The association between edentulism and progress of multimorbidity over 12 years among older American adults.

OBJECTIVES: To examine the relationship between edentulism and the progress of multimorbidity, and the role of nutritional intake and behaviours among older Americans. METHODS: We used 7 waves (2006-2018) of the Health and Retirement Study, a longitudinal survey of older Americans (number included in analysis 2,224). Edentulism was assessed in 2006 and 2012. Multimorbidity was indicated by 5 self-reported conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Behavioural factors were smoking, excessive alcohol consumption, physical activity, and body mass index. Nutritional intake was calculated by summing 10 nutrients (Protein, Vitamins C, D, B12, E, Calcium, Zinc, Polyunsaturated fatty acids, Folate and ß- carotene). Multilevel models for analysis of longitudinal data were used to assess the association between change in repeated measures of multimorbidity (between 2006 and 2018) and edentulism (2006) adjusting for nutritional intake, behavioural and socioeconomic factors. RESULTS: Participants who were edentate in 2006 and 2012 had higher rate-ratios (RR) for change in multimorbidity between 2006 to 2018 (RR: 1.29 and 1.28, respectively). After adjusting for socioeconomic factors, total nutrients and behavioural factors, these RR attenuated to 1.12 (95%CI: 1.06, 1.18) and 1.10 (95%CI: 1.05, 1.16), respectively. Total nutrition was negatively associated with progress of multimorbidity, but after adjusting for socioeconomic and behavioural factors the association became insignificant. Total nutrients rates in 2013 were significantly lower among those who were edentate in 2006 and 2012. CONCLUSION: There was a longitudinal association between edentulism and progress of multimorbidity. The relationship appeared to be mediated be behaviours and nutrition.

Dentists' Perceptions of Personal Infection Control Measurements in Response to COVID-19.

OBJECTIVE: To explore through focus groups (FGs) the perceptions of dental practitioners (DPs) from different countries of the challenges of implementing coronavirus disease 2019 (COVID-19) related biosafety measures, especially personal protection equipment (PPE), during the COVID-19 pandemic period. METHODS: DPs from Colombia, Germany, the United Kingdom, and the United States were invited to participate in country-based FGs. These were facilitated by an experienced moderator who explored the factors that guided the implementation of COVID-19 related biosafety measures and PPE use. Data were analyzed through thematic analysis on the basis of categories defined by the researchers deductively and inductively. RESULTS: A total of 25 DPs participated in 3 FGs (Colombia:n = 8; United Kingdom: n = 7; United States: n = 9) and 1 in an in-depth interview (Germany). DPs described using several processes to judge which guidance document to adopt and which aspects of the guidance were important in their practice. These included making judgments concerning the views of any indemnity organization to which the DPs were responsible, the staff's views in the practice, and the views of patients. In the absence of a single overarching guidance document, DPs filtered the available information through several considerations to find a level of PPE that they deemed "implementable" in local practice. CONCLUSIONS: The findings suggest that the implementation of evidence-based practice is subject to modification through a lens of what is "feasible" in practice. KNOWLEDGE TRANSFER STATEMENT: Clinicians, educators, and policy makers can use the results of this study to understand the process through which guidance is transformed into implementable patient care pathways in the dental practice.

Consensus Statement on Future Directions for the Behavioral and Social Sciences in Oral Health.

The behavioral and social sciences are central to understanding and addressing oral and craniofacial health, diseases, and conditions. With both basic and applied approaches, behavioral and social sciences are relevant to every discipline in dentistry and all dental, oral, and craniofacial sciences, as well as oral health promotion programs and health care delivery. Key to understanding multilevel, interacting influences on oral health behavior and outcomes, the behavioral and social sciences focus on individuals, families, groups, cultures, systems, societies, regions, and nations. Uniquely positioned to highlight the importance of racial, cultural, and other equity in oral health, the behavioral and social sciences necessitate a focus on both individuals and groups, societal reactions to them related to power, and environmental and other contextual factors. Presented here is a consensus statement that was produced through an iterative feedback process. The statement reflects the current state of knowledge in the behavioral and social oral health sciences and identifies future directions for the field, focusing on 4 key areas: behavioral and social theories and mechanisms related to oral health, use of multiple and novel methodologies in social and behavioral research and practice related to oral health, development and testing of behavioral and social interventions to promote oral health, and dissemination and implementation research for oral health. This statement was endorsed by over 400 individuals and groups from around the world and representing numerous disciplines in oral health and the behavioral and social sciences. Having reached consensus, action is needed to advance and further integrate and translate behavioral and social sciences into oral health research, oral health promotion and health care, and the training of those working to ensure oral health for all.

The impact of tooth colour on the perceptions of age and social judgements.

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

A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum in Dental Caries.

OBJECTIVE: To determine the difference in level of dental caries in adults and children who chew sugar-free gum (SFG), compared with those who do not chew SFG or use alternatives such as lozenges, candies, rinses, tablets, and other nonchewing controls. METHODS: Systematic review of published literature. RESULTS: Twelve studies of interventions of SFG for dental caries outcomes were included. SFGs were found to significantly reduce caries increment, giving a preventative fraction (PF) of 28% (95% CI, 7% to 48%). Including the 8 trials that used xylitol gum only as the basis of the intervention, the PF was 33% (95% CI, 4% to 61%). No adverse effects were recorded. There was a high level of heterogeneity among the trials included. CONCLUSION: The findings of this review provide tentative evidence that chewing SFG reduces caries increment in comparison to nonchewing controls. However, there is a considerable degree of variability in the effect and the trials included were generally of moderate quality. There is a need for future research to explore the acceptability and feasibility of the use of SFG as a public health intervention (PROSPERO 2018 CRD42018094676). KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by clinicians when deciding how best to implement dental caries prevention regimes for their patients. With consideration of cost and patient preference, this information could help to develop national policy directives on caries prevention and dictate the direction of future clinical research.

Feasibility of assessing training of primary care dental practitioners in endodontics of moderate complexity: mapping process and learning.

Objectives: To explore the feasibility of measuring quality of endodontic care provided by general dental practitioners (GDPs), using clinical, radiographic and patient-related outcomes, as well as understanding practitioner views and estimating financial costs. Methods: Multi-faceted mixed-methods two-part study involving retrospective analysis of the educational component (course assessments, endodontic training blocks and analysis of a sample of teeth treated at the beginning and end of training), and prospective analysis of patients treated by these dentists after completion of training. Participant: Dentists working in and patients treated in primary dental care in London. Intervention: Twenty-four-month training in endodontics. Comparison: Dentists enrolled in the training at different time points. Outcome: Measuring outcome of endodontic treatment. Results: Eight dentists (mean 36 years, SD = 8.2 years) participated in training. Subsequently, five of these dentists (mean 34.2 years, SD = 7.08 years) contributed to the prospective study and recruited 135 patients. Thirty-five patients completed all patient-related outcome questionnaires, and of these there were 16 cases with complete clinical and radiographic data (12%) at follow-up (10.1­36.4 months). Preliminary analysis revealed that a minimum of 45 cases of complete data would be required for multivariate analysis, requiring the recruitment of in excess of 375 patients to future studies to account for this level of loss to follow-up. Conclusions: Findings suggest it is possible to carry out mixed-methods and treatment-related outcome-based research in primary care. Measurement/data capture tools developed were tested and used successfully in measuring the adherence to treatment processes and outcome of endodontic treatment.

Development of a battery of tests to measure attitudes and intended behaviours of dental students towards people with disability or those in marginalised groups.

INTRODUCTION: Recommended curricula in Special Care Dentistry (SCD) outline learning objectives that include the domain of attitudes and behaviours, but these are notoriously difficult to measure. The aims of this study were (i) to develop a test battery comprising adapted and new scales to evaluate values, attitudes and intentions of dental students towards people with disability and people in marginalised groups and (ii) to determine reliability (interitem consistency) and validity of the scales within the test battery. MATERIALS AND METHODS: A literature search identified pre-existing measures and models for the assessment of attitudes in healthcare students. Adaptation of three pre-existing scales was undertaken, and a new scale was developed based upon the Theory of Planned Behaviour (TPB) using an elicitation survey. These scales underwent a process of content validation. The three adapted scales and the TPB scale were piloted by 130 students at 5 different professional stages, from 4 different countries. RESULTS: The scales were adjusted to ensure good internal reliability, variance, distribution, and face and content validity. In addition, the different scales showed good divergent validity. DISCUSSION: These results are positive, and the scales now need to be validated in the field. CONCLUSIONS: It is hoped that these tools will be useful to educators in SCD to evaluate the impact of teaching and clinical exposure on their students.

Patients' Acceptability of Computer-Based Information on Hypodontia: A Randomized Controlled Trial.

OBJECTIVES: To compare patients' acceptability of a hypodontia-specific interactive computer-based education material (ICB-EM) versus a British Orthodontic Society (BOS) hypodontia leaflet. TRIAL DESIGN: Two-arm parallel randomized controlled trial, 1:1 allocation ratio. METHODS: The study was conducted at a specialized secondary care facility in the Greater London area. Ninety-six new hypodontia patients aged 14 y and older were randomly assigned to the control group ( n = 49) receiving the BOS leaflet or the intervention group ( n = 47) receiving the ICB-EM. The main outcome measure was patients' evaluation of the intervention measured by the treatment evaluation inventory. RESULTS: The analyzed sample comprised 76 participants: control group ( n = 38) and intervention group ( n = 38). The mean age of the sample was 19 y (SD = 7.24) and 20.3 y (SD = 6.9) for the control and intervention group, respectively. The intervention group was significantly more satisfied with the ICB-EM than individuals who received the BOS leaflet ( t = -3.53, P = 0.001). CONCLUSION: Patients preferred the computer-based information. KNOWLEDGE TRANSFER STATEMENT: Patients attending dental care in the 21st century are adept in the use of computerised facilities for obtaining information. The results of the study will provide valuable evidence for clinicians on the level of acceptability of the patients toward interactive computer based health education as opposed to traditional paper leaflets.

Minimally invasive dentistry: Enhancing oral health related behaviour through behaviour change techniques.

Enhancing patients' oral health related behaviour is a critical component of the preventive approach which is central to the practice of minimally invasive dentistry. The first step in the process of behaviour change is creating capability to change behaviour through the provision of information and guidance. The second step involves enhancing the motivation to change through emphasising the benefits of behaviour change and emphasising the individual patients' susceptibility or risk of oral disease. The third step seeks to put motivation into action through creating opportunities to practice oral health behaviour. Planning interventions are one approach to achieving this. This article outlines the techniques for carrying out these steps in practice.

The perceived acceptability of the DEPPA patient assessment tool: A questionnaire survey of Denplan Excel patients.

Aim To establish the perceived acceptability of the use of the Denplan/Previser Patient Assessment tool (DEPPA) by patients. The secondary aim was to examine dental practitioners' views about the effects of a DEPPA consultation on patients' future oral health behaviours.Method Two questionnaire surveys: 365 patients attending general dental practice, who had been assessed using the DEPPA software; 12 dental practitioners who had completed a DEPPA assessment on the patients. Participants (both patients and GDPs) completed the Treatment Evaluation Inventory (TEI) to ascertain their views of the DEPPA assessment.Findings The overall mean for the Treatment Evaluation Instrument for the patients was 23.81 (SD 5.08), and for GDPs 23.81 (SD 2.99).Conclusion Participants expressed a high level of acceptability of the DEPPA tool. In particular, the tool is seen as enhancing the relationship between the patient and practitioner and providing information to support behaviour change.

The oral health of individuals with dental phobia: a multivariate analysis of the Adult Dental Health Survey, 2009.

Background Adults with dental phobia have been reported to have poorer oral health and oral health-related quality of life. The aim of this study is to explore the social and demographic correlates of oral health and oral health-related quality of life (OH-QoL) of people with dental phobia compared to the non-phobic population in the United Kingdom using the data from Adult Dental Health Survey (ADHS, 2009).Method Secondary analysis of data from the ADHS, 2009. A series of logistic regression analyses was performed with outcome measures of: presence of decayed teeth; presence of missing teeth; pulp exposure ulceration fistula abscess (PUFA) score; periodontal health indices (plaque, bleeding and loss of attachments); and quality of life (oral health impact profile [OHIP14] and oral impacts on daily performance [OIDP]). Predictors included in the models were: the presence of dental phobia; age; gender; occupational status; oral health-related behaviour; dietary intake of sugars; and perception of their last visit.Results People with dental phobia are more likely to have one or more decayed (caries) teeth/missing teeth. Furthermore, their self-reported oral health-related quality of life (OH-QoL) is poorer. There were no differences in PUFA scores or periodontal disease.Conclusion The impact of dental phobia on oral health appears to operate largely through the increased likelihood of the presence of caries, since there is an increased likelihood of the presence of teeth with active caries and missing teeth when other predictors of disease experience are controlled in the analysis.

Development of quality measurement instruments for root canal treatment.

AIM: To devise measurement instruments for 'quality' of root canal treatment to assess training and outcome of general dental practitioners working within primary care settings. METHOD: Scoring systems relating to quality of root canal treatment were developed using expert consensus and published literature. Domains scored included the Treatment Process, Quality of the Obturation, Clinical Healing, Radiographic Healing and Tooth Complexity. Scoring systems were applied to 10 clinical cases treated by each dentist at the beginning and 10 cases treated at the end of their clinical training and 135 cases treated after completion of training. The dentists recorded the treatment process and clinical healing in clinical logs. Two examiners independently scored the radiographs after undertaking calibration and training. Inter- and intra-examiner reliability of scoring radiographic outcomes was tested using Cohen's Kappa statistics. RESULTS: An instrument was created with four domains to assess quality (two for process and two for outcome of root canal treatment), and a measure of case complexity. Domains of treatment process (n = 240 teeth), outcome (n = 32 teeth) and complexity (n = 215 teeth) were scored using radiographs. The Kappa scores for intra-examiner reliability between 0.22 and 1, whilst inter-examiner reliability ranged between 0.18 and 0.99. CONCLUSION: Evidence-based scores for assessment of the quality (process and outcome) and complexity (structure) of root canal treatment were devised. They were reliable, provided that clinicians were trained in record keeping and examiners have in depth training and calibration in the use of the instruments.

Pilot study to train dentists to communicate about oral cancer: the impact on dentists' self-reported behaviour, confidence and beliefs.

OBJECTIVES: To evaluate the effect of a brief, focused training session on the use of an oral cancer communication guide on dentists' intentions, self-efficacy and beliefs with regards to communicating about oral cancer with patients. DESIGN: Pre-post intervention study. SETTING: The training session took place in a lecture theatre at King's College London. SUBJECTS AND METHODS: Dentists working in various settings were trained on the use of the oral cancer communication guide via a structured session that included an update on oral cancer, modelling the use of the guide in practice, and role playing. Dentists (n = 39) completed questionnaires pre-training, immediately post-training (n = 31) and after 2 weeks (n = 23). Questionnaires assessed current practice, self-efficacy and barriers to discussing oral cancer. RESULTS: A significantly higher proportion of dentists reported that they informed patients that they were being screened for oral cancer post-training (44%) than pre-training (16%). Significantly fewer perceived barriers and higher self-efficacy to discuss oral cancer were also reported. CONCLUSION: Training dentists in the use of the guide showed positive impact by reducing perceived barriers and increasing self-efficacy.

Effectiveness of a web-based child protection training programme designed for dental practitioners in Saudi Arabia: a pre- and post-test study.

AIM: Safeguarding children is an integral part of dental training and practice. The purpose of this research was to evaluate a web-based training program in child protection on dental practitioners' knowledge and practice in Saudi Arabia. In addition, participants' views of the course were also assessed. METHOD: Pre-, immediately post-training, and one month post-training knowledge and self reported behaviour were assessed following completion of an online training course in child protection by 82 dental practitioners working in Saudi Arabia. RESULTS: Eighty-two participants completed the whole training package and 62 completed the one month post-training survey. A significant increase in knowledge was found immediately after taking part in the child protection training program in comparison to baseline knowledge (P < 0.001). The course was highly rated by those who completed it. At one month following the training program, 21% have or intend to adopt a child protection policy in their practice, 29% identified a staff member to lead on child protection since completing the program, almost all participants have been aware of child abuse and neglect (CAN) signs in their daily practice and 27.4% have made a report of a suspected case of CAN in the last month since the training. CONCLUSION: The web-based training program in child protection was appraised positively and was effective in increasing knowledge and changing attitudes towards safeguarding children.

A Randomized Controlled Trial to Compare 3 Methods Designed to Enhance Adherence among Orthodontic Patients.

The purpose of this study was to compare 3 methods designed to enhance adherence to oral hygiene instructions in orthodontic patients: mind map, if-then plan, and leaflet. The study was a 3-arm parallel trial involving 90 orthodontic patients. The 3 groups were mind mapping, if-then planning, and patient information tools (leaflet). Group allocation was randomized in a 1:1:1 ratio. Allocation was concealed using sealed envelopes. The participant and their parents as well as the researcher undertaking the intervention and assessing the outcomes were not blinded. The statistician undertaking the analysis was blinded. Primary outcomes were plaque levels and bleeding point index. Secondary outcomes were patients' knowledge of behaviors deemed important during orthodontic treatment and self-reported behavior. Participants were assessed at 4 time points: at the fitting of the fixed appliance (T1), at initial follow-up 6 wk later (T2, at which time they were randomly allocated to the 3 groups of intervention), 6 wk after the intervention (T3), and 18 wk postintervention (T4). Mean levels of buccal and lingual plaque, as well as the proportion of sites with bleeding sites, showed no significant differences over time (buccal plaque, Ftime = 3.74, P = 0.06; lingual plaque, Ftime = 2.78, P = 0.06; bleeding on probing, Ftime = 0.68, P = 0.51) or between interventions over time (buccal plaque, Fint × Ftime = 0.38, P = 0.68; lingual plaque, Fint × Ftime = 0.30, P = 0.88; bleeding on probing, Fint × Ftime = 0.70, P = 0.59). There were no harmful consequences detected for any of the interventions. No single method of presenting the information proved superior to any other. This trial was registered with the Guy's & St Thomas's NHS Trust Research & Development Database. Knowledge Transfer Statement: Enhancing patient adherence to advice given by their clinician is an important component of orthodontic treatment. This study explored the use of structured techniques to enhance adherence. All 3 techniques enhanced adherence over the 18-wk study period when orthodontic treatment was being provided, but no single method proved superior to any other.

Oral Health Knowledge, Attitudes, and Perceptions of Pregnant Kuwaiti Women: A Qualitative Study.

Good oral hygiene is known to prevent maternal gingivitis, but little is known about Kuwaiti pregnant women's understanding and beliefs about maintaining and improving oral health during pregnancy. This qualitative study investigated perceptions, beliefs, and attitudes about oral health among Kuwaiti pregnant women and explored beliefs about maintaining and improving oral health during pregnancy. In-depth one-to-one interviews were conducted with a purposive sample of 19 Kuwaiti pregnant women across 7 government primary health care centers in Kuwait. A topic guide framed the questions, which explored pregnancy, oral health, oral health and pregnancy, oral health knowledge, and oral health behaviors. All interviews were digitally recorded, transcribed verbatim, and analyzed by thematic analysis. The key themes emerging from the data related to low oral health knowledge, unhelpful cultural beliefs concerning oral health during pregnancy, and lack of awareness about the effect of pregnancy on oral health. Pregnant women lacked motivation to seek dental care even when they considered dental treatment safe during pregnancy. Dentists' purported incorrect beliefs about providing dental treatment to pregnant women and the women's lack of motivation were identified as barriers to accessing oral health care and seeking oral health knowledge. Pregnant women in this study had not received the necessary oral health information to undertake appropriate oral health behaviors. Cultural beliefs and practices about oral health were identified that need to be tackled to improve and maintain positive oral health behaviors during pregnancy. Behavioral interventions must acknowledge the cultural sensitivity around beliefs during pregnancy and, as a first step, focus on correcting oral health knowledge among Kuwaiti pregnant women. Knowledge Transfer Statement: The results of this qualitative study can be used by oral health care workers and researchers to plan and design more targeted dental health education interventions with pregnant women. The information in this study might be helpful to public health decision makers to make more appropriate decisions about implementing dental health education with pregnant women.

Oral health status of non-phobic and dentally phobic individuals; a secondary analysis of the 2009 Adult Dental Health Survey.

INTRODUCTION: The aim of this study was to conduct an exploration of differences in oral health behaviour and outcome between dentally phobic and non-phobic participants in the UK Adult Dental Health Survey (ADHS, 2009). The null hypotheses for this study were that there are no differences in oral health status of non-phobic and dental phobic individuals. METHODS: The ADHS survey covered the adult population in England, Wales and Northern Ireland and was commissioned by the NHS Information Centre for Health and Social Care (NHS IC). Dental anxiety was defined using the Modified Dental Anxiety (MDAS) with the cut-off point set at 19 and above as indicating dental phobia. Descriptive statistics were calculated and the chi-square test was used to compare both groups in terms of their demographics, oral health, oral health-related behaviour and attitudes, and treatment. RESULTS: More women (16.8% [1,023]) than men (7% [344]) reported dental phobia. Generally, people with dental phobia were in routine occupations (648 [47.7%]), single (402 [29.4%]) and with lower educational attainment (858 [80.9%]). They were irregular attendees (798 [58.5%]), had a less restored dentition, increased numbers of one or more teeth with caries (292 [39.9%]), and were more likely to have PUFA (puss, ulceration, fistulae, abscess) scores of one or more (89 [12.2%]) in comparison to the non-phobic group (314 [5.6%]). However, people with and without dental phobia had similar numbers of sound and missing teeth (34.5% of the phobic group had 20 or more sound teeth in comparison to 31.7% of the non-phobic group). There were significant differences (p<0.001) between the phobic group's and non-phobic group's Oral Health Impact Profile-14 (OHIP) and Oral Impacts on Daily Performance (OIDP) scores with phobic participants having generally higher scores. Additionally, the phobic group responded negatively more commonly about their most recent dental treatment in terms of dentists' ability to listen to their concerns, explaining the reasons for their dental care while paying full attention to their needs by treating them with respect and dignity. The difference between the two groups was statistically significant (p<0.001). CONCLUSIONS: Participants reporting dental phobia are mostly females, irregular attendees and have a greater treatment need with increased caries levels.

Characteristics of patients attending for cognitive behavioural therapy at one UK specialist unit for dental phobia and outcomes of treatment.

AIM: To describe the characteristics of patients attending a psychologist-led cognitive behavioural therapy (CBT) service for individuals with dental phobia and the outcomes of treatment. METHOD: Analysis of routinely collected assessment and outcome data from 130 patients attending a single secondary service providing CBT for dental phobia. FINDINGS: The patients comprised 99 women and 31 men, with an average age of 39.9 years (SD 14.8). Approximately 77% of the patients scored at levels suggestive of dental phobia on the Modified Dental Anxiety Scale (MDAS). Fear of dental injections and the dental drill were the most common high scoring items on the MDAS. Ninety four percent of patients reported one or more impacts of their mouth, teeth and gums on their life using the OHIP-14. A minority of patients had co-morbid psychological conditions - 36.9% had high levels of general anxiety and 12.3% had clinically significant levels of depression. Suicidal ideation was reported by 12% of patients and four (3%) reported recent intent to commit suicide. Of all patients referred 79% went on to have dental treatment without sedation and 6% had their dental treatment under sedation. The average number of CBT appointments required before a patient received dental treatment without sedation was five. CONCLUSIONS: CBT offers an effective technique for helping dentally anxious patients receive treatment without sedation. Those interested in running such services should be cognizant of the moderately high level of co-morbid psychological conditions in this group.

Why don't dentists talk to patients about oral cancer?

OBJECTIVES: Up to half of oral cancer patients are diagnosed with advanced lesions. One route to early diagnosis could involve dentists raising awareness of oral cancer through discussions with patients, emphasising prompt help-seeking. This study explores opinions and practices of dentists regarding discussing oral cancer with patients including views on barriers and facilitators. DESIGN: Qualitative in-depth interviews.Setting Dentists working in general dental practices in the United Kingdom were interviewed in 2013. SUBJECTS AND METHODS: In-depth interviews with dentists (n = 16) were conducted. Interviews were audio-recorded and transcribed. Data was analysed using framework analysis. RESULTS: Dentists recognised the importance of raising awareness but identified several barriers to discussions including system factors (for example, time constraints and a lack of financial incentive), patient factors (for example, fear of invoking undue anxiety) and dentist factors (for example, a lack of sufficient knowledge, training and self-confidence). Facilitators included developing practice standards and good dentist-patient relationships. CONCLUSION: Identified barriers may hold back efforts to raise awareness of oral cancer and could be targeted in future initiatives to encourage early detection.