Predictors of recall assignment decisions by general dental practitioners performing routine oral examinations

Abstract

The aim of this study was to explore the decision-making behavior of general dental practitioners (GDPs) in performing routine oral examinations (ROEs). Change over time was studied by comparing data from a cohort sample of participants in two surveys in 2000 and 2005. A written questionnaire was sent to 809 dentists (509 responses were obtained) and 475 (61%) were used for analysis. Of the respondents, 347 also participated in the survey in 2000. The mean number of diagnostic ROE items per ROE was 6.9 (standard deviation = 1.7). Groups of GDPs were distinguished based on their answer to the question 'Do you apply for all patients a fixed recall interval between two successive ROEs?' and four personal profiles. Of the GDPs, 38.5% (n = 183) assigned fixed recall intervals (Fxs) for all patients. Individual recall intervals (Ivs) were applied by 61.5% (n = 292) of GDPs, depending on specific selected patient characteristics and risk factors. Logistic regression showed that GDPs applying Fxs also used fixed periods between successive bitewing radiographs. Furthermore, GDPs applying Ivs conducted more frequent periodontal screening and, in the event of periodontal problems, were more inclined to prescribe radiographs. Over a 5 yr period, a shift towards Ivs assignment (from 49% in 2000 to 61.5% in 2005) was found. Differences in assigned recall intervals (Fxs/Ivs) by GDPs are determined by three clinical ROE predictors and two GDP profiles. A shift towards a more individual assessment was found between 2000 and 2005 in the way that Dutch GDPs are dealing with the assignment of recall interval frequency.

Routine oral examinations in primary care: Which predictors determine what is done?

“…Based on previous research, 10,23 GDPs attitude towards periodontal screening showed to be a salient determinant of individualised assessment and assignment of variable recalls. In an elderly population (65% of the patients were older than 35 years of age), the risk of developing a periodontal condition is increased.…”

“…This is in contrast with previous research (self-reported recall adherence in questionnaire survey) suggested a strong correlation between 'positive attitude to screening periodontal disease' and variable assigned recall intervals. 10 An explanation could be that this performance from about 70 percent of the GDPs (who stated to assign individual recall periods) is probably more driven by non-clinical factors like reimbursement and financial patient preferences than by individual oral health status. Applying more than one recall period (6 and 12 months), due above-mentioned reasons, does not necessarily mean risk-based flexible recall interval assignment.…”

“…9 As a result, 6-monthly oral screening of relatively healthy patients is usual practice in developed countries. 10,11 However, it has been recommended to tailor the content and recall assignment to individual the patient's oral disease risk. [12][13][14][15] The main purpose of ROEs is to prevent oral disease and to manage further progression.…”

Routine oral examination: Clinical vignettes, a promising tool for continuing professional development?

“…General dental practitioners (GDPs) still assign standardised recall periods for all regular attendees. 9,10 Fuelled by quality of care aspects, GDPs are being confronted with new patient-tailored surveillance approaches. They have not been trained to screen systematically high-and lowrisk patients.…”

Current Status of Patient Recall in U.S. Predoctoral Dental School Clinics

“…11 Traditionally, biannual recall has been the norm; now, more and more clinicians are undertaking an individualized risk-based recall strategy. 8,9,[12][13][14][15][16][17][18][19][20][21][22][23] One of the major aspects of recall is patient education on preventive strategies. Dietary counseling, oral hygiene instructions, and encouragement to use luoride toothpaste are important for caries control, 24,25 while smoking cessation counseling can help prevent periodontal disease and oral cancer.…”