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The aim was to evaluate the establishment of an aseptic endodontic operative field in general dentistry by assessing general dentists' ability to reduce the amount of contamination to a non-cultivable level, and to compare the operative field asepsis at a general dentistry clinic with that at an endodontic specialist clinic. A total of 353 teeth were included in the study (153 in general dentistry, 200 at the specialist clinic). After isolation, control samples were taken, the operative fields disinfected with 30% hydrogen peroxide (1 min) followed by 5% iodine tincture or.5% chlorhexidine solution. Samples were collected from the access cavity area and buccal area, placed in a fluid thioglycolate medium, incubated (37°, 7 d), evaluated for growth/non-growth. Significantly more contamination was observed at the general dentistry clinic (31.6%, 95/301), than at the endodontic specialist clinic (7.0%, 27/386) (p <.001). In general dentistry, significantly more positive samples were collected in the buccal area than in the occlusal area. Significantly more positive samples were collected when the chlorhexidine protocol had been used, both in general dentistry (p <.001) and at the specialist clinic (p =.028). The result from this study shows insufficient endodontic aseptic control in general dentistry. At the specialist clinic, both disinfection protocols were able to reduce the amount of microorganisms to a non-cultivable level. The observed difference between the protocols may not reflect a true difference in the effectiveness of the antimicrobial solutions, as confounding factors may have contributed to the result. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to gain knowledge about the dentist's use and choice of digital extraoral imaging methods, panoramic radiography and cone beam computed tomography (CBCT).Materials and Methods: A questionnaire sent to 2481 dentists within the Swedish Dental Society contained questions about the panoramic technique and CBCT technique used, education, clinic size and type of service. The response rate was 53%.Results: The study showed that 61% of the Swedish dentists had access to panoramic techniques and that 84% used a direct digital sensor, while 6% used storage phosphor plate techniques. Around 8% of the Swedish dentists had access to CBCT. It was also observed that group practices had two times higher odds of having panoramic equipment compared with solo practices. Approximately 40% of the dentists had undergone postgraduate education in oral radiology during the last 5 years. Dental nurses and dental hygienists exposed 92% of the panoramic radiographs and 75% of the CBCTs. Thirty per cent of those clinics with access to a panoramic unit exposed >30 panoramic radiographs per month and 56% of the clinics having access to CBCT did more than 75 examinations per year.Conclusions: Today 61% of Swedish dentists have access to panoramic radiography and 8% have access to CBCT. There is a greater likelihood of having access if the dentist works in the public dental health service or in a group practice and if the dentist has undergone any postgraduate course in oral radiology. [ABSTRACT FROM AUTHOR]

Background: The prescription rate for antibiotics in dental clinics is not declining despite the increase in the antibiotic resistance problem. In this study, we observed the change in antibiotic prescription rates by dentists in a Korean dental hospital for various treatments after conducting interventions targeting dentists.Methods: The first intervention was to distribute guidelines. The second intervention was to remove the bundled prescription button containing antibiotics from the Electronic Medical Record system. A total of 22,098 treatment records were divided into 12 main treatment categories, and Chi-square tests and logistic regression analyses were performed.Results: After the interventions were applied, the overall prescription rate for antibiotics dropped. The antibiotic prescription rate decreased by an odds ratio of 0.774 (95% CI: 0.686-0.873) after intervention 1 and by an odds ratio of 0.574 (95% CI: 0.501-0.658) after intervention 2. The treatments with significantly reduced antibiotic prescription rates were extraction for orthodontic treatment, dental implant surgery, extraction of an impacted tooth and general extraction. These treatments are typically performed in patients without an active infection. The prescription rate did not change for periodontal treatments or endodontic treatments, which are usually performed in patients with an infection. The prescription rate also remained constant for minor operations and other basic treatments.Conclusion: The interventions induced behavioural changes in the dentists and were effective in lowering the antibiotic prescription rates in a dental hospital. In particular, there was a significant reduction in the prescription rates for implant surgery and tooth extraction in the absence of infection. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to gain knowledge about the dentist's use and choice of digital intraoral imaging methods.Materials and Methods: A questionnaire sent to 2481 dentists within the Swedish Dental Society contained questions about the type of X-ray technique used, problems experienced with digital radiography, and reasons for choosing digital technology, and about indications, clinic size and type of service. Response rate was 53%.Results: Ninety-eight percent of the dentists had made the transition to digital radiography; only 2% used film technique, and solid-state detector (SSD) was the most used digital technique. More years in service decreases the likelihood of applying individual indications for performing a full mouth examination. More retakes were done with SSDs compared to storage phosphor plates. Reasons for choosing digital techniques were that work was easier and communication with the patients improved. However, dentists also experienced problems with digital techniques, such as exposure and projection errors and inadequate image quality. The Swedish Radiation Safety Authority states that all radiological examinations should be justified, something not always followed.Conclusions: This study showed that 98% of the respondents, Swedish dentists within the Swedish Dental Society, used digital techniques, and the most used was the solid-state technique. [ABSTRACT FROM AUTHOR]

Objective: A trend towards the state governance of healthcare through quality indicators and national clinical guidelines has been observed, and it is argued that this trend can be a challenge to the autonomy of healthcare professionals. In Sweden, these regulatory tools have been implemented in combination with subsidies for adult dental care that are based on guideline recommendations which serve to ensure that dental care is evidence-based and cost-effective. This paper aims to analyse the implications of these changes regarding dentists' autonomy and whether the government's political intentions can be fulfilled.Material and Methods: The paper is based on documents from government authorities and professional theories.Results: The financial control over Swedish dental care has been strengthened, and it can be argued that this is a step in the right direction from a societal point of view, as public resources are limited. Dentists' professional autonomy with their patients is not affected, which is appropriate, as patients should be treated according to their individual needs and expectations.Conclusions: This article shows that the state's governance does not directly detail dentists' work, which indicates a balance between state governance and dentists' autonomy. However, further research is required to get knowledge on Swedish dentists' view of the governance. [ABSTRACT FROM AUTHOR]

Objective:The work of a health care leader is demanding; in order to cope, leaders need motivation and support. The occurrence of intrinsic factors called career anchors (combination of one’s competence, motives and values) could be a contributing factor in dentist leaders’ career decisions. The aim of our study was to identify dentist leaders’ career anchors and their association to dentist leaders’ retention or turnover of the leadership position. Material and methods:Materials were gathered in 2014 via an electronic questionnaire from 156 current (Leaders) or former (Leavers) Finnish dentist leaders. Career anchor evaluation was conducted by the questionnaire and scoring-table taken from Edgar Schein’s Career Anchors Self-Assessment. Both the most and the least important career anchors were detected by the highest and lowest scores and their occurrence reported as percentages. Associations between career anchor scores and tendency to stay were analyzed with logistic regression. Results:‘Technical/Functional Competence’ and ‘Lifestyle’ were most frequently reported as the most important and ‘Entrepreneurial Creativity’ and ‘General Managerial Competence’ as the least important career anchors. However, a higher level of ‘General Managerial Competence’ anchor was most significantly associated with staying in a leadership position. Instead, ‘Pure Challenge’ and ‘Lifestyle’ decreased the odds to stay. Conclusions:The knowledge of the important and essential career anchors of dentist leaders’ and individuals’ could perform crucial part in career choices and also in planning education, work opportunities and human resource policies promoting retention of dentist leaders and probably also other health care leaders. [ABSTRACT FROM PUBLISHER]

Objective: By 2023, fewer dentists are expected in Sweden, at the same time as the demand for dental care is expected to increase. Older people, in particular, are expected to require more dental health than previous generations. To meet this demand, the public sector dentistry in Sweden is moving towards changes in division of labour among dental professionals, including dentists, dental hygienists and dental nurses. However, the impact of this reallocation on the physical and psychosocial wellbeing of employees is unknown. The aim of this study was to compare workplaces with an equal or larger proportion of dental hygienists than dentists (HDH) with workplaces with a larger proportion of dentists than dental hygienists (HD) on the physical and psychosocial work load, musculoskeletal and psychosomatic disorders and sickness presence.Material: A total of 298 persons employed in the Public Dental Service in a Swedish County Council participated in this study.Conclusion: The medium large clinics HDH reported 85% of employee's with considerably more high psychosocial demands compared to employees in medium HD (53%) and large HD (57%). Employees in medium large clinics HDH also reported sleep problems due to work (25%) compared with employees in medium large clinics HD (6%), large clinics HD (11%) and small clinics HDH (3%). Clinic size does not seem to influence the outcome of the HD and HD clinics to any great extent. Of all employees, about 94-100% reported high precision demands and 78-91% poor work postures. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to investigate the self-perceived level of knowledge, attitudes and clinical experience in treatment of temporomandibular disorders (TMD) among general practising dentists (GPDs).Material and Methods: A web-based questionnaire was sent to all GPDs in the public dental health service in the County of Uppsala in 2010 (n = 128) and 2014 (n = 113). The GPDs were asked to answer questions in the following categories: Demographic information, Quality assurance, Clinical experience and treatment, Need for specialist resources in the field of TMD and Attitudes. Between the two questionnaires, the GPDs were offered TMD education and an examination template including three TMD questions was introduced in the computer case files. The results were also compared with a previous questionnaire from 2001.Results: The response rate was 71% (2010) and 73% (2014). The majority of the GPDs were women (70% in 2010 and 72% in 2014). The reported frequency of taking a case history of facial pain and headache increased between 2010 and 2014. In 2014, the GPDs were more secure and reported higher frequency of good clinical routines in treatment with jaw exercises and pharmacological intervention compared to 2001. Interocclusal appliance was the treatment with which most dentists felt confident and reported good clinical routines.Conclusions: The GPDs felt more insecure concerning TMD diagnostics, therapy decisions and treatment in children/adolescents compared to adults. There is a high need for orofacial pain/TMD specialists and a majority of the GPDs wants the specialists to offer continuing education in TMD. [ABSTRACT FROM AUTHOR]

Objective: Few studies of patient harm and harm-prevention methods in dentistry exist. This study aimed to identify and characterize dental patient safety incidents (PSIs) in a national sample of closed dental cases reported to the Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland.Materials and Methods: The sample included all available fully resolved dental cases (n = 948) during 2000-2012 (initiated by the end of 2011). Cases included both patient and next of kin complaints and notifications from other authorities, employers, pharmacies, etc. The cases analyzed concerned both public and private dentistry and included incident reports lodged against dentists and other dental-care professionals. Data also include the most severe cases since these are reported to Valvira. PSIs were categorized according to common incident types and preventability and severity assessments were based on expert opinions in the decisions from closed cases.Results: Most alleged PSIs were proven valid and evaluated as potentially preventable. PSIs were most often related to different dental treatment procedures or diagnostics. More than half of all PSIs were assessed as severe, posing severe risk or as causing permanent or long-lasting harm to patients. The risk for PSI was highest among male general dental practitioners with recurring complaints and notifications.Conclusions: Despite some limitations, this register-based study identifies new perspectives on improving safety in dental care. Many PSIs could be prevented through the proper and more systematic use of already available error-prevention methods. [ABSTRACT FROM AUTHOR]

Statement of the problem. An important aspect of dental education is teaching and learning shade matching. Objective. To assess the success of two different strategies for learning shade matching. Materials and methods. Seventy-one pre-clinical students (mean age 23; 33.3% men) were divided into two groups. One group (TTB) formed teams of two and they matched three pre-determined teeth on each other using the 3D-Master shade guide. After this exercise, they learned shade matching using a standardized device (Tooth Guide Training Box, TTB) by matching shade tabs in an artificial environment. The other group (GL) matched tooth color in a pre-defined clinical setting in groups of four students. After this, they matched the same teeth as before training, again in groups of two, similarly to group TTB. The reference tooth color was determined by two experienced prosthodontic clinicians. The L**a**b** values for the tabs were provided by the manufacturer and the color difference (Δ Eab) between the chosen tab and the reference was calculated. Linear general estimation equation models were used for statistical evaluation ( p == 0.05). Results. In the TTB group, the difference between Δ Eab values before and after training was 0.03, which was not significant ( p == 0.927; 95% CI: −0.70/0.77). In the GL group, Δ Eab was 0.98 smaller after training, which was significant ( p < 0.001; 95% CI: 0.50/1.50). Conclusion. The ability to match tooth color could be improved by using a group-learning approach in a clinical setting and implementation of such a training session should be considered in undergraduate and postgraduate dental education. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to make a clinical comparison of the chemomechanical method for caries removal and the conventional rotary instruments technique when used in children and adolescents. Material and Methods . The study comprised 120 patients aged 3-17 years randomized into two groups: caries were removed chemomechanically in 60 patients and 60 patients received conventional treatment with rotary instruments. The outcome variables were: clinically complete caries removal, pain during caries removal, need for local anesthesia, treatment time, preferences of patients, and clinical success of the restorations during the 12-month evaluation period. Results. Complete caries removal was achieved in 92% of chemomechanically treated teeth and in all teeth treated with rotary instruments (p>0.05). The chemomechanical method significantly reduced the need for local anesthesia (p<0.001). Eighty-five percent of patients treated with Carisolv and 47% treated with rotary instruments were satisfied with the treatment (p<0.05). The mean time for chemomechanical caries removal was 11.2±3.3 min and 5.2±2.8 min for caries removal with rotary instruments (p<0.001). At the end of the 12-month evaluation period, there was no observed influence of the caries removal method on the survival of the restorations. Conclusions. The chemomechanical caries removal technique is an adequate alternative to the conventional rotary instruments method and is advantageous in pediatric dentistry. [ABSTRACT FROM AUTHOR]

Objective. There is little information on antibiotic prescribing habits among dentists in general. In 1992 we reported a study among Norwegian dentists, and the present investigation was undertaken to find out if the patterns of antibiotic prescription had changed since then. Material and methods. A total of 470 randomly selected dentists (10% of total) received a questionnaire and a letter describing the survey and 313 responded. Results. Results indicated that 35% did not issue any prescriptions in a typical week, while 3% issued &nvge;5. Fifty percent reported that they might prescribe antibiotics when treating periodontal diseases, but only 3.4% reported the use of microbial diagnosis before selecting an antibiotic; 71% of the respondents reported use of antibiotics occasionally to prevent general complications of dental treatment; 80% prescribed antibiotics for prophylactic use if the patient revealed a history of endocarditis, while 5% reported never doing so. Conclusion. These findings are in concert with the results obtained 11 years ago, but indicating that dentists who had attended postgraduate courses on antibiotics prescribed such drugs more frequently. This was not statistically significant. However, it is of great concern that 5% never prescribed antibiotics when treating patients with a history of endocarditis, and that 20% did not know that amoxicillin was a penicillin. Such lack of knowledge may cause fatal results of therapy. [ABSTRACT FROM AUTHOR]

In a previous study, dentists reported very high scores for perceived physical workload, but only low to moderate scores for the musculoskeletal system. This is difficult to explain when other occupational groups in the dental services are compared, and is the main reason why the present study was performed. To measure muscular activity, a surface electromyography (sEMG) study was done, and included the subjects who reported neck and shoulder complaints in the previous study. A portable sEMG system (MyoGuard) was used to collect a myoelectric signal on-line and analysis of the myoelectric signal in a computer. sEMG was recorded from both trapezius muscles for approximately 4&ThickSpace;h during an ordinary working day. Twenty-seven dentists participated in the study. The results show accumulated rest% fairly close to that of female cashiers and supermarket employees and increased average rectified value percent (ARV%) during work that could contribute to the very high workload perceived by dentists. [ABSTRACT FROM AUTHOR]

Three UEDMA/TEGDMA (50:50 by weight) based dental composites were made, each with filler loadings of 53 vol.%. The three composites contained silane-treated filler particles with average particle diameters of 1.5, 3.0, or 10.0 microm. Twelve specimens per composite were mounted on wear wheels and run through 200,000 cycles in an ACTA wear machine. Six of these specimens per material were worn in slurries consisting of 30 g ground Millet seed shells and 120 g ground rice mixed with 275 mL water. The remaining six specimens were worn in similar 25% ethanol-water slurries. The composite wear profiles were recorded with a profilometer and used to calculate the wear. Hardness values of the composites were also measured both before and after storage for 2 weeks in either water or in a 25% ethanol water solution. The wear and hardness values from the measurements were analyzed using ANOVA. The wear analysis showed that the finer composites (1.5 microm filler diameter) wore the least and the coarsest composites (10 microm filler diameter) the most. The wear was significantly higher in the ethanol water slurry than in the water slurry. The hardness value of the coarsest composite decreased more than the finest composite during storage in water or 25% ethanol water. The hardness decrease was most pronounced in the alcohol solution. [ABSTRACT FROM AUTHOR]

The aim of this study was to elucidate whether a premaxilla with a supernumerary tooth has additional dental abnormalities. The study does not include premaxillas with a mesiodens, only premaxillas with parasagittally located supernumerary teeth. Radiographs from eight children, followed from 1 year and 5 months to 11 years and 5 months in the municipal dental health service in Denmark, were analyzed. One patient was seen only once. Dental abnormalities recorded included: invaginations on permanent incisors, resorption of roots of incisors, curved roots of incisors, delayed eruption, and delayed formation of roots. The study shows that there are dental abnormalities within the premaxillary region where the supernumerary tooth is located. This indicates that, apart from the supernumerary tooth, a more widespread deviation from normal conditions including tooth malformation, arrested eruption, and root resorption occur within the premaxillary region. The most important outcome of this study is that in the region with a supernumerary tooth the adjacent incisor shows delayed eruption after surgical removal of the supernumerary tooth. The deviations in root morphology, including root resorption, are not limited to patients who have had orthodontic treatment, but patients who did not receive orthodontic treatment also revealed deviations in root morphology. Therefore the treatment outcome can be different from the expected outcome. [ABSTRACT FROM AUTHOR]

This study compares the dental health of dentists with that of their population counterparts, and relates dentists' oral health to oral health behavior and professional preventive knowledge and orientation. A questionnaire requesting information on the dentists' oral health, preventive knowledge, and orientation and oral health behavior, was targeted at all actively practicing dentists (n = 250) in the Mongolian capital of Ulaanbaatar. A self-reported dentigram served as the basis for assessing dental health, while the 1996 National Oral Health Survey provided data for comparison with population counterparts. The response rate was 98%. Compared to their general-population counterparts, younger dentists exhibited a similar level of caries experience (DMFT) and missing teeth (NMT), whereas older dentists exhibited a lower level. In all age groups, mean numbers of decayed teeth (DT) among dentists were much smaller than for their population counterparts, whereas mean numbers of filled teeth (FT) were much higher. Of all, 81% reported brushing their teeth twice daily or more, 62% used fluoride-containing toothpaste always or almost always, and 52% consumed sugar-containing foods between main meals less than once a day. The better oral health behavior of dentists was best explained by their greater preventive knowledge and their better dental health by better oral health behavior in logistic models. It is concluded that among these dentists there is room for improvement of their own oral health behavior. Towards this end, specially designed continuing education courses could serve to improve dentists' health-related knowledge and change their oral self-care behavior. [ABSTRACT FROM AUTHOR]

The revised version of the Dental Beliefs Survey (DBS-R), intended to measure three dimensions of the patient dentist relationship as perceived by the patient, namely Ethics, Communication and Control, was tested in a confirmatory factor analysis. Five different models for the internal structure of the questionnaire were tested. The final model, a 5-factor solution, basically including the 3 assumed dimensions as well as the re-introduced dimension Trust covered in the first version of the DBS plus a global factor including all items, yielded an acceptable fit. This model also omits 4 items from DBS-R, i.e. items 3, 11, 18, and 28. The reduced DBS-R is recommended for clinical use when assessing the patient's perception of the relationship to the dentist, including both trust and ethical behavior. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify differences and similarities between the Nordic countries in dentists' use of dental amalgam as a restorative material, and also their knowledge and attitudes about amalgam from health, environmental, ethical, economic and social points of view. Procedures for handling amalgam waste were also studied. A random sample of 250 dentists was drawn from the national registers of authorized dentists in each country in late autumn 1997. At the beginning of 1998, a questionnaire was sent to all the dentists in the study group. The response rate was 77.6% in Denmark, 73.2% in Finland, 78.8% in Norway, and 84.0% in Sweden. In Finland and Sweden the use of dental amalgam had almost ceased, particularly for younger patients, while in Norway and especially in Denmark it was still widely used. Dentists' knowledge of the environmental effects of amalgam was confused, but most dentists had installed amalgam separators in their dental units by 1998. The majority of dentists in each country wanted to keep dental amalgam as a restorative material even in the future, and they did not want to ban the import of mercury to their home countries. Most dentists considered amalgam to be a health risk for at least some patients, and a great majority (from 76% in Sweden to 94% in Norway) considered composite as a possible odontological risk to patients. Since a majority of the dentists considered both amalgam and composites possibly harmful to patients, efforts to develop better alternatives to amalgam should continue. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate cooperation between dentists and denturists in Finland, particularly in relation to perceived competition between the two professions. From a representative sample of 350 private dentists and 253 denturists, 68% returned acceptably filled-in questionnaires dealing with competition and cooperation with other healthcare professionals. Dentists referred their patients significantly (P < 0.001) less often to denturists (26.2%) than denturists did to dentists (94.1%). Those who referred their patients to members of the other profession also received patients from the other profession significantly (P< 0.001) more often than those who did not (60.7% vs 16.7% among dentists; 90.0% vs 44.4% among denturists). Denturists saw themselves as competing with dentists (56.0%) significantly (P< 0.001) more often than dentists did with denturists (29.2%). Dentists practicing in small towns or rural areas cooperated more often with denturists than did those practicing in more urban areas. Among denturists, the likelihood of referring patients to dentists was associated with younger age and fewer clinical working hours. It was concluded that cooperation between dentists and denturists was common. Oral healthcare professionals who referred their patients to the other profession also benefited by receiving more patients on referral from them. Dental services provided by denturists are limited, which may explain their greater willingness to cooperate with dentists. [ABSTRACT FROM AUTHOR]

Studies in the Scandinavian countries have shown that orthodontists run an equal or even greater risk of contracting dermatitis compared to other dental personnel. The aim of the study was to find out whether the self-reported occupation-related health problems of general dental practitioners and orthodontists differ from those of office employees in Finland. The subjects were 147 general dentists, 81 orthodontists and 99 office employees (77% women and 23% men). The data were collected using a mailed questionnaire. Within the past year, 42% of the subjects had had occupational health problems, while 51% had experienced symptoms in the previous year or earlier. The complaints of hand dermatoses, musculoskeletal, as well as respiratory symptoms were significantly more common among women than among men. Musculoskeletal complaints were the most common symptoms in all occupational groups, but the odds ratio of having them were significantly higher for dental professionals compared to office employees. The frequency of self-reported hand dermatoses was 42% for dental professionals and 26% for office employees, but the difference did not reach statistical significance. The odds of having hand dermatoses were higher for atopic subjects and for women. Orthodontists did not differ from general practitioners in respect of any of the complaints reported. Materials used in dentistry were mentioned as the cause of symptoms by 49 (21.5%) of the dental professionals. The present results show an increased risk of self-reported musculoskeletal symptoms for the dental professionals. Also, a tendency towards increased occurrence of skin symptoms was noted for the dental professionals compared to office employees of this study. [ABSTRACT FROM AUTHOR]

In this article we report on how 64 dentists working in a big city in southern Sweden view their profession. The dentists ranged in age from 30 to 70 years (as it was indicated in intervals of 10 years). Their professional experience ranged from 2 to 44 years (mean, 23 years). We collected their views on the ideal skills of a good dentist by means of a questionnaire. From this material we identified three categories: 1) interpersonal skills; 2) clinical skills; and 3) others, such as self-confidence, stress tolerance, and managerial and administrative skills. Next, they rated the relative importance of a number of listed attributes in dentistry in this order: contact with patients, communication skills, empathy, manual skills, and theory. Finally, they described a number of aspects of their profession. We conclude that the importance of interpersonal skills, as well as stress tolerance and administrative skills, is emphasized by experienced practitioners but that these skills are not focused on in the dental curriculum. [ABSTRACT FROM AUTHOR]