'Selection criteria for dental radiography'.
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Humans↗
Biomedical subjects
N B Pitts
Publications and source records attributed to N B Pitts.
General dental practitioners' needs for continuing education on the management of fissure caries.
A process of identifying GDPs' perceptions of their needs for continuing education on one topic area is described. The method employed a combination of two traditional approaches for assessing educational needs, the so-called 'wisemen' approach and interviews with members of the target audience. The process identified three groups of GDPs with differing educational needs. Their perceptions of their educational needs are described, and the advantages and disadvantages of the process discussed and compared with other methods of assessing educational needs. The study confirmed the importance of identifying educational needs in the development of an educational programme.
Dental Fissures↗
The Scottish Health Boards' Dental Epidemiological Programme: initial surveys of 5- and 12-year-olds.
The Scottish Health Boards' Dental Epidemiological Programme, a joint venture between the Scottish Chief Administrative Dental Officers and the Dental Health Services Research Unit at the University of Dundee, was instigated in 1987 in response to the Chief Dental Officer's concern at the lack of any coordinated dental health information about children residing in the 15 Scottish Health Board areas. Each year a standardised dental survey of a random sample of children is now undertaken across Scotland. This paper reports, principally, the caries results of the first three surveys of 5, 12 and 5-year-olds undertaken at the end of 1987, 1988 and 1989, respectively. Marked variations in caries prevalence were found in different parts of Scotland, higher levels being recorded in the urbanised central belt and in the West. While there have been overall improvements since 1983, caries prevalence in Scotland remains substantially higher than in many other parts of the UK (mean DMFT for 12-year-olds in 1988 = 2.23, mean dmft for 5-year-olds in 1989 = 2.82), with 67.8% of 12-year-olds and 59.2% of 5-year-olds (in 1988 and 1989, respectively) still suffering from dentinal caries or past caries experience (DMFT/dmft greater than 0) when assessed by clinical examination alone. No continued improvement in caries prevalence was seen in the 1989 survey of 5-year-olds compared to the 1987 examination. Continued monitoring of this situation is indicated.
Child↗
The prescription and timing of bitewing radiography in the diagnosis and management of dental caries: contemporary recommendations.
This 'personal view' makes recommendations on the use of the bitewing radiograph in the diagnosis of dental caries on the basis of published evidence about the disease and available diagnostic methods. It suggests that posterior bitewing radiographs are required for all new patients if the approximal surfaces of the teeth cannot be examined directly. At this initial visit, an assessment of the caries risk of the individual patient should be made. Subsequent radiographic recall intervals are suggested, which are determined on the basis of this risk assessment. It should be appreciated that risk status may change over time and that, in the future, an individual's radiographic recall interval may have to be changed.
Adolescent↗
GDPs' and specialists' decisions in the management of fissure caries.
As part of a continuing education programme in dentistry, four specialists and 27 selected general dental practitioners were asked to rate 58 clinical management options relating to fissure caries in six simulated patient management problems called challenges. Their ratings are presented and the advantages and disadvantages of the approach are discussed. Areas of agreement and disagreement are highlighted and possible reasons for these explored.
Composite Resins↗
Some of the factors to be considered in the prescription and timing of bitewing radiography in the diagnosis and management of dental caries.
This article describes some of the factors to be considered by the practitioner when prescribing bitewing radiographs in the diagnosis and management of dental caries and draws on the literature of a number of disciplines including restorative dentistry, cariology, epidemiology and oral radiology. It seems appropriate to re-assess current practice in the light of information on changes in the disease of dental caries, its behaviour and the way this behaviour may vary in high and low caries risk groups. The diagnostic potential of the bitewing examination appears, at present, to be unrivalled, but other diagnostic methods, such as fibreoptic transillumination and tooth separation, must also be considered. Some methods to minimize radiation doses and increase diagnostic yield are discussed. Current knowledge of prescribing patterns is reviewed and areas of ignorance are mentioned as findings from future research in these areas may influence decisions about when to use and re-use bitewing radiographs.
Dental Caries↗
Continuing education for general dental practitioners using a printed distance learning programme.
This paper describes the development of a printed distance learning programme by a coordinated team approach. The programme has two components, a resource book and three patient management problem leaflets or challenges and is designed to update general dental practitioners on the management of fissure caries. It includes strategies to meet the educational needs of three groups of general dental practitioners with different educational requirements. It is concluded that the approach described meets the CRISIS criteria for effective continuing education and offers a useful approach to distance learning in dentistry.
Education, Dental, Continuing↗
An in vivo comparison of radiographic and directly assessed clinical caries status of posterior approximal surfaces in primary and permanent teeth.
At general dental practices in Scotland 211 children between the ages of 5 and 15 years were examined by 1 observer. A comparison of the status of 1,468 permanent and 756 primary posterior approximal surfaces was made on the basis of their appearance on posterior bite-wing radiographs and the findings of a direct in vivo visual examination, made after temporary tooth separation had been achieved over 1 week using elastomeric separation. For permanent tooth surfaces, 0% of radiolucencies in the outer half of enamel, 10.5% in the inner half of enamel, 40.9% extending to the outer half of dentine, and 100% extending to the inner half of the dentine were found clinically to be cavitated. The analogous results for primary teeth were that 2.0, 2.9, 28.3, and 95.5%, respectively, of radiolucencies appeared to be cavitated. Although further research with larger numbers of permanent teeth is indicated, these results may contribute to a re-evaluation of the optimal threshold for restorative intervention at approximal sites. Greater numbers of approximal radiolucencies and carious lesions (p less than 0.001) were found in those surfaces which initially had a normal anatomical contact when compared to those which did not.
Adolescent↗
The differentiation of sealant restorations from preventive fissure sealants, in subjects with clear sealants.
The aim of this study was to assess whether preventive fissure sealants could be differentiated from sealant restorations. The problem of being unable to differentiate between these two tooth states has implications for practitioners and epidemiologists (Davies, 1990). One hundred and seventeen permanent molar teeth, all sealed with a clear sealant, were examined under two types of conditions. These were the Daray 'Versatile light'; mirror, wet teeth, and the Daray 'Operating light 2'; mirror, dry teeth. The subjects' records were subsequently consulted to provide the validating criteria. The results suggest that in a dental hospital environment, when a clear sealant material is in place, it is possible to differentiate between preventive fissure sealants and sealant restorations. It would seem, however, that the 'sealant-alone' variety of sealant restoration was the one most often mistaken for a preventive fissure sealant. The different examination conditions did not markedly affect the examiners' ability to differentiate between the two tooth stage.
Adolescent↗
The Chief Scientist reports.... Problems in mounting and maintaining longitudinal studies--examples from dental health services research.
There already exists a body of literature on the conduct of classical epidemiological studies. However, guidelines tend towards detailing how such studies should be conducted and may not prepare the reader for the less-than-perfect scenarios that will inevitably be encountered. The Dental Health Services Research Unit in Dundee has been involved in longitudinal studies of dental treatment and dental health since its inception in 1979. The problems encountered in this research are considered under the headings of mounting the studies, samples, data collection, external changes, internal changes, dissemination and curtailment. It is hoped that a description of the often unpredictable problems associated with a particular set of studies will provide an insight which may assist others embarking on analogous projects in health services research.
Clinical Protocols↗
The clinical behaviour of free smooth surface carious lesions monitored over 2 years in a group of Scottish children.
As far as the authors are aware, no large-scale clinical studies of free smooth surface caries have been carried out in the past, although carious lesions on these surfaces can be diagnosed at an 'early' stage. In this study on a group of 2854 13-year-old children, caries affecting the free smooth surfaces (buccal and lingual) was found to be a common problem, with a total of 2917 lesions observed on molar teeth at the first examination. Most of the lesions involved no macroscopic loss of tooth contour. When the children were examined 2 years later, three-quarters of the lesions had either remained static or regressed. Free smooth surface lesions were more likely to develop initially, and more likely to progress, in individuals with poor oral hygiene. Free smooth surface caries experience showed a positive correlation with occlusal and approximal decay experience. The number of free smooth surface carious lesions can be used as a predictor of caries risk. Strategies for diagnosis and prevention are suggested for patients presenting with free smooth surface caries on molar teeth.
Adolescent↗
Five-year longitudinal study of restorative treatment received by Scottish children.
This prospective 5-year longitudinal study followed the dental care of a large, representative group of children initially examined in Scotland during the 1983 UK survey of children's dental health. The Dental Health Services Research Unit at the University of Dundee monitored the restorative treatment provided in the General Dental Service and the Community Dental Service for 1568 children aged 5, 8, 12 and 15 years in 1983, using information provided via the Scottish National Health Service. Over a 5-year period, records of attendance were received for 85% of the children (1340). A large amount of restorative care, distributed very unevenly across the sample, was provided. On average, attenders attended once per year (range over 5 years: 1-20) and received approximately one filling in each of the 5 years (range over 5 years: 0-58). The majority of restorative care (80.6% of the 8057 restorations) comprised amalgam fillings in posterior teeth, frequently (89%) involving the occlusal surface. This pattern of treatment has implications for planning cost-effective preventive care. Factors shown to have a significant influence on the number of amalgam fillings placed were initial caries prevalence, number of courses of treatment, age group and service.
Adolescent↗
Research into dental practice.
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General Practice, Dental↗
Initial development and in vitro evaluation of the HPL device for obtaining reproducible bitewing radiographs of children.
A new beam-aiming and collimating film holder, the HPL device, has been developed to facilitate the production of reproducible serial bitewing radiographs. The device holds two films in the mouth simultaneously and is held in position extraorally. Serial bitewing radiographs of skulls of children aged 7, 10, and 14 years taken with (1) a "freehand" technique, (2) a Rinn film holder, and (3) the HPL device were evaluated for degree of reproducibility, potential diagnostic yield, and technical errors. Compared with the other techniques, the HPL device produced a smaller number of overlapped surfaces and substantially fewer technical errors. In vivo studies of the new device are therefore indicated. The restriction of the field of primary and secondary irradiation may lead to a substantial reduction in absorbed radiation dose compared with other techniques.
Adolescent↗
Diagnostic methods for caries: what is appropriate when?
A Workshop was held which invited a range of speakers to consider separately the different diagnostic tools presently available for the detection of caries and then the various applications to which these tools can be put. Each presentation was followed by a vigorous discussion period. It was concluded that there is no one single method suitable for all anatomical sites and degrees of caries and that the requirements for epidemiological surveys, clinical trials and individual patient care are different. The choice of appropriate diagnostic technique(s) should be made, in each situation, on the basis of published performance data which has to be regularly re-evaluated due to the pace of change.
DMF Index↗
Clinical trials and legal liability in the UK.
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Clinical Trials as Topic↗
Effects of diagnostic threshold and overlapped approximal surfaces on reported caries status.
The aims of this study were to examine the influence upon reported caries status of: 1) employing different diagnostic thresholds and 2) using differing conventions for treating approximal surfaces which appeared overlapped on posterior bitewing radiographs. Caries prevalence data from a group of 211 Scottish schoolchildren aged 5-15 yr studied during a trial of elective temporary tooth separation in general dental practice in Scotland were used. In this "moderate" caries group, values for dmft/DMFT rose significantly (P less than 0.001) when the D1 diagnostic threshold (all grades of lesion accepted) was applied in comparison with the D3 threshold (only caries into dentine recognised); dmft increasing from 3.9 to 5.4 and DMFT increasing from 1.7 to 4.7. This demonstrated that an over-optimistic impression of overall caries levels may be given when only the D3 threshold is used uncritically. In this study the status of approximal surfaces which were overlapped on bitewing radiographs was assessed by direct clinical examination using the temporary elective tooth separation technique. The investigation showed that, for this juvenile population, most (81.8% mesial, 93.1% distal) overlapped approximal surfaces were sound. Significantly more mesial than distal surfaces were found to be overlapped.
Adolescent↗
The use of bitewing positioning devices in children's dentistry.
The use of film-holding, beam-aiming devices have been shown to have a number of potential advantages in achieving high quality bitweing radiographs, however, little information is available about their acceptability to children. The aims of this study were: (1) to determine the level of acceptance of a conventional type of film positioner to child patients in a general practice setting in Scotland and (2) to compare the acceptability to children of bitewing procedures using: the freehand technique, a 'Rinn' positioner and a new positioner, the 'HPL' device. In the general practice group, following modifications made during a pilot study, 211 children aged 3-15 years were offered a bitewing examination with a modified Rinn positioner at recall. The overall acceptance rate of the bitewing procedure was 82.5%. All 10 children aged 3-4 years offered bitewings refused, while 77 (69%) of subjects aged 5-9 years accepted, as did all the 89 children aged 10-15 years. In the comparison of acceptability investigation, three groups of 30 children aged 6-15 years requiring bitewing radiographs were selected at random. Each group had a different bitewing technique carried out by the same operator. The children's acceptance of all three techniques was high (87-97%) and no statistically significant difference was found between the acceptability of the freehand method and those involving film positioning devices. Although the unmodified Rinn design suffered from a number of problems, the modified version was found to be acceptable by many children.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗