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PubMedDate not supplied

Elder abuse and neglect: detection, reporting, and intervention.

Dental providers are in an excellent position to identify elder abuse and neglect (EAN), yet they are often reluctant to report or intervene in cases of suspected elder maltreatment. This problem is widespread, and the negative impact of this dilemma cannot be ignored. In 1999, the American Dental Association's House of Delegates, through Resolution 44H-1999, urged constituent dental societies to educate their members about abuse and neglect and individual states' legal reporting requirements. The American Society for Geriatric Dentistry (ASGD), responding to a need to inform its members about this issue, requested this literature review on elder abuse and neglect. This paper emphasizes the role of the dental profession in ameliorating EAN and offers ASGD members recommendations to aid individual practitioners and staff in educating and assisting the profession in recognizing and reporting EAN.

Aged↗
PubMed2000

Racial/ethnic variations of practicing dentists.

BACKGROUND: In recent years, the dental school population has changed from being predominantly white male to a more diverse racial and ethnic makeup. Noting this change in the student population, the American Dental Association undertook an in-depth study of the various racial/ethnic groups. METHODS: Questionnaires were sent to approximately 8,000 dentists nationwide. Samples were drawn for each of the following racial/ethnic groupings: white, black, Hispanic, Native American and Asian. The survey instrument asked questions about personal characteristics, work and private practice issues, household and practice income, and patient characteristics; it also asked for dentists' opinions. A final adjusted response rate of 57.0 percent was achieved. RESULTS: The majority of all dentists responded that they were "very satisfied" with their profession, but the survey found variations in patient mix, employment history and provision of free or discounted care. CONCLUSIONS: The survey examined dentists by race/ethnicity to identify differences and similarities. Cultural and ethnic minorities are the fastest growing segment of the U.S. population. As the profession becomes more diverse, practice patterns will affect the overall dental profession. PRACTICE IMPLICATIONS: Dentists' racial/ethnic backgrounds may change the provision of care as patient mix varies, with each dentist group treating a specific group of patients in regard to family income, racial/ethnic background and subgroups for whom they offer free or reduced-rate dental care.

Career Mobility↗
PubMed1988

Use of mouthrinses for professional indications.

In view of the relationship between supragingival and subgingival plaque, chemical agents which alter supragingival plaque may also alter subgingival plaque. As a result, a beneficial effect on gingival health may be anticipated. This article reviews the use of chemotherapeutic agents which reduce plaque and gingivitis. Indications for the use of these agents include patients with problems with mechanical plaque control, extensive splinting or fixed prostheses, intraoral fixation, orthodontic appliances, overdenture abutments and implants, and for patients in the immediate post-surgical period. Improvement of wound healing following periodontal surgery may represent one of the most valuable aspects of use of these agents. As mouthrinses, these agents cannot be expected to significantly alter subgingival plaque. However, for this purpose, their use in irrigation devices deserves further study. Since recent reports have suggested benefits of various mouthrinses when used as irrigants as compared to rinses may also reduce the bacterial back-spray associated with ultrasonic devices and high-speed handpieces, and thus provide a protective effect for dental personnel. The practitioner in the United States is encouraged to recommend products accepted by the American Dental Association's Council on Dental Therapeutics in order to insure both safety and efficacy.

Dental Devices, Home Care↗
PubMed1994

Factors associated with hepatitis B vaccine response among dentists.

The objective of this study was to evaluate personal and immunization factors associated with serologic evidence of hepatitis B virus (HBV) vaccine response. A study was conducted using data from United States dentists participating from 1987 to 1991 in the Health Screening Program of the American Dental Association's annual session. This study included dentists (n = 507) who (1) received their most recent dose of HBV vaccine within the previous 10 months, (2) completed a core questionnaire, and (3) were tested for HBV markers (HBsAg, anti-HBs, and anti-HBc) and were found not to have evidence of past or present infection. Non-responders were defined as dentists testing negative for all three markers (n = 100). Responders were defined as dentists having serological evidence of anti-HBs alone (n = 407). Logistic regression models were used to assess the relationship of vaccine response to the variables sex, age, number of vaccine doses, site of vaccination, type of vaccine, and history of hepatitis. Vaccine response was most strongly associated with sex, age, and number of doses. Factors unrelated to vaccine response included type of vaccine and history of hepatitis. Adherence to the recommended number of doses and early vaccination are critical to adequate protection against hepatitis B infection of dentists, who are often exposed to blood and other body fluids.

Adult↗
PubMed2001

The case for dental preferred provider organizations.

The dental PPO market is the fastest growing segment of the dental benefits business. As with traditional indemnity plans, dentists are reimbursed on a fee-for-service basis. Members can refer themselves to dentists of choice, including specialists, inside and outside the network. Employers' interest in DPPOs is expected to continue as they seek to control or reduce expenses associated with dental benefits plans. Dentist participation in managed care programs significantly lags medical, and fewer than half of practicing dentists participate in DPPOs. Negotiated discounts vary across carriers and geographic regions, generally ranging 15% to 30% off average fees. The American Dental Association predicts that dentists' participation in DPPOs will continue to increase, indicating further growth for these dental plans. There are financial incentives for members to stay in network.

Health Benefit Plans, Employee↗
PubMed2004

Establishing dental hygiene education in Germany: current facts and future perspectives.

As there is a marked need to increase the number of dental hygienists (DHs) working in German dental practices, efforts are being made to establish dental hygiene education in accordance with international standards. However, as current German legislation does not envisage a perennial full-time training programme, dental hygiene education may currently be provided within a modular concept only. The basic qualification for enrollment in a modular hygienist training programme of this kind is accredited vocational training as a dental assistant (DA), followed by board-certified continuing education as an oral prophylaxis assistant. Thus, the current system of advanced training for qualification as a DH is subject to at least 6 years' work experience in the field of dentistry. A 950-h full-time advanced training course, meeting all the requirements of this concept, was established by the Westphalia-Lippe Dental Association in cooperation with the University of Münster. The curriculum underlying this programme was outlined considering the recommendations for dental hygiene education issued by the European Federation of Periodontology, although reduced in standards to comply with current German legislation. In addition, the recommendations for American Dental Hygiene education by the American Dental Association were used as a guide for programme development. The contents and implementation of the Münster Dental Hygienist Curriculum may allow the professional competence generated during practical work experience to be linked with international requirements of dental hygiene education.

Accreditation↗
PubMedDate not supplied

Acute ethanol toxicity from ingesting mouthwash in children younger than 6-years of age.

The purpose of our study was to analyze reports of the American Association of Poison Control Centers (AAPCC) of suspected overingestion of ethanol from mouthrinses by children younger than 6 years of age between 1989 and 1994. Annual incidence rates of reported ethanol exposures attributed to mouthrinses were calculated. Lethal and toxic amounts of several mouthrinses were calculated using peak blood ethanol concentrations of 500 and 50 mg per 100 mL, respectively. In 1994, there were 2937 calls reported by poison control centers related to ethanol-containing mouthrinses, an estimated incidence of 168 reported exposures per 100,000 children younger than 6 years of age. A 15-kg child who ingests 212 mL (7.2 oz.) of Listerine (26.9% ethanol) ingests 57 mL (1.9 oz.) of ethanol, which is potentially lethal. Approximately one-tenth that amount of ethanol can produce a toxic reaction. Physicians, dentists, and other health care providers should inform parents of the dangers associated with accidental ingestion of mouthrinse and encourage them to keep mouthrinse out of the reach of children. The Food and Drug Administration (FDA) should require readily visible warning labels and child-resistant caps for containers with potentially toxic volumes of ethanol. The American Dental Association (ADA) should re-evaluate its acceptance criteria for advertising cosmetic mouthrinses in its publications and consider including child-resistant caps and warning labeling.

Accident Prevention↗
PubMed2004

Microbiological evaluation of dental unit water systems in general dental practice in Europe.

A range of opportunistic pathogens have been associated with dental unit water systems (DUWS), particularly in the biofilms that can line the tubing. This study therefore aimed to assess the microbiology of DUWS and biofilms in general dental practices across seven European countries, including the United Kingdom (UK), Ireland (IRL), Greece (GR), Spain (ES), Germany (D), Denmark (DK) and the Netherlands (NL). Water supplied by 51% of 237 dental unit water lines exceeded current American Dental Association recommendations of < or = 200 colony-forming units (CFU) ml(-1). Microbiological loading of the source waters was between 0 (Denmark, the Netherlands and Spain) and 4.67 (IRL) log CFU ml(-1); water line samples from the DUWS ranged from 1.52 (ES) to 2.79 (GR) log CFU ml(-1); and biofilm counts ranged from 1.49 (GR) to 3.22 (DK) log CFU.cm(-2). Opportunistic pathogens such as legionellae (DK and ES), including Legionella pneumophila SG1 (DK and GR), and Mycobacterium spp. (DK, NL, GR, D and ES) were recovered occasionally. Presumptive oral streptococci (ES and NL), oral anaerobes (GR), Candida spp. (UK, NL and ES) and blood (GR and IRL) were detected at relatively low frequencies, but their presence indicated a failure of the 3-in-1 antiretraction valve, leading to back siphonage of oral fluids into the water and biofilm phase. These findings confirm that a substantial proportion of DUWS have high levels of microbial contamination, irrespective of country, type of equipment and source water. The study emphasizes the need for effective mechanisms to reduce the microbial burden within DUWS, and highlights the risk of occupational exposure and cross-infection in general dental practice.

Bacteria↗
PubMed2005

John N. Crouse--crusader and mitigator.

During the last part of the nineteenth century, John N. Crouse fought hard to defeat the process patents of the International Tooth Crown Company. Prior to that time he engaged in a lucrative dental practice, was a President of the American Dental Association and was a highly respected dentist in Chicago. In the midst of his fight against the International Tooth Crown Company, Crouse organized a dental supply business and a dental journal. After the defeat of the Tooth Crown Company's patents, in an interesting turn of events, Crouse appeared to form an alliance with a party who formed another threat to the dental profession by foisting his patents on it. This article traces the life of a noteworthy man who could rightly be placed among the most important figures in American dentistry.

Dental Prosthesis↗
PubMed1995

Effect of dynamic loading methods on cement film thickness in vitro.

PURPOSE: Reduced cement flm thicknesses can improve crown seating and decrease marginal discrepancies. Improved marginal adaptation has the potential to reduce plaque accumulation, periodontal disease, and cement dissolution. Studies have indicated that dynamic seating methods can reduce seating discrepancies associated with zinc phosphate and resin cements. However, other types of cements and other dynamic techniques have not yet been studied or compared, nor has the mechanism for improved seating been fully explained. Therefore, the purpose of this study was to investigate the effect of a variety of loading methods on the film thicknesses of current types of crown and fixed partial denture cements compressed between glass plates. MATERIALS AND METHODS: This study investigated the effect of three dynamic loading methods on film thickness of six representative fixed prosthodontic cements. These included zinc phosphate, resin-modified glass ionomer, encapsulated glass ionomer, adhesive composite resin, composite resin, and polycarboxylate. The method was derived from American Dental Association specifications for cement film thickness. In control groups, the cements were placed between two glass glass plates and statically loaded with a 15-kg weight. The test groups were initially similarly loaded, and then for 30 seconds further subjected to simulated repeated patient opening and closing, vibrations from an electromallet, or an ultrasonic device. RESULTS: Mean film thicknesses ranged from 7.4 micrometers for polycarboxylate / ultrasound up to 40.3 micrometers for composite resin / static. Two-way analysis of variance revealed that the effects of material type and cementation method and their interaction all significantly affected film thickness (P < .0001). Multiple range analysis showed that dynamic methods were generally superior to static loading and that the ultrasonic method was the best overall. CONCLUSIONS: The different dynamic loading methods all significantly decreased cement film thicknesses between glass plates. The ultrasonic method was the most effective. The type of cement used also influenced film thickness. Composite resins were more affected than other materials.

Analysis of Variance↗
PubMed1992

Patient's rights and doctor's rights: HIV-infected physicians and dentists on the cut edge.

Media, professional associations, public health agencies, legislators, and courts have focused attention to the problem of HIV-infected healthcare professionals. Practitioners should become aware of recently revised ethical guidelines, the doctrine of informed consent, court decisions, and legislation because of the effects these events have on practice and because patients will pose questions on these issues.

Dentistry↗
PubMed2002

Anticaries efficacy of a sodium monofluorophosphate dentifrice containing xylitol in a dicalcium phosphate dihydrate base. A 30-month caries clinical study in Costa Rica.

PURPOSE: To compare the long-term caries increment associated with the use of two dentifrices: (1) a test dentifrice containing 0.836% sodium monofluorophosphate (1100 ppm F) in a dicalcium phosphate dihydrate base plus 10% xylitol; and (2) a positive control dentifrice containing 0.836% sodium monofluorophosphate (1100 ppm F) in a dicalcium phosphate dihydrate base. MATERIALS AND METHODS: Three thousand three hundred ninety four (3,394) school children aged 7-12 years were selected to participate in this double blind clinical caries study at 28 public schools in the central plateau of Costa Rica. Children accepted for participation were stratified into two balanced groups within the participating schools on the basis of age and sex, and assigned to one of the two dentifrices. The study was conducted in harmony with the guidelines for caries clinical studies published in 1988 by the Council on Dental Therapeutics of the American Dental Association, and employed clinical diagnostic criteria provided in 1991 guidelines published by the National Institute of Dental Research (NIH/NIDR). Dental radiographs were not employed. RESULTS: Of those subjects who met the initial inclusion/exclusion criteria for this study, 2,539 were available for the 30-month exam. DFS increments over the 30-month period of this clinical study were 1.30 for the test dentifrice containing 10% xylitol, and 1.51 for the positive control dentifrice without xylitol; for DFT, the corresponding increments were 0.69 for the test dentifrice containing 10% xylitol, and 0.81 for that which did not contain xylitol. For both DFS and DFT, the increments associated with the test dentifrice containing 10% xylitol were statistically significantly lower than those associated with the positive dentifrice without xylitol (P < 0.05), with the observed reductions in caries increment exceeding 10% in for both parameters.

Analysis of Variance↗
PubMed2000

Broad support evident for the emerging specialty of orofacial pain.

The emerging field of Orofacial Pain is being considered by the American Dental Association for full status as a new dental specialty. Many recent advances in the neuroscience of orofacial pain have lead to treatments by orofacial pain dentists that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited leaving many patients to continue to suffer. Subsequently, recent efforts to improve this by developing the field into a specialty have shown broad support among dentists and increased awareness of the benefits this field can provide for dentists and their patients. A recent survey of 805 individuals in the general population who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control-despite having the pain for more than 5 years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, President of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is very likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." (1). Development of the field of Orofacial Pain into a dental specialty has been motivated primarily by this issue; patients with complex chronic orofacial pain disorders have not been historically treated well by any discipline of health care. Recent studies of chronic orofacial pain patients have found that these patients have a high number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (2) (Fig. 1). Complex pain patients and the clinicians who see them are often confused about whom they should consult for relief of the painful disorder. Treatment for these patients within the existing structure of dental or medical specialties has been inadequate and millions of patients are left suffering. Insurers are also confused with regard to reimbursement and make decisions to exclude treatment for orofacial pain disorders under both dental and medical policies. However, Dentistry has taken a leading role in health care to address this national problem by developing the field of Orofacial Pain into a dental specialty. A study of dentists and dental specialists have shown that there is a recognized need and broad support for further development of this field into a new dental specialty(3).

Adult↗
PubMed1980

Fluoride supplements for children. A survey of physicians' prescription practices.

We present the results of a survey to determine how physicians prescribe fluoride supplements for their child patients. A questionnaire was mailed to a representative nationwide sample of 2,604 physicians who treat children. The response rate of completed returns was 49.4%. Results showed that while most respondents prescribed fluoride appropriately, there was some inappropriate prescribing for children receiving fluoridated water. Some physicians also neglected to prescribe for children who were not receiving fluoridated water. Previous differences in recommended schedules of administration between the American Academy of Pediatrics and the American Dental Association may have led to some of these problems. However, these two organizations have now standardized their recommendations.

Adolescent↗
PubMedDate not supplied

TMJ syndrome: is it compensable?

Temporomandibular joint (TMJ) syndrome has only recently surfaced as a workers' compensation or auto accident claim in the insurance industry. It usually appears as a secondary problem to cervical injuries. Further research is needed to establish guidelines for determining whether TMJ syndrome is compensable, but a survey of healthcare practitioners who deal with TMJ--such as the one described in this article--can help in making a determination until guidelines are established. In early 1990, the American Academy of Craniomandibular Disorders and the American Dental Association published guidelines; however, these guidelines address only diagnosis and treatment (Independent Medical and Dental Consultants, Inc., 1990). Further information is needed concerning TMJ's causes and whether the condition should be compensated. Sixty survey questionnaires were sent out to dentists and oral surgeons to identify causes of TMJ, symptoms, diagnostic methods, and treatment. The primary question for which the survey sought an answer was how to judge whether a person with a cervical injury complicated by TMJ syndrome should be compensated for TMJ problems. The remaining questions and answers concerned the medical management of patients with TMJ syndrome.

Health Planning Guidelines↗