Thesis (M.D. Sc)--University of Queensland, 2002. / Includes bibliographical references.

Thesis (M.D.S.)--University of Hong Kong, 1989.

Thesis (Ph. D.)--West Virginia University, 2003. / Title from document title page. Document formatted into pages; contains x, 107 p. : ill. Includes abstract. Includes bibliographical references (p. 51-68).

Thesis (M.D. Sc.)--University of Queensland. / CD-ROM by S.M. Mubarak and L.J. Walsh. Copyright date on the CD-ROM given as 1998. Includes bibliographical references.

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

<p> <u>Aim &amp; Hypothesis:</u> The experimental aims of the study were to use the National Health and Nutrition Examination Survey (NHANES) dataset to test and confirm the following hypotheses: 1) Characterize the periodontal condition among never smokers, former smokers and current smokers, 2) Analyze the association of time since quitting smoking and the periodontal condition among former smokers as a function of smoking history, 3) Analyze the association of duration of smoking and the periodontal condition among current smokers as a function of smoking history.</p><p> <u>Materials &amp; Methods:</u> This study analyzed data collected in the NHANES 2012 survey and included respondents for whom a periodontal exam and smoking status were obtained. Aim 1 was a descriptive analysis were used to characterize the sample. For Aim 2, unconditional logistic regression was conducted with time since quitting as the exposure and presence of periodontitis as the outcome, and included adjustment for confounders. Aim 3 analyses also used unconditional logistic regression, but included only current smokers, with duration of smoking habit as the exposure and periodontitis status as the outcome, adjusted for confounders.</p><p> <u>Results:</u> Smoking status was statistically significantly associated with periodontal status (chi-square p &lt; 0.0001). Among former smokers, after adjusting for confounders, each additional year since quitting smoking was associated with a statistically significant reduction in the odds ratio (OR) for periodontitis by 2.5%. Among current smokers, duration of smoking was not statistically significantly associated with periodontal status.</p><p> <u>Conclusions:</u> Rates of periodontitis were highest in current smokers, lower in former smokers, and lowest in never smokers. Among former smokers, longer time since quitting was associated with lower likelihood of periodontitis. Among current smokers, the duration of smoking was not associated with likelihood of periodontitis. These findings support the notion that dental practitioners have a public health mandate to help their periodontal patients quit smoking. Future research should determine the best strategies for facilitating smoking cessation in dental patients. </p>

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

A prospective study was carried out on 48 male and female patients aged 33 to 63 years to evaluate which factors have an effect on postoperative pain after placement of two implants in the anterior mandible. The factors considered were: (1) age, (2) sex, (3) duration of surgery, (4) length of implant, (5) expertise of surgeon and (6) body size. Length of implant and expertise of surgeon were found to be significant predictors of pain intensity and unpleasantness (P < 0.05). Implant surgery has qualities that complement the current oral surgery pain model, third molar extraction. For example, the surgical procedures involved in oral implant placement are more controlled and standardized. Furthermore, oral implants are most often used in older populations, whereas third molars are generally extracted in young adults. The results of this study will provide insight into the use of oral implant placement as a clinical acute pain model.

Caries in the primary dentition remains a public health problem despite a general decline in caries prevalence over the past 25 years. The present cross-sectional study investigates a hypothesized association between closed contact points in the primary dentition and approximal caries formation. It was carried out using a convenience sample of 286 children receiving dental care at the Montreal Children's Hospital. Bivariate analysis was performed using odd ratios, to determine which independent variables collected by the survey had a significant association with the dependent variable (approximal caries). Significant independent variables were then controlled for in multiple logistic regression analysis. These analyses revealed a strong association between the presence of approximal caries and closed contact points, warranting further investigation by longitudinal studies. If these results can be replicated, flossing the primary teeth and incorporating tooth position into prediction models could become important preventative weapons in fighting this disease.

Using mandibular 2-Implant overdentures is an alternative therapy for edentulous patients. Several studies have been conducted to evaluate the efficacy of this treatment modality compared to conventional dentures. However, most of these studies have emphasized the evaluation of the clinical aspects of the prostheses or did not use standardized specific patient based-outcomes. / Therefore, the main objectives of this research was to investigate the effect of using mandibular 2-implant supported prostheses and conventional dentures on oral health related quality of life, using a randomised controlled clinical trial design. The secondary objectives were to assess the factors that explained patients' satisfaction with their prostheses and to evaluate the association between ratings of satisfaction, ability to chew and laboratory tests of masticatory efficiency according to treatment received. In addition, the association between patients' pretreatment preference and general satisfaction with original prostheses was explored, as well as the possible effect of pretreatment preferences on post treatment satisfaction. / One hundred and two female and male subjects between the ages of 35--65 years responded to a newspaper advertisement for patients who wished to replace their current prostheses. Forty-eight subjects were randomly assigned to receive conventional denture and 54 to the implant group. Prior to treatment, subjects were asked to indicate which treatment they would prefer if given a choice. Patients' ratings of general satisfaction were evaluated with their original prostheses and two months after receipt of the new treatments using 100mm Visual Analogue Scales (VAS). Similarly, subject's quality of life was assessed using the Oral Health Impact Profile (OHIP), prior to and two months after receipt of the new prostheses. / Multivariate regression analysis showed that subjects in the implant group had significantly higher ratings of general satisfaction (p < 0.05) as well as, with their general ability to chew, stability and comfort compared to those who received mandibular conventional dentures. In addition, subjects in the implant group were significantly more satisfied with their ability to chew specific foods with different textures. To the contrary, no significant differences were observed between the two groups using laboratory measures of masticatory efficiency. / Furthermore, patients who received implant treatment had significantly lower OHIP scores (p < 0.05) indicating better quality of life compared to subjects in the conventional group. In this trial age, gender, level of education, income and marital status were not significantly associated with either ratings of satisfaction or quality of life. / Although patients' preferences were significantly associated with their ratings of satisfaction with original prostheses, preferences did not have a significant effect on post-treatment oral health related quality of life or satisfaction. / Overall, the results of this study suggest that, after two months of adaptation, a prosthesis supported by two osseointegrated implants provided significant improvement in oral health related quality of life and satisfaction compared to a conventional denture.