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The power of your vocal image.

Your vocal image is the impression that listeners form of you based on the sound of your voice. In a dental office, where the initial patient contact usually occurs over the phone, your vocal image is vitally important. According to social psychologists, people begin to make relatively durable first impressions within six to 12 seconds of perceiving a sensory cue. This means that patients begin to form their impressions of a telephone speaker almost immediately. Based on the qualities of the speaker's voice and how it is used, they'll form impressions related to everything from the speaker's physical and personality characteristics to his or her intellectual ability, and eventually even generalize their impressions to include the office that the speaker represents. If you want to improve your vocal image, you must first be aware of exactly what that image is. There are two factors that combine to create a vocal impression--the speaker's physical vocal tools and the sound that is created by them. The five physical tools involved are the lungs, vocal cords, throat, mouth and ears. At each stage in the sound production process, we can easily fall into negative habits and lazy patterns if we're not careful. Although we can't do much about our physical voice mechanism, we can certainly exercise a great deal of control over how our voice is used. A strong, confident voice is an essential part of effective interpersonal communication. If you want to project an image of confidence and professionalism, don't overlook the subtle benefits of effective vocal power.

Attitude↗

Careers and patterns of work of Scottish dental graduates: 1991 and 1994.

OBJECTIVE: To describe current patterns of employment, career intentions and factors that influence career choice in young graduates. DESIGN: A cross-sectional postal survey. SUBJECTS: Graduates from the years 1991 and 1994 were selected to provide cohorts before and after the introduction of mandatory vocational training. A total of 232 graduates were sent questionnaires and 183 replied (77%): 90 men (49%) and 93 women (51%). SETTING: The cohorts all came from Scottish dental schools. When surveyed in 1996/1997, 66% were working in Scotland and 28% were in England. The rest were elsewhere in the UK or abroad. MEASURES: A questionnaire which had been piloted, applied to medical graduates and then adapted for dentists, was used. RESULTS: The most common post held was that of Associate in General Dental Practice (61% of the sample) and the majority (85%) were working full-time. Only small numbers indicated that they wished to undertake a career in academia (6) or the hospital dental service (17). In choosing a career, males were more influenced by financial factors (P = 0.009) and women by the availability of part-time employment (P = 0.000). CONCLUSION: Despite the recent adverse publicity about general dental practice, most young dentists see their future in this sector of the profession. More worrying is the comparatively small number who wish to work within the hospital service or in academia. Results also indicate the need to develop schemes to retain women in the workforce.

Adult↗

Oral health knowledge and dental health practices among schoolchildren in Jerash district/Jordan.

OBJECTIVE: This study aims at determining the oral health awareness level, the patterns of dental health practices and their potential relationship with certain socio-demographic factors, including gender (sex), mother's education and the socio-economic status of the family, among 14-15-year-old schoolchildren in Jerash Governorate, Northern Jordan. PARTICIPANTS AND METHOD: Cross-sectional survey including 1362 public schoolchildren, who completed a self-administered structured questionnaire. RESULTS: Overall, the level of oral health knowledge among the surveyed children was low. Of the 1362 schoolchildren included in this survey, only 18 and 17% did know the meaning of plaque and what plaque can cause, respectively. Female performance was significantly better than male performance on two of the six knowledge questions (P < 0.01). While 17% of children have never been to the dentist, there are 10% only who visit the dentist on regular basis. The majority (56%) of these pupils said they visit the dentist when there is a serious dental or oral health problem. Fear of the dentist and difficulty in obtaining an appointment with the dentist were the causes of irregular visit to the dental clinic in 28 and 19% of the cases, respectively. CONCLUSION: Results of this study prove that oral health awareness level among public schoolchildren in Jordan is still poor and needs to be improved. Based upon these findings, the establishment of a long-term school-based oral health education programme in Jordan is highly recommended.

Adolescent↗

International profiles of dental hygiene 1987 to 2001: a 19-nation comparative study.

AIM: The purpose of this international longitudinal study is to examine patterns and monitor trends and changes in dental hygiene. METHOD: Information was collected from national dental hygienists' associations through surveys conducted in 1987, 1992, 1998 and 2001. Sample size increased from 13 countries in 1987 to 22 by 2001--of which 19 were included in the analysis. RESULTS: Overall, characteristics of the profession were remarkably similar; most noteworthy was the scope of dental hygiene clinical practice. Regarding historical development, educational programmes and professional organisation, the profession was more similar than dissimilar. Greater variation was evident regarding numbers, distribution, regulation, workforce behaviour, predominant work setting, and remuneration. Over the relatively short 14-year period, several observations were of particular interest: marked increase in the supply of dental hygienists, accompanied by a decline in their ratio to populations and to dentists and a high workforce participation rate; increase in baccalaureate dental hygiene programmes, with a gradual shift from the diploma as the entry-level qualification; and increase in scope of practice and professional autonomy, including for Europe and North America in particular, a decline in mandated level of work supervision and a slight but gradual increase in independent practice. CONCLUSION: By 2001, the profiles reflected the vast majority of the world's population of dental hygienists. Rate of change varied across the countries examined; however, the nature of the change overall was consistent, resulting in a continuing homogeneity in the profession worldwide. Observed trends, changes and persistent issues have implications for service accessibility and technical efficiency and should continue to be monitored.

Asia↗

Managing pediatric dental patients: issues raised by the law and changing views of proper child care.

The purpose of this paper was to examine legal issues regarding the management of pediatric dental patients and changing views of proper child care. Standards of care in pediatric dentistry are not static. They change in response to research, patterns of reimbursement, patient and parental expectations of reasonable care, and consensus among practitioners. The law pertaining to accountability for pediatric dental patient treatment largely reflects standards of care established by the pediatric dentistry profession. However, the law can also reflect changes in public expectations of reasonable care that can effectively outrun the discipline's efforts to reflect new knowledge or changing public concerns. A major impetus for considering the care of children in all settings has been the increasing recognition of suboptimal children's care, as well as concerns that children have either been abused or neglected in a number of settings. Too often, practices towards children have been untested and based only on the assumption that what is done is "for the child's own good." Pediatric dentists can respond to changing standards of reasonable care for pediatric dental patients, as expressed in legal decisions. They can also usefully consider how attention to child maltreatment has sensitized parents to be better consumers of services on their children's behalf. Rather than reacting only to public pressures for better means of behavior management, the challenge is to exceed expectations via new research and thoughtful anticipation of improvements that can be made.

Anesthesia, Dental↗

Reported infant feeding, oral hygiene and dental attendance patterns in children aged 5 years and under referred for extraction of teeth under general anaesthesia.

This study was designed to examine reported infant feeding, oral hygiene, and dental attendance practices in children who had established dental disease before attaining school age. Data were collected by structured interview from the mothers of 150 children aged 5 years and under who were referred to a hospital Paediatric Dentistry Unit for the extraction of teeth under general anaesthesia. Few children in this study had been exclusively breast-fed, and, although unconfirmed by data derived from matched caries-free controls, the development of dental caries would appear to be related to prolonged bottle-feeding, including the use of a night-time bottle until just before weaning, the early introduction and regular consumption of larger than average amounts of confectionery, coupled with reportedly regular but unsupervised toothbrushing. Although decay was already established in over a third of children before they visited a dentist for the first time, little evidence of restorative care was found. It would appear that the primary care services fail this youngest age-group.

Age Factors↗

Laser-induced breakdown spectroscopy: a tool for real-time, in vitro and in vivo identification of carious teeth.

BACKGROUND: Laser Induced Breakdown Spectroscopy (LIBS) can be used to measure trace element concentrations in solids, liquids and gases, with spatial resolution and absolute quantifaction being feasible, down to parts-per-million concentration levels. Some applications of LIBS do not necessarily require exact, quantitative measurements. These include applications in dentistry, which are of a more "identify-and-sort" nature - e.g. identification of teeth affected by caries. METHODS: A one-fibre light delivery / collection assembly for LIBS analysis was used, which in principle lends itself for routine in vitro / in vivo applications in a dental practice. A number of evaluation algorithms for LIBS data can be used to assess the similarity of a spectrum, measured at specific sample locations, with a training set of reference spectra. Here, the description has been restricted to one pattern recognition algorithm, namely the so-called Mahalanobis Distance method. RESULTS: The plasma created when the laser pulse ablates the sample (in vitro / in vivo), was spectrally analysed. We demonstrated that, using the Mahalanobis Distance pattern recognition algorithm, we could unambiguously determine the identity of an "unknown" tooth sample in real time. Based on single spectra obtained from the sample, the transition from caries-affected to healthy tooth material could be distinguished, with high spatial resolution. CONCLUSIONS: The combination of LIBS and pattern recognition algorithms provides a potentially useful tool for dentists for fast material identification problems, such as for example the precise control of the laser drilling / cleaning process.

Journal Article↗

Risk and prevention of hepatitis C virus infection. Implications for dentistry.

BACKGROUND: The occupational risk of hepatitis C virus, or HCV, infection in dentistry is very low. Nonetheless, the lack of an effective vaccine, the high rates of chronic infection and the limited effectiveness of treatment may cause concern for dental workers who come into contact with blood in their daily practices. DESCRIPTION OF THE DISORDER: The authors discuss the natural history, diagnosis and treatment, and patterns of transmission of HCV infection, including the Centers for Disease Control and Prevention's recommendations for management and follow-up of health care workers after occupational exposure to HCV. CLINICAL IMPLICATIONS: In the absence of an effective vaccine or postexposure prophylaxis, prevention of occupational transmission of HCV in dental settings continues to rely on the use of universal precautions, including barrier precautions and the safe handling of sharp instruments.

Dentists↗

Sealants: changing patterns.

Although the use of and the attitude toward sealants as a caries-preventive method have improved in the 8-year period between 1974 and 1982, the acceptance still is low, considering the potential value of sealants to patients who are at risk for occlusal caries. More efforts should be directed toward both increasing dentists' and patients' understanding and appreciation of the procedure in preventing caries. It is possible that such a "good sell" has been done with fluorides and oral hygiene that patients do not understand the added value of sealants for the prevention of occlusal caries. Dentists appear to underrate the value of sealants and overrate the value of oral hygiene procedures in the control of caries. Given that some dentists have less-than-positive attitudes toward sealants, it may not be enough to wait for the transmission of knowledge regarding sealants to proceed through the practicing dentist to the patient. Both patient and dentist groups need further appreciation of the value of this procedure if the control of occlusal caries is to be maximized.

Adolescent↗

A survey of the use of matrix bands and their decontamination in general dental practice.

AIMS: The aims of this study were to determine the pattern of use and re-use of matrix bands in general practice in Scotland, to demonstrate which type of matrix band is most commonly used and to examine infection control measures of relevance to the safe use and re-use of matrix bands. MATERIALS AND METHODS SUBJECTS: 621 of Scotland's 1,849 general dental practitioners were randomly selected. DATA COLLECTION: A 19-item self-reported questionnaire was mailed in June 1999 with a follow-up mailing sent in August 1999. ANALYSIS: Data analysis involved descriptive statistics and cross-tabulation. Where appropriate, differences between categories were tested for significance by a Chi-square test. RESULTS: A total of 479 questionnaires were returned, representing a response rate of 77%. Reported compliance with routine glove wearing was high (91%). Most dentists (92%) provided training on instrument cleaning and sterilisation for their dental nurses. Ultrasonic baths were used by 59% of practitioners; the remainder soaked or manually scrubbed instruments to remove debris before autoclaving. The Siqveland matrix was the matrix of choice for 96% of respondents. 7% provided a new matrix band for each patient. Most (64%) changed bands only when they were bent or damaged; 29% changed them daily or weekly. Deterrents to use of a new band for each patient were cost (39%) and time (52%). A total of 54% of respondents considered matrix band replacement unnecessary between patients. CONCLUSIONS: The Siqveland matrix band is the most popular among the study group of dental practitioners. Re-use of matrix bands is common. Guidelines for the safe re-use of matrix bands are required.

Attitude of Health Personnel↗

Universal patient acceptance: ethics pipe dream or key to improved access in dentistry?

The authors discuss ways that dentistry engages silently and sometimes unknowingly in practice patterns that adversely affect public access to dental care. The concept of acceptance is explained and contrasted with treatment and with access to care. The concept of Universal Patient Acceptance (UPA) is introduced, with a focus on how it underlies and precedes access, creating a pathway so that truer universal access to dental care can be realized. The authors argue that a commitment to Universal Patient Acceptance shows promise as an important starting point in the dental profession's concern to address society's unmet oral health needs.

Delivery of Health Care↗

Managing the cleft lip and palate patient.

We have attempted to elucidate, first through an examination of the basic science of clefting and then through a description of the roles of the various members of the cleft palate team, an understanding of the multiplicity of problems faced by this heterogeneous group of children with cleft lip or palate. With an incidence of cleft of 1 in 700 births, all practicing pediatricians will at some time be faced with a patient with a cleft. Pediatric management begins in the hospital nursery by ruling out possible associated anomalies (e.g., congenital heart disease or urinary tract) or syndromes. At the same time, cleft palate nursers may be needed to overcome feeding problems. Simultaneously, counseling for the family begins with a positive attitude toward outcome and an initial explanation of the schedule of corrective procedures, i.e., lip repair at 3 months of age and palate repair at about 1 year. The counseling should incorporate an understanding of the cause of clefting, both its genetics and teratogenetics, and then proceed to noting the actual recurrence risks of 1% for a new cleft and 16% if there is a positive family history in a first-degree relative. The recurrence risks in recognized syndromes may follow mendelian patterns. Later, the pediatrician can help the family deal with multiple ear infections and the likely need for tympanostomy tubes, anticipating the need for tubes in a way that might facilitate placement at the time of anesthesia for the lip or the palate repairs. An understanding of the speech and language difficulties that may be encountered in later infancy may relieve parental anxiety. Later, after palate repair, knowledge of velopharyngeal incompetence may avert premature hypernasal speech problems caused by adenoidectomy, which should be avoided if at all possible. The pediatrician needs to be aware of the tooth malformations that accompany clefting of the alveolus as well as the increased susceptibility to caries, so that the family may be directed to early intervention by the pediatric dentist. With support by pediatrics of the efforts of pediatric dentistry, the child is then in optimal condition for orthodontics. Continually keeping the child's emotional adjustment in mind, the pediatrician can encourage the child and family, knowing that with palatal expansion techniques plus possible bone graft surgery to the cleft alveolus at about 9 years of age, the child may be orthodontically corrected to very near normal.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗

Dental decisionmaking and variation in dentist service rates.

Previous medical and dental studies report wide variations in service rates across small areas, regions and providers. A major source of this variation appears to be the pattern of clinical decisionmaking of the provider. This argument was tested using dentist service rates (the average number of services provided per patient) calculated from 1984-1985 claims data for a population of well-educated, middle-class patients in Washington state, U.S.A. (N = 23,153). Service rates were calculated for each dental procedure in the following pairs of alternative treatments: crown vs amalgam or crown build-up; root canal therapy vs extraction; and fixed bridge vs removable partial denture. For each pair, dentists identified patient (e.g. cost, patient preference) and technical (e.g. periodontal status, tooth damage) factors which they considered to be important in choosing therapy. Regression analysis revealed that the technical factors explained little variation in the rates, while at least one patient factor was significant across services, except prosthetics. Environmental characteristics, structural features of the practice, and the dentists' practice beliefs also explained variation in the rates.

Crowns↗

[Ecological niche altering: bacterial resistance to antibiotics].

The antimicrobial resistances to antibiotics are a worldwide public health issue. Today's successful treatments of infections are threatened. If the antimicrobial resistances to antibiotics are not controlled, morbidity, mortality and health care costs would increase. The main reason for the increasing number of these resistances is the wrong use of antibiotics by: health professional prescriptors (physicians, dentists, veterinary surgeons), dispensers (pharmacists), patients (self-prescription, non-fulfillment of treatments) and health care authorities (lack of policy and ineffective management of the rational use of antibiotics). There are multiple ways to solve this problem, but none is definitive by itself. It is required to assume the coexistence with microorganisms instead of trying to exterminate them.

Adult↗

Acute vs. chronic pain.

The differences between acute and chronic pain are many and varied. They are so different from one another that they must be considered separate entities. The chronic pain patient does not fit the traditional acute illness model as conceptualized by patients and healthcare providers. Because of the complex nature of the pain mechanism as a protective "reflex" and the fact that the pain response gets caught up in emotional expression, pain becomes a learned behavior pattern. When the patient who presents to the dental office suffering from pain is found not to respond to conventional methods of treatment, the dentist should first consider the nature of the pain response and the fact that the patient may not meet all the requirements for the acute illness model. The manner in which the patient describes his or her pain can be a major clue as to the temporal classification of the pain, thus allowing the dentist the advantage of better decision-making. Great discernment on the part of the dental practitioner must be exercised in order to provide the optimum care for the patient. It is important for the dentist to consider the fact that there may be no underlying cause for the pain and it may be necessary to make proper referrals for management of this type of patient. At a more practical and human level, patients want to know if their pain will ever completely go away. Patients are frightened that their pain is attributable to some unrecognized pathology (catastrophic thinking). This drives them to search for the ultimate cure. Going from practitioner to practitioner worsens the confusion as the patient hopes that someone will be able to illuminate the problem. By being able to classify the pain into a recognizable and explainable syndrome, the pain practitioner is often able to offer hope to the patient. Although treatment often does not yield a completely pain-free state, understanding the basis for the pain can provide significant relief through proper management.

Acute Disease↗

Nurture personal referrals--your best source of new patients.

In your morning meetings, identify those patients who would be a great person to ask for a referral--patients who have expressed pleasure in receiving treatment from you. Then, determine who is going to ask for that referral. You wouldn't want to have EVERY-ONE ask them for a referral, so give someone that responsibility. Be sure that you have done some role playing and have practiced the verbal skills of "asking" for a referral. Get comfortable asking. Know that you will never know what you will get unless you ASK!!! All good businesses ask for referrals from their best customers. Learn from the masters. Pattern your own behavior after those who have acquired admirable results. When you identify patients who have accepted and have been pleased with your treatment, have come to their appointments on time, have gladly paid their bills, and have been a joy to treat, ASK these folks for a referral. More than likely they will refer others to you who are of like character. You can build a practice "on good patients just like you" and expect that to happen!!! Together, as a team, develop ways of acknowledging and nurturing your referral sources. If these wonderful people provide 70+ percent of your new patients, it benefits you to invest time and money in maximizing this source of practice growth.

Dentist-Patient Relations↗

Differences in tobacco assessment and intervention practices: a regional snapshot.

BACKGROUND: This research describes tobacco attitudes and practices of health care providers in the Upper Midwest. A baseline measure of preventive practices by providers was needed to plan effective tobacco intervention education programs. METHODS: Health care providers in a 16-county region received a mailed survey regarding tobacco assessment practices, intervention practices, attitudes, skills/knowledge, barriers, and desire for tobacco education. The survey was sent to all chiropractors, dentists, nurse practitioners/physician assistants, physicians (primary care and specialist), and public health nurses in the region. A total of 51.9% (n = 614) of all providers returned usable surveys. RESULTS: Significant differences were found between provider groups on all measured concepts. Primary care physicians, nurse practitioners/physician assistants, and public health nurses were more likely than specialist physicians, dentists, and chiropractors to assess, intervene, be supportive of tobacco cessation, have skills/knowledge about cessation, perceive fewer barriers, and want further education. CONCLUSIONS: In this region, provider groups differed in tobacco use assessment and treatment. All provider groups desired education regarding tobacco intervention. Region-wide tobacco cessation educational initiatives need to take into account differences between provider groups.

Adult↗

Antibiotic prophylaxis for patients with hydrocephalus shunts: a survey of pediatric dentistry and neurosurgery program directors.

A survey of antibiotic prophylaxis recommendations for patients with hydrocephalus shunts was sent to directors of advanced programs in pediatric dentistry and neurosurgery. Recommendations were sought for patients with ventriculoperitoneal (VP) or ventriculoatrial (VA) shunts who were to receive dental care. Most respondents believed that shunt infection (SI) was related infrequently to dental procedures. Pediatric dentists believed that 5.2% of infected VA shunts were related to dental procedures, while neurosurgeons believed the rate to be 3.0% (P < 0.05). There was no difference in perceived risk for VP shunts. Except for the equal risk associated with extractions, pediatric dentists were significantly more likely than neurosurgeons to recommend chemoprophylaxis for patients with VA shunts undergoing invasive dental procedures (P < 0.05). They were more likely to agree with neurosurgeons when VP shunts were involved. Except for the equal risk associated with dental prophylaxis, pediatric dentists and neurosurgeons believed VA shunt patients were at greater risk for SI than VP shunt patients (P < 0.05). Pediatric dentists were significantly more likely to ascribe SI to streptococcal organisms, and recommended penicillin for prophylaxis for both VA and VP shunts (P < 0.01 and 0.025, respectively). Although neurosurgeons believed that staphylococcal organisms were most likely to be responsible for SI (P < 0.001), 60% still recommended using penicillin for shunt prophylaxis following dental procedures.

Anti-Bacterial Agents↗