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Introduction: One way to slow the spread of resistant bacteria is by improved stewardship of antibiotics: using them more carefully and reducing the number of prescriptions. With an estimated 7%-10% of antibiotic prescriptions globally originating from dental practices and up to 80% prescribed unnecessarily, dentistry has an important role to play. To support the design of new stewardship interventions through knowledge transfer between contexts, this study aimed to identify factors associated with the decision to prescribe antibiotics to adults presenting with acute conditions across primary care (including dentistry).Methods: Two reviews were undertaken: an umbrella review across primary healthcare and a systematic review in dentistry. Two authors independently selected and quality assessed the included studies. Factors were identified using an inductive thematic approach and mapped to the Theoretical Domains Framework (TDF). Comparisons between dental and other settings were explored. Registration number: PROSPERO_CRD42016037174.Results: Searches identified 689 publications across primary care and 432 across dental care. Included studies (nine and seven, respectively) were assessed as of variable quality. They covered 46 countries, of which 12 were low and middle-income countries (LMICs). Across the two reviews, 30 factors were identified, with 'patient/condition characteristics', 'patient influence' and 'guidelines & information' the most frequent. Two factors were unique to dental studies: 'procedure possible' and 'treatment skills'. No factor related only to LMICs.Conclusions: A comprehensive list of factors associated with antibiotic prescribing to adults with acute conditions in primary care settings around the world has been collated and should assist theory-informed design of new context-specific stewardship interventions. [ABSTRACT FROM AUTHOR]

Objective: To explore barriers and facilitators to oral disease prevention in Danish dental care from a multi-stakeholder perspective. Methods: Eleven semi-structured focus groups and interviews about Danish oral healthcare were conducted with 27 stakeholders (general public, dental teams, dental policy makers) in Copenhagen. Transcripts were analyzed using deductive thematic analysis independently by KR and HL, supervised by JC and KVC. Results: Seven broad themes were identified, including both barriers and facilitators: Knowledge and attitudes, Education and training, Regulation, Incentivization, Multidisciplinary approach, Access to care and the Dental professional-patient relationship. Whilst all themes were relevant to each group of stakeholders, the salient driver within each theme was different for each group. Conclusions: Stakeholder perspectives on the Danish Oral health care system suggest the following are important features for a preventively focused system: (a) Involving all stakeholders in oral healthcare planning. (b) Securing sufficient and ongoing briefing regarding disease prevention for all stakeholders. (c) Regulatory support and creation of incentives to promote and facilitate implementation of disease prevention. (d) Appropriate prevention for disadvantaged groups within society which may be possible to a higher degree by means of multidisciplinary collaboration. (e) Personal relations between the patient and the professional based on mutual trust. [ABSTRACT FROM AUTHOR]

Data from the Adult Dental Survey conducted in 2009/10 have recorded some major changes in the pattern of oral conditions in British adults. The change in the number of sound and untreated teeth in recent decades has been particularly marked in younger adults. Across all ages there were 17.9 sound and untreated teeth per dentate adult, but among the youngest (16-24-year-olds) it was 26.9 teeth indicating rapidly improving prospects for young adults compared with their predecessors. Between 1998 and 2009 the overall prevalence of caries of all types in England has fallen dramatically from 54% to 31% overall, but the number of teeth affected by caries among those people affected by decay is almost unchanged at around 2.7 affected teeth per person. Caries, and the reduction in caries, affected people of all ages. The rate of new restorations is correspondingly low and young adults in particular had fewer restorations than their predecessors. Much activity is now likely to be around repairing or extending existing restorations. By contrast 37% of dentate adults had crowns, up from 34% in 1998, averaging around three crowns per person among those who have crowns. A minority of British adults had a very healthy periodontal status (17%) and moderate periodontal disease (pockets of 4 mm to less than 6 mm) has also reduced markedly in the last decade, in line with measurably less plaque and more frequent brushing. However, more severe disease has increased slightly (from 6% to 9% of adults). The frequency of impact of poor oral health on people's lives has also reduced in the last decade. However, while clinical conditions are improving, there is a proportion of dentate adults that experience negative effects on their daily life frequently (16%) and/or severely (17%) due to their oral health; who are more likely to be those in a lower socioeconomic position and those with worse clinical status in terms of caries and periodontal disease. [ABSTRACT FROM AUTHOR]

Introduction: An avulsed permanent tooth is one of the few true emergencies in dentistry. Children who suffer this injury require urgent dental care and prompt follow-up care. There is very limited evidence available regarding the provision of treatment for avulsion injuries in primary dental care.Objectives: To explore the experience of UK dentists in relation to the management of avulsed permanent teeth.Method: A self-completion questionnaire was designed and piloted. Questionnaires were sent to a random selection of one thousand GDPs with a stamped addressed return envelope. A second mailshot was sent to non-responders after eight weeks. Simple descriptive analysis was undertaken using Microsoft Excel. The results were compared with those from an earlier, similar study in Wales.Results: A total response rate of 61% was achieved. Just over 40% of responding dentists recalled replanting an avulsed permanent tooth in a child.Conclusions: Many dentists have limited or no experience of treating children with avulsed permanent teeth. Thirty-four percent of dentists have children with avulsion injuries under their care. Children with these traumatic injuries may benefit from shared care involving an interdisciplinary specialist team, in line with recommendations from the British Society of Paediatric Dentistry National Clinical Guidelines for Management of Avulsed Permanent Teeth in Children. [ABSTRACT FROM AUTHOR]