Personality traits and pre-treatment beliefs and cognitions predicting patient adherence to continuous positive airway pressure: A systematic review.

Adherence to Continuous Positive Airway Pressure (CPAP) for obstructive sleep apnoea (OSA) can be improved by behavioural interventions which modify patients' beliefs and cognitions about OSA, CPAP, and themselves. We have conducted the first systematic review of the literature on beliefs and cognitions held before starting treatment, and personality (which influences the former) that predict the decision to purchase or start CPAP, or CPAP adherence one month or more after CPAP initiation. A systematic search and screen of articles identified 21 eligible publications from an initial 1317. Quality assessment performed using an adapted Newcastle-Ottawa Scale demonstrated that 13 (62%) studies were poor quality and only seven (33%) were high quality. Eighteen factors, such as self-efficacy (confidence) in using CPAP and value placed on health predicted CPAP adherence; however, for only six (33%), utility as an intervention target is known, from calculation of individual predictive power. Studies did not use new behavioural frameworks effective at explaining adherence behaviours, nor did they interview patients to collect in-depth data on barriers and facilitators of CPAP use. Future studies cannot have these limitations if high quality evidence is to be generated for intervention development, which is currently sparse as highlighted by this review.

The perceived impact of Covid-19 on periodontal practice in the United Kingdom: A questionnaire study.

INTRODUCTION: COVID-19 has impacted dentistry in unprecedented ways. OBJECTIVE: The following research aimed to investigate the impact of the COVID-19 pandemic on periodontal practice in the United Kingdom using the COM-B (Capability Opportunity Motivation-Behaviour) model as the basis for a questionnaire. BASIC RESEARCH DESIGN: An online survey link was sent to all members of the British Society of Periodontology and Implant Dentistry. A total of 358 responses were received and analysed. RESULTS: The great majority of participants thought that the pandemic had an impact on their profession, while only 4.7 % had no concerns. The main worries related to financial concerns and ability to provide appropriate levels of care. More than 80 % of respondents agreed that their establishment was compliant with infection control procedures. Some participants felt benefits mainly in terms of more time for CPD activities. It was felt that some of the changes needed will need to be sustained long-term. CONCLUSIONS: Respondents were generally worried. However, they perceived they had the physical and psychological ability to effect changes to their practice, higher than the physical and social opportunities that they were afforded. Although the COVID-19 pandemic is causing profound changes and worries for the profession of Periodontology, clinicians are clear about their capability to control the situation and feel they have the motivation to make the required changes. CLINICAL SIGNIFICANCE: COVID-19 has presented clinicians with novel challenges. Investigating the professional response to change and expected impact is of interest in the current climate as we navigate the 'new normal'. Assessing the results could be useful in informing support strategies moving forward.

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.

Uptake of screening for type 2 diabetes risk in general dental practice; an exploratory study.

Aim The objective of this study was to determine dental patients' uptake of two preliminary screening tools for risk of diabetes (the Finnish Diabetes Risk Score -FINDRISC- and HbA1c finger-prick testing) in general dental practice, and to determine the number of patients at risk of type 2 diabetes (T2D) based on the results of these screening tests.Methods Patients aged 45 and over, who did not already have a diagnosis of diabetes, visiting primary dental practitioners for routine appointments in London (N = 244) and Staffordshire (N = 276), were offered the chance to be screened for diabetes risk using the FINDRISC a self-report screening tool to assess risk of development of diabetes in the next ten years. If a patient's score showed them to be at risk, they were offered an instant HbA1c finger-prick test to further screen for possible type 2 diabetes, where they were given their result instantaneously. Patients found to be at risk on either screening test, were referred to their GP for formal diagnostic testing.Results A total of 1,035 patients eligible for inclusion were asked to take part. Five hundred and twenty patients consented to screening. Of these, 258 patients (49.6%) were found to be at risk of developing diabetes based on FINDRISC scores and were referred to the GP for further testing and offered a further screening finger-prick blood test at the dental practice. A total of 242 (93.8% of those offered the test) accepted the on the spot finger-prick test. On this A1c test, had a result of 5.7% or higher, indicating increased risk for diabetes. Of the 258 who were referred to their GP for formal diabetes testing, 155 (60%) contacted their doctor. There was a significant association between the number of 'at risk' screening results a person received and whether or not a patient contacted their GP (P <0.0001). The odds of patients contacting the GP was 3.22 times higher if they were referred with two positive diabetes risk results (positive FINDRISC, positive HbA1c) rather than just one (positive FINDRISC, negative HbA1c).Conclusions The study demonstrates a two-step method of diabetes screening that appears to be acceptable by dental patients, a sizeable proportion of whom were identified as at risk of developing diabetes, and the majority following the recommendation for further testing with their GP. While the majority followed the recommendation for further testing with their GP, patients were three times more likely to contact their GP if they received a positive risk result on both screening tools.

Defining patient-centred care in dentistry? A systematic review of the dental literature.

Objective This paper presents the results of a systematic review, designed to explore how patient-centred care (PCC) is defined in the dental literature.Method An electronic search of MEDLINE (1946-2012), Embase (1980-2012) PsycINFO (1806-2012), the Cochrane Library and non-peer reviewed literature was conducted using a standardised search protocol. Definitions of patient centred care were identified and scored on two criteria to evaluate quality of definition and quality/type of evidence.Results Of the 28 papers included in the review the majority provided definitions of PCC synonymous with good quality general care (holistic, humanitarian). Only three mentioned the provision of information and the tools to facilitate informed choice. Less than a third of the papers included in this review were based on empirical evidence, and of those that were, only one was an RCT study.Conclusion The evidence suggests that the concept of PCC is neither clearly understood nor empirically and systematically assessed in dental settings. Whilst most authors seem to suggest that PCC is about delivering care that is humane, involving good communication and shared decision-making, there is no work assessing these concepts empirically or relating them to practical outcomes.

Risk communication in the dental practice.

The communication of risk in dental settings is a routine task that most clinicians are familiar with in their clinical encounters. However, work from medical settings has suggested that using this process in order to support health behaviour change in people may well be undermined by difficulties in understanding risk information, in presenting the information in a way that is clearly understood by the recipient and in the effects that such information may have for supporting further health behaviours by patients. This paper synthesises literature in the area that addresses these issues and explores approaches dental care professionals might consider when communicating risks in the dental surgery.

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.

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.

Are clinical decisions in endodontics influenced by the patient's fee-paying status?

OBJECTIVE: We explored whether the fee status of a UK patient influences clinical decision-making in endodontics. SUBJECTS AND METHODS: In a randomised-controlled vignette study describing either an 'NHS-funded', 'Privately-funded' or undisclosed fee-status patient, we examined the importance vocational trainer dentists placed on a series of factors normally considered when deciding whether to offer patients endodontic treatment as opposed to extracting the tooth. N = 119 experienced (M years post qualification = 20.01) dentists participated. MAIN OUTCOME MEASURES: Having read a vignette describing a hypothetical patient who could potentially be treated either endodontically or through an extraction, dentists rated a series of factors they would normally consider (for example, poor oral hygiene, the rest of their mouth is unfilled and caries-free), before recommending either endodontic treatment or an extraction. RESULTS: The patient's funding status had no influence on these dentists' clinical decision-making when considering endodontic treatment as an option (p >0.05) with the exception of a single item relating to infrequent attendance where the NHS patient was more likely than the 'undisclosed-fee' patient, to be offered extractions (F (2, 116) 3.43, p <0.04). CONCLUSIONS: We have found no strong evidence to suggest that the fee-status of a patient influences clinical decision-making in endodontic treatment by experienced dentists.

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.

A model of patient-centred care - turning good care into patient-centred care.

This paper builds on previous work reviewing patient-centred care in dentistry and acknowledges work that has questioned the measurement and effectiveness of patient-centredness in practice. In an attempt to move the debate from rhetoric to practice and enhance the practical utility of the concept, we present a practical hierarchy of patient-centredness that may aid the practical application of patient-centred care in clinical practice by making explicit a series of stages that a dental care professional needs to move through in order to provide care that is patient-centred. The model presented is illustrated through practical examples. The various stages inherent in it are described with the aim of making clear the perhaps automatic and taken for granted assumptions that are often made by dental care professionals and patients through the course of a consultation. Our aim is to encourage dental consultations to have more open, unambiguous communication, both about the risks and benefits of courses of action and about the choices available to patients.

Knowledge, attitudes, and experience of dentists living in Saudi Arabia toward child abuse and neglect.

AIM: To analyze the experience and knowledge of dental practitioners in Saudi Arabia regarding the identification of child abuse and neglect (CAN), to identify barriers that prevent the reporting of suspected cases of child maltreatment by dental practitioners, and to assess the need for training dentists in child protection. METHODS: A self-administered, web-based questionnaire was emailed to all of the members of the Saudi Dental Society (n = 7352) in 2012. RESULTS: The respondents (n = 122) demonstrated good knowledge of the forms and indicators of CAN. Moreover, a large proportion (59%) had experienced a case of child abuse or neglect in their practice over the previous five years. However, only about 10% of these respondents made a report. Fear of family reprisal, lack of certainty about the diagnosis of child maltreatment, and uncertainty about case management were critical barriers to the reporting of the suspected child maltreatment. In addition, only 20.9% of the respondents reported having knowledge of a child protection policy in their workplace. CONCLUSIONS: Based on the results of this survey, it appears that the level of knowledge among the respondents regarding the forms and indicators of CAN is good. However, a large proportion of respondents did not take action regarding suspected cases of CAN in their practice over the past five years. Therefore, additional resources and training are needed to support the identification and management of cases of child maltreatment by dental practitioners.

Why simple aesthetic dental treatment in general practice does not make all patients happy.

OBJECTIVE: We explored the role of personality and pre-treatment contentment with one's face and body in predicting satisfaction following simple aesthetic dental procedures. METHODS: In a single-centre repeated measures cohort design we examined the extent to which patient personality and baseline satisfaction with one's face and body predict post-treatment satisfaction. Data were collected from 60 patients attending a UK general practice in 2012. Adults (M age = 60.7 ± 12.6 years) receiving simple, routine aesthetic dental treatment participated. Satisfaction with one's face and body was assessed pre- and post-operatively through validated self-report measures. RESULTS: Although all participants were more satisfied post-treatment with their body overall (t [59] = 2.78, p <0.004) and with their face in particular (t [59] = 1.83, p <0.035), those scoring highly on neuroticism were generally unhappier both before and after treatment (r range = 0.277-0.360, p <0.05). In multiple regressions, post-operative facial satisfaction (R(2) = 0.475, p <0.001) was predicted by pre-operative facial satisfaction (ß = 0.616, t = 5.912, p <0.001) and to a lesser extent by neuroticism (ß = -0.241, t = 2.248, p <0.001). Baseline happiness with one's body (ß = 0.851, t = 11.996, p <0.001) was the sole predictor of post-treatment body satisfaction (R(2) = 0.744, p <0.001). CONCLUSIONS: Psychological variables may be important predictors of satisfaction with dental treatment and the clinical benefits of assessing them pre-operatively should be explored.

Motivation to study dental professions in one London Dental Institute.

INTRODUCTION: While past research has explored dental students' motivation to study, there is limited understanding in the reasons behind career choice for hygienists/therapists and dental nurses. The aim of this study was to investigate simultaneously the views of students of dentistry, hygiene/therapy and dental nursing in King's College London and explore similarities or differences in career choice. METHODS: All first-year students were invited to the questionnaire survey, exploring motivation to study using a 23-item instrument. Data were analysed using SPSS v18; statistical analysis included one-way analyses of variance and factor analysis. RESULTS: The overall response rate to the study was 75% (n = 209). Ten out of 23 factors were considered important by more than 80% of respondents, with 'job security' (93.8%), 'desire to work with people' (88%) and 'degree leading to recognised job' (87.5%) being top three. Analysis suggested that 52% of the total variation in motivating influences was explained by four factors: 'features of the job' (26%), 'education/skills' (11%), 'public service' (8%) and 'careers-advising' (7%); at group level 'features of the job' were significantly more important for the direct entrants to dentistry (P = 0.001). DISCUSSION: The findings suggest that across groups students were motivated to study by common influences reflecting altruistic, but also pragmatic and realistic motives, while 'features of the job' were more important for the direct entrants to dentistry.

The management of dental anxiety: time for a sense of proportion?

Dental anxiety and fear are common and potentially problematic, both for the patient and for the dental team in managing such patients. Furthermore, dental fear still presents a major barrier to the uptake of dental treatment. This article will take as its premise an assumption that anxiety manifests at different levels and that consequently management of dental anxiety involves both assessment and proportionate intervention. Methods for undertaking both assessment and management are outlined.

Barriers and opportunities of empowerment as applied in diabetes settings: a focus on health care professionals' experiences.

This exploratory study examines the opportunities and barriers health care professionals (HCPs) working with diabetes patients face when they try to implement the rhetoric of patient empowerment in practice. A small sample of diabetes HCPs (N=13), from National Health Service (NHS) hospital, walk-in and general practitioner (GP) clinics in South-East England, was interviewed through in-depth semi-structured interviews. Interviews were recorded, transcribed verbatim and analysed thematically. The analysis showed that empowerment was seen as beneficial for patients and HCPs. Time and resources could be moved from successfully empowered patients and focussed on more complex patients, this was termed 'selective empowerment'. The main barriers to empowerment were identified as a lack of resources, time and HCPs trained in empowerment techniques. Empowerment is a popular concept in theory, and presents HCPs with several opportunities but also important barriers in its practical, clinical implementation day-to-day.

Health care professionals' understanding and day-to-day practice of patient empowerment in diabetes; time to pause for thought?

This exploratory study examines what Health Care Professionals (HCPs) working with diabetes patients, understand by the term 'empowerment', their attitudes towards it and whether they believe they practise in ways consistent with empowerment principles. A small sample of diabetes HCPs (N=13), from National Health Service (NHS) hospital, walk-in and General Practitioner (GP) clinics in South-East England, was interviewed. In-depth semi-structured interviews established attitudes towards and use of empowerment in day-to-day practice. Interviews were recorded, transcribed verbatim and analysed thematically. There was no clear specific understanding of what empowerment is and what it involves, although there was broad reporting of factors around education and informed choices. Disagreement was evident about the level of freedom patients should have in making choices - from leading them to the 'right' choice to an acceptance that they may have the right to choose not to be empowered. No consensus emerged on what is successful empowerment and how it is measured. The resistance of some patients to the process of empowerment in its original definition of active partnership in care, was seen as problematic by HCPs. Although empowerment is a popular concept in theory, its practical, clinical implementation day to day, can be problematic.

Personality profile of students entering dentistry, hygiene/therapy and dental nursing at one London dental institute.

INTRODUCTION: King's College London Dental Institute (KCLDI) is the largest school in the UK, training dental professionals: Dentists, Hygienists/Therapists and Dental Nurses. Although previous work has examined dental students, there is a dearth of studies on the personality profile of students of hygiene/therapy and dental nursing. OBJECTIVE: To investigate the personality profile of students studying dentistry, hygiene/therapy and dental nursing at KCLDI, by programme, sex and ethnicity. METHODS AND MATERIALS: All entrants into dentistry, hygiene/therapy and dental nursing at KCLDI were invited to participate in the study. A self report questionnaire including the brief version of the Five-Factor Model and personal details was administered to the 218 recruited students in groups and under supervised conditions. RESULTS: One-way ANOVA on data from 148 questionnaires revealed significant differences; the medical graduate entrants to dentistry appeared to have a more extraverted profile than hygiene/therapy entrants (P<0.04). The graduate entrants to dentistry were more open to experiences than the direct entrants (P<0.03) and the dental nursing trainees (P<0.03). The medical graduate entrants also appeared more open to experiences than the dental nursing trainees; the latter also appeared to have a more sensitive profile compared to the medical entry students (P<0.03). No differences were found between groups in agreeableness and conscientiousness. CONCLUSIONS: The findings suggest the presence of personality differences between entrants to dentistry, hygiene/therapy and dental nursing. The implications of these findings are discussed.

The impact of different time frames of risk communication on Type 2 diabetes patients' understanding and memory for risk of coronary heart disease and stroke.

AIMS: We examined the impact of communicating risk of coronary heart disease (CHD) and stroke, using three time frames (1, 5 or 10 years), on Type 2 diabetic (T2D) patients' understanding of risk of CHD/stroke and their memory for these risks. METHODS: Patients (N = 95) estimated their risk of developing CHD/having a stroke as a result of diabetes, in one of three time frames. Using the United Kingdom Prospective Diabetes Study Risk Engine and the same time frame, patients were then given individualized, objective risk estimates of developing CHD/stroke. Following explanation of these risks, patients' risk understanding was examined by asking them to report again their risk of developing CHD/stroke. Six weeks later we assessed patient memory for these risks by asking them to recall their actual risk estimates for CHD/stroke. RESULTS: In all time frames, we successfully reduced participants' originally inflated risk perceptions of CHD (F(1,92) = 73.01, P < 0.001) and stroke (F(1,91) = 119.05, P < 0.001), although the 10-year risk group was the most resistant to correction for both CHD (F(1,90) = 9.32, P < 0.001) and stroke (F(2,88) = 3.97, P < 0.02). Participants' recall of their stroke risk at 6 weeks regressed towards original, inflated risk perceptions for the 10-year group only (F(4,176) = 4.73, P < 0.001). CONCLUSION: Patients' inflated perceptions of CHD/stroke risk can be easily corrected using shorter (1- or 5-year) risk communication time frames.