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PubMed2003

Michigan Medicaid's Healthy Kids Dental program: an assessment of the first 12 months.

BACKGROUND: In 2000, Michigan's Medicaid dental program initiated Healthy Kids Dental, or HKD, a demonstration program offering dental coverage to Medicaid-enrolled children in selected counties. The program was administered through a private dental carrier at private reimbursement levels. The authors undertook a study to determine the effect of these changes. METHODS: The authors obtained enrollment and utilization data for four groups: children covered in the first 12 months of HKD in 22 counties, children with private dental coverage in the same 22 counties in the same 12 months, Medicaid-enrolled children in the same 22 counties for 12 prior months, and Medicaid-enrolled children in 46 counties who were not included in the HKD program at any time. The authors compared access to care, dentists' participation, treatment patterns, patient travel distances and program cost. RESULTS: Under HKD, dental care utilization increased 31.4 percent overall and 39 percent among children continuously enrolled for 12 months, compared with the previous year under Medicaid. Dentists' participation increased substantially, and the distance traveled by patients for appointments was cut in half. Costs were 2.5 times higher, attributable to more children's receiving care, the mix of services shifting to more comprehensive care and payment at customary reimbursement levels. CONCLUSIONS: By increasing reimbursement levels and streamlining administration, the HKD demonstration program has shown that substantial improvements can be made to dental access for the Medicaid-enrolled population. PRACTICE IMPLICATIONS: The findings of this assessment suggest that appropriate attention to administration and payment levels can rapidly improve access for Medicaid-enrolled patients using existing dental personnel. By cooperating with state officials to design a program that addresses multiple issues, dental providers can help create a Medicaid dental program that is attractive to both providers and patients.

Adolescent↗
PubMed2006

Continuity of care and the European working time directive: a maxillofacial perspective.

The European Working Time Directive (EWTD) was introduced in 1993 and was heralded as both a challenge and an opportunity for the NHS to modernize its services Continuity of care is usually viewed as the ongoing relationship between a patient and a single practitioner. Fragmentation of this continuity by many doctors being involved in a patient's management may weaken this relationship. The effect of the EWTD on junior doctors training in various specialities is well studied, we however were interested to assess the effect of the EWTD on the patient-doctor relationship in a maxillofacial setting and aimed for this paper to serve as an indicator of current practice and facilitate future research in this area. Seventy-five consecutive patients were studied with 72 patient proformas analysed. Our findings show greater same consultant patient contact than that of the specialist registrars and senior house officers. We feel that this is largely due to new work patterns introduced through the advent of the EWTD.

Consultants↗
PubMed2006

Knowledge of oral health professionals of treatment of avulsed teeth.

The management and immediate treatment of an avulsed permanent tooth will determine the long-term survival of the tooth. The aim of this study was to evaluate the knowledge of oral health professionals on the new guidelines for emergency treatment of avulsed teeth. A 12-item questionnaire was distributed among general dentists, specialists, dental hygienists and dental assistants attending Continuing Education courses at the School of Dentistry, University of Southern California, between 2003 and 2004. This study reports only on the general practitioners who comprised 83% of the participants. The results revealed an uneven pattern of knowledge among them regarding the emergency management of an avulsed tooth. Statistically significant associations were related to the participants' previous dental trauma education and their age. In conclusion, there is a need to improve the knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth.

Adult↗
PubMed1992

Endodontic case selection: to treat or to refer.

Endodontic treatment in the United States is delivered primarily by general dentists. A dilemma often arises as to which cases should be treated and which should be referred for specialty care. The case selection system described here rates endodontic cases so that practitioners can assess those cases they are best qualified to treat.

Anesthesia, Dental↗
PubMedDate not supplied

Are dental practices less productive with older patients? Comparison of alternative output measures.

This study assessed the effects of increased visits by older dental patients on alternative measures of time- and dollar-based practice productivity. The Minnesota Dental Practice Analysis System was used for analysis of data from 31 practices (12,818 patients visits) reporting increased visits by older adults between June, 1980, and December, 1984. Results suggested that the productivity effects associated with older patient visits were highly dependent on the practice output measure selected. While increased visits by patients aged 70 and over were associated with increased monetary productivity per patient visit, time and monetary productivity per practice day were found to decline. An association between increased proportions of older patients visits and increased dentist minutes per visit appeared to account for this. This econometric analysis tends to support the notion that dental practices are less productive with older patients.

Adolescent↗
PubMed1993

Ontario dentists: 3. Radiographs prescribed in general practice.

In February 1991, a mail survey was used to poll a sample consisting of about 10 per cent of Ontario's general dentists. The data obtained provided information about the radiographs prescribed by dentists for five different patient types, which were described to the respondents. The per cent agreement between the radiographic procedures prescribed by Ontario dentists and the ADA-approved Center for Devices and Radiological Health (CDRH) guidelines ranged from three per cent to 79 per cent, depending on patient type and disease risk. For each patient and risk type, there was considerable variation in the radiographs prescribed.

Adult↗
PubMed1994

Ontario dentists: practice variation in referrals to pediatric dentists.

Variations in the pediatric referral practices of general dentists for children aged zero to 14 years may be related to issues concerning quality and standards of care, cost containment, and predictability in third-party payment programs. In September 1992, a survey mailed to a random sample of approximately 10 per cent of Ontario general dentists was used to gather information about pediatric referral practices as well as economic and demographic factors associated with these practices. Responses were received from 381 of the 540 dentists surveyed (69 per cent). Most dentists who gave reasons for pediatric referrals (85.6 per cent) named behavior management problems as the primary cause. However, 21.5 per cent did not refer any children under 14 to pediatric dentists. Due to the variable results obtained using assorted statistical tests to regrade the outcomes of interest, the self-reported nature of the data, and the large amount of pediatric referral practice variation left unexplained by the multivariate analysis (95 per cent), this study's findings are equivocal.

Adolescent↗
PubMed1999

Digital radiography in dentistry: what it should do for you.

Digital radiology will become an important part of dental practice. Manufacturers should develop more sophisticated tools, including software for digital subtraction; image processing routines for the diagnosis of caries, periodontitis and periapical disease; tools for three-dimensional viewing of the teeth and supporting structures; and analysis of bone trabecular pattern for early detection of systemic disease. Hardware improvements should include increased dynamic range and sensitivity to radiation, and improved resolution. Sensors should be made the size of film, and components should be interchangeable across manufacturers. The true opportunity offered by digital imaging, computer-aided diagnosis, should continue to develop with particular attention to development of tools that add value for solving diagnostic problems and ease of use for the dentist and patient.

Dental Equipment↗
PubMedDate not supplied

Children's first dental visit: attitudes and practices of US pediatricans and family physicians.

PURPOSE: The aim of the present study was to survey the recommendations and practices regarding the first dental visit by young children, as reported by family physicians and pediatricians in the United States. METHODS: A representative sample of family physicians and pediatricians was surveyed in the year 2000. The initial survey was mailed out to 1,500 family physicians and 1,000 pediatricians who were selected from the AMA Masterfile. After the first mailing, 3 follow-up questionnaires and a postcard reminder were mailed to the nonresponders within a period of 3 months. The questionnaire described case scenarios of 2, 12-month-old children, one with low caries-risk and the other at high risk with noticeable cavitation of the maxillary front teeth. RESULTS: The response rate to the survey was 43% (622 out of 1,439) for family physicians and 52% (493 out of 957) for pediatricians. When the case scenario of a child with high caries risk was presented, more than 90% of the respondents recommended that the child see a dentist as soon as possible. For the child with low caries-risk, the proportion of respondents recommending early dental visit was significantly lower: only about 19% of family physicians and 14% of pediatricians. For a child at low risk for dental caries, about 40% of family physicians and 63% of pediatricians recommended the first dental visit around the third birthday. The majority of the respondents (pediatricians=91% and family physicians=77%) reported frequent screening for gross tooth decay. However, only a minority of them (pediatricians=33% and family physicians=19%) frequently checked for early signs of tooth decay as part of their regular practice. CONCLUSIONS: US physicians can decide on referral patterns based on the risk status of a child. However, the majority of respondents do not regularly screen for early signs of early childhood caries.

Age Factors↗
PubMed2000

An exploratory qualitative study examining the social and psychological processes involved in regular dental attendance.

OBJECTIVE: This study aimed to provide a description of the psychosocial process involved in regular dental attendance. METHODS: The study design was a qualitative cross-sectional study using unstructured and semistructured interviews and observations of regular dental visits. The study participants included 12 men and 18 women attending general dental practices and six men and four women attending an emergency dental service. The data were systematically recorded and subjected to line-by-line grounded theory coding around the main concerns of those attending the dentist. RESULTS: The main concern of those attending for a regular dental visit was checking their oral health. The six-month recall was conceptualized as a checking cycle in six phases: recalling, responding, inducing (i), waiting, inducing (ii), and telling. The possible outcomes of the cycle were maintaining oral health, sustaining oral health, and a further checking cycle. Variations in checking cycles resulted from reordering and normalizing pressures within participants' lifestyles. CONCLUSIONS: The findings of this study suggest that people's patterns of dental attendance are similar to those of other chronic illnesses. An understanding of the dynamic psychosocial processes involved in frequent dental attendance may be achieved when further research into this phenomenon is conducted.

Appointments and Schedules↗
PubMed1990

[Referral pattern of patients with oral mucosal lesions].

The referral pattern was examined in 140 patients with oral mucosal lesions, who were referred to the department of Oral and Maxillofacial Surgery of the Free University Hospital, Amsterdam. It was shown, that dentists were consulted as often as general physicians. Furthermore, the study demonstrated that general physicians referred patients with oral mucosal lesions frequently to other medical specialists, rather than to the dentist or the oral and maxillofacial surgeon.

Adult↗
PubMed1992

Signature pattern analysis: a method for assessing viral sequence relatedness.

Signature pattern analysis identifies particular sites in amino acid or nucleic acid alignments of variable sequences that are distinctly representative of a query set of sequences relative to a background set. We explore the merits of using signature patterns for analysis of HIV-1 (human immunodeficiency virus type 1) sequences in cases of epidemiological linkage and potential superinfection. For these purposes, query sets are viral sequences that are all derived from one HIV-1 infected individual, hence the signature pattern is the array of sites that are characteristic of the range of viral variants obtained from that person. Once a signature pattern has been objectively defined, it can be used to examine other viral sequences from other individuals for evidence of genetic relatedness. A computer program to facilitate this analysis, VESPA, is described and applied to sequence data gathered during the investigation of HIV-1 transmission in a dental practice. The implications of signature polymorphisms seen within an infected individual, and shared polymorphisms between linked individuals, are also considered. VESPA may also be applied to the molecular analysis of biological phenotypes.

Amino Acid Sequence↗
PubMed1996

Removable prosthodontics: a survey of practices and attitudes among South Australian dentists.

All dentists registered in South Australia were surveyed in July 1993 in relation to removable prosthodontics. The replies indicated that removable prosthodontics constituted a significant part of most dental practices. Most dentists felt that removable prosthodontics should be an essential part of the undergraduate curriculum. They felt that more expertise is now required to manage the treatment of the ageing population with either their first or replacement removable prostheses. The majority of dentists felt that their own undergraduate training had equipped them well to manage removable prosthodontic treatment for their patients; however, many helpful suggestions were made on areas that they thought required more emphasis.

Adult↗
PubMed1992

Molecular epidemiology of HIV transmission in a dental practice.

Human immunodeficiency virus type 1 (HIV-1) transmission from infected patients to health-care workers has been well documented, but transmission from an infected health-care worker to a patient has not been reported. After identification of an acquired immunodeficiency syndrome (AIDS) patient who had no known risk factors for HIV infection but who had undergone an invasive procedure performed by a dentist with AIDS, six other patients of this dentist were found to be HIV-infected. Molecular biologic studies were conducted to complement the epidemiologic investigation. Portions of the HIV proviral envelope gene from each of the seven patients, the dentist, and 35 HIV-infected persons from the local geographic area were amplified by polymerase chain reaction and sequenced. Three separate comparative genetic analyses--genetic distance measurements, phylogenetic tree analysis, and amino acid signature pattern analysis--showed that the viruses from the dentist and five dental patients were closely related. These data, together with the epidemiologic investigation, indicated that these patients became infected with HIV while receiving care from a dentist with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Validation of a Hebrew version of the Oral Health Impact Profile 14.

OBJECTIVE: This study determined the validity of a Hebrew version of the Oral Health Impact Profile in a cross-sectional study of a general dental practice in Israel. METHODS: The original English version of a short-form oral health impact profile (OHIP-14) was translated into Hebrew using the back-translation technique. Participants were interviewed and examined clinically by a calibrated dentist. Information on the subjects' sociodemographic background and oral health conditions was collected. RESULTS: A total of 142 persons were interviewed and clinically examined. The Cronbach's alpha and the standardized item alpha for OHIP-14 were both 0.88. Cronbach's alpha of the translated OHIP-14 subscales ranged from 0.48 to 0.76. Construct validity of the translated Hebrew version was supported by the finding that the total OHIP score correlated with the number of decayed teeth, missing teeth, need for prosthodontic treatment, and pattern of dental attendance. Participants with oral pain were more likely to report impact on one of the OHIP subscales and to have more impacts than participants who were pain free. CONCLUSIONS: The Hebrew version of OHIP-14 presented acceptable validity and reliability. Further research is needed to assess the value of this measure in Israel.

Adult↗
PubMedDate not supplied

The influence of practice type, region, and age on treatment recommendations for primary teeth.

The purpose of this study was to investigate dentists' treatment recommendations for interproximal surfaces of primary molars based on the type of practitioner (general dentist or pediatric dentist), geographic location, and age of practitioner. Simulated cases, which included histories and pictures of bite-wing radiographs, were mailed to a random sample of 2000 general dentists and 1000 pediatric dentists. Dentists were asked to select their treatment recommendations for eight cases involving the interproximal surface of a specified primary molar. The return rate was 42% (1245) overall, with 36% (723) from general dentists and 52% (522) from pediatric dentists. An amalgam restoration was recommended most often for these eight cases. Dentists in the age 60+ category and pediatric dentists were more likely to recommend treatment for smaller interproximal lesions. Composite resins were recommended infrequently; however, dentists in the 60+ age category and dentists in the Northeast and Southwest were somewhat more likely to recommend composite resin than younger dentists, or dentists in other geographic locations. Dentists in the 40-49 age range, pediatric dentists, and dentists in the Southwest were the most likely to recommend stainless steel crowns. These simulated cases demonstrate differences and similarities in the treatment recommendations for interproximal lesions on primary molars based on age, practice type, and region.

Adult↗
PubMed1996

Dental attitudes and behaviour among a sample of dentate older adults from three English communities.

Improvements in oral health have resulted in impressive reductions in edentulousness in the middle aged and elderly. As part of a large, three-centred survey of adults aged 60 or over, 1211 dentate subjects were interviewed about their dental attendance pattern, their reasons for non-attendance, attitudes to edentulousness, treatment preferences and oral hygiene practices. The three areas sampled allowed north-south and urban-rural comparisons to be assessed. 19-28% of all subjects were dental non-attenders, but the prevalence was highest in the north. A perception that there was no need to seek dental care was the commonest reason given for non-attendance. Subjects from the northern samples were less likely to be upset at the prospect of edentulousness and less likely to opt for restorative treatment than their southern counterparts. Gender differences were pronounced in the north, with men being less concerned about edentulousness, less likely to opt for restoration and less likely to visit the dentist than women. In the south this difference was less evident. Generally, expectations were high and attitudes were based on the preservation of natural teeth. This is a positive development, but caution must be exercised to ensure that expectations are realistic.

Aged↗
PubMedDate not supplied

Oral health care practice and socio-demographic findings among the physicians in Ilorin, Nigeria.

BACKGROUND: In most developing countries, physicians attend to patients with oral health problems more than dentists usually because physicians are easily available. The aim of this study is to assess the level of practice of oral health care by physicians and make recommendations on how oral health care practice can be improved among the physicians. METHODS: This is a descriptive cross-sectional study carried out among 173 physicians who were randomly selected using their various health facilities. The study was carried out in Ilorin, the capital of Kwara State, Nigeria, over a period of six months. A well-structured questionnaire served as data collection tool while EPI-INFO version 6 software packages were used for analyzing data after being coded. RESULTS: There was a high level (74.1%) of practice of oral health care among the physicians and the major reasons for this were limited number of qualified dentists in the study area as well as lack of awareness by the patients concerning the treatment of oral health problems by dentists. Toothache and trauma were the most (68.2%) and least (2.3%) prevalent oral health problems respectively seen by physicians in this study. Antibiotics and analgesics were the medications used by the majority (58.1%) of the physicians to treat oral health problems. Almost all (97.7%) the respondents referred oral health problems to dentists while only 2.3% claimed never referred patients to a dentist. CONCLUSION: The available dental services in the study area cannot meet the oral health needs of the populace considering the fact that there are fewer dentists than physicians. Since this study showed a high level of practice of oral health care among the physicians, it is therefore necessary to include dentistry in the curricular of all medical schools in Nigeria and such curricula need to place more emphasis on promotive and preventive aspects of oral health as well as community participation.

Adult↗