Area-level inequalities in the provision of NHS orthodontic care in England from 2016 to 2019.

Objective To investigate geographic inequalities in the provision of NHS orthodontic care in England at the area level.Methods NHS dental activity data were analysed for the three financial years April 2016 to March 2019. The measures used were units of dental activity (UDA), units of orthodontic activity (UOA) and commencement of orthodontic treatment. Two orthodontic activity indices were created to assess relative volumes of care. Deprivation was measured using the index of multiple deprivations. Slope and relative inequality indices were used to assess inequality.Results Nearly 12.4 million UOA and 572,987 courses of treatment in England were reported under NHS arrangements in the three years studied. There were significant variations in the rates of UOA (0-716) and UDA (148-918) provided per 100 children (0-17 years) at the local authority level. The variation was not associated with deprivation at the local authority level.Conclusions There were significant disparities in the provision of NHS orthodontic treatment at the local authority level, but this was not associated with area-level measures of deprivation. Inequality in the uptake of orthodontic care may not be due to area-level disparities in service provision.

Impact of SARS-CoV-2 on surgical services in a Scottish remote and rural setting.

INTRODUCTION: The SARS-CoV-2 (COVID-19) pandemic has brought about instability in healthcare providers worldwide; this includes rural settings that had fewer cases of COVID-19 in the first year of the pandemic. This article examines the impact of COVID-19 on the surgical services offered at the Balfour Hospital, Orkney Islands, Scotland in the UK and the impact the pandemic had indirectly on the service in 2020. METHODS: The authors conducted a retrospective study concentrating on surgical services including emergency hospital presentations and the number of cancer diagnoses, specifically colorectal. Colorectal malignancies were specifically investigated as in the Balfour Hospital they are primarily diagnosed by surgeons. Focus was on diagnosis and outcomes between June 2020 and October 2020, in comparison with the previous year. This time period was chosen because surgical services reconvened after a period of inactivity due to the COVID-19 pandemic. The types of emergency admission into the Balfour Hospital during this time were examined, as well as delayed surgeries and the impact of delaying surgery. RESULTS: The data show that, although the prevalence of cancers diagnosed was static, patients presented at a much later stage, with significant impact on prognosis and quality of life. Aside from cancer diagnosis, non-urgent work was significantly disrupted due to the pandemic in 2020. The average waiting time for non-urgent clinic consultation increased from 6 weeks to 18 weeks during this period. The number of patients awaiting endoscopic investigations increased threefold. There was also an increase in the number of emergency admissions due to complications of disease. CONCLUSION: Although the effects of COVID-19 have been felt nationwide, the impact is more exaggerated in rural communities such as Orkney due to the small population. It is likely the indirect impact on surgical morbidity and mortality in Orkney in 2020 was disproportionately higher than the impact of COVID-19 in the local community. Furthermore, due to limited island resources, a significant number of patients required transfer to tertiary centres for management of complications. This is a unique issue affecting rural communities.

Outcomes of periodontal therapy in rheumatoid arthritis: The OPERA feasibility randomized trial.

AIM: Periodontitis is independently associated with rheumatoid arthritis (RA); however, there is limited data on whether periodontal treatment improves overall RA disease activity. We conducted a pilot feasibility randomized controlled clinical trial to test whether intensive periodontal therapy reduces RA disease activity in patients with active RA and periodontitis. MATERIALS AND METHODS: The following inclusion criteria were applied: patients with RA and periodontitis, aged 18+, stable on treatment with disease-modifying anti-rheumatic drugs for ≥3 months, disease activity score (DAS28) ≥3.2, and DAS28 >5.1 only if patient unwilling to take biologics. Participants meeting the inclusion criteria were randomized to immediate intensive periodontal therapy or to delayed therapy (control group) administered by a dental hygienist in a secondary care setting. Data were collected at baseline and at 3 and 6 months of follow-up. Participants randomized to the control group (delayed therapy) received the standard of care for the duration of the trial, including oral hygiene instructions delivered by a dental hygienist, and the same periodontal therapy as the intervention group after study completion (i.e., 6 months after randomization). The periodontal inflammation surface area was calculated using clinical attachment loss (CAL), periodontal probing pocket depth, and bleeding on probing. Cumulative probing depth was also measured. We examined the effect of periodontal therapy on periodontal outcomes and on clinical markers of disease activity in RA, as measured by the DAS28-C-reactive protein score as well as musculo-skeletal ultrasound grey scale and power Doppler scores. RESULTS: A total of 649 patients with RA were invited to participate in the study. Of these, 296 (46%) consented to participate in the screening visit. A sample of 201 patients was assessed for eligibility, of whom 41 (20%) did not meet the RA inclusion criteria and 100 (50%) did not meet the periodontal disease criteria. Among the 60 (30%) eligible participants, 30 were randomized to immediate periodontal therapy and 30 were allocated to the control group. The loss to follow-up was 18% at the end of the trial. There were no major differences with regard to baseline characteristics between the groups. Periodontal therapy was associated with reduced periodontal inflamed surface area, cumulative probing depths, RA disease activity scores, and ultrasound scores over the course of the trial. There was no change in CAL. CONCLUSIONS: Overall, the trial was feasible and acceptable to the study participants. Recruitment to and satisfactory retention in a randomized controlled trial on the effect of periodontal treatment on RA patients is possible, albeit challenging. In this feasibility study of patients with RA and periodontitis, periodontal treatment resulted in significant improvements in periodontal disease outcomes and overall RA disease activity, although complete resolution of periodontal inflammation was difficult to achieve in some cases.

150 years of dental education and research - University of Birmingham School of Dentistry.

This paper discusses the historical development of dental education and research over the last 150 years from a Birmingham School of Dentistry perspective. The School opened its doors to students in 1858 and has seen many changes and developments in both education and research. Looking back throughout the history, one of our greatest abilities as dental professionals is to be adaptable and the future will bring plenty of opportunity for us to demonstrate this. We have seen how resilient dentistry has been over the COVID-19 pandemic, both in terms of education and research; the next 150 years will be a very exciting time to work in the field.

'It's social interaction. . . but it's not': A qualitative study investigating the psycho-social experience of social media by individuals with a visual impairment.

People with visual impairment (VI) may encounter psychosocial challenges including difficulties with socialisation/interpreting visual social cues. Social media (SM) may provide alternative means of socialisation but little is known about the experience of SM from their perspective. Semi-structured interviews with 10 individuals with VI who regularly use SM were analysed according to interpretative phenomenological analysis. Analysis yielded two overarching themes: social media and identity, and social connectedness. Participants described benefits of shared experience, feelings of enhanced control and challenges of SM which emphasise exclusion/inequality. Findings highlight a need for further research to understand/improve the online experience for people with VI.

Using quizzes to provide an effective and more enjoyable dental education: A pilot study.

INTRODUCTION: Increasingly, dental education is using digital strategies to deliver teaching; however, not all of these learning materials are engaging and effective. AIM: To evaluate the perception and knowledge retention of undergraduate dental students after using two different digital learning tools: quizzes and PDF. METHODS: Thirty-three students from a Dental School in the United Kingdom took part in the research. They received learning material derived from the Prosthodontic (Kennedy classification) or Paediatric dentistry content (Tooth classification). The same content was delivered in two different formats: quiz game (n = 17) and PDF file (n = 16). The PDF file had ten images and their classifications, whilst the quiz had the same images with a question about the classification, along with alternatives (single best answer). RESULTS: All students gave similar performances on the knowledge assessment; however, their perception about the learning material differed. Students using quizzes (88%) agreed that they were fun and an interesting way of learning, while only 37.5% had this opinion about PDF material (p = .002). When using quizzes, learners were more motivated and confident. They would frequently recommend quizzes to other colleagues; however, the use of PDF was not suggested as frequently (p = .039). As a learning strategy, 100% of the students using quizzes wanted more of the same to study other dental subjects. This was not the case with the PDF format (p = .005). CONCLUSION: Despite quizzes and PDF files resulting in a similar understanding of dental subjects, learners prefer quizzes to supplement their studies. Educators should consider using this interactive digital tool to engage students, instead of PDF files.

A critical review of qualitative research publications in dental implants from 2006 to 2020.

OBJECTIVES: This critical review is aimed to investigate the current status of qualitative research in dental implant research and to explore the quality of available information. MATERIAL AND METHODS: A systematic search was done on the journal databases to identify dental implant research articles that used qualitative methodology during 2006 and 2020. The resulting articles were appraised against the checklist offered by the Critical Appraisal Skills programme (CASP) tool. Also, the theories evolved from the research were reviewed to understand the value of this methodology in dental implant research. RESULTS: Twenty-five (25) articles out of the 8,421 original results were identified as using qualitative methodology. The researchers have sought to identify the views of patients about tooth loss, dental implants, and the information they receive from dental professionals, and views of the dentists about dental implant practice. The review found that there were few inconsistencies in the quality of such research especially the qualitative data analysis. CONCLUSIONS: The quantity of qualitative research in dental implants remains low; however, the quality has improved in the past two decades. Despite these improvements, there is still a lack of research in understanding both patients' and dentists' views on dental implant procedures and management.

Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses.

BACKGROUND: Dental anxiety (DA) negatively impacts oral health-related quality of life, and patients with DA usually require more dental treatment time. AIM: To describe the global prevalence of DA in children and adolescents and to examine the influence of individual factors (age, sex, and caries experience) and variables related to DA measurement on pooled prevalence. DESIGN: Systematic review with meta-analyses of observational studies published between 1985 and 2020 (PROSPERO CRD42014013879). RESULTS: Searches yielded 1207 unique records; 224 full-text articles were screened, and 50 studies were used in the qualitative and quantitative synthesis. No study was considered as having high methodological quality according to 'The Joanna Briggs Institute assessment tool'. Overall pooled DA prevalence was 23.9% (95% CI 20.4, 27.3). Pooled prevalence in preschoolers, schoolchildren, and adolescents was as follows: 36.5% (95% CI 23.8, 49.2), 25.8% (95% CI 19.5, 32.1), and 13.3% (95% CI 9.5, 17.0), respectively. DA was significantly more prevalent in preschool children (one study) and schoolchildren (two studies) with caries experience and in female adolescents (one study). The scale used for DA assessment was shown to influence pooled prevalence in preschoolers and adolescents. CONCLUSION: DA is a frequent problem in 3- to 18-year-olds worldwide, more prevalent in schoolchildren and preschool children than in adolescents.

Communication, Trust and Dental Anxiety: A Person-Centred Approach for Dental Attendance Behaviours.

Effective communication forges the dentist-patient treatment alliance and is thus essential for providing person-centred care. Social rank theory suggests that shame, trust, communication and anxiety are linked together, they are moderated by socio-economic position. The study is aimed to propose and test an explanatory model to predict dental attendance behaviours using person-centred and socio-economic position factors. A secondary data analysis was conducted on a cross-sectional representative survey of a two-stage cluster sample of adults including England, Wales and Northern Ireland. Data were drawn from structured interview. Path analysis of proposed model was calculated following measurement development and confirmation of reliable constructs. The findings show model fit was good. Dental anxiety was predicted negatively by patient's trust and positively by reported dentist communication. Patient's shame was positively associated with dental anxiety, whereas self-reported dental attendance was negatively associated with dental anxiety. Both patient's trust and dentist's communication effects were moderated by social class. Manual classes were most sensitive to the reported dentist's communications. Some evidence for the proposed model was found. The relationships reflected in the model were illuminated further when social class was introduced as moderator and indicated dentists should attend to communication processes carefully across different categories of patients.

Challenges in dental implant provision and its management in general dental practice.

OBJECTIVES: Dental implants have become a well-publicised treatment modality in dentistry. Implants are generally placed in the private sector by dentists who have undertaken further learning. The continued maintenance of implants falls within the duty of care for the general dental practitioner. The objective of this qualitative study is to investigate the current status of dental implants in general dental practice, and to explore the dentists view on dental implant education at both undergraduate and postgraduate level. METHODS: In-depth interviews as a qualitative methodology was used in the study. The participants were recruited through theoretical sampling guided by saturation of information. Based on this, 22 general dental practitioners practicing in the UK were interviewed. Transcribed interview data were coded with NVIVO software and then analysed using a thematic framework analysis method. RESULTS: General dentists from different educational backgrounds, experience levels participated in the study. They highlighted that the guidelines and protocols when dealing with implants were unclear and expressed their unwillingness to treat patients who had their specialised dental treatment performed elsewhere. CONCLUSION: Expensive dental implant treatment is not being followed up by the general dental practitioner due to a wide range of barriers. Unclear care paths will lead to a likely increase in problems following implant placement. CLINICAL SIGNIFICANCE: General Dentists' views of dental implants in general practice and their expectations from education providers are explored and show the need for improved education.

Developing a questionnaire to measure psychological disturbance associated with tooth loss.

OBJECTIVES: To develop and validate a self-reporting measure to assess the psychological disturbance in adult patients with tooth loss and dentures Methods: Ethical approval obtained from the Health Research Authority NHS England (Ref:17/NI/0098). 128 participants (100 patients - 28 clinicians) were recruited to participate in the development and validation of the questionnaire. Inclusion criteria included adults (age ≥18) with tooth loss/dentures. Exclusion criteria included patients with a history of psychotic mental illness or patients who had treatment with dental implants. The development processes included: Phase 1. Development of questionnaire: describing the aims/target population of the questionnaire, generating a pool of items, defining the constructs to be measured, adapting psychological morbidity screening tools, Items reduction and producing a preliminary questionnaire. Phase 2. Validation of questionnaire: content validation, face validation, establishing construct validity, pilot testing and establishing reliability. RESULTS: Face and content validation indicated that the questionnaire was an appropriate tool to measure the impact of tooth loss and related psychological morbidities. Reliability analysis (Test re-test reliability/internal consistency) indicated the questionnaire has satisfactory reliability (correlation >0.7). Testing the theoretical hypothesis structure of the impact of tooth loss has also enhanced the construct validity of the questionnaire (domains correlated mildly (r>5 & <3) to strongly (r>5). Pilot testing confirmed the scale adequacy and wording clarity (>90 % of respondents). Results indicated that the developed questionnaire has adequate psychometric properties. CONCLUSION: A disease-specific measure that assesses the psychological impact of tooth loss and the effectiveness of interventions (i.e. dentures) has been developed and validated. CLINICAL SIGNIFICANT: A patient outcome measure was developed which could be used to assess the psychological impact of tooth loss and compare the effectiveness of various interventions like dentures and implants.

Mobile learning in dentistry: challenges and opportunities.

Introduction The impact of smartphone technology is changing the approach to learning and teaching in clinical dental education. The aim of this study was to understand the challenges, opportunities and attitudes that both dental undergraduate students in an English dental school and tutors experience when using electronic learning.Materials and methods Six faculty members and 20 students agreed to take part in semi- structured interviews. Topic question guides for the student interviews focused on searching for information and how they used mobile learning. Questions also asked about the barriers encountered when accessing information on the internet, their perspective on the term 'evidence-based' information, and their use of mobile apps. The question topic guide for faculty was similar, with an emphasis on their attitudes to the introduction of such technology in dental education.Results Both groups reported active use of mobile learning tools. However, students are in need of training and further guidance when searching for, evaluating and synthesising evidence-based information online. Likewise, tutors need to become familliar with e-learning tools so that they may better support their students.Conclusion The results from the study show that participants need training workshops to ensure that students are not only accessing evidence-based information, but can differentiate between evidence-based and non-evidence-based information apps. The tutors in this study also require information on how to provide their students with advice on using mobile technology. Institutions involved with clinical dentistry should acknowledge such challenges.

Instant Messaging in Dental Education.

Instant messaging (IM) is when users communicate instantly via their mobile devices, and it has become one of the most preferred choices of tools to communicate amongst health professions students. The aim of this study was to understand how dental students communicate via IM, faculty members' perspectives on using IM to communicate with students, and whether such tools are useful in the learning environment. After free-associating themes on online communication, two draft topic guides for structured interviews were designed that focussed on mobile device-related communication activities. A total of 20 students and six faculty members at the University of Birmingham School of Dentistry agreed to take part in the interviews. Students were selected from years 1-5 representing each year group. The most preferred communication tools were emails, social networking, and IM. Emails were used for more formal messages, and IM and social networking sites were used for shorter messages. WhatsApp was the most used IM app because of its popular features such as being able to check if recipients have read and received messages and group work. The students reported that changes were necessary to improve their communication with faculty members. The faculty members reported having mixed feelings toward the use of IM to communicate with students. The students wished to make such tools a permanent part of their learning environment, but only with the approval of faculty members. The faculty members were willing to accept IM as a communication tool only if it is monitored and maintained by the university and has a positive effect on learning.

What makes a good dentist? A pilot study.

UNLABELLED: This study investigates the attributes of a 'good dentist' with respect to the opinions of dental patients, dental students and qualified dentists and determines whether the dental profession and its patients are in agreement with the standards published by the General Dental Council (GDC) in 2005. A questionnaire was circulated amongst the above groups at the University Of Birmingham, School of Dentistry. Each participant was asked to rank 14 attributes for a dentist in order of their importance. The results indicated that generally there was no consensus between individual participants. There was, however, significant overlap between the top six attributes chosen by dental care professionals and the GDC standards. Patients tended to rank other non-GDC mentioned attributes more frequently. Attributes which were considered important by all were 'putting patient interests first and acting to protect them, respecting a patient's dignity and choices and having good technical ability'. CLINICAL RELEVANCE: It is important to gain an insight into patient attitudes and to be knowledgeable of the GDC professional standards, in order to improve overall conduct and performance as a dental practitioner.

UK population norms for the modified dental anxiety scale with percentile calculator: adult dental health survey 2009 results.

BACKGROUND: A recent UK population survey of oral health included questions to assess dental anxiety to provide mean and prevalence estimates of this important psychological construct. METHODS: A two-stage cluster sample was used for the survey across England, Wales, and Northern Ireland. The survey took place between October-December 2009, and January-April 2010. All interviewers were trained on survey procedures. Within the 7,233 households sampled there were 13,509 adults who were asked to participate in the survey and 11,382 participated (84%). RESULTS: The scale was reliable and showed some evidence of unidimensionality. Estimated proportion of participants with high dental anxiety (cut-off score = 19) was 11.6%. Percentiles and confidence intervals were presented and can be estimated for individual patients across various age ranges and gender using an on-line tool. CONCLUSIONS: The largest reported data set on the MDAS from a representative UK sample was presented. The scale's psychometrics is supportive for the routine assessment of patient dental anxiety to compare against a number of major demographic groups categorised by age and sex. Practitioners within the UK have a resource to estimate the rarity of a particular patient's level of dental anxiety, with confidence intervals, when using the on-line percentile calculator.

Investigation of the oral health needs for homeless people in specialist units in London, Cardiff, Glasgow and Birmingham.

AIM: The aim was to assess the oral health needs of homeless people in dedicated homeless dental units in London, Cardiff and Glasgow and a homeless shelter in Birmingham in order to allow recommendations for service delivery to be made for this socially excluded group. METHODOLOGY: Two questionnaires were designed, one to be completed by homeless people and the other by members of the dental team. A total of seventeen staff working in homeless dentistry completed questionnaires. Of these, nine were dentists, seven were nurses and one was a therapist. Twenty-seven homeless adults took part in interview. Of these, 22 were under active treatment at a homeless dental clinic and the remaining five were from the Birmingham homeless shelter who were not receiving dental care. RESULTS AND CONCLUSION: This study found evidence that the oral health of homeless adults was poor, with a high level of dental need. The service use of homeless people is low, with low levels of registration and utilisation of accident and emergency services. In terms of the most suitable method of dental treatment, staff felt a dedicated homeless service was most appropriate, whereas there was almost an equal split of patients advocating the General Dental Service or the dedicated dental clinics.

A flying start to health promotion in remote north Queensland, Australia: the development of Royal Flying Doctor Service field days.

CONTEXT: The Royal Flying Doctor Service (Queensland Section), Australia, provides health services for remote populations across an area of approximately 600,000 km2. The challenge presented to the service was to provide effective health promotion as well as acute clinical services. ISSUE: This article describes the development of field days, an initiative based on a capacity building approach to health promotion. Field days have been conducted at station properties, national parks, remote tourist facilities, a roadhouse and country racecourse. They usually consist of a morning interactive workshop based on locally identified health topics followed by an afternoon clinic. A developmental approach has been adopted, with participant feedback from each field day and reflections by health staff informing future field day activities and adjustments in methods of delivery. Between November 2001 and August 2005, 726 adults and 248 children attended 53 field days conducted at 18 remote locations in north Queensland. EVALUATION: Participants were asked to rate the overall usefulness, content and quality of the presentations/workshops on a scale from 1 (not useful/poor) to 10 (very useful/very good). Overall, feedback from participants was positive. The average scores were 9.1 for overall usefulness of the day and content of the sessions, and 9.2 for quality of the presentations. Field days demonstrate a flexible health promotion initiative based on a capacity building approach which is rated as useful and appropriate by participants. LESSONS LEARNED: The implementation of field days has highlighted the importance of building on community and organisational strengths as a means of overcoming skepticism about new services and approaches to health. Methods of delivery that are fun, non-threatening, practical, locally relevant, culturally appropriate and interactive work best. The development of field day packages containing workshop plans and resources facilitates flexibility and enables the program to be tailored to meet the needs of participants. Workforce planning and development have played a key role in reorienting existing services towards health promotion. Field days can inform the development of locally relevant health promotion initiatives based on a capacity building approach in other remote areas of Australia and internationally.