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Objective: This study aimed to evaluate the impact of root canal treatment on Oral Health-Related Quality of Life (OHRQoL) in general dental practice and compare it with tooth extraction. Additionally, patient satisfaction following tooth-preserving treatment was assessed. Material and methods: In all, 65 patients were recruited from 6 general dental clinics in Västra Götaland over 8 weeks, with 37 starting root canal treatment and 28 having extractions. Questionnaires, including Oral Health Impact Profile-14 (OHIP-14) and 9 questions assessing patient satisfaction, were administered at treatment initiation, and at 1, 6, and 12 months. The responses from both modalities were analysed using descriptive and analytical statistical methods. Results: The response rate ranged from 73.8% to 92.3%. Regarding OHRQoL, differences between the groups were few compared to baseline. However, significant improvements were observed in the extraction group at the 6- and 12-month follow-ups, in the ‘total score’, and the dimensions ‘pain’, ‘discomfort’, and ‘handicap’. Patient satisfaction was generally high, with cost being the least satisfactory item. Pain intensity remained consistently low. Conclusions: In this prospective cohort study few differences were found between the two treatment modalities. However, significant improvements were observed in the extraction group in several dimensions. The patient satisfaction regarding root canal treatment was considered high.

Background: Dental graduates need to demonstrate clinical competency. This mixed‐methods study explored the perceptions of clinicians who employ or work with new graduates from the University of Otago, New Zealand, and identified themes reflecting graduates' preparedness for independent practice. Methods: An online survey using a semantic differential scale and open‐ended questions collected opinions and experiences from the workforce. Quantitative data were analysed using SPSS software, and qualitative data were analysed thematically. Results: A representative sample of the workforce was obtained with a response rate of 35% (N = 83). Most clinicians engage new graduates to support the profession and/or rural communities. They perceived that graduates were well prepared in most areas, could translate theory to clinical practice and demonstrate professionalism. Graduates were reportedly stronger in basic dentistry, communication, ethics, and record keeping however were less strong in complex treatment planning, molar endodontics, fixed prosthodontics and exodontia. Clinical exposure during dental training was perceived as more limited, and mentoring and guidance in the transition to practice were deemed to be important. Conclusions: New Zealand dental graduates appear prepared for independent practice; however, maximising clinical opportunities during training, mentoring and early professional development in advanced areas of practice is essential to enhance competency and confidence. [ABSTRACT FROM AUTHOR]

Introduction: Studies in many countries have reported that dentists do not always comply with treatment quality guidelines when undertaking root canal treatment (RCT). However, there is no information on the compliance of dentists in Qatar with quality guidelines. Using an online questionnaire, this study aimed to collect baseline information on how dentists working within the Primary HealthCare Corporation (PHCC), Qatar, carried out RCT. Materials and Methods: A questionnaire was E-mailed to general dental practitioners (GDPs) and specialists. The questionnaire collected demographic information, continuous professional development (CPD) hours, information on early stages of RCT, RCT protocols, use of technology and materials. Statistical analyses were undertaken using version 27 SPSS software. Results: The response rate was 55% of GDPs and 83% of specialists. Twenty-six percent of GDPs never used rubber dams whereas specialists always used rubber dam (P < 0.001). The 57% of GDPs who undertook a complete RCT reported they treated mostly anterior and premolar teeth with few molars (12%), few attempted RCT retreatment (4%). All specialists treated molars (P < 0.001) and 50% undertook retreatment (P < 0.001). The majority of specialists reported using magnification (55%) with only 23% of GDPs using loupes (P < 0.001). During the past 2 years, 42% of specialists earned > 20 CPD hours which was significantly more than the 50% of the GDPs who undertook < 5 h (P < 0.001). Conclusions: Half of the GDPs working within the PHCC do not carry out RCT nor rubber dam isolation due to short duration of treatment session. Specialists generally follow the current guidelines when providing RCT, while the GDPs do so less often. [ABSTRACT FROM AUTHOR]

To increase the detection of unknown atrial fibrillation (AF), general practitioners have started screening their patients using small hand-held devices. It is thought that dental settings could be utilized for screening as they have regular access to patients. The aim of this study was to explore the perceptions of dental staff of screening for AF using a hand-held electronic device in primary dental care. The research took place in one large mixed NHS and private general dental practice. Views from staff including dentists, dental therapists, dental nurses, and managers were elicited via semi-structured interviews conducted face-to-face, audio recorded, and transcribed verbatim. Interviews continued until there were no new themes or patterns emerging from the data, and thematic saturation had been achieved. Eleven participants were interviewed. The main themes generated were methodology for screening, acceptability for screening within the practice, attitudes to screening, and implementation of screening. Overall, participants were positive about implementing AF screening in a dental practice but expressed concerns about time and remuneration. Staff also gave encouraging feedback regarding the simplicity of the portable screening device. Participants felt that AF screening in primary care dental practices was a good concept but may be challenging to implement in NHS Dentistry, especially due to the pandemic. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to evaluate the content, quality, and readability of orthodontic information contained on the websites of general dental practices located in Australia. An online search strategy was adopted to identify practice websites for evaluation. Websites satisfying inclusion/exclusion criteria were checked for the presence of pre-determined orthodontic treatment-related items. Three validated quality of health information and readability tools were applied for website content assessment. A total of 231 websites satisfied inclusion/exclusion criteria. The mean overall [SD] DISCERN score was 29.87 (6.03)/80, [95%CI: 29.09–30.65]. The majority of the websites (88.3%) recorded poor or very poor DISCERN quality of information scores. Most websites described orthodontic clear aligner treatment (91.3%). Information regarding Invisalign® was provided by 69.3% and myofunctional therapy by 22.5%. Only 7 (3%) websites indicated that orthodontic retention was indefinite. The mean [SD] Simple Measure of Gobbledygook (SMOG) score was 10.10 [1.31], (95%CI: 9.95–10.25). The SMOG and Flesch Reading Ease scores were closely correlated (r = −0.9041; 95%CI: −0.93 to −0.88; p < 0.0001) and signified difficult-to-read information. The content authors should consider the use of quality information and readability tools to ensure that readers access high-quality and readable information. [ABSTRACT FROM AUTHOR]

Background: Progression of dental caries can result in irreversible pulpal damage. Partial irreversible pulpitis is the initial stage of this damage, confined to the coronal pulp whilst the radicular pulp shows little or no sign of infection. Preserving the pulp with sustained vitality and developing minimally invasive biologically based therapies are key themes within contemporary clinical practice. However, root canal treatment involving complete removal of the pulp is often the only option (other than extraction) given to patients with irreversible pulpitis, with substantial NHS and patient incurred costs. The European Society of Endodontology's (ESE 2019) recent consensus statement recommends full pulpotomy, where the inflamed coronal pulp is removed with the goal of keeping the radicular pulp vital, as a more minimally invasive technique, potentially avoiding complex root canal treatment. Although this technique may be provided in secondary care, it has not been routinely implemented or evaluated in UK General Dental Practice. Method: This feasibility study aims to identify and assess in a primary care setting the training needs of general dental practitioners and clinical fidelity of the full pulpotomy intervention, estimate likely eligible patient pool and develop recruitment materials ahead of the main randomised controlled trial comparing the clinical and cost-effectiveness of full pulpotomy compared to root canal treatment in pre/molar teeth of adults 16 years and older showing signs indicative of irreversible pulpitis. The feasibility study will recruit and train 10 primary care dentists in the full pulpotomy technique. Dentists will recruit and provide full pulpotomy to 40 participants (four per practice) with indications of partial irreversible pulpitis. Discussion: The Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP) study will address the lack of high-quality evidence in the treatment of irreversible pulpitis, to aid dental practitioners, patients and policymakers in their decision-making. The PIP feasibility study will inform the main study on the practicality of providing both training and provision of the full pulpotomy technique in general dental practice. Trial registration: ISRCTN Registry, ISRCTN17973604. Registered on 28 January 2021. Protocol version Protocol version: 1; date: 03.02.2021 [ABSTRACT FROM AUTHOR]

Abstract Background Dental attendance provides an important opportunity for dental teams to explore with parents the oral health behaviours they undertake for their young children (0–5 years old). For these discussions to be effective, dental professionals need to be skilled in behaviour change conversations. The current evidence suggests that dental teams need further support, training and resources in this area. Therefore, the University of Leeds and Oral-B (Procter & Gamble Company) have worked with the local community and dental professionals to co-develop “Strong Teeth” (an oral health intervention), which is delivered in a general dental practice setting by the whole dental team. The protocol for this early phase study will explore the feasibility and acceptability of the Strong Teeth intervention to parents and the dental team, as well as explore short-term changes in oral health behaviour. Methods Forty parents (20 of children aged 0–2 years old, and 20 of children aged 3–5 years old) who are about to attend the dentist for their child’s regular dental check-up will be recruited to the study. Parents and children will be recruited from 4 to 8 different dental practices. In the home setting, consent and baseline oral health behaviour data will be collected. The researchers will ask parents questions about their child’s oral health behaviours, including toothbrushing and diet. Three different proxy objective measures of toothbrushing will be collected and compared with self-report measures of parental supervised toothbrushing (PSB). Discussion The parent and child will then attend their dental visit and receive the Strong Teeth intervention, delivered by the dental team. This intervention should take 5–15 min to be delivered, in addition to the routine dental check-up. Furthermore, children aged 0–2 years old will receive an Oral-B manual children’s toothbrush, and children aged 3–5 years old will receive an Oral-B electric rechargeable children’s toothbrush. At 2 weeks and 2–3 months following the Strong Teeth intervention, further self-report and objective measures will be collected in the parent/child’s home. This data will be supplemented with purposively sampled qualitative interviews with parents (approximately 3 months following the intervention) and dental team members (following delivery of the intervention). Trial registration ISRCTN Register, (ISRCTN10709150)

Abstract Background The aim of this study was to investigate the acceptance and assessment of work shadowing carried out by students and dentists in dental practices. Furthermore, the extent to which students perceive an improvement in their specialised, communication and social competencies, was to be examined. Methods 61 dental students in their clinical semesters at a German university participated in work shadowing placements at 27 different general dental practices. Before beginning, they received checklists of various competencies that they self-assessed using school grades (from 1 = ‘very good’, to 6 = ‘failed’), which they also repeated after completion. The dentists supplemented this with their external assessments. In addition, the students were requested to fill out a 54-item questionnaire and compose a freely-structured report after the work shadowing; the dentists filled out a questionnaire containing 16 items. The statistical analysis was carried out by means of the Friedman Test, including a post-hoc test (Bonferroni-Holm correction). Results The analysis showed a significant overall improvement in the students’ self-assessed competencies by 0.71* ± 0.43 grades. With an average of 0.33* ± 0.36, the dentists’ external assessment proved significantly higher than the self-assessment. The greatest improvements were perceived by the students in the areas of accounting (1.17* ± 0.77), practice organisation (1.05* ± 0.61) and dentist’s discussions (0.94* ±0.80) [*p

With patients living longer and retaining their natural teeth for longer, dental healthcare professionals are presented with new challenges. This paper outlines considerations for dental health care professionals managing periodontal disease in an ageing population. Although age itself is not considered an independent risk factor for periodontal disease, there may be complicating factors associated with ageing that impact upon the planning and delivery of care. This paper describes current evidence for the management of periodontal disease in the context of health conditions associated with ageing. It identifies aspects to consider and provides advice on how treatment planning for this patient population may be tailored. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Much of the literature concerned with health care practice tends to focus on a decision‐making model in which knowledge sits within the minds and bodies of health care workers. Practice theories de‐centre knowledge from human actors, instead situating knowing in the interactions between all human and non‐human actors. The purpose of this study was to explore how practice arises in the moment‐to‐moment interactions between general dental practitioners (GDPs), patients, nurses, and things. Method: Eight GDPs in two dental practices, their respective nurses, 23 patients, and material things were video‐recorded as they interacted within clinical encounters. Videos were analysed using a performative approach. Several analytic methods were used: coding of interactions in‐video; pencil drawings with transcripts; and dynamic transcription. These were used pragmatically and in combination. Detailed reflective notes were recorded at all stages of the analysis, and, as new insights developed, theory was sought to help inform these. Results: We theorized that knowing in dental practice arises as actors translate embodied knowing through sayings and doings that anticipate but cannot predict responses, that knowing is constrained by the interactions of the practice but that the interactions at the same time are a collective bricolage—using the actors' respective embodied knowing to generate and solve problems together. Conclusion: Practices are ongoing ecological accomplishments to which people and things skilfully contribute through translation of their respective embodied knowing of multiple practices. Based on this, we argue that practices are more likely to improve if people and things embody practices of improvement. [ABSTRACT FROM AUTHOR]

Introduction: General dentistry is the most common area of practice, and new dentists must have the competency and skills to safely deliver patient care. In New Zealand (NZ), completion of a 5‐year Bachelor of Dental Surgery (BDS) degree enables graduates to register with the Dental Council in NZ. This necessitates that the clinical component of the curriculum in final year dentistry (BDS5) transparently delivers learning opportunities and evaluates competency for independent practice. A review of the BDS5 Clinical Practice course was undertaken in 2015 and a revised curriculum introduced in 2016. Curriculum: We present a BDS5 curriculum for a Clinical Practice course that is learner focused with emphasis on comprehensive patient‐centred care, competency and professional practice. Learning opportunities and assessment processes are described alongside teacher training. These changes have provided students scaffolding to support clinical and professional development, and accommodate different learning preferences. The outcomes align with the competency requirements of the NZ regulatory body for registration as a general dental practitioner. Since its introduction 3 years ago, ongoing feedback from students and staff has been positive and indicates the curriculum is effective in achieving its objectives. Conclusions: This curriculum provides a firm foundation for students transitioning to independent clinical practice in the community and supports the professional development of clinical teachers. It may also be translated to other areas of health education to ensure the delivery of quality holistic patient care. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Primary care dentists are in a unique position to screen for alcohol misuse and provide brief advice to patients; however, lack of knowledge and confidence are some of the barriers cited for their reluctance to do so. Aims: This study describes the evaluation of a novel brief alcohol advice training programme specifically designed and tailored to the needs of NHS general dental practitioners. Materials and Methods: The training programme was developed as part of a feasibility trial and included a mixture of theoretical and practical elements. During 8 h of highly interactive sessions, participants took part in role‐plays, including scenarios of patients of varying age groups, oral health status, dental attendance and different levels of motivation. Training manuals and other resources were also given. Knowledge, attitudes and confidence scores were assessed before and after the sessions. Wilcoxon matched‐pairs signed‐ranks and McNemar's tests were used to compare participants’ performance before and after the completion of the programme. Results: Significant positive changes were observed in all training objectives. There was an overall improvement of 23% in levels of knowledge, a 40% increase in positive attitudes towards alcohol screening and intervention and 80% increase in confidence scores. Fidelity assessments of the implementation of the intervention in the trial showed that dentists who completed the training successfully went on to screen for alcohol misuse and provide brief advice to patients. Conclusion: NHS dentists can be successfully trained with the relevant knowledge, attitudes and confidence needed to deliver alcohol screening and brief advice to patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate patients' views on health service initiatives established to improve uptake of NHS primary dental care amongst adult patients in a socially deprived area, comparing practices with extended and regular contract capacity. Study design: Service evaluation and cross-sectional survey. Method: Questionnaire survey of patients attending a random sample of dental practices in three inner-metropolitan boroughs of south London following initiatives to improve access to dental care (across dental practices delivering regular and extended contracts for services) exploring attendance patterns and the influence and awareness of local initiatives to promote access. Results: Four hundred fifty adults across 12 dental practices completed questionnaires: 79% reported attending for routine and 21% for urgent care. Patients were most aware of banners outside practices, followed by dental advertisements in newspapers. Vouchers for free treatments were considered of the highest possible influence, followed by vouchers for reduced treatment costs and an emergency out-of-hours helpline. Awareness and influence were not aligned, and there was no evidence of difference by practice contract type whilst there were differences by age and type of attendance. Conclusion: The findings suggest that financial incentives and emergency services are considered the most influential initiatives for adult patients whose attendance patterns appear to be related to personal circumstances rather than merely being influenced by the provision of information. [ABSTRACT FROM AUTHOR]

The "Advancing Dental Education in the 21st Century" project assesses current status and trends to prepare for the future. Section 3 of the project asks what knowledge and skills should dental and advanced dental education learners have to provide dental care in 2040 and how should educators be preparing them. This executive summary of five background articles in this section focuses on predoctoral education, advanced dental education, the provision of medical services within dental practice, the incorporation of oral health services into primary care and medical practice, and interprofessional education and practice. The changing environment and external forces are presented along with their implications for advancing dental education. These forces include changes in population characteristics (e.g., demographics, disease prevalence, health disparities, consumerism), treatment needs and modalities, care delivery, science and technology, educational methods, and medical and dental integration. Future oral health professionals (OHPs) will care for more diverse patient populations, older patients with complex medical and dental needs, and relatively dentally healthy younger cohorts who require fewer complex restorative and prosthodontic treatments. Increasing integration of medical and oral health education and patient care will require OHPs to have more medical knowledge and to practice in intra- and interprofessional teams. OHPs increasingly will be providing patient-centered care as employees in large group practices, health care settings, and safety net clinics with expanded types of OHPs and improved materials and technology. Educators need to implement innovative curricula and educational methods to prepare for and adapt to the disruptive changes that lie ahead. [ABSTRACT FROM AUTHOR]

Background: Independent contractor status of NHS general dental practitioners (GDPs) and general medical practitioners (GMPs) has meant that both groups have commercial as well as professional identities. Their relationship with the state is governed by a NHS contract, the terms of which have been the focus of much negotiation and struggle in recent years. Previous study of dental contracting has taken a classical economics perspective, viewing practitioners’ behaviour as a fully rational search for contract loopholes. We apply institutional theory to this context for the first time, where individuals’ behaviour is understood as being influenced by wider institutional forces such as growing consumer demands, commercial pressures and challenges to medical professionalism. Practitioners hold values and beliefs, and carry out routines and practices which are consistent with the field’s institutional logics. By identifying institutional logics in the dental practice organisational field, we expose where tensions exist, helping to explain why contracting appears as a continual cycle of reform and resistance. Aims: To identify the factors which facilitate and hinder the use of contractual processes to manage and strategically develop General Dental Services, using a comparison with medical practice to highlight factors which are particular to NHS dental practice. Methods: Following a systematic review of health-care contracting theory and interviews with stakeholders, we undertook case studies of 16 dental and six medical practices. Case study data collection involved interviews, observation and documentary evidence; 120 interviews were undertaken in all. We tested and refined our findings using a questionnaire to GDPs and further interviews with commissioners. Results: We found that, for all three sets of actors (GDPs, GMPs, commissioners), multiple logics exist. These were interacting and sometimes in competition. We found an emergent logic of population health managerialism in dental practice, which is less compatible than the other dental practice logics of ownership responsibility, professional clinical values and entrepreneurialism. This was in contrast to medical practice, where we found a more ready acceptance of external accountability and notions of the delivery of ‘cost-effective’ care. Our quantitative work enabled us to refine and test our conceptualisations of dental practice logics. We identified that population health managerialism comprised both a logic of managerialism and a public goods logic, and that practitioners might be resistant to one and not the other. We also linked individual practitioners’ behaviour to wider institutional forces by showing that logics were predictive of responses to NHS dental contracts at the dental chair-side (the micro level), as well as predictive of approaches to wider contractual relationships with commissioners (the macro level). Conclusions: Responses to contracts can be shaped by environmental forces and not just determined at the level of the individual. In NHS medical practice, goals are more closely aligned with commissioning goals than in general dental practice. The optimal contractual agreement between GDPs and commissioners, therefore, will be one which aims at the ‘satisfactory’ rather than the ‘ideal’; and a ‘successful’ NHS dental contract is likely to be one where neither party promotes its self-interest above the other. Future work on opportunism in health care should widen its focus beyond the self-interest of providers and look at the contribution of contextual factors such as the relationship between the government and professional bodies, the role of the media, and providers’ social and professional networks. Funding: The National Institute for Health Research Health Services and Delivery Research programme.

Background: A complaint from a patient can have a serious impact on the well-being of dentists. Little is known, however, about the nature and the extent of this impact. Methods: Therefore in 2013 an anonymous survey was conducted among 955 dentists and dental specialists who were involved in a complaints procedure dealt with by the Complaints Committee of the Royal Dutch Dental Association (KNMT) in the period of mid-2008 to mid-2013. Results: In total 413 (43 %) of these dentists participated in the study. As a result of a formal complaint 71 % of the respondents experienced a considerable impact in their professional practising, while 52 % stated that it had (also) seriously influenced their attitude towards colleagues and patients. Furthermore, 60 % (also) mentioned effects of a complaints procedure regarding their mental and/or physical well-being. Conclusions: Being confronted with a formal complaint from a patient leads to a considerable impact on dentists' professional practice and personal well-being. It is remarkable this did not only pertain to a 'negative' impact, but also to a 'positive' impact. Despite unpleasant feelings, several dentists regarded the complaint as a 'wake-up call'. Furthermore, given the relatively high number of successful mediation attempts it can be concluded that this form of complaint handling appears to be a successful way of solving problems that have arisen between patients and dentists. [ABSTRACT FROM AUTHOR]

Objectives To assess the extent to which antibiotic prescribing in general dental practice conforms to clinical guidelines and to describe factors associated with antibiotic prescription in the absence of spreading infection or systemic involvement. Methods A cross-sectional study of the management of adult patients with acute dental conditions by General Dental Practitioners ( GDPs) in Wales, UK. Clinical information on the management of patients was compared to clinical and prescribing guidelines published by the Scottish Dental Clinical Effectiveness Programme and the Faculty of General Dental Practice ( UK). Multilevel logistic regression was used to identify patient, practitioner and consultation characteristics predictive of antibiotic prescribing in the absence of infection. Results Antibiotics were prescribed to 57.4% of 568 patients. Over half of antibiotics (65.6%) were prescribed in situations where there was no evidence of spreading infection, and 70.6% were used without the provision of an operative intervention. Only 19.0% of antibiotics were prescribed in situations where their use was indicated by clinical guidelines. Factors associated ( P < 0.05) with antibiotic prescription in the absence of infection were failure of previous operative treatment (Odds Ratio ( OR) 13.57), shortage of clinical time to undertake treatment ( OR 10.21), patients who were unable or unwilling to accept operative treatment ( OR 4.89), patient requests for antibiotics ( OR 3.69) and acute periodontal conditions ( OR 3.37). Conclusions A high level of inappropriate antibiotic prescribing was observed amongst the GDPs studied. Features of the healthcare environment, such as clinical time pressures, and patient-related characteristics, such as expectations for antibiotics and refusal of operative treatment, are associated with antibiotic prescribing in the absence of infection. Individuals responsible for the commissioning and delivery of dental services should seek to develop targeted interventions addressing these issues in order to ensure optimal antimicrobial stewardship within dentistry. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to evaluate the trend of dental practitioners in the federal state of Saarland in Germany in regard to restoring endodontically treated teeth using a Web-based survey. Materials and methods: An interactive Web-based survey instrument was developed, including seven clinical scenarios, presented by photographs of natural incisor and premolar with different types of cavities. Following a decision tree adapted to the clinical treatment, questions on different aspects of the post-endodontic treatment were asked. All 615 members of the Saarland Dental Association (SDA) were asked to participate in the survey. Results: A total of 33 % completed the survey. The majority of the participants believed in the reinforcement effect of the ferrule design, as well as the post placement. The vast majority of the responding practitioners (92 %) adapted their treatment strategies to a high extent to the destruction degree of the endodontically treated tooth. Fiber-reinforced composite (FRC) posts are the most popular prefabricated post type, regardless of the cavity size and tooth localization. Significant differences between the dentists according to the degree of experience were detected only for the use of glass-ionomer cements as core buildup material. Conclusions: The predominant post-endodontic treatment strategies of German dental practitioners are only partly in agreement with the current literature. There is a clear trend toward the increasing use of metal-free post and core materials. Clinical significance: Although the participants showed a general adoption of modern materials and techniques, different patterns of post-endodontic treatment were revealed that were not consistent with approaches supported by the literature. [ABSTRACT FROM AUTHOR]

Background Delivering improvements in quality is a key objective within most healthcare systems, and a view which has been widely embraced within the NHS in the United Kingdom. Within the NHS, quality is evaluated across three key dimensions: clinical effectiveness, safety and patient experience, with the latter modelled on the Picker Principles of Patient-Centred Care. Quality improvement is an important feature of the current dental contract reforms in England, with "patient experience" likely to have a central role in the evaluation of quality. An understanding and appreciation of the evidence underpinning PCC within dentistry is highly relevant if we are to use this as a measure of quality in general dental practice. Methods A systematic review of the literature was undertaken to identify the features of PCC relevant to dentistry and ascertain the current research evidence base underpinning its use as a measure of quality within general dental practice. Results Three papers were identified which met the inclusion criteria and demonstrated the use of primary research to provide an understanding of the key features of PCC within dentistry. None of the papers identified were based in general dental practice and none of the three studies sought the views of patients. Some distinct differences were noted between the key features of PCC reported within the dental literature and those developed within the NHS Patient Experience Framework. Conclusions This systematic review reveals a lack of understanding of PCC within dentistry, and in particular general dental practice. There is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient-centredness. Further research is necessary to understand the important features of PCC in dentistry and patients' views should be central to this research. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the degree of involvement of general dental practitioners working in primary health care centers of the Ministry of Health (MOH) of Kuwait in tobacco cessation activities. Subjects and Methods: A survey questionnaire composed of 48 structured multiple choice questions aimed at assessing practitioner knowledge, attitudes, perceived expectations, confidence, and perceived barriers preventing them from performing these activities was distributed to 150 general dentists working in MOH dental clinics. Results: One hundred forty-five dentists responded to the survey questionnaire. Twelve (12%) surveyed practitioners always or almost always incorporated overall tobacco cessation activities into their practice. Forty-one (3%) of the respondents felt that they had excellent cessation knowledge. One (1%) felt barriers prohibited their performance of cessation activities. One hundred (76%) participants strongly agreed that there was an expectation for them to perform cessation activities in their clinics. Fourteen (10%) respondents felt very confident about their cessation counseling skills. Conclusions: Findings showed that smoking cessation practices are not performed on a routine basis in MOH dental clinics. Practitioner knowledge and confidence showed the most significant association with the performance of cessation activities. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives The primary goal of dental education is to prepare students to work independently in a dental practice setting following graduation. Whilst academicians assess students' work preparedness through examinations and evaluations, it is equally important to understand the work preparedness as perceived by students. Methods All students in their final year of the graduate programme in dentistry were selected for this study. The questionnaire assessed the self-perceived confidence in skills and awareness needed to integrate into a general dental practice. Personal data such as gender, age and income status were optionally recorded. The questionnaire included open-ended questions relevant to the educational experiences and suggestions for improvement from student perspective. Results Sixty-three students (81.9%) responded to the questionnaire. The majority of the respondents (85.7%) perceived that their education had prepared them well for a career in dentistry, and 52.4% of the students considered that the combination of community placement and in-house training helped them to enhance clinical skills. Students' suggestion for improvements indicated that a large number would wish for more clinical sessions (71.4%), whilst only 28.6% preferred an equal distribution between general clinical placements, speciality clinical placement and didactic teaching as the essential factors in attaining competency. Conclusions Analysing and understanding the student's self-perspective on their dental education and work preparedness contribute towards the quality management of the dental curriculum philosophies: in holistic patient health care, lifelong learning, integration knowledge and skills, leading to the ultimate goal of clinical proficiency. [ABSTRACT FROM AUTHOR]

Objectives: To assess the value of a quality improvement programme for panoramic radiography. Methods: A prospective, cluster randomised controlled trial was conducted in 40 dental practices in England. Practices were randomly assigned into two groups, an 'active' practice receiving regular feedback on film quality and a 'control' practice receiving no feedback until the completion of the study. Results: 800 panoramic radiographs were examined for technical and processing faults. Following the first feedback to the 'active' practices, 100 films showed that the films taken were a significant predictor of a reduction in the number of technical (effect coefficient 0.51 (standard error SE 0.06); P < 0.001) and processing (effect coefficient 0.42 (SE 0.08); P < 0.001) faults compared to those in 'control' practices (n = 400). The 'active' practices continued to benefit from the second round of feedback, showing a marked reduction in technical (effect coefficient 1.31 (SE 0.06); P < 0.001) and processing (effect coefficient 1.18 (SE 0.11); P < 0.001) faults. Two months after completion of the study, a further 120 panoramic radiographs from 12 practices in each group were examined for quality. Significant differences between the two groups for both technical faults (effect coefficient 0.62 (SE 0.22); P = 0.02) and processing faults (effect coefficient 0.65 (SE 0.17); P < 0.001) were found. Conclusions: This cluster randomised controlled trial showed that distance feedback is an effective method in instructing dental practitioners to correct technical and processing errors experienced in producing panoramic radiographs. This intervention was effective in the short term whilst the practitioners were actively receiving feedback and for 8 weeks afterwards. Clinical significance: Panoramic radiography quality is often poor due to a lack of knowledge of correct patient positioning. A failure to comply with manufacturers' instructions regarding the changing frequency for processing chemistry also compounds the problem. Distant feedback is effective in improving film quality in the short term and after 8 weeks. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To measure the added value of panoramic radiography in new dentate patients attending for routine treatment. Methods: Thirty-seven general dental practitioners using panoramic radiographs routinely were recruited. Twenty dentate patients were identified prospectively by each participating dentist if they were new to the practice, attending for an examination and requesting any treatment deemed necessary. A panoramic radiograph was taken with appropriate intraoral radiographs in line with national guidelines. Each dentist completed a radiological report for the panoramic radiograph only and these 20 reports were forwarded to the researchers along with the 20 panoramic radiographs, their accompanying bitewing and periapical radiographs and twenty completed clinical assessment sheets. Results: 740 panoramic, 1418 bitewing and 325 periapical radiographs were assessed by the researchers. Only 32 panoramic films provided any additional diagnostic value when compared to intraoral films when guidelines had been observed resulting from the poor technical and processing quality of the accompanying intraoral films. Assessment of the number of caries and periapical lesions and the degree of periodontal bone loss from the intraoral films provided a greater diagnostic yield at the p <0.001 level of significance. The research found that dentists underestimated the number of caries lesions present and level of periodontal bone loss when compared to the researchers but overestimated the presence of periapical pathology, at the level of significance at p <0.001. Conclusions: The study found that there was no support for the use of panoramic radiographs in routine screening as there was no net diagnostic benefit to the patient. [Copyright &y& Elsevier]

Abstract: Objectives: The aim of this report was to evaluate the 5-year clinical performance and survival of zirconia (NobelProcera™) single crowns. Methods: All patients treated with porcelain-veneered zirconia single crowns in a private practice during the period October 2004 to November 2005 were included. The records were scrutinized for clinical data. Information was available for 162 patients and 205 crowns. Results: Most crowns (78%) were placed on premolars and molars. Out of the 143 crowns that were followed for 5 years, 126 (88%) did not have any complications. Of those with complications, the most common were: extraction of abutment tooth (7; 3%), loss of retention (15; 7%), need of endodontic treatment (9; 4%) and porcelain veneer fracture (6; 3%). No zirconia cores fractured. In total 19 restorations (9%) were recorded as failures: abutment tooth extraction (7), remake of crown due to lost retention (6), veneer fracture (4), persistent pain (1) and caries (1). The 5-year cumulative survival rate (CSR) was 88.8%. Conclusions: According to the present 5-year results zirconia crowns (NobelProcera™) are a promising prosthodontic alternative also in the premolar and molar regions. Out of the 143 crowns followed for 5 years, 126 (88%) did not have any complications. However, 9% of the restorations were judged as failures. Further studies are necessary to evaluate the long-term success. [Copyright &y& Elsevier]

The Hall Technique (HT) is a method for managing carious primary molars. Decay is sealed under pre-formed metal crowns without any caries removal, tooth preparation, or local anesthesia. The aim of this study was to compare HT clinical/radiographic failure rates with General Dental Practitioners’ (GDPs) standard (control) restorations. We conducted a split-mouth, randomized control trial (132 children, aged 3-10 yrs, GDPs n = 17) in Scotland. There were 264 study teeth with initial lesions, 42% of which were radiographically > half-way into dentin, and 67% of which had Class II restorations. Teeth were randomized to HT (intervention) or GDPs’ usual treatment (control). Annual clinical/radiographic follow-up data were recorded. Ninety-one patients (69%) had 48 months’ minimum follow-up. At 60 months, ‘Major’ failures (irreversible pulpitis, loss of vitality, abscess, or unrestorable tooth) were recorded: HT, 3 (3%); control restorations, 15 (16.5%) (p = 0.000488; NNT 8); and ‘Minor’ failures (reversible pulpitis, restoration loss/wear/fracture; or secondary caries): HT, 4 (5%); control restorations, 38 (42%) (p < 0.000001; NNT 3). Overall, there were follow-up data for 130 patients (2-60 mos): ‘Major’ failures: HT, 3 (2%); control restorations, 22 (17%) (p = 0.000004; NNT 7); and ‘Minor’ failures, HT, 7 (5%); control restorations, 60 (46%) (p < 0.000001; NNT 3). Sealing in caries by the Hall Technique statistically, and clinically, significantly outperformed GDPs’ standard restorations in the long term (Trial registration no. ISRCTN 47267892). [ABSTRACT FROM PUBLISHER]

The aim of this study was to investigate the quality of communication and master impressions for the fabrication of cobalt chromium removable partial dentures (RPDs) in general dental practice in England, Ireland and Wales in 2009. Two hundred and ten questionnaires were distributed to 21 laboratories throughout England, Ireland and Wales. Information was collected regarding the quality of written communication and selection of master impression techniques for cobalt chromium partial dentures in general dental practice. One hundred and forty-four questionnaires were returned (response rate = 68%). Alginate was the most popular impression material being used in 58% of cases ( n = 84), while plastic stock trays were the most popular impression tray, being used in 31% of cases ( n = 44). Twenty-four per cent ( n = 35) of impressions were not adequately disinfected. Opposing casts were provided in 81% of cases ( n = 116). Written instructions were described as being ‘clear’ in 31% of cases ( n = 44). In 54% of cases ( n = 76), the technician was asked to design the RPD. Based on the findings of this study, written communication for cobalt chromium RPDs by general dental practitioners is inadequate. This finding is in breach of relevant contemporary legal and ethical guidance. There are also concerns in relation to the fabrication process for this form of prosthesis, particularly, in relation to consideration of occlusal schemes. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: All-ceramic crowns have become increasingly used also in the posterior regions, but there are only few studies documenting the clinical outcome of these restorations. The aim was therefore to present the 3-year outcome of zirconia (NobelProcera™) single crowns. Methods: All patients treated with porcelain-veneered zirconia single crowns in a private practice during the period October 2004 to November 2005 were included. The patient records were scrutinized for data on the restorations and the supporting teeth. Information was available for 161 patients and 204 crowns. At the 3-year recall appointments, a sample of 18 patients with 25 crowns was clinically examined and interviewed regarding patient satisfaction. Results: Most crowns (78%) were placed on premolars and molars. The clinical outcome of the crowns was favourable. No zirconia core fractured and no caries was observed on the abutment teeth. Some types of complication were recorded for 32 (16%) crowns or abutment teeth. The most severe complications, in total 12 restorations (6%), were recorded as failures: abutment tooth was extracted (5), remake of crown due to lost retention (4), veneer fracture (2) and persistent pain (1). The CDA criteria for 25 crowns were rated favourably, and patient satisfaction with the zirconia crowns was in general high. Conclusions: The porcelain-veneered zirconia crowns (NobelProcera™) showed good clinical results, were well accepted by the patients, and only few complications were reported over the 3-year follow-up period. [Copyright &y& Elsevier]

Background: Practice beliefs and dentist preferences for patients have been related to service rates and appropriateness of care. If practice beliefs and preferences for patients are stable then they could restrain long-term changes in practice styles and service rates. The aim of this paper was to assess the stability of practice beliefs and preferences for patients between 1997 and 2007. Methods: Practice beliefs and dentist preferences for patients were recorded on a five-point Likert scale using mailed questionnaires from a random sample of dentists in 1997 (response rate = 60 per cent) and 2007 (response rate = 77 per cent). Results: In both 1997 and 2007, n = 215 dentists provided data. For practice beliefs, 1 out of 8 items were significantly different (p < 0.05; McNemar’s test) between the two observations (12.5 per cent of practice belief items) while 5 out of 37 dentist preferences for patient characteristics items were significantly different (13.5 per cent of items). Conclusions: The majority of items were not significantly different over time. This demonstrates a generally high degree of stability over time in the level of agreement with dentist practice beliefs and preferences for patients. Given that it may be difficult for clinicians to change practice beliefs and behaviours that have become established, it is important for policy makers to understand the relationship between provider characteristics and service patterns and for educators to positively shape beliefs and behaviours through undergraduate and continuing education. [ABSTRACT FROM AUTHOR]

The aim of this investigation was to describe the quality of prescription and fabrication of single-unit crowns by general dental practitioners in Wales. One hundred pre-piloted questionnaires were distributed to commercial laboratories in Wales with large catchment areas, and 20 pre-piloted questionnaires were distributed to the production laboratory at the Cardiff Dental Hospital. Information was collected relating to the quality of prescription and master impressions for single-unit crowns. One hundred and seven completed questionnaires were returned (response rate = 89%). Sixty per cent ( n = 64) of questionnaires related to single-unit crowns being made in general practice under private funding arrangements, 30% ( n = 32) were being made in general dental practice under National Health Service (public) funding arrangements and 10% ( n = 11) were collected from the Dental Hospital. Polyvinylsiloxane impression material was used to record the master impression in all cases ( n = 107). Plastic stock trays were used to make the master impression in 79% of cases ( n = 85), metal stock trays were used in 19% of cases ( n = 20) and special trays were used in 2% of cases ( n = 2). Eighty-five per cent ( n = 91) of master casts were considered to be adequate for crown fabrication. Less than 50% of written instructions ( n = 52) were considered ‘clear’ and of sufficient detail to adequately specify the planned crown. In 21% of cases ( n = 22), the technician had to contact the dentist for clarification of the design prior to making the crown. While the quality of impression making for single-unit crowns was of a reasonable standard, the quality of the accompanying written communication was poor and more than one-half of written instructions examined failed to meet the requirements of the European Union Medical Devices Directive. [ABSTRACT FROM AUTHOR]

Background: Practice beliefs have been related to service rate variation and appropriateness of care. The aim of this paper was to further develop practice belief scales by adding new items to an existing set and testing associations with dentist and practice characteristics, and services provided. Methods: Practice belief items were recorded on a five-point Likert scale using mailed questionnaires from a random sample of dentists in 2004 (response rate = 76.8 per cent). Results: Factor analysis yielded five factor-based scales, with three having adequate or near adequate internal consistency: Professional Autonomy (α = 0.72), Patient Focus (α = 0.71) and Preventive Orientation (α = 0.59). Responses were skewed towards strongly agree (scores 1–<2) for Professional Autonomy (60.6 per cent), Patient Focus (71.7 per cent) and Preventive Orientation (46.3 per cent). Higher percentages of dentists with strong agreement on Patient Focus were aged 30–39 and 60+ years, while lower percentages of dentists with strong agreement on Preventive Orientation were male (Chi-square, P < 0.05). Those strongly agreeing with the scales (scores 1–<2) had (Poisson regression; P < 0.05): lower rates of restorative, a rate ratio (RR) of 0.93, dentures (RR = 0.72) and extractions (RR = 0.63) for Professional Autonomy; higher rates of dentures (RR = 1.32), crowns (RR = 1.46) and extractions (RR = 1.47) for Patient Focus; and lower rates of restorative (RR = 0.88), dentures (RR = 0.78), crowns (RR = 0.72), extractions (RR = 0.50), endodontics (RR = 0.80), but a higher rate of scaling (RR = 1.13) for Preventive Orientation. Conclusions: The findings confirmed some of an earlier factor structure of practice beliefs, extended the potential practice belief domains, and demonstrated associations with service rates. [ABSTRACT FROM AUTHOR]

Aim To investigate the attitudes towards and use of rubber dam by Irish general dental practitioners. Methodology A pre-piloted questionnaire was distributed amongst a group of 600 dentists randomly selected from the Irish Register of Dentists. Replies from dentists working in specialist practice or the hospital dental service were excluded. Dentists were surveyed in relation to their use of rubber dam during a variety of operative and root canal treatments, as well as their attitudes to the use of rubber dam in dental practice. Results A total of 300 replies were considered from a total of 324 that were received. Seventy-seven per cent of respondents ( n = 231) worked in general dental practice and 23% ( n = 69) worked in the Irish Health Board/Community Dental Service. Rubber dam was ‘never’ used by 77% of respondents ( n = 228) when placing amalgam restorations in posterior teeth, 52% ( n = 147) when placing composite restorations in posterior teeth, and 59% ( n = 177) when placing composite restorations in anterior teeth. Rubber dam was ‘never’ used by 39% of respondents ( n = 114) when performing root canal treatment on anterior teeth; 32% ( n = 84) when performing root canal treatment on premolar teeth; and 26% ( n = 51) when performing root canal treatment on molar teeth. Fifty-seven per cent ( n = 171) considered rubber dam ‘cumbersome and difficult to apply’, and 41% ( n = 123) considered throat pack ‘as good a prevention against inhalation of endodontic instruments as rubber dam’. Conclusions Whilst rubber dam is used more frequently for root canal treatment than operative treatment, its use is limited. This presents quality issues, as well as medico-legal and safety concerns for both the profession and patients. [ABSTRACT FROM AUTHOR]

Background: Service rate variations and appropriateness of care issues have focused attention on factors that influence treatment decisions. The aims of this study were to examine what factors dentists consider in choosing alternative treatments, the stability of these factors over time and whether stability of treatment choice was related to age of dentist. Methods: Baseline data were collected by mailed self-complete questionnaires from a random sample of Australian dentists (response rate=60.3 per cent, n=345 private general practitioners provided service data from a typical day) in 1997–1998 and follow-up data were collected in 2004 (response rate=76.8 per cent, n=177 matched longitudinal cases). Results: The most frequent factors considered important across six alternative treatment pair choice scenarios were caries rate for ‘exam v. x-ray’, age of patient for ‘preventive v. restorative intervention’, cost of treatment for ‘crown v. buildup’, ‘root canal v. extraction’ and ‘bridge v. denture’, and calculus for ‘prophylaxis v. scaling’. The only differences over time were (t-test, P<0.05): higher proportions of responses in the mouth status group at follow-up for ‘exam v. x-ray’; higher proportions of responses in the visit history group at follow-up for ‘preventive v. restorative intervention’; a lower proportion of responses in the caries group at follow-up for ‘crown v. build-up’; and a higher proportion of responses in the treatment constraints group at follow-up for ‘prophylaxis v. scaling’. Conclusions: While a wide range of responses were offered as factors influencing the choice of alternative treatments, cost of treatment was a major consideration in situations where significantly cheaper alternatives existed, while patient preference was commonly included as a secondary consideration across a wide range of treatment choice scenarios. The treatment choice responses showed a high degree of stability over time across all age groups of dentists, suggesting that if routines are developed these are established before or soon after graduation as a dentist. [ABSTRACT FROM AUTHOR]

Objective. To identify the type of restorative materials used in general dental practice and their effects on the outcomes of restorative treatment of primary teeth.Method. The study involved a retrospective investigation of case notes of 677 child patients of 50 general dental practitioners (GDPs) in the northwest of England. The history of dental care received by each child during the primary dentition period was recorded. The type of restorative material used and the number of times that each tooth was restored were recorded. The proportion of primary teeth that were extracted due to pain or sepsis was calculated according to whether they were filled by amalgam or glass ionomer, or were left unfilled.Results. Of the treated teeth, 61% of first and 55% of second primary molars were restored with glass ionomer. Some 27.4% of first molars restored with amalgam required repeat restorations, compared with 42.5% of those filled with glass ionomer. The difference was highly significant (p<0.001). For all primary molar teeth, there was no difference in the proportion of extractions, according to the type of restorative material used or if carious teeth were left unrestored.Conclusions. In the hands of GDPs, glass ionomer restorations are used most commonly and are significantly more likely to require replacement than amalgam restorations. The type of restorative material used had no influence on outcomes. [Copyright &y& Elsevier]

Objective: To study the prevalence of xerostomia in an English population, attending general dental practice and relate it to age, medication and gender.Design Study: Cross-sectional.Setting: Five General Dental Practices in Merseyside, North of England.Subjects: 1,103 adult patients attending for routine dental care.Intervention: Questionnaire administered by dentists.Main Outcome Measures: Age, gender, systemic medication, reported oral dryness.Results: 1,103 patients (654 females) were recruited, of whom 427 (39%) were aged 60 years or older. 26% of patients reported taking medication. The overall prevalence of xerostomia was 12.7% (males--10.3%, females 14.4%). Age, medication and female gender were found to be significant risk factors for xerostomia, using logistic regression analysis.Conclusions: The prevalence of xerostomia (12.7%) in an English population was lower than reported in previous North American and Swedish studies. Medication was a significant risk factor for xerostomia and a better predictor of risk status, than either age or gender. [ABSTRACT FROM AUTHOR]

Background: Progression of dental caries can result in irreversible pulpal damage. Partial irreversible pulpitis is the initial stage of this damage, confined to the coronal pulp whilst the radicular pulp shows little or no sign of infection. Preserving the pulp with sustained vitality and developing minimally invasive biologically based therapies are key themes within contemporary clinical practice. However, root canal treatment involving complete removal of the pulp is often the only option (other than extraction) given to patients with irreversible pulpitis, with substantial NHS and patient incurred costs. The European Society of Endodontology's (ESE 2019) recent consensus statement recommends full pulpotomy, where the inflamed coronal pulp is removed with the goal of keeping the radicular pulp vital, as a more minimally invasive technique, potentially avoiding complex root canal treatment. Although this technique may be provided in secondary care, it has not been routinely implemented or evaluated in UK General Dental Practice., Method: This feasibility study aims to identify and assess in a primary care setting the training needs of general dental practitioners and clinical fidelity of the full pulpotomy intervention, estimate likely eligible patient pool and develop recruitment materials ahead of the main randomised controlled trial comparing the clinical and cost-effectiveness of full pulpotomy compared to root canal treatment in pre/molar teeth of adults 16 years and older showing signs indicative of irreversible pulpitis. The feasibility study will recruit and train 10 primary care dentists in the full pulpotomy technique. Dentists will recruit and provide full pulpotomy to 40 participants (four per practice) with indications of partial irreversible pulpitis., Discussion: The Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP) study will address the lack of high-quality evidence in the treatment of irreversible pulpitis, to aid dental practitioners, patients and policymakers in their decision-making. The PIP feasibility study will inform the main study on the practicality of providing both training and provision of the full pulpotomy technique in general dental practice., Trial Registration: ISRCTN Registry, ISRCTN17973604 . Registered on 28 January 2021. Protocol version Protocol version: 1; date: 03.02.2021., (© 2022. The Author(s).)