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Purpose: The role of antibiotic use in third molar (M3) surgery is controversial. The purpose of this study was to measure the association between antibiotic use and postoperative inflammatory complications after M3 surgery in the community office-based ambulatory private practice setting., Materials and Methods: The authors designed and implemented a prospective cohort study and enrolled a sample composed of patients who had at least one M3 removed in a private practice setting by oral and maxillofacial surgeons participating in a practice-based research collaborative from June 2011 through May 2012. The predictor variable was antibiotic use of any type, categorized as yes or no. The primary outcome variable was the presence or absence of an inflammatory complication, specifically surgical site infection (SSI) or alveolar osteitis (AO), after M3 removal. Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between antibiotic use and inflammatory complications after M3 removal, with statistical significance set at a P value less than or equal to .05., Results: The study sample was composed of 2,954 patients. Three fourths (75.2%) of the sample received antibiotics in some form. The overall inflammatory complication (AO or SSI) frequencies in the antibiotic and nonantibiotic groups were 5.0 and 7.5%, respectively (P = .012). After adjusting for differences between the two groups, statistical significance between the groups persisted., Conclusions: The results of this study suggest that antibiotic therapy, regardless of type, dose, frequency, or pattern of delivery, is associated with a decreased risk of inflammatory complications after M3 removal., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: Since 2013, Revive Dental Care has been operating a community outreach dental service for homeless and 'hard-to-reach' patients. This research aimed to (a) explore the dental care experienced by people accessing the service, (b) examine barriers and facilitators to using a dental service, (c) examine the impact of the service and (d) identify good practice in providing dental services for homeless people., Methods: Semi-structured interviews with 20 patients, nine members of the dental staff and four staff members from the community centres providing services for homeless people., Results: Findings suggest that homeless patients have overall poor daily dental care and experience significant dental problems due to a range of lifestyle factors. Most participants had not seen a dentist for many years and previous experiences of seeing a dentist were often unpleasant. Barriers to care included fear, embarrassment, lack of money, living chaotic lifestyles, not prioritising dental care and difficulties finding an NHS dentist that would take on homeless people. Service provision for homeless and/or hard-to-reach patients needs to be proactive with dental staff going to community settings and making personal contact., Conclusion: Crucially, providers must acknowledge that the patients are vulnerable. A successful service needs to be informal, adapt to patient needs and accommodates chaotic lives.

Objectives: We conducted health literacy environmental scans in 26 Maryland community-based dental clinics to identify institutional characteristics and provider practices that affect dental services access and dental caries education., Methods: In 2011-2012 we assessed user friendliness of the clinics including accessibility, signage, facility navigation, educational materials, and patient forms. We interviewed patients and surveyed dental providers about their knowledge and use of communication techniques., Results: Of 32 clinics, 26 participated. Implementation of the health literacy environmental scan tools was acceptable to the dental directors and provided clinic directors with information to enhance care and outreach. We found considerable variation among clinic facilities, operations, and content of educational materials. There was less variation in types of insurance accepted, no-show rates, methods of communicating with patients, and electronic health records use. Providers who had taken a communication skills course were more likely than those who had not to use recommended communication techniques., Conclusions: Our findings provide insight into the use of health literacy environmental scan tools to identify clinic and provider characteristics and practices that can be used to make dental environments more user friendly and health literate.

Introduction: Disparity exists between the growing consensus about the positive effects of reflection on performance and the scarcity of empirical evidence demonstrating this effect. Portfolios are considered a useful instrument to assess and supervise competence-based education and to stimulate reflection. The present study describes the introduction of a portfolio in a social dentistry and oral health promotion course and investigates student reflection as a predictor for the acquisition of the other competences in the course., Methods: Fourth year undergraduate dental students (n = 110) in the course 'Society and Health' between 2008 and 2011 collected evidence in their portfolios, demonstrating the acquisition of five competences: the ability to (1) assess the oral health profile of a target group; (2) integrate theoretical models in health promotion; (3) search for and apply scientific evidence; (4) work trans-, multi- and/or trans-disciplinarily; (5) reflect on personal development. Linear regression analysis was used to investigate the predictive value of reflection on the other course related competences., Results: Reflection scores proved to significantly predict other course-related competences, when analysing all students between 2008 and 2011 and for each year separately, explaining between 10.7% and 25.5% of the variance in the other competences., Conclusion: Undergraduate dental students' competences related to social dentistry and oral health promotion were significantly predicted by the reflection scores obtained in a portfolio-based context. In line with the growing consensus about the benefits of reflection for dental students and professionals, results suggest the value to further develop the integration of reflection in dental education and practice., (© 2012 John Wiley & Sons A/S.)

Introduction: Despite advances in evidence-based dental school educational programmes, the charge is sometimes made that dental students are 'no longer as good as they used to be'. Recent modifications have meant that dental education is now a 'life-long experience', of which dental school is the initial, albeit very important, component. Contemporary dental students will normally enter dental foundation (DF) training on completion of dental school. As such there may be value in including DF trainers in dental school teaching programmes. The aim of this paper is to report the experiences, feedback and opinions of these DF trainers following their first-hand experience of the community-based clinical teaching programme at Cardiff, and assess if their perspectives of contemporary dental student education changed following this., Materials and Methods: DF trainers were invited to attend the community-based clinical teaching programme at Cardiff on an observer basis. Twenty-four DF trainers attended, following which evaluation questionnaires were completed. Information sought included opinions and attitudes to the teaching programme, the physical environment in which the teaching programme took place, knowledge and attitudes towards community-based clinical teaching and modifications that DF trainers would make to the teaching programme to further improve the knowledge, skills and attributes of dental school graduates for DF training., Results: Responses were received from 20 DF trainers (response rate = 83%). All 20 respondents felt that the teaching provided within the community-based clinical teaching programme was appropriate, with one respondent noting that it was like 'a day in the life of a dental practice', 'where anything could present'. Sixteen respondents were satisfied with the scope and content of the community-based clinical teaching programme, with a small number recommending inclusion of teaching in relation to inlays/onlays (n = 2), simple orthodontics (n = 1) and splinting (n = 1). Eighteen respondents reported that they felt students were adequately prepared for entry into DF training. All 20 respondents reported that their visit to the community-based clinical teaching programme had improved their perception of contemporary dental school education with one respondent noting: 'I am certainly more confident about students graduating' and another noting: 'It has reassured me that there are final year dental students that appear very professional and competent'., Conclusions: This investigation has demonstrated there is much to be gained by inclusion of DF trainers in undergraduate dental student community-based clinical teaching programmes. In an era where tensions exist between dental school teaching and subsequent DF training and independent practice, inclusion of DF trainers can exert positive pressures on dental school programmes and on DF training to ensure that young and newly graduating dentists are best prepared to meet the needs of their patients.

Objective: To investigate camera awareness of female dental nurses and nursery school children as the frequency of camera-related behaviours observed during fluoride varnish applications in a community based health programme., Methods: Fifty-one nurse-child interactions (three nurse pairs and 51 children) were video recorded when Childsmile nurses were applying fluoride varnish onto the teeth of children in nursery school settings. Using a pre-developed coding scheme, nurse and child verbal and nonverbal behaviours were coded for camera-related behaviours., Results: On 15 of 51 interactions (29.4%), a total of 31 camera-related behaviours were observed for dental nurses (14 instances over nine interactions) and children (17 instances over six interactions). Camera-related behaviours occurred infrequently, occupied 0.3% of the total interaction time and displayed at all stages of the dental procedure, though tended to peak at initial stages., Conclusions: Certain camera-related behaviours of female dental nurses and nursery school children were observed in their interactions when introducing a dental health preventive intervention. Since the frequency of camera-related behaviours are so few they are of little consequence when video-recording adults and children undertaking dental procedures.

Unlabelled: Inequalities in oral health in areas of socio-economic disadvantage are well recognised. As children spend a considerable proportion of their lives in education, schools can play a significant role in promoting children's health and oral health. However, to what extent schools are able to do this is unclear. The aim of this study was therefore to investigate opportunities and challenges to promoting oral health in primary schools., Methods: A purposive sample of 20 primary schools from socially and economically disadvantaged areas of Cardiff, UK were selected to participate in this qualitative study. Data were collected through semi-structured interviews conducted with head teachers or their nominated deputies., Results: General awareness of health and oral health was good, with all schools promoting the consumption of fruit, water and milk and discouraging products such as carbonated drinks and confectionaries. Health promotion schemes wereimplemented primarily to improve the health of the children, although schools felt they also offered the potential to improve classroom behaviour and attendance. However, oral health was viewed as a separate entity to general health and perceived to be inadequately promoted. Successful health promotion schemes were also influenced by the attitudes of headteachers. Most schools had no or limited links with local dental services and, or oral health educators, although such input, when it occurred, was welcomed and highly valued. Knowledge of how to handle dental emergencies was limited and only two schools operated toothbrushing schemes, although all expressed an interest in such programmes., Conclusion: This study identified a positive predisposition to promoting health in primary schools. The challenge for the dental team, however, is to promote and integrate oral health into mainstream health promotion activities in schools. The paper also makes recommendations for further research.

Objectives: To identify likely future trends in recruitment of consultant anaesthetists to the ambulatory dental general anaesthetic (DGA) services., Participants: The sample consisted of all anaesthetic specialist registrars (SpRs) in their final year of training, within Mersey and South-Western Deaneries in the U.K., Research Design: A questionnaire divided into a quantitative section to establish level of training in ambulatory DGA, and a qualitative section designed to elicit opinions and attitudes towards ambulatory DGA services., Results: The response rate was 75% (27/36). Within both regions 81% (22/27) had received practical training in ambulatory DGA procedures. SpRs in the South-Western Deanery held the greatest misgivings about the ambulatory DGA technique. Once appointed to Consultant position only 11% (3/27) of respondents expressed a definite interest in providing ambulatory DGA services., Conclusions: Within the Northwest and Southwest of England, most specialist registrars in anaesthetics receive training in ambulatory DGA, although their future commitment to the delivery of these services is questionable.

Objective: To develop a personal digital assistant (PDA) application for oral health assessment fieldwork, including back-office and database systems (MobilDent)., Design: System design, construction and implementation of PDA, back-office and database systems., Methods: System requirements for MobilDent were collected, analysed and translated into system functions. User interfaces were implemented and system architecture was outlined. MobilDent was based on a platform with. NET (Microsoft) components, using an SQL Server 2005 (Microsoft) for data storage with Windows Mobile (Microsoft) operating system. The PDA devices were Dell Axim., Results: System functions and user interfaces were specified for MobilDent. User interfaces for PDA, back-office and database systems were based on. NET programming. The PDA user interface was based on Windows suitable to a PDA display, whereas the back-office interface was designed for a normal-sized computer screen. A synchronisation module (MS Active Sync, Microsoft) was used to enable download of field data from PDA to the database., Conclusions: MobilDent is a feasible application for oral health assessment fieldwork, and the oral health assessment database may prove a valuable source for care planning, educational and research purposes. Further development of the MobilDent system will include wireless connectivity with download-on-demand technology.

This article describes the conceptual and analytical framework that will be used to assess the effectiveness of the Pipeline, Profession, and Practice: Community-Based Dental Education Program. The evaluation will use a mixed method qualitative and quantitative data collection, analysis, and triangulation. Baseline measures are reported using data from the 2003 ADEA survey of dental school seniors. Baseline measures show the dental schools are confronting a major recruitment challenge that will require short and long pipeline efforts to attract and retain underrepresented and low-income (URM/LI) persons. Gaps were found between the perceptions of URM and non-URM students in the adequacy of the curricula. The majority of all seniors described the current extramural clinical rotations as positive experiences, but URMs were more likely to report the experience improved their ability to care for diverse groups.

Funded by The Robert Wood Johnson Foundation and the California Endowment and with student financial aid from the W.K. Kellogg Foundation, the primary goal of the Pipeline, Profession, and Practice: Community-Based Dental Education program is to reduce disparities in access to dental care. In a national competition, fifteen dental schools were selected to participate. By the final year (2007) of the five-year project, the schools are expected to achieve three objectives: 1) increase the time (sixty days/year) that senior students and residents spend in patient-centered community clinics and practices treating underserved populations; 2) provide didactic and clinical courses for students and residents that prepare them for their community experiences; and 3) recruit more underrepresented minority and low-income students. The national program office that directs the project is located at Columbia University, and a national advisory committee oversees the program for the sponsoring organizations. The challenge is to demonstrate that the Pipeline objectives are achievable and that the program is sustainable without external support.

To encourage the public to attend and accept oral cancer screening, further understanding is required of the ability of structured information to alter patient knowledge and risk perceptions. Previous work has shown the benefit of written information for those at high risk of oral cancer, especially for tobacco smokers. This study investigated three hypotheses: first that a patient information leaflet (PIL) would enhance risk perceptions, and second that the effect of the leaflet on knowledge would be confirmed as in previous studies and third that these improvements would be associated with smoking behaviour. Patients (N = 995) attending 20 general dental practices in Northern Ireland were invited to participate, 28 refused (response rate = 97%). Patients were randomised into two groups. The experimental group received a PIL and then completed a self-report questionnaire, whereas the control group followed same procedure without the PIL. Measures included a 36 item oral cancer knowledge scale and two items to assess risk perception. Usable data were available from 944 patients; mean (SD) age = 42 (15), 65% female. Risk perceptions of oral cancer were minimally effected by the PIL (p = 0.023). This effect was demonstrable in smokers. Smokers were sixteen (95% CI: 8-30) times more likely to believe that they were at greater risk of oral cancer than non-smokers. A clear benefit of the PIL on patients' oral cancer knowledge was found, particularly for smokers and those with a history of smoking. These findings demonstrate that public awareness of smokers can be raised with written information although health beliefs such as risk perceptions require more intensive intervention.

In a 25-year-old satellite dental program, advanced dentistry and dental hygiene students provide highly supervised dental treatment for patients in government-funded clinics in 3 under-serviced communities in northern Alberta. Analysis of the performance data of the 2003 University of Alberta dentistry students in their fourth and final year was used to evaluate this program. The data showed that the undergraduate students did numerous diverse general dental procedures during the 2-week rotation, most of which were basic treatments. Students could participate in the program up to 3 times. In subsequent rotations, students tended to do fewer preventive measures, and more restorative treatment and dental extractions. Available grading data for all students indicated that treatment objectives were fulfilled in the vast majority of cases. Such community-based field experience may significantly add to the competence of students entering private practice.

Since 1995 the Department of Community Dentistry of the University of Pretoria has been involved in the rendering of mobile primary oral health care services to children in the Hammanskraal area of Gauteng, South Africa, as part of their students' community-based training. Mokonyama Primary School was identified as the first school where a primary oral health care service could be rendered. The objective of this study was to evaluate the impact (outcomes) of a fissure sealant program on the dentition status of the school children. Seven years after the implementation of the program, the dentition status of children at Mokonyama was compared with that of a comparable group of children from the same area who were not exposed to the program. The results showed that the decayed, missing, and filled teeth in the primary dentition (dmft) in the six-year-old group in Mokonyama (1.74) did not differ significantly from the dmft (1.43) of the control group (p = 0.49). The decayed, missing, and filled teeth in the permanent dentition (DMFT) of 0.59 for the fifteen-year-old group in Mokonyama, however, differed significantly (p = 0.0001) from the DMFT of the control group (2.38). Fifteen-year-old children in Mokonyama had 75.2 percent fewer caries than their counterparts in the control group.

Objectives: The objective of this paper is to report key findings of a process evaluation that may be useful to other institutions seeking to implement a community-based oral health care program primarily targeting children in dentally underserved communities. By partnering with community-based organizations, public schools, and community health care providers, the Columbia University School of Oral and Dental Surgery (SDOS) established the Community DentCare Network (DentCare) in the Harlem and Washington Heights/Inwood neighborhoods of northern Manhattan. These low-income neighborhoods are characterized by poor oral health and have been designated by the federal government as health professions shortage areas., Methods: The method used in the process evaluation was open-ended qualitative interviewing by a sociologist with extensive experience in this methodology aided by a participant-observer within the DentCare program., Results: The heterogeneity of the two communities required different strategies and resources to gain trust and acceptance. Fundamental changes were required of SDOS over a 10-year period, beginning with prioritizing community service into a primary mission. Collaborating with medical clinics facilitated the implementation of the network when the partners shared the same philosophical goals. Faculty and staff with different skills were needed during the start-up and the sustained development phases of the program.

Socio-economics, family stress and parenting style each plays as important a role in the development of early childhood caries as dietary and microbiological factors. Therefore, to be successful, oral health promotion initiatives should be designed and implemented with due consideration of issues such as collaboration with community partners, the role of dental health in overall child health and the involvement of the community in program planning. This article briefly describes 3 programs that have been undertaken in British Columbia either as public health initiatives or as demonstration research projects to improve oral health in young children from diverse communities with a high prevalence of early childhood caries.

Aim: A review of different modes of pain relief for simple dental extractions under general anaesthesia in a community dental setting., Patients and Methods: Different analgesia regimens are used by different anaesthetic teams working in a single community clinic. A total of 72 patients were reviewed post-operatively in the recovery room and followed up with a telephone survey 24 h later to assess pain experienced by the patients. The efficacy of different analgesia regimens was analysed., Results: The majority of patients were pain free in recovery, independent of the method of pain relief used. Local anaesthetic injections appear superior to systemic analgesia, and patients with local anaesthetic injections were more settled in recovery., Discussion: Simple dental extractions cause pain and efficient administration of appropriate analgesia should be an integral part of the community dental service.

Dental treatment and oral health care were performed on inhabitants in the north area of Ishigaki Island in Okinawa. There are no dentists in the area at present. One hundred sixty-six patients received treatment taking 528 man-days, during the period from November 9 to December 8, 2000. The area has 2 primary schools and 1 junior high school. The average DMFT of the children in the primary schools was 1.31, and in the junior high school it was 4.98. Compared with Japanese national survey data, the children in the area had a higher DMFT. Among the treatment procedures, the rate of conservative treatment was 62%, most of which was composite resin filling. Preventive measures for dental disease were offered to the inhabitants by means of topical fluoride application or oral health education. The period of this promotion was too short to perform complete dental treatment and to prevent caries and periodontal disease. It seems that primary prevention and higher dental hygiene education are needed for inhabitants in no-dentist areas, because the inhabitants do not have access to dental service easily.

Objective: To achieve consensus within primary dental care on the contents of a clinical minimum data set to measure oral health status., Design: Using the Delphi process a simple random sample of 30 LDCs and 10 CDS services in England were asked to rank a list of existing clinical indicators in order of their perceived importance as a means of measuring oral health. A nominated panel representing the stakeholder organisations of primary dental care reviewed this ranking and identified a core group of clinical indicators to be included in a clinical minimum data set., Results: An 80 percent response rate to the Delphi process was achieved. Consensus was reached on a core group of 10 indicators, which can provide information on patient's perceptions of pain, function and appearance, and professional measurements of caries, teeth present, periodontal disease, oral sepsis, presence of mucosal pathology and tooth wear., Conclusions: A representative sample of primary care dentists in England and the key representative organisations of primary dental care achieved consensus on the contents of a clinical minimum data set to record oral health status in primary dental care. This is a first step in standardising the measurement of oral health status across primary care.

The Community Periodontal Index of Treatment Needs (CPITN) was used to assess the periodontal status of 213 handicapped persons attending seven institutions in Johannesburg. Fewer than 2% had healthy mouths, 8% had bleeding only, followed by calculus (46%), shallow pockets (40%) and deep pockets (4%). The mean number of sextants with bleeding or higher score was 5.9. Oral hygiene instruction was indicated for 98% and prophylaxis for 90% of the participants. The CPITN was easily used in the disabled population but may overestimate treatment need in view of the current understanding that periodontal disease does not automatically progress from a low CPITN level to the next. A more appropriate measure of treatment need in handicapped persons is required.

Background: Community dental clinics are good settings for smoking intervention. The aim here was to put forward a strategy for preventing adolescent smoking by means of a brief intervention., Methods: A total of 2,586 12-year-olds participated in this follow-up study. They were asked upon arrival for their annual routine dental examination to complete a smoking questionnaire and were randomly assigned to either the intervention group or the usual care control group according to the last digit of their date of birth (odd or even). The intervention comprised annually inquiring about smoking, showing photographs of the harmful effects of smoking on the teeth, allowing participants to examine their own mouth with a mirror, and finally counselling them in accordance with their answer to the question on smoking habits. The smoking status reported was not verified by other means., Results: The prevalence of smoking at the end of the 2-year follow-up was 18.1%, in the intervention group and 20.8% among the controls. However, no statistically significant differences between groups were found., Conclusions: These results reflect the difficulties of achieving successful results with long-term smoking cessation programs with adolescents in unstable conditions., (Copyright 1999 American Health Foundation and Academic Press.)

Our objective was to describe the management of oral cancer and pre-cancer as stated by primary care dentists and their views on screening. We conducted a survey of all general dental practitioners and community dentists in Northern Ireland (n = 635), to which 428 replied (response rate: 67%). 94% stated that examination of the oral soft tissues constituted part of their usual practice during the regular dental check-up. Suspicious lesions were generally referred early, 68.5% of dentists referring white lesions within one month of presentation. The corresponding figures for red lesions, lumps and persistent ulcers were 80.1%, 89.7% and 91.7%. The incidence of oral cancer was over-estimated (median '70' cases/year, versus the true figure of approximately 40/year) as, in all likelihood, was the percentage by which mortality could be reduced by screening (median: 50%). Accordingly the adoption of a screening programme was favoured over investment in health promotion. Indeed, only 14% said that their patients records routinely contained information about smoking or alcohol habits. Although there are some areas of practice which could improve and the potential of screening is probably over-valued, primary care dentists in Northern Ireland already opportunistically screen and refer patients promptly.

The appropriate use of pit and fissure sealants could reduce substantially the majority of occlusal caries among US school-aged children. The 1986-87 national oral health survey conducted by the NIDR showed that less than 8 percent of the children 5-17 years of age had sealants on their teeth. The purpose of this national study was to document the current status of community-based sealant programs and to identify general program characteristics. Data were gathered through a mail survey to all state dental directors and site visits to four selected comprehensive community-based programs. Twenty-nine states were currently conducting sealant programs. The vast majority of these programs had formal quality assurance systems and companion health education components. Eight states indicated that sealant programs had been terminated within the last two years. Medicaid reimbursement for sealants was available in 42 states, with a mean reimbursement rate of $10.71 per sealant. Reimbursement rates ranged from $3.00-$20.00 per sealant. State practice acts almost uniformly permitted the placement of sealants by dental hygienists (n = 48), but less frequently by dental assistants (n = 15). Approximately 43 percent of state practice acts did not require a dentist to be present physically when auxiliaries place sealants in public/community sealant programs. All respondents indicated that there was a need for additional programs in their state. No structural factors--for example, level of Medicaid reimbursement for sealants or state practice act requirements for auxiliary supervision--were found to be associated with the presence of community-based sealant programs. Nationally, only a small percentage of children appeared to be receiving sealants in community programs.

This study compared CPITN with plaque index (PlI), gingival index (GI), papilla bleeding index (PBI), and probeable pocket depth (PPD). 52 patients were examined, mean age 43 years. Partial mouth random recording (2 upper and 1 lower or 1 upper and 2 lower sextants) was made by CPITN of 150 sextants, and at 6 sites around each tooth in each sextant for each index using a pressure-sensitive probe, with Newman tip and Williams markings, and a WHO 621 tip, probing pressure 0.25 N. Ranges of each index were compared with corresponding CPITN data. Most (71%) sextants had CPITN scores of 4, indicating periodontitis. None had CPITN scored 0 or 1. A given CPITN code was found to represent extremes of ranges for all other indices evaluated. There was no relation between CPITN and PlI or GI, nor did CPITN reflect the number of sites affected per sextant, but there was a tendency for CPITN to relate with PBI and PPD. It was concluded that CPITN may be used as a general indicator of bleeding and pocket depth, but not of plaque or gingivitis. Other indices are required to reliably assess chronic inflammatory periodontal disease status in a given mouth.