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At least 919 records · Page 51Linked to original sources
PubMed1996

A questionnaire instrument to assess clinical decision-making in prosthodontics among general practitioners.

There are great variations in dentists' choice of treatment. The aim of this study was to evaluate a Patient Paper Case (PPC) technique to investigate such variation, adjusted for prosthodontics. The questionnaire was sent to all 131 general practitioners (GP) in the Public Dental Service in Orebro County and to all 100 GPs in private practice in Skaraborg County, Sweden, with 81% responding. There were three PPC questions, concerning 1) crown therapy or amalgam/composite filling, 2) fixed or removable partial denture, 3) fixed partial denture or single implant restoration. Respondents were asked to assess 13 or 14 items concerning the patient, dental conditions, and own skills. There was great variation in responses. In factor analysis four factors were found to capture between 54% and 60% of the variance of the items. They were interpreted as a time factor, a patient subjective factor, a clinical factor, and finally, for the PPC 1 and 2, a general health factor. The Swedish insurance regulations of single implant therapy, mandatory caries/filling-free, and vital adjacent teeth were reflected in the factor solution of PPC 3. It is concluded that the PPC method is feasible and useful in studies of clinical decision-making in prosthodontics.

Decision Making↗
PubMed1992

Determinants of dentists' geographic distribution.

Practice location may have greater economic importance today for dental students and dentists who are considering relocation and/or expansion to new sites than in the past. Yet, a literature review easily leads to the inference that practice location decisions are far too complicated and individualistic for there to be any systematic pattern of dentists' geographic distribution. This paper specifies and estimates an economic model that attempts to explain the distribution of dentists in particular market areas in the state of Connecticut and to test the hypothesis that the distribution, rather than exhibiting randomness, adheres to the prediction of theory. The findings show that the geographic distribution of dentists is significantly related to a few key variables. Given these results, and because this model can be applied to other areas and uses data that are readily available for any market area, it may be useful for educators involved in helping dental students with their practice location decisions.

Capital Financing↗
PubMed1990

Variation in dentist service rates in a homogeneous patient population.

Previous studies in medicine and dentistry document wide variations in service rates across small areas, large regions, and providers. The practice patterns of providers and underlying differences in patient need are thought to be important sources of this variation. To control for variation in patient needs, we calculated service rates of 200 general dentists in Washington state based on a homogeneous, well-educated, upper-middle-class population of patients. Wide variations were found in the rate for many dental services. Dentists' practice beliefs and characteristics of the practice were sources of variation in the rates. The evidence is insufficient to determine whether undertreatment of overtreatment occurred among dentists with the lowest and highest expenditures per patient, respectively. However, the perceived oral health status of adult patients was lower in practices with the lowest total expenditures per patient than in practices with the highest total expenditures per patient, suggesting the undertreatment of adult patients in the lowest-expenditure practices may have occurred.

Adult↗
PubMed1986

Study of computer applications in dental practice.

The results of this study indicated that some new patterns are emerging in computer usage by dentists. The majority in this study reported utilizing micro- and minicomputers rather than commercial services. The increasing acceptance of personal computers and their decreasing costs will certainly contribute to increased utilization and the development of additional applications.

California↗
PubMedDate not supplied

The growing challenge of providing oral health care services to all Americans.

By many measures, the practice of dentistry has improved for the dentist over the past decade. Hours of work are down, and compensation is increasing. However, there is a growing disconnect between the dominant pattern of practice of the profession and the oral health needs of the nation. To address these needs, the profession will need to take some radical steps toward redefinition, or the responsibility for many for these needs and special populations may shift to other providers and other institutions.

Dental Care↗
PubMed1999

The effects of gender and race on practice pattern preferences of dental students.

Type of practice arrangement is an important decision for student dentists, and one that has implications for the future delivery of dental care. This study examined the effects of two student-related characteristics, gender and race, on dental student preferences for three practice arrangements: solo ownership, group ownership, and employee practice. Dental students read content-validated practice descriptions and rated each practice in terms of long-range practice preferences. The descriptions differed according to three practice-related factors: (a) decision-making autonomy, (b) income opportunity, and (c) financial risk. The independent variables were student gender and student race. The dependent variable was student rating of a dental practice. Results indicated that student preferences for different practice arrangements differ by gender and by race. Males rated the solo owner arrangement more favorably than did females and Whites rated the solo owner arrangement more favorably than did African Americans. Also, females demonstrated a stronger preference for group practice than did males, while African Americans rated the employee practice arrangement more favorably than did Whites.

Black or African American↗
PubMed2003

Effectiveness of interventions to promote continuing professional development for dentists.

BACKGROUND: Continuing education is incumbent upon dentists as health professionals, but its promotion may be required, particularly in order to ensure regular professional updating. Continuing professional development may be delivered in a variety of ways, and new strategies and techniques must be evaluated for effectiveness. AIM: To evaluate the effectiveness of two interventions utilizing the philosophies and techniques of the discipline of Quality Improvement. METHOD: A self-assessment instrument (a manual) for quality dental practice was developed using the Delphi technique. A randomized, controlled trial of the interventions was conducted under field conditions for dental practice in Victoria, Australia. Dentists in Test Groups 1 and 2 completed the self-assessment manual, and received relevant references and their own scores for the manual in comparison with empirical standards. Dentists in Test Group 1 also attended a continuing education course on Quality Improvement. Dentists in Control Group 1 completed the manual only and received feedback of their scores. Dentists in Test Groups 1 and 2, and in Control Group 1 completed the manual again after 1 year as a post-intervention follow-up. Dentists in Control Group 2 completed the manual only at 1 year. RESULTS: The intervention involving self-assessment, receipt of scores and references for the manual resulted in modest improvements in total scores for dentists after 1 year, although a response bias was apparent. CONCLUSION: An effective method of facilitating change in quality dental practice was identified. Assessment of strategies and techniques for professional development of dentists should include observation of patterns of participation.

Attitude of Health Personnel↗
PubMed1994

The changing role of the dentist.

This paper considers some of the specific factors which have changed the role of the dentist in a historical context. The impact of post-war developments on postgraduate education, the Nuffield Inquiry of 1980 and the Dental Strategy Review Group are examined. The broader scope of the dentist and dental auxiliaries in general dental practice in the light of changes in disease patterns is described. The benefits to patient care of involving the general dental practitioner and the dental team in primary care services are emphasised. There is a need to educate and train all health care professionals together to promote multidisciplinary teamwork in clinical practice. Change is inevitable but is to be welcomed more than feared.

Dentists↗
PubMed1995

Survey of radiographic practices of general dentists for the dentate adult patient.

OBJECTIVE: The purpose of this study was to assess the radiographic practices of general dentists with emphasis on the influence of education on these practices. METHODS: Data were obtained from a mail survey of a stratified random sample of 963 general practitioners in Ontario, Canada, who graduated from the two provincial dental schools. Descriptive statistics were used, and associations were tested by Pearson's chi 2 analysis. RESULTS: The adjusted response rate was 80%. For the new patient, 62% of respondents chose a type of predetermined protocol with the panoramic/bite-wing survey as the predominant choice. Only 37% of respondents chose to prescribe selectively according to the patient's needs. For recall patients, 55% of dentists used selective radiography, and of those who chose a protocol, the vast majority preferred bite-wing radiographs only. CONCLUSIONS: Three influences on the dentists' choice of radiographic examination as suggested by the data were dental education, ownership of a panoramic unit, and who exposed the radiographs. These associations were statistically significant.

Adolescent↗
PubMed1991

Radiographic interpretation and treatment decisions among dental therapists and dentists in Western Australia.

All dentists and dental therapists employed in the Community Dental Services in Western Australia were invited to participate in a questionnaire study to find out about their use of radiographs and opinions and knowledge about the diagnosis of approximal caries. Replies were received from 45 dentists (95.1%) and 207 dental therapists (84.0%). Most dentists would not restore a lesion before it appeared on radiograph to have reached the dentine, while therapists were more likely to consider a restoration for a lesion just in enamel. Sixty percent of all respondents thought that a cavity was present when the radiographic lesion was confined to enamel. Fifty-seven percent of dentists thought that an average lesion took at least 12 months to progress from outer enamel to dentine, while a majority of dental therapists thought this would take less than 12 months. Radiographs were not frequently taken by the participants. Operators' opinions about cavity formation were the most important predictor of choice of treatment. In general, these participant's responses were similar to those provided by Norwegian and Dutch respondents in similar surveys conducted 5-6 yr ago, but the present participants worked in an optimally fluoridated area and might therefore have been expected to have adopted more cautious criteria for restorative treatment. Differences between dentists and dental therapists were generally not great. The results suggest that calibration of the operators in the service would offer benefits.

Chi-Square Distribution↗
PubMed1995

Variation in dentists' clinical decisions.

OBJECTIVES: The first comprehensive review of the recent literature regarding variation in dentists' clinical treatment decisions is presented. METHODS: Variation among dentists in the clinical decisions they make as well as the methods used for assessing this variation are examined at three levels of aggregation of clinical decisions: the dental practice (or dentist), the patient, and the individual tooth. RESULTS: The extent to which differences in dentists' clinical decisions have been examined is limited. Studies are particularly sparse at the level of the dental practice, where the aggregate of dentists' treatment decisions is reflected. Further, the methods and measures used to assess variation tend to be different across studies, making quantification of variation difficult. Nevertheless, the available information reflects substantial variation in measures such as rates of provision of specific procedures; cost and numbers of procedures recommended for specific patients; and diagnoses, intervention decisions, and treatment selections for individual teeth. CONCLUSIONS: Even when differences in patients are controlled, variation in dentists' clinical decisions is ubiquitous. While its consequences remain undetermined, the variation in basic clinical decisions such as caries diagnosis signals the need to consider the extent to which the appropriateness of care is affected.

Decision Making↗
PubMed1993

Agreement among dentists' recommendations for restorative treatment.

Differences among dentists in their decisions to recommend treatment have been studied principally at a "macro" level by examinations of variations in dentists' treatment recommendations for individual patients, or for patients aggregated to the practice level. If reasons for these differences are to be understood, however, a "micro" level examination of differences in dentists' decisions to recommend treatment for individual teeth is necessary. Extent of agreement to recommend treatment among dentists was explored for 1187 teeth in 43 patients. Each tooth was examined by a mean of 6.6 general practitioners. A modified reliability index and distributions of raw levels of agreement were used for quantification of agreement rates across an incomplete cross-classification for practitioners and patients. Overall inter-dentist reliability in recommending individual teeth for treatment was moderate, p = 0.62. Among unrestored teeth with no clinically evident caries, as judged by an independent experienced evident caries, as judged by an independent experienced examiner, reliability in treatment recommendations due to caries was fair, p = 0.51. Reliability was lowest for recommendations concerning previously restored teeth, p = 0.43. Among all teeth receiving at least one recommendation for treatment, only 22% received a unanimous recommendation. Over one-half of all instances of lack of agreement resulted from a single dentist's recommendation differing from those of all other dentists examining the tooth. The results suggest that much of the variation in dentists' practice profiles is due to basic differences in decisions to recommend treatment for individual teeth with specific conditions, and that the presence of previous restorations seems to magnify these differences.

Adult↗
PubMedDate not supplied

A comparison of general dentists' and pediatric dentists' treatment recommendations for primary teeth.

A survey which included a series of demographic questions, a brief clinical history, and pictures of eight radiographs was mailed to 2000 general dentists and 1000 pediatric dentists. Usable responses were received from 1369 (45%) dentists--765 (38%) general dentists, and 604 (60%) pediatric dentists. The dentists were asked to select the optimal treatment for a specified tooth in each radiograph. The results of this survey indicate that there were differences in the treatment recommendations of general and pediatric dentists. Whether or not pulp therapy was recommended, general dentists frequently recommended restoring teeth with amalgam. Pediatric dentists more frequently recommended restoring primary teeth with stainless steel crowns. There were differences in treatment recommendations within each group of practitioners, as well as between the two groups.

Chi-Square Distribution↗
PubMed1980

A comparison of interests of first year dental students and fellows of the Academy of General Dentistry on the Strong-Campbell Interest Inventory.

The SCII was used to evaluate the similarity of interests of a sample of practicing dentists and those interests of a sample of dental students. The two groups were found to have similar interest patterns, except for business and office considerations. While the SCII's specific vocation scale for dentistry did not yield very strong positive results in terms of identifying the dental students, it did reveal useful interest patterns. As a general instrument for self-assessment, or for counselors advising the young about a vocation in dentistry, the SCII has some utility if the pattern of interests is used.

Adult↗
PubMed2000

Going private? Exploring the drift away from the NHS.

The perception that dentistry is being privatised is widespread. A two-phase study was undertaken to investigate the factors influencing dentists' decisions to practise in the public and or private sectors. In phase I a national postal survey of general dental practitioners (n = 1011) explored differences in working practices and experience of NHS and non-NHS work. Survey data were supplemented in phase II by in-depth interviews with four subsamples of dentists in two regions. The survey found that although the majority of dentists continued to treat the majority of their patients within the NHS since the introduction of the 1990 contract patterns of practice have changed. Where private dentistry was increasing, it was regionally variable and arose mainly from concerns with financial security, maintaining quality of work and autonomy. Ideological differences were apparent in relation to differences in practice mix. Those who continued to work in the NHS, because of insufficient demand for private dentistry, did so in order to provide access to treatment and to maintain a reliable source of income and pension rights. Dentists interviewed expressed reluctance in withdrawing from NHS practice. Disillusionment with government policy and recognition of the marginal nature of dental health issues suggests that current trends will continue.

Dental Care↗
PubMed2002

Ergonomic risk factors associated with clinical dentistry.

Ergonomics has formed an integral aspect of dental education at the University of British Columbia since the early 1980s. However, studies continued to indicate that dentists are at risk for developing musculoskeletal problems. This provided the impetus for a study of the risk factors associated with these problems. The data analyzed from 421 survey respondents in British Columbia indicate that indeed dentists are experiencing musculoskeletal pain and discomfort. However, the data also suggest that dentists can recognize and identify their own postures, practicing positions, and the equipment usage patterns that are associated with increased risks of experiencing musculoskeletal pain and discomfort. Such recognition is the first critical step to avoiding or neutralizing ergonomic habits and work environment layouts that might otherwise unnecessarily shorten professional clinical careers.

Adult↗