Determinants of Iranian dentists' behaviour regarding infection control

Aim: To evaluate the determinants of Iranian dentists’ behaviour regarding infection control (IC). Design: A cross‐sectional questionnaire survey. Setting: Iranian general dental practitioners (GDP) participating in a national dental congress. Methods: The GDPs filled in a self‐administered questionnaire containing questions regarding their attitudes towards and their behaviour on several aspects of IC. Background factors included GDP’s year of birth, gender, and work‐related factors. Statistical evaluation employed the Chi‐square test, Cronbach alpha, and regression analysis. Results: In total, 479 GDPs returned the questionnaire. Their mean age was 38.6 years (SD = 9.4) and 53% were men. The vast majority of the GDPs had positive attitudes towards the inquired after IC criteria with no statistical difference based on the GDP’s background characteristics. Of all respondents, >70% reported that they inform the laboratory about the infection status of the sent items, disinfect impressions before sending to the laboratory, and wash patients’ mouths before working with high‐speed or ultrasonic devices. Adherence to all the studied IC criteria was reported by 10% of the respondents; more frequently by younger GDPs and those with fewer experience years (P < 0.05). Conclusion: Greater emphasis on infection control programmes in dentists’ education is called for especially in continuing education.     

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.     

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.     

Practice-based PREP Panel handling evaluation of a new impression mixing device and the associated material

Aims: To evaluate the handling of a new impression mixing device and the associated impression material by general dental practitioner members of the PREP Panel. Design: By means of a questionnaire, the participating practitioners recorded their views on the mixing machine and impression materials, having used these for ten weeks. Setting: UK general dental practices. Participants: General dental practitioner members of a UK practice‐based research group. Methods: A questionnaire was designed to elicit views on the performance of the mixing device and impression material under test. This was distributed to the practitioners who had used the test materials for 10 weeks and the data thereby obtained collated and presented, principally in the form of VAS scales. Outcome measures: Rating of various parameters of the mixing device and impression materials on VAS scales. Results: The Pentamix 3 machine scored well for ease of initial use [4.8 on a visual analogue scale (VAS) where 1 = very difficult to use and 5 = very easy to use]. In a range of criteria (including cleanliness, easy handling, time to fill the tray and overall convenience) the Pentamix scored highly on VAS scales. A maximum score of 5 (on a VAS where 1 = very dissatisfied and 5 = very satisfied) was achieved for reproducible mixing quality. The appreciation of the Pentamix 3 mixing machine was demonstrated by the fact that 85% (n = 11) of evaluators stated that they would recommend it to colleagues. Regarding the impression material under evaluation, 85% (n = 11) of the evaluators stated that they would recommend Impregum Quick impression materials to their colleagues. Conclusions: Within the limitations of this study, the Pentamix 3 automatic impression mixing device scored highly in this assessment, together with the impression materials assessed.     

Opinions and attitudes of the UK's GDPs and specialists in oral surgery, oral medicine and surgical dentistry on oral cancer screening

OBJECTIVE: To survey two broad areas of oral cancer awareness and management of patients at risk of oral cancer by specialists in oral surgery, oral medicine, surgical dentistry and general dental practitioners (GDPs) in the UK. The first of these included knowledge and awareness of aetiological factors, changing patterns of disease, and screening/detection programmes including their effectiveness. The second included oral cancer detection methods, advice on avoidance of high-risk activity and self-examination, and referral pattern of GDPs. DESIGN AND METHOD: A pretested, 44-item questionnaire, a covering letter, a brief outline of the research protocol and return, stamped envelope were mailed in March 2003. A sample of 200 GDPs whose names were obtained from the General Dental Council's main list and 305 dental specialist names obtained from specialist's list in surgical dentistry, oral medicine and oral surgery were selected randomly. Information on oral cancer awareness and practice, screening practice and education was obtained. RESULTS: The response rate was 66.9%. The knowledge of the dental specialists was consistent with that in reports of current aetiological studies on oral cancer. However there were gaps in the GDP's knowledge and ascertainment of oral cancer risk factors. Over 70% of the dental specialists provided counselling advice on the risks of tobacco and alcohol habits compared with 41.2% of GDPs. More GDPs (52.4%) than specialists (35.4%) believed that oral cancer screening on a national basis would be effective in decreasing the mortality of oral cancer. Over 95% of all respondents used a visual examination for oral cancer screening and 89.9% of all respondents strongly believed that visual screening is effective in the early detection of oral cancer. CONCLUSION: The results showed that GDPs had knowledge gaps in their awareness of oral cancer risk factors and the application of preventive measures. Most dental health providers in the UK perform visual screening of the oral mucosa for their patients. Opinion was equivocal as to whether a nationally based screening programme similar to cervical cancer would be effective in improving the mortality and morbidity of oral cancer.     

Quality of communication and master impressions for the fabrication of cobalt chromium removable partial dentures in general dental practice in England,Ireland and Wales in 2009

Summary The aim of this study was to investigate the quality of communication and master impressions for the fabrication of cobalt chromium removable partial dentures (RPDs) in general dental practice in England, Ireland and Wales in 2009. Two hundred and ten questionnaires were distributed to 21 laboratories throughout England, Ireland and Wales. Information was collected regarding the quality of written communication and selection of master impression techniques for cobalt chromium partial dentures in general dental practice. One hundred and forty‐four questionnaires were returned (response rate = 68%). Alginate was the most popular impression material being used in 58% of cases (n = 84), while plastic stock trays were the most popular impression tray, being used in 31% of cases (n = 44). Twenty‐four per cent (n = 35) of impressions were not adequately disinfected. Opposing casts were provided in 81% of cases (n = 116). Written instructions were described as being ‘clear’ in 31% of cases (n = 44). In 54% of cases (n = 76), the technician was asked to design the RPD. Based on the findings of this study, written communication for cobalt chromium RPDs by general dental practitioners is inadequate. This finding is in breach of relevant contemporary legal and ethical guidance. There are also concerns in relation to the fabrication process for this form of prosthesis, particularly, in relation to consideration of occlusal schemes.     

Influence of patient,visit, and oral health factors on dental service provision

OBJECTIVES: Service provision should reflect the oral health of the patient. However, patient and visit factors may influence service patterns and the appropriateness of care delivered. The aim of this study was to examine factors associated with variation in dental services and to assess whether variation by patient and visit characteristics persisted after controlling for oral health status. METHODS: A random sample of Australian dentists was surveyed during 1997-98 (response rate = 60.3%). Private general practitioners (n = 345) provided data on service provision, as well as patient, visit and oral health variables from a log of a typical clinical day (n = 4,115 patients). Multivariate Poisson regression models were run for eight service areas (e.g., diagnostic, preventive, and restorative). RESULTS: Significant effects (P < .05) were observed for oral health factors in all eight models, visit factors in all eight models, patient demographics in four models, dental knowledge/behavior in one model, and area-based socioeconomic status in one model. CONCLUSIONS: After controlling for oral health, visit characteristics persisted as significant predictors of services, with nonemergency visits, insurance, and capital city location associated with more favorable service mix patterns. Higher socioeconomic status areas and payment scale ratings also were associated with a better service pattern in particular service areas. These findings show that a wide range of factors, in addition to oral health, contribute to variation in service provision.     

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 cross-sectional survey investigating the care of the primary dentition by general dental practitioners working in Japan and England

Objective : To compare treatment decisions about primary dentistry made by Japanese and English general dental practitioners (GDPs). Method : Four clinical scenarios were used to ascertain the clinical opinions of GDPs about what treatment to offer a 6‐year‐old boy with a carious molar. The first and second scenarios were a single distal and a distal‐occlusal cavity in a vital tooth without pain. The third was a large distal‐occlusal cavity in a non‐vital tooth without pain. The fourth was large distal‐occlusal cavity in a non‐vital tooth with pain. The participants were 234 GDPs in Japan and 322 GDPs in England. Results : In the first scenario, 62.2% of Japanese GDPs preferred traditional restorative care compared with 34.7% of English GDPs. In the second scenario, Japanese participants were less likely to offer atraumatic treatment (16.5% vs. 34.9%). In the third scenario, Japanese dentists displayed a greater tendency to open the pulp chamber (55.2% vs. 7.6%). In the final scenario, 71% of Japanese GDPs would open the pulp chamber, whereas 50.3% of English GDPs favoured extraction. Conclusion : Japanese and English GDPs differed substantially in their views about the best treatment for a young child with a carious molar.     

Longitudinal comparison of factors influencing choice of dental treatment by private general practitioners

BACKGROUND: Service rate variations and appropriateness of care issues have focused attention on factors that influence treatment decisions. The aims of this study were to examine what factors dentists consider in choosing alternative treatments, the stability of these factors over time and whether stability of treatment choice was related to age of dentist. METHODS: Baseline data were collected by mailed self-complete questionnaires from a random sample of Australian dentists (response rate = 60.3 per cent, n = 345 private general practitioners provided service data from a typical day) in 1997-1998 and follow-up data were collected in 2004 (response rate = 76.8 per cent, n = 177 matched longitudinal cases). RESULTS: The most frequent factors considered important across six alternative treatment pair choice scenarios were caries rate for 'exam v. x-ray', age of patient for 'preventive v. restorative intervention', cost of treatment for 'crown v. build-up', 'root canal v. extraction' and 'bridge v. denture', and calculus for 'prophylaxis v. scaling'. The only differences over time were (t-test, P < 0.05): higher proportions of responses in the mouth status group at follow-up for 'exam v. x-ray'; higher proportions of responses in the visit history group at follow-up for 'preventive v. restorative intervention'; a lower proportion of responses in the caries group at follow-up for 'crown v. build-up'; and a higher proportion of responses in the treatment constraints group at follow-up for 'prophylaxis v. scaling'. CONCLUSIONS: While a wide range of responses were offered as factors influencing the choice of alternative treatments, cost of treatment was a major consideration in situations where significantly cheaper alternatives existed, while patient preference was commonly included as a secondary consideration across a wide range of treatment choice scenarios. The treatment choice responses showed a high degree of stability over time across all age groups of dentists, suggesting that if routines are developed these are established before or soon after graduation as a dentist.     

Periodontal treatment practices of Finnish dentists

OBJECTIVES: To evaluate the treatment practices of Finnish general practitioners (GPs) and dental teachers (DTs) regarding periodontal treatment modalities, and their knowledge of possible contraindications for periodontal surgery. MATERIAL AND METHODS: A questionnaire on two periodontal cases was mailed to 400 GPs, selected by stratified randomization from the public and private sector, and to 47 DTs. The response rate was 77%. Respondents were asked to choose the optimal treatment for a patient with a bleeding, 8-mm-deep periodontal pocket and to consider the influence on their treatment decision of the six possible contraindications for periodontal surgery presented, two of which were absolute (inadequate oral hygiene and poorly controlled diabetes) and four of which were relative contraindications. The respondents' treatment decisions were compared with recommendations from textbooks and the Consensus Report from the 1996 World Workshop of Periodontology. RESULTS: The majority of public (65%) and private (70%) dentists and almost all of the DTs chose treatment in agreement with recommendations. Correct answers from dentists were associated with a greater number of days in continuing education (OR = 1.5; p= 0.005). The two absolute contraindications were known by 38% of public and 31% of private sector dentists, and by 29% of DTs. The respective figures for relative contraindications were 40, 58 and 53%. CONCLUSION: The majority of Finnish dentists followed the recommendations, but elaboration of international guidelines for good clinical practice is still needed to help clinicians to make optimal treatment decisions.     

Learning priorities and attitudes towards computer-assisted learning of general medical practitioners, general dental practitioners and dental hygienists

Objectives: The objectives of this survey were to assess the attitudes and learning priorities of general medical practitioners (GMPs), general dental practitioners (GDPs), and dental hygienists (DHs) working at Jordan University of Science and Technology (JUST), Irbid, Jordan in relation to post‐graduate education, to gather information on their attitudes and skills in using computers and computer‐assisted learning (CAL) and to see whether the material in this form is acceptable to participate as a means of teaching. Methods: Data for this study was gathered via a questionnaire distributed to 63 health professionals including GMPs, general dental practitioners and DHs (mean age 24.79 ± 2.69 years) working at JUST. Results: Of the 63 participants, 80% of the participants have home computers, 38% have office computers at work and only 25% have both home and office computers. Approximately 53% of the participants had their first CAL experience at home. Seventy‐three of the participants indicated that connection to Internet is necessary for their work. Seventy‐one of the participants were interested in the possibility of using CAL to further improve and increase their medical knowledge. The most important topic for doctors was ‘learning about new techniques which may supersede those in current use’, for DHs it was ‘improve knowledge or skill in radiology’, and for dentists it was ‘reinforcement of well established techniques commonly used in dental practice’. Conclusions: It is necessary for practicing health care professionals to update themselves by taking continuous education courses after graduation more conveniently via CAL methods.     

A comparative study of costs for dental services and dentists’incomes in the United States and Norway*

Abstract – The United States and Norway have approximately the same per capita Gross Domestic Product (GDP) and average personal income, but their per capita health spending patterns are quite different. In 1982, the US spent 6.5% of its total health expenditures on dental services while Norway spent 5.4%. A higher percentage of Norwegian adults see a dentist annually as compared to US adults. In 1984, the mean net income of dentists in private practice was $66940 in the US and 27 125 in Norway; this is respectively 5 and 1 3/4 times the average per capita income in those countries. The American publicly-employed dentist earned approximately two-thirds of what the American private practitioner made, while still earning approximately 50% more than his Norwegian counterpart. Some basic information concerning the ratios of dentists, specialists, and dental hygienists to the population is given. The relative proportion of women dentists in the two countries is contrasted. Finally, data on graduates from the dental schools, enrollment cuts, and estimated dentist to population ratios by the year 2000 are described to compare future manpower that will be available to the two countries. Several dissimilarities in the political and social systems are described and discussed. It is emphasized that caution should be used when interpreting and comparing data about countries with different dental delivery, political, and social systems.     

Treatment experience, frequency of dental visits, and children's dental fear: a cognitive approach

Cognitive elements play a key role in dental anxiety. Nevertheless, relatively little is known about how dental treatments and frequency of visits to the dentist are related to dental fear and its cognitive antecedents. This study aimed to explore the relationships between dental visits, past treatment experiences, expectations on the aversiveness/probability of negative dental events, and dental fear in children. The participants were 147 children (60% female; mean age = 12.0 yr) who completed a questionnaire comprising measures of dental treatment-related experience (attendance, fillings, and extractions), perceived aversiveness and probability of dental events, and dental anxiety. Bivariate correlations and multiple linear regression analyses were used to analyze the data. A higher frequency of dental visits was associated with less dental fear and a decreased belief in the probability of negative events occurring during treatment. The type of treatments received was not directly linked to dental fear. However, having received fillings was significantly associated with the perceived probability of negative dental events, whereas extractions were positively associated with these expectations but negatively associated with the perceived aversiveness of possible dental events. Regular dental visits, as well as dental treatments, can influence, in different ways, cognitive elements associated with dental anxiety in children.     

An analysis of complaints against Victorian dental care providers 2000-2004

BACKGROUND: There are little data available on the number and type of complaints made against dental care providers in Australia, despite anecdotal reports of an increasing trend in health-related complaints and litigation. METHODS: Data were obtained from the Dental Practice Board of Victoria on complaints received between July 2000 and December 2004. RESULTS: There were 651 complaints against all dental care providers in the study period, which equates to a rate of 4.1 complaints per 100 dental care providers per year. Dentists were responsible for 490 of the complaints, with 66 complaints against dental prosthetists and 43 complaints against dental specialists. There were very few complaints against dental therapists and students, and no complaints against dental hygienists, with 47 complaints against unregistered people or institutions. CONCLUSIONS: This study found that there was a relatively low rate of complaints made against dental care providers in Victoria, with most occurring against dentists in private practice in Melbourne. Less that 10 per cent of complaints resulted in an adverse finding against the dental care provider.     

Consumption of dental services among adults in Denmark 1994-2003

The purpose of the present study was to measure the consumption of dental services among adults in Denmark and to analyze at what level socio-demographic/socio-economic factors influence dental attendance and oral examinations. A sample of 10% of the total population of 18 yr or older was randomly drawn from a population register, based on a cross-sectional design. Information on the use of dental services was retrieved from public registers along with data on gender, age-group, regions, ethnicity, education, marital status, and income. In addition, a cohort of persons was drawn from the sample in 1999 including only persons who were registered as residents in Denmark from 1999 to 2003. Over time, an increase in the number of dental visits and oral examinations was found among persons older than 45 yr, whereas a decrease was observed in the younger age-groups. Logistic regression analysis was applied to determine the effect of various variables on the experience of dental visits and oral examinations, and relatively high odds for dental attendance and oral examinations was found for the following: younger adults; women; married persons; high income; high education; and persons of Danish origin. The present dental healthcare system does not yet seem to have established mechanisms to address social inequalities in the consumption of dental services.