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Background and Aims: The stressful nature of dental practice is well established. Much less information is available on the coping strategies used by dentists and the emotions which underlie the stressful experience. Previous research has been almost exclusively questionnaire-based, limiting the range of emotions explored. This study used qualitative methods to explore the full extent of emotions and coping strategies associated with stressful events in primary dental practice.Method: Semi-structured interviews were conducted with 20 dentists in Lincoln and the surrounding area. Verbatim transcriptions were analysed using thematic analysis.Results: Participants reported a wide variety of stressful situations, consistent with the existing literature, which were associated with a diverse range of negative emotional responses including anxiety, anger and sadness. Dentists tended to have more difficulty identifying positive events and emotions. The designation of a situation as stressful or otherwise was dependent on the dentist's personal interpretation of the event. Data relating to the effects of stressors and the coping strategies used by dentists will be presented in subsequent papers.Conclusion: The situations which dentists find difficult are accompanied by a diverse set of emotions, rather than omnipresent 'stress.' This has implications for stress management programmes for those in dental practice. [ABSTRACT FROM AUTHOR]

The aim of this paper is to give readers an overview of contemporary standard setting methods used within dental education, and to provide a better understanding of the subject. We hope that it will be of benefit not just to those in academic dentistry, but all practitioners involved with both undergraduate and postgraduate assessment. [ABSTRACT FROM AUTHOR]

Part-time general dental practitioners (GDPs) and dental care professionals (DCPs) working in practice are being increasingly utilised to deliver undergraduate clinical dental education to both dental and hygiene/therapy students. As such, there is a need for appropriate recruitment processes and ongoing staff development in the different and complex role of the clinical teacher. Recently a group of experienced dental practitioners, making a journey from GDP to part-time clinical teacher, identified common themes, experiences, challenges and realisations. These were: 'what is clinical dental education?'; 'me as a clinical teacher'; and 'specific teaching issues'. The themes highlighted the complexity of dental education and the different environment of the teaching clinic from general practice. Some of the themes identified could be a starting point for the induction process to facilitate an easier transition from experienced GDP to clinical teacher. With the current demands from both students and patients alike, the 'three way dynamic of patient, student and teacher' needs to be supported if dental schools are to attract and develop the highest quality clinical teachers. It is of critical importance to give an exceptional experience to students in their clinical education as well as to patients in terms of excellent and appropriate treatment. The challenge for deans and directors of education is to find the resources to properly fund teacher recruitment, induction and the development of part-time GDPs in order to produce the expert teachers of tomorrow. [ABSTRACT FROM AUTHOR]

The dental profession is well placed to contribute important information in child protection cases but no previous research has been reported that assesses the volume or impact of this information. Comprehensive oral assessment clinics were introduced and established as an integral part of comprehensive medical assessments for children with welfare concerns in Greater Glasgow and Clyde. An assessment protocol and standardised paperwork for comprehensive oral assessments were developed to enhance information sharing and patient access to appropriate care. Two cases are presented and discussed to demonstrate the value of dental input. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to understand the opinion of general dental practitioners about the current level of implant education at both undergraduate and postgraduate levels.Materials and methods A questionnaire was sent to the general dental practitioners working in a group of practices in the West Midlands, UK. The completed responses were analysed.Results Ninety-one out of 101 dentists responded to the questionnaires (95.6%). Sixty-seven (77%) dentists stated that they learnt only theoretical aspects of dental implants during their undergraduate training. The majority of them stated that the training they received was not adequate. In addition, few barriers in dental implant provision by general dentists were also identified in the survey. The main barriers were risk of failures (56.3%), to avoid complications (65.5%) and the cost of learning (51.7%). The results were correlated to the implant competences set by the regulatory organisations such as General Dental Council and Association of Dental Education Europe.Conclusion The present study confirmed that the current implant education at both undergraduate and postgraduate levels in the UK does not instil confidence to the GDPs to provide and maintain dental implants. [ABSTRACT FROM AUTHOR]

This series of papers will examine how the Anglo-American dental profession was established in the eighteenth century, examining its need for a name and identity, public recognition and official status. This paper outlines the evolution of the names of the profession, from tooth-drawer to dentist, and notes the importance of the name to the profession. [ABSTRACT FROM AUTHOR]

Infection control and knowledge of common infectious agents is a cornerstone of safe dental practice. This paper summarises the measures that need to be taken to control cross infection and discusses some of the infectious agents of concern to dental practitioners. [ABSTRACT FROM AUTHOR]

Background Hungary has become a popular destination for foreign patients in the last two decades, particularly in dental care. Since 2008, increasing prices in Western Europe coupled with Hungary's accessibility and availability of dental treatment, has meant the country has become a leader in 'dental tourism'. As the quality of care in Hungary is high and prices are more affordable than in Western Europe, and due to the freedom of movement of people, services and goods within the EU, patient flow into Hungary has increased progressively.Objectives The aim of this article is to provide comprehensive empirical evidence from the perspective of a recipient country in dental tourism.Methods A questionnaire survey was conducted among Hungarian dentists (n = 273). Qualitative in-depth interviews were conducted with representatives of dental professional bodies (n = 10). Both research methods aimed to elicit dentists' views on the presence of dental tourism - particularly the push and pull factors (for example, source countries, competitors, information sources, patient motivation).Results The findings show that there are several reasons why Hungary could maintain a leading position in dental tourism. First, the cost/benefit ratio is outstanding. The affordable price and value for money were already recognised in the early 1990s and were appreciated even before Hungary joined the EU. Secondly, the high quality of Hungary's dental profession: a) dental professionals in Hungary are well-qualified dental practitioners who have received high level dental training; b) dental professional standards are up-to-date and often supervised; c) in Hungary dental technology, the quality of materials and equipment used in dental practices is of European level quality. The rate of complications in dental care is around 5%, similar to other European countries. Finally, previous treatment experiences are positive and patient satisfaction levels are high. More and more patients seek care in Hungary, and more and more patients state that they would be willing to return for further treatment in the future. [ABSTRACT FROM AUTHOR]

A good manageable treatment plan does not just happen, but comes about as the natural consequence of taking carefully considered steps. History taking and clinical examination are two of the most important aspects of the patient assessment process, and complement each other to such an extent that it is impossible to build a satisfactory treatment plan without combining and collating information from the two procedures. [ABSTRACT FROM AUTHOR]

This paper explores the entrepreneurial role of dentists in primary care dentistry. It reviews the changing context of dentistry, not least the reforms being introduced by the health and social care bill. It suggests that this new context will reinforce the need to consider the business side of dental practice, in particular, the importance of quality, creativity and innovation, alongside the importance of meeting the needs of patients. An entrepreneurial approach will be required in order to sustain dental practice in an increasingly competitive environment. [ABSTRACT FROM AUTHOR]

The aim of this short communication is to highlight the numbers of non-UK EEA qualified dentists currently registered with the General Dental Council (GDC) and to present a brief overview of the systems for the provision of oral healthcare in the non-UK EEA member states identifying differences in practise. The relevant data were gathered for the National Clinical Assessment Service (NCAS) as part of a wider project. It was found that at 31 December 2010, 28% of dentists registered with the GDC had not qualified in the UK. Of these more than 6,300 were European Economic Area (EEA) dentists with non-UK qualifications. The nature of their practise varied widely from member state to member state. The implications of these findings are discussed briefly. [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]

Routine dental care provided in special care dentistry is complicated by patient specific factors which increase the time taken and costs of treatment. The BDA have developed and conducted a field trial of a case mix tool to measure this complexity. For each episode of care the case mix tool assesses the following on a four point scale: 'ability to communicate', 'ability to cooperate', 'medical status', 'oral risk factors', 'access to oral care' and 'legal and ethical barriers to care'. The tool is reported to be easy to use and captures sufficient detail to discriminate between types of service and special care dentistry provided. It offers potential as a simple to use and clinically relevant source of performance management and commissioning data. This paper describes the model, demonstrates how it is currently being used, and considers future developments in its use. [ABSTRACT FROM AUTHOR]

The GDC's recent third interim edition of The first five years places renewed emphasis on the place of professionalism in the undergraduate dental curriculum. This paper provides a brief analysis of the concepts of ethics, professionalism and fitness to practise, and an examination of the GDC's First five years and Standards for dental professionals guidance, as well as providing an insight into the innovative ethics strand of the BDS course at the University of Glasgow. It emerges that GDC guidance is flawed inasmuch as it advocates a virtue-based approach to ethics and professionalism, and fails to distinguish clearly between these two concepts. [ABSTRACT FROM AUTHOR]

With the introduction of personal dental services (PDS) into the South West the Local Assessment Panel (LAP) devised a new scheme consisting of 'cookbook' audits and piloted the scheme amongst the PDS dentists of South and West Devon, Somerset and Avon in 2005/2006. When the new contracting arrangements came into force, and in the absence of guidance from above, the LAP in consultation with the PCTs decided to consolidate the successful pilot audit scheme for PDS dentists and extend the new scheme to all the participating PCTs and their performers. The current scheme covers Devon, Somerset, Avon and Gloucester PCTs and is administrated by Mrs Jackie Derrick on behalf of Somerset PCT. All the audits showed improvement with the exception of the patient satisfaction survey where the first audit cycle showed an average patient satisfaction rating of 99% which cannot be improved on. We have redesigned this audit to try and make it more challenging and informative. The improvement in clinical record keeping was particularly marked. With the advent of new contractual arrangements in April 2009 it is essential that practitioners are able to demonstrate quality assurance in their practice and we believe that the South West scheme is a dentist friendly scheme, relevant to everyday dental practice. [ABSTRACT FROM AUTHOR]

This paper describes the work undertaken by the Postgraduate Primary Care Trust (PCT) Dental Tutor for South Yorkshire and East Midlands Regional Postgraduate Dental Education Office during the first year of a two-year pilot. The tutor has special responsibility for facilitating the writing of Personal Development Plans (PDPs) and the introduction of Significant Event Analysis to the 202 general dental practitioners in the four Sheffield PCTs. Data were collected on significant events and the educational needs highlighted as a result. A hands-on workshop format was used in small practice groups and 45% of Sheffield general dental practitioners now have written PDPs compared with a 16% national average. A library of significant events has also been collated from the data collected. [ABSTRACT FROM AUTHOR]

Objective To reduce the number of antibiotics inappropriately prescribed by general dental practitioners, and to increase overall prescription accuracy.Design A prospective clinical audit carried out between September and March of 2002-3 and 2003-4.Setting General dental practices in Eastern England.Subjects and methods The pre-audit antibiotic prescribing practices of 212 general dental practitioners were recorded over an initial six week period. On each occasion this included which antibiotic had been chosen, together with its dose, frequency and duration, as well as the clinical condition and reason for which the prescription had been raised. When related to prophylaxis, the patient's medical history was also noted. Following education on contemporary prescribing guidelines, presentations which illustrated the practitioners' previous errors, and the agreement of standards to be achieved, the process was repeated for another six weeks, and the results compared.Results In the pre-audit period, 2,951 antibiotic prescriptions were issued, and during the audit this was reduced by 43.6% to 1,665. The majority were for therapeutic reasons, with only 10.5% and 13.6% for medical prophylaxis during the pre-audit and audit periods respectively. Over both periods, amoxicillin and metronidazole were the two most commonly prescribed antimicrobials (63.4% and 21.2% respectively). In the pre-audit period, only 43% of all prescriptions were error free in dose, frequency, and/or duration of use, but this rose significantly to 78% during the audit. Equally, using contemporary published guidelines, out of all the prescriptions made in the pre-audit period, only 29.2% were deemed to be justified, as compared to 48.5% during the audit.Conclusions Clinical audit, in conjunction with education, and prescribing guidelines can favourably change antibiotic prescribing patterns among general dental practitioners. [ABSTRACT FROM AUTHOR]

In this article derived from his recent research, John Zamet relates an account of a hitherto undocumented story – the experiences of dentists fleeing the Nazi regime in Germany in the 1930s and 1940s. Specifically he describes the administrative actions by the British authorities at the time and the subsequent effects that these procedures had on the lives of the practitioners and their families. [ABSTRACT FROM AUTHOR]

While the practice of dentistry has been demonstrated to be significantly stressful, there have been few published studies describing interventions to reduce the stress of dental practitioners. This article describes research into the prevention and alleviation of stress amongst a variety of healthcare professionals, including dental practitioners, and describes the findings from a small scale study of an intervention aimed at general dental practitioners who reported high levels of work related stress. It is argued that to be effective, interventions should be tailored to the individual needs of the practitioner, within a structured intervention framework. Further research into the effectiveness and cost-effectiveness of stress management for dental practitioners is required. [ABSTRACT FROM AUTHOR]

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach — as it largely relates to the presenting complaint — was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail. [ABSTRACT FROM AUTHOR]

Objectives: To 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. Methods: A 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. Results: A 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. Conclusions: For 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]

Unless the practitioner is familiar with the morphology of the roots of all teeth, and the associated intricate root canal anatomy, effective debridement and obturation may be impossible. Recent research has improved knowledge and understanding of this intricate aspect of dental practice. After studying this part you should know in what percentage of each tooth type you may expect unusual numbers of root canals and other anatomical variations. [ABSTRACT FROM AUTHOR]

Objective To determine the extent and types of change in seven domains of dental practice in a sample of English general dental practitioners (GDPs).Methods A postal questionnaire was sent to 561 GDPs on the dental lists of three health authorities in diverse regions of England. Information collected included demographic details on personal and practice characteristics, self-rating of amount of change in the seven domains of practice and factors influencing change.Results The response rate was 60%. Fifty-six per cent of the sample were under 40 years old. Over a third of respondents reported 'changing a lot or completely' certain clinical activities, practice management arrangements and practice amenities. The highest self-reported level of change was in clinical activities. Of the GDPs who reported changing their clinical activities, 56% reported an increase in preventive care, followed by crown and bridge (44%), periodontics (44%) and endodontics (43%). Practice management rated second in the mean rank scores for self-reported change. The main changes reported were the introduction of computer systems and employment of practice managers. A sizeable percentage (66%) reported increasing the amount of information they provided to patients and the time spent discussing care. Quality assurance activities were the area of practice least likely to have changed over a 5-year period. Over half the sample reported not being involved in any quality assurance activities in the previous 5 years. Those respondents who were younger, had a postgraduate qualification and earned more than 20% of their income from private practice reported higher levels of change.Conclusions General dental practitioners' work patterns are dynamic and appear to be responding to changing needs and demands on their service. The main changes were in the types of clinical procedures being carried out. The low prevalence of changes reported in auditing and peer review activities needs to be investigated further. [ABSTRACT FROM AUTHOR]

Introduction This paper reports an evaluation of the West Midlands Key Skills initiative that provides a framework for learning during vocational training (VT).Method The 48 vocational dental practitioners (VDPs) who began their VT in August 2001 in the West Midlands were surveyed at the start and end of training (45 completed both surveys). They rated their confidence and experience in the 31 components of the Six Key Skills on visual analogue scales. Views were elicited in a survey of both VDPs (47 returns) and their general practice trainers (44 returns). Semi-structured interviews were also held with a stratified sample of 9 trainers and all four VT advisors.Results In terms of VDP progress, a statistically significant increase in confidence and experience was found in each of the 31 components. Six themes were identified in the views data. (i) Supporting the development of Key Skills; (ii) workload implications; (iii) the 'right' six? (iv) links with the advanced diploma (MFGDP(UK)); (v) assessment of VT; and, (vi) consistency and quality assurance.Conclusion VT successfully develops the confidence and experience of newly qualified dentists in the Six Key Skills and has been well received by the majority of VDPs, trainers and advisors in the West Midlands. [ABSTRACT FROM AUTHOR]

Objectives: To examine how pricing policies were contrived in general dental practice in terms of fee-for-item and hourly rate and how these were affected by specialist status and the level of private care provided in a practice. Design: A postal questionnaire. Subjects: Members of the British Society for General Dental Surgery working in dental practice. Results: Out of 160 eligible members, responses were received from 124 members (78%). Fifty-seven respondents claimed to specialise in one or more fields of dentistry. The majority of respondents consulted fellow colleagues or partners for advice on fee setting. A minority took external advice. The charging method varied according to the item of treatment with fee-for-item used predominantly for items such as a new patient examination, and hourly rate used more for items such as a direct composite restoration. Seventy-one respondents stated that their practice was 80-100% private treatment and these practitioners were significantly more likely to charge by hourly rate than fee-for-item for many items of treatment. Specialist status did not have any effect on charging method. The most important factors related to the setting of fees-for-item or hourly rate were clinical time spent, practice overheads and laboratory costs. Conclusions: This project has taken the views of a large group of experienced general dental practitioners, many of whom work purely in the private sector. The most important factors affecting fee setting were clinical time, practice overheads and laboratory costs. The method of charging was most affected by the proportion of private treatment provided by the practice. [ABSTRACT FROM AUTHOR]

Objectives To elicit the attitudes and opinions of consultant anaesthetists working in Scotland, with regard to conscious sedation carried out by dental practitioners.Method A questionnaire was designed to gauge opinion of consultant anaesthetists in Scotland on the practice of conscious sedation by dentists. The questionnaire was sent to 353 consultant anaesthetists working in 49 hospitals within the 15 health boards in Scotland.Results Of the 366 questionnaires sent, 249 were returned of which 235 were valid. This gave a response rate of 64%. In general, those questioned felt that the provision of sedation in a hospital setting was more appropriate than in general dental practice. A majority (65%) thought that it was unrealistic for anaesthetists to provide all sedation for dental treatment, although many (58%) felt that anaesthetists should take more responsibility in this area. Again, a majority (60%) agreed that dentists should be trained to use sedation techniques for their patients but a significant number (63%) disagreed with the practice of operator/sedationist.Conclusion It is of concern to the dental profession that a significant number of anaesthetists do not feel that it is appropriate for dentists to be administering even the most simple methods of sedation. At present there are no clear, recognised guidelines as to the level of formal training required for the practice of conscious sedation by dentists. It is in the interests of the dental profession and the public to ensure that those choosing to practice sedation do so safely by following recognised guidelines in the training and practice of sedation. [ABSTRACT FROM AUTHOR]

Medical emergencies can occur in the dental practice. Medical Emergencies in the Dental Practice and Emergency Drugs in the Dental Practice posters have been designed to help dental practitioners to respond effectively and safely to a medical emergency. These posters, endorsed by the British Dental Association, are included with this issue of the British Dental Journal. Further copies can be downloaded from: https://www.walsallhealthcare.nhs.uk/medical-education.aspx. [ABSTRACT FROM AUTHOR]

This article covers the move forwards from pilot to prototype in the National Health Service (NHS) dental contract reform in England. The current status of the pilot and prototype schemes are summarised and some of the challenges for those practices who will be exiting the pilots discussed. [ABSTRACT FROM AUTHOR]

This series of papers examines how the Anglo-American dental profession was established in the eighteenth century, examining its need for a name and identity, public recognition and official status. This third paper describes the introduction of the title dentist as the preferred one when used officially and politically. [ABSTRACT FROM AUTHOR]

Bob ten Cate, speaker at the 2013 BDA/BDJ Winter Lecture, describes how we are just scratching the surface of understanding bacteria in biofilms. [ABSTRACT FROM AUTHOR]

The aim of this paper is to highlight a change in guidance relating to possible interactions between antibiotics and oral contraceptives. Until recently, dentists have been advised to warn women taking the combined oral contraceptive pill of the routine need to use additional contraceptive measures while taking courses of broad spectrum antibiotics. Recent guidance relating to this issue has changed and dentists may not be aware of this. This paper reminds dentists of the previous guidelines and related evidence, reviews the pharmacokinetics of hormonal contraception and presents them with the latest evidence-based guidance. This should change their clinical practice. [ABSTRACT FROM AUTHOR]

This brief review highlights the lack of evidence relating to sex and gender differences in oral health as well as the widespread conceptual confusion and conflation that often underlies them. A broader biomedical understanding of these issues will offer a valuable framework within which differences in oral health between women and men can be further explored. This in turn would facilitate the development of the evidence base necessary to optimise the efficacy of dental practice in meeting the needs of both women and men patients. [ABSTRACT FROM AUTHOR]

I believe that each one of us is capable of finding something of special interest within dentistry. Head, neck and back pain of dental origin has consumed me within my practice for years, but I appreciate that it is not for everyone. It has led me into areas in which I have often found myself caught between the science on which we pride ourselves as being the basis of our noble profession and practice, and the less comfortable and less 'explainable' areas of belief in the effectiveness of treatments, despite not being able to fully explain them in terms of that same, reassuring logic of science. [ABSTRACT FROM AUTHOR]

The development of the modern practice of dentistry can be traced to the work and life of Pierre Fauchard, a French dentist who worked in the first half of the eighteenth century. Fauchard was an exceptionally gifted and talented practitioner, who introduced many innovations to dentistry. In a significant break with the tradition of the time, he shared his knowledge and techniques with colleagues, and published these in the first comprehensive dental textbook. This paper reviews his life and contribution to modern dentistry. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to determine the pattern of use and re-use of matrix bands in general practice in Scotland, to demonstrate which type of matrix band is most commonly used and to examine infection control measures of relevance to the safe use and re-use of matrix bands.Materials and Methods: Subjects: 621 of Scotland's 1,849 general dental practitioners were randomly selected.Data Collection: A 19-item self-reported questionnaire was mailed in June 1999 with a follow-up mailing sent in August 1999.Analysis: Data analysis involved descriptive statistics and cross-tabulation. Where appropriate, differences between categories were tested for significance by a Chi-square test.Results: A total of 479 questionnaires were returned, representing a response rate of 77%. Reported compliance with routine glove wearing was high (91%). Most dentists (92%) provided training on instrument cleaning and sterilisation for their dental nurses. Ultrasonic baths were used by 59% of practitioners; the remainder soaked or manually scrubbed instruments to remove debris before autoclaving. The Siqveland matrix was the matrix of choice for 96% of respondents. 7% provided a new matrix band for each patient. Most (64%) changed bands only when they were bent or damaged; 29% changed them daily or weekly. Deterrents to use of a new band for each patient were cost (39%) and time (52%). A total of 54% of respondents considered matrix band replacement unnecessary between patients.Conclusions: The Siqveland matrix band is the most popular among the study group of dental practitioners. Re-use of matrix bands is common. Guidelines for the safe re-use of matrix bands are required. [ABSTRACT FROM AUTHOR]

Stereopsis and its role in dental practice has been a topic of debate in recent editions of this Journal. These discussions are particularly timely as they come at a point when virtual reality simulators are becoming increasingly popular in the education of tomorrow's dentists. The aim of this article is to discuss the lack of robust empirical evidence to ascertain the relationship (if any) between stereopsis and dentistry and to build a case for the need for further research to build a strong evidence base on the topic. [ABSTRACT FROM AUTHOR]

Objectives To assess if the GDC considers relevant factors at all stages of its deliberations into misconduct, as required by the determinations in the cases of Cohen, Zygmunt, and Azzam; and to assess whether those circumstances described in the Indicative Sanctions Guidance as warranting erasure from GDC registers led to that outcome.Design Retrospective analysis of practise committee transcriptsMaterials and Methods The consideration of specific factors in determining impairment of fitness to practise was compared with their subsequent consideration when determining the severity of sanction. Additionally, cases that highlighted aggravating circumstances deemed as serious enough to warrant erasure were monitored. Pearson's Χ test was used to detect any variation from the expected distribution of data.Results Sixty-six cases met with the inclusion criteria. Of the five factors considered, all but one was more likely to be heard when determining sanction having first been factored in to the consideration of impairment. Additionally, there was a statistically significant correlation between the aggravating factors and erasure from the registers.Conclusions The GDC do, in general, consider relevant factors at all stages of their deliberations into practitioner misconduct, and act in a manner that is consistent with their own guidance when determining sanction. [ABSTRACT FROM AUTHOR]

An interview with British professor Jimmy Steele is presented. He comments on the effect of the May 2015 election in Great Britain on the dentistry and contract reform of the National Health Service. Steele discusses the prototype contracts and his recommendations that are under the control of the Health Department. He also shares his involvement in the 2012 Child Dental Health Survey among children and offers advice to qualified dentists who are deciding on their career pathways.

AimsTo investigate the relationship between perceived quality and patients' tendencies to recommend a practice to friends and colleagues.MethodsData from 64 practices using the Denplan Excel Patient Survey (DEPS) were analysed. The Net Promoter Score (NPS max score 100), developed by Reichheld, is reported to each practice using DEPS. It is claimed that the NPS measures the likelihood that patients will recommend the practice to friends and colleagues. A Patient Perception Index (PPI max score 100) is also reported to practices. The PPI is calculated from the responses to the ten core questions of DEPS on perceived quality. The 64 practices were placed into three groups for data analysis according to their NPS result: group one practices receiving an NPS of less than 80, group two practices receiving an NPS of 80-89 and group three practices receiving an NPS of greater than 89. These groups represented practices scoring statistically significantly (to 90% confidence) below the mean NPS (group one), practices close to the mean NPS (group two) and practices statistically significantly (to 90% confidence) above the mean NPS.ResultsGroup one practices scored a mean PPI of 73, group two scored a mean PPI of 76 and group three a mean PPI of 80. These differences in values of PPI between the groups are statistically significant (to 90% confidence). Of the ten constituent issues which contribute to PPI, the greatest difference in scoring between group one and group three was found to be around perceived value for money.ConclusionThe probability of patients recommending a dental practice seems to rise in direct proportion to favourable perceptions of quality. A perception of 'ideal' value for money is the most highly correlated aspect with a high NPS. [ABSTRACT FROM AUTHOR]

AimIt is the aim of this paper to consider the factors associated with a patient's continuing attendance at a particular dentist's surgery.MethodsA data set was established consisting of General Dental Services' (GDS) patients whose birthdays were included within a set of randomly selected dates, 20 in each possible year of birth. The data set was restricted to those patients aged 18 or older in 2003 who attended only one dentist in only one postcode area in 2003, and who also attended only one dentist in the same postcode area in 2005, and where the dentist attended in 2003 was also practising in the same postcode area in 2005. The patients were classified by age, gender and charge-paying status, and by whether they had attended a GDS dentist in 2002, and the dentists attended in 2003 were classified by age and gender. The proportion of patients changing dentists between 2003 and 2005 was calculated, together with standard error (se), for each combination of these factors. This was then replicated for each year from 1993-2002.ResultsData for 323,382 patients were included in the analysis for 2003, these patients having not changed address during a two-year period, nor had their dentist changed location. The proportion of patients changing dentist over the period 2003 and 2005 was 15.5% (se 0.06 PCT). This has increased steadily since 1993, when the proportion was 12.4%.ConclusionsFactors influencing whether a patient changes dentist include patient age and charge paying status, dentist age and gender, and the patient's previous attendance pattern. [ABSTRACT FROM AUTHOR]

Ahead of her presentation at the 2015 British Dental Conference and Exhibition, the BDJ caught up with Elaine Halley, to find out more about the changing face of cosmetic dentistry, Digital Smile Design and the vision behind her dental spa. [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]

Objectives Key reforms in England and Japan have called for greater clinical leadership from general dental practitioners to deliver improvements in the quality of care for patients. In England, the reorganisation of the National Health Service has led to the development of Local Professional Networks to ensure services are clinically led, patient and outcome focused. In Japan, the rapidly changing demographics have led to calls for general dental practitioners to become more active in meeting the emerging population health challenges. Both require engagement at a strategic and a local level. However, little is known about what is meant by clinical leadership in dentistry or what training needs exist. The aim of this study was to develop and pilot a questionnaire to understand what general dental practitioners feel is important about clinical leadership and how they rate themselves.Methods A 61-item questionnaire was developed from the literature, an earlier qualitative study and refined through cognitive interviews. Questionnaires were distributed to general dental practitioners across the North West of England and Tokyo, using random sequence generation. For each item, the participant had to record whether they thought the statement was an important component of clinical leadership and how they rated themselves. Both were rated using a seven-point Likert scale. Data reduction was undertaken using principal component analysis to examine for factor loadings within the questionnaire. Differences in mean scores were also used to highlight substantive differences in how general dental practitioners rated the different components of leadership and how they rated themselves.Results The response rate for the pilot was low (22.9% and 7.5% for North West and Tokyo respectively). The items that were considered to be important in leadership reduced to two components in the North West (accounting for 62.1% of the total variance): 'How to lead' and 'How not to lead'. In Tokyo, 56.4% of the total variance was explained by three components: 'Demonstrating personal qualities', 'Working with others' and 'How not to lead'. When the self-rated items were reduced, three factors were found to be important in the North West: 'Working with others', 'Setting direction' and 'Managing services' (55.1% of the variance). 'Working with others', 'Demonstrating personal qualities', 'Pragmatism', 'Setting direction' and 'Improving services' were found to be important in Tokyo (52.8% of the variance). The questionnaire items relating to integrity, team-working and having a positive attitude during difficult times were rated highly by both groups. Items relating to providing vision for team, being assertive and having a positive attitude had the greatest mean difference, suggesting possible areas of training need.Conclusion The nature of the pilot study and the poor response rate makes any conclusion difficult to infer. Among those that participated, leadership was understood to be more important at a practice level rather than at a strategic level. The questionnaire should be refined further based on the results of the pilot and the data reduction. [ABSTRACT FROM AUTHOR]

Background The aim was to obtain stakeholders' views on the former London Deanery's joint educational service development initiative to train dentists with a special interest (DwSIs) in endodontics in conjunction with the National Health Services (NHS) and examine the models of care provided.Methods A convergent parallel mixed methods design including audit of four different models of care, semi-structured interviews of a range of key stakeholders (including the DwSI trainees) and questionnaire surveys of patients and primary care dentists.Results Eight dentists treated over 1,600 endodontic cases of moderate complexity over a two year training period. A retrospective audit of four schemes suggested that first molars were the most commonly treated tooth (57%; n = 341). Patients who received care in the latter stages of the initiative were 'satisfied' or 'very satisfied' with the service (89%; n = 98). Most dental practitioners agreed that having access to such services would support the care of their patients (89%; n = 215) with 88%; (n = 214) supporting the view that DwSIs should accept referrals from outside of their practice.Conclusion This initiative, developed to provide endodontic care of medium complexity in a primary care setting, received wide support from stakeholders including patients and primary care dentists. The implications for care pathways, commissioning and further research are discussed. [ABSTRACT FROM AUTHOR]

Objective To evaluate Class V restorations placed by UK general practitioners comparing those failing or surviving after two years, and to identify factors associated with early failure.Design Prospective longitudinal cohort multi-centre study.Setting UK general dental practices.Materials & methods Ten dentists each placed 100 Class V restorations and recorded selected clinical information at placement and recall visits. Univariate associations were assessed between recorded clinical factors and whether restorations had failed or not at two years. Multi-variable binary logistic regression was also undertaken to identify which combination of factors had a significant effect on the probability of early failure.Results At two years, 156 of 989 restorations had failed (15.8%), with 40 (4%) lost to follow-up. Univariate analysis showed a significant association between restoration failure and increasing patient age, payment method, the treating practitioner, non-carious cavities, cavities involving enamel and dentine, cavity preparation and restoration material. Multi-variable analysis indicated a higher probability of early failure associated with the practitioner, older patients, glass ionomer and flowable composite, bur-preparation and moisture contamination.Conclusions Among these practitioners, both analytic methods identified significant associations between early failure of Class V restorations and the practitioner, cavity preparation method, restoration material and patient's age. [ABSTRACT FROM AUTHOR]

This study investigated the effects that disposable infection control barriers and physical damage through use had on the power output from dental light curing units (LCUs) and light curing tips (LCTs). Five disposable infection control barriers were tested on a number of LCUs and LCTs. Testing involved the repeated measurement of power output of LCUs and LCTs on a radiometer. Two of the barriers tested caused statistically significant reductions in the mean light output intensity when compared to the no barrier control groups. One barrier type reduced the power output by 30 to 40%. It was also noted that physical damage to the LCTs affected power output by between 20 and 30%, which was then further reduced by the disposable barrier. This study showed that three of the five disposable infection control barriers had little effect on the overall efficiency of the power output of the LCUs. It also showed that physical damage to LCUs and LCTs can affect power output significantly. Infection control measures should be carefully considered before use to avoid undue effects on power output delivered from the LCUs/LCTs to ensure that the degree of polymerisation within the resin-based composite and curing efficiency are not affected unduly. [ABSTRACT FROM AUTHOR]

Aims and objectives This audit was carried out to assess the level to which recall intervals were individually and appropriately selected for patients attending dental practices across a primary care trust (PCT) area in Essex. Method A retrospective audit was carried out by reference to patient records to assess various criteria, including whether patients were categorised according to risk of oral disease, whether an appropriate recall had been selected and whether a discussion regarding a recall interval had been undertaken. An educational event highlighting the issue of recall intervals was held. Subsequent to this a prospective audit was undertaken to assess relevant criteria. Results Prospective audit data showed a marked increase in the use of patient risk assessments for caries, periodontal disease, oral cancer and non-carious tooth surface loss (NCTSL). Recall intervals were also more often selected based on a patient's risk status and discussed with the patient compared to that observed in the retrospective audit data. Conclusion This audit was successful as a tool to bring about change in the behaviour of dentists regarding their determination of appropriate recall intervals for patients. Whether that change in behaviour is long-term or transient requires further investigation. [ABSTRACT FROM AUTHOR]

Introduction Retaining and Returning Advisers (RRAs) were appointed to postgraduate dental deaneries in England in 2002 as part of the Government's strategy to retain the dental workforce and support return to practice following a career break. The study aimed to review RRAs' activities and consider the overall success of the RRA initiative five years from inception (2007). Design and methods A case study design, conducted in three phases, drawing on qualitative data. In Phase 1, semi-structured interviews were held with all RRAs in England (n = 12). Phase 2 involved an electronic survey of all 12 postgraduate dental deans in England (n = 10). In Phase 3, analysis was undertaken and a final report prepared. Results RRAs have been flexible in responding to the changing policy context, and devolved funding for the role to the local, deanery level. They have adapted to support more diverse target groups including those seeking vocational training equivalence and underperforming dentists. Future priorities were envisaged to be associated with primary care trusts' commissioning and quality assurance responsibilities, and supporting all members of the dental team. Conclusion RRAs have become well-established in deaneries and have made a successful contribution to addressing workforce and educational needs for a diverse group of practitioners. [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]

Objective To evaluate and improve upon the quality of water emanating from the dental unit waterlines (DUWLs) which supply irrigation for dental handpieces and triple spray syringes in general practice.Design A prospective clinical audit.Setting Seventy-two general dental practices in the East of England.Methods In 2006, 124 dentists initially registered to participate in the audit. By 2007, 72 had begun and by 2008, 68 had completed the project. This involved collecting samples of water discharged from the DUWLs in the dental practices both before the start and mid-way through a morning session. These were tested microbiologically at a United Kingdom Accreditation Service testing laboratory.Interventions Before the audit, 56% of the DUWLs were reportedly flushed through for 2 minutes at the start of the day, 29% were purged for 20 seconds in between each patient, 50% were treated with a wide range of different disinfectant solutions, 44% were drained down dry at the end of the day and 9% had no cross-infection control measures applied to them at all. In the audit, 100% used a disinfectant solution alone, predominantly either Alpron or Sterilox.Main outcome measures The minimum audit standard set was for the water samples to meet the United States' Centers for Disease Control and Prevention (CDC) guideline on the quality of DUWL water, namely that the United States' Environmental Protection Agency (EPA) regulatory standards for drinking water be adopted, in that no more than 5% of water samples should be contaminated with total coliforms and that they should not have more than 500 colony forming units per ml (cfu/ml) of heterotrophic water bacteria. However, the participating dentists were encouraged to try and achieve the more stringent European Union (EU) standards for potable (drinking) water, namely for the water samples to have neither Escherichia coli nor any other faecal coliforms present and for the aerobic colony count to be less than 100 cfu/ml at 22°C after 72 hours of culturing.Results In the pre-audit survey, none of the 72 DUWL water samples were contaminated with E. coli but in five of them (7%) coliforms were recovered. Only 25% reached the EU potable water standard, of which 11% had zero planktonic bacterial contamination. Three percent were above the EU standard but below the CDC guideline/EPA regulatory drinking water standard, while alarmingly, 72% of them failed to reach this minimum audit standard altogether. However, after the application of a suitable disinfectant for at least a month, the audit revealed that E. coli still remained absent in the water samples taken from the 68 DUWLs that completed the project and in only one (1.5%) were coliforms recovered. Remarkably, nearly 81% reached the EU potable water standard, of which 54% had zero planktonic bacterial contamination, with nearly an additional 6% reaching the American CDC/EPA standard and with only 13% failing outright.Conclusions Clinical audit using appropriate DUWL disinfectants can result in the improvement of the quality of water that is discharged through DUWLs, thereby minimising both the risk of cross-infection to vulnerable patients as well as to dental staff chronically exposed to contaminated aerosols. [ABSTRACT FROM AUTHOR]