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Aims Recent UK legislation allows dental therapists or jointly-qualified dental hygienist-therapists to work in the general dental service. This study aimed to investigate the extent of dentists' knowledge of the clinical remit of jointly qualified hygienist-therapists, their willingness to consider employing such a professional, and factors associated with these two measures.Materials and methods A postal questionnaire was sent to 616 NHS-registered dentists in South-East Scotland. Analysis and classification of responses to open-ended questions used standard non-parametric statistical tests and quantitative techniques.Results Following two mailings, a 50% (n = 310) response rate was obtained. A total of 65% of dentists worked in a practice employing a dental hygienist, while only 2% employed a dental therapist. Hygienists tended to work in larger practices. Dentists' knowledge of the clinical remit of the dually-qualified hygienist-therapist was found to be limited, reflecting a restricted and inaccurate view of the professional remit of a hygienist-therapist. The majority (64%) said they would consider employing a hygienist-therapist in their practice, rising to 72% amongst dentists already working with a hygienist. Reasons given by dentists who were negative about this prospect were sought. Those who worked with a hygienist tended to refer to lack of physical space, whilst those who did not tended to cite reservations on clinical skills, competence and responsibilities, or on the costs involved.Conclusions This study identified considerable ignorance and negativity among dentists about the nature and clinical remit of this group of professionals. Dually-qualified hygienist-therapists will be in a position to treat much of the routine disease that exists within the population, and dentists may benefit from education in relation to the substantial contribution these individuals could potentially make to patient care. [ABSTRACT FROM AUTHOR]

Aims Recent UK legislation allows dental therapists or jointly-qualified dental hygienist-therapists to work in the general dental service. This study aimed to investigate the extent of dentists' knowledge of the clinical remit of jointly qualified hygienist-therapists, their willingness to consider employing such a professional, and factors associated with these two measures.Materials and methods A postal questionnaire was sent to 616 NHS-registered dentists in South-East Scotland. Analysis and classification of responses to open-ended questions used standard non-parametric statistical tests and quantitative techniques.Results Following two mailings, a 50% (n = 310) response rate was obtained. A total of 65% of dentists worked in a practice employing a dental hygienist, while only 2% employed a dental therapist. Hygienists tended to work in larger practices. Dentists' knowledge of the clinical remit of the dually-qualified hygienist-therapist was found to be limited, reflecting a restricted and inaccurate view of the professional remit of a hygienist-therapist. The majority (64%) said they would consider employing a hygienist-therapist in their practice, rising to 72% amongst dentists already working with a hygienist. Reasons given by dentists who were negative about this prospect were sought. Those who worked with a hygienist tended to refer to lack of physical space, whilst those who did not tended to cite reservations on clinical skills, competence and responsibilities, or on the costs involved.Conclusions This study identified considerable ignorance and negativity among dentists about the nature and clinical remit of this group of professionals. Dually-qualified hygienist-therapists will be in a position to treat much of the routine disease that exists within the population, and dentists may benefit from education in relation to the substantial contribution these individuals could potentially make to patient care. [ABSTRACT FROM AUTHOR]

Objective Recently the issue of access to health services has been brought into sharp focus by clear evidence of rationing — patients queuing for NHS registration — in the NHS General Dental Services (GDS). Conventional estimates suggest that about 50% of adults are registered per annum. This paper demonstrates that these conventional measures of access and utilisation can generate potentially misleading inferences.Design By analysing individual-level claims data from over 35,000 patients over six years we are able to: identify the underlying patterns of utilisation that generate the aggregate 50% registration rate; provide more detailed estimates of utilisation and access; and suggest possible determinants of the patterns of utilisation we observe.Setting Primary care health services.Results In contrast to conventional estimates of access we find that close to 80% of the adult population in Scotland has had access to GDS over a six year period. Moreover, we find that the population is comprised of a relatively large group of patients (30% of the population) who access GDS at least once a year and a substantial group (19% of the adult population) who access services only once in six years. The groups who access services at intermediate frequencies are less numerous.Conclusions Assessing the effectiveness of the public provision of health care services requires accurate information regarding access to those services. This paper sets out a framework for analysing and interpreting longitudinal data to provide information on the extent of access to health care services. [ABSTRACT FROM AUTHOR]

This paper is based on a lecture to the symposium on 'apprenticeship to life long learning: dental education through the centuries', Centre for the History of Medicine, University of Glasgow. [ABSTRACT FROM AUTHOR]

This paper, the second of two reviewing the Childsmile programme, describes monitoring arrangements and summarises monitoring data covering the period 2006-2009. By mid-2009, around 28,000 infants in deprived areas of the West of Scotland had been given caries risk assessments by Health Visitors; 14,000 were enrolled with 142 Childsmile practices or clinics; and over 10,000 had begun making practice visits. The Childsmile Nursery and School programmes had provided 28,000 fluoride varnish treatments to nursery and primary school children. Daily supervised toothbrushing and distribution of oral health packs covered almost 100% of nursery schools and P1 and P2 classes in primary schools in the most deprived areas of Scotland. Feedback of monitoring information to programme managers is used to identify any variation or shortfall in programme coverage and delivery. [ABSTRACT FROM AUTHOR]

This paper is the first of two reviewing the Childsmile programme. It sets out to describe the development and implementation of this national oral health improvement programme for children in Scotland over its initial three-year period (January 2006 to December 2008) and into its second phase of development. It outlines the context in which the initiative was conceived, the initial development of its various components, and how monitoring and evaluation are shaping the delivery and direction of the programme. [ABSTRACT FROM AUTHOR]

Aim The purpose of this paper is to share information derived from the Glasgow Quality Practice Initiative with general dental practice teams, Dental Practice Advisers and others involved in quality improvement.Method A sample of 16 general dental practices was selected from volunteers to receive assistance in working towards a Quality Practice Award. Two Clinical Governance Advisers were appointed to provide this support.Data collected Quantitative, qualitative and observational data were collected, and comparisons made between practices that had and had not received support.Results Selected results are presented demonstrating both the baseline position and comparisons of the 'Intervention' and 'Non-Intervention' groups.Conclusions and recommendations Baseline levels of quality assurance were generally poor. It is asserted that the practices receiving Clinical Governance Adviser support benefited from the experience and made meaningful improvements. This has implications for the development of national policy in Scotland. [ABSTRACT FROM AUTHOR]

The role of competencies in postgraduate dental education and training has been a major topic of interest in recent years. Concerns have been voiced from all sides of the profession about how the competence of trainees and the quality of training can be assured so that high standards of patient care can be maintained. A three year project which seeks to develop a competency-based assessment system for general professional training is underway which hopes to answer some of the concerns and provide an evidence-based system of assessment for the early postgraduate years. This paper looks at the reasoning behind the project, its aims, and the progress made to date. [ABSTRACT FROM AUTHOR]

The first General Professional Training (GPT) scheme in Scotland ran from August 1996 to July 1998 with sixteen trainees completing one year in general practice and two six-month blocks in the hospital and community services. An independent evaluation of the scheme focussed on the advantages and disadvantages of GPT and the level of support for the scheme as well as providing stakeholders with an opportunity to contribute to its development. This paper reports the findings of the evaluation. [ABSTRACT FROM AUTHOR]

Within Scotland there has been a significant increase in the prescription of 2,800 ppm and 5,000 ppm fluoride toothpaste. The objective of this paper was to analyse the trends in high concentration fluoride toothpaste (HCFT) in the five Scottish South East and Tayside (SEAT) health boards and consider the options for future national management of this prescribing. A retrospective analysis of routine prescribing data for the years 2006-2012 was carried out in primary care dental practices in Scotland. The cost of HCFT prescribing in the five Scottish health boards has increased from £15,243 (4,147 items) in 2006/07 to £206,529 (24,113 items), in 2011/12. Out of 2,430 dental list numbers, 100 list numbers (4.1%) accounted for 70% of the total prescribing costs (£144,367). The public dental service employs 153 (6%) of dentists working in Scotland, who in turn prescribe 11.6% HCFT. There is a need to ensure that the prescription of HCFT is both encouraged as best practice care but also managed appropriately to ensure that its delivery is targeted at those who are most in need. [ABSTRACT FROM AUTHOR]

A model of out-of-hours telephone triage for patients with a dental emergency has been piloted in an area of Scotland since 2001. This is linked to an integrated patient booking service. The model has been developed into a national emergency dental service which is currently being made available to all NHS Board areas. This new national service incorporates a single point of telephone access, triage by trained dental nurses using a clinical decision support system and centralised patient booking arrangements. The new service is complemented by Emergency Dental Care Guidance published by the Scottish Dental Clinical Effectiveness Programme. This paper describes the model of out-of-hours dental care, its underlying principles and the process of development. [ABSTRACT FROM AUTHOR]

In March 2005 the Scottish Executive Health Department published the 'Action plan for improving oral health and modernising NHS dental services in Scotland'. Six areas required major new educational input: pre-qualification education, workforce supply, career development, dental practice and team development, clinical effectiveness/quality improvement and support for the oral health strategy. Targets from the action plan that have been fully achieved include: 1) undergraduate student numbers have reached the target output of 135 per year; 2) vocational training numbers match graduate numbers; 3) a vocational training scheme for dental therapists has been developed and numbers of VT places will match the number of qualifying therapists; 4) a new strategy to support dental nurse training will allow an additional 200 dental nurse training places by 2007; and 5) a clinical effectiveness programme has developed a rolling programme of guidelines, the first one of which, on conscious sedation, was released in May. The dental action plan has provided Scotland with the best opportunity for modernising dental services since the NHS was established. This paper describes some of the educational developments that will ensure NHS dental services in Scotland are 'fit for the future' and 'delivering for health'. [ABSTRACT FROM AUTHOR]

ObjectivesRecently the issue of access to health services has been brought into sharp focus by clear evidence of rationing — patients queuing for NHS registration — in the NHS General Dental Services (GDS). Conventional estimates suggest that about 50% of adults are registered per annum. This paper demonstrates that these conventional measures of access and utilisation can generate potentially misleading inferences.DesignBy analysing individual-level claims data from over 35,000 patients over six years we are able to: identify the underlying patterns of utilisation that generate the aggregate 50% registration rate; provide more detailed estimates of utilisation and access; and suggest possible determinants of the patterns of utilisation we observe.SettingPrimary care health services.ResultsIn contrast to conventional estimates of access we find that close to 80% of the adult population in Scotland has had access to GDS over a six year period. Moreover, we find that the population is comprised of a relatively large group of patients (30% of the population) who access GDS at least once a year and a substantial group (19% of the adult population) who access services only once in six years. The groups who access services at intermediate frequencies are less numerous.ConclusionsAssessing the effectiveness of the public provision of health care services requires accurate information regarding access to those services. This paper sets out a framework for analysing and interpreting longitudinal data to provide information on the extent of access to health care services. [ABSTRACT FROM AUTHOR]

Background In 2005 Cairns et al. published a paper ( 2005; 15: 310-318) examining the role of the general dental practitioner (GDP) in child protection (CP) in Scotland. This involved a questionnaire sent out to Scottish GDPs in 2003. Subsequently in 2006 all UK dental practices were sent Child protection and the dental team, a manual detailing roles and responsibilities with regard to CP. During this time the profile of CP within dentistry increased. There has been no published research since 2006 investigating whether the gap between the proportion of GDPs who suspect child abuse/neglect in their patients and those who refer cases has changed.Aim The aim of this research was to investigate whether this gap has changed between 2003 and 2010.Method A postal questionnaire based on that used by Cairns et al. was sent to 50% of GDPs in Scotland in March 2010.Results The response rate was 52% (53% male). Some 29% and 55% of respondents had received undergraduate or postgraduate training in child protection respectively. Over two thirds (37%) had suspected child abuse/neglect in one or more of their paediatric patients but only 11% had referred a case. The most common factor affecting the decision to refer was 'lack of certainty of the diagnosis' (74%). Some 77% thought that abused/neglected children had an increased caries increment and 73% of dentists were willing to get involved in detecting neglect.Conclusion Dentists in Scotland appear to be suspecting and referring more cases of child abuse/neglect than previously. The vast majority are willing to get involved in detecting neglect. [ABSTRACT FROM AUTHOR]

Introduction The purpose of this paper is to examine the size and variability of patients' expenditure in the general dental service (GDS) in Scotland during the recent past.Methods Retrospective analysis of individual patient's expenditure drawn from a 5% random sample of patients treated in the GDS in Scotland between January 1998 and September 2007. Three measures of expenditure per patient were used to assess the size and variability of patients' expenditure in the GDS: patient expenditure per claim, patient expenditure during a 12-month period and patient expenditure during the sample period.Results The size of patients' expenditure on the GDS is small relative to non-NHS insurance arrangements and other components of personal expenditure. There is relatively little variability in patients' GDS expenditure.Conclusions The relatively small size and variability of patient expenditure in the GDS in Scotland suggests that the system of patient charges provides some insurance against the cost of oral healthcare. However, a complete assessment of the insurance properties of the system of patient charges would require several other factors to be accounted for. [ABSTRACT FROM AUTHOR]

Objective To identify salient beliefs of general dental practitioners (GDPs) regarding their role in the identification of alcohol misuse and the provision of an alcohol related health message in the primary dental care setting.Method A convenience sample of 12 GDPs practising in the North Highland region of Scotland underwent semi-structured interview. An inductive approach was used with subsequent basic thematic content analysis performed on the transcripts.Results GDPs universally agreed that alcohol consumption plays a role in both oral health and general health but this did not translate into effective communication about alcohol during dental consultation. Current knowledge of recommended safe alcohol consumption guidelines was poor - evidence of potential GDP training requirements. The primary barriers related to disruption of the clinician-patient relationship, embarrassment or the perceived irrelevance to the clinical situation. GDPs expressed low confidence in approaching alcohol related problems.Conclusions GDPs felt that alcohol based discussions in primary care would not be relevant and would inevitably lead to disruption of the patient-clinician relationship. Further research is necessary to more fully understand the attitudes, behaviour and knowledge of GDPs regarding the provision of alcohol related health advice. The results of this study have informed the design of a paper postal survey for wider distribution. [ABSTRACT FROM AUTHOR]

Objectives To determine how dental handpieces are decontaminated and maintained in general dental practice.Design Observational survey.Setting The survey was carried out in general dental practice in Scotland. Survey visits ran from January 2003 until the end of March 2004.Methods Data were collected by interview and observation in 179 dental surgeries in Scotland.Results In virtually all surgeries, handpieces were cleaned before disinfection or autoclaving (99%; n = 177), most commonly by wiping the external surface with a cloth impregnated with disinfectant. Most surgeries lubricated their handpieces after cleaning and before sterilisation (91%; n = 162), although a number of surgeries (24%; n = 42) also lubricated their handpieces after sterilisation. In the majority (97%; n = 174) of dental surgeries, all handpieces were autoclaved after use, most frequently (89%; n = 160) in a bowl and instrument steriliser. In 38 surgeries (21%), handpieces were being wrapped (paper pouches) before sterilisation in bowl and instrument sterilisers. A minority of surgeries (20%; n = 36) had a dedicated handpiece for surgical procedures.Conclusions The majority of dental handpieces are manually cleaned externally with a disinfectant impregnated cloth and processed in a type N (bowl and instrument) bench top steam steriliser. Handpieces are lubricated with non-water soluble lubricants at different stages of reprocessing, indicating clarification is required in this area. More work is required by manufacturers to establish a validated cleaning and lubrication process to facilitate the sterilisation of handpieces. [ABSTRACT FROM AUTHOR]

Background In 2005 Cairns et al. published a paper ( 2005; 15: 310-318) examining the role of the general dental practitioner (GDP) in child protection (CP) in Scotland. This involved a questionnaire sent out to Scottish GDPs in 2003. Subsequently in 2006 all UK dental practices were sent Child protection and the dental team, a manual detailing roles and responsibilities with regard to CP. During this time the profile of CP within dentistry increased. There has been no published research since 2006 investigating whether the gap between the proportion of GDPs who suspect child abuse/neglect in their patients and those who refer cases has changed.Aim The aim of this research was to investigate whether this gap has changed between 2003 and 2010.Method A postal questionnaire based on that used by Cairns et al. was sent to 50% of GDPs in Scotland in March 2010.Results The response rate was 52% (53% male). Some 29% and 55% of respondents had received undergraduate or postgraduate training in child protection respectively. Over two thirds (37%) had suspected child abuse/neglect in one or more of their paediatric patients but only 11% had referred a case. The most common factor affecting the decision to refer was 'lack of certainty of the diagnosis' (74%). Some 77% thought that abused/neglected children had an increased caries increment and 73% of dentists were willing to get involved in detecting neglect.Conclusion Dentists in Scotland appear to be suspecting and referring more cases of child abuse/neglect than previously. The vast majority are willing to get involved in detecting neglect. [ABSTRACT FROM AUTHOR]

Introduction The purpose of this paper is to examine the size and variability of patients' expenditure in the general dental service (GDS) in Scotland during the recent past.Methods Retrospective analysis of individual patient's expenditure drawn from a 5% random sample of patients treated in the GDS in Scotland between January 1998 and September 2007. Three measures of expenditure per patient were used to assess the size and variability of patients' expenditure in the GDS: patient expenditure per claim, patient expenditure during a 12-month period and patient expenditure during the sample period.Results The size of patients' expenditure on the GDS is small relative to non-NHS insurance arrangements and other components of personal expenditure. There is relatively little variability in patients' GDS expenditure.Conclusions The relatively small size and variability of patient expenditure in the GDS in Scotland suggests that the system of patient charges provides some insurance against the cost of oral healthcare. However, a complete assessment of the insurance properties of the system of patient charges would require several other factors to be accounted for. [ABSTRACT FROM AUTHOR]

Objective To identify salient beliefs of general dental practitioners (GDPs) regarding their role in the identification of alcohol misuse and the provision of an alcohol related health message in the primary dental care setting.Method A convenience sample of 12 GDPs practising in the North Highland region of Scotland underwent semi-structured interview. An inductive approach was used with subsequent basic thematic content analysis performed on the transcripts.Results GDPs universally agreed that alcohol consumption plays a role in both oral health and general health but this did not translate into effective communication about alcohol during dental consultation. Current knowledge of recommended safe alcohol consumption guidelines was poor - evidence of potential GDP training requirements. The primary barriers related to disruption of the clinician-patient relationship, embarrassment or the perceived irrelevance to the clinical situation. GDPs expressed low confidence in approaching alcohol related problems.Conclusions GDPs felt that alcohol based discussions in primary care would not be relevant and would inevitably lead to disruption of the patient-clinician relationship. Further research is necessary to more fully understand the attitudes, behaviour and knowledge of GDPs regarding the provision of alcohol related health advice. The results of this study have informed the design of a paper postal survey for wider distribution. [ABSTRACT FROM AUTHOR]

Objectives To determine how dental handpieces are decontaminated and maintained in general dental practice. Design Observational survey.Setting The survey was carried out in general dental practice in Scotland. Survey visits ran from January 2003 until the end of March 2004.Methods Data were collected by interview and observation in 179 dental surgeries in Scotland.Results In virtually all surgeries, handpieces were cleaned before disinfection or autoclaving (99%; n = 177), most commonly by wiping the external surface with a cloth impregnated with disinfectant. Most surgeries lubricated their handpieces after cleaning and before sterilisation (91%; n = 162), although a number of surgeries (24%; n = 42) also lubricated their handpieces after sterilisation. In the majority (97%; n = 174) of dental surgeries, all handpieces were autoclaved after use, most frequently (89%; n = 160) in a bowl and instrument steriliser. In 38 surgeries (21%), handpieces were being wrapped (paper pouches) before sterilisation in bowl and instrument sterilisers. A minority of surgeries (20%; n = 36) had a dedicated handpiece for surgical procedures.Conclusions: The majority of dental handpieces are manually cleaned externally with a disinfectant impregnated cloth and processed in a type N (bowl and instrument) bench top steam steriliser. Handpieces are lubricated with non-water soluble lubricants at different stages of reprocessing, indicating clarification is required in this area. More work is required by manufacturers to establish a validated cleaning and lubrication process to facilitate the sterilisation of handpieces. [ABSTRACT FROM AUTHOR]