Adequacy of dental records in clinical practice: a survey of dentists.

PURPOSE: The purposes of the study were to determine Minnesota dentists' perception of the adequacy of their dental record documentation, assess the general format and contents of dental records they used, and compare the self-reported contents of dental records with guidelines established by the American Dental Association (ADA). METHOD: Using ADA's published recommendations for structure and guidelines of the dental record from 1987, a 20-item questionnaire was developed, pretested, and used to survey a random sample of 750 Minnesota dentists. Reminder postcards were sent two weeks after the initial survey mailing. A third mailing to nonrespondents, including cover letter and duplicate questionnaire, was conducted three weeks later. Of the surveys returned, 63% (N = 475) were analyzed. Data analyses, including frequencies and tests of chi-square, were conducted using Statview and SPSS. RESULTS: While 15% (N = 69) of respondents used a single-page record format, 44% (N = 209) used multiple forms filed in a specific location within the record. Of the dentists responding, 403 (85%) felt their record documentation was adequate without comparison to any specified criteria. However, statistically significant differences occurred between dentists' perception of record adequacy and the actual presence or absence of ADA criteria for all record components. Data analysis revealed that information was absent 9.4% to 87.1% of the time. CONCLUSION: A discrepancy exists between dentists' perception of dental record adequacy and the ADA recommendations for structure and guidelines. Inadequate dental record components should be targeted for improvement.

Neutrophil elastase in crevicular fluid: comparison of a middle-aged general population with healthy and periodontitis groups.

Neutrophil elastase (NE) was measured in crevicular fluid (GCF) collected from 3 subject groups. GCF was harvested at a single visit of subjects with periodontal health (n = 21) and with periodontitis (n = 28). Samples were obtained from 132 middle-aged, middle-class health conscious patients of a health maintenance organization (HMO) at baseline and 1 year later. GCF NE was higher in periodontitis than in health. Mean GCF NE of HMO subjects was much closer to health than to periodontitis. Few members of the HMO population had enzyme levels typical of periodontitis. Subjects and sites of the HMO population were segregated into 3 categories based on enzyme levels of the healthy and periodontitis subjects. Most HMO subjects and sites were in the activity category corresponding to healthy subjects. Only a small portion were in the activity category common in periodontitis. Enzyme levels in the highest activity category at both samplings were infrequent. High enzyme levels in the HMO population were not associated with attachment loss. Thus, assay of GCF NE provided little evidence of disease in a middle-aged, middle-class health conscious general population. This finding confirms an analysis of epidemiological surveys which concluded that a population such as studied here would not benefit from periodontal diagnostic testing.

Association between cigarette smoking, bacterial pathogens, and periodontal status.

The purposes of this study were to determine if: 1) an association exists between cigarette smoking and signs of periodontal disease after controlling for the confounding variables of age, sex, plaque, and calculus; 2) the prevalence of 5 bacteria commonly associated with periodontal disease differs between smokers and non-smokers; and 3) the presence of any of these bacteria or smoking are associated with a mean proximal posterior probing depth > or = 3.5 mm. Plaque, calculus, gingivitis, and probing depth were measured at the proximal surfaces of all teeth in one randomly selected posterior dental sextant in 615 adults. Subgingival plaque was sampled from the same sites and assayed for the presence of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotella intermedia, Eikenella corrodens, and Fusobacterium nucleatum. A subsample of non-smokers (n = 126), who were similar to smokers (n = 63) with respect to age, sex, plaque, and calculus, was randomly drawn from the original sample. These two groups were then compared on the basis of clinical and microbial parameters. The results indicated that the odds of having a mean probing depth > or = 3.5 mm were 5 times greater for smokers than the non-smoker subsample (odds ratio = 5.3; 95% CI = 2.0 to 13.8). No statistically significant difference in the prevalence of any of the bacteria was found between smokers and the non-smoker subsample. Based on logistic regression analyses of each of the 5 bacteria and smoking, mean probing depth > or = 3.5 mm was significantly associated with the presence of A. actinomycetemcomitans, P. intermedia, E. corrodens, and smoking (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of periodontal disease in a health maintenance organization and comparisons to the national survey of oral health.

The purposes of this study were to: 1) characterize the demographics, oral health behavior, and periodontal status of a health maintenance organization sample; 2) investigate the relationship between the location of posterior proximal measurement sites and prevalence estimates for periodontal disease; and 3) compare the prevalence of persons with pockets > or = 4 mm in the present sample to the 1985 NIDR Survey of Oral Health. The sample consisted of 1,090 adults attending a large health maintenance organization. All proximal sites in one randomly selected posterior dental sextant were examined for probing depth using a constant force probe. Demographic, medical, and behavioral factors were determined by questionnaire. Results indicated that the sample consisted primarily of medically and periodontally-healthy middle-aged adults with good oral hygiene habits. Overall, the mean probing depth was 2.95 mm with 10.1% of sites/subject > or = 4 mm. A larger percent of subjects had probing depths with pockets > or = 4 mm at lingual proximal sites than buccal proximal sites. Prevalence of subjects with pockets > or = 4 mm at mesio-buccal sites in the present study was similar to NIDR Region III data (15.3% vs. 17.4% respectively). However, when data from all posterior sites were included, the overall prevalence rate in the present sample increased to 36.8%. These findings indicate that disease prevalence is dependent on the location of surfaces measured and conservatively indicate that NIDR survey data may have underestimated the prevalence of persons with periodontal pockets > or = 4 mm by at least 20%.

A short-term, three-year epidemiological study of median nerve sensitivity in practicing dental hygienists.

PURPOSE: Hand-intensive, repetitive motion procedures such as those performed by dental hygienists can lead to median nerve dysfunction which, left untreated, can degenerate into clinical carpal tunnel syndrome (CTS). Vibrometry has been used as a method for early detection of sensory nerve impairment. METHODS: A cohort of 16 university-educated dental hygienists was evaluated by means of programmed frequency stimuli for median nerve dysfunction at graduation and at one, two, and three years postgraduation. RESULTS: The results indicate that median nerve dysfunction was not detected in this cohort. However, further analysis suggests that a significant loss of median nerve sensitivity, or permanent "threshold shift," has occurred in the three years since graduation. CONCLUSION: Whether this is a harbinger of future events is unknown at this time.

Five parameters of gingival crevicular fluid from eight surfaces in periodontal health and disease.

Volume and amounts of myeloperoxidase (MPO), lactoferrin (LF), aryl sulfatase (AS) and lactate dehydrogenase (LDH) were measured in gingival crevicular fluid (GCF) collected from the mesial and distal proximal surfaces of the premolars and first and second molars of 3 subject groups. Group assignment was based on subject mean gingival index (GI) and probing depth (PD) of sampled sites as follows: healthy, GI less than or equal to 0.5, PD less than or equal to 3.0; disease 1, GI greater than or equal to 1.0, PD greater than or equal to 3.0 mm; disease 2, PD greater than or equal to 4.0 mm. Attachment loss (ATL) of most sites in the 3 groups was: healthy, 0-1 mm; disease 1, 1-2 mm; and disease 2, 4-9 mm. GCF volume differed among surfaces and teeth in each of the 3 groups. The greater amount of GCF collected from posterior locations was not related to the GI and PD. Differences with sampling location in amounts of GCF constituents were restricted to MPO and LF. Most of these differences (greater amounts at posterior sites) were associated with more severe disease. Variability in amount and composition of GCF collected from different sites, therefore, should be considered in experiments which include quantitation of GCF parameters. The ratio of MPO in disease group 2 to disease group 1 was greater than similar ratios for GCF volume and LF, AS and LDH. The quantity of MPO was the only measure which differed between the 2 disease groups at all surfaces. MPO thus appears to have the greatest potential, among the measured parameters, to serve as a marker for advanced periodontal disease.

Comparison of measurement variability in subjects with moderate periodontitis using a conventional and constant force periodontal probe.

This study compared the intra- and inter-examiner measurement error of the Florida Probe, Florida Disk Probe, and conventional periodontal probe in persons having moderate to severe periodontitis. Single pass measurements using the conventional probe were compared to both single and double pass (corrected) measurements using the Florida Probe and Florida Disk Probe. The mean intra-examiner standard deviations of differences in repeated site probing depth measurements ranged from 0.60 to 0.93 mm for the Florida Probe and from 0.52 to 0.89 mm for the conventional probe. Based on overall averages, the conventional probe measured deeper probing depths than the Florida Probe at the same sites. This difference was especially evident in pockets greater than or equal to 6 mm in depth. Based on sites, the mean intra-examiner standard deviations of differences in repeated relative attachment level measurements using the Florida Disk Probe ranged from 0.55 to 0.82 mm. The mean standard deviations of site measurements for attachment level obtained with the conventional probe ranged from 0.62 to 1.14 mm. Inter-examiner measurement error was greater than intra-examiner measurement error for each probing method. It was concluded that use of the Florida Probe and Florida Disk Probe may offer significant advantages in reducing measurement error for some clinical examiners. For other examiners, use of the Florida Probes do not necessarily result in less measurement error than use of conventional probing methods.

A short-term epidemiological study of median nerve dysfunction in practicing dental hygienists.

The purpose of this study was to assess over time changes in median nerve function in a group of 20 students who entered the University of Minnesota dental hygiene program in 1986. This is a follow-up report on 16 of the 20 students who were evaluated two years postgraduation in 1990. Comparisons were made with prior evaluations of the subjects completed at graduation in 1988, and one year postgraduation in 1989. Digital vibrometry was used to evaluate median nerve sensibility threshold at each of the time periods studied. Analysis revealed that after one year of clinical practice, there was a mean sensibility threshold shift of 11.04% in the left median nerve and 8.42% in the right median nerve as measured by digital vibrometry. Results at two years postgraduation indicated that the threshold shift observed in an earlier study had been arrested. The reasons appeared to be twofold: (1) a period of work hardening with a concept of neuromuscular ligamentous tissue hypertrophy or adaptation to the rigors of dental hygiene practice, and/or (2) the practicing dental hygienist had learned to become more efficient in the provision of hygiene procedures. There were no reported symptoms of median nerve dysfunction and none of the subjects had been diagnosed as having CTS at any time during the two years since graduation. Continued evaluations will be necessary to determine whether the observations noted during the second year postgraduation evaluation indicated temporary or permanent slowing of the conditions necessary for the development of CTS.

Peripheral nerve dysfunction in practicing dental hygienists.

Hand-intensive repetitive procedures such as those performed by dental hygienists can lead to cumulative trauma disorders of the upper extremity. One such disorder is median nerve dysfunction leading to carpal tunnel syndrome (CTS). Vibrometry has been used in industrial settings as a method of early detection of sensory nerve impairment. This technique uses vibratory stimuli to assess the level of sensory perception in the fingertips. Using programmed frequency stimuli, 58 practicing dental hygienists were evaluated bilaterally for median nerve dysfunction. Results indicated that 15 (25.9%) of the dental hygienists reported the presence of CTS symptoms, while 7 (12.0%) tested positive for mild median nerve dysfunction. The findings suggest that vibrometry testing could aid in the early detection of CTS, thereby reducing its effects on clinical practice and facilitating early treatment.

Musculoskeletal pain among Minnesota dental hygienists.

Using a 33-item questionnaire, this study was conducted to determine the nature and prevalence of musculoskeletal pain in dental hygienists, and its effects on clinical practice. An 89% response was obtained from a random sample of 493 dental hygienists. Results revealed that 68% of the respondents reported having musculoskeletal pain in eight body locations the previous year. In addition, a large percentage of dental hygienists with a preexisting condition reported having musculoskeletal pain. Thirty-four percent stated that musculoskeletal pain had affected their clinical practice--forcing them to practice fewer days, decreasing their endurance, reducing speed and quality, and/or altering operating positions. The findings suggest that particular locations of pain could be related to dental hygiene practice. Further research is indicated to clarify specific patient-operator positions contributing to musculoskeletal pain so that prevention and early treatment become possible.

Carpal tunnel syndrome among Minnesota dental hygienists.

Because of inherent aspects of clinical practice, dental hygiene practitioners may be at risk for developing carpal tunnel syndrome (CTS). A study was conducted to determine the prevalence of CTS among dental hygienists and its effects on clinical practice. A 33-item questionnaire was mailed to a random sample of 493 dental hygienists. A 90% response rate was achieved. Results revealed that 7% of the respondents had been diagnosed as having CTS. However, 63% had experienced one or more symptoms. Six percent reported that CTS had affected their clinical practice in ways such as limiting the number of days practiced, diminishing their hand strength, or forcing them to leave the profession. The findings suggest a need for dental hygienists to obtain information on CTS symptoms to facilitate early diagnosis and treatment.

Dental hygiene student. Interest in advanced education.

This paper reports the results of a 1985 survey of certificate/associate degree students' interest in advanced education: baccalaureate degree completion and non-degree granting residency programs. Subjects included first- and second-year dental hygiene students enrolled in 12 vocational, community college, state, and research university institutions in a five-state region in the upper Midwest. The data collection instrument consisted of a 12-item mailed questionnaire. One hundred percent program and 78.7% student response rates were achieved. Results indicate that respondents are interested in degree completion and non-degree granting residency programs. Interest varied by age and by type of institution in which respondents were completing their dental hygiene education. While younger respondents were more likely to express interest in advanced education, respondents over the age of 30 were generally interested or undecided. Overall, respondents indicated slightly different areas of interest for degree completion versus residency programs. In general, respondents indicated an interest in pursuing advanced education on a part-time, evening basis, within five years of completion of their basic dental hygiene education. Cost, time, and family commitments were identified by respondents as major barriers to continuing their education.