Technical performance on amalgam restorations by dentists and auxiliaries in private practice.
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Biomedical subjects
Publications and source records attributed to J D Bader.
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Dental educators have been urged to evaluate curricula using information from dental practice. This paper presents data from a variety of sources that describe the distribution of treatment effort in dental practice. The data indicate that most dental treatment consists of a narrow range of procedures, that the focus of dentists' treatment efforts is primarily reparative, and that practitioners may not be achieving the broad curriculum objective of providing needed comprehensive patient care. Considerations for curriculum evaluators are suggested, and implications for the future are discussed.
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The dental public health literature contains almost no information on caries experience and treatment needs of Appalachian children, and little information concerning resource requirements for children's dental care programs in general. Data from three dental treatment programs in Appalachia are summarized for purposes of planning and evaluation of similar programs. Age specific caries and service experiences are presented, and evaluation criteria and planning considerations are discussed. Resource requirements, including time, cost and manpower are also presented, and special considerations for planning programs are discussed.
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An experiential educational system at the University of Kentucky College of Dentistry has been described. It consists of a summer externship program and an individualized externship program offered during the academic year. These programs provide dental students with extramural educational experiences in private dental offices to prepare them better for the practice of dentistry and to expose them to forces affecting the delivery of dental services.
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The relationship between self-reported medication use (exposure to one or more drugs with anticipated gingival effect--antidepressants, diuretics, antihypertensives, hormones) and four measures of gingival conditions (plaque index, gingival index, calculus index, maximum CPITN score) was examined among 594 patients in 35 dental practices in two North Carolina counties. Patients with long-term medication use were compared to patients without long-term use on four measures of gingival condition. When controlling for sex and age within age group, medication use was a significant predictor (P less than 0.05) for elevated gingival and plaque index scores among the white less than 65 group. For the white 65+ group (N = 90), medication use was not a significant predictor for any index score.
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Restorative treatment recommendations made by dentists examining patients were compared with recommendations made by dentists examining simulations of the same patients. Simulations consisted of unmounted casts, full-mouth radiographs, three still video images of each tooth, periodontal charting, and a written dental history. Each of 117 teeth in five patients was examined by at least three and as many as 13 dentists under simulation and live conditions, with no dentists examining the same patient under both conditions. About three-fourths of teeth receiving a recommendation for treatment from at least one dentist received such a recommendation from at least one dentist examining under each of the two examination conditions. For these teeth, about three-fourths of all dentists examining under each condition recommended treatment. For teeth receiving a recommendation for treatment under only one examination condition, smaller proportions of dentists recommended treatment. Overall, there was three times as much variation in treatment recommendations among dentists in an examination condition than between the "average" treatment recommended by dentists in the two examination conditions.
For 4735 posterior complex amalgams and crowns placed in adults with continuous dental HMO coverage, all additional treatment received over the subsequent 5 years was determined. The restorations were placed under routine clinical conditions by 74 different dentists among a broad spectrum of insured dental patients. Treatment outcomes were described in terms of a hierarchical classification of additional treatments. At the extremes, a successful outcome was defined as no additional treatment or an additional one- or two-surface restoration on the same tooth, and a catastrophic outcome as extraction or endodontic treatment. Due to clinical protocols, teeth with guarded to poor prognosis prior to treatment are overrepresented in the five-surface amalgam cohort. Successful outcomes characterized 72% of four-surface amalgams, 65% of five-surface amalgams, 84% of gold crowns, and 84% of porcelain crowns. Catastrophic outcomes occurred for 10% of four-surface amalgams, 15% of five-surface amalgams, 8% of gold crowns, and 9% of porcelain crowns.