Attitudes and use of rubber dam by Irish general dental practitioners

AIM: To investigate the attitudes towards and use of rubber dam by Irish general dental practitioners. METHODOLOGY: A pre-piloted questionnaire was distributed amongst a group of 600 dentists randomly selected from the Irish Register of Dentists. Replies from dentists working in specialist practice or the hospital dental service were excluded. Dentists were surveyed in relation to their use of rubber dam during a variety of operative and root canal treatments, as well as their attitudes to the use of rubber dam in dental practice. RESULTS: A total of 300 replies were considered from a total of 324 that were received. Seventy-seven per cent of respondents (n=231) worked in general dental practice and 23% (n=69) worked in the Irish Health Board/Community Dental Service. Rubber dam was 'never' used by 77% of respondents (n=228) when placing amalgam restorations in posterior teeth, 52% (n=147) when placing composite restorations in posterior teeth, and 59% (n=177) when placing composite restorations in anterior teeth. Rubber dam was 'never' used by 39% of respondents (n=114) when performing root canal treatment on anterior teeth; 32% (n = 84) when performing root canal treatment on premolar teeth; and 26% (n=51) when performing root canal treatment on molar teeth. Fifty-seven per cent (n=171) considered rubber dam 'cumbersome and difficult to apply', and 41% (n=123) considered throat pack 'as good a prevention against inhalation of endodontic instruments as rubber dam'. CONCLUSIONS: Whilst rubber dam is used more frequently for root canal treatment than operative treatment, its use is limited. This presents quality issues, as well as medico-legal and safety concerns for both the profession and patients.     

A study of endodontic treatment carried out in dental practice within the UK

AIM: The purpose of this study was to gather both qualitative and quantitative information on the nature of root canal treatment carried out by a group of dentists working within the United Kingdom. METHODOLOGY: A two-part questionnaire was posted to 720 dentists who graduated from the Dental School, Cardiff, Wales, UK. The first part requested basic information regarding age, year of qualification, field of practice, etc. The second part consisted of 15 questions on endodontic practice and root canal treatment. RESULTS: The response rate was 41.5%. Two hundred and ninety-nine questionnaires contained useful information. The majority of practitioners did not use rubber dam during root canal treatment. The vast majority (89%) exposed a radiograph with an instrument of known length in situ to gauge the 'working length', a small number relied upon tactile sensation. Most practitioners used local anaesthetic solution as an irrigant during instrumentation of the root canal. A wide variety of instruments were used for root canal treatment; a stepback technique was preferred by almost half the practitioners. Antiseptic solution was preferred as an interappointment dressing. More than half of the respondents used laterally condensed gutta-percha to obturate root canals in anterior teeth but only one-third used the same technique in posterior teeth. Less than half the respondents exposed a radiograph to check the fit of the master point prior to obturation. Two-thirds of practitioners used a zinc oxide based material as their root canal sealer. Three-quarters of the practitioners exposed a post obturation radiograph. CONCLUSIONS: The results of this study suggest that although some dentists are using the techniques taught during their undergraduate careers, a large percentage now use techniques with no evidence of clinical effectiveness.     

Are Polish and Swedish dental graduates adequately prepared for dental practice in the UK? A discussion of the transferability of general dental practitioners in Europe

In the context of European Union harmonization, this article compares the systems of training for general dental practice in three European countries, the UK, Sweden and Poland. A UK perspective is adopted and the question as to whether dentists who have qualified in Poland or Sweden are adequately prepared for practice in the UK is explored. The paper is a result of discussion between providers of dental training in the three study countries. Key similarities, strengths and weaknesses are identified and issues pertinent to the transferability of general dental practitioners within Europe are raised.     

Use of panoramic radiographs in general dental practice in England

The rapid growth in the use of panoramic radiographs provoked this survey of the reasons why general dental practitioners in Avon take such views. Of the 193 dentists who responded, 42 (22%) took one or more panoramic radiographs during a specified week. A total of 195 patients, 8% of those x-rayed, had a panoramic radiograph taken either alone or in combination with other views. Panoramic radiographs were stated to have been taken primarily for the diagnosis of caries (48%) and surgical (24%), periodontal (20%), orthodontic (20%) and endodontic/apical assessment. These findings are discussed with respect to published guidelines on the use of panoramic radiographs and the teaching of radiology in dental schools.     

Insurance status and provision of dental services in Australian private general practice

Abstract Annual expenditure on dental care in Australia amounts to ADD 1.9 billion. Approximately one-third of this expenditure involves private dental insurance, yet little is known about the impact of insurance on the provision of services. The aim of this analysis was to examine differences in dental service provision between insured and non-insured patients. Data collected from a random sample of dentists from a survey conducted in 1993-94 were used, providing 817 responses (response rate 74%). Logistic regression analysis controlling for patient age and sex and reason for visit indicated that in private general practice insured patients were more likely to receive preventive (OR=1.37), crown and bridge (OR = 2.25), and endodontic services (OR=1.27), but less likely to receive extraction services (OR=0.52). However, no significant differences by insurance status were found for diagnostic, restorative, or prosthodontic services in the multivariate models. These differences in service provision by insurance status indicate a more favourable pattern of services for insured patients, and point to equity issues in the provision of services.     

Hygienist employment and the presence of periodontal notations in general dental practice patient records

Available data suggest that the provision of periodontal ly related services in general dental practices is low. However, studies indicate that the employment of dental hygienists is associated with increased provision. One method of measuring is by examination of notations in patient treatment records. As part of a project assessing the effectiveness of professional education in changing the provision of periodontal services, 2280 records, comprising 60 randomly selected records of dentate adult patients who had received a dental examination in the previous 6 months were audited in each of 38 practices, 13 of which employed hygienists. Entries of a periodontal nature were classified under 3 categories: diagnostic, preventive and treatment. The presence or absence of each item on each record was recorded. Diagnostic services were notated infrequently overall, but practices employing hygienists had a significantly lower number of records with no diagnostic notations. Preventive items were more frequently notated in practices employing hygienists. Treatment items were most frequently notated in both types of practices. Overall, 13 of the 23 items were recorded significantly more frequently in practices employing hygienists.     

Development and testing of revised practice belief scales among private general dental practitioners

BACKGROUND: Practice beliefs have been related to service rate variation and appropriateness of care. The aim of this paper was to further develop practice belief scales by adding new items to an existing set and testing associations with dentist and practice characteristics, and services provided. METHODS: Practice belief items were recorded on a five-point Likert scale using mailed questionnaires from a random sample of dentists in 2004 (response rate = 76.8 per cent). RESULTS: Factor analysis yielded five factor-based scales, with three having adequate or near adequate internal consistency: Professional Autonomy (alpha = 0.72), Patient Focus (alpha = 0.71) and Preventive Orientation (alpha = 0.59). Responses were skewed towards strongly agree (scores 1-<2) for Professional Autonomy (60.6 per cent), Patient Focus (71.7 per cent) and Preventive Orientation (46.3 per cent). Higher percentages of dentists with strong agreement on Patient Focus were aged 30-39 and 60+ years, while lower percentages of dentists with strong agreement on Preventive Orientation were male (Chi-square, P < 0.05). Those strongly agreeing with the scales (scores 1-<2) had (Poisson regression; P < 0.05): lower rates of restorative, a rate ratio (RR) of 0.93, dentures (RR = 0.72) and extractions (RR = 0.63) for Professional Autonomy; higher rates of dentures (RR = 1.32), crowns (RR = 1.46) and extractions (RR = 1.47) for Patient Focus; and lower rates of restorative (RR = 0.88), dentures (RR = 0.78), crowns (RR = 0.72), extractions (RR = 0.50), endodontics (RR = 0.80), but a higher rate of scaling (RR = 1.13) for Preventive Orientation. CONCLUSIONS: The findings confirmed some of an earlier factor structure of practice beliefs, extended the potential practice belief domains, and demonstrated associations with service rates.     

Prosthodontic management of older severe hypodontia patients in general dental practice: A case series

Although a detailed understanding of the etiology of hypodontia is lacking, there is a need for awareness among dental professionals of the social and psychological consequences of severe hypodontia, as well as knowledge of those affected by hypodontia have ongoing dental treatment needs. Although, there may be a need for immediate referral of children to different specialists for optimal multidisciplinary treatment planning, most older patients with severe hypodontia can be treated by general practitioners. Practitioners therefore need to be aware of the ramifications of the condition and be capable of providing adequate oral health care for these patients and referring them for additional services when necessary. A case-report series is used to illustrate routine prosthodontic treatments that can be offered to older patients in general dental practice.     

The rubber dam in dental practice: use and practical advice

Use of rubber dam offers many advantages in endodontic, operative and prosthetic procedures. Rubber dam protects the patient against ingestion or inhalation of instruments or chemical products, the cavity against contamination and the dental practitioner against infections. This article gives technical advice for the easy application of rubber dam.     

Service-mix in general dental practice in Australia

An understanding of the current service-mix in private general practice in Australia and the factors that may influence its distribution is important in the anticipation of the future practice of dentistry. The present study aimed to describe service-mix, to investigate the association of service-mix with characteristics of presenting patients, and to identify and discuss a number of factors which may be influencing change in service-mix. Service-mix was dominated by restorative, diagnostic and preventive services and a limited number of services accounted for most service provision or dentist time. Both the broad areas of service and more frequently provided services were related to age of presenting patients. Service-mix appears to be changing over time. Changing needs and expectations of patients and philosophies and technologies available to dentists are among factors that push or pull service-mix in new directions. However, changing service-mix and practitioner variation require considerably more exploration.     

A survey of the pattern of private general dental practice in Queensland

All non-specialist ADA member private practitioners in Queensland were invited to participate in a survey to determine the number of the various types of permanent restorations placed in one week and the percentage breakdown of the time they devoted to the various areas of dentistry. Final year dentistry students at the University of Queensland were asked to estimate the projected breakdown of their time in future practice. Results showed that amalgam is still by far the most commonly used material followed by composite resin and glass ionomer cement and that restorative dentistry accounts for the bulk of the practitioners' time. Students' estimations of the work mix were in agreement with those of the practitioners.     

Reasons for taking radiographs in general dental practice

This survey investigated the reasons why general dental practitioners take radiographs. 179 (54%) dentists responded and provided information for 2359 patients who were radiographed during a specified week. Of those patients aged less than 15 yr, 62% were radiographed primarily for orthodontic purposes and 22% for caries. In older age groups, caries was the predominant reason for taking radiographs but endodontic assessment assumed increasing importance with age and accounted for 37% of radiographs in patients aged more than 45 yr. Only 8% of patients were radiographed for periodontal reasons. These findings are discussed with respect to the changing pattern of disease and treatment provided in general dental practice.     

A survey of the pattern of private general dental practice in Queensland, 1992

In 1987 all non-specialist ADA member private practitioners in Queensland were invited to participate in a survey to determine the number of the various types of permanent restorations placed in one week and the percentage breakdown of the time they devoted to the various areas of dentistry. Results of that survey were published in 1989. The survey with a few minor changes was repeated in 1992. Results show that there has been little change in the pattern of practice over the five years with restorative dentistry still taking a very large proportion of respondents' time and similar materials being used. The dental workforce appears to be relatively stable with low rates of overseas and interstate migration. There is evidence of an increasing number of women dentists in the workforce and this is emphasized by a breakdown of the current undergraduate enrolment.     

The treatment of temporomandibular disorders with stabilizing splints in general dental practice: one-year follow-up

BACKGROUND: The authors evaluated temporomandibular disorder (TMD) outcomes in general dental practice one year after treatment with stabilizing splints (SS) or nonoccluding control splints (CS). METHODS: Seventy-two randomly allocated subjects completed initial treatment. The outcomes measures were a pain visual analog scale (VAS), muscle tenderness, temporomandibular joint (TMJ) tenderness, interincisal opening, TMJ clicks and headaches. After initial treatment, 81 percent of the subjects were found to have been treated satisfactorily. The dentists referred the remaining subjects to a dental hospital. At one year, the authors recalled 52 of the original subjects for evaluation. RESULTS: Improvements after initial treatment were maintained at one year for all outcomes, except for TMJ clicking, which returned to pretreatment levels. Eighty-one percent of the subjects rated their treatment as either good or excellent in reducing jaw pain. The authors found that subjects were aware of more of their TMJ clicks than dentists observed at the one-year clinical examination, but most subjects thought their clicking or the associated pain had been reduced. Fifty-five percent subjects had used their splints in the previous six months, but only 31 percent of these had done so daily. There were no significant differences between splint groups. CONCLUSION: At one year, a good response to TMD treatment in general practice had been maintained, but many subjects still had clicking TMJs. CLINICAL IMPLICATIONS: Trained dentists can manage TMD satisfactorily, with only a small proportion of patients needing specialist attention.     

Amalgam and composite use in UK general dental practice in 2001

OBJECTIVE: This study determined the reasons for dentists' choice of materials, in particular amalgam and resin composite, in Great Britain. METHOD: A questionnaire was developed to elicit this information. The names and addresses of 1,000 UK-based dentists were selected at random. The questionnaire was mailed to these dentists with an explanatory letter and reply-paid envelope. RESULTS: Six hundred and fifty four replies were received. Regarding choice of material, 100% of respondents cited clinical indication as the most influential factor, although patients' aesthetic demands (99%), patients' choice (95%) and patients' financial situation (92%) were also reported to influence respondents' choice. Thirty-five per cent of respondents used composite 'sometimes', 15% 'often', and 1% 'always' in extensive load-bearing cavities in molar teeth. For composite restorations in posterior teeth, 92% 'always', 'often' or 'sometimes' used the total etch technique and 53% never used rubber dam. Seventy per cent of respondents agreed with the statement 'discontinuation of amalgam restricts a dentist's ability to adequately treat patients'. Eighty-one per cent considered that the growth in the use of composites increased the total cost of oral healthcare. CONCLUSIONS: Forty nine per cent of the respondents from England and Wales seldom or never place large composite restorations in molar teeth. Their choice of material is influenced greatly by clinical indications, and patients' aesthetic demands.     

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.