A survey of demand for specialist restorative dental services

OBJECTIVES: To determine the level of demand from general dental practitioners (GDPs) for specialist restorative dental services in the Yorkshire region. To investigate barriers and promoters to referral and GDPs' perceptions of restorative mono-specialists. METHODS: A postal questionnaire was sent to 301 randomly selected GDPs (stratified for location) registered in the six Family Health Service Units in Yorkshire. Questionnaires were piloted prior to release; reminders were sent to non-respondents. RESULTS: A response rate of 72% (n=217) was achieved, of these 195 questionnaires were useable (65% useable response rate). Results showed a large demand for restorative specialist services. Main promoters for National Health Service (NHS) referral were dentolegal issues (77% GDPs ranked this as a top three promoter) and for private referral increasing patient expectations (78%). The top barriers against referral were length of waiting lists for NHS patients (79% GDPs ranked this as a top three barrier) and high cost of treatment for private patients (88%). Excessive distance to specialist centre was the greatest barrier common to both NHS and private referrals. Fifty-eight per cent of GDPs would prefer to refer private patients to mono-specialists, compared with 5% who would prefer restorative specialists. CONCLUSIONS: There is a strong demand for specialist restorative services which may increase in the future. Results indicate a high regard for mono-specialists. Overall demand is for a prompt, locally based, low cost referral service.     

A survey of school dental screening practise in community dental services of England and Wales in 2003

OBJECTIVE: To describe the school dental screening process in Community Dental Services across England and Wales. Basic research DESIGN: Cross-sectional study using a postal questionnaire. CLINICAL SETTING: Community Dental Services. Participants: Clinical Directors of Community Dental Services in England and Wales. MAIN OUTCOME MEASURES: Respondents answers about the objectives of school dental screening, criteria used for referring a child, methods of informing parents of screening results, and methods used to confirm subsequent dental attendance. RESULTS: The response rate for this study was 92.1%. Respondents identified dental registration (75.2%) and attendance at a dentist (82.9%) as objectives of school dental screening. Less than one third (29.5%) saw the activity as having a preventive role. Caries in the primary and secondary dentitions and soft tissue lesions were reported as key criteria for referral. Methods of follow-up of screened positive children differed and were often inadequate; approximately one third of respondents used a letter carried home by the child that did not allow parents to inform the CDS of action taken. Half of the respondents routinely collected data on the number of screened positive children who subsequently visit a dentist. CONCLUSIONS: School dental screening is delivered in a similar fashion throughout England and Wales but methods of informing parents of a positive screen and follow-up mechanisms for children with positive screens vary. Most school dental screening programmes do not collect sufficient data to evaluate the impact of their programmes on children's oral health.     

Benzodiazepines in child dental care: a survey of its use among general practitioners and paediatric dentists in Sweden

Dental treatment in children too young or too apprehensive to co-operate is often performed under sedation. The aim of this study was to survey the use of rectal and oral liquid and tablet benzodiazepine sedation in Swedish child dentistry, and estimation of treatment success. A questionnaire was sent to 500 randomly selected dentists (GPs) working in the Public Dental Health Service and all (77) specialists (PDs) working at paediatric dentistry clinics. Benzodiazepine sedation was used by 73% of the GPs and 97% of the PDs. Seven per cent of the GPs and 87% of the PDs had sedation sessions at least once a month. Of the GPs, 60% administered the sedation rectally, 7% orally in liquid form, and 39% orally in tablet form. For PDs, the corresponding figures were 97%, 78%, and 68%. Sixteen per cent of the GPs and 84% of the PDs used midazolam for rectal sedation. PDs rated rectal sedation better than the GPs (p < 0.001). GPs rated their experiences of rectal sedation as better the more frequent the use (p = 0.03), as did PDs concerning oral liquid sedation (p = 0.03). Thus, it seems that a more regular use of sedation is advantageous in achieving better treatment outcome.     

Considerations for services from dental technicians in fabrication of fixed prostheses: A survey of commercial dental laboratories in Thessaloniki, Greece

STATEMENT OF PROBLEM: Effective communication and cooperation between dentists and dental technicians are essential in providing quality services. There has been a lack of information regarding dentist-dental technician communications and current methods and materials used for the fabrication of fixed partial dentures (FPDs). PURPOSE: This cross-sectional study identified the materials and techniques used for fabrication of FPDs, as well as the status of communication between dentists and dental technicians in Thessaloniki, Greece. MATERIAL AND METHODS: A questionnaire was developed with 7 sections pertaining to procedures and materials used for the fabrication of fixed prostheses: general questions, infection control, impressions/interocclusal records, die technique/mounting, information from final casts, prostheses design/materials, and communication/shade selection. The questionnaire was anonymous and distributed by the Association of Dental Technicians of Thessaloniki to all member laboratories (228) in the wider province of Thessaloniki, Greece. Due to the absence of normal distribution of the results, frequencies and medians were reported. RESULTS: Ninety-six of 228 dental laboratories responded (42.1% response rate). Twenty-six percent of dental laboratories did not routinely disinfect incoming items. The dental technicians considered 30% of incoming final impressions and 20% of interocclusal registrations as inadequate. Half of the time (55%) final casts were mounted by technicians on simple hinge articulators. Only 20% of tooth preparations had adequate finish lines. The majority (70%) of fixed restorations were metal-ceramic. Fifty-seven percent of dental technicians considered the delivery time requested by dentists as insufficient. CONCLUSION: The information provided in this study indicates areas of weakness in communication between dentists and dental technicians, along with areas where both parties should use greater care during clinical and laboratory procedures.     

Financing dental care: trends in public and private expenditures for dental services

This article examines the financing of dental care in the United States. The major issues addressed include the amount and sources of funds, the reasons for increased dental care expenditures, the comparison of dental care with other medical care expenditures, the policy implications of current trends, and some cautious predictions about the financing of dental care in the next 10 to 20 years. The supply of dental services is expected to increase substantially in the next 10 to 20 years with more dental school graduates, a new midlevel practitioner, and greater use of allied dental health personnel. Whether the supply of services will grow faster than the demand for care is unknown.     

Dental hygienists in Europe: trends towards harmonization of education and practice since 2003

Abstract: Aim: The aim of this study was to investigate the trends in dental hygienists’ education and regulation in the European Union (EU) and European Economic Area (EEA) to examine whether, since 2003, there has been harmonization in dental hygiene education. Methods: Information and data were obtained via piloted questionnaires and structured interviews with delegates from the International and European Dental Hygienists’ Federations and representatives of the Council of European Chief Dental Officers and by literature review. Results: In the EU/EEA, dental hygienists are legally recognized in 22 countries. Since 2003, there has been an increase in the number of Bachelor degree programmes and in autonomous practice. Entry to the profession is now exclusively via a Bachelor degree in five EU/EEA Member States and pending in two more. Ten Member States have adapted their degree programmes to the European Credit Transfer System. Two Member States combine education for dental hygienists and dental therapists. However, dental hygienists are not recognized by EU law and in five Members States, the introduction of the profession has been opposed by dental associations. Conclusions: For the reasons of wide variations in the standards of preventive care and periodontal therapies, the formal recognition of the dental hygiene profession by EU legislation and agreement on a pan‐European curriculum for dental hygiene education leading to defined professional competencies and learning outcomes is required. To achieve this, there is a need for a better collaboration between competent authorities including governments, universities and dental and dental hygienists’ associations.     

A survey on orthodontic-restorative dental services in a NHS hospital

The provision of a joint orthodontic-restorative hospital service is important in providing a quality service for some dental malocclusions. A prospective survey was carried out of the joint orthodontic-restorative clinic at Mayday University Hospital, during the months of January to August 2005. Data was collected using a data collection form. In total 61 patient's attended 4 joint clinics. Fifty per cent of referrals were by general dental practitioners. The commonest referral reasons were spacing and dental trauma. Over one third of patients were seen within 12 weeks of their referral, whilst two thirds start their treatment within 12 weeks of consultation. The commonest restorative treatment was periodontal therapy, crown and bridgework. Over one third of patients required joint orthodontic and restorative treatment. More than 12% of patients require oral surgery in the form of removal of impacted teeth, exposure of unerupted teeth, placement of bone anchors or orthognathic surgery. Consultation and treatment waiting times could be reduced by the introduction of more clinics and employment of more staff A representative in oral surgery maybe useful with the increase use of bone anchors and mini implants to aid joint orthodontic-restorative treatment. Access to an orthodontic and restorative consultant clinic is useful in providing patients with a high quality of multidisciplinary treatment planning in an efficient manner.     

Utilisation of dental services in Turkey: a cross-sectional survey

AIM: To assess the factors affecting the utilisation of dental service in Turkey. METHOD: A cross-sectional study using a sample of 866 adults randomly selected from nine provinces, collecting data on socio-demographic characteristics, frequency of dental visits and attitudes toward dental services in face-to-face interviews. RESULTS: 40.4% of adults had visited a dentist within the previous year. Logistic regression analysis showed that gender and educational level were significant factors affecting the utilisation of dental services, with women using dental services significantly more than men and those having higher education compared to those having low education. Satisfaction from the services of the private dental offices and private hospitals was higher than from state hospitals. Age, reasons for dental visit and the place of the last visit were found to be the most significant predictors of satisfaction. CONCLUSION: Utilisation of dental services is low amongst Turkish adults. Women and individuals with higher levels of education use dental services more than others. The majority of the people prefer private dental offices, where the patient satisfaction is high.     

Patterns and appropriateness of referral from general dental practice to specialist oral and maxillofacial surgical services

In this study we investigated patterns of referral and appropriateness of referrals to specialist oral and maxillofacial surgery services, using postal questionnaires and referral letters. The most common reasons for referral were the expected difficulty of the operation, the medical condition of the patient and the lack of facilities for general anaesthesia. Most referrals were made to the oral and maxillofacial surgery department of a general hospital but almost three-quarters of the respondents stated that they would refer patients to specialist surgical dentistry practices in the future. Few referrals to a university department of oral and maxillofacial surgery were considered to be inappropriate, nor were requests for a particular type of anaesthesia. Any future transfer from secondary to primary care for oral surgery may be hindered by the reduction in facilities for general anaesthesia in the primary care setting.     

A joint approach to treating dental phobics between community dental services and specialist psychotherapy services--a single case report

A 41-year-old male patient presented at the local dental hospital requesting treatment under IV sedation, a treatment that he had had for the past 25 years. The patient was referred to the specialist psychotherapy services for cognitive behavioural therapy (CBT), and received a 1 hour course of therapy. He was then introduced to dental services, and at this visit had a check-up, OPG, and treatment planning discussion. At a subsequent visit he had local anaesthetic, three fillings, and a scale and polish. The patient is now able to return to general dental practice, after only a brief therapeutic intervention, and subsequent dental treatment. The present and future cost saving to the NHS is substantial compared with the treatment method initially sought by the patient.     

Secular trends in dental services provided by dental therapists and dentists in Southwest Alaska

BackgroundThe goal of the study was to identify secular trends in dental service delivery between dental therapists and dentists in the Yukon-Kuskokwim Delta region of Southwest Alaska, the first area of the United States to authorize dental therapy practice.MethodsElectronic health record transactions from the Yukon-Kuskokwim Health Corporation from 2006 through 2015 (n = 27,459) were analyzed. Five types of dental services were identified using Current Dental Terminology procedure codes: diagnostic, preventive, restorative, endodontic, and oral surgery. Main outcomes were percentages of services provided by dental therapists compared with dentists and population-level preventive oral health care.ResultsThe overall number of diagnostic, preventive, and restorative services in the Yukon-Kuskokwim Delta increased. For diagnostic services, there was a 3.5% annual decrease observed for dentists and a 4.1% annual increase for dental therapists (P < .001). Similar trends were observed for restorative services. For preventive services, there was no change for dentists (P = .89) and a 4.8% annual increase for dental therapists (P < .001). Dental therapists were more likely than dentists to provide preventive care at the population level.ConclusionsDental therapists have made substantial contributions to the delivery of dental services in Alaska Native communities, particularly for population-based preventive care.Practical ImplicationsThe study’s findings indicate that there is a role for dental therapy practice in addressing poor access to oral health care in underserved communities.     

Utilization of dental health services among middle-aged people in Sweden and Denmark

In 1999, questionnaires were sent to random samples of 1001 Swedish citizens aged 55-79 years and 1175 Danish citizens aged 45-69 years. Various questions were asked concerning dental conditions, dental visit frequency per year, and money spent annually on dental care, etc. The objectives were to assess differences in the utilization of dental services and to compare out-of-pocket costs for dental care in Sweden and Denmark with control for age, gender, dental conditions and income. More than 80% of the subjects reported that a dentist had examined them less than 1 year previously. However, 77% of the Danes reported dental visits twice a year or more compared to 28% of the Swedes. Although the Danes reported a more frequent use of dental services, they had poorer dental conditions compared to the Swedes. Even though the Swedes used dental services less often than the Danes did, more subjects reported high 12-month out-of-pocket costs. In the present study, separate models were constructed for the two countries because there could be different mechanisms at play, as indicated by the results. The different insurance systems along with different degrees of commercialization in the two countries might be the most decisive factors in this context.     

Utilization of dental health services among middle-aged people in Sweden and Denmark

In 1999, questionnaires were sent to random samples of 1001 Swedish citizens aged 55-79 years and 1175 Danish citizens aged 45-69 years. Various questions were asked concerning dental conditions, dental visit frequency per year, and money spent annually on dental care, etc. The objectives were to assess differences in the utilization of dental services and to compare out-of-pocket costs for dental care in Sweden and Denmark with control for age, gender, dental conditions and income. More than 80% of the subjects reported that a dentist had examined them less than 1 year previously. However, 77% of the Danes reported dental visits twice a year or more compared to 28% of the Swedes. Although the Danes reported a more frequent use of dental services, they had poorer dental conditions compared to the Swedes. Even though the Swedes used dental services less often than the Danes did, more subjects reported high 12-month out-of-pocket costs. In the present study, separate models were constructed for the two countries because there could be different mechanisms at play, as indicated by the results. The different insurance systems along with different degrees of commercialization in the two countries might be the most decisive factors in this context.     

Relationship between orthodontic treatment and dental caries: results from a national survey

Objectives: Orthodontic treatment has been suggested to increase the risk of dental caries. The aim of this study was to evaluate the association between orthodontic treatment and the likelihood of dental caries. Methods: The study included data for adults aged ≥ 19 years who participated in the Korea National Health and Nutrition Examination Survey in 2013–2015. The participants’ demographic, socio-economic, and general and oral health-care data were collected by trained interviewers using a structured questionnaire. The number of decayed teeth (DT) and the decayed, missing and filled teeth (DMFT) index score on oral examinations performed by dentists were compared between subjects who underwent orthodontic treatment and those who did not, using the chi-squared test and logistic regression analysis. Results: All logistic regression analysis models showed a significant association between orthodontic treatment and untreated dental caries. The likelihood of having untreated dental caries was lower in subjects who had received orthodontic treatment than in those who had not, regardless of confounding factors (P < 0.001). After adjustment for confounding factors, the mean number of DT was lower in subjects who had received orthodontic treatment than in those who had not (0.66 vs. 0.94; P < 0.001). There was no statistically significant difference in the DMFT index score between the two groups. Conclusions: Orthodontic treatment was associated with a decreased likelihood of untreated dental caries. Moreover, there was no evidence indicating a link between the DMFT index score and orthodontic treatment.Key words: Dental caries, DMFT index, DT index, epidemiology, orthodontic treatment     

Treatment results in dental school orthodontic patients in 1983 and 1993

The effect of incremental changes in materials and techniques on orthodontic treatment outcomes is difficult to evaluate objectively. Treatment results for two groups of patients whose treatments were completed approximately 10 years apart were evaluated using the peer assessment rating (PAR) index and the index of orthodontic treatment need (IOTN) using the Wilcoxon matched-pairs signed-rank test. Patients in the later group who had been treated by postgraduate students primarily (using fixed appliances) had significantly lower IOTN and PAR scores at the end of treatment and showed a significantly greater reduction in the PAR score than a similar group of patients in the earlier group. There were no significant differences in treatment results between patients in the early and late groups who were treated with removable appliances. Differences in treatment results were most likely the result of changes in materials and techniques that had occurred in the 10 intervening years.