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Objective Attendance at accident and emergency departments (A&E) for non-traumatic dental conditions (NTDC) is increasing in high-income countries. Not all NTDC visits to A&E are inappropriate; however, those that are take up capacity with conditions which are adding to the pressure regarding cost and healthcare utilisation for A&E departments. The scale of this problem is yet to be understood in the United Kingdom (UK). The aim of this study was to systematically review the literature to identify peer-reviewed research publications reporting non-traumatic dental presentations at A&E departments in the UK.Data sources A structured search of Cochrane Library, EMBASE, MEDLINE, CINAHL, PsycINFO, Scopus and Web of Science databases from their earliest date to May 2018. Hand-searching of identified articles that met the inclusion criteria was also reviewed.Data selection Publications were included if they were primary research on A&E users in the UK with NTDC as the primary reason for the A&E visit.Data extraction Data were extracted on the study, patient and visit characteristics.Data synthesis Studies were assessed for methodological quality and the analysis took the form of a narrative review.Conclusion There is limited evidence, of variable quality, to inform on the extent of inappropriate presentations of patients with non-urgent NTDC to A&E departments in the UK. The evidence supports the hypothesis that dental patients are inappropriately seeking care for NTDC at A&E departments and this may be a driver of unnecessary antibiotic prescriptions. Further research should focus on the reasons for this occurrence.

Objective: To investigate job satisfaction among hygienist-therapists. Increasing numbers of hygienist-therapists work in UK primary dental care teams. Earlier studies suggest a clinical remit/clinical activity mismatch, without investigating any link with job satisfaction., Methods: A UK-wide survey of dental hygienist-therapists using a random sample of the General Dental Council Register of Dental Care Professionals. Factors associated with job satisfaction (measured by the Warr-Cook-Wall ten-dimension scale) were entered into a series of multiple regression analyses to build up a path model., Results: Analysis was undertaken on 183 respondents (response rate: 60%). Mean score for overall satisfaction was 5.36 (SD 1.28) out of a range of 1-7. Multiple regression analysis confirmed the following direct predictors of overall job satisfaction: satisfaction with colleagues, remuneration, variety of work; rating of hygiene work as rewarding; and not being self-employed (R(2) = 0.69). Satisfaction with variety of work was the strongest predictor, itself strongly predicted by the extent the clinical remit was undertaken. Dentists' recognition of their remit, quality of clinical work and qualifications had a strong indirect effect on overall job satisfaction., Conclusions: The study suggests both greater use of the therapy skills these individuals possess, and better recognition of their remit, qualifications and quality of work by their dentist colleague, may be linked to higher job satisfaction. The implications for the policy of greater team working in dental primary care are discussed.

Objectives: To determine whether practising dental therapists, including dually qualified hygienist/therapists, considered themselves to be part of the clinical team and whether clinical work referred to them met with their expectations., Methods: A postal survey enquired about work experiences of UK dental therapists, as previously described earlier in the series., Results: While they certainly considered themselves to be part of the clinical team, the majority of respondents did not feel 'fully utilised'. Seventy percent of respondents felt that the dentist had more patients that could be referred and 55% thought that they could do more extensive work. There was concern that dentists lacked awareness of therapists' clinical potential, although some respondents highlighted very positive experiences in practice., Conclusions: Dental therapists feel that they are part of the clinical team but consider that their skills are not fully utilised in many cases. There is scope for raising awareness among dentists regarding the therapists' clinical potential as well as sharing ideas for good working practice both within individual clinical settings and between different practices.

Objectives: To enquire into current remuneration arrangements among UK dental therapists and to explore the nature of any financially related concerns., Methods: Part of the postal survey of therapists described in the previous paper in this series., Results: The majority of therapists (63%) often work in multiple locations and therefore may be in receipt of more than one type of payment mechanism. Two thirds of therapists are paid an hourly rate in at least one of the locations where they work; just over half are paid a fixed monthly amount and one third are self-employed. Nine percent of respondents were receiving performance-related pay, using goal setting, incentives and bonuses. A number of financially-related concerns were identified., Conclusion: Diverse payment systems were reported. Some aspects could present important implications for future recruitment and retention.

Objectives: To conduct a survey of current working practices of UK dental therapists following the changes in permitted duties, allowed clinical settings and the introduction of the new dental contract in England and Wales., Methods: A piloted postal questionnaire was circulated in 2006 to all General Dental Council (GDC) registered therapists and those on the hygienists register possessing a dental therapy qualification. Two subsequent mailings were used to boost the response rate., Results: There was an 80.6% response rate (n = 587). Ninety-eight percent of respondents were female. Average time since qualification was 17 years. Eighty percent (n = 470) of respondents were currently working as a dental therapist, 53% part-time. Of the 470, half were engaged entirely in general dental practice (GDP), one third in the salaried dental services (SDS), while others worked across different settings. Only 39% claimed to spend most of their time treating children. Recently qualified therapists more often worked in GDP (p <0.001). Overall, a wide range of clinical duties were performed, although there was concern about maintaining skills across all the competencies since qualification, while emphasis on hygiene work was a limiting factor for some. On the basis of the continued professional development (CPD) activities described over one year, only half would have met the GDC CPD requirements from August 2008 for dental care professionals (DCPs)., Conclusions: More than half of therapists now work in GDP, compared with none six years previously. Many undertake a full range of duties. However, there was concern that some dentists use them for hygiene skills rather than across the whole range of their competencies, risking deskilling, while others reported their inability to gain employment as a therapist.

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