Physicians' attitudes toward medical screening in a dental setting.

OBJECTIVES: We assessed primary care physicians' attitudes toward medical screening in a dental setting. METHODS: A 5-point Likert scale (1 = very important/willing, 5 = very unimportant/unwilling) survey was mailed to a nationwide sample of primary care physicians in the United States. Descriptive statistics were used for all questions, and the Friedman nonparametric analysis of variance was used for multipart questions. RESULTS: Of 1,508 respondents, the majority felt it was valuable for dentists to conduct screening for cardiovascular disease (61 percent), hypertension (77 percent), diabetes mellitus (71 percent), and HIV infection (64 percent). Respondents were willing to discuss results with the dentist (76 percent), accept patient referrals (89 percent), and felt it was unimportant that the medical referral came from a dentist rather than a physician (52 percent). The most important consideration was patient willingness (mean rank 2.55), and the least important was duplication of roles (mean rank 3.52). Level of dentist's training was significantly (P < 0.05) more important than duplication of roles and reimbursement (mean ranks 2.84, 3.52, and 3.14, respectively), and significantly less important than patient willingness (mean rank 2.55). CONCLUSIONS: Primary care physicians considered chairside medical screening in a dental setting to be valuable and worthwhile.

Patients' attitudes toward screening for medical conditions in a dental setting.

OBJECTIVES: Previous studies demonstrated the efficacy of chairside medical screening by dentists to identify patients who are at increased risk for developing cardiovascular-associated events and the favorable attitude of dentists toward chairside medical screening. This study assessed patient attitudes toward chairside medical screening in a dental setting. METHODS: A self-administered questionnaire of eight five-point response scale questions was given to a convenience sample of adult patients attending an inner-city dental school clinic and two private practice settings. Wilcoxon-Mann-Whitney tests and t-tests were used to compare responses between study groups. Friedman nonparametric analysis of variance was used to compare response items within each question. RESULTS: Regardless of setting, the majority of respondents was willing to have a dentist conduct screening for heart disease, high blood pressure, diabetes, human immunodeficiency virus infection, and hepatitis infection (55-90 percent); discuss results immediately (79 percent and 89 percent); provide oral fluids, finger-stick blood, blood pressure measurements, and height and weight (60-94 percent); and pay up to $20 (50-67 percent). Respondents reported that their opinion of the dentist would improve regarding the dentist's professionalism, knowledge, competence, and compassion (48-77 percent). The fact that the test was not done by a physician was ranked as the least important potential barrier. While all respondents expressed a favorable attitude toward chairside screening, the mean score was significantly lower among clinic patients across most questions/items. The priority rankings within an item were similar for both groups. CONCLUSIONS: Acceptance by patients of chairside medical screening in a dental setting is a critical element for successful implementation of this strategy.

Dentists' attitudes toward chairside screening for medical conditions.

BACKGROUND: of previous studies demonstrated the effectiveness of chairside medical screening by dentists to identify patients at increased risk of experiencing cardiovascular-associated events. In this study, the authors assessed dentists' attitudes, willingness and perceived barriers regarding chairside medical screening in the dental office. METHODS: A national, random sample of U.S. general dentists was surveyed by mail by means of an anonymous questionnaire that involved a five-point Likert scale (1 = very important/very willing; 5 = very unimportant/very unwilling). Friedman nonparametric analysis of variance was used to compare response items within each question. RESULTS: Of 1,945 respondents, most were male (82.3 percent), white (85.7 percent) and 40 to 60 years old (59.4 percent) and had practiced for more than 10 years (84.5 percent). The majority thought it was important for dentists to conduct screening for hypertension (85.8 percent), cardiovascular disease (76.8 percent), diabetes mellitus (76.6 percent), hepatitis (71.5 percent) and human immunodeficiency virus infection (68.8 percent). Respondents were willing to refer patients for consultation with physicians (96.4 percent), collect oral fluids for salivary diagnostics (87.7 percent), conduct medical screenings that yield immediate results (83.4 percent) and collect blood via finger stick (55.9 percent). Respondents were significantly more willing (P < .001) to collect saliva than height and weight measurements or blood via finger stick (mean ranks: 2.05, 2.96 and 3.05, respectively). Insurance was significantly less important (P < .001) than time, cost, liability or patients' willingness (mean ranks: 3.51, 2.96, 2.94, 2.83 and 2.77, respectively). CONCLUSIONS: Dentists considered medical screening important and were willing to incorporate it into their practices. Additional education and practical implementation strategies are necessary to address perceived barriers. CLINICAL IMPLICATIONS: The findings of this study regarding chairside medical screening may lead to changes in our approach to dental education and may help define the practice of dentistry in the future.

The clinician's guide to the literature: interpreting results.

BACKGROUND: Oral health care professionals must have up-to-date information to guide clinical practice. The peer-reviewed literature contains the most reliable and current information. The clinical research literature relies on statistical analysis of data to make inferences and draw conclusions. In this article, the authors explore the fundamental principles that underlie statistical testing. CONCLUSIONS AND PRACTICE IMPLICATIONS: Having the fundamental tools to critically interpret the results presented in the literature is one of the essential elements for appropriately translating clinical research into practice.

Longitudinal trends in the use of individualized radiographic examinations at dental schools in the United States and Canada.

In the spring of 2002, a mail survey was conducted to determine the use of individualized radiographic examinations (selective radiography) for comprehensive care patients at all sixty-four U.S. and Canadian dental schools. Results from previous surveys were used to evaluate the long-term longitudinal trends. Among sixty-two schools (97 percent response rate), selective radiography was used by 34 percent of schools for dentulous adult patients, by 100 percent for edentulous adults, and by 28 percent for children. Having a credentialed chief of service increased the likelihood that selective radiography would be used for dentulous adults (odd ratio[OR]=2.36) and for children (OR=2.33). Selective radiography for dentulous adults increased from 2 percent of schools in 1977 to 36 percent in 1997 and leveled off thereafter. Between 1987 and 2002, selective radiography for edentulous adults was used at nearly all schools (96-100 percent) and for children at about a quarter of dental schools (22-28 percent). Among the sixty-one schools for which there are complete data since 1987, the continuous use of routine radiography was most common (39 percent of schools) for dentulous adult patients, whereas the continuous use of selective radiography was uncommon (7 percent).

Anomalies of the odontoid process discovered as incidental findings on cephalometric radiographs.

Two patients with unusual developmental anomalies of the odontoid process of the axis are presented. These anomalies were discovered as incidental findings on the cephalometric radiographs obtained as part of orthodontic treatment. Both patients had severe instability of the cervical spine at the articulation between the first and second cervical vertebrae that required referral to a medical specialist. When this was discovered, both patients were asymptomatic, with normal neurologic findings. Surgical stabilization of the spine was considered but deferred because the patients had no neurologic signs or symptoms. To protect them from head injury, the patients were advised to refrain from contact sports and strenuous exercise, and follow-up evaluations were recommended. These cases emphasize the need to evaluate head and neck structures shown on cephalometric radiographs, independent of the traditional morphometric analysis.

Dosimetry and cost of imaging for osseointegrated implants with film-based and computed tomography / Dosimetria e custo de imagem para implante ósseo integrado com filme e tomografia computadorizada

Thermoluminescent dosimeters were used to measure radiation doses at craniofacial sites in a tissue-equivalent phantom during film-based multidirectional tomography with the Tomax Ultrascan (Incubation Industries, Ivyland, Pa.) and during computed tomography with the Elscint Excel 2400 (Elscint Corp., Tel Aviv, Israel). Mean absorbed doses for presurgical mandibular and maxillary canine and molar implant assessments were converted to equivalent doses, which were then multipied by published weighting factors and summed to give effective doses. The computed tomgraphy device consistently delivered higher doses than the Tomax Ultrascan to all anatomic locations; the differences were most pronounced when only one or two implant sites were evaluated. The reasons for the dose disparities are considered both anatomically and procedurally. A survey of examination cost revealed film-based multidirectional tomography to be less expensive than computed tomography