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General practitioners, especially those working in areas where there is a high incidence of HIV, will inevitably have to face patients who may or may not know that they are HIV antibody positive. This paper gives some guidelines on how to approach the problem, using two case scenarios.
OBJECTIVE: To measure the subjective impact of oral health in a group of patients attending general dental practices in the North West of England and to investigate the attributes of dentists and practices in order to examine how such attributes might relate to patients' subjective perceptions of oral health. DESIGN: Fifteen general dental practices conducting a simultaneous survey of attending patients and 15 practitioners from these practices providing information about their attitudes to treatment, prevention and various aspects of their surgery. SETTING: General dental OUTCOME MEASURES: Patient subjective impact scores. Relationships between practice and practitioner variables and patients' subjectively perceived oral health. RESULTS: Fifteen practitioners with diverse practice attributes provided data on 718 patients. The mean total oral health impact score was 18.4. Twenty two per cent of patients had experienced pain in the four weeks before the survey and 11% had been unable to chew some foods. Fifty five per cent of the surveyed population had, in the previous year, worried about the appearance of their mouth and 65% had worried about their oral health in general. Dentists' beliefs were related to patient impact scores but practice attributes were not significantly associated with patients' impacts. CONCLUSIONS: Fourteen percent of the differences in patients' subjectively perceived oral health can be attributed to dentist attitudes and attributes. Further research regarding the influence of dentists personality and professional beliefs on patients well-being needs to be undertaken.
OBJECTIVES: The aims of this study were to determine the self-reported use of panoramic radiography, D- and E-speed film, rectangular collimation, film holders, equipment fitted with a long spacer cone (>200 mm) and the bisecting angle and paralleling techniques by general dental practitioners and to see if use was related to the dentists' age and postgraduate qualifications. METHODS: Three mailings of a self-completion questionnaire were circulated to 800 general dental practitioners working in the National Health General Dental Service in England and Wales. RESULTS: A response rate of 74% was achieved. Sixty-one percent of general dental practitioners reported use of panoramic equipment. Fifty percent of dentists always used E-speed film and 18% always used rectangular collimation. Sixty-eight percent of dentists always used bitewing film holders though fewer (37%) used periapical film holders. Sixty-three percent of dentists always used a long cone. The bisecting angle technique was used by 70% of dentists with 22% always using this technique for periapical radiographs. Thirty-one percent always used the paralleling technique. Use of panoramic equipment, periapical film holders, bisecting angle and paralleling techniques were associated with the dentists' age. Use of periapical film holders, bisecting angle and paralleling techniques and rectangular collimation were associated with dentists' postgraduate qualifications. CONCLUSIONS: There are several features of radiographic equipment and techniques that can aid high quality imaging and reduce patient dose. Although a number of these are being used in general dental practice in England and Wales they have yet to achieve universal adoption.
Periodontal care in general dental practice has begun to develop in a pattern which distinguishes it from more specialised periodontal therapy delivered in practices and hospital units devoted to that activity. Thus, more emphasis is laid upon screening in general practice, with monitoring of treatment progress in patients with mild disease also requiring a novel approach. The system needs to be underpinned with carefully designed record-keeping arrangements. There now appears to be an urgent need for a simple but robust method of measuring the outcome of simple periodontal treatment in general dental practice if further progress is to be made in this important area.
OBJECTIVES: To examine how pricing policies were contrived in general dental practice in terms of fee-for-item and hourly rate and how these were affected by specialist status and the level of private care provided in a practice. DESIGN: A postal questionnaire. SUBJECTS: Members of the British Society for General Dental Surgery working in dental practice. RESULTS: Out of 160 eligible members, responses were received from 124 members (78%). Fifty-seven respondents claimed to specialise in one or more fields of dentistry. The majority of respondents consulted fellow colleagues or partners for advice on fee setting. A minority took external advice. The charging method varied according to the item of treatment with fee-for-item used predominantly for items such as a new patient examination, and hourly rate used more for items such as a direct composite restoration. Seventy-one respondents stated that their practice was 80-100% private treatment and these practitioners were significantly more likely to charge by hourly rate than fee-for-item for many items of treatment. Specialist status did not have any effect on charging method. The most important factors related to the setting of fees-for-item or hourly rate were clinical time spent, practice overheads and laboratory costs. CONCLUSIONS: This project has taken the views of a large group of experienced general dental practitioners, many of whom work purely in the private sector. The most important factors affecting fee setting were clinical time, practice overheads and laboratory costs. The method of charging was most affected by the proportion of private treatment provided by the practice.
OBJECTIVE: To determine the extent and types of change in seven domains of dental practice in a sample of English general dental practitioners (GDPs). METHODS: A postal questionnaire was sent to 561 GDPs on the dental lists of three health authorities in diverse regions of England. Information collected included demographic details on personal and practice characteristics, self-rating of amount of change in the seven domains of practice and factors influencing change. RESULTS: The response rate was 60%. Fifty-six per cent of the sample were under 40 years old. Over a third of respondents reported "changing a lot or completely" certain clinical activities, practice management arrangements and practice amenities. The highest self-reported level of change was in clinical activities. Of the GDPs who reported changing their clinical activities, 56% reported an increase in preventive care, followed by crown and bridge (44%), periodontics (44%) and endodontics (43%). Practice management rated second in the mean rank scores for self-reported change. The main changes reported were the introduction of computer systems and employment of practice managers. A sizeable percentage (66%) reported increasing the amount of information they provided to patients and the time spent discussing care. Quality assurance activities were the area of practice least likely to have changed over a 5-year period. Over half the sample reported not being involved in any quality assurance activities in the previous 5 years. Those respondents who were younger, had a postgraduate qualification and earned more than 20% of their income from private practice reported higher levels of change. CONCLUSIONS: General dental practitioners' work patterns are dynamic and appear to be responding to changing needs and demands on their service. The main changes were in the types of clinical procedures being carried out. The low prevalence of changes reported in auditing and peer review activities needs to be investigated further.
Working closely together in a general dental practice can cause many stresses and inter-personal problems. Results are presented of discussions with groups of dental practitioners, their hygienists and dental surgery assistants, indicating stressors and complaints most common in each group.
A practitioner with 4 years' hospital oral surgery experience undertook minor oral surgery procedures within a general dental practice over a 4-year period. The variety of work completed is shown. The National Health Service fees for the procedures indicate that a practice limited to minor oral surgery is both practically and financially viable when referral fees and x-rays are included. Differences in the types of procedure undertaken by visiting 'specialist' practitioners and 'specialist' practices is highlighted. A population of 310,000 is suggested for a 'specialist' practice in minor oral surgery to be feasible.
This article is intended to inform general dental practitioners about the background to clinical governance, how it came about and how the government has introduced it into the NHS. Because clinical governance is new in general dental practice, how it eventually becomes incorporated is still debatable, but this article attempts to describe ways in which practitioners can use it to their advantage. It explains how a cultural change is needed in dental practice to embrace these issues of quality and that issues of clinical governance have become a General Dental Service 'Terms of Service' requirement for all practitioners.
Presentation of treatment plan options to patients in general dental practice involves the collation of information and its presentation in a clear and uncluttered environment. Visual aids are of value, as are effective verbal and written communications with the patient. Fees should be discussed openly, as should guarantees for, and limitations of, proposed treatment.
AIM: To investigate biopsy procedures in general dental practice. OBJECTIVES: To assess the views and attitudes of: specialists on the dental specialist surgical registers; dentists in general practice (GDPs) and patients undergoing biopsy procedures. METHOD: Questionnaires were sent to 98 oral and maxillofacial surgeons and surgical dentists, 335 general dental practitioners and 220 patients attending the Oral Medicine Clinic at the Dental Hospital, Manchester. Participation rates were 68 (74%), 227 (72%), and 158 (76%) respectively. RESULTS: Specialists: 47 (70%) would discourage dental practitioners undertaking biopsies. Concerns were a lack of skills and delays in referral; 20 (30%) considered GDPs should be able to perform simple biopsies for benign lesions. Dentists: 33 (15%) reported they had performed oral biopsies in the last two years; 136 (60%) felt they should be competent to biopsy benign lesions. Their main concerns were lack of practical skills and the risk of diagnostic error. PATIENTS: 112 (65%) worried about their biopsy result, 67 (39%) would feel anxious if their dentist did the biopsy, although 40 (23%) were anxious when biopsied in the oral medicine clinic. CONCLUSIONS: Both specialists on the dental surgical registers and GDPs feel there is a need for further training in biopsy technique for GDPs and better advertised and accessible pathology support. The current fee for biopsies may need upward revision. A main concern of patients is fear of an adverse biopsy report. Whilst patients are satisfied with specialist management any concerns were an insufficient reason for biopsy of a benign lesion not being undertaken in general practice.
Forty-five general dental practitioners evaluated the clinical handling properties and performance of a newly formulated glass ionomer cement of the powder/water type. Seven hundred and ninety restorations were placed and 457 were reviewed after seven months. This formulation set rapidly. Approximately 95 per cent of the restorations performed well over the period of assessment. The results of this trial were compared with those of a trial on an earlier glass ionomer cement. The main advantage of the new formulation was the improved handling properties, notably the speed of set. Misuse of the material was the major factor responsible for poor clinical performance.
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This case study describes the management of Callum, an anxious 7-year-old boy with extensive caries. Callum's dental care was carried out in a general dental practice in the North of England under the terms of the National Health Service. A preventive programme was carried out in conjunction with the restorative philosophy according to guidelines published by the Dental Practice Board in 1997.
General practice audit is essential in the process of developing an evidence-based approach to dental care. The CHAID (CHi-Squared Automatic Interaction Detector) statistical software package is both practical and user-friendly for many simple applications. The types of questions asked in general practice audit projects will frequently be suitable for analysis using this technique. This may include the identification of patients who are likely to fail appointments and place an additional financial burden on the practice. This paper illustrates the potential value of CHAID to general dental practitioners (GDPs) by using examples of commonly cited dental audit topics. This paper aims to illustrate how a simple statistical package (SPSS CHAID) may be of use for both audit and practice management activities.
This paper examines the problems encountered by general dental practitioners (GDPs) when they attempt to carry out research. It outlines the possible stages a GDP might use when planning to undertake research and possible areas of interest to investigate. Part 2 will appear in a subsequent issue of Primary Dental Care.
Dental nurses have reported dissatisfaction with their work which is associated with feelings of lack of control and being undervalued. This paper examines some of the possible reasons behind job dissatisfaction with illustrations from a pilot study conducted in general dental practice.