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Practice characteristics associated with patient-specific receipt of dental diagnostic radiographs

OBJECTIVE

To quantify the role of practice characteristics in patient-specific receipt of dental diagnostic radiographic services.

DATA SOURCE/STUDY SETTING

Florida Dental Care Study (FDCS). Study Design. The FDCS was a 48-month prospective observational cohort study of community-dwelling adults. Participants' dentists were asked to complete a questionnaire about their practice characteristics.

DATA COLLECTION/EXTRACTION METHODS

In-person interviews and clinical examinations were conducted at baseline, 24, and 48 months, with 6-monthly telephone interviews in between. A single multivariate (four radiographic service outcomes) multivariable (multiple explanatory covariates) logistic regression was used to model service receipts.

PRINCIPAL FINDINGS

These practice characteristics were significantly associated with patient-specific receipt of radiographic services: number of different practices attended during follow-up; dentist's rating of how busy the practice was; typical waiting time for a new patient examination; practice size; percentage of patients that the dentist reported as interested in details about the condition of their mouths; percentage of African American patients in the practice; percentage of patients in the practice who do not have dental insurance; and dentist's agreement with a statement regarding whether patients should be dismissed from the practice. Effects had differential magnitudes and directions of effect, depending upon radiograph type.

CONCLUSIONS

Practice characteristics were significantly associated with patient-specific receipt of services. These effects were independent of patient-specific disease level and patient-specific sociodemographic characteristics, suggesting that practitioners do influence receipt of these diagnostic services. These findings are consistent with the conclusion that practitioners act in response to a mix of patients' interests, economic self-interests, and their own treatment preferences.

Factors influencing the frequency of bitewing radiography in general dental practice

The aim of this study was to determine the influence of a range of patient and dentist factors on the prescription of bitewing radiography. A postal questionnaire of general dental practitioners working in the Birmingham and Manchester areas of England was used. Dentists were requested to score the influence of 15 factors upon their decision whether or not to take bitewing radiographs. Some of these factors were chosen to represent accepted "high caries risk" factors, some "low risk" factors, while others were chosen as they should be irrelevant to prescription of bitewing radiographs. There was a questionnaire response of 70.8%. Dentists recognized accepted high caries risk factors as being an indicator for bitewing radiography but the influence of low caries risk factors was less clear. Only "good oral hygiene" and the presence of "few restorations" were perceived as relevant to bitewing prescription, while fissure sealants were seen as an influence in favour of radiography by almost one third of dentists. Dentists tended to be influenced in their radiographic practice by the opinions of patients and fears of medico-legal consequences. Pregnancy was seen as contra-indicatory for bitewings by almost all dentists. These results suggest that greater emphasis should be placed upon radiographic selection criteria in dental education.

Radiographic screening examination: frequency, equipment, and film in general dental practice in Denmark

The aim of the present study was to evaluate types and frequencies of radiographic screening examinations, and radiographic equipment and film used in general dental practice in Denmark. A questionnaire was mailed to 400 randomly selected dental practitioners. A total of 258 questionnaires were returned, out of which 249 were analyzed. Two-thirds of the respondents performed radiographic screening examinations, of which bitewing-screening was the one most frequently used for first-visit and regular patients. The more recent their graduation year, the more apt were dentists to perform radiographic screening examinations. More than 40% of the dentists had radiographic units operating at a voltage capacity of 60-70 kV, and more than 50% had facilities for automatic or semiautomatic processing. Only one-quarter of the respondents used the Kodak Ektaspeed film (E-speed film). The results show that radiographic procedures and film used in general dental practice are not always in accordance with guidelines and recommendations.