Do dentists refer orthodontic patients inappropriately?

Knowledge and Awareness of the orthodontic triage and its uses among dental healthcare professionals - a cross-sectional study

INTRODUCTION

In orthodontics, the triage system is used to assess the preadolescents to rule out interventions needed earlier and to assess the nature of orthodontic problems as complex or moderate. The objective of this study was to determine the knowledge and awareness of orthodontic triage and its uses among dental healthcare professionals (DHCP).

MATERIALS AND METHODS

A triage awareness questionnaire (TAQ) was formulated and validated as reliable by a panel of five orthodontic specialists which was then circulated online among 400 DHCP. The questionnaire consisted of nine sections that assessed the current knowledge and usage of orthodontic triage among the dental community. Frequencies and percentages were reported for all categorical variables. Chi-square was used to assess the association among the variables.

RESULTS

The response rate was 28.2% with the majority of participants being general dentists. Regarding the knowledge and use of triage, 40% of DHCP were only familiar with the word "orthodontic triage" while being unaware of how it works and 79% denied using orthodontic triage. Regarding the management of anomalies, 42% of DHCP preferred extraction as the management of supernumerary teeth (p = 0.013). Practitioners belonging to private setups performed visual inspection in growing patients for assessment of their facial features (p = 0.012). Clinicians with more than one year of experience referred young patients to orthodontic specialists for the management of crossbite (p = 0.024). Younger clinicians (25-35 years) with more than one year of experience referred adult patients to orthodontists for correction of their unesthetic smile (p = 0.013).

CONCLUSIONS

This paper provides foundational data for the development of future policies and protocols supporting structured, evidence-based approaches to patient management via use of orthodontic triage. This study underscores the importance of targeted educational interventions to enhance understanding and implementation of orthodontic triage principles in clinical practice. Further probing is necessary to discern the disparity between understanding the orthodontic triage and effective employment of its components among practicing dental healthcare professionals.

Knowledge and Attitude towards Orthodontic Treatment among Non-Orthodontic Specialists: An Online Survey in Croatia

Objectives: The aim of this study was to examine the knowledge and attitudes towards orthodontic treatment among non-orthodontic specialists. Methods: A web-based survey was formulated for non-orthodontic dental specialists to respond to statements regarding an orthodontic treatment. It contained 20 multiple-choice questions with three or more possible answers. Two hundred and fifty questionnaires were sent via email, with explanatory letters, to randomly selected non-orthodontic Croatian dental specialists. Data were assessed using IBAM SPSS 23.0. and p < 0.01 was considered significant. Results: The results indicate that the majority of respondents were well informed about principles and practices in orthodontics. All the respondents (100%) were aware that malocclusions can affect a patient’s facial aesthetic and masticatory function. The results also showed statistically significant differences in answers about contraindications for orthodontics therapy among different non-orthodontic specialists (p < 0.01). Private health practitioners were better informed about the ideal time for the first orthodontic appointment (74.2%) and that implants and periodontal problems are not contraindications for orthodontic treatment (over 70%), in comparison with public health practitioners. Conclusion: Non-orthodontic specialists in this sample exhibit encouraging awareness and knowledge of the principals and practices of orthodontic treatment. Additional improving of practitioners’ knowledge and awareness can help patients with malocclusion to decide upon orthodontic treatment at earlier stages and avoid later complications in the future.

Dentists’ Self-perception on Teledentistry: The Changing Landscape Driven by Technological Booming in the 21stCentury

Aim:

Teledentistry has gained popularity worldwide because it is cost-effective and increase accessibility to dental healthcare. This study assessed the self-perceptions of teledentistry among dental practitioners in Saudi Arabia and examinedany gender-related differences.

Methods:

This cross-sectional study was conducted between January and December 2017 and recruited a convenience sample of dental practitioners, whose self-perceptions of the practice-related use of teledentistry were assessed viaateledentistry survey (TDS). The TDS consisted off our sections:efficiency in patient care, cost reduction,capabilities forimproving practice, and security and confidentiality.Data analyseswere conducted throughdescriptive statistics,internalreliability tests(Cronbach’s alpha), andchi-squaredtests of the TDS.

Results:

The response rate was 620/800(78%). Most respondents were female (62%), and 58% of themworked in the public sector. The internal reliability of the TDS was 0.85 for the whole sampleand 0.85 and 0.90 for males and females, respectively. Among the entire sample, 51% agreed that teledentistry reduced potential cost, and 65% reported shortened waitlists. More females (42%, p<0.001) than males (22%) agreed that teledentistry could help monitor a patient’s condition.More females (35%) than males (13%, p<0.001) considered that teledentistry would require additional appointments for imaging. More females(29%, p=0.0001) than males (22%) expressed great concern aboutpotential violations of confidentiality.

Conclusion:

These findings suggest thatteledentistry in dental practiceis well perceived by practitioners in Saudi Arabia. Gender differences in perceptions are linked to certain aspects of teledentistry.

Does the All Wales Universal Orthodontic Referral Form enable accurate triage of new NHS orthodontic patients? A service evaluation

Introduction This study was designed to investigate the accuracy of clinical information provided by referring general dental practitioners (GDPs) following the introduction of a standardised referral form across Wales (the All Wales Universal Orthodontic Referral Form [AWUORF]) and to see whether the information given could be reliably used to screen the referrals.Aim To evaluate whether priority cases were being readily identified and whether inappropriate referrals could be minimised, thereby potentially reducing waiting lists.Method A service evaluation involving the retrospective study of 200 consecutive referrals to a specialist practice over a three-month period. A descriptive data analysis was undertaken.Results The GDPs had successfully identified the main complaint in 156 (78%) of the referrals. Of the 44 (22%) clinically inaccurate referrals, there was no impact on the patient in terms of referral pathway in 32 (16%) cases, but in the remaining 12 (6%), 5 (2.5%) cases were prioritised unnecessarily and the remaining 7 (3.5%) would have been seen more quickly had the GDP provided the relevant clinical information. The appropriateness of referral in terms of eligibility of the patient to receive NHS-funded orthodontic treatment was high with only 18 (9%) patients failing to meet the criteria.Conclusion The AWUORF successfully guides the GDP to make appropriate referrals and enables accurate triage in the majority of cases.

A survey on orthodontic services provided by general dental practitioners

The aim of this survey-based study was to recognize professional determinants that account for variations in the level of orthodontic services provided and which distinguish providers and nonproviders of orthodontic services. Multiple regression analysis revealed that four practitioner characteristics explained 43% of the variance in the number of orthodontic patients treated. Dentists who treated more orthodontic patients (1) treated more general practice patients, (2) frequently used multiple sources to keep up to date in orthodontics, (3) perceived their patient base to contain more children, and (4) were likely to have attended an orthodontic course. The null hypothesis that selected characteristics of dentists providing orthodontic services were no different from those of dentists not providing orthodontic services was rejected. The provision of orthodontic services was associated with a higher level of continuing orthodontic education and treating more general practice patients, especially children.

Orthodontic treatment and referral patterns: A survey of pediatric dentists, general practitioners, and orthodontists

OBJECTIVE

This study aims to assess the orthodontic diagnostic skills, referral patterns, and the perceptions of orthodontic benefits of pediatric and general dentists in comparison with orthodontists.

MATERIALS AND METHODS

Two online surveys were e-mailed to pediatric dentists, general dentistry practitioners, and orthodontists registered as members of the Saudi Dental Society and the Saudi Orthodontic Society. The surveys included questions about the type of orthodontic treatment provided, referral trends, and timing; presumed benefits associated with successful orthodontic treatment; and diagnosis and treatment plans of seven cases representing different malocclusions.

RESULTS

In total, 25 orthodontists, 18 pediatric dentists, and 14 general practitioners completed the survey. Only 38.8% of pediatric dentists and 7.1% of general practitioners reported that they practiced orthodontics clinically. The perceptions of the three groups toward the benefits of orthodontic treatment were comparable in the psychosocial areas. However, the orthodontists perceived significantly lesser effects of orthodontic treatment on the amelioration of temporomandibular disorder (TMD) symptoms. Pediatric dentists tended to rate the need and urgency of treatment higher, while general practitioners tended to rate the need of treatment lower. The selected treatment plans for three early malocclusion cases showed the greatest discrepancies between the orthodontists and the other two groups.

CONCLUSIONS

The orthodontists consistently and significantly downplayed the perceived benefit of orthodontic treatment to reduce TMD symptoms. Also, while there was a similarity in the diagnosis, there were notable differences in the proposed treatment approaches, perceived treatment need, and timing of intervention between the three groups of practitioners.

A study to assess the quality of information in referral letters to the orthodontic department at Kingston Hospital, Surrey

AIM

To assess the quality of information included in referral letters sent to the orthodontic department at Kingston Hospital, Surrey, UK.

METHODS

Referral letters sent by both general dental practitioners (GDPs) and specialist orthodontists were analysed retrospectively in order to ascertain the percentage meeting the inclusion criteria as suggested by Mossey (2006) and the British Orthodontic Society (2008) for the quality of information included in an ideal orthodontic referral letter. Thirty-five consecutive letters sent between May and September 2005 and 206 letters sent in the same period in 2008 were collected by hand and analysed against the inclusion criteria. The numbers of referral letters received from GDPs, specialist orthodontists, and others sources were also determined.

RESULTS

Most of the referrals sent in 2005 and 2008 included 40-50% of the referral inclusion points. This was despite an almost twofold increase in the number of referral letters received from specialist orthodontic practitioners in 2008. The majority of the letters, from both GDPs and specialists, did not include details of the oral hygiene or caries status of the patient, or an indication of their motivation towards treatment. None of the referral letters included a plaque score.

CONCLUSION

The main weaknesses in the quality of information provided in referral letters were that in more than 80% of the letters there was no mention of the patient's medical history and no comment on caries status, the standard of oral hygiene, patient motivation for treatment, or an Index of Orthodontic Treatment Need score. The quality of information included in referral letters sent to Kingston Hospital orthodontic department needs to be improved.

Trends in finnish public orthodontic care from the professionals' perspective

The study maps out orthodontic care in Finnish municipal health centres in 2001, describes changes during the previous ten years reported by chief dental officers, and assesses the views of orthodontists on current public orthodontic services. The data were collected by questionnaires sent to all health centres and all orthodontists in Finland. Of all 0-18-year-olds, 11% were receiving orthodontic treatment with an appliance (range 2-43% among the health centres). The most frequently used appliances were headgear, quadhelix, and fixed appliances. Limited economic resources and the lack of orthodontic expertise were mentioned by the chief dental officers as factors decreasing the volume of services. The orthodontists mentioned the large regional variation and the lack of national guidelines as the most important aspects that should be improved on a national basis. To bring about improvement, they suggested increasing the number of specialist orthodontists and the delegation of orthodontic tasks to auxiliaries.

An Audit of the Quality and Content of Periodontal Referrals and the Effect of Implementing Referral Criteria

Aims

This audit aimed to assess the effect of implementing referral criteria on the quality and content of referral letters sent by general dental practitioners (GDPs) to the periodontal department of a teaching hospital.

Methods

Retrospective data were collected from a total of 450 referrals made in: (i) 1997, prior to any changes; (ii) 2000/2001, after referral guidelines were implemented; and (iii) 2004/2005, after referral criteria were redefined and circulated via Primary Care Trusts. A standardised data-collection form was used to record the information that was provided in the referral letters. This information was also compared to the findings at initial hospital consultations.

Results

There was a small improvement in the administrative details provided in the referral communications in 2000/2001 and 2004/2005. Medical history was often incomplete and was mentioned in 31–34% of referral letters. Use of the Basic Periodontal Examination (BPE) score increased from 17% (1997) to 57% (2004/2005). The information on clinical details otherwise increased in 2000/2001 with a tendency to decrease in 2004/2005. There was little agreement between the clinical details in the referral communications and the findings at consultation in the periodontal department.

Conclusions

Following implementation of referral criteria, there was an increase in the clinical details provided in referral letters. However, the validity of the information provided by the GDPs was often questionable. The number of referrals that provided medical history details remained unchanged. Use of a pro forma was not associated with an improvement in the quality of referrals in this audit.

Teledentistry for screening new patient orthodontic referrals. Part 1: A randomised controlled trial

OBJECTIVE

The primary aim was to evaluate the validity of a teledentistry system for screening new patient orthodontic referrals. The secondary aims were to evaluate whether the teledentistry system affected i) referral rates ii) inappropriate referral rates iii) number of failed appointments.

STUDY DESIGN

Randomised controlled trial.

SAMPLE

Fifteen dental practices in Greater Manchester, UK, were randomly allocated to either a teledentistry test group (n = 8) or a control group (n = 7). They referred 327 patients over a 15 month period.

METHOD

Practitioners in the test group referred patients to one of two consultant orthodontists via a 'store and forward' teledentistry system consisting of photographs sent as email attachments. The decision to accept or not accept a referral on this basis was compared with the same decision choice when the same patient was subsequently seen on a new patient clinic. This measured the validity of the system with the clinic's decision used as the gold standard. Patients in the control group were referred using the usual letter system. Referral rates, inappropriate referrals and number of failed appointments were then compared between the teledentistry and control groups.

RESULTS

The sensitivity (true positive value) of the teledentistry system was high at 0.80 with a positive predictive value of 0.92. The specificity (true negative value) was slightly lower at 0.73 with a negative predictive value of 0.50. The inappropriate referral rate for the teledentistry group was 8.2% and for the controls 26.2% (p = 0.037). There was no statistically significant difference in clinic attendance between teledentistry and control groups (p = 0.36).

CONCLUSIONS

Teledentistry is a valid system for positively identifying appropriate new patient orthodontic referrals. However, there is a risk that a patient is not accepted on the teledentistry system who would benefit from a full clinical examination. Teledentistry could be a significant factor in reducing the inappropriate referral rate. Patient participation in a teledentistry system does not appear to mean they are any more likely to attend their hospital appointment.

Appropriateness of orthodontic referrals: self-perceived and normative treatment needs of patients referred for orthodontic consultation

OBJECTIVES

The aims of this prospective study were to evaluate the self-perceived and normative orthodontic treatment needs of children referred for orthodontic consultation and to determine the proportion of children who were inappropriately referred.

METHODS

The sample consisted of 257 children with a mean age of 12.0 years (SD = 2.4). An orthodontist assessed the children's normative treatment need using the dental health component (DHC) of the index of orthodontic treatment need (IOTN), and for patients in the mixed dentition the need for interceptive treatment was assessed. Questionnaires were answered by both the child and the parent to assess satisfaction with dental appearance and desire for treatment.

RESULTS

The distribution of the IOTN grades showed that 73% of the children had definite need while 27% had borderline/no need for orthodontic treatment. Twenty-six per cent of children and 17% of parents did not express orthodontic concern, even though more than half of these children were in definite need of treatment as assessed by IOTN. The children's orthodontic concern was significantly related to the DHC scores. Out of the 103 children who were in the mixed dentition, only about 16% required interceptive treatment.

CONCLUSIONS

The results indicated that a significant number of children were inappropriately referred for orthodontic treatment. Referring dentists need to assess the normative treatment needs of the children as well as the children's and parents' commitment and desire for orthodontic treatment before deciding on the need for referral.

Orthodontic referrals via TeleDent Southwest

The information presented in this article must be interpreted with caution. Ideally the trial should have lasted longer because five of the seven participating dentists said they felt constrained from taking in more cases because access to TeleDent advice would cease before completion of all but the shortest of treatments. Second, the number of practitioners recruited into the trial was small, and the dentists chosen were highly selected. Third, almost all the data are based on the opinions of the participating dentists, and for three of the dentists the number of cases on which those opinions were based was small. Finally, it must be remembered that all United Kingdom NHS dentists are busy and work on a highly structured "time of service" payment system. Although the costs of hardware, software, line rental, and training were borne by the TeleDent project, there was no financial compensation for the time spent by dentists capturing images of their patient records and putting together the whiteboard and transmitting the information. There was a significant financial disincentive for using the system. Ideally, a long-term prospective randomized study of the effect of teledentistry advice on outcome of orthodontic treatment provided by general dental practitioners should be undertaken. The data collected in the current study supported the dentists' opinions that TeleDent SW enabled them to offer a better service for their patients and use specialist services more appropriately.

Attitudes of UK consultants to teledentistry as a means of providing orthodontic advice to dental practitioners and their patients

OBJECTIVE

To determine UK orthodontic consultants' attitudes to the provision of orthodontic advice to general dental practitioners by electronic means.

DESIGN

Questionnaire.

SETTING

Conducted by email and surface mail as appropriate in August 2000.

SUBJECTS

All those UK NHS orthodontic consultants contained in the membership lists of the Consultant Orthodontists Group of the British Orthodontic Society.

OUTCOME

An 86 per cent response was obtained from the 231 consultants.

RESULTS

More than half (58 per cent) of the consultants were interested in providing an electronic diagnostic service for the general dental practitioners in their locality and 70 per cent were in favour of further research into this possibility. Provided this was mediated through their GDP, only 26% would oppose consultant advice being given electronically from a centralized source.

CONCLUSIONS

A majority of UK orthodontic consultants support the concept of using teledentistry to make their advice more accessible to dentists and patients.

Are photographic records reliable for orthodontic screening?

AIM

The aim of the study was to evaluate the reliability of a panel of orthodontists for accepting new patient referrals based on clinical photographs.

SAMPLE

Eight orthodontists from Greater Manchester, Lancashire, Chester, and Derbyshire observed clinical photographs of 40 consecutive new patients attending the orthodontic department, Hope Hospital, Salford.

METHOD

They recorded whether or not they would accept the patient, as a new patient referral, in their department. Each consultant was asked to take into account factors, such as oral hygiene, dental development, and severity of the malocclusion.

STATISTICS

Kappa statistic for multiple-rater agreement and kappa statistic for intra-observer reliability were calculated.

RESULTS

Inter-observer panel agreement for accepting new patient referrals based on photographic information was low (multiple rater kappa score 0.37). Intra-examiner agreement was better (kappa range 0.34-0.90).

CONCLUSION

Clinician agreement for screening and accepting orthodontic referrals based on clinical photographs is comparable to that previously reported for other clinical decision making.

Orthodontic teaching practice and undergraduate knowledge in British dental schools

AIM

The aim was to survey current orthodontic teaching practice in the undergraduate syllabus at British dental schools and to test the abilities of undergraduate students according to the requirements of the GDC regulations.

MATERIALS AND METHODS

Information collected by means of a questionnaire sent to each dental school in 1998 was compared with similar data from 1994. The orthodontic knowledge and treatment planning ability of students was assessed by a multiple-choice examination paper completed by a random 10% sample of students from each dental school.

RESULTS

In 1998 on average 195 curriculum hours were devoted to orthodontics and each student treated five patients. The teaching of fixed appliances had increased considerably between 1994 and 1998. The average MCQ score was 58% (range 39-72%). Students scored well on questions that tested basic knowledge but much less well when they were required to apply that knowledge. Only three schools felt that it was realistic to expect undergraduates to formulate orthodontic treatment plans, as they are required to do by the GDC.

CONCLUSION

Results support the view that undergraduate orthodontic training should concentrate on diagnosis and recognition of problems rather than on providing limited exposure to treatment techniques.

Referral for secondary restorative dental care in rural and urban areas of Scotland: findings from the Highlands Et Islands Teledentistry Project

OBJECTIVES

To compare the reported level of use of secondary care services for restorative dental care in rural and urban areas of Scotland.

DESIGN

Postal questionnaire survey

SUBJECTS AND METHODS

Postal questionnaire sent to all dentists in the Highland region, the island regions in Scotland and Dumfries Et Galloway (n = 150) and an equal number were sampled from the remainder of Scotland stratified by health board area. Non-respondents were sent 2 reminders after which 62% of the sample had responded.

RESULTS

Most dentists (85%) who practised in what they considered were urban areas of Scotland said they felt that they had good access to a secondary referral service. Whereas most of those who practised in what they considered were rural areas either said they had no access to such a service (26%) or that access was difficult (53%), only 3% of those in urban areas said they had no access to a secondary restorative consultative service compared with 14% of dentists practising in rural areas of mainland Scotland and 54% of those practising on Scottish islands.

CONCLUSIONS

The survey suggests the people of the Scottish islands and some of the remoter parts of the Scottish mainland would be among those who might benefit from improvement in access to a restorative dentistry consultant service.

Primary and secondary dental care: how ideal is the interface?

In our previous paper in this journal, we described an ideal interface between primary and secondary dental care in terms of equity, seamless care and efficiency and effectiveness. This paper examines the published evidence describing considerable ongoing problems with the interface under these headings and the ways in which those problems might be better described, quantified and addressed.

Are specialist outreach clinics for orthodontic consultation effective? A randomised controlled trial

OBJECTIVE

To develop outreach clinics for orthodontic consultation and evaluate their costs and effectiveness.

DESIGN

Single centre randomised controlled trial with random allocation of referred patients to outreach or main base consultation appointments.

SETTING

One hospital orthodontic department and three community health centre clinics in Greater Manchester. Subjects 324 patients who were referred for orthodontic treatment.

MAIN OUTCOME MEASURES

The outcome of consultation, the cost and duration of the visit and the consumer's perceptions of the visit.

RESULTS

There were no differences in outcome of the consultation. While consumer travel costs and the duration of appointments were significantly higher for the main base clinics, these differences were not great. However, consumers preferred to attend an appointment in an outreach clinic.

CONCLUSIONS

There do not appear to be marked advantages or disadvantages in providing consultation appointments for orthodontics in outreach clinics

Patterns and appropriateness of referral from general dental practice to specialist oral and maxillofacial surgical services

In this study we investigated patterns of referral and appropriateness of referrals to specialist oral and maxillofacial surgery services, using postal questionnaires and referral letters. The most common reasons for referral were the expected difficulty of the operation, the medical condition of the patient and the lack of facilities for general anaesthesia. Most referrals were made to the oral and maxillofacial surgery department of a general hospital but almost three-quarters of the respondents stated that they would refer patients to specialist surgical dentistry practices in the future. Few referrals to a university department of oral and maxillofacial surgery were considered to be inappropriate, nor were requests for a particular type of anaesthesia. Any future transfer from secondary to primary care for oral surgery may be hindered by the reduction in facilities for general anaesthesia in the primary care setting.

The effect of orthodontic referral guidelines: a randomised controlled trial

OBJECTIVE

To develop and evaluate the effectiveness of referral guidelines for the referral of orthodontic patients to consultant and specialist practitioner orthodontists.

DESIGN

Single centre randomised controlled trial with random allocation of referral guidelines for orthodontic treatment to general dental practitioners.

SETTING

Hospital orthodontic departments and specialist orthodontic practices in Manchester and Stockport.

SUBJECTS

General dental practitioners and the patients they referred for orthodontic treatment.

MAIN OUTCOME MEASURE

Appropriateness of referral, defined as whether the patient was accepted for orthodontic treatment.

RESULTS

The referral guidelines did not reduce the number of inappropriate referrals.

CONCLUSIONS

Referral guidelines for orthodontic referrals did not influence the behaviour of the general dental practitioners. More research into the optimum methods of dissemination and implementation of referral guidelines for use in the general dental service is needed.

Rates of GDP referral of complete dentures to a teaching hospital

PURPOSE OF STUDY

To identify areas and sites of excessive referral of complete dentures by GDPs, allowing for factors which might distort referral rates.

METHODS

Two hundred and six consecutive valid referrals of patients over the age of 50 years with complete dentures to a local dental teaching hospital and originating from the 29 Sheffield electoral wards were audited from the beginning of 1995 to the end of 1997. The referring practitioner and electoral ward were recorded.

RESULTS

Referral rates were calculated according to the size of the 50+ population within each ward and were found to be normally distributed, following exclusion of two wards with much higher referral rates than normal (3.5 and 6 SDs [standard deviations] from the mean). After calculating mean numbers referred per full-time equivalent (FTE) GDP for all wards, practices and practitioners originating excessive numbers of referrals within a high-referring ward could be identified.

CONCLUSION

After taking into account factors which might permit a high referral rate to be acceptable, practices with inappropriately high referral rates can be identified and remedial teaching need pinpointed.

Referral patterns and the referral system for oral surgery care. Part 1: General dental practitioner referral patterns

OBJECTIVE

To investigate current GDP oral surgery referral patterns given the anticipated change since the introduction by the General Dental Council of the specialty of surgical dentistry.

DESIGN

Postal questionnaire.

SETTING

400 GDPs in Greater Manchester.

RESULTS

84% participation rate. 69% of dentists made a referral because of anticipated difficulty of surgery and 49% because of the complex nature of the patients' medical history. Practitioners who had undergone some oral surgery postgraduate training were more likely to undertake more surgery in their practices (P < 0.01) and to refer more patients for specialist care (P < 0.05). While female practitioners rated their own surgical confidence less highly than male practitioners (P < 0.001), and younger practitioners less than their older colleagues (P < 0.05), there was no significant difference in the number of referrals made.

CONCLUSION

The most common reasons for referral were the anticipated difficulty of surgery and patient medical compromise. There was a wide variation between practitioners in the number of patients referred for specialist care. Postgraduate oral surgery training was identified as a factor contributing to this variation. Other practitioner variables, such as sex, experience and type of practice were not found to contribute.

Perceptions of general dental practitioners of a local secondary care service in restorative dentistry

AIM

A major role of the hospital based secondary care service in restorative dentistry is to accept referrals in order to formulate treatment plans. The aim of this survey was to improve service provision at Newcastle Dental Hospital by establishing baseline quality perceptions from referring general dental practitioners (GDPs).

METHOD

A postal questionnaire was sent to 393 randomly selected local GDPs, with a response rate of 67%.

RESULTS

Results indicated great demand for advice and treatment which was higher than expected for temporomandibular joint problems. 42% of GDPs felt that treatment plans were not helpful and the period of waiting for a response following consultation too long. The reasons for this perception are discussed.

CONCLUSIONS

The need for better communication between primary and secondary care was highlighted, as was the distinct preference of GDPs for hospital consultants rather than registered specialist practitioners to carry out specialist treatment.

Factors influencing the decision about orthodontic treatment. A longitudinal study among 11- and 15-year-olds and their parents

The aims of the study were to evaluate the attitude towards orthodontic treatment among 11-(T1) and 15-year-old children (T2) and their parents, to present the distribution of referral rate and treatment uptake by a treatment need index assessed at T1 and to elucidate factors influencing the decision about orthodontic treatment in the period from T1 to T2. A group of 359 children and their parents answered separate questionnaires at T1, and 293 families responded to a follow-up study 4 years later. For the clinical examination, 224 children participated after exclusion of children in active treatment. The dental study casts were assessed by the Index of Orthodontic Treatment Need (IOTN). The mean referral rate was 56%, with a variation from 40% to 71% among different dental clinics. About 44% of the children had completed or were undergoing orthodontic treatment at T2. No significant sex differences among referred and treated children were discovered. Aesthetic motives were the most frequently reported subjective reason for orthodontic care. The untreated group expressed diminishing treatment desire in the follow-up period. The logistic regression analysis selected Dental Health Component (DHC) grades as a strong predictor for treatment uptake, followed by parents' concern and attitude to braces, while the 11-year-olds' own orthodontic concern was less significant. Children in the untreated group with late treatment decisions (T2) were best predicted by Aesthetic Component (AC) changes from T1 to T2. The results indicate that dentists play a key role in determining orthodontic treatment levels. High referral rates secured low risk of denying care to some patients. Treatment decision may be guided by the orthodontist. However, individual variation in attitude and desire influence treatment uptake even among children with great need.

Reasons for referral of very elderly patients to the community dental service in rural England and the implications for developing oral health care services

OBJECTIVE

To analyse the medical conditions and dental treatment requirements.

DESIGN

Retrospective analysis.

SETTING

Rural South West Surrey, England.

SUBJECTS

100 patients aged 75 or over who were referred for dental treatment to the Community Dental Services (CDS) because of various medical disabilities.

MEASUREMENTS

Age, sex, medical history including drug intake, dental treatment provided, time taken for treatment.

RESULTS

Two-thirds of the patients required domiciliary care; two-thirds had problems of mental confusion. In addition, 89% were dependent on carers. Treatment requirements indicate that the majority of dental care, although time consuming, were simple in nature and within the technical scope of a competent general dental practitioner (GDP).

CONCLUSION

This study implies that the reasons for referral are other than lack of dental skills and may be due to perceived difficulties in managing patients. Further research is recommended to establish whether aspects of patient management are problematic so that resources, including appropriate training programmes, can be developed to enable a quality service to be provided. In the evolving health care system in the United Kingdom (UK) these issues will need to be considered when developing contracts at a local level.

The consultant orthodontic service--1996 survey

OBJECTIVE

To evaluate the working patterns and facilities of the consultant orthodontist service.

DESIGN

A cross-sectional survey.

SETTING

Consultant orthodontist departments in the UK.

SUBJECTS AND METHODS

All consultant orthodontists in the UK were sent a questionnaire that gathered information on the individual consultant, the facilities available, the new patients referred and patients under current treatment.

RESULTS

The consultant orthodontist service provided treatment to a high number of patients who were in definite need of orthodontic treatment. A marked reduction in the use of removable appliances suggests improving standards of care and provision of more complex treatment. The caseload was high and a fair proportion of patients were returned to their referring dentists with treatment plans. The consultant service has not completely evolved into a service that provides treatment at a super-specialist level alone.

CONCLUSIONS

There has been little change in the consultant orthodontist service over the past ten years. Arguably, this is because of the wishes of the purchasers and the shortage of trained orthodontic manpower as a direct result of poor manpower planning and lack of funds for post-graduate training.

Variation in periodontal referral by general dental practitioners

This study investigated the extent of and reasons for variation in the periodontal referral patterns of general dental practitioners in Northern Ireland. A questionnaire was circulated to all general dental practitioners in Northern Ireland. This questionnaire investigated the management of periodontal disease in the general dental service and referral for specialist periodontal advice and treatment. A usable return was made by 355 (68%) of those surveyed. The mean number of periodontal referrals by each respondent in the past year was 6.5 (SD 7.7), range 0 to 80. Backward stepwise logistic regression analysis indicated that independent predictors of high referral rate were practice location close to the referral centre (p<0.0001); dissatisfaction with ability to treat periodontal disease under the National Health Service (p=0.001); that previous refusals of referral had not dissuaded a dentist from continuing to offer referral (p=0.002); not offering root planing as a treatment (p=0.005); and perceived inadequate postgraduate education in periodontology (p=0.03). It is concluded that considerable variation exists between general dental practitioners working in Northern Ireland in relation to the referral of patients for specialist periodontal advice and treatment. It is further concluded that in many cases non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in relation to periodontal referral.