Employment of auxiliaries by dentists is high and duties performed by those auxiliaries vary. The auxiliaries' years of experience prior to their present job is low, but tenure in the job is not as low since over 30% have been employed five years or more. Regardless of the category of dentists being considered (type of practice, year of graduation, employment of auxiliaries), the great majority of dentists (over 95%) do not think cutting soft or hard tissue should be delegated. Beyond these two procedures, however, the tables show considerable variation in attitude toward delegation when year of graduation and employment of auxiliaries are considered. Other procedures that a substantial portion of the profession does not believe should be delegated are administering local anesthetic agents; placing and finishing resins, composites, and silicate restorations; placing amalgam restorations; and carving and finishing amalgam restorations. The impact of these attitudes on delivery of care should be directed particularly toward the attitudinal differences occasioned by graduation year and employment of auxiliaries, since the proportion of graduates shifts regularly and employment of auxiliaries is increasing.

Attitude of Health Personnel↗

PubMed1975

Patterns of dental practice in the United States: solo vs group practice.

This overview of selected characteristics of group and solo practices provides baseline information on the dimensions and structures of two general practice types in the United States. It appears that although a dentist spends no more hours or sees no more patients on the average in a group practice, the structure in terms of use of auxiliaries, appointment flexibility, and structured programs provides the dentist in a group practice more opportunity to participate in other professional activities and generate a higher income. Further analysis on the interrelation of these variables will provide a more conclusive comparison of group and solo practices. Also, more conclusive research on variations among different types of group arrangements is needed to appreciate differences in partnerships, groups, and incorporations.

Allied Health Personnel↗

PubMedDate not supplied

The measurement of mandibular cortical bone height in osteoporotic vs. non-osteoporotic postmenopausal women.

The asymptomatic progression of osteoporosis, in conjunction with the possibility of catastrophic disability, makes this disorder a major public health priority. Various body sites, including the mandible, have shown susceptibility to decreasing bone density. In 1986, Benson et al. proposed a radiomorphometric technique called the Panoramic Mandibular Index (PMI) as an inexpensive noninvasive dental technique for osteoporosis screening, although no osteoporotic subjects were included in their study. The purpose of our study was to determine whether osteoporotic postmenopausal women would show a decrease in mandibular cortical bone height, as measured by the PMI index, when compared with nonosteoporotic postmenopausal women. Seventy-two Caucasian females (33 cases/39 controls), aged 54-71 years old, were selected through records and screening via a dual-energy x-ray absorptiometry scan (LUNAR-DEXA). ANOVA analysis indicated no differences in the mean PMI between case and control groups (0.37 +/- 0.15 and 0.38 +/- 0.13, respectively; p = 0.69). Other techniques, such as computer digitized radiography should be explored to test the validity of the PMI.

Absorptiometry, Photon↗

PubMedDate not supplied

Oral health care in US nursing homes, 1995.

In 1993, nursing home care was a $70 billion industry. Since oral diseases are intertwined with declining health, it is important to achieve a better understanding of oral health care in nursing homes. The purpose of this paper is to present basic information regarding the nature of dental care from the 1995 US National Nursing Home Survey. Data include general availability of dental services, a description of types of dentists' and dental hygienists' services, and numbers of full-time equivalent dentists and dental hygienists. SUDAAN software was used to adjust for the complex, multistage sample design. Of the estimated 16,700 nursing homes in the contiguous US in 1995, between 14,000 and 15,000 offered some level of dental services. About 15,600 nursing homes provided assistance for oral hygiene, while some 7720 nursing homes had dental hygienists' services available. Approximately 60% of nursing homes either did not have services of dentists at all, or had them only on call or only off-site. Availability of dental services varied by characteristics of nursing homes. Examination of the nature of dental care raises questions about whether the intent of the Federal standards for dental care in Medicare and Medicaid are really being met. As more elderly remain dentate, and as the oral comorbidities of chronic diseases become more recognized, appropriate oral health services for individuals in long-term care settings likely will increase as public health issues.

Administrative Personnel↗

PubMedDate not supplied

Attitudes toward and use of pit and fissure sealants.

The results indicate that attitudes toward and use of sealants are generally low. There are, however, some dentists who use sealants proportionately more than other dentists, these being less recent graduates, dentists who practice in the northeast, and those dentists who are oriented generally more toward preventive procedures. The reasons selected by dentists for not using pit-and-fissure sealants were surprising. Despite considerable published evidence to the contrary and the provisional acceptance of two by the American Dental Association, Council on Dental Materials and Devices, most dentists are not yet convinced of the effectiveness of the procedure in preventing caries. In addition, many dentists were concerned that the material did not last long in the mouth, although high retention rates for periods in excess of one to three years had been reported. Also, a great concern for the possible sealing in of decay seems unsubstantiated by either clinical experience or reports from studies designed to monitor the activity of bacteria sealed in pits and fissures of teeth. Conversely, dentists infrequently selected either the cost of equipment and material or the time required for the procedure as reasons for not using pit-and-fissure sealants. The demanding technical requirements for proper application of the sealant, however, especially the avoidance of any moisture contamination, does require skilled personnel and substantial chair time. These factors are important considerations in the determination of the cost-effectiveness of this procedure in comparison to other preventive procedures for pit-and-fissure caries. These inconsistencies indicate a problem in the transmission of knowledge regarding sealants. Increased use of sealants, then, seems to be dependent on improving communication regarding their function and value to the dental profession. Data on the effectiveness of sealants over periods of three or more years have recently been reported and additional evaluations of this procedure are being reported. It would be expected that reports published since this research during the winter of 1974 will have an effect on both attitudes toward and use of sealants.

Attitude of Health Personnel↗

PubMedDate not supplied

Drugs used for parenteral sedation in dental practice.

The relative efficacy and safety of drugs and combinations used clinically in dentistry as premedicants to alleviate patient apprehension are largely unsubstantiated. To evaluate the efficacy and safety of agents used for parenteral sedation through controlled clinical trials, it is first necessary to identify which drugs, doses, and routes of administration are actually used in practice. A survey instrument was developed to characterize the drugs used clinically for anesthesia and sedation by dentists with advanced training in pain control. A random sample of 500 dentists who frequently use anesthesia and sedation in practice was selected from the Fellows of the American Dental Society of Anesthesiology. The first mailing was followed by a second mailing to nonrespondents after 30 days. The respondents report a variety of parenteral sedation techniques in combination with local anesthesia (the response categories are not mutually exclusive): nitrous oxide (64%), intravenous conscious sedation (59%), intravenous "deep" sedation (47%), and outpatient general anesthesia (27%). Drugs most commonly reported for intravenous sedation include diazepam, methohexital, midazolam, and combinations of these drugs with narcotics. A total of 82 distinct drugs and combinations was reported for intravenous sedation and anesthesia. Oral premedication and intramuscular sedation are rarely used by this group. Most general anesthesia reported is done on an outpatient basis in private practice. These results indicate that a wide variety of drugs is employed for parenteral sedation in dental practice, but the most common practice among dentists with advanced training in anesthesia is local anesthesia supplemented with intravenous sedation consisting of a benzodiazepine and an opioid or a barbiturate.

Anesthesia, Dental↗

PubMedDate not supplied

Attitudes of dentists and physicians toward the use of dietary fluoride supplements.

One of the major goals of the reported research was to determine how consistent health practitioners' knowledge, attitudes and practices are with the consensus of the public health and research communities regarding caries prevention. Both professions are aware of current caries preventive methods, but have very mixed reactions toward their relative effectiveness in the United States, today. Dentists and physicians see a great deal of value in community water fluoridation and see some effectiveness from fluoridating school water supplies. They regard the prescription of dietary fluoride supplements as an effective caries prevention measure, but to a much lesser extent, and base their use of these prescriptions on the age of the child and the level of fluoride in the community's water system. Topical fluoride applications and fluoride dentifrices, as well, are thought to be very effective preventive measures by only a small proportion of dentists and physicians, as are fluoride mouth rinses. Dentists and physicians rate systemic fluorides as effective more often than they do other selected methods, as would the research community; but they are not as solidly behind these, as evidence would suggest they should be. Both community water fluoridation and dietary fluoride supplements are known to be very effective caries prevention measures, yet only 66 percent of the physicians think community water fluoridation is very effective and only 37 percent think dietary fluoride supplements are very effective.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Parents in oral hygiene education: an opinion survey.

Explore the source record for details and available documents.

Adolescent↗

PubMedDate not supplied

Sealant use and dental utilization in U.S. children.

The use of dental sealants has remained relatively low in the U.S. in comparison with other proven oral disease preventive therapies, and particularly among black children. Dental visits have also been consistently lower among black children. This paper describes the reported use of dental sealants and dental visits in U.S. children ages 6-17 using data from the 1989 National Health Interview Survey (NHIS). Family income and education interact with race in explaining the use of dental sealants and dental visits. Racial differences in sealant use and dental visits are more apparent in middle and upper socioeconomic levels, than lower socioeconomic level children. Overall, 15 percent of children ages 6-17 have dental sealants and 73 percent had a dental visit in the past twelve months. More white children whose parents had higher income levels and at least one year of undergraduate education (24 percent) had sealants than similar socioeconomic status (SES) black children (11 percent). Additionally, black children whose parents had a college education (68 percent) were less likely to have dental visits during the past 12 months than white children of similar SES (86 percent). These results provide an opportunity to evaluate factors and conditions that could form a basis of targeting programs to improve behaviors, attitudes, as well as access to preventive dental services.

Adolescent↗

PubMedDate not supplied

Public knowledge of prevention of dental disease.

The authors present data describing the level and extent of the general public's knowledge of oral diseases and their prevention. They discuss data from the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement in the context of national oral health objectives. They focus on demographic and socioeconomic differences seen in the public's knowledge of the preventive purposes of fluorides and dental sealants for dental caries and of symptoms of gum disease. Reported low levels of knowledge regarding oral disease symptoms and their prevention show the continuing trend reported during the past decade. Racial and ethnic minorities and groups with low levels of formal education demonstrate the least knowledge of prevention of oral diseases. For example, 76 percent of those with more than 12 years of schooling know the preventive purpose of water fluoridation, compared with 61 percent of those with 12 years, and 36 percent of those with less than 12 years of school. Efforts to increase levels of knowledge about oral disease prevention are required to achieve national objectives for oral health.

Adolescent↗

PubMedDate not supplied

Use of mouthguards and headgear in organized sports by school-aged children.

Sports-related orofacial trauma is a serious problem that can be prevented by wearing protective mouthguards and headgear. While this equipment is available, few studies have been done of wearing practices. This study assesses the wearing practices using data from the Child Health Supplement of the 1991 National Health Interview Survey. Results indicate that football was the only sport in which the majority of children used mouthguards and headgear. While statistically significant differences (p<.05) were found in use of the equipment in all sports by grade level, gender, parent's education, ethnicity, and by region of the the country, these differences were not consistent across sports. Healthy People 2000 calls for extending requirements for use of orofacial protective devices to all organizations sponsoring sports that pose risk to injury. Given the complex nature of the findings, multifaceted initiatives that include the promulgation of rules must be developed and tested to determine what approaches are effective in ensuring consistent use.

Adolescent↗