Dental Practice In Scotland Research Articles

Survey of the decontamination and maintenance of dental handpieces in general dental practice

To determine how dental handpieces are decontaminated and maintained in general dental practice. Observational survey. The survey was carried out in general dental practice in Scotland. Survey visits ran from January 2003 until the end of March 2004. Data were collected by interview and observation in 179 dental surgeries in Scotland. In virtually all surgeries, handpieces were cleaned before disinfection or autoclaving (99%; n = 177), most commonly by wiping the external surface with a cloth impregnated with disinfectant. Most surgeries lubricated their handpieces after cleaning and before sterilisation (91%; n = 162), although a number of surgeries (24%; n = 42) also lubricated their handpieces after sterilisation. In the majority (97%; n = 174) of dental surgeries, all handpieces were autoclaved after use, most frequently (89%; n = 160) in a bowl and instrument steriliser. In 38 surgeries (21%), handpieces were being wrapped (paper pouches) before sterilisation in bowl and instrument sterilisers. A minority of surgeries (20%; n = 36) had a dedicated handpiece for surgical procedures. The majority of dental handpieces are manually cleaned externally with a disinfectant impregnated cloth and processed in a type N (bowl and instrument) bench top steam steriliser. Handpieces are lubricated with non-water soluble lubricants at different stages of reprocessing, indicating clarification is required in this area. More work is required by manufacturers to establish a validated cleaning and lubrication process to facilitate the sterilisation of handpieces.

An Audit of Dentine Hypersensitivity Treatments in Six General Dental Practices in Scotland

This investigation sought to: (a) determine the agents used by nine dentists to treat dentine hypersensitivity and measure their effectiveness; (b) evaluate the adoptive ease and apparent success of the most effective treatment when used by all nine dentists; and (c) validate a novel categorical ranking score for dentine hypersensitivity. A clinical audit methodology was used in the setting of general dental practice. In the initial data-collection round, patients presenting with dentine hypersensitivity were treated using the dentist's favoured regimen. Evaluation of agent effectiveness was made by patient completion of a pre- and post-treatment visual analogue scale (VAS) for the frequency (f) and severity (s) of hypersensitivity. A four-point categorical ranking scale (CRS) was also used to assess the impact of hypersensitivity upon lifestyle (L) (1=No sensitivity/effect on what I eat/drink; 2=Sometimes sensitive, rarely interfering with what I eat/drink; 3=Sometimes sensitive, occasionally interfering with what I eat/drink; 4=Always sensitive, always interfering with what I eat/drink). The most successful treatment was determined and used by all participating dentists. Its effectiveness was then assessed using the same criteria. Four agents were routinely used to treat hypersensitivity: (Duraphat (D) (Colgate), Duraphat & Sensodyne (DS) (GlaxoSmithKline), Sensodyne (S) (GlaxoSmithKline), Seal & Protect (SP) (De Trey, Dentsply). All produced statistically significant (P<0.001) reductions in VAS (Tukey) and CRS (Kruskal-Wallis) scores, except for DS and S. Of these, the greatest percentage reduction was seen for SP (f=72.01%, s=71.19%, L=45.98%). When SP was applied by all dentists, similar percentage reductions were seen (f=68.74%, s=75.85%, L=38.33%). The CRS, in both data-collection rounds, correlated well with the corresponding VAS scores (Spearman R for f=0.77 (P<0.001) and for s=0.80 (P<0.001). For the dentists in this audit, the use of SP was found to be reliable and predictable. The CRS provided a simple and reliable measure of dentine hypersensitivity. Subject to validation in a larger study, this could be used in a future audit as an alternative to multiple VAS scores.

Assessing oral health‐related quality of life in general dental practice in Scotland: validation of the OHIP‐14

To validate the Oral Health Impact Profile (OHIP)-14 in a sample of patients attending general dental practice. Patients with pathology-free impacted wisdom teeth were recruited from six general dental practices in Tayside, Scotland, and followed for a year to assess the development of problems related to impaction. The OHIP-14 was completed at baseline and at 1-year follow-up, and analysed using three different scoring methods: a summary score, a weighted and standardized score and the total number of problems reported. Instrument reliability was measured by assessing internal consistency and test-retest reliability. Construct validity was assessed using a number of variables. Linear regression was then used to model the relationship between OHIP-14 and all significantly correlated variables. Responsiveness was measured using the standardized response mean (SRM). Adjusted R(2)s and SRMs were calculated for each of the three scoring methods. Estimates for the differences between adjusted R(2)s and the differences between SRMs were obtained with 95% confidence intervals. A total of 278 and 169 patients completed the questionnaire at baseline and follow-up, respectively. Reliability - Cronbach's alpha coefficients ranged from 0.30 to 0.75. Alpha coefficients for all 14 items were 0.88 and 0.87 for baseline and follow-up, respectively. Test-retest coefficients ranged from 0.72 to 0.78. Validity - OHIP-14 scores were significantly correlated with number of teeth, education, main activity, the use of mouthwash, frequency of seeing a dentist, the reason for the last dental appointment, smoking, alcohol intake, pain and symptoms. Adjusted R(2)s ranged from 0.123 to 0.202 and there were no statistically significant differences between those for the three different scoring methods. Responsiveness - The SRMs ranged from 0.37 to 0.56 and there was a statistically significant difference between the summary scores method and the total number of problems method for symptomatic patients. The OHIP-14 is a valid and reliable measure of oral health-related quality of life in general dental practice and is responsive to third molar clinical change. The summary score method demonstrated performance as good as, or better than, the other methods studied.

An economic analysis of implementing the SIGN third molar guideline: implications for the design and analysis of implementation studies

To compare the cost-effectiveness of four third molar guideline implementation strategies. Fifty-one dental practices in Scotland were randomized to one of four implementation strategies. The effectiveness of the strategies was measured by general dental practitioners' compliance with the guideline. The effectiveness of the guideline depended crucially upon the type of patient treated. In particular, for a minority of patients (14%) with no clinical signals of their 'type', the implementation strategies generate potentially large gains in evidence-based practice. However, the cost per patient of achieving these gains is large given that the costs are incurred for all patients, but benefits accrue only to a minority. The results show that the type of patient presenting for treatment can influence the effectiveness, cost-effectiveness and therefore policy conclusions. Consequently, the design and analysis of studies need to be sufficiently sensitive to detect subtle interaction effects. This may explain the dearth of guideline implementation trials with significant findings. The results also suggest that a more cost-effective implementation method in primary care dentistry may be to subsidize treatment conditional upon patient type.

The contribution by medical radiology departments to dental radiology in general dental practice in Scotland

The contribution by medical radiology departments to dental radiology in general dental practice in Scotland

The contribution by medical radiology departments to dental radiology in general dental practice in Scotland.

To determine the availability of the services of medical radiology departments to general dental practitioners in Scotland. Fifty-seven hospitals were identified as likely to have services available to general dental practitioners; 41 were within central urbanised areas (the 'Central Belt') and 16 in the more remote rural areas, (the 'Borders, Highlands and Islands'). The available services were identified by questionnaire. All 57 questionnaires were returned. Although there were significantly fewer larger hospitals in the 'Borders, Highlands and Islands', there was no significant difference in availability of services to general dental practitioners between the two parts of Scotland. The services of medical radiology departments are generally available to general dental practitioners in both the 'Central Belt' and the 'Borders, Highlands and Islands'.

Evaluation of a teledental PC videoconference link in the delivery of a restorative dentistry service to remote dental practices in Scotland

Evaluation of a teledental PC videoconference link in the delivery of a restorative dentistry service to remote dental practices in Scotland

The use of magnification in general dental practice in Scotland—a survey report

Objectives: This study had two aims, first, to quantify the level of the use of magnification in general dental practice in Scotland and second, to determine the current and potential areas of clinical use of magnification by general dental practitioners. Methods: A questionnaire was sent to all general dental practitioners in Scotland with a Health Board list number ( n=1790). The questionnaire asked the practitioners about their experience of magnification and their opinions on possible areas for clinical use. An information sheet and a prepaid envelope were included with the questionnaire. Results: One thousand two hundred and eighty (72%) of the dentists replied to the questionnaire. Nine percent of the respondents routinely used magnification. The level of routine use of magnification by practitioners increased with time since qualification. The suggested areas of clinical use of magnification by all the respondents were crown and bridge work, diagnosis and radiography. The routine users of magnification had a more positive view of magnification than non-users. Conclusions: Routine use of magnification was associated with the length of time the practitioner had been qualified and the attendance at a course at which magnification was discussed. The perceived uses of magnification depended on the experience of the practitioner with magnification. It was considered suitable for all clinical procedures except orthodontics and prosthodontics.

An in vivo Comparison of Radiographic and Directly Assessed Clinical Caries Status of Posterior Approximal Surfaces in Primary and Permanent Teeth

At general dental practices in Scotland 211 children between the ages of 5 and 15 years were examined by 1 observer. A comparison of the status of 1,468 permanent and 756 primary posterior approximal surfaces was made on the basis of their appearance on posterior bite-wing radiographs and the findings of a direct in vivo visual examination, made after temporary tooth separation had been achieved over 1 week using elastomeric separation. For permanent tooth surfaces, 0% of radiolucencies in the outer half of enamel, 10.5% in the inner half of enamel, 40.9% extending to the outer half of dentine, and 100% extending to the inner half of the dentine were found clinically to be cavitated. The analogous results for primary teeth were that 2.0, 2.9, 28.3, and 95.5%, respectively, of radiolucencies appeared to be cavitated. Although further research with larger numbers of permanent teeth is indicated, these results may contribute to a re-evaluation of the optimal threshold for restorative intervention at approximal sites. Greater numbers of approximal radiolucencies and carious lesions (p less than 0.001) were found in those surfaces which initially had a normal anatomical contact when compared to those which did not.

Effects of diagnostic threshold and overlapped approximal surfaces on reported caries status

The aims of this study were to examine the influence upon reported caries status of: 1) employing different diagnostic thresholds and 2) using differing conventions for treating approximal surfaces which appeared overlapped on posterior bitewing radiographs. Caries prevalence data from a group of 211 Scottish schoolchildren aged 5-15 yr studied during a trial of elective temporary tooth separation in general dental practice in Scotland were used. In this "moderate" caries group, values for dmft/DMFT rose significantly (P less than 0.001) when the D1 diagnostic threshold (all grades of lesion accepted) was applied in comparison with the D3 threshold (only caries into dentine recognised); dmft increasing from 3.9 to 5.4 and DMFT increasing from 1.7 to 4.7. This demonstrated that an over-optimistic impression of overall caries levels may be given when only the D3 threshold is used uncritically. In this study the status of approximal surfaces which were overlapped on bitewing radiographs was assessed by direct clinical examination using the temporary elective tooth separation technique. The investigation showed that, for this juvenile population, most (81.8% mesial, 93.1% distal) overlapped approximal surfaces were sound. Significantly more mesial than distal surfaces were found to be overlapped.

A survey of the use of micro-computers in general dental practice in Scotland

The aim of the study was to determine current and future use of micro-computers in general dental practice. A piloted questionnaire was sent to 736 general dental practitioners in Scotland, with the intention of contacting one principal from every dental practice known to the Scottish Dental Estimates Board. A total of 390 (53%) of the questionnaires were returned. If it is assumed that those dentists who did not reply have a low interest in computers then the results of the survey are not likely to lead to an overestimation of trends. Six per cent of the 736 practices that were contacted are using a micro-computer, mainly for practice management and particularly for word processing. In addition, 25% of the replies showed some interest in introducing micro-computers in the future. Thirty-four per cent of current users and 19% of prospective users indicated a high degree of interest in direct data transmission between the practice and the Scottish Dental Estimates Board.

Precautions reported to be used against cross-infection and attitudes to the dental treatment of HIV-positive patients in routine clinical dental practice in Scotland

The purpose of this study was to ascertain the precautions against cross-infection currently employed in routine practice by Scottish dentists, to relate these to current recommendations and to determine Scottish dentists' views on how dental treatment should be provided for patients known to be HIV positive. The subjects were 926 general dental practitioners and 201 clinical community dental officers among respondents to a questionnaire sent to a list of 1726 dental practitioners in Scotland. The results suggest that while some dentists are prepared to take an element of personal risk (in spite of recent improvements 18 per cent are still unvaccinated against hepatitis B, 66 per cent do not wear surgical gloves during routine treatment and 21 per cent claim not to wear gloves during procedures involving ‘bloodletting’), the vast majority (95 per cent) are nevertheless taking steps to protect their patients from cross-infection by using autoclave and dry heat sterilization. One-quarter of general dental practitioners and one-half of clinical community dental officers felt that HIV-positive patients should generally be treated in the branch of the dental service in which they worked, although greater proportions (52 per cent and 69 per cent respectively) said they were prepared to treat a regular patient who became HIV positive.

Blood borne viruses: precautions against cross-infection in routine dental practice in Scotland

Blood borne viruses: precautions against cross-infection in routine dental practice in Scotland