Is Dichotomization into Regular versus Irregular Dental Attenders Valid? A Qualitative Analysis.

AIMS: To discover whether dental visiting behavior can be understood as a dichotomy of planned versus problem based, or whether there were a range of different types of understanding and patient behavior, recognizable as patterns of dental visiting behavior. METHODS: Secondary analysis drawing on 2 qualitative studies of patients' accounts of dental attendance and oral health, with 1) opportunistic interviews with people attending urgent dental care services (n = 43; including 19 with follow-up) and 2) home-based, in-depth interviews with people attending a dental practice with a mixture of improved or deteriorated/poor periodontal health (n = 25). RESULTS: Four distinguishable patterns of dental visiting were identified in patients' accounts: Accepting and Active Monitoring, as well as Ambivalent and Active Problem-based dental visiting behavior. Individuals' patterns were relatively stable over time but could shift at turning points. Accepting Monitors were characterized as accepting dentists' recommendations and dental practice policies relating to oral health and visits, whereas Active Monitors were more independent in judging how often to attend for preventive appointments, while still valuing anticipatory care. Ambivalent Problem-based visitors placed a relatively low value on anticipatory care for oral health maintenance and drifted into lapsed attendance, in part because of service-related factors. This contrasted with Active Problem-based visitors, for whom using services only in an emergency was a conscious decision, with low value placed on anticipatory care. CONCLUSION: This article demonstrates the dynamic nature of patterns of dental visiting where the dental system itself is partly instrumental in shaping patterns of utilization in an ecological way. Thus, service-related factors tend to combine with patients' behavior in expanding inequalities. This illuminates the reasons why risk-based recalls are challenging to implement as a dental policy. KNOWLEDGE TRANSFER STATEMENT: The results of this analysis can be used by clinicians and policymakers to inform policy around supporting uptake of preventive health care visits, contributing in particular to understanding how risk-based preventive visiting policies may be better adapted to patients' understanding of the purpose of visits, taking into account that this is in part shaped by service-related factors in an ecological way, arising from patients' and dental teams' expectations.

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: study protocol for the RETURN randomised controlled trial.

BACKGROUND: People with disadvantaged backgrounds are less likely to visit the dentist for planned care, even though they have disproportionately poorer oral health. They are correspondingly more likely to experience dental problems and use urgent dental care, general practices and Accident and Emergency departments, which not only makes meeting their needs expensive, but, since these services often rely on prescriptions rather than addressing the clinical cause, can contribute to antimicrobial resistance. METHODS: The RETURN intervention has been developed with substantial community co-production, to be delivered opportunistically in urgent dental care settings. This brief intervention is delivered by dental nurses and involves material relevant to the 'in-group' targeted. The material includes booklets relating to barriers to planned dental visiting with corresponding short video clips featuring local people and including a modelling element. Dental nurses are trained to have supportive and non-judgemental conversations, assisting patients to set personal goals and action plans, which are reinforced in a follow-up text within a few weeks. A randomised controlled trial will be undertaken in 3 types of sites: dental practices delivering urgent care (a) within working hours, (b) out of hours, and (c) in a Dental Hospital. The trial will recruit 1180 adult urgent dental care users over 12 months, who have not visited a dentist for a planned care appointment for 2 years or more and do not have a dentist who they visit for routine care. It aims to investigate the effectiveness and cost-effectiveness of the intervention and to explore whether the intervention has different effects across the socio-economic gradient. Participants will be followed up at 6, 12 and 18 months after randomisation. Co-primary outcomes are attendance at a dental practice for planned care within 12 months and self-reported oral health-related quality of life at 12 months. DISCUSSION: This is a pragmatic trial, evaluating the effectiveness of the intervention under the usual condition in which it might be applied. Since dental practices work as independent contractors to the NHS, this brings implementation and fidelity challenges which will be explored and described in embedded qualitative work. TRIAL REGISTRATION: ISRCTN registry identifier ISRCTN84666712. Registered 12/04/2021.

Dentistry, e-health and digitalisation: A critical narrative review of the dental literature on digital technologies with insights from health and technology studies.

OBJECTIVE: To overview current developments in e-health and digitalisation in dentistry and identify gaps in the dental literature on this topic; Basic research design: a critical narrative review of published articles and relevant online materials; Results: Four themes are identified as characterising the current dental literature on e-health and digitalisation: 1) the impact of digitalisation on dental surgeries, 2) digital technology and practice management, 3) digitalisation beyond the dental surgery and in dentist-patient communication, and 4) digital technology and education. However, gaps remain in our understanding of the impact of digital technology on dental practice, particularly in relation to its ethical considerations. Following the example of the wider medical literature, the review introduces the field of critical digital health studies and identifies areas for future investigation and exploration based on its four characteristics: devices and software, data materialisation, data practices and data mobilities; Conclusion and Clinical significance: Digital technology is changing clinical practice and patient care. Dentistry needs to expand its understanding of how dental apps, digital workflow models and digital health information are transforming and disrupting dental practice in order to anticipate how this digital shift will impact on dentistry. The emerging field of critical digital health studies can signpost ways to improve research and practice on the topic in the future.

Unravelling adherence to prophylaxis in haemophilia: a patients' perspective.

Given the lifelong therapy in haemophilia patients, insight in non-adherence behaviour from a patient perspective is important to understand patients' difficulties with the following treatment recommendations. The aim of this study was to clarify the process underlying adherence (behaviour) to prophylactic treatment, from a patients' perspective. To develop a grounded theory, a qualitative study using individual in-depth interviews was performed to understand experiences, perceptions and beliefs concerning adherence to prophylaxis. From two Dutch treatment centres, 21 adults with haemophilia using prophylaxis were interviewed. Patients were asked how they experience their task to administer prophylaxis and how they adhere to this. The interviews were transcribed, coded and analysed in an iterative process, leading to the development of the grounded theory. Adherence was determined by the position of prophylaxis in life. The position of prophylaxis was determined by the perception of prophylaxis and the ability to exert prophylaxis. Patients' perception was influenced by two main factors: acceptance of haemophilia and feeling/fearing symptoms. The ability to exert prophylaxis was influenced by understanding haemophilia and prophylaxis and planning/infusion skills. The combination of different perceptions and skills led to four main positions of prophylaxis in life: (i) prophylaxis integrated in life, (ii) prophylaxis according to doctors' advice, struggling with irregular situations, (iii) prophylaxis is too much to handle, (iv) prophylaxis is a confrontation with illness. The adherence level gradually decreased from position 1 to 4. This information can be used to design tailored interventions to promote adherence.

The effect of enamel matrix derivative (Emdogain®) on gene expression profiles of human primary alveolar bone cells.

Emdogain® is frequently used in regenerative periodontal treatment. Understanding its effect on gene expression of bone cells would enable new products and pathways promoting bone formation to be established. The aim of the study was to analyse the effect of Emdogain® on expression profiles of human-derived bone cells with the help of the micro-array, and subsequent validation. Bone was harvested from non-smoking patients during dental implant surgery. After outgrowth, cells were cultured until subconfluence, treated for 24 h with either Emdogain® (100 µg/ml) or control medium, and subsequently RNA was isolated and micro-array was performed. The most important genes demonstrated by micro-array data were confirmed by qPCR and ELISA tests. Emdogain tipped the balance between genes expressed for bone formation and bone resorption towards a more anabolic effect, by interaction of the PGE2 pathway and inhibition of IL-7 production. In addition the results of the present study indicate that Emdogain possibly has an effect on gene expression for extracellular matrix formation of human bone cells, in particular on bone matrix formation and on proliferation and differentiation. With the micro-array and the subsequent validation, the genes possibly involved in Emdogain action on bone cells were identified. These results can contribute to establishing new products and pathways promoting bone formation.

Dental practitioners and a digital future: an initial exploration of barriers and incentives to adopting digital technologies.

BACKGROUND: Digital technologies are proliferating into dental practices. While their technical attributes have often been studied, it remains unclear why some dentists adopt and use these technologies more than others. AIM To explore the incentives for and barriers against accepting and using digital dental technologies. METHOD: Eleven semi-structured qualitative interviews were conducted with experts in dentistry, dental technology and dental education in the Netherlands. RESULTS: Dentists' acceptance and use of digital technologies are to varying degrees driven by the perceived advantages over analogue methods, perceived influence on treatment quality, dentists' personal and professional orientation, and social influence from peers and external groups. These effects are complemented by personal and dental-practice characteristics. CONCLUSIONS: The findings suggest that there are large differences in motivation to adopt and use digital technologies between early adopters, late adopters and non-adopters, which should be examined in greater detail. We recommend that educators, dentists, and representatives of the dental industry who deal with the diffusion of these technologies take account of dentists' widely different attitudes to digitalisation.

Learning intravenous infusion in haemophilia: experience from the Netherlands.

Nowadays, nearly all severe haemophilia patients in the Netherlands practice self infusion at home. Learning intravenous administration of clotting factor requires time and effort. In order to inform patients about the burden and time-investment needed to learn intravenous infusion, we performed a two-centre retrospective study. All data on the learning processes, involving haemophilia patients born between 1980 and 2010 treated in Utrecht or Amsterdam, were extracted from patient files. A total of 154 patients and their parents were analysed (168 learning processes). Almost all patients had severe haemophilia and started prophylaxis at a median age of 2.7 years. 152/154 patients successfully learned intravenous infusion, including nine patients who temporally stopped and succeeded later. Overall, parents or patients needed a median of eight visits (IQR 4.3-14) in a median of 7 weeks (IQR 4-14.8) to learn home treatment. Parents who began to infuse by CVAD started at a median age of 1.9 years and succeeded within a median of 12 visits during 7.5 weeks. Parents who learned to perform intravenous infusion started at a median age of 4 years and needed 11 visits during 9 weeks. In 77% of cases, the mother was the first who started learning to infuse the child. Patients started with self infusion at a median age of 12.9 years, requiring a median of five visits in 12 weeks. The majority of patients and parents were able to learn intravenous infusion, with 50% of all parents and patients succeeding within eight visits during 7 weeks.

Analytical assessment of the osteoinductive material COLLOSSE.

In this study, the growth factors in COLLOSSE were analyzed, using ELISA tests, mass spectrometry, western blotting, and a 24-day cell culture experiment using osteoblast-like cells. The results of the ELISA testing, mass spectrometry, and western blotting all confirmed that TGF-beta1 was the main growth factor in COLLOSSE at 55 ng/mg. The results from the culture test showed that the cell proliferation, alkaline phosphatase activity, and matrix calcification were all drastically changed by the addition of COLLOSSE, mirroring the effects of addition of TGF-beta1. We conclude that COLLOSSE is not only a rich source of TGFbeta-1, but also contains the growth factors TGFbeta-2, BMP-2, BMP-3, BMP-7, IGF-1, and possibly VEGF. Other growth factors might be present in COLLOSSE, but were not identified due to inherent detection limits of the used ELISA and mass spectrometry techniques. The number of osteoinductive factors in COLLOSSE causes a synergistic effect, explaining the new bone formation found in previously described in vivo studies, with much lower growth factor concentrations when compared with recombinant BMPs.

The effect of combined application of TGFbeta-1, BMP-2, and COLLOSS E on the development of bone marrow derived osteoblast-like cells in vitro.

This study investigated the combined application of Transforming Growth Factor beta-1 (TGFbeta-1) and Bone Morphogenetic Protein-2 (BMP-2) to stimulate osteogenic expression in vitro. TGFbeta-1 and BMP-2 fulfill specific roles in the formation of new bone. COLLOSS E, a bone-derived collagen product containing a variety of naturally occurring growth factors, was also used. Growth factors were administered to osteoblast-like cells from rat bone marrow (RBM). Proliferation and differentiation were monitored up to 24 days, by measuring total DNA content, alkaline phosphatase activity, and calcium content. Genetic expression of a set of differentiation markers at day 7 was measured by Q-PCR. Adding BMP-2 alone induced high proliferation rates, compared to the growth factor supplemented groups, and it induced high differentiation rates, compared to the control group. Adding TGFbeta-1 combined with BMP-2, TGFbeta-1 alone, or COLLOSS E resulted in a significant decrease in proliferation rate, but an increase in differentiation rate, compared to the control group. Additive or synergistic effects of application of TGFbeta-1 and BMP-2 were not observed. The observed effects of COLLOSS E mainly resembled those of TGFbeta-1 application alone. It can be concluded that BMP-2 is the most suitable candidate for osteogenic stimulation of RBM cells in these settings.