Do dentists refer orthodontic patients inappropriately?

One concern to both providers and consumers of orthodontic treatment is the length of new patient consultation waiting lists. A possible reason for the excessive length of these lists could be unnecessary referral of patients. This research project aimed to identify whether inappropriate referrals for new patient orthodontic consultations were a significant problem. The study was carried out in two FHSA areas in the north of England in two stages. The first part of the study involved an evaluation of GDP referral patterns to orthodontic secondary care providers. In the second part, information on the patients referred by the dentists was collected. We concluded that there was a marked variation in referral rates between the dentists and many patients were referred unnecessarily. Importantly, there was no association between dentists' referral rate and the number of inappropriate referrals made. It appears that referral guidelines for orthodontic treatment are necessary and they should be directed at all general dental practitioners.

Factors affecting the amount of long-term restorative dental treatment provided to 100 patients by 20 dentists in 3 Adelaide private practices

Apart from the effects of the frequency of patient attendance for dental examination, and of a change of dentist, little is known of those factors which may influence the amount of treatment provided in dental practice. The present study investigated during 1992 the effects of seven factors on the amount of treatment provided for 100 adult patients treated by 20 male dentists over many years in three selected Adelaide private practices. The amounts of particular types of restorative treatments provided were significantly related to patient age, gender and frequency of attendance, and to practice location, change of dentist and number of changes of dentist, and to the experience or time since graduation of the dentist. These factors were of special significance for the number of crowns provided, most of which were placed in older patients by more experienced dentists. But, there was no evidence of increased numbers of direct placement restorations being received by patients who attended more frequently or who changed their dentists.

The use of removable partial dentures amongst private dental practitioners in Singapore

A questionnaire survey was carried out in 1995 amongst university trained general dental practitioners in the city state of Singapore to assess the use of removable partial dentures (RPD). 37% of the original sample of 469 completed and returned the questionnaire. The results of this survey indicate that RPDs are a common treatment modality in Singapore. Acrylic partial dentures appear to be the preferred choice for RPD treatment. The work profile of those who had a postgraduate qualification in removable prosthodontics did not differ from that of the general dental practitioner.

Patterns of and reasons for tooth extractions in general dental practice in Ontario, Canada

While substantial proportions of the population of Ontario, Canada continue to have teeth extracted, little is known about the reasons for this loss. In this survey of Ontario general dental practitioners, 128 dentists provided information on 6143 patients they saw during a reference week. Approximately one-in-seven of these patients had or were going to have one or more extractions as part of their current course of treatment. The mean number of extractions for patients having at least one tooth taken out was 2.3 (SD = 2.5). Emergency patients were more likely than regular patients to have at least one extraction but, on average, had fewer teeth taken out. Orthodontic considerations were the main reason for tooth loss in childhood, caries continued to be an important cause of tooth loss at all ages and periodontal disease accounted for more teeth lost after 40 years of age than caries. This study differs from almost all others in finding that, overall, more permanent teeth were extracted because of periodontal disease than because of caries. The former accounted for 35.9% of teeth lost and the latter for 28.9%. While this may be due to methodological differences between this and other studies, it is consistent with epidemiological data on periodontal disease in the Ontario population and data showing that Ontarians receive little in the way of periodontal care.

Analysis of dentists' attitudes towards risks in oral radiology

OBJECTIVES

To develop a method of measuring dentists' attitudes towards radiation hazards and to describe their prevalence among Swedish general dental practitioners.

METHODS

A questionnaire was mailed to 2000 randomly selected dentists listed in the register of the Swedish Dental Society, with a response rate of 69.3%. An index for measurements of attitudes towards radiation hazards was constructed.

RESULTS

Those dentists who showed high concern at radiation hazards also restricted their use of X-ray examinations. Years in practice and attendance at extended (one-week) courses in oral radiology both had significant associations with risk attitude. Inexperienced dentists showed less concern for radiation hazards compared with those more experienced and were less scrupulous in their choice of radiographic procedures. Gender, working alone, in the public dental health services or in private practice had no significant association with attitude. Dentists who considered regulations laid down by the Swedish National Institute of Radiation Protection as wholly adequate had a high care attitude.

CONCLUSIONS

It is possible to study the relationship between attitudes and clinical behaviour by postal survey. Experience and continuing education affect dentists' attitudes towards risk and these attitudes in turn influence their clinical behaviour.

Microbiological root canal sampling: diffusion of a technology

Diffusion is the process whereby a technology enters and becomes part of the health-care system. In the present study, diffusion of microbiological root canal sampling (MRS) among general dental practitioners within the city of Gothenburg was observed for 25 years, from the establishment of the Laboratory of Oral Microbiology in 1966. Laboratory records at 5-year intervals were analysed and adopters were categorized as 'occasional' (1-2 samples/year), 'selective' (3-10) or 'regular' (> 10) samples. The diagnostic accuracy was assessed by analysing the results of culturing 574 samples referred in 1986. The acceptance rate varied between 2.9 and 5.1% except in 1986 when 10.1% of the practitioners in the area referred root-canal samples. While a minority of the adopters used MRS as a standard procedure, the strategy appeared to be directed towards selection of special cases. The results of culturing revealed a predominance of facultatives. Although evidence of contamination was found, the practitioners frequently appeared to produce valid microbiological samples.

Reasons for dentists' acceptance or rejection of microbiological root canal sampling

Microbiological root canal sampling (MRS) has been found to be used by only a few Swedish general dentists. The present study addresses the reasons for their acceptance or rejection of the technology. A questionnaire was mailed to 240 general dentists practising within the city of Göteborg. The questionnaire concerned certain practice characteristics and attitudes to MRS. The data showed that MRS is mainly performed by dentists working with adult patients in private practice. The technology is rarely used routinely, but is applied in selected cases. The main reason for non-adoption seems to be a perceived lack of relative advantage over conventional treatment strategies. Furthermore, opinions regarding the complexity and observability of the technology appear to influence acceptance significantly.

Orthodontists' perceptions of need for jaw surgery

Treatment recommendations in borderline orthognathic surgery cases were examined for influence of orthodontists' traits and orthodontist's perceptions of patients', surgeons', and psychologists' traits. A mail questionnaire consisted of 23 case vignettes describing borderline surgical candidates with certain physical, psychological, attitudinal, and support system traits, as well as demographic and attitudinal items. The response rate from 512 licensed Canadian orthodontists was 65%. Seventy-four percent of orthodontists preferred camouflage for themselves. Recommendation of camouflage predominated in 12 of 23 vignettes and surgery in only four, although the cost of surgery was considered justified. Psychological referral was recommended highly for certain patients: those hoping to improve negative life events through positive facial change, those having low self-esteem, and those wanting to opl out of surgery in the middle of orthodontic treatment. Certain patient traits appeared to influence orthodontists' treatment recommendations. The availability, expertise, and receptiveness to case discussion of oral surgeons and psychologists did not influence orthodontists' treatment recommendations.

Provision of domiciliary care in a UK urban area: results of a survey

A proportion of the population is unable to attend a dentist for treatment and it is therefore essential that an adequate domiciliary service is available. The availability of such a service was evaluated by means of a postal questionnaire distributed to 180 dentists practising in Manchester. The response rate was 57.8%. The results indicated that domiciliary care was provided by 84.6% of respondents, with the mean number of domiciliary patients treated per month being 2.9. Appointments for domiciliary care were arranged outside normal working hours by 65.9% of respondents and by arranging specific time periods by 43.2% of respondents. In general, domiciliary care was limited to prosthetic treatment, extractions, scaling and polishing, and simple restorations. A statistical association was found between number of years since graduation and the provision of domiciliary care.

General dental practitioner referral patterns for minor oral surgery

A questionnaire was sent to all general dental practitioners within Grampian region investigating the frequency of referral to hospital of medically fit patients for minor oral surgery. This was compared with their general dental practice experience and previous hospital employment. A 91.8% (n = 135) response rate was achieved. The responses indicated that practitioners refer if they believe specialist treatment is required, but less experienced practitioners were more likely to refer in the belief that general anaesthesia was necessary for treatment. A patient's request was a rare cause of referral, particularly with the more experienced practitioners. Referrals for the patient to avoid paying National Health Service (NHS) charges were rare, as were referrals due to lack of equipment. Inappropriate NHS fees for minor oral surgery treatment was a cause of referral by one third of practitioners.

Report of practicing dentists' activities which serve older people residing in Kentucky's nursing homes

This state-wide study of dental consultants to nursing homes provides a "first ever" profile of this small but important field in dentistry. As the number of older people continues to grow, particularly in the 85+ age group (which is most likely to be housed in nursing home facilities), the dental profession needs to understand and appreciate its professional obligations to this group of "special" patients. While the data is not absolutely clear, it does appear that perhaps 50% of all of the nursing homes in Kentucky do not have regular staff dentists working with them. Surprisingly, no dental hygienists seemed to be working with dentists, even though they could be quite useful for several types of clinical services and could be a big help with family and staff education projects. Nursing home consultants are dedicated individuals in the middle of their careers. Although gerontology in general and nursing home care, in particular, is primarily a women's field, women dentists in Kentucky are not yet very active in this aspect of dental practice. The list of problems and frustrations facing dentists seems long and difficult to resolve. In spite of this, the dentists working with nursing homes have continued their relationship for many years. While some dentists support more than one nursing home facility, the majority of the dental consultants do limit their efforts to a single nursing home.

A survey on orthodontics and the dental practitioner

A questionnaire was mailed to locally trained Division One dental surgeons. The questionnaire was designed to assess the practice of orthodontics, the undergraduate orthodontic curriculum in relation to the dental practitioner and continuing orthodontic education. The results showed that the undergraduate orthodontic curriculum was of limited use to the practitioner and that there was a need for a continuing orthodontic education programme. Information pertaining to various aspects of orthodontic practice was presented.

Partial denture prosthodontic procedures employed by practising graduates of the University of the Witwatersrand, Johannesburg

This study sought answers to the following two questions related to the teaching of partial denture prosthodontics in the Department of Prosthetic Dentistry at the University of the Witwatersrand, Johannesburg (Wits). Firstly, do practising graduates from Wits assiduously apply, or do they perhaps ignore, the concepts, principles, and practices taught to them at undergraduate level? Secondly, is there any merit in providing additional tutorials on partial denture prosthodontics to undergraduate students at Wits? A questionnaire was mailed to dentists who had graduated at Wits between 1979 and 1986. This sample of 302 subjects was divided into two groups: Group I--those who had graduated between 1979 and 1982; Group II--those who had graduated between 1983 and 1986 and had received additional tutorials on partial denture design. The results suggest that a wide gap exists between faculty beliefs about partial denture design and fabrication and the methods used in general dental practice. Moreover, additional tutorials had some effect on the attitudes and practices of the respondents.

Patient age and general dentists' treatment decisions

To test whether a patient's age plays a role in dentists' treatment planning decisions, a convenience sample of 159 general dentists attending a state dental society annual meeting was presented a vignette including intra-oral photographs, a brief case history and clinical diagnosis of a patient. The patient was partially dentate, and was described as having irreversible pulpitis of tooth #19. Three versions of the vignette were developed, with identical materials and information except for the patient's age (either 44, 65, or 84 years), and were randomly assigned to the participating dentists who were asked to develop a treatment plan for the patient's mandibular arch. The dentists planned limited therapy for the 84 year old because of their assumptions about the patient's brief life expectancy, cost, concern about the inability of the patient to tolerate extensive treatment, and a low cost/benefit ratio. These findings suggest that a patient's age influences general dentists' treatment planning decisions, perhaps limiting the treatment options offered to older adults. Additional research is necessary to further test these associations.