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Objective To determine the impact of multiple sclerosis (MS) on patient attendance at dental practices and maintenance of oral health.Design A cross-sectional postal questionnaire-based study.Setting Leicestershire, United Kingdom.Subjects and methods People with MS in Leicestershire identified from local health authority records (n = 476).Main outcome measures Number registered at dental practice, frequency of attendance, issues and perspectives relating to attendance and maintenance of oral health.Results A response rate of 61% (n = 289) was obtained. When compared to the general population, a higher number of people with MS were registered with a dentist (49%:88%) and displayed more frequent practice attendance (71%:81%) in the past year. People with MS reported difficulties in attending a dentist and maintaining oral health, which were exacerbated by deterioration in general health. Problems relating to reduced personal mobility had the greatest impact on attendance.Conclusions MS has a negative impact on perceived patient attendance and maintenance of oral health. Patients with a progressive disability could benefit greatly from the provision of preventive oral health care. The importance of seeking care earlier rather than later needs to be emphasised to both professionals and patients alike. Further efforts are required to increase awareness of the importance of oral health to the quality of life of people with MS and ensure that individuals with physical disabilities receive the same access to dental services as the able-bodied. [ABSTRACT FROM AUTHOR]

This is a case study to investigate in an objective way how fluoridation is reported in the press. All press cuttings collected by a reputable national agency covering a 9-month period were studied; were rated as being profluoridation, antifluoridation or neutral. The rating system was calibrated before the study by comparing the scores given by the author and a selected group of experts. Overall, press article coverage was antifluoridation, though it is not clear how intentional this is. [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 To determine the impact of multiple sclerosis (MS) on patient attendance at dental practices and maintenance of oral health.Design A cross-sectional postal questionnaire-based study.Setting Leicestershire, United Kingdom.Subjects and methods People with MS in Leicestershire identified from local health authority records (n = 476).Main outcome measures Number registered at dental practice, frequency of attendance, issues and perspectives relating to attendance and maintenance of oral health.Results A response rate of 61% (n = 289) was obtained. When compared to the general population, a higher number of people with MS were registered with a dentist (49%:88%) and displayed more frequent practice attendance (71%:81%) in the past year. People with MS reported difficulties in attending a dentist and maintaining oral health, which were exacerbated by deterioration in general health. Problems relating to reduced personal mobility had the greatest impact on attendance.Conclusions MS has a negative impact on perceived patient attendance and maintenance of oral health. Patients with a progressive disability could benefit greatly from the provision of preventive oral health care. The importance of seeking care earlier rather than later needs to be emphasised to both professionals and patients alike. Further efforts are required to increase awareness of the importance of oral health to the quality of life of people with MS and ensure that individuals with physical disabilities receive the same access to dental services as the able-bodied. [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]

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 ninth critical appraisal. In conclusion, the critical appraisal showed a wide range of factors that infl uence care-seeking about oral health. These included both barriers and triggers to care-seeking. Only five papers were found that provided relevant data, and their data collection settings varied widely. Further research into care-seeking about oral health would be useful for both policy makers and practitioners in understanding patients' needs. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This paper assesses the current internal assessment and BDS examination of undergraduate orthodontics in UK dental schools, the changes which have occurred in the last three years, and future changes proposed. Method: Questionnaires were emailed to the undergraduate orthodontic course leaders in each of the UK dental schools. Twelve dental schools agreed to participate in the survey. Responses were checked for completeness, summarised and sent back to individual course leaders to verify. These verified responses were then analysed. Results: There was a wide variation in the form and content of the in-course assessment and the BDS examination in the 12 UK dental schools. The in-course assessment varied from minimal to extensive, and in its percentage contribution to BDS. The use of written, clinical, and particularly patient treatment and laboratory assessments varied considerably from school to school. The format of the BDS examination varied in the number, type and timing of written examinations, in the number of students examined clinically, and in the use of additional examinations of viva, case presentation, or OSCE. Conclusions: Comparison of undergraduate orthodontic courses in UK dental schools revealed a wide variation in student assessment and examination. Current orthodontic internal assessments are inconsistent with no common pattern across the courses, and inconsistencies also exist in the BDS examination. Guidelines for orthodontic assessment and examination are needed to ensure standards and consistency in UK dental schools in the future. [ABSTRACT FROM AUTHOR]

This paper describes the historical origins and purpose of 'evidence-based practice' and describes the barriers to the growth of evidence-based practice within dentistry. It describes a new research agenda-setting process for dentistry, which includes identifying and prioritising the topics of most relevance to the work of primary dental care practitioners. By undertaking the work described in this paper we were striving to make research more relevant to the day to day decisions made by dentists in practice by introducing a new process, the intention being to promote and promulgate the practice of evidence-based dentistry. [ABSTRACT FROM AUTHOR]

The United Kingdom Clinical Aptitude Test (UKCAT) has now been an active part of UK dental admissions for seven years with the test being used by 11 dental schools within their admissions processes. This paper gives an overview on UKCAT and highlights some of the on-going work in relation to its development. This paper also highlights what UKCAT is and some developments with respect to the UKCAT. It also facilitates the process of keeping dental practitioners informed. [ABSTRACT FROM AUTHOR]

Dental graduates have a number of career pathways to choose from, one of which is to train as a specialist. It is sometimes difficult to obtain good advice on entering the specialist training process. This paper, aimed at recent dental graduates, gives an overview of what is required of applicants who wish to obtain a specialty registrar (StR) position in one of the 13 dental specialties recognised by the General Dental Council. The potential financial implications of specialist training are outlined, along with information on dental foundation training, MFDS and MJDF examinations and postgraduate degrees. The importance of gaining experience in clinical governance and research is outlined. Advice regarding the application process and interview technique is also included. It is the authors' intention that, having read this paper, recent dental graduates will have increased knowledge of the various career paths that lead to specialisation and those interested in specialising will have improved knowledge of how to begin their journey. [ABSTRACT FROM AUTHOR]

Objectives The objective of this paper is to describe the contemporary teaching of dental implantology to dental undergraduates in the United Kingdom and Ireland. The paper also aims to assess the attitudes of dental school educators in relation to future trends in dental implant training for dental undergraduates.Methods An online questionnaire relating to current and future possible trends in dental implantology education was developed and distributed to Heads of Division/Departments of Restorative Dentistry, or equivalent, in each of the 15 dental schools with undergraduate dental programmes in the United Kingdom and Ireland. The questionnaire included both 'open' and 'closed' style questions.Results All 15 dental schools invited to participate in this survey responded. Of the 15 schools, two do not provide any training for their undergraduate dental students in relation to implant dentistry. The teaching is mainly delivered in lecture-based or phantom head room settings (eight of the 13 implant-teaching schools). Only four schools allow their students to interact clinically with implant patients. All schools anticipate an increase in dental implant teaching in the next five years, however, there is much variation in the scope and nature of this increase.Conclusions The teaching of dental implants in the UK and Ireland has increased since the time of previous surveys. It would seem prudent for this theme of teaching to further increase in order to best prepare graduating students for independent clinical practice. [ABSTRACT FROM AUTHOR]

Ever-increasing needs and demands by dentists and all other members of the dental team for education and training at all levels – undergraduate, postgraduate and continuing – are straining the resources of existing providers of such education. At the same time, there are ever-increasing opportunities to develop online delivery and the use of a range of information and communication technology (ICT) systems and services further, in all aspects of dental education. This paper reviews recent developments that have led to an increased demand for dental postgraduate programmes and continuing professional development (CPD) courses in the United Kingdom and then discusses how ICT has and will impact on teaching practice. Examples include the use of teaching and learning resources in a virtual learning environment (VLE) and the increasing use of blended learning. The paper then explores the need for both teachers and students to adapt to the new environment to ensure they can benefit to the maximum and that teaching and learning practices are changed accordingly. [ABSTRACT FROM AUTHOR]

In 1998, the UK government published a White Paper outlining a comprehensive range of measures to reduce smoking rates across the population. In the same year a detailed overview of the evidence base for smoking cessation activities within the NHS was published. Both these documents provide useful information for health professionals interested in developing their roles in smoking cessation and prevention. An increased risk for the development of oral malignancies and a susceptibility for the breakdown of periodontal tissues are the most significant effects of smoking on the mouth. This paper aims to highlight how dentists and their team members can become actively involved in efforts to reduce smoking. Opportunities at both a clinical and public health level are considered. [ABSTRACT FROM AUTHOR]

The improvement of patient safety has been a long-term aim of healthcare organisations and following recent negative events within the UK, the focus on safety has rightly increased. For over twenty years, clinical audit has been the tool most frequently used to measure safety-related aspects of healthcare and when done so correctly, can lead to sustained improvements. This paper explains how clinical audit is used as a safety improvement tool in an English dental hospital and gives several examples of projects that have resulted in long-term improvements in secondary dental care. [ABSTRACT FROM AUTHOR]

In this paper, the actions needed to manage specific medical emergencies are discussed. Each emergency requires a correct diagnosis to be made for effective and safe management. Contemporary management in dental practice avoids the intravenous route when drugs are required to treat the emergency. [ABSTRACT FROM AUTHOR]

All dental practitioners must be proficient at taking a medical history, examining a clothed patient and recognising relevant clinical signs. The general examination of a patient should take into account findings from the history. This paper does not attempt to address the detailed oral and dental examination carried out by dental practitioners but focuses on the holistic patient assessment - essential for safe patient management. [ABSTRACT FROM AUTHOR]

Objective This paper describes an objective method for assessing the decontamination procedures used for reprocessing dental instruments in primary dental care facilities.Materials and methods The study population comprised all general dental practitioners in Scotland with an NHS list number. A two-stage process was used to identify which surgeries were to be surveyed, using a proportional stratified random sampling method. First, practices were randomly selected in proportion to the distribution of practices within each of the health boards. Then, if there was more than one dentist within a selected practice, simple random sampling was used to identify a single dentist within the selected practice to be approached. The surgery that the dentist worked from and its associated decontamination facilities were the subject of the survey. A set of data collection forms provided questions designed to investigate compliance with extant guidance documents on decontamination. Specific training for the survey team members was provided during a three day course, to ensure consistency of approach. The data collection forms were piloted in 20 dental surgeries.Results A methodology was developed, which utilised both staff interviews and direct observation of decontamination processes. Data were collected on a set of 28 standard forms, which could be machine read. Three hundred and seventy-three dentists were selected at random from the dental practitioners list held by Practitioner Services, Scotland. One hundred and eighty-nine practitioners either declined to participate or could not be contacted at the address supplied. One hundred and eighty-four surgeries were surveyed, data were available for analysis from 179 sites. Data from five sites were rejected because of illegibility (three) and incomplete data (two). Each surgery survey was undertaken by a team of two surveyors, comprising one infection control/decontamination expert and one experienced dental practitioner. The survey team interviewed the dental practitioner and dental nurse, reviewed documentation relevant to the survey, directly observed decontamination practices and recorded the physical layout of the premises.Conclusion The use of machine readable data collection forms, trained survey staff and direct observation of decontamination protocols provides a workable method for accurate collection of decontamination practice in primary care facilities. [ABSTRACT FROM AUTHOR]

Earlier this year English Heritage, the BDA Museum and The Lindsay Society for the History of Dentistry unveiled a plaque to Lilian Lindsay (1871-1960). This paper outlines the history and administration of the blue plaque scheme and celebrates the contributions made by dentists who have been commemorated with plaques. [ABSTRACT FROM AUTHOR]

This paper provides an overview of the main sources of fluoride (F) in children and discusses the importance of assessing F exposure at an individual and community level. It describes some of the methods used to assess F exposure by estimating F intake and excretion, together with the development and use of biomarkers for F and their importance. The paper focuses on what recent F research has shown in terms of significant sources of dietary F intake in UK infants and young children and the proportion of F intake that derives from F ingestion of toothpaste. This information is considered in the context of clinical dental practice and the implications of this research for oral health discussed. [ABSTRACT FROM AUTHOR]

Aim The aim of this paper was to review the oral health and future disease risk scores compiled in the Denplan Excel/Previser Patient Assessment (DEPPA) data base by patient age group, and to consider the significance of these outcomes to general practice funding by capitation payments.Methods Between September 2013 and January 2014 7,787 patient assessments were conducted by about 200 dentists from across the UK using DEPPA. A population study was conducted on this data at all life stages.Results The composite Denplan Excel Oral Health Score (OHS) element of DEPPA reduced in a linear fashion with increasing age from a mean value of 85.0 in the 17-24 age group to a mean of 72.6 in patients aged over 75 years. Both periodontal health and tooth health aspects declined with age in an almost linear pattern. DEPPA capitation fee code recommendations followed this trend by advising higher fee codes as patients aged.Conclusions As is the case with general health, these contemporary data suggest that the cost of providing oral healthcare tends to rise significantly with age. Where capitation is used as a method for funding, these costs either need to be passed onto those patients, or a conscious decision made to subsidise older age groups. [ABSTRACT FROM AUTHOR]

Dentistry in the United Kingdom demands a wide range of supportive and regulative bodies, the roles of which are intertwined, overlapping and changeable. The interaction between these bodies is not always clear, and often the present-day role of the body is far removed from its original purpose. Consequently, the system can appear daunting and opaque. Even so, a thorough understanding of this topic is requisite for those considering applying for higher specialist training, and pertinent for practitioners with an interest in the dental political arena. We hope this paper goes some way towards unravelling the tangle of boards, committees, associations, societies and councils that commonly influence dentistry, and provides a starting point for those interested in increasing their knowledge of the profession at the strategic level. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The use of skill mix in medicine is now widespread, yet it appears that its use in dentistry is not as prominent. Unlike doctors, dentists are required to mitigate the financial risk produced by their capital investment and ensure an adequate cash flow to cover their annual running costs. Examining the financial incentives for employing dental care professionals is therefore an important step to understand why dentistry appears to lag behind medicine in skill mix. It is also apposite, given the announcement of the coalition government to develop a new contract, which could introduce incentives for the use of dental care professionals in this way. The purpose of this short paper is to examine whether skill mix is profitable for general dental practices under the existing NHS contract in England. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Care pathways are defined as 'a methodology for the mutual decision making and organisation of care for a well-defined group of patients during a well-defined period'. Although most often used in Europe as a tool to improve the quality of care and to aid the continuity of care between disciplines and settings, care pathways also have an application in underpinning the commissioning process. This paper describes the development of a new model of commissioning for general dental practice services based on a need and risk assessment linked to specified care pathways for preventive care. In this system dentists are monitored on adherence to care protocols based on nationally accepted guidelines for preventive care interventions as well as recommended recall intervals for routine dental examinations. A traffic light system to distinguish between patients with different levels of need and risk of disease is being used. [ABSTRACT FROM AUTHOR]

This paper is the start of a series on general medicine and surgery for dental practitioners. It follows on from a previous series, published in the British Dental Journal in 2003. The proportion of older people in the UK population has been on the increase for several years. Dental practitioners who treat the general public often see older patients on a regular basis. This paper considers aspects of clinical management in the older patient with particular reference to the presentation of disease and factors to be considered in prescribing medication. [ABSTRACT FROM AUTHOR]

In December 2009, members of the newly redeveloped Primary Care Dentistry Research Forum (http://www.dentistryresearch.org) took 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 received the most votes formed 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.This paper details a summary of the findings of the fourth critical appraisal. In conclusion, there is a lack of evidence relating to dentists' perceptions of prevention and its application in practice. Qualitative primary research is needed to look at UK dentists' views and attitudes relating to their understanding of prevention and its application in practice. [ABSTRACT FROM AUTHOR]

Commissioned by the UK Committee of Postgraduate Dental Deans and Directors (COPDEND), the purpose of this work was to establish UK guidelines for dental educators. The final document comprises 79 statements, in eight domains. Each domain has four zones related to what dental educators (1) know, (2) do with members of the dental team as learners, (3) do with other dental educators as learners and (4) lead on. Launched in November 2008, the document provides a framework of good practice for use in the employment, development and management of dental educators in the UK. The guidelines are readily available from the COPDEND website. A key purpose of this paper is to report on the process of development and a central part of that was the integration of feedback and consultation on early drafts. These processes elicited a total of 102 responses. Issues raised in consultation included: (1) how the zones interrelate; (2) differentiation between domains; (3) measurability; and (4) implementation challenges. This paper includes our responses to these issues. [ABSTRACT FROM AUTHOR]

A healthcare curriculum must be up-to-date, fit for purpose and relevant to the population it serves wherever that population might be, worldwide. In this paper we describe the rationale for the design and implementation of a curriculum in a new dental school in UK. We assessed the general and dental health needs of our local population and proposed a set of core skills our dentists will need on graduation and in the future. This core learning falls into three domains of learning. The psychomotor domain covers the learning of technical skills for which we use the shorthand 'hands'. The affective domain covers empathy and behaviour management, that is the 'heart'; and the cognitive domain including critical thinking, the 'head'. The three domains require different ways of learning but all are delivered in context in an integrated, case-based spiralling curriculum building in complexity year on year. Students treat patients from half way through year 1, which helps them appreciate the relevance of the 'hands', 'heart' and 'head' of dentistry as they begin to build their knowledge and experience. [ABSTRACT FROM AUTHOR]

The number of students entering training for dental therapy has been increasing rapidly over the last few years. In practice, the scope of their work has increased, both in terms of permitted duties and their range of clinical settings. The possibilities for dental practitioners to work with therapists is therefore increasing, so it is important for them to be clear about therapists' potential capacity to provide added value to the dental team. This paper, which is the first of four covering aspects of dental therapy in the UK, traces the history of dental therapy together with the development of therapists' training opportunities and emerging competencies, up to the present. The subsequent three papers will describe aspects of a survey of dental therapists undertaken in late 2006. [ABSTRACT FROM AUTHOR]

This paper gives an overview of the strategic background for procurement of NHS primary care dental services and an outline of the processes involved in procurement. The main aim is to bring procurement to the attention of a wider audience of dental practitioners and provide advice for potential primary care dental service providers. The move towards local procurement of healthcare services, including primary care dental services, has been shaped by a number of strategic Government publications and is supported by law. In line with other public bodies, the NHS is subject to the European Union and international rules regarding procurement and awarding contracts. Primary Care Trust (PCT) Dental Service Commissioners have to ensure that their procurement strategy is transparent and non-discriminatory so that all providers have an equal opportunity to compete for contracts. In order to successfully tender for future service provision contracts, dental practitioners not only need to be aware of the process of procurement and its associated legal requirements. It is also important that they have a grasp of the expectations of PCTs. Commissioning services via procurement is set to become more commonplace and it is likely, in time, that competition for some contracts will increase in intensity. The importance of researching proposals thoroughly and adopting a professional, businesslike approach to tendering cannot be understated as this maximises chance of success in the new commissioning environment. [ABSTRACT FROM AUTHOR]

The Editor-in-Chief of the BDJ has previously raised important questions about dental workforce planning and the implications for dental graduates of recent changes and pressures. It is now time to revisit this issue. Much has changed since the last workforce review in England and Wales, and the rate of change is in all probability set to increase. First, at the time of writing this paper the momentous step of including dental care professionals (DCPs) on General Dental Council (GDC) registers in the United Kingdom has recently been completed. Second, the Scope of Practice of all dental professionals has been under consultation by the General Dental Council, and research evidence suggests that greater use should be made of skill-mix in the dental team. Third, within England, Lord Darzi has just published the 'Final Report of the NHS Next Stage Review', which emphasises 'quality care' and 'team-working' as key features of healthcare; this report was accompanied by an important document entitled 'A High Quality Workforce', in which plans for local workforce planning within the NHS are outlined, placing responsibilities at national, local and regional levels. Fourth, policy makers across the UK are wrestling with addressing oral health needs, promoting health and facilitating access to dental care, all of which have implications for the nature and shape of the dental workforce. Fifth, with the impact of globalisation and European policies we are net gainers of dentists as well as having more in training. Sixth, although there have been reviews and policy initiatives by regulatory, professional and other bodies in support of shaping the dental workforce, there has been little serious consideration of skill-mix and funding mechanisms to encourage team-working. Together, these events demand that we enter a fresh debate on the future dental workforce which should extend beyond professional and national boundaries and inform workforce planning. This debate is of great importance to future generations of dental healthcare professionals, funders, commissioners and providers of both dental services and dental education and training, and most importantly our patients and the public whom we serve. Furthermore, workforce planning must be linked to a philosophy of care which promotes promotion of health and embraces quality care, rather than merely treatment of disease, and addresses oral health needs and demands. [ABSTRACT FROM AUTHOR]

This paper describes a practical skills one day course in the 'management of medical emergencies' which is aimed at fulfilling the requirements for training for dentists and DCPs as defined by the Resuscitation Council UK and prefaced by the GDC. [ABSTRACT FROM AUTHOR]

This paper reports on a survey of the attitudes of general dental practitioners (GDPs) and dental nurses to continuing education. This has become the subject of increased policy attention in recent years. The Adult Dental Health Survey of 1998 indicated that in order to meet the increase in requirements for the provision of Dental Health Services in the UK the Professions Complementary to Dentistry (PCDs) would be required to play a greater role in the delivery of dental services. In 2001, the Government undertook a review of the dental workforce, with a remit to look at ways to modernise the education and training system for dentists and the other members of the dental team. [ABSTRACT FROM AUTHOR]

As a profession we have a responsibility to ensure that the oral health needs of individuals and groups who have a physical, sensory, intellectual, medical, emotional or social impairment or disability are met. In the UK, over 200,000 adults have profound learning disabilities and/or complex medical conditions. Adults with a disability often have poorer oral health, poorer health outcomes and poorer access to services than the rest of the population. This paper examines the need for Special Care Dentistry based on a review of published literature, surveys and health policy, and suggests how services might be delivered in the future. Existing models of good practice reveal that established clinicians working in this field have a patient base of between 850 and 1,500 patients per year and work across primary care and hospital settings, liaising with colleagues in health, social services and the voluntary sector to ensure integrated health care planning. On this basis, a conservative estimate of 133 specialists is suggested for the future, working in networks with Dentists with Special Interests (DwSIs) and primary dental care practitioners. A skilled workforce that can address the wider needs of people requiring Special Care Dentistry should be formally recognised and developed within the UK to ensure that the needs of the most vulnerable sections of the community are addressed in future. [ABSTRACT FROM AUTHOR]

Recent surveys from general dental practice have found increased placement of direct composite resin restorations in occlusal (Class I) and occlusoproximal (Class II) cavities in permanent teeth by general dental practitioners. This has been matched, and possibly driven, at least in part, by the development of new composite resin materials and bonding technologies. Recent studies by the authors have found an increase in the teaching of Class I and Class II composite resin restorations in the UK, Ireland, the US, and Canada. The increased teaching in the UK and Ireland, however, was not as great as in North America, and several worrying trends were observed. The aim of this paper is to discuss these trends and related factors considered important to the necessary further development of the teaching of Class I and Class II direct composite resin restorations, let alone modern operative dentistry in general, in the UK and Ireland. [ABSTRACT FROM AUTHOR]

Background: The 2003 Children's Dental Health Survey is the fourth in a series of decennial national children's dental health surveys in the United Kingdom. Aims: This paper reports on the orthodontic condition of children aged 12 and 15 years. Methodology: A representative sample of children across the UK were invited to participate in a clinical dental examination in school. Two thousand, five hundred and ninety-five 12-year-olds and 2,142 15-year-olds were examined. Current and past orthodontic treatment and type of appliance worn were recorded. Orthodontic treatment need was assessed by the Modified IOTN in those not undergoing treatment. A postal questionnaire sought parents' views on the orthodontic condition of their children and perceived need for treatment. Results: At age 12, 35% were judged to have an orthodontic treatment need, 57% had no need and 8% were wearing an appliance. The corresponding figures at age 15 were, 21% (need), 65% (no need) and 14% (wearing appliance). A higher proportion of girls (p < 0.05) were wearing an appliance than boys. A greater proportion of 15-year-olds were undergoing treatment than in the 1993 and 1983 surveys and the use of fixed appliances had increased. Conclusions: In this representative sample of UK children, one in five were still judged as having an orthodontic treatment need at age 15 years, as determined by the modified index of orthodontic treatment need. However, considerable variation was observed between professional and lay perceptions of need. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This paper assesses the current teaching of undergraduate orthodontics in UK dental schools and the changes these courses have undergone in the last three years. Method: Questionnaires were e-mailed to the undergraduate orthodontic course leaders in each of the UK dental schools. Twelve dental schools agreed to participate in the survey. Responses were checked for completeness, summarised and sent back to individual course leaders to verify. These verified responses were then analysed. Results: There was a wide variation in the orthodontic course form and content in the 12 UK dental schools. The greatest variation occurred in the clinical teaching hours (50 to 126), the types of patient treatment undertaken (removable only to full fixed), the laboratory teaching hours (0 to 60), the content of the laboratory course (removable appliances to fixed appliance typodonts), the in-course assessment (minimal to extensive, and 0% to 40% of BDS), and the format of the BDS examination. A number of dental schools reported reductions in their orthodontic courses in academic, clinical and laboratory hours and content, and in the number of undergraduate orthodontic teaching staff in the last three years. Conclusions: Comparison of undergraduate orthodontic courses revealed a wide variation in course hours and content, and in student assessment and examination. Considerable changes have occurred to the courses in the last three years. Half of the UK courses have been affected by The First Five Years General Dental Council document(1) and university pressures, with reductions in both course content and staffing in the last three years. For standards to be maintained, guidelines are needed to safeguard clinical content and student assessment in undergraduate orthodontic courses in UK dental schools. [ABSTRACT FROM AUTHOR]

When confronting a defiant or pre-co-operative young patient with extensive dental decay the dentist must decide between treatment under conscious sedation with passive restraint or general anaesthesia. Although some practitioners prefer to attempt and exhaust sedative techniques in most cases and use general anaesthesia as a last resort, many others do not mandate that alternate approaches first be attempted before treating under general anaesthesia and routinely recommend it as their first choice. What are the considerations involved in this decision-making process? Should the use of conscious sedation with restraint be revisited and perhaps even be considered the preferred method? What is the role of the dentist in the decision-making process? The purpose of this opinion-based paper is to present to the UK dentist a dilemma that paediatric dentists face in the US and in other countries as well and allow the reader to establish an opinion. [ABSTRACT FROM AUTHOR]

Personal dental services (PDS) are new forms of NHS dental care in England that employ a locally negotiated contract as opposed to one based on a nationally negotiated scale of fees. These schemes have been specifically designed to tackle local problems related to access and oral health needs. This practice paper examines the main findings of a Department of Health-funded evaluation from 20 first and second wave PDS pilots. The paper reveals that all PDS pilots changed treatment profiles in an attempt to meet local oral health needs and/or promote access to NHS dentistry. Moreover, PDS pilots appeared to encourage a new skill-mix, provide job satisfaction and improve working conditions. PDS pilots appear to have provided an opportunity to change the culture of primary dental care provision to one based on quality rather than on activity and cost. Their experiences should help inform the implementation of NHS Dentistry: Options for Change. [ABSTRACT FROM AUTHOR]

Bristol's much-publicised cardiac surgery problems and subsequent enquiry have drawn attention to the need for audit of treatment outcomes throughout all hospital specialties. Patient anxiety, government policy and the desire of the professions to re-establish public confidence, have further encouraged changes to the system. For medical and dental specialities, such challenges have already been taken up by the Royal Colleges with the establishment of clinical effectiveness committees. Hospitals have modified their procedures and, for consultants, yearly appraisal is already a reality. The Orthodontic Clinical Effectiveness Working Party of the Royal College of Surgeons of England (now the Clinical Effectiveness Committee of the British Orthodontic Society) set up this audit to measure the outcome of fixed appliance treatment and to establish a benchmark for the standard of treatment to be expected from a consultant orthodontist. This paper describes how the audit was carried out, presents the findings and goes on to discuss some of the wider issues involved in audit, clinical governance and appraisal. The Consultant Orthodontists Group of the British Orthodontic Society funded this audit and the results and data set of dental casts remain their property. [ABSTRACT FROM AUTHOR]

Part II. Continues a paper on how Great Britain's Apothecaries Act of 1815 shaped the dental profession. Reversal of fortune between chemists who practiced dentistry, and the pure dentists, following the Act; Influence of the Act on the social position, education and qualification of dentists.

This paper takes a look at the ancient institution of apprenticeship. In doing so it regards the conventions of the scheme as having had a positive influence on the morality, legal identity, and professional allegiance of dentists during the ethical development of their profession in the nineteenth century. Two important effects can be detected from the records available. One is general, since the moral ground of apprenticeship derived from, and spread throughout, society, and the other is particular to the development of dentistry as a profession, as those who were apprenticed to dentists acquired a natural loyalty to their dentist Masters in person, and to their craft. [ABSTRACT FROM AUTHOR]

This paper examines unusual eighteenth and nineteenth century dental treatment and its consequences, in a nobleman excavated from beneath St. Nicholas' Church, Sevenoaks, Kent, UK in the early 1990s. This rare archaeological case exhibits erosion of dental enamel on the labial surface of all the anterior dentition. A programme of historical research suggests that this might be attributed to the application of an acid-based dental tincture or the use of an abrasive substance to whiten the teeth. Palliative treatment for the consequence of this application was prescribed by Dr Robert Blake of Dublin. Further, it bears witness to three dental restorations, two of gold and one tin. The two gold (foil) fillings are an occlusal in the upper-right second molar and a cervical on the labial surface of the upper left canine. The tin filling is an occlusal in the upper left second molar. Excavation of the carious tissue appears to have been undertaken using a spoon shaped implement. [ABSTRACT FROM AUTHOR]

Background Interdisciplinary collaboration and communication during dental training has become an increasingly influential idea within dental schools, both in the United Kingdom and European contexts. Research into this curriculum innovation has provided evidence to argue that benefits accrue both in terms of professional understanding and the development of dental professional learning dispositions.Objective This study investigates the interactions within a trainee dental team. In particular, the paper reports the professional experiences and development of trainee dental technicians and undergraduate dental students during a prolonged shared learning exercise in a combined UK university dental school and hospital.Methods Using a qualitative approach with a phenomenological framework, data sources included reflective diaries, focus group interviews and participant feedback.Results Eleven major domains were identified that accurately characterised the participants' beliefs, thoughts and practices. The results indicate that both trainee dental technicians and undergraduate dental students were pragmatic but positive in terms of their expectations of shared learning. In particular, they regarded the exercise as useful in terms of communication and understanding each other's role. Evidence also indicated the presence of original elements such as crisis of confidence and feelings of awkwardness that do not arise in other studies.Conclusions The implications for dental education are that for effective professional collaboration during training to take place a merger of interests among educators and policy developers in dental education must occur, and the challenges encountered within practice cultures must somehow be overcome. Therefore, more investment in evaluating research into interprofessional learning in dentistry would contribute to our knowledge about the place and role of interprofessional education in the professional dental curriculum and beyond. [ABSTRACT FROM AUTHOR]

Objective To investigate the impact of General Dental Council (GDC) registration and mandatory CPD on dental technicians' views, job satisfaction and intention to leave the profession.Design Postal/online survey, conducted in parallel with a survey of dental nurses.Setting UK private and NHS practices, community services, dental hospitals.Subjects and methods Representative sample of GDC registrants. Main outcome measures: job satisfaction; intention to leave profession (dependent variable in regression analysis).Results 605 were sampled: 40 were ineligible (left the register in July 2011, re-qualified in another dental care profession, shared a practice address with another selected DT); 193 responded (response rate 34%). 22% were female (mean age 38.2 years) and 78% male (mean age 49.4 years). The general principle of registration was endorsed by 52%, and compulsory registration by 54%, but the fee level by only 13%. Most technicians felt that registration had had either no effect or a negative effect on their view of their career (80%), role (78%) or status within the dental team (85%), and 66% did not agree that training helped them to do their job better. Fifty-one percent were not satisfied with their job and 20% intended to leave the profession. Intention to leave was predicted by greater dissatisfaction with remuneration.Conclusions Criticisms regarding the cost and relevance of registration and the cost, relevance and accessibility of CPD, coupled with potentially high level of attrition from the profession, suggest a review of the fee and salary structure and greater support for CPD is warranted. [ABSTRACT FROM AUTHOR]

An understanding of a broader concept of health is increasingly important for all health professionals, including dentists, and has recently been incorporated as a key principle in the Government White Paper, The New NHS. This aims to deliver a dependable, high quality, egalitarian health service. In the past, performance measurements in the UK have often relied simply on those areas which are most easily quantified. For example, within the hospital service, performance was measured in terms of the cost and the number of finished consultant episodes, from which the 'purchaser efficiency index' was calculated. This tended to produce a driving force rewarding those doing more rather than those doing more better. It is analogous to the system which has been the backbone of NHS dental practice for many years, 'fee per item of service', where throughout is rewarded rather than outcome. However, the White Paper has signalled a move away from simply counting activity. From April 1999 within the hospital service the purchaser efficiency index has been replaced with more rounded measures, reflecting the changing concepts of health, in a new broader performance framework to determine what really counts for patients. It will focus on measuring health improvement, fairer access, better quality and outcome, including the views of patients. [ABSTRACT FROM AUTHOR]

As the Dental Auxiliaries Review Group report continues in the consultation stage, the dentist needs to keep up-to-date on all aspects of auxiliary career developments. Dental technician education and training has changed radically during the past 25 years as shown by three surveys--the latest carried out during 1998 and reported in this paper. As leader of the dental team, the dentist needs to be aware of these changes in order to make an informed contribution to the debate. [ABSTRACT FROM AUTHOR]

The soon to be published White Paper Our Healthier Nation will set out the Government's new public health agenda for the NHS. To improve oral health and reduce inequalities it is vitally important that the dental profession becomes an active player in the implementation of this policy. Each member of the dental team has an important role to play in oral health promotion. [ABSTRACT FROM AUTHOR]

Objectives To investigate autonomous working among singly and dually qualified dental hygienists and therapists in UK primary care. Earlier studies and policy papers suggest that greater autonomy for these groups may be a desirable workforce planning goal.Methods UK-wide postal surveys of hygienists, hygienist-therapists and therapists. Respondents were asked whether they undertook 15 clinical activities on their own initiative, how comfortable they would feel undertaking such clinical activities if referral from a dentist were not required, and how they perceived dentists' reactions.Results Overall response rate was 65% (n = 150 hygienists, 183 hygienist-therapists and 152 therapists). Over 80% of hygienists and hygienist-therapists reported undertaking BPEs, history-taking, pocket charting, mucosal examinations and recall interval planning autonomously. Similarly high proportions of hygienist-therapists and therapists reported giving local analgesia and choosing restorative materials autonomously. However, fewer than 50% of all three groups said they undertook dental charting, fissure sealing, resin restorations, taking radiographs, and tooth whitening autonomously. While confidence in undertaking such activities without a dentist's referral was generally high, it was lower in respect to mucosal examinations, identifying suspicious lesions, interpreting radiographs, tooth whitening, and (except for singly qualified dental therapists) diagnosing caries.Conclusions Results suggest high levels of experience and confidence in their ability to work autonomously across a wide range of investigative activities, treatment decision-making and treatment planning. The exceptions to this pattern are appropriate to the different clinical remit of these groups. [ABSTRACT FROM AUTHOR]