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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↗
PubMed2002

Dental visits to hospital emergency departments by adults receiving Medicaid: assessing their use.

BACKGROUND: Pain from toothaches represents a significant problem. People lacking access to private dental services may use hospital emergency departments, or EDs. In 1993, Maryland eliminated Medicaid reimbursement to dentists for adult emergency services. METHODS: The authors used the change in Medicaid policy that eliminated dentist reimbursement to establish two study periods. Data tapes describing patients' use of EDs were obtained from the Maryland Medicaid Management Information System. A total of 3,639 people visited EDs for dental problems sometime during the four-year study period. RESULTS: After controlling for age, race and sex, the authors found that the rate of ED claims was 12 percent higher in the postchange period than in the prechange period. Comparisons between periods show significant rate increases during the postchange period for men, whites, African-Americans and patients aged 21 through 44 years and 45 through 64 years. CONCLUSIONS: The change in Medicaid policy that eliminated dentist reimbursement and participation in the program appears to have increased the use of EDs for the treatment of dental problems. Practice Implications. Many EDs lack dental services and are not capable of providing definitive treatment. When definitive treatment is not provided, this pattern of care may be repeated if patients are forced to return for treatment.

Adult↗
PubMed1996

Oral health and health related behaviours among three-year-old children born to first and second generation Pakistani mothers in Bradford, UK.

Many young Muslim children whose families originated from the Indian sub-continent have poorer levels of oral health than their indigenous White peers, but it is unclear whether and to what extent subsequent generations may be similarly disadvantaged. This study aimed to compare dental health and associated behavioural attributes among United Kingdom-born three-year-old children of first and second generation Pakistani Muslim mothers resident in areas of social deprivation in Bradford, West Yorkshire. Multi-lingual interviews completed a home-based, semi-structured questionnaire, and a dental examination was conducted at a subsequent visit on 226 children, 117 with Pakistan-born mothers and 109 born in the UK. When the two generation groups were compared, no differences were observed in infant feeding practices, oral hygiene routines or dental attendance patterns, in mothers' attendance at ante-natal classes, or their knowledge of caries prevention. However, a higher proportion of UK-born mothers were able to speak English and reported that they had attended a dentist themselves, had received advice there, and were better informed of categories exempt from dental charges. A 24-hour retrospective qualitative dietary recall indicated that children of UK-born mothers consumed, on average, more frequent intakes of foods classified in the 'bread and cereal' group and of sweet drinks at meal times. While there were no significant differences in the proportion who were cavity free, children of UK-born mothers had higher mean caries experience (dmft=2.30) compared with those of Pakistan-born mothers (dmft=1.38). It was concluded that the total burden of dental caries experience among a subsequent generation of Pakistani children was higher than that of the previous generation. Poor dental health is likely to remain a challenge in this community for the foreseeable future.

Adult↗
PubMed1986

Reasons for taking radiographs in general dental practice.

This survey investigated the reasons why general dental practitioners take radiographs. 179 (54%) dentists responded and provided information for 2359 patients who were radiographed during a specified week. Of those patients aged less than 15 yr, 62% were radiographed primarily for orthodontic purposes and 22% for caries. In older age groups, caries was the predominant reason for taking radiographs but endodontic assessment assumed increasing importance with age and accounted for 37% of radiographs in patients aged more than 45 yr. Only 8% of patients were radiographed for periodontal reasons. These findings are discussed with respect to the changing pattern of disease and treatment provided in general dental practice.

Adolescent↗
PubMedDate not supplied

Nitrous-oxide use. I. Risk of potential exposure and compliance among Nebraska dentists and dental assistants.

Patterns of nitrous-oxide (N,O) use among Nebraska dentists and dental assistants are reported. More than 800 respondents answered questions relating to risk of N,O exposure and compliance with N,O standards in the dental office: 73 percent of these dental practices using N,O have a state-registration permit. Dentists and dental assistants (from registered and unregistered practices) reported risk of exposure differently. Important compliance issues emerged (the average compliance rate was 9 on a scale of 17). Most N,O users have scavenging systems, but they are not properly operated. Few dental practices test for leaks or conduct N,O-monitoring tests. By complying with the recommendations for N,O administration, dental-care workers can minimize their risk of exposure.

Air Pollutants, Occupational↗
PubMed1995

Dental splint prescription patterns: a survey.

A random sample of U.S. dentists was surveyed with a mailed questionnaire to determine the number of splints that they fabricated over the preceding year for bruxers, patients with myofascial pain-dysfunction syndrome and patients with TM joint pain. The results indicate that a significant number of dentists treat these disorders with dental splints. Estimates are provided for the dental profession's yearly splint output for each disorder.

Age Factors↗
PubMed1994

A comparative study of costs for dental services and dentists' income in the United States and Norway.

The United States and Norway have approximately the same per capita Gross Domestic Product (GDP) and average personal income, but their per capita health spending patterns are quite different. In 1982, the US spent 6.5% of its total health expenditures on dental services while Norway spent 5.4%. A higher percentage of Norwegian adults see a dentist annually as compared to US adults. In 1984, the mean net income of dentists in private practice was $66,940 in the US and $27,125 in Norway; this is respectively 5 and 1 3/4 times the average per capita income in those countries. The American publicly-employed dentist earned approximately two-thirds of what the American private practitioner made, while still earning approximately 50% more than his Norwegian counterpart. Some basic information concerning the ratios of dentists, specialists, and dental hygienists to the population is given. The relative proportion of women dentists in the two countries is contrasted. Finally, data on graduates from the dental schools, enrollment cuts, and estimated dentist to population ratios by the year 2000 are described to compare future manpower that will be available to the two countries. Several dissimilarities in the political and social systems are described and discussed. It is emphasized that caution should be used when interpreting and comparing data about countries with different dental delivery, political, and social systems.

Dental Health Services↗
PubMed1998

The changing role of dental auxiliaries: a literature review.

A review of the literature on dental auxiliaries and their utilization in the dental workforce is presented, and their future role is examined in the light of broader issues relating to changing disease patterns and service delivery. Legislative factors, productivity, quality assurance and the potential scope for dental auxiliaries in both the public sector and private practice setting are discussed. A strategy for adopting a team approach in the delivery of dental services is suggested, which would necessitate the dentist taking on the role of team leader and maintaining responsibility for overall treatment planning and quality assurance. Dental auxiliaries could provide basic preventive and restorative dental services, allowing dentists to concentrate on providing more complex high-technology treatment. Implications for the future training of dental auxiliaries are presented.

Australia↗
PubMed2005

[How the dental treatment for medically complicated patients can be improved].

This article is primarily an adapted translation in Dutch of an editorial paper in the journal Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. The editorial paper described the increasing need to prepare future practitioners for a more medical-based mode of oral health care and medically complicated patients. The current dental education in the United States has some shortcomings in this respect. Several steps are necessary to start improving dental treatment for patients with medical disorders. Second part of this article describes the current dental education regarding this topic in the Netherlands and how to improve this. Besides optimizing the dental-1 medical education of future dentist, also the mutual need of optimizing the medico-dental training of physicians is mentioned as, at least in the Netherlands, many patients visit their physician instead of their dentist with a non-teeth related oral problem.

Chronic Disease↗
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↗
PubMed1980

[Activation analysis of mercury in head hair of dentists (author's transl)].

Mercury contents in head hair of 58 dentists, working at the hospital of Nihon University School of Dentistry were determined using neutron activation analysis. The values ranged from 2.47 ppm to 13.7 ppm. The frequency distribution of the mercury contents increased steeply at about 2 ppm to the maximum of 4 approximately 5 ppm, and decreased to about 11 ppm, its distribution pattern followed a log-normal one with a median of 5.46 ppm. The dentists were divided into two groups and the mercury contents in head hair of them were compared with each other. The arithmetic and geometric means of the values for dentists who handled amalgam in dental practice were 5.66 ppm (SD +/- 1.80) and 5.40 ppm (SD multiplied/divided by 1.36), while those for the dentists who did not handle amalgam in dental practice were 5.96 ppm (SD +/- 2.82) and 5.38 ppm (SD multiplied/divided by 1.59). The values of them agreed well with each other. The arithmetic mean for all dentists was 5.79 ppm (SD +/- 2.28) and the geometric mean of them was 5.40 ppm (SD multiplied/divided by 1.46). They were much lower than the values reported by Suzuki, Miyazawa or Sairenji, et al. in the past year, and they agreed well to those for normal Japanese men with the same age. Therefore it is concluded that proper mercury handling might be established in the dental office.

Activation Analysis↗
PubMed1993

Myofascial pain dysfunction: treatments used by ADA members.

A survey of 10,000 members of the American Dental Association was conducted in order to identify the most commonly used treatments for myofascial pain dysfunction (MPD). A questionnaire was used in which MPD was defined, all treatments (including referral) were listed, and a percentage-of-use estimate for each treatment was requested. Results from 2,544 questionnaires showed that the most commonly used treatments are: flat plane splints with anterior/canine guidance or posterior group function, occlusal equilibration, thermal packs, relaxation/stress management training, diet counseling, and medications with anti-inflammatory (nonopioid) analgesic and muscle relaxant properties. The results also showed considerable variation in the ways common treatments are performed. A call is issued for systematic and careful research on the outcomes of these and other treatments and their major variations.

Adult↗
PubMed1991

Educating dentists about fissure sealants: effects on knowledge, attitudes, and use.

This study evaluated the effects of three modes of education on dentists' knowledge, attitudes, and use of pit and fissure sealants. A randomly selected group of dentists was invited to participate in a sealant education initiative. During a 12-month period, a total of 662 dentists either (1) attended continuing education courses, (2) received written materials and videotapes by mail, or (3) received only written materials by mail. A comparison group (n = 337) received no materials until after the education phase and evaluation had been completed. Pre- and postintervention surveys were used to measure changes in knowledge, attitudes, and sealant use. Response rates to the two surveys were 62 percent and 76 percent, respectively. Preintervention values for knowledge scores, an attitude scale, and sealant use were similar among the four groups. At followup, the three education groups had significantly higher knowledge scores than the comparison group. Attitude values for all but one group were not significantly different, and sealant use by all groups was identical. The numbers of respondents not using sealants declined slightly between surveys in the three education groups while rising slightly in the No-Education Group. Because program outcomes were similar to those of another sealant initiative, it can probably be concluded that continuing education will increase dentists' knowledge about sealants, but have little effect upon their attitudes or their use of the technique. The changes observed in this investigation may be due to the particular capacity for cognitive and affective changes of participants, characteristics of the technology being promoted, and external forces in the professional environment.

Adolescent↗
PubMed1996

Ontario dentists' knowledge and beliefs about selected aspects of diagnosis, prevention and restorative dentistry.

Based on the responses of 1,276 general dental practitioners in Ontario to a mail questionnaire, variations in certain aspects of the dentists' diagnostic, preventive and restorative knowledge and beliefs are examined. Despite recent practice recommendations and guidelines indicating that patient need and service selectivity, rather than traditional, routine prescriptions, should be the guiding principle of practice, many dentists seem to follow tradition in defining optimal intervals for dental examinations and prophylaxes, bitewing radiographs and topical fluoride applications. Although the respondents' knowledge and beliefs were correct and consistent with current evidence in many areas, some large deficiencies were identified. These include: a lack of awareness that professional prophylaxis prior to topical fluoride application is usually unnecessary and that sealant applications to certain teeth are not cost-effective; an over-estimation of the speed at which dental caries progress through the enamel; and, despite good knowledge about the opportunities for the remineralization of enamel lesions with fluorides, a tendency to restore enamel caries. In some instances, practitioner beliefs were shown to influence practice. For example, dentists who knew about the slow progression of approximal surface caries also reported more often that bitewing intervals should be longer, and that the placement of a restoration should be delayed until the caries penetrates the dentin. Similarly, correct knowledge about sealant effectiveness was positively associated with high sealant use. If dentists are to be expected to understand and follow emerging diagnostic, preventive and restorative practice recommendations and guidelines, continuing education is required to correct and update some of their knowledge and beliefs, as displayed in the responses to this questionnaire.

Adolescent↗
PubMed2000

The relevance of behavioural sciences in dental practice.

The aim of this paper is to illustrate how knowledge from behavioural sciences is necessary and relevant in creating a successful dental practice, benefitting patients and dental professionals. There are many ways to create a successful dental practice, the products of which are the various treatments performed by dentists or dental hygienists for their patients. Advanced technologies and methods are constantly improving these treatments and thus the technical and managerial aspects of dentistry. However, the success of dental practice is not only dependent on the technique applied or the technical skills of dental professionals, but also on patients, their attitudes and behaviour and the interaction between dental professionals and patients. It is well known that the success of dental treatments (for example, periodontal, orthodontic or implants) depends on the patient's behaviour, which includes compliance with certain oral hygiene regimens or specific dental visiting patterns. The outcome of the treatment depends on both the dental professional's knowledge and skills and the patient's skills, objectives and expectations. Furthermore, dental professionals and patients should be satisfied with the treatment plan as well as the outcome. This paper argues that in order for this to happen dental professionals need additional knowledge and skills from fields outside traditional dental sciences. In order to treat patients successfully, dental professionals must understand and change or modify patient behaviour, and the knowledge necessary for this is provided by the behavioural sciences.

Age Factors↗
PubMedDate not supplied

Practice characteristics of dental hygienists operating independently of dentist supervision.

PURPOSE: This paper presents business characteristics of ten experimental independent dental hygiene practices operating in California between 1987 and 1990. Sixteen dental hygienists participated in the experiment, the Health Manpower Pilot Project 139 (HMPP 139). HMPP 139 dental hygienists wanted to work independently in traditional office-based settings, institutional settings, and other arrangements. They worked in group and solo practices, on a full- or part-time basis. METHODS: Data were collected from the HMPP 139 practices on services provided, patient visits, fees charged, referrals to dentists, acceptance of Medicaid patients, and services to organizational clients. Data collection methods varied, depending on the question addressed. Surveys of dentists' offices provided data on fees and Medicaid policies for comparison with the independent dental hygiene practices. RESULTS: All experimental practices attracted new patients for each quarter in operation. These practices mostly provided prophylaxis treatments; however, a wide variety of services was provided. Fees charged in HMPP 139 office-based practices were less than comparable fees charged in dentists' offices. At least one-third of patients in the HMPP 139 office-based settings received a referral to or an opinion about a dentist from the dental hygienist. HMPP 139 practices were more available to Medicaid patients than were California dentists offices. Each experimental independent practice provided care to at least one client in a nontraditional setting. CONCLUSIONS: The HMPP 139 practices consistently attracted new patients. This suggests independent practice for dental hygienists may be a viable and flexible alternative if the practices can stabilize total patients at a sufficiently high level. An independent practice alternative might increase access to care, contain fees, and direct the flow of patients to dentists. Further study is needed to test these findings.

California↗