SPECIAL FEATURE. PEDIATRIC DENTISTRY.

There are approximately 2 million children living in the state of Michigan who will receive dental care with one of more than 5,500 MDA member dentists. Of these 5,500 MDA members, only approximately 100 are pediatric dentists.(1-3) Thus, it's safe to say that most children will find their dental homes in general dental offices. These general dentists will be providing preventive, diagnostic, and restorative care to most children under most circumstances. And with that in mind, it's of great importance that all dentists be comfortable providing high quality care to the majority of children, referring only a select group for care by a pediatric dentist.

Is general dentistry dead? How mid-level dental providers will affect the profession.

The rhetoric concerning mid-level providers and their impact on general dental practice is building in intensity. This is a complex issue and there is no clear picture of either the benefits or dangers to the public of such a delivery model, whether such plans are economically sustainable, or the role of general dentists in the configuration of future practices. The opinions of a representative sample of thinkers from various perspectives are sampled.

A model for dental practice in the 21st century.

The dental profession is responsible for the prevention, diagnosis, and treatment of diseases and disorders of the oral cavity and related structures. Although the majority of the US population receives excellent oral health care, a significant portion is unable to access regular care. Along with proposals to develop midlevel providers, the scope of practice for dentists needs to be reconceptualized and expanded. A broad number of primary health care activities may be conducted in the dental office, such as screening for hypertension, diabetes mellitus, and dermatopathology; smoking prevention and cessation activities; and obesity interventions. More than 70% of adults saw a dentist in the past year, which represents an unrealized opportunity to improve both oral health and general health.

Treatment planning for replacing missing teeth in UK general dental practice: current trends.

The aim of this study was to examine the confidence, barriers and attitudes towards the replacement of missing teeth by general dental practitioners (GDPs). The perceived impact of the recently introduced National Health Service (NHS) contract on the provision of prosthodontic treatments was also considered. Pre-piloted postal questionnaires were mailed to 500 GDPs in Wales. Open- and closed-ended questions were utilised to establish confidence, adequacy of training and attitudes towards treatments for replacing missing teeth. Two hundred and seventeen completed questionnaires were received (response rate = 43.4%). Many respondents described themselves as 'confident' or 'very confident' in the provision of removable partial dentures (RPDs) (acrylic = 100%, metal based = 99.5%), cantilever resin-bonded bridges (94.4%) and conventional bridgework (98.6%). GDPs were 'not confident' providing fixed-fixed resin-bonded bridges (21.1%) or implants (81.4%). Financial barriers were identified to the provision of prosthodontic treatments, including comments such as "the new [National Health Service] contract does limit the treatments available". Privately funded patients were more likely to be offered a fixed bridge or implant replacement of a missing upper first molar, whereas non-privately funded patients were more likely to be offered no treatment (P < 0.01). Most respondents reported confidence at providing more routine forms of prosthodontic care such as RPDs and bridges. It appears that funding arrangements may have an impact on treatments offered to replace missing teeth, particularly under the current NHS contract.

Trends in extraction of permanent teeth in private dental practices in Kerala state, India.

AIM: The aim of the present study was to identify the trends in tooth loss among patients attending four general dental practices in the south Indian State of Kerala. METHODS AND MATERIALS: The reasons for extraction of permanent teeth among patients who had attended the four clinics during a one-month period were categorized as follows: (1) dental caries and their sequelae, (2) periodontal disease, (3) orthodontic, (4) impactions, (5) prosthodontic, and (6) other reasons. RESULTS: A total of 997 permanent teeth were extracted, of which 445 (44.6 percent) teeth were extracted due to dental caries and their sequelae, 331 (33.2 percent) teeth due to periodontal disease, 111 (11.1 percent) teeth for orthodontic purposes, 25 (2.5 percent) teeth due to impactions, 25 (2.5 percent) teeth for prosthodontic purposes, and 60 (6 percent) teeth for other reasons. CONCLUSION: The results of the present study suggest that dental caries and periodontal disease were the two major causes of tooth mortality in this particular patient population. CLINICAL SIGNIFICANCE: This is probably the first study to report on the trends in tooth loss in general practice in India. Similar studies should be conducted in other regions of the country to generate valuable data regarding the oral health patterns of the nation's population.

Dental general anaesthesia--will the service disappear? A pilot study.

OBJECTIVES: To identify likely future trends in recruitment of consultant anaesthetists to the ambulatory dental general anaesthetic (DGA) services. PARTICIPANTS: The sample consisted of all anaesthetic specialist registrars (SpRs) in their final year of training, within Mersey and South-Western Deaneries in the U.K. RESEARCH DESIGN: A questionnaire divided into a quantitative section to establish level of training in ambulatory DGA, and a qualitative section designed to elicit opinions and attitudes towards ambulatory DGA services. RESULTS: The response rate was 75% (27/36). Within both regions 81% (22/27) had received practical training in ambulatory DGA procedures. SpRs in the South-Western Deanery held the greatest misgivings about the ambulatory DGA technique. Once appointed to Consultant position only 11% (3/27) of respondents expressed a definite interest in providing ambulatory DGA services. CONCLUSIONS: Within the Northwest and Southwest of England, most specialist registrars in anaesthetics receive training in ambulatory DGA, although their future commitment to the delivery of these services is questionable.

Trends in Generalist and Specialty Advanced Dental Education and Practice, 2005-06 to 2015-16 and Beyond.

This article reviews the data on advanced dental education for the past decade and explores what advanced dental education might look like in the years leading up to 2040, including how its graduates will address the oral health needs of the population. The authors based these projections on published data about advanced dental education collected by the American Dental Association and other organizations. Nevertheless, a certain degree of speculation was involved. The article presents current data and trends in advanced dental education, environmental factors impacting advanced dental education, and lessons drawn from other areas of health care that support the potential scenarios that are described. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Trends in service provision among Australian private general dental practitioners over a 20-year period.

AIM: To-investigate time trends in service provision. DESIGN: Five cross-sectional surveys across a 20-year period. SETTING: Australian private general practice PARTICIPANTS: A random sample of dentists. METHODS: Mailed questionnaires were collected in 1983, 1988, 1993, 1998 and 2003 (response rates 71%-76%). MAIN OUTCOME MEASURES: Services per visit, annual services per dentist; annual services per patient. RESULTS: Total services per visit increased over the study period from 1.78 to 2.37 (Poisson regression; P<0.05). However the annual number of services provided per dentist did not vary significantly, reflecting a trend among dentists to supply fewer patient visits per year. The annual number of services provided per patient increased from 3.47 to 5.50 (OLS regression; P<0.05), reflecting both increased service rates per visit and increased numbers of visits by patients. Dentists provided less restorative, prosthodontic and extraction services per year, but more diagnostic, preventive, endodontic and crown and bridge services. The annual care received per patient also included more diagnostic, preventive, endodontic and crown and bridge services but differed from the dentist pattern through increased rates of restorative services over the study period. CONCLUSIONS: The content of dentist workloads has changed to include less emphasis on removal and replacement of teeth and more effort on diagnosis and prevention aimed at retention of natural dentitions.

The use of an evidence-based portfolio in the management of change in dental practice.

In this paper the author gives his opinion about the problems of getting practices to change systems in order to institute clinical governance. There are many reasons why practices need to change and for this change to be monitored. This paper explains the need for change and the use of the evidence-based portfolio, which is produced by candidates for the Membership of the Faculty of General Dental Practice (UK) [MFGDP(UK)] examination. It can also be produced by individuals who are not taking the MFGDP(UK) examination in conjunction with the Faculty of General Dental Practice (UK)'s key skills programme. It provides a mechanism for demonstrating change and for assessing the quality of care provided by a general dental practice. The author concludes that the evidence-based portfolio will enable a practitioner to apply clinical governance in a practical way.

[The rise and development of general dentistry in China].

General dentistry is an important part of the dental medicine and general dentists and general dentistry form the basis of clinical dental medicine. China's general dentistry has a long history, which started as an independent specialist in the 1990s. At present, the Chinese general dental medicine has received more and more attention as an independent profession. General dental medical model has been rapidly developed in the general hospital department of dentistry, private practice and community dentistry institutions, dental specialist hospitals and so on. In this paper, we will review the rise and development of China's general dentistry, and report its theoretical characteristics, institutional framework, academic progress, member development report, and look forward to its development in the future.

Outlook of British dentists towards their profession.

Dental practice in Britain has undergone significant changes in recent years. These changes have undoubtedly affected the outlook of dentists towards dentistry. This study was undertaken to examine the current outlook of general dental practitioners working in the General Dental Service. A representative sample of 1000 dentists was surveyed by mail. The response rate was 73.7 per cent. Most characteristic of the respondents' outlook on various aspects of their profession is the wide diversity of opinion. Neither respondent gender or practice location were associated with outlook. More preventively oriented dentists and those whose practices were most busy, however, were found to have a more positive outlook.

Restorative service trends in private general practice in Australia: 1983-1999.

OBJECTIVES: Restorative services are a major component of the annual workload of a dentist, but are undergoing a period of change as population oral health continues to improve and restorative materials and techniques are developed. The aim of this study was to examine trends in the provision of restorative services over a 15-year period spanning 1983-84 to 1998-99. METHODS: A series of cross-sectional surveys was performed in 1983-84, 1988-89, 1993-94 and 1998-99 with response rates of over 70%. Data were collected by a mailed survey from a random sample of dentists from each state/territory in Australia. Dentists provided data on patients treated on a typical clinical day from which annual rates of provision of services per dentist were derived for restorative and related services. RESULTS: The overall number of annual restorative services provided per dentist declined over the four points of the study period. This trend reflected a steady decline in the annual number of amalgams provided per dentist. However, composite resins increased between 1993-94 and 1998-99, while glass ionomers, other-restorative services, crowns and fissure sealants all showed increases over the first three points of the study period. CONCLUSIONS: Over the study period the highest provision of restorative and related services changed from amalgams to composite resins, reflecting trends towards improved oral health and development of restorative materials. The decline in restorative services was not uniform across all age groups of patients, with increases observed among 45-64 and 65+ year olds, reflecting increased retention of teeth among adults.

Trends in work effort among private general dental practitioners.

Trends in the distribution and volume of dental services provide an empirical base upon which hypotheses on future service provision can be tested. The aim of this study was to examine changes in the distribution and volume of service provided in private general dental practice, and compare these with an existing conceptual model. A weighted, stratified random sample of Australian dentists was surveyed in 1983 (730 respondents, response rate 73 per cent) and 1988 (855 respondents, response rate 75 per cent). The data were weighted to provide population estimates for private general dental practitioners in 1983 and 1988. Service-mix data were converted to relative value units, a common scale based on work effort, and annual estimates of this work effort were calculated. Work effort was divided into low, medium and high level interventions. Medium level interventions comprised the greatest volume of work effort, followed closely by low level interventions, with high level interventions having the smallest volume. The pattern of work effort was in contrast to the conceptual model of service distribution, with low level interventions higher and high level interventions lower than expected. While there was a significant increase in work effort among high level interventions, there was no increase in work effort among low level interventions and no decrease in work effort among medium level interventions over the five year period 1983-88 as expected in the conceptual model for changing service provision.

Practice activity trends among Australian private general dental practitioners: 1983-84 to 1998-99.

AIM: To investigate time trends in practice activity. DESIGN: Four cross-sectional surveys across a 15 year period. SETTING: Australian private general practice. PARTICIPANTS: A random sample of dentists. METHODS: Dentists were surveyed by mailed questionnaire in 1983, 1988, 1993 and 1998 (response rates 71%-75%). Data were weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988, 1993 and 1998. MAIN OUTCOME MEASURES: Hours per year worked, patient visits per hour and patient visits per year. RESULTS: The number of patient visits per year declined across the period, related to parallel decreases in the number of patient visits per hour (ANOVA; P<0.05), while there was no significant difference during the period in the number of hours per year devoted to work. The interaction of dentist sex by time of survey indicated that while numbers of patient visits per year had remained stable for female dentists, there was a trend for the higher number of patient visits per year among male dentists at the beginning of the survey period to decline over time. CONCLUSIONS: Male dentists had higher levels of practice activity compared with female dentists, but a decline in the number of patient visits per year reflected a convergence of male practice patterns towards that of female dentists.

The implications of changing patterns in oral health for the general practice of dentistry.

Recent reports from several developed countries have shown reductions in caries prevalence, especially amongst children. As a result of these changes, dental practice surveys show that dentists now work fewer hours at the chairside and see fewer patients. There has been a decline in the time patients have to wait for appointments. There is anxiety amongst general dental practitioners that their income is reducing. The school dental service in the developed countries would be the first casualty of the caries-free society, and the reduction in demand for the services of school dental nurses has led to the closure of some training institutions. If the caries decline persists, the volume of restorative work will fall and there will be a shift of emphasis to periodontal care and geriatric dentistry. A change of attitude to the utilization of dental auxiliaries is predicted. In the developing countries, a restorative strategy is no answer to the increasing prevalence of dental caries, as most developing countries cannot afford the armamentarium required or its maintenance. The use of dental auxiliaries, especially dental hygienists, may not cope with the worsening picture of oral disease. It is proposed that volunteers recruited from the urban and rural areas be trained as lay health advisors. The prospects for the dentist in most developing countries are those of excessive work load, high cost of dental services and the continued neglect of preventive dental care.

Service provision trends among Australian private general dental practitioners: 1983/84 to 1998/99.

AIM: To investigate time trends in service provision. DESIGN: Four cross-sectional surveys across a 15-year period. SETTING: Australian private general practice. PARTICIPANTS: A random sample of dentists. METHODS: Dentists were surveyed by mailed questionnaire in 1983, 1988, 1993 and 1998 (response rates 71%-75%). Data were weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988, 1993 and 1998. MAIN OUTCOME MEASURES: Services per visit, annual services per dentist, annual services per patient. RESULTS: Total services per visit increased over the study period from 1.78 to 2.14 (Poisson regression; p < 0.05). However the annual number of services provided per dentist did not vary significantly, reflecting a trend among dentists to supply fewer patient visits per year. The annual number of services provided per patient increased over the period from 3.47 to 5.22 (OLS regression; p < 0.05), reflecting both the increased service rate per visit and increased numbers of visits by patients. Dentists provided less restorative, prosthodontic and extraction services per year, but more endodontic and crown and bridge services. The pattern of annual care received per patient also included more endodontic and crown and bridge services but differed from the dentist pattern through increased service rates over the study period in areas such as restorative, diagnostic and preventive. CONCLUSIONS: While dentists are providing a similar number of services annually, the content of their workload has changed to include less emphasis on removal and replacement of teeth and more effort on maintenance and retention of natural dentitions.

Where is UK general dental practice going?

Dentistry is a fundamental part of healthcare; without it a large proportion of the population would suffer severe detriment to their general health. However, in order to achieve our professional aims we have to pursue the business of dentistry.