Fear of fluoride.

Discusses how dental and medical scares have resulted in a "culture of fear" which has damaged patients and dentists. Forty years of pessimism have created a demoralised and risk-averse society. The reality of a steadily improving world demands a new attitude of rational optimism and a healthy scepticism about new scares.

The prevention of 'dry socket' with topical metronidazole in general dental practice.

OBJECTIVE: The purpose of the study was to determine if the intra-alveolar application of topical metronidazole gel could reduce the incidence of alveolar osteitis (dry socket) following routine tooth extraction in molar and premolar extraction sites. DESIGN: This was a multicentre, double blind, randomised, placebo-controlled clinical trial. A total of 302 patients took part, of which 23 returned with alveolar osteitis. Of these, eight had received the metronidazole gel and 15 the placebo. SETTING: The study was carried out in three general dental practices by general dental practitioners working in England over the period 2000-2003. MAIN OUTCOME MEASURES: Following extraction of either a molar or premolar tooth, either a 25% metronidazole gel or KY Jelly was syringed gently into the socket. A painful post operative complication was recorded if either a dry socket was present or the patient returned with pain. RESULTS AND CONCLUSIONS: The difference in the incidence of alveolar osteitis between the placebo and the active gel groups was not significant and it was concluded that 25% topical metronidazole gel was not effective in reducing the incidence of alveolar osteitis. It was found that the incidence of alveolar osteitis reduced with increasing age and was more likely to occur in a patient with a previous history of the condition.

Victims of the drill.

It is now widely recognised that dentistry based mainly on the restoration of teeth has failed to deliver dental health to our patients. There is an urgent need for GDPs to face up to the full implications of this failure and implement a truly preventive practice philosophy. We must also recognise the particular plight of our patients with very heavily restored dentitions who are the real victims of the drill and fill culture of the last 40 years. There must be no more additions to their ranks.

Ending the misery of child dental decay.

Dental caries in children's teeth has drastically declined in the last 30 years. We should be proud of this achievement but there is much still to do. One of the greatest stumbling blocks to further progress is, I believe, the current payment system for NHS children's dentistry which has failed to promote effective prevention amongst the most caries prone. To remedy this I propose some simple, low cost changes which could make decay in a child's tooth a rarity in our practices.

The future of dentistry--the evidence revolution.

An increasing demand for evidence-based practice will transform the way we treat our patients in the next decade. This represents both a threat and a golden opportunity for GDPs. I believe that we should grasp this opportunity and in partnership with our academic colleagues, develop a national programme of general practice research.

Preventing failed appointments in general dental practice: a comparison of reminder methods.

OBJECTIVE: To test the effectiveness of different systems of reminding patients about their appointments in order to reduce the rate of failed attendance. The expense in implementing a reminder system for patients was also estimated. DESIGN: A clinical study in a single-handed dental practice. SUBJECTS: Patients were reminded about their appointment using either postal, manual telephone or automated telephone reminders (or all three combined). A control group received no reminders. 500 patient attendances were recorded in each group. RESULTS: Patients failed to attend for 130 of the 2500 appointments considered in the study. There was a significant reduction in the failed attendance rate from 9.4% (with no reminder) to a minimum of 3% when a reminder was given to the patient before the appointment. However, there was no significant difference among the four reminder test groups, indicating that the form of the reminder made no difference to the failure rate. CONCLUSIONS: Reminding patients using postal or manual telephone techniques is effective at improving attendance. All of the reminder methods, telephone and postal, provided net cost savings rather than additional costs.

The prevention of failed appointments in general dental practice.

AIM: To identify those patients most likely to fail to attend dental appointments. DESIGN: Retrospective analysis of the attendance pattern of patients. SETTING: A National Health Service practice in Kent. SUBJECTS AND METHODS: Dental records of 1000 patients. MAIN OUTCOME MEASURES: Data (age, gender, plaque score, treatment planned, whether the patient was exempt from charges, distance between their home and the practice) were related to attendance history. RESULTS: 34.8% of patients receiving income support and 24.8% of children failed to attend compared with 18.6% of non-exempt adults. Differences between non-exempt adults and children [per cent difference 6.2%, CI = (0.6%, 11.8%)] and for those receiving income support [per cent difference 16.2%, CI = (6.2%, 26.2%)] were significant (P < 0.05). A significant improvement in the appointment failure rate was achieved using telephone reminders. CONCLUSIONS: Patients exempt from dental charges (mainly children and those receiving income support) were more likely to have failed to attend for their appointment. Whereas the attendance of children may be outside their control in some cases, we hypothesise that factors such as poverty in the group receiving income support may be an important influence in whether these patients feel able to attend for their appointments.