1. Summarise the intent, methods and outcomes of the article. The intent of this article was to measure the distribution of choices for the treatment of a child with differing severities of caries in a primary molar tooth among specialists in paediatric dentistry and general dental practitioners (GDP) in England. There were 500 GDP’s randomly selected and 148 specialists. 322 GDP’s and 115 specialists responded, there were 3 mailing rounds to maximise the response rate. Common hypothetical clinical case scenarios were developed and used to survey the opinions of a national sample about the care they would recommend for a child with a single carious primary tooth. The scenarios were agreed following discussion with a reference panel including 5 GDP’s, 3 specialists in paediatric dentistry and 2 consultants in public dental health. The scenarios reflected common dental conditions found in young children, there were 4 case scenarios differing in the severity of the caries but in each scenario the boy was described as being calm. Participants would then select their most preferred treatment option for each scenario. The outcome of the study indicated a substantial and important variation in choices of treatment among GDP’s and specialists.
2. Why do you think the authors adopt the views and opinions they did? The authors are highlighting the importance/urgency for the need of strong evidence for the most effective way to manage dental care in children. The study reveals differences of opinion not only about technique but also philosophy of care among and between GDP’s and specialists. Essentially the authors want readers to recognise there is a lack of evidence regarding the best way to treat young children, keeping in mind there are many factors that contribute to the decision being made by the dentist. Readers are also encouraged to keep an open mind regarding the different methods of treatment due to the current lack of credibility of current inconclusive studies. The different patterns of responses provide an indication of what interventions should be compared in future randomised control trials. This article was not to determine the best treatment but to allow interpretation of the variation shown in the answers of the case scenarios.
3. How could the opinions and outcomes in this article affect your practice as an oral health graduate?
The article demonstrates that there is currently a variation on how practitioners would treat their patient. It allows readers to think about other factors that influence how a OHP would practice. Although there was a substantial variation in the answers of the case scenarios, the article also highlights the importance of patient centred approach. As an OHP, we must think about the best treatment for a particular scenario whilst also being realistic on whether it can be implemented. For example, a non-compliant patient in comparison to a compliant patient may have an affect on the treatment being carried out. The article also states that it is worth considering the child’s perspective. Practitioners should consider the child’s dental experience, a child may find one treatment more traumatic than another. There have been observations that extractions in young children are strongly associated to dental anxiety. Essentially, oral health practitioners should be individualising the treatment for each patient to meet their needs, while also determining the best treatment for the best outcome, most cost effective and realistic result.
I agree with Rachel, The author wanted to address the lack of evidence in effective/management on dental care in children. Majority of the practitioners have their own way of treating patients and what was considered the most appropriate according to their patient and case scenario. Ideally, the author wanted to see a common approach 'one to two solutions' but in the real world there are many. All of the practitioners may have been taught differently, different method at that time and are certainly updated with their skills and new methods in treating patient, 'Minimal Intervention'. It is up to the practitioner and the patient itself to conclude to the most ideal treatment and management. These also include, most cost effective, realistic result, how compliant the patient is for treatment to be carried out. As an oral health graduate/soon to be, it is important to know as many methods as possible, as some method may not work as well as others on the patient. All patient are different and we would have to treat them according. It is important to discuss with the patient and caregiver options and the reason why as an operator you chose this treatment/method/material/restoration and management instead of the other. As well as, what is the most realistic method in their case and cost effective. Providing a treatment plan and management that is best for them and also come to an agreement with the caregiver, as we are performing on young patient that are unable to give consent yet.
1. Summarise the intent, methods and outcomes of the article. There is little evidence-based literature to guide dental professionals on how to best treat children with caries in the primary dentition. Differences in opinions among dental professionals are responsible for the variation in dental care offered to NHS patients. The aim of this study was to record the variation of treatment methods among GDPs and specialists in paediatric dentistry for children with carious deciduous molars. This was done by creating case scenarios, which would be used to survey the opinions of a national sample of GDPs and specialists in paediatric dentistry in England. These surveys would ask what recommendations for a child with a single carious deciduous molar would they make. The study was undertaken in England in 2004 and 2 surveys were provided using the same methodology. For the first survey, a simple, non-stratified random sample of 500 GDPs was extracted from all dentists working in England in the GDS who received payment from the NHS for treatment performed on primary teeth. The sampling and distribution of case scenarios to the GDPs was undertaken by the Dental Practice Board to comply with the Data Protection Act. In the second survey 148 paediatric specialists appearing on the General Dental Councils specialists list and practising in England were included. The study revealed great variation of opinion on restorative techniques and philosophy of care among and between GDPs and paediatric dental specialists. According to the author, the study shows that differences of opinions among dentists about the best way to manage/treat similar scenarios are contributing to the variation in care.
2. Why do you think the authors adopt the views and opinions they did? Great variation in treatment methods combined with a large proportion of the child population in England having caries experience can cause individuals to question the success of the health system. Slight differences in the treatment methods and techniques are normal in dentistry, however such treatment choices should be supported by evidence based literature. The lack of such evidence in England means that oral health care professionals have little guidance to follow. Evidence based, affordable guidelines should be available to all health care providers to monitor the progression and success in certain practice methodology. I believe the author adopted their opinions by recognising there is no existing guidelines available and such safety nets for dental professionals should be available.
3. How could the opinions and outcomes in this article affect your practice as an oral health graduate? It’s important that all oral health care providers work within their scope of practice, therefore as an oral health graduate I will treat my patients with the methods I have learnt during my studies and which fall within my knowledge base. Dentistry is a field that is always evolving based on new technologies, understanding, and evidence; therefore each oral health care provider should maintain their skills by keeping up with the changes and guidelines. The Dental Board of Australia has developed guidelines under the Health Practitioner Regulation National Law Act, which outlines standards for all practicing dentists, dental therapists, hygienists, and dental specialists (Dental Board of Australia, 2011). The requirements under the act include Continuing Professional Development (CPD), with every dental practitioner needing to complete a minimum of 60 hours of CPD activities over 3 years. 80% of the minimum 60 CPD hours must be clinically or scientifically based (Dental Board of Australia, 2011). By having such requirements in Australia, it creates a continuous development of practicing knowledge for all oral health practitioners, which minimises great variation in patient treatment management.
References
Dental Board of Australia, 2011, Guidelines on Continuing Professional Development, [online: 04/08/2014]
1. Summarise the intent, methods and outcomes of the article.
The purpose of the study was to detect, measure and describe variations in opinions on how GDP’s and specialists approach in the care of young children with carious primary molar teeth.
500 GDP’s were selected at random from a list of all GDP’s identified by the Dental Practice Board and all 148 specialists in paediatric dentistry. Questionnaires containing hypothetical clinical scenarios in which the severity of dental caries in a single primary molar differed. Each scenario had a list of possible treatment options and each participant needed to select their single most preferred option.
This study found that there was a large variation in the treatment choices for the scenarios given by GDP’s and specialists as well as different patterns found in their approach.
2. Why do you think the authors adopt the views and opinions they did?
The authors stated the need for better-designed randomised controlled trials to provide stronger evidence for the most effective way to manage the dental care of children.
In this study as the clinical case scenarios are only hypothetical they can only measure opinion and not a tool for measuring the actual care a dentist would provide as other factors that may not be mentioned in the case scenarios may influence the treatment options. It is stated that some caution is needed when interpreting the findings stated in this article.
3. How could the opinions and outcomes in this article affect your practice as an oral health graduate?
As there are a variations in treatment options that dental professionals may provide to their patients it is important to be able to understand the justification behind the different option available.
Treatment should be individualised to each patient. Every patient and situation is completely different and what may work and be a good option for one patient may not be as successful for another.
When individualising treatment options for a patient there are other factors that need to be taken in consideration such as previous dental experience, temperament of the patient, existing medical conditions etc.
It is important to understand that much more research is needed in this area to provide stronger evidence that a particular approach in a particular situation is better than another. Until that time it is essential that all dental professionals are able to adopt varying treatment options and be able to justify these options in a clinical situation.
1. Summarise the intent, methods and outcomes of the article.
ReplyDeleteThe intent of this article was to measure the distribution of choices for the treatment of a child with differing severities of caries in a primary molar tooth among specialists in paediatric dentistry and general dental practitioners (GDP) in England. There were 500 GDP’s randomly selected and 148 specialists. 322 GDP’s and 115 specialists responded, there were 3 mailing rounds to maximise the response rate. Common hypothetical clinical case scenarios were developed and used to survey the opinions of a national sample about the care they would recommend for a child with a single carious primary tooth. The scenarios were agreed following discussion with a reference panel including 5 GDP’s, 3 specialists in paediatric dentistry and 2 consultants in public dental health. The scenarios reflected common dental conditions found in young children, there were 4 case scenarios differing in the severity of the caries but in each scenario the boy was described as being calm. Participants would then select their most preferred treatment option for each scenario. The outcome of the study indicated a substantial and important variation in choices of treatment among GDP’s and specialists.
2. Why do you think the authors adopt the views and opinions they did?
The authors are highlighting the importance/urgency for the need of strong evidence for the most effective way to manage dental care in children. The study reveals differences of opinion not only about technique but also philosophy of care among and between GDP’s and specialists. Essentially the authors want readers to recognise there is a lack of evidence regarding the best way to treat young children, keeping in mind there are many factors that contribute to the decision being made by the dentist. Readers are also encouraged to keep an open mind regarding the different methods of treatment due to the current lack of credibility of current inconclusive studies. The different patterns of responses provide an indication of what interventions should be compared in future randomised control trials. This article was not to determine the best treatment but to allow interpretation of the variation shown in the answers of the case scenarios.
3. How could the opinions and outcomes in this article affect your practice as an oral health graduate?
The article demonstrates that there is currently a variation on how practitioners would treat their patient. It allows readers to think about other factors that influence how a OHP would practice. Although there was a substantial variation in the answers of the case scenarios, the article also highlights the importance of patient centred approach. As an OHP, we must think about the best treatment for a particular scenario whilst also being realistic on whether it can be implemented. For example, a non-compliant patient in comparison to a compliant patient may have an affect on the treatment being carried out. The article also states that it is worth considering the child’s perspective. Practitioners should consider the child’s dental experience, a child may find one treatment more traumatic than another. There have been observations that extractions in young children are strongly associated to dental anxiety. Essentially, oral health practitioners should be individualising the treatment for each patient to meet their needs, while also determining the best treatment for the best outcome, most cost effective and realistic result.
I agree with Rachel,
ReplyDeleteThe author wanted to address the lack of evidence in effective/management on dental care in children. Majority of the practitioners have their own way of treating patients and what was considered the most appropriate according to their patient and case scenario. Ideally, the author wanted to see a common approach 'one to two solutions' but in the real world there are many. All of the practitioners may have been taught differently, different method at that time and are certainly updated with their skills and new methods in treating patient, 'Minimal Intervention'. It is up to the practitioner and the patient itself to conclude to the most ideal treatment and management. These also include, most cost effective, realistic result, how compliant the patient is for treatment to be carried out. As an oral health graduate/soon to be, it is important to know as many methods as possible, as some method may not work as well as others on the patient. All patient are different and we would have to treat them according. It is important to discuss with the patient and caregiver options and the reason why as an operator you chose this treatment/method/material/restoration and management instead of the other. As well as, what is the most realistic method in their case and cost effective. Providing a treatment plan and management that is best for them and also come to an agreement with the caregiver, as we are performing on young patient that are unable to give consent yet.
Input from Kirsty - uploaded by Cathy
ReplyDelete1. Summarise the intent, methods and outcomes of the article.
There is little evidence-based literature to guide dental professionals on how to best treat children with caries in the primary dentition. Differences in opinions among dental professionals are responsible for the variation in dental care offered to NHS patients. The aim of this study was to record the variation of treatment methods among GDPs and specialists in paediatric dentistry for children with carious deciduous molars.
This was done by creating case scenarios, which would be used to survey the opinions of a national sample of GDPs and specialists in paediatric dentistry in England. These surveys would ask what recommendations for a child with a single carious deciduous molar would they make.
The study was undertaken in England in 2004 and 2 surveys were provided using the same methodology. For the first survey, a simple, non-stratified random sample of 500 GDPs was extracted from all dentists working in England in the GDS who received payment from the NHS for treatment performed on primary teeth. The sampling and distribution of case scenarios to the GDPs was undertaken by the Dental Practice Board to comply with the Data Protection Act. In the second survey 148 paediatric specialists appearing on the General Dental Councils specialists list and practising in England were included.
The study revealed great variation of opinion on restorative techniques and philosophy of care among and between GDPs and paediatric dental specialists. According to the author, the study shows that differences of opinions among dentists about the best way to manage/treat similar scenarios are contributing to the variation in care.
2. Why do you think the authors adopt the views and opinions they did?
Great variation in treatment methods combined with a large proportion of the child population in England having caries experience can cause individuals to question the success of the health system. Slight differences in the treatment methods and techniques are normal in dentistry, however such treatment choices should be supported by evidence based literature. The lack of such evidence in England means that oral health care professionals have little guidance to follow. Evidence based, affordable guidelines should be available to all health care providers to monitor the progression and success in certain practice methodology.
I believe the author adopted their opinions by recognising there is no existing guidelines available and such safety nets for dental professionals should be available.
3. How could the opinions and outcomes in this article affect your practice as an oral health graduate?
It’s important that all oral health care providers work within their scope of practice, therefore as an oral health graduate I will treat my patients with the methods I have learnt during my studies and which fall within my knowledge base. Dentistry is a field that is always evolving based on new technologies, understanding, and evidence; therefore each oral health care provider should maintain their skills by keeping up with the changes and guidelines.
The Dental Board of Australia has developed guidelines under the Health Practitioner Regulation National Law Act, which outlines standards for all practicing dentists, dental therapists, hygienists, and dental specialists (Dental Board of Australia, 2011). The requirements under the act include Continuing Professional Development (CPD), with every dental practitioner needing to complete a minimum of 60 hours of CPD activities over 3 years. 80% of the minimum 60 CPD hours must be clinically or scientifically based (Dental Board of Australia, 2011). By having such requirements in Australia, it creates a continuous development of practicing knowledge for all oral health practitioners, which minimises great variation in patient treatment management.
References
Dental Board of Australia, 2011, Guidelines on Continuing Professional Development, [online: 04/08/2014]
1. Summarise the intent, methods and outcomes of the article.
ReplyDeleteThe purpose of the study was to detect, measure and describe variations in opinions on how GDP’s and specialists approach in the care of young children with carious primary molar teeth.
500 GDP’s were selected at random from a list of all GDP’s identified by the Dental Practice Board and all 148 specialists in paediatric dentistry. Questionnaires containing hypothetical clinical scenarios in which the severity of dental caries in a single primary molar differed. Each scenario had a list of possible treatment options and each participant needed to select their single most preferred option.
This study found that there was a large variation in the treatment choices for the scenarios given by GDP’s and specialists as well as different patterns found in their approach.
2. Why do you think the authors adopt the views and opinions they did?
The authors stated the need for better-designed randomised controlled trials to provide stronger evidence for the most effective way to manage the dental care of children.
In this study as the clinical case scenarios are only hypothetical they can only measure opinion and not a tool for measuring the actual care a dentist would provide as other factors that may not be mentioned in the case scenarios may influence the treatment options. It is stated that some caution is needed when interpreting the findings stated in this article.
3. How could the opinions and outcomes in this article affect your practice as an oral health graduate?
As there are a variations in treatment options that dental professionals may provide to their patients it is important to be able to understand the justification behind the different option available.
Treatment should be individualised to each patient. Every patient and situation is completely different and what may work and be a good option for one patient may not be as successful for another.
When individualising treatment options for a patient there are other factors that need to be taken in consideration such as previous dental experience, temperament of the patient, existing medical conditions etc.
It is important to understand that much more research is needed in this area to provide stronger evidence that a particular approach in a particular situation is better than another. Until that time it is essential that all dental professionals are able to adopt varying treatment options and be able to justify these options in a clinical situation.