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PubMed2004

Estimated quantity of mercury in amalgam waste water residue released by dentists into the sewerage system in Ontario, Canada.

AIM: To estimate the quantity of dental amalgam that Ontario dentists release into waste water. METHODS: Information from a self-administered postal survey of Ontario dentists was combined with the results of other experiments on the weight of amalgam restorations and the quantity of amalgam waste that bypasses solids separators in dental offices. Algorithms were developed to compute the quantity of amalgam waste leaving dental offices when dentists used or did not use ISO 11143 amalgam particle separators. RESULTS: A total of 878 (44.0%) of 1,994 sampled dentists responded to the survey. It was estimated that Ontario dentists removed 1,880.32 kg of amalgam (940.16 kg of mercury) during 2002, of which 1,128.19 kg of amalgam (564.10 kg of mercury) would have been released into waste water in Ontario if no dentists had been using a separator. Approximately 22% of the dentists reported using amalgam particle separators. On the basis of current use of amalgam separators, it was estimated that 861.78 kg of amalgam (430.89 kg of mercury or 170.72 mg per dentist daily) was released in 2002. The use of amalgam separators by all dentists could reduce the quantity of amalgam (and mercury) entering waste water to an estimated 12.41 kg (6.21 kg of mercury, or 2.46 mg per dentist per day). CONCLUSION: Amalgam particles separators can dramatically reduce amalgam and mercury loading in waste water released from dental offices.

Algorithms↗
PubMed1992

Differences in time devoted to practice by male and female dentists.

Previous studies have found that female dentists work fewer hours per year than male dentists. This study examined factors which may explain the differences in hours worked per year that exist between male and female dentists in private practice. In 1988, a weighted, stratified random sample of dentists in Australia was surveyed by mailed questionnaire. There were 855 respondents (response rate = 75.5%) with 566 dentists from private practice (361 males and 205 females). Annual time devoted to dental practice was significantly lower for females, for dentists who were not the sole earner of the family income, and for dentists with young children. A significant interaction between sex of dentist and child age showed that hours per year in practice decreased only for females with young children. Hours worked per year were significantly higher among female dentists with no children, or older children. For males, hours worked remained at a higher level. The amount of time devoted to dentistry requires monitoring in the estimation and projection of capacity to supply dental services.

Analysis of Variance↗
PubMed2002

Nordic dentists' knowledge and attitudes on dental amalgam from health and environmental perspectives.

The aim of this study was to identify differences and similarities between the Nordic countries in dentists' use of dental amalgam as a restorative material, and also their knowledge and attitudes about amalgam from health, environmental, ethical, economic and social points of view. Procedures for handling amalgam waste were also studied. A random sample of 250 dentists was drawn from the national registers of authorized dentists in each country in late autumn 1997. At the beginning of 1998, a questionnaire was sent to all the dentists in the study group. The response rate was 77.6% in Denmark, 73.2% in Finland, 78.8% in Norway, and 84.0% in Sweden. In Finland and Sweden the use of dental amalgam had almost ceased, particularly for younger patients, while in Norway and especially in Denmark it was still widely used. Dentists' knowledge of the environmental effects of amalgam was confused, but most dentists had installed amalgam separators in their dental units by 1998. The majority of dentists in each country wanted to keep dental amalgam as a restorative material even in the future, and they did not want to ban the import of mercury to their home countries. Most dentists considered amalgam to be a health risk for at least some patients, and a great majority (from 76% in Sweden to 94% in Norway) considered composite as a possible odontological risk to patients. Since a majority of the dentists considered both amalgam and composites possibly harmful to patients, efforts to develop better alternatives to amalgam should continue.

Adult↗
PubMed1982

Public image of dentists and dental visits in Finland.

The public image of dentists and dental visits were surveyed in 1980 by interviewing a national sample of 648 Finns 15-50 years. 67 persons who reported having last visited a dentist more than 5 years ago were excluded from this report. 55% of the interviewees had visited the same dentists earlier, 69% of these had been seeing the same dentist for more than 3 years. The last dentist visited was characterized on three dimensions: technical competence, personality and organization of the surgery. This characterization demonstrated the importance of personal and professional characteristics of the dentists. The intervieews expressed a high degree of satisfaction with the last dentist visited. 28% of the variance in satisfaction experienced was explained in multiple regression analysis. The dental visit was considered important but unpleasant by the interviewees. The principle of free choice of dentist was important to the vast majority of interviewees. It seems that the process of forming the dentist's image is so complex that the dental profession should be comprehensively taught interpersonal skills.

Adolescent↗
PubMed2004

Caries-preventive measures applied by Mongolian dentists to their own children.

PURPOSE: To investigate caries-preventive measures (CPMs) applied by dentists in Mongolia to their own children in relation to the dentist-parents' professional and preventive care-related backgrounds and the children's dental health. MATERIALS AND METHODS: A questionnaire distributed to Mongolian dentists in 2000 surveyed their professional and preventive care-related backgrounds. The dentists filled in a dental chart for their own children aged 3 to 13 years and indicated which of seven listed CPMs were applied to each child. Of the dentists surveyed, 245 replied (98%); with 146 having children (n = 208) of the target age. Statistical evaluation included chi-square test, one-way ANOVA, linear regression analysis, and odds ratios based on 2X2 tables. RESULTS: Of the seven CPMs, the following were applied on average per child: 3.7 (SD = 1.6) to 3- to 5-year-olds; 4.4 (SD = 1.3) to 6- to 11-year-olds; 4.3 (SD = 1.4) to 12- to 13-year-olds; with the youngest children receiving the fewest CPMs (p = 0.02). Demonstrating toothbrushing techniques and taking children for regular preventive check-ups were the most frequently reported measures applied to the children. Conversely, pit and fissure sealants and restriction of sugar were the least reported. The number of CPMs was unrelated to any factors connected with the dentist-parents' backgrounds among the youngest group; correlated negatively to dentist-parents' work experience (p = 0.002) among the middle group; and positively to dentist-parents' preventive knowledge (p = 0.04) and self-reported competency (p = 0.005) among the oldest group. Among the middle group, more CPMs were applied to those with greater DMFT/dmft scores. CONCLUSION: Caries-preventive measures applied to dentists' children should be improved, especially in regard to sugar consumption. Comprehensive efforts are called for, stressing modern CPMs.

Adolescent↗
PubMed2004

Knowledge, opinions, and clinical experience of general practice dentists toward obstructive sleep apnea and oral appliances.

Undiagnosed obstructive sleep apnea (OSA) can contribute to hypertension, cardiovascular disease, stroke, and detract from overall quality of life. Dentists can play an important role in detecting, making recommendations for, and treating OSA with oral appliances (OAs). A survey of 18 questions of knowledge and opinion of, educational background for, and clinical experience with OSA and OAs was mailed to 500 general practice dentists in Indiana, United States. Two hundred survey returns produced 192 valid responses. Responders reported strong positive opinions toward OSA and OAs. However, 58% of dentists could not identify common signs and symptoms of OSA, and 55% of dentists did not know the mechanism for mandibular advance devices. Only 39% of dentists could identify snoring, mild OSA, and intolerance to continuous positive airway pressure as possible indications for OA treatment. Respondents reported a general lack of education about both OSA and OAs. Only 31 (16%) were taught about this issue in dental school; 77 (40%) knew little or nothing about OA treatment for OSA patients; 57 (30%) learned from postgraduate training. Cooperation and referrals between dentists and physicians were rated as "poor." Of the responders, 54% never consulted with physicians for a suspected OSA patient in their practice; 75% of dentists reported they have never been referred patients by physicians; and 80% of dentists never or less than five times prescribed OAs to OSA patients. Results suggest a need for increased education and training regarding OSA and OAs in dental school, as well as increased cooperation between dentists and physicians for better patient care.

Attitude of Health Personnel↗
PubMed2004

Dentists' molar restoration choices and longevity: a web-based survey.

STATEMENT OF PROBLEM: The increasing trend toward esthetics has led to controversy as to the longevity of esthetic restorations and the wisdom of having traditional restorations replaced for esthetic reasons. With the assumption that the way dentists treat their own teeth may be a good indication of the accumulated wisdom of the profession, knowledge of dentists' own restorative choices may provide guidance in selecting the most appropriate restorations. PURPOSE: The purpose of this article was to determine restorative choices of dentists for personal molars and estimate restoration longevity. MATERIAL AND METHODS: Information about dentists' molars was obtained from a Web-based survey designed to receive dentists' demographic data and charting of 8 molar teeth with estimated longevity. Approximately 12,000 e-mails asking to access the website were sent to dentists' addresses randomly selected from a commercial database. Nonrespondents received 1 reminder. The responses were statistically analyzed with a chi-square analysis (alpha=.05). RESULTS: Seven hundred fifty-seven valid replies provided information for 6,034 teeth (22% unrestored, 75% restored, 2% missing). Restorations reported included amalgam (36%), gold inlay/onlay (13%), complete veneer crown (CVC) (10%), metal-ceramic crown (MCC) (8%), and composite (7%). Other esthetic options accounted for less than 3%. Restorations with more than 20 years longevity included amalgam restorations (58%), gold inlays/onlays (48%) and crowns (23%). Fifty-six percent of esthetic restorations and 5% of amalgams were placed in the last 5 years. The following restorations were placed in the last year (n=186): 38% esthetic, 29% crowns (18% MCC; 11% CVC), and 17% gold inlay/onlay or amalgam. Significant differences (P<.001) were identified for dentist's gender, year of graduation and practice location. CONCLUSIONS: Most dentists have not replaced traditional metallic restorations with esthetic alternatives. Dentists still choose nonesthetic options for significant numbers of their own restorations.

Attitude of Health Personnel↗
PubMed2004

[Access to oral care and attitudes to the dentist by German and Turkish parents].

The aim of this study was to collect information on the attitude to dentists and access to dental care by German and Turkish parents. To meet this aim, 829 parents attending a school medical inspection received a questionnaire. 811 (97.8%) questionnaires were returned and 778 (93.8%) could be used for analysis. Compared to German parents Turkish parents had a more negative attitude to the dentist. In particular, communication with the dentist was assessed more negatively by Turkish parents. Clearly more Turkish than German parents agreed that their dentist frequently made them feel guilty because of poor oral hygiene (31.2 vs. 5.6%). 7.7% of German but 23.9% of Turkish parents thought that their dentist did not give them enough information. Among the Turkish interviewees, language problems rather played a minor role in communication problems. 12.6% of German and 19.3% of Turkish interviewees thought they could not believe everything what the dentist said. Only 54.0% of the German and 28.9% of the Turkish parents knew that fissure sealants were paid by the statutory sickness fund. Dentists should be better trained in dealing with patients with a different social or cultural background. Also, dentists should be taught to consider health problems rather from a social than from an individual aspect. To improve cost transparency, dentists should publish the list of services not covered by the statutory sickness fund. Moreover, an independent patient consultation service should be offered.

Adult↗
PubMed2006

Moral values and career: factors shaping the image of healthy work for female dentists.

OBJECTIVE: Female unpromoted general practice dentists (GPDs) constitute about one-quarter of all dentists in Sweden. These female dentists suffer from many problems relating to their psychosocial working conditions. There are wide discrepancies between their perception of the ideal job situation and reality. Previously, three factors were found to constitute the ideal job situation. The aim of this study was to analyze patterns in two of these factors, i.e. the moral and the career factors, for understanding how ideal circumstances are conceived, i.e. how "good work" for the dentists could be obtained. MATERIAL AND METHODS: In the year 2000, all female unpromoted GPDs (183 persons) within the Public Dental Health Service (PDHS) in a region in Sweden received a questionnaire; response rate 94%. Four multiple regression models were constructed for two factors of good work and for the differences between the ideal job situation and reality concerning these factors. RESULTS: In all models, the explained variance was high. Those dentists who were committed to moral issues perceived large differences between the ideal and reality concerning moral values. Dentists committed to career issues experienced large differences between the ideal and reality concerning career development. Those dentists - about 60% - who would not want to be a dentist if they were to choose today, perceived large discrepancies concerning moral and career issues. CONCLUSIONS: The PDHS organization has failed to convince or engage those whom it ought to engage, that is those with the highest level of commitment. Dentists' emphasis on moral values confirms the character of dentistry as primarily a human service work.

Attitude of Health Personnel↗
PubMed1999

Caries assessment and restorative treatment thresholds reported by Swedish dentists.

The aim was to study any variability in approximal and occlusal caries diagnoses and restorative treatment decisions among Swedish dentists. The material consisted of a pre-coded questionnaire sent to a random sample of 923 dentists with 4 items concerning approximal and occlusal caries diagnosis and restorative treatment decisions. Responses were received from 651 (70.5%) dentists. In an adolescent with low caries activity and good oral hygiene, more than 90% of the dentists stated that they would not automatically restore a primary approximal caries lesion if its radiographic appearance did not show obvious progression in the outer 1/3 to 1/2 of the dentin. Moreover, 67% of the dentists would only consider immediate restorative treatment of an occlusal surface if obvious cavitation and/or radiographic signs of dentin caries could be observed. When diagnosing questionable occlusal caries, the dentists largely relied on the radiographic appearance. Concerning both approximal and occlusal caries, the threshold for restorative treatment differed between the metropolitan regions in Sweden, and younger more often than older dentists would postpone restorative treatment of approximal caries until the lesion had reached a relatively advanced stage of progression. The responses also showed that dentists in private practice would restore approximal caries at an earlier stage of progression than the dentists in the Public Dental Health Service.

Adolescent↗
PubMed1988

Hepatitis B virus infection in Danish dentists. A case-control and follow-up study.

The authors determined the seroprevalence of hepatitis B virus markers among Danish dentists in 1985 in an effort to assess occupational risk factors. A case-control study approach was applied using pedodontists as zero-exposure controls. The study further allowed serologic and epidemiologic follow-up of dentists who participated in a similar study in 1976. The authors sought to determine whether exposure to hepatitis B virus in this population sometimes leads to immunization without infection (antibody to hepatitis B surface antigen (anti-HBs) positivity only). A total of 922 dentists (22% of all Danish dentists) gave blood; of these, 254 (28%) participated in the 1976 study. Serum samples were tested using commercial solid phase radioimmunoassays. The prevalences of anti-HBs and antibody to hepatitis B core antigen (anti-HBc) were 7.2% (95% confidence interval (CI) = 5.7-9.0) and 5.2% (95% CI = 3.8-6.6), respectively. Twenty-one dentists (31%) only had anti-HBs (without prior vaccination). Age-standardization of the two data sets (1976 and 1985) indicated no substantial change in seroprevalence. Private practitioners, especially those working in Copenhagen, had an increased odds ratio (OR) of being seropositive compared with that of pedodontists (OR = 3.0 (95% CI = 1.3-6.8) adjusted for age and sex and OR = 2.4 (95% CI = 1.1-5.2) adjusted for age and site of practice). The proportion attributable to occupational exposure was approximately 50%. In a logistic regression model, site of practice and type of specialty were associated with hepatitis B virus seropositivity (p = 0.01 and 0.05, respectively), whereas age, sex, hours of oral surgery per week, and use of gloves were not. Four persons had become seropositive in the follow-up study, for a seroconversion rate of 0.2% per year. Seven out of 18 dentists who were anti-HBs positive in 1976 were found to be anti-HBs negative in 1985. Most of these dentists had values below 10.0 units by S/N ratio (ratio of counts per minute of sample compared with the mean number of counts per minute of negative controls). The findings do not justify institution of a large-scale vaccination program for dentists, but there are certain subgroups of dentists which constitute candidates for vaccination.

Adult↗
PubMed1989

Attitudes of two groups of dentists towards dental hygienists.

The purpose of the study was to assess whether cooperation with a dental hygienist was based on pursuit of financial gain or on aspirations to improve patient care. To this end a questionnaire was sent to 972 dentists. 412 dentists replied, of whom 178 had patients treated by a dental hygienist. Questions were asked regarding practice profile, preventive orientation and dentists' opinion about the material and immaterial value of cooperation with a dental hygienist. Discriminant analysis showed that the main distinguishing factor between dentists who did and dentists who did not cooperate with dental hygienists was their opinion about the quality of the dental hygienists' work in relation to the non-financial costs for patients, insurance companies, and dentists. The difference in the dentists' opinions about the direct profitability of dental hygienists was not significant. The conclusion can be drawn that the orientation of Dutch dentists towards care for their patients plays a more important role in a dentist's decision to cooperate with a dental hygienist than is usually presumed.

Attitude of Health Personnel↗
PubMed2006

Oral health care for frail elderly people: actual state and opinions of dentists towards a well-organised community approach.

OBJECTIVE: This study was undertaken to provide an analysis of the actual oral heath care for frail elderly people living in different settings and to explore opinions of dentists towards new concepts in developing a community approach. METHOD: Data were collected from a sample of 101 dentists (15%) in the county of Antwerp using a self-administered 30-item questionnaire including questions about age, gender, education, organisational aspects of dental surgery, questions concerning dentists' own contribution to oral healthcare services for frail elderly people and statements concerning opinions and attitude toward the organisation of oral health care for frail elderly people. At the same time, qualitative data were collected from focus group sessions with all participating dentists. Non-parametric analysis was used to explore possible relationships between opinion and possible explanatory variables. RESULTS: Half of the dentists offered dental services to residential or nursing homes (mean number of treatments a year: 5.4) and at home (mean number of treatments a year: 2.4). Prosthetic treatments such as relieving denture pressure points, repairing, rebasing and making new dentures were carried out in 77.4% and 76.7% of the cases in residential or nursing homes and at home respectively. Extractions were carried out in 16% and 18.6% of the cases in both living situations respectively. The main reasons for dentists refusing domiciliary oral health care were the absence of dental equipment (63%), lack of time (19%), with 11% convincing the patients to be treated in their dental surgery. Analysis showed different opinions of dentists depending on age, gender and university of education; however, statistically significant differences were only found by age. CONCLUSION: The older the dentist, the greater the tendency to refuse domiciliary oral healthcare services. The younger dentists were reluctant to cooperate in the provision of oral health care in a structured community approach.

Adult↗
PubMed1996

Cost implications of differences in dentists' restorative treatment decisions.

OBJECTIVES: This study sought to determine the effects of variation in both dentists' decisions to treat and choice of treatment on the costs of care. METHODS: Each of 37 patients was examined individually by several practicing dentists (between 3-22, mean = 6.2). For each dentist's recommended treatment for each patient, the total cost of restorative treatment was calculated first using the least expensive treatment possible for each tooth indicated as needing treatment, and second using the costs of specific treatment selected by each dentist RESULTS: Considerable variation was found among dentists in each patients cost of treatment using both methods. The mean of the median cost per patient of the specific treatment selected was three times larger than the cost per patient of basic treatment. Few dentists were found to consistently recommend higher or lower cost treatment plans. CONCLUSIONS: These findings suggest that inconsistencies in both dentists' decisions to intervene and dentists' selection of treatment can have a profound effect on cost. Further, focusing utilization review on "outlier dentists" is likely to be much less productive in containing costs and improving quality than comprehensive attempts to improve consistency across the profession.

Composite Resins↗
PubMed1997

Restorative certainty and varying perceptions of dental caries depth among dentists.

OBJECTIVE: The question of whether dentists who most frequently identify tooth surfaces for definite restoration perceive dental caries as significantly deeper than other dentists is assessed. METHODS: One group of 20 dentists independently examined 145 unrestored approximal tooth surfaces on 16 bitewing radiographs and recorded their restorative and depth decisions. Another group of 15 dentists similarly scored 304 unrestored surfaces on 30 bitewing radiographs. Each group of dentists was later divided into four subgroups according to the number of surfaces designated for definite restoration by each dentist. RESULTS: As the number of tooth surfaces designated for definite restoration increased, mean caries depth (P < .05 for the high vs low subgroups) and the percent of dentinally carious surfaces increased, while the percent of surfaces assessed as sound decreased. Dentists with the lower numbers of surfaces designated for definite restoration came closest to the true histologic mean caries depth of the examined tooth surfaces. CONCLUSIONS: Dentists who designated high numbers of approximal tooth surfaces for definite restoration assessed caries as deeper than other dentists, and deeper than was proven histologically.

Analysis of Variance↗
PubMed1976

A survey of patients' attitudes to their dentist.

A survey of the dentist-patient relationship, carried out in several Melbourne suburbs, found that the incidence of dentures increases with age; that females visit the dentist more regularly and are more likely to wear partial dentures than males; that the young visit more regularly than the old; and that the wearing of dentures and the expense of treatment are significant factors which deter people from visiting the dentist more regularly. It was found that "fear" and "dislike" of the dentist, "low" confidence in the dentist and a poor dentist attitude to the patient are all associated with poor attendance. "Dislike" is a stronger deterrent than "fear", although "fear" is more common. Confidence in the dentist is high, most have a high opinion of their own dentist, and only a fifth of the respondents consider their dentist to be "rude" or "indifferent". Attitude associations are also discussed.

Adolescent↗
PubMed2003

The role of occupational stress in the maladaptive use of alcohol by dentists: a study of South Australian general dental practitioners.

BACKGROUND: It is well recognized that dentistry is a stressful profession. However, there are conflicting views about the extent to which such stress contributes to hazardous drinking among dentists. In addition, the relative contributions of stress and pre-existing vulnerability in predicting alcohol problems among dentists generally (and Australian dentists in particular) have yet to be determined. METHODS: The levels of stress and alcohol consumption of 312 South Australian dentists were measured. Factors known to mediate vulnerability to alcohol disorders were also assessed with appropriate psychometric instruments. RESULTS: High levels of stress/burnout, consistent with other studies of dentists' stress, were recorded. Hazardous levels of alcohol consumption, which were between two and four times higher than the normative South Australian population, were also reported, particularly among males and rural dentists. CONCLUSIONS: To a significant extent, stress and hazardous alcohol consumption are both present among South Australian dentists. However, compared with work stress/burnout, existing personal vulnerability factors are much stronger predictors of such hazardous alcohol consumption. We suggest that professional dental bodies, and state Dental Boards, may play a role in ensuring stress inoculation and guidance on safe limits of alcohol consumption for dentists-in-training; and in creating appropriate mechanisms for assisting dentists who experience alcohol related difficulties.

Adaptation, Psychological↗
PubMed2002

Health and neuropsychological functioning of dentists exposed to mercury.

OBJECTIVES: A cross sectional survey of dentists in the west of Scotland and unmatched controls was conducted to find the effect of chronic exposure to mercury on health and cognitive functioning. METHODS: 180 dentists were asked to complete a questionnaire that included items on handling of amalgam, symptoms experienced, possible influences on psychomotor function, and the 12 item general health questionnaire. Dentists were asked to complete a dental chart of their own mouths and to give samples of urine, hair, and nails for mercury analysis. Environmental measurements of mercury in dentists' surgeries were made and participants undertook a package of computerised psychomotor tests. 180 control subjects underwent a similar procedure, completing a questionnaire, having their amalgam surfaces counted, giving urine, hair, and nail samples and undergoing the psychomotor test package. RESULTS: Dentists had, on average, urinary mercury concentrations over four times that of control subjects, but all but one dentist had urinary mercury below the Health and Safety Executive health guidance value. Dentists were significantly more likely than control subjects to have had disorders of the kidney and memory disturbance. These symptoms were not significantly associated with urinary mercury concentration. Differences were found between the psychomotor performance of dentists and controls after adjusting for age and sex, but there was no significant association between changes in psychomotor response and mercury concentrations in urine, hair, or nails. CONCLUSIONS: Several differences in health and cognitive functioning between dentists and controls were found. These differences could not be directly attributed to their exposure to mercury. However, as similar health effects are known to be associated with mercury exposure, it would be appropriate to consider a system of health surveillance of dental staff with particular emphasis on symptoms associated with mercury toxicity where there is evidence of high levels of exposure to environmental mercury.

Adult↗