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As part of a review of the undergraduate curriculum to assess its relevance for a future general practitioner, a survey of self-perceived competency at graduation based on the competency list developed by the Association of Canadian Faculties of Dentistry was circulated to recent graduates and the graduating class. The overall response was 67.5 percent, and revealed that approximately 70 percent of the respondents felt well prepared in approximately 69 percent of the competencies. These were the common "bread and butter" items of dentistry, such as basic restorative dentistry, examination, diagnosis, treatment planning, local anaesthesia, and scaling. Those areas reported as less well-prepared for included financial and personnel management, performance of soft-tissue biopsies, and management of chronic orofacial pain. Clarification of the raw survey results in focus groups was needed to uncover specific details that could lead to remedial action in problem areas.

A mail questionnaire was used to assess variations in the knowledge and practices of Ontario dentists with respect to topical fluoride and prophylaxis procedures. The questionnaire was answered by 1,276 general dentists. A high percentage (72 to 83 per cent) of respondents identified six months as the optimal time interval at which both procedures should be repeated for all patients under 19 years of age. Relatively few dentists (< 10 per cent) indicated that there should be no specific time interval for re-treatment (i.e. that it should be individually selected). The respondents' preventive knowledge was found to be deficient in two areas: few dentists (16 per cent) knew that it is not necessary to provide a prophylaxis prior to topical fluoride application to achieve maximum caries protection; and most dentists overestimated the speed of caries progress from outer enamel to the dentinoenamel junction (DEJ) in both primary (83 per cent) and permanent (82 per cent) approximal tooth surfaces. In bivariate analysis, three variables were found to be consistently and significantly related to optimal time intervals selected for both topical fluoride application and prophylaxis procedures: year of graduation from dental school; level of hygienist employment; and percentage of patients with private insurance. Multivariate analysis also identified three significant variables: year of graduation from dental school; level of dental hygienist employment; and practice business. Continuing education courses are suggested as a means of updating dentists' knowledge regarding preventive services. Studies are needed to determine the extent to which recent recommendations regarding the professional application of topical fluorides have been followed.

This study assessed the use of pit and fissure sealants by Ontario dentists, as well as variations in the knowledge and practices of this population with respect to certain aspects of the preventive technique. A mail questionnaire on dental practices and knowledge was answered by 1,276 general dentists in Ontario. Most dentists (90 per cent) provided sealants to their patients, and reported using sealants on an average of 45 per cent of their patients between the ages of six and 16 years. While most dentists knew that sealants have been proven effective in preventing caries (90 per cent), many incorrectly believed that sealants are cost-effective to apply to both primary molars and permanent premolars (40 per cent and 68 per cent respectively). Bivariate analyses showed that many of the reported characteristics are statistically significant. The variables that were consistently associated with sealant use include: knowledge of the effectiveness and cost-effectiveness of sealants; year of graduation from dental school; level of dental hygienist employment; and continuing education participation. Although multivariate analyses identified many of these variables as statistically significant, only a moderate amount of the variation in sealant use for patients aged six to 16 was explained (R2 = 0.22). Due to misinformation about the cost-effectiveness of sealants, some dentists may overuse them in certain instances. Conversely, misinformation about the effectiveness of sealants and the risk of further decay after sealant placement has resulted in some dentists under-utilizing them. Continuing education courses are needed to update dentists' knowledge and beliefs regarding dental sealants. In addition, dentistry's professional bodies should develop clinical practice guidelines to aid dentists in their treatment planning decisions.

Based on the responses of 1,276 general dental practitioners in Ontario to a mail questionnaire, variations in certain aspects of the dentists' diagnostic, preventive and restorative knowledge and beliefs are examined. Despite recent practice recommendations and guidelines indicating that patient need and service selectivity, rather than traditional, routine prescriptions, should be the guiding principle of practice, many dentists seem to follow tradition in defining optimal intervals for dental examinations and prophylaxes, bitewing radiographs and topical fluoride applications. Although the respondents' knowledge and beliefs were correct and consistent with current evidence in many areas, some large deficiencies were identified. These include: a lack of awareness that professional prophylaxis prior to topical fluoride application is usually unnecessary and that sealant applications to certain teeth are not cost-effective; an over-estimation of the speed at which dental caries progress through the enamel; and, despite good knowledge about the opportunities for the remineralization of enamel lesions with fluorides, a tendency to restore enamel caries. In some instances, practitioner beliefs were shown to influence practice. For example, dentists who knew about the slow progression of approximal surface caries also reported more often that bitewing intervals should be longer, and that the placement of a restoration should be delayed until the caries penetrates the dentin. Similarly, correct knowledge about sealant effectiveness was positively associated with high sealant use. If dentists are to be expected to understand and follow emerging diagnostic, preventive and restorative practice recommendations and guidelines, continuing education is required to correct and update some of their knowledge and beliefs, as displayed in the responses to this questionnaire.

Variations in the pediatric referral practices of general dentists for children aged zero to 14 years may be related to issues concerning quality and standards of care, cost containment, and predictability in third-party payment programs. In September 1992, a survey mailed to a random sample of approximately 10 per cent of Ontario general dentists was used to gather information about pediatric referral practices as well as economic and demographic factors associated with these practices. Responses were received from 381 of the 540 dentists surveyed (69 per cent). Most dentists who gave reasons for pediatric referrals (85.6 per cent) named behavior management problems as the primary cause. However, 21.5 per cent did not refer any children under 14 to pediatric dentists. Due to the variable results obtained using assorted statistical tests to regrade the outcomes of interest, the self-reported nature of the data, and the large amount of pediatric referral practice variation left unexplained by the multivariate analysis (95 per cent), this study's findings are equivocal.

One-half of the dentists in general practice in Ontario were randomly selected for a survey in June 1992 to determine their practices and decision-making regarding some aspects of restorative dentistry. Using patient scenarios to describe clinical situations, respondents stated the threshold at which a restoration should be placed in various tooth surfaces of persons of different ages, according to the severity of the carious lesion and the usual restorative procedure for different case situations. A total of 1,276 (52 per cent) dentists responded to a detailed mail questionnaire. Data were entered into a personal computer (PC) and analyzed using frequencies and chi-square with the SPSS/PC+ statistical package. Multivariate analyses were undertaken to examine what characteristics of dentists independently explained variations in their usual restorative procedures for approximal and occlusal caries. With approximal lesions, as seen on bitewing radiographs, 60 per cent of the dentists indicated that they would place a restoration in a 12 year old with an enamel lesion that had not reached the dentino-enamel junction, whereas with 30- and 55-year-old patients, 28 and 20 per cent, respectively, would do so. At each patient age, there was a tendency for significantly younger dentists to restore enamel-only lesions more often than other dentists (p < .01). Variations in proposed treatment for an adult patient with above average oral hygiene, but with a small (1-1.5 mm diameter) occlusal cavity that had penetrated through the dentino-enamel junction, were also observed. In this case, 23 per cent of the dentists would prepare a conventional cavity extending to include all fissures, and restore the tooth with amalgam or composite; 45 per cent would prepare a cavity just larger than the outline of the lesion and restore it in the same way; 32 per cent would prepare a small cavity and place a preventive resin restoration. Significant differences in cavity design were also observed between graduates of the University of Toronto and the University of Western Ontario with respect to restoring approximal carious lesions. A number of the dentists' characteristics were significantly associated (p < .01) with these variations in procedures. These included the dentists' gender, year and university education and type of practice. The documentation and explanation of these large variations in restorative practices have important implications for continuing dental education.

Two different provincial programs for geriatric oral health care are described. Their relevance to the United States requires an understanding of the universal, national hospital (1961), and medical (1971) care programs of Canada and the different sociopolitical philosophy of its people. Ontario's new geriatric preventive dentistry program provides free preventive dental services to elderly residents of collective living centers by province-wide dental public health staff. Although it covers only 7% of Ontario's older population in these centers, initiatives are underway to include other elderly persons and to provide cost subsidization for referred treatment, if required. Since 1973, Alberta has provided, through dentists and denturists in private practice, comprehensive free dental benefits to all residents over 64 years of age. About 38% of eligibles now use the plan annually. Cost escalation per dentist user has been quite modest but less so for denturist users. The future of these two models and the problems associated with them are discussed.