Can we measure patients' perception during dental impressions? The Burdens in Dental Impression-Making Questionnaire - BiDIM-Q.

PURPOSE: To develop a reliable and valid instrument for the comprehensive assessment of patients' burdens during dental impression making, the Burdens in Dental Impression Making Questionnaire, BiDIM-Q. MATERIALS: The item pool was generated in a convenience sample of 20 prosthodontic patients using semi-structured face-to-face interviews. The final instrument was tested in 145 consecutively recruited patients, and psychometric properties of the BiDIM-Q were determined. Four different impression materials were used according to the manufacturers' instructions and indications: alginate, c-silicone, polyvinylsiloxane, and polyether. RESULTS: The final BiDIM-Q consisting of 12 items showed sufficient reliability, indicated by Cronbach's alpha of .82 and an average inter-item correlation of .29. Validity was supported by Pearson correlation coefficients for the correlation between the instrument's total score with the patients' overall satisfaction rating (r=.63), and by the correlation matrix for the correlations of the patients' perceptions with the practitioners' satisfaction ratings. Overall, patient perceived burdens were low with highest burdens observed when using polyether in partially dentate patients for pick-up impressions, while lowest burdens were reported when using c-silicone for impressions of edentulous jaws. CONCLUSION: The BiDIM-Q is a reliable and valid tool for assessing patient-based process-related quality of care in dentistry allowing a deeper insight into patients' perspective during dental impression making.

How patient and carer expectations of orthodontic treatment vary with ethnicity.

OBJECTIVE: To investigate if the orthodontic treatment expectations of Black British children and their primary carers vary compared with White British children and their primary carers. SETTING: A hospital orthodontic department (Queen Mary's Hospital, Sidcup, London, UK). PARTICIPANTS: Patients and their accompanying primary carers who had not received fixed orthodontic appliance treatment and were aged between 12 and 14 years old. METHOD: Informed consent was obtained from 100 patients and their primary carers, who completed a psychometrically validated questionnaire, to measure their expectations before a new patient orthodontic consultation. This cohort consisted of 50 Black British patients and their primary carers and 50 White British patients and their primary carers. RESULTS: Mean responses from patients and their primary carers for each ethnic group were compared using the independent groups t-test. Significant statistical differences were found between the two ethnic groups. The greatest statistical differences occurred between Black British patients and their primary carer and Black British primary carers and White British primary carers. Patients tended to have similar orthodontic expectations. There were no statistical significant differences in expectations between White British children and their primary carers. CONCLUSION: Differences in expectations of orthodontic treatment were more common between Black British and White British primary carers, than their children. White British primary carers had higher expectations at their child's initial appointment and expected dental extractions to be part of the orthodontic treatment plan. These differences have some implications for the provision of orthodontic care. A clinicians understanding of patients and their primary carer's expectations at the start of treatment can help in the quality and delivery of orthodontic care provided.

Influence of gag reflex on dental attendance, dental anxiety, self-reported temporomandibular disorders and prosthetic restorations.

To assess the influence of gag reflex severity, assessed according to the short form of the patient part of Gagging Problem Assessment Questionnaire (GPA-pa SF), on the dental attendance, dental anxiety, self-reported temporomandibular disorder (TMD) symptoms and presence of prosthetic restorations among patients requiring prosthodontic treatment in Turkey. A total of 505 patients (305 women; mean age: 46·35 years, SD: 28·2 years) undergoing dental examination were administered a questionnaire containing questions regarding their age, gender, education level, dental attendance, TMD symptoms (limitation in jaw opening, muscle pain, pain/sounds in the temporomandibular jaw), the Turkish version of the Modified Dental Anxiety Scale (MDAS) and the GPA-pa SF. Subsequently, any prosthetic restoration was recorded by a dentist. Descriptive statistics, one-way analysis of variance (anova) and the chi-square test were used for statistical analysis. Differences were found between GPA-pa SF scores 0, 1 and 2 for education level (P = 0·001), MDAS scores (P = 0·003), self-reported TMD (P = 0·000) and prosthesis wear (P = 0·000), but not for attendance patterns (P = 0·826). Patients with gag reflex had lower education levels, higher levels of dental anxiety, more self-reported TMD symptoms and fewer fixed or removable prosthetic restorations than patients without gag reflex. Gag reflex has impacts on dental anxiety, self-reported TMD and prosthetic restorations, but not on dental attendance patterns, according to the results of the GPA-pa SF.

Patient satisfaction and aesthetic outcome of implant-supported single-tooth replacements performed by dental students: a retrospective evaluation 8 to 12 years after treatment.

PURPOSE: To assess patient satisfaction and aesthetic treatment outcome of implant-supported singletooth replacements performed by dental students as part of their undergraduate curriculum 8 to 12 years after treatment. MATERIALS AND METHODS: A total of 51 patients were consecutively treated by dental students with 55 implant-supported single-tooth replacements within the incisor, canine and premolar regions. The surgical and prosthetic treatment was performed by the dental students under the supervision of dentists and oral and maxillofacial surgeons, all with specific knowledge about oral implantology. The outcome measures were patient subjective evaluation of peri-implant soft tissues, implant crown, implant function and total implant treatment using a Visual Analogue Scale (VAS). The professional evaluation included the peri-implant soft tissues, implant crown and total implant treatment (combined scores, PES/WES) using the Pink Esthetic Score (PES) and the White Esthetic Score (WES), as well as the level of incisor edge/occlusal surface in relation to neighbouring teeth. RESULTS: A total of 42 patients with 46 implants were available for evaluation 8 to 12 years after treatment. The patients were in general satisfied with the treatment outcome and few patients had low VAS scores. Most implants were characterised by single scores of 1 or 2 resulting in a mean PES score of 8.3 (maximum 14), a mean WES score of 6.3 (maximum 10) and a mean PES/WES score of 14.6 (maximum 24). However, 33% of the implants were characterised by recession (>1 mm) of the facial soft-tissue margin. Correlation analyses involving the subjective parameters indicated that the evaluation of the total implant treatment was mainly influenced by the appearance of the implant crown and to a lesser extent by the peri-implant mucosa. There were no significant correlations between the subjective and professional evaluation. Both the subjective and professional evaluation revealed implants in infraposition. This was registered in 7% and 17% of the implants, respectively. CONCLUSIONS: The patient satisfaction and aesthetic outcome 8 to 12 years after treatment with implant-supported single-tooth replacements performed by dental students as part of their clinical undergraduate dental curriculum were characterised by high patient satisfaction and an acceptable aesthetic treatment outcome. Therefore, it seems acceptable to include implant therapy of straightforward cases in the clinical undergraduate curriculum, provided there is substantial supervision by trained clinicians. CONFLICT-OF-INTEREST STATEMENT: The study was partially supported by Nobel Biocare, Denmark. There was no conflict of interest.

Dental difficulty for adult patients undergoing different dental procedures according to level of dental anxiety.

This study aimed to determine the level of dental anxiety before different dental care procedures. A group of 116 adults presenting for the first time at a French dental hospital were included in the study. These patients completed a French-language version of Corah's Dental Anxiety Scale 1 and used a visual analogue scale to score their perception of the level of difficulty generated by 13 different dental treatments. The acts perceived as the most difficult to face were root canal and restorative treatment without local anaesthesia (LA), followed by oral surgery. There was a positive correlation between DAS score and level of difficulty experienced during dental treatment. Healthy subjects declared difficulty in coping with dental care. Dental procedures may be a factor of co morbidity in terms of the psychological status of dental patients. A classification of dental procedures is given according to the level of difficulty generated.

The influence of sequence of impressions on children's anxiety and discomfort.

PURPOSE: Laboratory studies with adults and children have found lower pain reports when pain proceeds from high to low rather than from low to high. However, pediatric dentists often ease children into difficult procedures (from easiest to most difficult). This study investigated the influence of order during a clinical procedure that involved taking maxillary and mandibular alginate impressions. METHODS: Subjects were 24 children aged 5 to 6 years (preoperational stage) and 24 children aged 9 to 10 years (concrete operational stage). Children were randomly assigned to either start with the mandibular (presumed to be easier) or start with the maxillary (presumed to be harder) impressions. Discomfort during the sequence of impressions was measured using the "Affective Facial Scale." A telephone interview was conducted 2 weeks later to evaluate the memory of discomfort. RESULTS: The results indicated that the older children who started with the mandibular (easier) impression and ended with the maxillary (more uncomfortable) impression reported significantly lower discomfort than older children who started with the maxillary impression and ended with the mandibular (Mann-Whitney U, Z = -2.08; P < .037). The same tendency was noted 2 weeks later on a telephone interview. By phone, 92% of the older children who started with the mandibular impression rated the sequence of impressions as "not at all bad," while only 58% of the older children who started with the maxillary impression rated the overall experience as "not at all bad" (chi2 = 3.56, P < .059). The younger children did not show any significant difference in their ratings of discomfort at either of the assessment periods. CONCLUSIONS: Consistent with clinical practice, this study observed that older children benefit from beginning an appointment with an easier procedure and working up to a more difficult one.