The effect of education upon dentists' knowledge and attitude toward fissure sealants.

Sealants are highly effective in preventing dental caries in the pits and fissures of teeth. It has been shown, however, that sealants are not widely used by dentists. This study aimed to educate dental professionals about sealants and to evaluate the effect of such education on dentists' knowledge, attitude and use of sealants. A total of 312 dentists were surveyed to determine their knowledge and attitude toward sealants. Respondents were randomly allocated to "Education" group, who received education materials; and "No Education" group, who received no material (until after the education phase). After 12 months, 105 dentists responded to the post-intervention survey. Comparison between the two surveys shows that dentists' knowledge increased significantly in the "Education" group. No difference was detected in dentists' knowledge in the "No Education" group. Dentists' attitude and sealant use did not significantly improve in any of the groups. It is therefore, concluded that continuing education were more likely to change dentists' knowledge than attitude and behaviour. Effort to encourage sealant use by dentists should continue, but with the recognition that changes in behaviour occur over a long time and that other external factors in the professional environment may affect the rate of change.

Adolescent↗

PubMed2002

The use of radiation dose-reduction techniques in the practices of dental faculty members.

X-ray exposure to dental patients has been significantly reduced by the introduction of speed group E intraoral film, rectangular beam limitation, long position indicating devices (PIDs), and rare-earth intensifying screens for extraoral radiography. Research indicates that many dentists do not use these techniques. However, schools of dentistry have implemented them to varying degrees for many years, so this investigation was conducted to determine the extent to which dental school faculty members use these materials and techniques in their own practices. Comparisons were made between full- and part-time instructors, those in practice for fifteen years or less and those in practice for more than fifteen years, and those with postgraduate education versus those with no formal education beyond dental school. The significance of differences was measured with chi-square analysis. The results indicate that dentists with faculty appointments utilize dose-reducing techniques to degrees that are comparable to or greater than reported usage by non-dental faculty practitioners. Faculty dentists in practice fifteen years or less are more likely than their older colleagues to use E-speed film (p = 0.001), whereas those in practice more than fifteen years are more likely to use longer PIDs (p = 0.049). Greater acceptance of these practices by faculty may lead to reinforcement of their use in the clinical education of dental students.

Attitude of Health Personnel↗

PubMed2001

A survey of the use of dentin-bonding systems in Denmark.

OBJECTIVES: Dentin-bonding systems, which usually involve multistep procedures, are relatively new in dentistry. This study was conducted to survey dental practitioners in Denmark concerning their use of dentin-bonding systems. METHODS: A questionnaire regarding dentin-bonding systems was distributed to dentists at an annual dental conference, and 462 dentists were included in the survey. RESULTS: Dentin-bonding systems were used by 99% of the dentists. Twenty-one different dentin-bonding systems were being used, with six of the systems being used by 78% of the dentists. Of the 456 dentists who used a dentin-bonding system, 77% recalled a clinical procedure for their dentin-bonding system that was in accordance with the written instructions of the manufacturer. The degree to which the dentists complied with the instructions for use, was influenced by the number of operating steps involved for a given dentin-bonding system, by the frequency with which the dentin-bonding system was used, and by the degree to which the dentist was satisfied with the instructions for use provided by the manufacturer. The frequency with which dentin-bonding systems were used, was influenced by year of graduation, place of work, and gender of the dentist. SIGNIFICANCE: Further studies, which focus on the adherence of dental practitioners to instruction manuals are warranted as are investigations of the potential clinical consequences of incorrect use of dentin-bonding systems.

Attitude of Health Personnel↗

PubMedDate not supplied

Endodontic standards in general dental practice--a survey in Birmingham, Part I.

A postal questionnaire was used to evaluate endodontic treatment performed in the general dental services in Birmingham, assessing whether practice type--private or National Health Service (UK), or year of graduation, influences compliance with established guidelines. For the aspects of treatment investigated, many dentists were not following guidelines. More private practitioners adhered to the guidelines. Practitioner age was not related to compliance with guidelines, although there were differences in the procedures and materials employed among the different age groups. Within the survey's limits, it was concluded that endodontic performance varies from established guidelines.

Age Factors↗

PubMed2000

Dental care for children under general anaesthesia by private dental practitioners in New Zealand.

An overall reduction of approximately one-third in the availability of private dental care under general anaesthesia in New Zealand has occurred in the past 5 years. Private dentists providing dental care under general anaesthesia are disproportionately located in Auckland. Specialist anaesthetists or general medical practitioners are used to provide almost all the general anaesthetics; approximately half the dentists providing this service continue to use their dental surgeries for the procedure. Private dentists provide approximately one-third of the dental care under general anaesthesia for children each month in New Zealand, but utilise a greater number of sessions per month than the public-sector hospitals. Fees associated with dental care under general anaesthesia for children provided by private dentists are predominantly privately funded. Barriers to dental care for children provided by private dentists are primarily cost, difficulties for the dentists and anaesthetists to fit a general anaesthetic session into the practising day, and difficulties providing care for children under 3 years of age and for those with medical problems and disabilities.

Age Factors↗

PubMed2006

Practice characteristics associated with patient-specific receipt of dental diagnostic radiographs.

OBJECTIVE: To quantify the role of practice characteristics in patient-specific receipt of dental diagnostic radiographic services. DATA SOURCE/STUDY SETTING: Florida Dental Care Study (FDCS). Study Design. The FDCS was a 48-month prospective observational cohort study of community-dwelling adults. Participants' dentists were asked to complete a questionnaire about their practice characteristics. DATA COLLECTION/EXTRACTION METHODS: In-person interviews and clinical examinations were conducted at baseline, 24, and 48 months, with 6-monthly telephone interviews in between. A single multivariate (four radiographic service outcomes) multivariable (multiple explanatory covariates) logistic regression was used to model service receipts. PRINCIPAL FINDINGS: These practice characteristics were significantly associated with patient-specific receipt of radiographic services: number of different practices attended during follow-up; dentist's rating of how busy the practice was; typical waiting time for a new patient examination; practice size; percentage of patients that the dentist reported as interested in details about the condition of their mouths; percentage of African American patients in the practice; percentage of patients in the practice who do not have dental insurance; and dentist's agreement with a statement regarding whether patients should be dismissed from the practice. Effects had differential magnitudes and directions of effect, depending upon radiograph type. CONCLUSIONS: Practice characteristics were significantly associated with patient-specific receipt of services. These effects were independent of patient-specific disease level and patient-specific sociodemographic characteristics, suggesting that practitioners do influence receipt of these diagnostic services. These findings are consistent with the conclusion that practitioners act in response to a mix of patients' interests, economic self-interests, and their own treatment preferences.

Adult↗

PubMed2002

Predictors of Norwegian dentists' decisions to recommend replacement of teeth at the time of extraction.

OBJECTIVE: To study predictors of dentists' recommendations to replace the teeth which they extracted for adult patients in Norway in 1998. DESIGN: Cross-sectional postal questionnaire survey. PARTICIPANTS: A systematic random sample of 1,500 Norwegian general dental practitioners and response rate of 67% after two reminders. After exclusions, 302 dentists who had extracted 822 permanent teeth for 587 patients (16-92 years old) over a period of two weeks, were accepted for the study. RESULTS: According to the dentists, 30% of the patients were in definite need of a replacement for the extracted tooth or teeth, 29% were cases open to question and 41% had no need for a replacement. Model I: Tooth type extracted and the number of teeth extracted per patient were the most important predictors of the dentists definitely recommending a replacement after tooth extraction. Model II: When including the group of patients for whom a replacement was open to question, the odds of the dentists recommending a replacement for having an extracted anterior tooth or premolar increased from 13 (95% CI 6.16, 26.07) to 21 (95% CI 10.51, 40.69). Demographic characteristics had no significant effect on the dentists' decision. CONCLUSIONS: The two most important predictors for recommending a replacement after extraction were the position of the tooth or teeth and the number of teeth extracted. The reason why the number of remaining teeth had no significant independent effect was possibly because this group of patients had a relatively high number of natural teeth.

Adolescent↗

PubMed2000

Factors related to decisions to extract or retain at-risk teeth.

OBJECTIVES: Decisions to extract a tooth may be among the most critical in dentistry. The aim of this study was to prospectively investigate both clinical and nonclinical factors related to decisions to extract or retain teeth in private general dental practice. METHODS: A convenience sample of 196 Iowa dentists in private general dental practice reported on 549 cases where decisions were made to extract or retain teeth as they occurred in their practices during a one-month period in May 1997. Bivariate and multivariate analyses were used to identify factors that differentiated between cases where a tooth (or teeth) was extracted and cases where an at-risk tooth was retained. RESULTS: Of the 549 cases, 67 percent involved extraction, while the remainder involved alternatives to extraction. In comparing extraction cases to alternative treatment cases, we excluded 150 extraction cases because dentists reported that no alternative to extraction was available. Using Generalized Estimating Equations (GEE), we identified cost of treatment, presence of tooth mobility, poor prognosis of alternative treatment, and presence of gross caries as significant factors associated with extraction, while previous treatment of the tooth and concerns with patients' health were significantly associated with alternatives to extraction. CONCLUSIONS: For teeth at risk for extraction, cost, substantial periodontal disease, and several clinical factors were predictive of extraction.

Analysis of Variance↗

PubMed2004

Antibiotic prescription and dental practice within Saudi Arabia; the need to reinforce guidelines and implement specialty needs.

The aim of the present survey was to analyse the frequency and type of antibiotic prescriptions used in dental practice in Saudi Arabia, to assess the awareness of periodontal treatment need among dentists and specialists and to evaluate the distribution of dental specialties in Saudi Arabia. We distributed a questionnaire to 378 dentists including different specialists working in various major hospitals and dental departments. This same questionnaire was then redistributed, 3 years later, to 211 participants. Results from both surveys indicated that antibiotics were not always prescribed on a scientific basis. Cost was the most significant factor (p < 0.05). Interestingly, and although periodontal disease was included as one of the possible causes of infections, the penicillin group was shown to be the group of choice (p < 0.007) and was prescribed by 45% of all participants, metronidazole and tetracyclines followed and were the second most commonly prescribed antibiotics in both surveys (p < 0.05). It was further demonstrated that although the need for periodontics is present among patients and specialists, it is one of the least practised specialties (p < or = 0.008) along with oral surgery (p < or = 0.36).

Anti-Bacterial Agents↗

PubMed2004

Practice patterns of oral and maxillofacial surgeons in Australia: 1990 and 2000.

This study was undertaken to describe practice patterns of oral and maxillofacial surgeons in Australia and compare trends over time. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. Data were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). In both 1990 and 2000 the majority of surgeons worked 80+% of the time in the private sector (64.1 and 71.4%), had 80+% referrals from dental versus medical sources (74.0 and 74.7%), and had 80+% of patients from dentoalveolar rather than major maxillofacial surgery (70.7 and 69.7%). The percentage of dual qualified (dental plus medical degree) surgeons increased from 2.5% in 1990 to 17.1% in 2000 (P < 0.05; chi2). In 2000, surgeons who worked less than 80% in the private sector were more likely to report being overworked (57.9%) and that more surgeons were required in the public sector (65.0%) than those who worked 80% or more private (17.0 and 24.0%, respectively). Multivariate linear regressions of annual non-dentoalveolar surgical procedures per surgeon showed (P < 0.05) higher provision of implant (beta = 0.362), TMJ (beta = 0.267) and bone graft surgery (beta = 0.208) in 2000 compared to 1990, and higher provision of orthognathic (beta = 0.199), implant (beta = 0.194) and bone graft surgery (beta = 0.289) by dual qualified surgeons compared to those with only dental qualifications. Despite the mix of cases remaining predominantly dentoalveolar there was some change over time for selected non-dentoalveolar surgical procedures, with growth in the percentage of medically qualified surgeons and differences in surgery rates by qualification.

Adult↗

PubMed2004

Service provision by patient and visit characteristics in Australian oral and maxillofacial surgery: 1990 to 2000.

This study was set-up to describe main areas of service by patient and visit characteristics and compare trends in services between 1990 and 2000. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. Service provision data were collected from a one-week log. Data were available from 79 surgeons from 1990 (response = 73.8%) and 116 surgeons from 2000 (response = 65.1%). Service distributions were dominated by dentoalveolar surgery in 1990 (66.6%) and 2000 (63.5%). Multivariate analysis showed: patient age, location of visit (office/theatre/inpatient facility) and referral source (general/specialist and dental/medical) were associated with all five main areas of service; type of visit (consult/operation/review) was associated with four main areas; patient sex and place of visit (private/public) was associated with three main areas; the only significant change over time was an increased percentage of orthognathic surgery, odds ratio = 1.4 (95% CI: 1.1-1.7) times higher in 2000 compared to 1990. Main areas of service were associated with a range of explanatory variables such as age and sex of patients, and place, location and type of visit, and referral source. However, the distribution of services remained relatively stable over time.

Adolescent↗

PubMed1999

Survey of prosthodontic impression procedures for complete dentures in general dental practice in the United Kingdom.

STATEMENT OF PROBLEM: Anecdotal evidence suggests impression techniques used in general dental practice may vary from those taught at dental schools. There is little published information on this topic. PURPOSE: This study identifies the materials and methods used by general dental practitioners for recording impressions for the provision of replacement of complete dentures. METHODS: A total of 905 questionnaires were sent to general dental practitioners in the Greater Manchester area to identify current clinical practices. RESULTS: The results revealed that 88% of respondents use only irreversible hydrocolloid for primary impressions. If multiple responses are included, 99% of respondents mentioned irreversible hydrocolloids as an option for primary impressions. In response to the same question for secondary impressions, 94% of respondents mentioned irreversible hydrocolloids as an option. Other material mentioned as an option for secondary impressions included zinc oxide-eugenol (29%) and polyvinyl siloxane (13%). With regard to special trays, 75% of respondents routinely used laboratory constructed special trays to take definitive impressions. Questions on the requisite spacing, perforation, handle design of special trays, and on disinfection showed a diversity of opinion among practitioners. CONCLUSIONS: Although this survey reflected a diverse range of clinical preferences, it is clear that irreversible hydrocolloid dominates the impression market for complete dentures. The use of special trays is normal practice for complete dentures in general dental practice in the United Kingdom.

Acrylic Resins↗

PubMed1998

Orthodontic treatment timing: a survey of orthodontists.

There has been much debate with respect to the ideal time to initiate orthodontic treatment. Recent clinical trials have tested the effects of early orthodontic treatment. The purpose of this study was to understand orthodontists' perspectives on the best time to initiate treatment, factors that preclude early treatment, and experiences with compliance or adherence problems among their younger patients. Questionnaires were distributed to 335 practicing orthodontists throughout the United States. Respondents were first asked to indicate the best stage to initiate orthodontic treatment for 41 different types of occlusal deviations. They were then asked what conditions might preclude early orthodontic treatment. After one reminder, 137 questionnaires (41%) were returned. The sample consisted of practitioners with 3 to 52 years of experience and represented 46 different orthodontic training programs; 19% were female. The majority (92%) were in private practice. Among the 41 conditions listed, orthodontists would most likely treat 21 in the early mixed dentition, especially anterior crossbites (> 76%); 13 in the late mixed dentition, especially deepbite (> 60%) and mandibular inadequacy (> 59%); and 4 in either stage. Only two conditions would be treated in later stages (maxillary midline diastema, 43%; and congenitally missing teeth,39%). One third would postpone treating mandibular prognathism until adulthood. Patient variables that precluded treatment were behavior (98%) and compliance (96%) problems. Finances (76%) and family disruptions (57%) were less important deterrents to treatment. Orthodontists' experience with Phase I treatment influenced their decisions (p < 0.01). Orthodontists who have been in practice longer were more likely to treat temporomandibular joint sounds (p < 0.003) and deviations in opening (p < 0.002) than less experienced orthodontists; the latter were more likely to refer such patients to temporomandibular disorder specialists. These findings suggest that early orthodontic intervention is the norm, but practice characteristics affect treatment timing.

Adult↗

PubMed2004

The facilitating factors and barriers influencing change in dental practice in a sample of English general dental practitioners.

AIM: The objective of this study was to investigate the barriers and facilitators to change in dental practices among a sample of general dental practitioners (GDPs) from three regions of England. METHOD: In-depth face-to-face interviews with 60 GDPs were undertaken. The sample was selected from a group of 317 GDPs who had completed a questionnaire in the first phase of this study. The participants were selected to reflect diversity regarding the number and extent of self-reported changes reported in the questionnaire, and personal and practice characteristics. Of the 92 attempted contacts, 60 (65%) of the interviews were successfully completed. The interview schedule formed the basis of the interview. All the interviews and notes were transferred on to NUD*IST QSR version 4, a qualitative analysis package. RESULTS: No single factor was identified as being more important than another in facilitating change. The main facilitators for change were: financial factors, regular patient attendance, particularly a core patient group, staff loyalty, having regular staff meetings and open communication and having access to peer support. The main barriers to change were the reverse of the facilitators plus not having a financial stakehold in the practice. CONCLUSIONS: A range of factors were identified as influencing change in general dental practice. These include GDPs' attitudes and experience of change, patient factors, organisational issues, contact with peers and access to appropriate training courses.

Adult↗

PubMed2005

Contemporary dental practice in the UK: demographic data and practising arrangements.

OBJECTIVES: To investigate, by questionnaire, various aspects of primary dental care provision in the North West of England and Scotland. METHOD: A questionnaire containing 79 questions was sent to 1,000 practitioners, selected at random, in the North West of England and Scotland. Non-responders were sent another questionnaire after a period of 4 weeks had elapsed. RESULTS: Overall a response rate of 70% was achieved. The majority of practitioners were practice principals (65%), working in a group NHS practice (80%) located in a city or town centre (49%). On average 10-20 patients were treated each session with fewer patients treated per session under private arrangements. Many practitioners were found to lack hygienist support (44%) and to employ unqualified dental nurses (82%). Younger practitioners were more likely than senior colleagues to have access to up-to-date computers whilst 37% and 74% of respondents never used CAL programmes or magnification respectively. Contemporary cross-infection control standards were used by the majority of practitioners, although 3% of practitioners reported only autoclaving their handpiece once a day. CONCLUSIONS: The majority of practitioners, involved in this study, worked under National Health Service (NHS) regulations as principals in a group practice where the workload was greater than the private/independent sector. Contemporary cross-infection procedures were used routinely. In contrast computer-aided learning programmes and magnification were not used routinely. The practitioners in this study employed significant numbers of unqualified dental nurses.

Anesthesia, Dental↗