Hepatitis B virus: the risk to Australian dentists and dental health care workers

A survey of 1088 Australian dentists and dental health care workers showed that 8.2 per cent of dentists in private practice, 16.8 per cent of hospital dentists, 2.0 per cent of chairside assistants, 4.1 per cent of dental technicians, and 6.1 per cent of dental students had serological evidence of prior hepatitis B infection manifested by the presence of hepatitis B core antibody. No carriers of hepatitis B surface antigen were detected. The 784 replies to a questionnaire showed that 11.2 per cent of dentists had one or more serological markers to hepatitis B virus (HBV), 7.6 per cent gave a history of overt hepatitis B infection, and 53 per cent had been vaccinated against HBV. Of the 196 non-vaccinated dentists, 47 per cent did not desire to be blood tested. Continuing education of Australian dentists about the risk of infection with and the need for immunization against HBV is indicated.     

Dentists' use of caries risk assessment and individualized caries prevention for their adult patients: findings from The Dental Practice-Based Research Network

Riley JL, Gordan VV, Ajmo CT, Bockman H, Jackson MB, Gilbert GH, for The Dental PBRN Collaborative Group. Dentists’ use of caries risk assessment and individualized caries prevention for their adult patients: findings from The Dental Practice‐Based Research Network. Community Dent Oral Epidemiol 2011; 39: 564–573. © 2011 John Wiley & Sons A/S Abstract – Objectives: Few studies have examined dentists’ subjective ratings of importance of caries risk factors or tested whether dentists use this information in treatment planning. This study tested several hypotheses related to caries risk assessment (CRA) and individualized caries prevention (ICP). Methods: Data were collected as part of a questionnaire entitled ‘Assessment of Caries Diagnosis and Caries Treatment’, completed by 547 practitioners who belong to The Dental Practice‐Based Research Network (DPBRN), a consortium of participating practices and dental organizations. Results: Sixty‐nine percent of DPBRN dentists perform CRA on their patients. Recently graduated dentists, dentists with busier practices, and those who believe a dentist can predict future caries were the most likely to use CRA. The association between CRA and individualized prevention was weaker than expected (r = 0.21). Dentists who perform CRA provide ICP to 57% of their patients, compared with 42% for dentists who do not perform CRA. Based on their responses to radiographic and clinical scenarios in the questionnaire, dentists who use CRA appear to use this information in restorative decisions. Conclusion: A substantial percentage of DPBRN dentists do not perform CRA, and there is not a strong linkage between its use and use of individualized preventive regimens for adult patients. More progress in the implementation of current scientific evidence in this area is warranted.     

Determinants of general dentists' decisions to accept capitation payment: a conceptual model and empirical estimates

Abstract – Background: Shifts in payment options for dental care over several decades have resulted in more dental expenditures being paid through health maintenance organizations (HMOs), preferred provider organizations (PPOs), and capitation arrangements. Patients’ and employers’ choices to participate in these arrangements is determined in part by dentists’ willingness to participate in plans, and plan choices may be influenced by patient satisfaction, self‐reported oral health, and/or quality or cost of care. Objectives: This study examined determinants of dentists’ decisions to accept capitation payment for services. Research Design: Cross‐sectional mail survey in December 2006. Subjects: 1605 general dentists in Oregon. Measures: Questions addressed dentists’ perceptions of the importance of control over various practice parameters, willingness to accept capitation payment, employment or ownership status within the practice, and practice characteristics. Results: Capitation was accepted by 22.6% of the respondent dentists (n = 729). Reported average fees (2007 dollars) ranged from $60 (initial oral examination) to approximately $800 (porcelain crowns). The likelihood of accepting capitation payment was related to the number of dentists in the practice, but surprisingly owner‐dentists were no less likely than employee‐dentists (associates) to accept capitation. As expected, dentists’ usual and customary fees were negatively associated with accepting capitation. In contrast, measures of dentists’ importance of control were not related to decisions about capitation. Longer average appointment delays were related to acceptance of capitation, but the effects were small. Conclusions: Dentists’ behavior regarding payment acceptance is generally consistent with microeconomic theory of provider behavior. Study findings should inform practitioners, plan managers, and researchers in examining dentist payment decisions.     

Dentists’ knowledge,attitudes and practices regarding Hepatitis B and C and HIV/AIDS in Sanandaj,Iran

Background

Healthcare workers including physicians, dentists, nurses and laboratory workers are considered to be among the groups at the risk of blood-borne pathogen transmission. Thus, it is necessary to evaluate the Knowledge, Attitude, and Practices (KAP) of dentists regarding infection control and basic principles.

Methods

This cross-sectional study recruited 106 dentists in Sanandaj, Iran. The dentists’ KAP regarding hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV/AIDS were evaluated. Chi-square test, student’s t-test, and one-way ANOVA were used to assess differences between the groups. Data were analyzed in Stata 12.

Results

The results showed that the majority of the subjects in the study population (53.8%) were female. The mean?±?standard deviation (SD) for age and work experience was 39.6?±?9.80 and 10.6?±?8.7?years, respectively. The mean?±?SD for knowledge, attitude and practices of participants was 37.3?±?3.01, 22.9?±?4.80 and 24.07?±?5.06, respectively. The results also indicated that dentists’ higher level of knowledge about HBV, HCV and HIV/AIDS was significantly influenced by work experience (≥10?years; P?<?0.001) and graduation year (after 2006: P?<?0.001). Positive attitude towards HBV, HCV and HIV/AIDS was considerably influenced by age group (<?30?years: P?=?0.021), work experience (≥10?years: P?<?0.001), and workplace (dental office: P?=?0.016).

Conclusions

The results of this study demonstrated a satisfactory level of knowledge and attitude of dentists about HBV, HCV and HIV/AIDS infections, but some gaps were observed, suggesting that higher knowledge level of dentists plays a very important role in forming the attitudes and practices regarding patients with HBV, HCV and HIV/AIDS.

     

Reasons for tooth extraction in a Brazilian population

AIM: To identify the reasons for tooth extraction in Recife, Brazil and to test whether they differ by socio-economic groups and levels of caries experience. DESIGN: Cross-sectional survey. SETTING: Ten health centres of the public health system and ten health centres of insurance companies. PARTICIPANTS: Patients attending health centres. METHODS: Ten dentists from each selected centre and two patients from each selected dentist were randomly selected from; the list of all health centres in Recife, all dentists carrying out dental extractions at each selected centre and all patients who had an appointment with the selected dentists respectively. Participants were examined by both the researcher (AC) and dentists. OUTCOME MEASURE: Reasons for tooth extraction. RESULTS: Of the 404 teeth extracted, 70.3 per cent were because of caries and its sequelae; 15.1 per cent because of periodontal disease; 6.4 per cent for pre-prosthetic reasons; 3.7 per cent wisdom teeth, 2.5 per cent for orthodontic reasons and 1 per cent for trauma and patient's request. A trend was observed for patients with less than secondary school education and lower salaries to have more tooth extraction due to caries, but the differences were not of statistical significance.     

武汉市牙医对爱滋病的态度、知识及在感染控制中的行为调查分析

目的 :研究武汉市牙医对AIDS的态度、知识及在感染控制中的行为。方法 :对武汉市 5 0 0名牙医进行问卷调查和分析。结果 :收到有效问卷 46 7份。其中 6 3.2 %的牙医表示愿意治疗AIDS/HIV 病人。 6 0 .4%牙医认为血液是传播HIV的最危险的体液 ,且大多数牙医错误地认为唾液是传播HIV的媒介。 318名牙医每天戴手套操作治疗病人 ,但其中仅 12 8(40 .3% )名牙医在治疗完病人后更换手套。结论 :本研究表明牙医所掌握HIV传播的知识水平较低。同时牙医也没有提供足够的防护措施来保护自己和病人     

Holding up the oral health safety net: the role of National Health Service Corps alumni dentists in North Carolina

Background: Access to oral health care among low income populations is a growing problem. The National Health Service Corps (NHSC) might increase the supply of dentists motivated to provide services for this population. Objective: To determine if North Carolina dentists who began a service obligation with the NHSC in 1990–1999 continued to provide care for underserved populations and if they differ from non‐NHSC alumni primary care dentists who started practice in the state during that same period. Methods: All 19 NHSC alumni and 50 comparison dentists were surveyed by mail. NHSC alumni also responded to selected items in a telephone follow‐up interview. The two groups were compared using difference of means tests and multivariate contingency tables. Results: National Health Service Corps alumni were more likely to be African‐American (38%vs. 10%), work in safety net practices (84%vs. 23%), and see more publicly insured patients (60%vs. 19%) than comparison dentists. Yet their job satisfaction was comparable to non‐NHSC alumni dentists. Analyses suggested that current practice in safety net settings is affected by dentists’ race, altruistic motivations and previous NHSC participation. Conclusion and policy implication: Targeted recruitment of African‐American dentists and others wanting to work in underserved communities could amplify the effectiveness of the financial incentive of NHSC loan repayment and induce dentists to remain in ‘safety net’ settings.     

Routine oral examination: differences in characteristics of Dutch general dental practitioners related to type of recall interval

Abstract – Objectives: The aim of this study was to explore differences in behaviour (characteristics and opinions) among general dental practitioners (GDPs), using either a fixed (Fx) or an individualized recall interval (Iv) between successive routine oral examinations (ROEs). Methods: In the year 2000, data were collected by means of a written questionnaire sent to a random stratified sample of 610 dentists of whom 521 responded, of which 508 (83%) were used for analysis. Results: Two groups of GDPs were distinguished based on their answer to the question: ‘Do you apply for all patients a fixed recall interval between two successive ROEs?’ Fifty‐one per cent of the GDPs (n = 257) applied Fxs for all patients, generally for a period of 6 months. Ivs were applied by 49% (n = 251) of GDPs, depending on the determination of specific patient characteristics. Logistic regression analysis showed that GDPs applying Fxs also used fixed periods between successive bitewing radiographs for all patients. Furthermore, dentists applying Ivs required more time to conduct an ROE, partly because of a more extensive periodontal screening. GDPs applying Fxs, adhered more to the opinion that a fixed recall regime (every 6 months, as existed before 1995) should be re‐introduced, whereas the GDPs in support of Ivs were more in favour to support the opinion that the ROE is ‘an excellent instrument for effective, individualized oral care’. Conclusions: Dutch GDPs differ in the way they deal with the determination of recall interval frequency. These are also specific differences in performance and opinions regarding ROE. With the changing prevalence of oral diseases and the skewed distribution within populations, further research is advocated on consistent decision making to determine the most appropriate recall policy in preventing oral disease.     

Maximizing response rates to a survey of dentists: a randomized trial

Dentists currently practising within the Central Sydney Area were surveyed (n = 179). A randomized controlled trial was conducted to evaluate the effect of an advance telephone prompt (intervention group) compared with an advance letter prompt only (control group) in maximizing the response rate to a self-administered questionnaire. While the overall response rate was 83 per cent, the final response rate (89 per cent) from dentists in the intervention group was significantly higher than that from dentists in the control group (78 per cent) (chi 2 = 4.14, df = 1, p = 0.04). Advance telephone prompts are effective in maximizing the response rates from dentists and are recommended in future surveys of this professional group.     

Knowledge and competence in temporomandibular disorders among Swedish general dental practitioners and dental hygienists

Objective: The aim of this study was to investigate knowledge and competence in temporomandibular disorders (TMD) among dentists and dental hygienists working in the public dental service (PDS) in Sweden.

Materials and methods: The study population comprised all general dentists (n?=?110) and dental hygienists (n?=?80) working in the PDS in two Swedish counties: Kronoberg (K) and Blekinge (B). The participants filled out a questionnaire comprised of 15 questions.

Results: The results of these questions are presented. The overall response rate for the general dentists was 87%, while the rate for the dental hygienists was 71%. Statistically significant differences between the general dentists in the two counties were found regarding the following: education in the field of TMD over the last 5 years (K: 37%, B: 73%), evaluation of occlusion when examining patients with suspected TMD (‘always’: K: 61%, B: 82%), and a desire for consultation of the OFP (orofacial pain)/TMD specialist by telephone (K: 71%, B: 44%). Regarding the dental hygienists, there was a statistically significant difference concerning the use of the treatment modality ‘reassurance’ (K: 41%, B: 7%).

Conclusions: The majority of the dental care providers in both counties – irrespective of professional category – had a positive attitude towards patients with TMD. Knowledge and competence in the field are sparse and require postgraduate education. There is a great need of an OFP/TMD specialist for more complicated patients and a need to implement updated knowledge and competence in the PDS in these two counties.     

The effect of confirmation calls on appointment-keeping behavior of patients in a children's hospital dental clinic.

PURPOSE: The objective of this prospective, randomized, controlled study was to evaluate whether confirmation calls made one or two working days before scheduled appointments reduce the percentage of broken appointments in a children's hospital dental clinic. METHODS: Patients were randomly assigned to three groups: 1) confirmation call made one working day before appointment, 2) confirmation call made two working days before appointment; and 3) control group (no confirmation call). Clinic staff made confirmation calls during normal office hours. Patient arrival was classified as 1) < or =15 minutes late; 2) > 15 minutes late; or 3) broken appointment. RESULTS: Three hundred and thirteen subjects were enrolled in the study: 77 subjects in group 1; 71 subjects in group 2; and 84 subjects in the control group. Eighty-one subjects (26%) could not be contacted by telephone. Overall, there was a 62% reduction in broken appointments among patients who received a confirmation call as compared to the control group. There was no significant difference between confirmation calls placed one or two working days prior to the appointment (P=0.51). Confirmation calls had no effect on punctuality. In comparing indigent care and private insurance, there was no significant difference in broken appointments. However, within the private insurance group, a confirmation call resulted in 93% of patients keeping their appointment as compared to 63% in the control group (P<0.001). No significant difference was noted in the indigent care group, with 79% of patients in the confirmation call group keeping their appointments as compared to 66% in the control group (P=. 093). CONCLUSIONS: Confirmation calls reduced the percentage of broken appointments in a pediatric dental clinic. There was no difference between calls placed one or two working days prior to the appointment. The greatest reduction in broken appointments was shown in the private insurance group.     

A survey of general dental practitioners in Merseyside regarding urgent appointments and suspected cancer referrals.

AIMS: The aims of this study were to investigate the current situation regarding unregistered patients in the Mersey region who seek an urgent dental appointment, and to gather information on suspected oral cancer cases seen by dentists in the previous two years and about how such cases are referred. METHODS: The survey took the form of a short questionnaire sent in May 2006 to all general dental practitioners (GDPs) in the Mersey region who were registered with the regional postgraduate dental office. RESULTS: A total of 904 GDPs were identified and 572 (63%) returned completed survey responses. Half (276/572; 48%) reported that they could see new patients urgently under the National Health Service (NHS) and two-thirds (365/571; 64%) that they could see them either under the NHS or privately. Nineteen per cent reported that they would not see any new patients. Those in the most deprived areas were more likely to see a patient on the NHS. The waiting time for an urgent appointment, if it was offered, was over one week for nearly one-third (32%) of the dentists offering NHS care. Most dentists (84%) said that a patient suspected of having oral cancer would be referred the same day as the decision had been made to refer. CONCLUSION: Access to dental care has been a high-profile issue over the past few years. This survey indicated that in Merseyside, just under half of the dentists who responded were willing to see new patients with urgent problems under the NHS. It is suggested that this difficulty in access, together with some reported delays in obtaining appointments and the methods of onward referral, may cause additional barriers to early detection of oral cancer, especially for those in the most at-risk groups, who are also very frequently hard to reach.     

Influence of patients perception on their acceptance and understanding of dental care within an education system

This study examined the effects of conditions (that is, the fee structure and the easy of obtaining a dental appointment) on patient understanding and cooperation in clinical practice for dental hygiene and dental students. A questionnaire was given sequentially to 1483 patients attending the Tokyo Medical and Dental University dental hospital on "clinical education and patient satisfaction". Direct participants consisted of 650 patients, of which 213 (32.8%) were male and 422 (64.9%) female. The remaining 15 (2.3%) did not specify their gender. Patients who were satisfied with care received by dentists tended to be older compared to patients who were dissatisfied with dentists. The difference was significant (p < 0.001). Acceptable conditions for patients such as fees and appointments at the clinical session had an effected on patient acceptance of clinical training. The findings of this study suggest that patient satisfaction should be considered as part of the reasons for patients accepting dental care by students in their clinical education programs. Fees and appointment schedules strongly affect patient acceptance of clinical education.     

Description and evaluation of an education and communication skills training course in HIV and AIDS for dental consultants

A 2‐day course was organised for dental hospital consultants as part of a project on raising awareness of dental staff about HIV and AIDS. The course comprised an information update, practical experience in the diagnosis of oral conditions and a ‘hands‐on’ exercise in infection control. The 2nd day of the course consisted of experiential communication skills training using rôle‐play with actors and video feedback. Evaluation of the course showed that the consultants perceived the course to be valuable. There was a general improvement in dentists’ confidence in their knowledge, ability to communicate with HIV‐positive patients and in talking to staff who are unwilling to provide treatment. These changes are statistically significant and these skills are still being utilized and maintained 2 years later. Information and training packs prepared by multidisciplinary groups using a variety of teaching methods should be made available to those involved in training dental staff.     

How primary care dentists perceive and are influenced by research

Hopper L, Morris L, Tickle M. How primary care dentists perceive and are influenced by research. Community Dent Oral Epidemiol 2011; 39: 97–104.
© 2010 John Wiley & Sons A/S Abstract – Introduction: Little is understood as to how primary care dentists alter their clinical practice. Aim: To develop an understanding of how primary care dentists view and use research to inform their clinical practice. Methods: An iterative approach was followed using two methods of data collection. A focus group was undertaken with dentists and researchers who had been involved in primary care dental research. Subsequently phased, qualitative interviews were undertaken with primary care dentists with a range of research experiences. Focus group and interviews were audio‐recorded and transcribed verbatim. Six people participated in the focus group. Eighteen dentists participated in the interviews. Interviews were undertaken in four phases until saturation was achieved. Data were analysed using constant comparison. Findings: Evidence‐based dentistry was considered the ideal. However, the research base for primary care dentistry was thought to lag behind clinical services, to focus on incorrect endpoints, to disregard the patients’ voice and failed to consider the impact of conducting research on dental practices. Dentists modified their clinical practice based upon research, colleagues’ opinions, courses and ad hoc personal evaluation. Uptake of research was affected by the ethos of the practice, which determined whether the dentists were early or late adopters of research and financial viability of new interventions. Conclusion: Dentists wanted concise, timely evidence‐based guidance to aid their management of patients. Further research needs to be undertaken to understand how to develop an evidence‐based culture in primary dental care.     

HIV testing in the dental setting: A global perspective of feasibility and acceptability

HIV is no longer a death sentence with early diagnosis and effective treatment contributing to a good prognosis. Surveillance data, however, suggest that one in four people globally living with HIV are unaware of their HIV infection and remains at risk of transmitting their infection if having unprotected sex. A wider array of testing opportunities and settings are thus needed to address this issue of public health significance. Evidence suggests there is a role for the dental team, particularly dentists, in offering chairside point‐of‐care HIV screening to patients during their dental appointments. Dentists, dental hygienists, and other members of the dental team may still have a role in helping to identify new cases of HIV with the goal of improving health outcomes, addressing health inequalities and improving the quality and quantity of life. This paper reviews the global epidemiology of HIV/AIDS, summarizes the point‐of‐care HIV testing process, highlights key findings of international studies (from high‐, middle‐, and low‐income countries) on the role of dental professionals in point‐of‐care HIV testing, and offers suggestions for what additional evidence is needed to make point‐of‐care HIV testing a routine part of dental care.     

Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: a longitudinal and retrospective study

Abstract – Traumatic dental injuries are emergencies that must be treated promptly and properly in order to reduce the suffering, costs, and time for patients, parents, and health care providers. The aim of this study was to investigate the treatment, long‐term prognosis, and number of visits needed to manage cases resulting from complications of late presentation of traumatic dental injuries. The sample consisted of 195 children, all presented with complications of dental trauma at the Pediatric Dentistry Clinics in the Dental Teaching Hospital of Jordan University of Science and Technology in Irbid city, Jordan. Retrospective data relied on trauma forms as well the clinical notes and radiographs in the patients' records. Prospective data was collected by examining patients at recall appointments. The treatment of traumatized teeth in this sample ranged from no active treatment to extraction and prosthetic replacement. It was estimated that the number of visits needed to carry out the planned treatment for these patients ranged between 3 and 17.2 visits according to the type of treatment. Apexification procedure was the most time consuming. Thirty‐two per cent of teeth with apexification ended up with root fracture mainly subsequent to another minor trauma episode (in 85%), the rest were reported to be spontaneous fractures. Almost half of the teeth with luxation injuries became necrotic after 3 years. Teeth with avulsion actually kept on deteriorating even at the 36‐month follow‐up appointment. The long‐term prognosis of teeth with middle root fracture was favorable in (80%) of the teeth in the sample, despite the fact that they were splinted late. Luxation injuries led to more necrotic teeth (50%) than uncomplicated crown fractures. Multiple dental trauma episodes (MDTE) were reported in about 30% of the patients in the sample and were responsible for some of the complications noticed in this report. As all cases followed up in this report are late presentation of dental trauma, the findings may emphasize and highlight predictors for healing and favorable long‐term prognosis for such injuries. This will help selecting the treatment option that would lead to better outcomes with less expense and less time consumption for dentists and patients alike. The findings of this report also stress the importance of prevention of dental trauma and minimize its complications through proper treatment, educational programs, supervision of children during play, use of mouth guards, and orthodontic treatment of proclined incisors.     

Appointment-keeping behavior of Medicaid-enrolled pediatric dental patients in eastern Iowa

PURPOSE: The purpose of this prospective study was to assess the appointment-keeping behavior of Medicaid-enrolled pediatric dental patients in three Eastern Iowa practices. METHODS: During the month of October 1998, a tally was kept of all patient appointments at a private pediatric dental office, a public health dental clinic, and a university-based pediatric dentistry clinic. Patients were categorized as either Medicaid or non-Medicaid. Appointment behavior categories were defined as: On time; Failure; Late-notice Cancellation (less than 24 hours notice); and Tardy (greater than 10 minutes). The data was entered in SPSS and analyzed using the chi square statistic. Statistical significance was P < 0.05. RESULTS: A total of 1,406 appointments were recorded for all three sites. Overall, patients on Iowa Medicaid had higher appointment failure, late-notice cancellation, and tardiness rates than non-Medicaid patients at all three clinics. However, these differences were only statistically significant for the private office and the university-based clinic. Failed appointment rates for Medicaid patients were much higher at the private office (38%) than at the other two sites. CONCLUSION: Consistent with anecdotal reports from dentists, Medicaid patients had higher rates of broken appointments than did non-Medicaid patients, particularly in a private practice setting.