Screening for mouth cancer: the pros and cons of a national programme.

The paper highlights the pros and cons of a national programme for screening for oral cancer. It provides an overview of screening methods and the metrics used to evaluate a screening programme. It then reviews the evidence for mouth cancer screening against the criteria of the United Kingdom National Screening Committee.

The knowledge mobilisation challenge: does producing evidence lead to its adoption within dentistry?

The transfer of evidence into clinical practice is the ultimate aim of those engaged in health research. But is this a process that occurs naturally? Can health researchers take it for granted that the evidence they produce will be embraced by clinicians and incorporated into their everyday practice? In this article, we use the example of oral healthcare in dependent older people and the issue of antibiotic prescribing by GDPs to illustrate the fact that successful knowledge transfer between researchers and practitioners cannot be automatically assumed. What is needed, so we argue, are certain tools to facilitate the knowledge transfer, exchange and implementation process. These tools may take the form of human intermediaries, who can occupy the space in between the worlds of research and practice, acting as brokers to mobilise knowledge, or through the establishment of communities of practice. We outline both of these approaches here as a potential solution to the problem of knowledge mobilisation in dentistry.

Implementation and trial evidence: a plea for fore-thought.

In a world where evidence-based practice is see as the foundation of modern healthcare, this paper asks when and how should we be accounting for the input of patients, the public, dental professionals, commissioners and policy-makers in the evidence generation process?

Is skill mix profitable in the current NHS dental contract in England?

The use of skill mix in medicine is now widespread, yet it appears that its use in dentistry is not as prominent. Unlike doctors, dentists are required to mitigate the financial risk produced by their capital investment and ensure an adequate cash flow to cover their annual running costs. Examining the financial incentives for employing dental care professionals is therefore an important step to understand why dentistry appears to lag behind medicine in skill mix. It is also apposite, given the announcement of the coalition government to develop a new contract, which could introduce incentives for the use of dental care professionals in this way. The purpose of this short paper is to examine whether skill mix is profitable for general dental practices under the existing NHS contract in England.

Patient assessment in general dental practice - risk assessment or clinical monitoring?

Risk assessment in general dental practice is becoming increasingly common and has led to the development of care protocols, which aim to act as a framework for decision making to produce an optimum level of care. However, many models of risk have been informed by research undertaken in academia and are based upon summary statistics of populations. In practice, a significant proportion of patients attend on a non-symptomatic, continuous and regular basis, often over long periods of time. This provides general dental practitioners with a wealth of knowledge about their patients to inform clinical decision making on an individual basis. The purpose of this paper is to highlight the important differences between an academic assessment of risk and one that is relevant to practice, before introducing a simple tool to screen out patients who are considered to be 'low risk'. The relevance of this tool is discussed, along with its potential uses and limitations as a means to promote discussion during the development of the pilots for the new dental contract to be introduced by the coalition government.

A qualitative study examining the experience of primary care dentists in the detection and management of potentially malignant lesions. 1. Factors influencing detection and the decision to refer.

BACKGROUND AND AIMS: Many oral squamous cell carcinomas present as late stage disease and so the detection of early and pre-malignancy is considered to be of paramount importance. The majority of research examining primary care dentists' experience of the detection and management of early disease has been undertaken using questionnaires, with the inherent bias this introduces. The aim of this study was to use qualitative methods to develop a richer account of practitioners' views about screening and what factors influence the decision to refer a patient. METHODS: Semi-structured interviews were undertaken with eighteen dentists in Sheffield, transcribed and analysed using thematic analysis. Ten codes were identified according to the aims of the study and organized into four overarching themes. RESULTS: Although many dentists were screening regularly, some did not appear to be adopting a rigorous and systematic approach. A number of participants also placed more reliance on 'classical' presentations rather than the more varied presentation of potentially malignant lesions and were more influenced by the clinical history of the lesion rather than risk factors. CONCLUSION: Overall, the present research suggests that for some dentists, more rigour is required when examining for early disease.

A qualitative study examining the experience of primary care dentists in the detection and management of potentially malignant lesions. 2. Mechanics of the referral and patient communication.

BACKGROUND AND AIMS: The diagnosis of early and pre-malignant lesions of oral squamous cell carcinoma is of paramount importance given the mortality rate of late stage disease. Although studies have been undertaken examining how dentists manage and refer potentially malignant lesions, the majority of the research has used questionnaires, with the inherent bias this introduces. The aim of this study was to use qualitative methods to understand in more detail how practitioners manage potentially malignant lesions once they have been discovered. METHODS: Semi-structured interviews were undertaken with eighteen dentists in Sheffield, transcribed and analysed using thematic analysis. RESULTS: Five codes were identified relating to the mechanics of the referral, the management of the lesion and the patient's risk factors. Health promotional activities were not being undertaken by all the participants and for some, explaining positive results and giving advice about alcohol was perceived as particularly difficult. CONCLUSION: Overall, the present research suggests that further training is required to help dentists broach difficult issues with their patients.

The effect of air-polishing occlusal surfaces on the penetration of fissures by a sealant.

An in vitro study was performed to assess the depth of penetration of a fissure sealant after cleaning the occlusal surfaces with an air-polishing unit, and to compare the results with those obtained after cleaning with pumice and water and after no cleaning. Forty-six clinically non-carious premolars and permanent molars were randomly distributed into three groups. Following cleaning, etching and fissure sealing, the teeth were sectioned. Each section was examined under a light reflecting microscope and the depth of resin penetration was determined. Fissure cleaning with an air-polishing unit produced a statistically significant increase in depth of penetration of sealant resin, and its use as a standard cleaning method before fissure sealing is recommended.