[Show abstract][Hide abstract] ABSTRACT: Background:
Dentists with a special interest hold enhanced skills enabling them to treat cases of intermediate complexity. The aim of this study was to explore primary dental care practitioners' views of dentists with a special interest (DwSIs) in Endodontics in London, with reference to an educational and service initiative established by (the former) London Deanery in conjunction with the NHS.
A cross-sectional postal survey of primary care dentists working across different models of care within London was conducted, with a target to achieve views of at least 5 % of London's dentists. The questionnaire instrument was informed by qualitative research and the dental literature and piloted prior to distribution; data were analysed using SPSS v19 and STATA v12.0.
Six per cent of London's primary care dentists (n = 243) responded to the survey; 53 % were male. Just over one third (37 %; n = 90) were aware of the DwSI service being provided. Most practitioners reported that having access to a DwSI in Endodontics would support the care of their patients (89 %; n = 215), would carry out more endodontic treatment in the NHS primary dental care if adequately reimbursed (93 %; n = 220), and had more time (76 %; n = 180). Female respondents appeared to be less confident in doing endodontic treatment (p = 0.001). More recently qualified respondents reported greater need for training/support for performing more endodontic treatment in the NHS primary dental care (p = 0.001), were more dissatisfied with access to endodontic service in the NHS primary dental care (p = 0.007) and more interested to train as a DwSI in endodontics (p = 0.001) compared with respondents having a greater number of years of clinical experience since qualification.
The findings lend support to the concept of developing dentists with enhanced skills as well as ensuring additional funding, time and support to facilitate more routine endodontics through the NHS primary care to meet patient needs. More recently qualified dentists working in London were more concerned regarding endodontic service access, expressed need for training/support for undertaking more endodontic treatment in the NHS primary dental care and a desire to train as a DwSI in endodontics.
[Show abstract][Hide abstract] ABSTRACT: Background:
The aim was to obtain stakeholders' views on the former London Deanery's joint educational service development initiative to train dentists with a special interest (DwSIs) in endodontics in conjunction with the National Health Services (NHS) and examine the models of care provided.
A convergent parallel mixed methods design including audit of four different models of care, semi-structured interviews of a range of key stakeholders (including the DwSI trainees) and questionnaire surveys of patients and primary care dentists.
Eight dentists treated over 1,600 endodontic cases of moderate complexity over a two year training period. A retrospective audit of four schemes suggested that first molars were the most commonly treated tooth (57%; n = 341). Patients who received care in the latter stages of the initiative were 'satisfied' or 'very satisfied' with the service (89%; n = 98). Most dental practitioners agreed that having access to such services would support the care of their patients (89%; n = 215) with 88%; (n = 214) supporting the view that DwSIs should accept referrals from outside of their practice.
This initiative, developed to provide endodontic care of medium complexity in a primary care setting, received wide support from stakeholders including patients and primary care dentists. The implications for care pathways, commissioning and further research are discussed.
No preview · Article · Aug 2014 · British dental journal
[Show abstract][Hide abstract] ABSTRACT: Background: The National Health Service [NHS] in England has supported the development of primary care practitioners with ‘special interests’ across different professional groups, including dentistry; the implications for professions are under scrutiny. A pilot scheme to train NHS Dental Practitioners in the provision of endodontic treatment of ‘moderate difficulty’ was co-led by the former London Deanery (Health Education England: NW London) and local NHS commissioners.
Objective: to examine key stakeholders perceptions on this professional development and its future implications.
Methods: Nineteen semi-structured interviews and were conducted with stakeholders (trainees, educators, principal dentists, managers, specialists and commissioners) involved in establishing, running and participating in the initiative. Interviews were based on a topic guide informed by the literature, and a workshop involving the London trainees. Interviews were audiotaped and transcribed. Analysis was undertaken using framework methodology.
Results: The initiative was perceived as providing a range of benefits: service-related, quality/outcomes, educational, and professional. The opportunity to develop extended skills was being proactively harnessed to support the ‘re-stratification of dentistry’, with the emerging trained dentists perceiving themselves in ‘bridging the gap’ across the profession and organisations in assessing need and providing care. There was strong evidence of ‘bureaucracy’ with increasing managerial and professional accountability and negotiating of contracts for care. Trainees perceived themselves emerging as a distinct group within dentistry achieving greater status, skill and responsibility in supporting patient care and treating patients with greater confidence, whilst working in an area of dentistry related to their interests. Uncertainty about costs, funding and organisational changes within the NHS were amongst the concerns expressed regarding the future of the initiative.
Conclusion: The findings of this research suggest that extending the skills of dentists in primary care may contribute to the re-professionalisation of dentistry.
Acknowledgements: this research was funded by London Deanery
[Show abstract][Hide abstract] ABSTRACT: Improving access to National Health Service (NHS) dentistry is a public health issue that has been a focus for successive governments and policy makers in the UK. To inform this process, commissioners of services need to understand trends in service use and demands of the local population. This study explored inequalities in dental services use among adults in a socially deprived, ethnically diverse metropolitan area of London; satisfaction with services; and public views for improvement of services. Data from 695 adults were analysed for this study (56% of the eligible sample). Inequalities in dental services use and satisfaction with care according to sociodemographic factors were assessed in unadjusted and fully adjusted models. The proportion of participants who reported attending the dentist in the last 24 months was 69%, with inequalities according to social grade, ethnicity, sex and age but not according to borough of residence. The most common areas identified by respondents for service improvement were availability of dentists, affordability of care, and accommodation of services. Among those who visited the dentist in the last 24 months, 90% were satisfied with the quality of care provided. However, there were inequalities in satisfaction with care according to borough and reason for the last dental visit.
No preview · Article · Jun 2013 · European Journal Of Oral Sciences
[Show abstract][Hide abstract] ABSTRACT: Background
The oral health needs of older adults present increasing challenges to dental services. Objectives
To examine the clinical oral health status of dentate older people living in the community and attending dental services. Methods
One hundred and eighty-six dentate adults, aged 60years, underwent clinical examination (DMFS, Plaque and Gingival Indexes), salivary analysis and completed a questionnaire. ResultsParticipants had an average of 21.4 (6.2) teeth present and 1.2 (+/- 3.0) decayed, 51.0 (+/- 28.8) missing and 32.6 (+/- 20.5) restored surfaces. Individuals living in the most deprived areas had significantly lower numbers of teeth than those in the least deprived areas (19.1 +/- 7.5 cf 23.8 +/- 4.1; p<0.001). Whilst there were no significant differences in DMFS score, residents in the most deprived areas had significantly more missing and fewer filled surfaces than those in the least deprived areas (p=0.001 and p<0.001, respectively). Participants with 21 teeth (64%) had lower plaque scores, fewer decayed root surfaces, higher stimulated saliva flow rates and lower salivary lactobacilli and yeast counts than those with <21 teeth (p<0.05 for all). Conclusions
The findings highlight differences in clinical oral health by age and deprivation status and underline the importance of saliva and retaining a functional dentition.
[Show abstract][Hide abstract] ABSTRACT: In 2000, the first National Institute of Clinical Excellence (NICE) guidelines related to third molar (M3) surgery, a commonly performed operation in the United Kingdom, were published. This followed research publications and professional guidelines in the 1990 s that advised against prophylactic surgery and provided specific therapeutic indications for M3 surgery. The aim of the present report was to summarize the available evidence on the effects of guidelines on M3 surgery within the United Kingdom.
Data from primary care dental services and hospital admissions in England and Wales during a 20-year period (Hospital Episode Statistics 1989/1990 to 2009/2010), and from private medical insurance companies were analyzed. The volume and, where possible, the nature of the M3 surgery activity over time were assessed together, as were the collateral effects of the guidelines, including patient age at surgery and the indications for surgery.
The volume of M3 removal decreased in all sectors during the 1990 s before the introduction of the NICE guidelines. During the 20-year period, the proportion of impacted M3 surgery decreased from 80% to 50% of admitted hospital cases. Furthermore, an increase occurred in the mean age for surgical admissions from 25.5 to 31.8 years. The change in age correlated with a change in the indications for M3 surgery during that period, with a reduction in "impaction," but an increase in "caries" and "pericoronitis" as etiologic factors, in accordance with the NICE guidelines.
The significant decrease in M3 surgery activity occurred before the NICE guidelines. Thus, M3 surgery has been performed at a later age, with indications for surgery increasingly in accordance with the NICE guidelines. The importance of clinical monitoring of the retained M3s is discussed.
No preview · Article · Jul 2012 · Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons
[Show abstract][Hide abstract] ABSTRACT: To determine the effects of prescribing sugar-free chewing gum on the oral health and quality of life of dentate older people living in the community and attending for routine dental care.
A randomized controlled trial was conducted on 186 older people who were not regular chewers of gum, (aged 60 years and over with ≥ 6 teeth) recruited from primary care clinics. Participants were randomly allocated to a gum-chewing group (chewing xylitol-containing gum twice a day for 15 min; n = 95) or a control group (no gum; n = 91). Both groups were examined at baseline and at the end of the study (6 months later). The primary outcome measure for the study was increased in stimulated saliva flow rate. Secondary measures included improvements in Plaque and Gingival Indices, and self-perceived change in oral health.
The retention rate for the study was 78.5% (n = 146 at follow-up); reported compliance with the protocol was 84% (ranged between 12% and 100%). There was no significant change in the saliva flow of the gum-chewing group (1.20-1.17 ml/min), while the control group experienced an increase in flow rate (1.06-1.32 ml/min; P = 0.001). The gum-chewing group, however, demonstrated significant improvement in Plaque and Gingival Index scores over the control group. For the Plaque Index, the mean scores (±SD) were 0.29 (±0.29) and 0.56 (±0.46) for the gum-chewing group and control groups, respectively (P < 0.001), at the second examination, which remained significant after controlling for age and saliva flow rate. For the Gingival Index, the scores were 0.73 (±0.30) and 0.92 (±0.32), respectively (P < 0.001), which persisted after controlling for age. A significantly higher proportion of participants in the gum-chewing group perceived that their oral health had improved during the study period in comparison with the control group (40% cf 21%; P = 0.016).
Prescription of sugar-free chewing gum to dentate older people living in the community and attending routine dental services was not associated with a significant increase in stimulated saliva flow. There were, however, significant improvements in Plaque and Gingival Index scores, and in self-perceived oral health.
No preview · Article · Apr 2012 · Community Dentistry And Oral Epidemiology
[Show abstract][Hide abstract] ABSTRACT: Bifidobacteria are aciduric bacteria that might play a role in the caries process. To test the hypothesis that Bifidobacteria behave as caries-associated organisms, as predicted by the ecological plaque hypothesis, we determined salivary levels of Bifidobacteria and caries-associated organisms for 156 older adults. Salivary levels of Bifidobacteria, mutans streptococci, lactobacilli, and yeasts were correlated with each other (p < 0.001), negatively correlated with salivary flow rate (p < 0.001), and positively correlated with plaque index (p < 0.05). Salivary Bifidobacteria levels were positively associated with the number of filled (p < 0.001) and decayed (p = 0.036) tooth surfaces and negatively associated with number of teeth (p < 0.001) and salivary flow rate (p = 0.049). In regression analyses, caries experience was significantly associated with only salivary Bifidobacteria (p < 0.001) and yeast (p < 0.001) levels and the individual's age (p = 0.021). Bifidobacteria should be regarded as caries-associated organisms whose role in the caries process and as markers of caries risk requires further investigation.
No preview · Article · Sep 2010 · Journal of dental research
[Show abstract][Hide abstract] ABSTRACT: Objectives: To determine the effects of daily gum chewing on the oral health and quality of life of older people living in the community and attending for routine clinical care.
Methods: A randomized controlled trial was conducted on 186 participants, (aged 60 years and over, with ≥6 teeth) recruited from primary dental clinics, who were allocated to a gum-chewing group (chewing xylitol-containing gum twice a day for 15 minutes; n=95) or a control group (no gum; n=91). Both groups were examined at baseline and at end of study (six months later). The main outcome measure was stimulated whole saliva flow rate (ml/min). Secondary measures included Plaque and Gingival Indices, and self-perceived change in oral health.
Results: Retention rate for the study was 78.5% (n=146 at follow-up); reported compliance with protocol was 84% (12%-100%). The gum-chewing group demonstrated significant improvement in Plaque and Gingival Index scores over the control group. For the Plaque Index the mean scores (SD) were 0.29 (0.29) and 0.56 (0.46) for the gum-chewing group and control groups respectively (p<0.001) at the second examination, which persisted after controlling for age and saliva flow rate. For the Gingival Index the scores were 0.73 (0.30) and 0.92 (0.32) respectively (p<0.001), which persisted after controlling for age. There was no significant change in the saliva flow of the gum-chewing group (1.20 to 1.17 ml/min), while the control group experienced an increase in flow rate (1.06 to 1.32 ml/min; p=0.001). A significantly higher proportion of participants in the gum-chewing group perceived that their oral health had improved during the study period in comparison to the control group (40% cf 21%; p=0.016).
Conclusions: Regular use of sugar-free chewing gum is associated with certain clinical and self-perceived benefits in older people living in the community.
Acknowledgement: This study was sponsored by Dunhill Medical Trust.
[Show abstract][Hide abstract] ABSTRACT: Bifidobacteriaceae were isolated from saliva and infected dentine by using a mupirocin-based selective medium. Of the saliva samples, 94% harbored
bifids. The mean concentration (± the standard error) was 4.46 (±0.12) log10(CFU per ml + 1), and the predominant isolates were Bifidobacterium dentium, B. longum, Scardovia inopinata, Parascardovia denticolens, and Alloscardovia omnicolens.
[Show abstract][Hide abstract] ABSTRACT: Objective: To explore older people's views on ways of promoting the use of sugar-free chewing-gum for the prevention of oral diseases in that age group, in parallel with a randomized controlled trial (RCT) investigating the effects of sugar-free chewing-gum on the oral health and quality of life of older people living in the community.
Methods: In-depth, semi-structured interviews were conducted with older people (>=60 years) attending for routine dental care who were partially dentate. Purposive sampling was employed to gain a range of views from across the spectrum of older people, both RCT participants and non-participants. Questions included concepts relating to oral health, views and use of chewing-gum. Data were analysed using the matrix-based Framework Methodology. Dunhill Medical Trust sponsored this study.
Results: Thirty two interviews were conducted, with divergent views on the health-benefits of gum-chewing emerging. Health professionals', manufacturers', media' and personal contact' were perceived as important routes for promoting gum. Health professionals supported by relevant materials were considered as a trustworthy source of information. Manufacturers were seen as being able to promote its use by making the product easier to use through incorporating a means of disposal into packaging, distributing free samples and reducing the cost of the product. Media' (including radio and TV adverts and health slots) and finally 'personal contact' from people who have found the gum to be beneficial. The importance of clear information on the health benefits, societal change to the prevailing anti-gum culture together with a scientific basis were stressed. Such a message should not be financed by a party that stands to gain financially. Participants' suggestions were linked to their history of gum-chewing and beliefs in its efficacy.
Conclusion: A range of ideas for promoting the health related benefits of chewing gum were suggested. These reflected the participants' own experiences and beliefs.