Sealants and dental caries: insight into dentists' behaviors regarding implementation of clinical practice recommendations.
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BACKGROUND: The authors conducted a qualitative study of private-practice dentists in their offices by using vignette-based interviews to assess barriers to the use of evidence-based clinical recommendations in the treatment of noncavitated carious lesions. METHODS: The authors recruited 22 dentists as a convenience sample and presented them with two patient vignettes involving noncavitated carious lesions. Interviewers asked participants to articulate their thought processes as they described treatment recommendations. Participants compared their treatment plans with the American Dental Association's recommendations for sealing noncavitated carious lesions, and they described barriers to implementing these recommendations in their practices. The authors recorded and transcribed the sessions for accuracy and themes. RESULTS: Personal clinical experience emerged as the determining factor in dentists' treatment decisions regarding noncavitated carious lesions. Additional factors were lack of reimbursement and mistrust of the recommendations. The authors found that knowledge of the recommendations did not lead to their adoption when the recommendation was incongruent with the dentist's personal experience. CONCLUSIONS: The authors found that ingrained practice behavior based on personal clinical experience that differed substantially from evidence-based recommendations resulted in a rejection of these recommendations. PRACTICAL IMPLICATIONS: Attempts to improve the adoption of evidence-based practice must involve more than simple dissemination of information to achieve a balance between personal clinical experience and scientific evidence. (+info)
Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success.
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Residents of La Crosse, Wisconsin approved a public referendum in favor of water fluoridation on April 5, 1988. The vote, 57 percent supportive, culminated a two-year community effort. Three public referenda had been defeated in the past. Contributing to the success of this recent campaign were: broad-based community support led by a 34-member Citizens for Better Dental Health in La Crosse Committee; American Dental Association/Wisconsin Division of Health/US Public Health Service consultation and support; knowledgeable and supportive press coverage; the timing of the ballot to coincide with the Wisconsin Presidential Primary; and local chiropractic support to offset chiropractic anti-fluoridation leadership. La Crosse, population 50,000, was the largest fluoride-deficient community in a nine-state upper Midwest area. (+info)
The denturism initiative.
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Denturism, an organized movement by dental laboratory technicians to increase their control over the provision of denture services to the public, has generated a great deal of controversy among members of organized dentistry, the National Denturist Association, the Federal Trade Commission, consumer groups, and prepaid dental plans.Denturism is currently legal in Arizona, Colorado, Maine, and Oregon. In the first three States, the denturist must practice under the supervision of a dentist, but in Oregon the denturist is able to enter independent practice.The American Dental Association has held that a denturist is educationally unqualified to provide denture services directly to the consumer, Representatives of organized dentistry have characterized denturists as untrained and unskilled persons who would endanger the public's health and return one phase of dentistry to the apprentice system. They see denturism as constituting a major step backward in health care delivery and having an adverse effect on preventive dental care.The National Denturist Association, however, defines a denturist as a highly skilled person who specializes in the making of full and partial dentures. Denturists maintain that the dentist is an unnecessary middleman in the provision of denture services and is the primary cause of the high cost of dental prostheses. They contend that State dental laws providing that only dentists may render denture services have led to the high cost of these services without contributing significantly to the health and safety of the public.Organized dentistry in the United States has been fighting denturism in a number of ways. One that has met with considerable success has been the establishment of programs to provide people access to dental care, especially denture services, at lower costs. A second alternative under consideration is to license denturists but require them to practice under the supervision of a dentist. A third alternative under discussion is to expand the duties of existing dental auxiliary personnel.The final decision on denturism, however, will not be made by the dental profession or the denturists, but by the voting public and their elected representatives, based on the evidence they have before them. (+info)
The reaction of the dental profession to changes in the 1970s.
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This paper explores the changing realities of dentistry in the 1970s: the development of denturism; the maldistribution of dental practitioners; the growth and activities of expanded function auxiliaries; the intrusion of the Federal Trade Commission into professional issues resulting in advertising, supermarket and franchise dentistry; and the effect of prepayment plans. These realities are considered in terms of their impact on the profession and the efforts by the individual practitioner and his representative organizations to come to terms with them. (+info)
ADA supports vital tooth bleaching--but look for the seal.
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The ADA has lent its support to tooth bleaching by providing procedural codes, educational materials and product evaluation procedures. The author describes the elements of the ADA product evaluation process and the role they should play in product development. (+info)