The provision of orthodontic services by general dental practitioners. 2. Factors influencing variation in service provision

Previous work has shown that variations exist amongst general dental practitioners in the volume and type of orthodontic services provided, the type of orthodontic appliances used, and the objectives of the orthodontic treatment. The aims of this survey were to identify practitioner characteristics that account for variations in the level of orthodontic services provided and which distinguish providers and non-providers of orthodontic services. Multiple regression analysis revealed that four practitioner characteristics explained 41 per cent of the variance in the number of orthodontic patients treated. Dentists who treated more orthodontic patients: 1) treated more general practice patients; 2) frequently used multiple sources to keep up to date in orthodontics; 3) perceived their patient base to contain more children; and 4) were likely to have attended a Truitt course. Eleven variables best distinguished providers from non-providers of orthodontic treatment; 1, 2 and 3 above had the highest correlation with the discriminant function. The Null Hypothesis that selected characteristics of dentists providing orthodontic services were no different from those of dentists not providing orthodontic services was rejected. The provision of orthodontic services was associated with a higher level of continuing orthodontic education as well as treating more general practice patients, especially children.     

Provision of orthodontic care to adolescents in South Australia: The type, the provider, and the place of treatment

There are many pathways involving different providers and locations that individuals may take in obtaining orthodontic services. The aim of this study was to document the provision of orthodontic services and establish the pathways taken toward fixed orthodontic treatment by adolescents in South Australia. Data were collected on the use of orthodontic services by a cohort of adolescents enrolled in the School Dental Service at age 13 years and again at age 15 years. By age 15 years, 83.2 per cent of the adolescents had received orthodontic consultations, 27.3 per cent had received fixed orthodontic treatment and 41.4 per cent had received other forms of orthodontic treatment (extractions, space retainers or removable appliances). The majority of fixed orthodontic treatment was supplied by orthodontists in the private sector, while extractions and removable appliances were provided mainly by public sector general dentists. Most individuals used services in both the public and private sectors and the most frequent pathway taken by the adolescents receiving fixed orthodontic treatment involved consultation in both the public and private sectors, non-fixed orthodontic treatment in the public sector and fixed orthodontic treatment in the private sector. The findings indicate wide access to orthodontic consultation and a high uptake of fixed orthodontic treatment once the adolescent sought private sector orthodontic consultation. Orthodontic care was seen to be an interactive process between public sector general dentists and private sector orthodontists.     

Profile of orthodontic services provided in private practice by general practitioners and specialist orthodontists for an insured population

In Australia, the proportion, volume and type of orthodontic care provided by general practitioners and orthodontists are largely unknown. The overall objective of this study was to create a profile of orthodontic services provided by general practitioners and orthodontists for a cohort of insured patients using private practices in New South Wales, Australia, from 1st January 1992 to 31st December 1995. Data were derived from claims records submitted by members of a health insurance fund for rebates for fees paid to private practitioners for orthodontic services they received during the study period. Distribution of the volume and type of service provided by general practitioners and orthodontists was compared using the Chi-squared test. Statistical significance was taken at the 5 per cent level. Orthodontic services were provided predominantly by orthodontists (80%). Fixed orthodontic treatment was provided almost exclusively (91%) by orthodontists. The majority of removable appliance services was provided by general practitioners. Orthodontists provided more orthodontic services in the capital city and other metropolitan areas, whereas general practitioners provided more orthodontic services in rural areas. Orthodontists provided more services to members in the highest socio-economic group, whereas general practitioners provided more services to members in the lowest socio-economic group.     

Orthodontic treatment provided by pediatric dentists.

The purposes of this study were to document orthodontic treatment currently provided by pediatric dentists for comparison with past and future studies and to ascertain variables that influence practitioners' orthodontic treatment patterns. A 25-item survey was mailed to 492 diplomates of the American Board of Pediatric Dentistry. Surveys returned within 16 weeks were included for statistical analysis. The response rate was 73%. Most practitioners spent less than 10% of their practice time providing orthodontic treatment and reported that this would not change in the future. Practitioners who were dual trained in pediatric dentistry and orthodontics spent more time providing orthodontic treatment, although nearly half spent at least 50% of their time providing traditional pediatric dental treatment. Most pediatric dentists provided orthodontic treatment in the primary or early mixed dentition stages. The most common conditions treated were anterior crossbite, ectopic eruption, habits, posterior crossbite, and space maintenance. The most common orthodontic appliances used were fixed rapid palatal expanders and removable Hawley appliances with finger springs. Orthodontic treatment provided by pediatric dentists has decreased since it was last surveyed in 1983 and is not expected to change in the next 5 years.     

A survey of sodium hypochlorite use by general dental practitioners and endodontists in Australia

BACKGROUND: Sodium hypochlorite is used commonly as an endodontic irrigant, but there are no published reports that provide details of its use. This survey sought to determine the percentage of Australian dentists who practiced endodontics, whether they used sodium hypochlorite for irrigation, and the manner of dilution, storage and dispensing sodium hypochlorite used by both dentists and endodontists. METHODS: All Australian endodontists and a stratified random sample of 200 general dentists in Australia were surveyed to address the issues identified above. RESULTS: Almost 98 per cent of dentists surveyed performed endodontic treatment. Among endodontists, nearly 94 per cent used sodium hypochlorite for irrigation compared with just under 75 per cent of general dentists. Sodium hypochlorite use by general dentists was more common in Victoria and South Australia than in other States. An infant sanitizer (Milton or Johnson's Antibacterial Solution) was used by just over 92 per cent of general practitioners and by more than 67 per cent of endodontists. All other respondents used domestic bleach. One hundred and sixty four of the respondents (80 per cent of endodontists and over 90 per cent of general dentists) used a 1 per cent w/v solution. Ten practitioners used a 4 per cent w/v solution, five used a 2 per cent w/v solution and four used a 1.5 per cent w/v solution. Eighty per cent of the practitioners who diluted their sodium hypochlorite before use, used demineralized water for this purpose. The remainder used tap water. Only four practitioners stored sodium hypochlorite in a manner which risked light exposure and loss of available chlorine content. CONCLUSIONS: Sodium hypochlorite is commonly used as an endodontic irrigant and Australian dentists generally stored the material correctly.     

Provision of domiciliary dental care for the older person by general dental practitioners in Scotland.

The databank at the Scottish Dental Practice Board (SDPB) was explored to determine the domiciliary care provided, for those patients over 70 years of age, by general dental practitioners under the National Health Service in one year. Three thousand nine hundred and forty-three (3943) courses of treatment were provided, via domiciliary visits to patients in this age category, by 38 per cent (1012) of dentists registered to provide dental care under the National Health Service. Whereas 34 per cent of dentists under 40 years of age provided domiciliary care, 46 per cent of those over 40 years provided such a service (P less than 0.001). In Scotland, approximately 1 per cent of 70-79-year-old patients and 2 per cent of patients over 80 years received domiciliary dental care over a 1-year period. For those elderly people who received such care, the mean percentage doubled for every 5-year increase in patient age.     

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.     

Orthodontic education and practice in Canada: perceptions of the profession as shown in a recent survey

A questionnaire survey concerning the training and practice of orthodontics was mailed to 20 per cent of the licensed dentists and to dental specialists in the provinces of Ontario, Manitoba, Alberta, and British Columbia between March and August of 1987. The response rate was 49.4 per cent. Many dentists and orthodontists who completed the survey reported declines in patient load during the past three years. Dental schools are perceived to be providing inadequate orthodontic training, in both the undergraduate dental curriculum and in the area of continuing education. A desire for an increase in time, quality, and applications was expressed. Between 20.1 and 34.2 per cent of fully-banded orthodontic cases are being treated by general practitioners.     

Survey of dental practice/dental education in Victoria. Part III. Trends in general dental practice

The responses of practising dentists in regard to clinical time spent and demand trends in dental practice were combined with recent graduates' views of the emphasis given to various disciplines during their undergraduate training in order to provide information which might assist the undergraduate curriculum review. The greatest proportion of clinical time spent by general practitioners on various clinical disciplines was reported to be restorative, preventive, diagnostic and endodontic services. There was evidence to suggest that there is an increasing demand for a broad range of clinical services, particularly in country locations, and that general practitioners appear to be expanding their range of services, including those traditionally offered by specialists. Highest increasing demand over the past five years were for recent advances in 'aesthetic dentistry', endodontics, preventive services, orthodontics, periodontics and fixed prosthodontics. High rates of referral were reported only for fixed orthodontics and major oral surgery. Almost twice as many practitioners overall reported an increase (44 per cent) rather than a decrease (26 per cent) in volume of patients over the last five years. This trend was much more evident in country practices, however, with 55 per cent and 22 per cent compared with Melbourne city, 37 per cent and 29 per cent, increasing and decreasing, respectively. Although dental educators are challenged to ensure that graduates are adequately prepared clinically to meet the demands of dental practice there is mounting pressure to support the introduction of an intern year prior to full registration.     

Glove use by orthodontists: results of a survey in England and Wales.

Attitudes to glove wearing during treatment of patients were tested by distribution of a questionnaire to 2000 dentists known to be practising under the National Health Service regulations in England and Wales. Of the dentists who replied, 41 specialist orthodontists, representing approximately one-sixth of all orthodontists working in the general dental services in England and Wales, were identified. Results indicate that 39 per cent of these orthodontic respondents wore gloves routinely for all patients and procedures, while 49 per cent wore gloves for some patients or procedures, with 12 per cent never wearing gloves. Reasons given by the occasional glove wearers for not wearing gloves routinely included loss of tactile sensation, perceived small risk, lack of comfort, and restriction of movement. Six per cent of those who replied had experienced skin irritation considered to be associated with glove wearing, while latex gloves were preferred by 78 per cent of respondents who wore gloves.     

The delivery of orthodontic care in New Zealand. Part II: Analysis of a census of dentists

Part I of this study reported the level and distribution of the supply of specialist orthodontic services in New Zealand. This paper focuses on the amount and variety of orthodontic services supplied by dentists. A questionnaire sent to all dentists in New Zealand sought information on the amount and type of orthodontic treatment carried out between 1 July 1998 and 30 June 1999. The reply rate was 80.9 percent. The majority of dentists carried out some form of orthodontic treatment, predominantly of a minor nature. A small number provided significant amounts of treatment, both simple and complex. The majority of orthodontic treatment and the majority of comprehensive fixed-appliance treatment were undertaken by orthodontists. One-quarter of all orthodontic patients in New Zealand were treated by dentists, irrespective of the complexity of treatment. Nearly a fifth of all full fixed upper and lower appliances, and nearly a third of all single-arch fixed appliances were placed by dentists during the study period. In general, male dentists, dentists over the age of 40, those who had attended an orthodontic continuing education course in the previous 5 years, and those who referred fewer patients to an orthodontist carried out more procedures, including those of a complex nature; they also had a higher average active orthodontic patient load. Wanting to be more or less busy had little influence on the amount or complexity of treatment performed. Dentists in regions with a low supply of specialist orthodontic services provided more comprehensive fixed appliance treatment and had a higher orthodontic patient load. However, the presence or absence of an orthodontist in an urban area seemed to have little impact on the complexity of treatment or the orthodontic patient load of dentists. Despite fewer orthodontists in secondary and minor urban areas, dentists in these areas did not have a higher orthodontic patient load, but carried out a wider range of procedures and more complex procedures than those in main urban areas.     

Attitudes of UK consultants to teledentistry as a means of providing orthodontic advice to dental practitioners and their patients

Abstract

Objective: To determine UK orthodontic consultants' attitudes to the provision of orthodontic advice to general dental practitioners by electronic means.

Design: Questionnaire.

Setting: Conducted by email and surface mail as appropriate in August 2000.

Subjects: All those UK NHS orthodontic consultants contained in the membership lists of the Consultant Orthodontists Group of the British Orthodontic Society.

Outcome: An 86 per cent response was obtained from the 231 consultants.

Results: More than half (58 per cent) of the consultants were interested in providing an electronic diagnostic service for the general dental practitioners in their locality and 70 per cent were in favour of further research into this possibility. Provided this was mediated through their GDP, only 26% would oppose consultant advice being given electronically from a centralized source.

Conclusions: A majority of UK orthodontic consultants support the concept of using teledentistry to make their advice more accessible to dentists and patients.     

The delivery of orthodontic care in New Zealand. Part I: Analysis of a census of orthodontists.

A two-part study was undertaken to determine the supply of orthodontic services in New Zealand. Part I focuses on services supplied by specialist orthodontists. A companion paper will describe the amount and characteristics of orthodontic services supplied by dentists. All orthodontists in New Zealand in 1999 were surveyed to provide information on practice location and days practiced in 1996 (the year of the last population Census), and the amount and type of orthodontic treatment carried out in the year 1 July 1998 to 30 June 1999. The response rate was 78.9 percent. Data from 1996 were used to establish and quantify the location and distribution of orthodontists in New Zealand, and their spatial relationship to 12-year-olds and 10- to 14-year-olds using Geographic Information Systems. The information from 1998-1999 was used to determine the amount and variety of services provided by orthodontists and the makeup of their patient base. Nearly two-thirds of orthodontists had a branch practice. Over 50 percent of the 10- to 14-year-old population resided within 5 km of an orthodontist, and nearly three-quarters within 10 km. Disparities between regions existed in the supply of specialist orthodontic services. The catchment areas of main urban areas had more than three times the supply of orthodontists to 12-year-olds than did the secondary and minor urban areas combined. The mean average active patient load was 371, and the mean number of full upper and lower fixed appliances placed was 130.3 during the year of the study. Nearly half of all patients had been referred from dentists, approximately one-quarter were self-referred, and a quarter had been referred by dental therapists. Adults comprised 12.1 percent of the patient load of orthodontists; 60 percent were female.     

Treatment of adults with lingual orthodontic appliances

With the advent of lingual orthodontic treatment, an alternative became available to the adult patient who preferred to avoid the unesthetic appearance of conventional orthodontic appliances. The newer brackets and archwires described in this article, in combination with the proven technique developed by the author and others, has made lingual orthodontic treatment a practical reality. The appliance has been shown to be as effective as labial counterparts in correcting all types of malocclusions. New laboratory and indirect bonding techniques have eliminated the need for intricate wire bending and have reduced patient chair time and overall treatment time. Because of the premature introduction of early lingual appliances, many dental practitioners mistakenly believe that lingual treatment is less effective than labial treatment. As more examples of successful treatment are seen, dental practitioners will be more apt to refer patients to orthodontists proficient in this technique. Many graduate orthodontic programs now are teaching this technique to their residents. About 3000 patients currently are starting treatment with lingual appliances each year. This represents only about 1 per cent of adult patients. It is projected that this slowly will climb to about 10 per cent of adult orthodontic treatment over the next 5 years. The increased cost of this treatment, coupled with the resistance on the part of many orthodontists to learn the new technique, seem to be the limiting factors.     

A survey of dental radiography

A survey was conducted to provide an overview of dental radiography in Australia as practised by private general dental practitioners. There was a response of 77 per cent from the 1419 dentists who were sent questionnaires. Data are presented on how the survey was conducted, response by State or Territory, education details of respondents, special interest areas of respondents and reasons for retaking radiographs. Possible sources of bias in the results are also discussed. The two most common reasons given for retaking radiographs were processing errors (33.4 per cent) and incorrect technique (27.7 per cent).     

Time and methods used for complete denture construction in dental students and general dental practitioners in Great Britain in 1972.

A survey was conducted to assess whether there were any differences in the clinical methods employed in constructing full dentures by dentists and final year dental students.Students at twelve British dental schools and dentists who graduated between 1956 and 1970 were surveyed. Students took about $\text{4}\text{1}\text{2}$ hours spaced over 5–6 visits whilst dentists took 68·4 minutes over 4 appointments to complete a set of dentures. Over 90 per cent of dentists did a preliminary examination, one impression, adjustment of bite, try-in and final fit for 90 per cent or more of their full denture cases. Only 47·8 per cent generally took preliminary impressions and 30·4 per cent usually did border moulding. Facebows and gothic arch tracings were not frequently carried out by dentists. A small number of dentists appeared to allow their technicians to do procedures in the mouth. Students generally did all steps in denture construction and had to do the laboratory work in at least one case. They had to complete 3 cases at one dental school and as many as 20 at another.Twenty-two per cent of dentists said that of all their undergraduate subjects, they were best prepared in full denture construction by their dental undergraduate course; less than 5 per cent of students had that opinion. The majority of dentists and students would like the same amount of instruction in full dentures (75 per cent of dentists and 70 per cent of students); only 6·6 per cent of dentists wanted less teaching in the subject.There were differences between the time taken and number of stages employed by students and practitioners. If teachers are convinced of the usefulness of the procedures that they teach they should teach them with greater conviction.     

Factors influencing the diagnosis and treatment of periodontal disease by dental practitioners in Victoria

BACKGROUND: Healthy periodontal tissues are essential to overall dental health. Therefore, the detection and management of periodontal disease is an integral part of general dental practice. The aim of this study was to investigate confidence in diagnosis and management of periodontal disease by general dental practitioners (GDPs), assess if the Dental Practice Board guidelines on periodontal record keeping are being addressed, and, if necessary, try to find ways of improving the periodontal knowledge of GDPs. METHODS: A survey assessing practitioner confidence in diagnosing and treating periodontal disease was sent to a random selection of 550 dental care providers registered with the Dental Practice Board of Victoria. RESULTS: Two hundred and eighty five (51.8 per cent) of questionnaires were returned completed. It was found that 79.7 per cent of the sampled population screened all new patients for periodontal disease. The majority of respondents felt confident to diagnose and treat gingivitis and initial periodontitis. However, only 61.9 per cent felt confident to diagnose aggressive/early onset periodontitis, and many were not confident in treating advanced periodontitis (36.3 per cent) or aggressive periodontitis (51.6 per cent). The majority of dentists reported that they provided most of the non surgical periodontal therapy to their patients, while most surgical treatments were referred to specialist periodontists. Factors deemed to be important in influencing the decision to provide periodontal treatment included level of training and ability to motivate patients to improve oral hygiene. Many responents requested periodontic continuing education (CE) courses be run. CONCLUSIONS: Most of the dentists surveyed were confident to diagnose periodontal disease and to treat the more common presentations of periodontal disease. There is some evidence to suggest that some practitioners are not following the minimum requirements set by the Dental Practice Board of Victoria in relation to periodontal record keeping. The results also indicate a need for more periodontic CE courses in Victoria.     

A general dental practice research network: impact of oral health in general dental practice patients

OBJECTIVE: To measure the subjective impact of oral health in a group of patients attending general dental practices in the North West of England and to investigate the attributes of dentists and practices in order to examine how such attributes might relate to patients' subjective perceptions of oral health. DESIGN: Fifteen general dental practices conducting a simultaneous survey of attending patients and 15 practitioners from these practices providing information about their attitudes to treatment, prevention and various aspects of their surgery. SETTING: General dental OUTCOME MEASURES: Patient subjective impact scores. Relationships between practice and practitioner variables and patients' subjectively perceived oral health. RESULTS: Fifteen practitioners with diverse practice attributes provided data on 718 patients. The mean total oral health impact score was 18.4. Twenty two per cent of patients had experienced pain in the four weeks before the survey and 11% had been unable to chew some foods. Fifty five per cent of the surveyed population had, in the previous year, worried about the appearance of their mouth and 65% had worried about their oral health in general. Dentists' beliefs were related to patient impact scores but practice attributes were not significantly associated with patients' impacts. CONCLUSIONS: Fourteen percent of the differences in patients' subjectively perceived oral health can be attributed to dentist attitudes and attributes. Further research regarding the influence of dentists personality and professional beliefs on patients well-being needs to be undertaken.     

Profiling the interest of general dental practitioners in West Yorkshire in using teledentistry to obtain advice from orthodontic consultants.

OBJECTIVE: To seek opinions from general dental practitioners in Calderdale and Kirklees (West Yorkshire) regarding an online orthodontic referral service and to establish the profile of dentists working in primary care who would refer patients online for a consultant orthodontist's opinion. METHODOLOGY: All 91 general dental practices in Calderdale and Kirklees in West Yorkshire were sent a piloted questionnaire enquiring into their orthodontic treatment and referral patterns, and also into their attitudes to the use of the Internet and related technologies. Three mailings were performed, followed by telephone contact with non-responders. RESULTS: Usable responses were obtained from 119 general dental practitioners who worked in 71 practices (78%). Analysis of data showed that, when asked whether they would be interested in using teledentistry to obtain a consultant orthodontist's opinion online, 53/116 (46%) replied positively. The most frequently specified reason for this interest was that it would save time and would achieve a quicker opinion for a practitioner's treatment plan. These dentists were more likely to be familiar with the use of digital cameras, be using removable appliances, and currently be in the habit of referring orthodontic cases to consultants and specialists. CONCLUSIONS: Just under half of the dentists working in primary care in Calderdale and Kirklees who responded had a positive attitude towards the benefits of a teledentistry referral scheme. However, a substantial number remained undecided, possibly because they were unsure of their information technology (IT) skills. A further pilot study is planned. It will enquire into the feasibility of carrying out such an exercise across West Yorkshire.