A C Mellor

Dental anxiety and attendance in the North-west of England

The aim of this study was to record the level of anxiety and last recorded visit for a dental check-up of a random sample of 300 workers at three sites in the North-west of England. All subjects were asked to complete a short written questionnaire and 255 (85 per cent) usable forms were returned. The mean level of anxiety using the Corah Dental Anxiety Scale (DAS) (N.L. Corah, 1969, J. Dent. Res. 48, 596) was 9.1. Females had a statistically higher mean DAS than males but there was no correlation between DAS and either age or occupational status. Those subjects who claimed not to have had a check-up in the past year had a significantly higher mean DAS than those who claimed to have been in the past year. Multiple regression analysis showed that the reported time interval since the last check-up was the most important predictor of the DAS score. The implications of the results are considered for the future of restorative dentistry.

The capitation study. 1. Does capitation encourage 'supervised neglect'?

Four matched pairs of geographically and socially contrasting areas of Britain were randomly allocated within pairs to either a capitation or fee-for-service payment system for the dental care of children in a 3-year clinical trial. Measurements were made on the dental health of randomly selected 5-6 and 14-15-year-old patients and the views of their parents elicited. Patterns of treatment were also gained from the clinical records of randomly selected patients. In addition, the views of the dentists taking part, of the professions representatives, and of the administrators of the systems were obtained. No evidence of systematic neglect could be found among the children treated under capitation, but they had fewer fillings, more untreated diseased teeth and similar disease levels to their counterparts treated under fee-for-service. Dentists in capitation carried out fewer fillings, fewer extractions, took fewer radiographs and saw their patients less frequently than their fee-for-service colleagues

The Capitation Study. 2. Does capitation encourage more prevention

The results of a 3-year parallel, controlled clinical trial comparing a capitation system of payment for the dental care of children with fee-for-service, showed that capitation offered dentists more clinical freedom. Dentists in capitation used this to provide more preventive care, particularly advice to parents on the control of dental disease in their children. In contrast, few fissure sealants were placed and few topical fluoride applications were made under either system. However, parents in both systems were satisfied with the preventive service their children received and were confident of their ability to control their childrens dental disease. The effect of this increased preventive activity was not yet apparent within the period of the study

An assessment of capitation in the General Dental Service contract 2. Patterns of treatment provided to regularly attending patients

Objective: To compare the patterns of treatment of general dental practitioners working under fee-for-service in 1987/88 with those working under capitation in 1992/93.Design: 73 randomly selected general dental practitioners working under capitation in three contrasting areas in England retrospectively recorded the treatment provided during 1992/93 to a random selection of their regularly attending 6-12- and 14-15-year-old patients.Results: Mean numbers of examinations per year reduced in the three areas from 1.7-1.8 in 1987/88 to 1.2-1.4 in 1992/93. Mean numbers of visits per patient dropped from 2.5-2.9 to 1.8-2.2. Mean numbers of fillings in permanent teeth reduced from 0.15-1.04 to 0.09-0.52 and in deciduous teeth from 0.28-0.53 to 0.24-0.31. Mean percentages of children per dentist having extractions fell from 9.3-28.1% to 4.7-16.2% while the radiographs reduced from 14.0-9.0% to 6.0-10.6%. Mean percentages of children per dentist receiving oral hygiene instruction rose from 18-31% in 1987/88 to 26-33% in 1992/93. Dietary advice increased from 3-18% to 11-20% and fissure sealants from 3-6% to 3-12%.Conclusions: In 1992/93, dentists working under capitation were carrying out fewer examinations, fillings and extractions and were taking fewer radiographs for their regularly attending child and adolescent patients than dentists working under fee-for-service in 1987/88. These patients also attended less frequently for treatment but received marginally more preventive care and advice

The capitation study. 3. The views of participating dentists and the profession

During the course of a 3-year parallel, controlled clinical trial comparing a capitation system of remuneration with fee-for-service for the dental care of children, the views of the dentists were gained through meetings, informal communication, and a structured questionnaire sent to every dentist in the study. The questionnaires completed by the dentists who had been in the study from the beginning were used in the analysis. The views of practice principals on practice administration were also gained. Dentists in capitation claimed to have greater clinical freedom than those in fee-for-service, but the system under test involved more practice administration. The trial allowed the two systems to be compared under limited, controlled conditions, thus benefiting any substantive scheme that might be developed from it

Restorative dentistry: The sealant restoration: indications, success and clinical technique

In this paper we have considered the available literature which demonstrates that sealant restorations perform at least as well as amalgam restorations and are more conservative. Success depends on retention of the overlying sealant and if this is fully retained it is unlikely that any residual caries will progress. The diagnosis of occlusal caries and indications for sealant restorations are discussed and the clinical technique is described. We have concluded that sealant restorations are the optimum restoration in small and discrete occlusal cavities.

Attitudes of dental students towards elderly people

Questionnaires were distributed to first, third and fifth year dental students at two British dental schools, to assess their attitudes towards the elderly. A second follow-up questionnaire was given 1 year later to the five student years attending one of these dental schools, to compare attitudes and estimate how they affected their perceptions of treating this section of the community. In both questionnaire surveys, clinical dental students had a more positive attitude towards the elderly than did students in the non-clinical years of the course. In those students who had received both questionnaires on consecutive years, there was an improved attitude score. There were no significant differences in the attitudes of male and female students.

Factors affecting fee setting for private treatment in general dental practice

Objectives To examine how pricing policies were contrived in general dental practice in terms of fee-for-item and hourly rate and how these were affected by specialist status and the level of private care provided in a practice.Design A postal questionnaire.Subjects Members of the British Society for General Dental Surgery working in dental practice.Results Out of 160 eligible members, responses were received from 124 members (78%). Fifty-seven respondents claimed to specialise in one or more fields of dentistry. The majority of respondents consulted fellow colleagues or partners for advice on fee setting. A minority took external advice. The charging method varied according to the item of treatment with fee-for-item used predominantly for items such as a new patient examination, and hourly rate used more for items such as a direct composite restoration. Seventy-one respondents stated that their practice was 80-100% private treatment and these practitioners were significantly more likely to charge by hourly rate than fee-for-item for many items of treatment. Specialist status did not have any effect on charging method. The most important factors related to the setting of fees-for-item or hourly rate were clinical time spent, practice overheads and laboratory costs.Conclusions This project has taken the views of a large group of experienced general dental practitioners, many of whom work purely in the private sector. The most important factors affecting fee setting were clinical time, practice overheads and laboratory costs. The method of charging was most affected by the proportion of private treatment provided by the practice.

Micro-CT Evaluation of Voids in the Filling Material of Single-Rooted Teeth Obturated with Different Techniques

The aim of this study was to compare the volume of voids in a resin-based root canal filling (Resilon) with gutta percha using either cold lateral condensation or continuous wave of compaction filling techniques using computed X-ray micro-tomography (micro-CT). A total of 56 extracted upper anterior human teeth were decoronated, the canals shaped using rotary ProTaper files to a final size of F3 and randomly allocated into 4 groups (n=14) according to the filling material and obturation technique; Group 1: gutta percha/cold lateral (GP/C), Group 2: Resilon/cold lateral (R/C), Group 3: gutta percha/thermal (GP/T), Group 4:

Restorative dentistry: An investigation into sealant restoration usage in general dental practice in England

Aim A study was undertaken to investigate attitudes to sealant restorations and their usage in general dental practice in England.Method Seventy three dentists in three areas (Doncaster, Hereford/Worcester and Wycombe) provided retrospective details of treatment provided over a one year period for 4,250 6 – 12 and 13 – 15 year old subjects. Fifty nine of these dentists then completed a telephone questionnaire relating to their treatment patterns and attitudes to sealant restorations.Results The treatment data indicated that only 59 of the 4,250 children received a sealant restoration during the study period. Of the 44 dentists who claimed in the questionnaire to be using sealant restorations, only 28 had placed them in their selected patients.Conclusions Positive attitudes to sealant restorations were expressed but also concerns that may be prejudicing usage.