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Biomedical subjects

E J Kay

Publications and source records attributed to E J Kay.

At least 55 records · Page 3Linked to original sources
PubMed1996

Patterns of and reasons for tooth extractions in general dental practice in Ontario, Canada.

While substantial proportions of the population of Ontario, Canada continue to have teeth extracted, little is known about the reasons for this loss. In this survey of Ontario general dental practitioners, 128 dentists provided information on 6143 patients they saw during a reference week. Approximately one-in-seven of these patients had or were going to have one or more extractions as part of their current course of treatment. The mean number of extractions for patients having at least one tooth taken out was 2.3 (SD = 2.5). Emergency patients were more likely than regular patients to have at least one extraction but, on average, had fewer teeth taken out. Orthodontic considerations were the main reason for tooth loss in childhood, caries continued to be an important cause of tooth loss at all ages and periodontal disease accounted for more teeth lost after 40 years of age than caries. This study differs from almost all others in finding that, overall, more permanent teeth were extracted because of periodontal disease than because of caries. The former accounted for 35.9% of teeth lost and the latter for 28.9%. While this may be due to methodological differences between this and other studies, it is consistent with epidemiological data on periodontal disease in the Ontario population and data showing that Ontarians receive little in the way of periodontal care.

Adolescent↗
PubMed1996

Is dental health education effective? A systematic review of current evidence.

In order that health service resources are allocated in the way which most benefits the population, systematic review of the available evidence regarding the effectiveness of programmes and interventions are required. This study examined papers relating to dental health education interventions, which were published between 1982 and 1994 (n = 143). Each was scored by two independent researchers according to twenty predetermined validity criteria. For each paper which achieved a validity score of more than 12 (n = 37), data concerning the objectives of the intervention, the types and numbers of participants, and the outcomes, were extracted from the article. Where sufficient data were provided in a paper which met more than 15 of the validity criteria quantitative meta-analysis was carried out i.e. the results of the studies were pooled in order to calculate an overall intervention effect with confidence intervals. This combination of qualitative and quantitative review techniques showed that dental health interventions have: a small positive, but temporary effect on plaque accumulation (reduction in plaque index = 0.37 95% CI -0.29-0.59); no discernible effect on caries increment and a consistent positive effect on knowledge levels. The results of this analysis suggest that further efforts to synthesise current information about dental health education, in a systematic way, are required, along with maintenance of rigorous scientific standards in evaluation research.

Confidence Intervals↗
PubMed1996

Variations in restorative treatment decisions: an international comparison.

Variations between dentists in treatment thresholds and diagnostic decisions based on radiographs have not been fully explained. Since variations have been shown to exist between as well as within countries, it is possible that the structure of incentives inherent in different health care systems, and cultural influences on health and health care may play a part. This paper compares the results of a study undertaken in Scotland with a replication study undertaken in Canada concerning dentists' restorative thresholds and treatment decisions based on radiographic evidence. The Canadian dentists operated with greater sensitivity but lower specificity than their Scottish counterparts, although ROC analysis indicated similar overall abilities to detect carious lesions. The dentists' action thresholds also differed. However, methodological issues mean that the data from the study need to be interpreted with caution.

Adolescent↗
PubMed1996

Dentists' stated restorative treatment thresholds and their restorative and caries depth decisions.

OBJECTIVE: This study examines the relationships between stated restorative treatment thresholds of 16 dentists and both their restorative decisions and caries depth determinations for approximal tooth surfaces based on bitewing radiographs. METHODS: Sixteen dentists independently examined 15 pairs of experimental bitewing radiographs. They separately recorded restorative and dental caries depth decisions for 4,864 unrestored approximal tooth surfaces, 304 identical surfaces per dentist. In addition to caries depth and restorative decision data, these dentists provided their restorative thresholds using a five-point scale. RESULTS: Three dentists stated it would be appropriate to restore enamel lesions, nine would wait until caries had reached the dentinoenamel junction, and four would wait until caries extended into the dentine. Although dentists stating an enamel restorative threshold intended definitely or probably to restore relatively more surfaces and recorded relatively more surfaces with dentinal caries, ANOVA analyses revealed that the differences among the restorative and the depth means according to the restorative thresholds were not significant. Considerable variation existed in both the restorative and depth decisions among the dentists in each threshold group. CONCLUSION: Although interesting trends occurred in the restorative and depth decisions relative to the stated thresholds, this study suggests, like others in Europe, that these thresholds cannot be taken at face value to explain restorative decisions.

Analysis of Variance↗
PubMed1995

A new method of assessment of clinical teaching: ROC analysis.

Twenty-five clinical dental students with varying clinical experience were presented with case records consisting of a clinical history and a panoramic radiograph for 25 patients with bilateral lower third molars ('wisdom teeth'). The students were asked to indicate how certain they were that each lower third molar tooth needed removal using a 6-point rating scale. Immediately following the task, the students were presented with information on the indications for removal of lower third molars in the form of a lecture by a senior academic clinical teacher. One week later the students were asked to repeat the rating study, under the same conditions as before, using a further 25 clinical cases. Receiver operating characteristics (ROC) analysis, which provides a graphical and quantitative assessment of a group of observers' ability to detect need for treatment, was utilized to examine differences between junior and senior students and between the matched pre-training and post-training experiments. The ability of junior students to assign lower third molars for surgery was statistically no better than random selection of cases. Formal clinical teaching significantly improved this group's performance, but had no effect on the performance of senior students. Senior students were significantly better able correctly to assign lower third molars for surgical intervention than junior students. Therefore this study shows that clinical experience has a significantly greater influence on treatment-planning ability than formal teaching. ROC analysis is a useful tool for assessing the effectiveness of methods of undergraduate training.

Education, Dental, Graduate↗
PubMed1995

Healthy decision making: a new approach in health promotion using health state utilities.

Empowerment of the individual is the central tenet of health promotion philosophy. Application of health state utility methodology to clinical decisions will facilitate this process. The study reported here used health state utilities to examine the preferences of young adults concerning third molar care. Respondents were asked to indicate the strength of their preferences for various outcomes consequent to removing, or not removing these teeth by using standardised visual analogue scales. The results demonstrated that health state utilities for most complications of surgery were lower than, and therefore reduced health more than, those associated with the complications of leaving teeth in place. Therefore dental surgeons should be more circumspect about surgical intervention: this group of potential patients believed that the 'cure' is often worse than the 'disease'. This study illustrates the use of health state utilities, a methodology which allows patients' perspectives to be incorporated into the planning of rational health care.

Adult↗
PubMed1995

The effect of social and personal factors on the utilisation of dental services in Glasgow, Scotland.

This study examined potential mediators of dental attendance among two distinct adult populations who lived in contrasting social environments (deprived and affluent). The aim of the study was to describe and quantify the effect of both the potentially modifiable and the fixed factors which influence use of dental services. A two-stage weighted random sampling technique was used to select 863 participants who were interviewed. Of these participants, 372 lived in 'affluent' areas and 491 in 'deprived' areas. The 45 minute interview explored many aspects of oral health, and related behaviour and attitudes. The results showed a highly significant association between social deprivation and reported dental attendance (P < 0.001). Social environment was also significantly related to asymptomatic dental attendance. Deprived respondents' dental behaviours were significantly affected by life events and yet structural/organisational barriers to attendance had a significantly greater impact on the affluent population's dental visiting patterns than they did on the deprived population's. A regression model indicated that the best predictors of dental attendance were social environment, dental anxiety, perceptions about denture wearers and the value placed upon restored teeth. The study suggests that the barriers to dental attendance experienced by deprived populations are not easily modifiable, but belong instead to a group which relate to the socio-political agenda. The study also demonstrates the importance of accurate and regularly updated community registers for use in population based health services research.

Adolescent↗
PubMed1994

Relationship between dentists' treatment attitudes and restorative decisions made on the basis of simulated bitewing radiographs.

The implicit valuations which dentists place on the outcomes of their treatment decisions may be a major contributory factor in dentists' decisions about when to restore teeth. This study sought to examine the relationship between dentists' treatment attitudes and restorative dental treatment decision making. A group of 20 dentists were asked to indicate teeth in need of filling from 15 simulated bitewing radiographs. The dentists graded their level of certainty about their treatment decision as "definite", "probable" or "possible". Afterwards, the teeth were sectioned and examined using a microscope in order to determine how far through the tooth the caries had penetrated. The gold standard treatment criterion was that caries extending into the dentine of the tooth would require restoration. Receiver Operator Characteristic (ROC) analysis was used to examine the apparent weighting the dentists were giving to decision errors when planning treatment on the basis of bitewing radiographs. The dentists also completed a treatment attitudes questionnaire to determine their views about the relative importance of false negative and false positive treatment decisions. The results suggest that the most appropriate operating point for most of these dentists to achieve an outcome which matched their views about the relative importance of the two types of treatment error would be the point at which a filling would "definitely" be required.

Attitude of Health Personnel↗
PubMed1994

A study of the dietary fluoride supplementation prescribing pattern of south Glamorgan dentists.

Following the inclusion of dietary fluoride supplements in the Dental Practitioners Formulary on 1st January 1993, the aims of this study were to observe the fluoride supplementation prescribing pattern of South Glamorgan general dental practitioners and relate it to the latest caries prevalence data. The analysis was carried out on the prescribers and recipients of the prescriptions using post codes to locate all members of both groups into one of 26 dental planning areas (DPA) within the district. As the age of a minority of recipients could not be substantiated, an assumption that they were all 14 years or under was used to calculate a prescription to population ratio for each DPA. These ratios were correlated against the latest available caries prevalence data for each DPA to ascertain any relationship between the level of fluoride supplement prescription and the caries prevalence within South Glamorgan. Data were collected via the Prescription Pricing Division of Welsh Health Common Services Authority for the six month period, 1st January to 30th June 1993. Of 623 prescriptions dispensed within South Glamorgan, 581 were issued by dentists working in the District for patients living in the District. Of the 163 dentists registered within South Glamorgan FHSA, (boundary coterminous with the DHA) 49 made one or more prescription. Of these, 10 dentists wrote 20 prescriptions or more, totalling 401, during the study period, i.e. 6 per cent of the dentists made 69 per cent of the prescriptions. The correlation of the number of prescriptions issued per DPA (according to the dentists' location) with whole time equivalents in that DPA was 0.58 (P < 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Patients' needs--more than meets the eye.

For many years, 'need' for dental care has been measured by assessing the extent of disease present in an individual's mouth. A person is viewed as requiring treatment if their oral tissues are damaged in any way by pathological processes or trauma. However, GDPs understand that patients often only attend for care when they experience symptoms or events which disrupt their life in some way, so that dental attendance relies upon a person feeling that they do not look, speak or feel 'well' in some way.

Adult↗
PubMed1993

An example of the application of Markov models in dentistry--a prediction of the fate of molar teeth in 12-year-old Scottish children.

Markov analysis is a mathematical modelling technique which is particularly useful for predicting prognoses and probabilities of chronic diseases within populations. This paper applies Markov analysis to data concerning the condition of upper left permanent first molars in a group of individuals who were surveyed at age 12 and 15 years in Scotland by the Office of Population Censuses and Surveys. The Markov analysis predicted that in 1998, when the group of individuals would be 27 years old, 3.6 per cent of upper left first permanent molar teeth would be sound, 2.6 per cent would be decayed, 58.4 per cent would be filled and 35.4 per cent would be missing. A comparison of the Markov prediction for 18 year-olds in Scotland in 1989 with United Kingdom data for 16-24 year-olds published in 1988 indicated that the observed health status of the teeth was considerably better than that predicted by the Markov technique. The applicability of the Markov method to tooth status may therefore lie less in its ability to predict events as in being able to provide 'baselines' for future dental states in particular groups. Such an application of the Markov method could be used to determine whether dental deterioration among a group is occurring at a faster or slower rate than in the past.

Adolescent↗
PubMed1992

Variation in restorative treatment decisions: application of Receiver Operating Characteristic curve (ROC) analysis.

It has been evident for many years that dentists, when planning treatment for patients, do not act in a standard manner, and previous research has shown there to be wide variations in treatment planning amongst groups of dentists. Signal detection theory and Receiver Operating Characteristic (ROC) analysis allows measurement of an observer's ability to detect a lesion, while at the same time allowing examination of how a lesion, once perceived, is judged to be in need of treatment. An ROC curve is constructed by plotting the sensitivity (or true positive rate) of decisions made, against the false positive rate (equivalent to 1-specificity) when various decision attitudes, from interventionist to non-interventionist, are held. Fifteen pairs of simulated bitewing radiographs were shown to 20 dentists, who were asked to specify, for each approximal lesion, whether or not they would place a conventional restoration. The 7200 decisions made by the dentists were validated by sectioning and microscopically examining the teeth. The mean sensitivity of the dentists' decisions, when the strictest operating thresholds were held and caries into dentine was the validating criterion, was 0.26 and the mean specificity was 0.96. ROC analysis shows that when operating at the strictest threshold, the dentists were implying that specificity was weighted as being 2.7 times more important than sensitivity. ROC analysis leads to insight into how dentists differentially weight the true and false, positive and negative, outcomes of their decisions and thus allows explanation of why two dentists would rarely make exactly the same treatment plan for one patient, and also why different treatments might be offered to two patients exhibiting the same levels of disease.

Decision Support Techniques↗
PubMed1992

Restorative treatment thresholds and agreement in treatment decision-making.

It has been recognised for many years that treatment decision-making among dentists often shows wide variation. This study sought to examine the effect of dentists' stated treatment thresholds as a source of variation between them. Twenty dentists made 360 treatment decisions about the approximal surface of extracted teeth seen in simulated bitewing radiographs. They also stated their personal treatment thresholds, i.e. the depth of lesion which they intended to restore. One hundred and ninety pairwise comparisons of treatment decisions showed that only 16% of the dentist pairs showed substantial agreement. Dentist pairs who reported that they held the same interventive threshold achieved exactly the same mean level of agreement in treatment decision-making as dentist pairs who disagreed about the appropriate threshold for restorative intervention. The study suggests that restorative thresholds which are reported to be used by dentists may be poorly correlated with the number of positive treatment decisions actually made.

Adolescent↗
PubMed1992

Assessment of dental health state utilities.

The term "health state utility" implies the assigning of a numerical value to a state of health. Assessment of the success of health care procedures, using health state utilities, enables evaluation of available treatments and procedures in terms of differing health outcomes and therefore facilitates cost-benefit analyses. Although measurement of general health state utilities has become increasingly common in medicine using a variety of techniques, few attempts have as yet been made in dentistry to place valuations on different dental health states. The absence of tried and tested methods for measuring tooth quality make the benefits gained from preventive and restorative dental programmes difficult to quantify. The aim of this study was to assess the average utility values, held by a group of dentists and a group of members of the general public, for four different tooth states which it was hypothesised would have different values. These were 1) a decayed and painful posterior tooth; 2) a decayed and non-painful posterior tooth; 3) a posterior tooth which had been restored and would need further restorative treatment and 4) a permanently restored posterior tooth. A standard gamble questionnaire was used to elicit the utility values which were then substituted as "weightings" in a modified version of the "T-health" index (1). The results show that it is possible to assess dental health state utility values using the standard gamble method and that the average utility values of the dentists in the study were consistently higher than those of the general public.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Oral health and oral health behaviour in a population of diabetic outpatient clinic attenders.

The control of oral health in individuals suffering from diabetes mellitus may affect a diabetic individual's insulin requirements. This study examined the oral health status and behaviours of a group of diabetic patients and compared the results to those obtained in a recent UK national survey of oral health. The results showed that, despite reporting higher levels of oral self-care, the diabetic population suffered from higher rates of caries than "normal" individuals. These differences could not be accounted for by the treatment received from dentists. It is concluded that diabetic patients are more caries prone than the general population and that the cause of this difference should be sought, as the traditional aetiological agent for caries cannot account for the increased caries rate. If the aetiology of the findings of this study were determined, progress could be made in the search for indicators of increased caries risk.

Adolescent↗
PubMed1992

A programme of preventive dentistry in field conditions carried out in Glasgow, Scotland.

A caries-preventive regime comprising fluoride supplementation in age-related doses, three monthly acid-phosphate-fluoride applications, fissure sealing of deciduous and first permanent molars and chair-side dental health education, had been proved cost-effective in a single health centre setting. It was therefore expanded to a community-wide project in the Greater Glasgow area. This study describes the coverage achieved by the scheme, the demographic details of the children involved, and measured the dental health benefits accrued by the participants. The children received an annual dental examination and, to assess the effects of the programme, the records of 310 subjects who had attended three annual examinations were used. The deft and defs reductions ranged from 60 to 6.5 per cent and 58.8 to 9.6 per cent respectively, and equivalent DMFT and DMFS reductions ranged from 11.1 to 0 per cent, and 33.3 to 16.7 per cent respectively. Previously, deft reductions of 63.7 to 86.2 per cent, and defs reductions of 77.6 to 92.6 per cent had been reported (Stephen et al., 1983). In contrast, the corresponding deft and defs reductions achieved in this project were only up to 16.7 and 9.6 per cent respectively. The programme was most beneficial for children who had reached the age of three years after two year's participation in the scheme. The dental health benefits accrued by those receiving the preventive programme appear to be inversely proportional to its size. Therefore it represents an important example of the reduction of a preventive agents' effectiveness when used under field conditions, as opposed to those of controlled clinical trials.

Acidulated Phosphate Fluoride↗
PubMed1991

Designing dental health education materials for schoolteachers: formative evaluation research.

In the past, many school based dental health education programs have appeared to fail to bring about changes in children's behavior or measureable improvements in oral health. The reasons why this has been so are not always clear, but part of the explanation may be that inadequate attention has been paid to the research preceding the development of the dental health education materials used in the programs. This paper describes a rational planning cycle for evaluation research, which includes problem definition research, planning research, audience pre-testing and post-production audience testing for acceptability. Further stages involve post-dissemination evaluation, which include measures of effectiveness and implementation, but this paper argues that the four phases described above constitute a logical means of providing target groups with appropriate, acceptable and efficacious material.

Adolescent↗