Search

Objective Psychological research has established that the presence of dental anomalies negatively impact social judgements. This study sought to determine the effects of tooth colour on the subjective ratings of social judgements in a group of Caucasian adults. Methods A cross sectional experimental analogue design comprised fifty Caucasian adults: 25 women and 25 men. A total of 54 digitally modified photographs of Caucasian males and females (darkened, natural, whitened teeth) were evaluated. All participants evaluated each of the images on 12 characteristics: popularity, friendliness, social life, success, graduation, happiness, intelligence, perceived age, introversion/extraversion, self-confidence, attractiveness and satisfaction with the tooth shade. Analysis of variance (ANOVA) was used to compare ratings. Results Participants associated darkened teeth with poorer subjective ratings, with the highest ratings been given to whitened teeth, and natural teeth being intermediate. These trends were similar across all participant age groups and gender. Further, the gender and age groups of the images had a significant effect on the appraisals. Faces of younger models received higher ratings than the faces of older models and female images were rated higher than the males. Conclusion In the absence of other information, tooth colour exerts an influence upon the appraisals made in social situations. It appears that whitened tooth appearance is preferred to natural tooth appearance, irrespective of age and gender of the judge. The faces with more whitened dentition are perceived to be younger across all age groups and gender of the judges. Participants dissatisfied with their own tooth shade drew out more stereotypic behaviour. Clinical significance statement This research used standardised tooth colour as a basis to investigate perceived age and social functioning. As clinicians face daily challenges to achieve patient satisfaction with respect to dental aesthetics, standardizing the colour may enhance the patients’ satisfaction. Further, participants dissatisfied with their own tooth shade drew out more stereotypic behaviour. The whitened dentition may impair the psychological well-being of the individuals and is probably a reason for the increasing demand for cosmetic dental procedures. These results may be instructive for the development of a psycho-educational intervention to prevent any unrealistic expectations.

This study investigated U.K. dentists' knowledge and practice of behavioral management principles (BMPs) as applied to adults with learning disabilities (AWLD). A postal questionnaire enquired into the dentists' experience in managing AWLD, utilization of behavioral management techniques, and knowledge of BMPs. The response rate was 41% (N = 53). Two groups were investigated: specialists (dentists registered on the Special Care Dentistry specialists' list, n = 37) and nonspecialists (dentists not on the list, n = 16). Although specialists treated more AWLD than nonspecialists, both groups of dentists reported they felt highly confident in managing AWLD. However, all dentists' knowledge of the principles of nonpharmacological BMPs was low. Specialists had a tendency to use a greater range of nonpharmacological behavioral management techniques compared to non-specialists. These results suggest that dental team members need more training in the theory and practice of BMPs, which might lead to less reliance on costly pharmacological interventions and a clinical experience that is more respectful of the dignity and independence of AWLD.

This study ascertained the influence of orthodontic appliances on subjective ratings for social competence (SC), intellectual ability (IA), psychological adjustment (PA), and attractiveness in young adult orthodontic patients. A cross-sectional analytical questionnaire study was conducted with 130 undergraduates from the UK. Each participant was asked to look at a single, randomly assigned colour photograph of a young adult female and then asked to make judgements concerning her personal characteristics. Five modified photographs of the same young adult female were used: (1) no appliance, (2) stainless steel fixed orthodontic appliance, (3) ceramic fixed orthodontic appliance, (4) gold fixed orthodontic appliance, and (5) clear colourless aligner. Likert scales with higher scores indicating more positive ratings were used. The results were analysed using chi-square test, one-way univariate analysis of variance, and post hoc Tukey-B and Kruskal-Wallis tests. The results showed that greater perceived IA was associated with the appearance of no appliance (mean values: 7.56) rather than steel (6.67) or ceramic appliances (6.65) but similar to the gold (7.35) and aligner (7.08) appliances. No significant differences between the different orthodontic appliance appearances were found for SC and PA. A trend existed where the no appliance image (resembling a lingual appliance) or clear aligner was considered more attractive than the visible buccal fixed appliances. In the absence of other information, the judgements an individual young adult makes concerning the personal characteristics of a young adult are influenced by dental appearance and orthodontic appliance design. This may influence orthodontic appliance choice.

Background Dental disease is more common among people with intellectual disabilities than in the general population. Improvements in oral health require individuals to engage in daily oral hygiene and regular visits to a dental practitioner; both may be challenging for the individual with intellectual impairment. Materials and Methods A review of policies relating to behaviour management and physical restraint for individuals with intellectual disabilities and challenging behaviours was undertaken. Published studies of behaviour management in individuals with intellectual disabilities attending for dental treatment were reviewed. Reference to studies of children with average IQ and other populations were made where appropriate. Results There is little published evidence regarding behaviour management for people with intellectual disabilities who require dental treatment. Current policies place great emphasis on pharmacological management and restrictive behaviour management techniques. There is a paucity of studies which have employed a functional analysis framework. There are few incentives for dentists to implement positive approaches to behaviour management as current systems of payment reward the completion of numbers of treatments and thus there is an incentive to complete treatments quickly rather than to spend time with patients. Conclusions There is a need for research addressing the behaviour management of individuals with intellectual disabilities who require dental treatment, particularly the efficacy of non-restrictive techniques and the provision of incentives that reward the use of positive behaviour management among dentists. The use of restrictive techniques should be carefully monitored for compliance with best practice guidelines.

Background Limited information is available regarding the occupational health status of dentists (particularly in New Zealand), although previous research suggests that stress, hand dermatoses and musculoskeletal symptoms are common. Aims To determine the occupational health status of New Zealand dentists. Methods A nationwide postal survey of a representative sample of 750 dentists. Results There was a response rate of 77%. Most dentists (71%) reported their general health as very good or excellent; 43% rated their physical fitness as excellent or very good and 64% were happy and interested in life. Workplace bullying had been experienced by 19% and was higher for female and employee dentists and 29% had experienced a violent or abusive incident at work. Almost half of the sample (47%) had experienced at least one dermatitis-type condition in the previous 12 months. The most commonly reported sites for musculoskeletal problems experienced in the previous year were the neck (59%), lower back (57%) and shoulders (45%). Women had a higher prevalence of several occupational health problems, but were more satisfied with their overall health than male dentists. Conclusions The majority of dentists had good general health, but physical fitness levels were not ideal. The prevalence of hand dermatoses and musculoskeletal problems are high and impact significantly on dentists' daily lives. Interventions such as reducing weight and training in optimal working methods to reduce musculoskeletal problems and injuries (such as eye or needlestick incidents) might improve the health of this workforce but further research is required.

The Abberrant Behaviour Checklist was administered to 209 British mentally handicapped adults in two large residential facilities. This sample included a substantial proportion (45%) of non-ambulant people not included in previous studies. The five-factor solution originally reported by Aman et al. (1985a) was replicated using both four-point ratings and dichotomously recoded rating. For both methods of scoring, the five scales derived from Aman et al.'s original factor analysis remained highly internally consistent. Dichotomously coded ratings may offer the advantage over four-point ratings of retaining the same factor structure with better reliability.

To describe patients' and their parents' expectations of orthodontic treatment.A questionnaire survey of 100 patients and their primary care-givers attending a new patient orthodontic consultant clinic, at a teaching hospital.GKT Orthodontic Department, King's College Dental Hospital, London, UK.The sample consisted of 100 participants who completed the questionnaire, including 50 patients aged 12-14 years who had been referred to the orthodontic department for treatment. One parent of each patient was also invited to participate.Participants completed a valid questionnaire measure of orthodontic expectations that was tested for reliability and validity. Descriptive analysis of the responses was undertaken, and comparisons of children's and parents' expectations, in addition to ethnicity, were made.Patients and parents have similar expectations of treatment, with the exception of expectations of duration of orthodontic treatment (P0.01), having a brace fitted at the initial visit (P0.05), and restrictions with regard to what one can eat and drink as a result of orthodontic treatment (P0.05). Among the patient participants, different ethnic groups displayed different expectations of the initial orthodontic assessment visit, the likelihood of wearing headgear, the impact of orthodontic treatment on diet, and the reaction of peers to treatment (P0.05). For patients, ethnic group differences were reported for expectations regarding the initial visit, headgear and dietary restrictions (P0.05).Patients and their parents share similar expectations of orthodontic treatment for most aspects of care, although parents are more realistic in their estimation of the duration of treatment and the initial visit. The expectations of patients differ from those of their parents with regard to dietary and drink restrictions in relation to orthodontic treatment. Ethnicity significantly influences expectations of orthodontic treatment, and this may relate to differences in the patients' and their parents' assessed outcome of care.

Aim To identify the experiences of primary care trust employees, the dental teams and other key individuals of the planning, implementation and management of a Personal Dental Services scheme. Method A thematic analysis of a series of qualitative interviews with 29 individuals who were involved in the planning, implementation and management of a PDS scheme in South East London. Findings Nine key themes were analysed from the data. For each theme perspectives could be identified for both the employees of the primary care trusts and the dental team. These perspectives differ in key respects. Conclusions Practitioners value the PDS scheme and consider it a positive experience. They suggest that it has led to an increase in quality of care, and a more professional management approach to the practice. The practice team felt that they have benefited from an enhanced working environment. The main concern expressed was that patient registrations were not being accurately assessed. Those involved in the management of the PDS scheme, while endorsing local commissioning arrangements, were concerned that it was not known whether PDS was meeting local needs. There was little quality benchmarking, which would have allowed robust measure of success. The contract model and outcomes should have been more sensitively designed. There was concern expressed that the small number of practices who participated in the pilot scheme prohibits the possibility of thoroughly analysing the impact of local commissioning. Future local commissioning should identify mechanisms for ensuring the effective planning, management and evaluation of the impact of the schemes. A core element of this will be the specification of appropriate goals for commissioning.

While the practice of dentistry has been demonstrated to be significantly stressful, there have been few published studies describing interventions to reduce the stress of dental practitioners. This article describes research into the prevention and alleviation of stress amongst a variety of healthcare professionals, including dental practitioners, and describes the findings from a small scale study of an intervention aimed at general dental practitioners who reported high levels of work related stress. It is argued that to be effective, interventions should be tailored to the individual needs of the practitioner, within a structured intervention framework. Further research into the effectiveness and cost-effectiveness of stress management for dental practitioners is required.

The aim of this study was to explore undergraduate and postgraduate dental students' understanding of a good learning experience by using 'reflection on learning' as described by Schon. Four groups of Year 4 BDS students and one group of postgraduate students in dental public health took part in a series of focus group discussions. The responses were grouped into four broad themes (a) active, practical and positive learning; (b) interactive/together learning; (c) personal learning; (d) theory into practice. Six educational models of good learning proposed by the students are described.

Objective: To investigate changes in vocational dental practitioners (VDPs) views on repairing direct composite restorations (DCRs) during the vocational training (VT) year 2002-2003. Design: A questionnaire-based cohort study. Method: Data on the repair of DCRs, including indications and details of operative techniques were collected by a questionnaire sent at the beginning of the VT year (September 2002) to all 12 Postgraduate Dental Deans in England. A follow-up questionnaire was sent to the Deans near the end of the VT year (May 2003). They were asked, on both occasions, to distribute the questionnaires among their VDPs and to return the completed questionnaires. Results: Ten deaneries participated in the study. The September 2002 and May 2003 findings (306 respondents [66%] and 313 respondents [67%] respectively) were analysed using Chi-square statistic and t-test to identify any significant differences (P

BackgroundThe development of reliable, valid measures of psychopathology in people with intellectual disabilities is an important task. However, independent replication studies are rarely reported.AimsTo report data on the psychometric properties of the Psychiatric Assessment Schedule for Adults with Developmental Disabilities (PAS–ADD) Checklist.MethodThe PAS–ADD Checklist was completed for 226 adults as part of the assessment process for a specialist mental health service for people with intellectual disabilities.ResultsInternal consistency was acceptable. Factor analysis revealed one main factor that was characterised by items related to mood. The Checklist was sensitive to differences between diagnostic groups and had an overall sensitivity of 66%; its specificity was 70%.ConclusionsThe PAS–ADD Checklist is a quick and easy to use screening tool. Although at present it is the best measure available, it should not be the only method used to identify psychiatric disorders in people with intellectual disabilities.

The social and psychological development of children from birth to adolescence is described using the framework of Jean Piaget's theory of cognitive development. This theory proposes that children's understanding of the world proceeds through four broad stages, with each stage demonstrating an increasingly sophisticated understanding of concepts and how they can be used. The relevance of this development for children's understanding of oral health, disease and dental care is discussed.

Inter-rater reliability of the Motivation Assessment Scale (MAS) was assessed for independent ratings of 12 adolescents and adults with severe/profound mental handicap. Correlations of item and subscale scores across raters were low. The internal consistency of subscales and total scores of the MAA was high. It is suggested that future research using the MAS should include an analysis of the reliability of this measure and features of the raters and subjects which might limit the robustness of the MAS.

Abuse of vulnerable adults is largely under reported. The most common forms of abuse amongst this group are neglect and financial abuse, although an individual may be at risk of any or all forms of abuse. Certain individuals are at an increased risk of abuse due to their domestic environment and any physical or mental disability they may have. Clinical Relevance: Vulnerable adults constitute a significant proportion of the population. GDPs should be aware of the signs of abuse, to be able to identify those individuals at risk, and how and when to raise concerns of abuse to social services.

Previous research has established that people can make social judgements about someone else based on the condition of that person's teeth. The characteristics of visible tooth decay, with respect to the effect on such social judgements, have not, however, been subject to extensive investigation. This study sought to determine whether the position of visible decay and/or the extent of the lesion are determining factors in such social judgements of each other.In a between subjects design, 100 young people were randomly divided into 4 groups of 25 and each group shown a differently computer-modified photograph of the same person. Extent and location of the lesion were varied systematically. Participants were asked to rate the person in the photograph with respect to intellectual ability, social competence and psychological adjustment. The scores from those questions were analysed with one way analysis of variance (ANOVA) then Tukey's HSD where ANOVA revealed significant differences.The data confirmed previous studies that have shown that poor dental condition is highly correlated with perceived poor social performance and intellectual ability. Further, the data showed that with respect to the constructs of intellectual ability, extraversion and care for one's personal appearance, a more central position of caries is more predictive of poor social judgements than just the presence of visible decay, or even twice the amount of decay. We discuss the possible evolutionary and ontological reasons for making social judgements that are influenced by a person's dental health as well as considering the implications of our findings for dentists.

A block randomised controlled trial was conducted.Patients in the music (test) group listened to selected sedative music using headphones throughout the root canal treatment procedure. The control group subjects wore headphones but without the music.Anxiety was measured before the study and at the end of the treatment procedure. Patients' heart rate, blood pressure and finger temperature were measured before the study and every 10 min until the end of the root canal treatment procedure.The results revealed that there were no significant differences between the two groups for baseline data and procedure-related characteristics, except for gender. The subjects in the music group, however, showed a significant increase in finger temperature and a decrease in anxiety score over time compared with the control group. The effect size for state anxiety and finger temperature was 0.34 and 0.14, respectively.Relaxing music administered through headphones to subjects during root canal treatment decreased the procedure-related anxiety of the patients and significantly increased finger temperature, but does not significantly affect blood pressure and heart rate over the procedure.

Improvement in appearance is an important motivation for orthodontic treatment and orthognathic surgery, and two possible underlying causes are objective physical abnormalities, or the patient's personality type that leads them to concentrate on their appearance and request unnecessary interventions. Questionnaires that measure personality traits were given to 30 women who required orthognathic operations, and a control group of 30 other women. Traits measured were: satisfaction with the appearance of the face, head, and body; tendency to compare their appearance with that of others; the extent to which they are aware of their appearance and how they thought they should look; sense of self identity; depression; anxiety; and self-esteem. The only difference between patients and controls was that patients were more dissatisfied with their facial appearance than the others. Orthognathic patients were psychologically normal except that they had more dissatisfaction with their facial appearance. As this was the only difference, it is likely that their desire for operation was caused by a genuine physical abnormality rather than a perceived exaggerated aesthetic problem. It seems, therefore, that any patient who seeks orthognathic treatment because they have a personality that causes them to dwell on their appearance (which may lead them to hold unrealistic expectations of intervention) are screened out of the process before they begin treatment.

BACKGROUND Dentistry is understood to be a stressful profession. Although there has been recent research about stress and dentistry in the UK and the Netherlands, little is known about the job stressors and coping strategies of New Zealand dentists. AIM To investigate job stressors and coping strategies among New Zealand dentists. METHODS A nationwide postal survey of a representative sample of 700 dentists. RESULTS The response rate was 65%. The most commonly reported stressors were treating difficult children (52%), constant time pressure (48%) and maintaining high levels of concentration (43%). The strategies most utilized for managing work-related stress included interactions with people (78%), sports (64%) and forgetting about work (59%). Dentists who had graduated overseas reported more sources of stress than New Zealand graduates. There were differences in the strategies used by male and female practitioners to manage stress. CONCLUSIONS There is considerable variation in the number of stressors experienced by dentists. Overseas-qualified dentists appear to be under more stress than New Zealand-trained dentists and may need greater professional support. Dentists should be encouraged to make greater use of active coping strategies.

Objectives Recent work has demonstrated that female orthognathic patients display more dissatisfaction with their facial appearance after viewing idealised images of facial photographs, than do controls. Patients may request orthognathic surgery because they hope to improve their appearance to conform with ideals portrayed in the mass media, and these hopes may not be realistic. Patients who demonstrate certain personality traits are more likely to hold such hopes. The current study sought to identify the role of dental status (orthognathic patient versus control), personality traits and media images in dissatisfaction with facial appearance. Methods Female patients and controls completed a bank of personality measures and then gave repeated measures of satisfaction with their facial appearance after viewing images of ‘ideal’ and ‘average’ women. Results Neither group showed any change in satisfaction with appearance after viewing either set of images. Patients showed lower satisfaction with facial appearance than controls, but did not differ on other personality measures. Conclusions Viewing ‘ideal’ images of other women has no significant impact on satisfaction with appearance compared to viewing images of ‘average’ women. These results may help inform the development of a psycho-educational intervention to protect women against the negative effects of viewing idealised images in the media.

To describe the working practices and level of career satisfaction of dental therapists in New Zealand.Postal survey of dental therapists identified from the New Zealand Dental Council's dental therapy database. One mailing with one follow-up.Questionnaires were sent to 683 registered dental therapists. Replies were received from 566 (82.9%).Current working practice, career breaks, continuing education, career satisfaction.Respondents had a high career satisfaction, but were much less satisfied with their remuneration. After controlling for age and income satisfaction, therapists who felt that they were valued members of the dental community had over four times the odds of having higher overall job satisfaction. There were no differences in the mean career satisfaction scale score by age, but respondents aged 45 and over had a lower mean income satisfaction scale score than their younger counterparts (p0.05). Older respondents were more likely to report regularly placing fissure sealants (p0.05), participating in peer review (p0.05), and playing a role in team management/coordination (p0.05) than younger respondents. Most therapists (412; 82.2%) had taken at least one career break, usually for child rearing. A mean of 6.5 years (SD 5.9; range six weeks to 25 years) had been taken in career breaks. Younger therapists were more interested in moving into private practice than their older colleagues (p0.05). More than half of respondents planned to retire from dental therapy within 10 years.Urgent action is required to improve the recruitment and retention of dental therapists in the New Zealand School Dental Service. Measures to reduce the time taken in career breaks could increase the productivity of this workforce. Remuneration and career progression are key issues; therapists need to feel that they are valued members of the dental profession.

To explore the processes involved in oral health acculturation for Albanian-speakers in south London.A qualitative study utilizing 10 in-depth, semi-structured interviews and two focus groups with a purposive sample of 23 Albanian-speakers. Participants were recruited through community groups and by a snowball technique. Data were analysed using the constant comparative method.Participants attended the dentist more regularly and brushed their teeth more frequently in the U.K., particularly those from lower social class groups. However, young people consumed more sweet foods and drinks than in Kosovo. The priority of oral health was higher in the U.K. for most participants. Mothers of young children were more interested in prevention in the U.K., mainly as a result of receiving oral health information from health visitors and agencies such as Sure Start. However, oral health priorities generally remained treatment focused. Participants mainly attributed behavioural and attitudinal changes to structural and material factors such as the absence of war, higher living standards, better access to oral health information, products and dental services, and the greater availability of highly desirable sweet foods and drinks in the U.K.Understanding changes in social context may be crucial for comprehending the processes of oral health acculturation in immigrant populations. Material and structural changes which impact on oral health behaviours may be overlooked. Improving oral health knowledge can be a crucial step in shifting oral health priorities from a treatment to a prevention focus. However, unhealthy choices may persist due to the impact of wider cultural norms.

Previous studies have indicated that health beliefs are related to the periodontal disease status and treatment behaviour of patients. However, it is possible that treatment may affect a patient's health beliefs and thus complicate this issue. The present study therefore looked for changes in health control beliefs and oral health impacts in patients undergoing periodontal treatment in a dental school.Questionnaires assessing dental multidimensional locus of control (LOC) and oral health impact profile (OHIP) were posted to subjects due to attend for initial periodontal consultation and were returned by 127 patients who attended. Repeat questionnaires were sent to all subjects 6 months later when they had received some oral hygiene instruction, scaling and root planing, and 55 were returned.Comparison of data for those subjects who completed both questionnaires showed no difference in LOC but showed a trend (p = 0.065) towards reduced OHIP (i.e. improved oral health-related quality of life).These subjects apparently did not alter their health control beliefs about periodontal disease as a result of treatment, but there may have been an improvement in their oral health-related quality of life. Further studies are required to confirm these possibilities.

To explore the attitudes of undergraduate dental students towards academically unacceptable behaviour.Three sets of vignettes were designed exploring; attitudes towards sharing essays which students present as their own work (set 1), attitudes towards purchasing an essay from a commercial website (set 2), and attitudes towards working in a group (set 3). Eighty-nine dental students read the vignettes, then indicated whether they felt the student depicted should engage in the behaviour, and whether any assessment of the work would be a fair assessment of the student's ability. In addition for the group working vignette, respondents were asked to indicate whether in that situation they would speak to the tutor about their own contribution to the group product.Twenty-one respondents (24%) reported that students should share essays, 11 (12%) felt that the essay would be a fair assessment; 13 (15%) felt that students should buy commercially produced essays, five (6%) felt it would be a fair assessment. For the vignettes involving group work, 31 (35%) respondents felt that group-based assessments were fair, 65 (73%) of respondents felt it unlikely that they would speak to the tutor about their individual contribution.A disturbing proportion of dental students report that cheating is acceptable, the majority feel that unacceptable academic practices are not a fair indication of students' ability. The respondents reported that they were unlikely to report the unacceptable working practices of fellow students.

The development of a questionnaire to measure patients' and their parents' expectations before orthodontic treatment, and to test the reliability and validity of this measure.A two-stage methodology, with open-ended interviews to identify themes and concepts followed by development and testing of the questionnaire.GKT Orthodontic Department, King's College Dental Hospital.The sample consisted of 140 participants, 70 patients aged 12-14 years, who had been referred to the orthodontic department for treatment. One parent of each patient was also recruited.The study was in two phases. In the first phase 30 participants (15 new patients and their 15 parents) participated in open-ended interviews, which were analysed qualitatively. Information from these interviews was used to construct a questionnaire. During the second phase, the questionnaire was piloted on 10 participants, five new consecutive patients and their parents. The questionnaire was then distributed to 174 subjects (87 new patients and their 87 parents). Seventy-eight subjects (39 new patients and their 39 parents) completed the questionnaire before their orthodontic consultation. Another 96 subjects (48 new patients and their 48 parents) were invited to complete the questionnaire prior to and at their orthodontic consultation. Test-retest analysis was conducted on 22 participants (11 patients and their 11 parents), who completed the questionnaire previous to and at their orthodontic consultation, and contributed to the psychometric validation of this questionnaire.A questionnaire was devized using the key themes and concepts identified in the open-ended interviews. As a result, 10 questions, some with sub-questions were constructed using a visual analogue scale as the response format.The questionnaire developed had good face validity. Internal consistency of the questionnaire using Cronbach's alpha, produced an overall inter-item reliability0.7 along with item-total correlations0.3 in over 50% of questions. Test-retest reliability was statistically significant using Spearman's correlation.This study provides a valid and reliable measure of orthodontic expectations in participants aged 12-14 years and their parents.

The role of the GDP and the dental team in the recognition and management of child abuse is discussed. Information on the current legislation and protocols for referral are provided.This paper discusses child abuse and offers information and practical advice for the dental team.

Aim A descriptive study was undertaken to assess the quality of a range of patient information leaflets produced by the British Dental Association. Method Twenty-nine leaflets were assessed with regard to presentation, readability and quality. The topic areas covered included: treatment, self-care and disease related information. Presentation was evaluated with regard to layout, font size, typeface, use of illustrations, paper type and print colour. Readability was assessed using the Flesch reading grade and the SMOG reading grade. Quality was assessed using the DISCERN tool. Findings All leaflets scored quite well for readability, with the average SMOG Reading Grade Level being 9.10 (SD 0.80) and the average Flesch reading Grade Level being 6.18 (SD 0.83). There were, however, some areas of presentation that could be improved, specifically font size, illustration use and paper finish, which did not comply with the RNIB guidelines. Quality ratings using the DISCERN tool were low. In particular most leaflets scored poorly in setting out clear aims in the opening paragraph, in identifying sources and dates of information provided, and other sources of advice and support available. Few leaflets discussed the option of no treatment or how the treatment would affect overall quality of life. The role of shared decision making was rarely mentioned. Conclusion Patient information leaflets produced commercially are of high production quality and good readability but tend not to be patient centred.

Summary. Objectives. The aims of the present study were to investigate the type and prevalence of dental emergencies presenting at a teaching hospital paediatric emergency clinic in Trinidad, and to describe the socio-demographic factors related to the use of the service. Design and methods. The authors used a prospective study of consecutive dental patients presenting to a paediatric emergency clinic. Data recorded included type of presenting emergency and socio-demographic variables. Results. Data were available for 309 participants; 47% were male and 53% female. The average age of the participants was 8·66 years (SD = 3·75 years; range = 1–16 years). Seventy-three per cent of the participants’ parents were involved in manual work or unemployed, and 21% were in nonmanual/professional employment; the occupation was not known in 6% of cases. Caries-related problems accounted for 74% of emergencies. Dental trauma mostly affected the upper permanent incisor teeth, with concussion, subluxation and intrusion being the most common injuries. Conclusion. Dental emergencies presenting to this university-based clinic were predominantly related to caries and trauma. The service was more frequently utilized by children in the mixed dentition stage, children from lower socioeconomic groups and those living in the local area. The frequency of caries-related problems indicates the need for more community-based preventive strategies, including encouraging greater attendance for routine dental care and dental health education. Strategies for oral health promotion should also be developed to prevent dental trauma.

Information on admission to psychiatric inpatient units is lacking from the literature on contemporary services for people with intellectual disability and mental health needs. Here we report on predictors of admission for a cohort of 752 adults from this population living in community settings; 83 were admitted. We also report on two subsamples of this cohort for whom different psychometric measures concerned with psychiatric symptoms and behavior had been completed. Schizophrenia spectrum disorders and mild intellectual disabilities independently predicted admission for the total cohort. The presence of symptoms associated with psychosis and the presence of physical aggression predicted admission in the subsamples.

The Treatment Evaluation Inventory of Kazdin, French, and Sherick is a 19-item measure of the perceived acceptability of behavioural treatments. Development of two brief forms was based on data from two sources. For Study 1, data from 218 completed questionnaires were used to develop internally consistent brief scales. In Study 2 internal consistency and the validity of the brief forms were estimated for a set of 131 questionnaires. Item reduction was achieved by analysis of item-total minus item correlations. Brief forms with 3, 6, 9, and 12 items were proposed. Their internal consistency (Cronbach α) and construct validity were based on correlations of scores on each short form with the full scale scores and on comparing means of different forms. Discriminant validity was based on the difference between two groups (estimated effect size 0.7). Scores for all forms showed high internal consistency and correlated highly with total scale scores. Only the 12-item brief scale yielded mean scores similar to the full scale. The 3-item form could be used as a quick screen, and the 12-item form for more intensive purposes as it is most similar to the full-scale.

Aims To investigate experiences and expectations of parents/siblings of adults with Down Syndrome (DS) regarding oral healthcare, and explore factors impacting on access and experience of dental care for this group. Design A two phase qualitative and quantitative study using in-depth interviews with a convenience sample of six parents/siblings, and a postal questionnaire of 200 parents/siblings of adults with DS who are members of the Down Syndrome Association. Results The main themes elicited from the qualitative interviews related to concern, experiences, parents'/siblings' attitudes, preferences and information. The response rate from the postal questionnaire was 63.5%. Adults with DS attended the dentist regularly but received little restorative treatment. Experience of oral healthcare was influenced by the attitudes and skills of dental health professionals; stigma; and relatives' expectations of dentists, their oral health beliefs, information and support received, knowledge and priorities. Parents/siblings wanted dentists to be proactive in providing more information on oral health issues in collaboration with other health and social care professionals. Conclusions Whilst most adults with DS visited the dentist regularly, relatively little treatment had been provided. Parents highlighted a need for appropriate and timely oral health information early in their child's life, and access to dentists who were sympathetic, good communicators and well-informed about DS.

The training and education of Professionals Complementary to Dentistry (PCDs) has become a topic of close scrutiny and much debate in the recent past, particularly with the introduction of enhanced duties and compulsory registration of some groups. This paper will describe the background to, the conduct of and the findings from a workshop held to explore innovative approaches to the education and training of PCDs in the United Kingdom. Existing systems of training and education of PCDs will be reviewed through the exploration of published literature and through the collection of primary data from interviews with key personnel both in the UK and internationally. An option appraisal is described which identified the elements common to all training approaches, used the elements as the basis for innovative training options, and explored the perceived advantages and disadvantages of each option through focus group discussions at a one-day workshop. A model for the training and education of PCDs is described that maintains existing PCD roles, but offers a broader range of entry points to training, settings for training and that builds upon existing skills to facilitate progression through the PCD roles.

Objective To investigate the career development, perception of status within the dental team, and level of job satisfaction of dental technicians in the United Kingdom. Design Cross-sectional postal questionnaire survey of 1,650 dental technicians registered with the Dental Technicians Association. Replies were received from 996 (60%). Results Eighty two per cent respondents had a qualification in dental technology and 21% also had an advanced level qualification. Almost two thirds of the respondents had undertaken no verifiable continuing professional development in the previous year. Only 27% of respondents expected to develop their career over the next five years. Less than 50% of the respondents felt adequately valued as individuals and as a professional group in the dental team. Job satisfaction was significantly related to age, attendance at one or more courses in the last year, working shorter hours, feeling valued in the dental team, and future career plans. Conclusions Plans for the registration and role expansion of dental technicians provide opportunities for career development which have yet to be realised. The low levels of continuing professional development currently undertaken indicate the need for a review of the provision and funding of training at a strategic level. Whilst levels of job satisfaction are satisfactory, many dental technicians feel insufficiently valued in the dental team.

To determine the level of self-assessed oral symptoms and the impact of such symptoms among individuals from four ethnic groups resident in South-east England and the relationship between self-assessed oral health status, age, gender, employment status, educational level and ethnicity.Cross-sectional survey of a convenience sample of 366 individuals drawn from four ethnic groups.Subjective Oral Health Status Indicators (SOHSI).Individuals were recruited through community groups. All participants self-classified their ethnicity. Only completed questionnaires from participants categorising themselves as White, Black Caribbean, Chinese or Indian were included in the data analysis.Univariate statistical analysis revealed significant differences between ethnic groups in all but one of the SOHSI scales. Age and ethnicity (in particular membership of the Chinese community) emerged as significant predictors of SOHSI scale scores.Within the limitations imposed by convenience sampling, it has been found that differences exist among four ethnic groups in the UK in their reporting of self-assessed oral health status. Ethnicity and age, in particular, predict the reporting of self-assessed oral symptoms and the impact of such symptoms.

To compare the levels of career satisfaction expressed by three professional groups working in dental health: dental therapists, dental hygienists and dental practitioners.Level of career satisfaction was assessed using a ten point scale in three surveys. Postal surveys were conducted of all dental therapists and dental hygienists registered with the General Dental Council. Data for dental practitioners were collected as part of the British Dental Association Omnibus Survey 2000.Data are reported for 227 dental therapists, 2,251 dental hygienists and 970 dental practitioners.Significant differences were found between groups in the level of career satisfaction expressed. Dental practitioners were less likely to express high levels of satisfaction in comparison with the other two professional groups. Within each group characteristics of the respondents were associated with satisfaction levels. Younger dental therapists and dental hygienists expressed lower levels of career satisfaction. The level of career satisfaction expressed by dental practitioners was associated with gender, place of work (North vs South UK), year of qualification, size of practice and system of remuneration.Dental practitioners express lower levels of job satisfaction in comparison to other groups of dental health care professionals. Job dissatisfaction among dental practitioners is related to a number of socio-demographic factors.

To identify and describe conceptual models of oral health shared by people from different minority ethnic groups, in particular the relationship between 'oral health' and 'general health'. To identify how these conceptions vary across social factors.In-depth interviews. Analysis of the interview data to identify the conceptual models used by participants in discussing oral health and its relationship to general health.Ninety-five individuals from different ethnic groups.Two models of 'health' were identified. The first reflected a traditional model which related health to the absence of disease. The second encompassed a broad definition of health including not only physical but social and psychological well-being and the ability to carry out everyday functions. The model within which an individual operated was influenced by ethnicity and gender. Additionally, two models of the relationship between oral health and general health were identified: one in which the two concepts were seen as separate but related; the other in which oral health and general health were viewed as inseparable aspects of a single dimension.People from minority ethnic groups vary in their understanding of oral health and its relationship to general health. This variation can be explained in part by ethnic and cultural factors. This finding has important implications both for the design of measures which seek to assess oral health related quality of life, and for the development of health promotional materials.

To provide an overview of the use of non-clinical outcome measures in dentistry and to identify trends and strengths and weaknesses in existing research.Literature searches using medical and social sciences databases and stated inclusion and exclusion criteria. Categorisation and coding of accepted studies according to: concept of outcome, study design and standardisation of outcome measures used. Simple graphical and statistical analysis used to identify trends in outcome measurement and strengths and weaknesses.There has been a steady growth in non-clinical outcome measurement research in dentistry over the last 10 years. Most studies have addressed dental knowledge, attitudes or behaviours (KAB), socio-dental indicators or anxiety. Two-thirds of all studies have used non-standardised outcome measures. Different concepts of outcome are associated with different study designs and standardisation status of outcome measures used. Studies addressing dental "satisfaction" and KAB are more likely than average to use non-validated measures.There needs to be more focus on the development of methods to assess the validity of non-clinical outcome measures in dentistry. In addition more conceptual studies need to be undertaken on the theoretical links between the different concepts of outcome found in the current study.

The purpose of this study was to examine the determinants of the health behaviour of ethnic groups in relation to alcohol and tobacco use. A cross-sectional questionnaire survey was carried out using network sampling amongst community groups in the South Thames region of the United Kingdom. Self-classified ethnic groups were identified: Black-African; Black-Caribbean; Indian; Pakistani; Bangladeshi and Chinese/Vietnamese. A total of 1113 people were recruited in the study. In all of the ethnic groups, men were more likely than women to smoke tobacco. Chewing of pan and tobacco was common in the South Asian communities and alcohol consumption was high among the Black-Caribbean group. Those factors were predicted by education, employment, gender and being born in the UK. It is important to examine the determinants of such risk behaviours in order to aid appropriate targeting of health promotion interventions, particularly those related to cancer control.

Statement of problem. Loss of a part of the face or having a congenitally missing ear, nose, or eye is likely to have both a social and a psychologic impact on those affected. The nature and extent of this impact has not been explored previously. The provision of facial prostheses is an increasingly viable and beneficial treatment option, but the psychologic and social adjustment to the prosthesis has not been described. Purpose. This study performed a preliminary investigation of patients' responses to loss of part of the face, and their perceptions of the prosthetic restoration of their missing facial part. Methods. Nine individuals who had experienced prosthetic replacement of an ear, nose, or eye were interviewed. Interviews were semistructured, each respondent was interviewed individually and the interviewer followed a predetermined interview schedule. Themes emerging in the interviews were identified. Results. The main themes relating to the loss of the facial part were the importance of the story of the loss, coping through bargaining, and the impact of the loss on relationships. The important themes identified in regard to the prosthesis were issues in the maintenance of the prosthesis and the reactions of other people to the prosthesis. Conclusion. Loss of part of the face requires great adjustment. The reactions of other people were marked. Provision of a facial prosthesis can assist in the process of adjustment. (J Prosthet Dent 1999;82:585-90.)

As part of a study investigating the relation between elderly patients' cognitive level and occupational therapy improvement, a method for assessing dressing skills was devised. The article describes this method of assessing dressing skills in elderly patients during the first dressing session of occupational therapy. The scoring of behaviour is based on a principle of minimum prompting, whereby greater credit is given for unprompted behaviour than for dressing after verbal or physical prompts. The method has high inter-rater reliability and correlates with a global performance test of activities of daily living.

Good communication between dentists and their patients benefits the patient, the dentist and the dental team. In this paper a model is described to help our understanding of the processes of communication between dentist and patient. This model, together with evidence from empirical research, is used to advise general dental practitioners on how to improve their communication skills.

The authors set up a study to investigate the levels of stress experienced by dental students and the students' perceptions of the sources of stress. Levels of stress among students were found to be high, particularly during the first 2 years of dental school. Sources of stress included the practice of conservative dental surgery, dealing with administration and dealing with clinical demonstrators.

Commentary on: Preoccupation with one's appearance: a motivating factor for cosmetic dental treatment?

The Attention/Distraction: Inhibition/Excitation Classroom Assessment Scale (Evans, 1975; Evans & Hogg, 1984) was administered to 80 children with severe learning difficulties with the Peabody Picture Vocabulary Test (PPVT) and subscales of the British Ability Scales (BAS). Factor analysis replicated the Attention/Distraction scale but the Inhibition/Excitation scale split into a verbal component and the remaining items. A new factor named responsivity to consequences was identified. Attention/Distraction showed good concurrent validity with the BAS and PPVT. This study shows the robustness of the Attention/Distraction: Inhibition/Excitation Classroom Assessment Scale as a measure of individual differences in children with severe learning difficulties.

Objective To assess inequalities in the availability of NHS dental services between Health Boards in Scotland. Study design Postal questionnaire survey of all dentists (n = 2,852) registered with the General Dental Council at an address in Scotland. Methods Data obtained on NHS working hours were used to model dentist to population (D/P) ratios and primary care D/P ratios corrected for part time working, variation in service productivity and the provision of private services. Results A total of 2,134 completed questionnaires (74.8%) were received. There was a wide variation in D/P ratios between Health Boards. Dumfries & Galloway and Grampian had the lowest, and Tayside and Greater Glasgow the highest D/P ratios, irrespective of method of calculation. The corrected D/P ratios for the other Health Boards were more similar than was suggested by the simple ratios of registered dentists to population size. Conclusions There was considerable variation in the availability of NHS dental practitioners between Health Boards. Simple ratios of registered dentists to population size can mask the true availability of specific dental services such as NHS dental care.

Objectives This study was a first attempt to derive an estimate of the likely incidence of somatization-specific behaviour in a dental setting and its relationship with both somatic symptoms and symptoms of depression. Methods Somatization-specific behaviour was operationalized as reporting of inexplicable dental symptoms (eg pain), remarkable frequent attendance at a dental surgery, inexplicably high treatment use or unreasonable requests with regard to treatment. Results Of the 309 patients surveyed, 8.7% fulfilled one or more of the criteria for somatization-specific behaviour. This was particularly manifested by a high attendance rate (6.8%). Women exhibited somatization-specific behaviour significantly more often (73%) than men (27%). Support was found for the hypothesis that individuals exhibiting characteristics of somatization-specific behaviour would present themselves to dentists more often with dental complaints and would suffer more from symptoms of depression than patients that did not display these characteristics. Conclusions The results suggest that somatization is a factor in dental practice.

Objectives To examine the relationship between dental anxiety, dental attendance and past treatment history in 5-year-old children after taking into account confounding influences. Methods A cross sectional study of all 5-year-old children living in Ellesmere Port and Chester. All children were clinically examined and dmft and its components were recorded. A postal questionnaire was sent to parents of participating children to identify whether children attended the dentist on a regular asymptomatic basis or only when experiencing problems. Additionally parents were asked to judge whether they and their child were anxious about dental treatment. The socio-economic status of the family was measured using the Townsend Material Deprivation Index of the electoral ward in which they resided. The bivariate relationships between anxiety and reported attendance, caries experience, past extraction and restoration history were assessed using chi-square and t-tests. Multiple logistic regression analyses were used to identify predictors for dental anxiety. Results A total of 1,745 children received both a clinical examination and a questionnaire and 1,437 parents responded, a response rate of 82.3%. One in ten parents (10.8%) judged their child to be dentally anxious. Anxious children had significantly (p