Relationship Between Prereferral Periodontal Care and Periodontal Status at Time of Referral

Assessment of dental student education and preparedness in periodontics in two different models: Discipline-based and general practice-based learning

PURPOSE

To compare dental students' preparedness in clinical periodontal education following their participation in a discipline-based predoctoral periodontics clinic with dental students that received a general practice-based periodontal education.

METHODS

114 third-year dental students and 112 fourth-year dental students at the University of Texas Health Science Center in San Antonio, were emailed an online survey consisting of questions on their proficiency and confidence levels in diagnosing periodontal diseases and conditions, treatment planning, performing non-surgical periodontal treatment, identifying the need for referral, and their perceived impediments on their clinical periodontics education.

RESULTS

Approximately 97% of third-year dental students that participated in discipline-based predoctoral periodontics agree that they are overall confident in providing excellent periodontal care to their patients, and 91% of these students feel that their participation in the predoctoral periodontics clinic has enhanced their knowledge in periodontics as well as their confidence level when providing periodontal patient care. While 95% of fourth-year dental students agree that they feel confident in providing excellent periodontal care to their patients, only 83% felt that level of confidence during their third-year in dental school, and 77% believe that given the option to participate in the pre-doctoral periodontics clinic, their periodontal education would have been strengthened.

CONCLUSIONS

Our results show that the integration of a discipline based predoctoral periodontics clinic has benefited the dental students and boosted their knowledge and confidence in diagnosing and treating periodontal patients. This model can be improved by addressing space and time limitations.

Dental Students’ Knowledge, Confidence, Ability, and Self-Reported Difficulties in Periodontal Education: A Mixed Method Pilot Study

Evidence on periodontal education areas in which students have difficulties and their factors are limited. In this study, third- and fourth-year dental students’ knowledge was assessed as well as their confidence and ability in five periodontal educational areas using a mixed-method approach. A survey was used to collect data related to history-taking, medical examination, diagnosis, treatment planning, and follow-up. Student answers were compared to the consensual answers of an expert panel using the cosine-similarity index (CSI). Descriptive statistics assessed confidence and ability for diagnosis. Semi-structured individual interviews were used to collect data on reported reasons for difficulties in periodontal education. A content analysis was employed to analyze the interview data. Eighteen third- and fourth-year dental students completed the survey and eleven were interviewed. Students’ knowledge was adequate regarding diagnosis and treatment planning. Third-year students’ median CSI were 0.93 and 0.89, respectively. Fourth-year students’ median CSI were 0.9 and 0.93, respectively. Students felt confident in history-taking and examination but lacked confidence and ability in diagnosis and treatment planning. Reported reasons for difficulties in periodontal education were linked to both preclinical and clinical pedagogical issues. Further improvements in preclinical and clinical periodontal education are needed to address students’ lack of knowledge, confidence, and skills in key periodontal areas.

Long-term outcomes of adjacent and antagonistic teeth after implant restoration: a focus on patient-related factors

Purpose

To investigate factors affecting the antagonistic and adjacent teeth in patients after implant restoration and prosthetic rehabilitation.

Methods

In total, 160 patients who visited Kyungpook National University Dental Hospital for implant surgery, prosthesis placement, and supportive periodontal therapy (SPT) were included in this study. The average follow-up period was 88.06 months, and the maximum was 175 months. Patients’ history of smoking, diabetes, hypertension, and osteoporosis was investigated, and panoramic radiographs were taken after surgery and prosthetic treatment. During the follow-up period, extraction and prosthetic/endodontic treatments of the antagonistic and adjacent teeth were analyzed. The statistical analyses were performed using descriptive statistics, the chi-square test, the Fisher exact test, and multiple logistic regression analyses.

Results

Treatment was performed on 29.4% of the studied antagonistic teeth with extraction performed in 20.0% and prosthetic treatment in 10.0%. Furthermore, 19.4% of the studied adjacent teeth underwent treatment, of which extraction was performed in 12.5% and prosthetic treatment in 7.5%. The treatment rate for adjacent teeth was 25.3% in smokers, which was higher than that of non-smokers (12.3%) (P=0.039). Patients who were non-adherent to SPT showed a significantly higher rate (19.6%) of antagonistic prosthetic treatment than did those who were adherent (5.5%) (P=0.006).

Conclusions

Implant restoration can affect the adjacent and antagonistic teeth. Smoking, osteoporosis history, and absence of SPT may be risk factors for the treatment of the adjacent and antagonistic teeth.

Factors affecting periodontal disease referral and the adherence to guidelines among general dentists

BACKGROUND

Current research highlights a need to investigate the factors affecting periodontal disease referral. Limited literature exists on periodontal disease referral in Australia and no comparison to the periodontal disease referral guidelines exists.

OBJECTIVE

This study analyses the factors affecting periodontal disease referral and the adherence to guidelines in general dentists in Queensland, Australia.

METHODS

Fifty-seven general dentists who are members of the Australian Dental Association (Queensland) undertook an online survey.

RESULTS

The disease factor regarded as most important (90% of respondents) was unresolved inflammation upon re-evaluation. The non-disease factor regarded as most important (79% of respondents) was the operator's level of training. There is low awareness of the guidelines (36.7%) yet a reasonable adherence to them (78.3%). Of those aware of the guidelines, there was a statistically significant poorer adherence to the guidelines compared to those unaware (P = 0.036), while there is no significant difference in the adherence to guidelines between those who have and those who have not attended continuing professional development (CPD) courses (P = 0.66).

CONCLUSIONS

Adherence to current guidelines is not significantly impacted by the level of awareness of the guidelines or CPD attendance. The results from this study suggest a need to refine the current guidelines to better inform decisions about periodontal disease referrals.

Non-surgical and supportive periodontal therapy: predictors of compliance

AIM

To identify predictors of compliance during non-surgical and supportive periodontal therapy (SPT).

MATERIALS AND METHODS

In this retrospective study, demographic, dental, medical data of 427 new patients in a private practice were collected. Data were analysed in statistical models with non-surgical therapy and SPT compliance used as dependent variables.

RESULTS

Of the 427 patients, 17.3% never agreed to initial therapy, 10.7% never completed therapy and 20.8% completed treatment, but never entered SPT. Of the 218 SPT patients, 56% became non-attenders after a period of 20 months, 33% were erratic attenders and 10.5% were regular attenders until the end of the observation period (5.5-6.5 years). Patients became erratic attenders after a mean period of regular attendance of 18.1 ± 16.2 months, whereas 49.6% of the patients, who abandoned SPT, were regular attenders until the time they stopped. In a univariate correlation model, periodontal disease severity emerged as a significant predictor of the completion of non-surgical periodontal therapy (p = 0.01). In a multivariate linear regression model, smoking was negatively associated with SPT compliance (p = 0.047).

CONCLUSIONS

A low compliance of the population was observed. Smoking and periodontal disease severity represented significant, but modest modifiers of a patient compliance with SPT and initial therapy respectively.

Factors influencing the periodontal referral process

BACKGROUND

General dental practitioners (GPs) assess the periodontal status of patients and make decisions to treat patients or refer them to a periodontist. There is little information available regarding this process. The purpose of this study is to identify significant factors that GPs consider important in selecting a particular periodontist. The findings were compared and contrasted with responses of periodontists to gain perspectives from both groups involved in the referral process.

METHODS

Data from an online cross-sectional survey of GPs (n = 533) and periodontists (n = 533) who practice in the southeastern region of the United States (from the databases of the American Dental Association and American Academy of Periodontology member directories) were obtained.

RESULTS

The specialist's clinical skill was identified as the most important factor influencing periodontal referrals by GPs, whereas periodontists identified a previous positive experience between a GP and periodontist as the most important factor. In a descending order of importance, the top three rating averages (rated out of five) by GPs were clinical skill (4.84), a previous positive experience between a GP and periodontist (4.57), and communication (4.52). The top three factors of periodontists were a previous positive experience between a GP and periodontist (4.66), communication (4.40), and the likelihood of a good patient and periodontist rapport (4.29).

CONCLUSIONS

The periodontist's clinical skill was chosen by GPs as the primary factor influencing the referral decisions of GPs. Periodontists perceived a previous positive experience between the GP and periodontist as the most influential factor. Further studies are required to gain more insight into the referral process.

Objective, subjective, and self-assessment of preadolescent orthodontic treatment need--a function of age, gender, and ethnic/racial background?

Children from socioeconomically disadvantaged and/or underrepresented minority backgrounds in the United States have limited or no access to orthodontic treatment.

OBJECTIVES

To determine whether preadolescents' (a) objectively assessed orthodontic treatment need; (b) subjectively assessed orthodontic treatment need; and (c) self-perceptions of the psychologic aspects of their oral health-related quality of life and desire to have braces vary as a function of age, gender, ethnicity/race, and socioeconomic status (SES).

METHODS

Data were collected from 1,566 preadolescents (age range: 8 to 11 years; 47.3 percent male/52.7 percent female; 55.7 percent African-American/39.7 percent White/2.9 percent Hispanic) in oral exams and in face to face interviews. Malocclusion was determined with the Index of Orthodontic Treatment Need.

RESULTS

Children (17.2 percent) had definite treatment need, 33.7 percent were borderline, and 49.1 percent had little or no need. Objectively and subjectively assessed treatment need was not affected by the children's age or gender. However, girls were more critical of their smiles and wanted braces more than boys. The older the children were, the more critical they were and the more they wanted braces. African-American children and children in schools with higher percentages of children on free school lunches had less treatment need than White children and children in schools with lower percentages of students with free school lunches. While the provider-assessed treatment need was higher for White children than for Black children, Black children were less happy with their smiles than White children, and wanted braces more than White children. SES did not affect the children's self-perceptions.

CONCLUSIONS

Findings showed that substantial percentages of the preadolescents have an orthodontic treatment need. Orthodontic need and child self-perceptions varied as a function of the children's age, gender, ethnicity/race, and SES.