In dentistry comparative studies of diffusion of disease preventive innovations are rare and usually atheoretical. For these reasons the present study was designed 1) to determine whether or not normal distribution assumptions applied to decisions to adopt caries preventive fluoride programs in a public dental service; 2) to compare rates of adoption of two school-based and one clinic-based fluoride program, and 3) to look for evidence indicating which type of decision-making may have been involved. The programs studied were school-based fluoride brushing 4-5 times per year, fluoride mouthrinsing at least once a month, and professional topical fluoride applications at least once a year. Data were collected by postal questionnaires from public dental officers in Norway in 1972, 1977 and 1982. To determine the length of time which had elapsed from the time of innovation of the technologies to adoption, the dental literature was reviewed. The adoption curves for school-based fluoride brushing and rinsing, as well as for clinic-based topical fluoride application did not comply with the normal distribution assumption. The time lapse from innovation to adoption was in excess of 10 yr and the rates of adoption differed between programs. Decision-making would appear to have been primarily individual or collective. It was concluded that generalization beyond the innovations studied and the social and organizational setting of this particular investigation is inadmissible. Consequently, there is a need for more and larger scale comparative analytical studies to increase our understanding of diffusion and adoption of innovations in dentistry.
The 740 dentists authorized to practise dentistry in Norway during the years 1972-1976 were contacted by postal questionnaires in April/May the first and second year following authorization. Those authorized in 1972 and 1976 were surveyed only once, in 1972 and 1977, respectively. The response rate was always higher than 89%. Urban/rural and regional maldistribution of civilian dentists was reduced during the years 1972-1977 (Tables 1-7). The dentist/population ratio fails to allow for variation in need and demand for dental care, the use of ancillary personnel, demographic, socio-economic and cultural factors. Consequently, care should be exercised when judging the adequacy or otherwise of the supply of dentists by these results. The proportion of respondents whose place of work and home address at the start of dental studies, was the same county, increased during the observation period (Fig. 1), when in fact an opposite trend had been expected because of the progressively more difficult job situation for newly authorized dentists. It was concluded that this tendency to return "home" might be made use of in the efforts to make dental health services equally available and accessible to all citizens.
The purpose of the present study was to determine whether the caries-preventive effect of school-based programs with fluoride (F) mouthrinsing or toothbrushing was evident at the end of a post-treatment follow-up period of 11 years. Two groups of subjects examined at 14 years of age (born in 1960), who had participated in fortnightly F rinsing (n = 52) or in F brushing 4-5 times a year at school (n = 50), were re-examined radiographically and completed a questionnaire at age 25 years. A comparison group of 25-year-olds (n = 51) was also included. Analyses of variance showed that the benefits of participation in school-based F programs seem to have been lost. It appears that these caries-preventive programs have delayed rather than prevented caries and that F toothpaste and other caries-preventive efforts have been insufficient to avert a substantial caries activity during the follow-up period.
The aim of the present study was to collect information about primary, secondary, and tertiary reasons that dentists gave for extracting permanent teeth and to determine whether and how dentist-associated characteristics might influence the relative emphasis on clinical diagnosis versus non-disease considerations given as reasons. A national random sample of Norwegian dentists (n = 500) recorded reasons for tooth extraction during a period of 2 weeks in 1988 (response rate, 70%). Nine hundred and eight-five teeth were extracted from 692 patients. Disease-/condition-related diagnoses topped the list for primary and secondary reasons for extraction, whereas patients' wishes, economy, and esthetics came to the forefront among tertiary reasons. Logistic regression analysis showed that the choice between clinical diagnosis and non-disease considerations as primary and secondary reasons for extraction was significantly but moderately influenced by variables associated with the dentist.
The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive values for Corah's Dental Anxiety Scale (DAS) and two modified versions of it (MDAS; MDAS/4). A questionnaire was mailed to a simple random sample of 1,190 25-year-old residents in the west of Norway in 1997. Half the sample received DAS, the other half MDAS. The response rate after one reminder was 62%. The respondents completed the scales, gave demographic particulars and answered one question about dental visiting habits during the last 5 years plus an open-ended question about reasons for non-attendance. Using the answers to the latter question as validating criterion, it was found that, for all scales, sensitivity decreased while specificity improved when changing from a liberal to a stringent cut-off point. The scales gave low positive predictive values ( or = 0.98). Since DAS and MDAS/4 gave almost identical findings, the two samples were combined. At a cut-off point > or = 13 sensitivity was 0.83, specificity 0.84, positive predictive value 0.18 and negative predictive value 0.99. The corresponding estimates when the cut-off point was > or = 15 were 0.67, 0.90, 0.22 and 0.98. It is concluded that, in this test, DAS and the two versions of MDAS gave acceptable, or near acceptable sensitivity, specificity and negative predictive values, but far too low positive predictive values to be useful for prediction at the individual level.
The purpose of this study was to evaluate factors related to caries in 6-17-year-olds in 2 groups of Norwegian counties between 1966 and 1983. The average number of surfaces filled and permanent teeth extracted due to caries declined in the 4 northern counties from 1967. An increase was recorded in the 7 southwestern counties until 1971, then a decline. In the 1960s significantly more surfaces were filled and teeth extracted in the north compared to the southwest. Based on intra-county comparisons, the decline in surfaces treated was greater in the north between 1967 and 1983; 5.4 +/- 0.4 vs 3.7 +/- 0.7, P
The purpose of the present study was to determine whether or not the decline in caries prevalence had continued among Norwegian 5-, 12- and 18-yr-olds from 1985 to 1991. The analysis was carried out at national, county and dental district level based on the annual census reports from public dental officers. Caries decline continued at national level. Some counties exhibited increases from 1 year to the next, more so in the last 3 years than in the first 3 years of observation, but not consistently. There was stronger evidence for a leveling out or reversal of caries trend at district than at county level. Reversal affected more 5- than 15-yr-olds and more 12- than 18-yr-olds. The chief dental officers in districts reporting a reversal of trend in caries prevalence and in comparison districts showing continued caries decline were interviewed by telephone concerning factors which might explain the observed caries trend. The interviews revealed no obvious explanation why caries prevalence increased in some dental districts while it continued to decline in others. It is concluded that a reversal in caries trend has occurred in some Norwegian dental districts between 1985 and 1991 and that there is a need for a more detailed study of the situation.