Precautions reported to be used against cross-infection and attitudes to the dental treatment of HIV-positive patients in routine clinical dental practice in Scotland

The purpose of this study was to ascertain the precautions against cross-infection currently employed in routine practice by Scottish dentists, to relate these to current recommendations and to determine Scottish dentists' views on how dental treatment should be provided for patients known to be HIV positive. The subjects were 926 general dental practitioners and 201 clinical community dental officers among respondents to a questionnaire sent to a list of 1726 dental practitioners in Scotland. The results suggest that while some dentists are prepared to take an element of personal risk (in spite of recent improvements 18 per cent are still unvaccinated against hepatitis B, 66 per cent do not wear surgical gloves during routine treatment and 21 per cent claim not to wear gloves during procedures involving ‘bloodletting’), the vast majority (95 per cent) are nevertheless taking steps to protect their patients from cross-infection by using autoclave and dry heat sterilization. One-quarter of general dental practitioners and one-half of clinical community dental officers felt that HIV-positive patients should generally be treated in the branch of the dental service in which they worked, although greater proportions (52 per cent and 69 per cent respectively) said they were prepared to treat a regular patient who became HIV positive.     

口腔诊疗中异物误咽

口腔诊疗过程中,意外落入口腔内的异物一旦被患者误咽,不仅给患者带来心理和身体伤害,严重者还可能危及患者生命安全。本文对口腔临床诊疗过程中异物误咽的情况进行系统分析和回顾,以此提高临床口腔工作者医疗安全的警觉性。     

Survey of dental practice/dental education in Victoria. Part IV. Specialist dental practice

A survey of dentists registered with the Dental Board and resident in the State of Victoria included two sections, one for specialist/restricted practitioners and the other for practitioners, who had gained a postgraduate degree from the University of Melbourne between December 1982 and 1987. The responses of the former suggested that demand for most specialist services appears to be reasonably healthy at the moment and the majority of the latter indicated that they had been adequately trained for specialist practice. It was suggested that there are several market forces which could influence the number of applicants seeking specialist training in future. Strongest demand was likely to be sustained for oral surgery and orthodontics. This is despite evidence of a decline in demand for specialist orthodontic services in private practice. Attention was drawn to the 1986 Ministerial Review of Dental Services in Victoria, in which concern was expressed for the lack of access to orthodontic services for low income families. It was proposed that more cost-effective methods of deploying orthodontic personnel could be used, as in other countries, to provide this access. Demand for specialist services in endodontics, paediatric dentistry, periodontics and prosthodontics could decline in future as general practitioners steadily broaden their range of services through continuing education courses.     

Accessibility of Norwegian dental services according to family income from 1977 to 1989

During the last 10-20 yr there has been a marked increase in demand for dental services in most western countries. An important issue is how this increase in demand has influenced inequalities in use of services among different income groups in the population. It is of particular interest to study this in Norway, as almost all the costs for dental care among adults are borne by the patient. The aim of the present study was to examine how the effect of family income on demand for dental services has changed over time. The analyses were performed on three sets of national data from 1977, 1983, and 1989. The samples were representative of the non-institutionalized Norwegian population aged 20 yr and above. Inequalities in use of dental services among different income groups have decreased between 1977 and 1989. However, separate analyses on the data from 1989 showed that some inequalities still exist. A non-selective subsidizing policy for dental care is unlikely to have any great effect in reducing these inequalities. Subsidized dental care is likely to raise the total amount of dental care demanded. However, it is difficult to assess accurately the size of this increase as the elasticity of demand for dental care in Norway with respect to price is unknown.     

Demand for and utilization of dental services according to household income in the adult population in Norway

Abstract – Objectives: The aim of this study was to describe the effect of income on demand and utilization of dental services according to household income in the adult population. Methods: The data were collected using a questionnaire, which was sent to a random sample of Norwegians aged 20 years or older living at home, 1861 persons in total. Demand was measured according to whether the person had been to the dentist during the last year. Utilization was measured as expenditure for dental treatment for those who had been to the dentist during the last year. The independent variables were the respondents’ household income, age, gender, education, dental status and the mean fee for a dental consultation in the municipality. In the first stage, we carried out a logistic regression analysis of the log odds of having demanded dental services during the last year. In the second stage, we carried out a multiple regression analysis of expenditure for dental treatment for those who had been to the dentist during the last year. Results: Altogether, 80% of the respondents had been to the dentist during the last year. Demand during the last year varied most according to dental status. There was little difference between men and women. The results of the logistic regression showed that the probability of having been to the dentist was 0.82 for those with a household income of €25 000 and 0.85 for those with a household income of €100 000. Mean expenditure for dental treatment was €355. There was no statistically significant relationship between household income and expenditure for dental treatment. Conclusions: Differences in demand for dental services according to household income are small, and there are no differences in utilization according to income. The findings are interesting, because in a population in which people have to pay almost all the costs for dental treatment themselves, one would expect the income differences in demand and utilization to be greater.     

Treatment of the preschool child in a general dental practice

The treatment of the preschool child in general dental practice is interrelated with financial considerations in a similar way to treatment of all other patients. However for young children requiring conservation treatment in particular the time and consequently the costs involved are considerable. This paper provides examples of these problems experienced in the author's own practice.     

From production to performance: solving the positioning dilemma in dental practice

BACKGROUND: Thriving dental practices are excellent at providing a warm personal experience or are efficient, fast and cost-effective. Those that that attempt to do both end up being mediocre at just about everything. CONCLUSIONS: Introducing ideas from dramaturgy and service simultaneity in the services marketing literature, the authors provide a model for the conceptualization and redesign of the dental practice. PRACTICE IMPLICATIONS: Successful dental practices will be those that concentrate on low customization of activities in the back office or high customization of activities in the front office.     

运用Delphi法构建口腔门诊护士工作范畴

目的:构建新形势下口腔门诊护士工作范畴.方法:通过理论分析、文献回顾和专家函询,构建口腔门诊护士工作范畴的初稿,并运用Delphi专家咨询法明确口腔门诊护士工作范畴的一级指标和二级指标.数据采用SPSS17.0软件包进行变异系数和协调系数等统计学分析.结果:经过2轮Delphi专家咨询,入选专家30名.2轮专家咨询问卷的有效率分别为100％和73.3％,专家的权威程度系数为0.833;专家协调系数经检验,P＜0.05.2轮专家咨询共提出116条建议,课题组采纳96条.最终明确我国口腔门诊护士工作范畴包括4个一级指标和25个二级指标.结论:通过科学方法确定了新形势下我国口腔门诊护士的工作范畴,有利于口腔门诊护士的岗位管理,推动口腔门诊专科护士发展.     

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     

Facial and dental alterations according to the breathing pattern

There is controversy in the literature about possible interaction of the respiratory mode with the facial and dental structures.

Objectives

The aim of this study was to perform a longitudinal assessment of the changes in facial and dental structures in Angle’s Class II, division 1 malocclusion individuals, divided according to the respiratory pattern (predominantly nasal or mouth), at two distinct moments of craniofacial development.

Material and Methods

Pogonium and nose measurements were made on the lateral cephalometric tracings (LS’-Pog’, LS’-B’, B’-Pog’, Pog’-PogTeg’, Line NB, Pog-NB, N''-Prn, Prn-NPog, N-Prn-Sn, Prn-Sn-LS). Dental measurements were made on the plaster models (distances between the tips of the canine cusps and the tips of mesial cusps of the first molars) of 40 individuals aged 10 to 14 years (moment 1) and 13 to 16 years (moment 2), 23 being nose breathers (NB) and 17 being predominantly mouth breathers (MB).

Results

The Student’s-t test and two-way ANOVA with repeated measures were applied to indicate differences between the mean values of these variables according to the moments and/or respiratory mode.

Conclusions

There were alterations in the facial measurements, without interference of the breathing pattern. However, the breathing pattern influenced dental alterations.     

Comparison of clinical practice education in dental hygiene schools in eight countries

Objectives: The profession of dental hygienist is one of the few in which the primary function of the practitioner is to prevent oral disease and to promote the well‐being of patients. The aim of this study was to investigate clinical training conditions in schools of dental hygiene in eight countries (the USA, Canada, the UK, Sweden, Denmark, Thailand, South Korea and Japan). Methods: In 2006, we sent out a questionnaire in which we asked dental hygiene schools about how they educate dental hygiene students. Results: The techniques taught to students in schools in Western industrialised nations, such as the USA, Canada, Denmark, the UK and Sweden, were mainly related to dental preventive measures and dental health guidance. By contrast, training schools in South Korea and Japan placed less emphasis on dental preventive measures and dental health guidance. Dental hygienists in Thailand are trained to perform local anaesthesia and to fill and extract deciduous teeth although the country does not have a specific qualification system. Conclusions: The contents of clinical training and education in schools of dental hygiene differ greatly among countries.     

The effect of growing income disparities on U.S. adults' dental care utilization

ObjectiveThe authors conducted a study to measure the gap in dental care utilization between poor and nonpoor adults at the state level and to show how the gap has changed over time.MethodsThe authors collected data from the 2002, 2004, 2006, 2008 and 2010 Behavioral Risk Factor Surveillance System prevalence and trends database maintained by the Centers for Disease Control and Prevention to measure differences in dental care utilization between poor and nonpoor adults. Poor adults are defined as those at or below the federal poverty threshold. The authors estimated a series of linear probability models to measure the dental care utilization gap between poor and nonpoor adults, while controlling for potentially confounding covariates.ResultsIn 12 states (Arkansas, California, Florida, Georgia, Illinois, Indiana, Nebraska, Ohio, Oklahoma, South Carolina, Texas and Washington), the gap in dental care utilization between poor and nonpoor adults grew from 2002 through 2010. The remaining states had a stable utilization gap from 2002 through 2010. The study results show that four states (Alaska, Massachusetts, Minnesota, New York) and the District of Columbia had a smaller gap in dental care utilization in 2010 than that in other states.ConclusionsAt the state level, poor adults face greater access barriers to dental care than do nonpoor adults. As states limit dental coverage through Medicaid, poor adults are at greater risk of experiencing poor oral health outcomes.Practical ImplicationsIn states that are experiencing increasing inequality in dental care utilization between poor and nonpoor adults, policymakers may wish to explore alternative approaches that could address this situation.     

Spillovers from the Patient Protection and Affordable Care Act to employer-sponsored dental insurance enrollment

Background

Previous study results have indicated that the Patient Protection and Affordable Care Act (ACA) health insurance expansion for dependents (called the dependent coverage expansion) also led to a dental insurance expansion for dependents. In this study, the author examines whether this expansion is due to changes in employer-sponsored dental insurance.

A survey of the pattern of private general dental practice in Queensland

All non-specialist ADA member private practitioners in Queensland were invited to participate in a survey to determine the number of the various types of permanent restorations placed in one week and the percentage breakdown of the time they devoted to the various areas of dentistry. Final year dentistry students at the University of Queensland were asked to estimate the projected breakdown of their time in future practice. Results showed that amalgam is still by far the most commonly used material followed by composite resin and glass ionomer cement and that restorative dentistry accounts for the bulk of the practitioners' time. Students' estimations of the work mix were in agreement with those of the practitioners.     

Dental insurance, income and the use of dental care in Canada

Using recent Canadian health survey data, we investigated the effect of socioeconomic status on patients' use of dental services and dental insurance coverage. Our results point to an important socioeconomic gradient in the use of dental services. The probability of receiving any dental care over the course of a year increases markedly with dental insurance, household income, and level of education. Among those receiving at least some dental care, however, a person's general oral health--not financial factors--largely determined visit frequency. The insurance effect appears to operate through a reduction in price paid at point of service, not decisions by those with high anticipated need for dental care to selectively purchase insurance. Indeed, those with poorer self-assessed oral health, as well as those from Quebec (where dental benefits are subject to personal income tax) and those over 65 years of age (who have likely lost employer provided coverage) were less likely to be insured.     

Characteristics and practice profiles of migrant dentist groups in Australia: implications for dental workforce policy and planning

Introduction: Migrants comprise a growing proportion of the dental workforce in Australia. To date, research on migrant dentists is limited, raising policy questions regarding the motivations for migration, demographic profiles and work patterns. The purpose of this paper was to present findings from the first national survey of migrant dentists in Australia. Methods: All dentists with a primary dental qualification from an overseas institution and registered with the Australian Dental Association (n = 1,872) or enrolled as a graduate student in any of the nine dental schools in Australia (n = 105) were surveyed between January and May 2013. Results: A total of 1,022 participants (response rate = 54.5%) were classifiable into three migrant dentist groups: direct recognition (n = 491); Australian Dental Council (ADC) (n = 411); and alternative pathway (n = 120). Overall, 41.8% of migrant dentists were female. More than half of the ADC group (54.1%) were from lower middle income countries. The most frequent motivation for migration according to the direct recognition group (21.1%) was ‘adventure’, whereas other groups migrated for ‘better opportunity’. The majority of ADC respondents (65%) were under 45 years of age, and a larger proportion worked in the most disadvantaged areas (12.4%), compared with other groups. Gender, marital status, years since arrival in Australia and having children varied between the groups (chi square; P < 0.05). Conclusion: Dentist groups migrate to Australia for different reasons. The large proportion of the migrant dentist workforce sourced from lower middle income countries points towards deficiencies in oral health systems both for these countries and for Australia. The feminisation of the migrant dentist profile could in future affect dentist-practice activity patterns in Australia. Further research, especially on the settlement experiences of these dentists, can provide better insights into issues faced by these dentists, the nature of support that migrant dentists receive in Australia, the probable future patterns of work and potential impact on the dental workforce and dental service provision.Key words: Dental workforce, migrants, national survey, policy, practice profiles     

A survey of the pattern of private general dental practice in Queensland, 1992

In 1987 all non-specialist ADA member private practitioners in Queensland were invited to participate in a survey to determine the number of the various types of permanent restorations placed in one week and the percentage breakdown of the time they devoted to the various areas of dentistry. Results of that survey were published in 1989. The survey with a few minor changes was repeated in 1992. Results show that there has been little change in the pattern of practice over the five years with restorative dentistry still taking a very large proportion of respondents' time and similar materials being used. The dental workforce appears to be relatively stable with low rates of overseas and interstate migration. There is evidence of an increasing number of women dentists in the workforce and this is emphasized by a breakdown of the current undergraduate enrolment.