The care of the primary dentition by general dental practitioners and paediatric dentists

Objectives: This study aimed to explore the preferred treatment for pre-school children with caries of different severities in primary teeth among general dental practitioners (GDPs) and specialists in paediatric dentistry (PDs) in Hong Kong, and to determine the difference in practice patterns between the groups. Methods: A random sample of 476 GDPs (approximately 25% of all registered dentists) and all registered PDs (n = 28) were invited to participate in the study. Both groups were asked to select their single most preferred treatment option on eight hypothetical clinical case scenarios in which the severity of dental caries in a single primary molar/incisor of a 4-year-old healthy and cooperative boy differed. The distribution frequency of responses was tabled. Difference in the care approach patterns of GDPs and PDs were examined in bivariate and regression analyses. Results: The overall response rate of the study was 61.5% (310/504). There were significant differences between the GDPs and PDs on their preferred treatment in six out of eight case scenarios (P < 0.05). PDs favoured comprehensive restorative treatment more than GDPs. Non-interventionist approach, atraumatic restorative technique or extraction were more popular among GDPs. Variation in treatment choices was apparent within both GDPs and PDs, in which spread of treatment options was wider among GDPs. Conclusions: GDPs and PDs have different dental care approach patterns for pre-school children with dental caries. Wide variation in the views about the best way to treat the child exists within both groups.     

Evaluation of a continuing education intervention "Periodontics in General Practice"

Abstract Evidence exists that some dentists may be failing to perform adequate periodontal diagnostic and preventive care for their patients. Continuing education (CE) is an avenue that is frequently employed as a strategy to alter the style of practice. This paper presents an evaluation of a year-long continuing education intervention “Periodontics in General Practice”, conducted among randomly selected private general dental practices in Adelaide. South Australia. The CE intervention featured a 1-day seminar, bi-monthly newsletters, individualised 3-monthly comparative feedback, and technical assistance. The study employed a longitudinal quasi-experimental design, which allowed for evaluation of the effectiveness of the intervention among practices employing hygienists (n: = 12) and not employing dental hygienists (n: = 12), taking into account the covariates of baseline level of provision of periodontal services, the practice's level of participation in the intervention and attendance at other CE courses in periodontics over the year. A comparison group of practice (n: = 12) did not participate in the intervention over the year. Patient record audits, conducted at baseline and at 12 months, provided data for the evaluation of the effect of the intervention on the recording of periodontal diagnostic, preventive and treatment items. Practices participating in the intervention showed increases in the percentage of records containing at least one periodontal diagnostic notation, and those practices employing hygienists showed an increase in the percentage of records with at least one preventive notation and one treatment item. Using ANCOVA to account for covariation, the main effect of the study group was significant in explaining changes in the provision of preventive periodontal services. The results indicate that an extended continuing education intervention can have significant effect on the provision of periodontal services, and that the magnitude of the effect differs between practices employing and not employing hygienists.     

Do self-assessed oral health and treatment need associate with clinical findings? Results from the Finnish Nationwide Health 2000 Survey

Objective. To associate self-assessed oral health and treatment need with clinically determined findings. Materials and methods. As part of the Finnish nationwide comprehensive Health 2000 Survey, the present cross-sectional study included dentate participants aged 30–64 years who self-assessed their oral health and treatment need in an interview and who underwent a clinical oral health examination (n = 4385). Self-assessed oral health and treatment need were used as subjective indicators. Clinically determined dental and periodontal status described objective dental and periodontal health and treatment need. The evaluation of relationships between subjective and objective findings was based on two-by-two tables and multivariate analyses. Results. The better the self-assessed oral health, the better the objective dental and periodontal health. Those reporting need for treatment more often had the objective need in terms of dental or periodontal treatment, also when controlling for background factors. Of the subjective indicators, good self-assessed oral health best reflected the absence of clinically determined dental or periodontal treatment need. Those who reported a need for treatment were mainly adults with an objective dental and periodontal treatment need. Conclusions. Self-assessed good oral health is a fairly good estimate for the absence of clinically determined dental and periodontal treatment need. As implication for practice, self-assessed data could be used for screening purposes for oral health service planning and for priority allocation in large adult populations.     

The effects of periodontal curette handle weight and diameter on arm pain: A four-month randomized controlled trial

BackgroundThe design of periodontal curette handles may cause or aggravate arm pain in dental practitioners. The authors conducted a four-month randomized controlled trial to evaluate the effects of curette handle diameter and weight on arm pain among dental hygienists and dentists.MethodsOne hundred ten dental hygienists and dentists who performed scaling, root planing or dental prophylaxis procedures participated in this study. The authors assessed right wrist/hand, elbow/forearm and shoulder pain levels weekly. They randomized participants to receive either a set of light (14 grams) periodontal curettes with a large diameter (11 millimeters) or a set of heavy (34 g) periodontal curettes with a narrow diameter (8 mm). The authors compared changes in mean pain scores across the study period between intervention groups by using general linear models and controlling for covariates.ResultsThe improvement in pain scores across the three body regions was greater for participants who used the lighter, wider-diameter curettes. In the final adjusted model, the differences were statistically significant only for the shoulder region (P = .02).ConclusionsThe study results show that dental instrument design has an effect on upper-extremity pain in dental practitioners. Using a lighter instrument with a wider diameter may be an easy and cost-effective intervention to reduce or prevent upper-extremity pain associated with dental hygiene procedures.Clinical implicationsTo prevent or reduce arm pain, practitioners should consider using lightweight instruments with large diameters when performing scaling and root planing procedures.     

A survey to investigate shortfalls in the dental care professional (DCP) workforce in South Yorkshire in 2004.

AIM: To determine the composition of the dental care professional (DCP) workforce in South Yorkshire, the existence of any training requirements, and future intentions and motivations relating to the provision of National Health Service (NHS) dental care. METHODS: The study used mixed methods and incorporated a cross-sectional postal questionnaire and focus groups. The questionnaire was sent to all NHS dental practices in South Yorkshire (n=201) for completion by a principal general dental practitioner (GDP). Focus groups were held with GDPs in these practices. RESULTS: Responses were received from principal GDPs at 156 practices (78%). A total of 624 dental nurses, 65 dental hygienists and 24 dental therapists were employed in the responding General Dental Services (GDS) practices, representing whole-time equivalents (WTEs) of 458.5, 18.5 and 10.1, respectively. Many practices had current vacancies for DCPs, with 24.9 WTE available for dental nurses, 3.7 WTE for dental hygienists, and 5.0 WTE for dental therapists. Workforce shortages were evident among dental nurses (5.2%), dental hygienists (16.7%), and dental therapists (33.0%). Principal GDPs suggested that improved terms and conditions of employment for DCPs, particularly dental nurses, might aid recruitment and retention in NHS practice. CONCLUSIONS: Respondents perceived that there were shortages in the DCP workforce in South Yorkshire. Initiatives are required to address these shortages.     

Adequacy of Oral Health Information for Patients with Diabetes

Objective: We investigated the perception of dental hygienists regarding their adequacy of providing diabetics with diabetes‐related oral health preventive education. Methods: A one‐page questionnaire printed on both sides was mailed to 2,237 licensed registered dental hygienists with a South Carolina (SC) mailing address. In addition to the dental hygienists' background and practice characteristics, their perception of adequacy for educating patients with diabetes on various diabetes‐related oral health topics and reasons for inadequate coverage of materials were queried in the survey. Results: After two follow‐up mailings, 995 completed and usable surveys were returned. An average of 93.6 percent of respondents indicated that they adequately covered topics of oral hygiene and general oral health issues. However, about 60 percent of respondents reported not covering all essential materials related to oral health when educating diabetic patients. The three most common reasons were: a) insufficient time (60.1 percent); b) patient disinterest (41.2 percent); and c) insufficient information on oral care and diabetes (39.7 percent). Respondents reporting insufficient information were less likely to adequately address the effect of periodontal disease on diabetes (P < 0.001), effect of uncontrolled diabetes on periodontal disease (P < 0.001), and dry mouth management (P = 0.03). Conclusion: This study indicates that SC dental hygienists do not routinely provide patient education on diabetes‐related oral health and healthy lifestyle topics. Lack of time, patient disinterest, and insufficient information were the three main reasons for respondents not covering these essentials. A practical method for improving dental hygienists' comprehensive service to patients with diabetes is to offer them more continuing education on diabetes and oral health to supplement their knowledge, skills, and confidence to educate this growing population.     

Ten-year follow-up on adoption of endodontic technology and clinical guidelines amongst Danish general dental practitioners

Objective: The aim of this study was to re-assess the adoption of certain endodontic technology and central treatment principles of root canal treatments as advocated by guidelines presented by the European Society of Endodontology.

Material and methods: The questionnaire included the same questions in 2003 and 2013. The general dental practitioners (GDPs) anonymously reported how frequent (‘often’, ‘occasionally’, and ‘never’) they used certain endodontic technology and adhered to central treatment principles. The statistical analyses were performed using Chi-squared test and Goodman–Kruskal’s γ-coefficient as an association measure.

Results: The overall response rate of the 2013 group was 46.5% (n?=?531). The frequencies of GDPs reporting often use of rubber dam, apex locator and rotary NiTi instruments were significantly higher (p?p?p?=?.601) and time since graduation (p?=?.361), and the cluster analyses revealed the neglected use of rubber dam to be associated with no established postoperative recall system.

Conclusions: After 10 years, there was a higher frequency of GDPs who had adopted certain endodontic technologies. However, progress towards high-quality root canal treatment might be obstructed as the majority of GDPs avoids consistent use of rubber dam, and routinely neglects recalls for postoperative controls of their endodontic treatments.     

Salivary diagnostics for periodontal diseases

Background and OverviewThe use of salivary diagnostics continues to develop and advance the field of risk determination for periodontal diseases. Researchers are investigating genetic, microbial and protein biomarkers with the objective of translating findings to such aspects of clinical care as broad patient screening, monitoring and treatment planning.MethodsIn this review, the author briefly explores currently available salivary diagnostics used to identify bacteria prevalent in periodontal disease, and focuses on the future development and use of a variety of rapid disease detection platforms, such as lab-on-a-chip, as a point-of-care device for identification of patients' risk.Conclusions and Clinical ImplicationsSeveral diagnostic tests are commercially available, and point-of-care tests are under development. However, challenges remain regarding the introduction of these technologies to clinical practice and adoption by dental practitioners for promotion of personalized oral health care.The author explores currently available salivary diagnostics for periodontal disease and focuses on future developments in the field.     

Knowledge and competence in temporomandibular disorders among Swedish general dental practitioners and dental hygienists

Objective: The aim of this study was to investigate knowledge and competence in temporomandibular disorders (TMD) among dentists and dental hygienists working in the public dental service (PDS) in Sweden.

Materials and methods: The study population comprised all general dentists (n?=?110) and dental hygienists (n?=?80) working in the PDS in two Swedish counties: Kronoberg (K) and Blekinge (B). The participants filled out a questionnaire comprised of 15 questions.

Results: The results of these questions are presented. The overall response rate for the general dentists was 87%, while the rate for the dental hygienists was 71%. Statistically significant differences between the general dentists in the two counties were found regarding the following: education in the field of TMD over the last 5 years (K: 37%, B: 73%), evaluation of occlusion when examining patients with suspected TMD (‘always’: K: 61%, B: 82%), and a desire for consultation of the OFP (orofacial pain)/TMD specialist by telephone (K: 71%, B: 44%). Regarding the dental hygienists, there was a statistically significant difference concerning the use of the treatment modality ‘reassurance’ (K: 41%, B: 7%).

Conclusions: The majority of the dental care providers in both counties – irrespective of professional category – had a positive attitude towards patients with TMD. Knowledge and competence in the field are sparse and require postgraduate education. There is a great need of an OFP/TMD specialist for more complicated patients and a need to implement updated knowledge and competence in the PDS in these two counties.     

Differences in Characteristics of California Dentists Who Employ Dental Hygienists and Those Who Do Not

BackgroundDental hygienists can increase dentists’ productivity, yet nationwide, one-third of dentists do not employ a hygienist. The profession needs more information on the characteristics of these dentists and their reasons for not employing hygienists.MethodsThe author used a 2003 survey of California dentists and a logistic regression analysis to assess factors independently associated with dentists’ employment of hygienists. These factors included dentists’ personal, practice, population, productivity and patient care characteristics. She also assessed characteristics of dentists who did not employ hygienists and their reasons for not doing so.ResultsDentists who worked full time, employed more administrative personnel, had more operatories, had longer appointments, had more income from private payers and had more elderly patients were more likely to employ hygienists than were dentists with alternative characteristics. Graduates of dental schools outside the United States and those with fewer white patients were less likely to employ hygienists. Reasons for not employing hygienists included personal choice, high costs and not having a sufficient volume of work.ConclusionsThe author's findings suggested that in employing hygienists, dentists consider preferences, practice income and patient demand, among other factors. Further examination of reasons for employing hygienists is warranted.Practice ImplicationsHiring a hygienist increases a dental practice's patient capacity, yet not all dentists can or choose to do so. Policies aimed at increasing dental workforce capacity must take into account dentists’ characteristics and preferences.     

Service mix in general dental practices employing and not employing dental hygienists

Abstract Service mix studies conducted in Australia have indicated a low provision of periodontal services. The service mix in Australian general dental practices employing dental hygienists has not been studied. This study compares the service mix between 18 practices employing hygienists and 29 practices not employing hygienists in Adelaide. Practices employing hygienists tended to be larger group practices, with younger dentists seeing a younger set of patients. Practices employing dental hygienists provided a mean of 97.9 services to 57.2 patients over 2 days, significantly higher than the mean of 68.8 procedures to 39.1 patients in practices not employing dental hygienists. Comparing the % of procedures provided in treatment categories as a ratio of total procedures, practices employing dental hygienists provided significantly more periodontal procedures and less oral surgery, prosthetic and restorative procedures. Periodontally-related services accounted for an average of 37.7% of procedures in practices employing dental hygienists compared with 18.9% in practices not employing dental hygienists (p(0.05). Periodontal and preventive treatment of 50.7%) of patients in practices employing hygienists was delegated to a hygienist, and the level of delegation of periodontally-related procedures was 77.2%. Over 90% of procedures performed by hygienists were periodontally-related, with the removal of subgingival calculus accounting for 57.7% of all procedures provided by dental hygienists. In conclusion, practices employing hygienists had a more periodontally-orientated service mix, with hygienists acting to complement the services of dentists in the provision of periodontal services, rather than as a substitute for the dentist.     

Clinical manifestations of gastrointestinal diseases in the oral cavity

AimIn this review, several gastrointestinal diseases that dentists may encounter in practice are highlighted and discussed.Materials and methodsUsing MEDLINE (PubMed), a comprehensive review of gastrointestinal diseases and their oral cavity manifestations was performed.ResultsMany gastrointestinal diseases present with oral symptoms that are detectable by dentists and dental hygienists. Often, oral manifestations of the disease may appear before systemic signs and symptoms. Managing patients with these conditions requires dentists to adjust their treatment and/or involve other health professionals.ConclusionCare must be taken when providing periodontal therapy or dental implants to patients suffering gastrointestinal diseases who are at high risk of bleeding, infection, or malnutrition, for example. Also, pharmacological therapy for these patients may need to be customized.     

Predictors of recall assignment decisions by general dental practitioners performing routine oral examinations

The aim of this study was to explore the decision‐making behavior of general dental practitioners (GDPs) in performing routine oral examinations (ROEs). Change over time was studied by comparing data from a cohort sample of participants in two surveys in 2000 and 2005. A written questionnaire was sent to 809 dentists (509 responses were obtained) and 475 (61%) were used for analysis. Of the respondents, 347 also participated in the survey in 2000. The mean number of diagnostic ROE items per ROE was 6.9 (standard deviation = 1.7). Groups of GDPs were distinguished based on their answer to the question ‘Do you apply for all patients a fixed recall interval between two successive ROEs?’ and four personal profiles. Of the GDPs, 38.5% (n = 183) assigned fixed recall intervals (Fxs) for all patients. Individual recall intervals (Ivs) were applied by 61.5% (n = 292) of GDPs, depending on specific selected patient characteristics and risk factors. Logistic regression showed that GDPs applying Fxs also used fixed periods between successive bitewing radiographs. Furthermore, GDPs applying Ivs conducted more frequent periodontal screening and, in the event of periodontal problems, were more inclined to prescribe radiographs. Over a 5 yr period, a shift towards Ivs assignment (from 49% in 2000 to 61.5% in 2005) was found. Differences in assigned recall intervals (Fxs/Ivs) by GDPs are determined by three clinical ROE predictors and two GDP profiles. A shift towards a more individual assessment was found between 2000 and 2005 in the way that Dutch GDPs are dealing with the assignment of recall interval frequency.     

Expanding Oral Care Opportunities: Direct Access Care Provided by Dental Hygienists in the United States

Dental hygienists expand access to oral care in the United States.BackgroundMany Americans have access to oral health care in traditional dental offices however millions of Americans have unmet dental needs. For decades dental hygienists have provided opportunities for un-served and under-served Americans to receive preventive services in a variety of alternate delivery sites, and referral to licensed dentists for dental care needs.MethodsPublications, state practice acts, state public health departments, the American Dental Hygienists' Association, and personal interviews of dental hygiene practitioners were accessed for information and statistical data.ResultsDental hygienists in 36 states can legally provide direct access care. Dental hygienists are providing preventive services in a variety of settings to previously un-served and under-served Americans, with referral to dentists for dental needs.ConclusionDental hygienists have provided direct access to care in the United States for decades. The exact number of direct access providers in the United States is unknown. Limited research and anecdotal information demonstrate that direct access care has facilitated alternate entry points into the oral health systems for thousands of previously un-served and underserved Americans. Older adults, persons with special needs, children in schools, pregnant women, minority populations, rural populations, and others have benefited from the availability of many services provided by direct access dental hygienists. Legislatures and private groups are becoming increasingly aware of the impact that direct access has made on the delivery of oral health care. Many factors continue to drive the growth of direct access care. Additional research is needed to accumulate qualitative and quantitative outcome data related to direct access care provided by dental hygienists and other mid level providers of oral health services.     

Hygienist employment and the presence of periodontal notations in general dental practice patient records

Available data suggest that the provision of periodontal ly related services in general dental practices is low. However, studies indicate that the employment of dental hygienists is associated with increased provision. One method of measuring is by examination of notations in patient treatment records. As part of a project assessing the effectiveness of professional education in changing the provision of periodontal services, 2280 records, comprising 60 randomly selected records of dentate adult patients who had received a dental examination in the previous 6 months were audited in each of 38 practices, 13 of which employed hygienists. Entries of a periodontal nature were classified under 3 categories: diagnostic, preventive and treatment. The presence or absence of each item on each record was recorded. Diagnostic services were notated infrequently overall, but practices employing hygienists had a significantly lower number of records with no diagnostic notations. Preventive items were more frequently notated in practices employing hygienists. Treatment items were most frequently notated in both types of practices. Overall, 13 of the 23 items were recorded significantly more frequently in practices employing hygienists.     

Working profiles of dental hygienists in public and private practice in Finland and Norway

Abstract: Aim: The aim was to compare the working profiles of Finnish and Norwegian dental hygienists in public and private practice. To this end, we compared the procedures performed, the type of patients and the time devoted to different tasks. Subjects and methods: A questionnaire survey was originally conducted among a representative sample of dental hygienists in Finland (n = 595) and all authorized dental hygienists in Norway (n = 1 138) in 2004. The questionnaires collected data on the dental hygienists’ age, gender, year of graduation, working experience, work sector (private or public), working time spent on different activities and patient groups. The questionnaire also assessed how frequently the dental hygienists performed 25 different treatment measures. Results: The Norwegian dental hygienists spent 45.4% of their clinical time on check‐ups, whereas the Finns spent 49.9% of their time scaling. Dental hygienists in Finland and Norway working in the public sector spent 42.9% and 74.6% of their working time dealing with children and youth respectively. Conclusions: The working profiles of dental hygienists in Finland and Norway were quite similar, although differences in distribution by activities, type of patients and treatment measures do exist. The main activity of the dental hygienists was clinical work. The most commonly practised clinical activity among Finnish dental hygienists was scaling, and among Norwegians, check‐ups. Public dental hygienists in both countries dealt mainly with children and youths. Oral hygiene instruction was the most commonly reported treatment measure among both Finns and Norwegians.     

Differences in the assessment of restorative dental care

Caries diagnosis and assessment of restorations show a considerable variation between examiners. It can therefore be questioned whether a professional standard is available on this topic. In this study the judgement of general dental practitioners of the quality of restorative care and the number of adequately and inadequately treated teeth was compared to the judgement of dentists working in teaching institutes. Thirty general dental practitioners and 7 university dentists assessed occlusal photographs and bitewing radiographs of 20 patients with respect to the presence of caries and the quality of restorations. The general dental practitioners gave lower scores on a traditional schoolmark scale than the university dentists, but the latter scored more homogeneous. The agreement (Cohen's kappa) between pairs of examiners was similar for GDPs and experts. The expert group tended to have a more conservative attitude towards the level of restorative treatment to be judged. A univocal professional standard with respect to caries diagnosis and restoration assessment seems difficult to establish.     

Empowerment Through Mentorship and Leadership

Leadership is vital to future growth and change in the dental hygiene profession.Background and PurposeAs health care reform emerges, state practice acts expand and new models of dental hygiene practice are created and implemented, dental hygienists will assume leadership positions that may be quite different from the more traditional leadership roles they assume today. These dental hygienist leaders will envision, creatively design and implement oral health care programs to improve the oral health of the public. Mentoring, a vital component of leadership development, is critical for dental hygienists to acquire knowledge, guidance, and growth.MethodsThis paper provides a literature-supported overview of leadership and mentoring principles applicable to dental hygienists in their personal and professional lives. Opportunities for dental hygienists to assume leadership roles are also described.ConclusionsDental hygienists are poised to become leaders and vital members of the professional team promoting and integrating oral health care as a part of general health. Consequently, the dental hygienist's leadership roles are likely to expand and can be strengthened through mentoring relationships and mentoring teams. Ultimately, this can increase professional growth and career satisfaction for the dental hygienist as well as improve oral health care for the public.     

Korean dental hygienists' knowledge and opinions about etiology and prevention of dental caries

Objectives: Because of their formal education Korean dental hygienists have the potential to be the primary source of information on caries prevention for patients and the general public, and inuence the use and adoption of caries preventive procedures. The purposes of this study were to determine the knowledge and opinions about caries etiology and prevention among Korean dental hygienists, and to describe associated factors. Methods: A pre-tested, 20-item questionnaire was mailed to 1120 dental hygienists selected by stratied d random sampling and allocated proportionately. A postcard reminder was sent to all dental hygienists after 1 week. Non-respondents were sent additional complete mailings after 3 and 7 weeks. The response rate was 77% (n=863). Results: Analysis of six factors thought to be related to knowledge about caries etiology and prevention showed that dental hygienists who were taught to provide oral health education and believe that it is desirable to practice oral health education during dental hygiene school and those employed in health centers were likely to be more knowledgeable about caries etiology and prevention than other hygienists (P < 0.05). In regression analysis of the perceived effectiveness of caries preventive procedures, hygienists who provided oral health education during their formal training tended to rate caries preventive procedures as being more effective than other dental hygienists (P < 0.05). Conclusions: Overall, the results of this study suggest that most dental hygienists do not have up-to-date information on the etiology and prevention of dental caries, mechanisms of action ofuoride e and effectiveness of preventive procedures. Efforts to increase the level of knowledge of Korean dental hygienists about caries prevention should focus on strategies to educate dental hygienists who have not been taught to provide oral health education, who do not have favorable opinions about the desirability of oral health education, and who had no experience with providing oral health education as part of their work, especially hygienists working in private clinics. Further, these efforts should include the revision of dental hygiene curricula and continuing education courses.