[Dentist's satisfaction of continuing education: survey among dentists in Jerusalem].

Continuing professional development (CpD or Continuing education is defined as a career-long process required by dentist to maintain, update and broaden their attitudes, knowledge and skills in a way that will bring the greatest benefit to their patients and improve patient care. This research is a survey among 295 dentists, members of the IDA in Jerusalem. The study was conducted, in order to examine their satisfaction of CPD programs offered by IDA Jerusalem. Results indicate that in most variables )lecturer, knowledge and comfort)the satisfaction degree was at a high level. Differences in the level of satisfaction were found between general dental practitioners and dental specialists, and between dentist who graduated in Israel as compared to dentists who graduated abroad. There is a great need to further investigate this issue, in order to develop, promote and improve CE studies and arrive at practical conclusions to support the development of high-quality continuing dental education programs designed to upgrade high-quality dental care, similar to other countries that have CE programs.

[Speaker guidelines lecturing in continuing education].

Continuing Education in Europe is now named Continuing Professional Development (CPD) and concerns both Compulsory (56.7%) and Voluntary (43.3%) education programs. Since the target population is very important, it is obvious that there is a need creating an adapted teaching system. The responsibility of the education is mainly devoted to the organizations usually the Dental authorities, Universities and Dental National associations. Moreover the Speaker is the central person in charge of.the transmission of the knowledge and the skill. Therefore a proper evaluation is an imperative necessity. Generally the use of questionnaire is utilized in order to ascertain the satisfaction of the Dentists of the Lectures. In this three year survey an attempt to set up Speaker Guidelines was launched. The results showed that with a specific approach there is an increase of the motivation and the satisfaction.

Suggested guidelines for basic dental education in Europe.

With the enlargement of the European Community, a great effort was done. In order to abolish the inequalities that exists in the provision of oral health education and Oral healthcare delivery between Eastern and Western Europe. On the other hand, each day more emphasis is placed on the basic competencies and abilities gained during basic dental education due to internal and external driving forces. The differences between the systems are often very important prominent and seem to depend mainly on the national institutions or the government policy. Therefore there is a major responsibility for the profession in helping to integrate the dental practitioners in an updated approach. As a similar basic dental education will progressively been developed, the Continuing Education could become more complex. For this purpose, following a basic dental education complying with the current needs and demands, a more adapted Continuing Education program must be elaborated and promoted.

A behavioural approach in the treatment of elderly patients: a new philosophy.

Complete denture prosthodontists are very well aware of the influence of psychological factors in the success of their treatment. Recently, a number of authors tried to ascertain some psychosocial criteria in the predictability of patients' satisfaction. Although special attention was paid to concerns of socio-demographic and educational status, it was demonstrated that there is little relationship between quality of dentures and patients' satisfaction, nor a relationship between satisfaction and anatomical conditions. The purpose of this paper is to give a better understanding of the behavioural problems of this treatment and offer some solutions. Educational programmes should be influenced by behavioural problems in the management of the elderly patient.

[The influence of socio-demographic and psychological variables on the level of satisfaction of geriatric patients from dental care].

UNLABELLED: The increasing geriatric population poses unique treatment challenges for the dental practice. Satisfaction from dental treatment is considered to be an important issue that influences the attitude and cooperation of the geriatric patient. It is associated with the quality of treatment and with different variables, such as physical, emotional, social and financial. The objectives of the present study were to perform a preliminary characterization of a group of geriatric patients and to identify possible factors that might be associated with their level of satisfaction from dental treatment. MATERIAL AND METHODS: Fifty-one geriatric patients (20 males and 31 females) participated in the study. They were given a questionnaire which included 41 items regarding: socio-demographic variables, social activity, self image, level of apprehension, locus of control and level of satisfaction from dental care. RESULTS: Twenty-two patients reported a high level of satisfaction from dental treatment and twenty-nine reported a low level of satisfaction. No significant association was found between the degree of satisfaction from dental treatment and the examined variables of social activity, self-image and level of apprehension. Good doctor-patient relationships--"the art of care", is considered to have an important impact on the level of satisfaction, especially among the geriatric patients. CONCLUSION: Therefore, it is suggested that these relationships might determine the level of satisfaction of the geriatric patient from dental treatment.

Non-institutionalized elderly dental patients in Israel: socio-demographics, health concerns, and dental anxiety.

The purpose of this study was to evaluate which factors might influence health care attitudes such as anxiety about dental care by older adults in Israel. The study population consisted of 103 non-institutionalized patients (46 men and 57 women) over the age of 65 who attended a dental clinic that provided services for older adults during a one-year period. Socio-demographic information and information about the subjects' general health and their level of concern about health problems were obtained from self-reported questionnaires, while the dental anxiety level was found by means of a dental anxiety scale (DAS). Ninety-nine percent of the patients suffered from a major systemic disease such as diabetes, hypertension, atherosclerosis, respiratory disease, and rheumatic disease. Both unmarried and first-time patients expressed high anxiety scores. Patients with 12 or fewer years of formal schooling demonstrated significantly higher dental anxiety. Among patients who regularly attended a synagogue or a social club, concern about oral health was significantly higher than for the rest (p < 0.02). No association was found between having dentures and gender, or between having dentures and level of education. The reason for visiting the clinic (inability to eat, pain, or esthetics) was not associated with any other health concern or with dental anxiety levels. This study determined that patients who were unmarried, less educated, or attending the facility for the first time were more likely to experience dental anxiety. These patients merit special consideration.

Oral health needs of elderly short-term patients in a geriatric department of a general hospital.

The purpose of this study was to estimate the realistic dental needs of an elderly short-stay patient in a geriatric department. One segment of the elderly population at risk for whom surveillance would appear extremely important are those admitted temporarily to the hospital for acute or acute-on-chronic care. Little has been written about the oral needs of such patients. The study population was comprised of 468 patients of a geriatric department in a medical center examined by a dentist trained in gerodontics. An evaluation of the results showed that 65.3% needed direct oral hygiene assistance. Only 16.4% are able to participate in oral hygiene instruction; a few of them--6.6%--had a need of prosthodontic treatment. A once-weekly screening program was required to handle the oral problems, mainly Candida infections. Close cooperation with the ward staff is essential in order to develop and promote good oral hygiene for this very frail elderly population.

Prevalence of caries and edentulousness among 65-74-year-olds in Europe.

Reviewed in this article are epidemiological studies included in the WHO Global Oral Data Bank for noninstitutionalized European adults aged 65-74 years for the period 1986-96. Edentulous percentages, decayed, missing, filled teeth (DMFT) index, and data on the mean number of teeth are presented. At least one representative study had been carried out in 48% of the countries, with the quantity of information from countries with developed market economies being similar to that from countries with economies in transition. The proportion of 65-74-year-olds who were edentulous varied from 12.8% to 69.6%, the mean number of teeth ranged from 15.1 to 3.8, and the DMFT index from 22.2 to 30.2. The observed disparities in the oral health status among older European adults suggest that it may be possible to develop and implement oral health policies that take into account geographical and socioeconomic differences in populations.

The reasons for tooth loss in geriatric patients attending two surgical clinics in Jerusalem, Israel.

OBJECTIVES: Numerous studies around the world have been conducted in order to understand the reasons for tooth extractions in various age groups. Most studies have dealt with the general adult population but little attention has been paid to the elderly population. In Israel, as in most of the western countries, the elderly population is growing rapidly and thus demands for its dental needs are also increasing. In order to meet the dental requirements of the geriatric population, data on the main reasons of tooth mortality have been collected. DESIGN: Retrospective analysis of reasons for extraction divided into three categories: caries, periodontal disease and "other". SUBJECTS: The files of 302 consecutive elderly patients aged 65-95 years attending for extraction. The cause for tooth extraction was gathered from the written diagnosis described by the operator as well as from radiographs. Setting Two surgical clinics in Jerusalem serving low income residents. Results Results indicated that 30% of the extractions were due to caries, 65% were due to periodontal disease and only 6.4% related to "other" reasons. In both, males and females, periodontal disease was the major cause for tooth loss yet, females exhibited more extractions due to caries than males (35% vs 23% respectively). A relatively high incidence of tooth loss was documented for the 85+ age group. Of the teeth that were extracted, incisors and molars were equally the most frequent (29%) followed by premolars (26%) and canines (17%). Premolars were the teeth most frequently extracted out of the teeth removed due to caries (32%) whereas incisors were the most frequently removed within the group of teeth extracted due to periodontal disease (31%). CONCLUSIONS: The results of this study point to the importance of prevention and treatment of dental diseases, particularly periodontal disease, in adults aged 0 years and above in order to prevent tooth loss in their later years.

The old-old dental patient: the challenge of clinical decision-making.

As the U.S. geriatric population grows older, dentists should recognize the need to carefully consider age-related concerns that influence clinical decision-making. The authors discuss several prevalent problems typically found in "old-old" patients and propose a model for determining the appropriate extent of dental care for them.

Variables affecting denture satisfaction in Israeli elderly: a one year follow-up.

The purpose of this study was to investigate patient satisfaction with complete dentures after one year of use and several potential mitigating factors in Israeli elderly. Eight-four patients who were 54 years of age or older and who were rehabilitated with complete dentures were recalled for examination 12-15 months later; 84.5% (n = 70) were interviewed and reexamined by calibrated examiners who judged all prostheses to be clinically acceptable. The mean age of participants was 71.90 years and two-thirds were females. Over 73% reported that they wore their dentures "always." Nearly 79% indicated that they were pleased with their denture appearance. Difficulties were reported by 28.2%, while 46.5% reported difficulties with chewing. Chewing problems were significantly related to swallowing problems (P < .001); food enjoyment "as much now as you did five years ago" (P < 0.001); difficulties speaking (P < 0.05); and "having sores under your dentures" (P < 0.01) which affected 28.2% of the survey group. Married elderly expressed higher satisfaction with denture comfort as compared to "single" patients, and patients suffering from any systemic chronic diseases were more dissatisfied with appearance. A summary satisfaction scale of 7 items was constructed (Cronbach alpha reliability 0.6834) and logistic regression performed to identify key model variables for overall satisfaction. Stat sign findings included: 1) immigration year; 2) neurological or psychological disorder; and 3) age. The model correctly classified 92.75%. Findings suggest that a variety of factors may influence denture satisfaction. Gathering detailed information by means of a questionnaire before new denture fabrication may be an important tool for the dentist in predicting and consequently enhancing patient satisfaction with complete dentures.

Planning oral health care for the elderly in Israel for the years 2000 and 2025.

The methodology and conclusions of this workshop are reported here because the problems requiring solution are not unique to Israel. They will increasingly have wide geographical and political application. The population of Israel since its establishment in 1948 has increased about sixfold. The numbers of the elderly (65+) have increased about tenfold. The current situation must be examined and estimates obtained for the next ten years. Only thus can the system be enabled to cope with the problem as it develops. The chosen method was a carefully preplanned, multisectorial workshop. Recommendations were discussed, amended and finalised. The recommendations of the workshop included: Baseline national data is urgently required. Guidelines are required for selecting specific target populations to which priority should be given. The current favourable situation of adequate oral health manpower in Israel makes it possible to encourage providers of oral health care towards treatment for the elderly. It is essential that the appropriate health authorities allocate sufficient funds for the following urgent purposes: the conduct of a national survey of the elderly population; the establishment of oral health units on a trial basis in some selected hospitals; support institutions of higher education to facilitate training in geriatric dentistry. CONCLUSIONS. The workshop was multidisciplinary because it was necessary to include all the expertise and experience available as vital elements of the policy making process. This type of workshop was found to be an effective tool for planning oral health services.

A comparative study of the attitude of dental students towards the elderly.

The aim of this study was to assess the attitudes of dental students towards the elderly in the two dental schools in Israel. The study population comprised 180 dental students currently enrolled in the two dental schools in Israel. The response rate was 59% and 92% for the students in Tel Aviv and Hebrew University respectively. The self-administered questionnaire measured attitudes using the Rosencranz and McNevin Aging Semantic Differential Scales. Students' attitudes were observed to be more or less neutral. No differences of significance were observed between the students of the two schools. Social contact with and experience in treating the elderly did not seem to change students' attitudes and their desire to work with elderly patients in the future. Further development of the curriculum should be implemented in order to try to change students' attitudes towards the elderly from neutral to positive for the benefit of the provider and society.

[5-year treatment results of urethral stenosis using internal urethrotomy in adults]. / Résultats à cinq ans du traitement des sténoses de l'urètre par urétrotomie interne chez l'adulte.

The authors reviewed the records of 69 patients with a mean age of 51 years treated for single (81%) or multiple (19%) urethral strictures, in whom the first operation to be performed was endoscopic internal urethrotomy with a follow-up of at least 5 years. The mean follow-up was 71 months. The actuarial rate of good results was 27.2 +/- 11% at 5 years. The success rate of repeated internal urethrotomy was satisfactory, but was not evaluated with the same follow-up (62.5% after the first repeat urethrotomy with a mean follow-up of 13 months).

Dental behavioral aspects of a non-institutionalized elderly population.

Various studies have shown an increase in utilization of dental services among the elderly in the last three decades. This study aimed at evaluating utilization rate of non-institutionalized geriatric population in Jerusalem and determining reasons for non-utilization. To eliminate the factor of accessibility of services, a Jerusalem neighborhood with a dental geriatric clinic was selected and all residents were notified. A second letter requesting cooperation with a dentist who would be visiting their homes was sent, and was followed by a phone call. According to a list provided by the municipality, 175 homes were visited; only 87 were examined, 21.7% refused; 4.6% were disqualified for health problems, 13.7% died and 10.3% moved. Testing included: a clinical dental examination, an interview regarding number of visits at a dental clinic and reasons for non-utilization of services. Results indicated that 42.4% had visited a dentist during the last year and 37.6% had not seen a dentist for more than 5 years. Of those who had not seen a dentist for more than a year, 62.7% indicated having no problems, 9.8% indicated a financial barrier, 7.8% indicated no services available, 5.9% were too busy and only 3.9% indicated fear as the reason for non-utilization. Though the sample was relatively small, accessibility and availability of dental services have proven to be factors which increase utilization.

Oral health status and dental needs in a geriatric institutionalized population in Paris.

One hundred and forty-two residents of a geriatric hospital in France were given an oral exam and interviewed by questionnaire regarding their backgrounds, physical health and oral hygiene habits. The residents suffered from many systemic diseases and drug intake was relatively high. Over fifty percent reported mouth dryness, especially at waking. Twenty-three percent stated that they never brushed their teeth and the demand for dental services was low. Edentulousness was similar to those rates reported in Israel and the U.S. The majority of prostheses were rated by examiners as unacceptable and there were significant amounts of root and cervical caries in spite of the relatively high level of oral health care provided by the staff.

Gerodontology--a contemporary prosthetic challenge. 1. Mandibular impression technique.

In geriatric complete denture prosthodontics, several factors may contribute to the failure of the prosthetic device. The piezography technique, a special functional approach is described in order to overcome the difficulties of the mandibular denture.