Perception of recently graduated Dutch dentists of their education.

INTRODUCTION: The curriculum of the three dental schools in the Netherlands consists of a three-year bachelor's and three-year master's course. The education programmes focus inter alia on clinical dental reasoning, thinking and acting scientifically, general oral healthcare activities, and communication and (inter)professional cooperation. This study examined how recently graduated dentists, in the light of their work experience, evaluate their education in retrospect. MATERIALS AND METHODS: All 1074 dentists who graduated between 2012 and mid-2017 were invited by e-mail to answer a web survey. Of those, 314 (29%) took part in the study. RESULTS: The majority of dentists were positive about their knowledge of general and clinical oral healthcare fields when they graduated (70% and 68%, respectively). Fewer dentists were satisfied with their skills in terms of some specific procedures (50%) and clinical professional areas (33%). By far, the majority (85%) were satisfied with the educational skills of their teachers. The majority (70%) felt that their education fitted in well with their professional practice. Nevertheless, 60% thought a year's trainee work experience would be a good idea. The overall evaluation of dentists who have their own practices was less positive than those who do not. CONCLUSION: Knowledge and skills relating to managing a practice were not sufficiently addressed in the programme. The introduction of a practical internship would be desirable, preferably during the education. But when they look back, the majority of recently graduated dentists in the Netherlands are generally positive about the education they received.

Collaboration between general dental practitioners and dental hygienists: a qualitative study.

BACKGROUND: Influenced by governmental measures, collaboration in oral health care practices in the Netherlands has increased in recent decades. Previous studies on this subject have mainly concerned the composition of the staff or have been normative rather than descriptive. Based on the existing literature, four aspects were expected to be of significant influence on the collaboration on oral health care practices: goals, leadership, the allocation of tasks and responsibilities and formalization. METHODS: The aim of this study was to describe a classification of collaboration between general dental practitioners and dental hygienists within oral health care practices in the Netherlands. Eighteen semi-structured face-to-face interviews were conducted in nine oral health care practices, which differed with regard to both practice characteristics and characteristics of the principal general dental practitioner. In all practices, the principal general dental practitioner and one dental hygienist were consulted. The interviews were conducted in the practices of the respondents and were held between October 2019 and July 2020. The interviews were analyzed through theoretical thematic analysis using Microsoft Word 2010 and Atlas.ti 8. Three researchers coded and analyzed three practices, and discussed their results. Based on their mutual conclusions, one researcher analysed all practices. The final results were reviewed and approved by the other two researchers. RESULTS: Different factors influencing the collaboration between general dental practitioners and dental hygienist in the Netherlands were found. The most important factors seemed to be leadership style and goals for collaboration. Leadership style varied from very directive to very supportive and seemed to be connected to the allocation of responsibilities. Goals for collaboration varied from predominantly patient-related to mostly practice-related. Formalization appeared to be more present in larger practices and practices that are affiliated to a dental chain. CONCLUSIONS: Based on leadership style and goals for collaboration, a classification was identified. This classification is recommended as a starting point for further research on directive and supportive leadership in oral health care practices.

Work situation and prospects of recently graduated dentists in the Netherlands.

INTRODUCTION: Dentists who have graduated recently from a Dutch dental school work mainly in the Netherlands, where collaboration and differentiation are relevant factors. Furthermore, the Netherlands face regional undersupplies of dentists. The objective of this study was to describe choices and aims of recently graduated dentists for the near future. MATERIALS AND METHODS: An invitation for the web questionnaire was sent by e-mail to 945 dentists who had graduated from a Dutch dental school between 2013 and 2017, of whom 230 (24.3%) participated in the survey. RESULTS: Approximately three quarters (77%) of the recently graduated dentists worked as a general dentist in a practice of some else, primarily in urban areas. The choice for a practice was affected by location, earnings, and the opportunity to gain experience. Furthermore, the career choices were affected most by the desired length of the working week and financial security. The narrow majority (53%) of the recently graduated dentists believed that in 5 years they will be practice owner; 49% expected to be a differentiated dentist. Furthermore, 41% believed they will work in a smaller municipality. DISCUSSION: Although recently graduated dentists seem receptive to work in smaller municipalities, the peripheral regions are conceivably less appealing. Practice ownership conceivably is an option for the near future for a narrow majority of the recently graduated dentists. CONCLUSION: Recently graduated dentists have different preferences regarding their work situation in 5 years.

Developments in oral health care in the Netherlands between 1995 and 2018.

BACKGROUND: Over the past several decades, changes in legislation and regulations have been implemented in oral health care in the Netherlands. In 1995, for example, a major transformation in the funding of oral health care was implemented, after which most oral health care for adults was no longer covered by national insurance. In 1997, the Individual Healthcare Professions Act, in which the authorizations of care providers were described, was established. The Healthcare Quality, Complaints and Disputes Act, established in 2016, concerns the accountability of professional behavior. Regulations concerning employment have changed several times since 1995. These changes have affected the work and practice situation of oral health care providers. METHODS: Data from many publicly available sources were gathered and combined with internal reports mainly derived from the Data Stations project of the Royal Dutch Dental Association. This project was established in 1995 and, since its initiation, 6716 dentists have participated an average of 6.7 times. RESULTS: Between 1995 and 2018, nearly all professional groups in oral health care increased, particularly those of dental hygienists and prevention assistants. The number of dental practices decreased, but practices got larger in terms of dental units, number of patients, and personnel. The percentage of inhabitants visiting oral health care professionals remained unchanged, but the type of care provided moved towards more prevention. Oral health care providers exploited new opportunities to enhance and express their professional behavior. CONCLUSIONS: Oral health care in the Netherlands has evolved in recent years toward more collaboration in teams, and professions have established institutions to promote the quality and safety of care. Greater emphasis has been placed on prevention of dental diseases. These processes were influenced by new legislation and regulations, demographic changes within professional groups, and other social developments.

Are Dutch dental students and dental-care providers competent prescribers of drugs?

Dental students and dental-care providers should be able to prescribe drugs safely and effectively. As it is unknown whether this is the case, we assessed and compared the prescribing competence of dental students and dental-care providers in the Netherlands. In 2017, all Dutch final-year dental students and a random sample of all qualified general dental practitioners and dental specialists (oral and maxillofacial surgeons and orthodontists) were invited to complete validated prescribing knowledge-assessment and skills-assessment instruments. The knowledge assessment comprised 40 multiple-choice questions covering important drug topics. The skills assessment comprised three common clinical case scenarios. For the knowledge assessment, the response rates were 26 (20%) dental students, 28 (8%) general dental practitioners, and 19 (19%) dental specialists, and for the skills assessment the response rates were 14 (11%) dental students, eight (2%) general dental practitioners, and eight (8%) dental specialists. Dental specialists had higher knowledge scores (78% correct answers) than either dental practitioners (69% correct answers) or dental students (69% correct answers). A substantial proportion of all three groups made inappropriate treatment choices (35%-49%) and prescribing errors (47%-70%). Although there were some differences, dental students and dental-care providers in the Netherlands lack prescribing competence, which is probably because of poor prescribing education during under- and postgraduate dental training. Educational interventions are urgently needed.

Preferred and actual retirement age of oral and maxillofacial surgeons aged 55 and older in the Netherlands: a longitudinal study from 2003 to 2016.

BACKGROUND: In workforce planning for oral and maxillofacial surgeons in the Netherlands, it is important to plan timely, as these dental specialists are required to earn both medical and dental degrees. An important factor to take into account in workforce planning is the outflow of the profession through retirement. In the workforce planning in the Netherlands, it was assumed that retirement plans are a predictor for the actual moment of retirement. The purpose of this study was to investigate this assumption. METHODS: A standardised survey to investigate the work activity and retirement plans of oral and maxillofacial surgeons was conducted seven times between 2003 and 2016. With some minor variations, in every edition, all oral and maxillofacial surgeons aged 55 years and older who did not indicate to be retired in an earlier edition were invited to participate. The data of all seven editions was analysed to investigate what factors influence the actual retirement age. For the analyses of the data, ANOVA and linear regression were employed. RESULTS: The response rate was at least 80% in all editions. For all editions combined, 185 surgeons were invited one or more times, of whom 170 responded at least once. Between 2003 and 2016, the mean preferred retirement age increased from 63.7 to 66.7. Two thirds of the respondents who participated in more than one edition had revised their preferred retirement age upwards. Regarding the difference between preferred and actual retirement age, 45% of the oral and maxillofacial surgeons retired at a higher age than originally preferred and another 14% was still working at the age the originally preferred to retire. Linear regression shows that preferred retirement age is associated with sex and the number of working hours and that actual retirement age is associated with preferred retirement age, earlier preference to decrease working hours and working in non-academic hospitals. CONCLUSION: Altogether, it seems that in this group the preferred retirement age has some predictive value, but the oral and maxillofacial surgeons tend to retire at a higher age than they originally preferred to.

Opinions of dentists on the barriers in providing oral health care to community-dwelling frail older people: a questionnaire survey.

OBJECTIVE: The aim of this study was to investigate to what extent dentists in the Netherlands experience barriers in providing oral health care to community-dwelling older people. BACKGROUND: As most publications on the barriers in providing oral health care to older people consist of surveys on oral health care in care homes, it was decided to investigate the barriers dentists experience in their own dental practices while providing oral health care to community-dwelling frail older people. MATERIAL AND METHODS: A representative sample of 1592 of the approximately 8000 dentists in the Netherlands aged 64 or younger were invited to respond to a questionnaire online. The dentists were asked to respond to 15 opinions concerning oral healthcare provision to community-dwelling frail older people aged 75 years or more who experience problems in physical, psychological and social areas, as well as possible financial problems. RESULTS: The total response rate was 37% (n = 595; male=76%; average age 49). The majority of those who responded agreed that the reimbursement of oral health care to older people is poor. Two thirds of those who responded (66%) agreed that there are limited opportunities to refer the frail and elderly with complex oral healthcare problems to a colleague with specific knowledge and skills. CONCLUSION: Dentists experienced barriers in two domains; a lack of knowledge and practical circumstances. It was concluded that the dentist's gender, age, year of graduation and the number of patients aged 75 years or more treated weekly were in some respect, related to the barriers encountered.

The impact of a formal complaint on Dutch dentists' professional practice: a survey study.

BACKGROUND: A complaint from a patient can have a serious impact on the well-being of dentists. Little is known, however, about the nature and the extent of this impact. METHODS: Therefore in 2013 an anonymous survey was conducted among 955 dentists and dental specialists who were involved in a complaints procedure dealt with by the Complaints Committee of the Royal Dutch Dental Association (KNMT) in the period of mid-2008 to mid-2013. RESULTS: In total 413 (43 %) of these dentists participated in the study. As a result of a formal complaint 71 % of the respondents experienced a considerable impact in their professional practising, while 52 % stated that it had (also) seriously influenced their attitude towards colleagues and patients. Furthermore, 60 % (also) mentioned effects of a complaints procedure regarding their mental and/or physical well-being. CONCLUSIONS: Being confronted with a formal complaint from a patient leads to a considerable impact on dentists' professional practice and personal well-being. It is remarkable this did not only pertain to a 'negative' impact, but also to a 'positive' impact. Despite unpleasant feelings, several dentists regarded the complaint as a 'wake-up call'. Furthermore, given the relatively high number of successful mediation attempts it can be concluded that this form of complaint handling appears to be a successful way of solving problems that have arisen between patients and dentists.

Diagnosis and treatment of patients with halitosis by dental hygienists and dentists in the Netherlands.

OBJECTIVES: The aims of this study were to ascertain the knowledge level of halitosis in dental hygienists and dentists in the Netherlands and to examine how they deal with patients with halitosis. METHODS: A written survey (comprising 29 questions on personal and professional characteristics, clinical observation and treatment of halitosis, the referral of patients with halitosis and expert knowledge of halitosis) was randomly distributed to a sample of 327 Dutch dentist members of the Royal Dutch Dental Association (Koninklijke Nederlandse Maatschappij tot bevordering der Tandheelkunde; KNMT) and to a sample of 205 members of the Dutch Dental Hygienists' Association (members of the Nederlandse Vereniging van Mondhygiënisten; NVM). A total sample of 168 oral health professionals (92 NVM-dental hygienists and 76 dentists) was included. RESULTS: This sample can be considered as representative of the population of dental hygienists and dentists working in the Netherlands. Knowledge of halitosis in NVM-dental hygienists and dentists was generally the same. In both professions, attention to, and treatment of, halitosis did not take place at every patient contact, even among those who were able to treat patients with halitosis. CONCLUSIONS: This study supports the importance of training programmes aimed at increasing assertiveness, as well as the social and communication skills of dentists and dental hygienists to improve the diagnosis and treatment of patients with halitosis. A guideline on screening, diagnosis and treatment of halitosis may be useful to improve the attitude and behaviour of oral health-care professionals, ultimately aimed at stimulating optimal oral health care.

Recognizing and reporting domestic violence: attitudes, experiences and behavior of Dutch dentists.

BACKGROUND: On July 1(st) 2013 the Mandatory Reporting Code Act came into force in the Netherlands, making it compulsory for health professionals to adhere to a reporting code when they suspect patients to be victims of domestic violence (DV) or child abuse (CA). The Royal Dutch Dental Association (KNMT) developed a reporting code for dental professionals (RCD). Moreover, an e-learning module about DV has been developed. A web-survey was conducted to investigate how general dental practitioners (GDPs) deal with the RCD and what their experiences are with (signs of) DV and CA. METHODS: In April 2014 1038 GDPs were invited by e-mail to participate in a web-survey consisting of 24 items, through the KNMT Data Stations Project. The data was analyzed using SPSS (RELIABILITY, CHISQ and ANOVA). RESULTS: Of all GDPs invited to participate 264 (25 %) responded. 82 % of these GDPs are aware of their obligation to use the reporting code. 54 % of the GDPs are in favor of this obligation. 76 % of the GDPs have taken notice of the KNMT's RCD and 51 % of the GDPs have implemented the reporting code in one form or another in their practice. 24 % of the GDPs stated having suspected DV during the last twelve months in the case of 2.4 patients on average. 81 % took note of this in the patient's record and 58 % also took action in different ways. 54 % wants to complete the e-learning module. CONCLUSIONS: Most GDPs are aware of the new legislation and have taken cognizance of the RCD. Even though the majority of GDPs are not opposed to using a reporting code, over half of them have not yet implemented the code in practice. An important factor in this regard seems to be that a substantial minority of the GDPs says they are not sufficiently informed about aspects of reporting a case and about the steps they have to take.

Exploring collaboration reasons and leadership styles in Dutch primary oral healthcare practices.

AIMS: To outline the extent to which practice owners in Dutch oral healthcare practices (OHPs) use a directive and supportive leadership styles, to map out which goals practice owners in Dutch OHPs consider most important when choosing collaboration within the practice and to identify the reasons why oral healthcare professionals choose to engage in collaborative practice. MATERIALS AND METHODS: A survey involving 802 general dental practitioners, dental hygienists, and prevention assistants was conducted. The questionnaire covered, among other subjects, leadership styles and reasons for collaboration. Data analysis included descriptive statistics, chi-square tests, one-way ANOVA, linear regression, and logistic regression. RESULTS: Compared to employees, practice owners ascribe to themselves more characteristics of both directive and supportive leadership. The most frequently mentioned reasons for choosing a practice form that involves collaboration were the possibilities to provide the best care and the desire to focus on prevention. Healthcare providers chose to work in a collaborative practice for several reasons, which were associated with profession, age and gender. CONCLUSIONS: The degree of directive and supportive leadership among practice owners in dental care practices in the Netherlands showed a strong correlation. The most frequently mentioned reasons for choosing collaboration were related to healthcare content.

Willingness for Medical Screening in a Dental Setting-A Pilot Questionnaire Study.

An important way to manage noncommunicable diseases (NCDs) is to focus on prevention, early detection, and reducing associated risk factors. Risk factors can be detected with simple general health checks, which can also be performed in dental clinics. The purpose of this study was to investigate participants' willingness to participate in general health checks at the dentist, in particular the difference in opinion between medical patients and random healthy dental attendees. A total of 100 medical patients from an outpatient internal medicine clinic and 100 dental clinic attendees were included (total of 200 participants). The participants were asked for their opinion using six closed-ended questions. Overall, 91.0% of participants were receptive to information about the risk of diabetes mellitus (DM) and cardiovascular diseases (CVD). The majority (80-90%) was receptive to screening for DM and CVD risk, such as weight and height measurements, blood pressure measurement, saliva testing for CVD and to measure glucose and cholesterol via finger stick. No significant differences were found in the frequencies of the responses between the different groups based on health status, age, sex, or cultural background. This study shows that most participants are willing to undergo medical screening at the dentist for early detection and/or prevention of common NCDs.

Impact of the Coronavirus on Providing Oral Health Care in the Netherlands.

OBJECTIVE: Transmission of SARS-CoV-2 during oral health care is potentially increased compared to regular social activities. Specific amendments to the Dutch national infection control guidelines were promulgated. This study aimed to map the impact of the coronavirus pandemic on providing oral health care during the first wave of the coronavirus pandemic in 2020 in the Netherlands. METHODS: A cross-sectional web-based survey was sent via email to a representative sample of dental hygienists and dentists in the Netherlands. RESULTS: Of the 1700 oral health care practitioners approached, 440 (25.9%) responded to the survey. Patient access to oral health care was severely restricted during the lockdown in the spring of 2020. A total of 1.6% of the oral health care practitioners had laboratory-confirmed COVID-19 during the study period, although this is likely to be an underrepresentation due to limited access to testing at that time. Over half of the participants perceived an increased risk of virus transmission during aerosol-generating treatments in their practices. A large majority (65.0%-87.1%) of the oral health care practitioners followed the COVID-19-specific amendments to the national infection control guidelines. Compared to the pre-pandemic period, additional personal protective equipment and protocols were applied. Factors related with compliance with the additional recommendations were age, employment status, and occupation. CONCLUSIONS: The pandemic had a profound impact on both the accessibility and practice of oral health care. This survey study found that most Dutch oral health care practitioners paid extra attention to hygiene and infection control. Also, a low number of COVID-19 infections detected amongst Dutch oral health care practitioners was reported in the Netherlands. These overall outcomes suggest that safe oral health care can be provided when following the current infection control recommendations.

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

BACKGROUND: Some 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. METHODS: In 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. RESULTS: A 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. CONCLUSIONS: Older 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.

Provision of Oral Health Care by Dentists to Community-Dwelling Older Patients.

BACKGROUND: Research into oral health care for older people has shown that dental care in general decreases with increasing age and frailty and, therefore, oral health care provision may be complex. The aim of this study is to identify the oral health care dentists provide to community-dwelling older people and which barriers they experience in doing this. METHODS: In this cross-sectional study, a representative sample of dentists in the Netherlands was asked to prospectively select one older patient and describe this patient using a specially developed registration form; the patient was requested to fill out a questionnaire. The relationship between experienced barriers in providing oral health care to older patients and characteristics of the dentists and the patients was studied by means univariate and multivariate logistic regression analysis. RESULTS: In total, 923 dentists were asked to participate in the study. Data were available for 39.4% dentist-patient pairs. In most cases (87.4%), oral health care was focussed on conservation of the dentition. In all, 14.0% of the dentists experienced barriers in providing oral health care for older people. Some patient factors increase the risk of experiencing barriers, eg, the more difficult behaviour of older patients and the greater disease burden. CONCLUSIONS: Oral health care was mostly focussed on conservation of the dentition, and dentists especially experience barriers in oral health provision to older patients if they are already frail.

Exploring the development, evaluation and implementation of complex health interventions to prevent early childhood caries in preschool children: A scoping review protocol.

OBJECTIVE: This scoping review aims to identify complex health interventions (CHI's) to prevent early childhood caries (ECC), explore the level of complexity of the identified CHI's, and explore the details of their development, evaluation, and implementation. INTRODUCTION: Many interventions to prevent ECC have multiple interacting components and can be seen as CHI's. Recent reviews on these interventions have found inconclusive effects, which may be due to differences in the development, evaluation, and implementation of CHI's. INCLUSION CRITERIA: This scoping review will consider clinical trials reporting CHI's to prevent ECC that starts during pregnancy or in the first year of life. Studies in the English language will be included regardless of the country of origin, sociocultural setting, or context. METHODS: This review will follow the Joanna Briggs Institute methodology for scoping reviews. An initial search of PubMed identified keywords and Medical Subject Headings terms. A second search of PubMed, Embase, Clarivate Analytics/Web of Science Core Collection, ClinicalTrials.gov, and the Wiley/Cochrane Library will follow. Two independent reviewers will perform title and abstract screening, retrieve and review full-text studies, and extract data. The reference lists of all included sources will be screened for additional CHI's or relevant publications about a specific CHI. Data charting will be utilised based on study characteristics and intervention complexity. A 39-item instrument will be used to explore the details in the description of the CHI's development, evaluation, and implementation. The results will be presented in tables, visual outputs, and a narrative summary in response to the review questions. DISCUSSION: The proposed review will generate evidence which may provide a direction for the future design of studies on CHI's to prevent ECC and more complete information for those who want to adopt successful interventions to prevent ECC.

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

OBJECTIVES: To assess the oral health of older people who visit the community dental practice from both the dentists' and the patients' perspective. MATERIALS AND METHODS: In 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. RESULTS: In 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 RELEVANCE: Chronically 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.

Collecting standardised oral health data via mobile application: A proof of concept study in the Netherlands.

FDI World Dental Federation, founded as Fédération Dentaire Internationale, has taken the initiative to develop the Oral Health Observatory, a mobile application to conduct oral health surveys worldwide. The aim is to collect reliable standardized international data on oral health and oral health care via a network of dentists. A proof of concept study project was set up in the Netherlands to test the methodology and to validate the approach. Data about caries, gingivitis, oral self-care and oral health related quality of life were analysed and compared to datasets validated in other studies. The Android app embeds three questionnaires addressing oral health history, status and patient behaviour. One questionnaire was completed by the patient and two by the dentist. The proof of concept study involved two phases: in the first phase, five dentists, regular participants in KNMT-surveys, evaluated the usability of the app; after the first phase, the app was adjusted for a second phase. For this phase an extra 15 dentists were recruited from a group of 20 other dentists: five of them declined to participate. Attention was paid to ensuring there was a proportional representation of gender, age and region. In the second phase the five first and 15 new participants collected data on up to a maximum of 38 patients. Data from this 653 patients correspond with results from previously published surveys on the prevalence of caries and gingivitis in the Netherlands. Hence demonstrating an association between caries and gingivitis with oral self-care, problems eating and experiencing oral pain. This proof of concept study shows that the app makes it possible to collect reliable information on oral health in a short period of time. Both dentists and patients evaluated the methodology as user-friendly. Altogether, the results of this proof of concept study are promising.

Dentists' opinions on using digital technologies in dental practice.

OBJECTIVES: To investigate which opinions among dentists are associated with level of technology use, when characteristics of the dentist and dental practice, as well as motivating work aspects are taken into account. METHODS: A total of 1000 general dental practitioners in the Netherlands received a questionnaire on digital technologies they use, opinions on using technologies and related motivating work aspects. Questions were derived from expert interviews, the Dentists' Experienced Job Resources Scale and literature on technology implementation. Technology use was measured as the number of technologies used, and divided into three technology user groups: low (using 0-4 technologies, mostly administrative and radiographic technologies), intermediate (using 5-7, more varied technologies) and high technology users (using 8-12, including more innovative diagnostic technologies). Opinions on technology use and motivating work aspects were analysed using principal components analysis (PCA) and exploratory factor analysis. Scores on all components and factors were calculated for each respondent by computing the mean of all valid responses on the underlying items. Differences in these scale scores on opinions among the technology user groups were assessed using one-way analysis of variance and Kruskal-Wallis tests. A multiple linear regression analysis assessed the association of scale scores about opinions on technology use with the sum of technologies used, taking into account motivating work aspects and characteristics of the dentist and dental practice. RESULTS: The response rate was 31%. Dentists who were high technology users perceived technologies as yielding more improvements in quality of care, adding more value to the dental practice and being easier to use, than low technology users. High technology users thought technologies added more value to their work and they reported higher skills and resources. They also focused more on technologies and thought these are more ready to use than low technology users. High technology users derived more motivation from "Immediate results" and "Craftsmanship" than low technology users. Personal and practice characteristics, motivating work aspects, and the opinion scales "Focus" and "Added value to dentist" explained 50% of the variance in the number of technologies a dentist uses. CONCLUSION: Opinions on digital technologies among dentists and motivating work aspects vary with level of technology use. Being more focused on technologies and perceiving a higher added value from using them are associated with using more digital dental technologies, when taking into account motivating work aspects and characteristics of the dentist and dental practice.

Routine oral examination: differences in characteristics of Dutch general dental practitioners related to type of recall interval.

OBJECTIVES: The aim of this study was to explore differences in behaviour (characteristics and opinions) among general dental practitioners (GDPs), using either a fixed (Fx) or an individualized recall interval (Iv) between successive routine oral examinations (ROEs). METHODS: In the year 2000, data were collected by means of a written questionnaire sent to a random stratified sample of 610 dentists of whom 521 responded, of which 508 (83%) were used for analysis. RESULTS: Two groups of GDPs were distinguished based on their answer to the question: 'Do you apply for all patients a fixed recall interval between two successive ROEs?' Fifty-one per cent of the GDPs (n=257) applied Fxs for all patients, generally for a period of 6 months. Ivs were applied by 49% (n=251) of GDPs, depending on the determination of specific patient characteristics. Logistic regression analysis showed that GDPs applying Fxs also used fixed periods between successive bitewing radiographs for all patients. Furthermore, dentists applying Ivs required more time to conduct an ROE, partly because of a more extensive periodontal screening. GDPs applying Fxs, adhered more to the opinion that a fixed recall regime (every 6 months, as existed before 1995) should be re-introduced, whereas the GDPs in support of Ivs were more in favour to support the opinion that the ROE is 'an excellent instrument for effective, individualized oral care'. CONCLUSIONS: Dutch GDPs differ in the way they deal with the determination of recall interval frequency. These are also specific differences in performance and opinions regarding ROE. With the changing prevalence of oral diseases and the skewed distribution within populations, further research is advocated on consistent decision making to determine the most appropriate recall policy in preventing oral disease.