Development and use of a taxonomy to carry out a systematic review of the literature on methods described to effect distal movement of maxillary molars.

OBJECTIVE: To devise a taxonomy for the assessment of the orthodontic literature on methods described to effect distal movement of maxillary molars, to test the taxonomy for inter-assessor reliability, and to use it to classify studies in a systematic review of the literature. DATA SOURCES: Articles appearing in the American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, (British) Journal of Orthodontics, European Journal of Orthodontics, and the Journal of Clinical Orthodontics between 1988 and 1998. Data selection Articles describing or evaluating the effect of appliances known or thought to have a distalizing effect on maxillary molars. DATA EXTRACTION: A taxonomy was designed, tested by two reviewers independently to assess levels of agreement, and then used to record the features of the articles in a systematic review of the literature. DATA SYNTHESIS: Kappa scores were used to assess the level of agreement between reviewers and found to be satisfactory. Studies were grouped according to study design and features of their methodology quantified. CONCLUSIONS: Having devised and tested the taxonomy, we found that the quality of evidence for any method of moving maxillary molars distally was not high.

Violence and aggression at work.

The issue of violence and aggression towards healthcare personnel has received increasing attention over recent years. Surveys indicate that such behaviour does occur in both hospital and community dental settings, although in comparison, many other healthcare workers appear to be at greater risk. Information and advice to prevent and manage such situations, should they occur, are available.

Medical emergencies: the experience of staff of a UK dental teaching hospital.

OBJECTIVE: To assess the frequency of faints and other medical emergencies experienced by staff of a UK dental hospital. To investigate the training they had received in the management of medical emergencies, their perception of readiness to deal with emergencies and future training needs. SUBJECTS: All 193 clinical staff (dentists, hygienists, nurses and radiographers) of the University Dental Hospital of Manchester. DESIGN: Structured questionnaire with covering letter, reminders sent to non-responders. RESULTS: There was an 82% response. Fainting was the commonest event: other medical emergency events were experienced with an average frequency of 1.8 events per year, with the highest frequency reported by staff in oral surgery. Most expressed a need for further training: only 3% felt no need. CONCLUSIONS: Medical emergencies occur in dental hospital practice more frequently but in similar proportions to that found in general dental practice. There is a perceived need for further training among dental hospital staff in the management of medical emergencies.

Medical emergencies in general dental practice in Great Britain. Part 2: Drugs and equipment possessed by GDPs and used in the management of emergencies.

OBJECTIVE: To ascertain the emergency drugs and equipment possessed by general dental practitioners (GDPs), the treatment provided and drugs used in management of the medical emergency events they reported. DESIGN: Postal questionnaire survey of a random sample of GDPs in Great Britain. SUBJECTS: 1500 GDPs, 1000 in England & Wales and 500 in Scotland. RESULTS: There was a 74% response. An aspirator, an airway, oxygen, adrenaline and an injectable steroid were possessed by about 90% of respondents; glucose, glyceryl trinitrate and a salbutamol inhaler by about 80%. Glucose was used in management of nearly one in ten of the events reported, an inhaler, glyceryl trinitrate and oxygen were the next most commonly used. Cardiopulmonary resuscitation (CPR) was carried out in management of 1.1-1.4% of events not associated with general anaesthesia (GA) and in 4.7-16% of events associated with GA, an average of once in 250 years of practice. CONCLUSIONS: Most respondents possessed drugs and equipment necessary to manage a medical emergency. Half the drugs recommended by the 'Poswillo report' to be available in every dental practice were not used in more than 8000 years of practice.

Medical emergencies in general dental practice in Great Britain. Part 3: Perceptions of training and competence of GDPs in their management.

OBJECTIVES: To ascertain the training received in management of medical emergencies recalled by general dental practitioners (GDPs), as undergraduates and since graduation, to examine how well prepared they felt to manage such events and how their readiness might be improved. DESIGN: Postal questionnaire survey of a random sample of GDPs in Great Britain. SUBJECTS: 1500 GDPs, 1000 in England & Wales and 500 in Scotland. RESULTS: There was a 74% response. Among respondents, 75% had received training as undergraduates in the management of medical emergencies, 95% had subsequently received training. The proportion considering themselves 'well' or 'fairly well' prepared to manage emergencies rose from 30% at graduation to 80% currently. The 20% who felt themselves 'not very well' or 'not at all' prepared were less likely to possess the drugs and equipment to manage an emergency. Nevertheless, a need for further training was expressed by 96%: only 3% felt no need. CONCLUSIONS: Virtually all GDPs (99.2%), had received training in the management of medical emergencies at some time, principally since graduation. The 20% who feel inadequately prepared are less likely to possess the necessary drugs and equipment. There is a perceived need for further training among the majority of respondents.

Medical emergencies in general dental practice in Great Britain. Part 1: Their prevalence over a 10-year period.

OBJECTIVE: To assess the prevalence, nature and outcome of medical emergencies experienced by general dental practitioners (GDPs) over a 10-year period. DESIGN: Postal questionnaire survey of a random sample of GDPs in Great Britain. SUBJECTS: 1500 GDPs, 1000 in England & Wales and 500 in Scotland. RESULTS: There was a 74% response. Emergency events were reported by 70.2%: the number reported by a single individual ranged from none to 33. The most commonly experienced events, including those associated with general anaesthesia, were (as a percentage of the total) for England & Wales and Scotland, respectively: fits and seizures (31.0%, 36.3%); swallowed foreign bodies (15.7%, 18.1%); attacks of asthma (13.8%, 11.1%); chest pain associated with angina pectoris (10.1%, 11.0%) and diabetic events (10.6%, 9.0%): none of these resulted in any serious sequelae. More events were reported in Scotland. Overall, there were 20 deaths resulting from medical emergencies reported in the survey, 4 affecting passers-by and none associated with general anaesthesia. 8849 years of practice experience were represented (by 94% of respondents), from which an estimate of the frequency of events was made. CONCLUSIONS: An emergency event was reported, on average, for every 4.5 practice years in England & Wales and 3.6 years in Scotland and death associated with general dental practice, on average, once in 758 and 464 years, respectively.