Awareness and practice of Revised Code of Dental Ethics and Consumer Protection Act among dental practitioners in Andhra Pradesh: A cross sectional study

BACKGROUND

Given the imperative for dental practitioners to be familiar with the existing ethical principles and laws governing their practice, this study aimed to evaluate awareness and practice of the dentists (code of ethics) regulations 2014 and consumer protection act 2019 among dental practitioners in Andhra Pradesh state, India.

METHODS

A cross sectional study was conducted among 384 dental practitioners in Andhra Pradesh state, India. A questionnaire consisting of 25 items was used to assess awareness and practice of the dentists (code of ethics) regulations and consumer protection act. The data collected were analysed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.

RESULTS

Only 53(13.8%) dental practitioners in the study were aware that the dentists (code of ethics) regulations had been revised in 2014. About 190 (49.5%) practitioners were aware of the precise period for mandatory preservation of patient records. Most dental practitioners (278, 72.4%) accepted commissions in the form of gifts or cash from laboratories, radiologists, or pharmacists and 306 (79.7%) dental practitioners used unregistered dental lab technicians as employees in their practice. Furthermore, 297 (77.3%) practitioners were found to provide or sell drugs to patients in their clinic/office. The new regulations under consumer protection act 2019 were unknown to 194 (50.5%) dental practitioners.

CONCLUSIONS

The present study indicates that the awareness of dental practitioners towards the dentists (code of ethics) regulations 2014 and consumer protection act 2019 is inadequate. It highlights the need for training programmes and curriculum changes with a focus on ethical and legal issues in clinical dental practice.

Impact of a virtual learning environment on the conscious prescription of antibiotics among Colombian dentists

Appropriate antibiotic prescription contributes to reducing bacterial resistance; therefore, it is critical to provide training regarding this challenge. The objective of this study was to develop a virtual learning environment for antibiotic prescription and to determine its impact on dentists' awareness, attitudes, and intention to practice. First, the learning content on multimedia resources was developed and distributed into three challenges that participants had to overcome. Then, a quasi-experimental study was performed in which the virtual learning environment was implemented on dentists from seven Colombian cities. The median of correct answers and the levels of awareness, attitudes, and intention to practice were compared before, immediately after, and 6-months post-intervention. Wilcoxon signed-rank and McNemar's tests were used to determine the differences. A total of 206 participants who finished the virtual learning environment activities exhibited a favorable and statistically significant impact on the median of correct answers of awareness (p < 0.001), attitudes (p < 0.001), and intention to practice (p = 0.042). A significant increase occurred in the number of participants with a high level of awareness (p < 0.001) and a non-significant increase in participants with high levels of attitudes (p = 0.230) and intention to practice (p = 0.286). At 6 months, the positive effect on the median of correct answers on awareness and intention to practice persisted (p < 0.001); however, this was not evident for attitudes (p = 0.105). Moreover, there was a significant decrease in the number of participants who showed low levels of awareness (p = 0.019) and a slight increase in those with high levels of the same component (p = 0.161). The use of a virtual learning environment designed for dentists contributed to a rapid improvement in awareness and intention to practice antibiotic prescription; however, their attitudes and information retention need reinforcement.

Life satisfaction of Taiwanese dental graduates received residencies in the U.S.: a cross-sectional study

BACKGROUND

Each year, more than 200 international dental graduates start U.S. specialty trainings to become specialists. It is unknown if their life satisfaction is associated with any dental career-related factor before residencies (e.g. dental school class rank, research experience, or private practice experience) and after residencies (e.g. staying in the U.S., teaching status, workplace, or board certification). This cross-sectional study aimed to identify these potential factors by surveying Taiwanese dental graduates who pursued U.S. residencies.

METHODS

Life satisfaction was measured with a structured questionnaire, Satisfaction With Life Scale (SWLS), which includes five statements on a 5-point Likert scale. Online surveys were sent out to 290 Taiwanese dental graduates who were known to pursue U.S. residencies. T-test, one way analysis of variance, and multivariable adjusted generalized linear model (GLM) were used to assess the differences of mean SWLS scores from different variables.

RESULTS

Surveys were completed by 158 dentists. Mean SWLS score of 125 specialists was higher (p = 0.0007) than the score of 33 residents. For the 125 specialists, multivariable adjusted GLM demonstrated better life satisfaction was positively associated with multiple independent factors, such as having research experience, being ranked in the top 26 ~ 50% of the class in dental school, starting U.S. residency within 4 years after dental school, starting residency before year 1996, and specializing in endodontics (vs. periodontics). Life satisfaction was not associated with any factors after residency (e.g. staying in the U.S. afterwards, teaching status, or workplace), but better mean life satisfaction score was significantly associated with being American specialty board certified (p < 0.001) for the specialists in the 26 ~ 75% of their class in dental school. For the 33 residents, better mean life satisfaction score was associated with better dental school class rank in both bivariate (p = 0.020) and multivariable adjusted GLM (p = 0.004) analyses.

CONCLUSIONS

The life satisfaction of Taiwanese dental graduates pursuing U.S. residencies might be associated with some professional factors, such as research experience, dental school class rank, residency timing, specialty type, and specialty board certification. We hope our results may provide some objective information on making career decisions for international dental graduates/students who are preparing for U.S. residency.

Variations in odontological care routines for patients undergoing treatment for head and neck cancer in county councils/regions of Sweden

OBJECTIVE

To investigate current odontological care routines for patients treated for head and neck cancers in the county councils/regions (C/Rs) of Sweden.

METHODS

An invitation to fill in a web-based questionnaire was sent to dentists/dental hygienists working in dental clinics in the 12 C/Rs, treating and responsible for the odontological care of patients undergoing treatment for cancer of the head and neck. The questionnaire started with two mandatory and one non-mandatory questions, followed by questions regarding routines before (n = 28), during (n = 23), and after (n = 9) treatment, plus two additional questions, totalling 65 questions.

RESULTS

Four dental hygienists and six dentists in 10 of the 12 C/Rs answered the questionnaire. Three C/Rs stated that they measure both the unstimulated and stimulated salivary secretion rate, and another C/R stated that they measure the stimulated secretion rate only. Similar recommendations were given regarding oral hygiene, salivary stimulants and substitutes, and extra fluoride. However, great variations were seen regarding recommendations for preventing and relieving oral mucositis. There were also discrepancies regarding information about the importance of avoiding smoking and alcohol. In seven C/Rs, patients visited the dental hygienist once a week during cancer treatment.

CONCLUSION

The results suggests that there are great variations in odontological care given to patients undergoing treatment for cancer of the head and neck region in different county councils/regions in Sweden. There is a need to develop and implement evidence-based guidelines to decrease the risk of oral complications and increase both the quality of life and the quality of care.

Knowledge and Practice of Oral Cancer Screening in Teaching Faculty-Comparison of Specialty and Year of Clinical Experience

The purpose of this study was to assess the knowledge, practice, confidence, and perceived barriers to oral cancer screening among teaching faculty in Japan. Results were compared by specialist as well as years of clinical experience. A 25-question survey was used to assess the oral cancer screening practices of faculty dentists at Iwate Medical University, School of Dental Medicine, the only dental school located in the northeast (Tohoku) region of Japan. The study was approved by the Institutional Review Board of Iwate Medical University. The response rate was 83% (n = 110, 71.8% were male). This survey revealed that only 43.6% of the dentists performed oral cancer screening frequently (always or usually) at the initial appointment, and there was no significant differences between specialists and clinical experience. Visual inspection of the oral cavity was the primary screening method, but the frequency and content of the examination (TMJ and tonsil) was significantly different between specialties. A history of cancer and tobacco use motivated providers to perform an examination and was significantly different between various specialists and clinically experienced providers. In contrast, HPV and alcohol consumption were a weak motivator. The confidence level of providers on their examination knowledge/skills was poor, especially among junior faculty. More than 80% of junior faculty indicated a lack of knowledge/skills as a major barrier.

Simple Approaches for Establishing an Evidence-Based Dental Practice

Constructing an evidence-based dental practice requires leadership, commitment, technology support, and time, as well as skill practice in searching, appraising, and organizing evidence. In mastering the skills of evidence-based dentistry, clinicians can implement high-quality science into practice through a variety of opportunities including the development of clinical care guidelines, procedural technique protocols, and electronic dental record auto-note templates, as well as treatment planning, care prioritization, and case presentation. The benefits of building an evidence-based dental practice are many, including improvements in patient care and satisfaction, increased treatment predictability and confidence in care approaches, as well as potential cost savings.

Classifications of temporomandibular disorders and patients' examination protocols - comparative analysis by the convenience of their daily use in clinical practice

OBJECTIVE

Introduction:The problem of temporomandibular disorders (TMD) is relevant in today's world and is considered one of the most common pathologies causing nonodontogenic pain syndromes of maxillofacial region. The morbidity of temporomandibular disorders is 27 to 76% among patients who seek dental care. There is now a significant number of classifications of TMD, however, clinically convenient, morphologically and pathogenetically substantiated classification of temporomandibular joint's (TMJ) conditions has not yet been developed. Therefore, the patient's examination protocols differ substantially. The aim: To analyze and assess the quality of classifications and examination protocols for the patients with suspected TMD.

PATIENTS AND METHODS

Materials and methods: A comparative analysis of 5 TMD classifications and 3 protocols for the examination of patients with suspected TMDs were performed.

RESULTS

Review: A comparative analysis of following TMD classifications was conducted: American Academy of Orofacial Pain, Research Diagnostic Criteria for TMD, by B.W.Neville, D.D.Damm, C.M.Allen, J.E.Bouquot, by Christian Köneke, international classification of diseases ICD-10. The analysis of the following protocols for the examination of patients with suspected TMDs was conducted: M. Helkimo index, Hamburg protocol, M. Kleinrok protocol.

CONCLUSION

Conclusions: Difficulties in interpreting diagnoses by dentists are caused by ambiguities in classifications, a considerable number of clinical entities and their construction principles. Organ principle of structure has proved to be the most convenient for clinical application. The evaluation protocols are cumbersome and duplicate each other. Owing to the lack of a common opinion about the origin and development of TMD, use of the evaluation protocols is based on the experience of dental practitioners.

[The significance and effect of guidelines 2. Observations concerning validation and recommendations with respect to guidelines]

The proper functioning of guidelines depends in part on correct validation. Validation requires an established norm. The professional and proto-pro-fessional paradigm uses different standards for validation based on different epistemological assumptions. Several different fundamental principles are also applied among healthcare professionals themselves. This leads to an insurmountable methodological difference whereby validation is not possible or meaningful at the moment. An important role seems reserved for the epistemology of the humanities to explain and interpret the guidelines. In addition, the operationalization of guidelines does not seem to be straightforward. The use of guidelines shows that unintended effects, such as the exclusion of patients from insurance and reimbursement, arise. In addition the number of guidelines is increasing to such an extent that implementation and enforcement are in danger of being compromised. Recommendations are made to monitor the significance and effect of guidelines.

Discordance between presumed standard of care and actual clinical practice: the example of rubber dam use during root canal treatment in the National Dental Practice-Based Research Network

OBJECTIVES

Use of a rubber dam during root canal treatment is considered the standard of care because it enhances patient safety and optimises the odds of successful treatment. Nonetheless, not all dentists use a rubber dam, creating disconnect between presumed standard of care and what is actually done in clinical practice. Little is known about dentists' attitudes towards use of the rubber dam in their practices. The objectives were to: (1) quantify these attitudes and (2) test the hypothesis that specific attitudes are significantly associated with rubber dam use.

SETTING

National Dental Practice-Based Research Network (NationalDentalPBRN.org).

PARTICIPANTS

1490 network dentists.

OUTCOME MEASURES

Dentists completed a questionnaire about their attitudes towards rubber dam use during root canal treatment. Three attitude scales comprised 33 items that used a 5-point ordinal scale to measure beliefs about effectiveness, inconvenience, ease of placement, comparison to other isolation techniques and patient factors. Factor analysis, cluster analysis and multivariable logistic regression analysed the relationship between attitudes and rubber dam use.

RESULTS

All items had responses at each point on the 5-point scale, with an overall pattern of substantial variation across dentists. Five attitudinal factors (rubber dam effectiveness; inconvenient/time-consuming; ease of placement; effectiveness compared to Isolite; patient factors) and 4 clusters of practitioners were identified. Each factor and cluster was independently and strongly associated with rubber dam use.

CONCLUSIONS

General dentists have substantial variation in attitudes about rubber dam use. Beliefs that rubber dam use is not effective, inconvenient, time-consuming, not easy to place or affected by patient factors, were independently and significantly associated with lower rubber dam use. These attitudes explain why there is substantial discordance between presumed standard of care and actual practice.

Concordance between clinical practice and published evidence: findings from The National Dental Practice-Based Research Network

BACKGROUND

Documenting the gap between what is occurring in clinical practice and what published research findings suggest should be happening is an important step toward improving care. The authors conducted a study to quantify the concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in The National Dental Practice-Based Research Network ("the network").

METHODS

Network dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors. The authors coded responses to each scenario/clinical practice behavior as consistent ("1") or inconsistent ("0") with published evidence, summed the coded responses and divided the sum by the number of total responses to create an overall concordance score. The overall concordance score was calculated as the mean percentage of responses that were consistent with published evidence.

RESULTS

The authors limited analyses to participants in the United States (N = 591). The study results show a mean concordance at the practitioner level of 62 percent (SD = 18 percent); procedure-specific concordance ranged from 8 to 100 percent. Affiliation with a large group practice, being a female practitioner and having received a dental degree before 1990 were independently associated with high concordance (≥ 75 percent).

CONCLUSION

Dentists reported a medium-range concordance between practice and published evidence.

PRACTICAL IMPLICATIONS

Efforts to bring research findings into routine practice are needed.

Systematic review of the effectiveness of continuing dental professional development on learning, behavior, or patient outcomes

This study is based on a systematic review of studies using a randomized controlled trial or quasi-experimental design in order to synthesize existing evidence evaluating the effectiveness of continuing professional development (CPD) interventions in dentistry on learning gains, behavior change, or patient outcomes. The authors searched a range of electronic databases from 1986 to the present and screened all potentially relevant studies for inclusion, using pre-established inclusion/exclusion criteria. Following data extraction and quality appraisal of all included studies, a narrative synthesis of the studies was undertaken. Ten studies (in fourteen articles) were included. All were evaluation studies of CPD interventions targeted exclusively at dentists. The ten included studies evaluated a range of interventions: courses/workshops, written information, CAL, audit/self-reflection, face-to-face support, and black box combinations of these interventions. Two high- and moderately high-quality studies evaluated CAL CPD for dentists and found equivocal impact of CAL for dentists. A black box combination of interventions was rigorously evaluated and showed moderate impact on patient care. This finding suggests that multimethod and multiphased CPD has potential for the greatest impact. There is a need for more high-quality randomized controlled trials evaluating CPD interventions in dentistry. It is important that future evaluations of CPD interventions clarify the nature of the interventions such that they are explicit and replicable and that appropriate outcomes are selected (health of patients and change in practice or behavior as well as knowledge and understanding) in order to move the evidence base of effective practice forward in this area of dental education.

Cement application techniques in luting implant-supported crowns: a quantitative and qualitative survey

PURPOSE

To investigate different techniques used by dentists when luting an implant-supported crown and to evaluate the application of cement quantitatively and qualitatively.

MATERIALS AND METHODS

Participants were given a bag containing cement sachet, mixing pad, spatula, a variety of application instruments, and a polycarbonate crown form. The participants were instructed with a standardized audio-video presentation to proportion the cement, mix it, and apply it to the intaglio of the crown as they would if they were to cement it onto an implant abutment in a clinical situation. The crowns were weighed, first unfilled and then again once the applied cement had set. The mean weights of fully-loaded crowns (n = 10) were used as a control group. The patterns of cement loading were recorded. The weights of collected cement-loaded crowns were compared to those of the control group and analyzed statistically.

RESULTS

Four hundred and one dentists in several different geographic locations were surveyed. Three distinct cement loading patterns were observed: gross application (GA), brush-on application (BA), and margin application (MA). The mean weights for each cement loading pattern were 242.2 mg for the GA group, 59.9 mg for the BA group, and 59.0 mg for the MA group. The weight of cement in the GA group was significantly higher than that in the other groups. No statistically significant difference between groups BA and MA was seen.

CONCLUSIONS

The diversity of the cement loading patterns disclosed in this study indicates that there is a lack of uniformity and precision in methods and a lack of consensus in the dental community regarding the appropriate quantity of cement and placement method for a cement-retained implant crown.

A model for dental practice in the 21st century

The dental profession is responsible for the prevention, diagnosis, and treatment of diseases and disorders of the oral cavity and related structures. Although the majority of the US population receives excellent oral health care, a significant portion is unable to access regular care. Along with proposals to develop midlevel providers, the scope of practice for dentists needs to be reconceptualized and expanded. A broad number of primary health care activities may be conducted in the dental office, such as screening for hypertension, diabetes mellitus, and dermatopathology; smoking prevention and cessation activities; and obesity interventions. More than 70% of adults saw a dentist in the past year, which represents an unrealized opportunity to improve both oral health and general health.

The application of quality guidelines of the European Society of Endodontology in dental practice in Poland

INTRODUCTION

We analyzed the application of endodontic quality guidelines of the European Society of Endodontology by Polish dentists: endodontists, other specialists, and dental general practitioners (DGPs).

MATERIAL AND METHODS

A survey was done in 2008 among 544 dentists who attended hands-on sessions and lectures. The following data were collected: gender, professional experience, type of practice, specialization, and number of root fillings per week. Questions concerned the use of the rubber dam, electronic apex locator, radiographs, magnification by loupes or microscopes, nickel-titanium (NiTi) rotary system, warm gutta-percha, and treatment completed during no more than 2 visits. 3 response options were available: often, occasionally, never.

RESULTS

In the group we had 36.6% endodontists, 11.2% other specialists, and 52.2% DGPs. 95.9% of endodontists, 98.4% of other specialists, and 30.9% of DGPs (p <0.001) had at least 10 years of professional experience. 61.4% of endodontists performed more than 5 procedures per week, compared with 60% of DGPs and 42.4% of other specialists (p < 0.05). The use of radiographs, rubber dam, magnification, and NiTi rotary instruments was similar in the groups (p = NS). Dental general practitioners applied an electronic apex locator and completed the treatment during no more than 2 visits more often than endodontists and other specialists (p < 0.05). Dental general practitioners used warm gutta-percha more often than endodontists (p < 0.05). The percentage of dentists who declared use of all 7 procedures as "often" or "occasionally" was low (8.2% - other specialists, 6% - DGPs, and 3% - endodontists; p = NS).

CONCLUSIONS

The application of endodontic quality guidelines is not widespread among Polish dentists. Dentists who graduated more recently (DGPs) follow the guidelines more closely.

The diagnostic process

When first case examples presents to a dentist, a patient may have a specific complaint, be in need of routine evaluation, or arrive on referral from another health care provider. In all cases, proper diagnosis of existing problems is the essential first step in provision of appropriate oral health care. The clinician's approach to diagnosis and the need to arrive at the appropriate diagnosis are daily challenges in dental practice. This article discusses the prescriptive and descriptive theories of diagnostic reasoning using 4 case examples.

The assessment of infection control in dental practices in the municipality of São Paulo

OBJECTIVE

The goal of this study was to evaluate the infection control measures actually implemented by dental surgeons during dental practice, as patients and professionals are exposed to high biological risk in dental care environments.

METHOD

614 questionnaires (90.69%) were answered by professionals registered in updating or in post-graduate courses in the Municipality of São Paulo.

RESULTS

Out of surveyed professionals 30.62% admitted that surface protection barriers were not used, whereas 34.17% were using non ideal or outdated pre-disinfection practices. The autoclave was used by 69.38% of participants, although 33.80% were not monitoring control of the sterilization cycles. Chemical and biological indicators were not used simultaneously by 83.21% of respondents and were not employed on a daily or weekly basis by at least 81.75%. Dubious methods of sterilization were cited by 44.77%. Occupational accidents caused by cutting and piercing objects were reported by 47.88%; however, the biologic risk was underestimated by 74.15% of the professionals who suffered the accidents. Irritant solutions were used as an antiseptic agent by 18.55%.

CONCLUSIONS

Infection control measures reported by dental surgeons during their practices are deficient. It is necessary to educate, raise awareness of professionals, and promote constant updating courses on procedures which aim at improving safety of dental care.

The influence of systemic diseases on the diagnosis of oral diseases: a problem-based approach

Although all dentists are taught about the importance of oral health to general health and that systemic disease can manifest in the oral cavity, the 4-year dental school curriculum does not allow time to gain competency in these relationships. Nevertheless, all dentists must have skills in taking a medical history and an appreciation of oral findings that might have a systemic origin. This article focuses on the identification of abnormal signs and symptoms in the oral cavity and the determination of those that have a systemic origin. It is imperative that clinicians are mindful of the possible oral-systemic associations, because these could potentially have a huge impact on patient care.

Pay for performance: will dentistry follow?

BACKGROUND

"Pay for performance" is an incentive system that has been gaining acceptance in medicine and is currently being considered for implementation in dentistry. However, it remains unclear whether pay for performance can effect significant and lasting changes in provider behavior and quality of care. Provider acceptance will likely increase if pay for performance programs reward true quality. Therefore, we adopted a quality-oriented approach in reviewing those factors which could influence whether it will be embraced by the dental profession.

DISCUSSION

The factors contributing to the adoption of value-based purchasing were categorized according to the Donabedian quality of care framework. We identified the dental insurance market, the dental profession position, the organization of dental practice, and the dental patient involvement as structural factors influencing the way dental care is practiced and paid for. After considering variations in dental care and the early stage of development for evidence-based dentistry, the scarcity of outcome indicators, lack of clinical markers, inconsistent use of diagnostic codes and scarcity of electronic dental records, we concluded that, for pay for performance programs to be successfully implemented in dentistry, the dental profession and health services researchers should: 1) expand the knowledge base; 2) increase considerably evidence-based clinical guidelines; and 3) create evidence-based performance measures tied to existing clinical practice guidelines.

SUMMARY

In this paper, we explored factors that would influence the adoption of value-based purchasing programs in dentistry. Although none of these factors were essential deterrents for the implementation of pay for performance programs in medicine, the aggregate seems to indicate that significant changes are needed before this type of program could be considered a realistic option in dentistry.

[The stomatologic status of people of elderly and senile age]

This article presents the data of epidemiological inspection of 1000 persons of average, elderly and senile age. Prevalence and intensity of a current of the basic stomatologic diseases (caries, pathology of a paradont and a mucous membrane of an oral cavity, a temporal-mandibular joint and chewing muscles) have been studied. Indicators of need of people of various age groups in tooth prosthetics are established. Level of rendering the stomatologic help is defined to be insufficient in groups of people of elderly and senile age. Recommendations aimed at improvement of stomatologic help to people of elderly and senile age are made.

Meeting oral health needs to promote the well-being of the geriatric population: educational research issues

This article reviews some of the more recent demographic changes affecting aging populations. The author expands the concept of aging to include persons who may be chronologically young but biologically old because they are medically compromised or developmentally disabled. It is not known how many persons can be included in this definition who will need care, and the question is what are their needs and how are we going to teach dental students and dentists to care for them. These problems are discussed, and some models of care are described.

Smoking cessation practices in the dental profession

AIM

The purpose of this review is to describe the current status of smoking cessation initiatives in the dental profession.

REVIEW

A review of the initiatives undertaken by the dental profession to adopt smoking cessation recommendations as standard of care is presented.

SUMMARY

Facts about the effects of smoking on the major oral diseases are stated and supported by national statistics. The barriers for compliance by dental professionals are described based on published research, but even more importantly, possible solutions are offered.

CLINICAL SIGNIFICANCE

Awareness of the harmful effects of smoking tobacco can help dental professionals become more motivated to comply with current recommendations for smoking cessation in order to improve the oral and general health of the public.

Occlusal tooth surface treatment plans and their possible effects on oral health care costs

PURPOSE

The aim of this study was to evaluate decision making with regard to detection and treatment of carious lesions on occlusal tooth surfaces and to evaluate the possible costs related to the different treatment plans of a group of clinicians in private practice.

MATERIALS AND METHODS

Forty extracted permanent teeth with no fillings or macroscopic carious cavitations were selected and radiographed, using a standard method similar to bitewing and then mounted in two models. A sample of 130 clinicians in private practice in Piracicaba, Brazil were asked to carry out combined visual-radiographic caries examination of the occlusal surfaces and to recommend possible treatment plans for each surface. Teeth were sectioned bucco-lingually and caries was assessed using a stereomicroscope and classified as either enamel or dentine lesions. The costs of treatments suggested by each examiner were calculated, using a fee scale reported by the Brazilian Federal Council of Dentistry.

RESULTS

Most teeth (53.7%) that were found to be sound on histological examination were considered to have enamel lesions. In 85.7% of these cases, the clinicians recommended restorative treatments. There was about 14-fold difference among clinicians concerning the costs related to decision making.

CONCLUSION

Not only did the clinicians overestimate the presence and depth of carious lesions, but they also tended to treat enamel lesions using invasive therapeutic procedures. Great disparities were observed with regard to treatment costs related to decision making. Assuming an in vivo situation, the clinicians may be performing overtreatments and consequently interfering in the quality of patients' oral health.

Practice

Practice refers to a characteristic way professionals use common standards to customize solutions to a range of problems. Practice includes (a) standards for outcomes and processes that are shared with one's colleagues, (b) a rich repertoire of skills grounded in diagnostic acumen, (c) an ability to see the actual and the ideal and work back and forth between them, (d) functional artistry, and (e) learning by doing that transcends scientific rationality. Communities of practice, such as dental offices, are small groups that work together in interlocking roles to achieve these ends.

Caries preventive measures used in orthodontic practices: an evidence-based decision?

INTRODUCTION

Although it is well known that treatment with fixed appliances increases the risk of enamel demineralization, little information is available about preventive measures that orthodontists actually use. This study was executed to survey measures used in orthodontic practices to prevent decalcifications during fixed appliance treatment, and to compare these measures with the available evidence-based information.

METHODS

A questionnaire was sent to all privately practicing orthodontists in the Netherlands who were affiliated with the Dutch Dental Association.

RESULTS

Of 229 orthodontists, 178 (78%) returned the questionnaires. Most of the orthodontists had a basic practice protocol for preventing demineralizations at the start of treatment. This protocol nearly always included oral hygiene instructions. If demineralizations occurred, 99% of the orthodontists took extra measures. Comparing the measures applied in the orthodontic practices with the evidence from a systematic review, a number of differences became apparent. The additional use of chlorhexidine or toothpaste with a high fluoride concentration (which has been demonstrated to have an inhibitive effect) is rarely prescribed. Fluoride rinse is prescribed most often, although there is not any high-quality, long-term study that demonstrates a caries preventive effect in orthodontic patients. Sixty-eight percent of the orthodontists considered it necessary to develop a practice guideline for preventing demineralizations.

CONCLUSIONS

Orthodontists do not implement the available evidence in order to prevent enamel demineralizations during fixed-appliance treatment. A practice guideline incorporating this information should be developed.

The responsibilities and rights of dental professionals 3. Professional rights

Professional status, professional autonomy, clinical freedom, self-regulation and the right to serve patients and the community seem to be the main rights of dentists. Although they simply may be seen as privileges that are related to being a dentist, these rights cannot be considered independent from dentists' roles and responsibilities. They are, in fact, valuable tools that serve dentists to meet their broad responsibilities that arise from the 'social contract' between the profession and the public.

Treatment policies among Israeli specialists in paediatric dentistry

AIM

This was to evaluate some suggested diagnostic procedures, treatment policies and professional attitudes of specialists in paediatric dentistry, in light of the periodically published guidelines by The American Academy of Pediatric Dentistry, The European Academy of Paediatric Dentistry and The British Society of Paediatric Dentistry.

METHODS

Using a structured questionnaire, 67% of the Israeli specialists in paediatric dentistry, who agreed to participate in this study, were personally interviewed.

RESULTS

Only 7.5% of the participants reported that they carry out pulp capping of primary teeth in cases of pulp exposure. Over 50% reported restoring teeth after pulpotomy with preformed crowns. Most indicated sealing pit and fissures after considering depth and morphology of the fissures and correlation with the patient's risk to caries. Cleaning teeth after eruption of the first tooth was suggested by 75.5% of the participants. A striking majority (96%) claimed that they restored permanent anterior teeth with composite resins and most used these materials for occlusal restoration in both primary and permanent posterior teeth. Most specialists advocated the use of amalgam in proximal posterior restorations. The presence of a parent in the operatory/surgery was preferred by 85% of the dentists.

CONCLUSIONS

Israeli specialists in paediatric dentistry mostly comply with the mentioned guidelines. Further studies of this nature should also be encouraged in other countries to emphasize the importance of monitoring compliance with established and evidence based guidelines.

The role of dentist, practice and patient factors in the provision of dental services

OBJECTIVES

Service provision varies by dentist, practice and patient factors. However, limited subsets of these potential influences on service rates have been explored. More comprehensive models could improve our understanding of the factors influencing the pattern of care delivered. The aim of this study was to examine variation in dental services by dentist (treatment choice, practice beliefs, preferences for patients, demographics), practice (type, location, size and volume of practice) and patient (visit, demographic, oral health and socio-economic) characteristics.

METHODS

A random sample of Australian dentists was surveyed in 1997-98 (response rate=60.3%). Private general practitioners (n=345) provided dentist and practice data, and service provision and patient variables were collected from a log of a typical clinical day (n=4,115 patients). Multivariate negative binomial regression models were fitted for diagnostic, preventive, restorative, extraction and prosthodontic services.

RESULTS

Significant dentist factors included (P<0.05; RR=rate ratio): lower diagnostic rates (RR=0.78) for dentists with stronger practice beliefs for giving information about cost and treatment options; preventive rates were lower (RR=0.74) for male dentists and higher (RR=1.48) for younger dentists aged 20-29 years; restorative rates were higher (RR=1.27) for dentists that rated patient preferences more highly in treatment choice and in the dentist age group 30-39 years (RR=1.25); extraction rates were lower (RR=0.61) for dentists with stronger preferences for patients that would adhere with treatment but higher (RR=1.57) for dentists with stronger preferences for sociable patients; and prosthodontic rates were lower (RR=0.38) for dentists with stronger preferences for adaptable patients who were willing to cooperate when expected to do so. Practice factors included: higher preventive (RR=1.28) and prosthodontic rates (RR=2.07) in solo practice; higher preventive (RR=1.34) but lower prosthodontic rates (RR=0.42) in capital cities; lower diagnostic (RR=0.82) and extraction rates (RR=0.55) in practices with fewer other dentists; higher diagnostic (RR=1.33) and extraction (RR=1.62) rates but lower restorative rates (RR=0.84) in practices with lower patient visits per year. Patient factors included: lower preventive (RR=0.76) but higher extraction rates (RR=1.45) for emergency visits; lower extraction rates (RR=0.60) for the insured; higher diagnostic rates (RR=1.17) for new patients; higher restorative (RR=1.31) but lower prosthodontic rates (RR=0.46) for patients with decayed teeth; higher prosthodontic rates (RR=2.14) for those with dentures; and lower preventive (RR=0.66), but higher extraction (RR=2.22) and prosthodontic rates (RR=1.82) for patients from lower socio-economic status areas.

CONCLUSIONS

Dental service rates were influenced by large number of small effects from a wide range of dentist, practice and patient factors. Socio-economic and geographic barriers may need broad policy innovations to be addressed, but factors such as insurance and visit type have the potential to be altered to achieve better service outcomes and there is scope for research into clinical outcomes to improve the knowledge upon which treatment decisions are based.

Dental nomograms for benchmarking based on the study of health in Pomerania data set

AIM

Benchmarking is a means of setting goals or targets. On an oral health level, it denotes retaining more teeth and/or improving the quality of life. The goal of this pilot investigation was to assess whether the data generated by a population-based study (SHIP 0) can be used as a benchmark data set to characterize different practice profiles.

MATERIAL AND METHODS

The data collected in the population-based study SHIP (n=4310) in eastern Germany were used to generate nomograms of tooth loss, attachment loss, and probing depth. The nomograms included twelve 5-year age strata (20-79 years) presented as quartiles, and additional percentiles of the dental parameters for each age group. Cross-sectional data from a conventional dental office (n=186) and from a periodontology unit (n=130, Greifswald) in the study region as well as longitudinal data set of a another periodontology unit (n=135, Kiel) were utilized in order to verify whether the given practice profile was accurately reflected by the nomogram.

RESULTS

In terms of tooth loss, the data from the conventional dental office agree with the median from the nomogram. For attachment loss and probing depth, some age groups yielded slight but not uniform deviations from the median. Cross-sectional data from the periodontology unit Greifswald showed attachment loss higher than the median in younger but not in older age groups. The probing depth was uniformly less than the median and tended toward the 25th percentile with increasing age. The longitudinal data of the Unit of Periodontology in Kiel showed a pronounced trend towards higher percentiles of residual teeth, meaning that the patients retained more teeth.

CONCLUSION

The profile of the Pomeranian dental office does not deviate noticeably from the population-based nomograms. The higher attachment loss of the Unit of Periodontology in Greifswald in younger age strata clearly reflects their selection because of periodontal disease; the combination of higher attachment loss and decreased probing depth may reflect the success of the treatment. The tendency of attachment loss towards the median with increasing age may indicate that the Unit of Periodontology in Greifswald does not fulfill its function as a special care unit in the older subjects. The longitudinal data set of the Unit of Periodontology in Kiel impressively reflects the potential of population-based data sets as a means for benchmarking. Thus, nomograms can help to determine the practice profile, potentially yielding benefits for the dentist, health insurance company, or--as in the case of the special care unit--public health research.

[Pastoral psychology, spiritual counseling in dentistry. Review of the literature]

Although there were drastic changes in the XX-th century, still 70% of the Hungarian population believe in God, and 10-15% can be counted as active believer. A percentage of 44% of the hospitalised patients indicated a need of pastoral counseling during the treatment time. In the field of psychiatry and psychotherapy the percentage of the need of religious care (pastoral psychology, pastoral counseling) may be even higher. In the field of dentistry the increasing number of psychosomatic patients justify the introduction of such religious treatment methods into the dental care system as well. In this review authors try to collect the main points of this special, religious type of therapy to help dental professionals working in the field of psychosomatic dentistry in the orientation in this interesting and important field.

Board certification status and pediatric dentists' practice characteristics

PURPOSE

Board certification is often used as a surrogate indicator of provider competence and quality of care, although few studies have demonstrated its validity. The aim of this study was to assess the relationship between board certification status and a set of quality characteristics of pediatric dental practice.

METHODS

A 30-item questionnaire was developed that collected information regarding practice characteristics in the areas of: (1) professional growth/practice management; (2) emergency readiness; (3) treatment guidelines utilization; (4) patient pool selection; (5) safety; and (6) behavior management. The questionnaire was mailed to 250 board-certified and 250 noncertified pediatric dentists paired by year and program of graduation.

RESULTS

Overall, respondents-irrespective of pairing by program and year of graduation-tended to answer affirmatively or largely positively to most questions. Maintaining hospital privileges and having routinely CPR-certified staff were significantly related to the board certification status. When year of graduation and residency program attended was considered, however, this significance disappeared. In categories of treatment guidelines utilization, patient pool selection, safety protocols and behavior management, there was no significant difference between board certified and nonboard certified pediatric dentists (P > .05).

CONCLUSIONS

Generally, pediatric dentists independent of certification status, practice at a high level of quality, as measured in this study.

[Sporadic transmission of hepatitis C in dental practice]

Percutaneous contact with contaminated blood is the principal mode of transmission of the hepatitis C virus (HCV). However, the diagnosis of infection in patients in whom no parenteral risk factor can be identified allows speculation on the existence of other routes of transmission. In the field of dentistry, the role of saliva has still not been defined as a potential vehicle for infection nor the role of dental treatment as a possible occult factor in the sporadic transmission of hepatitis C. HVC-RNA is detectable in the saliva of over 50% of patients with chronic hepatitis C. The infectivity of the HVC particles detected in the saliva has not been determined, though it may be deduced from epidemiological studies that their potential for transmission, if it exists, is extremely limited. There has been no documented case of HVC transmission in a dental clinic. Studies which propose a history of dental treatment as a risk factor for HVC infection have not achieved conclusive results. The age distribution of the prevalence of HVC could indicate that a risk of iatrogenic transmission existed in the past, before the systematic application of universal barriers. The transmission of HVC in dental clinics may be considered a very infrequent occurrence as long as the norms for the control of cross-infection are respected.

Development of clinical practice guidelines for dentists: methods for topic selection

OBJECTIVES

The aim of this study was to compare four methods for assessing the preferences of the dental profession for topics to be considered for the development of clinical practice guidelines.

METHODS

The methods were: (1) a survey among dentists, (2) an analysis of topics discussed in dental peer groups, and (3) screening of dental journals. A fourth method was obtained from method number 3. The frequencies of the reported topics were calculated for each of the methods. For the fourth method, the number of publications per topic were plotted against the year of publication, and the slope of the linear regression line was used as an indicator. Within each of the four methods, the topics were ranked according to the frequency in which they were reported, and to the slope value. The reliability of the methods was tested by the "item-rest sum correlation", which is the correlation of the rank positions of one method with the sum of the rank positions obtained by the remaining three methods.

RESULTS

In using all methods, a total of 1027 topics were obtained. Reclassification resulted in 34 topics. Moderate item-rest sum correlations ranging from 0.34 to 0.48 were found for all methods, indicating that the rank order of every method moderately predicts the sum of the rank orders obtained by all other methods. The topic 'prevention of cross-infection' had the highest overall rank position.

CONCLUSION

It is concluded that the four applied methods appeared to provide a consistent ranking of potential topics. In view of the fact that the questionnaire method is generally applicable, this method should be preferred for assessing dentists' preferences for topics to be considered for the development of clinical practice guidelines.

Appropriateness of referrals for removal of wisdom teeth

A 6-month prospective study of 166 patients was undertaken to assess whether general dental practitioners who referred patients for removal of wisdom teeth were following current national guidelines. It was found that 92% of referrals followed the guidelines of the Faculty of Dental Surgery of the Royal College of Surgeons of England and the National Institute for Clinical Excellence. There were 13 inappropriate referrals - 3 patients were asymptomatic, 9 patients had a single episode of pericoronitis and 1 had crowding of the lower anterior incisors. General dental practitioners in this study seem to be following current guidelines consistently. No teeth were removed prophylactically.

Diagnostic codes in dentistry--definition, utility and developments to date

Diagnostic codes are computer-readable descriptors of patients' conditions contained in computerized patient records. The codes uniquely identify the diagnoses or conditions identified at initial or follow-up examinations that are otherwise written in English or French on the patient chart. Dental diagnostic codes would allow dentists to access information on the types and range of conditions they encounter in their practices, enhance patient communication, track clinical outcomes and monitor best practices. For the profession, system-wide use of the codes could provide information helpful in understanding the oral health of Canadians, demonstrate improvements in oral health, track best practices system-wide, and identify and monitor the progress of high-need groups in Canada. Different systems of diagnostic codes have been implemented by program managers in Germany, the United Kingdom and North America. In Toronto, the former North York Community Dental Services developed and implemented a system that follows the logic used by the Canadian Dental Association for its procedure codes. The American Dental Association is now preparing for the release of SNODENT codes. The addition of diagnostic codes to the service codes already contained in computerized patient records could allow easier analysis of the rich evidence available on the oral health and oral health care of Canadians, thereby enhancing our ability to continuously improve patient care.