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Biomedical subjects

M A Eijkman

Publications and source records attributed to M A Eijkman.

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

Defensive dental behaviour: illusion or reality?

Defensive medicine or defensive behaviour of physicians is considered a major problem in contemporary health care. It seems reasonable to assume that defensive behaviour also occurs in dental practice, although so far very little has been published in the dental literature on this subject. The main objective of this study was to investigate whether defensive behaviour occurs in dentistry. As a survey study 38 dentists were interviewed: 30 men and 8 women, mainly general dental practitioners with an average of 20.9 years in practice. The results of this pilot-study indicate that it is very likely that defensive behaviour occurs in dental practice, despite the fact that there is hardly any evidence of fear for malpractice claims and lawsuits among the respondents. The majority of the dentists interviewed stated that they carried out some treatments at their patient's request although they did not believe the treatment to be necessary from a professional point of view. A motive for deliberately refraining from treatment is lack of dental motivation by the patient and poor oral hygiene. According to some respondents patients are sometimes referred unnecessarily to specialists. Also 'difficult' patients run the risk of unwarranted referral to specialists, and, moreover referrals because of insurance reasons are mentioned. The financial situation of the patient and the defensive behaviour of dental practitioners seem to be closely connected.

Defensive Medicine↗
PubMed1997

Communication skills training courses in dental education.

In this article, some reasons for teaching communication skills in dental schools are discussed. An overview of 3 courses at the Amsterdam dental school is presented, along with the results of a student evaluation. Students evaluated these courses as useful and relevant for dental practice. It is concluded that this is especially so when the students recognize direct applicability of the courses to dental practice.

Communication↗
PubMed1997

[Variations among dentists in the diagnosis of caries and assessment of dental restorations].

It is well-known that dentists differ in judgement when confronted with the same clinical situation. To study this phenomenon, 2 groups of 5 general dental practitioners have assessed the material of 20 patients, each consisting of a set of 2 bite wing radiographs and 2 photographs of the (pre)molar region. The teeth were examined for caries and the quality of the restorations, supported by a protocol which was mailed in advance. The examiner variability was expressed as Cohen's kappa, calculated per pair of GDPs and subsequently averaged per group. The interexaminer agreement was fair for the diagnosis of caries and was highest for the assessment of approximal caries on the bite wing radiograph. The agreement with respect to the quality assessment of dental restorations proved to be poor on average. The intra-examiner agreement varied widely between examiners. No difference could be established between the groups. It can be concluded that, without training and calibration, a sufficient inter- and intra-examiner agreement among GDPs is difficult to reach. Consequently, a substantial variation is found in the individual GDP's restorative treatment planning.

Clinical Competence↗
PubMed1997

[Problems with dental information given to patients. A report by the consumer organisation].

The objective of this study was to investigate the information problems of Dutch dental patients in the years 1993-1995. Using a self-developed scale, the dental files of a consumer organisation were analysed and the information problems counted and categorised. Of all the dental dossiers 48% concerned information problems. The largest categories were: insufficient information about finances, insufficient information about the treatment/outcomes and the negligence of the information, complaints and questions of the patients. Together these categories make up 75% of the information problems. The results of this study stress that dentists should offer better structured information. More attention should also be paid to the abilities of the dentists to be communicative and to manage conflicts.

Communication↗
PubMed1997

[Quality of the sterilization process in the dental practice].

A survey was performed among 249 Dutch dentists on the use and functioning of sterilizers in their practice and on the quality control of the sterilization process. 99% of the dentists use a sterilizer. Only 1% uses only a thermodesinfector. 7.3% of the sterilizers tested did not function properly, based on a microbiological test. 76% of the sterilizers are not serviced on a regular basis. These sterilizers show more often failures in the sterilization process. It is concluded that although over 92% of the sterilizers in Dutch dental offices do function well, improvement on the quality control of the sterilization process is feasible and necessary. Besides an annual service, a regular control of the sterilization process itself, e.g. by using biological indicators, in combination with physical and/or chemical monitoring, is one of het methods to achieve this.

Data Collection↗
PubMed1997

On the assessment of dental health care attitudes in 1986 and 1995, using the dental attitude questionnaire.

OBJECTIVE: To re-establish and update the empirical data obtained in 1986 with the Dental Attitude Questionnaire. DESIGN: In 1995 this questionnaire, presented earlier by Hoogstraten and Broers (1986), was completed in a similar setting using similar subjects as in 1985, to make a comparison between 1986 and 1995 possible. SUBJECTS: 375 persons, all first grade psychology students who participated for additional course credit. Mean age was 21.7 years, 65 per cent were female. RESULTS: Data show a change in oral health care attitudes and a change in the internal consistency of the DAQ subscales, making the present version of the questionnaire inadequate for measuring present oral health care attitudes. CONCLUSION: This study has shown once more the importance of conducting replication studies after relatively long periods of time in order to update the psychometric characteristics of questionnaires.

Adult↗
PubMed1996

Opinions of Dutch dentists on the introduction of new legislation in the field of informed consent. A pilot study.

This article describes the results of four group discussions held with 34 Dutch dentists to examine their opinion on the introduction of new legislation in the field of some patient rights, particularly the duty to inform patients and the patient's authorization of a dental treatment procedure. From all the discussions it appears that most are ignorant of the contents of the legislation. A number of important consequences for the practice are mentioned. Amongst the negative consequences which are often named are: loss of income, a greater time investment per patient, the selection of patients, more insurance claims and an increase in administration and keeping dossiers. The positive remarks that emerge are working with protocols, an increase in the quality of care and a better education of the patient. The discussion draws attention to the legal framework of the dentist-patient relationship, although it is not yet clear how certain aspects will take shape in the daily dental practice.

Adult↗
PubMed1996

Quality of dental care: the view of regular attenders.

Patients' perceptions play an important role in assessing the quality of dental treatment. This study investigated 56 possible quality aspects on their importance as judged by regular attenders. A nationwide sample of 5000 Dutch people was contracted, 1328 persons meeting our selection criteria filled out the questionnaire and responded. The results show that hygiene of instruments and the availability of the dentist in case of emergency were considered the most important. It was concluded that in general these patients judged technical and functional aspects of dental care to be of more importance than communicative and informative aspects. Differences in perceptions were found according to sex and, to a lesser extent, to education, means of insurance and place of residence. But, on the whole, response patterns were homogeneous.

Adult↗
PubMed1996

Dutch dentists' conceptions of dental silver amalgam.

A sample of 468 dentists completed a questionnaire on their conceptions of amalgam. A minority (1-3%) reported that amalgam often causes toxic, galvanic and/or allergic side-effects. A considerably larger number (10-30%) stated that such side-effects 'sometimes' occur, while less respondents (6-11%) said they did not know. 60-80% said that such side-effects do not exist, or rarely. If a patient requested the removal of amalgam, one-third of dentists would do so often for cosmetic or toxic reasons, but only one-fifth in the case of a proven allergy. A very substantial percentage would not remove amalgam except for cosmetic reason. Substantial minorities thought that amalgam should not be used for pregnant women or children, or admitted that they did not know. The use of amalgam was rejected by 5%, while 9% could not decide whether they were for or against its use. Multivariate analysis reveals the existence of two dimensions in the data. The first dimension, referred to as "acceptance-of-amalgam", makes it possible to distinguish a subsample (about 9%) consisting of "rejectors-of-amalgam". On the second dimension, referred to as "conviction", a subsample (almost 20%) of "doubters" can be discerned, alongside "convinced adversaries" (about 4%) and "convinced advocates" (some 25%). The majority of the respondents are thought to be more or less in favour of the use of amalgam.

Attitude of Health Personnel↗
PubMed1996

Changes in caries prevalence in children and young adults of Dutch and Turkish or Moroccan origin in The Netherlands between 1987 and 1993.

In 1987, an epidemiological study was started with the aim to evaluate the development of dental health in young people insured by "Health Insurance Funds'. In The Netherlands, insurance by such funds is compulsory for individuals earning less than some income criterion (in 1995 59,000 Dutch florins) and their families, together approximately 60% of the Dutch population. Dental health care is included in the insurance. Caries data were obtained in subjects aged 5-23 years in 1987, 1990 and 1993. Mean DMFS scores of groups aged 11, 17 or 23 years in 1993 were about 40% lower than in 1987. No significant differences in mean number of dmfs of 5-year-olds in 1987 and 1993 could be observed. A breakdown by country of birth of the mother showed that the difference between indigenous Dutch juveniles and juveniles of Turkish or Moroccan origin depended on year of birth. Caries prevalence of Turkish or Moroccan children born in 1982 or later was higher than that of Dutch children of equal age; no significant difference in DMFS could be demonstrated between ethnic categories in juveniles born in 1976. In cohorts born before 1976, DMFS scores of Turkish/Moroccan juveniles were much lower than those of Dutch juveniles. It is suggested that these opposite trends were caused by the fact that subjects in the youngest cohorts had been born in The Netherlands, while the oldest cohorts spent the first years of their life in those parts of Turkey or Morocco where caries prevalence of children is low. Between 1987 and 1993 caries prevalence in 5-year-old children of Turkish or Moroccan origin decreased significantly.

Adolescent↗
PubMed1996

[Perspective of a patient in the general practitioners office and in the dental office].

Both general practitioners and dentists acknowledge the importance of the patient's perspective and the demand for care, and, consequently, of good communication with their patients. In general practice, the concept of reason for encounter has proved to be very useful for gaining more insight in the nature and the importance of the patient's perspective. Data from the Amsterdam Transition project show that the general practitioner understands the patient's reasons for encounters very well, and that the nature of the patient's reasons for encounter clearly affect the subsequent interventions. In this article, 260 letters concerning people's experiences with their dentist are used in order to provide an impression of communication problems in dentist practice in the Netherlands. Three major problem areas are identified, with a total of ten subcategories. Several of these are well known to the general practitioner as well. In addition, some problems are characteristic for the dentist practice. It is suggested to incorporate the concept of reason for encounter in dental care as an essential part of the description and analysis of the communication between dentists and their patients.

Communication↗
PubMed1996

[Defensive behavior? Also in dentistry?].

The objective of this pilot-study was to investigate if defensive behaviour of dental practitioners occurs just as in the general practice of family physicians. On the basis of a survey, developed in the Department of General Practice of the University of Amsterdam, 38 dentists (mainly general-practitioners with an average of 20.9 years in practice), were interviewed. The dentists mention defensive practices, but the reasons are unrelated to fear of law-suits. They recommend unnecessary treatments, based on the wishes of their patients. The financial situation of the patient and defensive behaviour are closely related. The respondents avoid to give treatments because of dentally unmotivated patients or deviant behaviour of their visitors. Unnecessary referrals to specialists are also cited. Defensive behaviour was found to play a role in 3.5% of all patient encounters.

Adult↗
PubMed1995

Dentists' views on cervical hypersensitivity and their knowledge of its treatment.

A random sample of 400 Dutch general practitioners was asked to complete a questionnaire dealing with the prevalence, conditions and therapies of cervical hypersensitivity of their patients. According to the 259 responding dentists an average of 10% of their patients suffered from moderate cervical pain. The estimated mode for severe pain was 1%. More than two thirds of the dentists reported inadequate brushing of the teeth to cause the hypersensitivity, about one half acknowledged periodontal causes, well over one quarter mentioned the involvement of dietary acids, and about one sixth implicated psychosomatic factors. Other causal factors were mentioned less often. Of the therapies available, the home-care methods appeared to be promoted most often, i.e. brushing with therapeutic toothpastes (77%), improvement of oral hygiene (51%) and local self-application (with finger) of a therapeutic toothpaste or fluoride preparations before the night (41%). Well over 50% reported to apply occasionally bondings/varnishes and 28% said to make sometimes cervical fillings. Other therapeutic possibilities were not, or very seldom, used.

Attitude of Health Personnel↗
PubMed1995

[Publishing in the native tongue?].

This study investigates the motives of Dutch dental researchers to publish their scientific data either in international journals, written in English, or in Dutch dental journals. Questionnaires were sent and 115 of them were completed and returned (response 57.5%). 108 of the respondents strongly preferred publishing in international dental journals. This option is connected with the researchers' own interests and the perceived importance for their field of study. 42% of the respondents consider publishing in Dutch newspapers more profitable than writing articles for Dutch dental journals. The Journal of Dental Research is considered the journal with the highest recognition.

Dental Research↗
PubMed1995

[The law concerning medical treatment agreement. Opinions of dentists].

The aim of this pilot study was to investigate the view of Dutch dentists on certain elements of consent to dental treatment. A total of 120, randomly selected general practitioners, drawn from the Dutch Dental Association registers and from four different regions, were invited to participate; 34 took part in group discussions. The form of these discussions was semi-structured. Questions were based on a literature survey and two interviews with experts. The outcome of the discussions indicate that most general practitioners are ill-informed about informed consent and, furthermore, that their understanding of the process is rather poor.

Attitude of Health Personnel↗
PubMed1994

[Patient education and therapy compliance].

The effects of oral health promotion activities depend on the degree of patient compliance, the extent to which a patient's behaviour is in accordance with dental health advice and instructions. Compliance is considered as a complex phenomenon. With the help of theories and models of health behaviour and the results of advertising research and consumer behaviour studies, some views are presented to increase patient compliance in dental practice.

Attitude to Health↗
PubMed1994

[Amalgam. XII. Amalgam removed and patient cured?].

The aim of this article is to present a critical reflection on 'cures of patients' after the removal of dental amalgam fillings, reported in the popular press. It is concluded that, when the removal of dental amalgams in patients with a hypersensitivity to mercury is put aside, possible explanations for these questionable cures are not connected with the removal of amalgam but may involve the functioning of the immune system, the relation between environment and the opinions of patients and the influence of psychological factors on illness and health.

Attitude to Health↗