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PubMed2001

An overview of reasons for the placement and replacement of restorations.

AIM: Surveys on reasons for the placement and replacement of restorations have been conducted in various countries. The purpose of this paper is to bring together and review the data of 10 such surveys with similar methodology. METHOD: The studies reviewed are all based on the protocol described by Mjör in 1981. RESULTS: The surveys reviewed provide data on the reasons for the placement and replacement of a total of 32,777 restorations. Notwithstanding differences between countries, different groups of practitioners and minor variations in methodology, the data included in the selected surveys indicate that everyday clinical practice in Scandinavia, UK and USA during the 1980s and 1990s has involved more replacement than initial restorations, with the ratio of initial to replacement restorations ranging from 1:1.1 to 1:2.4 for amalgam and 1:1.1 to 1:3.8 for composite materials. Primary caries has been consistently found to be the principal reason for the provision of initial restorations of amalgam and composite. The principal reason for the replacement of restorations of amalgam and composite has remained secondary caries as diagnosed clinically. Material failures (marginal degradation, discoloration, bulk fracture and loss of anatomic form) accounted for the replacement of more restorations of composite than amalgam. Recent surveys have reported secondary caries as the principal cause of failure of restorations of glass-ionomer cements and related materials. CONCLUSIONS: The clinical diagnoses of caries may continue to be found to account for the placement and replacement of most intracoronal restorations. Surveys of the type reviewed provide valuable insight into patterns of provision of dental care and highlight research priorities in relation to direct restorations.

Composite Resins↗
PubMed2002

Direct restorative material use of selected practitioners in the United Kingdom.

PURPOSE OF THE INVESTIGATION: To investigate, by questionnaire, the direct restorative materials used by a sample of practitioners from the United Kingdom. BASIC PROCEDURES: A postal questionnaire was distributed to a group of self-selected practitioners, who volunteered to participate in the study. In all 110 practitioners participated in the study. MAIN FINDINGS: The most used material for the restoration of occlusal (Class I) and approximal (Class II) lesions was amalgam with 61% and 73% of practitioners indicating that they used amalgam in this situation. Adhesive tooth-coloured materials, specifically composites and compomers, were preferred by the majority of practitioners for anterior approximal (Class III) and incisal (Class IV) restorations with compomer preferred for Class V restorations including non-carious cervical lesions and for the restoration of primary teeth. PRINCIPAL CONCLUSIONS: It is concluded that the general practitioners surveyed in this study tend to use amalgam for the restoration of Class I and II lesions as opposed to resin composite. The majority of practitioners in this study used compomers, a relatively new group of restorative materials, with little evidence of traditional glass-ionomer cements being used routinely.

Adult↗
PubMed2002

An audit on the placement and replacement of restorations in a general dental practice.

OBJECTIVES: To determine the reasons for placing and replacing restorations in a general dental practice amongst a group of patients. METHODS: This study used the method devised by Mjör and later modified by Burke and others. Instruction and data collection sheets were sent out to general dental practitioners (GDPs) for participation in a multicentre study. The GDPs were asked to record consecutively all restorations placed over a period of one month. The author is presenting his data collected over a period of six months using the same methodology. The author's results will be compared with a VDP study and the multicentre study. RESULTS: 779 restorations were placed during the six months of the study. Three hundred and sixty-four (47%) were initial placements and 415 (53%) replacements. Primary fractured teeth totalled (16%) of the restorations. Other reasons for restoration placement were marginal fracture/degradation (31%), non-carious defects (13%) and both primary and secondary caries (9%). The proportion of glass-ionomer restorations increased with the age of the patient compared with amalgam and composites (chi-square: p < 0.001), averaging 64% in age groups between 35 and 75 years, increasing to 88% in those patients over 75 years. CONCLUSIONS: The principal reasons for placement and replacement of restorations in this study were repairs to tooth fractures. The proportion of amalgams and composites decreased with age while the proportion of glass ionomers increased.

Adolescent↗
PubMed2003

A survey of current practices among general dental practitioners in Manchester in 2002.

AIM: The purpose of this study was to obtain data on current approaches for the restoration of endodontically treated teeth among general dental practitioners (GDPs) in Manchester, United Kingdom. METHOD: A questionnaire containing 19 single-answer, multiple-choice type questions was mailed to 503 GDPs practising in the Greater Manchester area in January 2002. An explanatory covering letter and a stamped addressed return envelope were enclosed. The data obtained were processed using SPSS statistical software. RESULTS: Three hundred and fifty-one (70%) of the practitioners responded to the questionnaire. The restoration of root-filled teeth was normally undertaken within 1-2 weeks of completing root canal therapy by 63% of the practitioners. Only 35% of the GDPs used posts routinely in the restoration of root-filled anterior teeth; the corresponding figure for posterior teeth was 15%. While a cast, precious metal post was the preferred choice in the restoration of anterior teeth, the use of prefabricated posts and related techniques predominated in the restoration of posterior teeth. Composite resin was the most popular choice of material for core build-up procedures in anterior teeth. Amalgam tended to be favoured for core build-ups in posterior teeth. The majority of the practitioners (56%) routinely restored root-filled anterior teeth by means of porcelain-fused-to-metal crowns. Seventy-three per cent of the GDPs preferred to restore root-filled posterior teeth by means of a full veneer crown. CONCLUSIONS: The results of this study suggest that the practitioners surveyed had a sound understanding of the principles involved in the restoration of endodontically treated teeth, with the possible exception of the need to establish a durable coronal seal as soon as possible after the placement of a root filling.

England↗
PubMed2005

A survey of general dental practitioners on the Mersey postgraduate register regarding the National Institute for Clinical Excellence (NICE) guidelines for the removal of wisdom teeth.

AIM: To ascertain the awareness of and response to the National Institute for Clinical Excellence (NICE) guidelines among general dental practitioners (GDPs) in the Mersey region. METHODS: A pre-piloted postal questionnaire was sent to all GDPs (522) on the Mersey postgraduate register. Day case statistics for third molar surgery at the local hospital were reviewed. RESULTS: Three hundred and eighty-seven (74%) of the GDPs responded and virtually all reported seeing patients with problems arising from third molars in the previous month. Thirteen per cent claimed that they were either unaware or unsure of the NICE guidelines and 34% reported that they did not have a copy. Seventy-eight per cent reported that they either definitely or probably agreed with the NICE guidelines, 56% that the guidelines had definitely or probably changed their management of third molar problems, 64% that they considered that the guidelines had definitely or probably reduced numbers of extractions/surgical removals, and 56% that they definitely or probably referred fewer patients with third molar problems. However, 89% said they had either frequently or occasionally encountered problems when they left a wisdom tooth on review (untreated). Eighty-four respondents provided free text comments on the NICE guidelines; half were favourable and half were critical. The local hospital's day case statistics indicated that there had been a fall in the annual number of patients undergoing third molar surgery from 494 in 1998 to 287 in 2002. CONCLUSIONS: It was concluded that the majority of respondents were aware of the guidelines and were using them. However, it was unclear whether or not the guidelines had, in themselves, led to a reduction in the number of referrals of patients with third molar problems, or that the reduction had already started, before the guidelines were published, and might have continued even if the guidelines had not been published.

Attitude of Health Personnel↗
PubMed1997

Reader's digest.

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Fees, Dental↗
PubMed1997

Bleaching teeth: practitioner trends.

Since the mid-1980s, bleaching teeth has grown significantly in popularity. This article provides an overview of current practitioner trends relative to this procedure.

Carbamide Peroxide↗
PubMed1999

One more time.

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Humans↗
PubMed2000

Practicing dentistry in the age of telemedicine.

BACKGROUND: This article examines teledentistry and some of its current legal issues. Topics include licensure, malpractice, technology and ethics. General recommendations for the dental practitioner are included. The literature review includes state and federal laws, the Telemedicine Report to Congress and numerous articles (both printed and electronic) associated with the topic. Sources were selected for timeliness and relevance to legal issues and implications of telemedicine/teledentistry for the dental practitioner. CONCLUSIONS: Numerous issues require resolution before telemedicine and teledentistry will truly realize their enormous potential to increase access to health care while decreasing health care costs. These issues include interstate licensure, jurisdiction and malpractice, as well as technological, security and ethical questions. PRACTICE IMPLICATIONS: Telemedicine and teledentistry are relatively new to the dental field. Many of the legal issues reviewed have yet to be resolved by the legislature or the courts. Furthermore, technology has not yet progressed to the point where the practitioner can be certain that no technological failure will occur during a teledental consultation. In spite of these problems, the potential of telemedicine and teledentistry is tremendous. Improvement in accessibility of health care and lowered health care costs are only two of the many advantages that will emerge as telemedicine and teledentistry become integrated with, and fundamentally change, the practice of medicine and dentistry.

Computer Graphics↗
PubMed2001

Third-molar removal patterns in an insured population.

BACKGROUND: The authors examined third-molar removal patterns in an insured population to see how these patterns compare with recommendations in the literature. METHODS: The source of treatment data was insurance claims for services rendered from July 1991 through December 1999; it included approximately 100 million dental procedures provided to about 7.4 million patients from all 50 states. The insured were public and private employees or retirees and their dependents. RESULTS: The authors found that third molars were the most commonly extracted permanent teeth, and they most often were removed from adolescents. Friday was the day of the week on which most extractions occurred, and the favored month was August, followed by July, December and June. Another important pattern revealed by the authors' analysis was that there was substantial variation among dental practices in whether patients had third molars removed and in the timing of the removal. They found that adolescent patients in some dental practices rarely were referred for third-molar removal, while in other practices, most or all had third molars removed. CONCLUSIONS: Third-molar removal patterns suggest that many third molars are not removed in response to acute pathology, and the observed variation in the likelihood and timing of these extractions reflects the lack of consensus on this topic in the dental literature. CLINICAL IMPLICATIONS: The apparent lack of consensus on third-molar removal should be resolved for the profession to maintain the confidence of the public that the recommended care is based on sound evidence.

Adolescent↗