title: Dentists' practice behaviors and perceived barriers regarding oral-systemic evidence: implications for education.
abstract: Observational studies consistently support a relationship between poor oral health and systemic diseases like cardiovascular disease and diabetes mellitus. The purpose of this study was to identify current practices and perceived barriers among North Carolina dentists regarding the incorporation of oral-systemic evidence into the delivery of patient care. A survey questionnaire was developed, pilot tested, revised, and mailed to 1,350 licensed dentists in North Carolina. The response rate was 49 percent. Bivariate analysis was used to compare practice behaviors and barriers among age, gender, practice type, and setting categorizations using the chi-square test. Respondents were predominantly male (77 percent), in solo practice (59.4 percent), and in urban or suburban settings (74 percent). Half (50 percent) reported updating medical histories at every patient visit. Younger dentists were significantly (p<0.05) more likely to inquire about patient blood glucose levels and utilize blood pressure guidelines. Perceived patient objections to additional fees and lack of patient acceptance were reported as significant barriers, especially among younger dentists. Significantly more rural dentists reported lack of appropriate referral options as a barrier (p<0.05). In the multivariate analysis, gender and type of practice but not age were statistically significant predictors of respondents' perceptions of patients' objection to additional fees. Dental schools need to prepare dental students for future roles in the assessment, management, and interprofessional collaboration that will be needed in the future.
authors.affiliation: Prof. Wilder is Professor and Director of Graduate Dental Hygiene Education, Department of Dental Ecology and Director of Faculty Development, University of North Carolina School of Dentistry; Prof. Bell is Assistant Professor, Pacific University School of Dental Health Science; Dr. Phillips is Professor, Department of Orthodontics and Assistant Dean for Advanced Education/Graduate Studies, University of North Carolina School of Dentistry; Dr. Paquette is Professor and Associate Dean for Education, Stony Brook University School of Dental Medicine; and Dr. Offenbacher is Chair, Department of Periodontology, OraPharma Distinguished Professor of Periodontal Medicine, and Director of the Center for Oral and Systemic Diseases, University of North Carolina School of Dentistry. wilderr@dentistry.unc.edu.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Wilder
authors.affiliation: Prof. Wilder is Professor and Director of Graduate Dental Hygiene Education, Department of Dental Ecology and Director of Faculty Development, University of North Carolina School of Dentistry; Prof. Bell is Assistant Professor, Pacific University School of Dental Health Science; Dr. Phillips is Professor, Department of Orthodontics and Assistant Dean for Advanced Education/Graduate Studies, University of North Carolina School of Dentistry; Dr. Paquette is Professor and Associate Dean for Education, Stony Brook University School of Dental Medicine; and Dr. Offenbacher is Chair, Department of Periodontology, OraPharma Distinguished Professor of Periodontal Medicine, and Director of the Center for Oral and Systemic Diseases, University of North Carolina School of Dentistry.
authors.forename: Kathryn P
authors.initials: KP
authors.lastname: Bell
authors.affiliation: Prof. Wilder is Professor and Director of Graduate Dental Hygiene Education, Department of Dental Ecology and Director of Faculty Development, University of North Carolina School of Dentistry; Prof. Bell is Assistant Professor, Pacific University School of Dental Health Science; Dr. Phillips is Professor, Department of Orthodontics and Assistant Dean for Advanced Education/Graduate Studies, University of North Carolina School of Dentistry; Dr. Paquette is Professor and Associate Dean for Education, Stony Brook University School of Dental Medicine; and Dr. Offenbacher is Chair, Department of Periodontology, OraPharma Distinguished Professor of Periodontal Medicine, and Director of the Center for Oral and Systemic Diseases, University of North Carolina School of Dentistry.
authors.forename: Ceib
authors.initials: C
authors.lastname: Phillips
authors.affiliation: Prof. Wilder is Professor and Director of Graduate Dental Hygiene Education, Department of Dental Ecology and Director of Faculty Development, University of North Carolina School of Dentistry; Prof. Bell is Assistant Professor, Pacific University School of Dental Health Science; Dr. Phillips is Professor, Department of Orthodontics and Assistant Dean for Advanced Education/Graduate Studies, University of North Carolina School of Dentistry; Dr. Paquette is Professor and Associate Dean for Education, Stony Brook University School of Dental Medicine; and Dr. Offenbacher is Chair, Department of Periodontology, OraPharma Distinguished Professor of Periodontal Medicine, and Director of the Center for Oral and Systemic Diseases, University of North Carolina School of Dentistry.
authors.forename: David W
authors.initials: DW
authors.lastname: Paquette
authors.affiliation: Prof. Wilder is Professor and Director of Graduate Dental Hygiene Education, Department of Dental Ecology and Director of Faculty Development, University of North Carolina School of Dentistry; Prof. Bell is Assistant Professor, Pacific University School of Dental Health Science; Dr. Phillips is Professor, Department of Orthodontics and Assistant Dean for Advanced Education/Graduate Studies, University of North Carolina School of Dentistry; Dr. Paquette is Professor and Associate Dean for Education, Stony Brook University School of Dental Medicine; and Dr. Offenbacher is Chair, Department of Periodontology, OraPharma Distinguished Professor of Periodontal Medicine, and Director of the Center for Oral and Systemic Diseases, University of North Carolina School of Dentistry.
authors.forename: Steven
authors.initials: S
authors.lastname: Offenbacher
mesh_terms: D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001786:Blood Glucose / Q000032:analysis; D001795:Blood Pressure Determination; D003430:Cross-Sectional Studies; D003729:Dental Care; D004194:Disease; D004497:Education, Dental; D005250:Fees, Dental; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009657:North Carolina; D010510:Periodontal Diseases / Q000150:complications*; D019239:Practice Patterns, Dentists'; D011331:Private Practice; D011364:Professional Practice; D011365:Professional Practice Location; D012017:Referral and Consultation; D012737:Sex Factors; D013383:Suburban Population; D016312:Treatment Refusal; D014505:Urban Population
chemical_list: D001786:Blood Glucose
keywords: cardiovascular disease; dental education; dentists; diabetes; disease management; interprofessional education; oral-systemic disease; periodontitis; risk factors