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Biomedical subjects

J D Bader

Publications and source records attributed to J D Bader.

At least 55 records · Page 3Linked to original sources
PubMed1993

Agreement among dentists' recommendations for restorative treatment.

Differences among dentists in their decisions to recommend treatment have been studied principally at a "macro" level by examinations of variations in dentists' treatment recommendations for individual patients, or for patients aggregated to the practice level. If reasons for these differences are to be understood, however, a "micro" level examination of differences in dentists' decisions to recommend treatment for individual teeth is necessary. Extent of agreement to recommend treatment among dentists was explored for 1187 teeth in 43 patients. Each tooth was examined by a mean of 6.6 general practitioners. A modified reliability index and distributions of raw levels of agreement were used for quantification of agreement rates across an incomplete cross-classification for practitioners and patients. Overall inter-dentist reliability in recommending individual teeth for treatment was moderate, p = 0.62. Among unrestored teeth with no clinically evident caries, as judged by an independent experienced evident caries, as judged by an independent experienced examiner, reliability in treatment recommendations due to caries was fair, p = 0.51. Reliability was lowest for recommendations concerning previously restored teeth, p = 0.43. Among all teeth receiving at least one recommendation for treatment, only 22% received a unanimous recommendation. Over one-half of all instances of lack of agreement resulted from a single dentist's recommendation differing from those of all other dentists examining the tooth. The results suggest that much of the variation in dentists' practice profiles is due to basic differences in decisions to recommend treatment for individual teeth with specific conditions, and that the presence of previous restorations seems to magnify these differences.

Adult↗
PubMed1993

How dentists classified and treated non-carious cervical lesions.

All North Carolina general dentists were shown color photographs of three non-carious cervical lesions. A fourth picture showed cervical caries. Respondents were asked how they defined each lesion, its cause, treatment and frequency of appearance in practice. Cervical caries was identified and treated by almost all responding dentists, but they applied more varied terms, causes and treatments to non-carious defects.

Clinical Competence↗
PubMed1993

Dilemmas in caries diagnosis.

New criteria and methods are needed to identify the changing expression of caries and to classify carious lesions into categories keyed to treatment strategies. Symposium speakers identified these problems and reviewed the changing philosophy of diagnosis.

Dental Caries↗
PubMed1992

Factors associated with job and career satisfaction among dental hygienists.

Information concerning dental hygienists' job and career satisfaction is dated and incomplete. Because satisfaction may be important in retention of dental hygienists, a survey of all active dental hygienists in private practices in North Carolina was performed to ascertain dimensions and levels of job and career satisfaction, as well as factors associated with these constructs. Of 2,099 eligible hygienists, 51 percent responded to a survey instrument containing 202 items addressing overall satisfaction, as well as satisfaction with a variety of work-related factors. Factor analysis was used to develop scales for job and career satisfaction, and for the work-related factors. Final reduced regression models indicated that the constructs of job and career satisfaction are separate and that each has distinct general and intrinsic dimensions. Models for general job and career satisfaction had R2 values of .45 and .27, respectively, and included a variety of work-related factors such as supervisory style and satisfaction with salary. Models for intrinsic job and career satisfaction were not as strong, with R2 values of .06 and .09, respectively. These models also included work-related factors such as satisfaction with hours of work, office safety arrangements, and supervisory style. These results suggest that general job and career satisfaction levels should be amenable to change through management interventions.

Adult↗
PubMed1992

Understanding dentists' restorative treatment decisions.

A critical review of the literature is presented that examines variation in dentists' restorative treatment decisions and the factors associated with this variation. Substantial variation has been documented in dentists' assessment of caries, in dentists' decisions to intervene, and in the selection of treatment recommended to the patient. However, the factors associated with this variation are not well documented. Following discussion of this review, a model is proposed to help guide further studies of dentists' restorative treatment decisions. This explanatory model incorporates the factors identified in the review, as well as others either observed informally or found in the medical literature. The implications of variation in dentists' treatment decisions highlight the importance of a full explication of the process dentists follow in making treatment decisions. Understanding this process, which heretofore has been examined only superficially because it has been regarded as a function of "clinical judgement," is fundamental to determinations of normative treatment needs, to interventions designed to reduce the frequency of inappropriate treatment, and to the development of valid practice parameters.

Decision Making↗
PubMed1992

Attitudes of dentists toward emerging competencies for health care practitioners.

Dentists' attitudes about the importance of formal training in a variety of skills were assessed as a part of the Pew Health Professions Commission initiative to help health professional schools prepare for the future. Through a telephone survey with a 54 percent participation rate, attitudes of a national sample of practitioners were determined concerning the importance of training in 16 competencies that reflect skills, attitudes, and behaviors identified by the commission. Most respondents indicated that competency in treating and preventing disease, practicing ethically, communicating with patients, applying problem solving techniques, and continuing to learn were very important. Conversely, less than half of dentists indicated that competency in managing information, responding to cultural diversity, supporting community agencies, and working in managed care settings were very important. The opinions of graduates since 1980 about their own training in the competencies tended to mirror their ratings of importance. These results demonstrate the continuing need for dental educators to consider prevailing opinion of practicing professionals as a part of any evaluation or planning effort.

Adult↗
PubMed1992

Reasons for changing employment positions among practicing North Carolina dental hygienists.

This study sought to identify factors associated with dental hygienists' decisions to leave one dental office and commence practice in another. Although dental hygienists' decisions to leave the profession have been examined in some detail, this more common phenomenon of changing positions has not been carefully examined. All currently practicing dental hygienists in North Carolina were surveyed in 1990, as a part of a cooperative project addressing retention of dental office team members. The survey collected information concerning the 976 respondents' (51% response rate) employment experience, reasons associated with leaving past positions, current job and career satisfaction, and personal characteristics. These data were analyzed to determine factors associated with both reported position changes and respondents' predictions of their professional activity status five years hence. No one reason or group of related reasons predominated among respondents' indicated reasons for leaving past positions. Approximately 25% of all changes were related to family responsibilities or spouse relocation. A larger proportion of changes was associated with a variety of job-related factors. Length of time in current position was not strongly related to job or career satisfaction, or to specific employment arrangements. The satisfaction measures were strongly associated with respondents' predictions of future activity status, while the employment arrangements were not. The results indicate that position changes occur for a variety of reasons, most, but not all, of which represent problems amenable to resolution through interventions designed to improve aspects of management within the practice.

Adult↗
PubMed1991

Effect of crown margins on periodontal conditions in regularly attending patients.

Subgingival margins of cast restorations have been associated with increased gingival inflammation and probing depth, but it is not known if such effects would be seen among patients receiving regular professional care. In this study, 831 regularly attending patients in 35 North Carolina dental practices were examined. Plaque, gingival inflammation, calculus, and probing depth were assessed on facial and mesiofacial surfaces of the Ramfjord teeth. Surface-specific analyses showed significantly greater (p less than 0.05) gingival inflammation and deeper probing depths with subgingival cast restoration margins for nearly all surfaces examined. Less frequently, decreases in plaque and calculus were associated with the presence of crowns. Intact surfaces in patients with cast restorations were not significantly different from the same surfaces in patients without cast restorations. Even among patients receiving regular preventive dental care, subgingival margins are associated with unfavorable periodontal reactions.

Crowns↗
PubMed1990

Association of dental health knowledge with periodontal conditions among regular patients.

Although routine patient education concerning periodontal disease is recommended as a means of improving oral health, strong associations between oral health knowledge and plaque or gingival inflammation scores have not been demonstrated. This study examined associations between four knowledge scales (likelihood of keeping teeth, signs of disease, role of diet, role of oral hygiene measures) and six periodontal status measures (plaque, gingivitis, calculus, probing depth, attachment loss, missing teeth) among 1088 regularly attending dental patients. In bivariate correlation analyses, there was a weak, direct association between stronger expectations of keeping teeth and better levels of periodontal health, while an inverse association between knowledge of signs of periodontal disease and better periodontal health was noted. Level of knowledge of the role of oral hygiene or of diet in periodontal disease was not associated with level of disease. When effects associated with age, sex, race, and different dental practices were held constant, these patient knowledge scales did not explain substantial proportions of variance in the periodontal disease measures. Among regular utilizers, the effects of receipt of dental care may be more determinative than level of patient knowledge.

Analysis of Variance↗
PubMed1990

Examiner agreement between hygienists and dentists for caries prevalence examinations.

Dentists have been used as examiners in caries prevalence examinations almost exclusively. Only rarely have dental hygienists been reported as examiners in these types of studies. This article describes the degree of agreement for prevalence data (DMFT, dmft) and specific caries prediction information collected by hygienist-screeners and dentist-examiners. A total of 5,233 first- and fifth-grade children were screened by hygienist-screeners using a tongue blade only and then examined by dentist-examiners using an explorer and mirror. Agreement was analyzed in terms of percent agreement and the kappa statistic. The values for screener-hygienist dentist-examiner agreement were compared to interexaminer and interscreener reliability values. Means were also calculated for the caries indices. The results indicated good agreement for the caries indices between the screener-hygienist and dentist-examiner. Agreement for the prediction indices tended to be lower. The results suggest that hygienists can be used as examiners in caries prevalence studies.

Child↗