Addressing oral disease--the case for tobacco cessation services.
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There is strong scientific evidence from clinical and epidemiological studies that tobacco use, particularly cigarette smoking, is linked to periodontal disease as well as other serious but less common oral health diseases. Given the strength of this evidence, dentists must include tobacco cessation services (TCS) as part of their routine care. This paper describes barriers to the adoption of TCS as identified by Alberta dentists participating in a randomized intervention trial and discusses strategies for overcoming these barriers. As well, suggestions are made to professional associations and educational institutes on ways to increase the incorporation of tobacco cessation into professional practice standards. (+info)
Lower use of dental services among long term cigarette smokers.
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STUDY OBJECTIVE: Given the advanced stage of most oral cancer cases at diagnosis, it is hypothesised that a significant proportion of higher risk adults do not visit a dentist annually. The study objectives were to assess whether long term smokers were less likely to visit the dentist. DESIGN: Data from the 1998 Massachusetts Behavioral Risk Factor Surveillance System, a population-based, random digit dial telephone health survey, were used to evaluate whether adults at higher risk of oral cancer attributable to long term cigarette smoking were less likely to go to the dentist, controlling for socioeconomic, demographic, and health related characteristics. PATIENTS: A representative sample of 2119 Massachusetts adults aged 35 and older. MAIN RESULTS: Adults who were long term smokers were less likely than never smokers to have visited the dentist in the previous year (adjusted OR = 0.69, 95% confidence intervals (CI) = 0.48, 0.99). Moreover, adults who were at higher risk from both long term smoking and low fruit and vegetable consumption were even less likely to visit the dentist than adults with neither risk factor (adjusted OR = 0.39, 95% CI = 0.22, 0.68). Among long term smokers, the likelihood of a yearly examination decreased with increasing smoking duration and amount smoked per day. CONCLUSIONS: These findings support the hypothesis that adults at higher risk of oral cancer attributable to long term cigarette smoking are less likely to have routine dental examinations, even controlling for socioeconomic and health related differences. (+info)
Assessing outcomes of curricular change: a view from program graduates.
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Graduates of dental programs constitute a stakeholder group that is able to provide unique information concerning the effectiveness of the dental curriculum in preparing them for dental careers. Following the implementation of planned curricular changes, graduates of the former and the new curricula were surveyed. Results indicate that, while both groups perceive themselves to have been adequately prepared by their D.D.S. program for practice, graduates of the new curriculum indicated a higher level of preparedness in several areas, especially regarding selecting, prescribing and administering pharmacotherapeutic agents. In addition, the results suggest that the change in the first two years from an emphasis on basic sciences and preclinical laboratory work to an early introduction to live dental patients and the integration of foundation sciences and clinical courses were endorsed. The evidence gathered from this alumni survey indicates that the reforms implemented in the dental curriculum were appropriate. Areas requiring further investigation are also discussed. (+info)
Variation, certainty, evidence, and change in dental education: employing evidence-based dentistry in dental education.
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Variation in health care, and more particularly in dental care, was recently chronicled in a Readers Digest investigative report. The conclusions of this report are consistent with sound scientific studies conducted in various areas of health care, including dental care, which demonstrate substantial variation in the care provided to patients. This variation in care parallels the certainty with which clinicians and faculty members often articulate strongly held, but very different opinions. Using a case-based dental scenario, we present systematic evidence-based methods for accessing dental health care information, evaluating this information for validity and importance, and using this information to make informed curricular and clinical decisions. We also discuss barriers inhibiting these systematic approaches to evidence-based clinical decision making and methods for effectively promoting behavior change in health care professionals. (+info)
The reasons for extraction of permanent teeth in Scotland: a 15-year follow-up study.
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AIMS: Although Scotland has the highest proportion of edentulous adults in the UK, the frequency of edentulousness has fallen by 21% during the last 20 years. This study, carried out in 1999, was designed to establish whether the reasons for tooth loss have also changed since 1984 when they were last determined. METHODS: The Scottish Dental Practice Board provided the names of every fourth dentist on its list among which 425 general dental practitioners were identified. They were asked to record permanent tooth extractions for 1 week, specifying the age, sex and dental attendance of patients who underwent extractions and the reasons for these extractions. 352 dentists took part: a response rate of 82.8%. RESULTS: The study confirmed that there has been a reduction in the number of extractions between 1984 and 1999: there were 25% fewer teeth extracted per patient and 30% fewer per dentist per week. From 0-20 years of age, orthodontics has replaced caries as the commonest reason for extraction and in all age groups over 20 years, caries has become the commonest reason in contrast to 1984 when periodontal disease was the principal reason in patients over 40 years old. CONCLUSIONS: Caries and its sequelae remain the most important cause of tooth loss throughout adult life in Scotland and, therefore, caries prevention and maintenance of restorations are of great importance at all ages. (+info)
Clinical practice guidelines in dentistry: Part I. Navigating new waters.
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Clinical Practice Guidelines (CPGs) are tools, developed by and for practitioners, to assist in clinical decision making. They are designed to enhance, not replace, clinical judgement and expertise. Well-developed guidelines use the evidence-based approach. The research evidence related to a topic is assembled in a systematic, comprehensive and unbiased manner. Recommendations are made based on the evidence and practitioner feedback is sought prior to formulating the final practice guideline. There are many misperceptions about CPGs and some dentists are wary about their development and use. In this paper, we explore some of the reasons for these misperceptions, review the benefits of sound guidelines, and discuss some of the challenges for guideline development in dentistry in Canada (+info)
Consent: the patients' view--a summary of findings from a study of patients' perceptions of their consent to dental care.
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AIM: A study was carried out which aimed to investigate peoples' perceptions of how their consent was given for dental treatment. METHOD: A structured questionnaire was completed by 50 patients receiving treatment in the British NHS and 12 of them completed an in-depth recorded interview. The data was analysed using a combination of quantitative and qualitative methods. RESULTS: The findings showed that 80% of patients had not been given any written treatment plan (FP17DC). 79% of patients mistakenly thought that the form signed requesting NHS treatment (FP17) was a consent form. When options were offered patients were more likely to consider that they were involved in the consenting process. However consent is still often implied rather than explicit. There was a range of experience reported by patients from those who felt that the dentist made the treatment decisions to those who felt that decisions had been made collaboratively. Although some patients were happy with the way their consent was obtained examples were also given of lack of information, confusion and even of deceit. CONCLUSIONS: There is an urgent need to clarify the status of NHS documentation regarding consent and a general need for awareness to be raised in the dental profession about the importance of obtaining consent which is freely given based on appropriate information which has been adequately understood. (+info)
An introduction to economic evaluation of health care.
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Economic evaluation is an accepted method for the appraisal of health care programmes. Although it is used widely in medicine, its use in the field of dentistry has achieved popularity more recently. Economic evaluation in dentistry is likely to become increasingly important in the future and this paper introduces readers to some of the basic concepts. (+info)