The role of dentist, practice and patient factors in the provision of dental services

OBJECTIVES: Service provision varies by dentist, practice and patient factors. However, limited subsets of these potential influences on service rates have been explored. More comprehensive models could improve our understanding of the factors influencing the pattern of care delivered. The aim of this study was to examine variation in dental services by dentist (treatment choice, practice beliefs, preferences for patients, demographics), practice (type, location, size and volume of practice) and patient (visit, demographic, oral health and socio-economic) characteristics. METHODS: A random sample of Australian dentists was surveyed in 1997-98 (response rate=60.3%). Private general practitioners (n=345) provided dentist and practice data, and service provision and patient variables were collected from a log of a typical clinical day (n=4,115 patients). Multivariate negative binomial regression models were fitted for diagnostic, preventive, restorative, extraction and prosthodontic services. RESULTS: Significant dentist factors included (P<0.05; RR=rate ratio): lower diagnostic rates (RR=0.78) for dentists with stronger practice beliefs for giving information about cost and treatment options; preventive rates were lower (RR=0.74) for male dentists and higher (RR=1.48) for younger dentists aged 20-29 years; restorative rates were higher (RR=1.27) for dentists that rated patient preferences more highly in treatment choice and in the dentist age group 30-39 years (RR=1.25); extraction rates were lower (RR=0.61) for dentists with stronger preferences for patients that would adhere with treatment but higher (RR=1.57) for dentists with stronger preferences for sociable patients; and prosthodontic rates were lower (RR=0.38) for dentists with stronger preferences for adaptable patients who were willing to cooperate when expected to do so. Practice factors included: higher preventive (RR=1.28) and prosthodontic rates (RR=2.07) in solo practice; higher preventive (RR=1.34) but lower prosthodontic rates (RR=0.42) in capital cities; lower diagnostic (RR=0.82) and extraction rates (RR=0.55) in practices with fewer other dentists; higher diagnostic (RR=1.33) and extraction (RR=1.62) rates but lower restorative rates (RR=0.84) in practices with lower patient visits per year. Patient factors included: lower preventive (RR=0.76) but higher extraction rates (RR=1.45) for emergency visits; lower extraction rates (RR=0.60) for the insured; higher diagnostic rates (RR=1.17) for new patients; higher restorative (RR=1.31) but lower prosthodontic rates (RR=0.46) for patients with decayed teeth; higher prosthodontic rates (RR=2.14) for those with dentures; and lower preventive (RR=0.66), but higher extraction (RR=2.22) and prosthodontic rates (RR=1.82) for patients from lower socio-economic status areas. CONCLUSIONS: Dental service rates were influenced by large number of small effects from a wide range of dentist, practice and patient factors. Socio-economic and geographic barriers may need broad policy innovations to be addressed, but factors such as insurance and visit type have the potential to be altered to achieve better service outcomes and there is scope for research into clinical outcomes to improve the knowledge upon which treatment decisions are based.     

Clinical evaluation of different treatment methods for oral submucous fibrosis. A 10-year experience with 150 cases

Over a 10-year period (1982–1991), a total of 150 patients divided into two groups with varying degrees of oral submucous fibrosis (OSF) were treated by either medical or surgical therapies. Medical treatment involved (a) conservative oral administration of vitamin B-complex, buflomedial hydrochloride and topical triamcinolone acetonide 0.1%, or (b) conventional submucosal injections of a combination of dexamethasone and hyaluronidase, or (c) a combination of both (a) and (b). The surgical group was treated by the excision of fibrotic tissues and covering the defect with split-thickness skin, fresh human amnion, or buccal fat pad (BFP) grafts. Treatment was chosen according to the stage of clinical progression to gain maximal interincisal distance (ID). The cases were followed up by monthly examinations for at least two years, or when possible even longer. A combination of (a) and (b) medical treatment was satisfactory in cases of mild impairment (ID > 20 mm) but in the long term it led to symptomatic relief only. Surgical therapy, on the other hand, when accepted by the patients, led to a significant improvement of trismus in cases of severe limitation (ID < 20 mm). Following this strategy, an additional ID increase was observed in all patients. BFP grafting was particularly successful in diminishing scarring after two years as compared with the other two grafts. Together with a cessation of the betel quid chewing habit before and after therapy, these treatment regimens combined with daily mouth opening exercises were found to be necessary to manage OSF cases in early and advanced stages of progression.     

Evaluation of residual monomer elimination methods in three different fissure sealants in vitro

The aim of this study was to determine the concentration of residual monomers and to evaluate the effectiveness of elimination methods of residual monomers in three different fissure sealant materials (Helioseal F, Filtek Flow and EXM-510). The sealant materials were divided into four subgroups because of the treatment methods used; one control group and three experimental groups (cotton roll, rubber cup and prophylaxis paste in cup). High performance liquid chromatography was used to determine the concentrations of residual monomers. Results of the study showed that residual Bis-glycidyl dimethacrylate elution was the highest in Helioseal F and the lowest in Filtek Flow with the three methods tested. For triethleneglycol dimethacrylate, EXM-510 eluted the highest residual monomer. It was also found that although the three tested methods were insufficient for removing all of the residual monomers and rubbing with cotton rolls was more effective than other two methods.     

Understanding Dental Service Use by Older Adults: Sociobehavioral Factors vs Need

Objectives: This study investigated correlates of dental care use in a representative sample of adults aged 70 and older throughout New England. Methods : Data were collected in in-home interviews and dental examinations. Following Andersen's behavioral model of health services utilization, varied measures of sociodemographic characteristics, dental health attitudes and practices, perceived need for care, and need objectively determined by clinical examination were included as potential correlates. Results : Recency of last visit was associated with positive attitudes toward dental care, regular dental hygiene, and having a usual source of care. Among dentulous subjects, recency of last visit also was related to sex and living arrangements. Frequency of visits for dentulous subjects was associated with the same variables, as well as with age and social class or education, in addition to need for care. For edentulous subjects, only a usual sourse of care and higher social class were associated with more frequent visits. Conclusions : Perceived need and attitudes toward dental care are important influences on use of care. Older persons must be convinced of the importance of regular dental care.     

Clinical evaluation of class II Targis inlays: preliminary results after 1 year

The aim of this study was to evaluate the clinical performance of a new generation of restorative resin, Targis (Vivadent), in class II inlay restorations. Forty class II Targis inlays were placed (18 premolars, 22 molars) in 26 patients (mean age=25.5). All test teeth were vital. All restorations were in occlusion and were placed adhesively using Variolink II high viscosity (Vivadent) in combination with Syntac adhesive system under rubber-dam by the same operator. The restorations were evaluated at baseline and after 6 months and 1 year, according to modified United States Public Health Service (USPHS) criteria by two examiners. The parameters evaluated were: anatomical form, marginal adaptation, marginal discoloration, colour match, surface finish, gingival index and secondary caries. Post-operative sensitivity was determined by direct questioning. Regarding all of the clinical evaluation criteria all 40 inlays exhibited clinically acceptable scores after 1-year evaluation period. Relying on these early 1-year results, the new restorative material (Targis) seems to be promising in class II inlays.     

Correlation between fracture properties and clinical performance of composite resins in Class IV cavities

One hundred and two Class IV cavities were restored randomly with four composite resins. The restorations were assessed at six months, one year, two years and three years for surface chipping, bulk fracture and incisal wear. The data were correlated with various mechanical properties of the materials. A significant correlation was found between surface chipping/bulk fracture and fracture toughness (P = 0.002), elastic modulus (P = 0.006) and tensile strength (P = 0.045). There was a trend towards an association between incisal wear and both elastic modulus and inherent flaw size. Fracture toughness may be a useful indicator of the clinical performance of composites in Class IV cavities.     

Amyloidosis with oral involvement. Case report

A patient with chronic renal failure was investigated after complaining of oral discomfort which was found to be due to macroglossia and generalized involvement of the oral soft tissues by amyloidosis. A search for multiple myeloma proved to be positive. She also had a previous history of Carpal-tunnel syndrome. Despite an initial good response to treatment with phenylalanine nitrogen mustard (melphalan hydrochloride), she finally succumbed to end-stage renal failure.     

The changing role of dental auxiliaries: A literature review

A review of the literature on dental auxiliaries and their utilization in the dental workforce is presented, and their future role is examined in the light of broader issues relating to changing disease patterns and service delivery. Legislative factors, productivity, quality assurance and the potential scope for dental auxiliaries in both the public sector and private practice setting are discussed. A strategy for adopting a team approach in the delivery of dental services is suggested, which would necessitate the dentist taking on the role of team leader and maintaining responsibility for overall treatment planning and quality assurance. Dental auxiliaries could provide basic preventive and restorative dental services, allowing dentists to concentrate on providing more complex high-technology treatment. Implications for the future training of dental auxiliaries are presented.     

Low-frequency repetitive transcranial magnetic stimulation for dyskinesia and motor performance in Parkinson’s disease

Dyskinesias are one of the most frequent and disabling complications of the long-term treatment of Parkinson’s disease (PD). Although the cause is not completely understood, it appears that an imbalance between excitatory and inhibitory inputs from the basal ganglia to the motor cortex leads to overactivation of motor and premotor areas. Overactivation of the supplementary motor area (SMA) has been observed in neuroimaging studies in dyskinetic PD patients. We investigated the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) of the SMA on levodopa-induced dyskinesias (LID) and motor performance in PD. We tested whether longer duration (10 days) and higher number of total pulses (1800 pulses) would enhance the beneficial effect. Seventeen dyskinetic PD patients were randomly assigned to real rTMS or sham (placebo) rTMS, and 1 Hz rTMS or sham rTMS was applied over the SMA for 10 consecutive days. Patients were assessed at baseline and 1 day after the last rTMS with a levodopa challenge test, and video recordings were taken. Dyskinesias and motor performance were rated off-line by two blinded raters using video recordings. After 10 days of treatment with rTMS, we observed that 1 Hz rTMS delivered over the SMA had decreased LID lasting for 24 hours without a change in motor performance, whereas sham rTMS induced no significant change in dyskinesia scores. These results support a possible therapeutic effect of low-frequency rTMS in LID. However, in order to suggest rTMS as an effective treatment, long-term observations and further investigations with a larger patient population are essential.     

高职高专类院校医疗美容技术专业《美容解剖学》教学研究与改革

随着美容技术的逐渐发展,医疗美容技术专业解剖学的教学改革势在必行,课程组从专业考察及体系重建、教师队伍建设、教材选择、教学方法和手段、实验实训、考试考核制度等方面进行改革,并充分体现解剖学与医疗美容技术专业相结合的特色。