Dental treatment and the alcoholic

Practising dentists must include in their diagnostic skills the ability to identify the patient with a high intake of alcohol. Dental status can often reflect the patient's perception of health and disease. The development of an appropriate treatment plan for these patients needs to take into account their generally unreliable nature. Appointments are often not kept; there is poor compliance with general health-care information, and compliance with preventive advice on dental care is achieved with difficulty. Symptomatic presentation is common with the alcoholic patient. The dentist should avoid "rushing in" to treat the presenting acute problem without appropriate investigation of the medical history. This should include consultation with the patient's medical advisor and other involved health professionals. A careful review of the oral mucosa for pre-cancerous or cancerous changes should be systematically included in the examination of any patient. Patients with a high intake of alcohol, and especially those who smoke, need to be carefully screened.     

Oral hygiene for children: a look at what we must have and what we should do

Numerous reports show the state of oral health in children from many parts of the world. They indicate that dental caries and periodontal disease in children are common and not under proper control and that there is a high prevalence of dentofacial anomalies requiring early treatment. What we must have in relation to oral hygiene for children are manpower, materials and health education. These needs are analysed in detail. What we do is described for three groups of children: preschool, school and adolescent and young adult. Six common factors for all children carrying out oral hygiene are outlined under the following headings: (a) increasing the resistance of the tooth by the use of fluorides, (b) the control of plaque, (c) correct nutrition, (d) dental health education, (e) early recognition of major disorders of the orofacial complex and (f) regular visits to the dentist and his auxiliary help. What we should be doing for each group is discussed. Finally, some thought about the future way to dental health are presented in which it is suggested that the computer revolution "will have an overwhelming and comprehensive impact on every human being on earth in every aspect of his or her life' (Evans, 1979). The question is asked and discussed whether the dental profession is preparing for this revolution and the great changes that will come in our methods of education, clinical practice, research and education. The paper ends with the proposal that now is the time for organized dentistry to examine its policies in relation to education, clinical practice, research and administration so as to produce a primary dental health service available to total populations in the countries of the world.     

Pediatric dentists' attitudes regarding parental presence during dental procedures

A controversial aspect of pediatric dentistry today is parental presence. A number of authors report an increase in the number of parents who wish to accompany their children throughout the dental appointment. Dentists historically have excluded parents from the treatment area, while pediatricians routinely keep the parent and child together. The purpose of this survey was to determine the frequency that Florida pediatric dentists permit parental presence during children's dental visits and to relate the influence of patient age, dentist's years in practice, procedure type, and practitioner attitudes on parental presence. A high return rate (98.9%) was obtained, and results indicated a significant increase in parental presence in the dental operatory and that further increases in parental presence are expected. Younger children were more likely to be accompanied by a parent for each procedure. Parental presence for examination was more likely than for restorative or extraction. Analysis of variance (ANOVA) indicated that the most frequent attitudes influencing the pediatric dentist's choice to exclude parents were that their presence: wastes time (P < 0.001); disrupts the child (P < 0.05); and makes the dentist uncomfortable (P < 0.05).     

Medical risk classification of dental patients in The Netherlands

This study centers on the general health of dental patients, evaluated on the basis of the physical status classification system of the American Society of Anesthesiologists (ASA). A total of 4,087 patients completed a risk-related, patient-administered questionnaire. On the basis of their medical data, a computerized ASA classification was determined for each patient: 63.3 percent were in ASA class I, 25.7 percent in class II, 8.9 percent in class III, and 2.1 percent in class IV. After verification and/or consultation with the physician, the dentist also determined the ASA class, and this was compared with the computerized outcome. The agreement expressed as a kappa value was 0.64; the computer result generally placed the patient in a higher category of medical risk. The computer-determined ASA classes differed among the various dental practices (chi 2 = 262.9; df = 138; P < .01). It is possible to estimate the risk class of dental patients on the basis of standardized medical information only; however, the definitive ASA class can only be determined after verification of the patient's reply or, in some cases, after consultation with a physician.     

Service quality in dentistry: the role of the dental nurse

Patients judge the dental service they receive by the interaction with the service providers-the dentist and his or her staff-as they are unable to judge the technical quality of the service. To perform well as a service provider, employees such as dental nurses have to be well motivated and satisfied with their position. A study of the role of the dental nurse in contributing to service quality in dentistry was carried out through interviews with dentists and nurses at 20 dental practices in the South Thames region in 1995. The results revealed that while dental staff believed that the role of the dental nurse was important in terms of the patient's view of the practice, perceptions of the nurse's role differed. The majority of dentists felt that the nurse's role should be to anticipate their needs, while the nurses' opinions were evenly divided between putting the needs of the patient first or those of the dentist. Nurses also felt that their role was stressful and reported a lack of praise and recognition of their efforts by dentists. Few practices had written contracts or performance appraisals. The results indicated a lack of effective communication in many dental practices, producing role strain for the nurse and reducing job satisfaction. Increasing job satisfaction reduces staff turnover, resulting in more consistent service quality and reducing associated costs. In order to achieve this, several recommendations are made with the aim of improving communication between staff in dental practices.     

The incentive effects of malpractice liability rules on dental practice behavior

OBJECTIVES: The impact of malpractice liability rules on dental practice behavior was estimated using data from a 1992 nationwide survey of US general dentists. The study examined the premise that malpractice liability rules can affect quality of care and related resource allocation decisions by dentists, but that market features, such as relatively complete and "non-experience rated" malpractice insurance, are likely to weaken the incentive effects of malpractice liability. METHODS: General practice dentists in the United States were selected randomly, and 3,048 dentists were studied by mail survey. Secondary data on county-level characteristics were used to measure market area factors. Quality-of-care measures were derived from the survey about self-reported practice policies and behavior and participation in continuing education. Legal measures were assembled from state statutes and appellate court decisions. Ordinary least squares was used to assess the relation between legal variables and dependent variables of quality of care, continuing education, and the rate of dental output. RESULTS: Hypotheses about the effects of malpractice law on practice quality and participation in continuing education were not supported. The relation between pro-dentist law and output was supported. A number of legal provisions related to differences in practice behavior, but often in ways opposite to the expected direction. CONCLUSIONS: The direct effects of specific malpractice liability rules on dentist practice behavior often failed to point in the direction predicted by theory and were economically insignificant. It is possible that relatively complete malpractice liability insurance, coupled with "noisy" liability rules, substantially dulls the deterrent effect of malpractice liability. Other forces, such as the dentist's past malpractice claims experience, were more significant in shaping dentist behavior.     

The role of the restorative dentist in the diagnosis and maintenance phases of implant therapy--Part III: The restoration and maintenance of oral health prior to the provision of the implant prosthesis

Establishing and maintaining the patient's oral health prior to provision of the definitive implant restoration is the responsibility of the restorative dentist and is an important aspect of comprehensive treatment. The additional time and expense required to provide oral hygiene and conventional dental treatment needs to be acknowledged by the implant team and the patient. An anticipated three to five treatment hours are often required to provide maintenance and hygiene care, with additional time needed to provide individualized conventional dental treatment to each patient. The provision of implant therapy is a rewarding experience when all aspects of treatment are properly planned and competently performed. The general practitioner is the logical resource to provide much of the necessary treatment that is directly and indirectly related to the provision of implant restorative dentistry.     

Musing of the feline hepatic voltage-dependent delayed-rectifier potassium channel gating

SETTING: Measures known to improve adherence such as short course chemoprophylaxis and directly observed therapy can be enhanced to a significant extent/by the use of incentives. Adherence to tuberculosis therapy is influenced by several factors, including the health care system, complexity of therapeutic regimens and patient's characteristics. Individual factors that negatively influence patient's adherence are the most difficult to counter. Preventive tuberculosis therapy is doubly challenging because the benefit of treatment is not felt, while toxicity from the medication, when it occurs, is experienced immediately. Ingenious incentives therefore have to make it worth the patient's while. During a study on preventive regimens, a request for an incentive, Sustacal, was observed to help completion of preventive regimens. Components of individual TB programs may help in patient adherence; it is important for health care staff to identify these aspects and, if they are successful, utilize these as an incentive to complete treatment.     

Dental Health Center 2000

The Dental Health Center concept is proposed as a method to maintain control of the dental delivery system while delegating the dentist's managerial and supervisory responsibilities to well-trained business executives. The Center would be a uniquely designed facility that operates 12 hours per day, 6 days a week for 50 weeks of the year. The participating dentists relocate their practices to the facility at a practice purchase price determined by the dentist, paid half in cash and half in center stock. In return, the dentists agree to produce that practice purchase price annually; in turn, they receive 45 percent of their monthly collected dental service fees and have access to all the services of the Center.     

Are you treating youngsters who are or should be receiving mental health services?

Psychiatrists now recognize that the disorders of children are serious, treatable conditions and as precursors of adult psychopathology. These conditions can seriously influence the patient's behavior when undergoing dental treatment. The dentist will probably assume that the behavior problems are directly related to the nature of the dental service, rather than particular underlying personality characteristics of preschool and school-age children. It is important that practitioners recognize and understand these conditions as they attempt to provide adequate treatment. No national epidemiological studies have been conducted in this country that would provide valid indicators of either the prevalence or incidence of mental disorders among children. Local studies, however, have been done that diagnosable disorders in children range from 17.6 percent to 22 percent, including 3 percent to 5 percent who have severe emotional or behavioral problems. The prevalence of many mental disorders is greater in males than in females, ranging from a ratio of 2:1 to 9:1. Lifetime prevalence of mental disorders, first diagnosed in infancy, childhood, and adolescence range as high as 15,000 cases per 100,000 persons. It is important for the dentist to recognize that (1) even the youngest of children seen in a dental practice may be in need of mental health services, (2) management problems may stem from mental health problems, and (3) families are unaware or unwilling to admit that a child may need help.     

Identification of caries risk children and prevention of caries in pre-school children

A special model for dental care in pre-school children was used in a small clinic in the county of Blekinge in southern Sweden. The model is based on screening of caries risk performed by a dental assistant before the caries attack. Any single risk factor or risk behavior in pre-school children was considered. The aim was to 1) evaluate the dental assistant's selection of caries risk children up to the age of three years, 2) compare dental health variables in 4 yr olds in the test clinic with those for the whole county in 1994 and 3) compare time spent by the dentist and the dental assistant in the test clinic and in the whole county per child up to the age of four. 102 children participated. One specially trained dental assistant screened all children using background factors combined with clinical examinations at ages 1, 2 and 3. Eighty-two children participated each year from one year. A systematized form for questioning the parents was used. Individual caries prevention was given including fluoride and antimicrobial treatments as well as fissure sealants in primary molars at caries risk. The proportion of children with caries lesions at four years and a caries risk assessment up to the age of two was 1.0 (sensitivity). The proportion of children with no caries lesions at four years and no caries risk assessment at year two was 0.7 (specificity). The most frequent risk factors found at 2 yrs were frequency order: lack of oral hygiene (visible plaque), deep fissures in molars and frequent intakes of sweet drinks. The proportion of children with no caries lesions at 4 yrs of age in the test clinic was 92.9% compared to a county mean of 76.4%. In the group of children where a risk assessment was made each year from one year the proportion of caries free children was 96.3%. The total time spent per child in the test clinic was 22 minutes more than the county mean. However, dentist's time, excluding assistance, was 28 minutes less in the test clinic. The results suggest that the model used for caries prevention in pre-school children is cost-effective, and that dental health can be remarkably improved.     

The provision of orthodontic services by general dental practitioners. 1. Methods and descriptive results

Information regarding orthodontic service provision by general dental practitioners in Australia is limited. The aim of this survey was to determine the amount and variety of orthodontic services provided by general dental practitioners in the Melbourne Statistical Division, Victoria, Australia. A random sample of 307 dentists drawn from the Victorian Dentists Register was surveyed by mailed questionnaire: 218 (71%) replied. Data were collected using a fortnight log. During this time 59 per cent of the dentists saw at least one orthodontic patient; one dentist saw 66 orthodontic patients. Removable orthodontic appliances were used by 35 per cent of the dentists and fixed orthodontic appliances by 18 per cent. Twenty-six per cent provided comprehensive orthodontic treatment, 22 per cent aligned incisors, and 21 per cent corrected anterior crossbites. The general dental practitioners surveyed provided a wide range of preventive and interceptive orthodontic services to generally a small percentage of their patients.     

Selection criteria for dental software

Dentists who wish to introduce a computer based patient record system in their office are confronted with a lack of information concerning the selection of dental software. As wishes and demands concerning the content and options given by a dental computer program can vary widely from dentist to dentist and as dental software is changing rapidly a global objective evaluation is of no practical validity. Therefore a list of general and specific selection criteria was developed, enabling the practitioner to make a personal, objective comparison of quality of content versus wishes, price and service of different dental software programs. The criteria are discussed in this article.     

Dental health attitudes among dentate black and white adults

OBJECTIVES: Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use. METHODS: As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried. RESULTS: Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account. CONCLUSIONS: Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.     

What physicians should currently observe in the area of dental health

Several factors govern the development of human dental caries. The actual caries incidence in children depends greatly on fluoride consumption, reduction of fermentable sugar intake (in favour of the use of sugar substitutes), dental health habits and regular dental check-ups. A significant reduction of dental caries in children and young adults is achieved in many countries following these principles. However, there remains a group, about 25%, with a particularly high incidence of caries. Today, efforts are directed at detecting these risk subjects. Mutans streptococci and lactobacilli are the main causative bacteria of human dental caries. The initiation of dental caries is preceded by colonisation of the dentition by S. mutans, usually in early childhood. The early establishment of these bacteria in the mouth of human infants is dependent on intrafamilial--mainly maternal--transmission of saliva. The higher the level of S. mutans in the maternal saliva, the more likely is the colonisation of primary dentition by cariogenic bacteria. The earlier the colonisation, the higher the incidence of caries. Today we have new diagnostic aids: Simple microbiological tests to detect the individuals with high salivary levels of these cariogenic bacteria, so called SM-millionaires. The tests are also a good educational aid for motivating patients to individual prophylaxis. What could a paediatrician or gynaecologist do to help the dentist? He could inform the parents early enough to avoid saliva contacts. For example, the mother should not take the child's spoon or pacifier in her mouth. The dentist meets the children much later, at an age where they already have caries. The older methods, mentioned at the begin, are also still valuable.     

The effects of visual surround eccentricity and size on manual and postural control

The aim of this study was to compare two different modes of behaviorally-oriented therapies for dental fear. The subjects were chosen consecutively from the waiting-list of a Dental Fears Research and Treatment Clinic. In addition, a control group was selected from patients treated under general anesthesia to compare levels of dental and general fear with the experimental groups. Twenty-two women, with a mean age of 31.8 yr, were included and randomly assigned to two groups. The median time of avoidance of dental care was 9.5 yr. One group received hypnotherapy (HT) and one group a behavioral treatment based on psychophysiological principles (PP). Both therapies included eight sessions followed by standardized conventional dental test treatments. Pre- and posttreatment measures were dental fear, general fear, mood, and patient behavior. Nine patients were not able to conclude the treatment sessions (6 HT and 3 PP); these patients did not differ significantly from the remaining patients before treatment. The PP group reported a statistically significant decrease in dental fear as well as a rise in mood during dental situations, as opposed to the HT group. General fear levels decreased but not significantly. Eleven patients completed conventional dental treatment according to a dentist's behavioral rating scale, indicating that they were relaxed, and no problems occurred during the treatments. These patients were referred to general practitioners within the community dental service. In conclusion, this small size study showed that a majority of the patients, who accomplished the behavioral therapy and the dental test treatments, became less fearful of dental care and were able to manage conventional dental care, including changing dentist.     

TFF1 gene expression in human medullary thyroid carcinoma

This epidemiological study investigated the reasons why children in Northern Ireland who need orthodontic treatment do not receive treatment even when it is provided free by the state. A total of 1584 15- and 16-year-olds were examined in 23 high schools with the Index of Orthodontic Treatment Need. The characteristics of the adolescents who had received orthodontic treatment were compared with those who had a definite need for treatment and yet did not receive treatment or advice. One in 10 of the adolescents examined had an unmet need for orthodontic treatment. Logistic regression analysis was used to assess the influence of 11 variables including socioeconomic status, religion, and standard of dental health on the uptake of orthodontic care. This analysis revealed that the only significant predictors of whether an adolescent received orthodontic treatment was the dental attendance pattern of the adolescent, the adolescent's dental health, and the dental attendance pattern of the adolescent's mother. Those adolescents who had good dental health, who regularly attended a dentist, and whose mother regularly attended a dentist were more likely to receive orthodontic treatment.     

Effects of cordocentesis on inferior vena cava velocity waveforms: differences between normally grown and growth-retarded fetuses

PURPOSE: The purpose of this investigation was to evaluate complete denture patients at pretreatment and postinsertion, 6 months and 18 months after denture delivery in order to develop an explanatory model of successful denture therapy to better understand patient acceptance of complete dentures. MATERIALS AND METHODS: Sixty complete-denture patients treated at a dental student clinic were followed through denture therapy and for 18 months thereafter. Subjects were examined and completed pretreatment questionnaires and posttreatment interviews. Three outcome measures of denture success were tested, and factors considered substantive in achieving a successful denture outcome were examined using multivariate analyses. RESULTS: At post-insertion, 76.7% of subjects were satisfied with their dentures, 74.6% said their expectations were met, and 66.7% said they adjusted easily to their new dentures; reports at 6 and 18 months were similarly high. Logistic regression findings suggest that psychological and interpersonal factors are more important determinants of denture satisfaction than anatomic or clinical factors. CONCLUSIONS: Subject characteristics including age, gender, race, income level, education, marital status, and maxillary and mandibular anatomy were not significantly associated with denture success as defined by the three outcome measures used in this study. Although these variables may represent important co-factors in the patient's acceptance of dental services and may affect the way a patient perceives dental care outcomes, statistically significant relationships were not found within our sample. Psychosocial variables, such as pretreatment expectations, satisfaction with the dental care received, and mental health showed a stronger relationship to a successful outcome.     

Fifty glorious years

Since the second world war, dentistry has undergone momentous changes, not only in clinical and mechanical developments but also in changes in people's perceptions of what care their dentist can offer them. Dental graduates today will be surprised at the great difference between their own education and that of their 1946 counterparts. This is one dentist's record of the last 50 years in dentistry and how certain advancements have affected his working life.     

Incidence of endocrine complications and clinical disease severity related to genotype analysis and iron overload in patients with beta-thalassaemia

OBJECTIVES: This study determined demographic characteristics, satisfaction with care, and likelihood of follow-up dentist visits for patients seen in office-based, independent, dental hygienist practices. METHODS: New patients were surveyed after their initial visits to independent hygienist practices to assess their demographic characteristics and satisfaction with care at both the beginning of practice operations and 18 months after the start of these practices. Follow-up surveys were sent to patients 12 and 24 months after their initial visits to the independently practicing dental hygienists to determine if patients had visited a dentist. RESULTS: Most respondents were white, female, had attended some college, and reported high family incomes. Ninety-eight percent of respondents were satisfied with their dental hygiene care. Follow-up questionnaires revealed that over 80 percent of respondents visited the dentist within 12 months of receiving dental hygiene care in independent settings. This level of follow-up care with dentists was found both for respondents who reported having a regular dentist at their initial visits with the hygienists and for those who reported not having a regular dentist. CONCLUSIONS: Independent practice by dental hygienists provided access to dental hygiene care and encouraged visits to the dentist.