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PubMed2006

Root canal treatment in Denmark is most often carried out in carious vital molar teeth and retreatments are rare.

AIM: To study the reasons given by a representative sample of Danish general dental practitioners (GDPs) for undertaking root canal treatment and, to investigate their confidence in performing root canal treatment on molar teeth. METHODOLOGY: A questionnaire was sent to 600 Danish GDPs randomly selected from the roster of the Danish Dental Association. They were asked to recall various factors about their experience of the last root filling they completed, including the reason for treatment and the pulp diagnosis. Self-assessments on 100-mm visual analogue scales (VAS) were reported concerning the confidence in performing root canal treatment of a molar. End-point definitions were 'very easy' (0) and 'very difficult' (100), respectively. Time reports of molar treatments were given in categorized groups. RESULTS: The most frequent reason for performing root canal treatment was caries within the tooth involved (55%). The majority of treatments involved teeth with vital pulps (54%). Retreatments were carried out in 2% of the cases. The confidence in performing root canal treatment varied but was relatively high, expressed as VAS-values below 50. The creation of an aseptic working field was regarded as the most difficult procedure followed by root canal preparation. Fifty-six percent of the responders stated a time frame of 46-75 min to complete root filling in a molar tooth. CONCLUSIONS: Root canal treatment in Denmark was reported to be undertaken most often because of caries. Treatment was typically performed in molar teeth with vital pulp. Even though apical periodontitis was frequently noted in root filled teeth, retreatments were rare. From a subjective perspective root canal treatment was not considered to be very difficult and was carried out relatively rapidly.

Analysis of Variance↗
PubMed2004

Attitudes towards the use of hand over mouth (HOM) and physical restraint amongst paediatric specialist practitioners in the UK.

PURPOSE: To assess the views of paediatric specialist dental practitioners in the United Kingdom of the use of the hand over mouth technique and physical restraint. METHODS: Questionnaire survey of all specialist dental practitioners in paediatric dentistry in the United Kingdom (n = 216). Replies were received from 179 individuals (82.8%). RESULTS: The majority of the sample (over 80%) described HOM as having three components, broadly mirroring the description of the technique in clinical textbooks. Approximately 60% of the respondents reported that HOM should never be used (106 individuals, 59.2%). Those who endorsed the use of HOM suggested it should be used with cases of hysterical, tantrum behaviour (57 respondents, 32%). The use of physical restraint was endorsed for certain disabled patients by 110 individuals (62%); for very young patients by 69 respondents (39%); premedicated patients by 35 respondents (20%); physically resistive patients by 25 respondents (14%). Forty-three respondents (24%) felt there were no psychological consequences of the use of HOM or physical restraint; 91 (51%) felt that HOM would result in the child fearing dental treatment. CONCLUSIONS: Specialist paediatric dental practitioners in the UK are familiar with the technique of HOM although they also feel that this technique should never be used. A large proportion of practitioners felt that the use of physical restraint was appropriate with certain disabled patients. The most commonly anticipated psychological sequeala which may accompany the use of these techniques was subsequent fear of dental treatment.

Attitude of Health Personnel↗
PubMed1997

Radiographic criteria employed to diagnose and treat approximal caries by final-year dental students in Mexico City.

A total of 407 final-year dental students in Mexico City were asked about the radiographic criteria they employed when assessing treatment needs for caries in a standardized patient case. 45.2% of participants would restore lesions confined to enamel; 60.7% believed that a lesion which had not passed the dentino-enamel junction would cavitate; and 65.4% said it would take on average 6 months or less for a lesion to progress from outer enamel to the dentino-enamel junction. Radiographic criteria appeared to reflect fears of rapid, inevitable progression of lesions. While local caries experiences had been reported to be high, there seems to be room for re-evaluating some clinical criteria employed to manage caries.

Attitude of Health Personnel↗
PubMed1998

A comparison of the management of potentially malignant oral mucosal lesions by oral medicine practitioners and oral & maxillofacial surgeons in the UK.

This study describes the results of a survey undertaken to assess the management of potentially malignant oral mucosal lesions by oral medicine practitioners and compares their approach with that of oral & maxillofacial surgeons that we have previously described. Significant differences were noted between the two groups in the use of photography to document the lesions and in the use of certain special investigations, which included measurement of serum iron, serum ferritin, serum Vit B12, red cell folate and candidal isolation. The groups also varied in the perceived importance of the age of the patient and anatomical site of the lesion when deciding on the need for further biopsy. There was also significant variation in the use of certain treatment modalities, including excising non-dysplastic and severely dysplastic/carcinoma in-situ lesions and eliminating trauma when treating mild/moderately dysplastic and severely dysplastic/carcinoma in-situ lesions. Significant differences in the frequency and duration of follow-up were noted for non-dysplastic lesions. Finally, the two groups differed significantly when asked to rank the perceived importance of certain factors (the histopathology of the most recent biopsy and the anatomical site of the lesion) when deciding the need to follow-up. Possible reasons for the variation are discussed.

Age Factors↗
PubMed1996

Reasons for apicectomies. A retrospective study.

A retrospective study was carried out to evaluate the clinical factors involved in deciding to perform apicectomies. Five hundred and seventeen teeth from 392 patients (211 women and 181 men) that had undergone apicectomy during the period from September, 1990 to December, 1992 were assessed using the patients' clinical records. The information recorded included the source of referral, the quality of preoperative root canal filling, the size of periradicular lesion, the type of the lesion (for biopsed lesions), the type of coronal and radicular restorations, and the different factors that influenced the decision to perform an apicectomy for each tooth. These factors were classified into technical and biological, and when they occurred together they were classified as combined. The decisions to perform apicectomies most commonly involved combined technical and biological factors. Biological factors alone only amounted to 35% of the total. Technical factors alone amounted to only 3% of the total. When all factors were considered, biological factors constituted 60%, whilst technical factors constituted 40%, of the total. The most common biological factors were persistent symptoms (54%), and continuing presence of a periradicular lesion (44%). The most common technical factors were post crown (60%) and crowned teeth without posts (31%). This study emphasised the need for a high standard of conventional root canal treatment in order to avoid surgical treatment.

Adult↗
PubMed1998

Initial treatment of traumatic dental injuries by dental practitioners.

The aim of this study was to investigate the nature of initial treatment provided by dental practitioners to children aged 1-17 years with various types of traumatic dental injuries at public dental clinics in Tanzania. Questionnaires on initial treatment were mailed to 188 practitioners and returned by 138 (73%). The reported treatments were analyzed in relation to the dental practitioners' qualifications and area of practice. Extraction of injured teeth was frequently reported for 64% of the injuries and prescription of antibiotics was reported by 67%, 48% and 46% of the practitioners for soft tissue injuries, concussion, and alveolar fracture respectively. Practitioners working at the Faculty of Dentistry were less involved in treating dental trauma than those at urban and rural clinics (P = 0.001), while no significant association was found with the level of education of the practitioners. Equal proportions of practitioners, about one-third each, reported correct, unnecessary and wrong treatment options. The quality of the treatments provided could not be explained by background variables. It can be concluded that dental practitioners in Tanzania provide a lot of over-treatment for traumatic dental injuries. Therefore, it is suggested that efforts should be made to improve and standardize treatment methods in Tanzania.

Adolescent↗
PubMed1997

Dental practitioner risk, knowledge and practice with regard to the hepatitis B vaccination in South Africa.

OBJECTIVES: To determine dental practitioner risk, knowledge and practice with regard to hepatitis B vaccination in South Africa. DESIGN: Cross-sectional, descriptive study. SUBJECTS: Dental students qualifying from the University of the Western Cape dental school between 1985 and 1995 (n = 173). METHODS: A telephonic survey, using a structured questionnaire. MAIN OUTCOME MEASURES: Knowledge and compliance with hepatitis B vaccination. RESULTS: The present study shows that (i) individuals are not maintaining HBV protection and (ii) individuals are at risk. CONCLUSIONS: Guidelines need to be developed to ensure that the entire dental team is not only vaccinated against HBV, but that post-vaccination testing and follow-up for booster vaccination is strictly adhered to.

Adult↗
PubMed2000

Osseointegrated implant for single-tooth replacement: a retrospective multicenter study on routine use in private practice.

BACKGROUND: Implant restorations first started with total edentulism. Later, the scientific community gave its approval for restorations in partial edentulism, and only recently some studies confirmed the validity of the treatment for single-tooth replacement. PURPOSE: The purpose of the study was to evaluate implant survival and prosthesis stability of Brånemark implants (titanium screws) when used routinely for single-tooth replacement in all regions. MATERIALS AND METHODS: Two hundred and fourteen patients received 252 implants for single-tooth replacement over a period of 8 years at five private clinics in Italy. The patients were treated in accordance with the protocol for Brånemark implants, and the data gathered have been analyzed according to established evaluation methods. RESULTS: During the observation period, 10 failures were recorded and 229 restorations were carried out. After the first year of loading, the total cumulative survival rate (CSR) was 96%, which then remained stable over the study time. The most frequent complication was loosening of the abutment screws (n = 22), amounting to 35% of all of the complications. This problem was related mainly to earlier types of abutments, whereas the more recent design, CeraOne abutment, showed a low frequency of screw loosening. CONCLUSIONS: The high survival rate, which is similar to that presented for prospective multicenter studies for single-tooth restorations with Brånemark implants, led to the conclusion that the use of this treatment modality is a reliable treatment for routine use in all oral regions.

Adolescent↗
PubMed1998

Current use of tooth-colored inlays, onlays, and direct-placement resins.

An extensive survey was conducted to determine the current prevalence of intracoronal tooth-colored restorations. Members and guests attending the American Academy of Esthetic Dentistry meeting in Cancun, Mexico, August 1997, were the participants in this survey. The participants were asked 21 basic questions related to all aspects of tooth-colored restorations. Definite responses were reported in percentages designating every subtitle of each question. Findings indicated that 84% of these restorations were direct placement resins, 4% were indirect placement resins, and only 2% were indirect ceramic. Survey outcomes also revealed that tooth-colored restorations are rapidly gaining popularity in the field of restorative dentistry.

Composite Resins↗
PubMed2000

In vitro evaluation of margins of replaced resin-based composite restorations.

PURPOSE: To evaluate in vitro any increase in size of Class V resin-based composite (RBC) restorations as a result of replacement. MATERIALS AND METHODS: For group 1, 20 Class V cavity preparations were prepared in extracted incisor and canine teeth. The cavosurface margin was prepared as a butt joint 90-degree angle toward the occlusal wall. Impressions were made of all preparations with a polyvinyl siloxane material. The cavities then received a 1.5-mm 45-degree bevel at the cavosurface margin of the occlusal wall. Impressions were again made of the preparations. The cavities were then restored with a conventional multistep bonding system (Scotchbond Multi-Purpose, 3M Dental Products, St. Paul, Minnesota) and a microfilled RBC (Silux Plus, 3M Dental Products). As a second part of the study (group 2), another 20 Class V cavity preparations were prepared. Half of the cavities received a bevel at the cavosurface margin of the occlusal wall, and half were finished with a butt joint. Impressions were made from all 20 specimens followed by resin-based composite restoration in the same manner as previously described. All the restorations from both group 1 and group 2 were then removed with carbide burs. New impressions were made, and 100 stone models were fabricated. The perimeter and area of the cavity preparations, including the beveled area, were recorded using a video-based imaging system equipped with macro lens, at 10 to 15 times magnification. Both perimeter and area of the postoperative cavity preparation were compared to the initial cavity size for both butt joint and bevel finishing. RESULTS: Intraclass correlation coefficient and paired t-test showed no significant difference between the preoperative bevel type of cavity preparation and its postoperative counterparts for both group 1 and group 2 (p > .05). However, a significant increase in the size of the cavity preparation was found preoperatively when a bevel was placed at the cavosurface margin. Postoperatively, a significant increase in size of the cavities was found for butt joint type finishing for both area (p = .0001) and perimeter (p = .0001), compared to initial cavity size.

Composite Resins↗
PubMed1996

Factors influencing the amount and type of dental services received by older adults in four municipalities in Ontario, Canada.

OBJECTIVES: The purpose of this study was to investigate the factors influencing the pattern (amount and types) of dental care provided to dental visitors participating in the baseline stage of the Ontario Study of the Oral Health of Older Adults. METHODS: We interviewed and examined older adults from four municipalities in Ontario and obtained dental service records for the previous two years for those reporting a dental visit. Individual services and their corresponding time and values were aggregated into categories. We compared the pattern of care for dentate and edentulous subjects, and by age, municipality of residence, and social, demographic and economic characteristics. RESULTS: The 473 subjects received 5,031 services, more than four hours of dental care per subject over the two years. The 29 edentulous subjects received about one-third the number of services compared with the dentate; however, there were no differences in relative time units (RTUs) or relative value units (RVUs). Among the dentate the amount of care (RVUs) varied by municipality of residence and by visiting behavior, but not by age, income, or other socioeconomic variables. CONCLUSIONS: Both dentate and edentulous visitors received over two hours of care per person per year. Dental care patterns were influenced by dental status, area of residence, and visiting behaviors.

Age Factors↗
PubMedDate not supplied

Survey results of reduced-fee and free-of-charge dental services by the membership of the Federation of Special Care Organizations in Dentistry.

In 1996, a questionnaire was mailed to all members of the Federation of Special Care Organizations in Dentistry (FSCO) in an attempt to learn more about their professional practices. Questions focused primarily on the amount of free and reduced-fee dentistry that the membership provided to the public. The questionnaire asked respondents to identify their field of practice; estimate the amount of time, the number of patients, and the monetary value of the dentistry provided; as well as to classify the types of patients to whom they provided these dental services for free or at reduced fees. Each of the FSCO respondents reported providing an average of $14,820 in free dentistry in 1995. Not surprisingly, the respondents reported treating a significant number of special-needs patients. Members also reported spending 31.0% of their clinical time working at reduced fees and 7.4% of the time working for free. This questionnaire revealed that the Federation of Special Care member respondents are donating a significant amount of dentistry and treating a large segment of special-needs patients.

Aged↗
PubMed1997

Paediatric dentistry discussion paper and case report. Management of small carious lesions in primary teeth: caries removal versus fluoride application and periodic 'observation' until exfoliation.

Differences in treatment rationale exist between dental practitioners with respect to the management of small carious lesions in primary teeth. Some do not consider it necessary to use a conventional restorative approach, preferring to apply topical fluoride and/or 'monitor' the lesion(s). This paper advocates the alternative approach which entails complete caries removal by mechanical means, the rationale being to eliminate the pool of cariogenic microorganisms and thereby protect sound teeth from succumbing to carious attack. A case is presented to illustrate the extent to which caries can progress and also involve other teeth if small cavitated lesions are simply treated by 'spot' application of fluoride. Clinical treatment of caries must be based on scientific knowledge of the microorganisms involved and an understanding of its transmissible and infectious nature.

Child, Preschool↗
PubMed2000

Antibiotic prescribing practices by South Australian general dental practitioners.

The prescribing habits of a randomly selected approximately 10 per cent sample of South Australian general dental practitioners were obtained by postal questionnaire. Sixty-eight (61 per cent) usable replies were received and analysed. Generally, there was an appropriate level of knowledge of antibiotic prescription. However, there was a tendency toward over-prescription and a demonstrated lack of knowledge of the incidence of adverse reactions, development of multiresistant strains and prophylaxis against bacterial endocarditis. All of these areas are real challenges to the profession, whether in an overall global community health sense or in a highly individualized clinical or medico-legal sense. These issues are discussed and the profession is urged to reconsider and re-educate itself on these challenges.

Anti-Bacterial Agents↗
PubMed2000

A survey of the distribution and types of full crowns prescribed in Melbourne, Australia.

The full crowns made by 11 commercial dental laboratories in Melbourne, Australia, were surveyed over a two-month period. The survey was designed to find which teeth were crowned and what types of full crowns were prescribed. Maxillary central incisors were found to be the most frequently crowned teeth (15.6 per cent) and porcelain-fused-to-metal crowns were the most commonly prescribed type of crown (82.9 per cent). This study may form a baseline with which other Australian studies may be compared and contrasted.

Crowns↗