Quantification of the esthetics of dentists’ before and after photographs

PurposeThe purpose of this study was to measure dentists’ before and after restorative treatment photographs to identify four metrics to describe the esthetic improvement: (a) central incisor width-to-height ratio; (b) central-to-lateral incisor width ratio; (c) lateral incisor-to-canine width ratio; and (d) lateral incisor percentage offset.Materials and methodsInternet searches for “before after” and “veneers” and “prosthodontic” were used to obtain 198 before and after photographs of patient treatments showing the restoration of the six maxillary anterior teeth with porcelain veneers, crowns or a combination. The four metrics were measured using Adobe Photoshop. Groups were compared with repeated measures ANOVA followed by a post hoc Tukey–Kramer test with the variables of “Before or After Treatment”; “Treatment Type” (veneers, crowns or a combination) and “General Dentist or Prosthodontist”.ResultsMean central incisor width-to-height ratio was 91.7% before treatment, 80.8% after; mean central-to-lateral incisor width ratios were 69.9% and 64.7%; mean lateral incisor-to-canine width ratios were 85.3% and 81.4% and lateral incisor percentage offsets were 9.6% and 8.7%. There were significant (p < 0.05) differences for before and after treatment for all variables except central-to-lateral incisor width ratio. Differences between specialist and general dentist were not statistically significant.ConclusionsOn average, esthetic prosthetic treatment resulted in reduced central incisor width-to-height ratio, increased proportional width of the mesially positioned tooth of adjacent anterior teeth and reduced lateral incisor offset. The mean values of treatments by GPs and prosthodontists were not statistically significantly different.Clinical implicationsKnowledge of dentists’ optimal restorative treatments provides insight on the esthetic outcome of extensive prosthodontic therapy.     

Should dentists become 'oral physicians'? Yes, dentists should become 'oral physicians'

In summary, a new designation for the dental profession is warranted, not because paramedical professionals have done it, but because the new designation is appropriate for what they are able to do. Moreover, it can be done now with little resistance or fanfare. As has been suggested by others, changing the name "dentist" to the name "oral physician" would result in several benefits: dentists' being recognized as providers of services such as tobacco-use cessation, oral cancer screenings, nutritional counseling and, most recently, as a major health care resource for dealing with bioterrorism; the public's visiting dental professionals for services other than traditional dental procedures; the profession's being more likely to teach and provide services outside of traditional dental procedures; third-party payers' being more likely to pay for services other than traditional dental procedures; the improvement in the public's oral health that would result from patients' visiting "oral physicians" for services other than traditional dental procedures.     

Availability and services of dentists under pressure?

Signals in society point to a shortage of dentists in the Netherlands. Aim of this study is to explore how patients, against the background of supposed shortage, judge the availability and services of dentists. For this research the 'Consumerspanel Health Care', in which 1.395 persons participate, was asked to complete a postal questionnaire. Response rate was 73.8%. Results show that there are presently no serious problems for patients with the services of dentist due to the presumed lack of dentists. The patients were very satisfied with the accessibility and the services delivered by the dentists in the Netherlands. With the availability there seem to be some possible problems.     

Sealants and dental caries: Insight into dentists’ behaviors regarding implementation of clinical practice recommendations

BackgroundThe authors conducted a qualitative study of private-practice dentists in their offices by using vignette-based interviews to assess barriers to the use of evidence-based clinical recommendations in the treatment of noncavitated carious lesions.MethodsThe authors recruited 22 dentists as a convenience sample and presented them with two patient vignettes involving noncavitated carious lesions. Interviewers asked participants to articulate their thought processes as they described treatment recommendations. Participants compared their treatment plans with the American Dental Association’s recommendations for sealing noncavitated carious lesions, and they described barriers to implementing these recommendations in their practices. The authors recorded and transcribed the sessions for accuracy and themes.ResultsPersonal clinical experience emerged as the determining factor in dentists’ treatment decisions regarding noncavitated carious lesions. Additional factors were lack of reimbursement and mistrust of the recommendations. The authors found that knowledge of the recommendations did not lead to their adoption when the recommendation was incongruent with the dentist’s personal experience.ConclusionsThe authors found that ingrained practice behavior based on personal clinical experience that differed substantially from evidence-based recommendations resulted in a rejection of these recommendations.Practical ImplicationsAttempts to improve the adoption of evidence-based practice must involve more than simple dissemination of information to achieve a balance between personal clinical experience and scientific evidence.     

Arab dentists’ refusal to treat HIV positive patients: a survey of recently graduated dentists from three Arab dental schools

Objective: To assess intended refusal of recent graduates from three Arab dental schools to treat HIV?+?patients and factors associated with this intention.

Materials and methods: In 2015, convenience samples of recent dental graduates were included from Libya, Egypt and the United Arab Emirates. Participants responded to a questionnaire assessing personal background, knowledge of oral manifestations and fluids transmitting HIV, perceived adequacy of training and self-efficacy to manage blood exposures, attitude to risk of infection, moral beliefs and willingness to treat HIV?+?patients. Logistic regression assessed factors associated with intended refusal to treat HIV?+?patients.

Results: The overall response rate was 552/710 (77.8%), mean age?=?23.7 years with 41.8% males. The mean (SD) scores for knowledge of oral manifestations and fluids transmitting HIV were 5.5 (1.3)/8 and 4.2 (1.7)/7. The mean (SD) scores for attitude to risk of infection and moral beliefs were 2.9 (1.0)/4 and 2 (0.9)/3, respectively. One-third of respondents indicated intention to refuse treating HIV?+?patients. Knowledge of body fluids transmitting HIV and moral beliefs were associated with lower odds of refusing to treat HIV?+?patients (OR?=?0.86 and 0.38) whereas attitude indicating greater concern for risk of infection was associated with higher odds (OR?=?1.54).

Conclusions: One third of dentists from three Arab dental schools indicated they would refuse to treat HIV?+?patients. Adequate knowledge and moral beliefs reflecting professional ethics were associated with lower odds of refusal counterbalancing the association with attitude indicating increased concern for risk of infection with implications for dentist education and training.     

Treatment of temporomandibular disorders – knowledge,attitudes and clinical experience among general practising dentists in Sweden

Objective: The aim of the study was to investigate the self-perceived level of knowledge, attitudes and clinical experience in treatment of temporomandibular disorders (TMD) among general practising dentists (GPDs).

Material and methods: A web-based questionnaire was sent to all GPDs in the public dental health service in the County of Uppsala in 2010 (n?=?128) and 2014 (n?=?113). The GPDs were asked to answer questions in the following categories: Demographic information, Quality assurance, Clinical experience and treatment, Need for specialist resources in the field of TMD and Attitudes. Between the two questionnaires, the GPDs were offered TMD education and an examination template including three TMD questions was introduced in the computer case files. The results were also compared with a previous questionnaire from 2001.

Results: The response rate was 71% (2010) and 73% (2014). The majority of the GPDs were women (70% in 2010 and 72% in 2014). The reported frequency of taking a case history of facial pain and headache increased between 2010 and 2014. In 2014, the GPDs were more secure and reported higher frequency of good clinical routines in treatment with jaw exercises and pharmacological intervention compared to 2001. Interocclusal appliance was the treatment with which most dentists felt confident and reported good clinical routines.

Conclusions: The GPDs felt more insecure concerning TMD diagnostics, therapy decisions and treatment in children/adolescents compared to adults. There is a high need for orofacial pain/TMD specialists and a majority of the GPDs wants the specialists to offer continuing education in TMD.     

State governance versus dentists’ autonomy – the case of Swedish dental care

Objective: A trend towards the state governance of healthcare through quality indicators and national clinical guidelines has been observed, and it is argued that this trend can be a challenge to the autonomy of healthcare professionals. In Sweden, these regulatory tools have been implemented in combination with subsidies for adult dental care that are based on guideline recommendations which serve to ensure that dental care is evidence-based and cost-effective. This paper aims to analyse the implications of these changes regarding dentists’ autonomy and whether the government’s political intentions can be fulfilled.

Material and methods: The paper is based on documents from government authorities and professional theories.

Results: The financial control over Swedish dental care has been strengthened, and it can be argued that this is a step in the right direction from a societal point of view, as public resources are limited. Dentists’ professional autonomy with their patients is not affected, which is appropriate, as patients should be treated according to their individual needs and expectations.

Conclusions: This article shows that the state’s governance does not directly detail dentists’ work, which indicates a balance between state governance and dentists’ autonomy. However, further research is required to get knowledge on Swedish dentists’ view of the governance.     

Evaluation of knowledge and experience of dentists of São Paulo State, Brazil about cardiopulmonary resuscitation

This work describes the knowledge and experience of dentists about cardiopulmonary resuscitation (CPR). A total of 182 dentists from S?o Paulo State, Brazil were interviewed: 59% judged themselves able to define CPR, although only 46% had a correct concept; 54% believed himself to be able to perform CPR, however, none of them referred to have received practical training in CPR; 3% of the interviewed professionals mentioned the occurrence of cadiopulmonary arrest in their dental office. It was concluded that dental surgeons in Brazil should be better trained for medical emergencies that can occur in the dental office.     

General dentists and special needs patients: does dental education matter?

Special needs patients are one of the underserved dental patient groups in the United States. This study investigates whether undergraduate dental education about special needs patients affects general dentists' a) professional behavior, b) practice characteristics, and c) attitudes concerning special needs patients. Data were collected from 208 general dentists (178 male/30 female; average age: 49.85 years) who were members of the Michigan Dental Association. The more the respondents agreed that dental education had prepared them well, the more likely they were to treat various types of special needs patients and to set up their practices so they could treat them and the more they liked treating these patients. In conclusion, most general dentists did not think their undergraduate dental education had prepared them well to treat special needs patients. However, the better they reported to have been educated, the more likely they were to treat special needs patients. Given the access to care problems for many special needs patients, it seems crucial to revise dental curricula and provide more didactic and clinical education concerning the treatment of special needs patients.     

The air turbine and hearing loss: are dentists at risk?

BACKGROUND: Damage to the dentist's hearing because of the popularity of the air turbine has been the subject of many articles, but no conclusive proof has been given that the turbine is a health factor. OVERVIEW: The author provides a historical review of the literature regarding hearing loss among dentists. CONCLUSIONS: In light of the inconclusive results of the literature review, the author recommends that further studies be conducted.     

Assessing dentists’ human papillomavirus–related health literacy for oropharyngeal cancer prevention

Background

Oropharyngeal cancers related to human papillomavirus (HPV) are on the rise. Dentists may be the next group of providers participating in the prevention of HPV. The aim of this study was to assess dentists’ health literacy regarding the connection of HPV and oropharyngeal cancer.

How do dentists perceive poverty and people on social assistance? A qualitative study conducted in Montreal, Canada

Despite significant needs, people on social assistance are sometimes reluctant to consult dentists because of previous negative experience and communication barriers. They feel poorly understood by oral health professionals and sometimes complain of being stigmatized. It is thus important to know how dentists perceive poverty and this group of patients. The aim of this study was to understand how dentists perceive poverty and people on social assistance. To investigate this largely unexplored question, a qualitative study was conducted based on in-depth interviews with thirty-three dentists practicing in Montreal, Canada. Interviews were audiotaped and transcribed for qualitative analysis. The study revealed two perspectives on poverty: 1) the individualistic-deficit perspective and 2) the socio-lifecourse perspective. In the individualistic-deficit perspective, which predominated among these participants, dentists explained poverty by individual factors and emphasized individuals' negative attitudes toward work and lack of capabilities. Conversely, dentists with a socio-lifecourse perspective described poverty as a structural rather than an individual process. Acknowledging individuals' distress and powerlessness, these dentists expressed more empathy toward people on social assistance. The results suggest the individualistic-deficit perspective impedes the care relationship between dentists and poor patients as well as highlighting the need to better prepare dentists for addressing issues of poverty and social inequities in clinical practice.     

Should dentists become 'oral physicians'? No, dentistry must remain dentistry

Dentistry is not an allied health profession. It is not a paramedical profession. It is time that dentistry be recognized as the profession that offers patients some of the most complex surgery performed on the human body--namely, restorative dentistry and rehabilitation of the masticatory system. Dentistry is the only anatomically focused health care profession that is university-based and for which primary care responsibility is maintained by the profession. An inferiority complex about what it means to be a dentist has served only to confuse the public and bring us further from our goal of improving the health of all our patients. This inferiority complex is driven by the public and the medical profession, neither of which understands how dentistry fits into overall health care. It is essential that every academic health center have oral health education as an integrated part of health care education for dentists, physicians, nurses, allied dental personel, physical therapists, psychologists and all who receive university-based health care education. In this way, all the health professions and the public will see dentistry and oral health as essential to patients' overall health. The idea of emulating those who do not have the strength of basic-science education, practice complexity, surgical skills or community status by seizing a new title will not elevate the profession for the future. The public knows what a dentist is. It is our task to inform the public about the capabilities of dentists and the value of oral health and our profession. We can accomplish this best by assuring that our profession's name, "dentistry," is understood to represent one of the world's most accomplished surgical endeavors, one that is thoroughly integrated into the fabric of health care. Thus, good oral health will be thoroughly integrated into what it means to be healthy.