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Biomedical subjects

J D Bader

Publications and source records attributed to J D Bader.

At least 37 records · Page 2Linked to original sources
PubMed1997

What do we know about how dentists make caries-related treatment decisions?

A conceptual model of dentists' treatment decision-making is discussed. The model suggests that dentists do not use a hypothetico-deductive process for the diagnosis of caries. Rather, caries is identified through a process of pattern recognition that in most instances is inextricably linked to intervention decisions. Individual dentists have inventories of caries scripts that, when matched by a particular clinical presentation, lead to decisions to treat. The scripts comprise salient factors that are dependent on individual dentist's characteristics and biases, and thus vary substantially across dentists. The scripts tend to be complex, highly visual, and difficult to describe. All of these characteristics suggest that efforts to improve dentists' caries-related treatment decisions should acknowledge this knowledge structure and be designed to change the salient factors or interpretations of salient factors within the context of the caries script.

Attitude of Health Personnel↗
PubMed1997

A case for diagnoses.

It is common practice to record treatment rendered, but not the diagnostic basis for these treatment decisions. This practice appears to undervalue diagnosis, as well as hamper feedback to practitioners and the profession about the effectiveness of treatments relative to specific diagnoses. It also leaves dentists open to liability for litigation and impedes research. A case is made that dentistry should follow medicine in exploring the use of standardized computer-codable diagnoses as part of record keeping. A two-step process is suggested to promote initial acceptance.

Decision Making↗
PubMed1996

Developing a measure of patient perceptions of short-term outcomes of third molar surgery.

PURPOSE: The purpose of the study was to develop an instrument to measure patients' perceptions of their experiences after the removal of third molar teeth. METHODS: Nineteen patients (ages 18 to 25 years) who underwent surgical removal of four third molars after local treatment for mild symptoms of pericoronitis completed a newly developed 14-item instrument each evening for the 14-day period after surgery. A focus group was used to further examine the experiences of a subset of subjects. RESULTS: On the first day postsurgery, patients reported a median level of 81 on the 0 to 100 scale of "limitation of daily activity because of pain" (100 = total interference). This dropped to 21 by day 5, and all but two patients returned completely to normal activities by day 8. During the first 3 days, the median level of "average pain" ranged from 51 to 33 (100 = pain as bad as could be), and all but two patient were pain-free by day 10. Bad taste/breath persisted for between 2 to 4 days; food impaction was experienced by nearly all patients from days 3 through 14. Swelling was encountered by 10 of the patients for the first 2 days and was reported by only one patient after day 5. CONCLUSIONS: This study demonstrated that patients' perceptions of their experiences could be collected using a self-administered instrument, and it confirmed the changes in postsurgical morbidity that occur in healthy, young adults. This instrument and these data will be valuable to those striving to make informed decisions regarding third molar surgery.

Activities of Daily Living↗
PubMed1996

Using crowns to prevent tooth fracture.

Placing crowns to prevent tooth fracture is thought to be a common but infrequently documented treatment procedure. Two studies are described that provide information about dentists' use of crowns to prevent tooth fracture. North Carolina general dentists indicated that 44% of the crowns they placed were for the principal reason of fracture prevention. However, when groups of dentists examined the same patients, there was little agreement about which teeth should be crowned due to risk of fracture. These results suggest that the placing of crowns to prevent fracture merits a careful determination of effectiveness and appropriateness.

Age Factors↗
PubMed1996

Case-control study of non-carious cervical lesions.

An exploratory case-control study of non-carious cervical lesions was undertaken to examine the effects of a variety of risk factors. Candidate exposure variables were related to erosion, abrasion, and tooth flexure, the three principal putative causal mechanisms for cervical lesions. Because previous studies have tended to focus on specific causal mechanisms, evidence for a multifactorial etiology is inconclusive. Data describing exposure factors were obtained through clinical examination, dietary and behavioral questionnaires, and analysis of study casts from 264 subjects (137 cases, 127 control). Salivary data were also obtained for a subset of these subjects. Patient and tooth-level logistic regression models were constructed for the full subject group, and the subset with salivary data. For the two patient-level models, only exposures related to brushing entered. For tooth-level models, multiple exposures representing all three causal mechanisms were included in both models. The results suggest that non-carious cervical lesions do have a multifactorial etiology, and that multiple causal mechanisms may operate in the initiation and progression of individual lesions.

Adult↗
PubMed1996

Cost implications of differences in dentists' restorative treatment decisions.

OBJECTIVES: This study sought to determine the effects of variation in both dentists' decisions to treat and choice of treatment on the costs of care. METHODS: Each of 37 patients was examined individually by several practicing dentists (between 3-22, mean = 6.2). For each dentist's recommended treatment for each patient, the total cost of restorative treatment was calculated first using the least expensive treatment possible for each tooth indicated as needing treatment, and second using the costs of specific treatment selected by each dentist RESULTS: Considerable variation was found among dentists in each patients cost of treatment using both methods. The mean of the median cost per patient of the specific treatment selected was three times larger than the cost per patient of basic treatment. Few dentists were found to consistently recommend higher or lower cost treatment plans. CONCLUSIONS: These findings suggest that inconsistencies in both dentists' decisions to intervene and dentists' selection of treatment can have a profound effect on cost. Further, focusing utilization review on "outlier dentists" is likely to be much less productive in containing costs and improving quality than comprehensive attempts to improve consistency across the profession.

Composite Resins↗
PubMed1996

A health plan report card for dentistry.

Employers are demanding information about the performance of the health care plans they purchase for their employees. As a result, "report cards" are now beginning to appear that provide standardized, population-based comparison data for managed medical care plans' quality of care, access and member satisfaction, utilization, and financial status. Although report cards for dental care plans have not yet been developed, it is likely that purchasers will soon expect such performance information. A prototype report card for dental managed care plans is proposed in an effort to facilitate the development of a consensus standard for dentistry. The thirty-eight measures proposed for the report card are designed to be obtainable with a realistic level of additional effort in most dental practices. They were selected to provide data on questions of importance to purchasers and to assess processes and outcomes important because there is strong evidence for their effectiveness. The rationale for the measures is discussed, as are the steps required to develop more sophisticated measures. While the responsibility for the procurement of the information needed for dental report cards will die initially with administrators of dental care plans, it is likely in the near future that individual practitioners will be expected to supply this information to both individual patients and potential contractors.

Administrative Personnel↗
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↗
PubMed1995

Does the cycle of rerestoration lead to larger restorations?

The common practice of rerestoring teeth has been termed the "cycle of rerestoration." Some researchers and clinicians have speculated that this cycle results in teeth receiving progressively larger restorations. In this study involving 1,337 decisions to replace existing restorations in posterior teeth, the authors noted that 70 percent of all recommendations resulted in an increased number of restored surfaces. This observed increase in restoration size raises questions about the effects of the rerestoration cycle on the health of a tooth and suggests that practitioners should attempt to avoid premature rerestoration since it could hasten the cycle.

Adult↗
PubMed1995

Preliminary estimates of the incidence and consequences of tooth fracture.

The authors studied all tooth fractures identified within a two-week period among adult enrollees in a dental health maintenance organization to determine the incidence and severity of this condition. They found complete fracture rates of 5.0 and 4.4 per 100 adults per year for all teeth and for posterior teeth, respectively, with 15 percent of fractures resulting in pulpal involvement or extraction. These estimates, the first to be reported, provide information that is potentially useful to patients and dentists making decisions about treatment intended to prevent tooth fracture.

Adult↗
PubMed1995

Practice parameters in dentistry: where do we stand?

Practice parameters or guidelines have been touted as a means of enhancing clinical decision making. The authors surveyed dental organizations and reviewed the literature to determine the availability of parameters for dental conditions. An Institute of Medicine report has suggested that for parameters to provide the desired benefits, they must meet certain criteria and possess certain characteristics. Using these criteria, the authors assess available parameters in dentistry.

Clinical Protocols↗
PubMed1994

Non-carious cervical lesions.

Non-carious cervical lesions are commonly encountered in clinical practice and present in a variety of forms. A knowledge of the aetiology of these lesions is important for preventing further lesions, halting progression of lesions already present, and determining appropriate treatment. The most commonly cited aetiological factors thought to lead to the development of cervical lesions are erosion, abrasion and tooth flexure. Evidence supports a multifactorial aetiology for non-carious cervical lesions. The purpose of this paper is to review the evidence for each of these aetiological factors as it relates to the development of non-carious cervical lesions. Specific features of cervical lesions linked to these factors, including their morphology, location, prevalence and distribution by age and sex will be discussed. Suggestions for future research into the cause and prevention of non-carious cervical lesions will be presented.

Dental Occlusion, Traumatic↗
PubMed1993

Relationship between epidemiologic coronal caries assessments and practitioners' treatment recommendations in adults.

Caries incidence determinations in adults reflect dentists' treatment decisions as well as epidemiologists' caries assessments because many patients receive treatment between the two assessments that are required to determine incidence. Yet knowledge of the relationship between epidemiologically assessed caries and practitioners' treatment recommendations is poor. In this study, the proportions of practitioners recommending treatment for a tooth, and the reasons for those recommendations, were compared across teeth grouped by their caries status as determined from an epidemiologic assessment. On average, for a tooth deemed carious by epidemiologic assessment, a mean of almost 90% of examining practitioners recommended treatment. Most but not all of these recommendations for treatment of teeth with epidemiologically determined caries were for caries-related reasons. Among teeth classified as sound by epidemiological assessment, the mean proportion of dentists recommending treatment was 11%. For restored, non-carious teeth a mean of 35% of examining dentists recommended treatment. Across all noncarious teeth, 25% of all treatment recommendations were related to caries. The mean patient F increment (number of newly filled surfaces) that would result from treatment recommendations practitioners indicated as being associated with caries was slightly less than one-half of the total F increment. Thus, F increments may substantially overestimate caries incidence.

Adult↗