title: Routine oral examinations in primary care: which predictors determine what is done? A prospective clinical case recording study.
abstract: OBJECTIVE
  Elements of a routine oral examination (ROE) in dental practice may be determined by patients' oral status, as recommended by prevailing knowledge, as well as by other factors. Our aim was to identify patient and GDP characteristics associated with aspects of oral health assessment (OHA) and clinical management (CM) in patients with various oral conditions.
  
  
  METHODS
  A prospective observational study was performed, based on clinical case recording of 1059 ROEs by 128 GDPs. A clinical case recording form was used to record oral health assessment, diagnoses made, and clinical management for each ROE. Multilevel logistic regression analyses (with random coefficients) were performed.
  
  
  RESULTS
  Overall, 'patients' age' in domains OHA as well as CM was the most salient predictor, while 'positive attitude to periodontal screening' showed to be a prominent GDP-factor. Patient characteristics mostly involved in OHA and CM were 'disease-free period' (odds ratios from 0.21 to 0.66), 'oral health compliance' (odds ratios from 0.32 to 0.65) and 'risk for periodontal disease' (odds ratios from 1.79 to 4.97). 'Continuing professional development' (odds ratios from 2.54 to 4.95), 'mean reading hours' (odds ratios from 2.25 to 4.48) and 'cooperation with peers' (odds ratios from 2.78 to 3.72) showed to be significant GDP-predictors.
  
  
  CONCLUSIONS
  ROEs are determined by patient oral health status, particularly by aspects of oral health compliance and risk for oral disease, but also by GDP characteristics. The latter may reflect perceptions of a professional role, which need to be considered in efforts to improve the quality of ROE in oral care.
authors.affiliation: Radboud University Nijmegen Medical Centre, College of Oral Sciences, Department of Preventive and Restorative Dentistry, Nijmegen, The Netherlands. d.mettes@dent.umcn.nl
authors.forename: Theodorus G
authors.initials: TG
authors.lastname: Mettes
authors.forename: Wil J M
authors.initials: WJ
authors.lastname: van der Sanden
authors.forename: Henk G
authors.initials: HG
authors.lastname: Mokkink
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
authors.forename: Alphons J M
authors.initials: AJ
authors.lastname: Plasschaert
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003731:Dental Caries / Q000175:diagnosis; D003792:Dental Records; D003945:Diagnosis, Oral; D017050:Episode of Care; D005260:Female; D005792:General Practice, Dental; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010510:Periodontal Diseases / Q000175:diagnosis; D010808:Physical Examination; D019239:Practice Patterns, Dentists'; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment