Brazilian dentists' knowledge regarding immediate treatment of traumatic dental injuries

Abstract –  The objective of this study was to assess the knowledge of dentists working in the city of Tubarão, southern Brazil, about the immediate treatment of traumatic dental injuries. A cross-sectional study was carried out involving all dentists who were working in the city in 2004 ( n  = 108). Data were collected through self-applied questionnaires with questions about sex, time elapsed since graduation, whether the dentists had attended postgraduate courses and also four questions about traumatic dental injuries in which the dentists selected the best answer. The response rate was 86.1%. For the two questions related to dental avulsion, 36.6% and 16.1% of professionals respectively, chose the correct answer according to the literature. For the question related to coronal fracture, 75.3% chose the correct answer. For the questions related to an incident without dental avulsion or fracture, 73.1% chose the correct answer. Time elapsed since graduation was the only variable statistically associated with the correct answer for the question related to coronal fracture. A significantly greater number of professionals with ≤10 years of experience chose the correct answer when compared with professionals with >10 years experience ( P  < 0.001). It can be concluded that the great majority of professionals would not intervene according to the literature in the cases of avulsion. Less time elapsed since graduation was statistically associated with the correct answer in the coronal fracture case.     

An investigation into dentists' management methods of dental trauma to maxillary permanent incisors in Victoria, Australia

Abstract –  Trauma to anterior teeth in children could become a long-term problem to dental health. To a large extent, the management actions of the dentists involved will determine the clinical outcome and, in turn, these actions will be related to their levels of knowledge. The aim of this study was to investigate dentists' knowledge of managing traumatic injuries to maxillary permanent incisors in children. A self-completion questionnaire containing 19 questions on management methods of treating dental trauma was mailed to 693 dentists in Victoria, Australia. The response rate achieved was 61%. This survey found that some of the respondents had adequate management knowledge for the different types of traumatic injuries, while others did not have the correct information. Approximately half the dentists considered milk as the preferred extraoral storage medium of choice for avulsed teeth and a period of 7–10 days splinting after replantation. A large proportion of dentists showed inadequate knowledge with regard to understanding the biological mechanisms causing replacement root resorption (61%) and external inflammatory root resorption (74%). Overall, the respondents to this survey demonstrated only a moderate level of knowledge in management of traumatic injuries to maxillary permanent incisors in children. Continuing professional development programmes may be a means of improving this deficient knowledge base.     

Dental professionals' knowledge and perceived need for education in bioterrorism preparedness

Dental professionals should be well prepared to provide care during bioterrorist events. In this study, we assessed the knowledge, opinions about playing various roles during a bioterrorist event, and perceived need for education of dental professionals (dentists and dental hygienists) from one region (Oregon) that had been exposed to bioterrorism and from another region (New England) not exposed. This cross-sectional study used an eighteen-item pretested, self-administered questionnaire distributed at the 2005 Oregon Dental Conference (n=156) and 2005 Yankee Dental Conference (n=297). Dental professionals' knowledge and perceived need for education on bioterrorist preparedness were quantified by multivariate linear and logistic modeling. More than 90 percent of the dental professionals were willing to provide care during bioterrorist events. Perceived knowledge was high; however, actual knowledge was low. Dental professionals who wanted to attend a continuing education course and who thought dental professionals should play more roles during a bioterrorist attack had higher actual knowledge. Willingness to provide care was not supported by adequate knowledge. No significant differences between New England and Oregon dental professionals were observed in terms of actual knowledge or perceived need for bioterrorism education. Integrating training and education into the predoctoral dental and dental hygiene curricula and developing continuing education courses would improve knowledge and better prepare dental professionals to effectively perform American Dental Association-recommended roles during any future bioterrorism events.     

Antibiotic prophylaxis for bacterial endocarditis--a study of knowledge and application of guidelines among dentists and cardiologists

Antibiotic prophylaxis and infective endocarditis is a controversial topic. The compliance with available guidelines among dentists is poor. The dental health education of patients by their cardiologists is inadequate. OBJECTIVE: The objective of this study was to investigate the knowledge and application of available guidelines on antibiotic prophylaxis to prevent infective endocarditis among general dental practitioners and cardiologists. DESIGN: Structured postal questionnaire SUBJECTS AND METHODS: A list of 515 dentists was obtained from a register held by the Postgraduate Medical and Dental Board. A list of 85 cardiologists was obtained from a national register held by the Cardiothoracic Society of Ireland. RESULTS: A 31% response rate was obtained from the cardiologists and 37% from the dentists. The majority of the cardiologists (84%) were in hospital practice and 64% of dentists were in private general practice. Cardiologists showed a preference for the AHA guidelines (50%) and more dentists use the BSAC guidelines (56%). The cardiologists were very familiar with the cardiac conditions that pose a risk for dental patients but weak at educating their patients on the importance of good dental health. The dentists were good at identifying procedures that could place their patients at risk but less informed about which cardiac conditions warranted prophylaxis. Decision-making among the dentists with regard to choice of prophylaxis and appropriate treatment intervals was poor. CONCLUSIONS: The knowledge of and compliance with the available guidelines is poor. Dental health education of at-risk patients by their cardiologists and dentists is inadequate. Further regular education of patients, dentists and medical practitioners is required.     

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.     

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??Traumatic dental injuries are caused by a collision that can generate enough mechanical energy to produce the injury. Injuries involve the hard dental tissues?? the pulp and the periodontal tissues. Crown fractures and luxations of permanent teeth occur most commonly in all dental injuries. Proper diagnosis?? treatment planning and follow-up are important for improving a favorable outcome. The study highlighted Chinese dentists’ need for continuing education in order to improve current knowledge in emergency management of teeth injuries. The International Association of Dental Traumatology??IADT??Guidelines for management of fractures and luxations of permanent teeth represent the best current evidence based on literature search and professional opinion. Guidelines should assist dentists and other health care professionals in decision making in order to provide the best care effectively and efficiently.     

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth.     

What do dentists know about statistics?

Abstract – A multiple choice test with nine statistical questions was sent to a random sample of Danish dentists to assess their knowledge of elementary statistical expressions (SD, SE, P<0.05, P> 0.05 and r). Of 250 dentists, 129 (52%) answered the questions. The test was also completed by 27 (71%) of 38 dental students immediately after the last lecture in statistics. The median number of correct answers was 2.2 among the dentists and 3.4 among the dental students. It is concluded that the statistical knowledge of most dentists, and to a lesser degree also dental students, is so limited that they cannot be expected to be critically against or to draw the right conclusions from those statistical analyses with which they are confronted. Only 35% of the dentists stated that it is very important that this problem be raised.     

Knowledge of oral health professionals of treatment of avulsed teeth

Abstract –  The management and immediate treatment of an avulsed permanent tooth will determine the long-term survival of the tooth. The aim of this study was to evaluate the knowledge of oral health professionals on the new guidelines for emergency treatment of avulsed teeth. A 12-item questionnaire was distributed among general dentists, specialists, dental hygienists and dental assistants attending Continuing Education courses at the School of Dentistry, University of Southern California, between 2003 and 2004. This study reports only on the general practitioners who comprised 83% of the participants. The results revealed an uneven pattern of knowledge among them regarding the emergency management of an avulsed tooth. Statistically significant associations were related to the participants' previous dental trauma education and their age. In conclusion, there is a need to improve the knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth.     

Dental screening of pediatric cardiac surgical patients

Dental screenings were completed on 209 pediatric patients six months and older that were scheduled for cardiac surgery from two different geographical locations. The screening involved an educational session on bacterial endocarditis and preventive dentistry followed by a dental examination. We found that sixty-two (30 percent) patients had seen a dentist regularly, ninety-three (44 percent) practiced daily oral hygiene and thirty-seven (18 percent) knew about bacterial endocarditis. Local dentists performed invasive procedures on seventy-one (34 percent) patients and thirty-four (48 percent) received antibiotic prophylaxis. Only twenty-three (68 percent) of the thirty-four patients received the then current American Heart Association antibiotic regimen. Dental disease was diagnosed in 175 (84 percent) of the 209 patients: 164 (78 percent) gingivitis; sixty (29 percent) caries; six (7 percent) dental abscess; three (1 percent) periodontal abscess; five (2 percent) periocornitis. Cardiac surgery was postponed in twenty-four (12 percent) patients. We conclude that parents lacked knowledge about bacterial endocarditis even after being informed during their routine cardiology visit, there appears to be a deficiency of knowledge among dentists regarding the indications and antibiotic regimen required to prevent bacterial endocarditis, and all cardiac surgical patients should have a dental exam and preventive dental program implemented prior to six months of age and dental screening prior to their cardiac surgery.     

Reporting of child abuse: a follow-up survey of Texas dentists

PURPOSE: Child abuse is a disturbingly common finding in society today. There have been substantial and significant increases in the incidence of child abuse since the last national incidence study was conducted in 1986. Kassebaum first reported the under-reporting of child abuse by Texas dental professionals in a survey in 1986. The objective of the current study was twofold: (1) assess the level of knowledge and attitudes among dental professionals on the important issue of child abuse; (2) evaluate and compare the results of the current study with a similar survey conducted in 1986. METHODS: A 24-question survey similar in format and content to the 1986 questionnaire was mailed to 1,046 Texas dentists, randomly selected from a membership roster provided by the Texas Dental Association. Both general dentists and selected specialists were included in the study group. The questionnaire consisted of multiple-choice and dichotomous yes/no questions. RESULTS: There were 383 responses to the questionnaire, yielding a response rate of 38%. The majority (N=289) of the respondents were general dentists. In answering questions about suspected and reported cases of child abuse, nearly 50% of the responding dentists reported they had suspected at least 1 case of child abuse. In the 1986 study, only 36% of the responding dentists reported they had suspected at least 1 case of child abuse. Between 1986 and 2001, the survey has shown that the percentage of dentists who reported at least 1 case to authorities slightly increased from 19% in 1986 to 25% in 2001, but the ratio of suspected to reported cases had not changed since 1986. CONCLUSIONS: Although the composite percentage of suspecting and reporting cases of child abuse from this survey is higher than the percentage demonstrated in 1986 study, there was no significant change in the relative ratio of reported cases to suspected cases in both surveys. This indicates that under-reporting of child abuse cases is still a significant problem in the dental profession in Texas.     

What do dentists know about statistics?

A multiple choice test with nine statistical questions was sent to a random sample of Danish dentists to assess their knowledge of elementary statistical expressions (SD, SE, P less than 0.05, P greater than 0.05 and r). Of 250 dentists, 129 (52%) answered the questions. The test was also completed by 27 (71%) of 38 dental students immediately after the last lecture in statistics. The median number of correct answers was 2.2 among the dentists and 3.4 among the dental students. It is concluded that the statistical knowledge of most dentists, and to a lesser degree also dental students, is so limited that they cannot be expected to be critically against or to draw the right conclusions from those statistical analyses with which they are confronted. Only 35% of the dentists stated that it is very important that this problem be raised.     

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.     

Dental health care waste disposal among private dental practices in Bangalore City, India

Any waste generated consequent to health care activity including any from a home environment is health care waste. Dental practices generate large amounts of waste cotton, plastic, latex, glass and other materials much of which may be contaminated with body fluids. OBJECTIVE: To assess the knowledge, attitude and behaviour of private dental practitioners on health care waste management in Bangalore City. METHODS: A cross-sectional study of 432 private dental practitioners in Bangalore City using a self-administered questionnaire. RESULTS: 389 dentists responded; 64.3% do not segregate waste before disposal and 47.6% hand over health care waste to street garbage collectors; 42.1% felt that there was a lack of waste management agency services and 16.9% felt that a lack of knowledge were the main hurdles. CONCLUSIONS: Dentists need education regarding health care waste disposal methods to improve their knowledge. A large proportion of the dentists are not practising proper methods of health care waste disposal. The existence of legislation governing healthcare waste disposal is not sufficient alone to motivate many practitioners to comply with guidelines.     

Dental school applicants by state compared to population and dentist workforce distribution

Millions of Americans face significant barriers that limit their access to oral health care, including the lack of dental health care professionals willing to provide dental services in underserved areas. The purpose of this study was to evaluate the relationship between the geographic distribution of dental school applicants and the population and number of dentists by state. Data from the Associated American Dental Schools Application Service (AADSAS), the American Dental Association (ADA), the U.S. Census Bureau, and the U.S. Department of Commerce were used to determine the total number of dental school applicants, dentists, and populations by individual state. Results suggest that, based on national averages, the majority of states may have too few dentists to meet current and future state population needs. Also, many of these same states may have too few dental school applicants when compared to state population and dental workforce figures. It was concluded that states may wish to consider targeted initiatives aimed at increasing the sizes of their dental school applicant pools in order to help address current and future local or regional dental workforce needs.     

Written Testimony from the American Board of Dental Public Health

The American Board of Dental Public Health strives to improve the health of our nation by establishing and promoting standards for dental public health practice and recognizing dentists for their special knowledge and ability in dental public health and preventive dentistry. As one of the eight specialties recognized by the American Dental Association, this specialty focuses upon the oral health of communities and population groups with an emphasis on oral health promotion, disease prevention, and access using organized community efforts. The board offers the following 12 recommendations:

• 1 Dental education must actively support diversity in education and practice to meet the public's needs in a culturally sensitive and cost-effective manner. Also, dental education must define its educational base in light of current as well as emerging and evolving needs of society.
• 2 Dental education must incorporate the interdisciplinary and multidisciplinary aspects of health services delivery.
• 3 3. Disease prevention and health promotion must be given a much higher priority in dental education.
• 4 Basic knowledge and experience in dental public health must be an integral component of predoctoral education.
• 5 The number of specialists in dental public health needs to be increased, and graduate training in both traditional and expanded areas of dental public health needs to be enhanced and increased.
• 6 Dental education must develop methods for incorporating new scientific knowledge and technologies into the curriculum and practice.
• 7 A systematic, objective approach needs to be developed to improve and enhance the role of oral health professionals to respond to a constantly evolving social and political environment and science base.
• 8 The role of dental education institutions in continuing education must be restructured and improved to address practitioner competency and relevancy to the needs of society.
• 9 Dental practice guidelines need to be established and monitored.
• 10 Accreditation, licensure, and certification need to be restructured to meet the health needs of the public.
• 11 Education and behavioral research to improve the dental education process needs to be reestablished, improved, and expanded.
• 12 Pilot programs need to be developed, implemented, and supported to stimulate the necessary changes in dental education to be more responsive to the needs of society.

The American Board of Dental Public Health (ABDPH) appreciates this opportunity to provide written testimony to the Institute of Medicine's (IOM) Committee on the Future of Dental Education. The recommendations of this committee will provide the nation with critical guidance toward meeting the oral health needs well into the next century.     

Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth

Abstract –  Avulsion of permanent teeth is the most serious of all dental injuries. The prognosis depends on the measures taken at the place of accident or the time immediately after the avulsion. Replantation is the treatment of choice, but cannot always be carried out immediately. An appropriate emergency management and treatment plan is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases in which the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence based on literature research and professional opinion. In this second article of three, the IADT Guidelines for management of avulsed permanent teeth are presented.