Dental Practice Board Research Articles

The ultimate guide to restoration longevity in England and Wales. Part 10: key findings from a ten million restoration dataset.

This paper defines key points from a ten million restoration dataset in order to compare and contrast the data from the previous nine papers, identifying common themes and/or differences in the factors affecting the survival of restored teeth to next intervention or extraction. It is the aim of this paper to present data on the survival of restorations in teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored tooth, and to discuss key findings regarding this. A data set was established, consisting of General Dental Services (GDS) patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the key findings with regard to recorded intervals between placing a restoration in any tooth and re-intervention on the tooth, with the size of the dataset also permitting examination of the time to extraction of the restored tooth. Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Included were all records for adults (aged 18 or over at date of acceptance). Overall, 13,896,048 tooth restorations were included in the analysis. With regard to time to re-intervention, overall, between 32% and 42% of restorations, depending on tooth type, had survived at 15 years, and with regard to time to extraction of the restored tooth, the range was from 77.8% to 84.2%. The analysis confirms that larger restorations of all types and in all types of teeth generally performed less well than smaller restorations. Crowns perform better in time to re-intervention than direct restorations, but worse, particularly for younger patients, in time to extraction. Patient treatment history, measured as the average annual spend on treatment, is a major factor in the survival of restored teeth, both to re-intervention and to extraction. The greater the spend, the worse the survival. Regarding dentists, there is little difference in the survival of restorations placed by dentists of different gender, but dentists' age has been shown to play a part in the present investigation, with restorations placed by younger dentists performing better for all types of restoration except crowns. For direct restorations, the older the patient the poorer the survival of the restoration, whether to re-intervention or to extraction. The prognosis of a tooth which receives a root filling in the same course of treatment as the other restoration is much poorer than for teeth without such a root filling.

The ultimate guide to restoration longevity in England and Wales. Part 9: incisor teeth: restoration time to next intervention and to extraction of the restored tooth.

It is the aim of this paper to present data on the survival of restorations in incisor teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored incisor tooth, and to discuss the factors which may influence this. A data set was established, consisting of General Dental Services patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the recorded intervals between placing a restoration in an incisor tooth and re-intervention on the tooth, and the time to extraction of the restored tooth. Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Overall, 2,526,576 restorations of incisor teeth in adults were included. At 15 years, survival of restorations in incisor teeth without re-intervention was 35%, and for restored incisor teeth survival to extraction was 81%. Approximately 35% of restorations in incisor teeth survived without re-intervention at 15 years, and 81% of restored incisor teeth survived for 15 years without extraction. Factors influencing survival include patient age, dentist age, and patient treatment need. Crowning an incisor tooth leads to an earlier time to extraction of the restored tooth.

The ultimate guide to restoration longevity in England and Wales. Part 8: Canine teeth: time to next intervention and to extraction of the restored tooth.

It is the aim of this paper to present data on the survival of restorations in canine teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored tooth, and to discuss the factors which may influence this. A data set was established, consisting of General Dental Services (GDS) patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the recorded intervals between placing a restoration in a canine tooth and re-intervention on the tooth, and the time to extraction of the restored tooth. Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Included were all records for adults (aged 18 or over at date of acceptance). Overall, 1,232,052 restorations involving canine teeth were included in the analysis. With regard to time to re-intervention, 33% of restorations had survived at 15 years, and with regard to time to extraction of the restored tooth, cumulative survival was 78% at 15 years. Veneers and crowns performed best in terms of time to re-intervention, but crowns performed worst when time to extraction was analysed. Overall, crowns and porcelain veneers placed on canine teeth perform best to re-intervention after 15 years, but crowns perform worst when the time to extraction of the restored tooth is examined and veneers perform best, with a 20 percentage point difference in cumulative survival at fifteen years between crowns and the best performing restoration in the under-40 year age group, this effect being accentuated in the over-40 year age group. Other factors influencing restoration longevity in canine teeth include: patient age, dentist age and the patient's annual need for dental treatment.

The ultimate guide to restoration longevity in England and Wales. Part 5: crowns: time to next intervention and to extraction of the restored tooth.

Aim It is the aim of this paper to present data on the survival of restorations in canine teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored tooth, and to discuss the factors which may influence this. Methods A data set was established, consisting of General Dental Services (GDS) patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the recorded intervals between placing a restoration in a canine tooth and re-intervention on the tooth, and the time to extraction of the restored tooth. Results Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Included were all records for adults (aged 18 or over at date of acceptance). Overall, 1,232,052 restorations involving canine teeth were included in the analysis. With regard to time to re-intervention, 33% of restorations had survived at 15 years, and with regard to time to extraction of the restored tooth, cumulative survival was 78% at 15 years. Veneers and crowns performed best in terms of time to re-intervention, but crowns performed worst when time to extraction was analysed. Conclusions Overall, crowns and porcelain veneers placed on canine teeth perform best to re-intervention after 15 years, but crowns perform worst when the time to extraction of the restored tooth is examined and veneers perform best, with a 20 percentage point difference in cumulative survival at fifteen years between crowns and the best performing restoration in the under-40 year age group, this effect being accentuated in the over-40 year age group. Other factors influencing restoration longevity in canine teeth include: patient age, dentist age and the patient's annual need for dental treatment.

The ultimate guide to restoration longevity in England and Wales. Part 2: Amalgam restorations - time to next intervention and to extraction of the restored tooth.

Aim It is the aim of this paper to present data on the survival of restorations in canine teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored tooth, and to discuss the factors which may influence this. Methods A data set was established, consisting of General Dental Services (GDS) patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the recorded intervals between placing a restoration in a canine tooth and re-intervention on the tooth, and the time to extraction of the restored tooth. Results Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Included were all records for adults (aged 18 or over at date of acceptance). Overall, 1,232,052 restorations involving canine teeth were included in the analysis. With regard to time to re-intervention, 33% of restorations had survived at 15 years, and with regard to time to extraction of the restored tooth, cumulative survival was 78% at 15 years. Veneers and crowns performed best in terms of time to re-intervention, but crowns performed worst when time to extraction was analysed. Conclusions Overall, crowns and porcelain veneers placed on canine teeth perform best to re-intervention after 15 years, but crowns perform worst when the time to extraction of the restored tooth is examined and veneers perform best, with a 20 percentage point difference in cumulative survival at fifteen years between crowns and the best performing restoration in the under-40 year age group, this effect being accentuated in the over-40 year age group. Other factors influencing restoration longevity in canine teeth include: patient age, dentist age and the patient's annual need for dental treatment.

Interest in dental implantology and preferences for implant therapy: a survey of Victorian dentists.

The purpose of this study was to gauge dentists' interest, knowledge and training in implantology, and to compare their treatment preferences with current literature. Subsequently, this information may be used to evaluate implantology education pathways. A cross-sectional postal survey of 600 randomly selected dentists registered with the Dental Practice Board of Victoria was conducted. Respondents were asked about background, interest and training in implantology, and implant treatment preferences. Results were analysed according to primary practice location, decade of graduation and attendance at continuing professional development (CPD) programmes. One hundred and seventy-six questionnaires were included for analysis. In general, dentists rate their implant knowledge, interest and enjoyment in restoring implants favourably. No differences were found between city and country practitioners, and different graduation decades. The level of CPD significantly influenced treatment preferences. Practitioners were generally unwilling to treat patients taking bisphosphonates, or to perform grafting procedures. Most dentists provide common services to treat peri-implant conditions. Direct-to-fixture is the most popular fixture-abutment connection. Overall, there is a high level of implant knowledge corresponding to current evidence in the literature. Level of CPD attendance is the most important factor in dentists' willingness to provide more implant therapy options.

Endodontists perceptions of single and multiple visit root canal treatment: a survey in Florianópolis – Brazil

One of the main debates that have occurred in Endodontics is about the amount of sessions required to complete an appropriate treatment. There are very different philosophies regarding this matter. Objective: to the aim of this study was to investigate the Endodontists’ point of view regarding single and multiple visit root canal treatment, identifying the basis on which the choice is made and how the information necessary for the choice is acquired. Material and methods: Endodontists registered in the dental practice board of Florianópolis/SC were contacted, and if they agreed to participate, they were interviewed using a questionnaire. The following topics were addressed: demographics, current clinical procedures, treatment rationales and preferences. Forty-three endodontists agreed to participate in the study. Results: Single visit endodontic treatment is carried out in 59.5% of biopulpectomy cases, 31.0% of necropulpectomy cases without lesion and only 11.9% in necropulpectomy cases with periapical lesion. The presence of vital pulp (81.4%) and a canal without exudate (93.0%) are the most important criteria for carrying out single visit endodontic treatment. The most used intracanal medication was calcium hydroxide. The lack of studies comparing long-term success on single visit endodontic treatment is considered an important issue to determine this therapy. Conclusion: It can be concluded that Florianopolis-Brazil endodontists prefer multiple visit over single visit root canal treatment in pulp necrosis cases. When pulp vitality is not compromised there is an increase in the number of endodontists who choose single visit root canal treatment.

Provision of oral health care to adult patients by dental therapists without the prescription of a dentist

Dental therapists are increasingly been seen as part of the solution to assist in improving access to dental care for underserved populations. The aim of this article is to report the outcomes of an educational bridging program designed to provide university-educated dental therapists with the appropriate knowledge and skills required to enable them to translate their current clinical scope of practice to adult patients aged 26+ years. Ten dental therapists completed an educational program approved by the Dental Practice Board of Victoria as a pilot. Feedback from patients and supervising and supporting dentists was provided during the project. Supervising and supporting dentists rated the knowledge and clinical skills of participants as good to high at the completion of the education program and considered them safe to treat adults patients. Patients were very satisfied with the dental treatment provided. Eight participants successfully completed the assessment and were permitted by the Dental Practice Board of Victoria to extend their clinical scope of practice to adult patients. Feedback from patients and dentists indicated that, following the completion of an educational bridging program, dental therapists with a university education were able to develop the knowledge and skills required to treat adult patients aged 26+ years without the prescription or supervision of a dentist. Enabling dental therapists to treat adult patients may have a role to play in improving access to dental care for underserved populations.

Evaluation of a Pilot Bridging Program to Enable Australian Dental Therapists to Treat Adult Patients

This study evaluated a pilot educational bridging program designed to provide dental therapists in Australia with the appropriate knowledge and skills required to enable them to translate their current clinical scope of practice to adult patients. Ten dental therapists completed a bridging program consisting of forty-two hours of didactic content, fourteen hours of clinical observation, forty-two hours of clinical practicum under direct supervision, and 105 hours of clinical experience with supervision by mentoring dentists. Process and impact evaluation was undertaken at various stages of the program by participants and supervising dentists. Self-reported confidence and knowledge for dental therapists had increased at the completion of the course. Supervising dentists reported high levels of knowledge for dental therapists after completing the course and said that the course adequately prepared the dental therapists to translate their current clinical scope of practice to treat adult patients. Eight of the ten participants successfully completed the assessment at the completion of the course and were permitted by the Dental Practice Board of Victoria to extend their clinical scope of practice to adult patients aged twenty-six years of age or more. The dental therapists thought that the educational model was relevant in developing their clinical skills. The evaluation indicates that this model is an effective method of extending the scope of practice for dental therapists and has important implications in enhancing the flexibility of the dental team.

SP3-35 Investigating dental treatment as a possible risk factor for variant Creutzfeldt-Jakob Disease (vCJD) in the UK

IntroductionThe potential for vCJD transmission in the healthcare setting has raised concerns over the risk posed by dental surgery. The aim of this study was to determine whether dental treatment...

Putting the Teeth into the UK Biobank

The author of this article has been involved in the development of the UK Biobank, and was instrumental in ensuring that dentistry has been included in the project. He describes what the UK Biobank is, what the project involves and aims to achieve, and how by July 2010 some 500,000 UK citizens aged from 40-69 years had been recruited. He then details the events that led to the inclusion of dentistry in the project, the key role that stored saliva samples will have, and how the project will link to data stored by the Dental Practice Board and now the National Health Service Business Services Authority. The article ends with a brief look into the future of the project.

A Competing Risk Survival Analysis Model to Assess the Efficacy of Filling Carious Primary Teeth

In recent years a strategy of selective, symptom-based intervention of carious primary teeth has been developed amongst some British general dental practitioners. Practice-based studies appear to provide evidence that policies of restoration of symptomless carious primary teeth do not confer any significant benefits above those associated with non-restorative care. However, results from these studies contrast with those of many clinical trials and prospective studies of primary molar restorations. In the current investigation, cohort study data from 5,168 carious primary molar teeth from 2,654 British children aged 4–5 years at baseline, augmented with Dental Practice Board treatment data, was utilised to assess the effect of restorative treatment on the likelihood of carious teeth subsequently progressing to either exfoliation or extraction. The effect of demographic and tooth level covariates on the fate of these teeth was also assessed. Multivariate multilevel parametric survival models were applied to the analysis of the carious-exfoliation and carious-extraction transitions to which the teeth were subject, assuming an underlying data hierarchy with teeth nested within individuals. Time of occurrence of caries affected survival experience, with teeth in which caries occurred later in life being associated with higher survival rates to extraction. Amongst filled teeth, later fillings were also associated with higher survival rates to extraction. Demographic and tooth level variables had a limited effect on survival experience. Treatment was found to be significantly associated with survival with respect to extraction, with survival rates of over 80% at 14 years, double those of untreated teeth.

Australian endodontists’ perceptions of single and multiple visit root canal treatment

To ascertain endodontist's point of view (treatment philosophy, rationale and preference) regarding single- and multiple-visit root canal treatment. To identify the basis on which the choice is made and how the information necessary for the choice is acquired. Endodontists registered with the dental practice board of every state in Australia were contacted, and if they agreed to participate, they were interviewed either face to face or by telephone. The following topics were addressed in an interview lasting 15 to 20 min: demographics, current clinical procedures, treatment rationales and preference. A hypothetical scenario was posed to investigate which treatment regimen they would prefer to deliver if biological concerns were eliminated from consideration. Fifty-two endodontists (71% of all Australian endodontists) agreed to participate in the study. Almost all (51/52) participants had performed single-visit root canal treatment, but very few routinely performed it. A majority of participants were willing to provide single-visit treatment where patients had time constraints, and in vital cases (including elective endodontics). The most powerful factor of influencing practice change was interpersonal contact with colleagues. Publications in academic journals have a weak influence in practice change. Australian endodontists strongly prefer multiple-visit over single-visit root canal treatment even in cases where biological concerns are not an issue. Operator preference rather than biological or patient considerations appear to be the primary determinant of treatment choice.

English general dental practitioners' views on the new contract: The problems of collecting information in a time of change

Aim To record English general dental practitioners' views on the new contract. Sample One thousand and forty nine general dental practitioners working under the PDS or GDS contract. Locations Randomly selected general dental practitioners working within the NHS in England. Methods Postal questionnaire, made up of two components: closed questions and a free answer section. Three waves of mailings were undertaken. Results Poor response rate of 28.5 per cent. Dentists felt marginalized by the government and disillusioned with the new contract. The free answer section was characterized by angry responses and worry about the impact of the changes on patient care and income. Discussion The fact that the Dental Practice Board circulated the questionnaire made many of the respondents suspicious of the overall aim of the research. This factor may have contributed to the low response rate. Conclusion More care should have been taken when piloting the questionnaire as the researchers under estimated the difficulties of collecting information in a time of change.

Evaluation of an e-learning CD-ROM

Aim To carry out a post-impact evaluation of a cross-infection control CD-ROM, developed for NHS dental teams as a continuing professional development e-learning tool. The program was commissioned by the Department of Health and developed by a project team through the UK Committee of Postgraduate Dental Deans. The Dental Practice Board had originally sent one copy of the CD-ROM to each dental practice in England in 2004. Method A quantitative statistical analysis of the results of 326 online respondents to the learning package and a survey of 118 dental practitioners drawn from the Dental Practice Board database. Results Practitioners felt the CD-ROM in this instance was well-designed and appropriate for their needs. It is inclusive and accessible to a wide range of dental professionals including nurses and hygienists. Conclusions This form of continuing professional development is popular with dental practitioners, although it should not be the only form of continuing professional development available. However, whilst the project was generally regarded as successful, there were problems with the distribution of the CD-ROM. This suggests that an online resource should be made available in the future.

Post-impact evaluation of an e-learning cross-infection control CD-ROM provided to all general dental practitioners in England

To carry out a post-impact evaluation of a cross-infection control CD-ROM, developed for NHS dental teams as a continuing professional development e-learning tool. The program was commissioned by the Department of Health and developed by a project team through the UK Committee of Postgraduate Dental Deans. The Dental Practice Board had originally sent one copy of the CD-ROM to each dental practice in England in 2004. A quantitative statistical analysis of the results of 326 online respondents to the learning package and a survey of 118 dental practitioners drawn from the Dental Practice Board database. Practitioners felt the CD-ROM in this instance was well-designed and appropriate for their needs. It is inclusive and accessible to a wide range of dental professionals including nurses and hygienists. This form of continuing professional development is popular with dental practitioners, although it should not be the only form of continuing professional development available. However, whilst the project was generally regarded as successful, there were problems with the distribution of the CD-ROM. This suggests that an online resource should be made available in the future.

Approaches to treating carious primary teeth

Aim To measure the distribution of choices for the treatment of a child with differing severities of caries in a primary molar tooth among specialists in paediatric dentistry and general dental practitioners (GDPs) in England. Method Two surveys were undertaken using the same tool. The populations invited to take part in the study were confined to dentists practising in England in 2004. They were 500 GDPs selected at random from the list of all GDPs with a National Health Service (NHS) contract identified by the Dental Practice Board (DPB) and all 148 specialists in paediatric dentistry appearing on the General Dental Council specialist register. The selected dentists were sent a questionnaire containing four hypothetical clinical case scenarios in which the severity of dental caries in a single primary molar differed. Each clinical case scenario had a list of possible treatment options and participants were asked to select their single most preferred treatment option. To maximise the response rate there were three mailing rounds. Results Of the 500 GDPs and 148 paediatric specialists sent a questionnaire, 322 (64%) GDPs and 115 (78%) specialists responded. The answers to each of the case scenarios indicate differences of opinion both between and among GDPs and specialists in the care they would recommend for a child with caries in a primary molar tooth. This variation in opinion about care was more pronounced for a single deep carious lesion than for a less severe lesion. The spread of treatment options chosen in each scenario indicates disagreement among GDPs and specialists about restorative techniques and philosophy of care. Conclusion In England there is wide variation among GDPs and specialists in paediatric dentistry about the best way to treat a young child with caries in a primary molar tooth. Well designed studies are urgently needed to provide strong evidence for the most effective way to manage the dental care of children.

Approaches taken to the treatment of young children with carious primary teeth: a national cross-sectional survey of general dental practitioners and paediatric specialists in England

To measure the distribution of choices for the treatment of a child with differing severities of caries in a primary molar tooth among specialists in paediatric dentistry and general dental practitioners (GDPs) in England. Two surveys were undertaken using the same tool. The populations invited to take part in the study were confined to dentists practising in England in 2004. They were 500 GDPs selected at random from the list of all GDPs with a National Health Service (NHS) contract identified by the Dental Practice Board (DPB) and all 148 specialists in paediatric dentistry appearing on the General Dental Council specialist register. The selected dentists were sent a questionnaire containing four hypothetical clinical case scenarios in which the severity of dental caries in a single primary molar differed. Each clinical case scenario had a list of possible treatment options and participants were asked to select their single most preferred treatment option. To maximise the response rate there were three mailing rounds. Of the 500 GDPs and 148 paediatric specialists sent a questionnaire, 322 (64%) GDPs and 115 (78%) specialists responded. The answers to each of the case scenarios indicate differences of opinion both between and among GDPs and specialists in the care they would recommend for a child with caries in a primary molar tooth. This variation in opinion about care was more pronounced for a single deep carious lesion than for a less severe lesion. The spread of treatment options chosen in each scenario indicates disagreement among GDPs and specialists about restorative techniques and philosophy of care. In England there is wide variation among GDPs and specialists in paediatric dentistry about the best way to treat a young child with caries in a primary molar tooth. Well designed studies are urgently needed to provide strong evidence for the most effective way to manage the dental care of children.

Attitudes and practice in the provision of removable partial dentures

To identify the factors shaping the pattern of removable partial denture (RPD) provision by dentists in England. Design Cross sectional survey of general dental practitioners. Details of current practice and provision, influences, attitudes and demographic details were collected using a self-completion questionnaire mailed to general dental practitioners identified through the Dental Practice Board register. Three hundred and eighty-five questionnaires were returned by general dental practitioners from 62 health authorities throughout England. The most important factor reported as influencing both the GDP's decision to provide a partial denture and its subsequent success was patient desire to have a partial denture. Constructing the denture from cobalt chrome, advising the patient on aftercare, making time available to make minor adjustments and being responsible for design were all factors dentists associated with success of a RPD. However, for a number of dentists there was a reported divergence between knowledge and practice. Overall it is clear that provision of partial dentures continues to be patient led. However, the decision making process is also influenced by a number of factors including time, cost and the NHS fee structure.

Inequality in uptake of orthodontics

Objective The purpose of this ecological study was to investigate the relationship between uptake of orthodontic services and factors that might influence receipt of care at a population level. Method The dental practice board supplied data on claims for courses of active orthodontic treatment from April 2001 to March 2002 for children from the former county of Avon. These data were analysed in relation to deprivation, living in an urban/rural setting and the proportion of the population from a black or minority ethnic group (BME). Results In Avon, children from deprived and rural areas were significantly less likely to be undergoing an active course of orthodontic treatment. Children from an area with a high proportion BME were significantly more likely to be undergoing treatment. Conclusion This research demonstrates that children from more deprived and rural communities in Avon are less likely to receive orthodontic treatment. This has important policy implications for primary care trusts that have a responsibility to ensure equal access to care for all of their children.