Business orientation and the willingness to distribute dental tasks of Dutch dentists.

AIM: Dentists have a dual professional role: they have to focus on good oral health in their patients and, at the same time, they have to organise their practices. The aim of this analysis was to assess the extent to which dentists can be seen as business-oriented and/or willing to delegate to dental team members and others, and to investigate which personal and practice characteristics of dentists can be regarded as determinants for these two aspects of their professional role. METHOD: The data were collected in 2000 by means of a written questionnaire sent to a random stratified sample of 790 dentists. RESULTS: 607 (77 per cent) dentists responded. Multivariate regression analysis showed that business oriented dentists distinguish themselves by having larger practices and a higher level of professional satisfaction. Furthermore, although to a lesser extent, on a regular basis, they treat patients from colleagues in the practice. There are proportionately fewer women dentists in this category. Dentists oriented on task distribution can also be typified by working in larger practices, but in addition they have a greater preventive treatment philosophy and have more hours of support provided by oral hygienists. CONCLUSION: Among Dutch dentists there exist clear differences in the way they take on their role as dentists with regard to business orientation and their willingness to distribute dental tasks.

[Shortage of dentists as a regional problem]. / Tandartsentekort als regionaal probleem.

This article is about the dental human resource situation at a regional level in the Netherlands. Based on data made available by the Dutch Dental Association (NMT) and the Central Bureau for Statistics (CBS), the supply of dentists and the potential demand for dental health care within 34 NMT-regions is described. Supply and demand are related to each other. In order to gain more insight into the relationship between the supply of and the demand for dental care some dentist/population ratios have been calculated for each region and for various segments of the population separately. It appears that these ratios per region vary considerably, which makes the dental human resource issue in the Netherlands, from a regional point of view, rather diverse.

Trends in periodontal status and oral hygiene habits in Dutch adults between 1983 and 1995.

UNLABELLED: In 1995, a dental survey, similar to one carried out in 1983, was performed among persons aged 25-54 in the city of 's-Hertogenbosch, the Netherlands. OBJECTIVE: To describe trends in adults periodontal health between 1983 and 1995. METHODS: The participants were interviewed at home and clinically examined in a dental van. RESULTS: Average scores for plaque, calculus, bleeding after probing and number of buccal root surfaces exposed to the oral cavity were lower in 1995 than in 1983. There was no significant change in the percentage of teeth with pocket depth of 3.5 mm or more between 1983 and 1995. No difference was found between frequency of toothbrushing in 1983 and 1995. CONCLUSION: The results suggest that the periodontal health of Dutch adults aged 25-54 years has improved since 1983.

[Are dentists willing to advise their patients to quit smoking?]. / Zijn tandartsen bereid hun patiënten te adviseren te stoppen met roken?

In order to know whether dentists are prepared to advise their patients to stop smoking, a representative study was performed in several EU-countries. From the Dutch results, it may be concluded that dentists in the Netherlands are aware of the harmful effects of tobacco use. They are prepared to pay more attention in their dental practice to these harmful effects for general health and for oral health in particular. The majority is willing to participate in a smoking cessation campaign, provided there is more information about 'why' and 'how'.

Trends in caries prevalence in Dutch adults between 1983 and 1995.

In 1995, a dental survey was performed among adults aged 25-54 in the Dutch city of 's-Hertogenbosch. A similar study was performed in the same city in 1983 and the aim of the present study was to describe trends in oral health from 1983 to 1995. National data show that the percentage of edentulous persons aged 30-39 and 40-49 decreased from 11.3 to 3.3 and from 28.5 to 13.8, respectively, between 1984 and 1993/94. The same trend was found in 's-Hertogenbosch. In persons with natural dentition under the age of 35 the mean number of DMFT decreased significantly between 1983 and 1995. In 1995 the mean number of FT was higher, and the mean numbers of DT and MT were lower than in 1983 in all age categories. It can be concluded that oral health in Dutch adults, as measured by caries prevalence, treatment level of caries and percentage of edentulous persons, improved significantly between 1983 and 1995.

[Professional practice by female dentists in the Netherlands]. / Beroepsuitoefening van vrouwelijke tandartsen in Nederland.

OBJECTIVE: Obtaining information about differences between male and female dentists in practising dentistry and about changes in practice arrangements. DESIGN: Descriptive analysis, using SPSS (CROSSTABS, ANOVA, HOMALS), based on information on the way(s) dentists practice their profession. SETTING: Department of Research of the Dutch Dental Association (NMT), Nieuwegien, The Netherlands. METHODS: A survey by means of a questionnaire, among a representative sample of 229 female dentists and a representative sample of 483 male dentists. RESULTS: Female dentists have on average fewer patients than male dentists, spend fewer working-hours weekly at their chair and practice more often in some form of partnership. Females have a spouse working in the dental practice less often than males and, while the spouse of males most often works as a dental assistant, the spouse of female dentists is most often also a dentist himself. Compared with male dentists, in 1994 female dentists more often had to arrange cover by a locum while in 1995 they had to take more days of leave due to personal illness or exceptional circumstances. CONCLUSION: In the Netherlands there are substantial differences in the practice of the profession by male and female dentists. This is important for the future policy of the NMT with regard to the required manpower in dentistry.

[Dental care frequency of female patients in the Netherlands]. / Tandheelkundige zorgconsumptie van vrouwelijke patiënten in Nederland.

OBJECTIVE: Investigate whether there are differences between men and women in dental attendance and in the consumption of dental care. DESIGN: Descriptive analysis, using SPSS (ANOVA, NPAR TEST), based on information on the treatments that are performed for dentate patients. SETTING: Department of Research (afd. O&I) of the Dutch Dental Association (NMT), Nieuwegein, The Netherlands. METHODS: From the practice-administration of 202 dentists, anonymous information was gathered on the treatments these dentists performed for 7698 dentate patients in the years 1993 to 1996. RESULTS: The results indicate that for young people there is only a difference in relation to fillings: girls receive fewer fillings than boys. For adults, however, more differences are apparent. First of all, women visit the dentist for a routine check-up somewhat more often than men. In addition, more X-rays are taken, more instruction is given on oral hygiene and more crowns are made for women, while they receive fewer fillings. CONCLUSION: Adult women and adult men show differences in dental attendance and consumption. These differences are, albeit partially, explained by the fact that adult women are proportionally more often insured for dental costs via the national health service.

[Adjustment of complete dentures. Have oral stereognosis and denture quality a predictable value?]. / Aanpassing aan een volledige prothese. Hebben orale stereognosie en prothesekwaliteit voorspellende waarde?

The denture complaints of 397 complete denture wearing participants were assessed. The quality of the dentures and denture bearing surfaces were professionally scored as well. Combination of these scores gave a specific denture quality, the so-called 'prosthetic condition'. The oral stereognostic capability was recorded with an Oral Stereognosis Test. There was no correlation between denture complaints and the results of the Oral Stereognosis Test, nor between denture complaints and prosthetic condition.

[Prescription of antibiotics for the prevention of bacterial endocarditis by dentists in the Netherlands]. / Het voorschrijven van antibiotica ter preventie van bacteriële endocarditis door tandartsen in Nederland.

In 1993 a representative sample of dental practitioners in the Netherlands was questioned on the use of antibiotics for the prevention of endocarditis in the previous year. Most of the responding dentists (67%) reported prescription of antibiotics for patients at risk. Some of them prescribed an antibiotic regimen that differed from the guidelines drawn up by the Dutch Heart Foundation. In 1992 only 47% of the responding dentists prescribed antibiotics for the prevention of endocarditis entirely according to these guidelines.

[Prescription of antibiotics for periodontitis patients by dental practitioners in the Netherlands]. / Het voorschrijven van antibiotica bij parodontitis-patiënten door tandartsen in Nederland.

In 1993 a representative sample of dentists in the Netherlands was questioned on the use of antibiotics in the treatment of periodontitis. It was found dat 50% of the general practitioners had a positive attitude, 15% a negative one and 35% had an indifferent attitude towards the use of antibiotics in periodontal treatment. Almost 40% of them indicated the prescription of antibiotics for periodontal reasons in the previous year. Most of the dentists (71%) prescribed a combination of metronidazole and amoxicillin. The average prescription frequency in 1992 was 18 times. The prescription frequency and the choice of a combination of metronidazole and a broad spectrum penicillin in the treatment of periodontitis is discussed, emphasizing the importance of the traditional mechanical therapy, the disturbance of the colonization resistance by means of antibiotics and the worldwide concern about the usage of antibiotics.

The survival rate of bridges. A study of 1674 bridges in 40 Dutch general practices.

The survival rate of 1674 bridges and the influence of several factors on the lifetime of bridges were analysed, based on data from patient records that belonged to a random sample of 40 Dutch general practices. It appears that the 12 year survival rate of the bridges is 87%. There is a significant difference in the survival rate between the bridges that meet and do not meet Ante's law, and only a weak significant difference between the bridges with vital vs. non-vital abutment teeth. Gender and age of the patient, length of the bridge, presence of a post and core build-up, or the construction of the bridge (conventional fixed vs. cantilever pontic) appear to have no influence on the survival rate of the bridges in this sample.

["Prosthetic condition" and satisfaction with dentures]. / 'Prothetische conditie' en tevredenheid met gebitsprothesen.

This study introduces the concept of 'prosthetic condition', combining the professionally assessed complete denture quality and quality of the residual alveolar ridge. In a group of 397 complete maxillary and mandibular denture wearers the prosthetic condition was assessed and the denture satisfaction recorded. The total prosthetic condition (maxillary and mandibular combined) was good in 225 (57%), moderate in 81 (20%), and poor in 91 (23%) subjects; the mandibular prosthetic condition was good in 155 (39%), moderate in 148 (38%), and poor in 94 (23%) subjects; 297 (75%) subjects were satisfied with their dentures. None of the criteria used for the prosthetic condition could explain the denture satisfaction. Furthermore, there was no significant correlation between prosthetic condition and denture satisfaction.

[Female dentists. Style of their professional practice]. / Vrouwelijke tandartsen. Wijze van beroepsbeoefening.

In many Western countries during the past decades there has been a strong increase in the number of women dentists. This review on current literature shows that women dentists differ from their male colleagues in their way of practising the profession. More so than men they prefer to work in a group practice or in some kind of partnership. Women dentists also appear to have relatively smaller practices than their male colleagues and on average they practise fewer hours per week. However, it is important to notice that for women dentists motherhood is an important restricting factor with regard to practising their profession, often resulting in career break and diminishing professional productivity. Because of the strong increase in the percentage of women dentists, it is important for future policies to recognise their specific issues and concerns, as well as the consequences for dentistry of their way of practising. Thus, planning of manpower and infrastructure of dentistry can be done in a more adequate way.

A 6-year follow-up study of oral function in shortened dental arches. Part II: Craniomandibular dysfunction and oral comfort.

In this clinical 6-year follow-up study subjects with shortened dental arches (SDA, n = 55), characterized by the absence of molar support, are compared with subjects with complete dental arches (CDA, n = 52) with respect to items concerning craniomandibular dysfunction and oral comfort. In addition, a small group of subjects with SDA and removable partial dentures in the lower jaw (SDA + RPD, n = 19) is included in this study. Oral comfort is defined using the following criteria: (i) absence of pain and distress, meaning the absence of signs and symptoms of craniomandibular dysfunction: (ii) chewing ability; and (iii) appreciation of the appearance of the dentition in relation to absent posterior teeth. Additionally, complaints about the free-end RPD are described. It is concluded that: (i) a SDA (consisting of 3-5 occlusal units, OU) is not a risk factor for CMD and is able to provide long-term sufficient oral comfort; and (ii) free-end RPD (in the lower jaw) in SDA do not prevent CMD and do not improve oral function in terms of oral comfort.

A 6-year follow-up study of oral function in shortened dental arches. Part I: Occlusal stability.

In this clinical 6-year follow-up study subjects with shortened dental arches (SDA, n = 55), characterized by the absence of molar support, are compared with subjects with complete dental arches (CDA, n = 52) with respect to occlusal stability. In addition, a small group of subjects with SDA and removable partial dentures in the lower jaw (SDA+RPD, n = 19) is included in this study. The aim of this study was to describe effects regarding occlusal stability in subjects with SDA during a 6-year period. The applied parameters for occlusal stability are: number of occlusal contacts in the anterior region, overbite, interdental spacing and alveolar bone support. The results of this study show that: (i) SDA do provide durable occlusal stability; (ii) free-end RPD do not contribute to occlusal stability in SDA; and (iii) SDA with periodontally involved teeth show continuing periodontal breakdown.

[Treatment of (pre)-edentulous patients. After care and directives]. / Traitement des patients (pré-)édentés. Arrière-plans et directives.

It can be expected that the percentage of edentulous people wil decrease in the coming decades as a result of an improved oral health, whereas the number of edentulous people will not decrease as a result of the strong increase of the ageing population. If the preservation of the natural dentition is no longer possible, the remaining teeth of a mutilated dentition have to be extracted according to some specific principles. But also the aftercare of the edentulous patient has to be extended according to some specific guidelines, within the framework of the so-called "preventive-prosthetic-treatment-strategy". Preservation of the alveolar process is the main goal in both cases.

Dental health behavior and attitudes--an application of correspondence analysis.

Differences in dental behavior and dental attitudes between people with (almost) all natural teeth, people with a full denture in both jaws and people with a full denture in only the maxilla are visualized by means of correspondence analysis in one overall picture. In this picture the three distinguished subgroups of dental patients and their characteristics are indicated as points in a two-dimensional space. The distances between the points in this picture show to what extent these points are connected. The findings obtained in this study can lead to the conclusion that: a. differences in dental status are related to differences in dental behavior and dental attitudes; b. people with all natural teeth and people with a full denture in both jaws obviously are opposite of each other in many respects, whereas people with a full denture in only one jaw can be characterized as a dental in-between group.

[The application of overdentures in the general dental practice]. / Algemeen-practici over de overkappingsprothese.

Overdenture therapy is recommended in certain dental conditions. The main reason is that remaining teeth or roots underneath an overdenture decrease the resorption of the alveolar bone. There is little information about how acquainted general practitioners are with this therapy, how often they apply it and what potential obstacles to overdenture therapy they experience. Therefore, a postal investigation was made amongst dentists in the Netherlands. The data suggest that overdenture therapy is a well-known mode of treatment. Overdentures are applied in many dental practices but to a lesser degree than conventional immediate dentures. The negative attitude of the patients seems to be the most important obstacle to overdenture therapy. Therefore, the patient should be better informed about the advantages of this prosthetic appliance.

Shortened dental arches and periodontal support.

The periodontal support of subjects with shortened dental arches (SDA, n = 74), and of subjects with SDA and free-end removable partial dentures in the lower jaw (SDA and RPD, n = 25) was compared with that of subjects with complete dental arches (CDA, n = 72). The periodontal support was determined by tooth mobility and alveolar bone height, measured on a radiograph, of the distal alveolar bone of the premolars. Significant differences in tooth mobility were found between the three groups of subjects. The relative bone height showed a trend towards lower values for the SDA group and the SDA and RPD group. For some teeth these differences were significant. Premolars that are the most posteriorly located occluding teeth in the dental arch tend to have a lower relative alveolar bone height than premolars in an intermediate location. This effect is more marked in the upper jaw than in the lower jaw. Premolars in the lower jaw, that serve as abutment teeth for free-end RPDs, tend to show lower values for the relative bone height. It is concluded that the differences between the three groups with regard to the periodontal support are small. The large amount of crowns and bridges in both the SDA and SDA and RPD groups, and the dental history of these subjects, resulting in SDA, should be taken into account. However, as indicated by the periodontal breakdown of premolars in some subjects with SDA, the combination of an existing severe periodontal involvement and a SDA is considered to be an unfavourable situation.

Differences in oral stereognosis between complete denture wearers.

To better understand patients' relative satisfaction with complete dentures, differences in oral stereognostic perception, based on the identification of small objects placed in the mouth, were investigated. It was found that the oral stereognosis test applied is reliable for measuring patients' oral stereognostic perception. However, the positive correlation of other studies concerning the relationship between oral stereognosis and satisfaction with complete dentures was not confirmed in this study.