Litigation, legislation, and ethics: subsequent remedial measures.
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Humans↗
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Results for “Practice Patterns, Dentists'”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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A review of perioperative corticosteroid use in dentoalveolar surgery.
OBJECTIVES: Dental surgeons are often advised to use corticosteroids during and after third molar removal and other dentoalveolar surgery to reduce postsurgical edema, but recommendations for use are rarely accompanied by definitive guidance regarding the type of steroid, dosage, or duration of administration. Many regimens in use appear to be based on anecdotal information from articles in the 1960s and 1970s and might be subtherapeutic. Few regimens have been updated with data from more recent studies, and well-designed comparison studies are lacking. STUDY DESIGN: In this article, the literature from the past 30 years is reviewed, meaningful findings are highlighted, and available data are used as a basis for formulating interim clinical recommendations for corticosteroid use pending the emergence of more evidence-based data. A meta-analysis of data was not performed. RESULTS: Recent data suggest that perioperative corticosteroid regimens should be administered in higher doses and for longer durations than recommended in the past and should be started before surgery for optimum benefit. CONCLUSIONS: Based on the literature review, interim recommendations for the use of corticosteroids are proposed, including dosages and regimens that appear rational for oral, intramuscular, or intravenous corticosteroid administration before and after extractions and other dentoalveolar surgery. These largely empiric recommendations might require adjustment when evidence-based data become available in future studies. There is a great need for well-designed clinical research to further evaluate protocols for corticosteroid use.
Administration, Oral↗
Evidence-based dentistry.
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Dental Implantation, Endosseous↗
Antibiotic prophylaxis in oral health care: administration strategies of general dental practitioners.
OBJECTIVE: To examine the strategies that general dental practitioners (GDPs) use to administer antibiotic prophylaxis and to study the agreement between the administration strategies of GDPs and local recommendations. METHODS: Postal questionnaires in combination with telephone interviews were used. Two hundred GDPs in two Swedish counties, Skåne and Orebro, were asked to participate. The response rate was 51% (n = 101). The GDPs were presented with eight simulated cases of patients with different medical conditions for which antibiotic prophylaxis might be considered necessary when performing dental procedures (scaling, tooth removal, root canal treatment). The administration strategies of the GDPs were compared with local recommendations. RESULTS: In general, the variation in the administration strategies of the GDPs was large. For two medical conditions, type 1 diabetes that was not well controlled and hip prosthesis, significantly more GDPs in Skåne than in Orebro administered antibiotic prophylaxis for tooth removal. Agreement between the administration strategies of the GDPs and local recommendations was low. Differences between the two counties were non-significant. Furthermore, within Orebro, GDPs who did not have formal access to local recommendations did not differ in their administration strategies from those who did. The choice of substance was seldom in agreement with the substance recommended, while the majority followed the recommended duration of treatment. CONCLUSION: Although recommendations existed, their impact appeared to be limited. This is significant, since the implementation of recommendations is crucial in making clinical practice more effective and in promoting the health of patients.
Adult↗
A survey of the opinions of orthodontic specialist trainees in the U.K.
A questionnaire survey was carried out to ascertain a profile of orthodontic postgraduates in training in the United Kingdom during 1993. Information about the postgraduates, their programmes and their career plans was collected. Eighty-nine questionnaires were distributed to those enrolled in 13 of the training programmes in the U.K. at that time from which the response rate was 64 per cent. The results can be compared with a similar survey carried out in the United States of America in 1992 (Keith and Proffit, 1994).
Adult↗
Bracket recycling--who does what?
At present there is debate concerning the practice of recycling orthodontic components. A survey of 300 members of the British Orthodontic Society showed that 47.5 per cent of respondents recycled metal brackets and that more specialist practitioners than consultants did so (p < 0.001). Only 7.2 per cent of the orthodontists who recycled brackets informed their patients that recycled brackets were used.
Equipment Reuse↗
Radiographic factors affecting the management of impacted upper permanent canines.
The aim of the investigation was to evaluate which radiographic factors influenced the orthodontists' decision whether to expose or remove an impacted upper permanent canine and was a retrospective, cross-sectional design. The sample consisted of all radiographic records of patients referred to the Orthodontic Department at Manchester University Dental Hospital with impacted upper permanent canines between 1994-1998 (n = 44). The following canine position measurements were made from the OPG: angulation to the midline, vertical height, antero-posterior position of the root, overlap of the adjacent incisor, and presence of root resorption of adjacent incisor(s). The labio-palatal position of the impacted canine was assessed from the lateral skull radiograph. Whether the impacted canine had been exposed and orthodontically aligned or removed was also recorded. Stepwise logistic regression analysis showed that the labio-palatal position of the crown influenced the treatment decision, with palatally positioned impacted canines more likely to be surgically exposed and those in the line of the arch, or labially situated, removed (P < 0.05). Additionally, as the canine angulation to the midline increased, the canine was more likely to be removed (P < 0.05). The orthodontists' decision to expose or remove an impacted upper permanent canine, based on radiographic information, seems to be primarily guided by two factors: labio-palatal crown position and angulation to the midline.
Adolescent↗
An audit of the current consent practices of consultant orthodontists in the UK.
OBJECTIVE: To collect information on the current consent practices of consultant orthodontists for orthodontic and joint orthognathic treatment. DESIGN: Postal questionnaire. SUBJECTS AND METHODS: The questionnaire was sent to all 222 consultant orthodontists held on the database of the British Orthodontic Society. The questionnaire consisted of five multi-part questions requiring tick-box responses. OUTCOME: A total of 199 questionnaires were returned. RESULTS: Written information on orthodontic treatment was provided by 56 per cent of respondents whilst 41 per cent obtained written consent. Written information on joint orthognathic treatment was provided by 47.5 per cent of respondents, whilst 20 per cent obtained joint written consent. Most who obtained written consent for orthodontics and joint orthognathic treatment used 16 years as an appropriate age for patients to provide their own consent. CONCLUSIONS: Consent practice amongst consultant orthodontists varies, with 35 per cent providing neither written information nor seeking written consent prior to orthodontic or joint orthognathic treatment.
Adolescent↗
Does articulating study casts make a difference to treatment planning?
OBJECTIVE: To assess whether articulating casts in centric relation (CR) compared with intercuspal position (ICP) makes a difference to treatment planning. DESIGN: Reliability analysis. SUBJECTS: Ten orthodontists. METHODS: Twenty case vignettes were examined on three occasions: twice with the casts in ICP and once in CR. A series of dichotomous decisions were made relating to the treatment need and treatment mechanics. MAIN OUTCOME MEASURES: The changes in treatment decisions were examined. Intra-examiner agreement between the two hand-held cast assessments (H1 v. H2) and between the first set of hand-held casts compared with the articulated casts (H1 v. A1) were evaluated using the kappa statistic. The differences between the kappa statistics for H1 v. H2 and H1 v. A1 were then tested with the Wilcoxon matched pairs signed rank sum test. RESULTS: The only statistically significant change in the kappa score between H1 v. H2 and H1 v. A1 was for the extraction decision (P= 0.007). No other statistically significant differences were found for the other treatment decisions, although trends were identified for orthognathic surgery and anchorage support decisions. CONCLUSION: Routine articulation of study models for all orthodontic patients is not supported by the results of this study. Articulation of the study models did not affect the treatment planning decisions in a meaningful manner. Further work with selected samples is required to determine if articulation is helpful for specific malocclusions.
Adult↗
Current products and practice section: religious, cultural, and ethical dilemmas in orthodontics.
There are potential religious, cultural and ethical dilemmas facing patients who are undergoing orthodontic treatment. Opinions were collected from religious and cultural leaders, as well as from non-religious groups who take an ethical standpoint on certain medical or dental treatment. Factors relating to ingredients in orthodontic products, timing of orthodontic appointments, and the effects of religious fasting are all discussed. It is important to recognize all patients' opinions and beliefs when planning and undertaking orthodontic treatment.
Cultural Diversity↗
Philosophies and practices regarding the management of the endodontic smear layer: results from two surveys.
The purpose of this investigation was to ascertain the prevailing attitudes within the endodontic community regarding smear layer removal. The first survey asked the philosophies and techniques currently being taught to predoctoral dental students and postdoctoral endodontic residents in the United States, whereas the second surveyed some of the members of the American Association of Endodontists currently practicing in the United States. Findings from these surveys revealed that more than three-fourths of the dental students and nearly two-thirds of the endodontic residents are not being taught routine smear layer removal. Slightly more than one-half of endodontists responded they practice smear layer removal. These surveys indicate that there is no clear consensus in the endodontic community, either academically or clinically, as to whether the smear layer should be removed or be allowed to remain before obturation of the root canal space.
Data Collection↗
Antibiotic use by members of the American Association of Endodontists in the year 2000: report of a national survey.
The purpose of this study was to determine the prescribing habits of active members of the American Association of Endodontists (AAE) with regard to antibiotics. A one-page, double-sided questionnaire was sent to the active members of the AAE living in the United States. The 1999 mailing list of 3203 members was obtained from the AAE, and the return rate was 50.1% (1606 surveys). With a sample size over 1000, the study was able to distinguish differences to within 0.5% with power = 80% (at alpha = 5%). The data were analyzed using descriptive statistics and chi-square tests of independence. Penicillin VK, 500 mg, 4 times a day, was the first choice antibiotic prescribed by 61.48% of respondents. Clindamycin (Cleocin), 150 mg, 4 times a day, was selected by 29.59%. For those patients with a penicillin allergy, 57.03% prescribed clindamycin and various erythromycin preparations were prescribed by 26.65%. A loading dose was used by 85.14%. The average duration of antibiotic therapy was 7.58 days. Those respondents involved in academics, either part-time or full-time, were significantly more likely to prescribe penicillin VK, 500 mg, 4 times a day at a rate of 85% versus those in part-time or full-time private practice at a rate of 67%. For cases of irreversible pulpitis, 16.76% of responding endodontists prescribed antibiotics. For the scenario of a necrotic pulp, acute apical periodontitis, and no swelling, 53.93% prescribed antibiotics. Almost 12% prescribed antibiotics for necrotic pulps with chronic apical periodontitis and a sinus tract. For the most part, the majority of the members of the AAE were selecting the appropriate antibiotic for use in orofacial infections, but there are still many who are prescribing antibiotics inappropriately. Although there were trends of improvement in some areas with regards to prescribing antibiotics, there were other areas where there had been no improvement in 25 years. Unless these trends change, our generation and those to come may not have effective antibiotics for use in the management of true orofacial infections.
Adult↗
A survey of clinical members of the association of dental implantology in the United Kingdom. Part II. The use of augmentation materials in dental implant surgery.
The following were the objectives of Part II of the survey: (1) to determine which augmentation materials were used by respondents, (2) to elicit which factors influenced the choice of augmentation materials, (3) to establish the perceived levels of evidence that support augmentation materials, and (4) to ascertain the clinical applications of particulate augmentation materials (autografts, allografts, and alloplasts). Autogenous bone and demineralized freeze-dried bone are used most frequently. The majority of respondents involved in bone augmentation indicated that alloplasts and allografts should be used to correct small defects or as volume expanders in conjunction with autogenous bone. Research publications and personal clinical observation mainly determine the choice of an augmentation material. Of the clinicians who preferred to use autogenous bone, 26.3% thought that there was at least one randomized controlled trial with histological evidence supporting its use in oral implantology. In comparison, 30% of demineralized freeze-dried bone users thought that there was at least one randomized controlled trial with histological evidence supporting its use. Collected bone debris is currently used for the correction of bone dehiscences and fenestrations around endosseous dental implants in the simultaneous implant-placement augmentation technique. There is a pressing requirement for the two most commonly used augmentation materials (autogenous bone and demineralized freeze-dried bone) to be evaluated by accepted scientific protocols. Although regard for autogenous bone as an augmentation material is high, its use in the form of collected bone debris seems to be limited at present.
Alveolar Ridge Augmentation↗
Implant restorations and their place in the dental practice.
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Dental Implantation, Endosseous↗
Effect of dental practice characteristics on racial disparities in patient-specific tooth loss.
OBJECTIVE: The objective of this study was to test the hypothesis that dental practice characteristics are associated with tooth loss incidence with both tooth-specific and patient-specific characteristics already taken into account. RESEARCH DESIGN: A population-based prospective cohort study was conducted. In-person interviews and clinical examinations were done at baseline, 24, and 48 months, with telephone interviews every 6 months. Practices that coincidentally served participants in the study completed practice characteristics questionnaires. To increase inferential power when testing practice-level effects, detailed tooth-specific and patient-specific data were simultaneously taken into account in tests for association between practice-level effects and tooth loss. SETTING: Data were from the Florida Dental Care Study. The key health outcome was tooth loss, a leading measure of a population's oral health. PARTICIPANTS: Eight hundred seventy-three African-Americans and non-Hispanic whites who had at least 1 tooth. RESULTS: Certain practice characteristics were associated with tooth loss, including the racial mix of the practice's patient population; persons who attended practices with higher percentages of African-Americans were more likely to receive a dental extraction regardless of the individual patient's race. CONCLUSIONS: This is the first longitudinal report of increased risk for tooth loss resulting from practice-level effects. Although a patient-level racial disparity remained evident, and even with detailed tooth-specific and patient-level characteristics taken into account, racial differences in characteristics of practices attended independently contributed to the patient-level racial disparity in health.
Black or African American↗
Microbiological root canal sampling: diffusion of a technology.
Diffusion is the process whereby a technology enters and becomes part of the health-care system. In the present study, diffusion of microbiological root canal sampling (MRS) among general dental practitioners within the city of Gothenburg was observed for 25 years, from the establishment of the Laboratory of Oral Microbiology in 1966. Laboratory records at 5-year intervals were analysed and adopters were categorized as 'occasional' (1-2 samples/year), 'selective' (3-10) or 'regular' (> 10) samples. The diagnostic accuracy was assessed by analysing the results of culturing 574 samples referred in 1986. The acceptance rate varied between 2.9 and 5.1% except in 1986 when 10.1% of the practitioners in the area referred root-canal samples. While a minority of the adopters used MRS as a standard procedure, the strategy appeared to be directed towards selection of special cases. The results of culturing revealed a predominance of facultatives. Although evidence of contamination was found, the practitioners frequently appeared to produce valid microbiological samples.
Bacteriological Techniques↗
The adoption of new endodontic technology amongst Danish general dental practitioners.
AIM: To assess the adoption of new endodontic technology in a population of Danish practitioners. METHODOLOGY: Members of the Copenhagen Dental Association (n = 1156) were approached with a questionnaire concerning the frequency of various endodontic procedures. Three options were available: often, occasionally and never. Responses were anonymous. The statistical analyses were performed as studies of association in two- or three-way contingency tables, and with Goodman-Kruskal's gamma-coefficient as the basic tool chosen. RESULTS: Only data from general practitioners (GPs) in private practice were analysed (n = 956). The response rate was 72%. NiTi hand instruments were often used to negotiate canals by 18%, whilst 10% often used NiTi rotary systems. Electronic apex locators were often employed by 15%. Nineteen per cent reported that warm gutta-percha was often used. A majority (53%) often spend two sessions to instrument a molar, and 20% often needed three or more sessions to finish the shaping phase. To complete a treatment of a nonvital case most practitioners reported to use at least three appointments. Only 4% frequently applied rubber dam. CONCLUSIONS: The adoption of new endodontic technology is at an early stage amongst Danish GPs. A new revised remuneration system might influence the rate of adoption, allowing the practitioners to act more rationally and produce a higher frequency of good-quality root fillings. Progress towards high quality endodontics might be hindered by the nonuse of rubber dam.
Denmark↗
An assessment of endodontic re-treatment decision-making in an educational setting.
AIM: To test the applicability of Praxis Concept (PC) theory in endodontic re-treatment decision-making amongst dental students of similar backgrounds, but from two dental schools. METHODOLOGY: A total of 172 students from two dental schools (n = 97 and n = 75) were asked to select their management choices (from five possible options) for each of six variations on quality (by way of adequacy of root filling) and complexity (by way of absence or presence of a post) of a simulated radiograph of an anterior tooth. The six variations each had five possible levels of periapical condition, giving a total of 30 cases for which management choices were sought. Individual re-treatment preference scores (RPS) were obtained, from which school and gender differences were compared by t-test. The association between students' stated re-treatment propensities and the different cases was expressed as odds ratios using unconditional logistic regression analysis. RESULTS: There were large inter-individual variations in RPS within the cases at both schools. Mean RPS for the group was 0.62 (SD 0.14), and did not differ between the schools (P = 0.44), but was significantly lower for males than females (P = 0.01). For all participants and a given case, if re-treatment was proposed for a particular size of lesion, then all larger lesions for that case were also marked for re-treatment. Presence of a defective root filling or overfilling reflected a greater propensity for re-treatment than when the root filling was adequate, whilst the absence/presence of a post had no clear effect on re-treatment choices. CONCLUSIONS: The findings support the explanatory potential of PC theory in endodontic re-treatment decision-making in the group investigated, and suggest that factors besides disease status alone, may contribute to the choices that clinicians make.
Attitude of Health Personnel↗