Opinions of Early Head Start staff about the provision of preventive dental services by primary medical care providers

OBJECTIVE: This study investigates the opinions of the Early Head Start (EHS) staff about physicians and nurses providing preventive dental services for children in EHS. METHODS: A cross-sectional survey was undertaken of the EHS staff having contact with families in EHS programs in North Carolina (NC). A self-completed questionnaire solicited their opinions (agree, disagree, don't know) about whether physicians and nurses can "provide preventive dental care" and "identify dental problems" in infants and toddlers. Staff knowledge (four items) and attitudes (five items) were tested for their association with whether staff had an opinion (agree/disagree versus don't know) and if so, what that opinion was (agree versus disagree) using the generalized estimating equation method. RESULTS: Questionnaires were completed by 476 staff (98 percent response) in 18 programs (100 percent response). The majority of staff believed that physicians and nurses can provide preventive dental services (66 percent) and identify dental problems (52 percent). Staff placing importance on ensuring access to dental care and who were knowledgeable about fluoride uses were more likely to have an opinion. Among staff with an opinion, those familiar with the NC program where these services are provided in medical offices were more likely to agree that physicians and nurses can provide preventive services and identify problems. CONCLUSIONS: Although the opinions of the majority of the EHS staff are not a barrier to using primary medical care providers to deliver preventive dental care, education is needed for staff who are unfamiliar with this approach.     

Public perceptions of the funding of NHS dental services.

A survey was carried out of 102 members of the general public, asking for their views of the recent changes in the government funding of NHS dentistry. Approximately 80% of those surveyed had heard about the changes. The majority thought that the implications of the change would be a rise in costs to patients and a fall in the number of NHS dentists.     

The provision of dental services in the Third World

The primary health care approach has been selected as the basic health care planning philosophy in the developing countries and as oral health is an integral part of general health, this approach could be applied for oral health promotion too. Sri Lanka shares most of the oral health problems common to other developing countries. Dental care is delivered free through hospital dental clinics to adults and school clinics to children. Field medical staff, village health volunteers, religious leaders, school-teachers, traditional medical practitioners and senior students in schools are deeply involved in oral health promotional activities. The traditional concept of health care delivery filtering through a number of layers has been replaced by an upward movement initiated by the people. Every effort is being made to strengthen the base of this structure where non-dental personnel are involved, the dental auxiliary personnel providing the services at the first referral level and the scarce professionals being concerned only with high quality oral care at the final referral level. In addition to preventive and educational services a certain amount of treatment has to be provided. These are supplied in static hospital clinics, in mobile clinics or portable equipment is used to set up temporary dental centres in remote areas. Highly sophisticated equipment imported from industrialized countries is used in the hospital service but this service is disrupted due to frequent breakdowns and lack of spares. Local production of dental equipment should be encouraged and research should be conducted to assess the most suitable equipment for third world countries.     

Efficiency in provision of public dental services in Norway

The paper examines productivity in the provision of public dental services in Norway. The main responsibility of the public dental services is to provide care for all children up to 18 years of age. Most dental care is provided by public dental officers. Productivity was measured by estimating a stochastic production frontier from input and output data from the public dental service in Norway. The results indicate that there are increasing returns to scale. Our measure of technical efficiency showed that the level of inefficiency is fairly small. However, the inefficiency is greater when estimated from a deterministic production frontier rather than from a stochastic frontier. One limitation of the present methodology is that it does not say anything about the level of efficiency in the Norwegian public dental service in absolute terms. A greater level of inefficiency would have been identified if a few counties had performed clearly better than the rest.     

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.     

Neurofibromatosis-1 and the provision of dental care

The general features of Neurofibromatosis-1 are outlined and the oral and maxillofacial features described. Two case reports of patients treated in the Department of Sedation and Special Care Dentistry at King's College London Dental Institute are presented, and the dental management of patients with Neurofibromatosis discussed. CLINICAL RELEVANCE: Neurofibromatosis-1 is a neurocutaneous genetic disease with a prevalence of one in 4000-5000. Dentists may be presented with these patients in their surgery and this article will help them to understand the condition and explain how to manage these patients.     

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.     

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.     

NHS direct and access to dental care

OBJECTIVE: To evaluate the effect of pre-operative administration of tranexamic acid in preventing prolonged post-operative bleeding in day-case patients. Day-case admission is highly appropriate for dentoalveolar surgery but one of the problems is prolonged post-operative haemorrhage which at times may delay discharge or necessitate readmission to hospital. Tranexamic acid has traditionally been used to treat post-operative bleeding. DESIGN: A prospective double-blind randomised study. SETTING: Eastman Dental Hospital, London. SUBJECTS AND METHODS: Fifty-six patients were consecutively selected from healthy adult volunteers who were having third molar extraction in the day case unit of the Eastman Dental Hospital over a period of 22 weeks. Tranexamic acid (25 mg/kg) or normal saline was administered intravenously at induction by the anaesthetist and blood loss was measured intra- and post-operatively. RESULTS: A significant reduction (P = 0.023) in the post-operative blood loss was found in the tranexamic acid group. However, there was no significant difference in the intra-operative (P = 0.4) and the overall total blood loss (P = 0.21). No patient receiving tranexamic acid required readmission to control prolonged bleeding, or suffered any side effects from the drug. CONCLUSION: This study has shown that one intravenous pre-operative dose of tranexamic acid is effective in preventing excessive post-operative bleeding in patients undergoing third molar extraction under a day case general anaesthetic and therefore facilitates safe discharge from hospital.     

The provision of dental care for the elderly person

In Britain over the past thirty years there has been a dramatic extension of life expectancy. This paper looks at the history of dental care, the current situation, mental health problems in the elderly, nutrition and the dental condition, provision of dental care for the partially dentate, a comparison of studies and recommendations for improved treatment and training.     

Evaluation of quadrant dentistry in provision of dental care

The chairtime required for a single Class I or Class II amalgam restoration at 163 sittings was compared with the chairtime required for 99 cases in which two restorations in a quandrant were treated at the same sitting. The "Quadrant Dentistry Efficiency Rate" was calculated and it was found that quadrant dentistry resulted in a saving of between 30% and 50% of chairtime. The individual speed of the three dentists treating the children did not greatly influence the percentage of chairtime saved.