Patients In General Dental Practice Research Articles

A randomized multi-centre study on the effectiveness of non-surgical periodontal therapy in general practice.

To evaluate the effectiveness of two non-surgical treatment protocols for periodontitis patients in general dental practice. Ninety-five dental hygienists (59 dental clinics) were randomly assigned to one of two treatment protocols: (i) establishment of adequate self-performed oral hygiene prior to a single session of ultrasonic instrumentation (guided periodontal infection control [GPIC]) or (ii) conventional non-surgical therapy (CNST) including patient education and scaling and root planing integrated in multiple sessions. Residual pockets at 3months were retreated in both groups. The primary outcome was pocket closure (probing pocket depth ≤ 4 mm) at 6months. Multilevel models were utilized. Based on data from 615 patients, no significant differences with regard to clinical outcomes were observed between treatment protocols. Treatment-related costs (i.e., chair time, number of sessions) were significantly lower for GPIC than CNST. Smoking and age significantly affected treatment outcomes. No significant differences between the two approaches were observed in regard to clinical outcomes. GPIC was more time-effective. Patient education should include information on the detrimental effects of smoking. gov (NCT02168621).

There is a paucity of economic evaluations of prediction methods of caries and periodontitis-A systematic review.

ObjectivesDirect cost for methods of prediction also named risk assessment in dentistry may be negligible compared with the cost of extensive constructions. On the other hand, as risk assessment is performed daily and for several patients in general dental practice, the costs may be considerable. The objective was to summarize evidence in studies of economic evaluation of prognostic prediction multivariable models and methods of caries and periodontitis and to identify knowledge gaps (PROSPERO registration number: CRD42020149763).Material and methodsFour electronic databases (PubMed, Web of Science, The Cochrane Library, NHS Economic Evaluation Database) and reference lists of included studies were searched. Titles and abstracts were screened by two reviewers in parallel. Full‐text studies reporting resources used, costs and cost‐effectiveness of prediction models and methods were selected and critically appraised using a protocol based on items from the CHEERS checklist for economic evaluations and the CHARMS checklist for evaluation of prediction studies.ResultsFrom 38 selected studies, six studies on prediction fulfilled the eligibility criteria, four on caries and two on periodontitis. As the economic evaluations differed in method and perspective among the studies, the results could not be generalized. Our systematic review revealed methodological shortcomings regarding the description of predictive models and methods, and particularly of the economic evaluation.ConclusionsThe systematic review highlighted a paucity of economic evaluations regarding methods or multivariable models for prediction of caries and periodontitis. Our results indicate that what we currently practice using models and methods to predict caries and periodontitis lacks evidence regarding cost‐effectiveness.

Clinician and Patient Factors Influencing Treatment Decisions: Ethnographic Study of Antibiotic Prescribing and Operative Procedures in Out-of-Hours and General Dental Practices.

Operative treatment is indicated for most toothache/dental abscesses, yet antibiotics instead of procedures are often prescribed. This ethnographic study aimed to identify clinician and patient factors influencing urgent dental care for adults during actual appointments; and to identify elements sensitive to context. Appointments were observed in out-of-hours and general dental practices. Follow-up interviews took place with dentists, dental nurses, and patients. Dentist and patient factors were identified through thematic analysis of observation records and appointment/interview transcripts. Dentist factors were based on a published list of factors influencing antibiotic prescribing for adults with acute conditions across primary health care and presented within the Capability-Opportunity-Motivation-Behaviour model. Contextually sensitive elements were revealed by comparing the factors between settings. In total, thirty-one dentist factors and nineteen patient factors were identified. Beliefs about antibiotics, goals for the appointment and access to dental services were important for both dentists and patients. Dentist factors included beliefs about the lifetime impact of urgent dental procedures on patients. Patient factors included their communication and negotiation skills. Contextual elements included dentists’ concerns about inflicting pain on regular patients in general dental practice; and patients’ difficulties accessing care to complete temporary treatment provided out of hours. This improved understanding of factors influencing shared decisions about treatments presents significant opportunity for new, evidence-based, contextually sensitive antibiotic stewardship interventions.

Comparing Quality of Life of Patients Undergoing Root Canal Treatment or Tooth Extraction

IntroductionThe knowledge of patient-centered outcomes concerning the consequences of root canal treatment in daily life is limited. The treatment option is often tooth extraction with possible prosthetic replacement. This study aimed to achieve a greater understanding of the patient perspective by evaluating the effect of root canal treatment in terms of quality of life and quality-adjusted life year (QALY) weights in comparison with patients who underwent tooth extraction. MethodsPatients with either root canal treatment or extraction were recruited from 6 clinics in the general public dental service during a predetermined period of 8 weeks. Three different instruments were used: the Oral Health Impact Profile evaluating the oral health–related quality of life (OHRQOL), the EQ-5D-5L evaluating health-related quality of life (HRQOL) and QALY weights, and a disease-specific questionnaire evaluating satisfaction regarding the root canal treatment. The evaluation was assessed at the initiation of treatment and after 1 month. Patient-based and tooth-specific characteristics were obtained from the dental records. ResultsEighty-five patients were included. The distribution between sexes was even, with 43 women and 42 men. The mean age was 51.1 years. Forty-eight patients (56.5%) had a tooth extraction, and 37 patients (43.5%) initiated root canal treatment. The response rate for the questionnaire at baseline was 95.3%, and at the 1-month follow-up, it was 74.1%. Two relevant and comparable groups were obtained after exclusion of the extracted third molars (n = 20), resulting in 65 patients for further analyses. At follow-up, the patients who initiated root canal treatment registered a significant improvement in perceived HRQOL according to the QALY weights (P = .02 and P < .01, respectively). Patients initiating root canal treatment reported generally high satisfaction. ConclusionsA cohort of patients either initiating root canal treatment or tooth extraction as a control group was established. Initiating root canal treatment had a positive impact on perceived HRQOL. The included patients in general dental practice registered overall high satisfaction regarding root canal treatment.

DENTAL CARE PROFESSIONALS AND CHILD PROTECTION: CASE SCENARIOS AND DISCUSSIONS.

Any concerns about paediatric patients in general dental practice can be stressful for all involved. Barriers to the reporting of concerns by dental teams are known to exist. Anything that can help ease those situations can only be beneficial. In this article we look at three scenarios that could arise which I am often asked about during teaching and training sessions on safeguarding and child protection for dental teams. They can be discussed at team meetings and training, so that if they are ever to happen for real, everyone will know exactly what to do. This article cannot be completely prescriptive as there will be local variations, but it gives general guidance on issues raised by the scenarios. If you already have a child protection policy in your practice, make sure you know what it says; and if you don't this article will point the way to further resources for developing one.

Prevalence of temporomandibular dysfunction and pain in adult general practice patients

Objective. To analyse the prevalence of temporomandibular disorders and related pain (TMD-pain) among adult recall patients in general dental practice. Materials and methods. From November 2006 to September 2008, all adults attending a Swedish Public Dental Service (PDS) clinic for recall examination were asked two standardized questions about temporomandibular pain and dysfunction. Mouth-opening capacity was measured. The responses to the questions and mouth-opening capacity were combined to give a TMD-pain score, on a scale of 0–3. The patients' acceptance of their TMD condition was also noted. Results. The subjects comprised 2837 adults (53% females, 47% men). Of the total sample, 4.9% reported a TMD-pain score of 1–3. The gender difference was significant: women predominated (p < 0.003). Forty-three per cent of those with TMD-pain scores of 1–3 (36% men, 47% women) considered that the condition warranted treatment, especially those registering a pain score (significant difference between pain and dysfunction groups, p < 0.000). Conclusions. The TMD-pain score shows promise as a useful instrument for detecting and recording TMD-pain. The prevalence of TMD disclosed in the study is high enough to be considered a public health concern. Most of the subjects with lower scores on the TMD-pain scale accepted their condition as not severe enough to require treatment.

Diagnosis and Referral of Orthodontic Cases: An Institutional Survey among Dental Graduates

ABSTRACT General dentists play an important role in intercepting the progression of malocclusion. The right stage of referral to specialist orthodontist is considered key to the success of orthodontic treatment. The objective of this study was to assess the preparedness of fresh dental graduates in dealing with orthodontic patients in general dental practice. A total of 80 general dentists who had recently completed the BDS program formed the study group. They were asked to respond to a self-administered questionnaire consisting of case scenarios to evaluate their knowledge of Angles classification, occlusal characteristics, the ideal stage of treatment and need for referral to specialist orthodontist. The response rate was 75% (n = 60). 87% (n = 52) correctly identified the Angles Classification of the presented cases. 87% (n = 52) and 100% (n = 60) correctly identified overbite and over-jet cases. Cross bite and deviated midline was correctly identified by 68% (n = 41) and 65% (n = 39) of the respondents respectively while 93% (n = 56) diagnosed median diastema correctly. Almost all the respondents (97%) identified the cases which have to be referred to the orthodontist while, more than half (55%) did not know the ideal time to initiate orthodontic treatment. The graduates recognized their limits of personal competence and successfully identified the cases that need to be referred to the orthodontist. Proper emphasis should be placed on the ‘the ideal time of referral and initiation of treatment’ during undergraduate orthodontic training. How to cite this article AlShahrani I. Diagnosis and Referral of Orthodontic Cases: An Institutional Survey among Dental Graduates. World J Dent 2014;5(1):33-36.

There Is No Diagnostic Value of Adding a Panoramic Image, When Selection Criteria for Intraoral Radiographs Are Respected, in Connection With Clinical Examination of New Adult Patients in General Dental Practice

Article Title and Bibliographic Information A study to determine the added value of 740 screening panoramic radiographs compared to intraoral radiography in the management of adult (>18 years) dentate patients in a primary care setting. Rushton MN, Rushton VE. J Dent 2012;40:661-9. Reviewer Ann Wenzel, DDS, PhD, Dr Odont Purpose/Question To measure the added value of panoramic radiography compared to selected intraoral radiographs in new dentate patients attending dental practice for routine treatment Source of Funding The project was funded by Trust of Private Patients Plan (PPP) Health Care Type of Study/Design Cross-sectional epidemiological study Level of Evidence Level 3: Other evidence Strength of Recommendation Grade Not applicable

Selecting Appropriate Recall Intervals for Patients in General Dental Practice – An Audit Project to Categorize Patients According to Risk

In 2004, the National Institute for Health and Clinical Excellence (NICE) was asked to prepare guidance for the NHS in England and Wales on the clinical need and cost-effectiveness of a dental recall examination for all patients at an interval based upon their risk from oral disease. (Dental Recall: recall interval between routine dental examinations). Unlike other NICE guidelines, this potentially applies to the whole population. The Department of Health wishes to reduce the number of'routine' six-monthly check-ups. Best practice now recommends that all patients undertake an oral health assessment prior to categorizing them into a recall programme. The article describes how an audit project was undertaken to establish compliance within General Dental Practice to the guidelines. Dentists and patients now have the opportunity to discuss appropriate recall intervals together and prescribe reviews at time periods appropriate to each patient's disease process and risk.

Attitudes about dental care among parents whose children suffer from severe congenital heart disease: a case‐control study

To examine attitudes and experiences of parents whose children have complex congenital heart disease (CHD) with respect to dental health information and advice, dental care, and service and to compare the results with data from an age- and gender-matched control group without any medical problems. Faculty of Medicine (Paediatric Cardiology and Paediatric Dentistry), Umeå University, Umeå, Sweden. Each group comprised parents of 33 children; the children's mean age was 9.4 years. All the cases and the controls resided in the county of Västerbotten, northern Sweden. Data were collected with a questionnaire with 20 joint questions to both groups and four additional questions to the CHD group. Of the 20 joint questions, significant differences were displayed in the following areas: the professional group that provided the parents with dental health information and advice (P < 0.01), attitudes to reception at the dental clinic, and experience of sedation before operative dental treatment (P < 0.05). Parents to 11 children with CHD who were patients at a specialist clinic for paediatric dentistry scored the reception at the dental clinic as excellent in nine cases and satisfactory in two, compared to excellent (3), satisfactory (11), decent (4), and poor (4) among those who were patients in general dental practice (P < 0.01). No statistically significant differences in educational level or in parental experience of dental health were noted between the two groups (P > 0.05). Children with CHD in northern Sweden mainly receive their dental health information from a physician or a dentist, and healthy children mainly receive information from a dental hygienist indicating that children with CHD are given priority in the dental care system. Parental attitudes to reception in the dental service differed, and parents of healthy children scored the reception at the dental clinic better than parents of children with CHD. It is suggested that children with severe CHD should receive dental care in clinics for paediatric dentistry, particularly at early ages.

Oral health and diabetes: making a real difference

Debbie Chandler of West Dorset Oral Health Promotion Unit gives advice on handling diabetic patients in general dental practice

Prosthodontic management of older severe hypodontia patients in general dental practice: A case series

Although a detailed understanding of the etiology of hypodontia is lacking, there is a need for awareness among dental professionals of the social and psychological consequences of severe hypodontia, as well as knowledge of those affected by hypodontia have ongoing dental treatment needs. Although, there may be a need for immediate referral of children to different specialists for optimal multidisciplinary treatment planning, most older patients with severe hypodontia can be treated by general practitioners. Practitioners therefore need to be aware of the ramifications of the condition and be capable of providing adequate oral health care for these patients and referring them for additional services when necessary. A case-report series is used to illustrate routine prosthodontic treatments that can be offered to older patients in general dental practice.

Treatment planning in general dental practice: case presentation and communicating with the patient.

Presentation of treatment plan options to patients in general dental practice involves the collation of information and its presentation in a clear and uncluttered environment. Visual aids are of value, as are effective verbal and written communications with the patient. Fees should be discussed openly, as should guarantees for, and limitations of, proposed treatment.

Excellence in publishing: the Wuehrmann prize

The American Academy of Oral and Maxillofacial Radiology (AAOMR) established “The Wuehrmann Prize” for the best radiology journal article of the year in 1995. The Award is named after Dr. Arthur H. Wuehrmann, a Distinguished Life Member of the Academy. Since then, eight published articles have been selected. The purpose of the award is to recognize excellence in publishing, which happens to be the motto of our publisher, Mosby Inc. The winning papers have been: White SC, Sapp JP, Seto BG, Mankovich NJ. Absence of radiometric differentiation between periapical cysts and granulomas. OOOOE 1994;78:650-4. Callender KI, Brooks SL. Usefullness of tomography in the evaluation of patients with temporomandibular joint disorders: a retrospective study. OOOOE 1996;81(6):710-9. Brooks SL, Brand JW, Gibbs SJ, Hollander L, Lurie AG, Omnell KA, Westessen PL, White SC. Imaging of the temporomandular joint: a position paper of the American Academy of Oral and Maxillofacial Radiology. OOOOE 1997;83(5):609-18. Christgau M, Hiller KA, Schmalz G, Kolbeck C, Wenzel A. Accuracy of quantitative digital subtraction radiography for determining changes in calcium mass in mandibular bone: an in vitro study. Journal of Periodontology Research. 1998;33(3):138-49. Bohay RN, Stephens RG, Kogan SL. A study of the impact of screening or selective radiography in the treatment and postdelivery outcome in edentulous patients. OOOOE 1998;86(3):353-9. White SC, Pullinger AG. Impact of TMJ radiographs on clinician decision making. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79:375-81. Liang H, Tyndall DA, Ludlow JB, Liang LA, Nunn NE. Accuracy of mandibular cross-sectional imaging with tuned-aperture computed tomography (TACT), iteratively reconstructed TACT, and multidirectional, linear, and transverse panoramic radiography. OOOOE 2001;91(5):594-602. Rushton VE, Lorner K, Worthington HU. Routine panoramic radiography of new adult patients in general dental practice: relevance of diagnostic yield to treatment and identification of radiographic selection criteria. OOOOE 2002;93(4):488-95. The Wuehrmann Prize is given to a paper published in OOOOE between July of the previous year and June of the year the prize is to be given. Papers eligible for the prize are those that present basic/clinical/epidemiological/survey research of relevance to OMFR that adheres to the principles of the scientific method. Position papers, case reports, and review articles are not considered for the Prize. Papers are judged based upon: (a) relevance to OMFR, (b) originality of research objectives and/or ideas presented, (c) innovativeness of study design (novelness of approaches/concepts), (d) appropriateness of epidemiological/statistical methods, and (e) clearness of presentation. The Awards Committee selects a Wuehrmann Prize Subcommittee, consisting of the Journal Section Editor as chair and 4 members of the Editorial Board, with a rotating membership. The Editor identifies approximately 7-10 notable articles meeting the criteria and provides the subcommittee with a list of these candidates within 2 weeks after publication of the June issue of OOOOE. Prior to this, subcommittee members may submit to the Editor titles of papers for consideration. The number of articles selected by the Editor for submission to the subcommittee is up to the discretion of the Editor. Each subcommittee member reads the candidate papers and ranks the top 5, sending the results to the Editor within one month. The Editor tallies the votes and notifies the Executive Secretary so the appropriate plaque can be made in time for the annual meeting. If there is not a clear winner after the first ballot, the subcommittee reaches consensus via e-mail and/or telephone discussion. Scanning the titles of the Prize winners reveals an interesting diversity of topics. New applications of technology, radiographic selection criteria, dental and jaw pathology, and an AAOMR position paper are included. Recognition of excellence in publishing should be a stimulating factor in the continuous improvement of the quality of articles in the Journal, and it is hoped that this Prize will result in that goal.

Routine panoramic radiography of new adult patients in general dental practice: relevance of diagnostic yield to treatment and identification of radiographic selection criteria.

We sought to measure the diagnostic yield of relevance to treatment on routine panoramic radiographs taken of new adult (ie, 18 years and over) patients in general dental practice. Routine panoramic radiographs (n = 1817) obtained from general dental practice were assessed and radiologic yield recorded using consensus viewing by 2 dental radiologists. A modified diagnostic yield of relevance to treatment for each radiograph was calculated by omission of findings that would have been identified on bilateral posterior bitewing radiographs and of radiologic findings of no relevance to treatment. Stepwise logistic regression analysis was used in attempt to identify clinical indicators of a high diagnostic yield of relevance to treatment. The diagnostic yield of relevance to treatment was zero for the majority (56%) of patients. This figure rose to 71% when the symptom-free patients were considered. Five clinical indicators for panoramic radiography were identified, as follows: clinical suspicion of teeth with periapical pathologic conditions, presence of partially erupted teeth, clinically evident caries lesions, swelling, and clinically suspected unerupted teeth. Routine panoramic radiography of adult dental patients is not supported by the results of this study. The use of clinical indicators to select patients may help to improve diagnostic yield.

Clinical quality assurance indicators for oral status and treatment of a group of older adults

To record and comment on the oral status and treatment provision over a 3-year period for a group of 150 patients aged between 50 and 64 with special reference to the WHO (ORATEL) quality assurance indicators. 150 patients in the defined age group who were attending a general dental practitioner for a routine examination were sampled over a 3-month period. The oral status was recorded by the GDP at the time of attendance and a retrospective analysis of treatment provided over three years was carried out by reference to the patient case notes. An analysis of the data relating to oral health status and previous treatment provision suggested that some indicators were easy to accurately record while others lacked clear diagnostic criteria. There were also some inconsistencies in format. There was a lack of coverage in a few important areas and some additional indicators were suggested. The ORATEL indicators form a useful core dataset for GDPs to use to measure oral health change within the patient base of their practices. The recording and analysis of quality assurance indicators by the GDP could make a significant contribution to the monitoring of the oral health change of patients in general dental practice.

Psychiatric distress, pain and fear in patients in general dental practice

Psychiatric distress, pain and fear in patients in general dental practice

Dental hygienists' influence on the patients' knowledge, motivation, self-care, and perception of change.

The purpose of this study was to assess the success of the dental hygienist in the dental health education of dental patients in general dental practice. Special emphasis was laid on health education in the field of periodontics. The answers on a questionnaire of 159 dental patients who visited a dental hygienist were compared with the answers of 302 dental patients who had never visited a dental hygienist. The comparison was done by means of t-test and regression analysis on specially developed scales with regard to knowledge, motivation, self-care, and perception of change. On all scales the dental patients who visited a dental hygienist scored better. This difference remained when social demographic variables and the dentist's influence were taken into account. This indicates that the dental hygienist is successful in the behavioral aspect of her work.

Oral hygiene instruction in general dental practice by means of self-teaching manuals.

The present study evaluates the applicability of delivering oral hygiene instruction to patients in general dental practice by means of self-educational programs. Patients (55) seeking dental treatment in 3 general dental practices in Denmark were divided at random into a conventional professional instruction group (C) in which each individual received personal instruction by the dentist and a self-instruction group (S), in which the patients were given self-educational programs. In order to evaluate the effect of the 2 types of instruction, the presence or absence of dento-gingival plaque and gingival bleeding by probing was recorded prior to the instruction and after 3 and 6 months. The patient of the self-instruction group (S) answered a questionnaire about the treatment 1 week after they had received the self-instruction program. An identical improvement in oral hygiene and gingival health was recorded in both treatment groups after 3 and 6 months. This finding indicates, that the self-educational programs were as effective in changing the oral hygiene habits of the patients as was personal oral hygiene instruction by dental personnel. The answers of the patients to the post-treatment questionnaire reflected a favorable attitude towards the use of self-educational programs.

Assessment of the medical status of patients in general dental practice. A comparative survey of a questionnaire and verbal inquiry.

Assessment of the medical status of patients in general dental practice. A comparative survey of a questionnaire and verbal inquiry