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PubMed1995

Factors contributing to mercury exposure in dentists.

Although mercury exposure levels among dentists have been steadily decreasing, occupational mercury exposure among dental professionals continues to be a matter of interest. This study examined personal professional and office characteristics of dentists to determine which factors contribute most to exposure. The resulting information will help dental professionals change their practices to minimize unnecessary exposure to elemental mercury.

Accidents, Occupational↗
PubMed2001

Tobacco use among adults--Arizona, 1996 and 1999.

In 1994, Arizona passed the Tobacco Tax and Healthcare Act (Proposition 200) that increased the tax on cigarettes from $0.18 to $0.58, and allocated 23% of the resulting revenues to tobacco-control activities. Since 1995, Arizona has used the tobacco-control funds (approximately $30 million per year) to support the Arizona Department of Health Services (ADHS) Tobacco Education and Prevention Program (TEPP), a comprehensive program to prevent and reduce tobacco use. To track changes in tobacco use, the knowledge and opinions of Arizona residents about tobacco use, and the proportion of smokers advised to quit smoking by health-care providers, ADHS conducted the Arizona Adult Tobacco Survey (ATS) in 1996 and a follow-up survey in 1999. This report compares results of these two surveys, which indicate that prevalence of tobacco use among adults decreased, and the proportion of adults who were both asked about tobacco use and advised to quit by health-care providers and dentists increased. On the basis of these findings, if all states implemented comprehensive programs similar to those in Arizona, the national health objective for 2010 of reducing the adult smoking rate by half during this decade could be achieved.

Adult↗
PubMed1993

Ontario dentists: 2. Bitewing utilization and restorative treatment decisions.

Guidelines for the selection of patients requiring radiological examination have recently been published in Canada and the United States. The purpose of this paper, the second in a three-part series on the results of a questionnaire to Ontario general practitioners, is to compare bitewing use in Ontario against the U.S. guidelines. This questionnaire determined the frequency of recall bitewing examination for low and high caries risk patients, as well as the factors that influence the diagnostic and treatment decisions of the responding dentists. For example, 49 to 78 per cent of dentists order recall bitewings--in accordance with U.S. guidelines--for their patients in individual low caries risk categories. Similarly, 49 to 88 per cent of dentists order recall bitewings for individual patients in high caries risk categories, which is also consistent with the U.S. guidelines. However, across all low and high caries risk groups of patients, the percentages of dentists who followed the recommended guidelines were 34 and 15 per cent, respectively. The responding dentists' estimates of the length of time required for caries to progress through enamel are indirectly associated with the interval prescribed for recall bitewing examination.

Adolescent↗
PubMed1993

Referral patterns of dentists: transference-countertransference.

The doctor-patient, doctor-doctor dental relationships are discussed from the viewpoint of transference-countertransference psychodynamics. The dental referral process is a triad of patient, general practitioner and specialist and, in many ways, is dependent upon Freud's concept of transference-countertransference. The unconscious distortions of this process may affect the patient's treatment as well as the interpersonal and intraprofessional relationships.

Countertransference↗
PubMed2007

Verifiable CPD paper: factors that influence the dental attendance pattern and maintenance of oral health for people with multiple sclerosis.

OBJECTIVE: To determine the impact of multiple sclerosis (MS) on patient attendance at dental practices and maintenance of oral health. DESIGN: A cross-sectional postal questionnaire-based study. SETTING: Leicestershire, United Kingdom. SUBJECTS AND METHODS: People with MS in Leicestershire identified from local health authority records (n = 476). MAIN OUTCOME MEASURES: Number registered at dental practice, frequency of attendance, issues and perspectives relating to attendance and maintenance of oral health. RESULTS: A response rate of 61% (n = 289) was obtained. When compared to the general population, a higher number of people with MS were registered with a dentist (49%:88%) and displayed more frequent practice attendance (71%:81%) in the past year. People with MS reported difficulties in attending a dentist and maintaining oral health, which were exacerbated by deterioration in general health. Problems relating to reduced personal mobility had the greatest impact on attendance. CONCLUSIONS: MS has a negative impact on perceived patient attendance and maintenance of oral health. Patients with a progressive disability could benefit greatly from the provision of preventive oral health care. The importance of seeking care earlier rather than later needs to be emphasised to both professionals and patients alike. Further efforts are required to increase awareness of the importance of oral health to the quality of life of people with MS and ensure that individuals with physical disabilities receive the same access to dental services as the able-bodied.

Architectural Accessibility↗
PubMed1992

Provider compliance with recommended dietary fluoride supplement protocol.

Proper dosage of dietary fluoride supplements is important for children without access to optimally fluoridated water to balance dental caries prevention and risks of dental fluorosis. Subsequent to water fluoride assay, compliance by physicians and dentists with the recommended dietary fluoride supplement dosage schedule was determined for 446 children. Approximately one third of child patients and 42% of siblings did not receive the recommended supplement dosage.

Adolescent↗
PubMed1997

Insurance status and provision of dental services in Australian private general practice.

Annual expenditure on dental care in Australia amounts to AUD 1.9 billion. Approximately one-third of this expenditure involves private dental insurance, yet little is known about the impact of insurance on the provision of services. The aim of this analysis was to examine differences in dental service provision between insured and non-insured patients. Data collected from a random sample of dentists from a survey conducted in 1993-94 were used, providing 817 responses (response rate 74%). Logistic regression analysis controlling for patient age and sex and reason for visit indicated that in private general practice insured patients were more likely to receive preventive (OR = 1.37), crown and bridge (OR = 2.25), and endodontic services (OR = 1.27), but less likely to receive extraction services (OR = 0.52). However, no significant differences by insurance status were found for diagnostic, restorative, or prosthodontic services in the multivariate models. These differences in service provision by insurance status indicate a more favorable pattern of services for insured patients, and point to equity issues in the provision of services.

Adolescent↗
PubMed1995

Prevention of bacterial endocarditis in Germany.

The goal of this study was to assess the current practice of endocarditis prophylaxis in Germany. We conducted a survey using a standardized questionnaire, which was sent to 100 hospital cardiologists, to 430 cardiologists in office practice and to 389 dentists and oral surgeons. In addition, 364 patients with valvular or congenital heart disease were interviewed in our outpatient clinic. Seventy five percent of cardiologists informed their patients by both written and oral instructions. Half recommended the use of penicillin, according to the German Society of Cardiology, while the rest followed recommendations of other societies. Sixty-three percent of patients who had undergone a procedure requiring prophylaxis against bacterial endocarditis within the year prior to the questionnaire, had actually received it. This is higher than previously reported, but is far from acceptable. The indications for prevention of endocarditis, as seen by the dentists, deviated markedly from official recommendations. Although 77% administered antibiotics themselves, in only 57% did the type of prophylaxis applied correspond to one of the available recommendations. Recommendations on the prevention of bacterial endocarditis are not well known dentists and oral surgeons who perform procedures for which it is indicated. Further patient- and physician-oriented strategies are urgently needed to improve compliance with prevention of endocarditis in Germany.

Anti-Bacterial Agents↗
PubMed1998

Factors associated with Mexico City dentists' willingness to treat AIDS/HIV-positive patients.

OBJECTIVE: The purpose of this study was to investigate the characteristics and infection control practices of dentists in Mexico City in relation to their willingness to treat AIDS/HIV-positive patients. STUDY DESIGN: The population study encompassed Mexico City dentists who were selected according to a geographic criterion. A questionnaire was delivered personally to each participant, and multiple logistic regression was used for data analysis. RESULTS: A total of 598 dentists participated in the study. The response rate was 99.3% (598/602). Seventy-four percent (444) of the dentists said they would be willing to treat AIDS/HIV-positive patients. Among the variables associated with the prediction of willingness to treat these patients were glove-wearing patterns (odds ratio, 2.39; confidence interval, 1.4-4.2), types of available sterilization equipment (odds ratio = 2.42; confidence interval, 1.4-4.1), fear of losing non-AIDS/HIV-positive patients (odds ratio = 4.28; confidence interval, 2.3-8.4), and risk perception of HIV transmission (odds ratio = 2.66; confidence interval, 1.5-4.9). An interaction was found between perception of risk of HIV transmission and increase in costs (odds ratio = 3.35; confidence interval, 1.3-8.9). CONCLUSIONS: Approximately 26% of the Mexico City dentists included in the study were not willing to treat AIDS/HIV-positive patients. Educational programs aimed at misperceptions appear to be warranted.

Acquired Immunodeficiency Syndrome↗
PubMed1995

General dentists' patterns of restoring endodontically treated teeth.

The manner in which endodontically treated teeth are restored influences tooth longevity and the cost of treatment. This article describes a study of how surveyed general dentists restored endodontically treated teeth and whether their methods were consistent with those suggested in the literature. Some patterns of restoration did reflect the literature's recommendations, but overall the findings call into question some of the ways in which post-endodontic restorative care is carried out.

Composite Resins↗
PubMed2006

The ethical and practical aspects of acceptance and universal patient acceptance.

"Acceptance" is an often presupposed, hidden core value and ethic focused on how dental and other health practitioners first accept people as possible patients. The three basic styles of patient acceptance are random, selective, and universal. Reduced public access to care results from the practice of random and selective acceptance. Only universal acceptance creates a potential pathway for improved access to care. The notion of Universal Patient Acceptance (UPA) is discussed here as one kind of applied ethical tool or clinical practice that allows for the ethic of acceptance to be more effectively pursued in daily practice. We suggest that health providers falsely surmise that they already understand and practice Universal Patient Acceptance. That myth and perspective are partly what keeps Acceptance hidden as an ethic and overlooked as a potential way to foster dialogue and indirectly promote better access to care. Without Universal Patient Acceptance, dental and health providers will continue to silently engage in practice patterns that adversely affect public access to care. The actual benefits of Universal Patient Acceptance are the subject of ongoing review and debate. Whatever those benefits might be will not likely be realized until Acceptance and Universal Patient Acceptance are included as part of dental and other health professional codes of ethics and training curricula. That is what we argue for here.

Codes of Ethics↗
PubMed1986

Dentist use patterns for pit and fissure sealants and topical fluorides.

A survey of 2,800 general dentists from six licensing regions was conducted to determine the current rate of pit and fissure sealants and topical fluoride use. The response rate was 56 percent. Seventy percent of general dentists used sealants on newly erupted secondary teeth and 20 percent of general dentists had never used sealants. Sixty-five percent of general dentists used topical fluorides on pedodontic patients at six-months intervals and 25 percent used them at one-year intervals. Dentists with more frequent use of sealants tended to be recent graduates who used new procedures, spent more practice time in pedodontics, came from the central region, had a hygienist in their practice, and belonged to the Academy of General Dentistry. Dentists with more frequent use of topical fluorides tended to perform frequent recall examinations. Those who performed frequent recall examinations were more likely to come from Florida and the Southeast, to believe caries spread rapidly, to be recent graduates, and to have a greater percentage of patients with insurance.

Adolescent↗
PubMed1996

Orthodontic services provided by general dentists.

A survey was mailed to a stratified random sample of general dentists to determine the amount and nature of orthodontic treatment provided by general practitioners to their patients. The response to the survey was 75%, a rate considered excellent for this type of mailing. A large majority of the responding dentists (76.3%) provide orthodontic services to their patients, with 19.3% providing comprehensive orthodontic treatment. The percentage of time spent providing orthodontic services varied greatly among general dentists, with only a very few practitioners spending more than 50%. The number of patients under active treatment also varied widely, with only about 17% of those practitioners providing comprehensive treatment having more than 50 patients. A comparison of the three groups of practitioners showed that there was no relationship between the level of orthodontic involvement (none, limited, comprehensive) and the number of miles from orthodontic specialist or the pattern of referrals to orthodontists. Extrapolation of data from this study to the results of other investigations led to an estimate of the relative percentage of treatment provided by orthodontic specialists, pediatric dentists, and general practitioners. Almost two thirds of orthodontic patients are treated by orthodontic specialists, with pediatric dentists treating less than 4%. Slightly less than one third of all orthodontic patients appear to receive treatment from general practitioners.

Comprehensive Dental Care↗
PubMed1994

Continuing education for dental practitioners.

Attendance of continuing education courses by dentists is important for the practitioner, the profession and the patient. This survey was undertaken to determine the attendance pattern and discipline preferences for such courses during the period 1985 to 1989. A total of 2674 questionnaires were sent to dentists and 706 (26.4 per cent) were returned. Courses were attended by 88.5 per cent of the respondents. The most popular disciplines were Operative Dentistry, Aesthetic Dentistry and Fixed Prosthodontics.

Curriculum↗
PubMed1996

Dentists' variability in restorative decisions, microscopic and radiographic caries depth.

Restorative and dental caries depth decisions were recorded for 5168 un restored approximal tooth surfaces by 17 dentists who worked in the school dental clinics of the North York (Ontario) Public Health Department. Each dentist examined 15 pairs of experimental bitewing radiographs for which true caries depth had previously been determined by microscopy of the sectioned teeth following production of the radiographs. The dentists independently recorded their restorative decisions and radiographic caries depth perceptions. The relationship between the variation in the dentists' restorative decisions and their perceptions of caries depth based on a re-reading of the bitewings on the one hand, and true caries depth on the other was also examined. The percentages of total variability in each dentist's restorative decisions attributable to radiographic and to microscopic caries depth were estimated using regression analyses. Large variations were found among the 17 dentists' distributions of overall restorative and depth decisions. The relationship between microscopic caries depth and the dentists' restorative decisions was, understandably, less strong than that of the dentists radiographic perceptions of caries depth and restorative decisions. Relative to true caries depth, high numbers of false positive and false negative restorative decisions were made. Overall, 50% of the variability in the dentists' restorative decisions was explained by the perceptions of radiographic caries depth; however, among individual dentists, the range was from 29% for one dentist to 69% for another. A much lower percentage of the overall restorative variation was explained by microscopic depth, 18%. Like the finding of the only two previous European studies that quantified the role of radiographs on clinical decisions, this study demonstrated that dentists' perceptions of dental caries depth using bitewing radiographs play a major but variable role in their restorative decisions for approximal tooth surfaces.

Clinical Competence↗
PubMed1987

Head angulation and variations in the maxillomandibular relationship. Part II: The effects on facial contour and lip support.

Twelve edentulous patients were evaluated for changes in facial contour and lip support when the head was progressively tilted backward. The mandibular facial contour changes did not occur in a progressive cause and effect type of relationship. A trend pattern could not be discerned. The maxillary facial contour did have a significant progressive cause and effect relationship in two of the 12 patients and was a positive relationship. As the angles were increased, the displacement of the maxillary facial contour increased anteriorly. The question as to why the maxillary facial contour had a significant progressive cause-and-effect relationship in two of the 12 patients and the mandibular facial contour did not remain unresolved. In a practical sense, it seems reasonable to establish the maxillomandibular relationship with the patient in a comfortable position. This and the ease of recording by the dentist are the primary considerations.

Adult↗
PubMed1999

Oral health of children in South Australia by socio-demographic characteristics and choice of provider.

UNLABELLED: Australia has a highly developed school dental program for providing dental care to schoolchildren which operates alongside well-established private practice delivery of dental care. While free school-based dental care has high utilisation where offered, little is known about the oral health outcomes of groups of children across different providers of dental care, or patterns of service use. This paper investigates the effects of socio-demographic characteristics and choice of dental provider on oral health amongst a random sample of secondary school students residing in Adelaide, South Australia. OBJECTIVES: To describe the oral health of children by different dental provider groups, to describe the association of socio-demographic characteristics with oral health outcomes; and to describe the differences in oral health that remained after controlling for socio-demographic confounding, by dental provider group. METHODS: The study included metropolitan Adelaide schoolchildren from Year 9 and 10 school grades (n = 373). RESULTS: Children who received care from the School Dental Service (SDS) and from both the SDS and private dentists (Mixed) had significantly lower caries experience (DMFS) than children who received care from private dentists (Private) or who had not received any care for at least 2 years (No Recent Care). There were differences in the socio-demographic characteristics between children who used different dental providers, and these socio-demographic characteristics were significantly associated with levels of decayed, missing and filled surfaces and surfaces which had been fissure sealed. After controlling for socio-demographic characteristics using multiple regression, significant differences were seen in mean caries experience (DMFS) and mean numbers of decayed surfaces and filled surfaces. CONCLUSION: Although from less advantaged backgrounds, children seen through the SDS had more favourable oral health outcomes than children seen by a private dentist.

Adolescent↗
PubMed1995

The provision of orthodontic services by general dental practitioners. 2. Factors influencing variation in service provision.

Previous work has shown that variations exist amongst general dental practitioners in the volume and type of orthodontic services provided, the type of orthodontic appliances used, and the objectives of the orthodontic treatment. The aims of this survey were to identify practitioner characteristics that account for variations in the level of orthodontic services provided and which distinguish providers and non-providers of orthodontic services. Multiple regression analysis revealed that four practitioner characteristics explained 41 per cent of the variance in the number of orthodontic patients treated. Dentists who treated more orthodontic patients: 1) treated more general practice patients; 2) frequently used multiple sources to keep up to date in orthodontics; 3) perceived their patient base to contain more children; and 4) were likely to have attended a Truitt course. Eleven variables best distinguished providers from non-providers of orthodontic treatment; 1, 2 and 3 above had the highest correlation with the discriminant function. The Null Hypothesis that selected characteristics of dentists providing orthodontic services were no different from those of dentists not providing orthodontic services was rejected. The provision of orthodontic services was associated with a higher level of continuing orthodontic education as well as treating more general practice patients, especially children.

Adult↗