The management of deep carious lesions and the exposed pulp in fully developed and immature teeth with irreversible pulpitis: a questionnaire-based study among Greek dentists.

OBJECTIVES: The study aimed to identify the preferred management techniques used by dentists in Greece for treating deep carious lesions or pulp exposure during the removal of carious tissue in teeth with irreversible pulpitis. Additionally, the study sought to explore how patient-related factors (such as age and symptoms) and operator-related factors (like material choice and the use of antibiotics) influence these management decisions. MATERIALS AND METHODS: The questionnaire, developed by five investigators, was divided into two parts: the first gathered respondent demographics, and the second presented clinical scenarios of deep carious lesions, requesting treatment strategies, materials used, and antibiotic prescription practices. The scenarios described patients with intense spontaneous pain and very deep carious lesions, differentiated by age and tooth development status.Data collection was via Google Drive, with analysis performed using SPSS 28, Chi-square, and Fisher's exact tests, with significance set at p < 0.05. RESULTS: The study polled 453 Greek dentists about their treatment choices, for deep carious lesions in mature and immature teeth with irreversible pulpitis The majority favored root canal treatment for mature teeth, however quite a few opted for partial or cervical pulpotomy. MTA emerged as the preferred capping material, emphasizing its biocompatibility. Hemostasis management varied, with saline and sodium hypochlorite as popular choices. In cases of immature teeth, a shift towards vital pulp therapy was evident, reflecting a preference for preserving healthy pulp to avoid complex procedures. CONCLUSIONS: Challenges identified include varying treatment preferences, the significance of bleeding control in vital pulp therapy, and the limited use of antibiotics for irreversible pulpitis. While the study has limitations, including sample size and potential biases, its findings offer valuable insights into the decision-making processes of Greek dentists. CLINICAL RELEVANCE: Future research and ongoing education within the dental community could contribute to standardizing treatment approaches and optimizing outcomes for patients with deep carious lesions and irreversible pulpitis.

Oral health of chemotherapy patients before and after provision of oral hygiene instructions at a tertiary care hospital: pre-post design.

OBJECTIVE: Disturbances in the oral mucosa is a major concern among patients undergoing chemotherapy. One of the most significant barriers in the implementation of oral care is the lack of knowledge. The aim of the study was to assess gingival and periodontal health status of chemotherapy patients before and after the provision of oral hygiene instructions. METHODS: A single group, pre-post test was conducted to assess oral health status of patients at the daycare chemotherapy, Aga Khan University Hospital, Karachi, Pakistan. Oral hygiene instructions were given with study models and leaflets. Patients were followed for 6-weeks. Oral health was assessed by using Simplified-Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI). Differences in indices were analyzed in STATA version-15.0 using Generalized Estimating Equation (GEE) and Wilcoxon Signed-rank test. RESULTS: Out of 74, 53 (72%) patients completed study follow-up. Improvement in the OHI-S was found in 14 (26%) patients (p-value < 0.001). GEE showed that age [adjusted OR = 1.10; 95% CI: 1.03-1.11], current chemotherapy cycle [adjusted OR = 1.19; 95% CI: 0.98-1.46], highest education level [Adjusted OR = 1.37; 95% CI: 1.08-12.7] and cancer therapy [Adjusted OR = 0.12; 95% CI: 0.24-0.55] were significantly associated with the change in OHI-S. Wilcoxon signed-rank test showed positive changes in the CPI (p-value < 0.001). CONCLUSIONS: Basic oral hygiene instructional intervention can be effective in improving the oral hygiene of chemotherapy patients. Nurses should also play a key role in providing psychological and nutritional support to patients.

A typology of internationally qualified dentists in the United Kingdom.

Introduction: The Global Strategy for Human Resources for Health 2030, requires member states to half their dependency on an international workforce by 2030. In order to design policies towards that goal, country-specific research on migration motivations of the health workforce is required. The United Kingdom (UK) is a net importer of health professionals and whilst there is a body of research on doctors' and nurses' migration, there is no research on the migration motivations of migrant dentists in the UK. This research explored the migration motivations of internationally qualified dentists (IQDs) in the UK and presents a typology to understand the global migration of dentists in the context of oral health workforce. Methods: The paper presents qualitative data from semi-structured interviews conducted between August 2014 and October 2017, of IQDs working in the United Kingdom. The topic guide for interviews was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis. Results: A total of 38 internationally qualified dentists (M = 18, F = 20), migrating from the five World Health Organization regions, and working in general practice, NHS hospitals and in community dental services across the four nations of the UK were interviewed. Seven types of internationally qualified dentists were identified working in the UK. They were livelihood migrants, career-orientated migrants, dependant migrants, backpacker migrants, commuter migrants, undocumented migrants, and education-tourist migrant. The categories were based on their migration motivations, which were complex, multifactorial, and included personal, professional, national, and international drivers. The typology, based on their migration motivations, offered a structured, comprehensive understanding of the migrant dental workforce. This typology involving dentists provides additional dimensions to commuter and undocumented migrants described in the context of other health professionals. The education-tourist migrant is a new category proposed as an extension to existing typology in health professional migration. Conclusions: The typology of internationally qualified dentists has congruency with other health professionals' typology in categories previously described and demonstrates that each of these categories are complex, fluid and change in response to policy changes. The new category of education-tourist migrant along with oral health dimensions of commuter and undocumented migrants adds to the existing typology in health professional migration.

Stress and occupational burnout levels among Palestinian dentists, and associated factors: A cross-sectional study in 2023.

Introduction: Stress and burnout rank among the foremost dentistry-related concerns. Understanding stress and burnout among Palestinian dentists is crucial for developing targeted interventions and support systems. The study aimed to assess stress levels among dentists in Palestine, identify factors contributing to stress, and determine the relationship between stress and burnout in this professional group. Method: ology: A cross-sectional study was conducted, employing a self-administered questionnaire to gather data from 271 dentists from March to June 2023. The Maslach burnout inventory was utilized to measure burnout across emotional exhaustion, depersonalization, and reduced personal accomplishment dimensions, while the 10-item perceived stress scale was employed to measure stress levels. Results: The findings revealed that 81% of Palestinian dentists reported experiencing moderate to high levels of stress. Emotional exhaustion was a prominent aspect of burnout, with 48% of participants reporting high levels. The multivariate linear regression analysis demonstrated a significant association between stress scores and female participants (p = 0.001), daily sleeping hours (p = 0.016), as well as emotional exhaustion and personal accomplishment burnout subscales (p ≤ 0.001 for both). Conclusion: The study revealed high-stress levels among Palestinian dentists, which were associated with sex and daily sleep hours. Furthermore, burnout was prevalent among dentists, particularly in terms of emotional exhaustion and personal accomplishment, which were strongly associated with increased stress levels. The results underscore the need for targeted interventions and support mechanisms tailored to factors facing dentists, especially among females and those who receive inadequate sleep. The relationship between burnout and stress levels highlights the intricate connection between these phenomena.

Perceptiveness and Attitude on the use of Artificial Intelligence (AI) in Dentistry among Dentists and Non-Dentists - A Regional Survey.

Artificial intelligence (AI) is an emerging tool in modern medicine and the digital world. AI can help dentists diagnose oral diseases, design treatment plans, monitor patient progress and automate administrative tasks. The aim of this study is to evaluate the perception and attitude on use of artificial intelligence in dentistry for diagnosis and treatment planning among dentists and non-dentists' population of south Tamil Nadu region in India. Materials and Methods: A cross sectional online survey conducted using 20 close ended questionnaire google forms which were circulated among the dentists and non -dentists population of south Tamil Nadu region in India. The data collected from 264 participants (dentists -158, non-dentists -106) within a limited time frame were subjected to descriptive statistical analysis. Results: 70.9% of dentists are aware of artificial intelligence in dentistry. 40.5% participants were not aware of AI in caries detection but aware of its use in interpretation of radiographs (43.9%) and in planning of orthognathic surgery (42.4%) which are statistically significant P < 0.05.44.7% support clinical experience of a human doctor better than AI diagnosis. Dentists of 54.4% agree to support AI use in dentistry. Conclusion: The study concluded AI use in dentistry knowledge is more with dentists and perception of AI in dentistry is optimistic among dentists than non -dentists, majority of participants support AI in dentistry as an adjunct tool to diagnosis and treatment planning.

A Pharmacy-Based Cross-Sectional Study to Assess the Antibiotic Prescription Pattern by Medical and Dental Practitioners in Saudi Arabia.

Introduction: The misuse and overuse of antibiotics in dental practice are well known and have become widespread worldwide. Its potential effect and high risk of serious reaction have emphasized the need to reduce and limit the precipitation. In this study we aimed to identify the prevalence, type, dose, and duration of antibiotics prescribed by general medical and dental practitioners in Saudi Arabia. Materials and Methods: This cross-sectional study was performed from April 2020 to December 2020. A total of 45,100 antibiotic prescriptions were collected from different governmental and private pharmacies and screened to be included in this study. Data extraction from all prescriptions followed a standardized form that included the following information: Doctor specialty, type of antibiotic, duration, and dose of antibiotic. Results: A total of 38,175 antibiotic prescriptions prescribed by licensed doctors practicing in governmental or private hospitals were included in this study. Thirty-five thousand one hundred and seventy-eight (92%) outpatient antibiotics were prescribed by medical practitioners, and 2997 (8%) antibiotics were prescribed by dentists. The most commonly prescribed antibiotic was Augmentin (60%), followed by metronidazole and amoxicillin (35%). The most common dose and duration prescribed by dentists for Augmentin was 625 mg, 3 times per day for 5 days, whereas that of metronidazole was 500 mg, 3 times per day for 7 days. Prescribed dose and duration of amoxicillin was 500 mg, 3 times per day for 7 days. Conclusions: This study helps in understanding healthcare practitioners' patterns and adds to the knowledge on how to deal with odontogenic infections. Further national studies are recommended to include more regions in Saudi Arabia and to illustrate the misuse of outpatient antibiotics.

Knowledge and Preparedness of Dentists in Response to Bioterrorism.

Introduction: In the current climate of heightened terrorist activity, the deliberate release or threat of biological agents like viruses, bacteria, fungi, or their toxins to induce sickness or death among civilians has become a genuine possibility. The most crucial action during a bioterrorist strike is early warning. The possibility of such an occurrence in dental setting is underestimated. Methods and Materials: Seventy five graduate students participated in the research. In a survey on zoonotic diseases, participants were asked whether they were familiar with the transmission from person to person, if the diseases caused significant morbidity and mortality, whether they were simple to produce and disseminate, and whether they posed a high risk of infection. Results: Graph Prism was used to examine the data. A single proportion test was used to determine the "Aware Not Aware" group. The first 10 questions assessed dentists objective knowledge of bioterrorism. The importance of the last six questions was determined by their analysis of dentists' preparedness and desire to respond to a bioterrorism associated occurrence via perceived knowledge. Conclusion: Given the real danger they may face, dentists needed to be vigilant regarding the prevention, detection, and treatment of zoonotic illnesses transmitted in their offices or as a vector while being commended for their courage in the face of adversity.

Knowledge and Awareness of Detecting Oral Premalignant Lesions among Dental Students, Interns, and Practitioners in Saudi Arabia.

Oral malignant lesions are the most common malignancy of which majority are diagnosed in advanced stages in Saudi Arabia. Patients with oral malignant lesion are first seen by general dental practitioners and dental students. Multiple surveys have been conducted and published to assess the students, interns, and dentists' awareness and attitude toward oral premalignant lesions worldwide. However, little is known about this issue in Saudi Arabia. We aimed to assess knowledge and awareness of detecting oral premalignant lesions among dental students, dental interns, and practitioners in Saudi Arabia. A cross-sectional questionnaire-based survey was conducted and electronically distributed. The questionnaire comprised of three sections including demographic variables, knowledge of risk factors of oral malignancy, and six clinical case scenarios. Descriptive statistics were used, and the results were reported using cross-tabulation and the Chi-square test. A 300 participants answered to the questionnaire, and 83% of respondents strongly agreed that smoking is a risk factor for oral malignancy. However, there was some uncertainty in responses for some more specific oral-related factors, such as a sharp-edged tooth and irritation from dental restoration. Furthermore, the knowledge and awareness of detecting frankly benign and frankly malignant lesions such as fibroma and squamous cell carcinoma are higher comparing to potentially malignant lesion, i.e. lichen planus. Knowledge and awareness of detecting oral premalignant lesions vary based on malignancy factors and by participants academic level. Fibroma and SCC are detected easily among all participants. However, lichen planus was the hardest to diagnose among oral lesions.

Knowledge, Attitudes, and Practices About the Use of Silver Diamine Fluoride Among Dentists in Riyadh, Saudi Arabia: A Cross-Sectional Study.

Introduction Dental caries is a worldwide disease affecting children and older populations. There are multiple interventions to treat dental caries that could be sometimes hard to deliver, due to the general status of patients such as insufficient cooperation or medically compromising conditions. Therefore, another alternative to control dental caries is being used and has been recently introduced and approved by the Saudi FDA which is silver diamine fluoride (SDF).  Objectives This study aimed to investigate the level of knowledge, attitudes, and practices about the use of SDF among dentists in Riyadh, Saudi Arabia. Materials and methods This cross-sectional study was conducted using pretested, an online digitally designed questionnaire sent to 500 Saudi Commission for Health Specialties (SCFHS) registered dentists working in the following specialties: general practitioners, interns, restorative, family, pediatric, and public health dentists who are working in public and private hospitals and clinics. One-way ANOVA was used to determine the comparison of participants' knowledge and Practice with three variables (participants' specialty, place of work, and years of experience), while Chi-square was used for the comparison of respondent's attitudes about the use of SDF and the above same variables. Result A total of 265 responses were received (response rate is 53%). The majority of the respondents were general practitioners and interns 144 (54.3%). Over 50% of dentists believed that they were very informed about SDF. The mean score of knowledge and practices of SDF of participants was found below average 49.13 (19.81) and 43 (26.12), respectively. Correlation of the mean score knowledge and practicing SDF with the type of specialty showed that pediatric dentists had statically significant (P<0.05) higher mean of knowledge 66.94 (SD=17.64) and practicing of SDF 61.93 (22.12) as compared to other specialties, while no statistically significant differences were found among the groups in the overall knowledge and practices based on years of experience and workplace. Attitudes were correlated with the three above variables (specialty, years of experience, and place of work) and showed that pediatric dentists had the highest satisfaction with the results of SDF (85.3%) and were more willing to recommend using it to others (91.2%) as compared to the other groups(P<0.05). No statistically significant differences were found with respect to the later variables. Conclusion The findings of this study showed that irrespective of the positive attitude of participants towards SDF, pediatric dentists were found to have higher knowledge and use SDF more than other dentists in different specialties. Furthermore, they showed higher satisfaction with its use. Years of experience and workplace had no effect on the level of knowledge or practice among participants.

Maternal periodontitis as a risk factor for preterm birth: A cross-sectional study.

Background: Preterm birth is a heterogeneous condition with multiple underlying causes, and periodontal diseases are one of them. Approximately 900000 preterm births are reported in Pakistan each year. Oral infections such as periodontitis during pregnancy are associated with adverse pregnancy outcomes such as low birth weight and preterm births. However, different studies have reported contradictory findings. We conducted a cross-sectional study to assess the association of preterm birth with oral infection in pregnancy. Methods: We conducted a cross-sectional analytical study on 400 postpartum pregnant women in Khyber Teaching Hospital, Peshawar. Only women within the age bracket of 18‒40 years were recruited. Data were collected by an interview-based structured questionnaire. The extent and severity index were used to assess the periodontal health of participants. Frequency tables were generated, and the chi-squared test was used to determine associations between different categorical variables. Results: The mean age of the participants was 25.8±4.9 years. Approximately 87.5% of the women had generalized periodontitis. Approximately 68% of mothers had moderate severity of periodontitis. The extent index showed no notable difference between the preterm and full-term birth groups. In contrast, the severity index displayed a statistically significant difference between the preterm and full-term birth groups. Conclusion: The majority of women had generalized periodontitis. The severity index demonstrated a significant association between maternal periodontitis and preterm births. There was no association between the age of mothers and preterm births. Complications in pregnancy were not associated with preterm births.

Dental education and practice: past, present, and future trends.

This position paper explores the historical transitions and current trends in dental education and practice and attempts to predict the future. Dental education and practice landscape, especially after the COVID-19 epidemic, are at a crossroads. Four fundamental forces are shaping the future: the escalating cost of education, the laicization of dental care, the corporatization of dental care, and technological advances. Dental education will likely include individualized, competency-based, asynchronous, hybrid, face-to-face, and virtual education with different start and end points for students. Dental practice, similarly, will be hybrid, with both face-to-face and virtual opportunities for patient care. Artificial intelligence will drive efficiencies in diagnosis, treatment, and office management.

Awareness and Incorporation of the Dental Home Concept Among General Dentists and Dental Therapists in Malaysia.

Background The dental home concept (DHC) refers to an approach in oral healthcare that emphasizes establishing a long-term, comprehensive, and family-centered relationship between a patient and their primary dental care. This study determined the awareness and incorporation of the DHC among general dentists and dental therapists in Malaysia. Methodology A total of 154 general dentists and 137 dental therapists providing oral healthcare services at the Ministry of Health (MOH) primary care facilities throughout Malaysia participated in this cross-sectional study. A self-administered questionnaire was used to measure the respondents' awareness of the DHC and incorporation of the DHC characteristics into their practice. Results Most dentists and dental therapists (61.7% and 67.2%, respectively) had not heard of the term DHC and were unaware of the concept. The respondents' awareness was not associated with their age, sex, years of service, facility location, and percentage of treatment given to children aged five years and below. However, most dentists and dental therapists responded positively about incorporating most DHC characteristics into their current practice. Conclusions Most dentists and dental therapists serving the MOH primary oral healthcare facilities were unaware of the DHC, although most DHC characteristics have already been incorporated into their practice. This study provides evidence of the incorporation of the DHC into the MOH primary oral healthcare services and suggests an effort to increase the awareness of the workforce regarding the concept and its implementation.

Access to Care Considerations for the Endodontic Treatment of Immature Permanent Teeth: A National Survey of Pediatric Dentists and Endodontists.

INTRODUCTION: This study aimed to investigate access to care and financial considerations associated with the endodontic treatment of immature permanent teeth. METHODS: Surveys were distributed to endodontists (n= 2,457) and pediatric dentists (n= 3,974) in the United States. Data were analyzed using X2 analysis and logistic regression. The level of significance was set to 0.05. RESULTS: The response rate was 13% (n=840). Respondent specialist groups were similar by age and years since specialty residency completion, but significantly different with regard to primary practice setting (e.g. private practice, Federally Qualified Health Center, hospital…), (p=0.001). The majority (91%) of respondents reported participation with dental insurance. Pediatric dentists (69%) were significantly more likely than endodontists (17%) to participate with public-payer dental insurance (p<0.001). The majority of respondents (82%) indicated that patients reported economic factors (time or money) as a barrier to accessing endodontic treatment. Pediatric dentists were significantly more likely to consider economic factors when treatment planning (p<0.001). Pediatric dentists were more likely than endodontists to have the opinion that endodontic procedures for treatment of necrotic immature permanent teeth should cost less than root canal therapy (apexification, p<0.001; regenerative endodontic procedures, p=0.002). Pediatric dentists (33%) reported encountering barriers when attempting to refer their patients to an endodontist. Inability to find an endodontist that participates with dental insurance was the most frequently cited barrier. CONCLUSIONS: Limited clinician participation with dental insurance and gaps in insurance coverage for endodontic procedures appear to contribute to access to care barriers for pediatric patients.

Dentists' perspectives, practices, and factors associated with informed consent process for fixed prosthodontic treatment: a cross-sectional study of kampala metropolitan area, Uganda.

BACKGROUND: Dentists have a legal and ethical obligation to obtain informed consent from patients before carrying out treatment. In Uganda, the process of obtaining informed consent in dentistry is not well documented. The aim of the present study was to determine dentists' perspectives and practices regarding informed consent to fixed prosthodontic treatment (FPT) in Kampala Metropolitan, Uganda. METHODS: A quantitative cross-sectional study was conducted among 153 dentists from July to September 2023. Data were collected using a semi-structured self-administered questionnaire that included both closed- and open-ended questions. The questionnaire included items on participants' sociodemographic information, perspectives, and practices about informed consent for FPT. Perspectives were rated using ten items on a five-point Likert scale. The minimum possible total score was 10, and the maximum possible score was 50. Descriptive statistics and Poisson regression were used to summarize and analyze the quantitative data, and the significance level was set at p < 0.05. Open-ended items were analyzed using content analysis. RESULTS: The majority (83.9%) of the participants were general dentists with working experience ranging from 1 to 38 years and a median of 8 years. The majority were familiar with the concept of informed consent and had positive perspectives regarding its use for FPT. The mean score for perspectives was 39.27 (SD, 5.42). However, there were variations in the practices of the dentists. More than three-quarters (87.6%) reported that they always obtained the patient's informed consent before FPT. Less than a third (29.4%) obtained written consent for FPT. About half of the dentists provided information regarding the procedure, benefits, and risks of treatment during the consent process. Bivariate analysis showed that the use of written consent for FPT was significantly (p < 0.05) associated with having a work experience of more than 10 years and having had training involving informed consent after undergraduate studies. CONCLUSION: The present study provides baseline data regarding perspectives and practices regarding informed consent for FPT among dentists in Uganda. It is recommended that regular training courses be developed to highlight the importance of improved informed consent practices for patient protection and to instruct dentists about obtaining valid informed consent. There is a need for future research to streamline guidelines for the informed consent process in dental care in Uganda.

Point-of-care diabetes testing in the dental setting: A national scope of practice survey.

OBJECTIVES: The aim of this study was to assess the knowledge of state dental directors regarding their state's professional practice act, specifically scope of practice laws regarding point-of-care chairside screening for diabetes. METHODS: A cross-sectional study design was used to examine the 50 state dental directors' knowledge of policy around point-of-care diabetes testing in their state. A five-item survey instrument was designed in a web-based platform and electronically distributed in 2022. RESULTS: Thirty-seven states (74%) responded to the survey. Regarding whether it was within the scope of practice for dentists to provide chairside point-of-care HbA1c screening, 17 states (46.0%) responded "yes," 5 states (13.5%) responded "no," and 15 states (40.5%) responded "don't know." Of the 17 states who provide diabetes testing, four states (23.5%) reported that dentists were reimbursed, nine states (53.0%) reported they were not reimbursed, and four states (23.5%) reported they did not know regarding reimbursement. CONCLUSIONS: There is significant state heterogeneity with regard to laws, regulations, and reimbursement for chairside diabetes testing in the United States. This is accompanied by vagueness and lack of specificity in the state education laws. For more widespread promotion and adoption of this evidence-based screening, the entire dental community including clinicians, educators, policymakers, payers, and professional organizations at all levels are encouraged to work together to advocate for clarification and specificity in the language of state education laws as well as reimbursement for this vital service.

Short (≤6 mm) compared with ≥10-mm dental implants in different clinical scenarios: A systematic review of randomized clinical trials with meta-analysis, trial sequential analysis and quality of evidence grading.

AIM: To systematically identify, synthesize and critically summarize the available scientific evidence from randomized controlled trials (RCTs) regarding whether short (≤6 mm) perform as well as long (≥10 mm) implants regarding implant survival, marginal bone loss, and biologic and prosthetic complications in different clinical scenarios. MATERIALS AND METHODS: Cochrane Collaboration's risk of bias tool and the GRADE approach were applied. Results were synthesized using random-effects meta-analyses assessed by trial sequential analyses. RESULTS: Forty reports on 19 RCTs comprising 2214 (1097 short; 1117 long) implants were included. Moderate/high certainty/quality evidence demonstrated similar 5-year survival rates for ≤6-mm and ≥10-mm implants in non-augmented bone and full-mouth rehabilitation in either jaw, and for 6-mm implants in the maxilla instead of sinus lift. Nevertheless, the evidence for 5-year survival rates remains inconclusive or insufficient for the remaining combinations of implant lengths and clinical scenarios. They include 4-mm and 5-mm implants as alternatives to sinus lift as well as placing all implant lengths ≤6 mm instead of vertical ridge augmentation with long implants. Marginal bone level and short- and long-term biologic or prosthetic complications were similar. CONCLUSIONS: Based on moderate/high certainty/quality evidence from 5-year RCTs, implants ≤6 mm may be viable alternatives to ≥10-mm implants in either jaw in native bone and full-arch rehabilitation, and 6-mm implants may be used as an alternative to sinus lift. TRIAL REGISTRATION: PROSPERO ID: CRD42021254365.

Process evaluation of a pragmatic feasibility trial on smokeless tobacco cessation intervention delivered in dental hospitals.

BACKGROUND: Article 14 of the WHO 'Framework Convention on Tobacco Control' recommends, that all oral healthcare providers provide support for tobacco cessation, to all patients. Despite evidence on the effectiveness of tobacco cessation interventions in dental settings, implementation remains low in most high-burden countries like Pakistan. A pragmatic pilot trial of a dentist-delivered behavioural support intervention for smokeless tobacco (ST) cessation, was conducted in dental hospitals in Pakistan. This paper presents the findings of the process evaluation of the trial. METHODS: A mixed-method process evaluation of a multi-centre randomised control pilot trial of dentist-delivered behavioural support intervention ST cessation was conducted. The intervention included three sessions namely: pre-quit, quit and post-quit sessions. The process evaluation involved: semi-structured interviews with trial participants (n = 26, of which dental patients were n = 13 and participating dentists were n = 13 conducted from June-August 2022); and fidelity assessment of audio recordings of the intervention sessions (n = 29). The framework approach was used to thematically analyse the interview data. RESULTS: Overall the trial procedures were well accepted, however, young patients expressed uneasiness over revealing their ST use status. The intervention was received positively by dentists and patients. Dentists identified some challenges in delivering behavioural support to their patients. Of these, some were related to the contents of the intervention whereas, others were related to the logistics of delivering the intervention in a clinical setting (such as workload and space). Acceptability of the intervention resources was overall low amongst young patients as they did not take the intervention resources home due to fear of their family members finding out about their ST use. The intervention was successful in achieving the intended impact (in those who engaged with the intervention), i.e., change in the patients' ST use behaviour. Giving up ST with the aid of behavioural support also had an unintended negative effect i.e., the use of harmful substances (cannabis, cigarettes) to give up ST use. Patients' satisfaction with their dental treatment seemed to influence the intervention outcome. CONCLUSION: While there are many variables to consider, but for the participants of this study, behavioural support for abstinence delivered through dentists during routine dental care, appears to be an acceptable and practical approach in helping patients give up ST use, in a country like Pakistan, where negligible support is offered to ST users.

Safety net patients' satisfaction with oral health services by provider type and intent to return for more care.

OBJECTIVES: This study examined patients' satisfaction with services provided by different oral health providers, their intent to return for additional care, and associations with patients' demographics and service characteristics. METHODS: Descriptive analyses and multivariable ordinal logistic regressions were conducted using survey data from 898 patients who received care at Apple Tree Dental (ATD) in Minnesota during 2021. The questionnaire included 12 statements on patient satisfaction with the clinician's ability to explain the dental diagnosis and treatment options, to be considerate of the patient's needs and dental anxiety, and to provide technically competent services. RESULTS: In general, patients reported high satisfaction with dental care and a strong intent to return to ATD for future services. No significant differences in patient satisfaction were observed by provider type. Patients' intent to return was higher among non-White respondents (OR = 1.76; 95% CI = 1.06-2.92) and patients who were more satisfied with their providers' technical competence/treatment (OR = 1.47; 95% CI = 1.37-1.57). The association between intent to return and patient satisfaction with providers' information/communication was stronger for patients treated by dental hygienists. The association between intent to return and patient satisfaction with providers' technical competence/treatment was also stronger for patients who were more satisfied with providers' information/communication and understanding/acceptance, and for those treated by their desired or usual provider. CONCLUSIONS: The study underscores the benefits of introducing dental therapists to the oral healthcare team, showing that this can be achieved without sacrificing either the quality of patient care or patient satisfaction.

Perceptibility and acceptability of lightness difference of a single maxillary central incisor.

OBJECTIVES: The aim of this study was to assess the lightness difference perceptibility and acceptability thresholds, for a single maxillary central incisor, and to investigate possible differences in these thresholds regarding the direction (+ΔL* vs. -ΔL*), the observer group (dentists vs. laypersons), and the gender and age of the observers. MATERIALS AND METHODS: A series of images with varying lightness (L*), were created by altering the right maxillary central incisor of a male Caucasian, on a frontal view full-portrait image. Digital modification of one central incisor by 1 ΔL* unit resulted in 15 different images: one control, seven with increased and seven with decreased lightness. The images were presented in random order, on a digitally calibrated monitor, to 158 observers, grouped into 79 dentists, and 79 laypersons, who were asked to evaluate every image and answer whether they perceive a difference and if yes, whether they accept this difference. A multifactorial analysis of covariance was performed to analyze the perception and acceptance of any difference in the central incisors and to estimate the thresholds. The statistical significance level was α = 0.05. RESULTS: Overall, the magnitude of ΔL*, direction of ΔL*, observer group and age were each significant (p < 0.001), as was gender (p = 0.03). The effect of the magnitude of ΔL* interacted with its direction and the observer group (p = 0.045), and the effect of age interacted with the direction of ΔL*, and the gender and the group of the observers. Estimated 50%:50% perceptibility thresholds ranged from 0.1 to 2.7, and 50%:50% acceptability thresholds ranged from 2.3 to 4.5. Overall, dentists perceived lightness differences at lower magnitudes than laypersons; difference in lightness was perceived and accepted at lower magnitudes when the tooth become lighter instead of darker; and female observers perceived and accepted lightness differences at lower magnitudes compared to males. As age increased overall, differences of lightness were perceived and accepted at higher magnitudes. CONCLUSIONS: Perceptibility and acceptability of lightness differences of a single maxillary central incisor are affected by the magnitude and the direction of lightness change, as well as the gender, the age, and the type of the observers. CLINICAL SIGNIFICANCE: Even small changes in lightness are perceivable; however, thresholds of perception and acceptance are dependent on the magnitude and the direction of change and are also dependent on the observer, with women, dentists and younger people perceiving and accepting changes at lower magnitudes of ΔL*.

Revised evaluation objectives of the Korean Dentist Clinical Skill Test: a survey study and focus group interviews.

PURPOSE: This study aimed to propose a revision of the evaluation objectives of the Korean Dentist Clinical Skill Test by analyzing the opinions of those involved in the examination after a review of those objectives. METHODS: The clinical skill test objectives were reviewed based on the national-level dental practitioner competencies, dental school educational competencies, and the third dental practitioner job analysis. Current and former examinees were surveyed about their perceptions of the evaluation objectives. The validity of 22 evaluation objectives and overlapping perceptions based on area of specialty were surveyed on a 5-point Likert scale by professors who participated in the clinical skill test and dental school faculty members. Additionally, focus group interviews were conducted with experts on the examination. RESULTS: It was necessary to consider including competency assessments for "emergency rescue skills" and "planning and performing prosthetic treatment." There were no significant differences between current and former examinees in their perceptions of the clinical skill test's objectives. The professors who participated in the examination and dental school faculty members recognized that most of the objectives were valid. However, some responses stated that "oromaxillofacial cranial nerve examination," "temporomandibular disorder palpation test," and "space management for primary and mixed dentition" were unfeasible evaluation objectives and overlapped with dental specialty areas. CONCLUSION: When revising the Korean Dentist Clinical Skill Test's objectives, it is advisable to consider incorporating competency assessments related to "emergency rescue skills" and "panning and performing prosthetic treatment."