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Objective To determine the impact of multiple sclerosis (MS) on patient attendance at dental practices and maintenance of oral health.Design A cross-sectional postal questionnaire-based study.Setting Leicestershire, United Kingdom.Subjects and methods People with MS in Leicestershire identified from local health authority records (n = 476).Main outcome measures Number registered at dental practice, frequency of attendance, issues and perspectives relating to attendance and maintenance of oral health.Results A response rate of 61% (n = 289) was obtained. When compared to the general population, a higher number of people with MS were registered with a dentist (49%:88%) and displayed more frequent practice attendance (71%:81%) in the past year. People with MS reported difficulties in attending a dentist and maintaining oral health, which were exacerbated by deterioration in general health. Problems relating to reduced personal mobility had the greatest impact on attendance.Conclusions MS has a negative impact on perceived patient attendance and maintenance of oral health. Patients with a progressive disability could benefit greatly from the provision of preventive oral health care. The importance of seeking care earlier rather than later needs to be emphasised to both professionals and patients alike. Further efforts are required to increase awareness of the importance of oral health to the quality of life of people with MS and ensure that individuals with physical disabilities receive the same access to dental services as the able-bodied. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This paper assesses the current internal assessment and BDS examination of undergraduate orthodontics in UK dental schools, the changes which have occurred in the last three years, and future changes proposed. Method: Questionnaires were emailed to the undergraduate orthodontic course leaders in each of the UK dental schools. Twelve dental schools agreed to participate in the survey. Responses were checked for completeness, summarised and sent back to individual course leaders to verify. These verified responses were then analysed. Results: There was a wide variation in the form and content of the in-course assessment and the BDS examination in the 12 UK dental schools. The in-course assessment varied from minimal to extensive, and in its percentage contribution to BDS. The use of written, clinical, and particularly patient treatment and laboratory assessments varied considerably from school to school. The format of the BDS examination varied in the number, type and timing of written examinations, in the number of students examined clinically, and in the use of additional examinations of viva, case presentation, or OSCE. Conclusions: Comparison of undergraduate orthodontic courses in UK dental schools revealed a wide variation in student assessment and examination. Current orthodontic internal assessments are inconsistent with no common pattern across the courses, and inconsistencies also exist in the BDS examination. Guidelines for orthodontic assessment and examination are needed to ensure standards and consistency in UK dental schools in the future. [ABSTRACT FROM AUTHOR]

This paper describes the historical origins and purpose of 'evidence-based practice' and describes the barriers to the growth of evidence-based practice within dentistry. It describes a new research agenda-setting process for dentistry, which includes identifying and prioritising the topics of most relevance to the work of primary dental care practitioners. By undertaking the work described in this paper we were striving to make research more relevant to the day to day decisions made by dentists in practice by introducing a new process, the intention being to promote and promulgate the practice of evidence-based dentistry. [ABSTRACT FROM AUTHOR]

The improvement of patient safety has been a long-term aim of healthcare organisations and following recent negative events within the UK, the focus on safety has rightly increased. For over twenty years, clinical audit has been the tool most frequently used to measure safety-related aspects of healthcare and when done so correctly, can lead to sustained improvements. This paper explains how clinical audit is used as a safety improvement tool in an English dental hospital and gives several examples of projects that have resulted in long-term improvements in secondary dental care. [ABSTRACT FROM AUTHOR]

In this paper, the actions needed to manage specific medical emergencies are discussed. Each emergency requires a correct diagnosis to be made for effective and safe management. Contemporary management in dental practice avoids the intravenous route when drugs are required to treat the emergency. [ABSTRACT FROM AUTHOR]

All dental practitioners must be proficient at taking a medical history, examining a clothed patient and recognising relevant clinical signs. The general examination of a patient should take into account findings from the history. This paper does not attempt to address the detailed oral and dental examination carried out by dental practitioners but focuses on the holistic patient assessment - essential for safe patient management. [ABSTRACT FROM AUTHOR]

Objective This paper describes an objective method for assessing the decontamination procedures used for reprocessing dental instruments in primary dental care facilities.Materials and methods The study population comprised all general dental practitioners in Scotland with an NHS list number. A two-stage process was used to identify which surgeries were to be surveyed, using a proportional stratified random sampling method. First, practices were randomly selected in proportion to the distribution of practices within each of the health boards. Then, if there was more than one dentist within a selected practice, simple random sampling was used to identify a single dentist within the selected practice to be approached. The surgery that the dentist worked from and its associated decontamination facilities were the subject of the survey. A set of data collection forms provided questions designed to investigate compliance with extant guidance documents on decontamination. Specific training for the survey team members was provided during a three day course, to ensure consistency of approach. The data collection forms were piloted in 20 dental surgeries.Results A methodology was developed, which utilised both staff interviews and direct observation of decontamination processes. Data were collected on a set of 28 standard forms, which could be machine read. Three hundred and seventy-three dentists were selected at random from the dental practitioners list held by Practitioner Services, Scotland. One hundred and eighty-nine practitioners either declined to participate or could not be contacted at the address supplied. One hundred and eighty-four surgeries were surveyed, data were available for analysis from 179 sites. Data from five sites were rejected because of illegibility (three) and incomplete data (two). Each surgery survey was undertaken by a team of two surveyors, comprising one infection control/decontamination expert and one experienced dental practitioner. The survey team interviewed the dental practitioner and dental nurse, reviewed documentation relevant to the survey, directly observed decontamination practices and recorded the physical layout of the premises.Conclusion The use of machine readable data collection forms, trained survey staff and direct observation of decontamination protocols provides a workable method for accurate collection of decontamination practice in primary care facilities. [ABSTRACT FROM AUTHOR]

The Department of Health's response to the national budget deficit is to ensure that the provision of NHS services is guided by four fundamental 'QIPP' principles: Quality, Innovation, Prevention, and Productivity. This agenda will govern all aspects of the National Health Service's (NHS') health care provision for the foreseeable future. NHS dental services will, like all other NHS services, need to make a contribution to the QIPP agenda. The purpose of this paper is to outline the implications for NHS dentistry. [ABSTRACT FROM AUTHOR]

Care pathways are defined as 'a methodology for the mutual decision making and organisation of care for a well-defined group of patients during a well-defined period'. Although most often used in Europe as a tool to improve the quality of care and to aid the continuity of care between disciplines and settings, care pathways also have an application in underpinning the commissioning process. This paper describes the development of a new model of commissioning for general dental practice services based on a need and risk assessment linked to specified care pathways for preventive care. In this system dentists are monitored on adherence to care protocols based on nationally accepted guidelines for preventive care interventions as well as recommended recall intervals for routine dental examinations. A traffic light system to distinguish between patients with different levels of need and risk of disease is being used. [ABSTRACT FROM AUTHOR]

In December 2009, members of the newly redeveloped Primary Care Dentistry Research Forum (http://www.dentistryresearch.org) took 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 received the most votes formed 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.This paper details a summary of the findings of the fourth critical appraisal. In conclusion, there is a lack of evidence relating to dentists' perceptions of prevention and its application in practice. Qualitative primary research is needed to look at UK dentists' views and attitudes relating to their understanding of prevention and its application in practice. [ABSTRACT FROM AUTHOR]

A healthcare curriculum must be up-to-date, fit for purpose and relevant to the population it serves wherever that population might be, worldwide. In this paper we describe the rationale for the design and implementation of a curriculum in a new dental school in UK. We assessed the general and dental health needs of our local population and proposed a set of core skills our dentists will need on graduation and in the future. This core learning falls into three domains of learning. The psychomotor domain covers the learning of technical skills for which we use the shorthand 'hands'. The affective domain covers empathy and behaviour management, that is the 'heart'; and the cognitive domain including critical thinking, the 'head'. The three domains require different ways of learning but all are delivered in context in an integrated, case-based spiralling curriculum building in complexity year on year. Students treat patients from half way through year 1, which helps them appreciate the relevance of the 'hands', 'heart' and 'head' of dentistry as they begin to build their knowledge and experience. [ABSTRACT FROM AUTHOR]

This paper gives an overview of the strategic background for procurement of NHS primary care dental services and an outline of the processes involved in procurement. The main aim is to bring procurement to the attention of a wider audience of dental practitioners and provide advice for potential primary care dental service providers. The move towards local procurement of healthcare services, including primary care dental services, has been shaped by a number of strategic Government publications and is supported by law. In line with other public bodies, the NHS is subject to the European Union and international rules regarding procurement and awarding contracts. Primary Care Trust (PCT) Dental Service Commissioners have to ensure that their procurement strategy is transparent and non-discriminatory so that all providers have an equal opportunity to compete for contracts. In order to successfully tender for future service provision contracts, dental practitioners not only need to be aware of the process of procurement and its associated legal requirements. It is also important that they have a grasp of the expectations of PCTs. Commissioning services via procurement is set to become more commonplace and it is likely, in time, that competition for some contracts will increase in intensity. The importance of researching proposals thoroughly and adopting a professional, businesslike approach to tendering cannot be understated as this maximises chance of success in the new commissioning environment. [ABSTRACT FROM AUTHOR]

The Editor-in-Chief of the BDJ has previously raised important questions about dental workforce planning and the implications for dental graduates of recent changes and pressures. It is now time to revisit this issue. Much has changed since the last workforce review in England and Wales, and the rate of change is in all probability set to increase. First, at the time of writing this paper the momentous step of including dental care professionals (DCPs) on General Dental Council (GDC) registers in the United Kingdom has recently been completed. Second, the Scope of Practice of all dental professionals has been under consultation by the General Dental Council, and research evidence suggests that greater use should be made of skill-mix in the dental team. Third, within England, Lord Darzi has just published the 'Final Report of the NHS Next Stage Review', which emphasises 'quality care' and 'team-working' as key features of healthcare; this report was accompanied by an important document entitled 'A High Quality Workforce', in which plans for local workforce planning within the NHS are outlined, placing responsibilities at national, local and regional levels. Fourth, policy makers across the UK are wrestling with addressing oral health needs, promoting health and facilitating access to dental care, all of which have implications for the nature and shape of the dental workforce. Fifth, with the impact of globalisation and European policies we are net gainers of dentists as well as having more in training. Sixth, although there have been reviews and policy initiatives by regulatory, professional and other bodies in support of shaping the dental workforce, there has been little serious consideration of skill-mix and funding mechanisms to encourage team-working. Together, these events demand that we enter a fresh debate on the future dental workforce which should extend beyond professional and national boundaries and inform workforce planning. This debate is of great importance to future generations of dental healthcare professionals, funders, commissioners and providers of both dental services and dental education and training, and most importantly our patients and the public whom we serve. Furthermore, workforce planning must be linked to a philosophy of care which promotes promotion of health and embraces quality care, rather than merely treatment of disease, and addresses oral health needs and demands. [ABSTRACT FROM AUTHOR]

This paper reports on a survey of the attitudes of general dental practitioners (GDPs) and dental nurses to continuing education. This has become the subject of increased policy attention in recent years. The Adult Dental Health Survey of 1998 indicated that in order to meet the increase in requirements for the provision of Dental Health Services in the UK the Professions Complementary to Dentistry (PCDs) would be required to play a greater role in the delivery of dental services. In 2001, the Government undertook a review of the dental workforce, with a remit to look at ways to modernise the education and training system for dentists and the other members of the dental team. [ABSTRACT FROM AUTHOR]

As a profession we have a responsibility to ensure that the oral health needs of individuals and groups who have a physical, sensory, intellectual, medical, emotional or social impairment or disability are met. In the UK, over 200,000 adults have profound learning disabilities and/or complex medical conditions. Adults with a disability often have poorer oral health, poorer health outcomes and poorer access to services than the rest of the population. This paper examines the need for Special Care Dentistry based on a review of published literature, surveys and health policy, and suggests how services might be delivered in the future. Existing models of good practice reveal that established clinicians working in this field have a patient base of between 850 and 1,500 patients per year and work across primary care and hospital settings, liaising with colleagues in health, social services and the voluntary sector to ensure integrated health care planning. On this basis, a conservative estimate of 133 specialists is suggested for the future, working in networks with Dentists with Special Interests (DwSIs) and primary dental care practitioners. A skilled workforce that can address the wider needs of people requiring Special Care Dentistry should be formally recognised and developed within the UK to ensure that the needs of the most vulnerable sections of the community are addressed in future. [ABSTRACT FROM AUTHOR]

Personal dental services (PDS) are new forms of NHS dental care in England that employ a locally negotiated contract as opposed to one based on a nationally negotiated scale of fees. These schemes have been specifically designed to tackle local problems related to access and oral health needs. This practice paper examines the main findings of a Department of Health-funded evaluation from 20 first and second wave PDS pilots. The paper reveals that all PDS pilots changed treatment profiles in an attempt to meet local oral health needs and/or promote access to NHS dentistry. Moreover, PDS pilots appeared to encourage a new skill-mix, provide job satisfaction and improve working conditions. PDS pilots appear to have provided an opportunity to change the culture of primary dental care provision to one based on quality rather than on activity and cost. Their experiences should help inform the implementation of NHS Dentistry: Options for Change. [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]

The soon to be published White Paper Our Healthier Nation will set out the Government's new public health agenda for the NHS. To improve oral health and reduce inequalities it is vitally important that the dental profession becomes an active player in the implementation of this policy. Each member of the dental team has an important role to play in oral health promotion. [ABSTRACT FROM AUTHOR]

This article is the first in a series of four, which explore the oral and dental health of male prisoners in the United Kingdom. The series comprises: an overview of the general and oral health status of male prisoners, a discussion on how multi-disciplinary team working can be used to benefit the care of patients in prison environments and a description of the future planning of dental services for male prisoners. The oral health of prisoners is linked to their general health status, due in part to the presence of common risk factors such as smoking, drinking alcohol and in some cases use of recreational drugs, poor dietary and poor oral hygiene habits. Barriers to healthcare services can all have an effect on oral disease in this group. This paper highlights some of the common medical problems that oral healthcare providers face when treating prisoners in male UK prison establishments. [ABSTRACT FROM AUTHOR]

Skin cancer is common and an increasing problem in the UK. It frequently occurs on the head and neck skin. A significant proportion of the adult population in the UK visits the dentist each year, thus making dental practitioners ideally placed to identify suspicious lesions, which could be skin cancer, as part of their routine extra-oral examination. These patients can then be referred on to hospital or their GP for further management. The dentist can also give advice on risk factors and self-monitoring to patients. This paper aims to describe the risk factors, pathology, presentation and treatments for the three most common forms of skin cancer - basal and squamous cell carcinomas, and malignant melanoma, to give the dental practitioner the knowledge and confidence to examine for and identify these skin cancers. [ABSTRACT FROM AUTHOR]

Background There is increasing evidence of the inappropriate use of antimicrobials in dentistry and this may contribute to the problem of antimicrobial resistance. The research to date with regard to efficacy of antimicrobial prophylaxis in reducing failure of integration and postoperative complications when placing dental implants remains equivocal. The aim of this study was to investigate how dentists in the UK use antimicrobials prophylactically in implant practice.Method An e-mail link was provided in 2011 to an anonymous online (Smart-Survey) questionnaire using three databases of dentists who, by being on them, had registered an interest in placing dental implants. Absolute frequencies were used to describe the study sample demographics and examine the distribution of responses for all the variables investigated.Results One hundred and nine completed questionnaires were received. Seventy-two percent (n = 76) routinely prescribed prophylactic antibiotics for all procedures. There was a wide variation in the pre-operative and postoperative prescription regimens with the majority (84%) stating that it was to prevent infection at the site of surgery or to reduce a bacteraemia.Conclusions Although this was a small study with a low response rate, wide variations in antibiotic prescribing regimens with respect to drug, dose and duration were found. Further research is needed and guidelines developed to prevent antibiotic overprescribing and misuse. [ABSTRACT FROM AUTHOR]

Data sourcesBritish Nursing Index, CINAHL, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects), EMBASE, Medline, PsycINFO and the reference lists of eligible papers were searched.Study selectionStudies that focused on practitioners with special interests (PwSIs) or roles clearly created/defined to be practising with special interests, detailing innovative ways of working with a special interest with evidence of formal evaluation of changing role of location of service from systematic reviews or interventions were included. Surveys of views on changing skill-mix or location of services, studies that did not concern dental or medical professionals, dental care or nursing professionals were excluded. Only studies in English and with a UK focus were included.Data extraction and synthesisAll titles and abstracts identified were screened for relevance. Two authors assessed quality and extracted data, queries were reviewed by a third author and a narrative synthesis was presented.ResultsTwenty-six papers met the criteria with a strong bias towards the medical literature. Five categories emerged:(i) specialist outreach; (ii) general practitioners with a special interest; (iii) nurse practitioners with a special interest; (iv) dental care professionals; (v) out-of-hospital services. Evidence showed specialist outreach clinics to be effective in relation to access and patient satisfaction with some having a higher quality of care but higher cost. However there may be cost-benefits associated with this care, particularly when part of a multifaceted intervention. There is controversy and a limited evidence as to whether the services provided by medical PwSIs are effective, and whether the benefits outweigh the risk and the cost. From the evidence obtained through early innovation, it appears that these services can increase access and are more satisfying for patients, and that these roles have the potential to bring more work satisfaction to the practitioners. Overall, the findings do support the view that moving specialist care into the primary care setting via appropriately trained nurse practitioners is an effective use of resources, but with the caveat that nurse practitioners in primary care are not necessarily cost-effective. There is evidence that professionals complementary to dentistry (PCDs) are able to diagnose a range of conditions and, with appropriate training, complete a wide range of dental procedures as well as dentists, but much of the evidence for other aspects of substitution was of lower quality, weak or insufficient.ConclusionsThere was limited evidence of the cost-effectiveness and health outcomes associated with changes in setting and skill-mix. However, there was evidence of improved access, patient and professional satisfaction. There is an overwhelming need for well-designed interventions with robust evaluation to examine cost-effectiveness and benefits to patients and the health workforce. [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]

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. [ABSTRACT FROM AUTHOR]

In this second part of a two-part report, further findings of a postal questionnaire sent in March 2005 to dentists with an interest in paediatric dentistry working in varied UK settings are presented and discussed in the context of current multi-agency good practice in safeguarding and promoting the welfare of children. Using insights gained from a survey of self-reported management of children with neglected dentitions, this paper explores whether paediatric dentists neglect child dental neglect. The authors conclude that current practice already includes much that contributes to promoting children's oral health and wellbeing. However, in a society where children continue to suffer as a result of abuse and neglect, they warn that improvements are needed in communication between dentists and other health and social care professionals if children's welfare is to be safeguarded and promoted effectively and future tragedies avoided. [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 practise that they felt most needed to be answered with conclusive research. The question which received the most votes formed 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.This paper details a summary of the findings of the fifth critical appraisal. The results of the critical appraisal conclude that there is a lack of evidence relating to perceptions of oral health in deprived areas. There were no studies identified that have compared the perceptions of oral health among people from deprived areas with those from non-deprived areas in the UK. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to assess by means of a postal questionnaire the numbers of general dental practitioners (GDPs) who used clinical photography and for what application.Method The questionnaire was distributed to 1,000 randomly selected dentists in the UK with an explanatory letter and reply paid envelope. The data collected was computerised and analysed statistically.Results Five hundred and sixty-two replies were received. Of the respondents, 48% used clinical photography, with 59% using a digital camera, 34% a 35 mm camera and 19% a video camera. Principal uses of clinical photography were treatment planning (84%), patient instruction/motivation (75%), medico-legal reasons (71%) and communication with the laboratory (64%).Conclusion Clinical photography was used by 48% of general dental practitioner respondents. [ABSTRACT FROM AUTHOR]

The aims of this paper are to provide an impartial overview of the proposals and agenda for the future brought together in the NHS Dentistry: Options for Change document in the context of previous dental service delivery in primary care, and to start to explore what Options for Change could mean for the future of NHS dental services. Options has been described as perhaps the most radical and ground breaking opportunity for NHS dentistry to finally move forward after prolonged periods of stagnation and disharmony. The Options agenda has the potential to bring in a new style of NHS practice for dentistry, providing a way to finally get off the current 'treadmill' and to develop new NHS dental services where prevention is a priority and providing high quality dental treatment, tailored to the long term needs of the 21st century patient, is the driving aim. However, the difficulties on all sides of leaving behind decades of disputes and overcoming real access, workforce and funding issues must not be underestimated or dismissed. The report was prepared by a working group comprising representatives from the profession, of patient groups and various sections of the Department of Health in England which was brought together by the then Chief Dental Officer. The key themes and priorities for action identified in Options include: local commissioning and funding, methods of remuneration for general dental practitioners, prevention and an oral health assessment for patients, clinical pathways, information and communication technology, practice structure, development of the dental team and the patient experience. The document also contains comprehensive reports of the three Options for Change task groups making recommendations for: 1) a new deal for patients - national standards, 2) systems of delivery of dental care and 3) education, training and development of the dental team. Ways forward for delivering improved, modern, effective, preventive, patient-centred dental care have been identified. This potential can, however, only be realised if viable and sustainable agreements can be achieved to operationalise the best choices. [ABSTRACT FROM AUTHOR]

Periodontal disease continues to be a major concern for dentists and patients. This paper reports the findings of the 1998 UK Adult Dental Health survey in relation to plaque, calculus, periodontal pocketing and loss of attachment. It is apparent from this study that moderate periodontal disease remains commonplace amongst UK adults and that the associated risk factors of plaque and calculus are in abundance, even amongst those who profess to be motivated about their oral health and attend the dentist regularly. The continued high prevalence of disease needs to be seen in the context of the far larger number of people who are now potentially at some risk, particularly in the older age groups, because of improvements in tooth retention. However, the cumulative effect of disease means that control of the periodontal diseases, even mild and slowly progressing disease, will be a key issue if large numbers of teeth are to be retained into old age. If that level of control is to be achieved we need a widespread improvement in our management of the disease, particularly in our ability to improve the oral cleanliness of the UK population. [ABSTRACT FROM AUTHOR]

Background The 'restructuring' of the NHS over the last decade has demanded a 'market oriented' service more receptive to the needs and priorities of 'clients' receiving health care. These changes have been important to the provision of dental health care in which there has been a similar need to provide increasingly patient and market oriented services. One of the ways in which quality care has been assessed within NHS Trusts is through the national 'Chartermark' award, which identifies national centres of excellence in health care and research. Aim The aim of this paper is to assess whether patients themselves considered the criteria identified by the Chartermark award important in the provision of good quality dental services Method This is a pilot study consisting of a structured questionnaire conducted face-to-face with a 'convenience' sample of 46 patients. Analysis Data were inputted into SPSS and thematic analysis was conducted on the data. Results The Chartermark criteria relevant to patient involvement were divided into four main themes. The findings from this small pilot study suggest that in relation to dental care, although patients are interested in information on standards, performance and complaints, there is considerable disinterest in organisational and financial dimensions. [ABSTRACT FROM AUTHOR]

Reducing inequalities in health has become one of the main health policy issues in the late 1990s. The Labour Government set up an independent inquiry into inequalities in health under Sir Donald Acheson to make recommendations on approaches to reducing health inequalities. This paper reviews the evidence on inequalities in oral health in Britain. Dramatic improvements in dental health in children and young adults have taken place in the past 30 years. The levels of caries in permanent teeth of children is low. Widening inequalities in oral health however exist between social classes, regions of England, and among certain minority ethnic groups in pre-school children. The main social class and minority ethnic differences in dental caries is in pre-school children. Wide district and regional differences also exist in prevalence of caries in young children. The area differences relate very strongly to deprivation. In adults the differences in decay experience is less unequal than in children but there are marked social class inequalities in edentulousness. Dental caries decreased in all social classes in the United Kingdom. The main causes of the inequalities are differences in patterns of consumption of non milk extrinsic sugars and fluoridated toothpaste. Improvements in oral health that have occurred over the last 30 years have been largely a result of fluoride toothpaste and social, economic and environmental factors. Oral health inequalities will only be reduced through the implementation of effective and appropriate oral health promotion policy. Treatment services will never successfully tackle the underlying cause of oral diseases. [ABSTRACT FROM AUTHOR]

The Cochrane Collaboration was founded in 1993 as an international, non-profit and independent organisation dedicated to making up-to-date, accurate and reliable information about healthcare readily available. This paper discusses how the Cochrane Oral Health Group reviews have contributed to the oral health evidence base used in the development of many international and UK dental guidance documents, particularly in the field of paediatric dentistry. [ABSTRACT FROM AUTHOR]

Dental general anaesthesia (DGA) is only permitted within a hospital setting where critical care facilities are available. Recently, concern has been expressed about the number of hospital admissions for the dental care of children following the publication of a high profile paper which highlighted an apparent increase in children being admitted for extractions due to caries under DGA. Coincidentally new best practice standards for paediatric DGA services have been published. An evaluation of DGA services in Yorkshire and the Humber suggested that existing monitoring was inadequate and is unlikely to represent true levels of activity and that any apparent increase may reflect the method of remuneration for services. In fact, recent changes in service structure and changes to improve quality have reduced DGA activity in some areas. In addition, the evaluation revealed that many services were not meeting standards of best practice. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the journal's plan to introduce the hybrid model of open access papers to authors and the issue of direct access (DA) for patients to dental care professionals (DCPs) in Great Britain.

Since the introduction of the Points Based Immigration System to the UK the opportunities for overseas trained dentists to train in the UK have been limited. This paper describes a new opportunity which has resulted from the Tier 5 Medical Training Initiative. [ABSTRACT FROM AUTHOR]

Introduction Patient reported outcomes of care are increasingly used as a measure of the quality of care. There has been a recent expansion in the number of dental therapists trained in the UK, and with legislation now permitting therapists to take on a wider role in dental practice, patients' perceptions about quality of care provided by therapists is an important issue.Objectives To investigate whether there were any differences in patient satisfaction after a visit to a therapist, compared to a visit to a dentist.Method A ten-item scale of patient satisfaction (Dental Visit Satisfaction Scale), which provides an outcome measure of overall patient satisfaction as well as three sub-scale outcomes (information-communication; understanding-acceptance; and technical competence) was used. A total of 240 questionnaires were given to consecutive patients attending an appointment with a therapist and 400 questionnaires were given to patients attending dentists, in eight different dental practices.Results Four hundred and thirty-one (67.3%) questionnaires were returned. Patients attending therapists were found to have a significantly higher level of overall satisfaction (p <0.001) and also in all three sub-scales (p <0.001), than those attending appointments with dentists.Conclusion Although a clear distinction in patient satisfaction according to the type of provider was found, the reasons behind this finding are unclear, and so care needs to be taken in interpreting the results, with further work undertaken to explore this phenomenon more fully. [ABSTRACT FROM AUTHOR]

Presents letters to the editor about dental care in Great Britain published in the February 23, 2002 issue of the 'British Dental Journal.' Experiences of misfitting dental crowns; Deterioration over time of output from light curing units; Occlusal misconceptions.

Dental nurses have reported dissatisfaction with their work which is associated with feelings of lack of control and being undervalued. This paper examines some of the possible reasons behind job dissatisfaction with illustrations from a pilot study conducted in general dental practice. [ABSTRACT FROM AUTHOR]

Over the past few years there has been a significant increase in the number of dentists and dental care professionals (registrants) having conditions placed on their practice either by the General Dental Council or NHS area teams. There are a number of reasons for this including the fact that patients complain more often, colleagues are now expected to alert the authorities if poor practice is detected and the demographics of the dental profession in the UK are changing. Steps have already been taken to prevent dentists getting into difficulty, such as the development of requirements for continued professional development by the GDC and past initiatives at a local level set up to assist dentist in difficulty. The regional offices of Health Education England and equivalent organisations in Wales and Scotland assist registrants in difficulty in meeting these conditions. Little published research has been carried out into this important service which has had to develop rapidly over the past few years. There is a need to investigate the current service, the views of those dental professionals being assisted and those providing the support to inform the further development of the service. This paper provides an introduction to a planned series of research papers reporting on our investigation into the service provided by HEE teams. [ABSTRACT FROM AUTHOR]

Objective To analyse the factors affecting the clinical performance and those influencing the survival of resin-retained bridgework provided at a UK dental teaching hospital between 1994 and 2001.Design A prospective analysis of restorations provided at a single centre using case notes with all patients invited for review to corroborate findings.Setting Department of Restorative Dentistry, University of Bristol Dental Hospital and School, Bristol, United Kingdom.Subjects and methods Between January 1994 and December 2001, data regarding 1,000 consecutive resin-retained bridges provided at Bristol Dental Hospital and School were recorded. Data was available for 805 patients at the time of the study. Following invitation, 621 patients attended for a review appointment. Life table and Kaplan-Meir survival analysis were carried out for all restorations provided.Results The five-year and ten-year survival rates estimated by the life-table method are 80.8% (95% confidence interval 78.0-83.6%) and 80.4% (95% confidence interval 77.6-83.2%) respectively. The median survival cannot be estimated for this study as the survival probability remains above 80% even at the longest follow-up. Analysis of clinical variables influencing survival revealed that design of the restoration and experience of the operator providing the restoration were significant factors. Resin-retained bridges made with minimal tooth preparation are shown to be superior in terms of longevity than those for which other types of tooth preparation is made. Patient satisfaction with their treatment was high. [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 health care 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]

Aims To investigate the working patterns and patient base of registered clinical dental technicians (CDTs); their relationships with dentists and other professionals in the dental team; their willingness to work within the NHS and their expectations for the future as a new professional group.Methods Face-to-face qualitative interviews of registered CDTs, selected because of their geographic representation and mode of working, informed the development of a postal questionnaire survey of all early registrants with the General Dental Council (GDC).Results The majority of CDTs reported working part-time, often combining clinical practice with their role as a dental technician. They reported both positive and negative working relationships with dentists and dental technicians, demonstrating collaboration and/or competition depending on whether the scope of CDTs was respected and patient care was shared or lost. CDTs role in the NHS was limited because they did not have the status of becoming a recognised provider of dental care. There was a desire to expand their scope of practice in future.Conclusion CDTs are embracing their new status as an occupational group within dentistry. Core features of becoming a professional group were exhibited including the importance of social and financial status and the need to negotiate their current and future roles in the healthcare system. [ABSTRACT FROM AUTHOR]

Background Recently, positive consent has been required for dental surveys in some parts of the UK. Concerns have been raised that when positive consent is used participation is reduced in deprived areas and reported caries levels are biased as a consequence. This paper analyses caries data collected under positive and negative consent arrangements to explore this issue further.Method Retrospective analysis of response rates by deprivation fifth and by caries experience of participating children in NHS coordinated dental surveys in Wales undertaken from 2001/2 until 2005/6 using negative consent and in 2007/8 using positive consent.Results Across Wales, the change from negative to positive consent was associated with greatly decreased participation. In comparison with previous surveys there was a large increase in children sampled but not examined. The decrease in the proportion of children sampled, who were examined and found to have no decay was similar across all deprivation fifths, with no obvious deprivation-related trend. There was a much larger reduction in the number of children with decay who participated across all quintiles of deprivation.Conclusion Caries status could be a more important factor than deprivation regarding opting out of the survey. It appears that children with caries are more likely to be opted out of the survey than similarly deprived peers without caries. Parents appear to be more likely to opt children with caries out of dental surveys when positive consent is used. These findings have significant implications for targets aimed at improving oral health which were set before the change in consent procedures, but reported upon after. [ABSTRACT FROM AUTHOR]

The author reflects on dental care access in Great Britain. He comments on the figures that cause inconsistency between National Health Services (NHS) and British Dental Association (BDA) regarding the access to NHS dental service. He highlights the paper by Penchansky and Thomas which defines the characteristics of dental care access. He also comments on the advantage and disadvantage of large number of dental care utilization. He presents some suggestions on how to improve oral health access.

Objective To investigate, by postal questionnaire, aspects of the selection and use of direct restorative materials, endodontic techniques and approaches to bleaching by general dental practitioners in the UK, and to compare and contrast the findings with those of a related study reported in 2004.Methods A questionnaire comprising 18 questions, each of a number of elements, was sent to 1,000 general dental practitioners in the UK, selected at random from the Dentists Register. Non-responders were sent a second copy of the questionnaire after a period of four weeks had elapsed.Results A total of 662 useable responses were returned, giving a response rate of 66%. Key findings included: dental amalgam was found to be the most commonly used material in the restoration of occlusoproximal cavities in premolar (59% of respondents) and molar teeth (75% of respondents); glass-ionomer cements and related materials were applied extensively in the restoration of deciduous molars (81% of respondents) and for the luting of indirect restorations (67% of respondents); the use of rubber dam was limited, in particular as an adjunct to procedures in operative dentistry (18% of respondents); relatively few respondents used preformed stainless steel crowns, and among the users only occasionally in the restoration of deciduous molars (23%); and bleaching, predominantly home-based (nightguard) vital bleaching (81% of respondents) was widely practised.Conclusion It is concluded that, for the practitioners surveyed, factors other than best available evidence influenced various aspects of the use of direct restorative materials and the clinical practice of endodontics. As a consequence, many of the features of general dental practice revealed in the process of the investigation were at variance with teaching in dental schools. Bleaching, in particular home-based (nightguard), vital bleaching, was provided by >80% of respondents, indicating widespread interest among patients in enhanced dental attractiveness. [ABSTRACT FROM AUTHOR]

Brushing teeth twice a day forms the main theme of the Colgate/BDA Oral Health Month program which is taking place in Great Britain throughout September 2003. This theme of brushing teeth is possibly both obvious and a little condescending to patients who keep hearing this message all the time. After all, surely everyone knows by now that dentists, hygienists, oral health educators and everyone involved in health care all preach the message of twice-daily brushing. Messages for regular tooth-brushing in the prevention of dental caries have occasionally been contradictory in the past, resulting in confusion in the minds of both patients and dental educators. patients. The Colgate/BDA Oral Health Month reminds dentists that their involvement, whether they are general practitioners, specialists, hospital or community practitioners, remains paramount. Dentists cannot abdicate the provision of oral hygiene to the rest of the dental team. Everyone in the practice must continue to stress its importance, either by backing up advice given by oral health educators, hygienists and therapists, or by remembering to repeat the message when contemplating treatment plans.

Objective: To investigate attitudes and opinions of the members of the British Dental Association towards implementing tobacco cessation strategies in dental practices. Design and Method: Questions about tobacco and tobacco cessation were asked on the September 2002 BDA Omnibus survey. The survey was sent out to a random sample of 1,500 BDA members, excluding retired members, overseas members and students. After two reminder circulations, 870 completed questionnaires were received, giving a response rate of 58%. Results: The survey results revealed good awareness amongst respondents of the health risks of tobacco. One fifth of respondents said that patients had asked them for advice on tobacco cessation. The majority (64%) of respondents stated that they gave advice on tobacco cessation 'fairly regularly' or 'always' (whether asked or not) and 37% of respondents recommended over-the-counter nicotine replacement therapy. Overall, 68% of respondents agreed that offering patients advice about tobacco cessation was the duty of every dentist. The most common barriers to a successful tobacco cessation campaign were perceived to be the amount of time required, lack of reimbursement, lack of training, lack of patient education materials and lack of knowledge of available referral resources. Nearly all respondents (92%) said that their practice was a completely smoke-free environment, and 66% of respondents had never used tobacco. The majority of respondents displayed patient education materials in their practice waiting/reception areas less than 60% of the time, and nearly a quarter (23%) never had them available. The survey revealed that most respondents did not feel particularly well prepared to assist patients in quitting tobacco, but 70% of respondents said they would be willing to cooperate with a campaign to inform all tobacco using patients about the advantages of tobacco cessation. Respondents felt that leaflets for patients, staff training and posters in the practice would contribute to the success of the campaign. Conclusion: Members of the dental team are very willing to implement tobacco cessation strategies in the dental practice. Most dentists feel that promotion of tobacco cessation is an important part of the duty of a dentist, but they feel inadequately prepared to deliver such advice. The major barriers to delivering successful tobacco cessation campaigns are the amount of time required, lack of reimbursement, lack of training, lack of patient education materials and lack of knowledge of available referral resources. The majority of dentists have received no training in tobacco cessation strategies. They feel that staff training and free availability of more patient education materials (leaflets, posters, etc) would help promote the success of such a campaign. [ABSTRACT FROM AUTHOR]

Background The 'restructuring' of the NHS over the last decade has demanded a 'market oriented' service more receptive to the needs and priorities of 'clients' receiving health care. These changes have been important to the provision of dental health care in which there has been a similar need to provide increasingly patient and market oriented services. One of the ways in which quality care has been assessed within NHS Trusts is through the national 'Chartermark' award, which identifies national centres of excellence in health care and research. Aim The aim of this paper is to assess whether patients themselves considered the criteria identified by the Chartermark award important in the provision of good quality dental services Method This is a pilot study consisting of a structured questionnaire conducted face-to-face with a 'convenience' sample of 46 patients. Analysis Data were inputted into SPSS and thematic analysis was conducted on the data. Results The Chartermark criteria relevant to patient involvement were divided into four main themes. The findings from this small pilot study suggest that in relation to dental care, although patients are interested in information on standards, performance and complaints, there is considerable disinterest in organisational and financial dimensions. [ABSTRACT FROM AUTHOR]

Provides information on the historical background and evolution of clinical dentistry in Great Britain from 1880 to 2005. Role of Queen Victoria of Great Britain in the development of denture in the late 1800s; Year when the method for restoring or replacing tooth tissue was developed by William Henry Taggart; Reason behind the reintroduction of ether in extractions in 1872.

Objectives: A cross-sectional national survey to explore perceptions of dental fluorosis and to determine the proportion of people regarding fluorosis as aesthetically objectionable at differing levels of defect. Methods: A survey using a multistage stratified random probability sample of 6,000 UK adult households. Face-to-face interviews were carried out using a structured questionnaire and photographs of different levels of dental fluorosis. Respondents were interviewed about the parameters of satisfaction, attractiveness and need for treatment for dental fluorosis. Results: The proportion of respondents perceiving teeth as unattractive, unsatisfactory and requiring treatment increased with increasing severity of dental fluorosis. Using agreement between the three negative perceptions as a measure, 14% of the sample perceived mild dental fluorosis as aesthetically objectionable, 45% at moderate level and 91% at severe levels. Conclusion: Negative perceptions of dental fluorosis were lower than reported previously. Three parameters were included in the approach to estimate aesthetically objectionable fluorosis which may provide a more realistic measure than those used previously. The nature of the index and the sample included suggest that findings of this survey provide a reasonable indicator of the likely impact of water fluoridation. Findings may have important implications for fluoridation policies in the United Kingdom and elsewhere. [ABSTRACT FROM AUTHOR]