The efficacy of a computerized caries detector in intraoral digital radiography

BACKGROUND: A unique software tool has been developed to assist dentists in the difficult task of diagnosing radiographs for proximal caries. The software, called Logicon Caries Detector (Northrop Grumman Information Technology, Herndon, Va.), extracts image features and correlates them with a database of known caries problems. The Logicon software was combined with the digital radiography system Trophy RadioVisioGraphy (Trophy Radiologie, Croissy-Beaubourg, France) and its effectiveness was measured in a clinical study, the results of which are reported here. METHODS: The manufacturer trained 18 dentists in private practices and one university clinic across the United States to use the Logicon Caries Detector software. The dentists diagnosed 175 surfaces with potential caries and adjacent teeth expected to be clean but included as control surfaces. The dentists first did a visual diagnosis only and then repeated the diagnosis using the software. If their final diagnosis called for it, a restoration was performed and the depth of caries was recorded. RESULTS: Effectiveness was gauged by calculating three measures of performance-sensitivity, specificity and accuracy-for dentin caries diagnosis by each dentist both before and after using Logicon Caries Detector. Sensitivity among all dentists before using the Logicon software was 70.3 percent and afterward was 90.5 percent, an improvement of 20.2 percent. Dentists' specificity was 88.6 percent before using the software and 88.3 percent afterward, with a difference of-0.3 percent. Dentists' accuracy was 75.6 percent before using the software and 88.3 percent afterward, with an improvement of 12.7 percent. CONCLUSIONS: Logicon Caries Detector enabled dentists to find 20 percent more cases of caries penetrating into dentin than they were able to find without it, while not causing them to mistreat any additional healthy teeth. CLINICAL IMPLICATIONS: Digital radiography and smart software like Logicon Caries Detector will improve dentists' diagnostic abilities and lead to better patient care.     

Knowledge, Attitude and use of Fluorides among Dentists in Texas

Aim: The centers for disease control and prevention (CDC) recommendations on fluoride use were published in 2001. This study examines how this information has diffused to practicing dentists and the level of fluoride knowledge and use among Texas dentists. Materials and methods: A questionnaire was sent to dentists who self-identified as being in pediatric (343), dental public health (72), and general practices (980); a 12% sample of registered dentists in Texas. Results: Response rate was 42.9%. About 90% of surveyed dentists reported using fluorides routinely. Only 18.8% reported fluoride varnish as the topical fluoride most often used. About 57% incorrectly identified primary effect of fluoride. 'Makes enamel stronger while tooth is developing prior to eruption' was the most commonly cited wrong answer (44%). Only 5% identified that posteruptive effect exceeds any preeruptive effect. Conclusion: Despite the evidence for fluoride varnish preventing and controlling dental caries being Grade I, its use is still uncommon. Dentists are expected to be knowledgeable about products they use, but this study reflects lack of understanding about fluoride's predominant mode of action. More accurate understanding enables dentists to make informed and appropriate judgment on treatment options and effective use of fluoride based on risk assessment of dental caries. Clinical significance: Lack of knowledge of, or failure of adherence to evidence based guidelines in caries prevention by use of appropriate fluoride regimens may adversely affect caries incidence in the population. Keywords: Dental caries, Fluorides, Evidence-based dentistry, United States, Diffusion of innovation. How to cite this article: Bansal R, Bolin KA, Abdellatif HM, Shulman JD. Knowledge, Attitude and use of Fluorides among Dentists in Texas. J Contemp Dent Pract 2012;13(3):371-375. Source of support: Nil. Conflict of interest: None declared.     

Fluoride varnish: a primary prevention tool for dental caries

Fluoride varnish is an effective tool that has been proven to prevent dental caries both in primary and permanent dentition. Its ease of use, acceptability and efficacy make it an important tool in the primary prevention of dental caries in high-caries-risk children. There has been an increase in third-party reimbursement for fluoride varnish applications in high-risk children and adults.     

Patterns of oral care in dental school and general dental practice

This study compared patterns of oral care provided by predoctoral dental students for patients seeking treatment at the University of Washington (UW) with patterns reported for general dental offices by the Washington Dental Service (WDS). Dental care included about 5 million services provided to 880,317 patients by 2,803 WDS general dentists and about 45,600 dental services provided to 9,488 patients by 155 UW dental students during 1999. There was high fidelity between databases and randomly surveyed patient records for treatment provided in both UW (95 percent) and WDS (97 percent) populations. While patient age patterns were generally similar, UW students completed more procedures for young children and for adults older than seventy-four years but completed fewer procedures for age groups of from thirteen to eighteen and from forty-five to fifty-four than general dental offices. The relative mix of all services completed by UW and WDS providers was similar (ANOVA, P=0.82). Within categories of service, the percentage of total services completed by students compared to those submitted by community dentists to WDS was about the same for examinations, radiographs, fluoride and sealants, amalgams, composites, single crowns, and endodontics. The percentage of total procedures completed showed a greater emphasis by UW students on inlays/onlays, dentures, extractions, and periodontal maintenance, and lesser experience with implants, orthodontics, sedation, and emergency procedures than general dental offices. We conclude that the relative distribution of clinical services provided by UW dental students is comparable to those procedures reported to WDS by dental offices in the adjacent community.     

Dentists' perception of their treatment practices versus documented evidence

OBJECTIVE: To compare the quality of real-life treatment practices to dentists' perceptions of treatment rendered. SETTING: One administrative unit of the Finnish public oral health service. METHODS: The original oral health records of a randomly selected sample of young adults who received treatment during 1994-1996 provided data on actual clinical examinations (n=208), radiographs (n=312), and root canal treatment courses (n=148) carried out by 50 dentists. Dentists' perceptions of the treatment rendered were obtained through a structured questionnaire completed during their working hours in 1996. OUTCOME MEASURES: Criteria for assessing the quality of treatment practices were based on Finnish health legislation, authoritative instructions, and consensus reports. RESULTS: Based on responses, 77% of the dentists followed the prevailing instructions on oral health record keeping (82%, if partial agreement included). Most dentists (88% fully agreed, 95% at least partly) perceived that their knowledge gained through continuing education was being applied in practice; no one answered no. A gap was found between dentists' perception of the treatment rendered and everyday treatment practices as recorded on patient documents. CONCLUSIONS: Overall, dentists' perception of the quality of their treatment practices exceeded that found in patient documents. This gap deserves consideration while planning research, education, or quality-improvement projects that relate to dentists' opinions.     

The effect of education upon dentists' knowledge and attitude toward fissure sealants.

Sealants are highly effective in preventing dental caries in the pits and fissures of teeth. It has been shown, however, that sealants are not widely used by dentists. This study aimed to educate dental professionals about sealants and to evaluate the effect of such education on dentists' knowledge, attitude and use of sealants. A total of 312 dentists were surveyed to determine their knowledge and attitude toward sealants. Respondents were randomly allocated to "Education" group, who received education materials; and "No Education" group, who received no material (until after the education phase). After 12 months, 105 dentists responded to the post-intervention survey. Comparison between the two surveys shows that dentists' knowledge increased significantly in the "Education" group. No difference was detected in dentists' knowledge in the "No Education" group. Dentists' attitude and sealant use did not significantly improve in any of the groups. It is therefore, concluded that continuing education were more likely to change dentists' knowledge than attitude and behaviour. Effort to encourage sealant use by dentists should continue, but with the recognition that changes in behaviour occur over a long time and that other external factors in the professional environment may affect the rate of change.     

Change in caries prevalence after implementation of a fluoride varnish program

Objective : In 1996 the caries prevalence of schoolchildren living in Neukölln, a district of Berlin, Germany, was higher than the mean of total Berlin. Hence, a special preventive program including the application of fluoride varnish was initiated. All 49 primary schools of the district joined the project. The aim of the present study was to evaluate in a cross‐sectional study whether the preventive program resulted in a reduced caries prevalence. Methods : The complete program included oral health education as well as the application of a highly concentrated fluoride varnish (Duraphat®). All children whose parents' consent was given could receive fluoride varnish twice a year. All children were examined once a year by four calibrated dentists. The baseline examination was conducted in 1995–96, the final examination in 1999–2000 (1995–96: n= 7,748; 1996–97: n= 15,673; 1997–98: n= 19,362; 1998–99: n= 19,822; 1999–2000: n= 17,984). Results : A total of 80,589 dental records were used for data analysis. A decline of DMFT‐values was observed in all age groups and school years. The major improvement was found in school year 1999–2000, when the program had been established for four years. Conclusion : The described program may be an effective public health measure for 6‐ to 12‐year‐old children with high caries prevalence.     

Dental Providers' Attitudes Regarding the Application of Fluoride Varnish by Pediatric Health Care Providers

Objectives: To ascertain what proportion of dental hygienists and dentists in Indiana, United States, support the application of fluoride varnish in medical offices, and to determine if support differed by dental provider characteristics, practice characteristics, a limited assessment of knowledge about fluoride, or use of fluoride. Methods: Practicing dental hygienists and dentists in 2005 were asked to fill out a mail questionnaire. Logistic regression models tested the association of independent variables with support for medical providers applying varnish. Results: Response rates were 36% (dental hygienists) and 37% (dentists); median year of graduation was 1988 and 1981. Sixty‐six percent of respondents were in solo practices, 82% of dentists in general practice, 5% in dental pediatrics, and 13% were other specialists. While 51.2% of dental professionals agreed that medical practices could apply fluoride varnish, 29% responded “none” should be allowed, and 19% were undecided. In the multivariable logistic regression for support of medical practices applying fluoride versus not supporting it, three practice characteristics and two measures of fluoride use were significant. Provider characteristics and a limited assessment about knowledge about fluoride were not significant. Conclusions: Half of dental professionals felt that it was appropriate for medical providers to apply fluoride varnish; pediatric dental professionals were less supportive. A few dental practice characteristics were associated with acceptance of the use of fluoride varnish by medical care providers: targeting messages to dental hygienists and those with practices in mixed rural‐urban areas may be a useful approach to garner greater support for this medical/dental partnership.     

Association of chlorhexidine and fluoride for plaque control and white spot lesion remineralization in primary dentition

Background. Plaque control and caries arrest still remain a challenge for dentists. Objective. This study was conducted to assess the effect of the combined use of chlorhexidine varnish and fluoride varnish on the visible plaque index (VPI) and white spot lesion (WS) remineralization in primary dentition. Methods. A total of 80 caries-active preschool children (3–5 years) were randomly divided into four groups. Group 1 received a chlorhexidine varnish application every week during 4 weeks. Group 2 received a fluoride varnish application every week during 4 weeks. Group 3 received alternated applications of chlorhexidine and fluoride varnish during 4 weeks. Group 4 served as control (without any type of cariostatic agent). Results. There was no statistically significant difference in the VPI and WS remineralization among the groups after 1 month. However, 3 months follow-up demonstrated that group 3 (chlorhexidine + fluoride) showed significantly better results for both VPI and WS remineralization. Conclusion. The combined application of chlorhexidine and fluoride varnishes is more effective on plaque and remineralization of incipient caries after 3 months than the same agents applied separately.     

Restorative treatment threshold reported by Iranian dentists

OBJECTIVE: To study Iranian dentists' conceptions of the earliest stage to place a restoration on proximal caries lesions. BASIC RESEARCH DESIGN: A questionnaire survey was carried out among the participants of two annual dental meetings in Tehran, Iran, in December 2004 and July 2005. The questionnaire was filled in anonymously and returned during the meeting days. The questions covered two patient paper cases with schematic drawings of the radiolucency of proximal caries lesions according to bitewing radiographs from 20-year-old patients: one high-caries case and one low-caries case. Dentists' gender, age, working experience and place, and participation in continuing education served as background data. In total, 1,033 dentists completed the questionnaire, 63% were men. Statistical evaluation was by the Chi square test and logistic regression. MAIN OUTCOME MEASURES: Respondents were to select from four alternatives the earliest stage in the progression of a lesion at which they would intervene by restorative treatment. RESULTS: For the high-caries case, 77% of the respondents chose to restore a caries lesion confined to enamel; activity in continuing education was the strongest factor (OR = 1.4) to explain dentists' restoring a lesion no earlier than in dentine. For the low-caries case, 32% chose to restore a lesion in enamel. Restoring a lesion no earlier than in dentine was more likely (OR = 1.5) among female dentists. CONCLUSION: Iranian dentists seem to prefer early restorative intervention, which indicates a need to focus on the preventive aspects of caries treatment both in dental curricula and in continuing education.     

Patterns of oral care in a Washington State dental service population

BACKGROUND: The authors compare patterns of oral health care reported by the Washington Dental Service, or WDS, Seattle, in 1993 and 1999 to assess changes in patient populations, practice characteristics, procedures and treatment costs in the state. METHODS: Data were obtained from dental benefits claims from a population of about 1.25 million people. Variables of interest included patient age and other demographic information, character of dental practice, dental procedures and treatment costs that combined WDS payment and patient copayment. RESULTS: The results showed high agreement (97 percent) between the database and randomly surveyed patient records. For both 1993 and 1999, general dental offices were responsible for more than 80 percent of patient care. Single crowns (21 percent), restorative services (15 percent) and dental prophylaxis (13 percent) made up about half of the costs of dental care. Broad categories of service were similar in 1993 and 1999, and anticipated major declines in restorative procedures related to caries were not apparent. The mix of services varied considerably by patient age and between generalists and specialists in both years. CONCLUSIONS: Patterns of oral health care among this insured patient population largely remained unchanged from 1993 to 1999, with some shifts in specific procedures and specialty care. During this period, dentists saw more patients and performed fewer treatments per patient, while total treatment costs per patient increased. CLINICAL IMPLICATIONS: Patterns of oral health care in the United States are projected to undergo major changes linked to improved oral health, declining trends in caries and periodontal diseases, scientific advances in treatment approaches and a patient population that is living longer. Changes in care patterns during this six-year period may reflect patient and provider preferences, as well as the influence of reimbursement policies. Dental benefits databases can serve as a critical resource for monitoring such changes.     

Tobacco cessation services in dental offices. Are we doing all we can?

Approximately 8,000 people die of oral and pharyngeal cancers every year in the United States. Approximately 70% of these deaths are related to smoking and other forms of tobacco use. Previous studies have shown that tobacco cessation services are underutilized in dental practice. A survey was mailed to 700 dentists in New York State. A total of 364 dentists (58.5%) responded to either the long survey or postcard. Although over 90% of dentists had asked at least one patient in the prior three months about his or her smoking status, only 37% had asked this question of most or nearly all patients. Variables that were associated with the provision of tobacco cessation services included level of preparedness, training and being a periodontist. Perceived barriers included lack of time and reimbursement, and patient resistance. These results suggest that training programs and professional perceptions of responsibilities are related to dentists' provision of tobacco cessation services, findings that could have a significant impact on future policy initiatives and educational endeavors.     

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.     

Evidence-based use of fluoride in contemporary pediatric dental practice

Fluoride is an important and effective means of reducing the caries incidence in children. Multiple fluoride products are available to dentists for use with their patients at risk for dental caries. The purposes of this paper are to: (1) review clinically salient evidence, primarily systematic reviews and meta-analyses, for the effectiveness of fluoride options and, where possible, combinations of fluoride exposures; and (2) make recommendations to dental practitioners based on the available evidence for the use of these various approaches in contemporary practice, particularly regarding the use of multiple fluoride sources. The available data suggest that therapeutic use of fluoride for children should focus on regimens that maximize topical contact, preferably in lower-dose, higher-frequency approaches. Current best practice includes recommending twice-daily use of a fluoridated dentifrice for children in optimally fluoridated and fluoride-deficient communities, coupled with professional application of topical fluoride gel, foam, or varnish. The addition of other fluoride regimens should be based on periodic caries risk assessments, recognizing that the additive effects of multiple fluoride modalities exhibit diminishing returns.     

Randomized pilot study to disseminate caries-control services in dentist offices

Background  

To determine whether education and financial incentives increased dentists' delivery of fluoride varnish and sealants to at risk children covered by capitation dental insurance in Washington state (U.S.).     

The Use of Dental Sealants by Ohio Dentists

Objectives : To assess the extent to which Ohio dentists report using pit and fissure sealants and factors associated with sealant use. Methods : A mail survey of a random sample of Ohio dentists was conducted in 1989 and repeated in 1992 with a newly drawn sample. Only responses from general dentists were analyzed using univariate analyses and multiple regression. Results : Dentists who reported using sealants increased from 79.4 percent in 1989 to 91.8 percent in 1992. In 1992, 42.9 percent were low-level users (<15% of school-aged patients), 41.7 percent were moderate-level users (15–39%), and 15.3 percent were high-level users (>39%). Over three-fourths of sealant-using dentists expressed some degree of willingness to seal incipient caries. The level of sealant use was associated with dentists' knowledge about sealants, conservative management of dental caries, number of children seen in the practice, and influence of insurance coverage for sealants. The regression model explained 22.0 percent of the variance. Clinical factors associated with the level of use were: dentists' willingness to seal premolars; caries-free teeth; teeth with deep, narrow pits and fissures; teeth with small, frank occlusal caries; and patients 18 years of age or older. This regression model explained only 15.1 percent of the variance. Conclusion : The great majority of Ohio dentists report using sealants. The percent of reported sealant users increased between 1989 and 1992. Ohio dentists are not consistent with regard to the percent of their child patients for whom they apply sealants or their willingness to seal incipient caries. Dentists continue to identify lack of insurance coverage for sealant application as a major barrier to patients receiving the service.     

The role of extended duties dental nurses in applying fluoride varnish for the prevention and control of dental caries

The role of extended duties dental nurses (EDDNs) in undertaking preventive dental care has provided an opportunity for their direct involvement in patient care, both at an individual patient level and as part of a population wide health improvement initiative. The article describes the developing role of the dental nurse in the clinical application of fluoride varnish, with associated evidence of effectiveness for the prevention and control of dental caries. The use of fluoride varnish as being central to caries preventive programmes for individual patients judged at risk of future dental caries is considered. A Scottish dental public health initiative which utilizes these extended skills and the benefits of fluoride varnish application is described. CLINICAL RELEVANCE: This paper illustrates how EDDNs can help to foster a greater team approach to overall patient care and preventive practice by applying fluoride varnish as part of an effective caries preventive programme.     

欧卡芙氟保护漆A型与多乐氟氟化钠护齿剂预防学龄前儿童龋病的效果对比

目的:比较欧卡芙氟保护漆A型与多乐氟氟化钠护齿剂预防学龄前儿童龋病的效果。方法:选取我市3岁儿童520名,随机分为3组,欧卡芙氟保护漆A型组(176名)和多乐氟氟化钠护齿剂组(174名)分别给予全口乳牙涂布该药物,空白对照组(170名)仅进行口腔卫生宣教。对比分析3组儿童干预前后患龋情况。结果:干预前3组儿童的患龋率及龋齿数差异均无统计学意义(P>0.05)。干预1年后,欧卡芙氟保护漆A型组患龋率、新增患龋人数均低于多乐氟氟化钠护齿剂组和空白对照组(P<0.05)。结论:两种药物均能防龋,欧卡芙氟保护漆A型防龋效果优于多乐氟氟化钠护齿剂。