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The practice of dentistry contributes to 3% of the carbon footprint of the NHS. As awareness and concern about climate change increases, all dental care professionals must play their part in reducing the environmental impact of the care they provide. This paper aims to describe a novel method of teaching, both the theory and practical application of sustainable dentistry, by integrating sustainable quality improvement methods into the existing management and leadership requirements of dental core training., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

Introduction Chairside teaching is an important part of dental undergraduate clinical education. Bedside teaching is well-reported in relation to undergraduate medicine but few publications relate to undergraduate dentistry.Aims and objectives To investigate the experience and benefits from chairside teaching/learning in the clinical years of a five-year dental programme in a UK university. We asked about general dental topic learning as well as human disease (HD) learning.Materials and methods An online survey gathered dental students' opinions on their recognition, knowledge and experience of chairside teaching/learning. We asked about clinics and clinicians and where they gained most from chairside teaching/learning. We encouraged free-text responses.Results Altogether, 127 students took part (62% response). Response rates approximated 60% for all three years. In total, 93% felt that chairside teaching/learning helped to a moderate/great extent for general dental topics and 73% felt that chairside teaching/learning helped to a moderate/great extent for HD topics. Free-text comments revealed students valued chairside teaching/learning and from which grade/level of staff they learned most.Discussion and conclusion Chairside teaching/learning is largely unreported and unrecognised in undergraduate education. Although not formally timetabled, enthusiastic staff with enough time to engage in chairside teaching can have a positive impact on student learning., (© 2024. The Author(s).)

Climate change represents an urgent global threat. Without action, rising temperatures resulting from human activity will increasingly affect our health and wellbeing through changing patterns of disease, extreme weather events and availability of resources. Expedient decarbonisation of the UK economy is an ambitious goal to which we must all contribute.The NHS aims to be the world's first net-zero health service and reach carbon-neutral status by 2040. Dental services are particularly resource-intensive. Some dental anxiety management techniques have a disproportionately high impact on the environment relative to their usage. Inhalation sedation with nitrous oxide is one such example.Nitrous oxide is a greenhouse gas almost 300 times more potent than carbon dioxide, but its utility to facilitate dental treatment for anxious and vulnerable patients is well-documented. This paper balances the health utility with environmental and social harm of continuing to use nitrous oxide and suggests evidence-based methods we can apply to limit the environmental impact of sedation services., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

Introduction This paper explores the declared and formal and informal taught endodontic curriculum within an undergraduate dental programme in the UK as part of a wider study, which also investigates the learned curriculum. Management of the dental pulp was chosen due to the availability of clear internationally recognised guidelines.Method The declared curriculum was identified through existing course guides and seminar and practical session plans. The formal taught curriculum was identified by cataloguing all lectures, practical teaching sessions, seminars and handouts available to dental students. Questionnaires using clinical vignettes were used to explore the informal taught curriculum.Results Valid responses to the questionnaire were received from 25/40 (62.5%) clinical supervisors. Disparities between national guidelines and the declared and taught curriculum were primarily due to broad learning objectives and disparate information from lectures and supervising clinicians. Although the majority of formal teaching aligned with national guidelines, the main deviation occurred within the informal taught curriculum.Conclusion This study highlights disparities between current evidence-based guidelines and the declared and taught curriculum in relation to pulp management in a UK dental school. Recommendations are that all policies, procedures and protocols are updated and aligned to a contemporaneous evidence base annually, plus engagement with clinical lecturers, to enable more standardised teaching., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

This paper examines the founding and development of the British Association for the Study of Community Dentistry, 36 years after establishment of the American Association of Public Health Dentistry, and its achievements over 50 years. Especially important are its major role in national and other epidemiological surveys, establishment of NHS dental public health specialist and consultant posts, and its journal, Community Dental Health., (© 2023. The Author(s), under exclusive licence to the British Dental Association.)

Introduction This study identifies funding of NHS services supporting dental students' teaching over the last 20 years, focusing on human disease (HD) teaching.Aims To identify NHS funding for education in UK dental schools following publication of the 1997 General Dental Council curriculum introducing specific funding for HD teaching and the years 2015/16 to 2019/20.Material and methods Searches of the medical literature, grey literature (government and regulatory authority reports, legislative articles) and freedom of information requests to hospitals helping to deliver teaching.Results There are few publications describing current funding of dental undergraduate teaching. Freedom of information requests gave data for NHS hospital allocations for teaching both clinical dentistry and HD. HD funding has dropped by £2 million in five years.Conclusions NHS Trusts linked to dental schools receive monies to deliver teaching and offset costs of accommodating students. Tracking these funds over 20 years has seen some schools lose up to £1 million of HD funding and some lose it all. Greater transparency regarding funding for HD delivery would help improve teaching. Increasing numbers of older patients, with a greater chronic disease burden who are retaining teeth into later life, need graduating dentists with good medical knowledge to deliver safe care., (© 2022. The Author(s).)

Introduction The demographic shift in the age profile of the UK is now well established. Older people have more complex requirements to maintain their oral health and appropriate training is required to provide good-quality oral and dental care. This research aimed to review the training in gerodontology currently being provided to undergraduate dental and dental hygiene therapy (DHT) students in the UK.Methods Quantitative data were generated through completion of an online questionnaire, emailed to the directors of dental education in each of the UK dental (n = 16) and DHT schools (n = 21). Data were analysed using IBM SPSS Statistics V26.Results There was a response rate of 37.5% from dental schools and 61.9% from DHT schools. Although gerodontology was being taught in every school that responded, it was only a standalone course in 16.7% of dental schools and 7.7% of DHT schools that responded. While all respondents reported a theoretical component, only 50% of dental schools and 53.8% of DHT schools reported providing clinical experience. Moreover, 33.3% of dental schools and 15.4% of DHT schools reported closely following the European curriculum guidelines in gerodontology.Conclusions The current training in gerodontology is not standardised across either dental or DHT schools in the UK and there seems to be a lack of awareness of the recommended European guidelines. The findings from this research demonstrate that future improvements in gerodontology training are still required for this to be achieved., (© 2022. The Author(s), under exclusive licence to the British Dental Association.)

Aim The aim of this survey was to determine compliance towards dental radiography selection criteria for paediatric patients undergoing new patient examinations in specialised tertiary care centres in the United Kingdom.Methods Five university-associated dental hospitals were included in this study. Retrospective data was collected reviewing all paediatric patients on the new patient assessment clinics, where dental imaging was requested or the patient had relevant previous imaging. Data was collected from 28 June 2018, continuing retrospectively for a maximum of six months or until 150 patients were reached. Patients referred solely for orthodontic assessment were excluded.Results Seven hundred and fifty patients were included with an average age of eight years - 95.5% of patients had a radiographic justification provided. All patients were grouped into 56 disease categories and a total range of one cross-sectional and nine planar radiographs were prescribed in this cohort. Each radiograph was assessed for compliance to the Faculty of General Dental Practice, European Association of Paediatric Dentistry and national Italian guidelines for dental diagnostic imaging. Additionally, selection criteria for CBCT scans were taken from SEDENTEXCT guidelines. Full panoramic radiographs were the most commonly prescribed at 34.8% (n = 261). However, this demonstrated the lowest compliance rate as per selection criteria at 75.9%. This was due to referrers requesting radiographs primarily for assessing dental development (18.8%; n = 49) and caries assessment (2.7%; n = 7). Other radiograph formats demonstrated varying levels of guideline compliance ranging from 93.5-100%.Conclusion This study identifies common radiograph request errors and can inform paediatric clinicians to improve compliance to guidelines and reduce radiation exposure to young patients.

Co-creation may be described as collaborative innovation towards a shared goal. It is increasingly being applied in education to develop interventions to support the development of various aspects of educational programmes, including dental education. Students are valuable partners in the process and their unique perspective allows for relevant and novel curricular developments. Other stakeholders within an institution, such as educators, subject experts and programme leads, are also frequently involved. The co-creation process has been reported to be mutually beneficial for all parties.Benefits of co-creation for students include the development of personal and professional skills that are not conventionally taught within a curriculum. Staff can feel more inspired and engaged. The process can lead to more inclusive and socially relevant curricula. There are also associated challenges, such as gaining adequate support and buy-in from stakeholders to ensure success. This paper explores the concept of co-creation and its application in education, providing recommendations on how it may be successfully applied within the context of dental education., (© 2024. The Author(s).)

This paper researches the history of treatment planning for extraction of the first permanent molars and the early influence of American orthodontists on dental practice in the UK. It also discusses the development of clinical guidelines for the enforced extraction of first permanent molars to the present day., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

In the UK, as in many countries, dental hygienists and dental therapists are registered dental healthcare professionals who are focused on prevention and promoting good oral and general health through patient education, motivation and behaviour change. They are key members of the dental team. This paper considers the role they play in supporting patients through their implant journey and emphasises their importance in the wider clinical team as part of a patient-centred approach to care., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

Community dental services (CDS) provide dental treatment for patients who cannot gain access or have treatment with their general dental practitioner. This includes groups of patients who are dentally phobic, medically compromised, or with physical or learning disabilities.This paper provides insight into the experience and the challenges of working in CDS as a dental core trainee (DCT). The post involves an equal split in the management of paediatric and special care dental patients.Patients seen in CDS can be split into cohorts such as paediatric, special care adults, dental anxious and others. Case discussions throughout the paper will illustrate commonly seen scenarios and exemplify patient management pathways though the service.NHS England Education provide training for DCTs through study days which focus on dental disciplines specific to their post., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

As the rate of new mouth cancer diagnoses continues to increase in the UK, awareness of risk factors and signs and symptoms remains low. This paper focuses on studies showing UK public awareness of risk factors, including alcohol, tobacco and human papillomavirus, as well as public understanding of signs and symptoms of mouth cancer. It includes a review of the effectiveness of campaigns in raising awareness of mouth cancer and examples of campaigns targeting other common cancers or risk factors that may provide useful learning ahead of upcoming mouth cancer campaigns. In addition, the awareness of the wider healthcare team and the importance of their role in identifying mouth cancer is explored. Current live campaigns in the UK are highlighted ahead of future initiatives now that the Mouth Cancer Action Charter has been launched and two new coalitions have been established., (© 2023. The Author(s), under exclusive licence to the British Dental Association.)

Introduction Issues arising from the current coding system in dentistry have been highlighted. Available codes are considered to lack clarity and fail to reflect all dental specialties. There are no paediatric-specific codes, which means codes from other specialties are used, which may not accurately reflect the work carried out.Aim This paper aims to explore the range of codes and the consistency and accuracy of current coding practices within the paediatric dentistry department at Newcastle Dental Hospital, and explore the potential impact of introducing new speciality-specific codes for the aforementioned procedures.Method Data were retrospectively collected to determine whether the following treatments had been undertaken, and if so, which procedure code had been used for the treatment: inhalation sedation; dietary advice; acclimatisation; preformed metal crowns, silver diamine fluoride application; and apexification. All codes used within the department for a six-month period were also reviewed retrospectively and the frequency in which procedures relating to the potential new codes would be undertaken within the department was estimated to facilitate consideration of potential financial impact of the introduction of new codes.Results Codes utilised for the aforementioned procedures did not accurately reflect work carried out despite being relatively consistent. The potential new codes corresponded to procedures that were commonly undertaken within the department.Discussion This study highlights shortcomings in the coding system relating to a lack of applicable codes for paediatric dentistry procedures. Introduction of new speciality-specific codes should help to address this deficit to ensure a more accurate representation of the needs of the community to help commissioning and workforce planning., (© 2023. The Author(s), under exclusive licence to the British Dental Association.)

A custom-made device is a medical device that is 'intended for the sole use of a particular patient' made 'in accordance with a written prescription'. In a dental setting, common examples of custom-made devices include crowns, dentures and orthodontic appliances. Until fairly recently, dental professionals who manufactured custom-made devices within the European Union (EU) were required to do so in accordance with Council Directive 93/42/EEC (Medical Devices Directive [MDD]), which was given effect in the UK by the Medical Devices Regulations 2002 (Statutory Instrument 2002/618 [UK MDR 2002]). The MDD has since been replaced by Regulation (EU) 2017/745 (Medical Device Regulation [EU MDR]). However, the withdrawal of the UK from the EU, the COVID-19 pandemic and the implementation of the Ireland/Northern Ireland Protocol has led to different parts of the UK following different legislative frameworks. Dental professionals in Great Britain (England, Scotland and Wales) who manufacture custom-made devices must follow the relevant requirements of the UK MDR 2002 (although devices may be placed on the market in accordance with the EU MDR until 30 June 2024), while those in Northern Ireland are subject to the EU MDR. This paper provides answers to some key questions regarding the ways in which these legislative changes have impacted the provision of custom-made devices in the UK., (© 2023. The Author(s), under exclusive licence to the British Dental Association.)

Cleft lip and/or palate includes a spectrum of congenital disorders affecting union on the lip, alveolus, hard and/or soft palate. The management of children born with an orofacial cleft requires a complex process from a multidisciplinary team (MDT) to restore form and function. Since the Clinical Standards Advisory Group (CSAG) report in 1998, the UK has reformed and restructured cleft services to improve the outcomes for children born with a cleft.The spectrum of cleft conditions, the members of the MDT and a chronological description of the stages of cleft management from diagnosis to adulthood are described using a clinical example. This paper forms the introduction to a series of more detailed papers which span all major aspects of cleft management. The papers will cover the following topics: dental anomalies; associated medical conditions among children; orthodontic management of patients; speech assessment and intervention; role of the clinical psychologist; challenges for the paediatric dentist; genetics and orofacial clefts; surgery - primary and secondary; restorative dentistry; and global perspectives., (© 2023. The Author(s).)

Archie Donaldson was a dentist with a great intellect. He was an outstanding editor of the British Dental Journal and honourary curator of the British Dental Association Museum for many years. He was well known in the history of medicine circles, both in the United Kingdom and abroad. His papers on the historical use of gold and electricity in the surgery are highly thought of, as is his definitive history of the National Dental Hospital., (© 2022. The Author(s), under exclusive licence to the British Dental Association.)

In January 2019, the United States National Academy of Medicine initiated a comprehensive study of the status of current knowledge and clinical practices associated with temporomandibular disorders (TMDs). The National Academy of Sciences, which includes the National Academy of Medicine, was chartered by the US Government in the late 1800s as a non-profit institution working outside of government in order to provide unbiased, objective opinions on matters including healthcare. In this brief paper, we will discuss the open access 2020 report Temporomandibular disorders: priorities for research and care, available online. While the main focus of this report was the situation of TMDs in the US, the evidence base, authorship, expertise and literature scope was international and the findings therefore are at least in part generalisable to and important for the UK.The authors of this commentary were directly involved in the National Academy process, with RO a panel member, JD a consultant and CG one of 15 reviewers of the draft report. There was a wide variety of clinical and research fields involved in gathering the evidence and constructing the report. In addition, there was extensive involvement from affected patients with TMDs and their families, which is critical because their perspective is typically omitted in textbooks and professional consensus meetings., (© 2022. The Author(s), under exclusive licence to the British Dental Association.)

In dentistry, all reputable manufacturers comply with international standards. This is important for quality assurance of dental materials. How such standards came into being and have evolved, however, is perhaps less well-known. This paper covers the necessity and formulation of standards and illustrates their application with reference to materials that may be considered as potential alternatives to dental amalgam. In addition, the uncertainties around such a framework following Brexit are summarised. Robust standards are essential for consumer protection and international trade., (© 2022. The Author(s), under exclusive licence to the British Dental Association.)

Due to the effects of the COVID-19 pandemic, internationally qualified dentists have been negatively impacted. This is due to the suspension of the Overseas Registration Exam (ORE) with no confirmation of any future dates. Similarly, UK dentistry was also affected by a significant increase in waiting lists all over the UK, with long waiting lists being present even before the pandemic. Due to these factors, many have highlighted and argued the need for internationally qualified dentists and urged the need to facilitate their registrations. Additionally, after Brexit, the government has introduced new immigration routes to attract overseas, highly educated human resources, so that they can contribute to different sectors in the UK. Considering these circumstances, there are a few alternatives to the ORE that could be introduced to facilitate the registration of internationally qualified dentists and to support NHS dental services. This paper suggests short- and long-term solutions to support the registration of internationally qualified dentists, considering that after two years, European-qualified dentists might need to undertake registration exams as well., (© 2022. The Author(s), under exclusive licence to the British Dental Association.)

Introduction The flipped classroom (FC) format involves the student reviewing the theoretical subject matter through material provided prior to a face-to-face teaching session. The intention is that because the student is familiar with the material, they will derive more from the tutor contact time. This format has been shown to increase student satisfaction, performance and cognitive development, and delivers better academic attainment.Method The present paper describes the transition from a traditional lecture-based approach to a blended FC format in the delivery of the application of dental materials and biomaterials course at a UK dental school during the academic year 2019/2020, and compares student feedback before and after the transition.Results The formal and informal feedback received from students after the change was entirely positive.Discussion FC shows great promise as an andragogic tool in a clinical discipline, but further quantitative research is required, especially in respect to measuring academic attainment.Introduction., (© 2021. The Author(s), under exclusive licence to the British Dental Association.)

The 1990s saw the introduction of three European directives that aimed to harmonise medical device legislation within the European Union (EU), which were given effect in the UK by The Medical Devices Regulations 2002 (Statutory Instrument 2002/618). Dental professionals who prescribe and manufacture custom-made devices were required to do so in accordance with the relevant requirements of one of these directives, Council Directive 93/42/EEC (Medical Device Directive [MDD]). The MDD has been replaced by Regulation (EU) 2017/745 (Medical Device Regulation [EU MDR]) and this paper answers some important questions regarding the ways in which this affects the provision of custom-made devices in a dental setting., (© 2021. The Author(s), under exclusive licence to the British Dental Association.)

The Overseas Registration Examination (ORE) is a popular examination required by overseas-trained dentists who qualified outside of the United Kingdom (UK), European Union or European Economic Area to join the UK dental workforce. In the last two to three years, booking to attempt this examination, especially the part 2 component, remains a concern raised repeatedly by candidates. This paper describes the philosophies that led to the use of the current booking system and proposes recommendations that will be beneficial both to candidates and to the General Dental Council.

The aim of this paper is to highlight the impact of racial disparities on the educational experiences of Black and minority ethnic students in healthcare education. Attainment gaps and barriers to career progression for minority ethnic home students in the United Kingdom have been recognised for decades, but little progress has been made to address these issues. Students and staff in higher education have been campaigning for 'decolonisation of the curriculum' to improve inclusivity and representation. These trends are being mirrored in medical education and there is growing recognition to decolonise the medical curricula. This would improve the educational experience and attainment of minority ethnic students and doctors, and would also help to address disparities in healthcare provision for minority ethnic patients. The context for decolonisation of the dental curricula is provided, followed by a discussion on the benefits, challenges and strategies for such decolonisation.

There is growing evidence that Black, Asian and Minority Ethnic (BAME) groups in the UK are at increased risk of death from coronavirus (COVID-19), with Black Afro-Caribbean, Indian, Pakistani and Bangladeshi populations being particularly at risk. Although the reasons are unclear, it is likely to be a combination of cultural and socioeconomic, as well as the higher prevalence of co-morbidities such as high blood pressure, cardiovascular disease, raised body mass index (BMI) and type 2 diabetes in these populations. The NHS is advising that frontline staff of BAME origin should be risk-assessed regarding their safety in working in clinical areas which are at risk of COVID-19. There is, however, little evidence on the risks posed to the BAME community within the dental profession. This paper outlines some of the challenges faced, and advocates that urgent action needs to be taken to mitigate the risks of COVID-19 and ensure BAME staff safety upon returning to work.

Introduction The COVID-19 pandemic has posed many challenges, including provision of urgent dental care. This paper presents a prospective service evaluation during establishment of urgent dental care in the North East of England over a six-week period.Aim To monitor patient volumes, demographics and outcomes at the North East urgent dental care centre and confirm appropriate care pathways.Main outcome methods Data were collected on key characteristics of patients accessing urgent care from 23 March to 3 May 2020. Analysis was with descriptive statistics.Results There were 1,746 patient triages (1,595 telephone and 151 face-to-face), resulting in 1,322 clinical consultations. The most common diagnoses were symptomatic irreversible pulpitis or apical periodontitis. Sixty-five percent of clinical consultations resulted in extractions and 0.8% in an aerosol generating procedure. Patients travelled 25 km on average to access care; however, this reduced as more urgent care centres were established. The majority of patients were asymptomatic of COVID-19 and, to our knowledge, no staff acquired infection due to occupational exposure.Conclusion The urgent dental care centre effectively managed urgent and emergency dental care, with appropriate patient pathways established over the six-week period. Dental preparedness for future pandemic crises could be improved and informed by this data.

General dental practice in the United Kingdom has been in a state of unrest for over two decades, with practitioners having been confronted by two contract changes. The latest contract change of 2006 resulted in much disquiet, and services continue to be piloted in order to develop a contract that satisfies the needs of both government and the profession. Within this context, this paper explores the issues surrounding the present situation. To date, the profession has expanded service provision into the private market which has resulted in an exaggerated inverse care provision. This could be perceived as a move towards a retail philosophy and away from healthcare. In order to restore an equitable balance of care provision, the authors present possible solutions that could satisfy both parties.

Background Extensive literature covers the relationship between psychiatric and dental health, but little research explores the ability of dental practitioners to confidently address patient mental health. This paper explored self-reported confidence of dental students when addressing patient mental health in a university setting.Methods Mixed-method approach involving a quantitative scenario-based survey and focus groups. Research participants were from years three, four and five of the Bachelor of Dental Surgery (BDS) degree.Results Survey data showed low confidence among dental students. Focus group themes included lack of education, prejudice and rejecting responsibility. Participants suggested communication skills workshops to help improve confidence.Discussion Self-reported confidence among dental students when addressing patient mental health was low, echoing wider literature findings. Focus groups highlighted an absence of patient mental health from the curriculum. Systematic reviews have recommended greater education around screening tools for 'assessing psychological comorbidity'. Using best practice, focus group data and psychologist guidance, we developed a communication skills case-based workshop for service improvement.Conclusion Low student confidence likely originates from limited focus within the BDS curriculum. The research will be expanded into other UK dental schools to explore the confidence of dental students nationally and to evaluate and trial the developed workshop.

Recent moves by public health academics and social scientists for increased recognition of the behavioural and social sciences (BeSS) in medical education in the UK have put the role and place of the BeSS in dental education back on the curricular agenda. Behavioural and social sciences have been a component of the UK dental curriculum since 1990 but, to our knowledge, have only been reviewed once, in 1999. The aim of this article is to reignite a discussion about the role and place of BeSS in dental education in the UK. It reiterates the benefits of BeSS to dental education and dentistry in general, while remaining cognisant of the implicit and explicit barriers that can conspire to side-line their contribution to dental education. This paper concludes by making renewed calls for more integration of BeSS into the dental undergraduate curriculum as well as sectoral recognition for its contribution to the advancement of dental education and the professional development of dentists.

Since 2015, a series of papers which describe the systems for the provision of health and oral healthcare in nine European Union (EU) countries (France, Germany, Greece, Ireland, Italy, Poland, Romania, Spain and Sweden) have been published in this journal. This tenth and final paper in the series compares aspects of the systems for each country, with each other and with that in the United Kingdom (UK). The topics which have been covered are the organisation and funding of oral healthcare, national populations and oral healthcare workforce, education of dentists, uptake of oral healthcare, expenditure on oral healthcare and oral epidemiology. The comparison shows that there are wide differences between the care provision systems between the individual countries. In all of them, oral healthcare continues to operate outside the mainstream healthcare systems. In particular, the proportion of costs paid for them from public funds, raised through taxation or through compulsory social insurances, and those paid for by individual patients varies greatly. No comparable data exist on quality of care.

Background The aim of this paper is to describe the oral health status of athletes with intellectual disabilities competing in the Special Olympics, GB National Games, held in Sheffield in August 2017.Methods and materials A convenience sample of athletes who participated in the Special Olympics Special Smiles screening programme was used. All data was recorded on validated Healthy Athletes screening forms.Results Of the 692 athletes that participated, 14% had untreated decay, 51.9% had at least one filling and 28.6% had signs of gingivitis. Furthermore, 6.2% reported pain from their mouth and 2.7% were found to require urgent treatment. Overall, 90.3% reported to clean their mouths at least once per day and 0.7% were found to be edentulous.Discussion The findings from this screening highlighted lower rates of decay, pain and urgent treatment need in comparison to Special Olympic screenings worldwide.Conclusion The oral health of athletes competing in the GB National Games 2017 was better than noted at most Special Olympic events throughout the world. There is little data published on the oral health of individuals with learning disabilities in the UK. These results provide valuable baseline data to monitor and review the oral health of Special Olympic athletes within Great Britain.

Objective: This paper reports data which helps identify changes and trends in the provision of indirect fixed prostheses in general dental practice in the UK. To determine by means of an anonymous, self-report questionnaire, the current trend in the provision of fixed prosthodontic treatments, with a special emphasis on the choice of treatment modalities, techniques and materials., Methods: The data presented were extracted from the data obtained from a validated,121-question questionnaire distributed at random to general dental practitioners in the UK attending postgraduate meetings in 2015/2016, with a wide distribution of locations., Results: A response rate exceeding 66% was achieved. Amalgam and light-cured composite were the preferred material for core build-up of vital teeth for around 62% of the respondents. Dentine pins were still being used by 66% of the respondents. The vast majority of respondents (92%) used a post and core to restore root-treated teeth. Fibre posts were the most commonly used (63%) type of preformed post among the respondents. Using the opposing and adjacent teeth as a reference to control tooth structure reduction during vital tooth preparation was the most common method, used by 42% of the respondents. Addition-cured silicone impression materials were the most frequently used impression material (78%). The surveyed practitioners were equally split between precious and non-precious metals as the substructure for indirect restorations. Glass-ionomer luting cements (47%) and resin-based cements (52%) were the most commonly used to cement porcelain fused to metal and zirconia indirect restorations, respectively. Laboratory made aesthetic veneers were prescribed by half of the respondents, while a third of them preferred direct resin composite as a veneer material., Conclusion: Within the limitations of the study, it was concluded that there has been an increase in the use of adhesive bonding and metal-free restorations. Amalgam and dentine pinscontinued to be used, contrary to international trends. Studies of the type reported are considered important in investigating trends and developments in dentistry.

The paper highlights the pros and cons of a national programme for screening for oral cancer. It provides an overview of screening methods and the metrics used to evaluate a screening programme. It then reviews the evidence for mouth cancer screening against the criteria of the United Kingdom National Screening Committee.

All members of the clinical dental team face a daily risk of a personal sharp injury. A wide range of sharp instruments are used, some of which are specifically designed to easily pierce the skin and mucosa. The instruments are placed, moved, passed between colleagues, used for treatment, replaced and cleaned, all in relatively confined areas. The clinical dental workplace and the decontamination unit are both therefore sharp-risk environments. There is a clear risk of a sharp injury and the potential consequences of occupational exposure to blood-borne pathogens are at least inconvenient and at worst, career and even life threatening. However, good sharp safety is not universally understood and practised throughout the dental profession. This paper considers the risk of sharp injury in dentistry and discusses some of the methods used to improve sharp safety.

As we debate shaping the future oral health workforce within the UK, to meet the needs of current and future populations, it is helpful to take an international perspective on this very important issue. Globally, there is a strong recognition that human resources for health (HRH) are fundamentally important to deliver effective care, accessible to all people. This paper reviews the outcome of the fourth global forum held by the World Health Organisation (WHO) in Dublin which highlighted the urgency for action. The main objectives of the forum were to advance the implementation of (i) the WHO Global Strategy on HRH 2030 and (ii) the United Nations High-Level Commission's Health Employment and Economic Growth recommendations. From an oral health perspective, the global burden of oral disease remains huge with untreated dental caries, periodontal disease and tooth loss ranking among the most prevalent conditions worldwide. Major considerations are how dental education, practice delivery and/or oral health systems as a whole could and should innovate to accommodate the growing needs of the population. As dental professionals, it also becomes necessary for us to engage and play a proactive role in this change process. Due to growing differences between population needs and available services, it is necessary for oral health personnel to work more closely with the broader health workforce so as to identify solutions that are in the best interests of the patients and populations at large.

Since 2015 the body known as NHS Improvement has published, and this year updated, its list of never events - defined as 'serious incidents that are entirely preventable because guidance or safety recommendations providing strong systemic protective barriers are available at a national level.' How this is interpreted, however, especially in dental terms, has been very poorly managed in my opinion, leading to the potential for increased risk of such events happening and raising anxiety levels among many colleagues, especially the newly qualified, and responses to them both at a local and national level potentially give the lie to the no-blame culture purported to exist within healthcare in the UK. This paper is intended to stimulate debate among those who lead our profession towards a realistic consensus view on management of these issues for the safety of our patients and the peace of mind of the profession.

Tuberculosis (TB) is a preventable and curable infection, but remains a significant cause of death. The dental team is likely to encounter patients with a history of TB, however, at present there is limited guidance available to inform the provision of oral healthcare for this patient group. This may lead to confusion with delays in care. There is a potential health risk posed to patients and co-workers by a member of the dental team who becomes infected. TB has the potential to be a major issue for oral healthcare in the United Kingdom (UK). This paper discusses the implications for both patient care and management of the dental team.

The role of human factors in healthcare has become increasingly well recognised, particularly following the Francis inquiry into the failings in care at the Mid Staffordshire NHS Foundation Trust and Berwick Reports. The recognition of human factors in dentistry, particularly in primary care, is less well developed. This paper aims to explore the relevance of human factors in dentistry and highlight the importance of considering their role in any adverse patient outcomes and, importantly for the future, the continued recognition and integration of teaching about human factors in healthcare in both undergraduate and postgraduate education.

This paper outlines the involvement of dentists in the treatment of patients following the terror attack at Manchester Arena on 22 May 2017. It predominantly describes the role of the authors - a paediatric dental consultant and maxillofacial surgery dental core trainee (DCT). As a result of the incident a number of patients suffered oro-facial injuries, with many treated at Central Manchester Foundation Trust Hospitals' Manchester Royal Infirmary and Royal Manchester Children's Hospital. The major incident response of the trust is discussed, as are the presentation of blast injuries and corresponding NHS guidance. Two paediatric cases present the role of the paediatric dental consultant in the acute, intermediate and long-term management of these patients. The presentation of unique dento-alveolar injuries in the context of other trauma and their subsequent treatment demanded true multidisciplinary management. The importance of teeth and oral health to physical and psycho-social wellbeing and recovery was clear and recognised by other teams involved in the patients' management. The experience reinforced the overall impact dental health has on physical and psycho-social health, and how a holistic approach is integral to treatment of major trauma.

Research is an intrinsic part of both academia and clinical best practice. Within an academic environment, this can include access to advice and guidance from trained professionals. Similarly, while sometimes overly risk-averse, within the NHS there is a structured and systematic approach to healthcare research. However, in the UK, a large number of specialist dental procedures take place within the private healthcare system, which does not have access to such support and guidance. How, then, can we generate our own dental research from private dental primary care settings? With a number of phrases becoming part of everyday vocabulary in dental primary care, such as practice-based research, patient-centred outcomes, evidence-based dentistry, it is time to consider this. From research ethics to writing papers, via GCP, IRAS, HEIs and MOOCs, this article summarises the experiences of one non-affiliated (non-academic, non-NHS) private dental practice attempting to enter the world of research. The authors discuss their experiences, share the multiple sources of support encountered along the way, and demonstrate the benefits to everyday practice gained by initiating research studies.

Dental students in the United Kingdom usually study histopathology as part of their undergraduate curriculum and this has traditionally been delivered using light microscopes in laboratory classes. Beginning in 2005, the oral pathology course in Sheffield was gradually modified by the introduction of virtual microscopy with a focus on creating a more integrated, clinically orientated and dynamic approach to student teaching and learning in histopathology. The purpose of this paper is to describe how virtual microscopy has been used to enhance dental students' learning of oral pathology, and its role in facilitating an integrated oral disease curriculum in Sheffield.

In the second paper of a series exploring quality in primary dental care a way to measure quality in dentistry is considered. Unless there are valid and reliable tools to measure quality then quality can never be improved. Measurement tools need to be acceptable to patients if they are to be employed, as well as to busy practices in terms of practicality and costs. Examples such as the General Medical Practitioner's Quality Outcome Framework need to be understood to see if they can be translated to dentistry.

This paper explores the concept of patient-centred care as a dimension of quality as applied to dentistry and provides a systematic review of the literature. The new NHS dental contract, which is currently being piloted in England, is committed to delivering improvements in quality. The Dental Quality and Outcomes Framework has been developed as a tool to measure quality and focuses on three key dimensions: clinical effectiveness, safety and patient experience. A systematic review of the literature reveals a lack of information pertaining to patient-centred care within dentistry, and in particular general dental practice. It would also suggest that there is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient centredness.

Care pathways have been used in a variety of ways: firstly to support quality improvement through standardising clinical processes, but also for secondary purposes, by purchasers of healthcare, to monitor activity and health outcomes and to commission services. This paper focuses on reporting a secondary use of care pathways: to commission and monitor performance of primary dental care services. Findings of a project involving three dental practices implementing a system based on rating patients according to their risk of disease and need for care are outlined. Data from surgery-based clinical databases and interviews from commissioners and providers are reported. The use of both process and outcome key performance indicators in this context is discussed, as well as issues which arise such as attributability of outcome measures and strategic approaches to improving quality of care.

This paper explores the concept of quality as applied to healthcare and its subsequent application to dentistry. The assessment of quality arose from the manufacturing industry and is viewed as a cornerstone of current Government thinking. The difficulties in defining and therefore in measuring are examined and, in particular, the tensions between quantifying quality at a population level and at an individual level. The findings of the application of quality measures to primary medical care are reviewed, especially those that are linked to financial reimbursement of care providers and the implications for any future dental agenda discussed.

The Department of Health's response to the national budget deficit is to ensure that the provision of NHS services is guided by four fundamental 'QIPP' principles: Quality, Innovation, Prevention, and Productivity. This agenda will govern all aspects of the National Health Service's (NHS') health care provision for the foreseeable future. NHS dental services will, like all other NHS services, need to make a contribution to the QIPP agenda. The purpose of this paper is to outline the implications for NHS dentistry.

In the last year there has been a great deal of public debate about homeopathy, the system of alternative medicine whose main principles are that like cures like and that potency increases relative to dilution. The House of Commons Select Committee on Science and Technology concluded in November 2009 that there is no evidence base for homeopathy, and agreed with some academic commentators that homeopathy should not be funded by the NHS. While homeopathic doctors and hospitals are quite commonplace, some might be surprised to learn that there are also many homeopathic dentists practising in the UK. This paper examines the statements made by several organisations on behalf of homeopathic dentistry and suggests that they are not entirely ethical and may be in breach of various professional guidelines.

Since August 2009, members of the Primary Care Dentistry Research Forum (http://www.dentistryresearch.org) have taken part in an online vote to identify questions in day-to-day practice that they felt most needed to be answered with conclusive research. The question which receives the most votes each month forms the subject of a critical appraisal of the relevant literature. Each month a new round of voting takes place to decide which further questions will be reviewed. Dental practitioners and dental care professionals are encouraged to take part in the voting and submit their own questions to be included in the vote by joining the website.The paper below details a summary of the findings of the seventh critical appraisal. In conclusion, the critical appraisal identified no evidence on the epidemiological scale of cross-infection caused in dental practices and therefore also of the cost impact of cross-infection caused in primary dental practices. As a result, no 'cost of illness', or cost-benefit assessment, exists or is feasible at this time.

Aim: The aim of this paper is to compare the demography (age, sex, ethnicity, social status) and academic experience (school type, tariff scores) of focused and successful applicants to preclinical dentistry with preclinical medicine, and with higher education in general in the UK., Method: Retrospective analyses of anonymised University and College Admissions Services (UCAS) data for focused applicants whose preferred subject was preclinical dentistry or medicine, and accepted (successful) applicants to the same programmes in 2006. These data were compared with publicly available data on applicants and accepted applicants through UCAS. Information for each medical, dental and general UCAS applicant included age, sex, ethnicity, socio-economic group, region, school type and tariff score. Logistic regression was used to model the probability of being accepted in relation to all explanatory variables and interactions., Results: In total there were 2,577 focused applicants to dentistry; 1,114 applicants were accepted, 4% (n = 46) of whom did not have it as their preferred subject choice. There were seven times as many focused applicants for medicine (18,943) when compared with dentistry; 8,011 applicants were accepted, 2.7% of whom did not have medicine as their preferred subject choice (n = 218). Just over half of the applicants to dentistry were from minority ethnic backgrounds (50.5%), exceeding medicine (29.5%), and higher education in general (19%). The proportion of female applicants was similar across all three groups at around 55%. Only one fifth (21%) of focused applicants to dentistry were mature compared with one third (33%) to medicine and one quarter (25.5%) of all UCAS applicants. Greater proportions of applicants to medicine (25.8%) and dentistry (23.5%) were from upper socio-economic backgrounds, compared with higher education in general (15.5%). When all other factors are controlled, the odds of being accepted for medicine, and for dentistry, are lower if mature, male, from a lower social class, from a minority ethnic group and have attended a further/higher education college., Conclusions: Focused and successful applicants for preclinical medicine and dentistry are more likely to be from higher social classes and a minority ethnic background than applicants to higher education in general. Dentistry attracts twice the level of Asian applicants as medicine and four times that of universities in general. Controlling for other factors, there is evidence that gender, ethnicity, maturity, and school type are associated with probability of acceptance for medicine and dentistry. Higher social status is particularly associated with acceptance for medicine. The implications of these findings are discussed in terms of widening access and social justice.