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

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

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

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

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

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

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

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

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

Objective To explore what motivates dentists to work in prisons using Vroom's theoretical model of motivation as an explanatory framework.Method In-depth interviews were conducted with ten of the 15 dentists working in Scottish prisons. The focus was to explore their motivations to work in Scottish prisons. The data were analysed using a thematic framework based on the three motivational dimensions of expectancy, instrumentality and valence.Results The dentists had the skills to help improve their prisoner-patients' oral health but their efforts were often hindered by institutional rationing and the requirement to fit in with prison routines and procedures (expectancy). Despite these institutional difficulties the dentists experienced work rewards associated with the improvement in the prisoners' oral health (instrumentality). Finally, the dentists experienced a feeling of personal worth and a sense of commitment to providing care to Scottish prisoners (valence).Conclusions The dentists' motivation to work in Scottish prisons may be explained by Vroom's Expectancy Theory. The dentists' motivation is characterised by their beliefs that their work will improve clinical outcomes which will be rewarded by the satisfaction experienced when they overcome environmental obstacles and provide oral health care for their prisoner-patients. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

Objective To assess inequalities in the availability of NHS dental services between Health Boards in Scotland.Study design Postal questionnaire survey of all dentists (n = 2,852) registered with the General Dental Council at an address in Scotland.Methods Data obtained on NHS working hours were used to model dentist to population (D/P) ratios and primary care D/P ratios corrected for part time working, variation in service productivity and the provision of private services.Results A total of 2,134 completed questionnaires (74.8%) were received. There was a wide variation in D/P ratios between Health Boards. Dumfries & Galloway and Grampian had the lowest, and Tayside and Greater Glasgow the highest D/P ratios, irrespective of method of calculation. The corrected D/P ratios for the other Health Boards were more similar than was suggested by the simple ratios of registered dentists to population size.Conclusions There was considerable variation in the availability of NHS dental practitioners between Health Boards. Simple ratios of registered dentists to population size can mask the true availability of specific dental services such as NHS dental care. [ABSTRACT FROM AUTHOR]

AimIn 2003, the West of Scotland Cancer Awareness Programme (WoSCAP) launched their oral cancer campaign to raise public awareness of the disease in five NHS boards across the West of Scotland. The aim of this study was to evaluate the campaign by reviewing patients attending rapid access clinics in the 11 secondary care units across the five boards.DesignData were collected in 2004 during the second phase of the campaign via a two part self-completing questionnaire; the first part collected information from the patients and the second part from the clinicians, in rapid access clinics in the secondary care units.ResultsIn total, 580 questionnaires were given out in the clinics with 538 completed patient sections (response rate 93%) and 500 completed clinician sections (response rate of 86%). More than two thirds of rapid access secondary care patients had seen a recent health campaign related to mouth cancer, and 46% responded that the campaign had encouraged them to seek advice more quickly. Of the patients examined in the clinics, 5% had a provisional diagnosis of a malignant lesion, 7% a potentially malignant lesion, and the majority of lesions were benign. The clinicians deemed 30% of the referrals to be inappropriate.ConclusionsThe results show a high percentage of patients attending rapid access clinics were aware of the campaign. However, there were a disproportionate number of inappropriate referrals to the rapid access clinics compared to genuinely urgent cases. [ABSTRACT FROM AUTHOR]

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

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

Objectives To identify the available workforce in general dental practice and to describe the job satisfaction, career and retirement plans of dentists in general and community practice. Design A postal cross-sectional survey. Setting Primary care dentists practising in Scotland in 2000. Materials and methods Semi-structured questionnaires were sent to all primary care dentists identified from the Scottish Dental Practice Division as being in practice in Scotland. Results The response rate was 70% (1,33S GDPs and 187 CDPs). Although most dentists in both the GDS and CDS stated that they enjoyed their work, 35% of GDPs would not now choose dentistry as a career. Eighty-three per cent of the GDPs' time was spent on clinical work, of which 5% was not NHS-funded. Daily demotivation was reported by 70%, most commonly citing the job itself and the NHS 'treadmill'. Two-thirds of CDPs were women, as were half of GDPs aged less than 30. Only 35% of CDPs planned early retirement but 80% of them felt underused. Two-thirds of GDPs planned to retire in their mid-SOs, and a further quarter planned to work part-time. Of the former, only a quarter agreed that nothing would induce them to work beyond this time. Conclusion Conditions of work within primary care dentistry require modification to retain the current workforce and accommodate the increasing proportion of women. Part-time employment packages may encourage older practitioners to work for longer, and allow younger practitioners to fulfil family or personal commitments. [ABSTRACT FROM AUTHOR]

Aims and objectives To review a long-standing mercury monitoring service offered to staff in dental practices in Scotland.Methods During the first 20 years of the service, dentists and their staff were contacted by letter and invited to participate. Respondents were asked to collect samples of head hair, pubic hair, fingernail and toenail for analysis of mercury. After 1995, head hair samples were collected initially and further samples were only measured if head hair mercury was elevated.Results At the start of this scheme many staff, including administrative staff, had systemic exposure to mercury (defined as increased mercury in all four samples). Incidents of exposure have decreased over the 35 years and are now very rare. Male staff were found to have higher mercury concentrations than female staff and dentists tended to have higher concentrations than other staff. Staff working in dental practices more than five years old had small but discernible increases in head hair mercury concentration. In recent years the use of reusable capsules such as Dentomats has been associated with a slight but statistically significant increase in head hair mercury concentrations when compared to the use of encapsulated amalgam systems. Staff wearing open-toed footwear had significantly higher toenail mercury concentrations compared to those who wore shoes.Conclusions Exposure of staff to mercury in Scottish dental practices is currently now very low. This is probably as a result of increased awareness to the toxicity of mercury and improved methods of preparing amalgam. It may be possible to reduce exposure further, although probably only slightly, by upgrading practices and using encapsulated mercury amalgam. [ABSTRACT FROM AUTHOR]

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

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

ObjectivesTo investigate the prevalence of dental sepsis in 5-year-old children in Scotland and the relationship between sepsis, treated and untreated decayed teeth, oral cleanliness (visible plaque on anterior teeth) and socio-economic deprivation.Subjects and methodsSix thousand, nine hundred and ninety-four children of mean age 5.3 yearswere examined as part of a survey conducted under the Scottish Health Board's Dental Epidemiological Programme. The presence of dental sepsis was recorded, in addition to caries status and presence of plaque. Postal code information was used to obtain a measure of material deprivation. Relationships between sepsis and its possible contributory factors were explored using stepwise logistic regression.Main resultsIn the whole sample, 4.8% of children examined had dental sepsis, ranging from 2% in the most affluent areas to 11% in the most deprived. Children with sepsis had much higher caries experience (mean dmft 6.30) than those without sepsis (mean dmft 2.36). However, when these factors and the presence of plaque were entered into a logistic regression model to predict presence or absence of dental sepsis, the most important factor was not deprivation, but untreated decay.ConclusionsThe proportion of children with sepsis increases markedly with caries experience. This disadvantage can be mitigated if more of the caries experience is treated. These findings would not support a policy of non-intervention for deciduous caries if oral sepsis is to be minimised. [ABSTRACT FROM AUTHOR]

Part II. Assesses the effectiveness of personal learning program in providing continuing professional development among dentists in Scotland. Factors preventing dentists from attending postgraduate courses; Role of the program in improving the dentists' self esteem; Benefits to patient treatment and quality of dental care.

Part I. Focuses on two pilot projects undertaken in Scotland, to provide personal learning plans to general dental practitioners. Discussion on a method of designing personal learning plans for two groups of dentists in different locations; Reasons behind practitioners' involvement in continuing professional development; Merits of personal learning plans to dental practitioners.

Objectives: To compare the reported level of use of secondary care services for restorative dental care in rural and urban areas of Scotland.Design: Postal questionnaire surveySubjects and Methods: Postal questionnaire sent to all dentists in the Highland region, the island regions in Scotland and Dumfries Et Galloway (n = 150) and an equal number were sampled from the remainder of Scotland stratified by health board area. Non-respondents were sent 2 reminders after which 62% of the sample had responded.Results: Most dentists (85%) who practised in what they considered were urban areas of Scotland said they felt that they had good access to a secondary referral service. Whereas most of those who practised in what they considered were rural areas either said they had no access to such a service (26%) or that access was difficult (53%), only 3% of those in urban areas said they had no access to a secondary restorative consultative service compared with 14% of dentists practising in rural areas of mainland Scotland and 54% of those practising on Scottish islands.Conclusions: The survey suggests the people of the Scottish islands and some of the remoter parts of the Scottish mainland would be among those who might benefit from improvement in access to a restorative dentistry consultant service. [ABSTRACT FROM AUTHOR]

Objectives To evaluate experience, practice and beliefs regarding occupational exposures to blood and oral fluids among a random sample of 300 dentists working in Scotland's NHS primary dental services.Method A cross-sectional postal survey assessed occupational exposure policies and procedures, recent occupational exposure incidence and current management. Beliefs were measured using constructs from the theory of planned behaviour, shown to influence behaviour in this population.Results Forty-two percent of dentists responded. Fourteen percent had sustained an occupational exposure in the previous 12 months; of those, 35% did not report their exposure. All respondents' practices had protocols in place for managing and reporting dental team member sharps injuries. Most (82%) had protocols for mucocutaneous exposures. Less than half (48%) had a protocol for managing and reporting patient exposures to blood or saliva. Dentists placed significantly more importance (z-score −4.44, p value <0.001) and necessity (z-score −4.17, p value <0.001) on reporting patient exposure than dentist occupational exposure.Conclusion This study suggests that while dentists generally have positive beliefs about reporting occupational exposures, there are gaps in practice. [ABSTRACT FROM AUTHOR]

Objectives To test the validity of the Kushida Index for screening for sleep apnoea in a West of Scotland adult population.Methods Specific intra-oral measurements and respiratory polysomnography were carried out on 71 patients in this prospective study. The intra-oral measurements were applied to the Kushida formula to obtain a value for the Kushida Index. This value was compared to the diagnosis obtained using polysomnography in the conventional manner.Results The sensitivity of the Kushida Index in this present study was 68% (95% CI 50-81) and the specificity was 71% (95% CI 52-84). The positive predictive value was 71% and the negative predictive value was 67%. The Mallampati score, Epworth sleepiness score and enlargement of the tongue, soft palate or tonsils were not statistically significantly related to a diagnosis of sleep apnoea (p >0.05).Conclusion With the limited sensitivity and specificity of the Kushida Index demonstrated in this study, this test cannot be recommended as a screening tool for sleep apnoea in a West of Scotland population. [ABSTRACT FROM AUTHOR]

Objectives To determine whether general dental practitioners (GDPs) currently provide alcohol-related advice (ARA) and to inform the development of an intervention, should one be required.Method Cross-sectional postal survey of a random sample of 300 GDPs in Scotland. The questionnaire assessed beliefs derived from psychological models that explain behaviour in terms of beliefs that are amenable to change, and so may inform development of an intervention to encourage the provision of ARA.Results Sixty percent of GDPs responded. Eighty-three percent of participating GDPs (145/175) had not provided ARA to patients in the previous ten working days. Attitude (perceived consequences), control beliefs (perceived difficulty), subjective norm (perceived social pressure), and self-efficacy (confidence) significantly predicted intention to provide ARA. Alcohol-related knowledge or personal alcohol behaviour did not predict intention to provide ARA.Conclusions There is scope to increase the provision of ARA in primary care dentistry and this study identified predictive beliefs, which could be targeted to encourage this behaviour. The next phase is to develop and test an intervention to encourage GDPs to provide ARA. [ABSTRACT FROM AUTHOR]

Aim To evaluate care home (N) staff knowledge of oral care provision for dependent older people in comparison to guidelines from NHS Quality Improvement Scotland (NHSQIS). This pilot study also aimed to identify barriers to delivering oral care and determine if oral health educator (OHE) training had an effect upon staff knowledge of oral care delivery.Setting This cross-sectional analytic investigation was undertaken within the Greater Glasgow & Clyde area between 2005 and 2007.Methods From 33 care homes (N), 28 participated in data gathering through an interview schedule involving 109 staff. A 'knowledge check-list' founded upon daily oral care guidelines from the NHSQIS best practice statement (BPS) served as a template for knowledge assessment. An OHE undertook small group discussions related to the BPS in a sub-group of original participants and a second round of data was collected.Results The majority of surveyed staff (n = 86, 79%) agreed that residents required assistance with oral care and placed oral care (n = 85, 78%) in a moderate to high priority. However, only 57% of managers and 49% of nurses had received training in oral care provision. Most staff (79% of managers, 85% of nurses) were unaware of the NHSQIS BPS. Deficiencies in knowledge were identified in several areas of the BPS. In particular, knowledge in the care of the natural dentition was inadequate. Between pre- and post-OHE training, the research suggests the following areas are liable to change: prioritisation given to oral care (p = 0.01), perceived competence (p <0.0001) and confidence in providing oral care advice (p <0.0001). Following OHE intervention, staff knowledge in oral care procedures compliant with best practice guidelines increased by 45%.Conclusions Knowledge of oral health provision by those responsible for the care of home residents was deficient. An OHE training programme structured around the NHSQIS BPS demonstrated a measurable increase in levels of staff knowledge of oral care procedures. [ABSTRACT FROM AUTHOR]

Unlabelled: AIMS To use a sensitive forensic test to measure blood contamination of used Siqveland matrix bands following routine cleaning and sterilisation procedures in general dental practice.Materials and Methods: Sixteen general dental practices in the West of Scotland participated. Details of instrument cleaning procedures were recorded for each practice. A total of 133 Siqveland matrix bands were recovered following cleaning and sterilisation and were examined for residual blood contamination by the Kastle-Meyer test, a well-recognised forensic technique.Results: Ultrasonic baths were used for the cleaning of 62 (47%) bands and retainers and the remainder (53%) were hand scrubbed prior to autoclaving. Overall, 21% of the matrix bands and 19% of the retainers gave a positive Kastle-Meyer test, indicative of residual blood contamination, following cleaning and sterilisation. In relation to cleaning method, 34% of hand-scrubbed bands and 32% of hand-scrubbed retainers were positive for residual blood by the Kastle-Meyer test compared with 6% and 3% respectively of ultrasonically cleaned bands and retainers (P < 0.001).Conclusions: If Siqveland matrix bands are re-processed in the assembled state, then adequate pre-sterilisation cleaning cannot be achieved reliably. Ultrasonic baths are significantly more effective than hand cleaning for these items of equipment. [ABSTRACT FROM AUTHOR]

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

The article focuses on the Nintendo Wii technology, developed by Pearse Hannigan, David Lagan, and Adam Gray, final year dental students at the University of Glasgow Dental School. The concept, which intends to aid dental students practice their operative skills, won the Dental Innovation Technology Ideas Award. The Nintendo Wii console will be used via a software to simulate operative techniques. Dr. David Watson of the University of Glasgow Dental School cites the advantages of the idea.

AimTo investigate current knowledge, examination habits and preventive practices of primary healthcare professionals in Scotland, with respect to oral cancer, and to determine any relevant training needs.SettingPrimary care.MethodQuestionnaires were sent to a random sample of 357 general medical practitioners (GMPs) and 331 dental practitioners throughout Scotland. Additionally, focus group research and interviews were conducted amongst primary healthcare team members.ResultsWhilst 58% of dental respondents reported examining regularly for signs of oral cancer, GMPs examined patients' mouths usually in response to a complaint of soreness. The majority of GMPs (85%) and dentists (63%) indicated that they felt less than confident in detecting oral cancer, with over 70% of GMPs identifying lack of training as an important barrier. Many practitioners were unclear concerning the relative importance of the presence of potentially malignant lesions in the oral cavity. A high proportion of the GMPs indicated that they should have a major role to play in oral cancer detection (66%) but many felt strongly that this should be primarily the remit of the dental team.ConclusionThe study revealed a need for continuing education programmes for primary care practitioners in oral cancer-related activities. This should aim to improve diagnostic skills and seek to increase practitioners' participation in preventive activities. [ABSTRACT FROM AUTHOR]

Aims To use a sensitive forensic test to measure blood contamination of used Siqveland matrix bands following routine cleaning and sterilisation procedures in general dental practice. Materials and methods Sixteen general dental practices in the West of Scotland participated. Details of instrument cleaning procedures were recorded for each practice. A total of 133 Siqveland matrix bands were recovered following cleaning and sterilisation and were examined for residual blood contamination by the Kastle-Meyer test, a well-recognised forensic technique. Results Ultrasonic baths were used for the cleaning of 62 (47%) bands and retainers and the remainder (53%) were hand scrubbed prior to autoclaving. Overall, 21% of the matrix bands and 19% of the retainers gave a positive Kastle-Meyer test, indicative of residual blood contamination, following cleaning and sterilisation. In relation to cleaning method, 34% of handscrubbed bands and 32% of hand-scrubbed retainers were positive for residual blood by the Kastle-Meyer test compared with 6% and 3% respectively of ultrasonically cleaned bands and retainers (P < 0.001). Conclusions If Siqveland matrix bands are re-processed in the assembled state, then adequate pre-sterilisation cleaning cannot be achieved reliably. Ultrasonic baths are significantly more effective than hand cleaning for these items of equipment. [ABSTRACT FROM AUTHOR]

On 18 September 2014, a referendum will be held on Scotland becoming a nation independent from the rest of the United Kingdom. Since devolution in 1999 child dental health in Scotland has improved significantly, although the National Health Service in Scotland has always been governed through a separate legislative framework from that in England and Wales. Scotland was also first to introduce a ban on smoking in public places and is pursuing minimum alcohol pricing to directly improve public health. This article explores if a vote for an independent Scotland would influence either dental and/or general health. [ABSTRACT FROM AUTHOR]

Objective To report on the dental health of three-year-old children in Greater Glasgow, and to examine the amount of dental caries associated with deprivation in this young age group.Design Dental inspections in nursery schools.Subjects and methods The national inspection programme using BASCD criteria was extended to include an additional group of nursery attending three-year-olds in Greater Glasgow in 2006/7 and 2007/8. Caries experience was analysed by logistic regression models and ROC plots.Results Fourteen percent of this population was sampled in 2006/7 and 19% in 2007/8 (usable data n = 1,711 in 2006/7, 2,428 in 2007/8). Mean d3mft was 1.1 in 2006/7 and 1.0 in 2007/8. The prevalence of caries experience was 26% in 2006/7 and 25% in 2008/9 (33% and 32%, respectively, for children in deprived areas). The adjusted odds-ratio for caries experience for children living in the most deprived areas was 2.90 (2.31, 3.64), p <0.001. There was a high rate of caries in the upper anterior teeth.Conclusion It was feasible to conduct large scale caries surveys of three-year-olds in a nursery setting. Poor dental health and inequality commence early in life. Caries prevention should be targeted toward deprived families from birth. [ABSTRACT FROM AUTHOR]

Objective To assess the treatment needs of patients undergoing pre-haematopoietic stem cell transplant (HSCT) dental assessment, to collate the examination findings and treatment provided and to define the management issues impacting on care.Design Single centre retrospective analysis.Setting Salaried Primary Care Dental Service, Western General Hospital, Edinburgh, UK.Subjects and methods One hundred and sixteen available charts of patients who attended for pre-transplant dental assessment during April 2004-June 2007 were examined.Results Ninety-four patients, 52 men (55.3%) and 42 women (43.6%), were included. Patients were referred a mean of 31.5 (SD 18.82) days before admission for transplant. Dental assessment occurred, on average, 7.88 days (SD 6.78) following referral. Eighty-eight (93.6%) patients were dentate, while six (6.3%) were edentulous. Eighty-eight (93.6%) patients presented with oral disease; 89 (94.7%) patients received dental care. Issues impacting on care were medical (n = 88, 93.6%), time constraints (n = 73, 77.7%), no GDP (n = 25, 26.7%), dental complexity (n = 5, 5.3%) and anxiety management (n = 1, 1.1%).Conclusion The majority of patients required dental care, most of which, for healthy adults, would normally be completed within a primary care setting. However, the issues surrounding the care of patients destined for HSCT indicate that there is a place for a dedicated dental service as part of the multidisciplinary team. [ABSTRACT FROM AUTHOR]

Objectives The primary objective of this survey was to assess the use of the Index of Orthodontic Treatment Need (IOTN) in dental primary care (Scottish general dental services – SGDS), and to compare orthodontic specialists (OS) and general dental practitioners (GDPs). The secondary objective was to explore the attitudes to mandatory introduction of the IOTN into the SGDS.Design Postal, self completed questionnaire.Setting Dental primary care, Scotland.Subjects Randomly selected sample of general dental practitioners (GDPs), n = 315, and all orthodontic specialist practitioners (OS), n = 49, identified as working in the SGDS.Main outcome measures Prevalence and experience of using the IOTN in the SGDS.Results Response rate was 46% (n = 169). Eighty-four percent of respondents did not use the IOTN. Thirty-five percent of respondent GDPs had never heard of the IOTN. Respondents reported using the IOTN as an inter-colleague communication tool and to grade case complexity. GDPs perceived the IOTN as beneficial in setting national standards of practice; OS saw it as a tool to justify the allocation of NHS resources to patients. Responses indicate concerns that IOTN introduction will restrict access to orthodontic care.Conclusions The IOTN is not widely used in the SGDS but is perceived as standardising treatment need assessment by GDPs and justifying the allocation of NHS orthodontic resources to patients amongst OS. Introduction of mandatory IOTN grading is likely to be contentious – the following needs to be considered: the index profile should be raised; its advantages highlighted; concerns about restricted access to orthodontic care addressed; and perceived need for locally accessed training met. [ABSTRACT FROM AUTHOR]

The advent of the Inter-Collegiate Membership in Orthodontics in the year 2000 will mark the end of an orthodontic diploma specific to the Royal College of Physicians and Surgeons of Glasgow. The Diploma in Dental Orthopaedics (RCPS) was the first orthodontic diploma in the United Kingdom. The fact that such a diploma has existed first as a DDO and latterly as the MDO (Membership) for some 50 years is remarkable in view of the relative infancy of most dental specialties and the fact that the General Dental Council has instigated a specialist register in orthodontics as recently as 1998. It was 1965, before other specialty diplomas became available in the British Isles, with the introduction of the FFD by the Royal College of Surgeons in Ireland. [ABSTRACT FROM AUTHOR]

Aims To understand current practice and the beliefs of dentists and hygienists towards factors which may influence the management of patients with periodontal diseases in primary dental care in Scotland. To inform the scope of a guidance publication and the future development of diagnostic analyses tools.Methods A qualitative approach of semi-structured telephone interviews with a randomly selected sample of dentists and hygienists was used. Interviews continued until saturation was reached and were audio-recorded and transcribed verbatim. The data were analysed using the method of framework analysis. To increase the participation of hygienists the topic guide was adapted into a self-reporting questionnaire and posted to all hygienists in Scotland.Results Eighteen dentists and three hygienists were interviewed. Key themes identified were extent of control over working environment, capabilities to treat appropriately and changing patients' oral hygiene behaviour. Factors which facilitated the management of patients with periodontal diseases were 'access to a hygienist' and 'beliefs about capabilities', while 'routine and habit', 'motivation of patients' and 'time and money' were perceived as barriers. Some evidence of variation in treatment provision and of varying levels of confidence among practitioners about treating more advanced periodontal conditions was identified. Two hundred and thirty-seven hygienists returned the postal questionnaire. Agreement was found with the views of the interviewed hygienists on beliefs about capabilities and routine record-keeping.Conclusion To improve the periodontal health of patients requires consideration of both extrinsic and intrinsic factors present in primary dental care. Practitioners would find having guidance on managing patients with basic periodontal examinations of three and four, referral criteria to secondary care, record-keeping and techniques to change patients' oral hygiene behaviour particularly useful. Applying the evaluative framework pre-publication indicated where knowledge translation interventions may be required in the future. [ABSTRACT FROM AUTHOR]

Objective To understand what influences the implementation of mixed dentition interceptive orthodontic treatment in primary care.Methods Postal survey of a random sample of 400 general dental practitioners in Scotland. The questionnaire assessed knowledge, beliefs and attitudes towards providing interceptive treatment in seven different clinical scenarios in order to identify variables that may explain the decision to undertake this treatment.Results One hundred and one (25%) completed questionnaires were received. Confidence to carry out the treatment plan (16%), knowledge (11%), and age (7%) all significantly predicted intention to provide interceptive treatment.Conclusions The greatest barrier to providing interceptive orthodontic care in general dental practice is practitioners' lack of self-confidence relating to the effectiveness of their chosen treatment plan. [ABSTRACT FROM AUTHOR]

Aim To determine the attitudes and awareness of dental and medical practitioners in Scotland to the provision of oral appliances for the management of snoring and sleep apnoea.Setting The questionnaire was completed by general dental practitioners randomly selected from across Scotland and by doctors specialising in sleep medicine within Scotland.Method A questionnaire was devised and sent to 17 specialists in sleep medicine and 210 general dental practitioners, community dental service practitioners and hospital-based dental practitioners. A reply-paid envelope was included with each questionnaire.Results There were 14 replies (82%) from specialists and 105 (50%) from dentists. All the specialists felt that dentists had a role in the management of these patients. Of the replies from dentists, 60 (57%) stated that they provided appliances but their screening for sleep apnoea and discussion of the side-effects of appliances varied widely. Seventy-eight dentists (74%) expressed an interest in attending a course on the management of sleep apnoea and snoring.Conclusions The current practice of specialists and dentists in the management of obstructive sleep apnoea and socially disruptive snoring with oral appliances in Scotland is varied. Many dentists expressed a wish for further training in this area. [ABSTRACT FROM AUTHOR]

ObjectiveTo report on the prevalence of postoperative morbidity in children undergoing tooth extraction under chair dental general anaesthetic (CDGA) in relation to pre-operative dental anxiety and anaesthetic induction distress.DesignA prospective national study.SettingTwenty-five Scottish DGA centres in 2001.Subjects and method407 children (mean age 6.6 years; range: 2.3 to 14.8 years; 52% male). Before CDGA, Tthe Modified Child Dental Anxiety (MCDAS) and Modified Dental Anxiety (MDAS) Scales were completed for children and accompanying adult respectively; the latter also returned a morbidity questionnaire 24hrs and one week post-operatively. Parents/guardians completed a questionnaire regarding their own dental anxiety (the Modified Dental Anxiety Scale). Anaesthetic induction distress was scored immediately before CDGA induction using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS).ResultsThe mean MCDAS score was 24.2 (population norm 18.2); 21% of adults were anxious. Forty-two per cent of children had induction distress; this related to their MCDAS scores (r = 0.43, p<0.001, Pearson Product Moment Correlation Coefficient). Morbidity at 24 hours and seven days was 63% and 24% respectively; this related to MCDAS scores (r = 0.15, p =0.029 and r = 0.17, p = 0.009, Pearson Product Moment Correlation Coefficient) and to induction distress (x2 = 7.14, p = 0.007 and x2 = 11.70, p = 0.001).ConclusionThe majority of children suffered next day morbidity and many still had symptoms a week later. Most children were dentally anxious; this related to induction distress and postoperative morbidity. [ABSTRACT FROM AUTHOR]

Objectives To explore the early responses of young oral cancer patients in Scotland to the symptoms of their emerging condition, to understand the ways they seek help and to inquire into delay caused by not recognising symptoms associated with cancer.Setting The survey was carried out in Maggie's Centres or in patients' own homes in Glasgow and Edinburgh among young patients diagnosed with oral cancer in the three years (2004-7) before the study.Methods This study employed qualitative methods. Data were collected by interview using a semi-structured interview schedule. The interview transcripts were analysed using a thematic framework and with the aid of NVivo qualitative analysis software (Version 8).Results Most of the cohort knew that smoking and alcohol could cause oral cancer. None thought it would happen to them. Descriptions of symptoms varied widely and several had used self-treatment provided from a pharmacy. There were various causes of 'patient delay' and self-treatment was not the only cause. Reinterpretation of symptoms without seeking professional help was not uncommon. Nobody suspected they had oral cancer until it was confirmed by their GP or GDP. All thought that something so small and painless couldn't be a serious problem.Conclusions The study further confirms gaps in understanding and awareness of oral cancer. Most had heard of oral cancer but they didn't think their symptoms were indicative of cancer and they self managed the problem. The culture of not bothering the GP/GDP unless it was perceived as serious is a barrier to earlier access. Findings support that further public awareness of oral cancer and its symptoms is required to alert the public that if their symptoms persist beyond three weeks they need a professional opinion. [ABSTRACT FROM AUTHOR]

ObjectivesTo investigate, by questionnaire, various aspects of primary dental care provision in the North West of England and Scotland.MethodA questionnaire containing 79 questions was sent to 1,000 practitioners, selected at random, in the North West of England and Scotland. Non-responders were sent another questionnaire after a period of 4 weeks had elapsed.ResultsOverall a response rate of 70% was achieved. The majority of practitioners were practice principals (65%), working in a group NHS practice (80%) located in a city or town centre (49%). On average 10-20 patients were treated each session with fewer patients treated per session under private arrangements. Many practitioners were found to lack hygienist support (44%) and to employ unqualified dental nurses (82%). Younger practitioners were more likely than senior colleagues to have access to up-to-date computers whilst 37% and 74% of respondents never used CAL programmes or magnification respectively. Contemporary cross-infection control standards were used by the majority of practitioners, although 3% of practitioners reported only autoclaving their handpiece once a day.ConclusionsThe majority of practitioners, involved in this study, worked under National Health Service (NHS) regulations as principals in a group practice where the workload was greater than the private/independent sector. Contemporary cross-infection procedures were used routinely. In contrast, computer-aided learning programmes and magnification were not used routinely. The practitioners in this study employed significant numbers of unqualified dental nurses. [ABSTRACT FROM AUTHOR]

ObjectivesTo investigate by questionnaire, the use and selection of materials and techniques for the placement of direct restorations and the provision of endodontics and bleaching by dental practitioners in the North West of England and Scotland.MethodsA questionnaire was sent to 1,000 general dental practitioners selected at random from dentists in Scotland and the North West of England. Non-responders were sent another questionnaire after a period of 4 weeks had elapsed.ResultsA total of 701 usable questionnaires were returned, giving a response rate of 70%. The most commonly used material for the restoration of Class II cavities in premolar and permanent molar teeth was amalgam (n = 605, 86%) and (n = 634, 90%) respectively. Many practitioners (n = 419, 60%) felt amalgam should continue to be used; but a majority (n = 374, 66%) remained unconvinced about the merits of amalgam bonding. A minority (n = 63, 9%) of practitioners used predominantly directly placed resin composite rather than amalgam to restore Class II cavities in premolar and permanent molar teeth. Home-based vital bleaching was provided by a significant number (n = 245, 35%) of practitioners with only 18% (n = 123) providing practice-based bleaching. The most commonly used endodontic obturation technique was cold lateral condensation (n = 527, 75%) with 61% (n = 425) of respondents not using rubber dam routinely for endodontics.ConclusionsFor the practitioners in this survey; amalgam was the most frequently selected direct restorative material. Few practitioners used amalgam bonding let alone direct resin composite for posterior restorations. Home-based rather than practice-based bleaching procedures were preferred; as were more traditional endodontic obturation techniques. [ABSTRACT FROM AUTHOR]