Papers by Michael MacEntee
International Journal of Qualitative Methods, 2011
This article explores several aspects of electronic communication, specifically its advantages an... more This article explores several aspects of electronic communication, specifically its advantages and disadvantages within the context of a brief experience using email to interview elders. Two older adults participated via email as the psychosocial impact of aging was collected using such venue. Our experiences are compared with published reports from others to analyze the benefits and limitations of email as a research tool. The email was spontaneous, comprehensive, interactive, efficient, confidential, and cost effective. The use of email within this exploratory study appeared to be an effective approach to collecting qualitative information about beliefs and behaviours from older adults who feel comfortable with this form of communication. The lack of similar studies limited the scope of discussion and comparison of findings; generalization is limited due to the small sample size. This investigation, however, suggested that the use of email as an interview tool may be considered in today's exploratory research arena as an alternative to conference calls or faceto-face interviews when time is a constraint.
The Journal of prosthetic dentistry, Jan 23, 2016
The value of digital panoramic radiographs to screen for problems before fabricating conventional... more The value of digital panoramic radiographs to screen for problems before fabricating conventional complete removable dental prostheses is unclear. The purpose of this retrospective study was to examine the influence of pretreatment digital panoramic radiographs on the clinical management of patients receiving complete removable dental prostheses. The clinical records, including panoramic radiographs, of 169 patients seeking new complete removable dental prostheses over a 6-year period were interpreted independently by both a prosthodontist and an oral and maxillofacial radiologist to identify radiographic findings that influenced clinical patient management. A 95% confidence interval and an observed proportion of agreement were used to interpret the results. Sixty percent of the 169 radiographs examined had 1 or more abnormal or positive radiographic findings; however, only 6 (<4%) of 165 abnormalities detected influenced patient management, and 3 of them were identified during t...
The International Journal of Prosthodontics, 1993
This study reviewed the prosthodontic treatment and aftercare required by 29 patients with 32 imp... more This study reviewed the prosthodontic treatment and aftercare required by 29 patients with 32 implant-supported prostheses (12 fixed and 20 removable) placed on 107 implants. Patients were followed for 4 to 39 months. The majority of implant-supported prostheses (53%) were placed in the mandible. Visual analogue scales were used by the patients to rate their satisfaction with their prostheses and their chewing ability. Approximately one third of the patients studied required three or more relines of their existing dentures between first- and second-stage surgeries, while over half of the definitive implant-supported prostheses required a major adjustment or repair. Removable prostheses required 78% of the total repairs and accounted for 80% of those prostheses that needed repeated repairs. In general, patients were very satisfied with their implant-supported prostheses, but 17% complained of mild speech difficulties and 7% noted slight difficulty in cleaning their fixed prostheses. Overall, the short-term prosthetic management required for the implant-supported prostheses in this study was substantial, particularly with the removable prostheses, and this should be taken into account when evaluating prosthetic options.
Oral Dis, 2008
The numbers of participants over 75 years of age in previous studies of oral health have not been... more The numbers of participants over 75 years of age in previous studies of oral health have not been sufficient to permit a full investigation of the influence of age on the mouth. In this study a disproportionate stratified random sample of 255 independent elders was selected from a list of urban voters to provide similar numbers of men and women in three age groups. The subjects were interviewed and examined, and nearly half of them had mucosal disorders. There was a significant (P &amp;amp;lt; 0.05) association between mucosal lesions and the use of dentures and tobacco, whereas stomatitis, denture-related hyperplasia and angular cheilitis in particular were associated significantly with men and with the use of defective dentures. Logistic regression revealed that neither age alone nor the quality of dentures predispose to mucosal lesions, but that the odds of finding stomatitis, denture-related hyperplasia and angular cheilitis in particular increased about three-fold in denture-users, and almost doubled in men.
Journal of Dental Education, Mar 1, 2011
The approach to care in dentistry has evolved over the past couple of decades from a narrow focus... more The approach to care in dentistry has evolved over the past couple of decades from a narrow focus on oral disease to addressing the psychosocial determinants of oral health. Subsequently, there have been many attempts to reform dental curricula through alternative models of education, such as competency-based and community-based educational models and problem-based learning. These efforts aim to improve the abilities of dental students in problem-solving, critical thinking, professionalism, and social and cultural competence to help them cope with the complexity of dealing with oral health-related issues and the constantly changing evidence underlying the practice of dentistry. However, it is not yet clear how well these educational initiatives meet their objectives or how they influence the reasoning skills of dental students. There is now a need to develop a conceptual framework for clinical reasoning in dentistry grounded on empirical evidence to direct the future evolution of dental education.
The International Journal of Oral Maxillofacial Implants, 2002
This randomized clinical trial examined implant overdenture (IOD) fabrication and maintenance tim... more This randomized clinical trial examined implant overdenture (IOD) fabrication and maintenance time and costs, adjustment and repair incidence, and patient satisfaction after 1 year. Sixty-four patients received 2 mandibular implants and an IOD with either a bar with 2 clips or 2 ball attachments for denture retention. Fabrication time, number of appointments, and chair time for adjustments were similar for the 2 denture designs. The most common adjustments for both types were to the IOD contours. Ball-attachment dentures required about 8 times longer for repairs than bar-clip prostheses. Approximately 84% of patients with ball-attachment dentures needed at least 1 repair, versus 20% of those with a bar-clip mechanism. The most common repairs were replacement of the cap spring or cap for the ball-attachment IOD and replacement of a lost or loose clip for bar-clip dentures. Patients were equally and highly satisfied with the improvements in function, comfort, and appearance with both types of IOD compared to their original conventional dentures. Given equivalent levels of patient satisfaction with either method of retention and a much higher repair rate for the ball attachment, it is suggested that a bar-clip design be used rather than the particular ball attachment utilized in this study.
Journal, 1992
This paper reviews the facts available on the biological effects of mercury released from amalgam... more This paper reviews the facts available on the biological effects of mercury released from amalgam restorations in teeth. There seems to be no doubt that mercuric vapor is released from restorations, but we do not know how much of this mercury is deposited in human tissues. There is no scientific evidence to support the belief that vapors from dental restorations either cause or exacerbate human diseases. Therefore, there is no clinical justification at present for replacing amalgam with other less durable or less predictable restorative materials.
The Journal of Prosthetic Dentistry, 2005
Few prospective trials of implant-retained mandibular dentures have evaluated the increase and du... more Few prospective trials of implant-retained mandibular dentures have evaluated the increase and duration of patient satisfaction, costs of denture maintenance in relation to different methods of attaching overdentures to implants, or the use of a reinforced framework. This report evaluates subjects&amp;amp;amp;amp;amp;amp;#39; satisfaction and prosthodontic maintenance during a 3-year randomized clinical trial of implant-retained mandibular complete dentures, whether reinforced or not with a cast framework, and attached by bar-clip or 2.25-mm ball-spring matrices to endosteal dental implants. One hundred edentulous subjects, each having at least 1 year&amp;amp;amp;amp;amp;amp;#39;s experience with conventional complete dentures, were selected from respondents to a university dental clinic&amp;amp;amp;amp;amp;amp;#39;s request for volunteers. Candidates were examined to verify adequate mandibular bone and medical suitability for implants. Subjects then received 2 implants in the anterior mandible before being stratified by mandibular bone height and gender and assigned randomly to 1 of 4 treatment groups. Every subject received a new maxillary complete denture in addition to an implant-supported mandibular complete denture, with or without a reinforcing framework, connected to implants by either a bar-clip or a ball-spring patrix and matrix. The dentures were adjusted and repaired as needed. Subjects indicated on a visual analogue scale (VAS) satisfaction with conventional dentures prior to the study and then with new dentures at 1 month, 1 year, and 2 years. The results reported here are from the first 68 subjects observed for 3 years after receiving new dentures (19 subjects received new dentures less than 3 years before this analysis, and another 13 subjects were lost to follow-up). VAS scores are presented in simple tables and graphs, and results for different groups were compared using 2-sided nonparametric rank tests and repeated measures ANOVA. With respect to costs and maintenance, t tests were used to compare group means. Sample size and other design considerations used a .05 significance level. After receiving new dentures with mandibular implant supports, improved satisfaction &amp;amp;amp;amp;amp;amp;quot;within subject&amp;amp;amp;amp;amp;amp;quot; was prompt, durable, substantial, and statistically significant, regardless of the attachment mechanism, and with or without a reinforcing framework. In contrast, there were no notable satisfaction differences between the 2 attachment mechanisms, or with the presence or absence of a reinforcing framework, either at specific intervals after receiving the new dentures, or in repeated measures ANOVA. For both attachment groups, most denture adjustments occurred during the first year. This accounted for 81% of total adjustments during 3 years, when the 34 subjects in the ball-spring group and the 34 in the bar-clip group were combined. The mean numbers of adjustments per subject and associated clinical times did not differ significantly between the 2 groups. Conversely, denture repairs declined more slowly than adjustments. Almost all repairs (90%) occurred in the ball-spring group to correct problems with the attachments, 39% in the first year, and tapering off only slightly in the following 2 years. Over 3 years of follow-up, mean numbers of repairs per subject differed significantly between groups: 6.7 repairs per person in the ball-spring group, compared to 0.8 in the bar-clip group ( P&amp;amp;amp;amp;amp;amp;lt;.001), and mean time per appointment was greater for repairs in the ball-spring group: 18.9 minutes compared to 16.9 ( P&amp;amp;amp;amp;amp;amp;lt;.01). The cast framework had no influence on the satisfaction expressed or on adjustments and repairs. Subjects were very satisfied with the new dentures, although the ball-spring attachment tested in this trial required substantially more repairs.
Journal of Dental Education, Dec 1, 2007
This study explores how dentists explain the concept of social responsibility and its relationshi... more This study explores how dentists explain the concept of social responsibility and its relationship to issues affecting access to oral health care by vulnerable segments of the population. Analysis of open-ended interviews with thirty-four dentists, including dental educators, and administrators and officials of dental public health programs in Canada and the United States revealed that four main themes-economics, professionalism, individual choice, and politics-influenced the respondents' sense of social responsibility in dentistry. There was a belief that social responsibility in dentistry is dominated by economic imperatives that impact negatively on the policies and practices directing access to care. Yet, despite the highly critical stance on dentistry as a business, there was practical recognition of the economic realities of dental practice. Nevertheless, those who focused on social responsibility as a professional obligation highlighted the privileges of self-governance along with the accompanying duty to serve the welfare of everyone and not just those who are socioeconomically advantaged.
The International journal of prosthodontics
The International Journal of Prosthodontics, 1997
This study examined the adjustments, repairs, time, and costs required to maintain 69 implant pro... more This study examined the adjustments, repairs, time, and costs required to maintain 69 implant prostheses in private prosthodontic practice for an average of 22 months after placement. For the removable prosthesis design, the most common adjustment was contouring the prosthesis and the most common repair was retentive component replacement. Screw tightening or fracture repair were the most frequently needed modifications for fixed implant prostheses. Each removable implant prosthesis averaged four times as many postplacement adjustments and almost twice as many repairs as did each fixed implant prosthesis, and the mean length of each maintenance appointment was also longer for removable prostheses. Mean repair costs were approximately 60% higher for the removable design.
Social Science Medicine, Jul 31, 2002
There is a growing concern in most countries to address the problem of inequities in health-care ... more There is a growing concern in most countries to address the problem of inequities in health-care within the context of financial restraints on the public purse and the realities of health professions that are influenced strongly by the economic priorities of free-market economies. Dental professionals, like other health professionals, are well aware that the public expects oral health-related services that are effective, accessible, available and affordable. Yet, there is remarkably little reference in the literature to the theories of distributive justice that might offer guidance on how an equitable oral health service could be achieved. This paper considers three prominent theories of distributive justiceFlibertarianism, egalitarianism and contractarianismFwithin the controversial context of basic care and quality of life. The discussion leads towards a socially responsible, egalitarian perspective on prevention augmented by a social contract for curative care with the aim of providing maximum benefit to the least advantaged in society. r (M.I. MacEntee). 0277-9536/02/$ -see front matter r 2002 Elsevier Science Ltd. All rights reserved. PII: S 0 2 7 7 -9 5 3 6 ( 0 1 ) 0 0 1 7 4 -5
Journal, Sep 1, 2010
Open-field aluminum-nickle-cobalt magnets have been used in prosthodontics for many years, but su... more Open-field aluminum-nickle-cobalt magnets have been used in prosthodontics for many years, but success has been limited because these magnets are susceptible to corrosion by the saliva and because their retentive force is weak relative to the initial retention offered by mechanical attachments. More recently, magnets have been made from alloys of the rare earth elements samarium and neodymium, which provide stronger magnetic force per unit size. In addition, a new generation of laser-welded containers has improved protection from salivary corrosion. The current resurgence of interest in this type of attachment appears justified because, unlike mechanical attachments, magnets have potential for unlimited durability and might therefore be superior to mechanical ball or bar attachments for the retention of removable prostheses on implants. To date, no long-term prospective trials have been conducted to confirm the clinical durability of this new generation of magnets for retaining dentures on either teeth or implants. The aim of this study was to document initial clinical experiences and levels of satisfaction among edentulous patients treated with mandibular implant-supported overdentures retained using a new generation of rare-earth magnetic attachments. At the outset, all but one of the 17 patients had had several years of experience with implant-supported overdentures. During the first year, the mean overall satisfaction among these 17 patients increased from less than 70 to over 90 out of 100 (standardized visual analogue scale). No unusual difficulties were encountered in rendering the treatment or maintaining the attachments. This report offers preliminary evidence of the excellent potential of these magnets for retaining mandibular implant-supported overdentures.
... Also of Interest: Dry Mouth, The Malevolent Symptom: A Clinical Guide Leo M. Sreebny and Arja... more ... Also of Interest: Dry Mouth, The Malevolent Symptom: A Clinical Guide Leo M. Sreebny and Arjan Vissink 9780813816234 ISBN: 978-0-8138-1264-9 www. wiley. ... Psalms 71: 9 A SCENARIO Mrs. Olivera&amp;amp;amp;amp;amp;#x27;s reflections on life&amp;amp;amp;amp;amp;#x27;s course. ...
Journal of Dental Education, Dec 1, 2005
Little is known about how dental students respond to dental geriatrics. This article describes a ... more Little is known about how dental students respond to dental geriatrics. This article describes a qualitative analysis of reflective journals submitted over two years by ninety-two senior students who participated in a brief clinical rotation in longterm care facilities. We used an inductive interpretive approach to analyze the journals. Eight themes emerged from the analysis: 1) complexity of the institutional environment; 2) heterogeneity of the resident population; 3) multidisciplinary environment; 4) record keeping; 5) interactions with residents; 6) the difficulty of oral health care for frail residents; 7) bridging the gap between theory and practice; and 8) the emotional impact of the clinical experiences. Apparently, the students appreciated the opportunity to witness the complexity of care in a multidisciplinary context and to observe a practical program of oral health care. They described the rotations as unique and emotionally challenging but very worthwhile. Overall, they wrote positively about their experiences with the elderly residents, acknowledged the contribution of the rotation as important to their clinical maturation, and reported that the experience enhanced their appreciation of a dentist's professional responsibilities.
Journal of Dental Education, 2010
Education in dentistry as in medicine is guided principally by the ontology and theory of science... more Education in dentistry as in medicine is guided principally by the ontology and theory of science, which provides definitions of health and disease, legitimizes research methods, and influences the role of the clinician. The challenge of managing chronic oral disease and disability prompts interest in social theory as much as science. Therefore, dental geriatrics requires a solid foundation in the humanities from the belief that the determinants of health and the cause of chronic diseases lie within an intermingling of biology, economics, sociocultural structure, and human behavior. The dental curriculum in many places is reorganizing from the horizontal foundation of basic sciences to an integration of foundational and clinical knowledge focused on clinical competencies and integrated care. The impact of this integration on dental geriatrics necessitates a more humanistic and naturalistic perspective in dental education to balance and challenge the current evidence for best clinical practice, which at present is based almost exclusively on science. Consequently, dental students should be exposed to a consilience of the science and the humanities if dentists are to address effectively the needs of an aging population.
Journal of Dental Education, Sep 1, 2012
This study presents a conceptual framework for clinical reasoning by dental students. Using a thi... more This study presents a conceptual framework for clinical reasoning by dental students. Using a think-aloud method with six vignettes, the researchers interviewed eighteen dental students from two stages of training about oral health-related problems influenced by biopsychosocial factors. Verbatim transcripts of the interviews were analyzed to identify the processes and strategies of clinical reasoning used by the students to produce treatment plans. The process included 1) rituals to collect information; 2) forward and backward reasoning to generate and test clinical hypotheses; 3) pattern recognition from integrated scripts of knowledge and experience; and 4) decision trees to assess options and outcomes. The process was supplemented by scientific, conditional, collaborative, narrative, ethical, pragmatic, and part-whole reasoning strategies. Senior students showed a keen awareness of the contextual determinants of care and emphasized patients' motivations for treatment. In contrast, junior students focused more on problems associated with individual teeth as they struggled to integrate the information within each vignette. In this article, the processes and strategies for reasoning used by both groups of dental students are abstracted and then illustrated by a model of clinical reasoning that accommodates the complicated contexts in which clinical problems usually arise.
Community Dental Health, Apr 1, 2006
This study explores the evolution of conceptual frameworks and models of health and disability to... more This study explores the evolution of conceptual frameworks and models of health and disability to construct an explanatory model of oral health. The International Classification of Impairments, Disabilities, and Handicaps adopted by the WHO is based largely on social role theory and a utilitarian tradition portraying disablement as a negative and socially unacceptable consequence of impairment. It has been the major conceptual influence on the construction of psychometric tools for dentistry. However current views of chronic disease are refocused on the influence of coping strategies used by people to prevent or limit disability and handicap. Consequently, the WHO adopted the International Classification of Functioning, Disability and Health (ICF) as an alternative description of health and health-related states based on an existentialist view of the body, the person and society. In addition, an ethnographic exploration has identified three major domains of oral health--oral hygiene, comfort and general health--that dominate the opinions of people with oral impairments. Application of the framework and language of the ICF to the major domains of oral health provides the basis for a new biopsychosocial model of oral health, function and disablement.
Journal Canadian Dental Association, Jun 1, 2006
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Papers by Michael MacEntee