Work place characteristics, work stress and burnout among Dutch dentists

Gorter RC Albrecht G et al. Eur J Oral Sci 1998; 106: 999–1005

Burnout seemed related most strongly to a lack of career perspective, but it was unrelated to working environment.

There are three essential aspects to burnout: mental or emotional exhaustion, a negative or cynical attitude toward patients (depersonalisation or dehumanisation) and a negative self-image. In this study, a stratified random sample of around 9% of Dutch dentists were sent a questionnaire on these matters and other aspects of their work. There were 709 respondents (75%). The burnout aspect of the questionnaire consisted of 20 items assessing emotional exhaustion (EE), depersonalisation (D) and personal accomplishment (PA). The other aspects were work place characteristics (10 items), and work stress (94) with 7 subscales.

Compared to the Dutch standard scores, dentists scored significantly less EE and D, and more PA; that is, they experienced less burnout. Among the working stress factors, total burnout related most strongly to career perspective, with work pressure and patient contacts (for example, pressure from dissatisfied patients) also substantially involved. The authors comment that the lack of career development deserves more attention in the future.

Clinical judgement as a basis for choice of recall interval in child dental care?

Wang NJ, Berger B et al. Community Dent Health 1998; 15: 252–255

The majority of children were recalled over 1 year later when clinicians used their own judgement to decide the interval.

Over the last 30 years, caries has decreased in Norway, as in many other countries. Studies have shown that resources are used better if recalls are less frequent for groups who are largely healthy. In the public health system of one Norwegian county in 1995, all dentists and hygienists reported the recall intervals for 2,513 children aged 3–18. At that time, 65% of 5-year-olds and 40% of 12-year-olds had no caries experience.

Half of the children were assigned a recall interval of 20 months or more, and only 10% were recalled in less than 12 months. Children who had had fillings placed in the current course of treatment were given a shorter recall interval on average (15 months) than those who had no fillings (17.4 months). The authors discuss their results with reference to other countries where recall intervals differ. For instance, in the UK, mean intervals of 7.5 months were reported within the last 15 years.

Forty-five-year tooth survival probabilities among men in Oslo, Norway

Hujoel PP, Löe H et al. J Dent Res 1998; 77: 2020–2027

Risk of tooth loss was highest in the first decade post-eruption, and low thereafter but gradually increasing up to the fifth decade.

Tooth survival was examined in a cohort of 565 Norwegian males first examined in 1969, and followed up to 1995, when 223 were still available. The overall tooth loss chart was bath-tub shaped (an engineering concept which fits many biological phenomena), meaning a high loss in the early stages, then a period with a low, gradually increasing loss, and finally an increased loss at the end.

Survival of incisors and canines was greater than 95%; the rates for premolars were from 84% to 92%; and for molars, they were from 59% to 96%. There was considerable individual variation. Over the first four post-eruptive decades, the respective tooth mortality risks (excluding orthodontic extraction) were: 2.0%, 0.2%, 0.6%, and 1.1%.

The relationship between signs and symptoms of temporomandibular disorders and bilateral occlusal contact patterns during lateral excursions

Watanabe EK, Yatani H et al. J Oral Rehabil 1998; 25: 409–415

Different occlusal contact patterns were found to be associated with different complaints in a large group of TMJ disorder (TMD) patients.

In 143 dentate TMD patients who were all examined by one author, 75% complained of pain in the TMJ or masticatory muscles region, 47% had difficulty in mouth opening, 41% heard sounds from the TMJ, and 5% had masticatory difficulties.

Four-fifths of patients were diagnosed as having internal TMJ derangement, while a small number each had osteoarthritis, capsulitis, synovitis and masticatory muscle disorders.

Several associations were found: medial pterygoid pain on palpation, with working side only contacts on excursion to the other side; sternomastoid pain on palpation, with balancing contacts on excursion to the same side; and shoulder stiffness and eye pain, with balancing contacts on excursion to the other side. The authors discuss the varied previous findings of research on these matters, and suggest further studies are needed.