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PubMed2001

Dental services. An analysis of utilization over 20 years.

BACKGROUND: Utilization studies serve as an important tool for oral health policy decision-making. A number of important reports have been published that help to characterize the dental utilization patterns of most Americans. For the most part, these studies have focused on utilization estimates for a particular survey period or year. Fewer studies have examined changing utilization patterns over time. METHODS: This article focuses on dental utilization and the changes in utilization for the civilian, community-based U.S. population during 1977, 1987 and 1996. Using data from the National Medical Care Expenditure Survey, National Medical Expenditure Survey and Medical Expenditure Panel Survey, the authors provide national estimates of dental visits for each of several socioeconomic and demographic categories during 1977, 1987 and 1996. RESULTS: Although the dental use rates for children between 6 and 18 years of age were the highest of any age group in each of the three years studied, the use rate for children and the elderly increased during this same 20-year period. Data also showed that the gap in use rates between lower- and higher-income people widened during the 20-year period. Generally, use rates according to sex and race/ethnicity were unchanged in each of the survey years, except for a narrowing of the gap between whites and nonwhites by 1996. CONCLUSION: These data are unique and comparable and establish a mechanism by which dental visits can be compared during a 20-year period. While aggregate utilization rates generally were stable during this 20-year period, some differences within socioeconomic and demographic groups are notable. For instance, the use rate increased during the 20-year period for people 65 years of age and older and for children younger than 6 years of age. PRACTICE IMPLICATIONS: By understanding these analyses, U.S. dentists will be better positioned to provide care and meet the needs of all Americans.

Adolescent↗
PubMed1996

Recognition of the scope of oral and maxillofacial surgery by the public and health care professionals.

PURPOSE: A recent British study has reported a lack of awareness among the general public as to the benefits provided by the specialty of oral and maxillofacial surgery (OMFS). Medical and dental practitioners surveyed had a greater awareness of OMFS than the general public, yet were deficient in knowledge of the wide range of services provided by them. Therefore, a similar survey was conducted in the Boston area to determine the awareness among the general public and health professionals of the proper providers of treatment for the maxillofacial region and the level of knowledge of the specialty of OMFS. MATERIALS AND METHODS: The study incorporated five groups of respondents: dental students, dental practitioners, medical students, medical practitioners, and the general public. The survey was mailed, or distributed, randomly to persons representing each group in the Boston area. Between 200 and 300 surveys were sent to each group, and data collection was stopped at 100 responses per group. Surveys from the general public were screened to eliminate responders involved in health professions. For each of 20 specific situations or treatments, respondents were asked to choose a source of treatment from among four categories of specialists: ear nose and throat surgery (ENT), plastic surgery, OMFS, and periodontology. A chi-square analysis was performed for each question to compare the pattern of responses among categories of respondents. RESULTS: The data showed that most of the health professionals, 90% of students, and 98% of practitioners had heard of OMFS, whereas only 62% of the public have heard of this specialty. Furthermore, only 22% of the lay responders had ever been treated by an OMFS. The results also suggested that many health professionals had a lack of understanding about the wide scope of surgical procedures that OMFSs offer. CONCLUSION: Despite all the progress that has occurred in OMFS, a large portion of the American population is still unaware of the specialty. If patients are to receive the best treatment available, it is essential to educate health care consumers and providers about the different specialties available and their role within the health profession.

Attitude of Health Personnel↗
PubMed1994

Selection of restorative materials in dental treatment of children and adults in public and private dental care in Finland.

To obtain information on the present selection of dental restorative materials and factors related to it, questionnaires were sent to a random sample of public health centres (47) and private dental practitioners (716) in May 1992. The dentists were asked to collect information on all fillings they placed during 3 and 1 working days, respectively. The study material consisted of 9886 fillings placed by 855 dentists. Glass ionomer was the major filling material in children younger than 17 years, ninety-one per cent of the fillings in deciduous teeth and 47% of those in permanent teeth were inserted using that material. In adults, composite was the most frequently used material, fifty-two per cent of the fillings placed by private practitioners and 43% of those placed in health centres. In total, amalgam was used in 15% of fillings placed for patients 0-16 years old and in 29% of fillings in adults. The results show that in children, glass ionomer is the most frequently used filling material and the use of amalgam is very limited. In adults as well, amalgam seems to be increasingly replaced by other filling materials.

Adolescent↗
PubMed1987

Gender trends in the career patterns of recent dental graduates.

The gender composition of U.S. dental schools has changed dramatically over the past 25 years. While women represent less than 10 percent of the practicing dental population, the dramatic increase in dental school enrollment by women will be reflected in a much larger percentage of female dental practitioners in the near future. It is not clear how this trend will affect the structure and organization of the dental profession or the delivery of dental care. This study examined gender differences among recent dental graduates' professional commitment, choice of practice arrangements, and income. The data consist of a random sample of 1979, 1980, and 1981 graduates of U.S. dental schools with an adjusted response rate of 77.6 percent (n = 2,648 males and 346 females). Findings include statistically significant gender differences in mean annual income from private practice, administration, or teaching of dentistry; total family income before taxes; employment status in private practice; marital status, and the number of children under 18 years of age. A gender difference of fewer than four hours worked per week, while statistically significant, is less than previous reports in the literature. Gender remained as a statistically significant predictor of income when controlling for practice ownership, hours per week worked, background, and family/social variables. These findings have policy implications for dental resource planning, organized dentistry, dental education, and the delivery of dental care.

Career Choice↗
PubMed1996

Dental attendance patterns in renal transplant recipients.

OBJECTIVES: Renal transplant recipients (RTR) represent a large and growing population of individuals on potent immunosuppressant therapy who are at significantly greater risk of developing lip and oral mucosal disease, including lip cancer. The aims of this study were to determine the proportion of RTR receiving regular dental treatment, the dental services they used, and the relationship between the prevalence of lip and intraoral lesions and dental attendance. DESIGN: The lip and oral mucosa of 159 RTR and 160 controls were examined. Subjects were asked questions about frequency of dental attendance and which service they used. RESULTS: 57.9% RTR attended a dentist regularly compared with 51.3% controls. Among the RTR who attended a dentist regularly, 54.3% visited their general dental practitioner, and 45.6% attended a dental hospital for treatment. This was significantly different from controls where 92.7% of regular attenders used their general dental practitioner (P < 0.001). Although the prevalence of oral lesions in RTR (54.7%) was more than twice as many as controls (19.4%), no significant difference was observed between RTR regular dental attenders and non-attenders. CONCLUSIONS: This study indicates a clear need for oral health care and screening to be focused on RTR.

Adult↗
PubMedDate not supplied

A statistical study of physician care patterns in high school football injuries.

This study examines the specialty background, relative activity, role, and cost of care among physicians treating high school football injuries in six western states. There were 1,000 injuries (in 1,000 players) in the 1980 football season. Among the players, 30.7 and 17.9% were treated solely by general practitioners and emergency room physicians, respectively. Orthopedic surgeons exclusively managed 17.1% of players, and 6.8% were seen initially by the emergency room physician and referred to an orthopedic surgeon. Osteopaths solely treated 6.4% of players. Chiropractic was the exclusive care for 6.4%. Four and nine-tenths per cent of players were seen initially by general practitioners and referred to an orthopedic surgeon. Emergency room physicians referred 3% of their injured high school football players to general practitioners. The remaining 6.8% of players were cared for by dentists, pediatricians, general surgeons, naturopaths, neurosurgeons, urologists, otolaryngologists, and ophthalmologists. General practitioners referred 14% of their patients, and emergency room physicians referred 73.6% of their patients. The most common referral was to an orthopedic surgeon. Two hundred ninety-eight players ultimately received care from an orthopedist, including 82% of all patients with fractures. For patients with the same diagnosis, costs for care by orthopedic surgeons were 54% higher than the fees charged by a general practitioner.

Athletic Injuries↗
PubMed1990

Reasons for replacement of Class II amalgam restorations in private practice.

In a series of postgraduate courses in Cariology for dentists in the period 1980-84, a total of 102 private practitioners participated in a study of the reasons for replacing amalgam restorations. Twelve reasons were specified on a form and the dentist was asked to mark one or more of them for each filling replaced. The total number of fillings evaluated was 2033. In 87.9% of the restorations only one reason was given for the replacement; two, three, four and five reasons were registered in 10.5, 1.1, 0.4 and 0.1%, respectively. The six most frequent reasons were: "secondary caries" (34.0%), "fracture of the filling" (15.5%), "primary caries" (12.1%), "fracture of the tooth" (10.2%), "marginal ditching" (7.2%), and "caries under the filling" (5.6%). The restorations replaced for a combination of two reasons (N = 213) were studied separately. The three most frequent combinations were: "secondary caries + fracture of the filling" (17.8%), "secondary caries + marginal ditching" (14.1%), and "secondary caries + caries under the filling" (11.3%). - Thus, the main conclusion from this study is that approximately half of the replacements of class II amalgam restorations were occasioned by caries disease.

Dental Amalgam↗
PubMed2001

Utilization of dental services in Southern China.

A population's utilization of dental services is an important parameter in oral health care planning, which has rarely been studied in China. The objectives of this report were to describe the dental service utilization pattern of middle-aged and elderly Chinese and to analyze the influence of selected variables on the use of dental services. A Guangdong Province population of 1,573 35- to 44-year-olds and 1,515 65- to 74-year-olds recruited from urban and rural communities was interviewed in their local dialect. It was found that 23% of the middle-aged and 24% of the elderly subjects had visited a dentist within the preceding year. The two most commonly cited reasons for not having seen a dentist for at least 3 years were: no perceived need, and no serious dental problems. Among subjects who had visited a dentist within 3 years, the 3 most commonly received treatments were: fillings, extractions, and dental prostheses. Furthermore, a logistic regression analysis showed that women, subjects who lived in urban areas, were better educated, were wealthier, and had better oral health knowledge were more likely to be a recent dental service user. In conclusion, dental service utilization among the adult Southern Chinese was found to be low, problem-driven, and influenced by some socio-economic factors.

Adult↗
PubMed2006

Dental health attitudes and behaviour among dental students in Jordan.

OBJECTIVE: Examine and compare differences in oral health attitudes and behaviour among Jordanian dental students. BASIC RESEARCH DESIGN AND PARTICIPANTS: Cross-sectional study of 314 dental students was conducted to compare differences in oral health behaviour and attitudes among these students in different levels of academic education. SETTING: Jordan University of Science and Technology. METHODS: Subjects were surveyed using a modified version of the Hiroshima University Dental Behavior Inventory (HU-DBI) questionnaire (20 Items). Multivariate binary and polytomous logistic regression analyses were performed in order to study change of patterns of statements during preclinical and clinical, and year of study, respectively. RESULTS: The percentage of students claiming to brush their teeth twice daily or more often was four times higher amongst clinical students than amongst pre-clinical students.. The odds of visiting a dentist only in case of toothache was reduced by a factor of more than three among clinical year students (OR 0.30, 95% CI 0.15-0.61). Clinical year students rarely complained of bleeding gums after toothbrushing (OR 0.10, 95% CI 0.03-0.27). On the other hand, a number of items regarding use of dental floss and tooth paste, bad breath, colour and appearance of teeth, and cigarette smoking was similar between preclinical and clinical students. Evaluation of trends during dental studies employing polytomous multivariate logistic regression analysis revealed an abrupt change at the end of preclinical studies for items characterizing professional attitude. CONCLUSIONS: With advancement in dental school, dental student's oral health awareness and attitudes improved in some aspects. Preventive dentistry courses should be taught early in the dental curriculum of the pre-clinical years.

Attitude of Health Personnel↗
PubMed2001

Knowledge and attitude of dental health workers towards fluoride in Riyadh area.

OBJECTIVE: To assess the knowledge, attitudes, and beliefs of the dentists and hygienists in the Riyadh area of the Kingdom of Saudi Arabia towards fluoride. METHODS: One hundred and thirty dentists and hygienist working in dental clinics in Riyadh were randomly selected. Self-administered questionnaires covered the following areas: general information, the use and application of fluoride, pharmacodymanics and pharmacokinetics of fluoride. The subjects responded to each of the statements by ticking one of the 3-scaled options from "agree" to "disagree". RESULTS: The majority of the respondents (65%) supported an assessment of the pattern of dental caries before fluoridating the water, 23% disagreed and 5% did not know. Also one hundred and three (79%) of the sample supported fluoridation of water, 16 (12%) disagreed, and 4 (3%) did not know. Fifty-five (42%) agreed that dental caries are expected to increase if fluoridating water is discontinued for one year, while 52 (40%) disagreed and 16 (12%) did not know. In addition, there was a low score concerning knowledge of side effects and toxicity of fluoride among health care workers. Overall, there was no statistical significance between academics and non-academics. CONCLUSION: There was a good attitude and knowledge of fluoride as a preventive measure among dentists. This study also demonstrated that the majority of the health care professionals in Riyadh area were in favor of water and milk fluoridation, however; there was a lack of knowledge regarding side effects and toxicity.

Adult↗
PubMed2006

The big OE: New Zealand dental graduates' self-reported experience of working overseas.

UNLABELLED: Recent dental workforce reports have highlighted a poorer-than-expected cohort remainder rate for recent New Zealand dental graduates, and it is not currently clear whether this trend reflects the permanent loss of some of New Zealand's new dental workforce, or is the continuation of what may be considered to have been a "rite of passage" for new dental graduates. OBJECTIVES: To examine the working and travelling patterns (if any) of New Zealand dental graduates, specifically to ascertain the most common countries in which New Zealand graduates have practised, the number of years of experience acquired before leaving, and the length of time spent overseas before returning. METHODS: A nationwide survey was posted to a random sample of 600 general dental practitioners (GDPs) requesting sociodemographic details and information on whether or not they had practised dentistry overseas. RESULTS: The response rate was 81.2 percent, and 368 of the 449 respondents were NZ graduates. Overall, 215 (58.4 percent) had practised overseas. The United Kingdom (47.6 percent) and Australia (9.8 percent) were the two most common countries for those who had done so. A larger proportion of male practitioners had practised outside New Zealand, and those who graduated earlier were also more likely to have practised overseas, and in the United Kingdom. After controlling for gender, those with 15-30 years in practice were 2.4 times more likely to have practised overseas (95 percent CI 1.5, 4.0), while those with 31+ years of experience were 4.4 times more likely to have done so (95 percent CI 2.4, 8.2). CONCLUSION: Despite some recent changes, gaining experience overseas continues to be a feature of practice for New Zealand dental graduates.

Adult↗
PubMed1996

Women in oral and maxillofacial surgery: factors affecting career choices, attitudes, and practice characteristics.

PURPOSE: This study analyzed the factors that attract women to the field of oral and maxillofacial surgery, their attitudes toward various aspects of the specialty, current practice patterns, and biases that may have been or are still being encountered. METHODS: Surveys were mailed to practicing female oral and maxillofacial surgeons, to oral and maxillofacial surgery residency programs to be distributed to their female residents, and to male and female dental students. RESULTS: A total of 107 surveys were sent to practicing female surgeons and 105 to oral and maxillofacial surgery programs. There was a return rate of 71% and 70%, respectively. Practicing female oral and maxillofacial surgeons tended to be young, Caucasian, and married. Fifty-nine percent were boarded, and 47% owned their own practices. Four of 76 had interrupted their residencies, and 18 had interrupted their practices at some point. More than 64% of practicing female oral and maxillofacial surgeons believed that there was a bias against women in this field. Female residents showed an overwhelming satisfaction with their career choice, but nearly half of them alluded to the need for dedication, a restriction of social life, or a concern for entering an male-dominated field. For students, the time commitment during residency and while in practice, and compromised family and social life, were the most commonly mentioned deterrents to entering oral and maxillofacial surgery, and lifestyle and the excitement of the field were its major attractions. CONCLUSION: Despite some biases in the field, women are practicing oral and maxillofacial surgery full time and are combining their career with full family lives. Among dental students, the time commitment and social compromise are the largest deterrents to entering the specialty of oral and maxillofacial surgery.

Adult↗
PubMed2004

Smokeless tobacco cessation guidelines for health professionals in England.

Smokeless tobacco is used in the UK predominantly by members of the Indian, Pakistani and especially Bangladeshi communities. The most commonly used form is tobacco mixed with lime and additional psychoactive compounds, most notably areca nut. The resulting "quid" is chewed or held in the mouth. Studies from Asia indicate that use of this kind of product is linked with an increased risk of oral cancers and possibly low birth-weight infants. There is little high quality research evaluating interventions to promote cessation of smokeless tobacco use, especially of the forms used in the UK. However, what evidence there is suggests that advice to stop coupled with behavioural support and counselling may increase long-term abstinence rates by some 5-10%. It seems appropriate therefore to recommend that dentists, GPs and other relevant health professionals should routinely assess and record smokeless tobacco use in patients belonging to relatively high prevalence groups, that they ensure that smokeless tobacco users know the potential health risks (as well as the health risks of smoking) and that they advise them to stop and keep a record of the outcome. Dental professionals should also examine the oral cavity of smokeless tobacco users for lesions when the opportunity arises. Patients expressing an interest in stopping should be referred to specialist smoking cessation services for behavioural support and specialists in areas of high smokeless tobacco use will need to ensure that they are sufficiently knowledgeable and their services sufficiently accessible to these users. There is insufficient evidence to recommend the use of nicotine replacement therapy or bupropion to aid smokeless tobacco cessation. Research is needed in the UK to quantify the personal and population health risks from smokeless tobacco, the benefits of stopping, the effectiveness of interventions aimed at promoting cessation and patterns of use, knowledge and attitudes of users.

Adolescent↗
PubMedDate not supplied

Project USAP the use of sedative agents in pediatric dentistry: 1991 update.

A national survey of members of the American Academy of Pediatric Dentistry was conducted to update information on the use of sedative agents by pediatric dentists. All 2532 members of the Academy were sent questionnaires regarding their use of sedation and 1497 responded. Practitioners were questioned regarding how frequently they used sedative agents and the nature of patients receiving sedation. In addition, they were questioned on reasons for change, if any, in their use of sedation during the past two years. A separate survey was conducted of directors of all 55 postdoctoral training programs in pediatric dentistry. Forty-six directors responded to questions concerning the type and frequency of sedation use in their programs. Both surveys demonstrated wide differences in sedation use between different training programs and between different practitioners. The heavier use of sedation by some practitioners or by some training programs, as compared with others, generally was not related to the percentage of handicapped patients who received sedation, nor to the type of training. Frequent users of sedation (more than once each day) were located more in the south/southeastern and western parts of the country and they tended to have been in specialty practice for more than 10 years.

Chi-Square Distribution↗
PubMed2001

Differences in dimensions of satisfaction with private and public dental care among children.

UNLABELLED: Measures of patient satisfaction have application in understanding patient behaviour, and in evaluating dental providers, services, and facilities. Further, differences in delivery systems may be reflected in variation between the component dimensions of satisfaction. AIM: The aim of this study was to compare perceptions of satisfaction with care provided by the School Dental Service (SDS) and private dentists. DESIGN: A three-stage cross-sectional survey was conducted during 1993-94. This analysis is based on Stage 2 of the study (n=2,792 participants, response rate=78.0%). SETTING: Schools in metropolitan Adelaide, South Australia. PARTICIPANTS: Parents and schoolchildren. INTERVENTIONS/METHODS: Mailed self-complete questionnaires. MAIN OUTCOME MEASURES: The Dental Satisfaction Index (DSI) and component subscales. RESULTS: Overall satisfaction using the DSI showed no significant difference between SDS users and users of private dental care. Parents of children using the SDS had lower satisfaction scores for 'general satisfaction', 'quality', 'access', and 'continuity', but had higher satisfaction scores for the dimensions of 'cost' and 'availability' (OLS regression; P<0.01). These patterns of satisfaction with dental care by provider group persisted after controlling for time since last visit, parental education level, insurance status, occupation and language spoken (OLS regression; P<0.05). This may reflect a counter-balancing of dimensions of satisfaction across provider groups resulting in no significant difference in the DSI. CONCLUSIONS: Overall satisfaction was high and did not vary by provider group, but there was variation in the component dimensions of satisfaction.

Attitude to Health↗
PubMed1995

The prophylaxis of infective endocarditis: current practices in France. French Federation of Cardiology.

Over the last 10 years, the French Federation of Cardiology has circulated recommendations regarding the use of chemoprophylaxis in patients at risk for infective endocarditis. A national survey conducted in 1991, however, showed that the vast majority of both general practitioners and dentists were unaware of these recommendations. Therefore, a Consensus Conference was convened in 1992, with the object of defining and circulating new guidelines which were to be as practical as possible, for the prophylaxis of infective endocarditis. The Consensus Conference first defined which categories of subjects were at risk for infective endocarditis and which types of procedures were potential causes of endocarditis. The second task of the Conference was to determine recommendations for chemoprophylaxis before procedures at risk. For ambulatory dental procedures, a single oral dose of 3 g of amoxicillin administered in the hour preceding the procedure was recommended. Additional recommendations were made for subjects with an allergy to penicillin, for procedures requiring general anaesthesia or for urologic or digestive tract procedures. These recommendations were printed on credit-card format cards and distributed to all practising cardiologists, who were encouraged to give each of their patients at risk a personal card bearing his/her name and the type of heart condition at risk. It is hoped that these measures to both simplify the prophylactic antibiotic regimen and circulate the recommendations from the Consensus Conference may reduce the incidence of this still severe disease.

Anti-Bacterial Agents↗
PubMed2005

Developments in oral health policy in the Nordic countries since 1990.

PURPOSE: There is a number of systems for the provision of oral health care, one of which is the Nordic model of centrally planned oral health care provision. This model has historically been firmly based on the concept of a welfare state in which there is universal entitlement to services and mutual responsibility and agreement to financing them. This study reports and analyses oral health care provision systems and developments in oral health policy in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) since 1990. MATERIAL AND METHODS: Descriptions of and data on the oral health care provision systems in the Nordic countries were obtained from the Chief Dental Officers of the five countries, and contemporary scientific literature was appraised using cross-case analyses to identify generalisable features. RESULTS: It was found that in many respects the system in Iceland did not follow the 'Nordic' pattern. In the other four countries, tax-financed public dental services employing salaried dentists were complemented by publicly subsidised private services. Additional, totally private services were also available to a variable extent. Recently, the availabilty of publicly subsidised oral health care has been extended to cover wider groups of the total population in Finland and Sweden and, to a smaller extent, in Denmark. Concepts from market-driven care models have been introduced. In all five countries, relative to the national populations and other parts of the world, there were high numbers of dentists, dental hygienists and technicians. Access to oral health care services was good and utilisation rates generally high. In spite of anticipated problems with increasing health care costs, more public funds have recently been invested in oral health care in three of the five countries. CONCLUSION: The essential principles of the Nordic model for the delivery of community services, including oral health care, i.e. universal availability, high quality, finance through taxation and public provision, were still adhered to in spite of attempts at privatisation during the 1990 s. It appeared that, in general, the populations of the Nordic countries still believed that there was a need for health and oral health care to be paid for from public funds.

Delivery of Health Care↗
PubMed2000

Child behavior in a private pediatric dental practice associated with types of visits, age and socio-economic factors.

The purpose of this study was to describe child patient behavior patterns seen in a private pediatric dental practice. Patient behavior for every individual visit was recorded over a span of 3 consecutive months using the Sarnat Behavior Scale as the descriptive measurement device. Behavior during 5 categories of procedures was recorded: new patient examination/introduction to the office, periodic recare, restorative dentistry, orthodontic adjustment and quick check observation. Socio-demographic variables such as age, sex, method of payment as an indicator of socio-economic status, prior dental experience and referral source were also recorded. The results of this study showed: 1. the younger the child and the more threatening the procedure, the more often negative behavior was noted, 2. patients whose dental treatment was paid for by Medicaid and who are likely to be in a lower socio-economic strata, often exhibited more negative behavior than the fee-for service counterparts, 3. in general, there was no difference in the behavior between males and females, although males age 8 to 12 had a higher incidence of negative behavior than females when undergoing restorative dental procedures. There are trends between age, type of procedure, source of patient referral, method of payment and familiarity with the office, that may be able to used as behavioral predictors in a private pediatric dental office.

Age Factors↗