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Objective: To investigate Ontario dentists’ perceptions of patient interest in sedation and general anesthesia (GA) during treatment and patient fear and avoidance of dental treatment. Methods: Using the Royal College of Dental Surgeons of Ontario roster, we randomly selected 3001 practising Ontario dentists, from among those who listed an email address, to complete a 16-question survey by mail or online. Demographic information (e.g., gender, size and type of primary practice, and years of experience) was collected as well as dentist reports of patient interest in sedation/GA and level of fear regarding treatment. Analysis included sample t-tests to compare Ontario dentist responses with patient responses to a 2002 national survey. Results: 1076 dentists participated (37.9% response rate), comprised of 69.7% males, 84.4% general practitioners, 0.5–42 years of practice (mean 20.6 years), and 40.6% from cities with a population larger than 500,000. Dentists underestimated patients’ interest in sedation/GA, with dentists and patients reporting patients “Not interested” as 66.8% and 43.9%, respectively, and “Interested depending on cost,” 19.8% v. 42.3%. Dentists also underestimated patient interest in sedation/GA for specific dental procedures including scaling, fillings/crowns, root canal therapy and periodontal surgery (p < 0.01). Dentists overestimated patient fear levels (“Somewhat afraid,” 19.9% v. 9.8%; “Very afraid,” 10.6% v. 2.0%; “Terrified,” 6.0% v. 3.5%) and the proportion of patients avoiding dental care (13.3% v. 7.6%). Conclusion: Dentists underestimate patients’ preference for sedation/GA and overestimate their fear and avoidance of dental care. The significant disparities between the views of dentists and patients may affect the availability and provision of sedation and general anesthesia in Ontario dental practices.

OBJECTIVE: This study aims to assess barriers to the use of deep sedation/general anesthesia (DS/GA) identified by dentists in Ontario. METHODS: An email invitation to a web-based survey was distributed to all licensed dentists and specialists who have provided an email address to the provincial regulator (n = 5507). Descriptive and regression analyses were performed to explore practice and demographic factors associated with the use of DS/GA. RESULTS: The response rate was 18.3%. A quarter (24.8%) of respondents reported inadequate access to DS/GA. Access was poorest in rural communities and greatest in the Greater Toronto Area (GTA). Overall, 74.5% of dentists indicated that they had used DS/GA in the past 12 months. Use was defined as having provided the service or referred a patient in the past 12 months. Non-use was most likely among general dentists, part-time dentists, dentists > 64 years and dentists in urban locations. Wait times and travel distances were reported as longer for medically complex patients. The most common reasons for non-use of DS/GA were a lack of perceived demand and additional costs to patients. For DS/GA users, the greatest barrier was additional costs to patients. CONCLUSION: Access to DS/GA in Ontario is not uniform; it remains a challenge in rural communities and regions outside the GTA, especially in the north. Use is lowest among general dentists and urban dentists despite adequate access, with dentists' perception of need for DS/GA and cost to the patient acting as major barriers. Education for dentists and better insurance coverage for patients may improve access for these patients.

One-half of the dentists in general practice in Ontario were randomly selected for a survey in June 1992 to determine their practices and decision-making regarding some aspects of restorative dentistry. Using patient scenarios to describe clinical situations, respondents stated the threshold at which a restoration should be placed in various tooth surfaces of persons of different ages, according to the severity of the carious lesion and the usual restorative procedure for different case situations. A total of 1,276 (52 per cent) dentists responded to a detailed mail questionnaire. Data were entered into a personal computer (PC) and analyzed using frequencies and chi-square with the SPSS/PC+ statistical package. Multivariate analyses were undertaken to examine what characteristics of dentists independently explained variations in their usual restorative procedures for approximal and occlusal caries. With approximal lesions, as seen on bitewing radiographs, 60 per cent of the dentists indicated that they would place a restoration in a 12 year old with an enamel lesion that had not reached the dentino-enamel junction, whereas with 30- and 55-year-old patients, 28 and 20 per cent, respectively, would do so. At each patient age, there was a tendency for significantly younger dentists to restore enamel-only lesions more often than other dentists (p < .01). Variations in proposed treatment for an adult patient with above average oral hygiene, but with a small (1-1.5 mm diameter) occlusal cavity that had penetrated through the dentino-enamel junction, were also observed. In this case, 23 per cent of the dentists would prepare a conventional cavity extending to include all fissures, and restore the tooth with amalgam or composite; 45 per cent would prepare a cavity just larger than the outline of the lesion and restore it in the same way; 32 per cent would prepare a small cavity and place a preventive resin restoration. Significant differences in cavity design were also observed between graduates of the University of Toronto and the University of Western Ontario with respect to restoring approximal carious lesions. A number of the dentists' characteristics were significantly associated (p < .01) with these variations in procedures. These included the dentists' gender, year and university education and type of practice. The documentation and explanation of these large variations in restorative practices have important implications for continuing dental education.

PURPOSE: To examine the influence of gender on practice ownership among Ontario dentists. METHODS: In 2012, a 52-item survey was sent to a random sample of 3000 Ontario dentists (1500 men and 1500 women) to collect information on personal, professional and sociodemographic characteristics. The resulting data were analyzed using descriptive statistics and linear regression modeling. RESULTS: The 867 respondents included 463 men, 401 women and 3 people whose gender was unreported, yielding a response rate of 29%. Univariate regression analyses revealed that male dentists were 2.2 times more likely to be practice owners than female dentists. Dentists > 60 years were less likely to be owners than younger dentists. The odds of practice ownership were lower for dentists who preferred the ability to secure part-time work. A higher level of confidence in one's business acumen significantly predicted practice ownership. Dentists making concessions in their career to pursue family life were more likely to be associates, and those who perceived that their partners made concessions to aid in their career were more likely to be owners. In multivariate analyses, the effect of gender on practice ownership became insignificant, yet the influence of age, preference for career aspects, confidence in business skills and perceptions regarding concessions by self and partner persisted. Gender-stratified analyses revealed that familial factors significantly predicted ownership for female dentists, but not for male dentists. CONCLUSION: Gender appears to be linked to practice ownership, but when other factors are considered such as age, preference for part-time work, higher levels of confidence in business skills and perceptions of career concessions, the relationship does not remain.

OBJECTIVE: Local anesthetics are believed to be the most frequently used drugs in clinical dentistry, and although they are generally regarded as safe, some adverse reactions can be expected and do occur. The purpose of this study was to obtain, by means of a mail survey, information on the types and amounts of local anesthetics used by Ontario dentists during 2007. MATERIALS AND METHODS: A survey requesting data on the annual use of injectable local anesthetics was mailed to all 8,058 dentists licensed by the Royal College of Dental Surgeons of Ontario in 2007. RESULTS: The effective response rate to the single mailing was 17.3% (1,395 respondents). By extrapolation, the estimated use of local anesthetics by all Ontario dentists during 2007 was determined to be about 13 million cartridges, which represents an average of 1,613 cartridges per dentist per year. Lidocaine with epinephrine 1:100,000 was the most commonly used formulation with 37.31% of total anesthetic use, followed by articaine with 1:200,000 epinephrine (27.04%) and articaine with 1:100,000 epinephrine (17.16%). Overall, local anesthetics combined with a vasoconstrictor accounted for more than 90% of total anesthetic use. A minority of survey respondents (15.68%) indicated that their pattern of anesthetic use had changed significantly in the past few years. Patterns of use were similar for early and late survey respondents. These data provide a current account of the use of local anesthetics by Ontario dentists.

BACKGROUND: To investigate, among Ontario dentists, (1) self-reported barriers to access to sedation and general anesthesia (GA) services and (2) their current use of sedation and GA. METHODS: Of Ontario dentists practising, 3001 were randomly selected to complete a 16-question survey by mail or online in 2011. Mixed analysis of variance (ANOVA) followed by independent-sample t tests or 1-way ANOVA evaluated the relation between dentists' views and demographic variables including sex, clinical experience and size of primary practice. RESULTS: Of the participants (n = 1076; 37.9% response rate), 69.7% were male, 84.4% were general practitioners, mean time in practice was 20.6 years (0.5-42 years) and 42.2% were in cities of over 500 000 people. Most dentists (60.2%) provided anesthesia services, although 38.2% indicated lack of training and the belief that there is no patient demand (25.3%) as reasons not to use anesthesia in their offices. Nitrous oxide was used 17.5% of the time for all dental procedures except implants. Barriers to referral of patients for anesthesia services included high costs associated with sedation/GA (72.2%) and patient fear of anesthesia (33.5%). CONCLUSION: This study identified a perceived lack of patient demand, lack of dentist training, high costs of sedation/GA and patient fear of sedation/GA as primary barriers to use of sedation/GA in Ontario dental practices. The use of various anesthesia modalities is diverse, with 60.2% of dentists providing sedation/GA.

PURPOSE: To determine the influence of gender on weekly work hours of Ontario dentists. METHODS: In 2012, a 52-item survey was sent to a random sample of 3000 Ontario dentists (1500 men and 1500 women) to collect information on personal, professional and sociodemographic characteristics. The resulting data were analyzed using descriptive statistics and linear regression modeling. RESULTS: The 867 respondents included 463 men, 401 women and 3 people whose gender was unreported, yielding a response rate of 29%.Most dentists worked full-time, with men working, on average, 2 h/week longer than women. Younger dentists worked more than older dentists. Practice ownership increased weekly work hours, and men reported ownership more often than women. Canadian-trained women worked significantly fewer hours than those trained internationally. Women were more likely than men to work part time and take parental leave and more often reported being primary caregivers and solely responsible for household chores. Women with partner support for such tasks worked more hours than those who were solely responsible. Dentists with children ≤ 3 years of age worked fewer hours than those without children; however, after controlling for spousal responsibility for caregiver duties, this effect was eliminated. More women than men reported making concessions in their career to devote time to family. CONCLUSION: Gender, age, practice ownership, training location and degree of spousal support for household and caregiving responsibilities were predictors of weekly work hours. For women specifically, training location and household and caregiving responsibilities predicted weekly work hours.

Guidelines for the selection of patients requiring radiological examination have recently been published in Canada and the United States. The purpose of this paper, the second in a three-part series on the results of a questionnaire to Ontario general practitioners, is to compare bitewing use in Ontario against the U.S. guidelines. This questionnaire determined the frequency of recall bitewing examination for low and high caries risk patients, as well as the factors that influence the diagnostic and treatment decisions of the responding dentists. For example, 49 to 78 per cent of dentists order recall bitewings--in accordance with U.S. guidelines--for their patients in individual low caries risk categories. Similarly, 49 to 88 per cent of dentists order recall bitewings for individual patients in high caries risk categories, which is also consistent with the U.S. guidelines. However, across all low and high caries risk groups of patients, the percentages of dentists who followed the recommended guidelines were 34 and 15 per cent, respectively. The responding dentists' estimates of the length of time required for caries to progress through enamel are indirectly associated with the interval prescribed for recall bitewing examination.

Variations in the pediatric referral practices of general dentists for children aged zero to 14 years may be related to issues concerning quality and standards of care, cost containment, and predictability in third-party payment programs. In September 1992, a survey mailed to a random sample of approximately 10 per cent of Ontario general dentists was used to gather information about pediatric referral practices as well as economic and demographic factors associated with these practices. Responses were received from 381 of the 540 dentists surveyed (69 per cent). Most dentists who gave reasons for pediatric referrals (85.6 per cent) named behavior management problems as the primary cause. However, 21.5 per cent did not refer any children under 14 to pediatric dentists. Due to the variable results obtained using assorted statistical tests to regrade the outcomes of interest, the self-reported nature of the data, and the large amount of pediatric referral practice variation left unexplained by the multivariate analysis (95 per cent), this study's findings are equivocal.

Based on the responses of 1,276 general dental practitioners in Ontario to a mail questionnaire, variations in certain aspects of the dentists' diagnostic, preventive and restorative knowledge and beliefs are examined. Despite recent practice recommendations and guidelines indicating that patient need and service selectivity, rather than traditional, routine prescriptions, should be the guiding principle of practice, many dentists seem to follow tradition in defining optimal intervals for dental examinations and prophylaxes, bitewing radiographs and topical fluoride applications. Although the respondents' knowledge and beliefs were correct and consistent with current evidence in many areas, some large deficiencies were identified. These include: a lack of awareness that professional prophylaxis prior to topical fluoride application is usually unnecessary and that sealant applications to certain teeth are not cost-effective; an over-estimation of the speed at which dental caries progress through the enamel; and, despite good knowledge about the opportunities for the remineralization of enamel lesions with fluorides, a tendency to restore enamel caries. In some instances, practitioner beliefs were shown to influence practice. For example, dentists who knew about the slow progression of approximal surface caries also reported more often that bitewing intervals should be longer, and that the placement of a restoration should be delayed until the caries penetrates the dentin. Similarly, correct knowledge about sealant effectiveness was positively associated with high sealant use. If dentists are to be expected to understand and follow emerging diagnostic, preventive and restorative practice recommendations and guidelines, continuing education is required to correct and update some of their knowledge and beliefs, as displayed in the responses to this questionnaire.

In February 1991, a mail survey was used to poll a sample consisting of about 10 per cent of Ontario's general dentists. The data obtained provided information about the radiographs prescribed by dentists for five different patient types, which were described to the respondents. The per cent agreement between the radiographic procedures prescribed by Ontario dentists and the ADA-approved Center for Devices and Radiological Health (CDRH) guidelines ranged from three per cent to 79 per cent, depending on patient type and disease risk. For each patient and risk type, there was considerable variation in the radiographs prescribed.