Sample Of General Dental Practitioners Research Articles

Assessed and perceived oral health of older people who visit the dental practice, an exploratory cross-sectional study.

ObjectivesTo assess the oral health of older people who visit the community dental practice from both the dentists’ and the patients’ perspective.Materials and methodsIn this exploratory cross-sectional study the oral health of Dutch community dwelling older people was assessed. A representative sample of general dental practitioners was asked to randomly and prospectively select one older patient and describe this patient using a specially-developed registration form; in addition the patient was requested to complete a questionnaire. The oral health of older people was described from the perspective of the dentists and the perspective of the older people themselves based on the definition of oral health from the World Dental Federation (FDI].Relations between oral health of older people and dentist and older patient characteristics were analysed using Spearman’s rank correlation coefficient (rho) and an ordinal regression model.ResultsIn total, 923 dentists were asked to participate in the study; data was available for 39.4% dentist-patient pairs. Dentists assessed the oral health of older patients as good or acceptable in 51.4% of the cases while this was the case in 76.2% of older patients themselves. The assessment of the dentist gets more negative with high treatment intensity and with older patients having certain diseases and more medication, while the assessment is more positive for older patients who visit the dentist on a regular basis.Older people’s assessment of their oral health gets more negative by being female and with high treatment intensity, having certain diseases and higher use of medication.Conclusions and clinical relevanceChronically illness as expressed by the number of diseases and the use of medication, seems to be a risk factor for poor oral health.Older patients themselves assess their oral health differently, mostly more positive, than their dentist.

Oral Health of Older Patients in Dental Practice: An Exploratory Study

BackgroundSome older people stop visiting the dentist when they get older. This study aims to identify the characteristics and oral health status of older people who do visit community dental practices. MethodsIn this exploratory cross-sectional study, the oral health of Dutch community-dwelling older people was assessed. A random sample of general dental practitioners and older people who visit the dental practice was drawn. The dentists were asked to prospectively select one older patient and describe this patient using a specially developed registration form; the patient was requested to complete a questionnaire. Data were described for 3 distinct groups of older people. Statistical measures for distribution and dispersion were used to describe the oral health of community-dwelling older patients in relation to the age. ResultsA total of 373 (40.4%) dentist registration forms and 372 (40.3%) patient questionnaires were returned. Data were available for 364 (39.4%) dentist–patient couples. Amongst the patients, 52.8% were female and most had a high socioeconomic status. About 65.7% had one or more problems related to general health, and 75.2% used medication. Regarding the overall oral health status, the average number of teeth was 20, 3.5% were edentulous. Oral health problems were more common in the older patient group (aged 75+), in whom frailty was also most common. ConclusionsOlder people who visit community dental practices are still relatively healthy, non-frail, and highly educated. Even in this group, there is a turning point in both general and oral health from the age of 75.

An internet-mediated investigation into the reported clinical use of rubber dam isolation by GDPs in the UK - part 1: factors influencing rubber dam use.

Aims To investigate the reported use of rubber dam isolation by UK general dental practitioners (GDPs), utilising an internet-mediated (SurveyMonkey) questionnaire reporting the demographic profile of respondents and the attitudes and factors influencing rubber dam use.Methods A piloted questionnaire was distributed to a random sample of GDPs in a private Facebook group, investigating respondent demographics, clinical applications, and attitudes towards and factors influencing rubber dam use. The data were analysed using descriptive statistics along with chi-squared and pairwise Mann-Whitney U tests.Results The response rate was 61%, with 403 valid completed questionnaires. Of these, 218 (54%) were female and 185 (46%) were male, with an age range of 23-72 years. Most of them (248; 62%) worked in mixed practices. The majority agreed that rubber dam aids placement of posterior restorations (311; 78%), provides clearer access (308; 76%), enables a higher clinical standard (355; 89%) and increases restoration longevity (257; 65%). Most agreed that proper isolation for root canal/operative procedures cannot be achieved without rubber dam use (329; 82%). Respondents disagreed with the following statements: root canal therapy completed without rubber dam isolation is as successful as those completed using rubber dam (338; 85%), rubber dam is difficult to apply (292; 73%) and rubber dam is disliked by patients (257; 64%). Respondents agreed that rubber dam use is influenced by clinical setting (259; 64%), procedure (390; 97%), choice of material being placed (382; 95%) and ease of application (337; 84%). Furthermore, 218 (54%) of the respondents expressed an interest in further training in rubber dam use.Conclusions This study provides greater insight into the attitudes and factors influencing rubber dam use, while demonstrating an interest in further training.

The use of diet diaries in general dental practice in England.

Diet diaries are recommended as a tool to support behaviour change in dental patients at high risk of dental diseases. However, little is known about their use in dental practice. This study aimed to investigate whether and how general dental practitioners (GDPs) use diet diaries and identify factors which influence their use. A postal questionnaire was sent to a stratified random sample of general dental practitioners. The questionnaire asked about demographic and professional characteristics of the GDPs and their practices regarding diet advice, collection of dietary information, diet diaries usage (e.g. frequency, considerations and barriers), and interpretation of diet diaries. Descriptive, bivariate and multivariate analyses were conducted. From 972 eligible GDP participants, 250 (26%) responses were received. Whilst almost all of these GDPs reported giving diet advice to patients routinely, and 40% reported also referring to dental care professionals in the practice to deliver dietary advice, only 28% (70) reported that they are involved in using diet diaries. GDPs appeared to target patients for dietary advice: GDPs reported they personally gave diet advice to an estimated 63% of their patients, and referred patients to DCPs for diet advice for 11% of their (GDPs') patients. GDPs used diet diaries more often for child than adult patients. Diet diaries usage was lower among younger dentists and in practices with higher percentages of NHS patients (p⟨0.05). Perceived insufficient remuneration for time involved in using diet diaries was the main reason given for their lack of use. Although recommended as best practice, most English GDPs do not frequently use diet diaries to collect diet information in dental practice, mainly due to perceived financial and time constraints. Development of a more efficient tool to assess the dietary habits of dental patients is needed.

Applying psychological theories to evidence-based clinical practice: identifying factors predictive of placing preventive fissure sealants

BackgroundPsychological models are used to understand and predict behaviour in a wide range of settings, but have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. This study explored the usefulness of a range of models to predict an evidence-based behaviour -- the placing of fissure sealants.MethodsMeasures were collected by postal questionnaire from a random sample of general dental practitioners (GDPs) in Scotland. Outcomes were behavioural simulation (scenario decision-making), and behavioural intention. Predictor variables were from the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model, and knowledge (a non-theoretical construct). Multiple regression analysis was used to examine the predictive value of each theoretical model individually. Significant constructs from all theories were then entered into a 'cross theory' stepwise regression analysis to investigate their combined predictive valueResultsBehavioural simulation - theory level variance explained was: TPB 31%; SCT 29%; II 7%; OLT 30%. Neither CS-SRM nor stage explained significant variance. In the cross theory analysis, habit (OLT), timeline acute (CS-SRM), and outcome expectancy (SCT) entered the equation, together explaining 38% of the variance. Behavioural intention - theory level variance explained was: TPB 30%; SCT 24%; OLT 58%, CS-SRM 27%. GDPs in the action stage had significantly higher intention to place fissure sealants. In the cross theory analysis, habit (OLT) and attitude (TPB) entered the equation, together explaining 68% of the variance in intention.SummaryThe study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the creation of a replicable methodology for identifying factors that may predict clinical behaviour and so provide possible targets for knowledge translation interventions. Results suggest that more evidence-based behaviour may be achieved by influencing beliefs about the positive outcomes of placing fissure sealants and building a habit of placing them as part of patient management. However a number of conceptual and methodological challenges remain.

The use of the Index of Orthodontic Treatment Need in dental primary care

The primary objective of this survey was to assess the use of the Index of Orthodontic Treatment Need (IOTN) in dental primary care (Scottish general dental services - SGDS), and to compare orthodontic specialists (OS) and general dental practitioners (GDPs). The secondary objective was to explore the attitudes to mandatory introduction of the IOTN into the SGDS. Postal, self completed questionnaire. Dental primary care, Scotland.Subjects Randomly selected sample of general dental practitioners (GDPs), n = 315, and all orthodontic specialist practitioners (OS), n = 49, identified as working in the SGDS. Prevalence and experience of using the IOTN in the SGDS. Response rate was 46% (n = 169). Eighty-four percent of respondents did not use the IOTN. Thirty-five percent of respondent GDPs had never heard of the IOTN. Respondents reported using the IOTN as an inter-colleague communication tool and to grade case complexity. GDPs perceived the IOTN as beneficial in setting national standards of practice; OS saw it as a tool to justify the allocation of NHS resources to patients. Responses indicate concerns that IOTN introduction will restrict access to orthodontic care. The IOTN is not widely used in the SGDS but is perceived as standardising treatment need assessment by GDPs and justifying the allocation of NHS orthodontic resources to patients amongst OS. Introduction of mandatory IOTN grading is likely to be contentious - the following needs to be considered: the index profile should be raised; its advantages highlighted; concerns about restricted access to orthodontic care addressed; and perceived need for locally accessed training met.

Summary of: The use of the Index of Orthodontic Treatment Need in dental primary care

Objectives The primary objective of this survey was to assess the use of the Index of Orthodontic Treatment Need (IOTN) in dental primary care (Scottish general dental services – SGDS), and to compare orthodontic specialists (OS) and general dental practitioners (GDPs). The secondary objective was to explore the attitudes to mandatory introduction of the IOTN into the SGDS. Design Postal, self completed questionnaire. Setting Dental primary care, Scotland. Subjects Randomly selected sample of general dental practitioners (GDPs), n = 315, and all orthodontic specialist practitioners (OS), n = 49, identified as working in the SGDS. Main outcome measures Prevalence and experience of using the IOTN in the SGDS. Results Response rate was 46% (n = 169). Eighty-four percent of respondents did not use the IOTN. Thirty-five percent of respondent GDPs had never heard of the IOTN. Respondents reported using the IOTN as an inter-colleague communication tool and to grade case complexity. GDPs perceived the IOTN as beneficial in setting national standards of practice; OS saw it as a tool to justify the allocation of NHS resources to patients. Responses indicate concerns that IOTN introduction will restrict access to orthodontic care. Conclusions The IOTN is not widely used in the SGDS but is perceived as standardising treatment need assessment by GDPs and justifying the allocation of NHS orthodontic resources to patients amongst OS. Introduction of mandatory IOTN grading is likely to be contentious – the following needs to be considered: the index profile should be raised; its advantages highlighted; concerns about restricted access to orthodontic care addressed; and perceived need for locally accessed training met.

The facilitating factors and barriers influencing change in dental practice in a sample of English general dental practitioners

The objective of this study was to investigate the barriers and facilitators to change in dental practices among a sample of general dental practitioners (GDPs) from three regions of England. In-depth face-to-face interviews with 60 GDPs were undertaken. The sample was selected from a group of 317 GDPs who had completed a questionnaire in the first phase of this study. The participants were selected to reflect diversity regarding the number and extent of self-reported changes reported in the questionnaire, and personal and practice characteristics. Of the 92 attempted contacts, 60 (65%) of the interviews were successfully completed. The interview schedule formed the basis of the interview. All the interviews and notes were transferred on to NUD*IST QSR version 4, a qualitative analysis package. No single factor was identified as being more important than another in facilitating change. The main facilitators for change were: financial factors, regular patient attendance, particularly a core patient group, staff loyalty, having regular staff meetings and open communication and having access to peer support. The main barriers to change were the reverse of the facilitators plus not having a financial stakehold in the practice. A range of factors were identified as influencing change in general dental practice. These include GDPs' attitudes and experience of change, patient factors, organisational issues, contact with peers and access to appropriate training courses.

What are the factors and barriers leading to change in how dentists practise their dentistry?

Aim The objective of this study was to investigate the barriers and facilitators to change in dental practices among a sample of general dental practitioners (GDPs) from three regions of England. Method In-depth face-to-face interviews with 60 GDPs were undertaken. The sample was selected from a group of 317 GDPs who had completed a questionnaire in the first phase of this study. The participants were selected to reflect diversity regarding the number and extent of self-reported changes reported in the questionnaire, and personal and practice characteristics. Of the 92 attempted contacts, 60 (65%) of the interviews were successfully completed. The interview schedule formed the basis of the interview. All the interviews and notes were transferred on to NUD*IST QSR version 4, a qualitative analysis package. Results No single factor was identified as being more important than another in facilitating change. The main facilitators for change were: financial factors, regular patient attendance, particularly a core patient group, staff loyalty, having regular staff meetings and open communication and having access to peer support. The main barriers to change were the reverse of the facilitators plus not having a financial stakehold in the practice. Conclusions A range of factors were identified as influencing change in general dental practice. These include GDPs' attitudes and experience of change, patient factors, organisational issues, contact with peers and access to appropriate training courses.

Attitudes to water fluoridation in general dental practice in the North East of England.

To find out the knowledge of, and attitudes towards, water fluoridation of a sample of general dental practitioners working in the North East of England. Anonymous, self-completed postal questionnaire. North East of England, both a fluoridated and non-fluoridated area. Following a small pilot survey, questionnaire to 79 general dental practitioners (44 in a non-fluoridated area, 35 in an area supplied with fluoridated water at one part per million) contracted to provide National Health Service (NHS) treatment in the North East of England. Fifty-five general dental practitioners returned questionnaires (a 70% response rate). Most respondents supported the principle of water fluoridation. Over half of the respondents indicated that they would benefit from more information and training on the issue of water fluoridation. There were marked differences in knowledge and attitudes to fluoridation between dental principals and associates. The sample was evenly split about what to do with a parent who was unsure about (whether to support) fluoridation even after the dentist had discussed the issue and answered questions. The majority of general dental practitioners support water fluoridation although some lack knowledge and expertise which might inhibit advocacy of it.

What do GDPs think about fluoridation?

Objective To find out the knowledge of, and attitudes towards, water fluoridation of a sample of general dental practitioners working in the North East of England. Design Anonymous, self-completed postal questionnaire. Setting North East of England, both a fluoridated and non-fluoridated area. Subjects and methods Following a small pilot survey, questionnaire to 79 general dental practitioners (44 in a non-fluoridated area, 35 in an area supplied with fluoridated water at one part per million) contracted to provide National Health Service (NHS) treatment in the North East of England. Results Fifty-five general dental practitioners returned questionnaires (a 70% response rate). Most respondents supported the principle of water fluoridation. Over half of the respondents indicated that they would benefit from more information and training on the issue of water fluoridation. There were marked differences in knowledge and attitudes to fluoridation between dental principals and associates. The sample was evenly split about what to do with a parent who was unsure about (whether to support) fluoridation even after the dentist had discussed the issue and answered questions. Conclusions The majority of general dental practitioners support water fluoridation although some lack knowledge and expertise which might inhibit advocacy of it.

Dentists' perceptions of trends in restorative dentistry in the UK.

To obtain responses to a questionnaire on likely trends in the clinical practice of restorative dentistry from a national sample of general dental practitioners (GDPs) who were principals of group practices in the UK. A panel of nine experts had been convened previously to define areas of trends in restorative dentistry in the UK and to formulate these into statements. Twenty trends were identified and framed into a 22-item questionnaire based on the trend statements. The questionnaire was sent to a national sample of 2800 principal dentists in group practices. Names of principal dentists were taken from the Yellow Pages directories, a group practice being defined as at least one principal dentist and one other practitioner. Levels of agreement for questionnaire scores of > or = 70% for all segments of a statement were taken as indicating a possible trend. Of the 2800 questionnaires sent out, 1448 were returned, a return rate of 52%. Of these, 1217 questionnaires were usable, an overall response rate of 44%. Good agreement was obtained for 14 statements (64%). The 14 trend statements that scored a level of good agreement were taken as indicating possible trends in dentistry in the UK as perceived by those GDPs who responded to the questionnaire. However, in view of the fact that the 1217 usable questionnaires received reflected the opinions of 10% of the principal dentists in group practice in the UK, this will not be representative of all principal dentists in practice. Nevertheless for the purposes of gaining some insight into trends in restorative dentistry, it could be considered to be of value.

General dental practitioners' knowledge of and attitudes towards evidence based practice.

To assess general dental practitioners' understanding of, and attitudes towards, evidence based practice (EBP). A random sample of general dental practitioners currently practising in the North West of England. A cross-sectional survey using self administered, structured, postal questionnaires in January 2001. A majority of the respondents had some understanding of technical terms associated with EBP. Only 29% (60/204) could correctly define the term EBP. When faced with clinical uncertainties 60% (122/204) of general dental practitioners turned to friends and colleagues for help and advice. Eighty one percent of respondents were interested in finding out further information about EBP (165/204). Barriers to its use included a lack of available time and financial constraints. EBP is not a concept that every dentist is familiar with, however, the general dental practitioners surveyed were enthusiastic and expressed a desire to find out more information on EBD. It appears to be the right time for an educational program targeted at GDPs to enhance their knowledge and use of EBD in everyday practice.

What do GDPs think of evidence-based practice?

Aims To assess general dental practitioners' understanding of, and attitudes towards, evidence-based practice (EBP). Subjects A random sample of general dental practitioners currently practising in the North West of England. Method A cross-sectional survey using self-administered, structured, postal questionnaires in January 2001. Results A majority of the respondents had some understanding of technical terms associated with EBP. Only 29% (60/204) could correctly define the term EBP. When faced with clinical uncertainties 60% (122/204) of general dental practitioners turned to friends and colleagues for help and advice. Eighty one percent of respondents were interested in finding out further information about EBP (165/204). Barriers to its use included a lack of available time and financial constraints. Conclusions EBP is not a concept that every dentist is familiar with, however, the general dental practitioners surveyed were enthusiastic and expressed a desire to find out more information on EBD. It appears to be the right time for an educational program targeted at GDPs to enhance their knowledge and use of EBD in everyday practice.

Variations in tooth preparations for resin-bonded all-ceramic crowns in general dental practice.

To investigate variations in tooth preparations for resin-bonded all-ceramic crowns (RBCs) in general dental practice (GDP). Laboratory-based retrospective analysis of dies for RBCs. General dental practices in the UK and Ireland (2000). A sample (n = 132) of laboratory models containing 180 tooth preparations for RBCs, featuring work from different general dental practitioners was obtained from four commercial dental laboratories. Aspects of the preparations were quantified and compared with accepted criteria defined following a review of the literature. The teeth found to be most frequently prepared for RBCs were maxillary incisors (41%). Margin positions were variably positioned with 29% of the preparations on the buccal aspect having subgingival margins. There were many tooth preparation dies for low fusing RBCs (47%) and Chameleon Fortress RBCs (62%) demonstrating overpreparation in the mesiodistal plane. The majority of the margins (84% buccally and 79% lingually) of the dies examined exhibited appropriate shoulder or chamfer finishes. Of the Chameleon Fortress preparations analysed, 86% had been underprepared occlusally. 42% of the teeth had been prepared with no regard to tooth morphology and demonstrated just one plane of reduction. The majority (93%) of the clinicians failed to provide any information regarding the shade of the prepared tooth stump. On the evidence of this survey of this sample of general dental practitioners' work, it was found that relevant guidelines for the preparations of RBCs are not being fully adhered to.

General dental practitioners diagnostic and treatment decisions related to fissure sealed surfaces

Objectives: The purpose of this in-vitro study was to assess the validity and reproducibility of the diagnosis and treatment planned for occlusal surfaces prior to and following the placement of a clear sealant by a sample of general dental practitioners (GDPs). Methods: 160 permanent posterior teeth were examined by 25 GDPs. The GDPs were not given any criteria and were therefore free to diagnose and plan care, as they felt appropriate. Each GDP conducted four examinations, two prior to and two after sealing. The teeth were serially sectioned to provide the validating criterion. Results: After sealant placement, there was a statistically significant increase in specificity and decrease in sensitivity of both diagnostic and treatment decisions. The reproducibility expressed by the κ-statistic was of the order of 0.5 prior to and after sealing with regard to diagnostic decisions. There was a general tendency to diagnose less disease after placement of a sealant ( P<0.001). There was also significantly less care (preventive or restorative) planned after sealant placement ( P<0.001). Conclusions: The placement of a sealant resulted in the diagnosis of less disease and less restorative treatment. This may be appropriate as evidence exists to support the use of sealants as caries therapeutic agents.

A survey of general dental practitioners' postgraduate education activity and demand for extended modular postgraduate programmes.

The aim of this paper is to assess the level of involvement of general dental practitioners in postgraduate education and training, identify their speciality interests, preferred format of course presentation and assess the potential demand for modular postgraduate programmes. A questionnaire analysis of a one in three random sample of general dental practitioners on Health Authority lists in the North West of England and North Wales was designed and carried out. Out of a random sample of 799, 552 GDPs completed an anonymous questionnaire in 1998 which investigated their current postgraduate activity, the areas of specialist interest and their interest in extended modular postgraduate education courses with associated summative assessment. Fifty three percent of respondents attended more than four postgraduate sessions per year of whom the majority (59%) were in 35-44 year old age group. 79% identified Section 63 courses as their first preference and 63% preferred mixed didactic and 'hands on' courses. Seventy five percent of respondents expressed an interest in attending modular programmes which might lead to a postgraduate qualification. In conclusion, an enthusiasm to attend existing postgraduate courses was identified but a demand was also perceived for courses of longer duration possibly leading to additional postgraduate qualifications.

Dental practitioners' experiences on the usefulness of restorative materials in Finland 1992-1996.

To analyse general dentists' choice of restorative materials in Finland, where the use of amalgam has significantly decreased and the use of composites increased during the past 10 years. Postal survey in 1997 to a random sample of general dental practitioners mainly working with adult patients. Percentage distribution of dentists' opinions. The response rate was 82%. Tooth-coloured restorations were considered to be more time consuming, technically complicated and to have shorter life spans. Most dentists were not willing to return to the wide-scale use of amalgam restorations. The rapid changes in the restorative material selection have not resulted in serious problems in restorative therapy.

A survey examining the attitudes of general dental practitioners toward change in undergraduate dental education.

To determine the attitudes of general dental practitioners toward aspects of change in undergraduate dental education. Descriptive postal survey using a cross-sectional random sample of general dental practitioners administered in 1997. 689 general dental practitioners practising in five regions of England with close proximity to a dental school selected by a one in two stratified random sample. Response rate: 70%. The questionnaire was both valid and reliable with an internal consistency reliability coefficient of 0.84. Responses identified strong support for preparing dental students for the wider role of the dentist and an emphasis toward self-directed learning. Other themes emerging from the investigation included support for learning to work as part of a dental team and for students to have experience of general dental practice early on in the undergraduate course. These responses have implications for curriculum design, syllabus, teaching methods, resources and staff development for dental schools in the UK.

A survey of radiographic techniques and equipment used by a sample of general dental practitioners

A study of radiographic practices of general dentists was conducted by mail survey. Eighty percent of 963 dentists returned completed questionnaires. All participants resided in the province of Ontario, Canada, and were graduates of either of the two provincial dental schools. Fewer than one third of radiographs were taken by the dentist with only 10% of dentists taking three fourths or more of the radiographs in their practices. There was infrequent use of E speed film (11%) and rectangular collimation (8%). Automatic processing was used by 93% of dentists. Although the overwhelming majority of dentists used a film holder, 2% still have the patient hold the film. The type of film holder used was affected by dental school experience, whereas the use of E speed film was not.