Dental fear and satisfaction with dental services in Switzerland

Objectives: Dental satisfaction is associated with continuity of dental care, compliance with dentist advice, and positive health outcomes. It is expected that people with higher dental fear might have less dental satisfaction because of more negative dental experiences. The objective of this study was to examine satisfaction and reasons for satisfaction with dental practitioners in Switzerland and variations by dental fear. Methods: A national sample of 1,129 Swiss residents aged 15‐74 (mean = 43.2 years) completed a personal interview at their home with questions assessing dental fear, dental service use, general satisfaction with their dentist, and reasons for satisfaction or dissatisfaction. Results: Overall, 47.9 percent of participants responded that they were satisfied with their dentist and 47.6 percent that they were very satisfied. Satisfaction differed significantly by gender, language spoken, region of residence, and educational attainment. Greater dental fear was significantly associated with greater dissatisfaction with the dentist. The percentage of people who were very satisfied with the dentist ranged from 56.0 percent among people with no fear to 30.5 percent for participants with “quite a lot” of fear but was higher (44.4 percent) for people who stated that they were “very much” afraid of the dentist. The most common reasons attributed for satisfaction with dentists were interpersonal characteristics of the dentist and staff. People with “quite a lot” of fear were found to endorse these sentiments least. Conclusions: Although higher dental fear was associated with more dissatisfaction with the dentist, the level of satisfaction among fearful individuals in Switzerland is still high.     

Treatment outcome in subgroups of uncooperative child dental patients: an exploratory study

Objectives. The principal aims of this study were to evaluate the treatment outcome in subgroups of uncooperative child dental patients and to test the validity of these subgroups, which were based on fear and personality characteristics. Design. An exploratory, intervention study using quantified questionnaire, interview and observation data. Sample and methods. Eighty‐six 4 to 12‐year‐old uncooperative child dental patients (of whom 81 were divided retrospectively into four subgroups) and their accompanying parents were followed up during treatment at a specialist paediatric dental clinic in Sweden. Treatment was based on behaviour management techniques, supported by nitrous oxide/oxygen sedation if necessary. At baseline, parents answered a questionnaire including questions on child dental and general fear, temperament and behaviour, and parental dental fear, emotional stress, locus of control, parenting efficacy and attitudes to dental care, some of which were repeated post‐treatment. The treating dentist rated child behaviour according to the acceptance of a maximum of 14 treatment steps at each visit. Results. Approximately 90% of all children managed to undergo the dental treatment. Child dental fear and parental emotional stress decreased during treatment. Externalizing, impulsive children showed lower acceptance. In fearful, inhibited children, integrated use of sedation appeared to facilitate acceptance. Validity of the subgroups characterized as ‘fearful, extrovert, outgoing’, ‘fearful, inhibited’ and ‘externalizing, impulsive’ was supported, while heterogeneity within the group of ‘non‐fearful, extrovert, outgoing’ children made validation difficult. Conclusion. Fear and personality characteristics may serve as diagnostic aids when planning treatment of uncooperative child dental patients. Controlled outcome studies using differentiated treatment methods for children with different fear and personality profiles are needed.     

Attitudes of parents towards their presence in the operatory during dental treatments to their children

The purpose of the present study was to assess attitudes of parents toward their presence in the operatory, while their children undergo dental treatment. One hundred and four adults, who accompanied their children to dental treatments were asked to complete a questionnaire before the dental visits. The survey consisted of three sections sociodemographic information of the children and family, sociodemographic information of the parents, and preference of parents regarding staying with their children in the operatory, and willingness to assist the dentist when the behavior of their child could not be completely handled by the dentist. Most of the parents expressed a wish to be present in the operatory (70.2%). No sociodemographic variable of the parents or children was found to significantly influence the attitude of the parents toward their presence in the operatory. Most parents (58%) said they were willing to assist should the dentist not succeed to manage their children. Our results demonstrate a general trend among parents to be with their children in the operatory when they undergo dental treatment and to actively assist the dentist when behavioral problems are encountered.     

Health literacy impact on patient-provider interactions involving the treatment of dental problems

Health literacy-related problems can interfere with effective doctor-patient communication and effective patient care. This study examined several health literacy-related markers for patients seeking treatment in hospital emergency departments and physician and dentist offices for dental problems and injuries. Participants consisted of low-income white, black, and Hispanic adults who had experienced a dental problem or injury during the previous twelve months and who visited a hospital emergency department, physician, or dentist for treatment. A stratified random sample of Maryland households participated in a cross- sectional telephone survey. Interviews were completed with 94.8 percent of 423 eligible individuals. Multivariable logistic regression analyses were performed. Only 10.0 percent of the respondents expressed a difficulty understanding what they were told by the health provider, while 4.9 percent expressed a difficulty understanding the dental or medical forms they were asked to complete and 6.9 percent reported that they had difficulty getting the health provider to understand their dental problem or injury. Logistic regression analysis found that males and Hispanics were significantly (p<0.05) more likely to experience health literacy-related problems. In general, respondents did not express health literacy-related problems. Additional research is needed to identify health literacy-related barriers to effective patient-provider communication.     

Issues in the dental care management of patients with bloodborne infectious diseases: an opinion survey of dental school seniors

This study revealed some significant findings concerning the views of dental school seniors. Through a series of questions, we determined the opinions that seniors had about treating patients with bloodborne infections and the way they regarded their professional responsibility to provide care to these patients. We were able to identify that the majority of seniors had knowingly treated patients with one of these diseases, and believed that they had a professional obligation to do so. The study showed that these future professionals were aware of the risks related to disease transmission and they had real concerns about those risks; nevertheless, they were prepared to accept their professional obligation to provide care to these individuals. More than half of the survey population was fearful of treating patients with these diseases, and over half indicated that they would not treat these patients given the choice. This fear was compounded by their presumption that other patients would not want to be treated by a dentist who provides care to HBV/HIV patients, and by the presumption of increased cost of infection control. More than three fourths of these dental seniors agreed that treatment of infected patients would place them at higher risk. Nevertheless, in the face of this perceived danger, 62 percent indicated that they were willing to treat these patients, 79 percent said that they were capable of treating them, and 76 percent acknowledged the responsibility of the profession to treat. Another finding of note involves the treatment of infected patients and the effect that treatment experience had on the seniors' attitudes.(ABSTRACT TRUNCATED AT 250 WORDS)     

A two-wave interview study of frequency of dental visits and dental complaints

A panel of 268 persons were interviewed twice at an interval of 2 years concerning their visits to dentists and their dental status. The answers they gave on the two occasions agreed well, except for the year of the last visit if it had taken place long ago. This was true both for the people who had gone to the dentist between the interviews and for those who had not. The panel was also asked whether they had any dental complaints. Sixteen percent of them reported complaints at one or both interviews. Complaints were more common among persons who did not often go to the dentist. The persons with complaints did not always get rid of them by going to a dentist. It is concluded that interview data be used for investigating the dental health and behavior of people who do not often go to the dentist, and that dentists are more successful in maintaining good dental health in people who have no dental complaints than in people who report having complaints.     

Effect of a beta-adrenergic blocking agent on dental anxiety

The effect of propranolol was studied on 23 dental phobics in a double-blind, placebo-controlled clinical trial involving actual dental treatment. The subjects were selected because they showed high physiological reactivity in the dental situation. Twelve subjects received the test drug and 11 subjects received the placebo at individualized doses of either 80 or 120 mg. A significant difference in self-reported anxiety at the injection phase of treatment and less overall pain intensity and aversiveness were observed for the propranolol as compared with the placebo group. No differences were detected for behavior ratings. Beta-adrenergic blocking agents may have utility for reducing anxiety in individuals fearful of dental treatment.     

Dentists and dental technicians as competing suppliers of complete dentures in Southwest Finland

In Finland, not only dentists but also dental technicians with special training have the right to supply clients with complete dentures. The present study investigated how the demand for their services is distributed between these two professional groups, and what are the factors affecting the distribution. The material consisted of 220 randomly selected subjects who had lost all their teeth in one or both jaws. Of the full dentures worn, 50% had been made by a dentist and 41% by a dental technician, while in 10% one denture, either maxillary or mandibular, was made by a dentist and the other by a dental technician. 56% of the subjects said they would choose a dental technician the next time health center services become more general and patients are more able to get treatment by dentists at a reduced cost, it seems probable that the majority of the edentulous will again resort to the dentists. However, judging by the current attitudes, a considerable number of the edentulous will continue to resort directly to the dental technician for the supply of dentures.     

General dental practitioners' knowledge of and attitudes towards evidence based practice

AIMS: To assess general dental practitioners' understanding of, and attitudes towards, evidence based practice (EBP). SUBJECTS: A random sample of general dental practitioners currently practising in the North West of England. METHOD: A cross-sectional survey using self administered, structured, postal questionnaires in January 2001. RESULTS: A majority of the respondents had some understanding of technical terms associated with EBP. Only 29% (60/204) could correctly define the term EBP. When faced with clinical uncertainties 60% (122/204) of general dental practitioners turned to friends and colleagues for help and advice. Eighty one percent of respondents were interested in finding out further information about EBP (165/204). Barriers to its use included a lack of available time and financial constraints. CONCLUSIONS: EBP is not a concept that every dentist is familiar with, however, the general dental practitioners surveyed were enthusiastic and expressed a desire to find out more information on EBD. It appears to be the right time for an educational program targeted at GDPs to enhance their knowledge and use of EBD in everyday practice.     

Public awareness and acceptance of dental implants.

To investigate public awareness and acceptance of dental implants, 120 adult US citizens were asked to answer a questionnaire. Of the 109 persons who completed the questionnaire, 77% had heard about dental implants, mostly through media and lay persons. Only 17% named a dentist or physician as the source of information. Persons with many missing teeth were not more aware of implants than those with fewer missing teeth. Of 19 removable denture prosthesis wearers, 15 knew about implants but only one third learned of them from their dentist or physician. Of 84 persons with information about implants, 51 would consider implant treatment, 17 would not, and 16 were undecided. Esthetics was the most frequent motivating factor favoring implants, while high cost was the most frequent argument against them. Younger interviewees were significantly more often in favor of implants than older persons. It was concluded that public awareness and acceptance of dental implants are high. Dentists and physicians, however, play only a minor role as sources of information.     

General dental practitioners' knowledge of and attitudes towards the employment of dental therapists in general practice

OBJECTIVE: To investigate general dental practitioners' knowledge of and attitudes towards dental therapists, to ascertain the likelihood of their employment in general dental practice, what client groups they would be likely to treat, and to identify the main perceived barriers to their employment in general dental practice. METHOD: Postal questionnaire. SETTING: General dental practitioners in the county of West Sussex. SAMPLING: All dentists holding a contract to provide general dental services in West Sussex were contacted. Final sample size was 200. KEY FINDINGS: Thirty eight per cent of dentists said they would employ a therapist if legislation allowed. Main perceived barriers were cost, lack of knowledge and dentists' acceptance. CONCLUSIONS: In general dentists had a favourable attitude towards dental therapists, although there was a real lack of knowledge about their permitted duties. Most dentists felt therapists should treat children and people with special needs.     

Attitudes to water fluoridation in general dental practice in the North East of England

OBJECTIVE: To find out the knowledge of, and attitudes towards, water fluoridation of a sample of general dental practitioners working in the North East of England. DESIGN: Anonymous, self-completed postal questionnaire. SETTING: North East of England, both a fluoridated and non-fluoridated area. SUBJECTS AND METHODS: Following a small pilot survey, questionnaire to 79 general dental practitioners (44 in a non-fluoridated area, 35 in an area supplied with fluoridated water at one part per million) contracted to provide National Health Service (NHS) treatment in the North East of England. RESULTS: Fifty-five general dental practitioners returned questionnaires (a 70% response rate). Most respondents supported the principle of water fluoridation. Over half of the respondents indicated that they would benefit from more information and training on the issue of water fluoridation. There were marked differences in knowledge and attitudes to fluoridation between dental principals and associates. The sample was evenly split about what to do with a parent who was unsure about (whether to support) fluoridation even after the dentist had discussed the issue and answered questions. CONCLUSIONS: The majority of general dental practitioners support water fluoridation although some lack knowledge and expertise which might inhibit advocacy of it.     

Dentists' views on fearful patients. Problems and promises

A large number of patients treated in the general dental health service in Western countries report dental fear to some degree. Dentists' views of treating these fearful patients are not well described in the literature.Therefore, the aims of the study were to explore dentists' attitudes towards, experience of, and feelings about treating fearful patients. The sample consisted of 1293 members of the Association of Public Health Dentists in Sweden who were asked to respond to a web survey concerning dental fear. The response rate was 69% (n = 889).The majority of the responding dentists stated that dental fear is a problem in routine dental care,treating patients with dental fear is a positive challenge and they felt they were making a contribution.They also reported that treating patients with dental fear is associated with hard work, poor revenues, and little appreciation by employers. Female dentists reported a greater proportion of patients with dental fear and greater self-efficacy regarding the treatment of these patients, compared with their male colleagues. Dentists trained in other EU countries reported stress more often and less perceived contribution when treating fearful patients, compared with colleagues trained in Sweden. CONCLUSION: Dentists' views of treating fearful patients are mainly positive; however, it is problematic that dentists feel stress and that dentists who treat many fearful patients feel their employers do not appreciate their efforts.     

Frequency of dental visits in Sweden during 1974–77

Abstract A longitudinal study of the frequency of dental visits has been conducted on a sample of 1302 individuals aged 20–60 years. These individuals had previously been interviewed regarding their dental care habits. They had also (subsequent to the interview) been clinically examined by a dentist. The results presented are based on the official dental care consumption statistics if, Sweden, and thus differ from the information obtained from the interviews. In all age groups women had a higher frequency of dental visits than men. The average number of courses of treatment carried out over a 4-year period was 2.0. Only 23% of the individuals received treatment once a year or more often, whereas 79% received treatment at least once during a period of 4 years. These figures were lower than those reported in the interviews. Individuals with a higher number of courses of treatment had also had a higher frequency of dental visits before, had been called in by their dentist for check-ups, had a higher income and knew more about teeth and their care, used oral hygiene aids daily and were living in metropolitan areas. Younger people with many remaining teeth and those with many decayed teeth had had a higher frequency of courses of treatment.     

Optimizing the dental delivery system

This paper examines the application of information and principles derived from social science research to increasing the effectiveness and efficiency of the dental care delivery system. Four major delivery system attributes are considered: the availability, accessibility, appropriateness and acceptability of care. The dentist to population ratio is a major determinant of the availability of dental care and many factors have to be considered in deciding on the appropriate number of dentists needed in a population. Optimum size of dental practices is another aspect of availability. The evidence suggests that practices with 2 or 3 dentists are more efficient than solo practices. However, large group practices appear only to be of equal or even less efficiency than small group practices. The accessibility of dental care is influenced by the geographical location of practices, the convenience of obtaining care during non-working hours, the reduction and dissemination of information on dental fees and, most importantly, the beliefs of people concerning their oral health status. The appropriateness of care concerns the impact of different services on improving oral health. Relatively little clinical research has been published on the costs and benefits of different dental services. The acceptability of dental care concerns both patients who visit the dentist and the larger society. Studies show that patients who visit the dentist are generally satisfied with the care they receive. Societal attitudes about the dental care system have not received much attention. Although social science research on the dental care delivery system is at an early stage of development, some data exist which are relevant to optimizing the practice of dentistry.     

Public knowledge of dental registration and management of common dental problems

The government has recently changed its policy on dental registration. There is now a requirement to attend a dentist within 15 months of the previous appointment or dental registration will lapse. The authors of this article undertook a survey of the patients attending for dental treatment at the accident and emergency department of their hospital to ascertain whether inappropriate attendance was due to ignorance about general dental services. Of the 501 respondents 14% had not seen their general dental practitioner within the last 15 months and were therefore no longer registered--only 21% realized that they had to keep regular appointments or dental registration would lapse. A proportion (30%) had tried to contact the dentist outside normal working hours; 27% of these were unhappy with the outcome. Telephone calls were unanswered in 38% of those expressing dissatisfaction and 45% subsequently attended hospital for treatment.     

Sedation for pediatric dental patients

There are few areas of dental therapeutics as controversial as the pharmacologic management of fearful and uncooperative pediatric dental patients. A pediatric dentist is faced with one of the most difficult tasks in our profession: maximizing comfort and cooperation while minimizing risks and costs of dental care for the unmanageable child. Pharmacosedation provides the means for children to avoid psychologically traumatic experiences that might inhibit regular oral health care when they become adults. By controlling disruptive behaviors, the pediatric dentist is able to provide quality dental care in an environment that is pleasant for the child, the parent, and the practitioner.     

Psychosocial aspects of dental and general fears in dental phobic patients

Phobic reactions can often be a significant health problem for fearful dental patients. This is true in particular for individuals with long-time avoidance and elevated general psychological distress. The aim of this study was to investigate the expression of dental fear among 67 dental phobic individuals with a low versus high degree of general fear. Reported etiologic background factors, avoidance time, general psychological distress and psychosocial manifestations and consequences of dental phobia were studied. No significant difference in dental anxiety level between individuals with low versus high general fear was found, and both groups reported high frequencies of negative dental experiences. The low-fear group reported a longer (though not statistically significant) average avoidance time than the high-fear group. However, patients with a high level of general fear showed a significantly higher degree of psychological distress, and also reported stronger negative social consequences from their dental anxiety. These results indicate that the character of dental fear might be different between different groups of fearful patients, which makes the condition psychologically handicapping. Such aspects should be assessed in the diagnostic analysis of patients with severe dental anxiety. In particular, assessments of signs of general psychological distress are warranted.     

Determinants for dental visit behavior among Hong Kong Chinese in a longitudinal study

OBJECTIVES: The aim of this research was to study the major determinants for dental services utilization among middle-aged Hong Kong Chinese in a longitudinal study using an expanded Andersen and Newman model as the theoretical framework. METHODS: A random sample of 372 middle-aged Hong Kong Chinese were interviewed and clinically examined in an oral health survey. The findings were explained to the subjects and they were advised to seek care from their own dentist as appropriate. RESULTS: A total of 322 subjects were interviewed over the telephone after 12 months. About half had visited a dentist within the study period. Results of the bivariate analysis showed that proportionally more subjects who had dental benefit coverage, had prevention-oriented attitudes, were regular users of dental services, had received counseling from a dentist, or had more filled teeth at the baseline examination had visited a dentist within the study period. Logistic regression analysis produced a final model consisting of seven factors and three interaction terms that was able to classify 68 percent of the subjects into the correct user category. CONCLUSION: The expanded Andersen and Newman model was useful as a theoretical framework in studying the dental services utilization behaviors of the Hong Kong adults.     

Understanding dental fear

Collecting the answer to the 3 basic questions discussed above is both an art and a science that takes practice on the part of the doctor. Yet, by doing so, a treatment plan can be tailored that not only addresses the patient's motivators, but also considers their barriers to treatment. Patients who present with dental fear need not be viewed as challenging or difficult. Instead, they often represent the ideal patient (only in disguise). They often need extensive dental care. They are loyal, staying with a dentist despite changes in dental insurance coverage or moving away from the office. They are proud of their success and are genuinely most outgoing in serving as referrals. And finally, they are deserving of the very best care we have to offer.