Differences in the Ratios of General and Dental Specialists in Europe.

BACKGROUND: The European Economic Area (EEA) is composed of member states with a multitude of different regions. This study aimed to analyse the ratios of general dentists and dental specialists to the total population and the proportion of dental specialists to general dentists in 24 European countries and to explore specific intranational differences within 2 countries: France and Germany. METHODS: Available official documents and webpages from the United Kingdom and 23 of the 30 countries comprising the EEA were analysed. Data were expressed as absolute values, ratios of general dentists and dental specialists in the total of population, and percentages of dental specialists/dentists. The Mann-Whitney U test was used to clarify the main ratios that distinguish France from Germany, and cluster analysis was employed to determine similar areas. RESULTS: Significant differences were found between countries, with Ireland and Austria having the lowest ratio of dentists and Romania and Greece having the highest. The Czech Republic, the Netherlands, France, and Denmark had the lowest ratios of dental specialists to the total population. Lithuania, Sweden, and Germany had the highest number of dental specialists. Orthodontists were the most numerous specialists (5.0% of dentists), followed by oral surgeons (2.7%). In France, differences between departments were pronounced and associated with the presence of dental schools and per capita income. In Germany, only the correlation between per capita income and the density of oral surgeons was significant. CONCLUSIONS: Diverse ratios of general dentists and dental specialists to the total population and the proportion of dental specialists to general dentists were discovered within the examined countries, and their maximum values were 2.5, 5.7, and 4.1 times the minimum values, respectively. Differences were even found within the same country, as was the case in France and, to a lesser extent, in Germany.

Utilization of Stainless Steel Crowns by Pediatric and General Dentists.

Purpose: Dental caries affects 23 percent of U.S. children aged two to five years old. 1 Stainless steel crowns (SSCs) are used for extensive caries and offer greater longevity than other restorations; however, disparity exists between pediatric and general dentists in restoration type provided. The purpose of this study was to evaluate utilization of stainless steel crowns among pediatric and general dentists by reviewing insurance claims. Methods: Data were obtained from a commercial dental insurance claims data warehouse from more than 50 dental insurance plans and multiple carriers in the United States for children 12 years old and younger. Data were examined for treatment of the primary dentition using SSCs or direct restorations. A generalized linear mixed effects model tested differences in the utilization of SSCs by general dentists (GDs) versus pediatric dentists (PD). Results: The data included 107,487 GDs and 5,395 PDs. The records included 2,555,726 claims for direct restorations and 440,423 claims for SSCs. PDs are more likely to place SSCs compared to GDs (odds ratio equals 3.2; P<0.0001). Conclusions: Pediatric dentists are more likely to restore carious primary dentitions with stainless steel crowns than general dentists. Perhaps increased training at the dental undergraduate level and access to more continuing education courses for general dentists would increase the utilization of SSCs.

The Spectrum of Histological Findings in Oral Biopsies

Aim: To undertake a retrospective analysis of the use of a diagnostic pathology service, to determine the source of oral biopsies submitted for histological analysis, and to examine the range and frequencies of histologically diagnosed oral lesions in an Irish population. Methods: A retrospective analysis was carried out on all oral biopsies submitted for histological analysis to an oral and maxillofacial diagnostic pathology service from June to December 2015. Results: In total 724 oral biopsies were submitted. The majority of diagnoses were benign (80.3%) and the remaining diagnoses were made up of malignancies (6.7%) and potentially malignant disorders (PMDs), histologically characterised by epithelial dysplasia (13%). Less than 1% of biopsies were submitted from general dentists in primary care. Conclusion: This study showed that oral biopsies are not submitted from the primary care setting, but rather from hospital-based specialist units or referral-based specialist practitioners. There was a broad range of histological diagnoses, the majority of which were benign.

Modalities of using endodontic nickel-titanium rotary instruments and factors influencing their implementation in dental practice.

BACKGROUND: To establish the extent of using nickel titanium rotary instruments (NiTi-RIs), to identify reasons for using / not using NiTi-RIs, to explore usage modalities and to identify factors and measures that can increase implementation of NiTi-RIs in general dental practice. METHODS: Two pilot questionnaires were conducted on academic staff members at College of Dentistry, Taibah University, general dentists (GDs) and endodontists to finalise the questionnaire. A sample size was calculated considering the expected and minimum accepted response rates (60 and 48%, respectively) and a 99.9% Confidence Level. The online-questionnaire was sent to 600 GDs and all endodontists (175) working in Saudi Arabia. A reminder was emailed after 10 weeks to encourage non-respondents to complete the questionnaire. Responses, were collected and converted into numerical data which were analysed using the Chi-square test (p = 0.05). RESULTS: Significantly most respondents (71.9%) used NiTi-RIs (p < 0.001); with more endodontists (96.9%) than GDs (60%). Most users (62.5%) had been using NiTi-RIs for More than 3 years (p < 0001). The trend of using NiTi-RIs increased as participants' experience and the number of root-canal treatments performed per week increased (p = 0.021). While most respondents (45.3%) used NiTi-RIs because of faster root-canal preparation, the majority of non-users (85.3%) didn't do so because of high cost. The highest proportion (43.3%) reported better undergraduate education as the most important factor that can significantly increase NiTi-RIs usage. The majority (91.8%) prepared glide-path before using NiTi-RIs; especially with stainless steel hand-files (63.3%). CONCLUSIONS: NiTi-RIs are relatively well adopted in Saudi dental practice. However, better education, especially during undergraduate training and lower cost can increase their usage. Overall, clinicians showed good awareness of NiTi-RIs usage aspects which reflected on usage modalities.

Is detecting oral cancer in general dental practices a realistic expectation? A population-based study using population linked data in Scotland.

Aims: To examine, for the first time on a population-basis via data linkage, whether early detection by general dental practices (GDP) is a realistic expectation by i) estimating the number of OC cases/year a dentist in Scotland may encounter over time, accounting for the deprivation level of practice location and dental registration/attendance rates, and ii) assessing whether patients attended GDPs two years pre-diagnosis. Materials and methods: Scottish Cancer Registry data on all OC cases (2010-2012), published NHS Scotland dental workforce and registration/participation statistics, and individual patient data linked with NHS dental service activity were analysed. Results: Dentists were estimated to potentially encounter one case of OC every 10 years, OCC every 16.7 years, and OPC every 25 years. However, 53.7% of OC patients had made no dental contact two years pre-diagnosis. Conclusion: Strategies for early detection must consider the rarity of OC incidence and poor dental attendance patterns. These results highlight the importance of improving access and uptake of dental services among those at highest risk to increase the opportunities for early detection.

Reduced antibiotic prescription rates following physician-targeted interventions in a dental practice.

BACKGROUND: The prescription rate for antibiotics in dental clinics is not declining despite the increase in the antibiotic resistance problem. In this study, we observed the change in antibiotic prescription rates by dentists in a Korean dental hospital for various treatments after conducting interventions targeting dentists. METHODS: The first intervention was to distribute guidelines. The second intervention was to remove the bundled prescription button containing antibiotics from the Electronic Medical Record system. A total of 22,098 treatment records were divided into 12 main treatment categories, and Chi-square tests and logistic regression analyses were performed. RESULTS: After the interventions were applied, the overall prescription rate for antibiotics dropped. The antibiotic prescription rate decreased by an odds ratio of 0.774 (95% CI: 0.686-0.873) after intervention 1 and by an odds ratio of 0.574 (95% CI: 0.501-0.658) after intervention 2. The treatments with significantly reduced antibiotic prescription rates were extraction for orthodontic treatment, dental implant surgery, extraction of an impacted tooth and general extraction. These treatments are typically performed in patients without an active infection. The prescription rate did not change for periodontal treatments or endodontic treatments, which are usually performed in patients with an infection. The prescription rate also remained constant for minor operations and other basic treatments. CONCLUSION: The interventions induced behavioural changes in the dentists and were effective in lowering the antibiotic prescription rates in a dental hospital. In particular, there was a significant reduction in the prescription rates for implant surgery and tooth extraction in the absence of infection.

Dental responsibility loadings and the relative value of dental services.

OBJECTIVE: To estimate responsibility loadings for a comprehensive list of dental services, providing a standardized unit of clinical work effort. METHODS: Dentists (n = 2500) randomly sampled from the Australian Dental Association membership (2011) were randomly assigned to one of 25 panels. Panels were surveyed by questionnaires eliciting responsibility loadings for eight common dental services (core items) and approximately 12 other items unique to that questionnaire. In total, loadings were elicited for 299 items listed in the Australian Dental Schedule 9th Edition. Data were weighted to reflect the age and sex distribution of the workforce. To assess reliability, regression models assessed differences in core item loadings by panel assignment. Estimated loadings were described by reporting the median and mean. RESULTS: Response rate was 37%. Panel composition did not vary by practitioner characteristics. Core item loadings did not vary by panel assignment. Oral surgery and endodontic service areas had the highest proportion (91%) of services with median loadings ≥1.5, followed by prosthodontics (78%), periodontics (76%), orthodontics (63%), restorative (62%) and diagnostic services (31%). Preventive services had median loadings ≤1.25. CONCLUSION: Dental responsibility loadings estimated by this study can be applied in the development of relative value scales.

Periodontal treatment in private dental practice: a case-based survey.

BACKGROUND: This study aimed to assess the management and referral patterns of Victorian general dental practitioners based on periodontal diagnosis. METHODS: Following ethics approval, Victorian general dental practitioners were invited to complete five randomized text-based periodontitis scenario questionnaires. Based on their diagnosis, respondents were asked for their management options and asked to specify who would perform these treatments. Respondents were also asked about referral procedures. RESULTS: One hundred and thirty-five dentists attempted the survey. Most were in group practice and based in Melbourne. Of the total respondents, 22.5% worked in a practice employing a hygienist. The management of periodontal disease was appropriate, and treatment options increased with severity. As severity increased, patients were more likely to be referred to a periodontist. Periodontal services referred by general dentists to dental hygienists increased with the number of days the hygienists worked within a practice. Over- and underdiagnosis did not markedly affect management. The recommendation of antibiotics, mouthwashes and periodontal surgery varied depending on year and school of graduation. CONCLUSIONS: The general dentists that completed the survey are managing periodontal conditions appropriately and according to current guidelines.

Dental Treatment in a State-Funded Primary Dental Care Facility: Contextual and Individual Predictors of Treatment Need?

OBJECTIVE: This study examined individual and contextual factors which predict the dental care received by patients in a state-funded primary dental care training facility in England. METHODS: Routine clinical and demographic data were extracted from a live dental patient management system in a state-funded facility using novel methods. The data, spanning a four-year period [2008-2012] were cleaned, validated, linked by means of postcode to deprivation status, and analysed to identify factors which predict dental treatment need. The predictive relationship between patients' individual characteristics (demography, smoking, payment status) and contextual experience (deprivation based on area of residence), with common dental treatments received was examined using unadjusted analysis and adjusted logistic regression. Additionally, multilevel modelling was used to establish the isolated influence of area of residence on treatments. RESULTS: Data on 6,351 dental patients extracted comprised of 147,417 treatment procedures delivered across 10,371 courses of care. Individual level factors associated with the treatments were age, sex, payment exemption and smoking status and deprivation associated with area of residence was a contextual predictor of treatment. More than 50% of children (<18 years) and older adults (≥65 years) received preventive care in the form of 'instruction and advice', compared with 46% of working age adults (18-64 years); p = 0.001. The odds of receiving treatment increased with each increasing year of age amongst adults (p = 0.001): 'partial dentures' (7%); 'scale and polish' (3.7%); 'tooth extraction' (3%; p = 0.001), and 'instruction and advice' (3%; p = 0.001). Smokers had a higher likelihood of receiving all treatments; and were notably over four times more likely to receive 'instruction and advice' than non-smokers (OR 4.124; 95% CI: 3.088-5.508; p = 0.01). A further new finding from the multilevel models was a significant difference in treatment related to area of residence; adults from the most deprived quintile were more likely to receive 'tooth extraction' when compared with least deprived, and less likely to receive preventive 'instruction and advice' (p = 0.01). CONCLUSION: This is the first study to model patient management data from a state-funded dental service and show that individual and contextual factors predict common treatments received. Implications of this research include the importance of making provision for our aging population and ensuring that preventative care is available to all. Further research is required to explain the interaction of organisational and system policies, practitioner and patient perspectives on care and, thus, inform effective commissioning and provision of dental services.

Perception of dental practitioners regarding the use of antioxidants in oral health.

BACKGROUND: Free radicals play a key role in the development of several pathological conditions. Therefore, antioxidants (AOs) are the first line of defense against free radical damage and are critical for maintaining optimum health and well-being. OBJECTIVES: To assess the perception of dental practitioners regarding use of antioxidants in oral health. METHOD: A cross-sectional questionnaire study was conducted among 296 dental practitioners in Tricity (Chandigarh, Mohali, Panchkula, India). A self-structured close-ended questionnaire was used to assess the perception of dentists regarding the use of antioxidants in their patients. It consisted of 12 questions with dichotomous response and five point likert scale ranging from strongly agree to strongly disagree. Descriptive statistics were used to summarize the data, followed by the Chi-square test to check significant differences between the responses. Correlation between responses were analysed through the Spearman's rank correlation. Statistical analysis was done using Statistical Package for Social Sciences version 20 (Illinois, Chicago, USA). RESULTS: A statistically significant difference was observed between genders, with females 181 (61%) having more knowledge than males 115 (39%) regarding the use of antioxidants in their clinical practice. It has been found that dental professionals in academics prescribes more antioxidants to their patients than the private practitioners. Postgraduates 76 (77.6%) had a higher level of knowledge than graduates 86 (43%). CONCLUSIONS: Knowledge about antioxidants should be highlighted in the health sciences curriculum. It is recommended to expand the use of antioxidants in oral health to bring down the burden of chronic diseases like periodontitis and catastrophic diseases like precancerous lesions and oral cancer. KEY WORDS: antioxidants, free radicals, mouth neoplasms, oral health.

Provision of Specific Dental Procedures By General Dentists in the National Dental Practice-Based Research Network: Questionnaire Findings.

BACKGROUND: Objectives were to: (1) determine whether and how often general dentists (GDs) provide specific dental procedures; and (2) test the hypothesis that provision is associated with key dentist, practice, and patient characteristics. METHODS: GDs (n = 2,367) in the United States National Dental Practice-Based Research Network completed an Enrollment Questionnaire that included: (1) dentist; (2) practice; and (3) patient characteristics, and how commonly they provide each of 10 dental procedures. We determined how commonly procedures were provided and tested the hypothesis that provision was substantively related to the 3 sets of characteristics. RESULTS: Two procedure categories were classified as "uncommon" (orthodontics, periodontal surgery), 3 were "common" (molar endodontics; implants; non-surgical periodontics), and 5 were "very common" (restorative; esthetic procedures; extractions; removable prosthetics; non-molar endodontics). Dentist, practice, and patient characteristics were substantively related to procedure provision; several characteristics seemed to have pervasive effects, such as dentist gender, training after dental school, full-time/part- time status, private practice vs. institutional practice, presence of a specialist in the same practice, and insurance status of patients. CONCLUSIONS: As a group, GDs provide a comprehensive range of procedures. However, provision by individual dentists is substantively related to certain dentist, practice, and patient characteristics. A large number and broad range of factors seem to influence which procedures GDs provide. This may have implications for how GDs respond to the ever-changing landscape of dental care utilization, patient population demography, scope of practice, delivery models and GDs' evolving role in primary care.

Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis.

Peri-implantitis is an inflammatory disease affecting soft and hard tissues surrounding dental implants. As the global number of individuals that undergo restorative therapy through dental implants increases, peri-implantitis is considered as a major and growing problem in dentistry. A randomly selected sample of 588 patients who all had received implant-supported therapy 9 y earlier was clinically and radiographically examined. Prevalence of peri-implantitis was assessed and risk indicators were identified by multilevel regression analysis. Forty-five percent of all patients presented with peri-implantitis (bleeding on probing/suppuration and bone loss >0.5 mm). Moderate/severe peri-implantitis (bleeding on probing/suppuration and bone loss >2 mm) was diagnosed in 14.5%. Patients with periodontitis and with ≥4 implants, as well as implants of certain brands and prosthetic therapy delivered by general practitioners, exhibited higher odds ratios for moderate/severe peri-implantitis. Similarly, higher odds ratios were identified for implants installed in the mandible and with crown restoration margins positioned ≤1.5 mm from the crestal bone at baseline. It is suggested that peri-implantitis is a common condition and that several patient- and implant-related factors influence the risk for moderate/severe peri-implantitis (ClinicalTrials.gov NCT01825772).

Ergonomics and musculoskeletal disorder: as an occupational hazard in dentistry.

OBJECTIVE: Musculoskeletal disorders (MSDs) are commonly experienced in dentistry. The objective of this study is to determine the prevalence of ergonomics and MSDs among dental professionals. MATERIALS AND METHODS: A cross-sectional survey was conducted among 170 dentists of different specialties. The questionnaire gathered information regarding demographic details, MSDs, work duration, working status, awareness of ergonomics, etc. Data was analyzed using SPSS version 15.0. Student's t-test and analysis of variance (ANOVA) test was used for comparison in mean scores. Stepwise multiple linear regression analysis was used to assess the independent variables that significantly influenced the variance in the dependent variable (pain). RESULTS: It was found that 73.9% of the participants reported musculoskeletal pain and most common painful sites were neck and back. More than half of the participants, i.e. 232 (59.3%) were aware of correct ergonomic posture regarding dental. Almost percentage of pain increased significantly with increase in age and working time. Among all specialties, prosthodontics were found to have more prevalence of MSDs. CLINICAL SIGNIFICANCE: The appearance of musculoskeletal symptoms among dental professionals was quite common. It suggested that ergonomics should be covered in the educational system to reduce risks to dental practitioners.

UK dentists' experience of iatrogenic trigeminal nerve injuries in relation to routine dental procedures: why, when and how often?

OBJECTIVES: To estimate the frequency of trigeminal nerve injuries associated with local anaesthetic administration, as experienced by UK dentists. METHOD: A convenience sample of clinicians attending 12 study days over the UK was invited to complete an anonymised questionnaire exploring the nature of professional practice, dentists' practice demographics, experience of nerve injuries and related factors. Dental procedures related to reported trigeminal nerve injuries (TNIs) were divided into low risk, likely local anaesthetic (LA) related nerve injury, and high risk procedures, more likely to be direct nerve damage by the procedure (procedural related nerve injury). Data were analysed using Microsoft Excel and SPSS V17. RESULTS: Overall 79% of attendees completed a questionnaire (n = 415); clinicians held an average of 19 years' clinical experience. The numbers of clinicians surveyed included general dental practitioners (n = 290; 64%) and oral surgery (OS) specialists (n = 125; 36%). The estimated incidence of TNIs for the UK GDP workforce was 3,770 TNIs per year or 0.13 TNI per dentist per year. For specialists the incidence was increased to 0.39 TNI per specialist per year. Of all injuries only half were reported, mainly to indemnity organisations. LA-related injuries were most common for GDPs and third molar surgery for OS specialists. It is estimated that TNIs will occur in 1 in 3,289 high risk procedures such as third molar surgery and 1 in 14,330 for low risk procedures, such as restorative dentistry, most likely LA-related. From 25% to 29% of these dental procedures related TNIs were permanent. CONCLUSIONS: Nerve-related injuries in dentistry are not uncommon. Dental practitioners should be aware of the significant disability associated with iatrogenic nerve injuries and risk factors relating to LA-related trigeminal nerve injury. Clinicians should familiarise themselves with infiltration LA-techniques that may reduce these nerve injuries and with the Care Quality Commission regulations for reporting injuries to patients as a result of treatment.

A survey of adoption of endodontic nickel-titanium rotary instrumentation part 1: general dental practitioners in Wales.

OBJECTIVE: To assess adoption of endodontic nickel-titanium (NiTi) rotary technology by general dental practitioners and identify factors influencing its uptake. DESIGN: Postal questionnaire. SETTING: General dental practitioners working in Wales. METHODS: General dental practitioners (n = 584) were approached regarding their usage or otherwise of nickel-titanium rotary instrumentation during root canal shaping. The postal questionnaire took the form of an anonymous survey comprising 13 questions. These questions covered usage parameters, satisfaction, training issues and reasons for avoidance of NiTi instruments. RESULTS: The response rate was 71%. Nickel-titanium rotary instruments were used routinely by 67% of those responding practitioners. Principle factors cited as being implicated in the decision to not adopt NiTi use included cost (65% of responses), lack of training and the perceived risk of instrument fracture. CONCLUSIONS: Over two thirds of dental practitioners in Wales use rotary NiTi endodontic technology with the majority having converted to such systems more than three years ago. There was, however, a significant disparity in NiTi usage between solely NHS practitioners (42%) and private practitioners (90%). Continued provision of high quality hands-on practical workshops may be of benefit in facilitating a positive initial NiTi experience in order to assist the transfer to these newer technologies.

[Distribution of patients' complaints presented to the law court of the Israel Dental Association according to themes, dental area profession and the results].

The purpose of this study was to review the distribution of patients' complains presented to the law court of the Israel Dental Association in Tel Aviv district, according to their topics, dental areas and results. 260 complaint cases filed between 2000 and July 2008 were reviewed. only 186 cases, to which an arbitration proceeding conducted full appeal only, were taken into account . Dentists, who encountered many complaints, were classified according to their country of graduation, as specialists or general dentists. The complaints were classified according to their specific dental field, year of complaint, to the number of arbitrations each year, to the number of appeals each year, to the entity who submitted the appeal, to the difference between the verdict in the District compared to the national ruling, to the distribution of complaints by gender and to the frequency of complaints by anonymous doctors. The distribution of complaints in accordance with topics was as follows: 30% in oral rehabilitation 13.5% in Dental prosthesis, 12.4% in implants, in endodontics 5.3%, 3.7% in maxillofacial surgery, 3.2% on ethics, 2.7% in orthodontics, 1.1% in periodontology 0.5 % in pedodontics and 28% in combined dental domains. 92.5% of complaints filed against dentists who were not experts. 7.5% of the complaints were filed against s specialists. Specialists in the field of oral rehabilitation encountered the largest number of complaints, i.c. 30%. Approximately 35.2% of complaints filed against dentists who have completed their studies in Eastern European countries and 24.9% against the Israeli graduates. 63% of referrals to the Court from Tel Aviv district for which a full arbitration procedure / appeals were presented by women whereas only 37% were presented by men. An analysis of the findings in the difference between the verdicts in the District compared to the national ruling it showed a tendency to aggravation of punishment. (P = 0.003) The Greatest number of appeals was filed in 2001, mostly by patients. In 2004, the greatest number of appeals were filed mostly by dentists. Most appeals have been filed over the years by patients. Against a small number of doctors several complaints were filed. The majority of complaints that were filed in a specific period against one doctor was 6.

Routines for interocclusal appliance therapy among general dental practitioners in a Swedish county.

The aims of this study were to investigate what kind of interocclusal appliances that were chosen among Swedish dentists when treating temporomandibular disorders (TMD), the clinical rationale for the treatment, the diagnoses that warranted the appliance treatment, the use of adjunct TMD treatments and prognostic considerations, and possible differences in these respects between children/adolescents and adults with TMD, and, finally, possible differences between private practitioners and general practitioners in the public dental service. During the 12-months-period April 2009-March 2010 all general dental practitioners in the county of Jönköping, Sweden, were asked to fill in a questionnaire when performing a TMD treatment with an interocclusal appliance. A total of 394 questionnaires were filled in and returned, 216 (55%) from dentists in public dental service and 178 (45%) from private practitioners. It was found that in 40% of the cases, no pre-treatment recording of the functional status in the masticatory system had been made. The commonest reasons for the treatment were bruxism, headache, and replacement of a previous appliance. Less than half of the appliances made were hard acrylic appliances. Some kind of adjunct therapy had been made in 22% of the cases treated in public dental service. The corresponding figure for those treated by private practitioners was 25%. Therapeutic jaw exercises was the commonest adjunct therapy followed by selective occlusal adjustment. In the vast majority of cases, the dentists judged the prognosis of the treatment to be good. It is concluded that a large number of appliances made to treat TMD were soft appliances, especially in public dental service. This reflects a possible overuse of soft appliances at the expense of hard acrylic appliances. Furthermore, in a large number of cases, the treatment was performed without any pre-treatment registrations, and adjunct therapies were rarely used. In all these respects,there is an improvement potential for the treatment of TMD in general dental practice.

General dental practitioners and hearing impairment.

OBJECTIVE: Hearing impairment (HI) remains a problem among dentists Hearing loss at speech frequencies was recently reported among dentists and dental hygienists. This study aimed to investigate prevalence and factors associated with perceived HI among dentists. METHODS: In 2009-2010, 100 general dental practitioners (GDPs) and 115 general (medical) practitioners (GPs) (mean ages, 43.7 and 44.4 years) from Rome (Italy), who commenced practice ≥ 10 years ago, were interviewed on a series of occupation- and recreation-related HI risk factors and on HI-associated symptoms (tinnitus, sensation of fullness, hypoacusis). Prevalence of presumptive HI (≥ 1 symptom perceived during workdays and weekends) was assessed and factors associated with presumptive HI were investigated. RESULTS: Prevalence was 30.0% (95% confidence interval, 21.0-39.0%) and 14.8% (95% confidence interval, 8.3-21.3%) among GDPs and GPs, respectively. Occupation (GDP vs. GP), family history of hypoacusis, hypertension, ear diseases and smoking were significantly associated with presumptive HI. Within GDPs alone, significant associations were found for frequent use of ultrasonic scalers, use of dental turbines aged≥1 year and prosthodontics as prevalent specialty. CONCLUSIONS: GDPs experienced HI risk than GPs. Such a risk was not generalized to all dentists, but was specific for those who frequently used noisy equipment (aged turbines, ultrasonic scalers) during their daily practice. CLINICAL SIGNIFICANCE: GDPs with 10 or more years of practice who routinely use potentially noisy equipment, could be at risk of HI. In order to prevent such condition, daily maintenance and periodical replacement of dental instruments is recommended.

The medical and dental attendance pattern of patients attending general dental practices in Warwickshire and their general health risk assessment.

BACKGROUND: The dental team could have an important role to play in general health risk assessment within primary and community healthcare.Aims To describe medical and dental attendance patterns, demographics and health profiles of patients routinely attending general dental practices in Warwickshire. To identify whether a subgroup attend dental practices regularly but attend medical practices infrequently and discuss whether preventive healthcare interventions delivered in general dental practice would be appropriate. METHODS: A self-completion questionnaire was administered to patients attending 16 dental practices in Warwickshire. RESULTS: Eight hundred and eleven completed questionnaires were returned (74% response). Seven hundred and eighty-nine (98%) respondents visited their dentist every one to two years or more frequently and of these a subgroup of 121 (15.3%) visited their general medical practice surgery or health centre less often than every two years. In the subgroup 9.5% reported high blood pressure, 17.6% currently smoked, 22% drank above recommended guidelines, 32.1% were overweight and 7.3% obese. DISCUSSION: The data suggest there may be a role for dental practitioners in identifying patients at risk of having undiagnosed or future general health problems and providing appropriate general health advice, screening or signposting the patient to relevant general healthcare facilities either within or external to the dental practice.

Perceptions of soft tissue laser use in orthodontics.

OBJECTIVES: To compare attitudes of orthodontists, periodontists, and general dentists regarding the use of soft tissue lasers by orthodontists during the course of orthodontic treatment. MATERIALS AND METHODS: An analogous survey was developed to evaluate and compare the current opinions of a representative sample (n  =  538) of orthodontists (61.3%), periodontists (24.3%), and general dentists (14.3%) regarding orthodontists' use of soft tissue lasers. RESULTS: The majority (84%) of orthodontists, periodontists, and general dentists regarded the use of a soft tissue laser by orthodontists as appropriate. When compared to orthodontists and general dentists, a lower percentage of periodontists indicated that soft tissue laser use by orthodontists was appropriate (P < .01). For each of the eight specific soft tissue laser procedures investigated, periodontists reported a significantly lower level of appropriateness than did orthodontists and general dentists (P < .01). Around 75% of the total sample believed that referral would not be affected by the use of soft tissue lasers by orthodontists. CONCLUSIONS: Orthodontists, periodontists, and general dentists differed in their opinions of the perceived appropriateness of soft tissue laser use by orthodontists, with periodontists reporting a lower level of appropriateness. Clinicians need to communicate effectively to ensure that orthodontic patients in need of adjunctive soft tissue surgery are treated to the accepted standard of care.