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AIM: This study aimed to inform the implementation of the updated Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance, 'Management of Dental Patients taking Anticoagulant or Antiplatelet Drugs', and to determine training needs by investigating dental professionals' current practice and beliefs regarding management of patients taking these medications. METHODS: Dental professionals were recruited via the NHS Education for Scotland Portal. The online questionnaire collected demographic information, data on current practice and information about beliefs regarding behaviours related to the management of patients on anticoagulant or antiplatelet medication. Quantitative data were analysed using SPSS and subjected to frequency calculations, t-tests, one-way ANOVA and linear regression. Qualitative data were collected via free text boxes and analysed using thematic analysis. RESULTS: One hundred and fifty-seven participants responded to the questionnaire. The majority of respondents stated they were aware of the guidance and always based their practice on it. The majority of respondents always assessed the patient's individual bleeding risk prior to dental procedures. Most respondents felt that they did not know how to appropriately manage patients taking low doses of low molecular weight heparins (LMWH), and only 38% of respondents always followed SDCEP guidance about direct oral anticoagulants (DOAC) medication and procedures with a low associated risk of bleeding. DISCUSSION: This study demonstrates a need for further educational support surrounding LMWHs and management of patients on DOAC medication. Time and remuneration represent barriers to guidance implementation in primary care. CONCLUSION: There is good awareness and adherence to the guidance in primary care settings, however training needs were identified to support implementation.
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INTRODUCTION: In response to the COVID-19 pandemic, the Scottish Dental Clinical Effectiveness Programme (SDCEP) initiated a rapid review of the evidence related to the generation and mitigation of aerosols in dental practice. To support this review, a survey was distributed to better understand the provision of aerosol generating procedures (AGPs) in dentistry. METHODS: An online questionnaire was distributed to dental professionals asking about their current practice and beliefs about AGPs. Data were analysed using qualitative content analysis. RESULTS: Analysis revealed confusion and uncertainty regarding mitigation of AGPs. There was also frustration and scepticism over the risk of SARS-COV-2 transmission within dental settings, the evidence underpinning the restrictions and the leadership and guidance being provided, as well as concern over financial implications and patient and staff safety. DISCUSSION: The frustration and concerns expressed by respondents mirrored findings from other recent studies and suggest there is a need for reflection within the profession so that lessons can be learned to better support staff and patients. CONCLUSION: Understanding the profession's views about AGP provision contributed to the SDCEP rapid review and provides insights to help inform policymakers and leaders in anticipation not only of future pandemics but in considering the success of any large scale and/or rapid organisational change.
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Introduction: The COVID-19 pandemic resulted in a series of significant changes and adjustments within dentistry, as dental professionals dealt with temporary closures of dental practices, increased use of personal protective equipment, a reduction of clinical procedures, and extensions to training programmes. Recent research has illustrated the impact of the pandemic on the dental profession, indicating that many dental professionals felt emotionally exhausted and experienced significant uncertainty and anxiety. This qualitative study aimed to understand how these experiences and emotions changed over the course of six months, in dental trainees and primary dental care staff in Scotland. Methods: A longitudinal diary study was conducted (June-December 2020) with dental trainees and primary dental care staff. The diary asked respondents to answer three questions related to their emotional exhaustion, on a weekly basis. There was also an open question asking respondents to describe any significant issues or concerns they had experienced during the preceding week because of the impact of the COVID-19 pandemic on their work or training. This qualitative data was explored using a trajectory analysis approach to determine specifically changes over time. Results: The trajectory analysis revealed several key concerns prevalent amongst respondents, and how they fluctuated over the six months. Concerns included: the impact of the pandemic on respondents' future careers and on dentistry more generally; adapting to new working environments; the impact on their patients' dental treatment and oral health; the impact on their health and wellbeing; financial considerations and adjusting to new safety measures as part of the remobilization of dental services. Discussion: In the second half of 2020, as the UK was adjusting to the introduction of new COVID-19 safety measures in everyday life, the dental profession were grappling with significant changes to their working environment, including PPE, redeployment, use of aerosol generating procedures (AGPs), and timelines for re-opening practices. This longitudinal diary study has shown some parts of the dental profession in Scotland expressed very varied and personal concerns and anxieties related to COVID-19. Respondents' candor in their diary entries revealed explicit, frequent and high levels of uncertainty and worry related to their training and career. Collectively, the data corpus highlighted the emotional toll these anxieties have taken on the dental professions in Scotland. Conclusion: These findings demonstrate the need for (a) increased provision of mental health and wellbeing support services for dental staff and (b) the study of the linkage between organization of pandemic management to the working practices of staff delivering services. Interventions, at various levels, should take into consideration the fluctuating nature of dental professionals' concerns and anxieties over time, to address both immediate and longer-term issues.
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Background: The COVID-19 pandemic has placed increased demands on clinical staff in primary dental care due to a variety of uncertainties. Current reports on staff responses have tended to be brief enquiries without some theoretical explanation supported by developed measurement systems. Aim: To investigate features of health and well-being as an outcome of the uncertainties surrounding COVID-19 for dentists and dental health professionals in primary dental care and for those in training. In addition, the study examined the well-being indices with reference to normative values. Finally a theoretical model was explored to explain depressive symptoms and investigate its generalisability across dentists and dental health professionals in primary dental care and those in postgraduate training. Methods: A cross-sectional survey of dental trainees and primary dental care staff in Scotland was conducted in June to October 2020. Assessment was through "Portal," an online tool used for course bookings/management administered by NHS Education for Scotland. A non-probability convenience sample was employed to recruit participants. The questionnaire consisted of four multi-item scales including: preparedness (14 items of the DPPPS), burnout (the 9 item emotional exhaustion subscale and 5 items of the depersonalisation subscale of the MBI), the 22 item Impact of Event Scale-Revised, and depressive symptomatology using the Patient Health Questionnaire-2. Analysis was performed to compare the levels of these assessments between trainees and primary dental care staff and a theoretically based path model to explain depressive symptomology, utilising structural equation modelling. Results: Approximately, 27% of all 329 respondents reported significant depressive symptomology and 55% of primary care staff rated themselves as emotionally exhausted. Primary care staff (n = 218) felt less prepared for managing their health, coping with uncertainty and financial insecurity compared with their trainee (n = 111) counterparts (all p's < 0.05). Depressive symptomology was rated higher than reported community samples (p < 0.05) The overall fit of the raw data applied to the theoretical model confirmed that preparedness (negative association) and trauma associated with COVID-19 (positive association) were significant factors predicting lowered mood (chi-square = 46.7, df = 21, p = 0.001; CFI = 0.98, RMSEA = 0.06, SRMR = 0.03). Burnout was indirectly implicated and a major path from trauma to burnout was found to be significant in primary care staff but absent in trainees (p < 0.002). Conclusion: These initial findings demonstrate the possible benefit of resourcing staff support and interventions to assist dental staff to prepare during periods of high uncertainty resulting from the recent COVID-19 pandemic.
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INTRODUCTION: Recent cross-sectional surveys have shown the detrimental impact of COVID-19 on the health and well-being of dental practitioners and dental care professionals. This qualitative study complements the growing quantitative evidence base with an in-depth exploration of the lived experiences of those working in primary care dental teams in Scotland. METHODS: Focus groups were carried out with primary care dental team members and trainees between July and October 2020. Olsen's tripartite framework of health service sustainability was operationalised to explore how participants experienced uncertainty and their attempts to sustain dental services. RESULTS: Analysis revealed significant concerns surrounding the sustainability of dental services and dental training programmes as a consequence of the emergency level response to the pandemic. Restrictions on dentistry were seen to be severely impeding desirable clinical outcomes, particularly for the most vulnerable groups. Participants experienced being unable to deliver high quality care to their patients as both confusing and distressing. The capability of the dental health care system to meet a growing backlog of dental need and manage this effectively in a pandemic era was called in to serious question. Ongoing uncertainties were affecting how participants were thinking about their professional futures, with stress about income and employment, along with heightened experiences of professional isolation during the pandemic, resulting in some looking at possibilities for retraining or even considering leaving their profession altogether. DISCUSSION: The impact of the pandemic has produced considerable uncertainty regarding the sustainability of dental services in the medium to longer term. It has also served to expose the uncertainties practitioners grapple with routinely as they attempt to sustain their NHS dental service delivery. CONCLUSION: This study brings in to sharp focus the diversity of challenges, confusions and uncertainties experienced by dental practitioners and dental care professionals during the COVID-19 pandemic and the need for suitable and ongoing measures to be put in place to support their mental well-being.
