Provision of care to the underserved populations by National Health Service Corps alumni dentists

OBJECTIVE: This study examined factors associated with dentists continuing to provide care to the underserved populations beyond their National Health Service Corps (NHSC) obligation period. METHODS: Self-administered questionnaires were mailed in 1998 to 404 dentists who had completed their service obligation between 1980 and 1997. The outcome variable was dentist self-report of continuing to work with the underserved population past NHSC obligation. RESULTS: Among 249 respondents (62% response rate), 46 percent of alumni dentists continued to work with an underserved population. Multivariate analyses found that being an African American (odds ratio [OR] = 3.2), higher final salary during the NHSC assignment (OR = 1.2), and higher altruistic motivation to work with the underserved populations prior to entering NHSC (OR = 1.1) were significantly associated with continued service to the underserved populations. CONCLUSIONS: A small number of factors were associated with alumni NHSC dentists' decisions to continue to provide care for the underserved populations. Targeting African-American students and students interested in caring for the underserved may improve the long-term commitment of dentists to provide care for the underserved populations. Attention will also need to be given to increased salary as a potential intervention to increase the numbers of dentists who continue to serve the underserved populations.     

Quality of orthodontic treatment performed by orthodontists and general dentists: A blind comparative evaluation

Objective:To perform a blind comparative evaluation of the quality of orthodontic treatment provided by orthodontists and general dentists.Materials and Methods:Sixty cases of orthodontic treatment were evaluated—30 treated by specialists in orthodontics and 30 treated by general dentists with no specialization course. Orthodontists were selected randomly by lots, in a population of 1596 professionals, and recordings were performed based on the guideline established by the Objective Grading System proposed by the American Board of Orthodontics. Each participant was asked to present a case considered representative of the best outcome among the cases treated, regardless of the type or initial severity of the malocclusion. Statistical analysis involved the chi-square, Wilcoxon, and Mann-Whitney tests. The level of significance was set at P  =  .05 for the statistical tests.Results:The results showed that 29 orthodontists (96.7%) presented cases considered satisfactory and would be approved on the qualification exam, whereas only 15 dentists (50%) had cases considered satisfactory. Moreover, treatment time was significantly shorter among the orthodontists (P  =  .022), and the posttreatment comparison revealed that orthodontists achieved better outcomes considering all the variables studied.Conclusions:Orthodontists spend less time on treatment and achieve better quality outcomes than cases treated by general dentists who have not undergone a specialization course in orthodontics.     

Developmental problems concerning children's oral functions,based on a questionnaire administered to dentists and guardians

ObjectivesThis study aimed to clarify the importance of dental support for eating problems of infants, young children and disabled children, based on a questionnaire survey administered to dentists and guardians.Materials and methodsThe respondents consisted of 1001 dentists, pediatric dentistry administrators randomly selected by each prefectural or municipal dental association, and 1031 guardians of preschoolers who attended kindergartens or children's day-care centers. Answers were received from 712 dentists and 844 guardians. We compared answers to question No. 16 for dentists and questions No. 23 & 26 for guardians. Furthermore, we compared free comments to question No. 16 for dentists and answers to No. 27 for guardians. Question No. 27 for dentists and question No. 21 for guardians similarly asked about children's eating problems, and we thus next compared the tendencies noted in answers to these questions. In addition, a componential analysis was conducted for free text answers to question No. 31 for dentists and question No. 34 for guardians to qualitatively examine “free comments to children's eating problems”. Free comments were statistically analyzed using a text-mining approach in IBM SPSS Text Analytics for Surveys.ResultsThe results revealed that guardians had more concerns about the following issues (relative to dentists): “vegetables” (23-fold) and “picky eating/fad eating/biased eating” (eight-fold). Issues of more concern to dentists (relative to guardians) were “mastication/chewing” (two-fold) and “dental caries/decay” (1.3-fold).ConclusionsThis study suggested that guardian's anxieties regarding children's eating problems have variable background factors.     

Attitudes of dentists, working in Riyadh, toward people with a sensory impairment

This study was conducted to determine the attitudes of dentists, working in Riyadh, toward people with a sensory impairment (SI), according to the Scale of Attitude Towards Disabled Persons (SADP). The SADP scale was modified to focus solely upon sensory impairment. The modified scale was pre-tested and then incorporated into a self-administered questionnaire. This was then administered to 600 dentists (response rate, 73.7%) working in the city of Riyadh, Saudi Arabia. The modified scale showed itself to be reliable, with a Chronbach's coefficient α 0.616 and four-factor analysis, which accounted for 38.5% of the variance. Ninety-four percent of the dentists were generally positive toward SI in the society. There were, however, significant variations in attitudes, with a more positive score for dentists who had worked for 30 years or more ( p ± 0.005), were specialists ( p < 0.005), received little or no undergraduate training in this subject ( p < 0.05), and who received their undergraduate training in Europe/North America ( p < 0.001). However, in a stepwise regression model, all these variables were significant except for the years of practice. The modified SADP showed dentists, working in Saudi Arabia, having a positive attitude toward people with SI.     

Attitude of a group of South Africans toward advertising by dentists in private practice]

The advertising of dental services in South Africa is controlled by rules and regulations of the South African Medical and Dental Council. According to these, advertising is not permissible with the exception of specified professional information which may be made known only by means of a nameplate and an entry in a telephone directory. Questionnaires were sent to a randomised sample of 2,100 persons in order to determine the attitude of South Africans towards advertising by private practitioners. According to information obtained from this study there is a strong indication that consumers of dental services prefer a freer form of advertising by dentists in the private practice.     

Tobacco and oral health: attitudes and opinions of European dentists; a report of the EU working group on tobacco and oral health

AIM: To discover whether dentists are prepared to advise their patients to stop smoking. DESIGN: Postal questionnaire. SETTING: Member countries of the European Union. PARTICIPANTS: Dentists in 12 EU countries. MAIN OUTCOME MEASURES: Dentists' knowledge of links between tobacco-use, general health and periodontal health. Knowledge of, and preparedness to offer, tobacco-cessation activities for patients. Personal and practice smoking policies. RESULTS: EU-dentists are aware of the harmful effects of tobacco use in general and on oral tissues in particular. Over two-thirds of EU-dentists feel that offering information about tobacco cessation is the dentist's duty, while slightly less actually do so. Lack of time and reimbursement mechanisms are the most often mentioned barriers for co-operation with a campaign. Less than 10 per cent of EU-dentists smoke every day while three-quarters of practices are totally smoke free. CONCLUSIONS: EU-dentists want to be informed and supported on the issue by leaflets, brochures, continuing education and patient education materials. More attention should be paid to the relation of smoking and implant failure.     

Toothache pain: a comparison of visits to physicians, emergency departments and dentists

BACKGROUND: Researchers' understanding of the use of emergency departments (EDs) and physicians' offices for the treatment of toothaches is limited. The authors conducted a study to explore their use by low-income and minority adults in comparison with the use of traditional dental services. METHODS: Participants included low-income white, African-American and Hispanic adults who had experienced a toothache during the previous 12 months. A stratified random sample of 4,200 households in Maryland participated in a cross-sectional telephone survey. Trained survey staff completed interviews with someone in 272 (68.3 percent) of 398 eligible households. RESULTS: Only 8.7 percent of respondents contacted an ED for toothache pain relief, while 20.1 percent contacted physicians. The majority of respondents who contacted an ED (80.5 percent) or a physician (82.6 percent) also contacted a dentist. Contacts with a dentist were reported by 58.6 percent of respondents. The authors conducted tabular analyses using chi(2) tests of statistical significance (P < .05) and SUDAAN's multivariable logistic regression procedure (Research Triangle Institute, Research Triangle Park, N.C.) (P < .05). CONCLUSIONS: Respondents experiencing toothache pain ultimately sought definitive resolution of their pain from dentists while visiting EDs and physicians for temporary relief. Access to dentists' services was particularly problematic for Hispanics and was exacerbated by health literacy issues. CLINICAL IMPLICATIONS: The elimination of oral health disparities must involve consideration of cultural influences on minority populations, as well as the responsibilities of the dental profession.     

Recruitment and standardization of a group of Australian dentists for a multipractice study on dental caries prevention

BACKGROUND: This introductory paper details the recruitment and standardization of a group of dentists participating in a clinical trial. The trial is being undertaken to determine the cost-effectiveness of a structured preventive programme compared to standard care within private dental practices. We recruited private dental practitioners from a variety of locations in New South Wales (NSW) and the Australian Capital Territory (ACT). We sought to quantify the diagnostic reliability of dentists involved, and to define, quantify, and analyse standard care. METHODS: This is a multi-centre, clustered randomized controlled trial, where dentists are allocated to an intervention preventive or control group. Recruitment was facilitated with the support of key stakeholders and included oral presentations at divisional meetings of the Australian Dental Association, NSW Branch (ADA). A detailed time-in-motion study of 426 dental procedures was undertaken in order to define the parameters of standard care. The reliability study involved each dentist reading a set of 12 pairs of bitewing radiographs that had been produced and reviewed under standardized conditions. The reliability analysis was undertaken blind to allocation status of the dentist. RESULTS: Recruitment ceased three months into the planned six-month recruitment period, 31 practices having approached the researchers. Eight suburban, five Central Business District (CBD), five rural (in fluoridated communities), and four rural (in non-fluoridated communities) practices have been recruited. Standard care did not differ significantly between intervention and control practices (Mann-Whitney U: z = -0.50; P = 0.6). Diagnostic reliability was substantial (Kappa = 0.79 [range 0.73-0.811 and 0.78 [range 0.72-0.82]) in relation to the intervention and control practices, respectively; P = 0.6. CONCLUSION: The involvement of private dental practices in research is feasible and well supported by the profession. Standard care does not differ significantly between intervention and control practices. Inter- and intra-observer reliability was substantial, and not statistically different between the two arms of the trial.     

Musculoskeletal symptoms of dentists assessed by a multidisciplinary approach

Musculoskeletal health was studied as part of a comprehensive health examination in 131 professionally active dentists. 42% of dentists had experienced pain and disability (interference with daily activities) by neck-shoulder problems during the preceding year, with a tendency to greater prevalence in salaried dentists than in private practitioners. For the lower back, this percentage was 37. Somatic symptoms of stress, perceiving dentistry as physically too heavy or mentally too straining and a poorer general health status rating were all associated with a greater 1-yr prevalence of neck-shoulder and lower back pain and disability and with poorer general physical fitness. Age, weekly work hours, working posture, use of an assistant, or radiographic degenerative changes in the dentist's skeleton were not associated with 1-yr prevalence of neck-shoulder or lower back pain and disability. The results provide evidence that physical exercise should be recommended to dentists and might also be applicable to subjects in other occupations with similar requirements.     

Providing dental care to pregnant patients: A survey of Oregon general dentists

BackgroundA growing number of studies and reports indicate preventive, routine and emergency dental procedures can be provided safely to pregnant patients to alleviate dental problems and promote oral health of mothers and children.MethodsIn 2006 and 2007, the authors conducted a survey of 1,604 general dentists in Oregon. The survey asked dentists about their attitudes, beliefs and practices regarding dental care for pregnant patients. The authors compared the responses with 2006 guidelines from a New York State Department of Health expert panel.ResultsThe response rate was 55.2 percent. Most respondents (91.7 percent) agreed that dental treatment should be part of prenatal care. Two-thirds of respondents (67.7 percent) were interested in receiving continuing dental education (CDE) regarding the care of pregnant patients. Comparisons of self-reported knowledge and practice with the aforementioned guidelines revealed several points of difference; the greatest regarded obtaining full-mouth radiographs, providing nitrous oxide, administering long-acting anesthetic injections and use of over-the-counter pain medications.ConclusionsDentists need pregnancy-specific education to provide up-to-date preventive and curative care to pregnant patients. The results of the study identified specific skills and misinformation that could be addressed through CDE.Clinical ImplicationsComprehensive dental care provided during pregnancy is needed to ensure the oral health of all women at risk of experiencing pregnancy-specific problems, as well as the prevention of early childhood caries.     

Quality assessment of dental restorations: a comparison by dentists and patients

The purpose of this study was to examine the relationship between the patient's and dentist's perception of quality. A group of 117 patients completed a questionnaire which rated their perceptions of the quality of their prior dental treatment. Each patient was given a thorough dental examination, and all restorations were evaluated for 14 criteria of quality. A dental quality index was calculated for each patient, and this was correlated with the patient's overall satisfaction and also with the patient's perception of quality of treatment. Both correlations indicated that no relationship existed between these two perceptions of quality. It was concluded that patients and dentists were looking at different criteria when judging quality of dental care.