Dental sedation.
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Anesthesia Department, Hospital↗
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Results for “Practice Patterns, Dentists'”
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The prevalence and nature of recent self-reported changes in general dental practice in a sample of English general dental practitioners.
OBJECTIVE: To determine the extent and types of change in seven domains of dental practice in a sample of English general dental practitioners (GDPs). METHODS: A postal questionnaire was sent to 561 GDPs on the dental lists of three health authorities in diverse regions of England. Information collected included demographic details on personal and practice characteristics, self-rating of amount of change in the seven domains of practice and factors influencing change. RESULTS: The response rate was 60%. Fifty-six per cent of the sample were under 40 years old. Over a third of respondents reported "changing a lot or completely" certain clinical activities, practice management arrangements and practice amenities. The highest self-reported level of change was in clinical activities. Of the GDPs who reported changing their clinical activities, 56% reported an increase in preventive care, followed by crown and bridge (44%), periodontics (44%) and endodontics (43%). Practice management rated second in the mean rank scores for self-reported change. The main changes reported were the introduction of computer systems and employment of practice managers. A sizeable percentage (66%) reported increasing the amount of information they provided to patients and the time spent discussing care. Quality assurance activities were the area of practice least likely to have changed over a 5-year period. Over half the sample reported not being involved in any quality assurance activities in the previous 5 years. Those respondents who were younger, had a postgraduate qualification and earned more than 20% of their income from private practice reported higher levels of change. CONCLUSIONS: General dental practitioners' work patterns are dynamic and appear to be responding to changing needs and demands on their service. The main changes were in the types of clinical procedures being carried out. The low prevalence of changes reported in auditing and peer review activities needs to be investigated further.
Adult↗
A wider perspective.
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Diffusion of Innovation↗
Management of dental trauma in primary care: a postal survey of general dental practitioners.
OBJECTIVES: To determine the self-perceived knowledge and attitudes of general dental practitioners (GDPs) concerning management of dental trauma in primary care. To identify potential barriers to the management of dental trauma in primary care. DESIGN AND SETTING: A self-completion postal questionnaire survey of 417 GDPs in six local health authority districts in northeast England. MAIN OUTCOME MEASURES: Likert scale responses to 20 statements designed to test self-perceived knowledge and attitudes. Following descriptive statistical analysis. Factor analysis with principle components analysis was undertaken to identify areas of correlation in questionnaire responses, followed by Chi squared test, Spearman's Rank Correlation and analysis of variance (ANOVA) to measure association between variables. RESULTS: The response rate was 74%. Enamel and dentine fractures were the most common injury, with 45% of GDPs responding seeing more than 10 cases of dental trauma in the preceding year and 53% of respondents seeing one to three cases of complicated crown fracture. Seventy-eight per cent believed that NHS remuneration was inadequate, but only 8% would refer patients with dental trauma to secondary care for this reason. Half of the GDPs believed that trauma could be treated more effectively in practice if NHS payments were greater. GDPs were significantly more likely to agree with this statement if they had previously undertaken a postgraduate course in the treatment of dental trauma (p=0.002). Single handed GDPs were statistically significantly more likely to agree with the statements 'I would not treat dental trauma cases at my practice because the NHS payment is inadequate' (p=0.008) and 'Treating dental trauma at my practice requires too much of my clinical time to be worthwhile' (p=0.002). Ninety-six per cent of GDPs disagreed that treatment of dental trauma rested solely within secondary care. Ninety-six per cent of GDPs agreed that they had a responsibility to provide initial emergency treatment for trauma patients prior to referral. Eighty-eight per cent of GDPs felt that aids to management would be useful. CONCLUSIONS: Although GDPs believed that financial remuneration was inadequate, this did not prevent them treating trauma cases. They strongly agreed that they had responsibility for the management of dental trauma in primary care and that they believed trauma could be treated more effectively in practice if payment was greater. Time constraints were perceived as a barrier to long-term management of complex trauma cases in primary care. GDPs would welcome the use of management aids.
Analysis of Variance↗
Conscious sedation services provided in secondary care for restorative dentistry in the UK: a survey.
OBJECTIVES: To assess the views of consultants in restorative dentistry on sedation services in secondary care for restorative dentistry and their involvement in the provision of this. DESIGN: Postal questionnaire survey in the UK. SETTING: Consultants in restorative dentistry. RESULTS: There was an 80% response rate from 179 consultants. Among consultants in restorative dentistry there was a perceived need for sedation services in restorative dentistry within NHS hospitals other than for teaching purposes. Anxiety and level of trauma of dental treatment affected whether consultants felt it appropriate for patients to have such treatment under sedation. One third (48) of consultants treated patients under conscious sedation, a significant number of these held NHS posts and had graduated more recently. Of those (41) who provided treatment under conscious sedation in an NHS setting, most (38, 93%) provided treatment under intravenous sedation of whom only eight (21%) acted as operator/sedationist. Nearly all consultants (135, 94%) felt that specialist registrars in restorative dentistry should undergo some form of training in sedation. CONCLUSIONS: Although consultants in restorative dentistry recognise the need for training in and the provision of sedation in secondary care for restorative dentistry, only one third of respondents currently provide this service.
Anesthesia, Dental↗
What is scientific evidence?
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Dental Research↗
A cohort investigation of the changes in vocational dental practitioners' views on repairing defective direct composite restorations.
OBJECTIVE: To investigate changes in vocational dental practitioners (VDPs) views on repairing direct composite restorations (DCRs) during the vocational training (VT) year 2002-2003. DESIGN: A questionnaire-based cohort study. METHOD: Data on the repair of DCRs, including indications and details of operative techniques were collected by a questionnaire sent at the beginning of the VT year (September 2002) to all 12 Postgraduate Dental Deans in England. A follow-up questionnaire was sent to the Deans near the end of the VT year (May 2003). They were asked, on both occasions, to distribute the questionnaires among their VDPs and to return the completed questionnaires. RESULTS: Ten deaneries participated in the study. The September 2002 and May 2003 findings (306 respondents [66%] and 313 respondents [67%] respectively) were analysed using Chi-square statistic and t-test to identify any significant differences (P<0.05). Significant changes in the attitudes of the VDPs during the VT year included a shift to viewing reduction in treatment time (30% to 48%), cost to patient (12% to 20%) and the management of the partial loss of a restoration (57% to 70%) as indications for repairs. In contrast, there was a significant change in viewing secondary caries as an indication for repair (46% to 29%). In addition, there was a significant, worrisome shift in relation to the use of bonding systems and finishing instruments, together with a reduction in the anticipated longevity of composite repairs. CONCLUSION: Aspects of VDPs' attitudes to the repair of DCRs were found to change significantly during the VT year. Not all aspects of the changes observed were considered to be positive. Knowledge and understanding of repairs to DCRs need to be strengthened.
Administrative Personnel↗
Ivory tower derision.
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Attitude of Health Personnel↗
Opportunistic and reprehensible.
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Hospitals, Teaching↗
A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting.
OBJECTIVE: To assess the effect of educational outreach visits on antibiotic prescribing for acute dental pain in primary care. STUDY DESIGN: RCT. SETTING: General dental practices in four health authority areas in Wales. SUBJECTS AND METHODS: General dental practitioners were recruited to the study and randomly allocated to one of the three study groups (control group, guideline group or intervention group). Following the intervention, practitioners completed a standardised questionnaire for each patient that presented with acute dental pain. INTERVENTIONS: The control group received no intervention. The guideline group received educational material by post. The intervention group received educational material by post and an academic detailing visit by a trained pharmacist. The educational material included evidence-based guidelines on prescribing for acute dental pain and patient information leaflets. MAIN OUTCOME MEASURES: The number of antibiotic prescriptions issued to patients presenting with dental pain and the number of 'inappropriate' antibiotic prescriptions. Antibiotics were considered to be inappropriate if the patient did not have symptoms indicative of spreading infection. RESULTS: A total of 1,497 completed questionnaires were received from 23, 20 and 27 general dental practitioners in the control, guideline and intervention group respectively. Patients in the intervention group received significantly fewer antibiotic prescriptions than patients in the control group (OR (95% CI) 0.63 (0.41, 0.95)) and significantly fewer inappropriate antibiotic prescriptions (OR (95% CI) 0.33 (0.21, 0.54)). However, antibiotic and inappropriate antibiotic prescribing were not significantly different in the guideline group compared to the control group (OR (95% CI) 0.83 (0.55, 1.21) and OR (95% CI) 0.82 (0.53, 1.29) respectively). CONCLUSIONS: Strategies based upon educational outreach visits may be successfully employed to rationalise antibiotic prescribing by dental practitioners.
Adult↗
Grass roots observation.
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Anti-Bacterial Agents↗
Sincere concerns.
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Dental Implantation, Endosseous↗
Prescribing patterns.
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Anti-Bacterial Agents↗
A comparison of digital and film radiography in Dutch dental practices assessed by questionnaire.
OBJECTIVES: The purpose of this study was to assess the experiences of general dental practitioners (GDPs) with solid-state and storage phosphor digital sensors compared to film. METHODS: In a mail survey 578 questionnaires were sent to Dutch GDPs who were users of digital X-ray detectors and film. The questionnaire requested demographic data, information about the digital system used and the user-friendliness of the X-ray detector system. In the analysis of the data these variables were related to the type of system used and also to the demographic data. The data were analysed using descriptive statistics, variance-analysis (One-Way ANOVA) and nonparametric tests (Kruskal-Wallis, Mann-Whitney and Wilcoxon) (SPSS 9.0). RESULTS: Four hundred and twenty-four questionnaires were returned (overall response rate 73%). The user-friendliness of the handling of the different systems before exposing the radiograph is better for conventional film, whereas the handling after exposing the radiograph favoured the digital X-ray detector systems. CONCLUSIONS: The user-friendliness was best for film pre-exposure and digital sensors post-exposure.
Adult↗