ABSTRACT
Objective To investigate the clinical experiences of foundation dentists (FDs) in the North West of England.Methods Three research methods were used: a questionnaire completed by FDs at the end of their training; an analysis of the clinical logs of experience recorded in the educational portfolios; and analysis of NHS Business Services Authority (NHSBSA) activity data for the 12 month period of training of FDs.Results A response rate of 100% (N = 50) was achieved for the questionnaire and complete data for 49 of the 50 FDs was available from the NHSBSA and clinical logs in the educational portfolios.Discussion Trainees were satisfied with the clinical experience and believed their workload and patient mix provided a broad experience of clinical conditions, although 40% felt there were gaps in their clinical experience. There were wide ranges in the number of individual clinical procedures performed by FDs with some providing very few endodontic treatments, crowns, bridges, metal dentures and fissure sealants. There was a statistically significant difference (P <0.0005) in self- reporting of procedures recorded in the portfolio log when compared to the NHSBSA data.Conclusion The results from this study suggest that there is satisfaction amongst FDs with FT, but there is wide range in the level of clinical experience amongst FDs with some gaps which need to be addressed. In order to provide a consistent, cost effective approach to the delivery of FT changes are required to ensure minimum levels of clinical procedures are achieved during FT. The information collected in the training portfolio must be robust in order to make valid judgements on progress.
Subject(s)
Dental Care , Dentists , Personal Satisfaction , England , Humans , Surveys and QuestionnairesABSTRACT
We aimed to record all new patients who presented to departments of oral surgery, oral medicine, and oral and maxillofacial surgery, and to dental hospitals in the UK, with avascular necrosis of the jaws including bisphosphonate-related necrosis (BRONJ) over a 2-year period (1 June 2009-31 May 2011). They were eligible irrespective of age, cause, or coexisting conditions. Data on incidence, clinical characteristics, risk factors, and coexisting conditions were collected. A total of 383 cases were registered: 369 were described as BRONJ, 5 as avascular necrosis, and 9 were unknown. Bisphosphonates had been given orally in 207 (56%), intravenously in 125 (34%), both orally and intravenously in 27 (7%), and was unknown in 9 (2%); one had been given denosumab. The main risk factor was dental extraction, and the mandible was commonly affected. The median duration of administration until onset of BRONJ was 3 years in those treated intravenously and 4 years in those treated orally. Levels of engagement with the study varied between regions, and extrapolation from the 2 most involved (Merseyside and Northern Ireland) found around 8.2-12.8 cases/million/year, which is 508-793 patients/year across the UK. To our knowledge this is one of the first studies to estimate national rates of BRONJ. It confirms that the risk and incidence are low. With changes in trends for antiresorptive bone medication, and increasing numbers of elderly people, it would be useful to repeat the registration in the future.
Subject(s)
Bisphosphonate-Associated Osteonecrosis of the Jaw/epidemiology , Jaw Diseases/epidemiology , Osteonecrosis/epidemiology , Administration, Intravenous , Administration, Oral , Adrenal Cortex Hormones/therapeutic use , Aged , Aged, 80 and over , Alcohol Drinking/epidemiology , Bone Density Conservation Agents/administration & dosage , Chronic Disease , Diphosphonates/administration & dosage , Female , Humans , Incidence , Longitudinal Studies , Male , Mandibular Diseases/epidemiology , Middle Aged , Neoplasms/drug therapy , Osteoporosis/drug therapy , Prospective Studies , Risk Factors , Smoking/epidemiology , Time Factors , Tooth Extraction/statistics & numerical data , United Kingdom/epidemiologyABSTRACT
The purpose of this paper is to review the principles of antibiotic prescribing in light of the increasing worldwide problem of antibiotic resistance and the evidence of inappropriate use of antibiotics in dentistry. Guidance based on a review of the scientific evidence and recommended good practice for prescribing antibiotics in dental practice will be given.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Prescriptions , General Practice, Dental , Antibiotic Prophylaxis , Drug Resistance, Bacterial , Humans , Practice Guidelines as Topic , Prescription Drug MisuseABSTRACT
A questionnaire study was undertaken with trainers and trainees from 12 deaneries in England and Northern Ireland in June 2010 to evaluate workplace-based assessments (WPBAs) in foundation training. From the sample consisting of 741 trainers and 643 foundation trainees, experience of WPBAs was positive overall, playing an important role in trainees' learning during foundation training and building confidence. However, there is a need for comprehensive training in the WPBA tools used to ensure their efficacy.
Subject(s)
Clinical Competence , Education, Dental , Educational Measurement/methods , Internship and Residency , Adult , Clinical Governance , England , Feedback , Female , Humans , Learning , Male , Middle Aged , Northern Ireland , Program Evaluation , Self Concept , Surveys and Questionnaires , United Kingdom , WorkplaceABSTRACT
OBJECTIVE: The aims of this survey were to evaluate the effectiveness of workplace based assessments (WPAs) in dental foundation training (formerly vocational training [VT]). METHODS: Two online questionnaire surveys were sent to 53 foundation dental practitioners (FDPs) and their 51 trainers in the Mersey Deanery at month four and month nine of the one year of dental foundation training. The questionnaires investigated the effectiveness of and trainers' and trainees' satisfaction with the WPAs used in foundation training, namely dental evaluation of performance (D-EPs), case-based discussions (DcBD) and patients' assessment questionnaires (PAQs). The questionnaires also investigated the perceived impact of reflection and feedback associated with WPAs on clinical practise and improving patient care. RESULTS: A total of 41 (7.4%) FDPs and 44 (86.3%) trainers responded. Of the 41 FDPs, the majority found that feedback from WPAs had a positive effect on their training, giving them insight into their development needs. Overall 84.1% of the FDPs felt the WPAs helped them improve patient care and 82.5% of trainers agreed with that outcome. CONCLUSIONS: The findings from this study demonstrate the value of WPAs in dental foundation training by the use of feedback and reflection in directing the learning of foundation dental practitioners and that this can lead to improved clinical practise and patient care.
Subject(s)
Clinical Competence , Education, Dental , Educational Measurement/methods , Internship and Residency , Adult , Attitude to Health , Clinical Governance , England , Feedback , Female , Humans , Learning , Male , Mentors , Middle Aged , Patients/psychology , Personal Satisfaction , Program Evaluation , Surveys and Questionnaires , Teaching/methods , WorkplaceABSTRACT
OBJECTIVE: To investigate current endodontic clinical practice in the north west of England and evaluate practitioner's training needs. METHOD: A questionnaire was posted to 702 primary care dentists in the north west of England in January 2006. The questionnaire investigated aspects of dentists' endodontic clinical practice, the provision of endodontics within their practice, their recent postgraduate training in endodontics and their training needs. RESULTS: Responses to the questionnaire were received from 498 (70.9%) primary care dentists, of which 449 questionnaires contained useful information. Only 30% of respondents use rubber dam for isolation in all endodontic cases. The majority used radiographs either as the only method for establishing the working length (57.3%) or in conjunction with an apex locator (34.5%). Most dentists used sodium hypochlorite solution as an irrigant during the root canal treatment. Almost 55% used a combination of conventional hand files and rotary files to prepare root canals. Fifty-eight percent used the crown down technique while 35% used the step back technique for canal preparation. Almost two-thirds routinely used non-setting calcium hydroxide as an intra-canal medicament. Lateral condensation technique was the popular obturation method and the vast majority of respondents routinely took postoperative radiographs. Almost 25% of respondents had not received any teaching or training in endodontics in the past two years. CONCLUSIONS: The results of this study suggest that primary care dentists in the north west of England have embraced modern techniques and follow most aspects of accepted endodontic practice. Despite the majority having postgraduate training in the last two years, only a minority used rubber dam routinely for endodontic treatment.
Subject(s)
Education, Dental, Continuing , Endodontics/education , Needs Assessment , Practice Patterns, Dentists' , Primary Health Care , Root Canal Therapy , Adult , Calcium Hydroxide/therapeutic use , Dental Pulp Cavity/diagnostic imaging , England , Female , Humans , Male , Middle Aged , Private Practice , Radiography , Root Canal Filling Materials/therapeutic use , Root Canal Irrigants/therapeutic use , Root Canal Obturation/methods , Root Canal Preparation/instrumentation , Root Canal Preparation/methods , Rubber Dams , Sodium Hypochlorite/therapeutic use , State Dentistry , Surveys and Questionnaires , Tooth Apex/diagnostic imagingABSTRACT
AIM: To investigate the clinical management of patients attending for emergency dental treatment. DESIGN: A retrospective analysis of clinical record cards. METHOD: Information was collected from patient record cards concerning the patient's reason for attendance and their management at an emergency dental clinic in South Sefton, Liverpool. RESULTS: Over a nine month period, 1,718 patients attended the clinic; 1,472 record cards were analysed. Over 80% of the patients attending the out of hours (OOH) clinic had pain associated with a localised dental infection or dental abscess. Where a diagnosis was recorded, only 67% of patients received appropriate treatment. Over 50% of patients received antibiotics alone with no other definitive treatment provided. The principal antibiotic prescribed for both adult and child patients was amoxicillin. CONCLUSION: The current study has highlighted that GDPs working within the OOH services are not adhering to current clinical and best practice guidelines with respect to patient examination, diagnosis, management, in particular the correct prescribing of antibiotics for dental infections, and clinical record keeping.
Subject(s)
After-Hours Care/statistics & numerical data , Dental Care/statistics & numerical data , Emergency Treatment/statistics & numerical data , Abscess/epidemiology , Adolescent , Adult , After-Hours Care/standards , Aged, 80 and over , Amoxicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Child , Dental Audit , Dental Care/standards , Dental Caries/epidemiology , Dental Records/standards , Dental Restoration Failure , Dental Restoration, Permanent/statistics & numerical data , Drug Prescriptions/statistics & numerical data , Emergency Treatment/standards , England , Female , Guideline Adherence , Humans , Male , Practice Guidelines as Topic , Primary Health Care/standards , Primary Health Care/statistics & numerical data , Retrospective Studies , State Dentistry , Tooth Diseases/epidemiology , Tooth Injuries/epidemiologyABSTRACT
OBJECTIVES: This study investigated blood contamination of artificially and clinically contaminated Siqveland matrix bands and retainers. A modified version of the recognised Kastle-Meyer test for blood was used to compare the efficacy of enzymatic agents, a washer-disinfector and an instrument washer for pre-sterilisation cleaning of Siqveland matrix bands and retainers. METHODS: Assembled Siqveland matrix bands were contaminated either artificially with horse blood or clinically during dental treatment. Contaminated assembled matrix bands and retainers were subjected to immersion in an enzymatic agent, automated processing in a washer-disinfector or instrument washer, or a combination of pre-soaking and automatic cleaning. Residual blood contamination from each band and retainer was measured and compared to the volume of blood recovered from an unprocessed control group of contaminated assembled matrix bands or retainers. RESULTS: Residual blood was recovered from every clinically contaminated assembled Siqveland matrix band and retainer. The volume of blood recovered from assembled Siqveland matrix bands ranged from 0.13-7.1 microl and from retainers, following removal of the matrix band, from 0.001-1.523 microl. The most effective method of pre-sterilisation cleaning for artificially contaminated assembled matrix bands was processing in the washer-disinfector. Conversely, the most effective method for cleaning clinically contaminated assembled matrix bands and retainers was pre-soaking in an enzymatic agent followed by a heavy-duty cycle in an instrument washer. CONCLUSIONS: It is not possible to clean assembled Siqveland matrix bands using any method currently available to dental practitioners. Matrix bands should be discarded after use on one patient. Once the band is removed, all detectable blood can be removed from the retainer by pre-soaking in an enzymatic detergent followed by processing in an instrument washer.
Subject(s)
Decontamination/methods , Dental Disinfectants , Equipment Contamination , Infection Control, Dental/methods , Orthodontic Brackets , Orthodontic Retainers , Animals , Blood , Detergents , Disinfection/instrumentation , Disinfection/methods , Enzymes , Equipment Contamination/prevention & control , HorsesABSTRACT
OBJECTIVE: To investigate antibiotic prescribing for paediatric dental patients requiring general anaesthesia. DESIGN: A prospective clinical study of children referred for dental treatment under general anaesthesia. METHOD: Information was collected by way of a two-stage questionnaire for children attending three community NHS trusts for dental extractions under general anaesthesia between July 2001 and January 2003. RESULTS: A total of 360 questionnaires were analysed. There was wide variation in the waiting times (0-278 days) between referral and treatment under general anaesthesia. Most children (53%) attended with dento-alveolar abscess, 46% with caries only and 1% for orthodontic extractions. Antibiotics were prescribed to 52% of patients with an abscess and 32% with caries only. Only 16% of patients presented with moderate to severe pain, 5.5% with diffuse swelling and 12% with a raised temperature. Antibiotics were prescribed for patients with diffuse swelling (63%) and raised temperature (50%) but also for patients with pain only (39%) and localised swelling (52%). Amoxicillin was the most frequently prescribed antibiotic (82%), with wide variation in all antibiotic regimens. CONCLUSION: This study provides evidence of inappropriate prescribing of antibiotics to children referred for treatment under general anaesthesia with wide variations in the regimens employed. There was no conclusive evidence that long waiting times for definitive treatment influenced antibiotic prescribing. In some areas the delay for definitive treatment for this group of vulnerable patients was unacceptably long.