Showing papers by "Jan E Clarkson published in 2007"

Complete or ultraconservative removal of decayed tissue in unfilled teeth

Abstract: Background: The treatment of deep dental decay has traditionally involved removal of all the soft demineralized dentine before a filling is placed. However, this has been challenged in three groups of studies which involve sealing soft caries into the tooth. The three main groups either remove no caries and seal the decay into the tooth, remove minimal (ultraconservative) caries at the entrance to a cavity and seal the remaining caries in, or remove caries in stages over two visits some months apart to allow the pulp time to lay down reparative dentine (the stepwise excavation technique). Objectives: To test the null hypothesis of no difference in the incidence of damage or disease of the nerve of the tooth (pulp), progression of decay and longevity of restorations irrespective of whether the removal of decay had been minimal (ultraconservative) or complete. Search strategy: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed and EMBASE databases were searched. The reference lists in relevant papers were checked. Selection criteria: Randomized controlled trials and controlled clinical trials comparing minimal (ultraconservative) caries removal with complete caries removal in unrestored permanent and deciduous teeth. Data collection and analysis: Outcome measures recorded were exposure of the nerve of the tooth (pulp) during caries removal, patient experience of symptoms of pulpal inflammation or necrosis, progression of caries under the filling, time until the filling was lost or replaced. Due to the heterogeneity of the included studies the overall estimate of effect was calculated using a random-effects model. Main results: Four studies met the inclusion criteria; two stepwise excavation studies and two ultraconservative caries removal studies. Partial caries removal in symptomless, primary or permanent teeth reduces the risk of pulp exposure. We found no detriment to the patient in terms of pulpal symptoms in this procedure and no reported premature loss or deterioration of the restoration. Authors’ conclusions: The results of this systematic review reject the null hypothesis of no difference in the incidence of damage or disease of the nerve of the tooth (pulp) irrespective of whether the removal of decay had been minimal (ultraconservative) or complete and accepts the null hypothesis of no difference in the progression of decay and longevity of restorations. However, the number of included studies is small and differ considerably. Partial caries removal is therefore preferable to complete caries removal in the deep lesion, in order to reduce the risk of carious exposure. However, there is insufficient evidence to know whether it is necessary to re-enter and excavate further but studies that have not re-entered do not report adverse consequences.

The effect of advance telephone prompting in a survey of general dental practitioners in scotland: a randomised controlled trial.

Abstract: OBJECTIVES Evaluation of advance telephone prompting on the response rate to a postal, self-completed questionnaire To provide an estimate of the cost of such a strategy METHOD A sample of 315 GDPs was randomly selected from a randomised database of GDPs practicing in Scotland 157 GDPs were randomly allocated to receive an advance telephone prompt, via the practice receptionist; 158 were allocated to a control group Four days after prompting all trial participants were mailed identical questionnaires, cover letter and postage paid return envelope RESULTS Response rates: 53%--advance telephone prompt group and 40%--control group The effect size, 13%, was found to be statistically significant, p = 0026 Total estimated strategy costs: 7400 pounds sterling The incremental cost was estimated to be 493 pounds sterling for each additional response CONCLUSIONS Advance telephone prompting of GDP's, via the practice receptionist, statistically significantly improves the response rate to a postal self-completed questionnaire This is estimated to be a cost effective strategy for improving response rates to postal questionnaires

What influences intention to become a postgraduate trainer

Abstract: Objective Only a small proportion of eligible dentists become dental vocational trainers. The aim of this study was to apply Social Cognitive Theory to further an understanding of beliefs underpinning intention to become a dental vocational trainer. Subjects Primary care dentists. Design A self-administered questionnaire was distributed at all continuing professional development courses during November 2004 regardless of course enrolment numbers, content or duration. Outcome measure Intention to train. Predictive measures Attitude toward being a trainer, attitude toward attending the trainer course, and confidence in ability to train (training self-efficacy). Results Of the 316 respondents, 47% intended never to train. Training self-efficacy accounted for the majority of variance in intention to train (15%, step 1) with attitude to training accounting for a further 4% (step 2) (Hosmer and Lemeshow test: Chi-square = 7.36, df = 8, p = 0.498; 95% CI for EXP(b): training self-efficacy = 1.38-2.06, attitude = 1.17-2.08). Attitude to the trainer course did not enter the regression model. The most influential belief relating to intention to train was confidence in teaching, and for intention never to train was evaluating a trainee's skills. Both intenders and non-intenders believed training and attending training courses would be time-consuming and financially costly, suggesting these are not primary factors in making the decision to become a trainer. Conclusions Using a psychological model provided a starting point for understanding intention to become a vocational trainer and a rationale for the format of future interventions. Results suggest intention to train may be influenced by targeting dentists' confidence in teaching and performing evaluative aspects of training.