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Introduction: In 2018, the General Dental Council introduced reflective practice as part of an Enhanced Continuing Professional Development (ECPD) system, mandatory for registrants in the United Kingdom. The aim of this pilot study was to investigate dental professionals' perceptions and practice of reflection and to explore the benefits of an evidence-informed reflective practice learning course., Material and Methods: This study was conducted at two dental schools in the United Kingdom (UK). A short course on reflective practice which included pre- and post-course surveys, using closed- and open-ended questions, was afforded to dental professionals attending Continuing Professional Development (CPD) courses. Quantitative data were analysed using SPSS version 25.0 software, and responses to open-ended questions were explored by content analysis., Results: Fifty-two dentists attending the short course provided responses; the majority were female (73%, n = 38) and internationally qualified (60%, n = 31). The pre-course questionnaire revealed that the majority of participants (94%; n = 49) considered reflection as part of their professional practice, with 55% (n = 29) reporting doing so daily. Most (88%; n = 46) had received no formal training. The post-course questionnaire revealed that 88% (n = 46) found the course useful as it gave a "systematic and schematic" approach enhancing the participants' understanding of reflective practice., Conclusion: The findings suggest that a theoretically informed short course on reflective practice was welcomed by participants who showed a strong interest in learning how to reflect supported by mentors. This pilot provides the basis for further research on reflective practice., (© 2021 The Authors. European Journal of Dental Education published by John Wiley & Sons Ltd.)

To evaluate the association between dentists' profile and health work management with the performance of primary care dental teams in the Brazilian National Health System, both nationally and regionally. Secondary data analysis from a Brazilian National Programme that evaluated 18,114 Brazilian dental teams, working in the public sector, between 2013 and 2014. Twenty-four independent variables taken from dentists' profile and dental team management characteristics were analysed to assess their influence on reported "dental team performance." An estimated score was generated from their performance on 20 dental procedures by an item response theory model. Multiple linear regression models were performed for each Brazilian geographical region, separately and for the whole of Brazil. p values ≤ 0.05 were considered significant. Two variables related to dentists' profile, "having graduate studies" ( β = 0.151) and "undertaking continuing professional development training" ( β = 0.101), were associated with enhanced dental team performance in all five Brazilian geographical regions and nationally. The dental team management variables of "having a flexible dental appointment list" ( β = 0.218) and "monitoring oral health indicators" ( β = 0.132) also contributed to improve team performance in each of the regions and nationally. Dentists' profile influenced the performance of dental teams from south region more than the other regions. The findings suggest that continuing professional development, including postgraduate education, and strategic management characteristics are important for primary dental care performance and should be reflected in health policy initiatives in support of quality care. Regional factors could be considered for health care management., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Suellen da Rocha Mendes et al.)

Aim To review the key determinants of health and wellbeing among dentists working in the UK.Methods Rapid review of the literature (1996-2018) across seven health and social science databases through OVID and the Cochrane Library, professional and health system sources. Records were screened according to agreed inclusion and exclusion criteria by title, abstract and full text. Data extraction and qualitative synthesis of the included studies were performed. Quality assessments for risk of bias were made using a mixed methods appraisal tool.Results Thirty-eight studies met the criteria for inclusion. Fourteen were assessed as high, 22 as medium and two of low quality, most involving cross-sectional research in the form of questionnaire surveys. Whereas overall, the health and wellbeing of dentists within the UK is reported as 'good', recently published evidence suggests a less positive view may be emerging. The health and wellbeing of dentists is associated with a wide range of factors: personal, professional career, relationships, job specification, workplace and system. Emerging evidence suggests additional concerns about the regulation of dentistry. Workplace characteristics were most often explored among researchers and reported as being a key issue.Conclusion Evidence highlights multiple determinants of health and wellbeing, most notably related to workplace characteristics; however, while there is a relative lack of well-founded prospective research investigating the nature and direction of the relationships and comparison across UK health systems, there is increasing evidence of health and wellbeing concerns that require further investigation.

Objectives: First, to assess the psychometric properties of key questions included in a public sector evaluation of primary dental care in Brazil; and second, to evaluate the performance of dental teams in relation to these items., Methods: Secondary analysis of a national primary care dataset monitoring quality and access to dental care. Data were collected through face-to-face interviews with representatives of dental teams participating in the 'National Programme for Improving Access and Quality of Primary Care'. Twenty-three mandatory questions about the dentists' reported delivery of dental procedures were included in the analysis. Item Response Theory (IRT) modelling was applied to measure the psychometric properties of the instrument-level of difficulty and discrimination parameter of each item-and then to estimate dental team performance scores based on these parameters. Based on IRT, possible scores ranged from -4 to +4., Results: Three of the 23 mandatory items were removed due to poor internal consistency, resulting in a scale of 20 items for assessing dental team performance. The results showed variation in procedures delivered by the dental teams; whilst more than a half of the procedures were executed by at least 80% of the dental teams, those relating to dentures (partial/total) and frenectomy (lingual/labial) were performed by less than 30%. Amongst the 20 items included in the model, those related to partial/total dentures and oral cancer follow-up presented higher levels of difficulty and were less frequently provided. The items relating to the treatment of deciduous teeth and access to the dental pulp of permanent teeth had the highest discrimination parameters and, consequently, greater weight in the performance's score estimation; therefore, dental teams that did not perform these items had the lowest performance scores. In the present study, dental team performance scores ranged from -3.66 to +1.87 with a mean/median of -0.06/+0.01., Conclusion: The findings suggest that whilst the items within the instrument demonstrated some potential to discriminate between poor and very poor teams, they were ineffective in discriminating between poor and good teams. Whilst Brazilian dental teams perform many mandatory procedures, variation in the nature of their delivery of care requires further investigation to enhance service provision to the population., Competing Interests: The authors have declared that no competing interests exist.

Aim To investigate clinical dental technicians' (CDTs) current working practices and their perception as registered dental professionals regarding their practice of dentistry, role and relationships in the dental team and within the UK healthcare system.Methods A postal questionnaire was sent to all 304 CDTs registered with the United Kingdom General Dental Council in September 2015, which included an information sheet and a consent form. Data were entered onto a computer and analysed using SPSS and free text responses were analysed using thematic analysis.Results A response rate of 37.8% was achieved. The majority of participants were male (93%), based in England (83%), working full time (66.4%), in the private sector (89.4%) and spending up to 50% of their time working as a CDT carrying out clinical work. CDTs reported barriers to their progression being the lack of an NHS contract and their limited scope of practice, which they wished to have extended to further their skill set and include direct access to provide partial dentures without a dentist's prescription.Conclusion There was some evidence that CDTs are becoming more recognised and valued members of the dental team. While CDTs felt they had progressed since their establishment in 2007, the respondents considered there was still a need for progress to be made towards integration within the dental system and recognition by the public. CDTs wished to see changes to their performer status and to have a wider scope of practice. The majority of CDTs work in the private sector, thus there is a need to explore their future roles within the state dental provision.

Objective: The aim of this review was to examine the migration motives, the barriers to and facilitators of integration of international dental graduates, compared with nurses and doctors in the United Kingdom., Methods: Electronic databases Ovid MEDLINE, EMBASE, PubMed, Web of Knowledge and OECD publications were systematically searched for English language publications from January 2000 to January 2017. A total of 31 qualitative studies were selected and quality appraised and meta-synthesis of the qualitative data was carried out using framework synthesis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to present the findings., Results: There were no studies on migration motives and one study on integration experiences of international dentists in the UK. The nursing literature had the highest volume and quality of evidence on nursing workforce, whilst there was limited literature on international doctors in the UK. Migration of health professionals to the UK is determined by personal and professional factors, together with source country-specific and UK drivers. Active recruitment, post graduate training and financial gain act as strong common macro, meso and micro drivers that perpetuate migration into the UK, but the extent to which each of these drivers influence nurses' and doctors' migration is different. Integration experiences for international nurses and doctors differed based on their source country experiences and the work environment they entered. Nurses reported a wider knowledge and skills gap, more multi-level discrimination and less career progression compared to the doctors. The migrants' integration experiences depend on their cultural awareness, discrimination exposure, English language and communication skills, social and professional support networks, social integration and personal attributes., Conclusion: Migration of international health professionals is motivated by macro, meso and micro drivers at the international, national, professional and personal levels. The UK has strong common macro pull factors which attract nurses, doctors and dentists and may impact on the effectiveness of policies to restrict their migration. The integration experiences of nurses and doctors differ and further research is required to understand the integration experiences of dentists, in order to retain these professionals by tailoring policies to each of these professions.

Background: Oral diseases affect most of the global population. The aim of this paper was to provide a contemporary analysis of 'human resources for oral health' (HROH) by examining the size and distribution of the dental workforce according to World Health Organization (WHO) region and in the most populous countries., Method: Publically available data on HROH and population size were sourced from the WHO, Central Intelligence Agency, United Nations, World Bank and the UK registration body. Population-to-dentist and dental-workforce ratios were calculated according to WHO region and for the 25 most populous countries globally. Workforce trends over time were examined for one high-income country, the UK., Results: The majority of the world's 1.6 million dentists are based in Europe and the Americas, such that 69% of the world's dentists serve 27% of the global population. Africa has only 1% of the global workforce and thus there are marked inequalities in access to dental personnel, as demonstrated by population to dental-workforce ratios. Gaps exist in dental-workforce data, most notably relating to mid-level clinical providers, such as dental hygienists and therapists, and HROH data are not regularly updated. Workforce expansion and migration may result in rapid changes in dentist numbers., Conclusion: Marked inequalities in the distribution of global HROH exist between regions and countries, with inequalities most apparent in areas of high population growth. Detailed contemporary data on all groups of HROH are required to inform global workforce reform in support of addressing population oral health needs., (© 2018 FDI World Dental Federation.)

Throughout the life course, oral diseases are some of the most common non-communicable diseases globally, and in Europe. Human resources for oral health are fundamental to healthcare systems in general and dentistry is no exception. As political and healthcare systems change, so do forms of governance. The aim of this paper is to examine human resources for oral health in Europe, against a workforce governance framework, using England as a case study. The findings suggest that neo-liberalist philosophies are leading to multiple forms of soft governance at professional, system, organisational and individual levels, most notably in England, where there is no longer professional self-regulation. Benefits include professional regulation of a wider cadre of human resources for oral health, reorientation of care towards evidence-informed practice including prevention, and consideration of care pathways for patients. Across Europe there has been significant professional collaboration in relation to quality standards in the education of dentists, following transnational policies permitting freedom of movement of health professionals; however, the distribution of dentists is inequitable. Challenges include facilitating employment of graduates to serve the needs and demands of the population in certain countries, together with governance of workforce production and migration across Europe. Integrated trans-European approaches to monitoring mobility and governance are urgently required., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Dentists with a special interest hold enhanced skills enabling them to treat cases of intermediate complexity. The aim of this study was to explore primary dental care practitioners' views of dentists with a special interest (DwSIs) in Endodontics in London, with reference to an educational and service initiative established by (the former) London Deanery in conjunction with the NHS., Methods: A cross-sectional postal survey of primary care dentists working across different models of care within London was conducted, with a target to achieve views of at least 5 % of London's dentists. The questionnaire instrument was informed by qualitative research and the dental literature and piloted prior to distribution; data were analysed using SPSS v19 and STATA v12.0., Results: Six per cent of London's primary care dentists (n = 243) responded to the survey; 53 % were male. Just over one third (37 %; n = 90) were aware of the DwSI service being provided. Most practitioners reported that having access to a DwSI in Endodontics would support the care of their patients (89 %; n = 215), would carry out more endodontic treatment in the NHS primary dental care if adequately reimbursed (93 %; n = 220), and had more time (76 %; n = 180). Female respondents appeared to be less confident in doing endodontic treatment (p = 0.001). More recently qualified respondents reported greater need for training/support for performing more endodontic treatment in the NHS primary dental care (p = 0.001), were more dissatisfied with access to endodontic service in the NHS primary dental care (p = 0.007) and more interested to train as a DwSI in endodontics (p = 0.001) compared with respondents having a greater number of years of clinical experience since qualification., Conclusion: The findings lend support to the concept of developing dentists with enhanced skills as well as ensuring additional funding, time and support to facilitate more routine endodontics through the NHS primary care to meet patient needs. More recently qualified dentists working in London were more concerned regarding endodontic service access, expressed need for training/support for undertaking more endodontic treatment in the NHS primary dental care and a desire to train as a DwSI in endodontics.

Background: A medium- and long-term perspective is required in human resource development to ensure that future needs and demands for oral healthcare are met by the most appropriate health professionals. This paper presents a case study of the Sultanate of Oman, one of the Gulf States with a current population of 3.8 million, which has initiated dental training through the creation of a dental college., Objectives: The objectives of this paper are first to describe trends in the dental workforce in Oman from 1990 to date and compare the dental workforce with its medical counterparts in Oman and with other countries, and second, to consider future dental workforce in the Sultanate., Methods: Data were collected from published sources, including the Ministry of Health (MoH), Ministry of Manpower (MoM), and Ministry of National Economy (MoNE)-Sultanate of Oman; the World Health Organization (WHO); World Bank; and the Central Intelligence Agency (CIA). Dentist-to-population ratios were compared nationally, regionally and globally for medicine and dentistry. Dental graduate outputs were mapped onto the local supply. Future trends were examined using population growth predictions, exploring the expected impact in relation to global, regional and European workforce densities., Results: Population growth in Oman is increasing at a rate of over 2% per year. Oman has historically been dependent upon an expatriate dental workforce with only 24% of the dentist workforce Omani in 2010 (n = 160). Subsequent to Oman Dental College (ODC) starting to qualify dental (BDS) graduates in 2012, there is an increase in the annual growth of the dentist workforce. On the assumption that all future dental graduates from ODC have an opportunity to practise in Oman, ODC graduates will boost the annual Omani dentist growth rate starting at 28% per annum from 2012 onwards, building capacity towards global (n = 1711) and regional levels (Gulf State: n = 2167) in the medium term., Conclusion: The output of dental graduates from Oman Dental College is improving the dentist-to-population ratio and helping the Sultanate to realize its aim of developing an Omani-majority dental workforce. The implications for retention of dentists and team training are discussed.

Background: Despite overall improvements in oral health, a large number of children in United Kingdom (UK) are affected by dental caries; and the implementation of oral health promotion in some families remains a challenge. As such, children from those families suffer high caries rates, and are frequently referred for tooth extraction under General Anaesthesia (GA), one of the commonest reasons for paediatric hospital admissions. The aim of this investigation is to explore referring primary care General Dental Practitioners' (GDPs) views and experiences in trying to promote better oral health for those children., Method: A qualitative study, utilizing face-to-face, semi-structured interviews with GDPs in three London boroughs who refer children for extraction of decayed teeth under GA selected based on referral rate. Qualitative Framework Analysis was used to present the results., Results: Eighteen GDPs (56% male) were interviewed: average age 42 years (range: 26-73 years). informants reported challenges to promotion of oral health categorised as: (1) child's young age, poor cooperation, and high treatment need; (2) parental skills to face up to modern day challenges and poor attitudes towards good oral health (3); social inequality, exclusion and cultural barriers in immigrant families; (4) National Health Services (NHS) primary care practice remuneration, constraints and training; (5) inadequate secondary care communication and engagement; and (6) failure in establishing national policy to grasp the width and depth of the problem., Conclusion: GDPs feel frustrated and isolated in their efforts to promote oral health in those children. These findings suggest difficult challenges on all fronts. Reform of preventive dentistry funding and delivery, as well as a multiagency multidimensional approach that is mindful of the social determinants of children's oral health and barriers to application of oral and wider health initiatives are needed to address this important public health issue.

Comprehensiveness relates both to the scope of services offered and to a holistic clinical approach. The aim of this study was to identify the perception of Brazilian dentists regarding key concepts of comprehensiveness and its importance in primary health care oral health services performed in the public sector. Focus groups were conducted to explore three main concepts, 'patient welcoming', 'bonding' and 'quality of care', as well as their aspects. In total, there were four focus groups comprising seven general dentists, all of whom had at least two years of experience in primary care, from municipalities of varying sizes. Discussions of approximately 60 minutes were conducted, audio-recorded and transcribed. The data were analysed by qualitative thematic analysis, in line with the framework approach. The general dentists reported that they are aware that in the Brazilian Health System, the onset of patient care by primary health care services must happen through 'patient welcoming.' Nevertheless, they suggested that this action is often performed poorly due to the large volume of patients. Although they knew the importance of 'bonding', they realised that there is a lack of education preparing professionals to address interpersonal and social issues. They were aware that 'quality of care' is related to multiple factors. Comprehensiveness, as an approach in dental public health practices, needs to be enhanced, and there is evidence that primary care dentists are aware of the need for such an approach.

Objectives: To quantitatively identify the perception of dentists regarding comprehensiveness and its domains of "patient welcoming", "bonding" and "quality of care" in primary dental care settings of a large Brazilian city., Methods: A questionnaire was administered to all dentists comprising the primary health care service to Belo Horizonte with tenured jobs and 40 work hours per week, totalling a population of 207 professionals. The response rate was 90.34%. A pilot test was conducted with 44 dentists working in primary care for at least two years and who did not participate in the main study. Descriptive statistical analysis involved calculating proportions. No confidence intervals were calculated because this was a census study., Results: In most items (79.0%), professionals' perceptions about the comprehensiveness were overwhelmingly positive. When we stratified the analysis by domain and checked those items about which dentists had a less favourable perception, 22.7% were in the patient welcoming domain, 25.0% were in the bonding domain and 12.5% were in quality of care., Conclusions: Comprehensiveness, as an approach in health care practice, needs to be enhanced, and there is evidence that these dentists are aware of its importance.

Background: Brunei Darussalam is a Sultanate with a Malay Islamic monarchy. There are high levels of dental disease among its 406,200 population. The population's oral health needs require an integrated blend of primary and specialist care, together with oral health promotion., Process and Outcomes: This paper describes the planning and measures taken to address these needs. In accordance with an oral health agenda published and launched in 2008, focusing on access, health promotion and prevention, and the education and training of the dental workforce, the Brunei Darussalam Ministry of Health is seeking to improve oral health status and reduce the burden of oral disease. It also seeks to transform the country's oral health services into a preventatively orientated, high-quality, seamless service underpinned by the concept of 'teeth for life'. In the process of effecting this transition, the Brunei Darussalam Ministry of Health is developing a dental workforce fit for future purpose, with an emphasis on a modern approach to skill mix. An important element of this programme has been the development of a highly successful Brunei Darussalam Diploma in Dental Therapy and Dental Hygiene., Conclusion: It is concluded that the Brunei Darussalam oral health agenda and, in particular, the forward-looking programme of dental workforce development is a model for other countries facing similar oral health challenges., (© 2013 FDI World Dental Federation.)

Background: Dentistry in the UK has a number of new graduate-entry programmes. The aim of the study was to explore the motivation, career expectations and experiences of final year students who chose to pursue a dental career through the graduate entry programme route in one institution; and to explore if, and how, their intended career expectations and aspirations were informed by this choice., Method: In-depth interviews of 14 graduate entry students in their final year of study. Data were transcribed verbatim and analysed using framework analysis., Results: There were three categories of factors influencing students' choice to study dentistry through graduate entry: 'push', 'pull' and 'mediating'. Mediating factors related to students' personal concerns and circumstances, whereas push and pull factors related to features of their previous and future careers and wider social factors. Routes to Graduate Entry study comprised: 'early career changers', 'established career changers' and those pursuing 'routes to specialisation'. These routes also influenced the students' practice of dentistry, as students integrated skills in their dental studies, and encountered new challenges.Factors which students believed would influence their future careers included: vocational training; opportunities for specialisation or developing special interests and policy-related issues, together with wider professional and social concerns.The graduate entry programme was considered 'hard work' but a quick route to a professional career which had much to offer. Students' felt more could have been made of their pre-dental studies and/or experience during the programme. Factors perceived as influencing students' future contribution to dentistry included personal and social influences. Overall there was strong support for the values of the NHS and 'giving back' to the system in their future career., Conclusion: Graduate entry students appear to be motivated to enter dentistry by a range of factors which suit their preferences and circumstances. They generally embrace the programme enthusiastically and seek to serve within healthcare, largely in the public sector. These students, who carry wider responsibilities, bring knowledge, skills and experience to dentistry which could be harnessed further during the programme. The findings suggest that graduate entry students, facilitated by varied career options, will contribute to an engaged workforce., (© 2011 Newton et al; licensee BioMed Central Ltd.)

Background: Research into the motivation and expectations of the emerging workforce and their short-term expectations has already been reported with a view to informing professional and policy decisions. The objective of this component of the research programme was to examine the long-term goals and perceived influences on final year dental students' professional careers., Methods: Univariate analysis of a self completed questionnaire survey of all final year dental students from King's College London, comprising questions on demography, long-term career goals and influences, proposed commitment to dentistry, commitment to healthcare systems and the influences thereon. Statistical analysis included Chi Squared tests for linear association., Results: Ninety per cent of students responded to this survey (n = 126), the majority of whom were aged 23 years (59%), female (58%) and Asian (70%). Long-term career goals were fairly evenly split between 'dentist with a special interest' (27%), 'primary dental care practitioner' (26%) and 'specialist' (25%), with 19% not certain. Only 60% of total respondents anticipated working full-time in the long-term (79% males cf 52% females; p = 0.00). The vast majority of respondents (> or =80%) identified 'work-life balance', 'financial stability' and 'professional development' as 'important' or 'very important' influences on the number of future sessions. Females were significantly more likely to rate childcare commitments as an important influence on their future working capacity compared with males (p = 0.00). A wide range of factors were considered important or very important in making the NHS attractive, led by support for professional development (88%) and feeling valued by patients (88%), as well as funding, time with patients, rewards for prevention and practical issues such as dental materials and premises. Females were significantly more likely than males to be attracted to work within the NHS by 'childcare support' (p = 0.02), 'retraining facilities after career break' (p = 0.01), 'assistance with student debt' (p = 0.01) and 'incentives to work in deprived areas'., Conclusion: Long-term career plans of new graduates from this London Dental School commonly embrace opportunities for professional development as well as personal issues such as work/life balance and financial income. Significant differences were identified between male and females long-term plans and influences. The implications of these findings are discussed.

Dentists, managing highly prevalent oral disease are in demand across the world and hence potentially highly mobile. Both the United Kingdom and Australia, continue to be favourable destinations for migrant dentists. This paper undertakes a comparative analysis of the professional integration of migrant dentists in the UK and Australia, and health system responses, while explicating implications for future health workforce governance. In doing so, the paper adopts a system-thinking approach to analyse interactions between the migration system and other societal systems. This is the first multi-country study to analyse the professional integration of migrant dentists through the lens of health workforce and migration governance. The study draws on semi-structured qualitative interviews with migrant dentists in both countries, together with national systems registration and examination data and relevant policies, together with data from government and global datasets. Both countries are high-income countries with a relatively large dentist-to-population ratio maintained through reliance on migrant dentists. The health systems and migration governance have responded by increasing the number of local graduates with limited success in the UK, potentially due to organisational demands, and the multifactorial complex mutual influences between higher education systems, labour market, feedback loops and dentist migration systems creating a nexus. [ABSTRACT FROM AUTHOR]

Preventive care in dental settings, and beyond, has the potential to make a real difference to patients' general and oral health. The aim of this article is to support frontline dental teams, working across NHS and private systems, to engage with the evidence-based resource: 'Delivering Better Oral Health' (DBOHv4). This is a key resource for busy dental professionals on the front line. Regularly updated, it brings together the existing body of evidence on clinical prevention in an accessible contemporary digital format. [ABSTRACT FROM AUTHOR]

Introduction: Regulatory processes for Oral health care professionals are considered essential for patient safety and to ensure health workforce quality. The global variation in their registration and regulation is under-reported in the literature. Regulatory systems could become a barrier to their national and international movement, leading to loss of skilled human resources. The General Dental Council is the regulatory authority in the UK, one of the nine regulators of health care overseen by the Professional Standards Authority.Aim: The aim of this paper is to present the professional integration experiences of internationally qualified dentists (IQDs) working in the UK, against the background of regulation and accreditation nationally.Methods: Registration data were obtained from the General Dental Council to inform the sampling and recruitment of research participants. Semi-structured interviews of 38 internationally qualified dentists working in the United Kingdom were conducted between August 2014 and October 2017. The topic guide which explored professional integration experiences of the dentists was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis to detect themes.Results: Internationally qualified dentist's professional integration was influenced by factors that could be broadly classified as structural (source country training; registration and employment; variation in practising dentistry) and relational (experiences of discrimination; value of networks and support; and personal attributes). The routes to register for work as a dentist were perceived to favour UK dental graduates and those qualifying from the European Economic Area. Dentists from the rest of the world reported experiencing major hurdles including succeeding in the licensing examinations, English tests, proving immigration status and succeeding in obtaining a National Health Service performer number, all prior to being able to practice within state funded dental care.Conclusion: The pathways for dentists to register and work in state funded dental care in UK differ by geographic type of registrant, creating significant inconsistencies in their professional integration. Professional integration is perceived by an individual IQD as a continuum dictated by host countries health care systems, workforce recruitment policies, access to training, together with their professional and personal skills. The reliance of the UK on internationally qualified dentists has increased in the past two decades, however, it is not known how these trends will be affected by UK's exit from the European Union and the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: In Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL.Methods: A dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the 'International Caries Classification and Management System (ICCMS)' tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S5&6P and S6P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need.Results: To meet the needs of a single year-group of childrens' needs, an average of 163 DTs (range: 133-188) would be required to deliver Conventional care (CC); 39 DTs (range: 30-45) to deliver basic Surgical and Preventive care (S6P); 54 DTs for more extended Surgical and Preventive care (S5&6P) (range 38-68); and 27 DTs (range: 25-32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565-6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255-1438 DTs) to deliver basic Surgical and Preventive care (S6P); 2,000 DTs (range 1590-2236) for more extended Surgical and Preventive care (S5&6P) (range 1590-2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016-1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251-488) for the S6P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586-1179) would be needed for the S5&6P scenario in which all teeth with distinctive and extensive caries into dentine are extracted.Conclusion: The study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel. [ABSTRACT FROM AUTHOR]

The levels and types of oral health problems occurring in populations change over time, while advances in technology change the way oral health problems are addressed and the ways care is delivered. These rapid changes have major implications for the size and mix of the oral health workforce, yet the methods used to plan the oral health workforce have remained rigid and isolated from planning of oral healthcare services and healthcare expenditures. In this paper, we argue that the innovation culture that has driven major developments in content and delivery of oral health care must also be applied to planning the oral health workforce if we are to develop 'fit for purpose' healthcare systems that meet the needs of populations in the 21st century. An innovative framework for workforce planning is presented focussed on responding to changes in population needs, service developments for meeting those needs and optimal models of care delivery. [ABSTRACT FROM AUTHOR]

The aim of this article is to encourage general dental practitioners (GDPs) to obtain feedback from patients on a regular basis and act on it. This article will familiarize clinicians with the current concepts of patient experience, patient satisfaction and patient reported outcome measures. It will explore the reasons why dentists should engage in seeking patients' opinions and will shed light on some of the validated questionnaires which are in use in the UK and internationally. Aspects of care considered important by patients are explored and important questions which should be included when developing individual practice questionnaires are highlighted. We build on previous Dental Update articles on this subject by taking the reader through the concept of the Plan Do Study Act (PDSA) cycle and how this can be utilized. This paper will not only allow dentists to improve and grow their practices, but also contribute towards clinical governance and the ethos of patient-centred care. CPD/Clinical Relevance: This article enables dental professionals to appreciate the importance of obtaining patient feedback on key issues relating to their dental care. It suggests ways in which dental teams could engage in obtaining patient feedback and act upon it to develop the quality of services. [ABSTRACT FROM AUTHOR]

Background: In primary care dentistry, strategies to reconfigure the traditional boundaries of various dental professional groups by task sharing and role substitution have been encouraged in order to meet changing oral health needs.Aim: The aim of this research was to investigate the potential for skill mix use in primary dental care in England based on the undergraduate training experience in a primary care team training centre for dentists and mid-level dental providers.Methods: An operational research model and four alternative scenarios to test the potential for skill mix use in primary care in England were developed, informed by the model of care at a primary dental care training centre in the south of England, professional policy including scope of practice and contemporary evidence-based preventative practice. The model was developed in Excel and drew on published national timings and salary costs. The scenarios included the following: "No Skill Mix", "Minimal Direct Access", "More Prevention" and "Maximum Delegation". The scenario outputs comprised clinical time, workforce numbers and salary costs required for state-funded primary dental care in England.Results: The operational research model suggested that 73% of clinical time in England's state-funded primary dental care in 2011/12 was spent on tasks that may be delegated to dental care professionals (DCPs), and 45- to 54-year-old patients received the most clinical time overall. Using estimated National Health Service (NHS) clinical working patterns, the model suggested alternative NHS workforce numbers and salary costs to meet the dental demand based on each developed scenario. For scenario 1:"No Skill Mix", the dentist-only scenario, 81% of the dentists currently registered in England would be required to participate. In scenario 2: "Minimal Direct Access", where 70% of examinations were delegated and the primary care training centre delegation patterns for other treatments were practised, 40% of registered dentists and eight times the number of dental therapists currently registered would be required; this would save 38% of current salary costs cf. "No Skill Mix". Scenario 3: "More Prevention", that is, the current model with no direct access and increasing fluoride varnish from 13.1% to 50% and maintaining the same model of delegation as scenario 2 for other care, would require 57% of registered dentists and 4.7 times the number of dental therapists. It would achieve a 1% salary cost saving cf. "No Skill Mix". Scenario 4 "Maximum Delegation" where all care within dental therapists' jurisdiction is delegated at 100%, together with 50% of restorations and radiographs, suggested that only 30% of registered dentists would be required and 10 times the number of dental therapists registered; this scenario would achieve a 52% salary cost saving cf. "No Skill Mix".Conclusion: Alternative scenarios based on wider expressed treatment need in national primary dental care in England, changing regulations on the scope of practice and increased evidence-based preventive practice suggest that the majority of care in primary dental practice may be delegated to dental therapists, and there is potential time and salary cost saving if the majority of diagnostic tasks and prevention are delegated. However, this would require an increase in trained DCPs, including role enhancement, as part of rebalancing the dental workforce. [ABSTRACT FROM AUTHOR]

The article discusses Ebola outbreak in West Africa including Sierra Leone. Topics discussed include healthcare, oral surgery and public health. Other topics such as incubation period, symptoms and progression of the disease are discussion. Disease transmission, oral aspects of the disease and Ebola risk factors are also mentioned.

Background Research suggests that health professionals who have trained together have a better understanding of one another's scope of practice and are thus equipped for teamwork during their professional careers. Dental hygiene-therapists (DHTs) are mid-level providers that can deliver routine care working alongside dentists. This study examines patterns of delegation (selected tasks and patients) by dental students to DHT students training together in an integrated team. Methods A retrospective sample of patient data (n =2,063) was extracted from a patient management system showing the treatment activities of two student cohorts (dental and DHT) involved in team training in a primary care setting in the South of England over two academic years. The data extracted included key procedures delegated by dental students to DHT students coded by skill-mix of operator (e.g., fissure sealants, restorations, paediatric extractions) and patient demography. χ² tests were conducted to investigate the relationship between delegation and patient age group, gender, smoking status, payment-exemption status, and social deprivation.Results A total of 2,063 patients managed during this period received treatments that could be undertaken by either student type; in total, they received 14,996 treatment procedures. The treatments most commonly delegated were fissure sealants (90%) and restorations (51%); whilst the least delegated were paediatric extractions (2%). Over half of these patients (55%) had at least one instance of delegation from a dental to a DHT student. Associations were found between delegation and patient age group and smoking status (P <0.001). Children under 18 years old had a higher level of delegation (86%) compared with adults of working age (50%) and patients aged 65 years and over (56%). A higher proportion of smokers had been delegated compared with non-smokers (45% cf. 26%; P <0.001). Conclusions The findings suggest that delegation of care to DHT students training as a team with dental students, involved significantly greater experience in treating children and adult smokers, and providing preventive rather than invasive care in this integrated educational and primary care setting. The implications for their contribution to dentistry and the dental team are discussed, along with recommendations for primary care data recording. [ABSTRACT FROM AUTHOR]

The article focuses on the career options for dentists in Great Britain. Topics include vocational training for jobs in healthcare centers, the jobs in the National Health Service (NHS) healthcare system, and options like community, salaried and personal dental services. Also discussed is the option of post-graduate studies along with a job.

As the UK population ages and older people retain their natural teeth for longer, the complexity of the oral health needs in older people is becoming more challenging. Older patients are often registered with a GP and will increasingly be likely to require dental care. Older people in particular may benefit from dental care but may not have a dentist or perceive any risk of oral disease. This article therefore provides practical insight into the oral health management of older people to assist in addressing their oral health needs. [ABSTRACT FROM AUTHOR]

Background: Preventable oral diseases such as dental caries remain common in the United Kingdom. Clustering of poor health is observed within deprived communities, such as inner-city areas, where elevated levels of dental need are associated with lower uptake of dental care. Successful oral health promotion (OHP) initiatives are contingent upon effective community engagement. The aim of this pilot study was to engage with families with young children to explore community views on oral health and dental care and thus tailor OHP initiatives more effectively to their needs. Methods: Qualitative research, involving individual interviews and triad focus groups with parents/caregivers, was conducted in a south London inner-city community as part of a 'Well London' programme initiative. Results: Seventeen parents/caregivers participated in this pilot study. Parents/caregivers described a spectrum of oral health behaviours based on their social history, past dental experiences and cultural influences. All parents described a clear desire to create healthy lives for their children; however, two broad groups were apparent, termed 'Oral Health Prioritisers' and 'Oral Health Non-prioritisers'. The former reported regularly accessing dental care for their children, believing that oral health contributes to systemic health. Non-prioritisers, however, preferentially used key services considered most beneficial to their child's wellbeing. Dental services were considered a low priority for this group, where oral health was synonymous with absence of pain. Participants in both groups favoured OHP initiatives involving a range of health and social care services, with schools at the epicentre of programmes. First-time parents were proposed as an important group requiring support in future OHP initiatives with evidence suggesting that first-born children may have delayed presentation to a dentist. Conclusions: The findings suggest that this inner-city community may contain sub-groups with contrasting perspectives on oral health and oral health behaviours; nevertheless, there was support for a systems approach to oral health promotion initiatives involving a range of health and social care services, including a critcal role for schools, and actively connecting with first-time parents. The findings provide the basis for further research. [ABSTRACT FROM AUTHOR]