Investigation into the enablers and barriers of career satisfaction among Australian oral health therapists.

OBJECTIVES: This qualitative study explored the enablers and barriers of career satisfaction among Australian oral health therapists (OHTs) and the reasons behind career changes. METHODS: Participants were recruited in 2 ways: 1) recruitment posts were made on the Facebook pages of two professional groups; and 2) an email was sent to the Doctor of Dental Medicine students of the University of Sydney School of Dentistry, inviting those with OHT qualifications to participate. Each participant completed a semi-structured interview which was guided by open-ended questions. The average interview length was 45 min. All interviews were recorded, transcribed verbatim and manually coded. Thematic analysis of the qualitative data was completed using an inductive approach. RESULTS: Twenty-one OHTs participated in this study. The enablers of OHT career satisfaction include clinical practice, job variety, career flexibility, being in a supportive team environment and the opportunity for constant learning and growth. The barriers to career satisfaction include musculoskeletal problems, restrictions on the scope of practice use, psychological stress and lack of recognition from others. OHTs remain in the profession due to stable income and employment opportunities. The main reasons for retirement were burnout and pursuing dentistry. OHTs pursue dentistry to expand their scope of practice. CONCLUSION: This study revealed the enablers and barriers of OHT career satisfaction in an Australian context. OHTs are an important component of modern dental workforces, and reasons for attrition within the workforce are essential for maintaining responsiveness to community oral health needs.

Perceptions and attitudes of dental practitioners towards impacts of Covid 19 pandemic on clinical dentistry: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic challenged all healthcare providers including dental practitioners. This cross-sectional study aimed to investigate the dental practitioners' perceptions and attitudes towards the impacts of COVID-19 on their professional practice, career decision and patient care. METHODS: Data was collected from dental practitioners registered in New South Wales (NSW), Australia using an online survey. RESULTS AND CONCLUSION: Responses received from 206 dental practitioners revealed their perceptions and attitudes towards COVID-19 infection risk, clinical guidelines, and measures adopted to deliver patient care. Majority of participants perceived the risk of infection in dentistry was higher compared with other health professionals. Most dental practices have followed guidelines received from professional associations and adopted multiple measures such as providing hand sanitizer, social distancing, and risk screen, to ensure safe delivery of oral health care. Over 80% of dental practitioners raised concerns on patients' accessibility to dental care during the pandemic. Despite tele-dentistry was introduced, almost half of the participants did not recognize tele-dentistry as an effective alternative. Moreover, negative impacts of COVID-19 pandemic on dental practitioner's professional career have been reported, including lower practice safety, reduction in working hours and income. Noteworthy, one quarter of participants even considered changing their practice environment, moving sectors or even leaving their career in dentistry. However, majority of the dental practitioners are willing to stay in their current practice environment and continue their career in dentistry. Our observations demonstrate the systematic disruption to dental practice faced in Australia due to the COVID-19 pandemic. Providing dental practitioners with timely educational training and support is important to minimise negative impacts of the challenges and to optimise dental care.

An Exploratory Study of Allied Health Students' Experiences of Electronic Medical Records During Placements.

BACKGROUND: Allowing students to access and document in electronic medical records (eMRs) during clinical placements is viewed as critical for ensuring that graduates have a high level of digital proficiency prior to entering the workforce. Limited studies have explored student access to eMRs in health disciplines outside of medicine and nursing. OBJECTIVE: Our main objective was to examine allied health students' experiences and perceptions of the opportunity to develop eMR competencies during their placement, across a range of allied health disciplines and placement settings. METHODS: An explanatory sequential design was used, comprising a quantitative survey (n = 102) followed by qualitative semi-structured interviews (n = 6) with senior allied health students to explore their experiences and perceptions of eMR access during placements. RESULTS: Of the 93 students who responded to the question about their placement eMR, nine (10%) reported their placement site did not use an eMR and four students reported that they were not allowed to access the eMR during their placement. Most students (64%, 54 out of 84) accessed the system using their own credentials, but 31% (26 out of 84) used someone else's log-in and password. Students were satisfied with the eMR training and support received while on placement, but there was significant variability across sites on the level of training and support provided. All students believed that eMR access was beneficial for learning and preparation for work, improved delivery of care, taking ownership of work, and feeling responsible for patient care. CONCLUSION: Providing students with access to eMRs during placements is fundamental to the development of a student's professional identity and to recognizing their role in the delivery of interprofessional patient care. For graduates to be equipped to effectively contribute to multi-disciplinary care in a digital health environment, universities need to work with practice partners to standardize and formalize eMR access, registration, training, and support, and to provide students with early exposure and training on eMRs in university courses.

Australian dentists' knowledge, preparedness, and experiences during the COVID-19 pandemic.

BACKGROUND: COVID-19 is a global health crisis. Close contact with the mucous membranes and respiratory secretions of patients and aerosol-generating procedures renders dentists and other oral health professionals at high risk of exposure to SARS-CoV-2. We examined dentists' knowledge, preparedness, and experiences of managing COVID-19 in Australia. METHODS: A cross-sectional online survey of dentists with a current membership with The Australian Dental Association (ADA) was conducted between March and April 2021. RESULTS: Of the 368 survey responses, most dentists (72.3%) reported having a good level of knowledge about COVID-19, with most visiting the ADA Federal COVID-19 (74.7%) and state/territory department of health websites (62.8%), respectively to source up-to-date information. Most dentists (87.6%) felt prepared to manage COVID-19 into the future, although 66% reported not receiving training or certification in the use of PPE. Over half (58.7%) reported not being concerned about contracting SARS-CoV-2 at work, with some (28.9%, n = 98/339) feeling more stressed than usual and having heavier workloads. CONCLUSION: COVID-19 had significant impact in oral healthcare in Australia. Dentistry has adapted to the varied challenges raised by the pandemic. Comprehensive training and detailed guidelines were fundamental for successful patient management during the COVID-19 outbreak.

Child Fluoride Varnish Programs Implementation: A Consensus Workshop and Actions to Increase Scale-Up in Australia.

This paper presents the findings of the National Fluoride Varnish Workshop in 2018 along with subsequent actions to scale-up the use of fluoride varnish nationally in Australia. The use of fluoride varnish programs to prevent dental caries in high-risk child populations is an evidence-based population health approach used internationally. Such programs have not been implemented at scale nationally in Australia. A National Fluoride Varnish Consensus Workshop was held in Sydney in November 2018 with an aim of sharing the current work in this area being undertaken by various Australian jurisdictions and seeking consensus on key actions to improve the scale-up nationally. Forty-four people attended the Workshop with oral health representatives from all Australian state and territory health departments, as well as the Australian Dental Association (ADA) at both NSW branch and Federal levels. There was strong support for further scale-up of fluoride varnish programs nationally and to see the wider use of having non-dental professionals apply the varnish. This case study identifies key actions required to ensure scale-up of systematic fluoride varnish programs as part of a strategic population oral health approach to preventing dental caries among high-risk children who may not routinely access dental care.

Rationalisation and 'McDonaldisation' in dental care: private dentists' experiences working in corporate dentistry.

Introduction This study examines how dentists experience the corporatisation of dentistry and the impacts of rationalisation. The emergence of corporate dentistry in the early twenty-first century has introduced greater competition into the dental marketplace. Ritzer's theory of 'McDonaldisation' explores the rationalisation of services through corporatisation and provides an apt framework with which to understand the qualitative insights gathered through this project.Methods Semi-structured interviews and reflective journals were used to collect insights from dentists who were working in private practice. Data were then subjected to thematic analysis.Results A total of 20 private dentist participants provided 22 separate interviews and multiple reflective accounts. Following analysis, three key themes emerged: 1) opportunities provided by corporate dentistry; 2) balance between professionalism and commercialism in corporate dentistry; and 3) competition between independent and corporate dentistry.Conclusions The participants' insights demonstrate how Ritzer's four dimensions of rationalisation - efficiency, predictability, calculability and control - have been encapsulated by corporate dentistry in Australia. Corporate interests in Australian dentistry are perceived to improve competition and offer opportunities for younger and less experienced dentists, but the findings also suggest that those leading corporate dentistry need to ensure that rationalisation does not diminish the caring relationship between dentists and patients.

Is there a social justice to dentistry's social contract?

How should the dental profession of the 21st century frame its interactions with the society it is tasked to care for? What has this relationship looked like in the past, and what does it look like today? In this article, we examine these and other issues through the framework of the social contract, with a focus on exploring how social justice fits within the transaction of duties between the dental profession and society. We begin by describing the social contract and how this is uniquely defined within the context of dentistry; specifically, how the context of dentistry as, in part, an aesthetically driven discipline, impacts the social contract. We then consider how the nature of the profession's relationship with society, and the orientation by which it provides its services (which is sometimes critically unclear in its definitional terms), impacts the profession's contribution to ensuring social justice in oral health and oral healthcare. Through examining the nature of how the social contract has shifted (for example, by the attenuation of professional monopolies), we also ask whether this is evidence of a loss of confidence in the dental profession as an altruistic institution. We end by suggesting that the dental profession must engage with the tenets of social justice within the social contract. Failure to do so is likely to lead to erosion of dentistry as a high-status profession and societal willingness to seek solutions to oral health needs from other professional and non-professional sources.

A global review of the education and career pathways of dental therapists, dental hygienists and oral health therapists.

Introduction With ongoing needs in oral healthcare being unmet, dental therapists, dental hygienists and oral health therapists have the potential to assume greater roles and responsibilities in the provision of care. This review provides a global overview of the education and career opportunities of these professions, contributing to the discussion on the future trajectories of all three professions.Methods A scoping review was conducted to collate and summarise the current available evidence from peer-reviewed journal articles, published reports and books, and websites of professional associations and government agencies.Results Of the 145 sources identified and reviewed, 53 were included in the qualitative synthesis. The themes were categorised into domains: 1) dental therapy; 2) dental hygiene; and 3) oral health therapy.Conclusion The results of this review indicated that, although there has been continuous advocacy for dental therapists, dental hygienists and oral health therapists to assume roles beyond the traditional clinical practice, the majority of the professionals still mainly practise as clinicians. Many dental therapists, dental hygienists and oral health therapists felt limited by their scope of practice and were dissatisfied with the lack of career pathways. Additional research is needed to examine the influences behind career development for all three professions.

Conceptualisations of the social determinants of health among first-year dental students.

BACKGROUND: Social conditions have a significant impact on the health of individuals and populations. While the dental curriculum is focused on teaching students about the diseases that affect the dentition and oral structures from a biomedical perspective, education about the social determinants of health is frequently regarded as less important. Thus, it occupies a smaller and disconnected part of the dental curriculum. The aim of this study was to explore the ways dental students conceptualised the social determinants of health after one year in dental school. METHODS: Reflective statements written by first year dental students at the end of the first year of study were collected. This qualitative study has an interpretivist basis and a thematic analysis of the reflections was conducted by two researchers. Metzl's structural competencies were used as a further analytic device. RESULTS: Four inter-related themes were identified: First, professional attitudes taken up by students influence their conceptions. Second, structural barriers to students understanding social determinants of health generate partial understandings. Thirdly, the social gulf that exists between the student body and people of different circumstances provides context to understanding the student's perspectives. Finally, we described how students were learning about the social determinants of health over the academic year. CONCLUSIONS: Dental students face several challenges when learning about the social determinants of health, and translating these learnings into actions is perhaps even more challenging. Metzl's structural competencies provide a framework for advancing students' understandings. One of the most important findings of this research study is that coming to an understanding of the social determinants of health requires sustained attention to social theories, practical experiences as well as institutionalised attitudes that could be achieved through an intentional curriculum design.

A disability-based exploration of psychosocial barriers and enablers to accessing dental services for people with clinically severe obesity: A qualitative study.

This qualitative study aimed to explore psychosocial barriers and enablers to accessing dental services for people with clinically severe obesity (PwCSO). Eight focus groups were conducted by one researcher with 40 adult participants at the Adult Healthy Weight Clinic within a hospital-based obesity service. Thematic analysis of focus group transcripts was performed to reveal insights relating to how PwCSO experience dental care and view oral health. A total of 11 participants were male, 29 female, all between the ages of 23 to 74 (mean age of 50). The body mass index of participants ranged from 31.6 to 84.6 kg/m2 . The results highlighted four key themes, including "disempowerment to act to improve oral health", "weight-related stigma and discrimination", "unpredictability of the dental environment" and a "lack of tailored services for PwCSO". A number of subthemes were identified, which reflect the six categories of barriers to access from the disability literature: availability, affordability, acceptability, accommodation, accessibility and appropriateness. These were explored to further appreciate the unique psychosocial considerations for this group. This study concluded that PwCSO face significant barriers to accessing dental services across all six categories highlighted in the disability literature. The study findings provide valuable patient-based information regarding the psychosocial barriers to accessing dental services, which are relevant for all healthcare professionals. The study reflected an increased need for promotion of the dentist's role in obesity management and obesity-related dental training, including familiarization with the biopsychosocial domains of obesity to reduce weight related stigma and discrimination, as an area for further study. The findings also guide the design of Specialized Bariatric Dental Services in the future, with a focus on enablers to access.

Taking responsibility for the tooth: A semiotic and thematic analysis of oral health and disease in the TV show 'Embarrassing Bodies'.

Oral health and dentistry are seldom the subject of medical reality TV. This study investigates whether the dental segments within the British medical reality show, 'Embarrassing Bodies', may contribute to the anthropological understanding of oral health and social status, through semiotic and thematic analysis. This methodology involves close examination of both the visual and narrative themes within the programme. The show presents mouths afflicted by oral disease as traumascapes, the framing of which provides voyeuristic appeal. The portrayal of dental disease as negatively affecting human flourishing through shame and the inhibition of intimacy was common across the analysed cases. The key themes of intimacy and social distance; discipline, blame and personal responsibility; carnography; disciplining gaze and authority; and redemption and rebirth were identified through analysis. The cases also present a strong correlation between a lack of personal responsibility and the development of dental disease within the wider context of social class, with the dentist as a disciplining authority, enforcing professional and societal norms.

How are the social determinants of health being taught in dental education?

INTRODUCTION: The social determinants of health that influence how wellness and illness are experienced within society must be a core component of dental curricula where aspiring dental professionals are taught about the aetiology and social history of dental diseases. Through this scoping review, we examine the current approaches that have been employed to incorporate the social determinants of health within dental curricula. METHODS: Using a scoping review methodology, we searched the databases Scopus, PubMed, and Embase using keywords relevant to the social determinants of health and dental education. RESULTS: Following screening and sorting, 36 articles were included within this review. The majority of the articles described research that evaluated outcomes of educational interventions with relevance to the social determinants of health. The remainder of the included studies discussed attitudes and readiness relative to the social determinants of health and how this core competency could be taught effectively. CONCLUSION: The included literature revealed that the social determinants of health frequently are not the focus of educational activities in dental curricula, with students frequently having little active guidance on how they might make sense of their educational experiences in this domain. The socioeconomic, cultural, political, geographic, and structural barriers that contribute to patients being impacted by the social determinants of health should be explicitly addressed and discussed with students as a foundation element of the dental curriculum.

Overtreatment as an ethical dilemma in Australian private dentistry: A qualitative exploration.

BACKGROUND: The phenomenon of overtreatment in dentistry is under-explored and has not been the subject of much research inquiry. Most dental care in Australia is provided by practitioners in private dental practice. This research expands understanding of how the nexus between professionalism and commercialism in dentistry is impacted by the phenomenon of overtreatment. METHODS: Data were collected through recorded interviews and written reflections from private dentists working in the Australian context. The data were then examined using thematic analysis to understand common themes and reveal deeper insights. RESULTS: A total of 20 participants were recruited for this study. Participants spoke of their experiences in practice where financial targets and pressure from practice owners to provide high-cost treatments presented challenges to their professionalism. The participants expressed that the way in which dentistry is remunerated based on activity was a motivation towards engaging in overtreatment. The participants also spoke of finding a balance between commercialism and professionalism within private dental practice. CONCLUSIONS: Participants' reports provided insights into how the mismanagement of the commercial elements of private dental practice led to a transactional ('buyer beware') relationship between the consumers and providers of dental services, rather than a relationship founded upon professional altruism and trust. Consumer empowerment through the commercialization of dentistry has potential to be a positive influence on the patient experience in accessing dental care. However, this research has shown that the shift of power through consumerism also risks attenuating professional appreciation of the imbalanced nature of the patient-clinician relationship in dentistry.

Do health systems cover the mouth? Comparing dental care coverage for older adults in eight jurisdictions.

Oral health is an important component of general health, yet there is limited financial protection for the costs of oral health care in many countries. This study compares public dental care coverage in a selection of jurisdictions: Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States. Drawing on the WHO Universal Coverage Cube, we compare breadth (who is covered), depth (share of total costs covered), and scope (services covered), with a focus on adults aged 65 and older. We worked with local experts to populate templates to provide detailed and comparable descriptions of dental care coverage in their jurisdictions. Overall most jurisdictions offer public dental coverage for basic services (exams, x-rays, simple fillings) within four general types of coverage models: 1) deep public coverage for a subset of the older adult population based on strict eligibility criteria: Canada (Alberta), Australia (New South Wales) and Italy; 2) universal but shallow coverage of the older adult population: England, France, Sweden; 3) universal, and predominantly deep coverage for older adults: Germany; and 4) shallow coverage available only to some subgroups of older adults in the United States. Due to the limited availability of comparable data within and across jurisdictions, further research would benefit from standardized data collection initiatives for oral health measures.

Incorporating Humanities in Dental Education is Essential, but Seldom Routine.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Humanities in Predoctoral Dental Education: A Scoping Review. Marti KC, Mylonas AI, MacEachern M, Gruppen L. J Dent Educ 2019;83(10):1174-1198. SOURCE OF FUNDING: None declared. TYPE OF STUDY/DESIGN: A scoping review.

Exploring the evolution of a dental code of ethics: a critical discourse analysis.

BACKGROUND: What can the analysis of the evolution of a code of ethics tell us about the dental profession and the association that develops it? The establishment of codes of ethics are foundational events in the social history of a profession. Within these documents it is possible to find statements of values and culture that serve a variety of purposes. Codes of ethics in dentistry have not frequently presented as the subjects of analyses despite containing rich information about the priorities and anxieties within the profession's membership at the time that the code was written. MAIN TEXT: This essay uses critical discourse analysis to explore the 2012 and 2018 versions of the Code of Ethics produced by the New South Wales Branch of the Australian Dental Association. This method of discourse analysis examines contradictions between the discourses within the codes and how these relate to broader social realties that surround the dental profession in New South Wales. By analysing the 2012 and 2018 codes together, it is possible to understand how the dental profession views its commitments to society as established through the social contract. Through this assessment, it will be demonstrated that both codes suffer due to their failure to consider the public as a key stakeholder in the creation and curation of the Code of Ethics and how this this relates intimately with the social contract between the profession and the public. CONCLUSION: Without the public being the central consideration, both codes amount to declarations of professional privilege and dominance. Although the more recent 2018 Code of Ethics demonstrates insight into the changes in public trust placed in the professions, this analysis shows that that the current code of ethics is still reluctant to recognise and engage with the public as an equal stakeholder in the planning and provision of oral health care and the development of the profession's values and cultural trajectory.

"Preparedness for Practice" for Dental Graduates Is a Multifaceted Concept That Extends Beyond Academic and Clinical Skills.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Conceptual framework explaining "preparedness for practice" of dental graduates: a systematic review. Mohan M, Ravindran TKS. J Dent Educ 2018;82(11):1194-1202. SOURCE OF FUNDING: None declared. TYPE OF STUDY: Systematic review.

Knowledge, Attitudes and Practice Behaviour of Midwives Concerning Periodontal Health of Pregnant Patients.

Maternal gum disease is associated with adverse pregnancy outcomes such as preterm birth and low birthweight. This study aims to evaluate the knowledge, attitudes and practice behaviour of Australian midwives regarding the periodontal health of pregnant women to inform interprofessional antenatal care. This was an observational, cross-sectional study. We circulated an online questionnaire to Australian midwives from August 2018 to February 2019. Key outcome variables were knowledge, attitudes, and practice behaviours related to oral health. Key predictor variables were years of practice, practice location, and dental history. We summarized responses with frequency tables and assigned tallied scores for analysis using non-parametric statistical tests. 100 responses were analysed, including from rural (n = 23) and urban (n = 77) midwives. Eighty percent of midwives agreed that maternal dental care can positively affect pregnancy outcomes. Fluoridated toothpaste use (19.1%) was incorrectly answered to prevent gum disease more often than psychological stress control (7.9%), a correct answer. Rural midwives demonstrated a significantly higher knowledge score (p = 0.001) and significantly more positive practice behaviours towards oral health (p = 0.014) than urban midwives. Australian midwives have positive attitudes towards antenatal oral health but misunderstand gum disease aetiology and prevention. This study highlights areas to improve interprofessional education for optimal oral health and pregnancy outcomes.

The relationship between professional and commercial obligations in dentistry: a scoping review.

Introduction The practice of dentistry has become increasingly commercialised and commodified. Conflicts between the commercial and professional obligations that dental practitioners face have been discussed in the academic literature. This review collates the available information and discusses how the area of commercialism and professionalism has developed.Methods A scoping review was carried out to assess the current literature in this area. Several databases were searched using relevant terms. Following collection of literature sources these were initially screened for duplication.Results Of the total of 141 sources which were reviewed by title, abstract and keywords, 47 sources were selected for full text review. Qualitative synthesis revealed the three overarching themes of: (1) preserving professional values; (2) the realities of dental practice; and (3) contrasting and conflicting priorities.Conclusion The interaction between commercialism and professionalism presented in the reviewed literature suggested that commercial interests in dentistry are a direct threat to professional values. Accompanying this discussion was a relative dearth of pragmatic exploration of how this conflict might be managed. There was also a lack of consideration of how the corporatisation of dental businesses might affect - whether positively or negatively - the nexus between commercial and professional obligations in dentistry.