Provision of diagnostic and preventive services in general dental practice

OBJECTIVE: Diagnosis and prevention are among the most frequently provided services in Australian private general dental practice, and have increased over recent times. The aims of this study were to examine the provision of examinations, radiographs, prophylaxis and topical fluoride, and to assess whether these services varied by patient, visit and oral health characteristics.

BASIC RESEARCH DESIGN: Data were collected by a mailed survey of a random sample of dentists from each State/Territory in Australia in 1998-99 with a response rate of 71%.

MAIN OUTCOME MEASURES: Data were collected from a log of service items provided on a typical day.

RESULTS: Multivariate analyses of services showed that emergency visits were associated with higher rates [RR = Rate ratio, 95%CI] of radiographs (RR = 1.32, 1.06-1.66) but lower rates of prophylaxis (RR = 0.37, 0.29-0.48) and topical fluoride (RR = 0.20, 0.08-0.47) compared to non-emergency visits. Capital city patients had a higher rate of topical fluoride (RR = 2.06, 1.17-3.64) services than non-capital city patients. Patients with decayed teeth had a lower rate of prophylaxis services (RR = 0.82, 0.68-0.99) than patients with no decay. Compared to the reference of caries, patients with aesthetic problems had lower rates of radiographs (RR = 0. 19, 0.08-0.47) and topical fluoride (RR = 0.24, 0.08-0.71), those with cuspal fracture/failed restoration also had lower rates of radiographs (RR = 0.54, 0.37-0.80) and topical fluoride (RR = 0.52, 0.28-0.95), those with denture problems had lower rates of examinations (RR = 0.53, 0.32-0.87), radiographs (RR = 0.05, 0.01-0.28), prophylaxis (RR = 0.13, 0.04-0.37) and topical fluoride (RR = 0.04, 0.01-0.32), those with periodontal disease had higher rates of examinations (RR = 1.45, 1.13-1.85) and prophylaxis (RR = 2.39, 1.79-3.19), those with pulpal/periapical infection had lower rates of examination (RR = 0.55, 0.42-0.74) and prophylaxis (RR = 0.36, 0.19-0.66), but higher rates of radiographs (RR = 1.92, 1.48-2.50), those with recall/maintenance care had higher rates of examinations (RR = 2.23, 1.85-2.69), prophylaxis (RR = 2.63, 2.05-3.38) and topical fluoride (RR = 2.88, 1.76-4.70), while those with other diagnoses had lower rates of prophylaxis (RR = 0.60, 0.37-0.97) and topical fluoride (RR = 0.28, 0.10-0.77) services.

CONCLUSIONS: Radiographs may often be used to confirm disease rather than in early detection, and prevention was mainly provided to asymptomatic patients in routine maintenance schedules. Many emergency patients and those with oral diseases present missed the benefits of prevention.

Brennan DS, Spencer AJ

Community Dent Health. 2003 Mar;20(1):5-10.

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