Access to dental care among older adults in the United States

Oral health is essential to an older adult's general health and well-being. Yet, many older adults are not regular users of dental services and may experience significant barriers to receiving necessary dental care. This literature review summarizes national trends in access to dental care and dental service utilization by older adults in the United States. Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce, including concern about training opportunities in gerontology and geriatrics for dental and allied dental practitioners.     

Dental care for children under general anaesthesia by private dental practitioners in New Zealand

An overall reduction of approximately one-third in the availability of private dental care under general anaesthesia in New Zealand has occurred in the past 5 years. Private dentists providing dental care under general anaesthesia are disproportionately located in Auckland. Specialist anaesthetists or general medical practitioners are used to provide almost all the general anaesthetics; approximately half the dentists providing this service continue to use their dental surgeries for the procedure. Private dentists provide approximately one-third of the dental care under general anaesthesia for children each month in New Zealand, but utilise a greater number of sessions per month than the public-sector hospitals. Fees associated with dental care under general anaesthesia for children provided by private dentists are predominantly privately funded. Barriers to dental care for children provided by private dentists are primarily cost, difficulties for the dentists and anaesthetists to fit a general anaesthetic session into the practising day, and difficulties providing care for children under 3 years of age and for those with medical problems and disabilities.     

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).     

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.     

Teledentistry in the United States: a new horizon of dental care

Teledentistry has been developing since 1994 as a means to allow dental professionals to communicate with one another over long distances. It allows collaboration by multiple practitioners regarding a patient and the necessary treatment for this patient. Teledentistry can be greatly utilized with rural communities or those of underserved populations. It would increase the accessibility of specialists, besides decreasing time and cost associated with specialty consultations. Real-time videoconferencing and store and forward techniques are the mostly commonly used methodologies for teledentistry. Teledentistry will become more widely seen and utilized by the increase in digital media found in dental practices.     

Radiographic equipment and techniques used in general dental practice: a survey of general dental practitioners in England and Wales

OBJECTIVES: The aims of this study were to determine the self-reported use of panoramic radiography, D- and E-speed film, rectangular collimation, film holders, equipment fitted with a long spacer cone (>200 mm) and the bisecting angle and paralleling techniques by general dental practitioners and to see if use was related to the dentists' age and postgraduate qualifications. METHODS: Three mailings of a self-completion questionnaire were circulated to 800 general dental practitioners working in the National Health General Dental Service in England and Wales. RESULTS: A response rate of 74% was achieved. Sixty-one percent of general dental practitioners reported use of panoramic equipment. Fifty percent of dentists always used E-speed film and 18% always used rectangular collimation. Sixty-eight percent of dentists always used bitewing film holders though fewer (37%) used periapical film holders. Sixty-three percent of dentists always used a long cone. The bisecting angle technique was used by 70% of dentists with 22% always using this technique for periapical radiographs. Thirty-one percent always used the paralleling technique. Use of panoramic equipment, periapical film holders, bisecting angle and paralleling techniques were associated with the dentists' age. Use of periapical film holders, bisecting angle and paralleling techniques and rectangular collimation were associated with dentists' postgraduate qualifications. CONCLUSIONS: There are several features of radiographic equipment and techniques that can aid high quality imaging and reduce patient dose. Although a number of these are being used in general dental practice in England and Wales they have yet to achieve universal adoption.     

An evaluation of a training programme in primary care research for general dental practitioners

AIMS: To determine whether general dental practitioners would find seminars on research methods in primary care research of interest and whether they would be stimulated to plan their own research. METHOD: Questionnaire with both open and closed questions distributed to participants at the end of the seminars. 10 seminars in locations throughout the north west of England were planned. RESULTS: 98 dentists attended the seminars of whom 81 returned questionnaires, giving a response rate of 82.6%. More than 60% found the seminars and the specially developed teaching manual very useful. However there was somewhat less enthusiasm for undertaking research projects. CONCLUSIONS: The findings suggest that some GDPs are interested in primary care research but are not keen to initiate or plan research themselves.     

Access to dental care: a call for innovation.

For many Americans dentistry not only works but works very well. Most Americans receive the care that they need and want. However, dentistry's success has not been whole or uniform and it has not reached every corner of America. In a society as prosperous as our, it is incumbent upon us, as a profession to help make sure that dentistry's success is accessible to each and every American. While recent efforts to address dental services use disparities may result in some improvements, most likely no single national effort will be globally effective. New ideas, including innovations that are local in design and market sensitive, will be needed to make the kinds of improvements that are desired.     

Emergency preparedness: a survey of dental practitioners

A total of 6,505 questionnaires were mailed to practicing dentists in Florida and Kentucky. The dentists represented all dental specialties and had been graduated from 72 different dental schools. The results of the survey indicate that improvement is needed in training, office organization, and advanced preparation for the emergency management of patients. The results also indicate that dentists encounter many medical emergencies in their offices.     

Provision of domiciliary dental care for the older person by general dental practitioners in Scotland.

The databank at the Scottish Dental Practice Board (SDPB) was explored to determine the domiciliary care provided, for those patients over 70 years of age, by general dental practitioners under the National Health Service in one year. Three thousand nine hundred and forty-three (3943) courses of treatment were provided, via domiciliary visits to patients in this age category, by 38 per cent (1012) of dentists registered to provide dental care under the National Health Service. Whereas 34 per cent of dentists under 40 years of age provided domiciliary care, 46 per cent of those over 40 years provided such a service (P less than 0.001). In Scotland, approximately 1 per cent of 70-79-year-old patients and 2 per cent of patients over 80 years received domiciliary dental care over a 1-year period. For those elderly people who received such care, the mean percentage doubled for every 5-year increase in patient age.