OBJECTIVES: This thesis adopts a multivariate approach to examine perceptions and practices regarding routine dentist-patient interactions in initial consultations. METHODS: A 16-item Dental Patient Feedback on Consultation skills (DPFC) questionnaire was adapted for use in the dental setting through face, content, and construct validity. A cross-sectional survey (n=389) of patients’ perceptions of their dentist’s clinical performances was conducted in a teaching hospital. Test-retest reliability (n=42) was assessed. Variations in DPFC responses (scale and item level) were examined in relation to socio-demographics and dental attendance patterns in bivariate and regression analyses. Second tier data was collected in the form of 70 audio-visual recordings (~15 hours) which were transcribed and sequentially analyzed to identify internal structures. Corpus-based discourse and sociolinguistic analysis drawing on traditions of Conversation Analysis, was used to identify dental consultation stages and sequential patterns across turn-taking systems. Transcribed recordings from the top quartile of survey results (n=18) were examined to reveal how dentists and their patients co-accomplished ‘successful’ consultations. RESULTS: Face validity of the DPFC questionnaire ranged 81.1-100%. Content Validity Index ranged 0.73-1.00. Variations across DPFC scores regarding global ratings of satisfaction were apparent (p<0.001). Cronbach’s alpha value was 0.94 and Intraclass Coefficient Correlation value was 0.89. Results identified that dental attendance pattern was a factor associated with DPFC (p<0.05); but no significant differences were observed regarding socio-demographics. Corpus-based discourse and sociolinguistic analysis indicated seven specific consultation stages across the 70 recordings. This was divided into two parts by radiographic imaging, namely Part A: Opening, Oral Problem Presentation, Medical History Taking, Oral Examination, Post-examination; and Part B: Diagnosis and Explanation, and Closing. Sequential analysis of Turn-Constructional Units in the Oral Problem Presentation Stage across the 70 recordings indicated patterns for dentists’ soliciting and patients’ presenting. Dentists solicited patient problems through open-ended questions (n=68) and closed-ended questions (n=2). Patients adopted two oral problem presentation types either using talk with gestures (n=61) or without gestures (n=9). Sequential analysis of the top quartile of recordings (n=18) revealed that patients perceived higher satisfaction with clinical communication if dentists re-visited their oral problems in the Diagnosis and Explanation Stage through a stepwise formulation. This presented as re-visiting patients’ oral problems through either repeating patients’ own terms or repairing patients’ prior talk. Finally, a case is analyzed to examine how a patient perceived effective dentist communication despite receiving a less-than-satisfactory admission outcome. CONCLUSIONS: The lack of socio-demographic variations in DPFC indicates similar treatment across groups and standardized communication practices by dentists in this public hospital context. Patients with prior dental visits within one year require greater attention in first encounters, possibly due to their recently unresolved oral problems. To enhance the quality of dentist-patient communication, dentists need to attend to patients’ non-verbal signals during talk when presenting oral problems. In identifying how patients and dentists co-accomplish ‘successful’ communication, a clear topical thread connecting patients’ oral problem presentation with the final dentist explanation stages emerged. Empirical findings suggest re-visiting of patients’ oral problems before delivering diagnosis may enhance patient perceptions of ‘successful’ communication in initial consultations. / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

Introduction: The ideal timing to initiate orthodontic treatment is an important, yet controversial issue. The purpose of this study was to investigate the provision of orthodontic care for 7 types of skeletal dysplasia by paediatric dentists and orthodontists in Canada. Methods: A questionnaire was distributed to randomly selected orthodontists (N=140) and paediatric dentists (N=132) throughout Canada. Surveys returned within 8 weeks were included for c2 statistical analysis. Results: The response rate was 59% for orthodontists and 54% for pediatric dentists. Orthodontists and pediatric dentists differed significantly in the timing of their first orthodontic consultation (p < 0.01). More pediatric dentists used to the dental age to determine the appropriate time to initiate treatment (p < 0.01), whereas more orthodontists relied on the pubertal indicators (p < 0.01). More orthodontists would intervene in the early mixed dentition for moderate mandibular prognathia (p < 0.01); mid-mixed dentition for severe mandibular retrognathia (p < 0.01), late mixed dentition for moderate mandibular retrognathia (p < 0.01) and permanent dentition for skeletal openbite and severe mandibular prognathia (p < 0.01). Most pediatric dentists would intervene in the early and mid-mixed dentition for the specified cases of skeletal malocclusions (p < 0.05). Conclusions: The results of this investigation indicate both consistencies and variation between orthodontic and paediatric practitioners with regard to preference in treatment timing, and the factors that influence these decisions.

Thesis (M.S.)--University of Michigan, 1976. / Typescript (photocopy). Includes bibliographical references (leaves 156-166). Also issued in print.

Thesis (M.S.)--University of Michigan, 1976. / Typescript (photocopy). eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 156-166).

Thesis (PhD Dentistry)--University of Pretoria, 2006. / Includes bibliographical references.

Thesis (PhD(Dentistry))--University of Pretoria, 2006. / Includes bibliographical references.

Thesis (Ph. D.)--University of Iowa, 1996. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (Ph. D.)--University of Iowa, 1996. / Includes bibliographical references.

Title page, table of contents and preface only. The complete thesis in print form is available from the University of Adelaide Library. / Forensic odontology has been defined as the application of dental science to the administration of the law and the furtherance of justice. It involves the correct handling, examination and presentation of dental evidence in both civil and criminal matters. Its principal role is in the personal identification of the living and the dead that may be the victims of criminal activity, mass disasters or accidental events. It is also concerned with the determination of age of persons and the investigation of tooth marks on skin and any other substance which may have forensic significance. The importance of dental evidence as a means of identification has been recognised for many years. Modern forensic odontology dates back to the tragic fire in the Bazaar de la Charite in Paris on 4th May 1897, resulting in 126 deaths. The problem of identification of the victims was addressed by M. Albert Hans, the Paraguayan Consul, who proposed calling for the assistance of the dentists who had treated the deceased. Subsequently, Dr Oscar Amoedo, a Cuban dentist living in Paris, using the experiences of these dentists, published a thesis entitled 'L'Art Dentaire en Medecine Legale' which soon became recognised as the standard textbook on forensic odontology I first became aware of the potential for identification by means of dental evidence when I was a child. One evening in October, 1939, my dentist father was called out by the police to attend at the city morgue to view the body of a patient who had been decapitated by a train at a suburban level crossing. He was asked whether he could recognise gold inlays he had placed in the victim's mouth and thereby identify him. He was not required to make a formal written report but merely a nod of the head was sufficient at that time. My particular interest in forensic odontology, however, was inspired in 1961 when I attended a lecture arranged jointly by the Dental Board of South Australia and the Law society, presented by visiting Professor Gosta Gustafson, Professor of Oral Pathology at the Dental School, University of Lund, Malmo, Sweden, on the subject "Dental Aspects of Forensic Medicine". I was fascinated by his graphic accounts of the cases he had undertaken, particularly those during the second world war when, as Sweden had maintained its neutrality, his expertise in identification had been utilised by both warring sides. I was intrigued by his description of the method he used when called by the German High Command to determine the number of persons who had been present at the time of the explosion of a bomb in the bunker on the occasion of the unsuccessful attempt by a group of high ranking German generals to assassinate Adolph Hitler towards the end of World War II. He gathered all the victims' teeth scattered about the walls inside the bunker, made ground transverse sections of each tooth, compared each section microscopically War II. He gathered all the victims' teeth scattered about the walls inside the bunker, made ground transverse sections of each tooth, compared each section microscopically and matched those which demonstrated the same pattern of enamel development. In 1967, Inspector Ted Calder and Senior Sergeant Barry Cocks, on behalf of the South Australia Police Department, addressed a regular monthly meeting of the South Australian Branch of the Australian Dental Association, and appealed for a group of volunteer dentists to be formed to assist in emergencies requiring dental expertise, particularly in situations involving the identification of victims of major disasters. I was present at that meeting and submitted my name as a volunteer. When some six months had elapsed without hearing anything further about this group, I phoned the secretary of the Dental Association who informed me that since only one member had volunteered, nothing more had been done about the proposal. I then phoned Sergeant Cocks and he invited me to join him next day for lunch at the staff cafeteria at Police Headquarters. Sergeant Cocks urged me to join the South Australian Branch of the Forensic Science Society which was being organised under the chairmanship of Mr Andrew Wells, then Crown Prosecutor and later a Justice of the Supreme Court of South Australia. This I did and subsequently became a member of its steering committee. When it became known that I was available as a volunteer to assist in cases requiring expertise in forensic odontology, I soon began receiving requests from the police to assist in cases requiring dental identification. The post mortem material from these cases was usually brought by police officers in person to my surgery, often in buckets carried through the waiting room. I would also receive calls from Dr Manock asking me to call at his office to collect skulls for identification. I would work on these cases at night in my home. In South Australia, services in forensic pathology were originally provided by pathologists from the Institute of Medical and Veterinary Science (IMVS) located on the campus of the Royal Adelaide Hospital. Forensic autopsies were carried out in the City Morgue situated in the grounds of the West Terrace Cemetery until December, 1978, when its function was transferred to the new Forensic Science Centre in Divett Place, which included a modern mortuary on the ground floor. The Coroner and his courtroom were situated on the first floor of the same building which was named The Forensic Science Centre. In 1968, Dr Colin Manock, a specialist forensic pathologist from England was appointed to the IMVS, and he was joined by Dr Ross James in 1973. Subsequently both were transferred to State Services at the Forensic Science Centre. In 1973, the Criminal Law and Penal Methods Reform Committee was established by the Government of South Australia under the chairmanship of the Hon Justice Roma Mitchell. She immediately invited submissions on, inter alia, forensic science. Acting on a suggestion by Sergeant Cocks, I prepared a submission on forensic odontology, proposing that a dedicated forensic odontology laboratory be established in the Dental School of the University of Adelaide. This would provide a specialised service to the Coroner and the Commissioner of Police. It would also provide facilities and an environment conducive to education and research in this field. When the Mitchell report was published, it included my submission word for word Since many of the cases that presented required attendance in courts of law, and as I had not received any special training or formal qualifications in forensic odontology, in order to satisfy the requirements of the courts for qualifying as an expert witness, I felt the need for further education in this subject. At that time, however, forensic odontology was not widely recognised in Australia. It had not developed as a special branch of dentistry and there were no courses offered in this field here. My membership in the Forensic Science Society included a subscription to the Journal of the Forensic Science Society, and I also was able to obtain copies of The Scandinavian Society of Forensic Odontology Newsletters. From these sources I learned that forensic odontology was well advanced in Japan, Norway, Sweden, Denmark, Finland and Britain. I was advised to apply for a Winston Churchill Memorial Fellowship which would enable me to undertake a study tour of relevant institutions in these countries. This I did, and I was awarded a Churchill Fellowship in 1976. (see special report: Brown Kenneth A. 1976. The status of forensic odontology in Europe and Japan.) I continued to provide this service in an honorary ad hoc capacity from 1967. This situation was most unsatisfactory because it raised legal issues concerning the security of material evidence taken by myself to work on in my home, and it was most unfair to my family. When this situation came to the knowledge of the State Government at the end of 1979, funds were made available to establish a dedicated forensic odontology service within the Dental School in the University of Adelaide in accordance with the Mitchell Report. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1523307 / Thesis (D.D.Sc.) -- University of Adelaide, School of Dentistry, 2010

Thesis (M.D.S.) -- University of Adelaide, Dept. of Dentistry, 1989. / Includes bibliographical references.