General dentists' referrals of 3- to 5-year-old children to pediatric dentists

BACKGROUND: Little is known about general dentists' referral patterns. The authors explored the practice, dentist and patient characteristics associated with general dentists' likelihood of referring children aged 3 to 5 years to pediatric dentists. METHODS: The authors sent all Iowa general dentists (N = 1,089) a 25-item questionnaire regarding the referral of children in their practices. The authors merged the resulting information with an existing database (Iowa Dentist Tracking System) to create the dataset. A total of 65.4 percent of the dentists (712) participated. RESULTS: Logistic regression analysis demonstrated that an increase in the percentage of children in the practice decreased the likelihood of the dentist's referring the children (odds ratio [OR] = 0.93, 95 percent confidence interval [CI] = 0.90 to 0.96). Practices with more than 5 percent of patients with public insurance were more likely to refer children (OR = 1.96, 95 percent CI = 1.26 to 3.06), as were dentists with additional training beyond dental school (OR = 1.69, 95 percent CI = 1.06 to 2.69). CONCLUSION: These data indicate that both practice and dentist characteristics are associated with the likelihood of making referals; however, there needs to be further study on general dentists' referral decisions. PRACTICE IMPLICATIONS: As the characteristics of the dental work force evolve, there is a need to study referral patterns and the influence they have on work force policy, patient accessibility and educational curriculum.     

The influence of practice type, region, and age on treatment recommendations for primary teeth.

The purpose of this study was to investigate dentists' treatment recommendations for interproximal surfaces of primary molars based on the type of practitioner (general dentist or pediatric dentist), geographic location, and age of practitioner. Simulated cases, which included histories and pictures of bite-wing radiographs, were mailed to a random sample of 2000 general dentists and 1000 pediatric dentists. Dentists were asked to select their treatment recommendations for eight cases involving the interproximal surface of a specified primary molar. The return rate was 42% (1245) overall, with 36% (723) from general dentists and 52% (522) from pediatric dentists. An amalgam restoration was recommended most often for these eight cases. Dentists in the age 60+ category and pediatric dentists were more likely to recommend treatment for smaller interproximal lesions. Composite resins were recommended infrequently; however, dentists in the 60+ age category and dentists in the Northeast and Southwest were somewhat more likely to recommend composite resin than younger dentists, or dentists in other geographic locations. Dentists in the 40-49 age range, pediatric dentists, and dentists in the Southwest were the most likely to recommend stainless steel crowns. These simulated cases demonstrate differences and similarities in the treatment recommendations for interproximal lesions on primary molars based on age, practice type, and region.     

Survey of Iowa general dentists regarding the age 1 dental visit

PURPOSE: The purpose of this study was to assess Iowa general dentists regarding the age 1 dental visit. METHODS: A 15-item survey was mailed to 1,521 licensed dentists to address their knowledge, attitudes, and behavior regarding the age 1 dental visit. Chi-square statistics and logistic regression models were used to analyze data. RESULTS: Seven hundred fifteen (47%) useable surveys were returned from 2 mailings. Five hundred forty (76%) general dentists were familiar with the American Academy of Pediatric Dentistry (AAPD) age 1 dental visit recommendation. Most reported obtaining this information through continuing education (37%). Eleven percent believed the first dental visit should occur between 0 and 11 months of age, and 66% reported seeing children younger than 2. "Prefer to refer infants to a pediatric dentist" (20%) was the most common reason for not seeing children 0 to 23 months old. Bivariate and multivariate logistic regression analyses indicated that dentists who believed children should have their first dental visit at 0 to 23 months and those willing to see children at age 0 to 23 months were younger, more recent graduates, more likely to be female, aware of the AAPD recommendations, and were already seeing children 0 to 23 months. CONCLUSIONS: The majority of Iowa general dentists are aware of the AAPD age 1 dental visit recommendation.     

Treatability of children according to Dutch dentists

Most dentists find it important to treat the dentition of children; nevertheless cavities often remain untreated. In order to gain insight into the treatability of children, a survey was carried out involving 4,500 dentists of a health insurance company. A representative group answered questions about the necessity of treatment, and treatability of children and about the possibility of referring children to a colleague or a paediatric dentist. According to the questionnaire dentists find it important to treat the dentition of children. Most problems during dental treatment occur in the 0-6 years age group. Dentists are more likely to refer children in this age group to a colleague or pediatric dentist for treatment.     

Cooperation and competition between dentists and denturists in Finland

The aim of this study was to investigate cooperation between dentists and denturists in Finland, particularly in relation to perceived competition between the two professions. From a representative sample of 350 private dentists and 253 denturists, 68% returned acceptably filled-in questionnaires dealing with competition and cooperation with other healthcare professionals. Dentists referred their patients significantly (P < 0.001) less often to denturists (26.2%) than denturists did to dentists (94.1%). Those who referred their patients to members of the other profession also received patients from the other profession significantly (P< 0.001) more often than those who did not (60.7% vs 16.7% among dentists; 90.0% vs 44.4% among denturists). Denturists saw themselves as competing with dentists (56.0%) significantly (P< 0.001) more often than dentists did with denturists (29.2%). Dentists practicing in small towns or rural areas cooperated more often with denturists than did those practicing in more urban areas. Among denturists, the likelihood of referring patients to dentists was associated with younger age and fewer clinical working hours. It was concluded that cooperation between dentists and denturists was common. Oral healthcare professionals who referred their patients to the other profession also benefited by receiving more patients on referral from them. Dental services provided by denturists are limited, which may explain their greater willingness to cooperate with dentists.     

Are general dentists' practice patterns and attitudes about treating Medicaid-enrolled preschool age children related to dental school training?

PURPOSE: The purpose of this study were to investigate the willingness of general practitioners to provide dental care for preschool-aged children, and to explore the relationship between dental school experiences and practitioners' attitudes about treating Medicaid-enrolled children 3 years of age and younger. METHODS: A survey was mailed to 3,559 randomly selected general dentists in Texas. Respondents were asked to answer questions about their willingness to provide specified dental procedures for children of different ages, their dental school experiences with pediatric dentistry and whether these experiences were hands-on, lecture or no training, and their attitudes concerning treating Medicaid-enrolled children 3 years of age or younger. Associations between attitudes about treating Medicaid-enrolled children and dental school experiences were determined. RESULTS: The response rate was 26%. Almost all respondents were willing to provide routine procedures such as an examination (95%) and prophylaxis (94%) for children 5 years or younger. However, as children became younger and procedures more difficult, the number of general dentists willing to provide treatment decreased. The level of dental school training was significantly associated with the attitudes of general dentists about providing dental care for Medicaid-enrolled preschool-aged children (P < or = 0.05). CONCLUSION: Identification of factors associated with general dentists' willingness to see young children may improve access by increasing the number who will provide care for preschool-aged children.     

Louisiana dentists' attitudes toward the dental Medicaid program.

PURPOSE: This study was performed to determine factors associated with Louisiana dentists' participation in the Dental Medicaid Program. METHODS: Surveys were mailed to all pediatric and general dentists as reported by the Louisiana State Board of Licensing. A second mailing was made to non-respondents. RESULTS: Surveys from 956 of 1,926 dentists (50%) were returned. Of 607 general dentists and 40 pediatric dentists who treated dental Medicaid-enrolled children in the past year, 269 (44%) and 18 (45%), respectively, treated all Medicaid-enrolled children. Newly graduated dentists were more likely to be actively enrolled than their more established counterparts (chi 2 = 10.67; p = 0.01). Medicaid reimbursement levels were viewed as "much less" than private fees by 62%, "less" by 33% and "the same" by 4% of the respondents. Broken appointments were the most prevalent reported problem (80%), followed by low fees (61%), patient non-compliance (59%), unreasonable denial of payments (57%), slow payment (44%), and complicated paperwork (42%). With the exception of the perceived importance of Medicaid reimbursement levels, active and inactive general and pediatric dentists' perceptions of the importance of Medicaid issues were not significantly different. These findings indicated that significantly more Medicaid-active general dentists who allocated 10% of their office visits to Medicaid-eligible children felt that slow payment (p = 0.002) and complicated paperwork (p < 0.001) were more important problems than general dentists who allocated less time to Medicaid-eligible children. CONCLUSIONS: Louisiana dentists' sources of dissatisfaction with Medicaid are similar to those of dentists in other states. Some of the issues are programmatic and are within the power of the dental Medicaid director and state legislature to address. Patient-related issues such as frequent broken appointments may be addressed by assigning case managers to Medicaid beneficiaries.     

Dentists who practice with spouses or relatives: a pilot study of practitioners in Iowa

Of 130 practicing dentists in Iowa surveyed, 73, or 6% of the practicing dentists in that state, responded that they worked with a total of 108 relatives. Half of the relatives were the dentists' spouses. One to ten relatives worked in each office. Overall, the dentists were satisfied with the associations and expected them to continue. Most dentists had informally defined associations, and 10% had written contracts. Dentists named "office policy and organization" most often and "finances" least often as motives behind the associations and "personal growth" most often and "recognition" least often as a satisfaction with the association. The respondents suggested 567 ideas for other dentists considering such associations.     

General dentists' perceptions of educational and treatment issues affecting access to care for children with special health care needs

This study analyzed a data subset of a national survey of general dentists conducted in 2001 to determine their overall care of children with special health care needs (CSHCN). In the survey, dentists were asked to respond to questions in the following areas: did they provide care for CSHCN (children with cerebral palsy, mental retardation, and those who are medically compromised); what were their perceptions of the training they received in dental school related to CSHCN; what was their interest in additional training for CSHCN; and what factors influenced their willingness to provide care for CSHCN? Only about 10 percent see CSHCN often or very often, and only one in four respondents had hands-on experience with these patients in dental school. Postgraduate education in general practice or advanced general dentistry residency had no effect on willingness to care for CSHCN. Older dentists, those accepting Medicaid for all children, and those practicing in small communities were more likely to see CSHCN. Dentists willing to see CSHCN also were more likely to perform procedures associated with special needs and underserved child populations including pharmacologic management and stainless steel crowns. Dentists with hands-on educational experiences in dental schools with CSHCN were less likely to consider such factors as level of disability and patient behavior as obstacles to care and were more likely to desire additional education in care of CSHCN.     

A study into dentists' knowledge of the treatment of traumatic injuries to young permanent incisors

OBJECTIVE: The aims of this study were to evaluate dentists' knowledge of the emergency treatment of traumatic injuries to young permanent incisors, and to investigate barriers to treatment. DESIGN: A closed-ended questionnaire was sent to 1023 general dental practitioners (GDPs) and community dental officers (CDOs) in West/North Yorkshire and Humberside, UK. METHODS: The questionnaire comprised 17 questions. Six questions asked for general information about the participants (i.e. profession, age, gender, year of graduation, training or education on dental trauma, and willingness to provide emergency care), 10 were relevant to the emergency treatment of crown fractures, root fractures, luxation and avulsion injuries, and the last question queried any perceived barriers to treatment. Results. Seven hundred and twenty-four questionnaires were returned, a response rate of 71%, and these indicated that dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. The CDOs were significantly more knowledgeable than the GDPs, as were younger and more recently graduated dentists compared with older ones. The GDPs regarded the difficulty of treating children and the inadequate fees of the UK National Health Service as important barriers to treatment. Dentists who attended continuing dental education courses on dental traumatology had a more thorough knowledge than those who did not. CONCLUSION: Overall, the dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. Greater emphasis on undergraduate and postgraduate education in this area is indicated.     

Cooperation and competition between dentists and denturists in Finland

The aim of this study was to investigate cooperation between dentists and denturists in Finland, particularly in relation to perceived competition between the two professions. From a representative sample of 350 private dentists and 253 denturists, 68% returned acceptably filled-in questionnaires dealing with competition and cooperation with other healthcare professionals. Dentists referred their patients significantly (P < 0.001) less often to denturists (26.2%) than denturists did to dentists (94.1%). Those who referred their patients to members of the other profession also received patients from the other profession significantly (P < 0.001) more often than those who did not (60.7% vs 16.7% among dentists; 90.0% vs 44.4% among denturists). Denturists saw themselves as competing with dentists (56.0%) significantly (P < 0.001) more often than dentists did with denturists (29.2%). Dentists practicing in small towns or rural areas cooperated more often with denturists than did those practicing in more urban areas. Among denturists, the likelihood of referring patients to dentists was associated with younger age and fewer clinical working hours. It was concluded that cooperation between dentists and denturists was common. Oral healthcare professionals who referred their patients to the other profession also benefited by receiving more patients on referral from them. Dental services provided by denturists are limited, which may explain their greater willingness to cooperate with dentists.     

Training for dentists in smoking cessation intervention

BACKGROUND: Although dentists are ideally placed to deliver smoking cessation advice and assistance to their patients, smoking cessation interventions are not often incorporated as a routine part of dental care. Research is needed to identify factors that facilitate and inhibit dentists' capacities to deliver smoking cessation advice. METHODS: An initial focus group discussion was conducted in Melbourne with 10 dentists. Six Victorian country dentists were interviewed in depth by telephone. Following this qualitative data collection, a random sample of 250 dentists (response rate of 57 per cent) was interviewed by telephone. Dentists were asked about their perceived role, current practices, knowledge of resources and services and opinions on training in relation to smoking cessation. RESULTS: Dentists are willing to ask and advise patients about smoking, but are less inclined to assist patients to quit or arrange follow-up. Dentists are more likely to implement one-off, opportunistic interventions rather than take a systematic preventive approach. Dentists are interested in attending further education and say they require training to be relevant to the context of their day-to-day running of the dental practice. CONCLUSIONS: Training should aim to legitimize the dentist's role in smoking cessation and provide strategies and resources so that dentists can practise interventions as part of their day-to-day work.     

Characteristics of dentists participating in capitation and Preferred Provider Organization dental plans

BACKGROUND: In 1998, the American Dental Association Survey Center conducted a telephone and mail survey of U.S. dentists in private practice in an effort to determine the extent of dentists' participation in capitation and preferred provider organization, or PPO, dental plans and the characteristics of dentists who participate in those plans. METHODS: An initial telephone screening survey of a random sample of 11,550 dentists in private practice was conducted to identify dentists who participated in PPO or capitation dental plans. Dentists who participated in either of these plan types then were asked to complete a mail survey on their plan participation. RESULTS: The majority of dentists participating in either type of dental plan reported having never left a dental plan. Dentists who belonged to more than one PPO or capitation plan reported that a larger percentage of their patients were enrolled in these plans and that more of their practice's gross income came from the plans. Participation in PPO and capitation plans has had a positive impact on the practices of many of the responding dentists, particularly with regard to expanding their patient base. CONCLUSIONS: The authors found that the majority of dentists participating in PPO dental plans found it to be a positive experience overall. Dentists participating in capitation plans were less satisfied; more than 50 percent of capitation plan participants reported some level of dissatisfaction with the plans. The majority of dentists participating in a PPO plan expected to renew participation when their current contract expired; a much smaller percentage (though still a majority) of responding capitation-plan participants indicated the same. PRACTICE IMPLICATIONS: Responding dentists' overall indication of satisfaction with their current PPO plan participation probably indicates further growth for these dental plans. On the other hand, capitation plan participants seem much less satisfied with their plans. PPO plans, therefore, seem much more likely to be the type of plan that dentists will choose in the future.     

Perceptions of desirable tooth color among parents, dentists and children

BACKGROUND: As part of a large-scale fluoridation cessation study, standardized examiners assessed 8,281 school-aged children for dental fluorosis using the Thylstrup Fejerskov index, or TFI, in which scores range from 0 (no fluorosis) to 9 (severe loss of enamel with change of anatomical appearance). METHODS: Dentists, parents and children were asked to respond to a statement, "The color of these teeth (mine or my child's) is pleasing and looks nice." Agreement or disagreement with the statement was indicated on a five-level scale, with a rating of 1 representing total agreement with the reference statement. The authors used repeated-measures analysis of variance to ascertain differences in satisfaction with the esthetic appearance of the subject's tooth color across dentists', parents' and subjects' perceptions. RESULTS: Girls were more critical of their tooth color than were boys; however, parents and dentists were more critical of boys' tooth color than of girls'. While younger subjects were more critical than older subjects, parents of younger subjects were less critical than those of older subjects. Dentists' ratings were not significantly associated with subjects' age group. Subjects with a TFI score of 1 or 2 were not significantly more critical than subjects with a TFI score of 0, while those with a TFI score of 3 of higher were. Similarly, only parents of subjects with a TFI score of 3 of higher had significantly different ratings. CONCLUSIONS: The three stakeholders in the esthetic treatment of children-parents, dentists and patients-appear to see the potential outcome of such treatment differently. CLINICAL IMPLICATIONS: Dentists should ensure that parents and children agree about the course of treatment, the rationale for undertaking it and the results that could reasonably be expected.     

Practices and opinions of pediatric and general dentists in Connecticut regarding the age 1 dental visit and dental care for children younger than 3 years old

PURPOSE: This study aimed to determine the percentage of general and pediatric dentists in Connecticut that were aware of, and practice, the current AAPD guidelines for the age one dental visit and to determine the services they provide to 0-2-yr-old patients. METHODS: A survey was mailed to Connecticut general and pediatric dentists seeking information on practice type, years in practice, training, ages of children seen, procedures performed and opinions regarding the age one dental visit. RESULTS: The response rate was 42% for general dentists and 84% for pediatric dentists, giving a sample of 113 and 60 dentists, respectively. All responding pediatric dentists reported seeing 0-2-yr-olds as compared to 42% of general dentists. Although not statistically significant, general dentists who were female or in practice less than 10 years were more likely to see 0-2-yr-olds. The majority of pediatric dentists reported performing all procedures surveyed, however, only just over half of general dentists provided topical fluoride or restorative care. Among pediatric dentists, 98% were aware of the AAPD guidelines and 92% agreed with them compared to 41% and 45% of general dentists respectively. CONCLUSIONS: Nearly all Connecticut pediatric dentists are caring for 0-2-yr-olds compared to 42% of Connecticut general dentists.     

The involvement of Iowa dentists in hospice care

The relationships between dentist characteristics and professional education with involvement of Iowa dentists in hospice care were investigated. Using the 1999 Iowa Health Professional database, a survey requesting information regarding involvement in and training for care of hospice patients was mailed to all licensed dentists (N = 1,210). Two mailings yielded a 54.6% response rate. Of the 638 dentist respondents, the mean age was 47, 86% were male, 88% general dentists, and 295 (46%) reported providing some treatment for hospice patients. At least one dentist reported providing hospice patient care in 72 of Iowa's 99 counties. About 90% of dentists treating hospice patients were general practitioners. Males were more likely to provide treatment (p < 0.0313). Neither dentist age nor years in practice were significant predictors. Dentists were more likely to treat hospice patients in the office (IO, 40%). The most prevalent treatments were denture relines (31% IO; 71% OO), examinations (16% IO; 68% OO), and emergency treatment (12.5% IO; 53% OO). More than 86% of surveyed dentists indicated that their professional education did not adequately train them to meet the clinical, psychosocial, communication, or spiritual needs of hospice patients.     

Opinions on the provision of dental care in Iowa nursing homes

Using a stratified random sample, a questionnaire was mailed to 400 practicing dentists and 200 directors of nursing (DONs). Response rates were 58.3% for dentists and 50% for DONs. Dentists were representative of Iowa dentists, with 85% male, mean age 49.1 years, and 22.4 years in practice. All DONs were female, with mean age of 44.9 years. Of the participating dentists, 86% had provided dental care for nursing home residents, but the majority of care was completed in dental offices. Three‐quarters of dentists were somewhat/not interested in nursing home dentistry. Dentists and DONs held common perceptions of the most frequent problems related to care provision at nursing homes: low financial reimbursement, especially for Medicaid patients; no portable dental equipment; no suitable area for dentistry; dentist's preference to treat patients at their dental practice; and transportation of residents to a dental practice. Dentists and DONs had some differing perceptions about oral health care (p < .01). Minimal dental care was provided on‐site at Iowa nursing homes.     

Antibiotic use for treating dental infections in children: a survey of dentists' prescribing practices

BackgroundThe authors conducted a study to examine the antibiotic prescribing practices of general and pediatric dentists in the management of odontogenic infections in children.MethodsThe authors relied on a cross-sectional study design to assess the antibiotic prescribing practices of general and pediatric dentists in North Carolina. The survey instrument consisted of five clinical case scenarios that included antibiotic-prescribing decisions in a self-administered questionnaire format. The participants were volunteers attending one of four continuing education courses. The authors invited all pediatric dentists in private practice to participate in the study, as well as general practitioners who treated children in general practice. The authors compared the practitioners&;apos; responses for each clinical case scenario with the prescribing guidelines of the American Academy of Pediatric Dentistry and the American Dental Association.ResultsA total of 154 surveys were completed and returned (55 percent response rate). The mean age of respondents was 47 years, and the mean number of years in practice was 19. Of the 154 overall, 106 (69 percent) were general practitioners and 48 (31 percent) were pediatric dentists. Across the three in-office clinical case scenarios, adherence to professional prescribing guidelines ranged from 10 to 42 percent. For the two weekend scenarios, overall adherence to the professional prescribing guidelines dropped to 14 and 17 percent. Dentists who had completed postgraduate education (n = 73 [51 percent]) were more likely (P < .05) to have adhered to published guidelines in prescribing antibiotics.ConclusionsThe results of this survey show that dentists&;apos; adherence to professional guidelines for prescribing antibiotics for odontogenic infections in children was low. There appears to be a lack of concordance between recommended professional guidelines and the antibiotic prescribing practices of dentists. Clearer, more specific guidelines may lead to improved adherence among dentists.