The views and attitudes of parents of children with a sensory impairment towards orthodontic care

A questionnaire was sent to the parents of 77 visually impaired (VI), 210 hearing impaired (HI) and 494 control children seeking their views on their child's dental appearance, orthodontic treatment need and issues that might influence the child undertaking treatment. The parents' views were compared with a dentist's assessment of treatment need using the Index of Orthodontic Treatment Need (IOTN). There was disagreement between the dentist's assessment and the parents' perceptions in all groups. However, the least disagreement was seen in the HI group. There was a statistically significant (P < 0.05) association between control and HI parents' views of their children's treatment needs and their opinion on their dental appearance. Most parents thought that orthodontic treatment was difficult to obtain and expensive and that their child would find difficulty coping with the treatment. Furthermore, parents of VI children considered that treatment was unlikely to be undertaken due to their child's reduced concern for their appearance. The study indicates that the awareness of treatment need for VI and HI children differs between their parents and dentists.     

Traumatised permanent teeth in 11–16-year-old Saudi Arabian children with a sensory impairment attending special schools

Abstract  – The aim of this study was to determine the prevalence of traumatised permanent teeth among sensory (visual (VI) and hearing (HI)) impaired children attending special schools in Riyadh, Saudi Arabia. All the dental injuries involved incisor teeth, and trauma was noted in 33 (6.7%) children attending government schools (control group) compared to 7 (9%) VI children and 24 (11.4%) HI children. Differences in the dental trauma only reached statistical significance between the HI and control group ( P  < 0.05). Gender differences were only apparent in the HI group, with males having higher levels of traumatised teeth. In addition, HI children aged 11–12 years were more prone to trauma than children in the control group of the same age ( P  < 0.05). In conclusion, sensory impaired children do have a tendency for more dental trauma. However, this was only statistically significant for HI children. Whereas a gender difference was most noticeable for the HI group, with males having higher levels of trauma, this was noticeable by its absence among VI children.     

Attitudes of dentists, working in Riyadh, toward people with a sensory impairment

This study was conducted to determine the attitudes of dentists, working in Riyadh, toward people with a sensory impairment (SI), according to the Scale of Attitude Towards Disabled Persons (SADP). The SADP scale was modified to focus solely upon sensory impairment. The modified scale was pre-tested and then incorporated into a self-administered questionnaire. This was then administered to 600 dentists (response rate, 73.7%) working in the city of Riyadh, Saudi Arabia. The modified scale showed itself to be reliable, with a Chronbach's coefficient α 0.616 and four-factor analysis, which accounted for 38.5% of the variance. Ninety-four percent of the dentists were generally positive toward SI in the society. There were, however, significant variations in attitudes, with a more positive score for dentists who had worked for 30 years or more ( p ± 0.005), were specialists ( p < 0.005), received little or no undergraduate training in this subject ( p < 0.05), and who received their undergraduate training in Europe/North America ( p < 0.001). However, in a stepwise regression model, all these variables were significant except for the years of practice. The modified SADP showed dentists, working in Saudi Arabia, having a positive attitude toward people with SI.     

Smoking cessation counseling in dentistry: attitudes of Nigerian dentists and dental students

The study was aimed at assessing the awareness, attitude, practices, willingness, and perceived barriers of dental students and dentists in Lagos University Teaching Hospital, Lagos, Nigeria, in relation to smoking cessation in the dental care setting. An anonymous self-administered questionnaire that contained questions relating to attitudes, views, and perceived barriers to smoking cessation activities in the dental clinic was hand-delivered to all dentists and clinical dental students in 2007. One hundred and thirty-six respondents took part in the study (response rate=81.9 percent). Although 95 percent of the respondents believed that smoking affects the dental management of the patient, only 65 percent always ask their patients about their smoking habits, and only 30 percent have heard about smoking cessation programs. A significantly higher proportion of students always ask patients about their smoking habits compared with dentists (p=0.0017). Also, a significantly higher proportion of dentists (97 percent) advised their patients against tobacco use compared with 77 percent of students (p=0.0000). Only 2 percent and 3 percent agreed that it is their professional responsibility to educate or encourage patients to quit smoking, respectively. Also, 98 percent strongly disagreed that it is within the scope of dental practice to ask about tobacco use, and 86 percent disagreed that tobacco counseling can be effective in helping patients quit tobacco use. Perceived barriers reported were lack of time (88 percent), lack of necessary materials (81 percent), and lack of knowledge of smoking cessation (74 percent). However, 81 percent of the respondents said they are willing to undergo training in tobacco use cessation. Since most of the dentists and dental students had poor attitudes and negative perceptions of smoking cessation activities, possibly due to lack of training and resources to carry it out in the clinics, there is need to include smoking cessation training in the dental curriculum in Nigeria.     

How willing are dentists to treat young children?: A survey of dentists affiliated with Medicaid managed care in New York City, 2010

BackgroundDespite recommendations for children to have a dental visit by the age of 1 year, access to dental care for young children, including children enrolled in Medicaid, remains limited. The authors conducted a survey to assess the availability of dentists to see young children enrolled in Medicaid managed care (MMC) in New York City (NYC), to determine barriers to the provision of dental care to young children and, within the context of MMC, to identify strategies to facilitate the delivery of dental care to children.MethodsThe authors mailed a survey to assess the provision of dental services to young children and perceived barriers and facilitators to 2,311 general dentists (GDs) and 140 pediatric dentists (PDs) affiliated with NYC MMC. A total of 1,127 surveys (46 percent) were received. The authors analyzed the responses according to provider type, youngest aged child seen, provider’s ability to see additional children and practice location. The authors compared responses by using the χ² test.ResultsFewer than one-half (47 percent) of GDs saw children aged 0 through 2 years. Provider type, years in practice and percentage of Medicaid-insured patients were associated significantly (P χ .005) with youngest age of child seen. Among respondents seeing children aged 0 through 2 years, PDs were significantly more likely to provide preventive therapy (P = .004) and restorative treatment (P χ .001). Additional training and access to consulting PDs were identified by GDs as potential facilitators to seeing young children.ConclusionA high proportion of NYC GDs affiliated with MMC do not see young children.Practice ImplicationsNinety-four percent of NYC MMC– affiliated dentists are GDs, but 53 percent of GD respondents did not see children aged 0 through 2 years in their practices. Improving access to dental care for young children requires changes in GDs’ practices, possibly by means of additional training and access to consulting PDs.     

A survey of undergraduate orthodontic training and orthodontic practices by general dental practitioners

PURPOSE of the STUDY: To assess satisfaction with undergraduate orthodontic training, the variety of treatments undertaken in general practice, practitioners' perceived competence in orthodontics and the level of interest in continuing education in orthodontics. DESIGN: Cross-sectional questionnaire-based study. MATERIALS and METHODS: A questionnaire was mailed to 520 general practitioners in Dublin, Kildare and Wicklow as listed in Irish Dental Council Register of Dentists 2003. RESULTS: Forty-six percent of dentists responded. More than half (54 per cent) of the respondents were satisfied with both academic and clinical aspects of undergraduate training. Twenty-nine percent regularly perform orthodontic treatment. Only 60 percent feel comfortable treating orthodontic emergencies. Over 70 percent have either already attended or aspire to attend further training in orthodontic diagnosis and interceptive orthodontics. CONCLUSIONS: Our study indicates that in the greater Dublin area, graduates (those qualified less than 10 years) are increasingly satisfied with undergraduate teaching. Orthodontic treatment is performed regularly in general dental practice with interceptive procedures most often carried out. While ability to deal with orthodontic emergencies is not universal, practitioners do appear confident to perform a variety of orthodontic procedures. Interest in continuing education in orthodontics is very high. Our study indicates that participation in continuing education in orthodontics appears to translate into greater provision of orthodontic care in general practice.     

Experience of dental care for children with congenital heart disease among Swedish dentists

This study was conducted in order to examine the experience of and attitudes to dental care for children with congenital heart disease (CHD) among Swedish general dentists. 183 general dentists employed in the Public Dental Health Service in the counties of V?sterbotten and Uppsala, and private practitioners listed with dentistry for children in the county of V?sterbotten, Sweden, were enrolled in the study. Data were collected with a questionnaire with 18 questions. Eighteen per cent of the dentists stated that they had received special education or information except the graduate training to treat children with CHD. Forty-eight per cent of the dentists had one or more patients with CHD. Seventy-two per cent of these stated that their CHD-patients had a caries problem. Statistically significant differences were displayed between answers on the questions "who in the dental team perform the major part of the dental care for children with CHD" and "what is your opinion on which personal category that should perform the major part of the dental care for this group of children" (p < 0.001). Among dentists whose clinical time mainly was used for dentistry for children, it was more common to treat children with CHD (p < 0.001) than for dentists with a lower degree of dentistry for children. The study showed that the Swedish dental care for children with CHD today mainly is performed by dental nurses, dental hygienists and general dentists. This strongly differs from the dentist's opinion on who should perform the major part of the dental care for this group of children. These findings taken together with the very low number of dentists that had received special education or information except the graduate training to treat children with CHD indicates that the Swedish dentists are unsettled and insecure in the dental treatment of children with heart defects. An early and close cooperation between specialists in pediatric dentistry, dentists with special training and general dentists is strongly desirable to support the dentists and facilitate the dental care for children with CHD.     

Are general dentists' practice patterns and attitudes about treating Medicaid-enrolled preschool age children related to dental school training?

PURPOSE: The purpose of this study were to investigate the willingness of general practitioners to provide dental care for preschool-aged children, and to explore the relationship between dental school experiences and practitioners' attitudes about treating Medicaid-enrolled children 3 years of age and younger. METHODS: A survey was mailed to 3,559 randomly selected general dentists in Texas. Respondents were asked to answer questions about their willingness to provide specified dental procedures for children of different ages, their dental school experiences with pediatric dentistry and whether these experiences were hands-on, lecture or no training, and their attitudes concerning treating Medicaid-enrolled children 3 years of age or younger. Associations between attitudes about treating Medicaid-enrolled children and dental school experiences were determined. RESULTS: The response rate was 26%. Almost all respondents were willing to provide routine procedures such as an examination (95%) and prophylaxis (94%) for children 5 years or younger. However, as children became younger and procedures more difficult, the number of general dentists willing to provide treatment decreased. The level of dental school training was significantly associated with the attitudes of general dentists about providing dental care for Medicaid-enrolled preschool-aged children (P < or = 0.05). CONCLUSION: Identification of factors associated with general dentists' willingness to see young children may improve access by increasing the number who will provide care for preschool-aged children.     

Oral health in pregnancy: educational needs of dental professionals and office staff

Objective: Dental care during pregnancy is important for pregnant women and their children. Comprehensive guidelines for the provision of dental services for pregnant patients were published in 2006, but there is relatively little information about their use in actual practice. The aim of this study was to examine differences in knowledge and attitudes regarding dental care in pregnancy among dentists, dental hygienists, dental assistants, and nonclinical office staff. A secondary aim was to identify sources of influence on attitudes and knowledge regarding the guidelines. Methods: A survey was used to collect information from 766 employees of a Dental Care Organization based in Oregon; responses from 546 were included in the analyses reported here. Results: Statistically significant differences in knowledge were found among the professional‐role groups. Dentists and hygienists consistently answered more items correctly than did other respondents. Within all professional‐role groups, knowledge gaps existed and were most pronounced regarding provision of routine and emergency services. Positive perceptions of providing dental care during pregnancy were associated with higher knowledge scores (z = 4.16, P < 0.001). Conclusions: Updated dental education and continuing education for all dental office personnel are needed to promote the diffusion of current evidence‐based guidelines for dental care during pregnancy.     

Undergraduate student experience in dental service delivery in rural South Australia: an analysis of costs and benefits

BACKGROUND: Rural experience for dental students can provide valuable clinical education, change attitudes to rural practice, and make a valuable contribution to clinical service provision. The aim of this paper is to assess the costs and benefits of service delivery by students through rural training programmes. METHODS: Groups of two students worked in the public dental clinics in adjacent rural centres where there had been long-term difficulties in recruiting staff. The costs and benefits of the programme were assessed by the impact on waiting lists, the total cost per patient of a course of care and by the marginal cost of adding service provision by students to existing arrangements. RESULTS: The total costs of emergency and complete treatment provided by students were greater than the costs of treatment provided by public-sector dentists but less than the costs of private providers treating public patients. However, the value of services were greater when care was provided by students or private providers and the marginal cost of students providing services was 50-70 per cent of the cost of care provided by public dentists. CONCLUSION: This assessment suggests that the service benefits achieved compliment the primary objective of influencing the attitude of students to rural practice.     

Access to dental care in Alabama for children with special needs: parents' perspectives

BACKGROUND: Access to dental care and delivery of quality dental health services are important for children with special needs. The authors surveyed parents of children with special needs in Alabama to determine their perceptions of access and barriers to dental care for their children. METHODS: The authors sent a questionnaire to 2,057 parents of children aged 3 to 13 years with special needs--cleft lip and/or palate; cerebral palsy, or CP; spina bifida; or epilepsy/seizure disorders--who were listed in a database provided by Children Rehabilitation Services of Alabama. The authors conducted univariate and multivariate analyses to calculate odds ratios and 95 percent confidence intervals. RESULTS: The overall response rate was 38 percent (N = 714). Eighty-five percent of respondents reported that their children had received some form of routine dental care. However, 35 percent of respondents reported they had had problems finding dentists willing to treat their children. Among those with problems, significant barriers to dental care included their children's having Medicaid insurance, poor oral health or CP, as well as a shortage of dentists with training in the care of children with special needs. CONCLUSIONS AND PRACTICE IMPLICATIONS: While the majority of respondents said their children had access to dental care, one-third said their children had problems receiving this care. Many of these problems can be ameliorated. Increasing providers' participation in the Medicaid program and improving their knowledge about, empathy for and training in the care of children with special needs is essential in improving access to dental care for this population.     

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

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

Barriers to dental care in an elderly population resident in an inner city area

A sample of 765 elderly people living in London was interviewed and examined. Barriers to dental care stemmed from: elderly people's beliefs that dentures should last a life-time and dental visits are unnecessary for edentulous persons: mobility difficulties; fear; problems with access to NHS care and with access to satisfactory care. The attitudes of general dental practitioners, community dentists and final year dental students towards elderly people were favourable. Sixty per cent of surgeries were on the ground floor, and 46 per cent of premises were unsuitable for wheelchair access. Carers wanted improvement in domiciliary services. The provision of domiciliary care was significantly related to training. There was a paucity of experience in this field amongst dental students. Community dentists recognized a need for retraining before providing care for handicapped elderly people.     

The prediction of dentists' work behaviour; factors affecting choice or intention in the treatment of special need patients.

The present study was undertaken as part of an overall strategy to develop a co-ordinated dental health care programme for special need patients between general dental practitioners and the community dental service. The beliefs, attitudes and work behaviours of the practitioners were examined, using the theory of reasoned action, in order to highlight perceived difficulties associated with treating this particular patient group as well as to find those dentists willing to treat and carry out domiciliary dental care for them. The results demonstrated that those dentists who had previous experience of treating special need patients and carrying out a variety of domiciliary dental treatments intended to provide dental care for this group. Furthermore, the dentists differed in their evaluations with regard to beliefs and attitude. Those dentists who intended to provide dental care appeared to have more positive attitudes and were able to assess and perceive the relevance as well as the reality of their own beliefs in the light of their previous working behaviours.     

Attitudes among dentists and dental hygienists towards extended scope and independent practice of dental hygienists

Aims: Attitudes of dentists and dental hygienists towards extended scope and independent dental hygiene practice are described in several studies, but the results are heterogenous. The purpose of this systematic review was to compare the attitudes of dentists and dental hygienists towards extended scope and independent dental hygiene practice. Methods: PubMed, AMED and CINAHL were screened by two independent assessors to identify relevant studies. Only quantitative studies that reported the percentages of dentists'' and dental hygienists'' attitude towards extended scope and independent dental hygiene practice were included. The random-effects model was used to synthesise possible heterogenous influences. Results: Meta proportions with regard to a positive attitude towards extended scope of practice are 0.54 for dentists and 0.81 for dental hygienists. Meta proportions of a positive attitude towards independent practice are 0.14 for dentists and 0.59 for dental hygienists. A meta analysis with regard to negative attitudes could only be performed on extended scope of practice and did not reveal a difference between the two professions. We obtained homogeneous outcomes of the studies included regarding negative attitudes of dentists . A minority of dentists hold negative attitudes towards extended scope of dental hygiene practice. Study outcomes regarding negative attitudes of dental hygienists were heterogeneous. Conclusions: Positive attitudes are present among a majority of dentists and dental hygienists with regard to extended scope of dental hygiene practice, while for independent dental hygiene practice this holds for a minority of dentists and a majority of dental hygienists.Key words: Dental practice, general dental practice, hygienist, oral health policy, primary oral health care     

Oral health status of New Hampshire Head Start children, 2007‐2008

Objectives: We report on the baseline prevalence and severity of dental caries of children enrolled in the New Hampshire Head Start program during the 2007‐2008 school year. Methods: We selected a random cluster sample of 607 children aged 3‐5 years attending 27 Head Start centers across the state. Four volunteer dentists provided oral examinations and determined the presence of untreated dental caries, caries experience, and treatment urgency. Results: Overall, 40 percent of the participating children had experienced dental caries, and 31 percent had at least one untreated decayed tooth. Approximately 22 percent of the children had evidence of maxillary anterior caries, 23 percent were in need of dental care, and <1 percent needed urgent care. Conclusions: The prevalence of dental caries is comparable with that reported by Head Start programs elsewhere. The prevalence of caries affecting maxillary anterior teeth is higher. Further studies should examine state‐specific barriers to dental care among this population.     

Factors influencing the decision about orthodontic treatment

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.     

Dental service provision in Victorian residential aged care facilities

BACKGROUND: The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are at high risk of developing dental diseases, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Traditionally, dental service provision has been problematic and sporadic for these residents. METHODS: A postal survey of a random sample of Victorian general dentists and Directors of Nursing (DONs) of Victorian RACFs was undertaken in 2006 to ascertain the participation of dentists in the provision of dental care and to identify factors impacting on the organization and provision of dental care for residents. RESULTS: The response rate for dentists was 57.3 per cent, and for DONs 64.4 per cent. Half of the dentists reported that they had provided care to residents of aged care facilities in the past 12 months, and they spent an average of one hour per month providing care. Overall, dentists were concerned with their level of undergraduate education and training in various aspects of dentistry for residents of aged care facilities. DONs reported significant difficulty obtaining adequate dental care for their residents. Common problems identified by both dentists and DONs included a preference for dentists to treat residents in their own practice, dentists not willing to go to RACFs and a lack of portable dental equipment for dentists to use. CONCLUSIONS: There were low levels of interest and participation from Victorian dentists in providing dental care for residents of aged care facilities. Dentists had a strong preference for treating patients at their own practice, and there were a number of significant barriers that appeared to impact on the provision of dental care in RACFs.     

Profiling the interest of general dental practitioners in West Yorkshire in using teledentistry to obtain advice from orthodontic consultants.

OBJECTIVE: To seek opinions from general dental practitioners in Calderdale and Kirklees (West Yorkshire) regarding an online orthodontic referral service and to establish the profile of dentists working in primary care who would refer patients online for a consultant orthodontist's opinion. METHODOLOGY: All 91 general dental practices in Calderdale and Kirklees in West Yorkshire were sent a piloted questionnaire enquiring into their orthodontic treatment and referral patterns, and also into their attitudes to the use of the Internet and related technologies. Three mailings were performed, followed by telephone contact with non-responders. RESULTS: Usable responses were obtained from 119 general dental practitioners who worked in 71 practices (78%). Analysis of data showed that, when asked whether they would be interested in using teledentistry to obtain a consultant orthodontist's opinion online, 53/116 (46%) replied positively. The most frequently specified reason for this interest was that it would save time and would achieve a quicker opinion for a practitioner's treatment plan. These dentists were more likely to be familiar with the use of digital cameras, be using removable appliances, and currently be in the habit of referring orthodontic cases to consultants and specialists. CONCLUSIONS: Just under half of the dentists working in primary care in Calderdale and Kirklees who responded had a positive attitude towards the benefits of a teledentistry referral scheme. However, a substantial number remained undecided, possibly because they were unsure of their information technology (IT) skills. A further pilot study is planned. It will enquire into the feasibility of carrying out such an exercise across West Yorkshire.     

Dental education and dentists' attitudes and behavior concerning patients with autism

The number of patients diagnosed with autism spectrum disorders (ASD) in the United States has increased significantly. The objectives of this study were to explore general and pediatric dentists' professional attitudes and behavior towards patients with ASD; these dentists' perceptions of their dental education about these issues; and the relationships among their educational experiences, attitudes, and behaviors concerning patients with ASD. Survey data were collected from 162 general dentists in Michigan and 212 pediatric dentists across the United States. The results showed that 89 percent of pediatric dentists and 32 percent of general dentists treat patients with ASD. The respondents disagreed with statements indicating that their predoctoral dental education had prepared them well to treat patients with ASD. However, the better they felt prepared, the more likely they were to provide care for these patients. The frequency with which pediatric dentists said they use appropriate behavior management strategies when treating patients with ASD correlated with the quality of their educational experiences. In conclusion, given the growing number of patients with ASD, it is important to revisit dental education efforts targeted towards preparing future dental care providers for the treatment of patients with ASD and special needs.