How do specialist surgeons treat the atrophic tooth gap? A vignette-based study among maxillofacial and oral surgeons

Background There is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons. Methods A total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants “patient age” and “endocarditis prophylaxis” and vignette 2 with determinants “anxiety” and “bisphosphonate therapy”. Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle. Results A total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. “Patient age” and “patient anxiety” were not significantly associated with any therapy decision. However, required “endocarditis prophylaxis” led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. “Bisphosphonate therapy” was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision. Conclusion “Patient age” as well as “patient anxiety” appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy.

ENDOCARDITIS PROPHYLAXIS IN DENTAL PRACTICE: EVALUATION OF KNOWLEDGE AMONG DENTISTS, AND CARDIOLOGISTS

Background: Infective endocarditis (IE) is a rare condition that is associated with considerable morbidity and mortality. Almost 100 years ago, the links between endocarditis and procedures, particularly dental procedures, were postulated. Over 50 years ago the first guidelines recommending antibiotic prophylaxis (AP), with the aim of preventing IE from developing after dental procedures, were proposed. Objective: This study aimed to assess the degree of knowledge about endocarditis prophylaxis (EP) among cardiologists, and dentists, and to identify the areas of knowledge that require attention Methods: We conducted a cross-sectional study of 43 cardiologists and 87 dentists in the city of Rabat. Respondents completed a questionnaire to evaluate their knowledge of EP after signing their informed consent. Data were examined through analysis of variance using the chi-squared test (X²) and Fishers exact test to test the significance of the differences between proportions. Findings: 53.5% of cardiologists report following the European Society of Cardiology (ESC) against 62.1% of dentists refer to the French Agency for Health Product Safety (FAHPS), 27.9% of cardiologists are aware of cardiac conditions with a high risk of IE compared to 75.9% of dentists. 2.3% of cardiologists are aware of invasive oral procedures against 54% for dentists. 69% of cardiologists and 70% of dentists have a correct antibiotic prophylaxis prescription regime. 4.7% of cardiologists and 24.1% of dentists know the meaning of spontaneous bacteremia. Conclusion : Both groups had inadequate knowledge of dental procedures. Dentists showed a greater knowledge of heart disease requiring prophylaxis in dental practice. It is thus necessary to reinforce EP knowledge in undergraduate and postgraduate programs and to encourage dentists and cardiologists to keep up-to-date on this issue.

How Do Specialist Surgeons Treat the Atrophic Tooth Gap? - A Vignette-based Study Among Maxillofacial and Oral Surgeons

BackgroundThere is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons.MethodsA total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants “patient age” and “endocarditis prophylaxis” and vignette 2 with determinants “anxiety” and “bisphosphonate therapy”. Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle.ResultsA total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. “Patient age” and “patient anxiety” were not significantly associated with any therapy decision. However, required “endocarditis prophylaxis” led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. “Bisphosphonate therapy” was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision.Conclusion“Patient age” as well as “patient anxiety” appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy.

Infective endocarditis: prevention and antibiotic prophylaxis

After considerable revision of the previous guidelines on infective endocarditis prophylaxis by the American Heart Association in 2007, the Swiss recommendations were revised and published accordingly in 2008. The Swiss societies of Infectious Diseases (SSI), Pediatric Cardiology and Cardiology and the Pediatric Infectious Disease Group of Switzerland present the current update in a joint initiative.