Response rates to questionnaire-based studies in the contemporary dental literature: A systematic review.

OBJECTIVES: This systematic review aimed to investigate what is a reasonable response rate for dental questionnaire-based studies in recent literature and to assess the factors that affect the response rates. METHODS: We used MEDLINE/PubMed to search the dental literature of 2021 (January-October). Two reviewers independently assessed studies eligibility and extracted data using standardized electronic extraction form. RESULTS: One hundred and seventy-two studies were eligible, of these a total of 149 response rates were reported from 133 studies, whereas the remaining 39 studies were excluded as they did not report response rates. The median response rate across the included studies was 77% (mean = 70.8%). We found significant negative correlation between the response rate and the actual number of distributed questionnaires (sample size) (r = -0.4127; P < 0.001). We also found an association between the response rate and the area of distribution, e.g., national or international (P = 0.0012). However, a wide variation was observed in the quality of information reported within this review and we did not find clear evidence of association between the response rate and other variables such as questionnaire piloting, number of questions in the questionnaire and the journal impact factor. CONCLUSIONS: The findings of this systematic review confirm the association between the response rate and the sample size, where the response rate increases when the sample size less than 300 participants. In addition, a higher response rate could be achieved when the study conducted within the same institution (e.g., university). SIGNIFICANCE: Questionnaire-based research can provide answers to several questions that could not be answered by other types of research related to the field of dentistry, dental health practitioners and students' attitudes and behaviours and more. Questionnaire-based publications can effectively contribute to dental research; thus, dental journals should consider development of a minimum set of guidelines in the reporting of questionnaire-based manuscripts.

Factors associated with dental fluorosis among Malaysian children exposed to different fluoride concentrations in the public water supply.

OBJECTIVES: To determine the prevalence of dental fluorosis, and factors associated with its occurrence in two cohorts of children exposed to different fluoride concentrations in the Malaysian water supply. METHODS: A cross-sectional study was conducted among lifelong residents (n = 1,155) aged 9 and 12 years old living in fluoridated and nonfluoridated areas. Malaysian children aged 12 years were born when the level of fluoride in the public water supply was 0.7 ppm while those aged 9 years were born after the level was reduced to 0.5 ppm. Fluorosis was blind scored using standardized photographs of maxillary central incisors using Dean's criteria. Fluoride exposures and other factors were assessed by parental questionnaire. Data were analyzed using descriptive statistics, Chi-squared analyses, and logistic regression. RESULTS: Fluorosis prevalence was lower (31.9 percent) among the younger children born after the reduction of fluoride concentration in the water, compared to a prevalence of 38.4 percent in the older cohort. Early tooth brushing practices and fluoridated toothpaste were not statistically associated with fluorosis status. However, the prevalence of fluorosis was significantly associated with parents' education level, parents' income, fluoridated water, type of infant feeding method, age breast feeding ceased, use of formula milk, duration of formula milk intake, and type of water used to reconstitute formula milk via simple logistic regression. Fluoridated water remained a significant risk factor for fluorosis in multiple logistic regression. CONCLUSIONS: Fluorosis was lower among children born after the adjustment of fluoride concentration in the water. Fluoridated water remained as a strong risk factor for fluorosis after downward adjustment of its fluoride concentration.

The impact of stopping or reducing the level of fluoride in public water supplies on dental fluorosis: a systematic review.

OBJECTIVE: The increased availability of fluoride and concern over the impact of fluorosis, have led to guidance suggesting a decrease or cease in the optimal concentration of fluoride in water fluoridation schemes. To date there have been no systematic reviews looking at both impact of fluoride reduction and total cessation. This review aimed to examine the impact of stopping or reducing the level of fluoride in public water supplies on dental fluorosis. CONTENT: Multiple databases were searched (MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Web of Science). Two reviewers independently screened sources, extracted data and assessed study quality. Results were synthesised qualitatively and quantitatively. The main outcome measure was the prevalence of dental fluorosis. SUMMARY: Six studies of cross-sectional design were included. Two studies were scored as evidence level B (moderate) and the remaining four publications were evidence level C (poor). Meta-analysis indicated fluorosis prevalence was significantly decreased following either a reduction in the concentration of fluoride or cessation of adding fluoride to the water supply (OR:6.68; 95% CI:2.48 to 18.00). OUTLOOK: The evidence suggests a significant decrease in the prevalence of fluorosis post cessation or reduction in the concentration of fluoride added to the water supply. However, this work demonstrates that when studies are subject to current expectations of methodological and experimental rigour, there is limited evidence with low methodological quality to determine the effect of stopping or reducing the concentration of fluoride in the water supply on dental fluorosis.

The impact of a reduction in fluoride concentration in the Malaysian water supply on the prevalence of fluorosis and dental caries.

OBJECTIVE: To assess the prevalence and severity of dental fluorosis and caries among Malaysian children following the reduction in fluoride concentration from 0.7 to 0.5 parts per million (ppm) in the public water supply. METHODS: This study involved lifelong residents aged 9- and 12-year-olds in fluoridated and nonfluoridated areas in Malaysia (n = 1155). In the fluoridated area, children aged 12 years and 9 years were exposed to 0.7 and 0.5 ppm, respectively, at the times when maxillary central incisors developed. Standardized photographs of maxillary central incisors were blind scored for fluorosis using Dean's criteria. Dental caries was examined using ICDAS-II criteria. RESULTS: The prevalence of fluorosis (Dean's score ≥ 2) among children in the fluoridated area (35.7%, 95% CI: 31.9%-39.6%) was significantly higher (P < 0.001) than children in the nonfluoridated area (5.5%, 95% CI: 3.6%-7.4%). Of those in the fluoridated area, the prevalence of fluorosis decreased from 38.4% (95% CI: 33.1%-44.3%) for 12-year-olds to 31.9% (95% CI: 27.6%-38.2%) for 9-year-olds, although this difference was not statistically significant (P = 0.139). The mean caries experience in the permanent dentition was significantly lower in the fluoridated area than in the nonfluoridated area for both age groups (P < 0.05). In the multivariate models, the difference in the differences of caries experience between fluoridated and nonfluoridated areas remained statistically significant. This suggests that caries-preventive effect is still maintained at 0.5 ppm. CONCLUSION: Findings indicate that the change in fluoride level from 0.7 to 0.5 ppm has reduced fluorosis and maintains a caries-preventive effect. Although there is a reduction in fluorosis prevalence, the difference was not statistically significant.

An update on the reasons for placement and replacement of direct restorations.

AIM: The aim of this study was to review patterns of restoration placement and replacement. A previous study had been carried out in the late 1990s and this study sought to update the literature in this important aspect of dental practice. METHOD: Studies based on the protocol of Mjör (1981) were selected. Such studies involved participating dentists completing a proforma each time a patient presented for a new or replacement restoration. RESULTS: Twenty-five papers were included in this study, of which 12 were included in the original review. The pre-1998 review reported on the placement of 32,697 restorations, of which 14,391 (44%) were initial placements and 18,306 (56%) were replacements. The new studies included in the post-1998 review reported on an additional 54,023 restorations, of which 22,625 (41.9%) were initial placements and 31,398 (58.1%) were replacements. Therefore, across all studies considered, information is available on 86,720 restorations, of which 37,016 (42.7%) were new placements and 49,704 (57.3%) were replacements. Comparing review periods, there was a reduction in the placement of amalgam restorations from 56.7% (pre-1998 review) to 31.2% (post-1998 review), with a corresponding increase in the placement of resin composites from 36.7% to 48.5%. The most common use of amalgam was seen in Nigeria (71% of restorations), Jordan (59% of restorations) and the UK (47% of restorations). The most frequent use of resin composite was seen in Australia (55% of restorations), Iceland (53% of restorations) and Scandinavia (52% of restorations). Secondary caries was the most common reason for replacing restorations (up to 59% of replacement restorations). CONCLUSION: In the years subsequent to the initial review, replacement of restorations still accounts for more than half of restorations placed by dentists, and the proportion of replacement restorations continues to increase. Trends towards the increased use of resin composites is noted in recent years. CLINICAL SIGNIFICANCE: Further research is required in this area to investigate changes in the approaches to the restoration of teeth, especially with increased understanding of the concept of restoration repair as an alternate to replacement.

Characteristics of child dental neglect: a systematic review.

OBJECTIVE: Neglect of a child's oral health can lead to pain, poor growth and impaired quality of life. In populations where there is a high prevalence of dental caries, the determination of which children are experiencing dental neglect is challenging. This systematic review aims to identify the features of oral neglect in children. METHODS: Fifteen databases spanning 1947-2012 were searched; these were supplemented by hand searching of 4 specialist journals, 5 websites and references of full texts. Included: studies of children 0-18 years with confirmed oral neglect undergoing a standardised dental examination; excluded: physical/sexual abuse. All relevant studies underwent two independent reviews (+/- 3rd review) using standardised critical appraisal. RESULTS: Of 3863 potential studies screened, 83 studies were reviewed and 9 included (representing 1595 children). Features included: failure or delay in seeking dental treatment; failure to comply with/complete treatment; failure to provide basic oral care; co-existent adverse impact on the child e.g. pain and swelling. Two studies developed and implemented 'dental neglect' screening tools with success. The importance of Quality of Life tools to identify impact of neglected dental care are also highlighted. CONCLUSIONS: A small body of literature addresses this topic, using varying definitions of neglect, and standards of oral examination. While failure/delay in seeking care with adverse dental consequences were highlighted, differentiating dental caries from dental neglect is difficult, and there is a paucity of data on precise clinical features to aid in this distinction. CLINICAL SIGNIFICANCE: Diagnosing dental neglect can be challenging, influencing a reluctance to report cases. Published evidence does exist to support these referrals when conditions as above are described, although further quality case control studies defining distinguishing patterns of dental caries would be welcome.

Current trends in community-based clinical teaching programs in U.K.and Ireland dental schools.

Community-based clinical teaching/outreach programs using a variety of approaches have been established in many predoctoral dental schools around the world. The aim of this article is to report current trends in the teaching of community-based clinical teaching/outreach teaching in dental schools in the United Kingdom and Ireland. In late 2010-early 2011, a questionnaire was distributed by e-mail to deans of the eighteen established dental schools in the United Kingdom and Ireland. The questionnaire included both open and closed questions relating to current and anticipated trends in community-based clinical teaching. Fourteen responses were received (response rate=78 percent). All fourteen responding schools reported inclusion of a community-based clinical teaching program. Ten schools indicated that their program was based on total patient (comprehensive) care including the treatment of child patients. In nine schools, the program is directed by a senior clinical academic in restorative dentistry. As well as student dentists, ten schools and seven schools include teaching of student dental therapists and student dental hygienists, respectively. There is a varied experience within the schools surveyed in terms of the extent, nature, and content of these programs. Overall, however, community-based clinical teaching was seen as part of the future of dental school education in many schools as an ideal way of preparing graduates for Dental Foundation Training and subsequent independent practice.

Evaluation of a U.K. community-based clinical teaching/outreach program by former dental students two and five years after graduation.

Over the past few years, community-based clinical teaching/outreach teaching programs have been established in many dental schools in the United Kingdom. One such program was developed by Cardiff University at the local St. David's Hospital in 2002. Students visit this unit throughout their dental school program--as an assistant/observer initially, but gaining a significant amount of clinical operating experience within the unit during their final year of studies. While contemporaneous feedback from current dental students at this and other programs has been positive, very little information exists on the impact of this form of training on the subsequent clinical careers and working practices of qualified dentists. In autumn 2009, a postal questionnaire was distributed to dentists who graduated from the School of Dentistry at Cardiff in 2004 (n=41) and 2007 (n=51). Fifty-eight responses were returned, for a response rate of 63 percent: 2004 (66 percent), 2007 (61 percent). Forty-seven respondents (81 percent) reported that their learning experience at the St. David's outreach teaching program had been of significant assistance in their professional development in their subsequent clinical careers. Positive features of the program included the availability of a suitably trained dental nurse for all procedures (n=26, 45 percent), ready access to helpful/approachable teaching staff (n=24, 41 percent), and a good working atmosphere (n=23, 40 percent). Overwhelmingly, former dental students reported that the educational experiences they gained were positive and have had a beneficial effect on their subsequent clinical careers. Further development of community-based clinical teaching/outreach training as part of dental school training programs is encouraged.

Effect of community-based clinical teaching programs on student confidence: a view from the United kingdom.

Over the past few years, community-based clinical teaching programs have become established within many dental schools in the United Kingdom. One such primary care teaching unit was developed to support the dental undergraduate program at Cardiff University in 2002. Students visit this unit throughout their five-year dental school training-as assistants/observers initially, but gaining about twenty-eight days of clinical operating experience each within the unit during their final year of studies. The aim of this article is to report the effect of this teaching program on the confidence of students to perform a range of clinical treatments. The final-year dental class of 2007-08 (n=55) at Cardiff University were asked to rate their confidence in their ability to perform thirty-six selected clinical tasks on a five-point scale prior to commencing their clinical operating experience at the community-based clinical teaching program and again at completion of the one-year program. Completed responses were received from forty-seven students (response rate=85 percent). The same students completed the initial and the final surveys. After one year, there were significant increases (p<0.05) in student confidence in performing thirty of the thirty-six selected clinical tasks. The largest positive change was in the area of endodontics: on a five-point scale, there was an increase of one unit for incisor/canine endodontics, 1.04 units for premolar endodontics, and 1.17 units for molar endodontics. These increases were statistically significant (p<0.05). The next largest positive change was for the provision of bridgework: 0.98 unit increase in confidence for providing conventional bridgework (p<0.05) and 0.91 unit increase for resin-retained bridgework (p<0.05). We conclude that clinical experience within a community-based clinical teaching program can have positive effects on dental students' confidence to perform a wide range of clinical tasks. Further work is needed to identify the benefits of this training on the clinical and professional development of young and recently graduated dentists.

Child protection: training and experiences of dental therapists.

OBJECTIVE: To identify the training in, experience of and barriers to reporting child abuse among dental therapists in the UK. DESIGN: Postal survey. SUBJECTS AND METHODS: A postal questionnaire was sent to all practising dental therapists (DTs) in the UK registered with the GDC (n = 851) in October-December 2007. RESULTS: A response rate of 49% (n = 420) was achieved; 24 (5.7%) questionnaires were incomplete and excluded. One hundred and ninety-three respondents (48.7%) had qualified in the last 10 years. One hundred and forty-seven (37.1%) recalled undergraduate training; 248 (62.6%) had received training since qualifying; 66 (16.6%) recalled no child protection training. Overall child abuse had been suspected by 135 (34%) DTs, while 72 (18%) had suspected but not referred the case. CONCLUSIONS: The majority of dental therapists (83%, n = 330) have received training in child protection. Overall, 34% (n = 135) have suspected child abuse and 83% (n = 112) of these DTs recorded their suspicions in the patient record. In line with current guidance, most DTs would discuss a case with another dentist.

Preformed metal crowns: views of a group of dental practitioners in North Wales.

OBJECTIVES: To determine the views of general dental practitioners (GDPs) in North Wales on the use of preformed metal crowns (PMCs) for the treatment of primary molars. METHOD: Following ethical approval, all GDPs in the North Wales Health Authority (85) were invited to participate in the study. After consent was given, a trained GDP conducted all interviews regarding the participants' approach to restorative care in children, preferred materials, use of local anaesthesia (LA), training, and use of PMCs. Their recorded responses were transcribed and analysed at a line-by-line level to identify themes within the data. The analysis was conducted according to a framework approach. RESULTS: Of the 85 GDPs, 27 responded to the invitation. After ten interviews no new substantive themes were emerging and data collection ended (saturation sampling). The GDPs who responded had practised for between three and 35 years and graduated from nine dental schools. The GDPs interviewed knew the advantages of PMCs but did not use them. Most had received undergraduate training with PMCs and were confident they would be able to place them if required. Reasons given for not using them included: limited experience, cost and time placing them, fear of hurting the child patient, need for LA, and glass-ionomer cement being easier to use. CONCLUSIONS: These GDPs knew that PMCs were the most durable restorative option and thought they had the skill to place them. However, they believed a less interventive approach, without LA, worked best with children, and PMCs did not fit well with this approach.

The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances: a systematic review.

INTRODUCTION: Decalcification is a significant problem during fixed orthodontic treatment. Topical Fluorides can reduce or eliminate the problem, but the relative effectiveness of different treatments or combinations of topical fluoride preparations is unknown. This systematic review was undertaken to determine the effectiveness of topical fluoride preparations in preventing decalcification during fixed orthodontic treatment. METHODS: A wide search of published and unpublished material in any language was undertaken by using general and specialist databases; key dental journals were searched by hand. Predefined inclusion criteria based on objective outcome measures of decalcification, duration of treatment, presence of a comparison group, and study design were applied to determine study selection. Included studies were double extracted onto pre-designed data extraction sheets. RESULTS AND CONCLUSIONS: By screening titles and abstracts, we identified 143 articles; after the inclusion criteria were applied, 7 reports (of 6 studies) remained. Differences in the methodologies and reporting made statistical analysis impossible. However, the use of topical fluorides in addition to fluoride toothpaste reduced the incidence of decalcification in populations with both fluoridated and non-fluoridated water supplies. Different preparations and formats appear to decrease decalcification, but there was no evidence that any 1 method was superior. There was some evidence that the potency of fluoride preparations might be important.

Orofacial piercings: perceptions of dental practitioners and piercing parlours.

OBJECTIVES: To identify the advice given by piercing parlours prior to orofacial piercing and to determine how many dental practitioners see complications from orofacial piercings. METHOD: Administered questionnaire to 19 piercing parlours and postal questionnaire to 400 dental practitioners in south-east Wales. RESULTS: Ninety-nine per cent of 227 dental practitioners in south-east Wales had treated patients with orofacial piercings, over three-quarters had seen a patient for a complication caused by the piercing, and over half (N=120) had treated a patient for a complication of piercing. Tongue (N=225) and lip (N=209) piercings were most frequently seen and the most commonly occurring complication was fractured or cracked teeth (N=176). Almost all practitioners wanted more information on orofacial piercing and its sequelae. All 19 piercing parlours in south-east Wales warned clients about pain following piercing and 18 mentioned swelling; only four discussed possible damage to teeth and none discussed the risk of airway obstruction. CONCLUSIONS: Despite the concerns of dental and medical professionals orofacial piercing remains popular and the complications it causes are frequently seen by dental practitioners. There is a need for literature to assist both dental practitioners and piercers in advising and safeguarding patients.

Assessing the anxious patient.

Dental anxiety is a problem for many adults and children and for many patients anxiety acts as a barrier to treatment: avoidance of treatment, irregular attendance or attendance for emergency treatment only being typical ways of dealing with the problem. For the dental team a patient's anxiety poses major management problems, as an anxious patient may require more time for treatment, is very likely to miss appointments and may have raised pain thresholds. A major cause of stress for clinicians is the management of anxiety in their patients.

Validation of undergraduate clinical data by electronic capture (barcode).

Assessment of clinical activity is common in dental schools. An audit project to confirm that dental undergraduate clinical activity recorded by electronic data capture is an accurate representation of the clinical case entry is reported. A printout of clinical activity for a period of a week was generated retrospectively and used to identify case notes. Activity recorded in the case notes was compared with the computer printout. All discrepancies were noted. A total of 125 patient files with 270 barcoded items of treatment were retrieved; 29 of 78 (37.1%) paediatric and 23 of 47 (48.9%) orthodontic cases had discrepancies between the case notes and the computer entry. However, some items recorded in the notes do not require barcoding and vice versa. When these were accounted for, only 19 items of treatment appeared in the notes that should have been barcoded, a 7% shortfall in recording of clinical activity. The barcode system is an accurate and reliable way of recording undergraduate clinical activity.