An appraisal of options of the training and education of Professionals Complementary to Dentistry.

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.

A national survey of dental technicians: career development, professional status and job satisfaction.

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.

The self-assessed oral health status of individuals from White, Indian, Chinese and Black Caribbean communities in South-east England.

OBJECTIVES: 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. METHOD: Cross-sectional survey of a convenience sample of 366 individuals drawn from four ethnic groups. MEASURES: Subjective Oral Health Status Indicators (SOHSI). PARTICIPANTS: 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. FINDINGS: 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. CONCLUSIONS: 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.

The working practices and job satisfaction of dental nurses in Trinidad and Tobago: findings of a national survey.

OBJECTIVE: To describe the working practices and level of job satisfaction of dental nurses in Trinidad and Tobago. DESIGN: Postal survey. PARTICIPANTS: Fifty enrolled and practising dental nurses in Trinidad and Tobago were surveyed, 38 replied (76%). OUTCOMES MEASURES: Current working practice, career breaks, continuing education, job satisfaction. RESULTS: All dental nurses were employed by the Ministry of Health or Regional Health Authorities. Most performed a wide range of clinical and administrative duties along with delivering dental health education. Forty five per cent of respondents had taken a career break since qualifying with maternity and child rearing being the most common reason (94%). Sixty six per cent had attended a continuing education course in the previous year, with this most frequently being a dental refresher course. Satisfaction with pre-qualification training was high but current job satisfaction was low. Concerns with working conditions and career paths were identified. CONCLUSION: Dental nurses in Trinidad and Tobago expressed confidence in their ability to perform their current duties and showed interest in continuing education. Job satisfaction was low.

Vacant posts reported in dental practice: implications for human resource planning.

OBJECTIVES: To describe the proportion of dental practitioners who report vacancies within their dental practice for the following: dental surgeons, dental hygienists, dental nurses and dental receptionists. To determine the proportion of dental practitioners working in general dental practice who would consider employing a dental therapist. METHOD: Analysis of data from the British Dental Association Omnibus Survey 2000. The sample comprised 992 qualified dentists in all fields of practice. FINDINGS: The most commonly reported vacancies were for dental surgeons (18% of practitioners reported vacancies), dental nurses (17%) and dental hygienists (12%). Approximately 46% of general dental practitioners reported that they would employ a dental therapist if legislation permitted. The main reason for not employing a dental therapist was insufficient space in the dental practice. CONCLUSIONS: A large number of vacancies exist for dental surgeons, dental nurses and dental hygienists in the United Kingdom. Around half of dental practices express an interest in employing dental therapists should legislation permit.

Testing a model of the relationship between gender, ethnicity, clinical status and impact in older adults from minority ethnic groups.

OBJECTIVE: To identify the relationship between indicators of self-assessed symptom status, the reported impact of oral conditions and clinical indices, and the extent to which this relationship was moderated by gender and ethnicity. DESIGN: Secondary analysis of data from an oral health survey of minority ethnic groups. PARTICIPANTS: Purposive sample of 376 individuals from minority ethnic groups in the United Kingdom recruited through community groups. MEASURES: Numbers of decayed, missing and filled teeth. Measures of self assessed symptoms, and impact upon quality of life. RESULTS: Impact of oral conditions upon lifestyle was predicted by the number of missing teeth, the presence of pain on eating certain foods and the presence of toothache in the previous four weeks. Social variables (gender and ethnicity) did not predict impact either singly or through interaction with symptoms. CONCLUSIONS: The findings support a linear model of the relationship between the experience of oro-facial symptoms and impact on everyday life amongst older adults.

Levels of career satisfaction amongst dental healthcare professionals: comparison of dental therapists, dental hygienists and dental practitioners.

OBJECTIVE: To compare the levels of career satisfaction expressed by three professional groups working in dental health: dental therapists, dental hygienists and dental practitioners. BASIC RESEARCH DESIGN: 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. PARTICIPANTS: Data are reported for 227 dental therapists, 2,251 dental hygienists and 970 dental practitioners. RESULTS: 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. CONCLUSIONS: 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.

The mouth-body split: conceptual models of oral health and their relationship to general health among ethnic minorities in South Thames Health Region.

OBJECTIVE: 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. BASIC RESEARCH DESIGN: 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. PARTICIPANTS: Ninety-five individuals from different ethnic groups. RESULTS: 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. CONCLUSIONS: 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.

The ethnicity of dental practitioners in the United Kingdom.

OBJECTIVE: To describe the proportion of dental practitioners, currently practising in the UK, who are from different ethnic groups. METHOD: Analysis of data from the British Dental Association Omnibus Survey 2000. The sample comprised 970 qualified dentists in all fields of practice. FINDINGS: Dental practitioners from minority ethnic groups constitute approximately 14% of the population of dentists. There has been an increase in the proportion of dentists from minority ethnic groups amongst cohorts of dentists qualifying since 1987. There is some evidence that dentists from minority ethnic groups are more likely to treat patients under NHS payment. CONCLUSIONS: The profession of dentistry in the United Kingdom appears to have little problem attracting members of some minority ethnic groups in particular those of Indian, Pakistani and Bangladeshi origin. Individuals of Black Caribbean and Black African origin are under-represented.

A national survey of dental hygienists: working patterns and job satisfaction.

OBJECTIVE: To describe the working practices and level of job satisfaction of dental hygienists in the United Kingdom. DESIGN: Postal questionnaire survey of 3,955 dental hygienists registered with the General Dental Council. Replies were received from 2,533 (64%). RESULTS: At the time of the survey only a small proportion of respondents (11%) were not working as dental hygienists, the most common reason for a current career break being child rearing. The majority of dental hygienists (78%) were employed in general dental practices, and most worked in more than one practice (64%). Approximately half worked part-time (fewer than 30 hours per week), and part-time working was more common amongst those respondents with childcare responsibilities. In the region of 60% of respondents had taken one or more career breaks during their working life, and the average total duration of career breaks was 11 months, the most common reason for all career breaks was child rearing. Additional qualifications had been gained by 35% of the sample, a high proportion (75%) had attended training courses in the previous year. The respondents expressed a high degree of job satisfaction, those who were older and who had childcare responsibilities expressed higher levels of job satisfaction. CONCLUSIONS: Dental hygienists express a high level of job satisfaction. A proportion take breaks in their career, most commonly for pregnancy and child rearing. The majority return to part-time employment after their career break. Planning of future requirements for the training of professionals complementary to dentistry should be informed by a consideration of the working patterns of dental hygienists.

Barriers to the use of dental services by individuals from minority ethnic communities living in the United Kingdom: findings from focus groups.

OBJECTIVE: To describe the barriers identified by individuals from minority ethnic communities resident in the United Kingdom to their use of dental services. METHOD: Focus group discussions were held with individuals from minority ethnic groups. Data were analysed using the technique of content analysis on the basis of categories defined by the researchers. FINDINGS: Barriers to regular attendance identified by participants included: language, a mistrust of dentists, cost, anxiety, cultural misunderstandings, concern about standards of hygiene. The type of barrier identified differed between ethnic groups, though mistrust of dentists was common to all groups. CONCLUSIONS: The findings confirm previous research identifying barriers to the use of dental services. However, for the first time in the United Kingdom, it has been suggested that the nature of the perceived barriers varies across ethnic groups. These findings have implications for attempts to increase use of dental services among individuals from minority ethnic communities.

Workforce planning in dentistry: the impact of shorter and more varied career patterns.

OBJECTIVE: To compare the frequency and duration of career breaks taken by three groups of dental health care professionals and to assess the impact of these and changes in working hours on human resource planning. BACKGROUND: Dental personnel planning has been the subject of recent attention, particularly the role of professionals complementary to dentistry. Data on which to plan a dental personnel strategy have been lacking. METHOD: Questionnaire survey of a random sample of 10% of dental practitioners, and of all dental therapists and dental hygienists registered with the General Dental Council. The proportion of each group who had taken a career break at some point during their career was analysed for each professional group. RESULTS: A larger proportion of female general dental practitioners (61%) than male practitioners (27%) take a break in their career at some point during their working lives. The proportion of hygienists who take career breaks is similar (57%) to the proportion of female GDPs. The proportion of dental therapists who take a career break (who in this sample were all female) is 71%. The duration of career breaks taken by women is longer than that for males, the median length of career breaks for male dental practitioners is 4 months; female dental practitioners 9 months; hygienists 11 months; therapists 11.5 months. Female GDPs who take a career break can be expected to have a working life 25% shorter than a GDP who does not take a career break. CONCLUSIONS: As the proportion of female general dental practitioners increases, and with the possible expansion of the role of professionals complementary to dentistry, there is likely to be an increase in the proportion of dental personnel who take a career break during their working lives. Planning of dental personnel requirements should consider the likely effect of career breaks upon the availability of dental staff.

Self-assessed oral health status of ethnic minority residents of South London.

OBJECTIVE: To determine the self-assessed oral health status of individuals from minority ethnic communities living in South London. METHOD: A sample of 1,057 individuals from minority ethnic communities (as defined by Office of Censuses and Surveys categories) resident in South London were asked to complete measures of their oral and facial symptoms, the impact of their oral health on their daily functioning and of their satisfaction with the appearance of their teeth and gums. MEASURES: Self-assessed oral health status was determined by means of two short scales addressing oral symptoms and the impact of oral health on activities of daily living. Satisfaction with the appearance of the teeth and gums was also assessed. FINDINGS: No significant differences were found between minority ethnic communities in the number of symptoms reported, in the level of impact which such symptoms cause, or in their dissatisfaction with the appearance of their teeth and gums. Reporting of symptoms and impact were mildly though significantly correlated with dissatisfaction. CONCLUSIONS: There appears to be little difference between ethnic communities in their reporting of oral and facial symptoms, though these groups report higher levels of dissatisfaction with the appearance of their teeth and gums. Social and demographic factors play an important role in determining perceptions of oral health. The findings should be interpreted with caution given the difficulty of sampling minority ethnic communities and the subsequent limited representativeness of the sample.

The working practices and job satisfaction of dental therapists: findings of a national survey.

OBJECTIVE: To describe the working practices and level of job satisfaction of dental therapists in the United Kingdom. DESIGN: Postal questionnaire survey of 380 dental therapists registered with the General Dental Council. RESULTS: Only 13% of dental therapists are also qualified as dental hygienists. Around 75% of those registered with the GDC are currently employed as dental therapists. Of those not currently working as dental therapists most were either working as hygienists or caring for their children at home. Over 90% of those working as therapists are employed within the Community Dental Service. About half work part-time. Part-time working is more common among respondents with childcare responsibilities. Most dental therapists are employed in clinical roles, and perform a limited range of treatments. A small proportion appear to have been asked to undertake duties which are not currently legal for them to perform. Three-quarters of those who were currently working as dental therapists had taken career breaks at some point, the most common reasons for such a break being a change in career and/or child rearing. The respondents expressed a high level of job satisfaction, particularly among older dental therapists. CONCLUSIONS: Dental therapy offers a potentially rewarding career in terms of job satisfaction. Any planned increase in the numbers of training places for dental therapists should their role be expanded, for example to include working in general dental practice, would need to take cognisance of the high rate of part-time working and the proportion who could be expected to take career breaks at some point in their working lives, as is the case with female dental practitioners.

The work patterns of male and female dental practitioners in the United Kingdom.

AIM: The aim of the study was to determine differences between male and female dental practitioners in the type of dentistry they practice, and their working practice, and to compare these data to previously published studies of the working practices of female dentists in the United Kingdom. DESIGN: A postal questionnaire survey. PARTICIPANTS: A 1 in 10 sample of individuals taken from the UK Dentists Register. RESULTS: The data revealed that women dentists are more likely than male dentists to work in the Community Dental Service. Within general dental practice women are more likely to work part-time, to carry out National Health Service treatment and to specialize in orthodontics or paediatric dentistry. More women than men take career breaks, and the reasons for taking career breaks differ between male and females. Women take longer career breaks on average. However, differences between male and female practitioners in the total duration of their career breaks are largely accounted for by child rearing. Finally, male dental practitioners are more likely than female dental practitioners to report reading professional journals. The findings are analysed in the light of previous surveys of the working practices of female dental practitioners both within the United Kingdom and internationally. CONCLUSION: The main finding reported here is that there are no differences between men and women in the number and length of career breaks taken, if childcare is excluded.

Predictors of tobacco and alcohol consumption and their relevance to oral cancer control amongst people from minority ethnic communities in the South Thames health region, England.

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.

A study of the career development of male and female dental practitioners.

AIM: The aim of the study was to determine differences between male and female dental practitioners in the positions they occupy within their employment, and to analyse the correlates of such differences. METHOD: Postal questionnaire survey of a 1 in 10 sample of individuals taken from the General Dental Council register. RESULTS: Female dental practitioners occupy lower positions in the employment hierarchies of the Community Dental Service and the Hospital Dental Service. Women general dental practitioners are significantly less likely to be sole proprietor of, or a partner in, a general practice. Ownership of a general practice is related to: sex, age, number of years qualified, number of children, and hours worked. Consultants in the Hospital Dental Service are more likely to be male, older, to have been qualified longer and (obviously) to hold more additional qualifications than their non-consultant colleagues. Senior Dental Officers and Directors of the Community Dental Service are more likely to be male, work longer hours and (again obviously) to hold more additional qualifications than Community Dental Officers. CONCLUSIONS: Differences exist between male and female dental practitioners in the positions they occupy within employment hierarchies. Age, length of time since qualification and the acquisition of additional qualifications are consistently found to differentiate dental practitioners' status.

The oral health of older people from minority ethnic communities in south east England.

OBJECTIVES: To describe the clinical health status and subjective oral health status of older adults from minority ethnic communities resident in South East England. DESIGN: Cross sectional survey incorporating a clinical examination and a questionnaire assessment of subjective oral health status. SETTING: Community groups working with individuals from minority ethnic communities. SUBJECTS: A total of 540 individuals from 7 minority ethnic communities. MEASURES: Clinical assessment of oral health status using BASCD criteria. Assessment of oral symptoms and impact experienced together with satisfaction with oral status, by structured questionnaire. RESULTS: On all measures of clinical health status the participants were healthier than a comparison group based on data from the Adult Dental Health Survey. The participants expressed high levels of subjective oral symptoms. Levels of satisfaction were lower than those found in the Adult Dental Health Survey. There was evidence of some variation across minority ethnic communities in clinical and subjective oral health status. CONCLUSIONS: Approximately 20% of the 540 adults from minority ethnic communities resident in the South East of England surveyed were relatively fit orally. They experienced a great many oral symptoms, and in approximately 30% of individuals these were sufficient to interfere with their quality of life. ETHICAL APPROVAL: The research described in this paper was approved by the Ethics committee of King's College London.