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Biomedical subjects

P Milgrom

Publications and source records attributed to P Milgrom.

At least 91 records · Page 5Linked to original sources
PubMed1989

Oral hygiene instruction and health risk assessment in dental practice.

We studied oral hygiene instruction given to 109 patients in 19 Washington State dental practices to investigate the extent to which therapists targeted their efforts toward patients with high disease risk. Patients were examined prior to instruction and prophylaxes. Therapists' instructions were tape-recorded and their content analyzed: therapists' expectations were scored. There were no statistically significant associations between patients' initial plaque levels and the process/content of the oral hygiene instructions delivered. On average, therapists spent 9.4 minutes of each prophylaxis session discussing oral hygiene. Therapists were judged more genuine with those patients for whom they had higher expectations of compliance, i.e., those with less plaque and low disease risk. We conclude that dental practitioners were not employing effective risk assessment strategies in selection of patients most in need of intensive instructional efforts.

Attitude of Health Personnel↗
PubMed1989

How effective is oral hygiene instruction? Results after 6 and 24 weeks.

We studied the clinical effectiveness of oral hygiene instruction given to 71 "high" plaque patients in 19 Washington State dental practices to determine the extent of plaque reduction. Patients were examined prior to instruction and prophylaxis. Therapist instructions were tape-recorded and content analyzed, and therapists' expectations were scored. Patients were surveyed as to oral health behaviors and general health habit characteristics. Only 20 of 71 (28%) initially "high" plaque patients had reduced mean plaque scores to 1.0 or less at six weeks. An additional 13 percent had deteriorated plaque levels at 24 weeks. We concluded that therapists did not consistently follow principles of effective instruction and often overestimated their effectiveness. Determinants of relapse involve the educational process, the patients' oral status, and patients' life situations.

Adult↗
PubMed1988

The structure and function of dental-care markets. A review and agenda for research.

The growth of dental health services over the past 15 years has produced several issues in dentistry. Because economic markets are the cornerstone of dental delivery in the US, informed responses to these issues require a thorough understanding of dental-care markets. The empirical literature is reviewed to examine the structure of dental markets, to assess the major determinants of market equilibrium, and to examine the social and health consequences of dental-care markets. Results reveal that while dental markets are imperfectly competitive, it is unclear whether prices exceed competitive levels. Little is known about the effects of dental markets on public oral health and society. Future research is proposed in two broad areas: 1) updating early studies conducted when few Americans had dental insurance benefits; and 2) path-breaking research to advance our knowledge of dental-care markets in particular and medical-care markets in general.

Community Participation↗
PubMed1988

The influence of dentist supply on the relationship between fluoridation and restorative care among children.

Because fluoridation effectively reduces dental caries among children, it may also reduce their demand for dental care. The authors tested this proposition among 985 insureds aged 9 to 14 in Washington State using dental claims from 1982 to 1985. In the sample almost two thirds of the children with continuous fluoridation exposure lived in markets with the smallest number of persons per dentist. Relative to other children, these children received more diagnostic and preventive services and had the highest probability of receiving restorative care. Among children who received restorations, children in this group had the fewest restorations. While the last result reflects expected reductions in caries due to fluoridation, the others may reflect providers' response to less tooth decay and increased competition for patients.

Adolescent↗
PubMed1988

Factors influencing dental decision making.

In clinical decision making, dentists routinely choose between alternative treatments such as crown vs amalgam/composite buildup, root canal vs extraction, fixed bridge vs removable partial denture, and prophylaxis vs subgingival curettage or periodontal scaling. A number of technical and patient factors can influence dentists' choice of treatment in these situations; however, little is known about their relative importance. To address this issue, a list of technical (e.g., periodontal status and caries rate) and patient (e.g., cost and patient preference) factors possibly influencing choice of treatment was developed for each pair of services. Responding to a mail questionnaire, 156 general dentists in Washington State listed the top three factors influencing their choice of service in each pair. Results revealed that dentists took different factors into account in choosing among alternative treatments. Technical factors dominated over patient concerns; only about 33 percent of the dentists considered patient factors important in choosing alternative therapies. The latter group was less preventively oriented, were solo practitioners, worked longer hours, and had lower prices. Results suggest patients may have little influence on prescriptions of therapy among experienced general dentists.

Attitude of Health Personnel↗
PubMed1988

The prevalence and practice management consequences of dental fear in a major US city.

In 1986, 1,019 residents of Seattle were surveyed about their dental fears, dental experiences, and perceived oral health status. High dental fear in Seattle was found to affect 204 per 1,000 people. More than 66% acquired their fear in early childhood. Females were 1.8 times more likely than males to report high fear (P less than .001). An individual was 1.6 times as likely to have high levels of dental fear if he or she had at least one oral problem such as bleeding gingiva (P = .004).

Adolescent↗
PubMed1988

Recognizing and treating fears in general practice.

Recognizing and treating dental fears requires attention to the behavioral, physiologic, and cognitive manifestations of anxiety. This article provides questions to ask and strategies to employ to identify and use in assisting the fearful patient in general practice.

Adaptation, Psychological↗
PubMed1987

Problematic gagging: principles of treatment.

The causes of problematic gagging are discussed and a behavioral method for its treatment is recommended. Four case studies illustrating the application of this approach are presented.

Adult↗
PubMed1987

Dental care demand among children with dental insurance.

As the number of families with dental insurance and expenditures for dental care has increased over the past two decades, so has interest in determining cost-sharing effects on dental demand among insureds. Using a representative sample of Pennsylvania Blue Shield children insureds during 1980, we estimate cost-sharing effects on dental demand for basic (diagnostic, preventive, restorative, endodontic, and extraction services) and orthodontic care. Results indicate that cost-sharing has little influence on the probability of using any dental services and basic expenditures. However, the probability of using orthodontic services decreases 2.1 percent when the proportion of orthodontic expenditures paid by the parent increases 10 percent. By reducing the cost of care, cost-sharing reduces social class differences in dental demand common in unisured populations, likely producing public oral health benefits.

Child↗
PubMed1987

Dental care demand: insurance effects and plan design.

This study concentrates on an important health policy question: the impact of dental insurance on the demand of adults for dental services. Demand equations for individuals are estimated from a systematic random sample of 4,173 families with complete information on their dental claims (insured through Pennsylvania Blue Shield) and survey data. The principal contributions of the research are twofold: (1) to provide rigorous, large-sample estimates of the demand for dental services of insured individuals--providing a complementary set of "natural" experiment results to the randomized experiment results of the RAND Health Insurance Experiment--and (2) to estimate the incremental effects on dental care demand of certain factors related to adverse selection. The study is a companion to a previously published study of children by the same authors. Generally, the analysis shows relatively small money price elasticities of dental care demand among this insured adult population (ranging from -.01 to -.266 across specific types of service). Given a finding that total expenditures for Basic services are 37 percent and 90 percent higher, respectively, for community-rated (versus experience-rated) primary subscribers and insureds, we conclude that differential adverse selection between community- and experience-rated groups accounts for significant differences in dental demand.

Adult↗
PubMed1986

Development of a measure of job satisfaction for dentists and dental auxiliaries.

This paper describes the development of a multidimensional, 38-item measure of job satisfaction appropriate for dentists, dental hygienists, and dental assistants. Items were grouped into the following 12 subscales: income, recognition, opportunity to develop professionally, time to develop professionally, responsibility, non-patient tasks, staff relations, quality of care, leisure time, fatigue, time pressure and general satisfaction. The measure was developed from a set of 45 items included in questionnaires administered to dentists and staff of 126 dental practices in Washington State, USA. Questionnaires were returned by 117, 121 and 106 dentists; 69, 80, and 82 hygienists; and 322, 329, and 320 assistants, respectively, in each of the 3 yr (1979, 1980, 1981). Factor analysis (principal components analysis with varimax rotation) plus categorization of items by a panel of professionals were used to initially group items into subscales. Contribution to internal consistency was the final criterion for an item's inclusion in a subscale. Internal consistency reliability of subscales ranged from 0.68 to 0.95. Statistically significant relationships were found between individual job satisfaction subscales and intent to change job for hygienists and assistants.

Dental Assistants↗
PubMed1986

Local anaesthetic adverse effects and other emergency problems in general dental practice.

This paper has three parts: local anaesthetic adverse effects, haemorrhage control and altered immune response. Primary emphasis is placed on the problems with anaesthetics since their use is widespread. Every day, nearly 2 million injections of local anaesthetic are given in dental practice. From 2.5 to 10 per cent of patients experience adverse reactions. This adverse effect rate is 10 times higher than that in medicine for the same drugs. Allergic, toxic, idiosyncratic and psychogenic effects are discussed. New data on the role of local anaesthetic agents, vasoconstrictors and preservatives is presented. In addition, the problem of anaesthetic failure (occurring in over 10 per cent of patients) is explained. Treatment (drug and psychological) for anaesthetic related emergencies such as panic attacks, shortness of breath, palpitations and nausea is recommended. Prevention and treatment of haemorrhage is explained. Medical and dental conditions may increase clotting time (e.g., systemic disease or local factors such as granulation tissue). Preventive strategies are outlined and laboratory tests discussed. Emphasis should be placed on the use of local anaesthetics with vasoconstrictors, haemostatic agents and pressure. The final aspect of the paper discussed new data on problems for dentists arising with patients who have altered immune function. In particular AIDS is discussed from the point of view of protection of the dentist and dental treatment for the patient.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Development and validation of a measure of dental patient satisfaction.

As part of the Washington State Dental Auxiliaries Project, a 42-item measure of patient satisfaction with dental care was developed. The measure is comprised of 13 subscales: dentist-patient relations, technical quality of care, access, patient waiting time, cost, facilities, availability, continuity, pain, auxiliaries performing expanded duties, staff-patient relations, staff technical quality of care, and office atmosphere. The measure was developed from a set of 52 items included in a questionnaire administered to the patients of private dental practices in Washington state. Usable questionnaires were returned by 30.8% of patients receiving questionnaires in 1979, 40.1% in 1980, and 34.0% in 1981. Factor analysis plus categorization of items by a panel of professionals were used initially to group items into subscales. Contribution to internal consistency was the final criterion for an item's inclusion in a subscale. Internal consistency of subscales ranged from 0.44 to 0.80. The concurrent validity of subscales was assessed by relating patient satisfaction to characteristics of the dental practices. The following statistically significant relationships between subscales and criterion variables were observed: dentist-patient relations and percent of patients seen by the dentist; access and number of weeks appointments must be booked in advance; patient waiting time and actual patient waiting time; continuity of care and percent of patients seen by the dentist; auxiliaries performing expanded duties and delegation to auxiliaries; and staff technical quality and percent of hygienist restorations with satisfactory quality. Each relationship was in the expected direction.

Adult↗
PubMed1985

Psychophysiological responses to dental injections.

Dentists frequently change local anesthetic formulations on the basis of a patient's experience of adverse effects. Frequently, less effective anesthetics are selected because a lack of understanding exists regarding the nature of untoward events. This may exacerbate the problem. Allergic reactions are overreported, whereas fear responses frequently are unrecognized. This article outlines the clinical problem of adverse reactions to local anesthetics in dental practice. Clinical recommendations based on proper diagnosis are provided to prevent recurrence of the problem.

Adult↗
PubMed1985

Delegation of expanded functions to dental assistants and hygienists.

One hundred and twenty-six dental offices in Washington State kept a record of each time an expanded function was performed by the dentist, hygienist, or assistant. There were five two-week recording periods starting in February 1979 and ending in February 1981. Consistent with increasing productivity, dentists most frequently delegate tasks to dental assistants rather than dental hygienists and delegate an individual task consistently if it is delegated at all. For tasks that may be delegated to the assistant, a relationship was found between the per cent of dentists delegating an individual task and the amount of the dentist's time that is freed through delegating that task. From the perspective of quality of care, the per cent of dentists who delegate a task was inversely related to the complexity of the task.

Dental Assistants↗