Assessing competency in exodontia: A UK perspective.

INTRODUCTION: Assessment ensures that undergraduate students and postgraduate trainees are providing optimal patient care. Numerous assessment methods are currently being used within the United Kingdom. Therefore, the purpose of this review was to provide an overview of the methods used to assess competency in exodontia and compare methods against criteria defined for good assessment. MATERIALS AND METHODS: A systematic narrative review was carried out. Databases were electronically searched for published studies assessing the competence of undergraduate students and postgraduate trainees in exodontia up to October 2023.The validity, reproducibility, equivalence, feasibility, educational impact, catalytic effect and acceptability of each assessment method was considered. RESULTS: In this review, 591 undergraduate students (n = 529) and postgraduate dental trainees (n = 62) had their competence in exodontia assessed. Undergraduate students were assessed on simple exodontia with forceps and elevators, whereas postgraduate trainees were assessed on the surgical removal of mandibular third molars. Only one study took place in a simulated dental environment, the remaining (n = 7) took place in a clinical environment. A range of formative and summative assessment methods were identified including structured clinical objective tests (SCOT), self-assessment, peer assessment and logbooks. Common marking criteria such as global rating and checklist scales were also highlighted. CONCLUSION: This review highlights the lack of evidence to support one form of assessment and the lack of consensus on assessment within the United Kingdom. Further research related to this topic, alongside the opinion of trainees and trainers is required to improve assessments. This will maximise learning opportunities for trainees and translate to better patient care.

Temporomandibular Disorders and Fibromyalgia Prevalence: A Systematic Review and Meta-Analysis.

PURPOSE: To evaluate the prevalence of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) in TMD patients and the prevalence of TMDs in patients with FMS. METHOD: A systematic search was performed in electronic databases. Studies published in English examining the prevalence of comorbid TMDs and CWP/FMS were included. The Newcastle-Ottawa Scale was used to assess study quality, and meta-analyses using defined diagnostic criteria were conducted to generate pooled prevalence estimates. RESULTS: Nineteen studies of moderate to high quality met the selection criteria. Meta-analyses yielded a pooled prevalence rate (95% CI) for TMDs in FMS patients of 76.8% (69.5% to 83.3%). Myogenous TMDs were more prevalent in FMS patients (63.1%, 47.7% to 77.3%) than disc displacement disorders (24.2%, 19.4% to 39.5%), while a little over 40% of FMS patients had comorbid inflammatory degenerative TMDs (41.8%, 21.9% to 63.2%). Almost a third of individuals (32.7%, 4.5% to 71.0%) with TMDs had comorbid FMS, while estimates of comorbid CWP across studies ranged from 30% to 76%. CONCLUSIONS: Despite variable prevalence rates among the included studies, the present review suggests that TMDs and CWP/FMS frequently coexist, especially for individuals with painful myogenous TMDs. The clinical, pathophysiologic, and therapeutic aspects of this association are important for tailoring appropriate treatment strategies.

Restorative intervention thresholds and treatment decisions of general dental practitioners in London.

Introduction Minimally invasive dentistry has been promoted as the contemporary approach to the operative management of dental caries. Operative intervention should be undertaken on cavitated lesions which are actively progressing. However, there may be large variability in the restorative intervention thresholds and care plans of general dental practitioners (GDPs).Aims To investigate restorative threshold and treatment decisions for occlusal and proximal carious lesions in a cohort of GDPs in London. To investigate potential differences based on number of years since graduation and attendance on a caries management course.Materials and methods A previously used, validated caries questionnaire was distributed to foundation dentists, general practice dentists and practising educational supervisors in NHS London dental practices. Results Two hundred and seventeen GDPs participated in the study. For occlusal lesions, nine (9.1%) newly-qualified dentists selected to intervene surgically on lesions confined to enamel, compared to 24 (29.8%) dentists who have been qualified for more than five years (p <0.05). In addition, a greater number of dentists who had attended a training course were more likely to do a minimally invasive preparation for a proximal lesion (38.2%), compared to 19.8% of those who had not (p <0.05). The majority of all participants (74.2%) chose to restore a proximal lesion using resin composite. Despite this material choice, 58.5% of those graduating within five years opted to prepare a traditional Black's class II cavity. Conclusion A practitioner's restorative intervention threshold and their choice of treatment appears to be negatively affected by the number of years post-qualification, and positively influenced by attending a caries management course.