Direct referral day case oral surgery for dental practitioners: a pilot investigation.

Direct referral of patients for day case surgery by general medical practitioners (without hospital assessment) has become widely accepted but few facilities exist for this form of referral from general dental practice. In order to evaluate whether direct access day surgery is applicable to dentistry, the quality of referral by GDPs and hospital consultant clinics was compared in a prospective study (1994-1997) involving 1581 patients.     

Factors influencing referral for specialist endodontic treatment amongst a group of Dutch general practitioners

AIM: To analyse the need for endodontic referral amongst a group of Dutch general practitioners and to examine the current referral patterns and factors influencing the decision to refer. METHODOLOGY: A questionnaire was designed to investigate the perceived need for endodontic referral, the factors that influenced the decision process, the specialist to whom the case was referred and the frequency of referring. The questionnaires were distributed amongst 500 dentists attending a scientific meeting of the Netherlands Society for Endodontology (NVvE) and to 83 members of 10 study groups responding to a request in a newsletter. These groups were chosen to represent those dentists who possessed a similar degree of general dental knowledge and were acquainted with the requirements that endodontic treatment should meet. RESULTS: The response rate was 41%. Of the respondents, 93% felt the need to refer cases to specialists. The majority of dentists preferred to refer to an endodontist rather than an oral surgeon. The major factors considered to be important or very important (37 and 54%, respectively) for endodontic referral were the presence of an obstruction in the canal, followed by the presence of a perforation or resorption (43 and 34%, respectively) and persistent signs and/or symptoms (39 and 32%, respectively). NVvE members referred significantly less to oral surgeons than nonmembers. CONCLUSIONS: Amongst a group of Dutch general practitioners there is a substantial perceived need for referring endodontic cases to specialists.     

Variation in periodontal referral by general dental practitioners

Abstract. This study investigated the extent of and reasons for variation in the periodontal referral patterns of general dental practitioners in Northern Ireland. A questionnaire was circulated to all general dental practitioners in Northern Ireland. This questionnaire investigated the management of periodontal disease in the general dental service and referral for specialist periodontal advice and treatment, A usable return was made by 355 (68%) of those surveyed. The mean number of periodontal referrals by each respondent in the past year was 6.5 (SD 7.7), range 0 to 80. Backward stepwise logistic regression analysis indicated that independent predictors of high referral rate were practice location close to the referral centre ( p <0.0001); dissatisfaction with ability to treat periodontal disease under the National Health Service ( p =0.001); that previous refusals of referral had not dissuaded a dentist from continuing to offer referral ( p =0.002); not offering root planing as a treatment ( p =0.005); and perceived inadequate postgraduate education in periodontology ( p =0.03). It is concluded that considerable variation exists between general dental practitioners working in Northern Ireland in relation to the referral of patients for specialist periodontal advice and treatment. It is further concluded that in many cases non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in relation to periodontal referral.     

The adoption of new endodontic technology amongst Danish general dental practitioners

AIM: To assess the adoption of new endodontic technology in a population of Danish practitioners. METHODOLOGY: Members of the Copenhagen Dental Association (n = 1156) were approached with a questionnaire concerning the frequency of various endodontic procedures. Three options were available: often, occasionally and never. Responses were anonymous. The statistical analyses were performed as studies of association in two- or three-way contingency tables, and with Goodman-Kruskal's gamma-coefficient as the basic tool chosen. RESULTS: Only data from general practitioners (GPs) in private practice were analysed (n = 956). The response rate was 72%. NiTi hand instruments were often used to negotiate canals by 18%, whilst 10% often used NiTi rotary systems. Electronic apex locators were often employed by 15%. Nineteen per cent reported that warm gutta-percha was often used. A majority (53%) often spend two sessions to instrument a molar, and 20% often needed three or more sessions to finish the shaping phase. To complete a treatment of a nonvital case most practitioners reported to use at least three appointments. Only 4% frequently applied rubber dam. CONCLUSIONS: The adoption of new endodontic technology is at an early stage amongst Danish GPs. A new revised remuneration system might influence the rate of adoption, allowing the practitioners to act more rationally and produce a higher frequency of good-quality root fillings. Progress towards high quality endodontics might be hindered by the nonuse of rubber dam.     

Evidence-based practice among a group of Malaysian dental practitioners

The objective of this study was to assess dentists' knowledge and use of evidence-based practice (EBP), including their attitudes toward and perceptions of barriers that limit the use of EBP. A cross-sectional survey was used with self-administered questionnaires involving dental practitioners in the state of Selangor, Malaysia. One hundred ninety-three replies were returned, for a response rate of 50.3 percent. More than two-thirds (135/193, 69.9 percent) of the respondents had heard of EBP. Out of the 135 respondents who had heard of EBP, a majority agreed it was a decision-making process based on evidence (127/135, 94.2 percent) and involved a series of steps from formulating the research question, locating and assessing the evidence, to applying it if suitable (129/135, 95.6 percent). Out of the 135 respondents who had heard of EBP, a high percentage agreed that EBP improved their knowledge and skills (132/135, 97.8 percent) and treatment quality (132/135, 97.8 percent). For advice, a majority of the 135 respondents frequently consulted friends and colleagues (123/135, 91.1 percent), made referrals (120/135, 88.9 percent), consulted textbooks (112/135, 83.0 percent), and referred to electronic databases (90/135, 66.7 percent). Out of the 135 respondents, many perceived EBP as very important (59/135, 43.7 percent) and important (58/135, 43.0 percent) and were interested to learn further information about EBP (132/135, 97.8 percent). The main reported barriers were lack of time (87/135, 64.4 percent), financial constraints (54/135, 40.0 percent), and lack of knowledge (38/135, 28.1 percent). A majority of the 135 respondents had knowledge of and positive attitudes towards EBP. However, due to barriers, a majority of them preferred colleagues, textbooks, and referrals for advice instead of seeking evidence from electronic databases.     

Manual dexterity as a predictor of quality of care among dental practitioners.

This study explores the relationship between time to complete a manual dexterity exercise and quality of restorative dentistry. Ninety-seven general practitioners volunteered to take part in the study. An average of 14 patients per office were recalled and an average of five recent restorations per patient were examined clinically by trained peer reviewers. Subsequently, 74 of the 97 dentists participated in a session in which the O'Connor Tweezer Dexterity test was administered. Pearson correlations between speed on the test of tweezer dexterity and quality measures indicated that, on the average, those practitioners who took longer to complete the tweezer test achieved significantly higher scores on restorative quality.     

Survey of radiologic practices among dental practitioners

The purpose of this study was to determine the factors that influence and contribute to patient exposure in radiologic procedures performed in the offices of 132 staff members within the dental department of a teaching hospital. A questionnaire was prepared in which data were requested on brands of film used, type of x-ray unit used, processing, and use of leaded apron, cervical shield, and film holder. Offices were also visited to evaluate performance of existing dental x-ray equipment. Both the Dental Radiographic Normalizing and Monitoring Device and the Dental Quality Control Test Tool were evaluated. The average exposure was equivalent to the class D film (220 mR), but only 13% of those surveyed used the faster class E film, which would reduce patient exposure in half. The survey indicates that dentists are not using the newer low-exposure class E film in their practices.     

Updating practices among Yorkshire general dental practitioners

Ninety-eight per cent was the response achieved by a June 1989 postal survey to determine how general dental practitioners (GDPs) in Yorkshire Region maintain their professional knowledge. Such a good response adds confidence to the survey's findings which show many GDPs are educationally active and use a variety of media to keep up to date. Nevertheless, there remains a substantial proportion who should be doing more and need encouragement.     

Alcohol and drug use among vocational dental practitioners

OBJECTIVE: This study was designed to investigate the prevalence of alcohol and drug use in vocational dental practitioners (VDPs). DESIGN: Anonymous self-report questionnaire. SUBJECTS AND METHODS: All UK vocational dental practitioners (n = 719) who started practice in the summer of 1999 were questioned on their use of alcohol, tobacco, cannabis and other illicit drugs whilst a VDP and before graduation. RESULTS: Eighty-nine per cent of males and 88% of females reported alcohol use. Of these, 35% of males and 36% of females drank above sensible levels (up to 21 units per week for males, 14 units for females), with 48% of males and 52% of females "binge drinking". Thirty-three per cent of respondents reported cannabis use whilst a VDP. Regular drug use (use at least once a month) other than cannabis whilst a VDP was found to be highest among males, with regular ecstasy use reported by 4% and regular cocaine use reported by 2%. Regular tobacco use (ten or more cigarettes per day) was reported by 9% of VDPs. Regular tobacco users were found to be six times more likely to use cannabis on a regular basis, three times more likely to use ecstasy on a regular basis and four times more likely to use cocaine on a regular basis than those VDPs who reported non regular tobacco use. CONCLUSION: VDPs are drinking above sensible limits, binge drinking, using tobacco and indulging in illicit drug use to a degree that will cause health problems. However, use of all substances had reduced since qualification.     

Attitudes toward the shortened dental arch concept among Swedish general dental practitioners

PURPOSE: The purpose of this investigation was to obtain the opinions and assess the attitudes of Swedish general dental practitioners in private practice versus a public health care setting regarding management of patients with a shortened dental arch (SDA). MATERIALS AND METHODS: A questionnaire containing different statements regarding the SDA concept was sent to a random sample of 189 clinicians. Differences between male and female practitioners and between private practitioners (PPs) and those employed by the Public Dental Health Service (PDHS) were tested for statistical significance by the Student t test. RESULTS: The response rate was 54% (102 clinicians). Among the respondents, 62% were men and 38% were women. Fifty-six percent were PPs and 44% were employed by the PDHS. The results showed small differences in attitudes between various groups of practitioners but large individual variations. In general, Swedish general practitioners had a positive attitude toward the SDA concept with respect to oral function and oral comfort. They recognized few risks with a dentition lacking molar support, although female clinicians were more risk conscious. PPs expressed fewer advantages in using the SDA concept than PDHS practitioners with respect to the reduced risk for overtreatment, better patient economy, and the ability for older patients to keep their teeth. CONCLUSION: The results from this questionnaire study indicate that, overall, Swedish general practitioners have an affirmative opinion toward the SDA concept.     

The dental hygienist as a co-therapist in the endodontic practice.

This paper explores the potential contributions to patients, the practice, the endodontist, and the dental hygienist that may be realized by the employment of one or more dental hygienists to serve as endodontic co-therapists in the delivery of endodontic treatment. An endodontic co-therapist is an individual who participates with the endodontist in the assessment, planning, implementation, and evaluation of treatment much like the periodontal co-therapist relationship that exists between periodontists and dental hygienists. Dental hygienists are ideal individuals for this role because of their education in basic, clinical, and behavioral sciences. Suggestions are provided for which services could be delegated by the endodontist to the dental hygienist during each phase of care. Advantages of this contemporary approach to the delivery of endodontic treatment are also addressed.