Dental service provision in Victorian residential aged care facilities

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

Task division between dentists and dental hygienists in Norway

Abstract – Objective: The aim of the study was to investigate the attitudes among dentists and dental hygienists to the policy objective in Norway of delegating more dental work from dentists to dental hygienists. Method: A questionnaire was mailed to a random sample of 1111 dentists and 268 dental hygienists in 2005. The response rates were 45% (504) among the dentists and 42% (112) among the dental hygienists. The survey sought to explore any discrepancies between current and preferred mix of different work tasks, as well as attitudes to the idea of substituting dentists with dental hygienists for certain work tasks. Logistic regression was used to analyse how answers differed by respondent characteristics. Results: Dentists spent only half of their total working hours on complex dental services, i.e. tasks that only dentists are skilled to undertake. Nearly 40% of their time was spent on tasks that dental hygienists are qualified to perform; examinations, screening and basic treatments. Still, the mix of work tasks that dentists preferred would involve slight changes: on average only 2% points more complex treatment and 3–4% points less of those tasks that dental hygienists are permitted to provide. Seemingly contrary, as many as 60% of dentists answered that it was ‘desirable to delegate’ more tasks to dental hygienist. However, only 21% of the dentists agreed that dental hygienists should be the entry point for dental services. Dental hygienists would prefer to do relatively more basic treatments and fewer examinations and screening, and the vast majority among them supported the idea that they could be the entry point for dental services. Conclusion: The results suggest that there will not be major changes in the division of labour between dentists and dental hygienists in Norway, if dentists are to be held responsible for taking such initiatives. Although dentists agree that more of their current work could– in principle – be delegated to dental hygienists, they do not prefer to reduce much of their own current activity of those work tasks that dental hygienists are qualified to perform.     

Recall intervals, dental hygienists and quality in child dental care

Abstract Decline in dental disease and the need to provide dental care efficiently suggest changes in clinical and administrative routines in public dental care provision for children. A field project in Norway demonstrated productivity gains after the introduction of individualized recall intervals and using dental hygienists to conduct recall examinations. The purpose of the present study was to assess changes in the quality of dental health outcome and changes in the quality of the process of dental care provision. Recall intervals were increased from a target of 12 months to 16 and 18 months in two districts. Dental hygienists undertook all recall examinations and referred to dentists those patients who required operative care. Bitewing radiographs were inspected for all 18-yr-olds who were examined in 1989, 1990 and 1991 (n=956) and for those who were examined before the changes were implemented in 1987 (n=300). For each child, approximal caries on 24 surfaces was scored according to a 4-point severity scale. Clinical records were examined to determine what treatment had been provided. For each year after the changes were implemented, the quality of health outcome was assessed by comparing the radiographic caries prevalence and the number of sound surfaces with 1987 data. Quality in the process of care provision was indicated by the treatment decisions for approximal caries and by the proportion of uninterpretable surfaces on radiographs for each study year. The mean number of sound surfaces increased over time. A declining proportion of sound surfaces was restored over the study period, and almost all caries lesions extending deep into dentine were restored. Radiographic quality improved during the project period. The overall finding was that the changes to clinical and administrative routines were not associated with major changes in the quality of care provided in the short run.     

Use of dental hygienists and returns to scale in child dental care in Norway

Abstract The purpose of this study was to investigate, in the provision of dental care for children, technically and economically efficient combinations of dentists and dental hygienists and to study returns to scale by analyzing production functions. Data from 137 dental health clinics were analyzed. Output was registered as the number of 3–18-yr-old children to whom the clinic delivered complete dental care. Resource input was registered as hours spent by dentists, denial hygienists and dental assistants to deliver care to the children. The average clinic that employed dental hygienists used one hygienist hour per three dentist hours for child dental care. It would save dentist time, but not costs, to extend the use of hygienists. Increased use of dental hygienists might be economically efficient if the work distribution between the personnel groups were changed, for example, by delegating more examinations and preventive care to hygienists. There were technical opportunities for further substitution of dental hygienists for dentists both by introducing dental hygienists in the clinics that only used dentists in child dental care and by extending use of hygienists in clinics that already employed hygienists. This study found no productivity gain from centralizing treatment of children in large dental clinics.     

Dental hygienists as providers in long-term care facilities

The authors surveyed all practicing dental hygienists (n = 870, response rate = 69%) in Kansas about providing preventive dental care to elderly residents of long‐term care (LTC) facilities. Maximum likelihood estimates stepwise logistic regressions were used to predict the likelihood of dental hygienists filling the need for a specialty workforce. Few respondents wanted to work exclusively with elderly patients. Lack of interest in LTC practice was related to the number of children living at home or discomfort with patients who had limited abilities to communicate. Interest in part‐time geriatric practice was related to motivation to help older patients and unhappiness with current role limitations. Implications for reimbursement and educational offerings are discussed. While dental hygienists could fill a need in preventive oral health for elderly patients, it remains to be seen if subsequent policy changes result in that outcome.     

Dental utilization for medicaid‐enrolled adults with developmental disabilities in Iowa residential care facilities

The goal of this study was to evaluate the dental utilization of Medicaid‐enrolled adults in Iowa residential care facilities (n = 1423). Medicaid enrollment and claims files for 2003 were used, as well as information from the Iowa Department of Inspections and Appeals. Dental utilization was defined as having any dental visit during 2003. Of the residents, 74.1% utilized at least one dental service in 2003. Residents in facilities that were part of smaller organizations, and younger residents, were more likely to have had a dental visit. Of those with a visit, over 80% received a preventive service but this declined with age. Despite additional barriers, dental utilization was generally good for Medicaid‐enrolled residents of residential care facilities in Iowa. Residents in smaller facilities of smaller organizations received more personalized care. Older residents were less likely to have a parent involved, were more likely to be edentulous, and sought care less frequently.     

An analysis of complaints against Victorian dental care providers 2000-2004

BACKGROUND: There are little data available on the number and type of complaints made against dental care providers in Australia, despite anecdotal reports of an increasing trend in health-related complaints and litigation. METHODS: Data were obtained from the Dental Practice Board of Victoria on complaints received between July 2000 and December 2004. RESULTS: There were 651 complaints against all dental care providers in the study period, which equates to a rate of 4.1 complaints per 100 dental care providers per year. Dentists were responsible for 490 of the complaints, with 66 complaints against dental prosthetists and 43 complaints against dental specialists. There were very few complaints against dental therapists and students, and no complaints against dental hygienists, with 47 complaints against unregistered people or institutions. CONCLUSIONS: This study found that there was a relatively low rate of complaints made against dental care providers in Victoria, with most occurring against dentists in private practice in Melbourne. Less that 10 per cent of complaints resulted in an adverse finding against the dental care provider.     

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

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

Scleroderma: considerations for dental hygienists

Abstract:  Scleroderma, the general name of a group of progressive diseases affecting the connective tissues is the most deadly of the varying connective tissue disorders. Characterized by abnormal thickening of the skin, this collagen-vascular disease is associated with immune dysfunction. Hallmark signs of scleroderma include fibrosis, vascular instability and initial inflammation resulting from excessive collagen deposition. Oral facial involvement is considerable, necessitating adaptations in patient oral self-care and influencing oral hygiene. Appropriate dental hygiene management of patients with this autoimmune disorder requires an understanding of clinical characteristics, the recognition of oral facial involvement, treatment considerations and pharmacological interventions. With this information, dental hygienists will be better prepared to provide compassionate, safe and effective dental hygiene management and care to patients with scleroderma.     

A randomized controlled trial assessing the effectiveness of professional oral care by dental hygienists

Abstract: Objectives:  This study was designed to compare professional oral care (POC) by a dental hygienist with tooth brushing and mouth rinsing by patients themselves according to the instructions of a nurse (control). Methods:  Forty patients were randomly assigned to either the POC group (n = 20) or control group (n = 20). The presence of plaque and bacteria was assessed clinically. Results:  One patient in the POC group and three patients in the control group dropped out because of exacerbation of underlying disease or death. Plaque control record scores were significantly lower in the POC group than in the control group on the fifth hospital day and the day of discharge. There was no significant difference between the groups in the detection rate of Candida species; and nosocomial pathogens on either day. Conclusions:  Professional oral care by a dental hygienist is more effective than tooth brushing and mouth rinsing by patients themselves according to the instructions of a nurse.