Practices and opinions of pediatric and general dentists in Connecticut regarding the age 1 dental visit and dental care for children younger than 3 years old

PURPOSE

This study aimed to determine the percentage of general and pediatric dentists in Connecticut that were aware of, and practice, the current AAPD guidelines for the age one dental visit and to determine the services they provide to 0-2-yr-old patients.

METHODS

A survey was mailed to Connecticut general and pediatric dentists seeking information on practice type, years in practice, training, ages of children seen, procedures performed and opinions regarding the age one dental visit.

RESULTS

The response rate was 42% for general dentists and 84% for pediatric dentists, giving a sample of 113 and 60 dentists, respectively. All responding pediatric dentists reported seeing 0-2-yr-olds as compared to 42% of general dentists. Although not statistically significant, general dentists who were female or in practice less than 10 years were more likely to see 0-2-yr-olds. The majority of pediatric dentists reported performing all procedures surveyed, however, only just over half of general dentists provided topical fluoride or restorative care. Among pediatric dentists, 98% were aware of the AAPD guidelines and 92% agreed with them compared to 41% and 45% of general dentists respectively.

CONCLUSIONS

Nearly all Connecticut pediatric dentists are caring for 0-2-yr-olds compared to 42% of Connecticut general dentists.

Clinicians choices of restorative materials for children

BACKGROUND

Recently, there has been an expansion in the range of tooth-coloured restorative materials available. In 1999, the National Health and Medical Research Council recommended clinicians use alternatives to amalgam in children 'where appropriate'.

METHODS

A three-part 29-item questionnaire was developed, tested in a focus group, and distributed to members of the Australasian Academy of Paediatric Dentistry (AA; paediatric dentists and paediatric dentistry postgraduate students; n=55), and the Australian and New Zealand Society of Paediatric Dentistry, Victorian Branch (SPD; general dentists and dental therapists; n=50). Participant information, material choices, and six hypothetical clinical scenarios were addressed.

RESULTS

The overall response rate was 74 per cent. For both groups, the first ranked factor influencing choice of restorative material for vital primary teeth was child age, and caries experience for vital first permanent molars. For moderate-sized Class I and II restorations in primary molars, a tooth-coloured material was chosen by 92 and 84 per cent respondents respectively. For restoring two separate proximal lesions in a primary molar, 65 per cent chose a tooth-coloured material followed by a stainless steel crown (27 per cent; all AA members), then amalgam (8 per cent). The SPD respondents were significantly more likely to choose glass ionomer cement for Class I and II restorations and for restoring two proximal lesions (all p=0.000) in primary molars than AA respondents, who were more likely to choose composite resins/compomers or amalgam/stainless steel crowns for these restorations. Younger respondents (21-40 years) were significantly more likely to choose composite resins/compomers or amalgam/stainless steel crowns (p=0.048) than older respondents (41-65 years), who were likely to choose glass ionomer cement.

CONCLUSIONS

For Class I and II restorations in primary molars, glass ionomer cement was the material chosen most frequently (SPD respondents); preference for amalgam or stainless steel crowns was low (both SPD and AA groups). The wide range of materials chosen for the hypothetical clinical scenarios suggests the need for guidelines on selection of restorative materials, and the need for longitudinal studies to follow actual clinical outcomes of the materials chosen.

Development of a rational antibiotic usage course for dentists

AIM

The aims of this report are to describe the development process of this rational antibiotic usage course and to evaluate the short-term efficiency of the course in terms of the level of improvement in knowledge and feedbacks of the participants.

MATERIALS AND METHODS

A needs assessment survey was carried out on the curriculum development process in order to determine the patterns of drug usage and level of knowledge on antibiotics of potential participants. A total of 162 dentists from two dental hospitals in Izmir were interviewed using standard questionnaires. The course content and educational strategies were determined according to the needs assessment results. Fifty-eight dentists applied to the first three courses conducted between 2002 and 2004. Pre/post-test design was performed for level of improvement in knowledge and a questionnaire form, scored by Likert Scale with 5 point, was used for participants' feedback.

RESULTS

The mean score, which was 9.74 +/- 2.71 in pre-test, increased to 18.16 +/- 1.58 in post-test and the difference was significant (t = -28.805; P = 0.000). The knowledge and approach of the trainers was appreciated most of all. Participants enjoyed the course very much, and reported a high level of satisfaction regarding the content, trainers, educational techniques and teaching material. The suggestions for future courses included increasing the course length (21.2%). Results from the needs assessment survey revealed that the study population over-used antibiotics, relied on incorrect sources of information, was unaware of the results of irrational antibiotic usage and did not check sufficiently with patients before prescribing.

CONCLUSIONS

These findings supported the need for regular courses in the application of antibiotics in dental practice and continuous refreshment of knowledge.

Clinical inertia in dentistry: a review of the phenomenon

AIM

Dentistry has been slow to adopt innovations in dental practice even when they are recommended by national organizations and supported by evidence-based guidelines. The objective of this review is to describe clinical inertia, a concept described frequently in the medical literature, and to use findings from tobacco cessation and dental sealant studies as evidence of its existence.

METHODS AND MATERIALS

A review of the literature published during the past 30 years was conducted to determine the state of affairs of two very different areas of dental practice, tobacco cessation intervention and application of sealants, to demonstrate the concept of clinical inertia in dental practice. Factors such as over estimating services provided, unfounded reasons not to act, lack of adequate training, and competing demands that account for the inertia were examined.

DISCUSSION

Clinical inertia is a complex concept that needs more attention in dentistry. A variety of strategies will be required to overcome it in order to provide the best care for the public.

CONCLUSION

Clinical inertia is a useful paradigm for explaining delays in the incorporation of new knowledge into clinical practice. It offers a model against which the broader dental community can develop and test strategies to reduce the delays in translating best practices into daily practices.

CLINICAL SIGNIFICANCE

The path to providing state-of-the-art care for the public is to engage in the discovery, dissemination, and acquisition of new knowledge then transform it into evidence-based best practices to be used in daily clinical practice.

Clinical decision making in restorative dentistry, endodontics, and antibiotic prescription

The purpose of this study was to evaluate the influence of geographic location of graduation (Israel, Eastern Europe, Latin America) on decision making regarding management of dental caries, periapical lesions, and antibiotic prescribing routines. A questionnaire was given to ninety-eight general practitioners regarding demographic and work habits. Photographs of lesions were shown on a screen. Participants reported recommended treatment and whether they would routinely prescribe antibiotics following regular endodontic treatment, retreatment, and impacted third molar surgical extraction in healthy patients. There was a 94 percent (n=92) response rate, of which eighty-five responses were used in the data analysis. Surgical treatment of asymptomatic enamel caries lesions was not recommended by most of the subjects, and surgery was recommended for DEJ caries lesions in low or moderate caries risk patients, both without significant differences between geographic regions of dental school graduation. Israelis had a lower frequency of retreatment in asymptomatic teeth that demonstrated periapical radiolucency with post restoration (without crown) compared to Latin Americans and East Europeans. Most of the participants would not retreat asymptomatic teeth that demonstrated periapical radiolucency with post and crown. After third molar surgery, 46 percent of participants routinely prescribed antibiotics. Significantly more Latin American graduates prescribed antibiotics following endodontic treatment, retreatment, and third molar extractions (p<0.05). Overmedication (antibiotics) and overtreatment (caries) among young practitioners reflect failure of undergraduate education in proper use of antibiotics and management of the carious lesions according to the patient's clinical presentation and caries risk assessment rather than routinely undertaking surgical caries treatment.

Influence of clinicians' socio-demographic, professional and educational variables on their compliance with preventive measures against hepatitis B and C

PURPOSE

To investigate the influence of a number of variables regarding clinicians' gender, social class, length of time since graduation and the level of knowledge on their use of available preventive measures against hepatitis B and C.

MATERIALS AND METHODS

A cross-sectional questionnaire-based survey was carried out involving a random and representative sample (n = 319) of the clinicians working in Recife, Pernambuco, North-East Brazil. The participants were interviewed by means of a questionnaire, prepared and pretested by the researchers. Pearson's chi-square and Fisher's exact tests were used in the statistical analyses (significance level: 5%).

RESULTS

Female clinicians were found to make more frequent use of equipment such as lab coats, scrub caps and masks (P = 0.0357). With regard to lab coat use in relation to social class, it was seen that clinicians from social class B used it less (P = 0.0077). The length of time since graduation was seen to be connected with the use of scrub caps (P = 0.0003), coating of equipment with polyvinyl chloride plastic film (P = 0.037), use of alcohol for cleaning equipment (P = 0.0012), two-handed recapping of needles (P < 0.0001) and immunisation (P = 0.003), showing that those who graduated most recently were more likely to take adequate infection control steps. The fact that clinicians had been informed about hepatitis B and C, and also their knowledge about its contagion, was positively associated with their levels of vaccination against HBV (P = 0.0313 and 0.0108, respectively).

CONCLUSIONS

The adherence to preventive practices against hepatitis B and C was shown to be connected with the clinicians' socio-demographic, professional and educational variables.

Risk-based approach in preventive practice among Iranian dentists

PURPOSE

To study risk-based preventive practice among Iranian dentists.

MATERIALS AND METHODS

A questionnaire survey was conducted at two annual dental meetings in 2004 and 2005 in Tehran. Using a five-point Likert scale, respondents indicated their level of agreement with taking preventive measures including oral hygiene, use of fluoride, diet and dental check-up for a high- and a low-risk (HR and LR, respectively) hypothetical patient case. Respondent's smoking and activity in smoking cessation were enquired about as well. Of 1033 responding dentists, 980 (64% men) were eligible for this study. Statistical evaluation was by the chi-square test and logistic regression.

RESULTS

The top four of the eight measures were instructions on tooth brushing and flossing, advice related to fluoridated toothpaste, and regular dental check-ups, with the choice 'fully agree' being more prevalent for the HR (74%-58%) than for the LR case (59%-41%). For the HR case, 45% of the respondents fully agreed with applying chair-side tooth cleaning, 41% with advice on diet modification, and 38% with advice on home-use of sodium fluoride mouthwash. Of all respondents, 76% were nonsmokers and 56% reported that they always recommend their smoking patients to quit. Female gender and activity in professional reading were associated with higher levels of agreement for applying preventive measures to the HR case. Non-smoking was the strongest explanatory factor (OR = 3.6, 95% CI = 2.6-5.1) of dentist's higher involvement in smoking cessation.

CONCLUSION

Risk-based preventive dental care should be emphasised and applied in order to maximise efficient use of resources.

Oral health service systems in Gauteng Province, South Africa

OBJECTIVES

To describe the provision of restorative care and dental operators' opinion about their conditions of service in a South African provincial oral health service system.

DESIGN

Assessment of oral health service over a four-month period.

SETTING

Gauteng Province, South Africa.

SUBJECTS

Dental operators in public oral health service.

INTERVENTIONS

Operator interview, collection of treatment statistics, calculation of the mean score of restoration-extraction ratio per operator.

MAIN OUTCOME MEASURES

Number and type of restorations and tooth extractions rendered, daily patient load, perceived occupational stress level and opinion about main reasons for operator stress.

RESULTS

A total of 88,705 patients had been treated. The mean number of patients treated daily was 26 (SD = 8.4). Operators extracted 39,242 teeth and placed 2992 restorations. The main type of dental treatment was extraction. The mean score of the restoration-extraction ratio per operator was 0.09 in the primary, and 0.07 in the permanent dentition. The mean level of stress was 4.9 (SD = 1.9). The majority of operators regarded patients' high dental anxiety as the main reason for stress, followed by high patient load. The mean level of stress increased with the increase in number of patients treated per day (r = 0.44, p = 0.004) and also with the increase in the number of tooth extractions performed per day (r = 0.41, p = 0.008).

CONCLUSIONS

Restorative dental care in this public oral health service is limited, tooth extraction being the predominant treatment provided. High patient load and high patient levels of dental anxiety determine this situation, according to the operators. The health authority should introduce appropriate solutions in order to address the prevailing situation adequately.

Routine oral examination: clinical performance and management by general dental practitioners in primary care

The aim of this clinical study was to explore the contents of routine oral examinations (ROE), carried out by Dutch general dental practitioners (GDPs), in relation to the oral health status of regularly attending patients. An observational study was performed, based on clinical case recording. Using The Data Station Project of the Dutch Dental Association as the study base, 215 GDPs were recruited, of whom 131 participated in the study. A clinical case-recording form was developed to document clinical behavior. The contents assessed concerned patient characteristics, contents of the ROE visit, diagnoses made, and clinical behavior in response to ROE findings. This study showed substantial variation in clinical behavior related to specific ROE domains, including patient history and record keeping, whereas GDPs acted consistently on other domains, such as clinical examination and recall length assessment. Furthermore, the ROE performance was more strongly associated with GDP characteristics than with patient characteristics. The mean ROE time was 10 min, and recall intervals were most frequently assigned at 6 months, irrespective of the oral condition. This study highlights a need for continuing education to promote risk-based oral screening. Further research is needed to identify factors responsible for the variation in GDP performance, just as research on clinical practice guideline implementation methods is warranted.

Age and gender differences in the use of behavior management techniques by pediatric dentists

PURPOSE

This study evaluated differences in the use of behavior management techniques among older and younger male and female pediatric dentists.

METHODS

We surveyed all active members of the American Academy of Pediatric Dentistry residing in the U.S. and Canada. Responses were received from 2467 (59%). The survey contained items on age, gender, and use of behavior management techniques.

RESULTS

Males respondents outnumbered females 2:1. Age categories were dichotomized as < 46 and > or = 46 years. Females constituted 53% of the younger group and 14% of the older group. Four gender/age categories were used. A minority indicated that they used hand-over-mouth and active immobilization of sedated patients. No significant differences by groups were seen for use of most basic behavior management techniques. Significant differences by gender/age distribution were seen for the use of non-verbal communication and advanced techniques. Most differences in anticipated changes in technique use were age-related. Most favored parental presence in the operatory, though older males were significantly less likely to allow parental presence for some procedures.

CONCLUSIONS

Some statistically significant differences in the use of behavior management techniques exist between older and younger male and female pediatric dentists. Overall, however, the 4 gender/age groups report similar frequencies of use of the techniques surveyed in this study.

A survey of consultants and specialists in restorative dentistry on their use of health-related quality of life questionnaires

A national survey of 178 consultants and specialists in restorative dentistry was undertaken to assess their use of health-related quality of life questionnaires in patients having oral rehabilitation following treatment for oral cancer. The response rate was 74% (132). 42% treated patients following oral cancer, 25% forming part of the head and neck multidisciplinary team. Only 19% had ever used questionnaires. Main barriers to their use were lack of experience with evaluation (27%), lack of staff to administer questionnaires (21%) and insufficient time (18%). Few clinicians thought that questionnaires were not clinically relevant or that no suitable instrument existed. In order to facilitate the use of an oral rehabilitation-specific questionnaire in clinical practice there needs to be greater awareness of the potential benefits, training in the process and the means of reducing the administrative burden.

The North Carolina Medicaid program: participation and perceptions among practicing orthodontists

INTRODUCTION

Limited provider participation in the Medicaid program is a barrier to access to orthodontic care for Medicaid-eligible patients. The goals of this study were to determine the participation level of North Carolina (NC) orthodontists in the Medicaid program, to examine NC orthodontists' perceptions of the Medicaid program and its beneficiaries, and to determine whether there are differences between practitioners who do and do not accept Medicaid patients.

METHODS

Questionnaires were mailed to all active orthodontists (n = 203) as reported in the NC State Dental Board of Licensing Section of the NC Health Professions Data System. Respondents were categorized as current Medicaid providers, past Medicaid providers, or orthodontists who have never accepted Medicaid.

RESULTS

Forty of 166 respondents were current Medicaid providers, 33 were past providers, and 93 never accepted Medicaid patients. All 3 groups thought that low fee reimbursement is a major problem. Those who have never participated in the Medicaid program were more likely to perceive each barrier as a major problem. Past Medicaid providers saw broken appointments and tardiness to appointments as greater problems than current providers.

CONCLUSIONS

Perceptions of Medicaid patients and lack of knowledge appear to be major barriers to provider participation.

Dentoalveolar Procedures for the Anticoagulated Patient: Literature Recommendations Versus Current Practice

PURPOSE

To evaluate the current practice of oral and maxillofacial surgeons in Michigan regarding perioperative warfarin therapy and dentoalveolar surgery in defined procedure risk groups.

MATERIALS AND METHODS

Surveys were distributed to all surgeons (n = 188) registered with the Michigan Society of Oral and Maxillofacial Surgeons. Low/moderate/high surgery risk groups were defined based on retrospective data accumulated for procedures on pretransplant liver failure patients. We requested the surgeon's maximum tolerated International Normalized Ratio (INR) for each risk group. In addition, surgeons were asked if their routine practice for each group included continuation or discontinuation of therapeutic warfarin perioperatively.

RESULTS

A 72.6% response rate was achieved. The average maximum INR cutoff values for the various risk groups were: low, 2.68; moderate, 2.28; and high, 2.01. Routine discontinuation of warfarin occurred in these groups 23.6%, 48.8%, and 70.5%, respectively. Using a paired t test, these results showed statistically significant differences in patient management practices (P < .001) between the low, moderate, and high risk groupings.

CONCLUSION

Lack of uniformity exists regarding warfarin therapy and dentoalveolar surgery. No studies to date involve significant numbers of moderate/high risk procedures to provide evidence-based support of safety with maintenance of therapeutic INR. For moderate or high risk procedures, the majority of surgeons prefer warfarin discontinuation with minimally therapeutic or subtherapeutic levels, a practice that secondarily increases risk for thromboembolism. Based on these preliminary data, we believe a prospective trial to elucidate stronger management guidelines for both the moderate and high risk surgery population is indicated.

Service patterns associated with coronal caries in private general dental practice

OBJECTIVES

To describe the pattern of dental services associated with dental caries by level of carious lesion severity.

METHODS

Data were collected by a mailed survey from a random sample of dentists from each State/Territory in Australia in 2003-2004. Dentists provided service data on patients treated on a typical clinical day for patients attending with a diagnosis of dental caries.

RESULTS

Restorative rates were higher for insured patients, radiograph rates were higher for emergency visits, prophylaxis and topical fluoride rates were higher for non-emergency visits and at capital city locations with topical fluoride also higher for patients from higher socio-economic status areas, endodontic rates were higher for emergency visits and at non-capital city locations, while extraction rates were higher for males, uninsured patients and for emergency visits. Poisson regression models compared the rates of services from different service areas for initial and cavitated carious lesions with gross carious lesions, controlling for patient demographics, visit type, location and socio-economic status. Restorative services were provided at higher rates (P<0.05) for cavitated carious lesions (RR=2.38), radiographs were provided at lower rates for both initial (RR=0.28) and cavitated carious lesions (RR=0.31), both prophylaxis and topical fluoride services were provided at higher rates for initial carious lesions (RR=2.33 and 3.00, respectively), endodontic services were provided at lower rates for both initial (RR=0.03) and cavitated carious lesions (RR=0.07), and extractions were provided at lower rates for both initial (RR=0.23) and cavitated carious lesions (RR=0.16) compared to the reference category of gross caries.

CONCLUSION

Service patterns varied by level of carious lesion severity with initial carious lesions managed by more preventive services, cavitated carious lesions with more restorative services, gross carious lesions with more radiographic, endodontic and extraction services. However, initial carious lesions tend to be managed with restorative rather than preventive service, suggesting scope for increased management by minimum intervention approaches.

Approaches taken to the treatment of young children with carious primary teeth: a national cross-sectional survey of general dental practitioners and paediatric specialists in England

AIM

To measure the distribution of choices for the treatment of a child with differing severities of caries in a primary molar tooth among specialists in paediatric dentistry and general dental practitioners (GDPs) in England.

METHOD

Two surveys were undertaken using the same tool. The populations invited to take part in the study were confined to dentists practising in England in 2004. They were 500 GDPs selected at random from the list of all GDPs with a National Health Service (NHS) contract identified by the Dental Practice Board (DPB) and all 148 specialists in paediatric dentistry appearing on the General Dental Council specialist register. The selected dentists were sent a questionnaire containing four hypothetical clinical case scenarios in which the severity of dental caries in a single primary molar differed. Each clinical case scenario had a list of possible treatment options and participants were asked to select their single most preferred treatment option. To maximise the response rate there were three mailing rounds.

RESULTS

Of the 500 GDPs and 148 paediatric specialists sent a questionnaire, 322 (64%) GDPs and 115 (78%) specialists responded. The answers to each of the case scenarios indicate differences of opinion both between and among GDPs and specialists in the care they would recommend for a child with caries in a primary molar tooth. This variation in opinion about care was more pronounced for a single deep carious lesion than for a less severe lesion. The spread of treatment options chosen in each scenario indicates disagreement among GDPs and specialists about restorative techniques and philosophy of care.

CONCLUSION

In England there is wide variation among GDPs and specialists in paediatric dentistry about the best way to treat a young child with caries in a primary molar tooth. Well designed studies are urgently needed to provide strong evidence for the most effective way to manage the dental care of children.

Attitudes and practice in the provision of removable partial dentures

OBJECTIVE

To identify the factors shaping the pattern of removable partial denture (RPD) provision by dentists in England. Design Cross sectional survey of general dental practitioners.

METHODS

Details of current practice and provision, influences, attitudes and demographic details were collected using a self-completion questionnaire mailed to general dental practitioners identified through the Dental Practice Board register.

RESULTS

Three hundred and eighty-five questionnaires were returned by general dental practitioners from 62 health authorities throughout England. The most important factor reported as influencing both the GDP's decision to provide a partial denture and its subsequent success was patient desire to have a partial denture. Constructing the denture from cobalt chrome, advising the patient on aftercare, making time available to make minor adjustments and being responsible for design were all factors dentists associated with success of a RPD. However, for a number of dentists there was a reported divergence between knowledge and practice.

CONCLUSION

Overall it is clear that provision of partial dentures continues to be patient led. However, the decision making process is also influenced by a number of factors including time, cost and the NHS fee structure.

Use of local anesthesia in restorative treatment for adults in Finland

OBJECTIVE

In this survey we investigated the frequency of use of local anesthesia (LA) in restorative treatment for vital teeth in adults in Finland.

MATERIAL AND METHODS

A postal questionnaire was mailed to 592 dentists selected by systematic sampling from the membership list of the Finnish Dental Association; 57% responded. The questionnaire inquired "How often do you use local anesthesia when restoring vital teeth in adults?" for three types of primary restorations: class III for incisors, class II for premolars or molars, and class V on gingival margin for premolars or molars. Statistical evaluation included chi-square and logistic regression modeling.

RESULTS

For restorative treatment of class III primary restoration for incisors, 21% of the dentists used LA always or almost always, 47% fairly often, 30% occasionally, and 2% rarely or never. For class II restoration for premolars or molars, 25% of dentists used LA always or almost always, 58% used LA fairly often, 16% occasionally, and 1% rarely or never. Controlling for gender and time elapsed since graduation, public dentists were more likely to use LA always or almost always for Class II (OR=2.0) and Class III (OR=1.8) restorations. No such difference appeared for Class V restorations.

CONCLUSION

The majority of dentists have accepted LA as part of their everyday practice, with more widespread use among public dentists. Still, to prevent future dental fear among patients, dentists should emphasize pain-free treatment.

Traitement chirurgical des fractures du condyle mandibulaire de l'adulte en France en 2005

INTRODUCTION

The authors had for aim to present the latest trends in the surgical management of mandibular condylar fractures in France, in 2005.

MATERIAL AND METHODS

One hundred maxillofacial surgeons were questioned on the surgical management of condylar fractures and indications. Results were presented at the 41st Congress of Stomatology and Maxillofacial surgery.

RESULTS

The overall reply rate was 70%. Condylar fractures are generally managed in teaching hospitals. Open reduction and fixation was deemed appropriate in low subcondylar fractures in 76% of the cases, in 10% for diacapitular fractures. Therapeutic details and indications were a matter of huge variability.

DISCUSSION

This survey highlighted the absence of any consensus as far as condylar fractures are concerned. It seems that the higher the fractures are, the lesser they are approached.

Attitudes of general dental practitioners in the UK to the use of composite materials in posterior teeth

OBJECTIVE

To determine the opinions and current methods used in placing posterior composite restorations by general dental practitioners.

SETTING

The study was completed by general dental practitioners randomly selected from across the UK.

METHOD

A questionnaire was devised to gain this information. It was sent to 500 UK dentists chosen at random from the general dental register, with an explanatory letter and reply-paid envelope.

RESULTS

Two hundred and sixty-seven replies were received. Sixty-one percent of dentists felt amalgam use had decreased over the last five years, 75% felt posterior composite use had increased. Regarding choice of posterior material, almost all cited clinical indication as the most influential factor while patient's aesthetic demands (89%),wish for a certain material (78%) and the dentist's confidence using a certain restorative material (76%) were contributing factors. Regarding the techniques used, contemporary techniques were employed although there was confusion regarding the need for rubber dam and the most appropriate method of lining the cavity. A case scenario of a pregnant patient who required treatment found that 66% of respondents would place a restoration other than a temporary dressing, with 16% placing an amalgam restoration.

CONCLUSIONS

The majority of dentists surveyed place load bearing posterior composite restorations regularly. Their choice of restorative material is influenced by clinical indications and the patient's aesthetic demands. The techniques used were appropriate, although there was confusion around the need for rubber dam and the most appropriate method to line the cavity. There was also confusion in relation to the most appropriate materials for use in pregnancy.

Knowledge, attitude, and practice of dental implantology in Nigeria

AIM

The purpose of this study was to assess the knowledge, attitude, and practice of dental implantology among dentists practicing in Nigeria.

MATERIALS

Self-administered questionnaires to assess the knowledge, practice, and attitude of dental implantology were sent to dentists practicing in all the 6 geopolitical zones of Nigeria (i.e., all tertiary dental institutions, and selected general and private hospitals within the zones). Data collected were analyzed and presented in descriptive and tabular forms.

RESULTS

The response rate was 77%. Only 2 (1.3%) of the respondents claimed to have employed implant(s) for dental restoration in their practice, while 152 respondents (98.7%) have never used implants as a method of tooth/teeth restoration. Of the latter, 46.1% have suggested implants for full/partial denture patients, 31.8% have suggested dental implants to patients needing single-tooth replacement, and 89.6% were ready for dental implant placement if equipment and materials for dental implants backed up with adequate training were provided. Of respondents, 83.1% also believed that implantology is a multidisciplinary approach, and 42.9% rated implants as the best option for dental restoration.

CONCLUSIONS

The practice of implant dentistry is presently very low in Nigeria. Clearly, there is a need for dental implant education for Nigerian dentists to increase their knowledge and proficiency in dental implant dentistry. In addition, all efforts should be made to include implant education and practice in dental curricula in undergraduate and postgraduate institutions in Nigeria.

Periodontal Services Rendered by General Practitioners

BACKGROUND

There are few reports in the dental literature regarding the types of periodontal services offered by general practitioners (GPs). The purpose of this study was to determine the specific nature of periodontal services rendered by GPs and to investigate whether certain variables affect GPs' practice patterns.

METHODS

A 13-item survey was mailed to a random sample of 600 dentists practicing in the state of Virginia. GPs were asked to identify the periodontal services rendered in their office within a 3-month period. Descriptive statistics, simple correlation, and stepwise multiple regression analysis were used to identify significant relationships between variables and periodontal services.

RESULTS

Ninety percent of GPs reported treating at least one patient with scaling and root planing, and 16% of GPs reported rendering this service to >36 patients. Eighty-six percent of GPs reported providing periodontal maintenance in their practices. Approximately 50% of dentists reported up to 24 patients having received periodontal maintenance. Fifty-eight percent of GPs reported that >or=90% of scaling and root planing was done by the hygienists. Fifty-five percent of GPs treated at least one patient with site-specific therapy using chemotherapeutic agents. Twenty-eight percent of GPs treated one to five patients with low-dose antibiotic. Seventy percent of GPs treated at least one patient with occlusal therapies, and 50% reported treating one to five patients with occlusal therapies. The most common surgical services performed included crown lengthening and pocket reduction surgery, which were done by 38% and 21% of GPs, respectively. A few GPs (N = 26) performed the majority of periodontal surgical services. Variables found to influence specific services rendered by GPs included year of dental school graduation, recent hours of continuing education related to periodontics, combined number of dental hygienist days per week, percentage of periodontal patients in practice, and referral for non-surgical periodontal therapy.

CONCLUSIONS

A variety of periodontal services were offered by GPs. The most common services were non-surgical in nature. Certain variables affected specific periodontal services rendered in general dental offices.

Survey of prosthodontic service provided by general dentists in Virginia

STATEMENT OF PROBLEM

Activities in prosthodontic treatment may be changing due to prevalence of disease and new treatment options. Studies cite conflicting evidence in regard to prosthodontic services, particularly removable prosthodontics.

PURPOSE

This project was designed to describe the amount of prosthodontic services provided by general dentists in Virginia. Results may enhance understanding practice patterns in Virginia and regions with similar demographics.

MATERIAL AND METHODS

Licensed Virginia dentists (n=600) were randomly selected from the Virginia Department of Health Professions website. Each individual was mailed a survey of questions about his or her demographics and practice activities with regard to prosthodontics.

RESULTS

Of the 333 respondents, 195 provide prosthodontic treatment and function as general dentists. On average, they spend 25% of their practice time providing prosthodontic services (17% fixed and 8% removable). They provide at least 1 complete denture for a mean total of 24.3 patients per year, at least 1 removable partial denture for a mean total of 28.7 patients per year, at least 1 fixed partial denture for a mean total of 23.0 patients per year, at least 1 implant-supported crown for a mean total of 12.3 patients per year, and at least 1 implant-supported fixed partial denture for mean total of 3.3 patients per year. Data were analyzed using descriptive statistics. Data for total population and median income were analyzed with the Wilcoxon signed rank test.

CONCLUSION

Virginia dentists continue to provide considerable numbers of fixed prosthodontic restorations, removable partial dentures, and complete dentures, while providing a growing number of implant-supported restorations.

Decision making of Israeli, East European, and South American dental school graduates in third molar surgery: is there a difference?

PURPOSE

This study was designed to evaluate decision making among Israeli, Eastern European, and South American dental school graduates in oral surgery issues.

MATERIALS AND METHODS

During a military dental convention, a survey was conducted among 85 dentists that included a questionnaire and a panoramic image presentation.

RESULTS

Removal of the mandibular third molar was recommended more often by the Israeli graduates, Eastern European dentists recommended less maxillary antagonist extraction, and South American graduates had the lowest rate of recommendation for extraction of a partially impacted mesioangular and distoangular mandibular third molar in a 19-year-old patient, and of a fully impacted horizontal mandibular third molar in 19- and 35-year-old patients. In all groups, more dentists recommended extraction of disease-free third molars in 35-year-old than in 19-year-old patients.

CONCLUSION

According to study results, decision making regarding third molar treatment is not evidence-based and is not rational. Further postgraduate education in this area is warranted.

Changes and factors associated with dentists' willingness to treat patients with severe disabilities

OBJECTIVE

This study investigated changes in dentists' willingness to treat severely disabled patients and to understand dentists' opinions on reimbursements after the implementation of a dental care financial reward program in Taiwan.

METHODS

Three hundred dentists from 29 teaching hospitals were randomly selected to answer a structured questionnaire, and 184 structured questionnaires were returned. Multiple regression analysis was used to examine the factors associated with dentists' willingness to treat severely disabled patients.

RESULTS

Approximately 60% of the dentists said reimbursements for treatment of severely disabled patients were reasonable. 50.4% of dentists were willing or very willing to treat disabled patients. Seventy-nine percent dentists affected by the program had a higher willingness but 83.7% dentists said this program did not make a significant difference to their income. 52.8% of dentists agreed the program would increase the quality of dental care. The factors significantly affecting dentists' willingness included dentist's age, specialty field, perception of the program in promoting the quality of dental services, and perception of the ability to provide adequate treatments for severely disabled patients.

CONCLUSIONS

The rewards program significantly increased the willingness of most hospital-base dentists to treat the severely disabled patients although the effect of incentive to their income was limited.

Referral Patterns of General Dental Practitioners for Oral Surgical Procedures

PURPOSE

The health maintenance organizations (HMOs) in the United States continue to be a powerful force in the field of medicine. Their infiltration into dentistry has placed an emphasis on having the primary care provider (general practitioner [GP]) function as the central orchestrator from which patient care cascades. The purpose of this study is to determine the self-perceived threshold and referral tendencies for the GP to a specialist for oral surgical needs.

MATERIALS AND METHODS

Six hundred dentists were randomly selected to receive a questionnaire containing 16 clinical cases. These randomly arranged cases consisted of a brief case history and appropriate radiographs. Each case differed in complexity and was grouped according to surgical difficulty as follows: group I--simple dentoalveolar surgery, group II--complex dentoalveolar surgery (including any third molar case), group III--cases requiring placement of an implant, group IV--simple surgery for a medically compromised patient, and group V--complex surgery for a medically compromised patient.

RESULTS

Differences in the referral patterns of cases were noted comparing age, gender, and years of practice of the GP. A higher referral rate to the specialist was also observed in patients with remarkable medical conditions. Most general dentists referred the complex dentoalveolar surgery cases. There exists a gender difference in the referral patterns of female dentists compared to their male counter parts in similar age groups and years of clinical practice. Most dentists referred the implants procedures to oral and maxillofacial surgeons or periodontists. Referrals for simple and complex surgical procedures were most often made because of inadequate surgical experience.

CONCLUSIONS

When designing dental health policy with regard to exodontia, dentoalveolar surgery and management of the medically compromised patient, insurance companies and public health administrators should consider the existing competencies and level of comfort of the GP.

Dentists' management of the diabetic patient: contrasting generalists and specialists

OBJECTIVES

We measured and contrasted general dentists' and periodontists' involvement in 3 areas of managing diabetic patients-assessment of health status, discussion of pertinent issues, and active management of patients--and identified and contrasted predictors of active management of diabetic patients.

METHODS

We conducted a cross-sectional mail survey of random samples of general dentists and periodontists in the northeastern United States during fall 2002, using lists from the 2001 American Dental Directory and the 2002 American Academy of Periodontology Directory. Responses were received from 105 of 132 eligible general dentists (response rate=80%) and from 103 of 142 eligible periodontists (response rate=73%).

RESULTS

Confidence, involvement with colleagues and medical experts, and professional responsibility were influential predictors of active management for periodontists (R2=0.46, P<.001). Variables pertaining to patient relations were significant predictors for general dentists (R2=0.55, P<.001).

CONCLUSIONS

Our findings permitted us to assess and compare general dentists' and periodontists' behavior in 3 realms--assessment of diabetic patients' health status, discussion of pertinent issues, and active management of diabetic patients--and to identify components of potentially effective targeted interventions aimed at increasing specialists' and generalist dentists' involvement in the active management of diabetic patients.

Antibiotic prophylaxis practices in dentistry: a survey of dentists and physicians

BACKGROUND

A survey was conducted to determine prescribing practices of general dental and medical practitioners regarding the use of antibiotics for prophylaxis.

MATERIALS AND METHODS

A questionnaire with an accompanying letter was designed to investigate prescribing practices of general dentists and physicians. The survey encompassed demographic data, mechanisms to keep current with prophylactic practice, first- and second-line drugs prescribed with doses and directions, applicable medical conditions and dental procedures warranting antibiotic prophylaxis. Names were chosen randomly from provincial lists and ethics approval was granted. Responses were compared with 1997 American Heart Association (AHA) guidelines.

RESULTS

In all, 1,500 surveys were sent to each group, with a response rate of 32% of dentists and 17% of physicians. There was a significant difference (p < 0.05) between dentists (95%) and physicians (71%) in selecting the correct first-line antibiotic, amoxicillin, and in choosing the correct dose of amoxicillin (i.e., 2 g, 1 hour before treatment): 88% of dentists and 48% of physicians (p < 0.05). Appropriate second-line drugs were correctly selected by 84% of dentists and 67% of physicians--a significant difference (p < 0.05)--with clindamycin chosen most often (82% and 49%, respectively). Over 90% of respondents in both professions correctly identified conditions, such as prosthetic heart valve and endocarditis, requiring antibiotic prophylaxis.

CONCLUSIONS

Clinicians are not always aware of current clinical guidelines, and dentists and physicians exhibit different patterns regarding antibiotic prescribing. Dentists are more familiar than physicians with current protocols of the AHA.

Antemortem Dental Records: Attitudes and Practices of Forensic Dentists

This study was designed to provide insight concerning the attitudes and practices of forensic dentists regarding antemortem dental records reviewed for purposes of dental identification. Forensic dentists were invited to participate in a 10 item survey. The majority of the respondents reported a considerable amount of experience in dental identifications of the deceased. Sixty-six percent reported having suspected dental negligence or fraud in their antemortem record reviews. Only 17% believe that a forensic dentist should report suspected dental negligence, while 31% agree that dental fraud should be reported. Their response to additional issues addressed in the study suggests diversity in the practices and attitudes of forensic dentists in the use of antemortem dental records. In conclusion, opening a dialogue among practicing forensic dentists may lead to a standardized set of recommendations by the appropriate societies in the forensic dental community.

Oral Cancer Prevention and Early Detection Knowledge and Practices of Illinois Dentists ? A Brief Communication

OBJECTIVES

The purpose of the study was to assess Illinois dentists' self-reported knowledge and practices concerning oral cancer prevention, early detection, and management as a baseline prior to conducting interventions designed to increase dentists' capacity to detect and manage oral cancers and counsel their patients about risk reduction.

METHODS

A weighted sample to represent licensed dentists in 19 counties yielded 518 dentists who responded to a 38-item mailed survey in 2004.

RESULTS

Over 92 percent of the dentists reported providing oral cancer exams. However, many are not doing them properly or at frequent intervals. Over two-thirds had oral cancer continuing education, but 40 percent had it more than 2 years prior to the survey. Training in risk counseling was rare.

CONCLUSIONS

Interventions are needed to assure appropriate skill and knowledge levels for oral cancer early detection, management, and risk counseling by Illinois dentists.

[Survey of the current situation on clinical application of root canal treatments in Zhejiang province]

PURPOSE

To investigate the present situation of root canal treatment (RCT) applied by the endodontists in the major hospitals of Zhejiang province.

METHODS

Dentists in different hospitals were asked to fill in the questionnaire, which included the methods and factors of the first-choice treatment of endodontic diseases, instruments and materials used in RCT. The data were analysed by descriptive analysis and Mann-Whiteney U test using SPSS12.0 software package.

RESULTS

410 effective questionnaires from 76 different hospitals were received. The reply rate was 91.1%. RCT was performed as the first-choice of endodontic treatment in 93.5% of total 410 dentists. And 90.2% of them used hand instruments to prepare root canals. Push-pull or stepback technique was widely used in anterior or posterior root canal preparation. Hydrogen peroxide was adopted to irrigate root canal by the majority of respondents (88.3%). Nearly half of the respondents used camphorate phenol as intracanal medicine. 77.6% of them adopted cold lateral condensation technique and 32.7% of them used gutta-percha mixing with iodoform for canal obturation. 74.6% of them applied one-visit endodontic treatment sometime and prescribed antibiotics or hormone to the patients after RCT.

CONCLUSIONS

Although RCT has been widely used in endodontic diseases by dentists in Zhejiang province, some advanced techniques and new materials still need to be adopted and refined.

[Determination of working length in general endodontic practice]

Accurate determination of root canal length is essential for successful endodontic therapy. Two methods are generally accepted for working length measurements: radiographic length determination and by the means of electronic apex locators. The purpose of this study was to evaluate the working length determination habits of Hungarian dentists using a survey form containing 15 selective closed questions for data collection. The results indicate that 70% of the dentists preferred the radiographic method. 19% of the responders employ electronic apex locator. 21% of dentists relied on fingertip tactile sense or on the patient's response. 44% of the responders determined the working length after pulp tissue removal. 22% of dentists make the measurements at the end of root canal instrumentation. 34% of the dentists disregard the evaluation of the preoperative radiographs for the estimated working length determination. The results suggest that whilst most of the general practitioners use the techniques currently taught in dental schools, a large proportion of them apply methods not accepted by contemporary dental profession.

Thresholds of restorative decision in dental caries treatment among dentists from small Brazilian cities

PURPOSE

To investigate the thresholds of restorative intervention in dental caries treatment, based upon the lesion depth seen in radiographs, among Brazilian dentists working in small cities. In addition, the threshold of restorative intervention was compared with demographic and work-related characteristics.

MATERIAL AND METHODS

The studied population comprised dentists (n = 89) who were working in 2000 in 20 small cities of the Midwest region of the Southern Brazilian State of Santa Catarina. Four different radiographs were shown of extracted premolars fixed upon a plaster base. The criteria for the radiograph analyses were proposed by Nuttall et al (1993).

RESULTS

Of investigated dentists, 16.7% would restore a carious lesion confined to the outer half of the enamel and 33.3% would restore a carious lesion in the outer and inner half of the enamel, but without involving the enamel-dentine junction. The percentage that would restore lesions in the outer half of dentine was 91.7%. Dentists who had attended postgraduate courses in areas of interest of this study tended to adopt a more conservative treatment when compared with dentists who had not attended (p < 0.01).

CONCLUSIONS

There was a great variation in the thresholds of intervention based upon lesion depth seen in radiographic images amongthe investigated Brazilian dentists. An interventionist attitude was observed, which could result in over-treatment. It is highly recommended to educate general practitioners from the studied region in performing early diagnosis of lesions and non-invasive care in order to treat initial carious lesions with only remineralisation and monitoring.

Utilization of stainless steel crowns by general dentists and pediatric dental specialists in Indiana

The purpose of this study was to evaluate utilization of the stainless steel crown by both the general and pediatric dentists in Indiana. Although reports indicate that there has been a dramatic reduction in dental caries in the US, almost 20 percent of children have dental decay by age four, with almost 80 percent having a cavity by 17 years of age. After reviewing the literature, Seale has recommended that the stainless steel crown is the most successful restoration for children with a rate of high caries. All dental schools in North America teach the value of using stainless steel crowns and the method of tooth preparation. We hypothesized that greater use of the stainless steel crowns would be made by specialists than by general dentists. In this study, of the 200 questionnaires distributed, 62.5 percent were returned and analyzed. The results imply that stainless steel crowns are being significantly underutilized in general dental practice. It is interesting, and perhaps of concern, that the general dentists are not interested in continuing education courses about this subject. Over the next few years, with the aging of the pediatric dental community in Indiana, general (not specialty) dentists will treat most of the children. Because of this, pre-doctoral education needs to place more emphasis on preparation and utilization of the stainless steel crown.

The orthodontic workforce in Ireland: a report by the Orthodontic Society of Ireland

There are currently 110 specialist orthodontists in the Republic of Ireland. The response rate to this survey was 95 (85%); one-third of the orthodontic workforce are women; there are 49 (45%) orthodontists employed in the hospital service (including consultants) and 60 (55%) working in private practice; half (50%) of the orthodontists in hospital settings are female; only nine (18%) of those in private practice are female; two-thirds (66%) of the orthodontists in Ireland are under the age of 45; a little over one-quarter (28%) are under the age of 35; of those in the 25-35 age bracket, almost 80% are employed in the HSE. With increasing age, more orthodontists work in private practice; adult patients comprise 28% of the reported caseload in private practice compared to 12% in hospital settings; non-extraction patients account for 37% of the caseload in hospital settings compared with 57% in private practice; and almost one-quarter (24%) of those in hospital practice stated that they intended to change their working practice in the future.

Use of radiographs for periodontal diagnosis in private practice

The aim of the present study was to determine the percentage of dentists who use radiographic examination on the initial appointment, and establish the relation between the use of periodontal probe and graduation year. Dentists were interviewed in their private offices in three cities in Rio Grande do Sul. They were asked about the routine use of radiographic examination and, if applicable, what technique was applied and what clinical instrument was used at the first appointment. Opened and closed questions were included in the interview and for some of them more than one answer was possible. A significant number of dentists (62.9%) reported some kind of radiographic examination at the initial appointment. Among the radiographic techniques, the periapical was the most cited (74.3%), followed by the panoramic (36.2%) and bite-wing (32.9%) techniques. There was an association between the use of periodontal probe and the use of radiographic examination at the initial appointment. Dentists who used periodontal probe used radiographic examination more frequently (p=0.010). More recently graduated dentists (1991-2005) used radiographic examination more than the others (p=0.022). In conclusion, a large number of dentists reported the use of radiographic examination at the initial appointment. There was an association between the use of this examination technique and the use of the periodontal probe; recently graduated dentists used radiographic examinations more frequently than the others.

An Analysis of Current Analgesic Preferences for Endodontic Pain Management

A descriptive, cross sectional survey was developed to determine the preferences of endodontists when prescribing analgesics. Eleven clinical scenarios describing common endodontic diagnoses or procedures with specified severity of pain were provided. A survey was sent to 310 AAE members and 63 responded, providing a 20% response rate. Respondents were given various choices for analgesic prescription including various dosages of ibuprofen or acetaminophen (APAP), or combination narcotic medications. Data were analyzed by chi2 tests. Non-narcotics were preferred over narcotics for all clinical situations. Significantly more respondents selected ibuprofen 600 mg (4x a day) regardless of the severity of preoperative or postoperative pain (p<0.001). Educators and board-certified AAE members were less likely than nonboard certified AAE members to manage their patient's perceived severe pain with narcotic analgesics.

General dentists and pediatric dental patients: the role of dental education

The objective of this study was to investigate whether undergraduate dental education affects general dentists' practice characteristics, attitudes, and professional behavior concerning the treatment of pediatric patients. Data were collected with a self-administered mailed survey from 241 general dentists who were members of the Michigan Dental Association (response rate=48.2 percent). While 40.4 percent of the respondents reported that their dental education had prepared them well to treat child patients, only 33.4 percent indicated that their clinical education had prepared them well. The level of educational preparedness was significantly correlated with a) practice characteristics such as how well the practice was set up to treat children and how knowledgeable and comfortable the staff was concerning providing care for children, b) attitudes concerning the treatment of child patients, and c) professional behavior such as the types of services provided for child patients versus the number of referrals made. The findings strongly suggest that educational experiences concerning the treatment of pediatric dental patients will shape future dental care providers' attitudes and professional behavior. Given the lack of access to dental care for children, it seems crucial to carefully evaluate undergraduate dental curricula to ensure that future dental care providers receive sufficient educational and especially clinical experiences concerning the treatment of child patients.

Discrimination or discretion? Exploring dentists' views on treating patients with hepatitis C

BACKGROUND

People with hepatitis C (over 259 000 Australians) experience stigma and discrimination, whether perceived or actual, in health care settings. They are less likely to access health care, presenting a major barrier to preventive care and treatment. This study aims to identify factors contributing to such discrimination, barriers to optimal care and strategies to overcome these.

METHODS

A purposive sample of 25 Victorian dentists took part in semi-structured interviews to investigate their experiences and attitudes in providing care to people with hepatitis C. Interviews were taped, transcribed and coded for thematic analysis.

RESULTS

All dentists interviewed were aware of Standard Precautions. However, there were some who changed practices when seeing a client with hepatitis C, suggesting that they lack confidence in Standard Precautions. When prompted, these dentists were concerned that patients may perceive these actions as discriminatory. All participants, including a small minority who expressed negative views about injecting drug users, felt a professional obligation to treat all patients.

CONCLUSIONS

Most dentists have appropriate attitudes regarding patients with blood-borne viruses. However, it is important for dentists to understand how their actions may be interpreted by those who feel sensitive about their status. Dentists need to feel genuinely confident about Standard Precautions and have a realistic view of the infection risk posed by patients with blood-borne viruses.

Treatment concepts for restoration of endodontically treated teeth: A nationwide survey of dentists in Germany

STATEMENT OF PROBLEM

Opinions concerning proper restoration of endodontically treated teeth (ETT) vary. A variety of techniques and materials for post-and-core restorations are available. The rationale for post placement performed by German dentists was unknown.

PURPOSE

The purpose of this study was to determine current opinions, applied techniques, and materials for the restoration of ETT in Germany.

MATERIAL AND METHODS

A nationwide questionnaire-based survey containing 18 multiple choice questions regarding treatment philosophies, favored post type, and materials for core foundations was mailed to 36,500 German general dentists. A total of 6029 questionnaires (16.5%) were returned. Data were evaluated in terms of the dentists' occupational experience and the frequency of post placement. Descriptive statistics were used to analyze the data.

RESULTS

Irrespective of their occupational experience, 52% of the surveyed dentists consider post placement for almost every postendodontic restoration of ETT. The majority of dentists (54%) believe that a post reinforces ETT. Cast posts and cores are used by 55% of all dentists, whereas 34% use prefabricated posts exclusively. Screw posts are the most popular prefabricated post type (47%). Composite resin (51%) is preferred for core foundation, followed by glass ionomer cements (GICs) (26%). Amalgam is seldom used (0.5%). Posts are placed primarily with zinc phosphate cement (51%), followed by GIC (38%).

CONCLUSION

The treatment philosophy of German dentists is not in complete agreement with recommendations found in the literature. The belief that a post would reinforce an ETT might explain the high frequency of post placements. Due to the partially inconsistent responses, it is difficult to derive a generalized treatment concept.

Antibiotic prescribing practices among Norwegian dentists

OBJECTIVE

There is little information on antibiotic prescribing habits among dentists in general. In 1992 we reported a study among Norwegian dentists, and the present investigation was undertaken to find out if the patterns of antibiotic prescription had changed since then.

MATERIAL AND METHODS

A total of 470 randomly selected dentists (10% of total) received a questionnaire and a letter describing the survey and 313 responded.

RESULTS

Results indicated that 35% did not issue any prescriptions in a typical week, while 3% issued > or =5. Fifty percent reported that they might prescribe antibiotics when treating periodontal diseases, but only 3.4% reported the use of microbial diagnosis before selecting an antibiotic; 71% of the respondents reported use of antibiotics occasionally to prevent general complications of dental treatment; 80% prescribed antibiotics for prophylactic use if the patient revealed a history of endocarditis, while 5% reported never doing so.

CONCLUSION

These findings are in concert with the results obtained 11 years ago, but indicating that dentists who had attended postgraduate courses on antibiotics prescribed such drugs more frequently. This was not statistically significant. However, it is of great concern that 5% never prescribed antibiotics when treating patients with a history of endocarditis, and that 20% did not know that amoxicillin was a penicillin. Such lack of knowledge may cause fatal results of therapy.

Reasons for third molar teeth extraction in Jordanian adults

AIMS

To assess reasons for third molar teeth extractions in a sample of Jordanian dental patients and to evaluate the association of extractions with other independent variables.

METHODS AND MATERIALS

The study sample was comprised of dental patients in North Jordan who had third molar extractions. Data were collected from 36 dentists who were instructed to administer questionnaires to their adult patients undergoing third molar extractions and then to record the primary reason for those extractions. The data in this study was analyzed using a descriptive summary and chi square statistics.

RESULTS

Dentists performed 810 extractions for 648 patients. The reasons for the extractions were: dental caries and its consequences about 42%, eruption problems 39%, periodontal diseases about 7%, and approximately 9% of extractions were a result of the dentist's choice. The percentage of extractions due to dental caries significantly increased with increasing age. However, significant numbers of teeth were extracted due to eruption problems (51%-69%) in young adults. For 46+ year olds, 23% of extractions were caused by periodontal diseases. Extraction due to dental caries was distributed equally among the sexes. Persons with irregular tooth brushing and fewer dental visits had significantly more third molar teeth extracted due to caries and periodontal diseases compared to persons with regular tooth brushing and dental visits.

Sedation in Wales: a questionnaire

AIM

To identify the current provision of sedation in primary dental care in Wales.

DESIGN

Postal questionnaire survey.

SETTING

Wales 2003.

SUBJECTS AND MATERIALS

Questionnaires were sent to all dentists appearing on the Dentists Register with addresses in Wales (n = 1374). The questionnaires sought details on personal status, use of and training in conscious sedation techniques.

RESULTS

In total 951 (69%) questionnaires were returned, 720 (90%) respondents worked in a primary dental care setting. Only 87 (12.1%) primary care dentists offered some form of sedation.

CONCLUSIONS

The provision of conscious sedation services in primary dental care in Wales is poor.

Root canal treatment in Denmark is most often carried out in carious vital molar teeth and retreatments are rare

AIM

To study the reasons given by a representative sample of Danish general dental practitioners (GDPs) for undertaking root canal treatment and, to investigate their confidence in performing root canal treatment on molar teeth.

METHODOLOGY

A questionnaire was sent to 600 Danish GDPs randomly selected from the roster of the Danish Dental Association. They were asked to recall various factors about their experience of the last root filling they completed, including the reason for treatment and the pulp diagnosis. Self-assessments on 100-mm visual analogue scales (VAS) were reported concerning the confidence in performing root canal treatment of a molar. End-point definitions were 'very easy' (0) and 'very difficult' (100), respectively. Time reports of molar treatments were given in categorized groups.

RESULTS

The most frequent reason for performing root canal treatment was caries within the tooth involved (55%). The majority of treatments involved teeth with vital pulps (54%). Retreatments were carried out in 2% of the cases. The confidence in performing root canal treatment varied but was relatively high, expressed as VAS-values below 50. The creation of an aseptic working field was regarded as the most difficult procedure followed by root canal preparation. Fifty-six percent of the responders stated a time frame of 46-75 min to complete root filling in a molar tooth.

CONCLUSIONS

Root canal treatment in Denmark was reported to be undertaken most often because of caries. Treatment was typically performed in molar teeth with vital pulp. Even though apical periodontitis was frequently noted in root filled teeth, retreatments were rare. From a subjective perspective root canal treatment was not considered to be very difficult and was carried out relatively rapidly.

Knowledge of prescribing antimicrobials among Yemeni general dentists

OBJECTIVE

Overuse of antimicrobial agents is closely related to an increase in bacterial resistance. A sound knowledge of appropriate prescribing of antimicrobials among health professionals is thus critical in combating the resistance. The objectives of this study were to assess the rationale for and patterns of antimicrobial prescriptions by general dental practitioners in Yemen.

MATERIAL AND METHODS

A questionnaire containing 65 closed questions was used for this cross-sectional study and distributed to 280 dentists in the three major governorates in Yemen. The anonymously completed questionnaires sought answers to demographic questions and to questions on the therapeutic and prophylactic use of antimicrobial agents in dentistry. Correct and incorrect answers were defined according to information available in the current authoritative literature. Each correct answer was given a score of 1 while an incorrect answer scored 0. Thus, the total score had an attainable range from 0 to 65. Frequencies, means, and associations were assessed statistically.

RESULTS

Out of 181 collected forms (response rate 64.6%), 150 were appropriately completed and used for data analyses. Penicillins were the most frequently prescribed drugs (72%), followed by spiramycin (10%). It was found that up to 84% of practitioners were likely to prescribe an antimicrobial agent when there was no clinical indication for such a medication. Many respondents (70%) would consider antibiotics for at least one of the given non-clinical factors.

CONCLUSIONS

The results suggest that dental practitioners in Yemen lack uniformity in the rationale for appropriate prescribing of antimicrobials to their patients. Consequently, to reduce overuse, there is an urgent need for the dental community in the country to be informed about evidence-based guidelines and the appropriate use of antimicrobial agents in clinical dental practice.

Smoking cessation as a dental intervention--views of the profession

OBJECTIVE

To undertake a questionnaire-based survey to determine the attitudes and activities of dental professionals in primary care in the Northern Deanery of the UK in relation to providing smoking cessation advice.

METHODS

Questionnaires for dentists, hygienists and dental nurses were sent to hygienists to distribute to other members of the team. The information collected included: smoking status of the professionals and the practice; roles of the dental team in giving smoking cessation advice; levels of training received; and potential barriers to giving this brief intervention.

RESULTS

Over 90% of practices were smoke-free environments and significantly more dental nurses (23%) were smokers compared to dentists (10%) and hygienists (7%) (p<0.01). The majority of dentists and hygienists enquired about smoking status of their patients and all three groups believed that hygienists and dentists should offer brief smoking cessation advice. Potential barriers to delivering smoking cessation advice were identified: lack of remuneration; lack of time; and lack of training.

CONCLUSION

Dental teams in primary care are aware of the importance of offering smoking cessation advice and, with further training and appropriate remuneration, could guide many of their patients who smoke to successful quit attempts.

Disseminating evidence from health technology assessment: The case of tobacco prevention

Objectives: The aims of the present study were to investigate the awareness among dentists and dental hygienists of evidence-based reports and guidelines on tobacco cessation activities and the impact these publications had on clinical practice.

Methods: A questionnaire was mailed to dental hygienists and dentists in Stockholm County, Sweden, and the results were compared with a previous investigation.

Results: Among the respondents, awareness of a popular science version of a systematic review on smoking and its effect on oral health was reported by 90 percent of the hygienists and 66 percent of the dentists. The information was used in clinical work by 34 percent of the dentists and 54 percent of the hygienists. Reported changes in patterns of practice were more frequent recommendations to use nicotine replacement therapy and a more widespread use of setting quit dates. Approximately one quarter of the dental professionals reported that they had increased tobacco cessation consultation because of the results from the reports.

Conclusions: Changes in patterns of practice were observed after dissemination of evidence-based information on tobacco cessation. Methods that were proven to be effective in the evidence-based report such as discussing quit dates and recommending nicotine replacement therapy were more commonly used after the publication of the report. Short, popular versions of extensive systematic reviews seem to be useful for implementing evidence-based knowledge and changing clinical practice.

Oral health care for frail elderly people: actual state and opinions of dentists towards a well-organised community approach

OBJECTIVE

This study was undertaken to provide an analysis of the actual oral heath care for frail elderly people living in different settings and to explore opinions of dentists towards new concepts in developing a community approach.

METHOD

Data were collected from a sample of 101 dentists (15%) in the county of Antwerp using a self-administered 30-item questionnaire including questions about age, gender, education, organisational aspects of dental surgery, questions concerning dentists' own contribution to oral healthcare services for frail elderly people and statements concerning opinions and attitude toward the organisation of oral health care for frail elderly people. At the same time, qualitative data were collected from focus group sessions with all participating dentists. Non-parametric analysis was used to explore possible relationships between opinion and possible explanatory variables.

RESULTS

Half of the dentists offered dental services to residential or nursing homes (mean number of treatments a year: 5.4) and at home (mean number of treatments a year: 2.4). Prosthetic treatments such as relieving denture pressure points, repairing, rebasing and making new dentures were carried out in 77.4% and 76.7% of the cases in residential or nursing homes and at home respectively. Extractions were carried out in 16% and 18.6% of the cases in both living situations respectively. The main reasons for dentists refusing domiciliary oral health care were the absence of dental equipment (63%), lack of time (19%), with 11% convincing the patients to be treated in their dental surgery. Analysis showed different opinions of dentists depending on age, gender and university of education; however, statistically significant differences were only found by age.

CONCLUSION

The older the dentist, the greater the tendency to refuse domiciliary oral healthcare services. The younger dentists were reluctant to cooperate in the provision of oral health care in a structured community approach.

Trends in service provision among Australian private general dental practitioners over a 20-year period

AIM

To-investigate time trends in service provision.

DESIGN

Five cross-sectional surveys across a 20-year period.

SETTING

Australian private general practice

PARTICIPANTS

A random sample of dentists.

METHODS

Mailed questionnaires were collected in 1983, 1988, 1993, 1998 and 2003 (response rates 71%-76%).

MAIN OUTCOME MEASURES

Services per visit, annual services per dentist; annual services per patient.

RESULTS

Total services per visit increased over the study period from 1.78 to 2.37 (Poisson regression; P<0.05). However the annual number of services provided per dentist did not vary significantly, reflecting a trend among dentists to supply fewer patient visits per year. The annual number of services provided per patient increased from 3.47 to 5.50 (OLS regression; P<0.05), reflecting both increased service rates per visit and increased numbers of visits by patients. Dentists provided less restorative, prosthodontic and extraction services per year, but more diagnostic, preventive, endodontic and crown and bridge services. The annual care received per patient also included more diagnostic, preventive, endodontic and crown and bridge services but differed from the dentist pattern through increased rates of restorative services over the study period.

CONCLUSIONS

The content of dentist workloads has changed to include less emphasis on removal and replacement of teeth and more effort on diagnosis and prevention aimed at retention of natural dentitions.