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.     

Utilizing dental hygienists to undertake dental examination and referral in residential aged care facilities

Hopcraft MS, Morgan MV, Satur JG, Wright FAC. Utilizing dental hygienists to undertake dental examination and referral in residential aged care facilities. Community Dent Oral Epidemiol 2011; 39: 378–384. © 2011 John Wiley & Sons A/S Abstract – Objective: The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are commonly dependent on others for their daily oral hygiene care and often display high levels of plaque and calculus. With declining edentulism rates, periodontal disease is becoming more prevalent in this population. The aim of this study was to investigate the ability of a dental hygienist to undertake a dental examination for residents of aged care facilities, devise a periodontal and preventive treatment plan and refer patients appropriately to a dentist. Methods: A total of 510 residents from 31 Victorian RACFs were examined, with 275 dentate residents included in this study. Between May 2005 and June 2006, residents were examined by a single experienced dental epidemiologist and one of four dental hygienists using a plane mouth mirror and periodontal probe. Results: A total of 510 residents from 31 RACFs had a dental examination from a dentist and one of four dental hygienists. The treatment needs of residents examined were high, with nearly all of the 275 dentate residents requiring preventive and periodontal treatment, and three‐quarters requiring referral to a dentist for treatment. There was excellent agreement between the dentist and hygienists regarding the decision to refer residents to a dentist for treatment, with high sensitivity (99.6%) and specificity (82.9%). Only 8.0% of residents were referred by a hygienist to a dentist when the dentist considered that no referral was required. Conclusions: Dental hygienists have the skills and knowledge necessary for undertaking a dental examination for residents, correctly identifying the majority of residents who require a referral to a dentist. They are capable of formulating appropriate dental hygiene treatment plans for residents of aged care facilities. It is recommended that there should be greater utilization of hygienists in the provision of dental care to residents of aged care facilities, as a safe, efficient and effective use of health resources.     

Opinions of dentists and directors of nursing concerning dental care provision for Adelaide nursing homes

BACKGROUND: The complex oral health problems of nursing home residents have been well documented. However, the influences on residents' oral health status, including opinions and experiences of dental professionals and nursing home staff, have not yet been adequately investigated. METHODS: The baseline questionnaire component of this longitudinal study was mailed to all registered dentists practising in Adelaide and Adelaide nursing home directors of nursing (DONs). RESULTS: 413 dentists and 97 DONs indicated that Adelaide dentists' interest and training in nursing home dentistry was low. Dental service provision for nursing home residents was very low and dentists preferred to provide treatment at their dental practices. Few dental hygienists were working in nursing homes and dental professionals provided little educational assistance for nursing home staff. Dentists and DONs held several common and many varying perceptions of the problems associated with dental care provision in nursing homes. Both identified a group of nursing home environmental constraints and a lack of portable dental equipment. DONs further identified a group of resident related problems, and dentists a group of dental practice-related problems. CONCLUSIONS: These study results provide important information concerning problems with nursing home dentistry for dental service providers, educators, policy-makers, administrators and nursing home staff.     

Disparity between medical and dental care of institutionalised elderly in Singapore.

Elderly persons tend to give dental care a lower priority than medical care. This study examined existing arrangements for and financial support of dental and medical care to elderly persons living in 68 long-term care facilities in Singapore. The chief administrators of all the homes for the aged were interviewed regarding the provision of physical and financial access to dental and medical care for their residents. Information was verified with a random selection of their residents. Results showed that a significantly higher number of homes (93 per cent) assumed responsibility for the provision of medical care than for dental care (70.7 per cent). A significantly greater proportion of them offered in-house medical care (42.6 per cent) than in-house dental care (5.9 per cent). Financial support for payment of providers' fees, hospitalisation and the transportation costs of ambulatory visits for both medical and dental care was found to be similar but generally inadequate. Greater commitment towards improving physical and financial access to dental care for the institutionalised elderly is necessary.     

Participation in continuing professional development by Victorian dental practitioners in 2004

BACKGROUND: Continuing professional development (CPD) has been long considered an integral component of professional practice across a range of health professions. It is believed to ensure the maintenance of practitioner clinical competence and knowledge of current concepts. This study investigated the participation in and attitudes of Victorian dental personnel to CPD activities. METHODS: A self-administered cross-sectional survey of a random sample of registered dental care providers (n = 451) was conducted from March to June 2005 using an anonymous, postal, self-administered questionnaire. RESULTS: The response rate was low (48.1 per cent). Nearly 90 per cent of respondents attended a CPD course in 2004, with the mean hours of attendance ranging from 8.3 to 36.9 hours, depending on registration category. Nearly half of the dentists attended more than 20 hours of CPD courses, while less than 20 per cent of prosthetists attended more than 15 hours of CPD courses. Three-quarters of respondents supported mandatory CPD as a condition of registration. CONCLUSIONS: There was a high level of participation in continuing professional development activities by surveyed Victorian dental care providers in 2004, although more than half of the dentists and specialists, and nearly two-thirds of therapists, hygienists and prosthetists would fail to meet the new DPBV mandatory requirements for CPD.     

The provision of orthodontic services by general dental practitioners. 1. Methods and descriptive results

Information regarding orthodontic service provision by general dental practitioners in Australia is limited. The aim of this survey was to determine the amount and variety of orthodontic services provided by general dental practitioners in the Melbourne Statistical Division, Victoria, Australia. A random sample of 307 dentists drawn from the Victorian Dentists Register was surveyed by mailed questionnaire: 218 (71%) replied. Data were collected using a fortnight log. During this time 59 per cent of the dentists saw at least one orthodontic patient; one dentist saw 66 orthodontic patients. Removable orthodontic appliances were used by 35 per cent of the dentists and fixed orthodontic appliances by 18 per cent. Twenty-six per cent provided comprehensive orthodontic treatment, 22 per cent aligned incisors, and 21 per cent corrected anterior cross-bites. The general dental practitioners surveyed provided a wide range of preventive and interceptive orthodontic services to generally a small percentage of their patients.     

Attitudes of the Victorian oral health workforce to the employment and scope of practice of dental hygienists

BACKGROUND: Increasing the number of dental hygienists and expanding their scope of practice are two policy directions that are currently being explored to increase the supply of dental services in the context of projected oral health workforce shortages in Australia. Understanding factors relating to the employment of hygienists and the attitudes of the oral health workforce to dental hygiene practice are important in this policy debate. METHODS: A postal survey of a random sample of Victorian dentists, periodontists, orthodontists and hygienists was undertaken in 2006. Dentists and specialists were grouped into those whose practice employed or did not employ a hygienist. Data on the attitudes of dentists, specialists and hygienists towards various aspects of dental hygiene practice were explored. RESULTS: A response rate of 65.3 per cent was achieved. Hygienists believed that their employment made dental care more affordable (53.7 per cent) and improved access to dental care (88.1 per cent), while few dentists believed hygienists made care more affordable. Most hygienists believed they were capable of diagnosing periodontal disease and dental caries and formulating a treatment plan, but there was less support from employers and non-employers. Dentists were strongly opposed to independent practice for dental hygienists, although there was qualified support from employers for increasing the scope of practice for hygienists. CONCLUSIONS: Dentists who worked with hygienists acknowledged their contribution to increasing practice profitability, efficiency and accessibility of dental services to patients. Hygienists and employers supported increasing the scope of dental hygiene practice, however the majority of non-employers opposed any expansion.     

Barriers to dental care in an elderly population resident in an inner city area

A sample of 765 elderly people living in London was interviewed and examined. Barriers to dental care stemmed from: elderly people's beliefs that dentures should last a life-time and dental visits are unnecessary for edentulous persons: mobility difficulties; fear; problems with access to NHS care and with access to satisfactory care. The attitudes of general dental practitioners, community dentists and final year dental students towards elderly people were favourable. Sixty per cent of surgeries were on the ground floor, and 46 per cent of premises were unsuitable for wheelchair access. Carers wanted improvement in domiciliary services. The provision of domiciliary care was significantly related to training. There was a paucity of experience in this field amongst dental students. Community dentists recognized a need for retraining before providing care for handicapped elderly people.     

Oral health services in PR China as evaluated by dentists and patients

OBJECTIVE: To describe the function of oral health services and the delivery of oral health care in PR China. DESIGN: Cross-sectional surveys. Self-administered questionnaires gathered information on professional practices and attitudes of Chinese dentists. Patients were examined clinically for caries and services rendered. Patients were interviewed about oral health status, reason of dental visits and consumption of services, perceived need for care and self-care practices. Setting: Wuhan City of the Hubei Province of China. SUBJECTS: Random samples of dentists (n = 250) working with child and adult patients in 1998 in Wuhan City. Each dentist had a representative sample of 20 patients attending consecutively for care enrolled in the study. RESULTS: On average, the dentists saw 12 patients per day, with most time devoted to restorative treatment and extraction. The majority of dentists held the opinion that in China little attention is given to preventive care. Forty per cent of the patients were new to the dentists and more than half attended care because of pain or acute symptoms. The reported mean number of decayed, missing, and filled teeth varied from 2.6 for 12-year-old patients to 10.7 for patients aged 65-74. Daily toothbrushing was practised by more than 90% of the patients in all age groups, however, the tradition of regular dental visits was weak. Most patients (51-75 per cent) attended for care due to acute problems or pain. CONCLUSION: The study indicated the need for reorientation of the Chinese oral health services towards prevention.     

Professional development for dentists: patterns and their implications

BACKGROUND: Approaches to models of professional development for dentists continue to evolve. This study examined the participation and attitudes of dentists in non-formal and informal professional development and continuing dental education. METHODS: Two methodologies were utilised: a self-administered cross-sectional survey of dentists in Victoria, Australia (conducted October to December, 1994), and a review of the records of the Continuing Education Unit of the School of Dental Science at The University of Melbourne for 1995 to 1999. For the cross-sectional survey, the sampling frame was the register of dentists of the Dental Board of Victoria in 1994. RESULTS: From a sample of 616 dentists invited to participate, 396 usable questionnaires were returned (response rate, 66.8 per cent). The valid data indicated that 52.5 per cent of dentists belonged to a study group, 66.5 per cent subscribed to at least one dental journal (other than the Australian Dental Journal), 88.9 per cent discussed dental matters with colleagues regularly, 98.6 per cent personally assessed their own work, 13.3 per cent did not attend continuing education courses and 18.1 per cent did not complete any courses in the year preceding the survey. Participation patterns in continuing education courses were related to socio-demographic characteristics of dentists. Some support was apparent for flexible delivery options for professional development. CONCLUSIONS: Involvement of dentists in Victoria, Australia in professional development activities is high, with complex participation patterns. Whether these patterns adequately address their own and the community's needs for such activities is debatable. Such issues should impact on any regulatory models for professional development for dentists and the development and use of alternative continuing education modalities.     

Oral health care for nursing home residents in The Netherlands – a national survey

Abstract – In order to be able to develop adequate oral health care programs for nursing home residents in The Netherlands, currently available arrangements and problems experienced by dentists participating in this field of dentistry were evaluated in a national survey. One questionnaire was mailed to the managements of all nursing homes and a second to all dentists known to be involved in nursing home dentistry. The response rates were very high. The study indicated that, in almost every nursing home, dental care for residents was available, at least in cases of dental emergency. On average the dentists were spending only limited time on nursing home dentistry. The majority of dentists examined or treated the residents only when either the patients or others experienced or discovered an oral health problem. In delivering this kind of care the dentists experienced a lot of problems. These findings suggest that the oral health care for nursing home residents in The Netherlands must be evolved by research, special training of dentists, and through development of special care programs.     

The practical oral care video--evaluation of a dental awareness month initiative

BACKGROUND: A collaborative effort for the Australian Dental Association's Dental Awareness Month in 2002 included the production of 'Practical Oral Care - a video for residential care staff'. This evaluation of the project aimed to profile the video purchasers, evaluate the usefulness and appropriateness of the video and accompanying booklet using a mailed questionnaire, and elicit appropriate and practical themes for future geriatric oral health promotion and research. METHODS: A national mail-out of evaluation questionnaires was undertaken to all purchasers of the video. RESULTS: Of the 792 purchasers at the time of the project, 294 questionnaires were returned with 83.7 per cent from residential aged care facilities, 12.6 per cent from dental professionals and 3.7 per cent from health educators. The great majority of purchasers agreed or strongly agreed that the booklet was practical and useful, video was the best format, video length was appropriate, content was realistic, the video assisted staff to identify residents at risk for dental problems and better meet their oral care needs, and improved awareness about oral care issues. Analysis of purchasers' comments highlighted the need for the production of videos on more specific practical oral care issues with behaviourally difficult residents and residents with dementia, to be supplemented with a self-directed learning package. CONCLUSIONS: The Practical Oral Care video was a successful national collaborative geriatric oral health promotion initiative and provided the opportunity to increase awareness about oral care issues in residential care.     

Oral healthcare access and adequacy in alternative long‐term care facilities

This study was undertaken to determine practices and perceived barriers to access related to oral health by surveying administrators in Michigan alternative long‐term care facilities (ALTCF). A 24‐item questionnaire was mailed to all 2,275 Michigan ALTCF serving residents aged 60+. Facility response rate was 22% (n = 508). Eleven percent of facilities had a written dental care plan; 18% stated a dentist examined new residents; and 19% of facilities had an agreement with a dentist to come to the facility, with 52% of those being for emergency care only. The greatest perceived barriers were willingness of general and specialty dentists to treat residents at the nursing facility and/or private offices as well as financial concerns. Substantial barriers to care were uniformly perceived. Oral health policies and practices within Michigan ALTCF vary, as measured by resources, attitudes, and the availability of professional care. There is limited involvement by dental professionals in creating policy and providing consultation and service.     

An investigation into dentists' perceptions of barriers to providing care of dental trauma to permanent maxillary incisors in children in Victoria, Australia

BACKGROUND: Perceived barriers in the treatment of dental trauma may influence the optimum management of dental trauma. Any hesitation that dentists might have in managing dental trauma is important to investigate. The aim of this study was to investigate dentists' perceptions of barriers to providing care of dental trauma to permanent maxillary incisors in children. METHODS: A self-completion questionnaire survey containing six questions on demographic data and 15 questions relating to barriers to treating dental trauma was mailed to 693 dentists in Victoria, Australia. RESULTS: The response rate achieved was 61 per cent. Of the respondents, 90 per cent had no hesitation in treating dental injuries and 80 per cent of these frequently agreed that dentists should treat all dental trauma. Approximately half the dentists (51.5 per cent) frequently found uncooperative children to be the main barrier to providing care. CONCLUSION: The overall consensus from the present study was that treating dental trauma is not unappealing for dentists in general practice.     

Opinions of Dentists on the Treatment of Elderly Patients in Long-term Care Facilities

The high prevalence of disorders in the mouths of elderly residents in long-term care (LTC) facilities suggests that the dental services available to the residents are inadequate. A questionnaire was sent to most of the dentists practicing in Vancouver (British Columbia) to solicit their opinions on treating older patients in LTC facilities, and a response was obtained from 334 (55%). It indicated that 19 percent of the respondents had treated old people within this context, although few of them felt they had been educated adequately for the service. Many reasons were offered to explain the small participation. Most respondents had never been asked to attend a facility. Many felt that it interfered with their practice and leisure, and they were concerned about the limited options available for treatment. Dentists who had attended facilities were motivated by a sense of professional or public responsibility, but they were uneasy about the limited options and about the inadequate space and equipment available. In general, the dentists were not interested in attending an institutionalized geriatric population, and they felt ill-prepared for the service.     

Differences in the perceptions of HIV risk amongst dental care providers in Western Australian clinics

This paper examines the perceived risk of occupationally contracting HIV among dental care providers. This examination is based upon responses to a mailed questionnaire from all registered dentists (76 per cent response rate, n = 550) and dental therapists (63 per cent response rate, n = 208) in Western Australia during 1992. Results indicate that: 1) dental care providers who perceive a high risk of occupationally contracting HIV report a more conservative, cautious approach to HIV infection than do providers who perceive less risk of contracting the virus; 2) dental therapists are more likely than dentists to report a higher degree of perceived risk of occupationally contracting HIV; and 3) dentists are more likely than dental therapists to perceive compliance with universal precaution guidelines in dental practices in which they work. Reasons are presented for a suspicion that both sets of perceptions may be exaggerated. The need to educate dental therapists on the realistic risks of occupationally contracting HIV and to educate dentists on the value of compliance (and of appearing to comply) with universal precaution guidelines in order to help reduce undue stress and hindrances in the provision of safe and effective dental care in this era of AIDS concludes this paper.     

Dentists' Attitudes and Practices Toward Provision of Orthodontic Treatment for Children with Visual and Hearing Impairments

The objective of this study was to determine differences in behavior and attitudes of dentists in Riyadh, Saudi Arabia, in providing orthodontic care for children who are sensory impaired. A self‐administered questionnaire was sent to all dentists working in Riyadh to assess the following domains: personal characteristics of the dentists and their practices, provision of dental care for children who are visually‐impaired (VI) and/or hearing‐impaired (HI), and their attitude toward providing orthodontic care for these children. Attitudes were measured on two scales and the overall score of these two scales represented each respondent's attitude. Thirty percent of the dentists provided dental care for children with VI and 45.3 percent did for children with HI. The provision of orthodontic care was significantly affected by the country in which the dentists had received their dental training, both for children with VI and HI (p<0.01), and by number of years they had been in practice for children with VI (p<0.05). Regression analysis showed that only the country of dental training significantly affected the dentist's attitude score. There were also significant variations in attitudes toward the provision of orthodontic treatment for children with sensory impairment (SI), influenced by dental training and experience. In practical terms, this means that improvement in attitudes needs to be initiated at the dental undergraduate level. Establishing global guidelines for the provision of orthodontic treatment for patients with sensory impairment is likely to assist both professionals and patients.     

Problems of persons with cerebral palsy in obtaining dental care

A bstract — This project investigated the availability and accessibility of dental care for cerebral-palsied children and young adults attending the Spastic Centre, New Farm, Brisbane. Most come from high and middle income families and are probably not representative of the handicapped population in this respect.
A questionnaire was sent to 100 parents and 86 responded. Profiles were established of the dentists providing the treatment, the dental services, and the nature of the patient's handicap. Only about 10 per cept of parents found difficulty in obtaining dental treatment for their children and about 25 per cent of patients experienced difficulty under treatment. Only 25 per cent of parents found access to dental services difficult; the main problem being outside the dentist's suite. Subjects with quadriplegia appeared to experience the most difficulty with dental treatment. Three-quarters of the parents indicated they would like a Government dental service at the Spastic Centre.     

Caries,bitewings, and treatment decisions

BACKGROUND: The most common adjunct to the visual and tactile clinical examination for dental caries is the bitewing radiograph. The aim of this study was to report on treatment planning decisions made by Victorian dentists when given a range of predetermined radiographic scenarios. METHODS: A postal survey was conducted to obtain data from 550 dentists selected systematically (every fourth dentist) from the register of the Dental Board of Victoria (1996). RESULTS: The survey response rate was 64 per cent. Fifty per cent of responding dentists selected an operative intervention for radiographic lesions confined to enamel. CONCLUSIONS: A review of current dental literature does not support this approach because a large proportion of proximal tooth surfaces that have associated radiolucencies confined to enamel are not cavitated. This study supports the need for continuing education programmes on the management of dental caries; such programmes should follow an evidence-based model.     

Dental care for elderly people by general dental practitioners

In Salford, the care and facilities for elderly people provided by general dental practitioners in practices having three or more dentists were compared with those given in smaller practices. Accessibility and size of dental practice were significantly related, with larger practices being more accessible to elderly and disabled people than smaller ones. A domiciliary service was given by all dentists, regardless of size of the practice. Forty-three per cent of dentists in the larger but none in the smaller practices recalled full denture patients. Eighty-seven per cent of dentists in the larger practices, compared with 53% of those in small ones, gave correct answers to seven or more of 14 questions about the elderly. Attitudes towards the elderly were measured using a seven-point scale: the more favourable the attitude, the higher the score. The mean score for dentists in large practices was 5.13, which was significantly greater than the mean score of 4.16 for those in small practices (P less than 0.001).