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Objectives To develop a patient's attitude questionnaire regarding prevention in oral health for use internationally. Methods Using a mixed methods approach, a questionnaire was developed and refined as part of ADVOCATE (Added Value for Oral Care) study, involving partners in six countries: Netherlands, Hungary, Denmark, Ireland, Germany, and the UK. A literature review explored the history of oral healthcare delivery systems to develop a template for each of the six ADVOCATE countries. A systematic review identified the perceived barriers and facilitators to preventive oral healthcare and underpinned a topic guide and established the patient questionnaire domains. Focus groups in each ADVOCATE country developed the first version of the questionnaire. Patient and Public Involvement and Engagement (PPIE) in each ADVOCATE country tested the questionnaire and led to further refinement. The questionnaire was produced in five languages. Content validity and reproducibility used principal component analysis (PCA) and exploratory factor analysis (EFA) refined the questionnaire. Results The literature review aided an understanding of each country's oral healthcare system, and the findings from the 25 studies identified in the systematic review found the main barriers/facilitators to preventive oral healthcare were cost, knowledge (preventive treatments and advice), and a patient awareness and adherence to preventive advice/treatments. Interviews and focus groups with 148 participants in the ADVOCATE study identified receiving the appropriate level of care/feeling valued, cost, level of motivation/priority, not feeling informed, knowledge, and skill mix as the main barriers/facilitators. Fifty-three PPIE members refined the questionnaire. The pilot questionnaire was tested with 160 participants. Non-essential or highly correlated variables were then removed, leaving 38 items, covering 6 domains (cost, advice received, advice wanted, message delivery, motivation, knowledge, and responsibility) within the questionnaire. A second pilot test-run was undertaken with 185 participants. The test-re-test reliability demonstrated strong consistency of responses between the two time points (kappa range 0.3–0.7, most p

Objective: To use a discourse analysis approach to identify salient features in the lived experiences of dental professionals in relation to explaining periodontal (gum) disease to patients. Methods: Interview data from 13 UK-trained and three internationally-trained dental professionals was examined using thematic discourse analysis. The first stage (discourse analysis) focused on the identification of language patterns in the interview data. This stage forms the focus of this paper. Findings: Six discourse categories (Clinician, Collaborator, Educator, Rapport Builder, Mentor and Professional) were identified that related to the participants’ perceived professional roles. The categories were associated with differing worldviews and language use patterns, but with some overlap. All interviewees used a variety of discourse categories in their accounts, but a few relied predominantly on one category, e.g., Clinician or Mentor. Conclusions: The local discourse categories identified in this study reflect broader discourses in healthcare relating to the roles of providers and patients, which have evolved through time. Practice implications: Practising dental professionals are faced with a diverse range of patients who have different communication preferences. A suite of discourse categories can act as a ‘toolbox’ that dental professionals can flexibly draw on when needing to adopt a role that could predispose a particular patient to positive oral health behaviour change.

Background/Aims: Tooth auto-transplantation is a treatment option, which is often not considered to replace anterior maxillary incisors in children and adolescents. There are multiple prognostic factors that may influence the outcomes of premolar auto-transplantation, but there is limited evidence from human studies. The aim of this study was to report the outcomes of auto-transplanted premolars in the anterior maxilla following traumatic dental injuries (TDIs) and to identify their prognostic factors. Materials and Methods: The clinical records of patients who had premolars transplanted in the anterior maxilla following TDI, with appropriate radiographs and a minimal of 1-year follow-up, were reviewed retrospectively. A specific data extraction form was developed, tested and used to collect information for the prognostic factors and outcomes. Results: The cohort included 120 patients with 144 auto-transplanted premolars. The mean age was 12.2 years (±2.0), and the mean observation period was 3.7 years (±1.8). The success rate was 80%, and the survival rate was 93%. Unfavourable outcomes included external replacement resorption in 12.5%, uncontrolled external inflammatory resorption in 2.7%, and both resorption types in 4.9% of teeth. Periodontal healing was significantly associated with donor tooth root maturity, graft handling at the time of surgery including ease of donor tooth extraction and placement at the recipient sites, recipient site alveolar bone status, and post-operative transplant mobility. Seventy-four teeth (53.4%) were immature at the time of transplantation where pulp revascularisation was anticipated, and 52 (70%) of those had radiographic and clinical signs of pulp healing. Pulp healing was significantly related to donor tooth eruption stage, ease of extraction of donor tooth, and ease of placement in the recipient site. Conclusions: Good outcomes were observed for premolar teeth auto-transplanted in the anterior maxilla. The main prognostic factors were ease of extraction of donor tooth and ease of placement in the recipient sites and donor tooth root maturity.

Background In 2020/21, as part of the COVID-19 pandemic response and for the first time in England, newly qualified foundation dentists (FDs) were trained to participate in flu and COVID-19 vaccination programmes to offer additional workforce capacity. The largest of these efforts was in Yorkshire and the Humber where 106 FDs were trained and ready to mobilise. The aim of this service evaluation was to appraise the use of FDs in delivering vaccinations. Methods Mixed methods using an online questionnaire to FDs and in-depth remote interviews conducted with host organisations, Public Health England, Health Education England and others. Results The questionnaire response rate was 89% (n = 94), with 54 FDs having participated in vaccinations at a rate of 50-100 vaccines per day. All were confident with flu vaccine administration and most (n = 44/54) with COVID-19 vaccination. Eleven stakeholder interviews were conducted. Main barriers included the siloed delivery of dental care from other health services, resulting in collaborative barriers and a lack of understanding about the profession's skillsets. Facilitators included host organisations' capacity to hold multiple honorary contracts and provide competency sign-off. Conclusion Utilising the dental workforce to deliver vaccinations was feasible at a time of crisis and when trainees' access to dental patients was limited., Key points Key stakeholders planning and delivering the 2020/21 flu vaccination programme in Yorkshire and the Humber recognised a workforce gap created by programme expansion as part of the COVID-19 pandemic response. Foundation dentists were invited to support the flu programme and later, the COVID-19 vaccination programme.Strong system leadership and collaboration between a wide range of healthcare organisations supported innovative solutions for training, indemnity, host-employment arrangements and competency sign-off. Foundation dentists mobilised for flu vaccinations were ready to be rapidly transferred to support the COVID-19 vaccination programme.In the context of limited access to dental patients due to the pandemic, foundation dentists were able to be trained to deliver vaccinations safely and effectively and their contribution to vaccination programmes was valued.

ObjectivesCurrent evidence suggests that periodontal disease could be a causal risk factor for rheumatoid arthritis (RA) onset and progression. Earlier periodontal intervention in individuals at risk of RA could provide a unique opportunity to prevent or delay the onset of RA. This study aimed to explore the acceptability of periodontal treatment as a measure to potentially prevent RA among at-risk individuals and healthcare professionals.MethodsSemistructured interviews were conducted with anti-CCP positive at-risk individuals (CCP+ at risk) and a range of healthcare professionals. At-risk participant data were analysed using reflexive thematic analysis; subsequent coding of healthcare professional data was deductive, based on a preidentified set of constructs.ResultsNineteen CCP+ at-risk and 11 healthcare professionals participated. Three themes (six subthemes) were identified: (1) understanding risk (knowledge of shared at-risk factors; information and communication); (2) oral health perceptions and experiences (personal challenges and opportunities for dental intervention and oral health maintenance; external barriers) and (3) oral health treatment and maintenance (making oral health changes with the aim of preventing RA; acceptability of participation in periodontal research).ConclusionsPeriodontal disease is common in individuals at risk of RA, but the impact of poor oral health may not be well understood. Oral health information should be tailored to the individual. CCP+ at-risk participants and healthcare professionals identified seeking dental treatment can be hindered by dental phobia, treatment costs or inability to access dentists. While CCP+ at-risk individuals may be reluctant to take preventive medications, a clinical trial involving preventive periodontal treatment is potentially acceptable.

This research aimed to identify and explore perceived challenges and facilitators to acquiring routinely collected oral healthcare data for research in six European countries with the aim of generating practical solutions for future initiatives. Seventeen participants from the UK, Denmark, Germany, Hungary, Ireland and the Netherlands participated who were either data requestors or data providers for the ADVOCATE project. Focus groups using the nominal group technique were undertaken using PESTLE as a theoretical framework to guide the discussion. The data were analysed using content analysis. Four main challenges were identified: 1) legality rules influencing the data available, 2) variations in data standardisation/coding between countries, 3) relationships and responsibilities between stakeholders, and 4) data not available for secondary use. The facilitators included: 1) having a framework in place to guide the process, 2) having strong relationships between stakeholders, 3) having technical elements in place to support the process, and 4) taking a pragmatic approach to the available data. It is hoped that identifying these challenges will raise awareness of potential issues for undertaking such research and that tackling these and building on the facilitators will establish stronger foundations for the sharing of data within and across disciplines and countries.