The blurred lines of professionalism in dentistry.

Introduction Literature surrounding the definition, portrayal and teaching of professionalism in dentistry is widespread. However, there has been substantially less focus on the boundaries of professionalism and what constitutes unprofessional or a lapse in professionalism.Aims What about a dentist's conduct calls their professionalism into question? In exploring this, we shed light on where the boundary between professional and unprofessional conduct is blurred.Methods Drawing on data from a larger study, we conducted a thematic analysis on a series of statements surrounding professionalism and 772 open-text online survey responses from dental professionals and the public.Results Professionalism in dentistry and the circumstances where it is brought into question appears to centre around patient trust. Blurriness occurs when we consider how trust is established. Two lines of argument were constructed: patients' trust in the professionalism of their dentist is founded on any behaviour bearing a direct influence on clinical care or that challenges the law; and patients' trust also extends to aspects that reveal the inherent character of the dentist and that can threaten their integrity.Conclusion We recommend an approach to professionalism that mirrors a dentist's approach to clinical practice: learned and tailored interactions, and judgement and reflection.

Are the standards of professionalism expected in dentistry justified? Views of dental professionals and the public.

Introduction In the UK, the General Dental Council specifies nine principles of professional standards that dental registrants must follow. There are views that such standards are high, patients' expectations are rising, and the professionalism of dental professionals is increasingly scrutinised. This paper explores whether the high standards expected in dentistry are justified.Methods We applied thematic analysis to 772 free-text responses from dental team members and the public to a modified Delphi survey. Respondents described their views of professional and unprofessional behaviours in dentistry. Data were obtained as part of a larger review of professionalism in dentistry.Results Two lines of argument were identified: professionalism standards are high, but justifiably so; and professionalism standards are too high. Within these, four broad themes emerged: patient trust; comparison with other professions; a culture of fear; and perfection.Conclusion High professionalism standards are justified in a profession where patient trust is paramount. However, a problem lies in the culture that surrounds professionalism in terms of litigation and dental professionals feel pressure to possess an unattainable, infallible nature. These negative impacts need minimising. We suggest that undergraduates and continuing professional development approach professionalism with care, to foster a supportive, positive and reflective culture of professionalism.

Professionalism in the dental practice: perspectives from members of the public, dentists and dental care professionals.

Introduction This paper examines views on professionalism in the dental practice workplace through a thematic analysis of data from eight focus groups.Methods Focus groups were conducted with 19 dentists, 13 dental care professionals and 19 members of the public in England and Wales. The research was part of a larger mixed-methods study of professionalism in dentistry commissioned by the General Dental Council.Results The four most prominent themes in the focus group data were: communication, the cost of treatment, the role of the dental team and consequences of professionalism concerns. Participants agreed that these are fundamental professionalism issues, although there was some difference of opinion about addressing them. There was disagreement about the responsibilities of different members of the dental team in maintaining professionalism.Conclusion We conclude that communication skills training should be a central part of the professionalism at all levels of training. Education about team working could foster a more collaborative approach to professionalism across the dental team and support good, patient-centred oral healthcare. Support and guidance are required to help professionals reflect and learn from mistakes.

The dental core training experience: the views of trainees and their postgraduate training leads.

Introduction Dental core training (DCT) is an optional, postgraduate programme with a duration of one to three years that dentists in the UK can pursue to further strengthen their skillset.Aims To understand career motivations and preferences of trainees pursuing DCT, and their perceptions and experiences of the programme.Methods Data were gathered from 176 DCT trainees across England through focus groups or individual paper-based responses to questions, as well as telephone interviews with ten associate postgraduate dental deans/training programme directors.Results Trainees were generally positive about their overall DCT experience. They developed confidence, self-reliance and skills in teamwork and clinical aspects, gaining from exposure to conditions uncommon in general practice. Limitations and challenges varied by post and unit. The importance of broad, cross-specialty experience was recognised. Although run-through training would eliminate unwelcome annual relocation, it was deemed unsuitable for all trainees, particularly those intending a career in general practice.Conclusion DCT appears to be advantageous for those intending careers in general dental practice, those aiming for specialist practice and those uncertain of their future career trajectory. Although trainees reported positive training experiences and significant gains, future considerations are suggested, including maintaining flexibility to accommodate different motives for DCT and limiting across-unit variation.

A whole-team approach to optimising general dental practice teamwork: development of the Skills Optimisation Self-Evaluation Toolkit (SOSET).

Introduction Studies across the health service reveal benefits of teamwork and barriers to its optimal use. Drawing upon the established Maturity Matrix Dentistry method, the Skills Optimisation Self-Evaluation Toolkit (SOSET) was developed to enable the whole dental team to critically review how they address skill-mix in delivery of patient-centred oral healthcare in their practice. This paper outlines the development of the SOSET and explores its usefulness to general dental practice teams.Methods Research literature and interview data from general dental practice teams were coded for high-level factors (positive and negative) influencing teamwork. We used this coding to identify skill-mix domains, and within each, define criteria. The SOSET process was refined following consultations with dental professionals and piloting.Results Eighty-four papers were coded and 38 dental team members were interviewed across six sites. The SOSET matrix was developed containing nine domains reflecting the use of skill-mix, each containing six development-level criteria. The domains addressed factors such as team beliefs on skill-mix and knowledge of team members' scope of practice, patient demand, the business case, staffing and training, and the practice premises. The process was piloted in 11 practices across South Wales, and feedback was received from 92 staff members. Results showed that the SOSET process was straightforward, that the whole team could contribute to discussion and that it would be used to improve practice. Following piloting, four domains were merged into two new domains, and the number of criteria within all domains was reduced and the wording simplified (seven domains, with four criteria each).Conclusion We used a systematic and rigorous process to develop the SOSET to support dental teams to progress their teamwork practices. Its usefulness was demonstrated in the pilot. The SOSET is now being offered to general dental practices across Wales.

Tackling the challenge of the impact of continuing education: An evidence synthesis charting a global, cross-professional shift away from counting hours.

INTRODUCTION: Health professionals worldwide are required to maintain their knowledge and skills through continuing education. However, there is limited evidence that the accumulation of hours of educational activity enhances practice. The aim of this study was to review evidence of the impact of continuing professional development (CPD), best educational practice and new models of CPD requirements. METHODS: We conducted a rapid evidence synthesis, reviewing literature and websites on continuing education for healthcare and non-healthcare professionals. RESULTS: We extracted data from 184 publications. Evidence of changed practice and improved patient care is uncommon in studies of CPD. What evidence there is suggests that activities are more likely to have impact if a combination of methods is used and if they are aligned with learning needs. Impact is also affected by the learner and their work environment. In terms of CPD requirements, we identified three models: input-based; outcomes-based and mixed models. We found a clear shift from quantitative, time-serving, input-models to outcomes-focused models which emphasise the identification of learning needs, selection of educational activity relevant to practice and reflection on practice improvement. Across a range of professions, recently updated CPD regulations no longer require registrants to accumulate CPD hours/points/credits. CONCLUSION: Outcomes-based models support registrants' engagement in relevant, meaningful CPD which holds greater potential to positively impact on practice and strengthen patient safety. In funding this study, the UK General Dental Council exemplifies its commitment to reviewing its CPD requirments.

A novel dual action monolithic thermosetting hydrogel loaded with lidocaine and metronidazole as a potential treatment for alveolar osteitis.

Alveolar osteitis is a complication that can occur after tooth extraction, whereby exposed bone results in severe throbbing pain for the patient and can be prone to infection. The current treatment options are widely regarded as sub-optimal. The aim of this project was to investigate in vitro the plausibility of a dual-action monolithic drug-loaded thermosensitive hydrogel that undergoes thermal gelation within the tooth socket and releases both anaesthetic and antimicrobial agents. Hydrogels containing different levels of lidocaine HCl and metronidazole were prepared based upon Carbopol 934P NF and Pluronic F-127 blends. Membrane-less drug release was determined from the set hydrogels into phosphate buffered saline (PBS) at 37 °C as a function of time, following analysis by HPLC. Gelation characteristics and hydrogel dissolution characteristics were also determined. At 23.38% Pluronic F-127, sol-gel transition commenced at 23 °C and gelation was completely at 37 °C (physiological temperature). Setting times varied with Pluronic content and there was an inverse relationship between drug release and Pluronic content. Sustained and dose dependent release of both drugs was observed at therapeutically relevant levels over 24 h, via a combination of diffusion, dissolution and surface erosion processes. Based on the amounts of drugs released, it was determined that hydrogels containing up to 0.5% lidocaine and 0.1% metronidazole exhibited low risk of cytotoxicity to primary human gingival fibroblasts. In an in vivo scenario, the sol-phase formulation would make contact with all inner surfaces of a tooth socket prior to transitioning to monolithic gel-phase and provide sustained release of lidocaine and metronidazole at sub-toxic levels, thereby providing simultaneous pain relief, protection from ingress of debris and pathological bacteria.

Dental therapists in general dental practice. A literature review and case-study analysis to determine what works, why, how and in what circumstances.

INTRODUCTION: In the United Kingdom, policy and guidance changes regarding the role of dental therapists (DTs) were implemented in recent years with a view to changing dental care to a more preventive-focussed, teamwork approach. However, success in the adoption of this model of working has been varied. AIMS: Adopting a realist approach, our aim was, to examine the use of DTs in general dental practices in Wales, exploring what works, why, how and in what circumstances. MATERIALS AND METHODS: The research comprised two stages. (a) A structured literature search, dual-coding papers for high-level factors describing the conditions or context(s) under which the mechanisms operated to produce outcomes. From this, we derived theories about how skill-mix operates in the general dental service. (b) Six case studies of general dental practices (three with a dental therapist/three without a dental therapist) employing a range of skill-mix models incorporating semi-structured interviews with all team members. We used the case studies/interviews to explore and refine the theories derived from the literature. RESULTS: Eighty-four papers were coded. From this coding, we identified seven theories which reflected factors influencing general dental practices within three broad contexts: the dental practice as a business, as a healthcare provider and as a workplace. We tested these theories in interviews with 38 dental team members across the six care studies. As a result, we amended five of the theories. CONCLUSION: Our analysis provides theory about outcomes that DTs may facilitate and the mechanisms that may assist the work of DTs within different contexts of general dental practice.

Radicular cyst arising from a traumatized primary incisor: a case report of a rare complication that emphasizes the need for regular follow up.

Radicular cysts associated with the deciduous dentition are rare. The literature is sparse regarding cysts associated with primary incisor teeth, which is surprising given the frequency with which these teeth are traumatized. Most cases reported involve molar teeth associated with apical infection following on from caries. A case of a 3-year-old boy who developed a large radicular cyst associated with a previously traumatized upper primary incisor is reported.