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This article provides an opinion on the NHS NICE guidance on wisdom tooth removal introduced in 2000. Guidelines should support clinical decision-making by providing recommendations based on sound evidence but the wisdom tooth guidelines were published without any research evidence. General dentists and oral surgeons in England and Wales are under pressure to comply with this guidance but what have been the implications for patient care? There is growing evidence that patients have not been best served, with significant numbers developing caries in an adjacent tooth before consideration of wisdom tooth assessment. [ABSTRACT FROM AUTHOR]

Introduction This paper examines views on professionalism in the dental practice workplace through a thematic analysis of data from eight focus groups.Methods Focus groups were conducted with 19 dentists, 13 dental care professionals and 19 members of the public in England and Wales. The research was part of a larger mixed-methods study of professionalism in dentistry commissioned by the General Dental Council.Results The four most prominent themes in the focus group data were: communication, the cost of treatment, the role of the dental team and consequences of professionalism concerns. Participants agreed that these are fundamental professionalism issues, although there was some difference of opinion about addressing them. There was disagreement about the responsibilities of different members of the dental team in maintaining professionalism.Conclusion We conclude that communication skills training should be a central part of the professionalism at all levels of training. Education about team working could foster a more collaborative approach to professionalism across the dental team and support good, patient-centred oral healthcare. Support and guidance are required to help professionals reflect and learn from mistakes., (© 2022. The Author(s).)

Objectives This study sought to identify how patient information on the Internet has influenced the delivery of oral care and the use practitioners themselves make of the Internet.Methodology Data were collected via a self completed 18 item postal questionnaire, sent to a random sample of 620 dentists on the GDC register in Wales.Results In total 457 (74%) of the questionnaires were returned. One half of all practitioners stated that patients had asked them about material of relevance to dentistry obtained from the Internet, although in the majority of cases this happened less frequently than once a month. The most common topics enquired after were cosmetic procedures, dental amalgam and implants. A minority of dentists, 47 (11%) viewed the Internet as a threat to the dentist-patient relationship. However, 169 (39%) agreed information gained from the Internet had led to patients demanding inappropriate care or more complex treatment (135/31%). Having to take time to discuss Internet material was viewed as a burden by 93 practitioners. The potential of the Internet to widen inequalities in access to oral health information was agreed upon by one third of respondents. Concerns over the quality and reliability of Internet derived information, together with a lack of knowledge of appropriate sites, prevented dentists using the Internet as an oral health education resource. However, only 18.7% claimed never to use the Internet for their own Continuing Professional Development. Access for CPD purposes was mainly from home. Of those working in general practice, 54 had their own practice website, and a further 103 said this was something they were considering. Email was used to communicate with patients by 42 dentists, mainly to make appointments.Conclusions Views on the impact of the Internet were generally positive, but there is a long way to go before its full potential is realised. [ABSTRACT FROM AUTHOR]

Introduction The COVID-19 pandemic has had a large impact on dentistry across Wales. Dentists were facing significant levels of psychological distress prior to the pandemic, so it was important to monitor dentists' mental health during this unprecedented challenge.Aims To gain both an understanding of the impact that the COVID-19 pandemic has been having on the mental health of dentists working in Wales, as well as understanding the levels of stress the pandemic has caused. We also aimed to understand the specific causes of stress.Results High levels of stress were found, with 82% of respondents saying stress levels in the dental team have increased noticeably. Three-quarters of respondents have gone to work despite not feeling mentally well enough. Working conditions and financial pressures caused by the pandemic have directly impacted the mental health of many dentists. As a result, they have been using both adaptive and maladaptive coping methods to cope with the stress of the pandemic, with over one-third of respondents drinking alcohol more frequently than before the pandemic.Conclusions The pandemic has had a profound impact on the professional lives of dentists working in Wales. Their interactions with patients and colleagues have been greatly affected, as well as their work and working conditions. These have all substantially contributed to increased stress levels. Without significant improvements to the working conditions of dentists, as well as continued psychological support, large-scale burnout in the future is not only possible, but likely., (© 2022. The Author(s), under exclusive licence to the British Dental Association.)

On the special occasion of the society's Golden Jubilee Conference in Cardiff, as a historical institution a short review of its own history was apposite. [ABSTRACT FROM AUTHOR]

Objective: To compare the level of prescribing and types of antibiotics prescribed for dental problems by general medical practitioners and dentists.Design: Secondary analysis of standard consultation data and prescription records from four different settings.Setting: 30 participating general practices in the General Practice Morbidity Database for Wales in 1996.Subjects: 1,185 attendances for tooth-related problems, at 30 participating practices in the General Practice Morbidity Database for Wales in 1996. Standard consultation records from a GDP emergency dental rota, and two weekend emergency dental clinics: one in a health centre, the other in a dental hospital.Results: More than two thirds (68%) of attendances at general medical practices for tooth-related problems resulted in a prescription for antibiotics. In contrast less than a third (28%) of patients seen by a GDP rota, about half (52%) of patients at a weekend emergency clinic in a health centre, and just more than a third (38%) of patients attending the dental hospital clinic received antibiotics. General medical practitioners were also more likely to prescribe broad-spectrum antibiotics than dentists.Conclusion: For acute dental problems general medical practitioners are more likely to prescribe antibiotics than dentists. There also appear to be inter-professional differences in the tendency to prescribe broad spectrum antibiotics. Initiatives to rationalise prescribing for dental conditions may need to target doctors as well as dentists. [ABSTRACT FROM AUTHOR]

Introduction The UK General Dental Council says that the new graduate will have the range of skills required to begin working as part of a dental team and be well-prepared for independent practice. This study examines the views of new dental graduates in the area of dental and maxillofacial radiology.Materials and methods A questionnaire survey of newly graduated dentists in Wales and South West England asked about their experience of undergraduate education in dental and maxillofacial radiology, and their confidence in the use and interpretation of imaging techniques in early independent practice.Results Most survey participants were confident in the teaching they had received in dental radiography and radiology, and that they could apply their knowledge and understanding to the more common investigations used in general dental practice. They were less confident in the uncommonly used techniques, such as oblique lateral and lateral cephalometric views.Discussion This study is encouraging in that new dental graduates say that their undergraduate education has given them the knowledge to be able to take, interpret and make clinical diagnoses using the commonest radiological investigations. This tends to validate the undergraduate education received and identifies areas to improve.Conclusion New dental graduates are confident in their knowledge and skills, and apply these to the most commonly used radiological investigations used in general dental practice.

Introduction This study was designed to investigate the accuracy of clinical information provided by referring general dental practitioners (GDPs) following the introduction of a standardised referral form across Wales (the All Wales Universal Orthodontic Referral Form [AWUORF]) and to see whether the information given could be reliably used to screen the referrals.Aim To evaluate whether priority cases were being readily identified and whether inappropriate referrals could be minimised, thereby potentially reducing waiting lists.Method A service evaluation involving the retrospective study of 200 consecutive referrals to a specialist practice over a three-month period. A descriptive data analysis was undertaken.Results The GDPs had successfully identified the main complaint in 156 (78%) of the referrals. Of the 44 (22%) clinically inaccurate referrals, there was no impact on the patient in terms of referral pathway in 32 (16%) cases, but in the remaining 12 (6%), 5 (2.5%) cases were prioritised unnecessarily and the remaining 7 (3.5%) would have been seen more quickly had the GDP provided the relevant clinical information. The appropriateness of referral in terms of eligibility of the patient to receive NHS-funded orthodontic treatment was high with only 18 (9%) patients failing to meet the criteria.Conclusion The AWUORF successfully guides the GDP to make appropriate referrals and enables accurate triage in the majority of cases.

Aim This research was undertaken to explore NHS general dentistry in Wales, from the perspective of both the dental practice and the general population, in order to understand patient access to NHS general dentistry. The health boards' dental budgets, and how well they have been used for primary care general dentistry, were examined. Contributory factors to patient access problems were also examined.Background Our research shows that access for new patients has dropped to an all-time low in recent years. Causation is multifactorial. In Wales, dentists must achieve 95% of their UDA target or their practice will face 'clawback'; having to pay back monies for not achieving UDA targets. Practices may also hand back monies from their contract if they feel they will end up facing clawback at the year's end.Methods The clawback and handback data, budgetary and contract reduction data, and practice opening and closures numbers, were acquired in the period of March 2017 to April 2018 via a series of freedom of information requests to each of the Welsh health boards. Telephone interviews with dentists and practice owners were conducted in the summer of 2017. Patient access information was gathered from the health boards and from contacting dental practices where this information was not available.Results It was found that, on average, only 15% of all NHS practices in Wales were accepting adult NHS patients in 2017-2018 and 21% of all NHS practices had waiting lists. Cwm Taf had the best access to an NHS dentist, however, this figure was not high at 52% (15 practices). Cardiff and Vale patients were the most likely to struggle to find a dentist, with just two practices in the whole health board accepting adult NHS patients. In Wales, clawback and handback resulted in £16,322,445 of the general dental service (GDS) budget being unspent from 2014/2015 to 2016/2017. This figure increases in consideration of the monies lost from practices through contract reduction, with contracts being reduced by more than £4,000,000 from 2014/2015 to 2016/2017, making a total of £20,322,445 of the budget not being spent on NHS dentistry over a period of three years. This means that, on average, 6% of the Welsh GDS budget was unspent every year between 2014 and 2017.Conclusion Dentists want to be able to treat more patients and see more patients with a higher need, but limitations upon patient access and the fear of clawback within the current contract make this very difficult. An increasing population and a further handback of NHS contracts mean it is likely that this problem of access will continue to worsen. The current system of clawback and handback only exacerbates the access problem because taking on new patients is a risk to dentists trying to achieve such tightly managed targets. Dentists are incentivised in the current UDA contract to treat healthy patients. A larger proportion of high needs patients can result in a practice failing to reach its targets and facing clawback, handback or contract reduction. Clawback is prevalent in all health boards, meaning that patients with poor oral health are disproportionately affected. Inverse care law is felt acutely in general dentistry.

Aim: It is the aim of this paper to present data on the survival of restorations in incisor teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored incisor tooth, and to discuss the factors which may influence this., Methods: A data set was established, consisting of General Dental Services patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the recorded intervals between placing a restoration in an incisor tooth and re-intervention on the tooth, and the time to extraction of the restored tooth., Results: Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Overall, 2,526,576 restorations of incisor teeth in adults were included. At 15 years, survival of restorations in incisor teeth without re-intervention was 35%, and for restored incisor teeth survival to extraction was 81%., Conclusions: Approximately 35% of restorations in incisor teeth survived without re-intervention at 15 years, and 81% of restored incisor teeth survived for 15 years without extraction. Factors influencing survival include patient age, dentist age, and patient treatment need. Crowning an incisor tooth leads to an earlier time to extraction of the restored tooth.

Background In April 2006, fundamental changes were made to the arrangements for commissioning state funded (National Health Service, NHS) dental care in England and Wales. These involved the dissolution of a universal national contract and the introduction of locally commissioned primary dental care services. Suggested advantages included the elimination of a fee-for-item 'treadmill', an increased emphasis on prevention and improved patient access. This change came at a time when many practitioners were opting to provide care outside the NHS.Objectives This study investigated dentists' experience of the new contract and compared this with attitudes determined in a previous survey of the same cohort of dentists conducted immediately before the changed commissioning arrangements.Methods Data were collected via a postal questionnaire, comprising a combination of 60 open and closed questions, mailed to 608 general dental practitioners in Wales.Results Four hundred and ninety-six (77%) questionnaires were returned. Four hundred and seventeen practitioners continued to provide NHS dental care. Only 46 (11%) of the 417 practitioners agreed that they liked the new method of remuneration and the majority (362 [86.8%]) perceived that they still delivered state-funded care in a 'treadmill' environment. This compares with 34.9% of dentists who perceived the new system as a 'treadmill' immediately before its implementation. Three hundred and forty-eight (83.4%) disagreed that they were able to spend more time on prevention and 356 (85.3%) did not feel they had more time to spend with patients – key objectives of the reforms. Two hundred and seventy-five (65.9%) respondents agreed that local NHS commissioners were controlling their business.Conclusion This survey, conducted 18 months after the implementation of the new commissioning arrangements, suggests that practitioners are deeply unhappy with local commissioning. It raises questions as to whether the changes have achieved the Government's stated objectives in reforming state-funded primary dental care. [ABSTRACT FROM AUTHOR]

Aims To ascertain the current management protocols of patients on warfarin by general dental practitioners (GDPs) in South West Wales and to compare these findings with current guidelines and the results from a previous audit published in 2003.Materials and methods A questionnaire similar to that used in the first audit was sent to 447 GDPs in South West Wales. In addition, questions were included on factors which might affect international normalised ratio (INR), the timing of pre-operative INR assessment and the risk of bleeding associated with implant surgery. GDPs' details were derived from the online GDC database of registered dental practitioners. Registered specialists and GDPs who practised only orthodontics were excluded.Results Of the 447 questionnaires distributed, 332 (74%) were returned. Eight percent (n = 26) of the respondents did not treat patients on warfarin. Two hundred and forty-seven respondents (74%) considered implant placement as a procedure with high risk of bleeding, with inferior dental block, sub-gingival restorations and sub-gingival debridement receiving a lower response (45%, 28% and 12%, respectively). When planning a high risk procedure, 206 respondents (63%) indicated they would seek advice from a cardiologist or general medical practitioner; none of the respondents would advise the patient to reduce their warfarin dose, while 1% indicated they would ask the patient to stop taking warfarin without seeking any medical opinion. A total of 278 respondents (84%) stated they would check the INR before treatment and of these, 214 (65%) indicated they would do so within 24 hours of treatment and 60 (18%) within 48 hours. Ten respondents said they would not normally check INR. One hundred and twelve respondents (34%) considered 2.5 as the safe upper INR limit for performing high risk procedures, 21 (6%) considered an INR of between 1 and 2 as the safe limit, 99 (30%) considered and INR of 3 as safe, 36 (10%) considered 3.5 as safe and 36 (10%) considered an INR of 4 as safe. Finally, 286 respondents (86%) considered drug interactions and 236 (71%) considered alcohol as significant influencing factors on INR.Conclusions The findings demonstrate a broad change in practice towards the new recommendations produced in 2001 but also highlight that further education and support may be necessary, as well as greater consistency in published guidelines. [ABSTRACT FROM AUTHOR]

Objective This study was undertaken to devise a suitable survey instrument to measure morale, and to undertake an assessment of morale amongst vocational dental practitioners (VDPs) in the UK.Design Postal questionnaire survey.Setting Dental vocational training schemes in the UK.Subjects Vocational dental practitioners.Method A confidential postal questionnaire was used to measure levels of morale among all VDPs in the UK in 2007.Results A response rate of 76.7% was achieved. The mean morale score for Scottish VDPs was significantly higher than that of the Northern Irish VDPs, which in turn was significantly higher than those of the VDPs in England or Wales. In England and Wales females recorded higher morale scores than males. Lowest morale scores were associated with statements referring to concerns about future changes to NHS dentistry, and the limits on treatment within the NHS system. The highest scores were associated with good working relationships.Conclusion The use of an appropriately tested questionnaire has provided a convenient objective measure of morale. The morale of VDPs in the United Kingdom was lower than expected. Scottish VDPs recorded higher morale scores than other VDPs and responded more positively in the survey instrument. The most negative responses from all VDPs were regarding the effect of the NHS system on treatment and concerns about future changes to the NHS. [ABSTRACT FROM AUTHOR]

The authors reflect on the role of dental educators to prepare students in dental practice as independent practitioners in Cardiff, Wales. The authors note that the significant challenge of dental practice is in dental school programmes that develop and train students to become effective oral health care provider. They cite that community-based clinical teaching programmes basically response these challenges.

Background In April 2006, fundamental changes were made to the arrangements for commissioning state funded (National Health Service, NHS) dental care in England and Wales. These involved the dissolution of a universal national contract and the introduction of locally commissioned primary dental care services. Suggested advantages included the elimination of a fee-for-item 'treadmill', an increased emphasis on prevention and improved patient access. This change came at a time when many practitioners were opting to provide care outside the NHS.Objectives This study investigated dentists' experience of the new contract and compared this with attitudes determined in a previous survey of the same cohort of dentists conducted immediately before the changed commissioning arrangements.Methods Data were collected via a postal questionnaire, comprising a combination of 60 open and closed questions, mailed to 608 general dental practitioners in Wales.Results Four hundred and ninety-six (77%) questionnaires were returned. Four hundred and seventeen practitioners continued to provide NHS dental care. Only 46 (11%) of the 417 practitioners agreed that they liked the new method of remuneration and the majority (362 [86.8%]) perceived that they still delivered state-funded care in a 'treadmill' environment. This compares with 34.9% of dentists who perceived the new system as a 'treadmill' immediately before its implementation. Three hundred and forty-eight (83.4%) disagreed that they were able to spend more time on prevention and 356 (85.3%) did not feel they had more time to spend with patients – key objectives of the reforms. Two hundred and seventy-five (65.9%) respondents agreed that local NHS commissioners were controlling their business.Conclusion This survey, conducted 18 months after the implementation of the new commissioning arrangements, suggests that practitioners are deeply unhappy with local commissioning. It raises questions as to whether the changes have achieved the Government's stated objectives in reforming state-funded primary dental care. [ABSTRACT FROM AUTHOR]

The article reports that the Welsh Assembly is considering and allowing dentists to charge patients who miss their dental appointments. According to an NHS task force, missed appointments cost the NHS millions of pounds per year. It also argued that the discretionary charge will improve access to vital health services.

The article discusses the private dentistry regulation in Wales. It is said that dentists will have to register with the healthcare regulator Healthcare Inspectorate Wales (HIW). It is cited that the registration of the dentists under the Care Standards Act 2000 was required by the Private Dentistry (Wales) Regulations 2008.

The article reports on the recommendations of the Welsh Assembly Government's Health Wellbeing and Local Government committee regarding the shortage of dentists in Wales. It relates that the committee calls for a significant increase in the number of dental school places and suggested that local health boards should employ more salaried dentists. The committee also calls for more dental care professionals and suggests extra bursaries as a way of encouraging more undergraduate applications.

Objectives To determine knowledge and educational needs of dental practitioners in Wales regarding congenital or acquired cardiac disease and the provision of antibiotic prophylaxis.Design Self-administered postal questionnaire.Settings Cardiff University Dental Hospital, district general hospitals (HDS), all general dental practices (GDP) and community dental service (CDS) clinics throughout Wales.Methods A questionnaire sent to 1,182 dentists in Wales in 2004-5.Results 528 questionnaires were returned (a response rate of 45%). These were analysed using one-way analysis of variance to compare summary scores between the occupation groups. Significant differences in knowledge of cardiac risk factors for infective endocarditis and for dental procedures requiring cover were observed between the occupation groups. The majority of dentists (92% GDPs, 94% CDS and 77% HDS) requested postgraduate education in cardiac risk factors and laminated flow diagrams for their surgeries as the preferred educational format.Conclusion The knowledge of Welsh dentists regarding cardiac conditions or procedures which are risk factors for paediatric and adult patients varied according to place of work. The study identified potential for under- and over-prescription of antibiotic prophylaxis within the current guidance. There was confusion as to which patient groups and cardiac conditions required prophylaxis and for which particular dental procedures. Postgraduate education detailing advances in cardiology practice is necessary for dentists. [ABSTRACT FROM AUTHOR]

The article provides information on the 52nd Annual meeting of the European section of the International College of Dentists under the Presidency of Professor Phillip Dowell in Cardiff, Wales. Over two hundred delegates from twenty-one European countries and the U.S. converged to attend the three day meeting. The theme of the event looks into various aspects of oral care.

AimsTo identify the number of claims reported by the Dental Practice Board (DPB) for the three adult preventive codes for the year ending October 2002 in Wales. To identify the attitudes of practitioners to the use of these codes.DesignA cross-sectional study using routinely gathered DPB data and data generated by a postal questionnaire.SampleAll DPB claims for the 12 months ending October 2002. A randomised sample of 400 dentists currently practising in Wales for the postal questionnaire.ResultsThe DPB data showed great variation across Wales for: the number, type and distribution of preventive code claims; the age and payment status of patients prescribed these treatments; and the proportion of male versus female dentists claiming for the codes.The questionnaire response rate was 67% (n = 267). The results showed that most respondents were deterred by the restrictions on the codes, insufficient reimbursement and a perceived unwillingness of patients to pay for preventive care.ConclusionFew dentists provide preventive care to adults under the existing remuneration system. Work is necessary to enable dentists to use effective preventive techniques for adult patients.These results can be considered to show the baseline provision of prevention and could facilitate the evaluation of any changes to the current system. [ABSTRACT FROM AUTHOR]

The article focuses on the availability of an online survey form for dentists to respond to the compact discs mailed to dental practices in England and Wales on Cross Infection Control for the Dental Team.

ObjectivesThis study sought to identify how patient information on the Internet has influenced the delivery of oral care and the use practitioners themselves make of the Internet.MethodologyData were collected via a self completed 18 item postal questionnaire, sent to a random sample of 620 dentists on the GDC register in Wales.ResultsIn total 457 (74%) of the questionnaires were returned. One half of all practitioners stated that patients had asked them about material of relevance to dentistry obtained from the Internet, although in the majority of cases this happened less frequently than once a month. The most common topics enquired after were cosmetic procedures, dental amalgam and implants. A minority of dentists, 47 (11%) viewed the Internet as a threat to the dentist-patient relationship. However, 169 (39%) agreed information gained from the Internet had led to patients demanding inappropriate care or more complex treatment (135/31%). Having to take time to discuss Internet material was viewed as a burden by 93 practitioners. The potential of the Internet to widen inequalities in access to oral health information was agreed upon by one third of respondents. Concerns over the quality and reliability of Internet derived information, together with a lack of knowledge of appropriate sites, prevented dentists using the Internet as an oral health education resource. However, only 18.7% claimed never to use the Internet for their own Continuing Professional Development. Access for CPD purposes was mainly from home. Of those working in general practice, 54 had their own practice website, and a further 103 said this was something they were considering. Email was used to communicate with patients by 42 dentists, mainly to make appointments.ConclusionsViews on the impact of the Internet were generally positive, but there is a long way to go before its full potential is realised. [ABSTRACT FROM AUTHOR]

Reports that a cash grant was awarded to the Welsh National Health Service by the Welsh Assembly Government. Value of the grant; Use of the money to finance a series of Personal Dentist Service (PDS) pilots; Objective of the PDS.

Reports that a full-time dentist has been employed by Pembrokeshire Local Health Board -- the first in Wales -- to provide emergency dental treatment to those people who do not have a National Health Service dentist. Recruitment of Doctor Devendra Rajcoomar from the West Indies; Work in Milford Haven beginning March 2005; Rajcoomar's educational attainment and career history.

Objective To compare the level of prescribing and types of antibiotics prescribed for dental problems by general medical practitioners and dentists. Design Secondary analysis of standard consultation data and prescription records from four different settings. Setting 30 participating general practices in the General Practice Morbidity Database for Wales in 1996. Subjects 1,185 attendances for tooth-related problems, at 30 participating practices in the General Practice Morbidity Database for Wales in 1996. Standard consultation records from a GDP emergency dental rota, and two weekend emergency dental clinics: one in a health centre, the other in a dental hospital. Results More than two thirds (68%) of attendances at general medical practices for tooth-related problems resulted in a prescription for antibiotics. In contrast less than a third (28%) of patients seen by a GDP rota, about half (52%) of patients at a weekend emergency clinic in a health centre, and just more than a third (38%) of patients attending the dental hospital clinic received antibiotics. General medical practitioners were also more likely to prescribe broad-spectrum antibiotics than dentists. Conclusion For acute dental problems general medical practitioners are more likely to prescribe antibiotics than dentists. There also appear to be inter-professional differences in the tendency to prescribe broad spectrum antibiotics. Initiatives to rationalise prescribing for dental conditions may need to target doctors as well as dentists. [ABSTRACT FROM AUTHOR]

For anticoagulation therapy, warfarin is used to reduce the risk of thrombo-embolic events in patients with mechanical prosthetic heart valves, certain cardiovascular conditions, deep vein thrombosis (DVT) and hypercoagulable states.(1). The International Normalised Ratio (INR) is used as a measure of anticoagulation and is expressed as a ratio of the patient's prothrombin time (PT) to control prothrombin time. In a person with a normal PT, the INR is approximately 1. The therapeutic range is the value of INR or degree of anticoagulation required to prevent the development of serious thrombo-embolism and is normally maintained between 2.0 and 4.5. It is important to recognize that the INR is only valid for patients on well controlled anticoagulant therapy, ie where the level of anticoagulation is reasonably stable over a moderate length of time.(2).

Sera were collected from 50 practising dental surgeons and 50 control subjects matched for age (+/- 1 year) and sex. Each participant completed a questionnaire including personal details and, in the case of dentists, information relating to protective work-wear and other cross-infection control measures employed within the surgery. The sera were examined by complement fixation tests for antibodies to influenza A, influenza B, respiratory syncytial virus and adenovirus. The dental group had a significantly elevated prevalence of antibodies to influenza A (P = 0.01), influenza B (P < 0.001) and respiratory syncytial virus (P = 0.001) compared with the controls. More dentists than controls also carried antibodies to adenoviruses, although this difference did not attain statistical significance. Wearing of masks or eye protection did not markedly reduce infection with these viruses among the dentists. It is concluded that dentists are at occupational risk of infection with respiratory tract viruses, and that mask- or spectacle-wearing afford little protection.