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Biomedical subjects

E J Kay

Publications and source records attributed to E J Kay.

At least 37 records · Page 2Linked to original sources
PubMed2001

The reasons for the extraction of various tooth types in Scotland: a 15-year follow up.

OBJECTIVES: The aim of this survey was to investigate the reasons for extraction of the various tooth types in Scotland. This study replicated one which was undertaken 15 years earlier. A further aim, therefore, was to identify any changes in the frequency of extraction of each tooth type in the 15 years between the two studies. METHODS: The names of every fourth dentist on the list of the Scottish Dental Practice Board were obtained. Four hundred and twenty-five general dental practitioners were asked to record permanent tooth extractions for 1 week. Data requested for each extraction were: the patient's age, gender and dental attendance pattern, the type of tooth removed and the reason for the extraction. RESULTS: Three hundred and fifty-two dentists participated (a response rate of 82.8%). There were 25% fewer teeth extracted per patient and 30% fewer per dentist than in the 1984 study. In 1999, more teeth of most types were extracted from regular attenders whereas, in 1984, more teeth of all types were extracted from irregular attenders. Premolars and first and second molars were the tooth types most frequently extracted in both surveys. In 1999 premolars were the teeth most commonly removed below 21 years of age, accounting for 57.5% of extractions in this age range. Molars accounted for 33.8% of extractions in this age range compared with 52% in 1984. Overall, caries was found to be the principal reason for loss of all tooth types apart from lower incisors which were extracted mainly for periodontal reasons. However, below 21 years, 84.5% of premolar extractions were performed for orthodontic purposes. CONCLUSIONS: Over the last 15 years, the overall number of extractions has reduced and the proportion of extractions from regular attenders has increased. Proportionately more premolars and fewer molars were extracted from under-21-year-olds. This observation can be explained by an increase in orthodontic extractions or a decline in extractions for caries in this age group. However, when extractions from the population as a whole are considered, caries and its sequelae remains the principal reason for loss of all tooth types other than lower incisors which are extracted mainly for periodontal reasons.

Adolescent↗
PubMed2001

Risks and values in treatment decision making.

The 1984 Oral Health Strategy defined oral health as a subjective state rather than an objective one. It also made clear that oral health was far more than the mere absence of oral disease. Healthcare outcomes can therefore only be evaluated by the individual receiving healthcare rather than by those who provide it. The task of the healthcare provider is to determine the probability of achieving particular health outcomes. Weighting the value of an outcome by the probability with which it will occur can inform decision-making. The decisions which result from using such a system are sometimes counter-intuitive but ensure that the patient's values are fully incorporated into the decision-making process. This is particularly important in cases where the problem is aesthetic rather than pathological. Patients' evaluations of health outcomes are also known as health state utilities. Even if only considered implicitly, use of utility weighting ensures that patient consent is informed consent and encourages communication and understanding between patient and practitioners.

Decision Making↗
PubMed2000

The ability to successfully include primary dental care practitioners in commissioning groups.

OBJECTIVES: To evaluate two total purchasing (TP) sites and ascertain whether general dental practitioners (GDPs) could be successfully included in the total purchasing model of health care commissioning. Another objective was to examine the role GDPs may play in future primary care commissioning groups and trusts. DESIGN: An observational cross-sectional study of two dental purchasing pilots in the North West Region. SUBJECTS: Two TP sites were studied, one in South Cheshire, the other East Lancashire. Each TP organisation had a dental subgroup which had a formal structure and was given an active role in dental healthcare service decision making. MAIN OUTCOME MEASURES: General dental practitioners' ability to manage dental health care provision in the selected sites and the suitability and effectiveness of the services managed by them. RESULTS: GDPs were willing and able to form cohesive primary care commissioning organisations but attitudes in secondary care prevented the implementation of their decisions. CONCLUSIONS: Structural, organisational and psychological changes would be necessary if GDP led purchasing were to be successfully implemented. Such changes are vital if GDPs and the dental profession are to have an effective role in the newly formed primary care groups and trusts.

Community-Institutional Relations↗
PubMed2000

Past and present attempts to control health service expenditure and its effects on National Health dentistry.

OBJECTIVE: To examine the methods used by policy makers to try to reduce or limit expenditure within the National Health Service. METHOD: A chronological examination of cost related health care policy and its wider impact on society. Comparison of past developments in the NHS with new methods of health care organisation in the United Kingdom (UK). The experiences of two dental Total Purchasing Pilots are used to describe where the dental profession now stands in relation to current NHS developments. RESULTS: The introduction of Primary Care Groups (PCGs) constitutes part of a continued effort by health care policy makers to control expenditure on health services. In the PCG system, as in Total Purchasing (TP), a group of primary care practitioners control a finite budget. These groups therefore must decide which health care services should be available to the population they represent. Inevitably such systems result in the rationing of health care, but the decisions are instigated by primary health care professionals rather than by government edict. CONCLUSION: Unless GDPs are allowed, willing and able, to participate in and influence the newly emerging Primary Care Groups and Trusts, dental services may once again be pushed to the fringe of NHS care provision. Without adequate representation, the value of dental care may not be recognised and PCGs may decide to make use of traditional dental resources, to fund other services.

Cost Control↗
PubMed2000

Development and preliminary evaluation of an instrument designed to assess dental students' communication skills.

The aim of this study was to develop, and assess the inter-observer reliability of an instrument for evaluating dental students' communication skills. Methods used were process-tracking of interactions between experienced practitioners and patients, development of the instrument and its simultaneous use by two researchers observing 43 third year dental students prior to communication skills training. The results found that the instrument was appropriate for the purpose for which it was designed, and was easy to utilise. There were no significant differences between observers' total scores. Item-specific weighted kappa scores showed almost perfect agreement between observers for all but four of the 31 items. The lowest interobserver weighted kappa score was for the measurement of eye contact (k = 0.60). In conclusion, assessment of communication skills is now a necessity in the undergraduate curriculum. Preliminary analysis of an instrument of communication skills in the dental surgery indicates that it may be possible to do this reliably.

Clinical Competence↗
PubMed2000

A new method of measuring how much anterior tooth alignment means to adolescents.

The aim of this study was to develop an instrument to measure an individual's value of the appearance of their anterior teeth. Structured interviews were carried out using the Index of Orthodontic Treatment Need (IOTN) as a basis for time trade-off and visual analogue utility measurement. The subjects of the study were forty-five 11-14-year-old children at new patient consultation with an orthodontist (seekers) and forty-five 11-14-year-old children in school (non-seekers) It was possible to derive utility values using the techniques adopted. The seekers and non-seekers of treatment had significantly different utility values for anterior tooth appearance (P < 0.05, Mann-Whitney). This study suggests that it is possible to develop utilities that reflect how patients value the appearance of anterior teeth. These utilities had a predictive validity in that there were significant differences in seekers' and non-seekers' utility values. The seekers placed a higher value than non-seekers on the desirability of a good aesthetic appearance.

Adolescent↗
PubMed1999

Socio-economic status and orthodontic treatment need.

OBJECTIVES: This study aimed to examine the relationship between socio-economic status and both normatively assessed and self perceived need for orthodontic treatment. METHODS: More than six thousand 14-year-old children were assessed for orthodontic treatment by trained and calibrated examiners. The Index of Orthodontic Treatment Need was the measuring instrument along with a questionnaire which asked: "Do you think your teeth need straightening?" RESULTS: Normative need for orthodontic treatment (IOTN >3) was more common amongst deprived children than among their affluent counterparts. The same was found for perceived need. However, the children who wanted treatment were not necessarily those who needed it and vice versa. CONCLUSIONS: Socio-economic status affects normatively measured orthodontic treatment need through, as yet, undefined mechanisms. It also affects a person's perception of need for orthodontic treatment, but these two associations are separate. The mismatch of need and desire for treatment is a problem for orthodontists.

Adolescent↗
PubMed1999

A cluster randomized controlled trial testing the effectiveness of a school-based dental health education program for adolescents.

OBJECTIVES: This trial investigated the value of a school-based dental health education program in terms of changes in knowledge, reported behavior, and plaque scores. METHODS: A total of 2,678 pupils with a mean age of 12.1 years attending 28 schools participated in a school-based dental health education program. The study used a cluster randomized controlled study design. The health service administrators stipulated that all participants receive the intervention; to meet this requirement, a rolling program of two six-month periods was utilized. During the first six months, half the adolescents received the intervention program, the other half acting as controls. Throughout a further six-month period, all participants received the intervention program. This research design allowed comparisons between participants receiving the program for six and 12 months. At baseline, six, and 12 months, a random subsample of 40 children in each participating school had their plaque scores recorded and a questionnaire was used to record their knowledge of dental health and reported dental behavior. RESULTS: The analysis used the subjects clustered within the schools, which were the units of randomization. The intervention program produced statistically significant improvements (P < .001) in knowledge about periodontal disease and the frequency of sugar intake and dental caries in both assessment time periods. The reported frequency of brushing did not change, but the group who had received 12 months of the intervention were more likely (P < .05) to brush for over a minute. At six months the early intervention group had a statistically significant, 13 percent reduction in the mean proportion of sites with plaque compared with the late intervention group (P = .043). This difference was sustained at 12 months (P = .037). CONCLUSION: This cluster randomized control trial demonstrated that the intervention program resulted in an improvement in knowledge of dental disease and an increase in the reported duration of brushing. These improvements were accompanied by a significant improvement in oral hygiene and a reported reduction in gingival bleeding.

Adolescent↗
PubMed1999

Props and pitfalls in oral health promotion in the practice.

Practitioners often become demoralized and demotivated with regard to promoting the oral health of their patients as, so often, their efforts appear to be fruitless. This paper examines the published evidence and draws on behavioural theory in order to help practitioners understand what help and support they can offer their patients in order to improve oral health.

Behavior Therapy↗
PubMed1999

Oral health promotion and caries prevention.

This paper is based on a paper presented at a British Dental Association caries prevention symposium. It represents the views of the authors and does not necessarily represent the views of any organisation with which they, or the work reported, are associated.

Dental Caries↗
PubMed1998

Caries prevention--based on evidence? Or an act of faith?

The era of evidence-based healthcare requires that dentists' actions are supported by scientific proof of effectiveness. In this paper, evidence regarding the impact of strategies for caries prevention is derived from epidemiology and from a systematic review of research papers.

Cariogenic Agents↗
PubMed1998

Reducing variability in treatment decision-making: effectiveness of educating clinicians about uncertainty.

The objective of this study was to investigate whether or not education about the concept of uncertainty reduced variability in treatment decision-making. Three small groups of dentists in North York, Canada were asked to make restorative treatment decisions about simulated bitewing radiographs. They subsequently took part in a seminar about variations in perception and judgement and were given explanations of sensitivity, specificity and receiver operating characteristic (ROC) curve analysis. A repeat reading of the radiographs was then performed by both test and control groups. Results indicated that the intervention increased the accuracy, and decreased the variability of dentists' restorative treatment decisions. Kappa statistics were 0.33, 0.34 and 0.31 before the seminar, and 0.40, 0.43 and 0.41 after the seminar. Standard errors for kappas were 0.06, 0.05 and 0.05 before the seminar, and 0.02, 0.02 and 0.05 after the seminar. The area under the ROC curve was 0.7136 before the seminar and 0.7835 after the seminar. The data demonstrate that the dentists' decisions were less variable and more accurate following the educative intervention. This study suggests that there is potential for improving consistency and accuracy in clinical decision-making through education in probabilistic reasoning.

Adult↗
PubMed1997

A survey of dental professionals' health and well-being.

Past research has indicated that working within dentistry may offer a considerable threat to health. However, no data have previously been published regarding the general well-being and lifestyles of dental personnel. This descriptive study, which was undertaken by the BDA, aimed to examine the self-perceived health and well-being of people working in dental surgeries and to describe their health related behaviours.

Adult↗
PubMed1997

Reasons for tooth extractions in dental practices in Ontario, Canada according to tooth type.

In a study of tooth extractions in general dental practices in Ontario, Canada, 165 dental practitioners provided information on 6134 patients attending during a reference week. Of these, 11.6 per cent of patients had one or more permanent teeth extracted. Periodontal disease was given as the reason for 35.9 per cent of these extractions and caries for 28.9 per cent. Analysis by tooth type showed that third molars were the most common tooth type extracted. However, there were differences in the types of teeth extracted by age. Posterior teeth were most frequently lost by the younger age groups and anterior teeth by older subjects. There were also differences in the reasons for the loss of different tooth types. A comparison of these results with those of a similar study in Scotland suggests that age and tooth type does not account for the excess of extractions due to periodontal disease in this Canadian population. Differences in practice patterns and attitudes towards the retention of teeth may be contributing factors.

Adolescent↗
PubMed1996

A qualitative investigation of factors governing dentists' treatment philosophies.

The day to day decisions made by general dental practitioners have a significant influence on the oral health of the population, and yet are often poorly understood. This paper describes a qualitative study which sought to identify issues, other than the extent of pathology, which impinge upon dentists' restorative treatment decision making. It also aimed to develop a classification of these issues. Content analysis of in-depth interviews with 20 randomly selected general dental practitioners delineated 10 broad areas of concern. While each of these topics may influence a treatment decision to a greater or lesser degree, the issues relating to treatment planning can be divided into a classification which involves patient, profession and practitioner characteristics. This study indicates that an understanding of disease processes and of available treatment options is an insufficient basis for treatment decision making, as many considerations outside these straightforward concepts of health are brought to bear on decisions made within the dental surgery.

Clinical Competence↗
PubMed1996

Restorative treatment decisions from bitewing radiographs--performance of dental epidemiologists and general dental practitioners.

The object of the study was to compare the performance of a group of eight trained and standardized dental epidemiologists making restorative treatment decisions with that of a group of 20 general dental practitioners. Both groups read the same set of 15 pairs of simulated bitewing radiographs. For each approximal tooth surface image, the examiners were asked to record on a six-point rating scale the confidence with which they would or would not place a restoration. A histological gold standard was available, based on microscopic evaluation of sections of the extracted teeth used for study. The reference criterion was "caries into dentine". The only statistically significant differences in performance between the two groups were at the "definitely" plus "probably" restore rating level. For the proportions of correct decisions out of all treatment decisions at this level, the epidemiologists scored 89% compared with 86% for practitioners (P < 0.01) while for Youden's J index, the corresponding values were 0.44 and 0.34 (P < 0.05). The findings suggest that the benefits in improved performance from examiner training may be small.

Bicuspid↗
PubMed1996

Dentists' variability in restorative decisions, microscopic and radiographic caries depth.

Restorative and dental caries depth decisions were recorded for 5168 un restored approximal tooth surfaces by 17 dentists who worked in the school dental clinics of the North York (Ontario) Public Health Department. Each dentist examined 15 pairs of experimental bitewing radiographs for which true caries depth had previously been determined by microscopy of the sectioned teeth following production of the radiographs. The dentists independently recorded their restorative decisions and radiographic caries depth perceptions. The relationship between the variation in the dentists' restorative decisions and their perceptions of caries depth based on a re-reading of the bitewings on the one hand, and true caries depth on the other was also examined. The percentages of total variability in each dentist's restorative decisions attributable to radiographic and to microscopic caries depth were estimated using regression analyses. Large variations were found among the 17 dentists' distributions of overall restorative and depth decisions. The relationship between microscopic caries depth and the dentists' restorative decisions was, understandably, less strong than that of the dentists radiographic perceptions of caries depth and restorative decisions. Relative to true caries depth, high numbers of false positive and false negative restorative decisions were made. Overall, 50% of the variability in the dentists' restorative decisions was explained by the perceptions of radiographic caries depth; however, among individual dentists, the range was from 29% for one dentist to 69% for another. A much lower percentage of the overall restorative variation was explained by microscopic depth, 18%. Like the finding of the only two previous European studies that quantified the role of radiographs on clinical decisions, this study demonstrated that dentists' perceptions of dental caries depth using bitewing radiographs play a major but variable role in their restorative decisions for approximal tooth surfaces.

Clinical Competence↗