Awareness and Incorporation of the Dental Home Concept Among General Dentists and Dental Therapists in Malaysia

Background The dental home concept (DHC) refers to an approach in oral healthcare that emphasizes establishing a long-term, comprehensive, and family-centered relationship between a patient and their primary dental care. This study determined the awareness and incorporation of the DHC among general dentists and dental therapists in Malaysia. Methodology A total of 154 general dentists and 137 dental therapists providing oral healthcare services at the Ministry of Health (MOH) primary care facilities throughout Malaysia participated in this cross-sectional study. A self-administered questionnaire was used to measure the respondents' awareness of the DHC and incorporation of the DHC characteristics into their practice. Results Most dentists and dental therapists (61.7% and 67.2%, respectively) had not heard of the term DHC and were unaware of the concept. The respondents' awareness was not associated with their age, sex, years of service, facility location, and percentage of treatment given to children aged five years and below. However, most dentists and dental therapists responded positively about incorporating most DHC characteristics into their current practice. Conclusions Most dentists and dental therapists serving the MOH primary oral healthcare facilities were unaware of the DHC, although most DHC characteristics have already been incorporated into their practice. This study provides evidence of the incorporation of the DHC into the MOH primary oral healthcare services and suggests an effort to increase the awareness of the workforce regarding the concept and its implementation.

Current endodontic practice and use of newer technologies in Australia and New Zealand

BACKGROUND

This study investigated endodontic clinical preferences, adoption of newer technologies and information sources among dentists and endodontists.

METHODS

Dental and endodontic society members in Australia and New Zealand were surveyed online regarding their endodontic treatment preferences, armamentarium, information sources and continuing professional education (CPE) attendance.

RESULTS

Complete responses were received from 71 endodontic specialists or postgraduates (Group E) and 139 general dentists (Group D). Most of Group E used dental operating microscopes (95.8%), endodontic cone-beam computed tomography (CBCT; 98.6%) and calcium silicate-based materials (CSBMs; 97.2%), significantly more (P < 0.001) than Group D (86.3% used loupes, <32% used CBCT for endodontics or CSBMs). Most respondents used dental dam always for endodontics (94.3%), electronic apex locators (EAL; 81.0%) and engine-driven nickel-titanium (NiTi) instruments (91.4%); Group E had more experience with engine-driven NiTi (P < 0.001). Endodontic CPE attendance was highest at dental association programs (P < 0.001) while hands-on NiTi training attendance was highest via commercial companies (P < 0.05). Online information sources were commonly used (38.8% of Group D, 59.2% of Group E).

CONCLUSION

Dental dam, EAL and engine-driven NiTi were almost universally used. The endodontic group reported high adoption of newer endodontic technologies. Endodontic CPE and information sources should be further surveyed as online engagement evolves. © 2023 Australian Dental Association.

Analysis of Smile Aesthetic Changes With Fixed Orthodontic Treatment

INTRODUCTION

 The mouth and teeth are vital in facial aesthetics and the face as a whole is the most critical individual component determining one's physical look. As dentists, we need to be aware that this might significantly alter the care given to a patient since the patient's and the dentist's ideas of beauty may be quite different. This study sought to ascertain how the general public, general dental specialists, and orthodontics all rated the attractiveness of patients who had received orthodontic treatment using a visual scale, as well as how the facial reference could be used to gauge the improvement in smiles.

METHODOLOGY

 The attractiveness of 80 continuously treated patients was assessed by comparing their pre- and post-treatment posed grin images. The attractiveness of participants' smiles was evaluated using the Visual Simple Scale, which measures affect, and the Graph of Facial Stylish Reference, which measures objectively. "Making a Jazzy Face Chart" - The analysts were able to fairly evaluate changes in elements such as the symmetry of the smile twist, the position of the gingival peak of the front teeth relative to each other, the height of the incisal edges of the front teeth, the width of the connector band of the front six teeth, and the general tip of the front teeth by referring to photographs taken during treatment. We put the Visual Basic Scale to the test by having five male orthodontists, five male general dental specialists, and five male laypeople rate how much of an improvement they noticed between the before and after photos of a patient's smile.

RESULTS

 According to the findings of the first section of the research, orthodontic treatment generally leads to an increase in all indicators. Some instances, however, demonstrated worsening in characteristics such as grin arc consonance, gingival zenith location relative to each other, and incisal edge height. The second half of this research revealed that the opinions of orthodontic specialists, general dentists, and the general public varied with regard to the beauty of a smile.

CONCLUSION

 Based on this research, we can say the following: Orthodontic treatment led to improvements in many of the variables that contribute to smile attractiveness, factors include the interproximal width of contact area, the height of the incisal margins of the front teeth, and the location of the gingival zenith in relation to one another, to name a few. The results of this research support the idea that the aesthetics of the smile should be assessed at the last stages of orthodontic treatment when fine adjustments are being made.

Perceptions, attitudes and factors that influence prescribing by general dentists in Australia: A qualitative study

BACKGROUND

Longitudinal studies of dental prescribing in Australia show that dentists make some inappropriate prescribing choices; literature has shown that dentists tend to overprescribe antibiotics and prescribe for incorrect indications. The unnecessary use of antibiotics is a contributing factor towards the development of antibiotic resistance. The aims of the study were to obtain a greater understanding of the perceptions, attitudes and factors that influence dental prescribing for all major relevant drug classes.

METHOD

Semi-structured interviews of 15 purposively sampled dentists practising in Victoria, Australia were conducted from June-September 2018. Two dentists practised in rural areas and the remainder in urban locations. The range of clinical experience varied from 2.5 to 37 years, with a mean of 13 years. The transcripts were analysed thematically.

RESULTS

Dentists generally preferred amoxicillin as first-line therapy for odontogenic infections, with some confusion about the spectrum and uses of antibiotics. Overprescribing was evident, mostly due to basing judgement for use of antibiotics on symptoms rather than clinical signs. Other factors, such as time pressure, patient expectations, pressure from assistant staff, concern about online criticism and medico-legal considerations, influenced prescribing. Of the dentists who prescribed anxiolytics, most did not have a care protocol for their sedated patients.

CONCLUSION

A variety of prescribing practices were described, and future interventions should target misconceptions around the appropriate use and choice of antibiotics, resources to address the shortfall in knowledge of therapeutics, patient education and staff training, as well as appropriate care and monitoring of sedated patients.

Low reproducibility between oral radiologists and general dentists with regards to radiographic diagnosis of caries

AIM

Early clinical and radiological diagnosis of dental caries is one of the fundamental objectives of clinical dentistry because of the high frequency of the disease and severe complications if caries remains untreated, especially among the elderly and patients with immunodeficiency. Dental panoramic tomography (DPT) is a common radiographic method for evaluating dentition when indicated, especially in an adult population. The aim of this study was to assess the reproducibility of diagnosis between specialists in oral radiology and general dentists with regards to caries lesions based on DPTs of adults.

MATERIAL AND METHODS

One-hundred DPTs taken from adult patients (average age 35) and then analyzed and reported on by 42 general dentists were then analyzed independently by two specialists in oral radiology with respect to caries lesions in the premolar and molar areas using radiographic criteria established for caries diagnosis. The general dentists versus oral radiologists were not calibrated before. Level of agreement between specialists and general dentists was measured using Cohen's kappa.

RESULTS

Comparison between observations of general dentists and specialists in oral radiology showed that 61% of the caries lesions on proximal surfaces of premolars and molars observed by specialists went unobserved by general dentists. Cohen's kappa value for specialists was 0.85 (p < .001) and for each specialist and general dentists 0.48 (p < .001) and 0.44 (p < .001).

CONCLUSIONS

The reproducibility between specialists in oral radiology and general dentists for detecting caries in DPTs was low.

Oral health care for patients with developmental disabilities: A survey of Michigan general dentists

AIMS

The aim of this study to examine the level of access to dental care in Michigan for individuals with DD and explore the dentists' practices, attitudes, and perceived barriers to providing care to this vulnerable population.

METHODS AND RESULTS

A survey was mailed to a random sample of 1250 general dental practitioners with an active license in the State of Michigan. The survey included questions related to dentists' demographic information, opinion about willingness, barriers, and training needs associated with delivering care to children and adults with developmental disabilities. Descriptive statistics were computed and chi-squared tests and logistic regression models analyzed the association between predictor and key outcome variables. Results show that most dentists treated individuals with developmental disabilities (80.3%). Respondents who indicated that they currently do not treat these patients identified behavior management of patient (67.9%), inadequate training and experiences (52.4%) and severity of patient's condition (41.7%) as the most common reasons for not providing care to individuals with developmental disabilities.

CONCLUSION

A majority of Michigan general dentists treat patients with developmental disabilities. Addressing barriers like training and improved reimbursements might help in increasing the number of dentists willing to treat patients with developmental disabilities.

Cryosurgery: A Simple Tool to Address Oral Lesions

AIM

The study was aimed at evaluating the efficacy of cryosurgery in the management of oral mucosal lesions. Time taken for healing, postoperative pain, secondary infection, and recurrence of lesion was evaluated.

MATERIALS AND METHODS

A total of 30 patients with oral mucosal lesions were included in the study. The patients were evaluated for pain and postoperative infection which was documented on the 1st, 3rd, 7th, 21st day after the procedure. Other parameters such as healing time and scarring were assessed at 21st day. Recurrence of the lesion was evaluated in the 3rd and 6th postoperative month. All these data were statistically evaluated.

RESULTS

The pain and swelling which reduced mainly during the 7th postoperative day which was highly significant. The discomfort of the patient was relatively less. Only three patients showed delayed healing out of all patients. Recurrence of lesion was noted in two cases which conclude to about 6.7%.

CONCLUSION

The cryosurgery is overall a better modality for treatment of oral lesions as it is more reasonable with adequate success. The procedure is relatively more acceptable and has shown to have a faster recovery.

Quality of Impressions and Work Authorizations Submitted by Dental Students Supervised by Prosthodontists and General Dentists

Preclinical fixed prosthodontics is taught by Department of Prosthodontics faculty members at Virginia Commonwealth University School of Dentistry; however, 86% of all clinical cases in academic year 2012 were staffed by faculty members from the Department of General Practice. The aims of this retrospective study were to quantify the quality of impressions, accuracy of laboratory work authorizations, and most common errors and to determine if there were differences between the rate of errors in cases supervised by the prosthodontists and the general dentists. A total of 346 Fixed Prosthodontic Laboratory Tracking Sheets for the 2012 academic year were reviewed. The results showed that, overall, 73% of submitted impressions were acceptable at initial evaluation, 16% had to be poured first and re-evaluated for quality prior to pindexing, 7% had multiple impressions submitted for transfer dies, and 4% were rejected for poor quality. There were higher acceptance rates for impressions and work authorizations for cases staffed by prosthodontists than by general dentists, but the differences were not statistically significant (p=0.0584 and p=0.0666, respectively). Regarding the work authorizations, 43% overall did not provide sufficient information or had technical errors that delayed prosthesis fabrication. The most common errors were incorrect mountings, absence of solid casts, inadequate description of margins for porcelain fused to metal crowns, inaccurate die trimming, and margin marking. The percentages of errors in cases supervised by general dentists and prosthodontists were similar for 17 of the 18 types of errors identified; only for margin description was the percentage of errors statistically significantly higher for general dentist-supervised than prosthodontist-supervised cases. These results highlighted the ongoing need for faculty development and calibration to ensure students receive the highest quality education from all faculty members teaching fixed prosthodontics.

Quantifying Appointments, Treatment Time, Impressions, and Diagnostic Data of Cases Staffed by General Dentists and Prosthodontists in a Dental School Clinic

The aim of this retrospective study was to quantify differences between general dentists and prosthodontists regarding appointments, treatment time, impressions, and preoperative diagnostic data in teaching predoctoral clinical fixed prosthodontics. Electronic dental records (n=356) of patients treated at one dental school in academic year 2012 were randomly selected for review to obtain the following data: faculty and student demographics, number of appointments and treatment time from preparation to cementation, number of impressions made, completion of oral disease control treatment (ODCT), and presence of preoperative periapical radiographs and diagnostic casts. The results showed that ODCT was completed in 78%, preoperative radiographs were present in 76%, and diagnostic casts made in 53% of the cases reviewed. There was no statistically significant difference in number of appointments, treatment time, or number of final impressions when students were staffed by general dentists or prosthodontists. When students were supervised by multiple faculty members, there was generally an increase in treatment time and number of appointments and final impressions. Although this study found no statistically significant differences between general dentists and prosthodontists regarding the criteria evaluated, the results suggest that faculty development and calibration are needed to ensure ODCT is completed and preoperative radiographs are present prior to initiating fixed prosthodontic procedures.

Perceptions of single-visit and multiple-visit endodontic treatment: a survey of endodontic specialists and general dentists in Hong Kong

AIM

To study the preference of practice for single- and multiple-visit endodontic treatment by Hong Kong endodontists and general dental practitioners (GDPs), and to investigate their reasons for choosing single- or multiple-visit treatment in their practice.

METHOD

An anonymous questionnaire was mailed to all 16 registered endodontists and 800 randomly selected GDPs in Hong Kong to explore their preference and reasons for selecting single- or multiple-visit endodontic treatment for their patients. Information on the use of magnifying loupes, microscopes and the number of years they have been in dental practice was also collected.

RESULTS

Eight endodontists and 429 GDPs returned their questionnaires and the response rate was 50% and 53.6% respectively. Among the GDPs, 404 (94.2%) undertook endodontic treatment in their practices. For those performing endodontic treatment, the mean number of years of practice was 23.6 ± 4.8 for endodontists and 15.3 ± 9.1 for GDPs. Seven endodontists (87.5%) used a surgical microscope. For GDPs, only 25 (6.2%) used a surgical microscope and 123 (30.4%) used magnifying loupes during endodontic treatment. Seven endodontists (87.5%) and 375 GDPs (92.8%) predominantly performed multiple-visit treatment. The commonest reasons for choosing multiple-visit treatment for both endodontists and GDPs were the positive effects of interappointment medications (n = 3, 37.5%) and that the tooth to be treated had doubtful prognosis (n = 103, 25.5%). The commonest reason for choosing single-visit treatment for both endodontists and general dentists was that treatment could be completed in one visit (n = 4, 50%) and (n = 127, 31.4%).

CONCLUSION

Most Hong Kong endodontists and GDPs preferred offering multiple-visit endodontic treatment.

Interest and satisfaction of dentists in practicing periodontics: A survey based on treatment of gingival recession

BACKGROUND

Gingival recession is a common occurrence and patients often report to dental clinic with associated problems such as root surface hypersensitivity, esthetic concerns, cervical root abrasions, and root caries that make it a concern for patients. Based upon the fact that gingival recession is an enigma for clinicians because of multitude of etiological factors and plethora of treatment modalities present for its treatment, a survey was conducted to assess knowledge as well as opinion about most common etiology, classification, and preferred treatment of gingival recession and to evaluate the interest and satisfaction of dentists in practicing periodontics.

MATERIALS AND METHODS

Study design consisted of a cross-sectional online survey, conducted among dentists practicing in state of Punjab, India, in the month of April 2011. A structured online questionnaire consisting of 17 questions evaluating the interest of dentists in periodontics based on knowledge about gingival recession (most of them giving the possibility of multiple choices of answers) was sent to about 300 dentists. Pearson Chi-Square and Mann-Whitney U tests were used for statistical analysis of data collected. P ≤ 0.05 was considered as statistically significant and P ≤ 0.01 considered as highly significant.

RESULTS

A greater proportion of periodontists had better knowledge about etiology (P = 0.07), classification (P = 0.000), and treatment of gingival recession (P = 0.000). A greater number of periodontists opted for the surgical modalities to correct the defects produced by gingival recession as compared to non-periodontists and had better interest (P = 0.000) and satisfaction (P = 0.000) in practicing periodontics.

CONCLUSION

The results elucidated that periodontists had better interest and satisfaction in practicing periodontics, and were more inclined towards surgical correction of gingival recession as compared to non-periodontists.

Oral and pharyngeal cancer control through continuing education

A standardized continuing education course was developed to determine if behavior in dental practices could be modified to improve office participation in oral and pharyngeal cancer control through early detection and tobacco-use cessation.