Musculoskeletal disorders amongst practising South African oral hygienists.

OBJECTIVES: The study sought to determine the level of musculoskeletal disorders among working oral hygienists in South Africa and potential determinants that are associated with these disorders. METHODS: Oral hygienists registered with the HPCSA were requested to complete an anonymous questionnaire. Apart from demographic information they were asked to report on any musculoskeletal symptoms experienced in the hands, neck, shoulders and lower back as well as details of workload, types of scaling procedures, size of instruments, the mobility of the operator's chair and the adjustability of patient chairs. RESULTS: Of the 362 respondents, 61.3%, 66.5%, 56.6% and 59.6%, experienced hand, neck, shoulder and lower back symptoms respectively. Twenty-eight percent of the respondents performed hand-scaling for more than four hours per day. Twenty-six percent reported immobile operator chairs, while 12.6% reported patient chairs that were difficult to adjust. Employing multivariate analysis, excessive hand scaling was associated with hand and shoulder symptoms, while immobile operator's chairs and poorly adjustable patient chairs were respectively associated with neck and lower back problems. CONCLUSIONS: The prevalence of work-related musculoskeletal disorders in practising oral hygienists in South Africa appears to be similar to that in developed countries. Significant determinants of musculoskeletal disorders may be immobile operator stools, poorly adjustable patient chairs and excessive hand-scaling daily.

Dental Dam and Isovac Usage: Factors Influencing Dental Students' Decisions on Isolation Techniques.

The Isovac system was introduced into the Virginia Commonwealth University dental curriculum with the intention that it would be used as a substitute when the dental dam could not be placed. The aim of this study was to determine the usage and factors that influenced dental students' decisions to use the dental dam or Isovac. All third-and fourth-year dental students (n=210) were asked in 2017 to complete a 26-item survey. The survey asked about students' operative procedures completed using the dental dam and Isovac, their own and their patients' preferences, basic dental dam knowledge, full-time and adjunct faculty recommendations of method, importance of factors influencing their decisions, and anticipated dental dam use after graduation. Comments were also allowed. A total of 164 students responded to the survey, for a 78% response rate. Of the respondents, 58% said they used the Isovac only when they could not use the dental dam. Among the eight general practice groups in which students are educated in delivery of comprehensive dental care, preference was significantly different for placement of Class II restorations. Overall, the students' dental dam knowledge was low, and the knowledge results were not associated with its use. According to the students, recommendations by full-time and adjunct faculty members were significantly different. Factors ranked by importance from greatest to least for determining which isolation method to use were as follows: moisture control, procedure, patient comfort, application time, ease of placement, and attending faculty. Student comments overwhelmingly favored dental dam usage if a dental assistant was available. This study found that dental dam and Isovac use was not standardized among the general practice groups and faculty. Student education, faculty calibration, and increased use of trained dental assistants are required to ensure education is consistent among all general practice groups.

Computer and Internet usage by Canadian dentists.

OBJECTIVES: To determine the frequency of computers in Canadian dental offices and to assess their use; to evaluate Internet access and use in Canadian dental offices; and to compare use of computers and the Internet by Canadian dentists, by the general public and by other dental groups. METHODS: An anonymous, self-administered survey of Canadian dentists was conducted by mail. A potential mailing list of 14,052 active Canadian dentists was compiled from the 2003 records of provincial regulatory bodies. For each province, 7.8% of the general dentists were randomly selected with the help of computer software. The surveys were mailed to this stratified random sample of 1,096 dentists. RESULTS: The response rate was 28%. Of the 312 respondents, 4 (1%) were in full-time academic positions, 15 (5%) were not practising, and 9 (3%) provided incomplete data. Therefore, 284 survey responses were available for descriptive analysis. Two hundred and fifty-seven (90%) of the respondents had a computer in their primary practice. Computers were used mainly for administrative tasks (accounting, bookkeeping and scheduling) rather than clinical tasks. Internet access was common (185/250 or 74%), and high-speed Internet access (93/250 or 37%) was increasingly common, judging from the results of previous studies on computer use. The main reasons given for not having in-office Internet access were security or privacy concerns and no reported need for or interest in the service. CONCLUSIONS: Computer use was high in this sample of Canadian dentists, but a small proportion of dental offices remained without computers. Canadian dentists" use of the Internet was greater than that of American dentists, private enterprise and the North American public in general.

A metal halide light source for laboratory curing of prosthetic composite materials.

A high-intensity laboratory photo-curing unit has been developed with the aim of improving the post-curing properties of composite veneering materials. This study introduces the structure of the curing unit and examines the resulting properties of a representative composite material. The curing unit is equipped with two metal halide lamps that radiate both ultraviolet and visible light. Unlike conventional metal halide lamps for industrial use, these metal halide lamps radiate an increased intensity of visible radiation. Properties of a microfilled composite veneering material cured with the new metal halide unit were ascertained. A xenon photo-curing unit was also used as a control. The specimens cured with the metal halide unit exhibited greater Knoop hardness numbers and flexural moduli as compared with those cured with the xenon unit, and also showed reduced water solubility values. These results suggest that the metal halide light source is effective in curing composite materials within a shorter period of time and with improved conversion.

The importance of productivity in estimating need for dentists.

BACKGROUND: Although the number of dentists is an important determinant of supply, other factors also contribute. Technological advancements and well-trained and managed auxiliary personnel affect supply by allowing dentists to produce more dental services per unit of time. METHODS: This article examines trends in dental output, productivity, number of dentists and dental care utilization from 1960 through 1998. The authors estimated growth rates for the entire period and selected subperiods using regression analysis. Growth rates for dentist productivity and per capita utilization are important to estimate the number of active dentists needed in the year 2020. RESULTS: Based on ADA practice survey data, the annual growth rate in dentists' productivity was 1.41 percent from 1960 through 1998. However, productivity grew at different rates during this period. It increased 3.95 percent per year from 1960 to 1974. There was a decline in productivity of 0.13 percent annually from 1974 to 1991. From 1991 to 1998, productivity grew 1.05 percent annually. CONCLUSIONS: Accurate estimates of changes in dentist productivity are important in evaluating the adequacy of the number of dentists to meet the demand for dental services. PRACTICE IMPLICATIONS. Since productivity generally increases over time, failure to account for changes in productivity can lead to an overestimation of the number of dentists required for any given level of demand for dental services.

Evaluation of curing units used in private dental offices.

It is well known that numerous factors influence the light output of curing units, but many dentists are unaware that the output of their curing lights are inadequate. This study was conducted to evaluate the light intensity of visible-light curing units in private dental offices and to assess their curing efficiency by measuring compressive strength of a light-cured resin. Also, in order to determine the maximum light intensity of the curing units, lamps, filters, and fiber optic bundles were replaced by new ones and curing efficiency remeasured. Light intensity was measured by employing a Quantum Radiometer LI-189 at a wavelength of 470 +/- 40 nm using a bandpass filter. Compressive strength of a light-cured resin using the light units was measured employing an Instron Testing Machine at a crosshead speed of 1.0 mm/min. From the evaluation of 105 light units, the light intensity ranged from 28 to 1368 W/m2 (0 approximately 500 W/m2; 41.9%, 500 approximately 1000 W/ m2; 45.7%, 1000 approximately 1500 W/m2; 12.4%). Light intensity of the light unit in private offices decreased 15.9 approximately 82.1% compared to brand-new units. Reduction of light intensity impaired compressive strength of the light-cured resin to varying degrees (148.3 approximately 279.9 MPa) compared with the highest value (317 MPa) obtained from brand-new light units. The replacement of the parts increased the light intensity, with maximum increases of 36.0% for lamps, 157.7% for filters, 46.2% for fiber optics, and 322.7% for all three parts. The results of this study indicated that the light intensities of the curing units used in private practice were lower than expected.

Disability part 2: access to dental services for disabled people. A questionnaire survey of dental practices in Merseyside.

This article aims to identify how accessible general dental practitioners thought that their services were and to identify the barriers they face in providing care for disabled people. A postal questionnaire survey was undertaken of all general dental practices in the Liverpool, Sefton, St Helens and Knowsley Health Authorities. Only one quarter of practices described themselves as having full physical access for disabled patients. However, despite this, over 90% of practices reported treating disabled patients and most were willing to treat more disabled patients. Dentists identified physical barriers, lack of time and the lack of domiciliary equipment as the main barriers to providing care for disabled people. Although dentists were willing to treat disabled patients few dental practices were accessible at the time of the survey. Further work is needed to ensure that dental practices comply with the Disability Discrimination Act.

The use of autoclaves in the dental surgery.

Autoclaving is the absolute method of achieving instrument sterilization in any health care setting. However, it does rely on an effective pre-sterilization routine for instrument handling and the subsequent correct loading and operation of the autoclave. This paper addresses the issue of correct autoclave use, the causes of failures and the regular monitoring.

Reliability of biologic indicators in a mail-return sterilization-monitoring service: a review of 3 years.

Most mail-return sterilization-monitoring services use spore strips to test sterilizers in dental clinics, but factors such as delay caused by mailing to the laboratory could cause false negatives. The aims of this study were to determine the influence of poststerilization time and temperature on the biologic indicator recovery system and to evaluate sterilization failure and its possible causes in dental clinics subscribing to a mail-return sterilization-monitoring service. Spore strips used in independent tests revealed the poststerilization time and temperature after a 7-day delay to have no significant influence. Sixty-six dental clinics that received quarterly biologic indicators to evaluate the effectiveness of their sterilizers had sterilization failure rates of 28.7% in 1992, 18.1% in 1993, and 9.1% in 1994, a statistically significant decrease in sterilization failure during the 3-year period. The usual causes of failure were operator error in wrapping of instruments, loading, operating temperature, or exposure time.

Effectiveness of light-curing units in vocational training practices. A project administered by the Research Committee of the Faculty of General Dental Practitioners (UK).

A project has been organised by the Research Committee of the Faculty of General Dental Practitioners (UK) in conjunction with vocational training advisers in which vocational dental practitioners (VDPs) tested the effectiveness of the light-curing units in their surgeries using Heliotests (Ivoclar-Vivadent) and Z100 Composite (3M). The VDPs also completed a questionnaire giving details of their light-curing units. The mean incremental depth stated as being used by the respondents was 2.6 mm; 43.5% of the participants' light-curing units (n = 63) were found to produce a depth of cure less than this figure. However, no correlation was found between reported post-operative clinical problems and cure depth lower than 2.6 mm. A negative correlation between depth of cure and age of light-curing unit was noted, with older units tending to cure the composite samples to less depth than newer units (p = 0.002). One-fifth of the participating VDPs' practices had some means of checking curing-light effectiveness. Greater awareness of the need to monitor practice light-curing units is therefore required.

[Biological safety in dentistry: development of a useful method for quality control of sterilization]. / Bioseguridad en odontología: desarrollo de una metodología útil para el control de calidad de esterilización.

534 autoclaves from Rosario dentist offices were controlled by a method developed in our laboratory, that consists in: a) a procedures instruction; b) a survey ; c) a colorimetric control; d) a biological control. By this method it is possible to detect the mistake in the autoclave function by only one step. The results showed that 86.90% of the autoclaves lacked thermometers, 76.60% lacked manual thermostats, 83.33% were automatic and 58.80% did not sterilize. It can be concluded the necessity of a periodic control by this method, the importance of a commercial quality control of the furnaces and the urgency of continuous education over biosafety concepts.

[The type testing of light-polymerization equipment, II: the 1998 status]. / Typenprüfung von Lichtpolymerisationsgeräten II: Stand 1998.

In this study 16 different light curing units, available on the Swiss market, were tested for their features, radiant power and light distribution across the face of the curing tip and components like integrated radiometer, timer and cooling device. The basis of this study was the test protocol published in the november edition (11/1999). The features of the light curing units differed from one another. The Optilux 500 had all conceivable features that it could be designated the standard in features. If all these technical options are necessary has to be decided by the consumer. However, the components such as the timer, radiometer and voltage stabilizer are important because they influence the time of irradiation and the radiant power. The radiant power (mW) i.e., the radiance (mW/cm2) were measured in 2 spectral areas which are important for visible light polymerisation. The absolute values for the standard curing tip at a voltage of 230 V lay between 143.4 and 389.7 mW for the wavelengths between 400-520 nm and between 17.7 and 41.8 mW for the wavelengths between 462-472 nm. The resultant specific radiance values were between 268.3 and 862.6 mW/cm2 in the broad spectrum of 400-520 nm and 33.5 and 95.4 mW/cm2 in the narrow spectrum of 462-472 nm. Where the standard curing tips were replaced by guides with other diameters, tips with larger entrances showed more radiant power, light guides with smaller exits also showed more radiance. Turbo tips have larger entrances than exits and therefore combine both positive effects. The intensity wasn't distributed equally across the face of the curing light guide. Characteristically there was a concentric distribution of the intensity, with the maximum found in the centre and a decrease to the margin. Corresponding to the radiance values, curing light tips with decreasing diameters showed more homogeneous distribution patterns. Only Turbo tips showed worse distribution. Comparing the light intensity at a voltage of 207 V and 244 V to the normal voltage of 230 V it was found that not all curing units had an integrated voltage stabilizer. Just 9 out of the 16 tested units had an integrated radiometer. Comparison of the evaluated radiance values to the values given by the integrated radiometer revealed an agreement in just two cases. The marginal values, programmed by the manufacturer varied between 70 and 300 mw/cm2 and lie therefore, too low.

[Determination of the need of polyclinic departments and offices for dental equipment]. / Opredelenie potrebnosti poliklinicheskikh otdelenii i kabinetov v stomatologicheskom oborudovanii.

The calculating method of stomatologic instrumentation optimum quantity required for an outpatient department (room) is presented. It is based on the stop-watch study performed in the course of therapeutic or diagnostic procedures. The new method allows the assessment of the need of any establishment in instrumentation when appropriate requests are executed, and to make the most efficient use of instruments at the working place.

Economic impact of dental hygienists on solo dental practices.

The fact that a significant percentage of dentists employ dental hygienists raises an important question: Are dental practices that utilize a dental hygienist structurally and operationally different from practices that do not? This article explores differences among dental practices that operate with and without dental hygienists. Using data from the American Dental Association's 2003 Survey of Dental Practice, a random sample survey of U.S. dentists, descriptive statistics were used to compare selected characteristics of solo general practitioners with and without dental hygienists. Multivariate regression analysis was used to estimate the effect of dental hygienists on the gross billings and net incomes of solo general practitioners. Differences in practice characteristics--such as hours spent in the practice and hours spent treating patients, wait time for a recall visit, number of operatories, square feet of office space, net income, and gross billings--were found between solo general practitioners who had dental hygienists and those who did not. Solo general practitioners with dental hygienists had higher gross billings. Higher gross billings would be expected, as would higher expenses. However, net incomes of those with dental hygienists were also higher. In contrast, the mean waiting time for a recall visit was higher among dentists who employed dental hygienists. Depending on personal preferences, availability of qualified personnel, etc., dentists who do not employ dental hygienists but have been contemplating that path may want to further research the benefits and opportunities that may be realized.

Articulators in dental education and practice.

This study showed that only a small percentage of students continued to use or prescribe articulators after beginning their practices. Yet many restorative teaching programs have utilized semiadjustable articulators with the intent to stimulate a continued use of the instrument in practice. Perhaps the emphasis of instruction should not be placed upon a certain type of articulator for all restorative dentistry but instead upon the selection of an articulator dependent upon the degree of difficulty encountered with each patient. For example, a simple articulator may be used for simple treatment such as a single full gold crown in an otherwise healthy mouth with physiologic occlusion. This does not obviate the need for properly related master and opposing full-arch casts of high quality. Also, instruction is required which will assure that the new crown does not introduce occlusal interferences in centric relation, the intercuspal position, or laterotrusive and mediotrusive excursions. Emphasis should be taken away from teaching use of only one instrument. It should instead be directed toward an understanding of the basic principles of occlusion, cultivating an ability to differentiate the complexity of treatment, and then selecting an instrument which will provide the most practical and suitable result. An effort should be made to compensate for the instrument's limitations by careful clinical examination and correction.

A new method for measuring nocturnal tooth contacts.

A new portable system for measuring nocturnal tooth contacts has been devised. This system was suitable for patients to take home and record tooth contacts by themselves. A micro photo sensor using optical fibres was applied to detect tooth contacts. The sensor and the target were accurately fixed to opposed molars, respectively on the same side, with removable metal attachments. Patients were instructed to set the attachment to their tooth each experimental night. In the present study, data was assembled for four or five nights in three subjects who were free of masticatory pain and dysfunction. Each subject showed an individual tooth contact pattern. It is suggested that this new system is useful and convenient for measuring nocturnal tooth contacts.