Knowledge and management of molar-incisor hypomineralisation amongst dentists in The Netherlands.

BACKGROUND: Molar-incisor hypomineralisation (MIH) is a frequently encountered dental condition in the clinical setting, and correct diagnosis can influence management outcomes. AIM: To assess the knowledge of and attitudes towards the management of MIH amongst dentists in the Netherlands. DESIGN: The study was conducted as a cross-sectional web survey. The questionnaire used included questions regarding respondent characteristics, awareness, knowledge and management of MIH and was distributed through the Royal Dutch Association for Dentistry (KNMT) to a random sample of 900 dentists. Variables were analysed using descriptive statistics, and differences between distinct groups of dentists were tested using the chi-squared test. RESULTS: Respondents consisted of 76.6% general dental practitioners, 9.1% paediatric dentists and 14.3% differentiated (specialist) dentists, with a 25.6% overall response rate. The majority knew the term MIH and its clinical characteristics, and could distinguish MIH from other enamel defects. Regarding aetiological factors, 76.6% reported a genetic component. In an asymptomatic case, 47.3% reported non-invasive treatments. In a mild symptomatic case, treatments from non-invasive to invasive were reported (p < .05). In a severe symptomatic case, the majority reported invasive treatments. Two-thirds of respondents were interested in further clinical training about MIH. CONCLUSIONS: Most respondents knew the term MIH and its clinical characteristics and would like further clinical training about MIH.

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.

Longitudinal patterns of provided oral healthcare services to Dutch young patients: An observational study.

General dental practitioners (GDPs) differ in the preventive and curative care they provide to their young patients. This may be related to variation in the caries risk of patients, but also to differing opinions among GDPs about 'proper care'. Longitudinal data offers the possibility to make care patterns of GDPs comparable and to reveal possible treatment variation between GDPs. GDPs who participated in this study delivered data on the oral healthcare services (OHS) they provided to young patients during the period 2013-2017. Subsequently, data from patients who received regular OHS for 4 to 5 years were used in the analyses. Based on this, longitudinal preventive and curative care patterns were distinguished. Patients were divided into 3 preventive care patterns: no prevention, occasional prevention, and regular prevention. Furthermore, 3 curative care patterns were distinguished: no curation, curation in 1 year, and curation in several years. These care patterns were then combined. In addition, patients were classified into caries risk categories based on the caries-related treatments they received over a 2-year period: low (no procedures), elevated (1 procedure), and high (2 or more procedures). The caries risk based on the first 2 years and the last 2 years in the dataset were combined into a longitudinal caries risk profile. The most frequent combined care pattern (35.8%) was no curation and occasional or regular prevention. The most common longitudinal caries risk profile was low at beginning and end (45.2%). Dental practices varied considerably in the distribution of curative and preventive care patterns. Thereby, no relationship was shown between curative care patterns and provided preventive care. There was also a large spread in the provided OHS within the various caries risk profiles. These diversities indicated treatment variation between GDPs, which is unwarranted if less or more care is provided than necessary.

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.

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.

General and paediatric dentists' knowledge, attitude and practises regarding the use of Silver Diammine Fluoride for the management of dental caries: a national survey in the Netherlands.

BACKGROUND: Silver Diammine Fluoride (SDF) is a topical medication used to arrest cavitated carious lesions non-invasively. The primary aim was to investigate, and analyse the relationships between; knowledge, attitudes and practises (including barriers and facilitators) for SDF use in the management of dental caries by general dental practitioners (GDPs) and paediatric dentists (PDs) in the Netherlands. A secondary aim was to explore any differences in these, between these groups. METHODS: A randomly selected sample of 600 Dutch GDPs (out of 9,502 respectively) and all 57 registered Dutch PDs were invited to participate in this cross-sectional survey, consisting of four sections: (1) participant characteristics, (2) knowledge (through responses to summative questions), (3) attitudes (through statement agreement using 5-point Likert scale), and (4) practises, use, barriers and facilitators (through multiple choice questions). RESULTS: The response rates were: GDPs 23% (n = 140) and PDs 47% (n = 27). Knowledge: out of 15 questions to test understanding of SDF, the mean number of correct answers were GDPs 6.7; standard deviation (SD) 2.6 and PDs 7.4, SD 2.2 with no significant difference. The mean overall attitude score showed positive attitudes towards SDF use for both groups. Compared to GDPs, PDs were more likely to use SDF (p < 0.001) and expected to increase their use (p = 0.037). The main barrier for users was parental acceptance (47%) and for non-users it was lack of knowledge (60%). The main facilitator for both users and non-users was gaining knowledge through courses and workshops, followed by written information leaflets about SDF for parents. CONCLUSION: Less than half of the knowledge questions about SDF were answered correctly. Despite low knowledge, attitude towards SDF use was positive. Practitioners believed that its use would be facilitated by professionals having more accessible information and training and by the availability of parent information leaflets. Furthermore, SDF is used more frequently by PDs than GDPs.

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.

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.

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.

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.

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.

The relationship between claimed restorations and future restorations in children and adolescents: An observational follow-up study on risk categories for dental caries.

Various models are available to assess caries risk in individuals. In general past caries experience is considered as the best single predictor for future caries development in populations. Likewise, recent restorations have been used to predict future restorations. We aimed to evaluate a classification model for risk categories for dental caries in children based on claims data from Dutch healthcare insurance company Zilveren Kruis. The baseline caries risk categories were derived from the number of claimed restorations in two baseline years (2010 through 2011). These categories were defined as low (no new restorations), moderate (1 new restoration), and high (2 or more new restorations). First, we analyzed the relationship between baseline caries risk categories and the number of new restorations during 3 years of follow-up (2012 through 2014). Secondly, we used negative binominal two-level analyses to determine the accuracy of our classification model in predicting new restorations during follow-up. Thirdly, we reclassified the participants after 3 years and determined the changes in the categorization. We included insurance claims data for the oral healthcare services in 28,305 children and adolescents from 334 dental practices for the period 2010-2014. At baseline, 68% of the participants were in risk category low, 13% in moderate and 19% in high. The mean number of new restorations during follow-up was 0.81 (SD 1.72) in baseline risk category low, 1.61 (SD 2.35) in moderate, and 2.65 (SD 3.32) in high. The accuracy of the multivariate model for predicting 0/>0 restorations was 50%. After 3 years, 60% of the study participants were in the same risk category, 20% were in a lower, and 21% in a higher risk category. Risk categories based on claimed restorations were related to the number of new restorations in groups. As such, they could support planning and evaluation of oral healthcare services.

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.

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.

Antibiotic prophylaxis prescribing habits in oral implant surgery in the Netherlands: a cross-sectional survey.

BACKGROUND: There seems to be no consensus on the prescription of prophylactic antibiotics in oral implant surgery. The Dutch Association of Oral Implantology (NVOI) guidelines do not include a clear policy on prophylactic antibiotic prescriptions for oral implant surgery among healthy patients. The purpose of the study was to determine whether antibiotic prophylaxis is commonly prescribed in the Netherlands by general dentists, maxillofacial surgeons and oral implantologists in conjunction with oral implant surgery among healthy patients and to assess the type and amount of prophylactic antibiotic prescribed. METHODS: This observational cross-sectional study is based on a web survey. A questionnaire developed in the United States of America was translated and slightly adjusted for use in the Netherlands. It contained predominantly close-ended questions relating to demographics, qualifications, antibiotic type, prescription duration and dosage. An email including an introduction to the study and an individual link to the questionnaire was sent in February 2018 to a sample of 600 general dental practitioners and all 302 specialized dentists (oral implantologists, periodontists and maxillofacial surgeons) recognized by the NVOI. Overall, 902 questionnaires were anonymously sent. Finally, 874 potential participants were reached. Collected data were analyzed through descriptive statistics. RESULTS: In total, 218 (24.9%) participants responded to the questionnaire, including 45 females (20.8%) and 171 males (79.2%). Overall, 151 (69.9%) regularly placed oral implants. Of them, 79 (52.7%) prescribe antibiotics only in specific situations, 66 (43.7%) regularly, and 5 (3.3%) did not prescribe antibiotics at all. Overall, 83 participants who prescribe antibiotics did so both pre- and postoperatively (57.2%), 47 only preoperatively (32.4%) and 12 exclusively postoperatively (8.3%). A single dose of 2000 mg of amoxicillin orally one hour prior to surgery was the most prescribed preoperative regimen. The most frequently prescribed postoperative regimen was 500 mg of amoxicillin three times daily for five days after surgery. On average, participants prescribe a total of 7018 mg of antibiotics before, during or after oral implant surgery. CONCLUSIONS: Antibiotic prophylaxis in conjunction with oral implant surgery is prescribed in the Netherlands on a large scale, and recommendations based on the last published evidence are frequently not followed.

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.

Minimally Invasive Intervention for Primary Caries Lesions: Are Dentists Implementing This Concept?

Contemporary minimally invasive treatment concepts for restorative treatment of primary caries lesions include both delayed intervention and smaller-sized preparations restricted to removal of carious tissue. The aim of this study was to investigate whether these concepts have resulted in a trend towards a more conservative choice made by dentists regarding treatment thresholds and restorative techniques. The results from previously conducted, precoded questionnaires developed by Espelid and Tveit, as well as from a recent Dutch questionnaire, were collected and analysed. A worldwide trend towards more minimally invasive strategies in the operative treatment of caries lesions could not be observed, neither for the initiation of operative treatment nor for the preparation techniques. However, in some countries, changes over time could be assessed, especially in Norway, where a reduction in the proportion of interventions is visible for both occlusal and approximal lesions, indicating that more dentists are postponing interventions until the lesions have progressed to a deeper level. From the Dutch national survey, it could be concluded that operators that intervene at an earlier stage of approximal lesioning (stage ≤4) also intervene at an earlier stage of occlusal caries (stage ≤3) (p = 0.012; OR = 2.52; 95% CI: 1.22-5.22). Generally, it can be concluded that dentists worldwide still tend to operatively intervene at a too early stage of caries, although variations exist between countries. A worldwide shift could be observed in the restorative material applied, since composite resin has almost completely replaced amalgam for restoring primary caries lesions.

Periodontal disease in Down's syndrome patients. A retrospective study.

AIM: The purpose of this study was to assess the periodontal condition of people with Down syndrome (DS). Furthermore, risk factors were identified for the development of periodontitis. METHODS AND RESULTS: Data were collected at the Centre for Special Care Dentistry (CBT) Rijnmond from the records of all 183 registered patients with DS who were 18 years of age on 31 December 2013. Patients were divided into two groups on the basis of their periodontal status: healthy or periodontally compromised. A total of 36.6% of the DS patients had actually incurred damage by periodontitis. The risk factors were: high age at the time of intake, large number of treatment sessions, and impossibility for the "Dutch Periodontal Screening Index" to be measured. In conclusion, the early introduction and continuous attendance of DS patients in a CBT can contributed to better results for a healthy periodontal condition.

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.