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PubMed1993

Quality assurance in medicine: a dental audit system.

Two principal components of a quality assurance system for dental plans are described, using a case report to illustrate the methodology. Criteria of acceptable quality of patient care for general practice were developed first. Then plan, practice and patient profiles, derived from claims or encounter data, were used to identify the nature and extent of aberrant patterns which were uncovered. Based on analysis of the profiles, site visits were made to a targeted sample of practices and selected patient dental records were evaluated for various levels of the process of care. Categories were rated as either acceptable or unacceptable. Principal dentists were debriefed on the findings and a report including corrective action plans prepared for the responsible agency. Follow-up to monitor compliance is planned. Although aberrant profiles do not necessarily mean that care is unacceptable, the findings from the record review confirmed the concerns raised by the data analysis.

Capitation Fee↗
PubMed1994

Working patterns of male and female dentists in the UK.

A random selection of male (250) and female (250) dentists in the Dentists Register 1992 were sent a postal self-administered questionnaire to determine their working patterns, places of work and whether or not they had children of school age or younger. There was also space for free comment. Responses from 75% of males and 81% of females were received. Results show that 79% of males, compared with 46% of females, work in full-time dentistry, chiefly in general dental practice. Family commitments were the principal reason for 30% of female dentists working part-time. A small number (14%) of male dentists work in a second career alongside part-time dentistry. As a female dentist's family becomes older and less dependent so the number of sessions worked increases. Overall, female dentists felt well suited and satisfied with their chosen profession. A small, but worrying group (4%) of male full-time general dental practitioners were very dissatisfied with dentistry as a career and showed clear signs of severe psychological stress expressed in the style and nature of free comments made.

Career Choice↗
PubMedDate not supplied

Pain management in school-aged children by private and public clinic practice dentists.

A mail survey of 198 Seattle dentists who treat children assessed their beliefs about pain control in school-aged children and examined the relationship of those beliefs to pain management behaviors. The survey population of general dentists and pediatric dentists in clinics and private practice had a response rate of 89.6%. Two of three dentists always use local anesthetic when doing restorations or extractions and also provide more anesthetic at the child's request. One in three dentists never provides postoperative medication following tooth extractions. Ten percent regularly deny child pain and many do not believe child pain reports are valid. Dentists who work in private practice are more likely to provide local anesthetic than are dentists who work in clinics. Dentists who desire more control over a child are less likely to provide local anesthetic. Dentists who question children about comfort are more likely to provide additional anesthetic based on a child's report of discomfort and to provide postoperative medication if the dentist perceives a dental procedure to be painful.

Adolescent↗
PubMed2003

Orthodontic treatment provided by pediatric dentists.

The purposes of this study were to document orthodontic treatment currently provided by pediatric dentists for comparison with past and future studies and to ascertain variables that influence practitioners' orthodontic treatment patterns. A 25-item survey was mailed to 492 diplomates of the American Board of Pediatric Dentistry. Surveys returned within 16 weeks were included for statistical analysis. The response rate was 73%. Most practitioners spent less than 10% of their practice time providing orthodontic treatment and reported that this would not change in the future. Practitioners who were dual trained in pediatric dentistry and orthodontics spent more time providing orthodontic treatment, although nearly half spent at least 50% of their time providing traditional pediatric dental treatment. Most pediatric dentists provided orthodontic treatment in the primary or early mixed dentition stages. The most common conditions treated were anterior crossbite, ectopic eruption, habits, posterior crossbite, and space maintenance. The most common orthodontic appliances used were fixed rapid palatal expanders and removable Hawley appliances with finger springs. Orthodontic treatment provided by pediatric dentists has decreased since it was last surveyed in 1983 and is not expected to change in the next 5 years.

Chi-Square Distribution↗
PubMed1989

Taking time out: a study of women dentists who have experienced career breaks.

Data on the careers and work patterns of women dentists were established in 1975. Social and economic changes, as well as change within the profession, such as the fact that almost half the students entering dental schools are now female, pointed to the necessity of a further survey in 1985. Questionnaires were sent off to 4513 women dentists resident in England and Wales, with a resultant response of 76 per cent. Part of the questionnaire concentrated on the length of career breaks experienced by/taken by women dentists in order to determine whether there has been any change in the pattern of taking time out in dentistry over the decade. At the time of the survey, 388 women (12 per cent) were retired, in addition, just over half of the women who replied had experienced a break at some stage during their career. These breaks from practice are described and discussed.

Age Factors↗
PubMed2000

Mineralization of human premolar occlusal fissures. A quantitative histochemical microanalysis.

The mechanisms of cariogenesis in occlusal fissures remain elusive because of limited information about fissure structure and wall mineralization. The purpose of the present study was to determine the correlation between morphological patterns in occlusal fissures in human premolars and quantitative histochemical patterns of mineralization in the walls of these formations. We used scanning electron microscopy and quantitative X-ray microanalysis with the peak-to-local background ratio method and microcrystalline calcium salts as standards. We distinguished three morphological patterns of fissures in scanning electron microscopic images. The wall of the fissures was less mineralized than the control enamel in all three types of fissures. Because the fissure walls are hypomineralized, we suggest that practicing dentists should take into account the degree of mineralization when they are preparing the fissures for the application of sealant.

Bicuspid↗
PubMed1995

Cross-infection control in general dental practice: dentists' behaviour compared with their knowledge and opinions.

This study aimed to establish how dentists' knowledge, opinion and behaviour about cross-infection control were related and how they were affected by their ages, gender and the sizes of the practices in which they worked. In 1990/91 all general dental practitioners in the North Western Health Region of England were asked to complete a questionnaire about cross-infection control; 917 (75%) did so. Responses from all single-handed and one dentist selected randomly from each group practice were analysed (n = 546). The score to measure behaviour was based on guidelines on cross-infection control issued by the British Dental Association and this was correlated with scores for knowledge and opinion. The more knowledgeable not only tended to hold favourable opinions about the guidelines but also to practise them. Younger dentists were more knowledgeable about cross-infection control measures than older and more likely to wear gloves. Irrespective of age, all female dentists were more likely to wear gloves than their male colleagues. Single-handed dentists were less willing to treat carriers of HIV and HBV. Although 65% thought that recommended control procedures are feasible, 43% considered them prohibitively expensive.

Adult↗
PubMedDate not supplied

Factors contributing to dentists' extraction decisions in older adults.

To evaluate which dental and non-dental factors contributed to dentists' extraction decisions in a sample of older adults, an archival study was conducted using community-dwelling and long-term-care older adults receiving dental care at an urban seniors' clinic. Four dentists who provided dental care to older adults reviewed patient records for whom they had extracted at least one tooth over a 21-month period. They identified one or more factors contributing to their extraction decisions. From 105 adults (mean age, 80.6), there were 221 extractions. Frequent contributors to dentists' extraction decisions included non-restorability in 53.8% of all extractions, dental caries (45.6%), prosthetic considerations (45.2%), and periodontal disease (40.3%). The non-dental contributors in 13% to 17% of extractions included patient/family request, inability to care for one's teeth, and financial limitations. When identifying the "most important" (or "primary") factor in their extraction decisions, dentists most frequently indicated non-restorability, followed distantly by patient/family request, periodontal disease, and financial limitations. This investigation demonstrates that non-dental factors are important in dentists' extraction decisions. Of these, patient/family request and financial limitations appear to be most influential.

Aged↗
PubMedDate not supplied

Geographic differences in the attitudes, knowledge and infection control practices of Ontario dentists.

Geographic differences in the HIV related attitudes, knowledge and behaviours of 5,997 dentists in Ontario were investigated using mailed questionnaires (response rate 70%). Proportionately more respondents from larger population centres reported that they knowingly treated HIV-infected patients (p < 0.00001), they were unwilling to treat HIV-infected patients (p < 0.05), they had an exaggerated perception of the risk of HIV infection after a needlestick injury (p < 0.01), they were concerned about personal risk (p < 0.01) and staff fears (p < 0.05) related to HIV/AIDS, and that patients with HIV or AIDS should be treated in hospitals/specialized practices (p < 0.001). Multiple logistic regression analysis controlling for age, sex, and specialty, showed that respondents who practised in smaller population centres were significantly more willing to treat HIV-infected patients ( < 10,000, odds ratio = 1.6; 10,000-49,999, odds ratio = 1.3). Significantly fewer respondents in the Central West, and Central East Health Planning Region, where AIDS is most prevalent, reported that they were willing to treat HIV patients.

Adult↗
PubMed1990

Preventive dentistry in Texas, USA.

This paper presents the results of a 1985 survey of 1000 Texas dentists regarding three major types of preventive measures--educational services, preventive procedures, and diagnostic services. The results show that among several given educational services, respondents tended most to instruct on correct brushing or flossing and tended least to counsel on diet. Among preventive procedures, most dentists removed plaque or calculus. A very small portion applied occlusal sealants on patients under the age of 15. As for diagnostic services, most performed oral cancer screening exams. Most performed dental X-rays, but many did not use leaded protection on their patients while taking X-rays. A large number did not check their patients' blood pressure. Income, attendance of continuing education programs, and number of dental hygienists were strong, positive predictors of provision of all three types of preventive measures. Dentists who practiced in more populous areas, or had practiced for fewer years, more likely provided patients with educational services and preventive procedures. Dentists delivered more preventive procedures if they attended more professional dental meetings. Dentists who worked more hours were more likely to provide educational services and preventive procedures. Patient load correlated negatively with dentists' delivery of preventive procedures.

Adult↗
PubMed1991

Time to adoption of an innovation by dentists in private practice: sealant utilization.

Dentists can be divided into five adoption categories based upon their time of adoption of pit and fissure sealants: innovators, early adopters, early majority, late majority, and laggards. The differences among dentists in the five adoption categories were examined for four classes of variables: practice characteristics, dentist characteristics, communication of information, and practice environment. Questionnaires were mailed in September 1984 to a random sample (N = 521) of Washington State dentists in general practices. A total of 376 completed questionnaires were returned, for a response rate of 72 percent. Adoption of sealants proceeded as follows: 5 percent of dentists through 1973, 24 percent through 1979, 50 percent through 1982, and 75 percent through 1984. Adoption category was related to percent of assistants who were certified, delegation to assistants and hygienists, magnitude of the fees charged by the practice, number of staff meetings per month, the dentist having been an officer in a dental organization, year the dentist adopted other new technologies, dentist's self-rating of willingness to try new things, percent of patients who are children, and percent of the dentist's colleagues who used sealants. These data lend some support to the two-stage or opinion-leader model of diffusion and suggest that new technologies can be promoted by first influencing dentists who consistently adopt early.

Adolescent↗
PubMed1993

Frequency of examination of children by dentists working under different payment systems in the United Kingdom.

The aims of this study were, first, to determine the frequency of dental examination of child patients by general dental practitioners working under a fee-for-service or capitation payment system in eight areas of the United Kingdom and, secondly, to consider how the frequency of examination varied by dentist payment system, by area, by age of the child and by dentist. The number of examinations carried out by 198 general dental practitioners over a one-year period for 17,389 children aged 0-15 years was recorded. The mean number of examinations per year for children treated by dentists working under the fee-for-service system was 1.7, and for those treated under the capitation system 1.6; this difference, although small, was statistically significant. The dentist and the age of the child were also shown to be related to the number of examinations but not the area in which the dentist worked.

Adolescent↗
PubMed1993

The influence of social, economic, and professional considerations on services offered by dentists to long-term care residents.

Many studies have focused on the disabilities and behavior of the elderly population in an attempt to explain the frequent reports of poor oral health among residents of long-term care (LTC) facilities, but little attention has been given to the experiences and opinions of dentists relating to the problem. This study was conducted to discover how dentists feel about older patients and about working in LTC facilities. A response to a questionnaire was obtained from 334 (55%) of the 603 dentists in Vancouver who treated adults. The responses were subjected to bivariate and multivariate analyses. Three models were constructed from factors that might interest a dentist in attending a patient in a facility; the factors in each model were ranked in order of importance. Interest was associated significantly with lack of concern for time lost in practice, with training in managing medically compromised patients, and with a positive attitude toward elderly patients. Dentists with fewer years in practice were attracted by the economic potential of the service, while the older and busier dentists were less involved because of the disruption to their practice and leisure. Dentists who made home visits also were more likely to be interested. The model based on professional considerations was superior to either the social or economic model in explaining an interest in the service.

Adult↗
PubMed2003

PRIME--PRocess modelling in ImpleMEntation research: selecting a theoretical basis for interventions to change clinical practice.

BACKGROUND: Biomedical research constantly produces new findings but these are not routinely translated into health care practice. One way to address this problem is to develop effective interventions to translate research findings into practice. Currently a range of empirical interventions are available and systematic reviews of these have demonstrated that there is no single best intervention. This evidence base is difficult to use in routine settings because it cannot identify which intervention is most likely to be effective (or cost effective) in a particular situation. We need to establish a scientific rationale for interventions. As clinical practice is a form of human behaviour, theories of human behaviour that have proved useful in other similar settings may provide a basis for developing a scientific rationale for the choice of interventions to translate research findings into clinical practice. The objectives of the study are: to amplify and populate scientifically validated theories of behaviour with evidence from the experience of health professionals; to use this as a basis for developing predictive questionnaires using replicable methods; to identify which elements of the questionnaire (i.e., which theoretical constructs) predict clinical practice and distinguish between evidence compliant and non-compliant practice; and on the basis of these results, to identify variables (based on theoretical constructs) that might be prime targets for behaviour change interventions. METHODS: We will develop postal questionnaires measuring two motivational, three action and one stage theory to explore five behaviours with 800 general medical and 600 general dental practitioners. We will collect data on performance for each of the behaviours. The relationships between predictor variables (theoretical constructs) and outcome measures (data on performance) in each survey will be assessed using multiple regression analysis and structural equation modelling. In the final phase of the project, the findings from all surveys will be analysed simultaneously adopting a random effects approach to investigate whether the relationships between predictor variables and outcome measures are modified by behaviour, professional group or geographical location.

Biomedical Research↗
PubMed1990

P.L. 99-252--implications for dentists and their clinical practice.

This paper is one of a series attempting to determine the impact of Public Law 99-252, the Comprehensive Smokeless Tobacco Health Education Act of 1986, on decreasing smokeless tobacco use. Potential indicators are discussed that could be used by the dental profession to determine the efficacy of the profession's involvement in existing and future prevention and cessation efforts relative to this law. In this review, six major areas are considered for measuring declines in smokeless tobacco use relative to the role of the dental health practitioner. These areas encompass the following: (1) the dental profession's knowledge of smokeless tobacco health hazards, (2) dental practitioners' involvement in measuring changes in use patterns, (3) the influence dentists have with their patients and community in decreasing smokeless tobacco use, (4) the general attitude and intention to quit on the part of dental patients, (5) active governmental involvement efforts, and (6) health effects of smokeless tobacco that might be used for identifying decreasing smokeless tobacco use. Within each of these six broad categories, more specific indicators for measuring the impact of P.L. 99-252 relative to the dental profession were considered.

Dentists↗