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PubMedDate not supplied

The evolution of human occlusion--ancient clinical tips for modern dentists.

Man evolved in an environment in which the occlusion was worn down quickly, resulting in flattened occlusal and interproximal surfaces. This rapid wear reduced occlusal decay, traumatic occlusion, malaligned teeth, impactions, and temporomandibular disease (TMD). In the last 250 years, however, new food production techniques created an environment that was less dentally abrasive than earlier diets. Teeth were not worn down as programmed in our "evolutionary blue-print." This lack of wear resulted in increased caries, cusp fractures, bruxing, malocclusion, periodontal disease, and TMD. A practical re-creation of ancient dental wear patterns can help to reduce these modern dental diseases.

Animals↗
PubMed2006

Good work for dentists--ideal and reality for female unpromoted general practice dentists in a region of Sweden.

Female unpromoted general practice dentists (GPDs) in the Public Dental Health Service (PDHS) constitute about one fourth of all working dentists in Sweden. Unpromoted means that the position is without managerial functions. According to many reports, they have a problematic psychosocial work situation. THIS THESIS AIMED TO: Describe the perceived health for these GPDs, in comparison with others with a similar work situation. Analyse their sense of support in comparison with others. Describe how they perceived "good work", i.e. both the healthy and socially responsible work, and whether there was a difference between their ideal and their reality. Analyse patterns in two aspects - the moral and the career aspects - of "good work" for dentists. In zooo, questionnaires were sent to all female unpromoted GPDs in the PDHS in a region of Sweden. The response rate was 94%. RESULTS: The dentists felt unwell, worse than other compared groups. There was little support from the management. There was little inter-colleague contact. There was no cross-sectional assciation between collegial neworks and support, but the qualitative investigation showed that collegial networks were perceived as positive. There was a great difference between ideal and reality concerning good work. The dentists felt a lack of influence, and this was the greatest difference of all. Three components of good work - "moral values and skill discretion", "career development" and "work environment" were found. The dentists emphasized the moral basis of their work, confirming the character of dentistry as primarily human service work. IN CONCLUSION: There were serious work environmental problems among these dentists. The dentists felt unwell and felt a great lack of influence on important decisions. There was little inter-colleague contact, but collegial networks were perceived as positive. There was little support from the management, indicating a clear weakness in the relations between employers and female unpromoted GPDs in the PDHS. Three components of good work were found, where the moral component was the most important but it also showed the greatest difference between ideal and reality. Thus, the dentists emphasized the moral basis of their work, confirming the character of dentistry as primarily human service work and not industrial work. The dentists with the highest level of commitment perceived the largest differences. The PDHS organization has therefore failed to convince or engage those whom it ought to engage, i.e. those with the greatest commitment. The way to improve the female unpromoted GPDs' work situation would be through increased influence and support, bridging the gap between ideal and reality.

Adult↗
PubMed1985

Changing patterns of attitudes and oral health behaviour.

In the past, dental diseases were extremely common in the Scandinavian populations and the tooth loss figures appalling. Developments during the last few decades have led to a high standard of living, a high dentist-population ratio, increased public economic support for dental care and preventive dental care programmes for children. These have contributed to a drastic decrease in caries frequency and severity among the younger groups. Data concerning changes in periodontal disease activity are sparse, but there are indications that more natural teeth are being retained longer. Since prevention and control of periodontal disease is highly dependent upon personal behaviour, investigations of what people know, think and do about the role of the individual in disease control are important to future strategies. This review indicates that the Scandinavian populations have a fair knowledge of dental diseases and the individual's own role in prevention. Most people know what constitutes appropriate daily oral hygiene practice but a gap between knowledge and actual performance is apparently quite common. There is evidence, however, that the frequency of toothbrushing is increasing; so is interdental cleaning, even though the present level is unsatisfactory. The frequency of dental visits is also increasing and it is predicted that more people with more teeth will seek dental care in the future. Regular dental care during childhood seems to be a strong predictor of dental visit patterns and dental health status later in life. The improvements in dental health habits and associated phenomena have resulted in the retention of more teeth in older subjects. This may mean more teeth at risk to periodontal disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Use of fissure sealants by dentists in private practice in Mexico City.

This paper presents findings on the use of pit and fissure sealants by dentists working in private practice in Mexico City. A total of 386 dentists participated in the study. Dentists working in high, middle, and low socioeconomic areas of the city were personally interviewed and their patients' records of the last 5 working days were reviewed. 45% of the dentists indicated that they used sealants and 10% used them during the 5 days studied. A greater proportion of recent dental graduates used sealants compared with older graduates. The dentists who utilized sealants were more likely to apply fluoride treatments in their practice than dentists who did not utilize sealants. The proportion of sealants in relation to all treatments provided was low (0.8%), and even lower in the low socioeconomic areas (0.02%). Considering the high dental caries experience of Mexican children, the use of dental sealants should be promoted by Mexico City dentists. In addition, school-based sealant programmes should be established, particularly in low socioeconomic areas.

Adolescent↗
PubMed2002

Patterns of oral care in a Washington State dental service population.

BACKGROUND: The authors compare patterns of oral health care reported by the Washington Dental Service, or WDS, Seattle, in 1993 and 1999 to assess changes in patient populations, practice characteristics, procedures and treatment costs in the state. METHODS: Data were obtained from dental benefits claims from a population of about 1.25 million people. Variables of interest included patient age and other demographic information, character of dental practice, dental procedures and treatment costs that combined WDS payment and patient copayment. RESULTS: The results showed high agreement (97 percent) between the database and randomly surveyed patient records. For both 1993 and 1999, general dental offices were responsible for more than 80 percent of patient care. Single crowns (21 percent), restorative services (15 percent) and dental prophylaxis (13 percent) made up about half of the costs of dental care. Broad categories of service were similar in 1993 and 1999, and anticipated major declines in restorative procedures related to caries were not apparent. The mix of services varied considerably by patient age and between generalists and specialists in both years. CONCLUSIONS: Patterns of oral health care among this insured patient population largely remained unchanged from 1993 to 1999, with some shifts in specific procedures and specialty care. During this period, dentists saw more patients and performed fewer treatments per patient, while total treatment costs per patient increased. CLINICAL IMPLICATIONS: Patterns of oral health care in the United States are projected to undergo major changes linked to improved oral health, declining trends in caries and periodontal diseases, scientific advances in treatment approaches and a patient population that is living longer. Changes in care patterns during this six-year period may reflect patient and provider preferences, as well as the influence of reimbursement policies. Dental benefits databases can serve as a critical resource for monitoring such changes.

Adolescent↗
PubMed2004

Trends in dental and allied dental education.

BACKGROUND: Educational programs play an important role in preparing a qualified dental work force. This article reviews the current status and trends in dental, advanced dental and allied dental education programs in the United States and examines their impact on the dental work force. OVERVIEW: This analysis focuses on survey data collected by the American Dental Association during the past 10 to 15 years and compares recent patterns in applications, enrollment and graduation with previous trends. The numbers of educational programs, applicants, enrollees and graduates have increased in dentistry, dental hygiene and dental assisting, while dental laboratory technology has declined in all measures. The proportion of women in dentistry has increased, while the ethnic profile of dental and allied personnel has shown little change. Both the cost of dental education and student debt continue to increase. CONCLUSIONS: Despite increases in the number of educational programs and overall numbers of graduates from dental and allied dental education programs, the proportion of underrepresented groups still lags behind their representation in the overall population, and the number of allied personnel falls short of practice needs. PRACTICE IMPLICATIONS: Patterns in applications, enrollment and graduation are important determinants of the dental and allied dental work force. The cost and funding of education significantly affect the attractiveness of dental careers and the sustainability of educational programs and should be monitored carefully by the profession.

Costs and Cost Analysis↗
PubMed1997

Study of psychosocial aspects of adult orthodontic treatment.

A semistandardized questionnaire was administered to adult orthodontic patients to gain insight into their motives for seeking treatment and their experience during treatment. The data collected from 60 patients aged 18 to 52 years were used for descriptive statistics and calculation of correlations. The results indicate that apart from objective and immediately comprehensible reasons for certain behavioral patterns, ideas influencing emotional life may have an important effect on attitudes toward treatment. The results may be useful for both initial consultation and patient management and guidance during treatment.

Adolescent↗
PubMed1994

Trends in work effort among private general dental practitioners.

Trends in the distribution and volume of dental services provide an empirical base upon which hypotheses on future service provision can be tested. The aim of this study was to examine changes in the distribution and volume of service provided in private general dental practice, and compare these with an existing conceptual model. A weighted, stratified random sample of Australian dentists was surveyed in 1983 (730 respondents, response rate 73 per cent) and 1988 (855 respondents, response rate 75 per cent). The data were weighted to provide population estimates for private general dental practitioners in 1983 and 1988. Service-mix data were converted to relative value units, a common scale based on work effort, and annual estimates of this work effort were calculated. Work effort was divided into low, medium and high level interventions. Medium level interventions comprised the greatest volume of work effort, followed closely by low level interventions, with high level interventions having the smallest volume. The pattern of work effort was in contrast to the conceptual model of service distribution, with low level interventions higher and high level interventions lower than expected. While there was a significant increase in work effort among high level interventions, there was no increase in work effort among low level interventions and no decrease in work effort among medium level interventions over the five year period 1983-88 as expected in the conceptual model for changing service provision.

Adult↗
PubMed1994

A survey of radiographic techniques and equipment used by a sample of general dental practitioners.

A study of radiographic practices of general dentists was conducted by mail survey. Eighty percent of 963 dentists returned completed questionnaires. All participants resided in the province of Ontario, Canada, and were graduates of either of the two provincial dental schools. Fewer than one third of radiographs were taken by the dentist with only 10% of dentists taking three fourths or more of the radiographs in their practices. There was infrequent use of E speed film (11%) and rectangular collimation (8%). Automatic processing was used by 93% of dentists. Although the overwhelming majority of dentists used a film holder, 2% still have the patient hold the film. The type of film holder used was affected by dental school experience, whereas the use of E speed film was not.

Filtration↗
PubMed1995

Identification of elderly in particular need: results of a survey undertaken in residential homes in the Manchester area.

OBJECTIVES: This paper aims to identify which groups of elderly people living in residential institutions are in particular need of dental care and advice. Comparison of different types of residential institution allows identification of elderly in greatest need of dental assistance. METHODS: A postal survey of carers in 250 residential homes for elderly people in Manchester, UK, was undertaken to determine the frequency of dental visits, arrangements for dental care of the residents' teeth and denture cleansing and appliance-wearing patterns and, also, the carers' knowledge and practice of simple dental and oral maintenance procedures for residents. Comparisons were undertaken using the SPSS software package of: social service and private homes, large and small homes, homes where regular visits were undertaken and those not regularly visited, and also homes which maintained records of their clients' dental state with those which did not. RESULTS: Residents' oral health tended to be more at risk in smaller or privately managed homes, in those where no dentist visited regularly and where no records of dental care were kept. CONCLUSION: The dental profession needs to especially target homes where care is less well organized, not only to examine and treat residents, but also to instruct carers in simple mouth care techniques, in order that dental disability in an increasingly dentate population can be minimized.

Aged↗
PubMed1996

The validity of spot urine samples for low-level occupational mercury exposure assessment and relationship to porphyrin and creatinine excretion rates.

Hg and porphyrin levels in single void urine specimens (spot samples) were compared with calculated 24-hr urine levels in 35 (20 [correction of 25] male and 15 female) practicing dentists who had been occupationally exposed to low levels of elemental Hg. The study aimed to: 1) determine the individual variability for Hg and porphyrin concentrations in spot samples over a 24-hr period; 2) test for the presence of diurnal variation in urinary Hg and porphyrin concentrations; and 3) determine the time of day at which a spot sample would give a Hg concentration closest to the 24-hr average concentration. Results confirmed previous reports of a first-order diurnal pattern with a mid-morning peak for Hg concentration (P < .001). A second-order model best described creatinine excretion (P = .0089), with peaks at about 5:00 and 19:00. The use of creatinine adjustment for Hg concentration significantly reduced the intraindividual variation around the diurnal curve. No diurnal patterns were found for any of the porphyrins examined. We recommend that, for small clinical studies using urinary Hg concentration, 24-hr sampling would be ideal, but that for mass screenings and cross-sectional studies, spot samples may be useful because they correlate fairly well with 24-hr averages (creatinine adjusted, r = 0.61; unadjusted, r = 0.74). Because of the existence of diurnal variation, for all cases using serial sampling attention should be paid to time of day.

Adult↗
PubMed1990

Voluntarily informing others of positive HIV test results: patterns of notification by infected gay men.

Forty gay men who had recently learned that they were infected with human immunodeficiency virus (HIV) were interviewed to determine the frequency with which they voluntarily informed physicians, dentists, friends, family members, and current and past sexual partners of their positive test results. Ninety percent of the subjects informed a personal physician, and 48 percent of the subjects who sought dental care informed the dentist. Sixty-six percent of subjects with at least one current sexual partner notified every current sexual partner, although notification was not associated with a greater likelihood of safer sex practices. Ninety percent of the subjects who had past sexual partners made no attempt to inform them. Sixty-eight percent confided in at least one friend, but only 35 percent told a family member.

AIDS Serodiagnosis↗
PubMed1995

Changing patterns of dental disease and the implications for dental practice.

Changing disease patterns is one of the effects on dental practice. Although the amount of simple treatment is declining, the amount of complex treatment required is increasing. Important social changes influencing dental practice include the gross inequalities in oral health that are seen in New Zealand. Regional health authorities are the bodies which will have to assess the need for treatment and allocate funding, but private practitioners will have the opportunity to enter into contracts with purchasing bodies to provide care. In comparison with other countries, the number of dentists in New Zealand is correct provided fluoridation and the School Dental Service continue.

Adolescent↗
PubMed1997

Oral health habits and the number of teeth present in Japanese aged 50-80 years.

OBJECTIVE: To suggest appropriate oral health habits for daily practice in order to prevent tooth loss. DESIGN: Cross sectional study correlating mean number of teeth and oral health habits. SETTING: All 97 dental clinics in an urban area (population 256,000) in Osaka Prefecture, Japan. SUBJECTS: 1,248 persons aged 50-80 who received dental treatment at any of the dental clinics between 10 January and 7 February, 1992. OUTCOME MEASURES: The number of teeth present was recorded by the dentists in their clinics. The subjects were asked to complete questionnaires on oral health habits, prior dental attendance patterns and the perceived general health status. RESULTS: Mean number of teeth present had a significant relationship with perceived health status. Implementation of particular oral health habits, such as using a toothbrush with nylon tufts and hard tufts, changing the toothbrush within three months, receiving tooth brushing instruction, scaling, and prompt dental treatment were related positively to the number of teeth present. Furthermore, the frequency of dental visits in the past showed an inverse relationship with the mean number of teeth present. This result does not necessarily mean, however, that regular dental visits are undesirable. From multiple regression, the mean number of teeth was calculated to be from 27.9 to 16.9 at 50 years of age and from 12.2 to 3.0 at 80 years of age in relation to oral health habits. CONCLUSIONS: To keep more teeth in the later years, it is evident that prevention of dental disease in earlier life is essential, and that individuals should receive prophylactic treatment, and maintain proper tooth brushing habits throughout life.

Age Factors↗
PubMed1997

An assessment of capitation in the General Dental Service contract 2. Patterns of treatment provided to regularly attending patients.

OBJECTIVE: To compare the patterns of treatment of general dental practitioners working under fee-for-service in 1987/88 with those working under capitation in 1992/93. DESIGN: 73 randomly selected general dental practitioners working under capitation in three contrasting areas in England retrospectively recorded the treatment provided during 1992/93 to a random selection of their regularly attending 6-12- and 14-15-year-old patients. RESULTS: Mean numbers of examinations per year reduced in the three areas from 1.7-1.8 in 1987/88 to 1.2-1.4 in 1992/93. Mean numbers of visits per patient dropped from 2.5-2.9 to 1.8-2.2. Mean numbers of fillings in permanent teeth reduced from 0.15-1.04 to 0.09-0.52 and in deciduous teeth from 0.28-0.53 to 0.24-0.31. Mean percentages of children per dentist having extractions fell from 9.3-28.1% to 4.7-16.2% while the radiographs reduced from 14.0-9.0% to 6.0-10.6%. Mean percentages of children per dentist receiving oral hygiene instruction rose from 18-31% in 1987/88 to 26-33% in 1992/93. Dietary advice increased from 3-18% to 11-20% and fissure sealants from 3-6% to 3-12%. CONCLUSIONS: In 1992/93, dentists working under capitation were carrying out fewer examinations, fillings and extractions and were taking fewer radiographs for their regularly attending child and adolescent patients than dentists working under fee-for-service in 1987/88. These patients also attended less frequently for treatment but received marginally more preventive care and advice.

Adolescent↗
PubMed1995

Prevention and detection of oral cancer: the views of primary care dentists in Northern Ireland.

Our objective was to describe the management of oral cancer and pre-cancer as stated by primary care dentists and their views on screening. We conducted a survey of all general dental practitioners and community dentists in Northern Ireland (n = 635), to which 428 replied (response rate: 67%). 94% stated that examination of the oral soft tissues constituted part of their usual practice during the regular dental check-up. Suspicious lesions were generally referred early, 68.5% of dentists referring white lesions within one month of presentation. The corresponding figures for red lesions, lumps and persistent ulcers were 80.1%, 89.7% and 91.7%. The incidence of oral cancer was over-estimated (median '70' cases/year, versus the true figure of approximately 40/year) as, in all likelihood, was the percentage by which mortality could be reduced by screening (median: 50%). Accordingly the adoption of a screening programme was favoured over investment in health promotion. Indeed, only 14% said that their patients records routinely contained information about smoking or alcohol habits. Although there are some areas of practice which could improve and the potential of screening is probably over-valued, primary care dentists in Northern Ireland already opportunistically screen and refer patients promptly.

Alcohol Drinking↗
PubMed1996

Relationships between clinician variability and radiographic guidelines.

This study evaluated the replicability of clinical measurements under careful calibration of multiple dentists and how the replicability can relate to their use as selection criteria in guidelines for prescribing dental radiographs. For 48 consenting patients, three dentists clinically examined each patient and recorded the presence of all clinical findings using standardized selection criteria. The examinations were performed independently of each other, but with periodic conferences of the dentists to clarify general measurement criteria. The degree of agreement among the dentists is described by the interrater agreement kappa for several standard clinical indications such as rating of caries, periodontal disease, and tooth mobility. Almost perfect agreement was obtained for tooth status, restoration size, and restoration material. Moderate agreement resulted for measures of caries, defective restoration presence, and gingival recession presence. Only fair agreement was obtained for other periodontal disease measures. The relationship between extent of agreement and guidelines' results was examined for the FDA Guidelines. The differences among the dentists' clinical measurements resulted in considerable differences among the radiographs that were selected by the FDA Guidelines' criteria. Even so, the missed disease rates for 490 patients in a larger study of the FDA Guidelines' efficacy were very low and did not vary greatly among the three dentists. We conclude that guidelines' criteria can be quite robust to variation from dentists' clinical measurement differences, as seen from the FDA Guidelines applied under the idealized setting where the dentists are periodically recalibrated through group discussions of the clinical measurements' definitions and interpretations.

Adolescent↗
PubMed2002

Ethics: how the Apothecaries Act of 1815 shaped the dental profession. Part 1. The Apothecaries and the emergence of the profession of dentistry.

The Apothecaries Act of 1815, (revised by the Act of 1825) has been credited with being the most important forward step in the education of the general medical profession in the nineteenth century, although a closely argued revisionist view of its significance by S W F Holloway makes clear his view that it was also a successful and deeply reactionary political move by the physicians to emasculate a rival group growing rapidly in numbers and power. This paper demonstrates that the Act also created a distance between the true dentists and others, like the chemists and druggists, who carried out dental functions. By so doing the Act defined the social identity of the profession of dentistry, in its numbers, status, nineteenth century reform and pattern of education. The paper proposes the apothecary/general medical practitioner as a social as well as ethical role model for the general dental practitioner.

Ethics, Dental↗