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Conditions and tools for evidence-based dental practice.

Before evidence-based dentistry becomes a norm in practice, several conditions must be met. These include an attitude of questioning authority and training in how to use the literature, a supportive environment from colleagues and practice-based research. Some new tools--in the form of journals with more user-friendly formats and direct access to databases--are also necessary.

Dental Research↗

National oral health survey Zimbabwe 1995: quality of restorations.

In 1995, a second national oral health survey was carried out, ten years after the first. Application of a multi-stage sampling procedure resulted in 3709 persons being examined. The restorations were assessed using the criteria described by Kroeze et al (1990). Only ditches on the tooth/restoration margins that were wider than 0.4 mm were considered to be carious. The background variables studied were age, gender, type of location, socioeconomic status (SES) and level of education. The prevalence of restorations in all persons examined was 3.4 per cent. Restorations were found much more often among urban (95.5 per cent) than rural people (4.5 per cent) and also among those living in high (75 per cent) compared to low SES suburbs (25 per cent). Amalgam was more often used (89 per cent) than composite resin (10 per cent). The most frequently observed type of restoration was Class I (45 per cent) followed by Class II (39 per cent) and Class III (7 per cent). The prevalence of satisfactory restorations was 83.9 per cent. Failures were due to 'fractured restorations' (6.3 per cent), 'caries at the margin' and 'breakdown of restoration margin', both 4 per cent. Amongst adults, multiple-surface amalgam restorations failed more often than single-surface ones. It is concluded that the prevalence of restorations found was very low. There is a need to extend the provision of preventive and restorative oral health care by a more equitable distribution of oral health personnel and by making more finance available to rural and low-SES suburban areas.

Adolescent↗

Use of articulators in the United Kingdom by consultant orthodontists in planning orthognathic surgery.

This questionnaire survey aimed to investigate articulator use in orthognathic surgical planning by consultant specialists in the United Kingdom (UK). A total of 205 questionnaires was sent to all consultant orthodontists in the UK. One hundred thirty questionnaires were completed, representing a 63.4% response rate. Consultants had been in their post for a median of 10.5 years (range 0 to 30 years) with a mean of 11.3 (SD 8.4) surgical cases per year. When asked which cases had been planned on a semiadjustable articulator, two thirds of consultants (67.7%) planned maxillary single-jaw procedures, 45.4% planned mandibular single-jaw procedures, and 77.7% planned bimaxillary procedures. While 98.5% of consultants reported access to at least one type of articulator, 14.6% of maxillary single-jaw and 5.4% of bimaxillary surgery was not planned on any articulator. Twice as many consultants who had been in their post fewer than 11 years had been trained on a semiadjustable articulator, compared to those who had more than 11 years of experience. Semiadjustable articulators were the most popular for planning orthognathic surgery. Consultants with less than 11 years of experience completed more surgical cases each year and were more likely to have been trained on a semiadjustable articulator than consultants with more than 11 years of experience. However, no link exists between the age of the consultant and the type of articulator selected for planning; this suggests that more mature consultants have received further training on contemporary articulator systems since receiving their accreditation.

Dental Articulators↗

Causes and pattern of tooth extraction in children treated at the University College Hospital, Ibadan.

A study of 429 children age 0-15 years who attended the paedodontic clinic of the Department of preventive Dentistry for treatment from January 1995 to December 1995 with a view of assessing causes and pattern of tooth extraction was carried out. 51.52% of the children had extraction. Dental caries and its sequelae accounted for the highest indication for extraction (57.47%) while periodontal disease accounted for the least (0.45%). Deciduous teeth were mostly extracted with the deciduous molars being the teeth frequently extracted. The frequency of extractions shows that a challenging situation exists for those engaged in the organisation of dental health education and emphasis should be on prevention.

Adolescent↗

Off the mark.

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Evidence-Based Medicine↗

The incidence of cysts and tumors around impacted third molars.

The objective of this retrospective analysis was to determine the incidence of the development of cysts and tumors around third molars and to discuss some relevant issues in relation to the removal of asymptomatic, impacted third molars. 9994 impacted third molars, removed in 7582 patients, formed the basis of this study. The analysis revealed 231 cysts (2.31%) and 79 tumors (0.79%), including 7 benign tumors (0.77%) and two malignant tumors (0.02%). The incidence of cysts and tumors around impacted third molars was 3.10%.

Adolescent↗

The occupational risk to dental anesthesiologists of acquiring 3 bloodborne pathogens.

OBJECTIVE: To estimate the occupational risk to dental anesthesiologists of contracting 3 bloodborne pathogens: hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). METHODS: Through an anonymously returned, mailed questionnaire, dental anesthesiologists in Canada and the United States provided information regarding percutaneous and mucocutaneous contacts with contaminated fluid during the treatment of patients under deep sedation and general anesthesia as well as other general practice information. A mathematical model was applied to determine the occupational risk. RESULTS: Of the 101 (65%) returned questionnaires, 98 reported having treated patients within the previous 6 months. Of these, 41 (42%) had at least one percutaneous accident (89 accidents in total), and the projected mean annual injury rate for dental anesthesiologists overall was 1.82. The most common causes of injury were burs, intraoral needles, and dental instruments. Operator error during use was associated with 31% of reported accidents. Significantly more injuries were reported by those who also reported a mucocutaneous contact and by those working more than 25 hours per week. The projected mean annual number of mucocutaneous exposures was 0.88 for dental anesthesiologists overall. CONCLUSIONS: The calculated annual risk to the average dental anesthesiologist of acquiring HBV (if not immune), HCV, and HIV following percutaneous injury was very low for all infections (HBV the most; HIV the least). The risk of contracting HIV following mucocutaneous contact was extremely low.

Anesthesia, Dental↗

Gender and age-related differences in the pattern of complete denture referrals from general dental practitioners.

This study was designed to identify gender and age-related differences among complete denture referrals from general dental practice to a dental teaching hospital over a 4 year period. Referral rates were calculated according to male/female ratios in the edentulous population. Although more women than men were referred overall, the proportion of males to females referred was similar to that in the edentulous population. Significant gender-related differences in referral patterns were identified, suggesting that edentulous males with complete denture problems, and aged 69 or less, made proportionately less use of hospital services, and proportionately more when aged 70 or over.

Adult↗

The future is coming and it will be amazing: computers in dentistry.

The computer in the dental office, especially at chairside, provides both "high tech" and "high touch" benefits. Single entry of data has the benefit of accuracy and time savings. It also makes data available regarding the practice in an easy-to-use fashion. Some suggestions are offered to those contemplating the addition of a computer system to their offices.

Budgets↗