Worldwide prevalence of carpal tunnel syndrome among dental health care personnel - A systematic review and meta-analysis.

Background: Carpal Tunnel Syndrome (CTS) is one such common disorder among dental health care personnel caused due to the entrapment neuropathy of the median nerve in the carpal tunnel. We aimed to evaluate the pooled estimates of the CTS among dental healthcare personnel. Methods: We systematically reviewed the existing literature from six databases till January 1 st, 2022. Studies reported in English along with the prevalence of CTS or where prevalence could be calculated were included. Independent screening of title and abstracts, and the full text was done by two examiners. Information collected was authors, year of publication, geographic location, type of dental healthcare personnel, sample size, distribution of age, sex, CTS, method of diagnosis, and risk of bias. The random effect model was used to estimate the pooled estimates. Results: Thirty-seven studies yielded 38 estimates. A total of 17,152 dental health care personnel were included of which 2717 had CTS. The overall pooled prevalence of CTS among the included studies was 15%, with a high heterogeneity. Meta-analysis showed no significant difference in the pooled estimates of CTS between male and female dental healthcare personnel (OR: 0.73; 95% CI: 0.52 -1.02; I 2= 69.71). The pooled estimates among the dentist and dental auxiliaries were 20% and 10%, respectively. The pooled prevalence of CTS with self-reported measures, clinical examination and NCS were 21%, 13% and 8% respectively. Meta-regression showed that the prevalence estimates were significantly associated with publication year (coefficient: 0.006; 95% CI= 0.002-0.01). Conclusion: One out of seven dental health care personnel may be affected by CTS. No significant difference was seen in the prevalence of CTS between male and female dental healthcare personnel.

Surface wear and adhesive failure of resin attachments used in clear aligner orthodontic treatment.

PURPOSE: This study evaluated adhesive and cohesive failures and the surface wear of attachments employed in clear aligner treatment (CAT) using three-dimensional (3D) superimposition. METHODS: In all, 3D models of 150 teeth were obtained from intraoral scans from patients undergoing CAT with at least 4 months between each scan. Of the initial sample, 25 teeth were discarded, and 125 teeth were included in the study. Superimpositions of each individual tooth at the first and second time points were made using computer-aided design (CAD) software (Meshmixer; Autodesk, Mill Valley, CA, USA). Analyses were performed to compare surface wear and failures related to type of attachment (optimized/conventional), dental group (molars/premolars/anterior teeth), and arch (mandibular/maxillary). Mann-Whitney and Kruskal-Wallis statistical tests were applied with significance set at 5%. RESULTS: More surface wear was observed in conventional attachments, mandibular and anterior teeth with statistical significance for surface wear on the distal surface of conventional attachments (p < 0.05). Cohesive failure was observed in 10% of attachments, occurring most frequently on optimized attachments and molar teeth. Adhesive failure was observed in 10% of the samples, more frequently on conventional attachments and posterior teeth. CONCLUSION: Attachment type (conventional vs. optimized) was significantly correlated with surface wear on the distal surface of the attachment. Arch (mandibular or maxillary) and group of teeth (anterior or posterior) showed no correlation with surface wear. Failure, both adhesive and cohesive, correlated with attachment type and group of teeth, but not with the arch in which they were located.

Color changes of nanocomposites used for clear aligner attachments: an in vitro study.

PURPOSE: The purpose of this study was to compare the color changes of two different nanocomposites used for two different designs of clear aligner attachments. METHODS: In all, 120 human premolars were embedded in 12 upper dental models with 10 premolars in each model. Models were scanned and attachments were digitally designed. Conventional attachments (CA) were prepared for the first six models and optimized multiplane attachments (OA) were prepared for the other six models with packable composite (PC) on the right quadrant and flowable composite (FC) on the left quadrant of each model. The models were subjected to 2000 thermal cycles at 5 °C/55 °C and then consecutively immersed in the five different staining solutions each for 48 h to simulate external discoloration. Color measurements were taken with a spectrophotometer. Color changes (∆E*ab) of the attachments before and after immersion were compared with the Commission Internationale de l'Éclairage L*a*b* (CIELAB) color space approach. RESULTS: When ∆E*ab values were examined, no significant difference was observed between the groups according to the attachment type (P > 0.05). After the coloration process, the flowable composite group showed less coloration than the packable composite group for both attachment designs (P < 0.05). Color difference values after the staining procedure were significantly higher in the CA-PC and OA-PC groups compared to the CA-FC and OA-FC groups (P < 0.05). CONCLUSION: Color change of the packable nanocomposite was more pronounced than that of the flowable nanocomposite for both attachment designs. Therefore, clear aligner attachments created using flowable nanocomposite can be recommended, especially in the anterior region where esthetics are important for the patient.

Factors associated with suicidal ideation and suicide attempts by Australian dental practitioners.

INTRODUCTION: To investigate factors associated with suicidal ideation and suicide attempts amongst Australian dental practitioners. METHODS: A self-reported online survey of 1474 registered dental practitioners in Australia was conducted from October to December 2021. Participants reported thoughts of suicide in the preceding 12 months, prior to the preceding 12 months and prior suicide attempts. RESULTS: Overall, 17.6% reported thoughts of suicide in the preceding 12 months, 31.4% prior to the preceding 12 months, and 5.6% reported ever having made a suicide attempt. In multivariate models, the odds of suicidal ideation in the preceding 12 months were higher in dental practitioners who were male (OR = 2.01), had a current diagnosis of depression (OR = 1.62), were experiencing moderate (OR = 2.76) or severe psychological distress (OR = 3.58), had self-reported illicit substance use (OR = 2.06) or had previous self-reported suicide attempts (OR = 3.02). Younger dental practitioners had more than twice the odds of recent suicidal ideation than those aged 61+ years, with higher resilience having decreasing odds of suicidal ideation. LIMITATIONS: This study did not address help seeking behaviours directly related to suicidal ideation, so it is not clear how many participants were actively seeking mental health support. The response rate was low and results may be subject to responder biases, with practitioners experiencing depression, stress and burnout being more willing to participate. CONCLUSION: These finding highlight a high prevalence of suicidal ideation amongst Australian dental practitioners. It is important to continue to monitor their mental health and develop tailored programs to provide essential interventions and supports.

Trastornos mentales comunes y calidad de vida relacionada con la salud mental en trabajadores de salud bucal / Common mental disorders and mental health-related quality of life among oral health providers

Introducción: Existen pocos estudios sobre los trastornos mentales comunes y calidad de vida relacionada con la salud mental en trabajadores de salud bucal. Objetivo: Describir los trastornos mentales comunes y la calidad de vida relacionada con la salud mental en trabajadores de equipos de salud bucal en atención primaria de salud del Sistema Único de Salud de la Región Metropolitana de Salvador de Bahía, Brasil. Métodos: Estudio transversal y descriptivo, que utilizó el Cuestionario de declaración de síntomas para evaluar trastornos mentales comunes, el Cuestionario de salud para calidad de vida relacionada con la salud y un cuestionario de caracterización sociodemográfica. Resultados: Conformaron la muestra 161 profesionales (59,6 por ciento odontólogos y 40,4 por ciento auxiliares de salud bucal). El promedio de la puntuación para Cuestionario de declaración de síntomas fue mayor para los odontólogos (p = 0,032). Los dominios de salud mental del Cuestionario de salud fueron menores y significativos en odontólogos. Tres factores del Cuestionario de declaración de síntomas presentaron alta correlación negativa con los dominios de salud mental del Cuestionario de salud. Conclusiones: Los odontólogos presentaron mayores síntomas de trastornos mentales comunes y deterioro de la calidad de vida relacionada con la salud mental que los auxiliares de salud bucal, siendo necesarias estrategias de promoción de la salud mental para trabajadores de los equipos de salud bucal(AU)

Introduction: Few studies are available about common mental disorders and mental health-related quality of life among dental healthcare providers. Objective: Describe the common mental disorders and the mental health-related quality of life of members of oral health teams from the primary health care section of the Unified Health System in the Metropolitan Region of Salvador de Bahia, Brazil. Methods: A descriptive cross-sectional study was conducted based on the Symptom reporting questionnaire for the evaluation of common mental disorders, the Health questionnaire about health-related quality of life, and a sociodemographic characterization questionnaire. Results: The study sample was composed of 161 professionals, of whom 59.6 percent were dentists and 40.4 percent were dental auxiliaries. Dentists obtained a higher average score in the Symptom reporting questionnaire (p = 0.032), whereas their scores in the mental health domains of the Health questionnaire were lower and significant. Three factors in the Symptom reporting questionnaire exhibited a high negative correlation with the mental health domains of the Health questionnaire. Conclusions: Dentists presented greater symptoms of common mental disorders and mental health-related quality of life deterioration than dental auxiliaries. It is therefore necessary to implement mental health promotion strategies aimed at members of oral health teams(AU)

The knowledge, attitude and practice level of dental auxiliaries regarding oral health care for pregnant patients in the eastern province of Saudi Arabia.

Background : The purpose of this research was to assess the knowledge, attitude, and practice of dental auxiliaries related to oral health care for pregnant patients in the Eastern Province of Saudi Arabia. Methods: A cross-sectional study using a questionnaire survey was conducted. The knowledge, attitude, and practice were rated using the Likert scale out of 5. Knowledge and practice were categorized using Bloom's cut off point methods (≥80% is good, and <80% is bad) . Concerning attitude, (≥80% is positive, and <80% is negative). The questionnaires were sent to all dental hygienists and assistants (N=358), and responses were collected from 218. Statistical Package for the Social Sciences (SPSS) software was utilixed to conduct statistical analysis. Results: Out of the 358, 218 responded (response rate = 61%).  More than half of the respondents showed relatively good knowledge (57.3%). Most respondents had a positive attitude (89.4%). Regarding practice, approximately two-thirds had a good practice (67.4%). The knowledge score of hygienists was significantly higher than dental assistants, and respondents with experience in treating pregnant patients had significantly higher knowledge scores than others who did not have experience in treating pregnant patients. There is a statistically significant positive correlation between practice scores and education. Conclusions: The findings suggest the need to establish continuous education programs and for dental hygienists and dental assistants to adopt the best practice guidelines on perinatal oral health.

Nutrition Care Practices of Dietitians and Oral Health Professionals for Oral Health Conditions: A Scoping Review.

BACKGROUND: Oral health conditions, such as dental caries, pose a substantial burden worldwide. Although there are many risk factors for poor oral health, diet is often implicated as a cause of these issues. The purpose of this scoping review was to identify and map studies that have captured information on the "real-world" nutrition care practices of oral health professionals (OHPs) and dietitians to optimize oral health, and specifically the dentition and periodontium. METHODS: A search of peer-reviewed articles was conducted using MEDLINE, CINAHL, and Embase. Articles that addressed the review objective and met the following criteria were included: English language, published since 2000, and study conducted in a high-income country. RESULTS: Overall, 70 articles were included. Most articles reported on cross-sectional survey studies and provided self-reported data on OHP practices; few articles reported on dietitians. Most articles reported only general/unspecific information on assessment and intervention practices, such as dietary analysis, nutrition counselling, and diet advice, and lacked specific information about the care provided, such as the dietary assessment tools used, type of information provided, and time spent on these activities. Barriers to the provision of nutrition care by OHPs were common and included time and lack of remuneration. Few studies reported on collaboration between dietitians and OHPs. CONCLUSIONS: Several studies have captured self-reported information on nutrition care practices of OHPs related to oral health; however, there is limited information available on the details of the care provided. Few studies have examined the practices of dietitians.

The effects of static seated and standing positions on posture in dental hygiene students: a pilot study.

Background: Musculoskeletal disorders (MSDs) are highly prevalent among dental hygiene professionals. The purpose of this pilot study was to evaluate and compare seated and standing postures during simulated dental hygiene practice to determine ergonomic risks associated with each posture. Methods: A convenience sample of 35 female second-year dental hygiene students with no history of musculoskeletal disorders was enrolled in this IRB-approved study. In 2 separate sessions, 1 seated and 1 standing, participants instrumented 1 quadrant of the mouth in a simulated oral environment. Two images per session, per participant, were taken to evaluate biomechanical demands of each posture using the Rapid Upper Limb Assessment (RULA) tool. The same 4 calibrated researchers scored all images independently and mean scores for each posture were analysed. Results: Thirty-four students completed the study. Results revealed statistically significant (p = 0.001) differences in mean RULA scores between seated (M = 3.91, SD = 0.77) and standing (M = 4.50, SD = 1.00) postures, although these differences may not be clinically relevant. Discussion: When postures were independently assessed, seated postures were more acceptable on average compared to standing postures, yet both were in the unacceptable range. Lack of training in standing postures may have impacted the results. Conclusion: Results support the need for additional ergonomic training in dental hygiene curricula. Less than ideal posture when seated or standing could increase MSD risk. Future research should examine biomechanical loads of seated and standing postures, as well as the combination of these postures, for more insight into their ergonomic benefits and associated MSD risks.

Contexte: Les troubles musculosquelettiques (TMS) sont très répandus parmi les professionnels de l'hygiène dentaire. Cette étude pilote visait à évaluer et à comparer les postures assise et debout dans le cadre de simulations de la pratique de l'hygiène dentaire afin de définir les risques sur le plan de l'ergonomie liés à chacune de ces postures. Méthodes: Dans le cadre de cette étude approuvée par un comité d'examen institutionnel, on a examiné un échantillon de commodité réunissant 35 étudiantes en hygiène dentaire de 2e année sans antécédents de troubles musculosquelettiques. À l'occasion de 2 séances distinctes, une effectuée en position assise et une effectuée en position debout, les participantes ont travaillé sur un quadrant de la bouche dans un environnement oral simulé. On a pris 2 images par séance et par participante pour évaluer les exigences biomécaniques de chacune des postures à l'aide de l'outil d'évaluation rapide des membres supérieurs (RULA). Les 4 mêmes chercheurs calibrés ont attribué une note à toutes les images de façon indépendante. On a ensuite analysé la moyenne de ces notes pour chacune des postures. Résultats: Trente-quatre étudiantes ont participé à l'étude jusqu'à son terme. Les résultats ont révélé des différences statistiquement significatives (p = 0,001) dans les moyennes des notes de l'outil RULA entre les postures assise (M = 3,91, ET = 0,77) et debout (M = 4,50, ET = 1,00). Toutefois, ces différences pourraient ne pas être pertinentes sur le plan clinique. Discussion: Dans le cadre de l'évaluation indépendante des postures, en moyenne, la position assise était plus acceptable que la position debout. Cependant, les 2 postures se trouvaient dans la fourchette de valeurs inacceptables. Il est possible que le manque de formation en position debout ait une incidence sur les résultats. Conclusion: Les résultats confirment la nécessité d'une formation supplémentaire sur l'ergonomie dans les programmes d'hygiène dentaire. Une posture non idéale en position assise ou debout pourrait entraîner une hausse du risque de TMS. À l'avenir, des études devraient examiner les charges biomécaniques des postures assise et debout, ainsi que la combinaison de ces postures, afin de renforcer la compréhension de leurs avantages ergonomiques et des risques de TMS connexes.

Avaliação de propriedades psicométricas de um instrumento para análise da atuação de auxiliares em saúde bucal / Evaluation of psychometric properties of an instrument for analysis the performance of oral health assistants

Na Odontologia, os (as) Auxiliares em Saúde Bucal estão conquistando mais espaço por comporem as equipes de saúde bucal favorecendo os aspectos ergonômicos e de biossegurança, aumentando a produtividade no consultório e proporcionando maior eficiência. No Brasil, em 2008, a Lei 11.889 regulamentou a atividade profissional desta categoria. A regulamentação da profissão implica na adoção de procedimentos que permitam descrever, com confiabilidade, o perfil profissional e caracterizar as atividades realizadas por esses profissionais. Um instrumento que se presta a esses propósitos é o questionário. O objetivo desse estudo foi mensurar propriedades psicométricas de um questionário destinado a identificar as características do trabalho de Auxiliares em Saúde Bucal. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais (CAAE n. 17378718.5.0000.5149 de 02/10/2019). O questionário, foi construído a partir da Lei 11.889/2008 que regulamentou a atividade profissional desta categoria, no Brasil. Ele contém 21 questões sendo sete referentes à identificação pessoal e 14 sobre as atribuições profissionais e foi enviado a 75 Auxiliares em Saúde Bucal pelo aplicativo WhatsApp. O questionário foi aplicado duas vezes aos mesmos participantes, com um intervalo de uma semana. Na análise das propriedades psicométricas verificou-se a consistência interna, por meio do coeficiente Alpha de Cronbach total e a estabilidade temporal por meio do Kappa de Cohen. Utilizou-se para análise o software SPSS versão 25.0. A consistência interna das 14 questões relativas às atribuições resultou em um coeficiente Alpha de Cronbach igual a 0,949 e Kappa de Cohen superior a 0,6 em todas as questões. Não houve alteração importante no Alpha de Cronbach quando se retirou quaisquer questões. As propriedades psicométricas encontradas foram consideradas satisfatórias, revelando que se trata de instrumento com adequada confiabilidade e estabilidade temporal.

In Dentistry, Dental Surgery Assistants (DSA) are gaining more space by composing the oral health teams, favoring ergonomic and biosafety aspects, increasing productivity in the dental surgery and providing greater efficiency. In Brazil, in 2008, the Law 11,889 regulated the professional activity of this category. The regulation of the profession implies the adoption of procedures that allow to describe the professional profile and characterize the activities performed by these professionals. A questionnaire is an instrument that can be used for this purpose. The aim of this study was to measure psychometric properties of a questionnaire designed to identify the work characteristics of Dental Health Assistant (DHA). The project was approved by the Research Ethics Committee of the Federal University of Minas Gerais (CAAE n. 17378718.5.0000.5149 of 10/02/2019). The questionnaire was designed according to the Law 11,889 that regulated the professional activity of this profession, in Brazil. It contains 21 questions, seven referring to personal identification and 14 about professional attributions and was sent to 75 DHA through the WhatsApp app. The questionnaire was applied twice to the same participants, with an interval of one week. In the analysis of psychometric properties, internal consistency was verified through the total Cronbach's Alpha coefficient and temporal stability through Cohen's Kappa. The SPSS software version 25.0 was used for analysis. The internal consistency of the 14 questions related to the professional attributions resulted in a Cronbach's Alpha coefficient equal to 0.949 and a Cohen's Kappa coefficient greater than 0.6 in all questions. There was no major change in Cronbach's Alpha coefficient when any questions were removed. The psychometric properties found were considered satisfactory, revealing that it is an instrument with adequate reliability and temporal stability.

Novel corona virus disease (COVID-19) awareness among the dental interns, dental auxiliaries and dental specialists in Saudi Arabia: A nationwide study.

BACKGROUND: Dental health care workers (DHCW's) are invariably at a higher risk of contracting COVID-19. The objectives were; to investigate the current knowledge on COVID-19 among the DHCW's; and to conduct quasi-experiment among the DHCW's who were unaware of the disseminated COVID-19 information. METHODS: A nationwide cross-sectional study targeting dental interns, auxiliaries, and specialists with a two-staged cluster sampling technique was performed. A 17-item questionnaire was subjected to reliability and validity tests before being administered. The participants for quasi-experiment were separated from the original sample after their initial response. Chi-square test assessed responses to knowledge statements between the participants. Difference in mean knowledge scores between the categories of DHCW's and sources of COVID-19 information was assessed using ANOVA. Data from the quasi experiment (pre vs post knowledge intervention) was subjected to paired t-test. Percentage of DHCWs providing correct or wrong responses to each knowledge statement at baseline and after 7 days were compared using McNemar test. RESULTS: The overall sample consisted of 706 (N) participants, and the DHCW's with no prior knowledge on COVID-19 (N=206) were part of the quasi experiment. Findings from cross-sectional study revealed that knowledge was significantly (p<0.05) related to the qualification level (interns vs auxiliaries vs specialists). However, the difference in the source of information (WHO/CDC vs Journal articles vs MoH) did not demonstrate any effect. Number of participants with correct responses to knowledge questions had significantly (p<0.05) increased after intervention. Also, the overall mean knowledge score (10.74±2.32 vs 12.47±1.68; p<0.001) had increased significantly after the intervention. CONCLUSION: In conclusion, the basic knowledge on COVID-19 among the DHCW's in Saudi Arabia is acceptable. Timely dissemination of information by the Ministry of Health, Saudi Arabia had a positive impact on the COVID-19 knowledge score of the DHCW's.

Work-related musculoskeletal symptoms and coping strategies among dental auxiliaries at hospital universiti Sains Malaysia.

BACKGROUND: Dental personnel are vulnerable to work-related musculoskeletal symptoms (WMSS) due to the nature of their profession. AIM: To determine WMSS experienced by dental auxiliaries and their coping strategies toward these symptoms. SETTING AND DESIGN: A cross-sectional study was conducted on 82 dental auxiliaries at a university dental hospital in Malaysia. MATERIALS AND METHODS: Nordic musculoskeletal questionnaire and the Brief COPE questionnaire were used to measure the musculoskeletal symptoms and coping strategies of the respondents, respectively. Data were analyzed using IBM SPSS version 22.0. RESULTS: Dental auxiliaries consisted of dental staff nurses (30.5%), dental surgery assistants (40.2%), dental technologists (18.3%), and healthcare assistants (11.0%). Their mean [standard deviation (SD)] age was 33.4 (7.60) years. Most of the respondents had been troubled with ache, pain, and discomfort at the neck, 54.9% (95% confidence interval 44.0%, 66.0%]. In addition, they were troubled mainly with distress at the low back (34.1%) and the ankle or feet (34.1%) which had prevented the respondents from doing their regular job over the past 12 months. The most common areas that had troubled the respondents over the past 7 days were the neck (36.6%), low back (36.6%), and ankle or feet (36.6%). The coping strategy most commonly practiced by the respondents was religion with a mean (SD) score of 3.70 (2.15), followed by active coping [3.13 (0.68)] and acceptance [3.13 (0.69)]. CONCLUSION: The prevalence of WMSS was high in the dental auxiliaries particularly in the neck region. The most common coping strategy used was religion. Awareness programs on the prevention of WMSS among the dental auxiliaries should be increased.

Practice Patterns and Attitudes of Expanded Function Dental Auxiliaries in the State of Maine.

Purpose: Various workforce models, including the expanded function dental auxiliary (EFDA), have been created as a means to address the crisis in oral health access. Limited assessments have been conducted regarding the effectiveness of the EFDA. The purpose of the study was to assess the implementation, geographic practice patterns and attitudes regarding the education of EFDAs in the state of Maine.Methods: Licensure information on the Expanded Function Dental Auxiliaries (EFDA) in Maine was obtained from the Board of Dental Practice. A 19-item survey consisting of closed and open-ended questions pertaining to practice demographics, settings, procedures and attitudes towards basic and ongoing continuing education was sent both via email and traditional mail to all EFDAs licensed in Maine (n=75). Descriptive statistics were used to analyze the data.Results: A response rate of 59% (n=43) was achieved. A majority of EFDAs (60%, n=26) were employed in private dental practices; 12% (n=5) practiced in a community/public health setting. Regarding access to care, 51% (n=22) stated that their practice did not accept Medicaid coverage. However, over half indicated feeling that they were making moderate to significant impact on increasing access. A little more than one third (35%, n=17) reported working in Penobscot County, which is not a designated provider shortage area. A majority of respondents reported less than half of their continuing education courses were relevant to EFDA practice.Conclusions: EFDA practitioners are providing needed oral health care services, however they may not be providing access to care for the intended at-risk and underserved populations in designated geographic areas. Practice patterns of EFDAs in Maine should be assessed in greater depth.

Explaining the intention of dental health personnel to report suspected child maltreatment using a reasoned action approach.

BACKGROUND: This study provides an empirical test of the reasoned action approach (RAA) socio-cognitive theory with the aim of 1) predicting the intention of public dental health personnel (PDHP) to report suspected child-maltreatment to child welfare services (CWS); 2) estimating the effects of the theoretical constructs of RAA, including experiential and instrumental attitudes, injunctive and descriptive norms, and perceived capacity and autonomy regarding PDHP's behavioural intentions; and 3) exploring whether the RAA operates equivalently (i.e., is invariant) in male and female providers. METHODS: This national cross-sectional study was conducted in Norway. An electronic survey was distributed to 1542 dentists and dental hygienists working in the public dental health service. The survey included RAA items constructed in accordance with the recommendations for the RAA model. Structural equation modelling (SEM) was used to identify factors derived from the theory of RAA to predict PDHP reporting intentions. RESULTS: A total of 77.8% (1200) of those surveyed responded to the survey. The present study provided support for the utility of the RAA across both male and female providers in predicting their intention to report suspected child-maltreatment to the CWS. The final modified SEM model revealed that instrumental attitudes and perceived behavioural control (based on merged capacity and autonomy parameters) were the strongest predictors of intention to report, followed by the reporting of descriptive norms, injunctive norms and experiential attitudes. These factors explained 63.6% of the observed variance in the reporting intention. CONCLUSIONS: The large amount of explained variance suggests that RAA is a well-functioning theory that predicts PDHP's reporting intentions to CWS across gender, and gives an understanding of the socio-cognitive factors involved. To strengthen reporting intention among dental personnel, this study suggests educators should focus on the value and positive consequences of reporting, the resources available and how to overcome obstacles; attention to normative expectations and individuals' feelings about reporting may also be helpful.

Estresse ocupacional e engajamento em profissionais de saúde bucal / Occupational stress and engagement in oral health professionals / Estrés laboral y compromiso de profesionales de salud bucal

Objetivo: Avaliar os níveis de estresse ocupacional e engajamento em profissionais de saúde bucal de unidades da Atenção Primária à Saúde. Métodos: Estudo quantitativo, descritivo, correlacional e transversal, realizado com profissionais da saúde bucal das unidades de Atenção Primária à Saúde do município de São José do Rio Preto, São Paulo, em 2017. Utilizaram-se três instrumentos autoaplicáveis: um elaborado pelos pesquisadores, contendo variáveis sociodemográficas e profissionais, a Escala de Estresse no Trabalho e a Utrecht Work Engagement Scale. Os níveis de estresse ocupacional e engajamento foram calculados segundo modelo estatístico proposto pelos instrumentos e, para a análise, utilizou-se teste de correlação de Pearson, considerando significância de 95%. Resultados: Participaram 31 profissionais, sendo 20 (64,5%) cirurgiões-dentistas e 11 (35,5%) auxiliares de saúde bucal. Houve prevalência do sexo feminino (n=21; 67,7%), faixa etária de 40 anos ou mais (n=14; 45,2%), casados (n=26; 83,9%), concursados/estatutários (n=16; 51,6%), com carga horária semanal de 40 horas (n=23; 74,2%), sem outra atividade remunerada (n=19; 61,3%), três a dez anos de atuação na Atenção Primária à Saúde (n=13; 41,9%) e satisfeitos com a profissão (n=28; 90,3%). A amostra não apresentou níveis importantes de estresse, mas nove (29,0%) profissionais obtiveram escores compatíveis com estresse importante (>2,5). Os profissionais apresentaram níveis altos de engajamento em todas as dimensões. Estresse ocupacional e engajamento se correlacionam negativamente. Conclusão: Os trabalhadores apresentaram altos níveis de engajamento. Estresse ocupacional e engajamento tendem a ser inversamente proporcionais.

Objective: To evaluate the levels of occupational stress and engagement in oral health professionals from Primary Health Care units. Methods: It is a quantitative, descriptive, correlational and cross-sectional study conducted with oral health professionals from Primary Health Care units in the city of São José do Rio Preto, São Paulo, in 2017. We used three self-applied instruments: one developed by the researchers, containing sociodemographic and professional variables, the Stress at Work Scale, and the Utrecht Work Engagement Scale. Occupational stress and engagement levels were calculated according to the statistical model proposed by the instruments and, for the analysis, Pearson's correlation test was used, considering the significance of 95%. Results: 31 professionals participated, being 20 (64.5%) dental surgeons and 11 (35.5%) oral health auxiliaries. There was a prevalence of females (n = 21; 67.7%), aged 40 years or older (n = 14; 45.2%), married (n = 26; 83.9%), hired / statutory ( n = 16; 51.6%), with a weekly workload of 40 hours (n = 23; 74.2%), without any other paid activity (n = 19; 61.3%), three to ten years of experience in the Primary Health Care (n = 13; 41.9%) and satisfied with the profession (n = 28; 90.3%). The sample did not show significant stress levels, but nine (29.0%) professionals obtained scores compatible with significant stress (> 2.5). Professionals had high levels of engagement in all dimensions. Occupational stress and engagement correlate negatively. Conclusion: Workers had high levels of engagement. Occupational stress and engagement tend to be inversely proportional.

Objetivo: Evaluar los niveles de estrés laboral y compromiso de profesionales de salud bucal de unidades de la Atención Primaria de Salud. Métodos: Estudio cuantitativo, descriptivo, de correlación y transversal realizado con profesionales de salud bucal de las unidades de Atención Primaria de Salud del municipio de São José do Rio Preto, São Paulo, en 2017. Se ha utilizado tres instrumentos auto aplicables: uno de ellos ha sido elaborado por los investigadores con variables sociodemográficas y profesionales, la Escala de Estrés en el Trabajo y la Utrecht Work Engagement Scale. Los niveles del estrés laboral y del compromiso han sido calculados según el modelo estadístico propuesto por los instrumentos y para el análisis se utilizó la prueba de correlación de Pearson con significancia del 95%. Resultados: Participaron 31 profesionales siendo 20 (64,5%) cirujanos-dentistas y 11 (35,5%) auxiliares de salud bucal. Hubo prevalencia para el sexo femenino (n=21; 67,7%), la franja de edad de 40 años o más (n=14; 45,2%), casados (n=26; 83,9%), concursantes/estatutarios (n=16; 51,6%), con 40 horas semanales de trabajo (n=23; 74,2%), sin otra actividad remunerada (n=19; 61,3%), entre tres y diez años de actuación en la Atención Primaria de Salud (n=13; 41,9%) y satisfechos con la profesión (n=28; 90,3%). La muestra no ha presentado niveles importantes de estrés pero nueve (29,0%) profesionales tuvieron puntuaciones compatibles con el estrés importante (>2,5). Los profesionales presentaron niveles altos de compromiso para todas las dimensiones investigadas. El estrés laboral y el compromiso se han correlacionado de manera negativa.

Perception of Special Needs Dentistry education and practice amongst Australian dental auxiliary students.

INTRODUCTION: The role of dental auxiliaries in collaborative care of patients with special needs is compelling. This study was undertaken to investigate the perceptions of Special Needs Dentistry (SND) education and practice amongst students enrolled in Australian programmes in dental auxiliary, namely dental hygiene, dental therapy and oral health therapy (DH/DT/OHT). MATERIALS AND METHODS: All Australian institutions offering DH/DT/OHT programmes (n = 14) were invited to participate in a self-administered questionnaire survey, conducted online, involving students across all academic years. Twelve institutions agreed to participate, but only five institutions were included in the final analysis, with a student response rate of 31.1%. Answers to open-ended questions were coded and grouped for measurement of frequencies. Quantitative data were analysed via chi-squared and Fisher's exact tests (significance taken as P < .05). RESULTS: The majority of students could not define SND (87.0%) were not aware of the existence of this specialty (53.5%) and did not have clinical experience treating patients with special needs (68.9%). Nevertheless, they felt comfortable and positive about treating these patients independently. Most agreed that they should receive clinical and didactic education in SND, with many of them expressing interest in pursuing a specialty training in this field. CONCLUSION: DH/DT/OHT students' comfort levels, positive attitudes and supportiveness for SND suggested positive implications for these practitioners to partake in multidisciplinary management of patients with special needs, thus indicating the need for standardised training requirements and practice guidelines in this area of care.

Prevalence of dental caries in patients with intellectual disabilities from the Association of Exceptional Children's Parents and Friends of Southern Brazil / Prevalência da cárie dentária em pacientes com deficiência intelectual da Associação de Pais e Amigos das Crianças Excepcionais do Sul do Brasil

ABSTRACT Objective: This study was conducted to determine the prevalence and severity of dental caries, missing and restored teeth (DMFT) and the efficiency of oral health programs for patients with intellectual disabilities, from age 11 to 38, who attended at the Association of Exceptional Children's Parents and Friends (APAE) in Passo Fundo, southern Brazil. Methods: The prevalence of dental caries was assessed by DMFT in 109 patients. The mean and standard deviation were evaluated by One-way ANOVA with 5% significance level. Results: 47 of the evaluated students were female and 62 male, with moderate mental disability, Down syndrome, cerebral paralysis and epilepsy. The DMFT average was 3.93 for 11-14 years, 3.47 for 15-19 years, 4.74 for 20-30 years and 5.68 for the group 31-40 years. There were no significant differences among the DMFT index, gender and intellectual disability for the groups. Conclusion: Patients had acceptable oral hygiene within their limitations, suggesting that prevention and dental care program developed in APAE-PF/RS could be used as a model for health care for patients with intellectual disabilities in other institutions and other cities.

RESUMO Objetivo: Determinar a prevalência e a severidade da cárie dentária, ausências dentárias e restaurações pelo índice CPOD, tão bem como a eficiência dos programas de saúde bucal de pacientes com deficiência intelectual, com idades de 11 a 38 anos, que frequentavam a Associação de Pais e Amigos das Crianças Excepcionais-APAE Passo Fundo, Sul do Brasil. Métodos: A prevalência da cárie dentária foi avaliada pelo índice CPOD em 109 pacientes. A média e o desvio-padrão foram avaliados pela ANOVA unidirecional com nível de significância de 5%. Resultados: 47 dos estudantes avaliados eram do sexo feminino, e 62 do masculino, apresentando deficiência mental moderada, síndrome de Down, paralisia cerebral e epilepsia. A média do CPO-D foi de 3.93 para as idades de 11-14 anos, 3.47 para 15-19 anos, 4.74 para 20-30 anos e 5.68 para os pacientes com 31-40 anos. Não houve diferenças significativas entre o índice de CPOD, gênero e deficiência intelectual. Conclusão: Os pacientes apresentaram higiene bucal aceitável dentro das suas limitações, sugerindo que o programa de prevenção e tratamento odontológico desenvolvido no APAE-PF/RS poderia ser utilizado como modelo de atenção à saúde para pacientes com deficiência intelectual em outras instituições e outras cidades.

Work process of an oral health team according to the dentists / Rotina de trabalho da equipe de saúde bucal sob a ótica do cirurgião dentista

ABSTRACT Objective: The aim of this study, conducted with the participation of the dentists of public service of Campinas, Dental Hygienist Technicians (TSBs) and Oral Health Assistants (ASBs), was to investigate the adequacy of the work process relative to the legal duties and professional limits. Methods: All the 180 dentists linked to the public service in 2014 were invited to take part in the study. Structured and self-administered questionnaires were sent to the these professional and they focused on vocational training and the allocation of functions in routine health care based on the provision of Law 11.889/2008. Results: Considering the respondents, the post-graduation period was 22.1 ± 7.4 years and they had a mean number 16.2 ± 8.9 years of public service. The majority of dentists worked with assistants (82.8%) during the period of study. Regarding the functions delegated to assistants, of the 36 functions identified, it was noted that 14 (38.9%) of the functions delegated diverged from their legal attributes, for most respondents; of these 35.7% (5) denoted extrapolation of ASBs functions, 28.6% (4) extrapolation of TSBs functions and 35.7% (5) underutilization of assistants, in particular TSBs. Conclusion: The authors concluded that most actions were being delegated in a manner consistent with the legal provisions, however, there were still situations of extrapolation of assistant's functions and underutilization of TSBs.

RESUMO Objetivo: Investigar junto aos dentistas da rede pública de Campinas a adequação da rotina de trabalho em equipe com as atribuições legais e os limites de atuação profissional, dos Técnicos em Saúde Bucal (TSBs) e Auxiliares em Saúde Bucal (ASBs). Métodos: Todos os 180 dentistas da atenção básica do serviço público receberam questionários estruturados e auto administrados, com foco na formação profissional e na atribuição de ações na rotina da atenção em saúde, com base na disposição da lei 11.889/2008. Resultados: Os respondentes apresentavam 22,1±7,4 anos de formação e 16,2±8,9 anos de vínculo público. A maioria dos dentistas trabalhava com auxiliar (82,8%). Quanto às ações, das 36 funções apontadas, 14 (38,9%) apresentaram delegação divergente às atribuições legais para a maioria dos respondentes, dentre as quais, 35,7% (5) denotavam extrapolação de funções de ASB, 28,6% (4) extrapolação de função de TSB e 35,7% (5) subutilização dos auxiliares, em especial do TSB. Conclusão: Conclui-se que a maioria das ações está sendo delegada de maneira condizente à disposição legal, havendo, no entanto, situações de extrapolação de funções dos auxiliares e de subutilização dos TSB.

Productive efficiency and its determinants in the Community Dental Service in the north-west of England.

OBJECTIVES: To assess the efficiency of service provision in the Community Dental Services and its determinants in the North-West of England. SETTING AND SAMPLE: 40 Community Dental Services sites operating across the North-West of England. BASIC RESEARCH DESIGN: A data envelopment analysis was undertaken of inputs (number of surgeries, hours worked by dental officers, therapists, hygienists and others) and outputs (treatments delivered, number of courses of treatment and patients seen) of the Community Dental Services to produce relative efficiency ratings by health authority. These were further analyzed in order to identify which inputs (determined within the Community Dental Services) or external factors outside the control of the Community Dental Services are associated with efficiency. MAIN OUTCOME MEASURE: Relative efficiency rankings in Community Dental Services production of dental healthcare. RESULTS: Using the quantity of treatments delivered as the measure of output, on average the Community Dental Services in England is operating at a relative efficiency of 85% (95% confidence interval 77%- 99%) compared to the best performing services. Average efficiency is lower when courses of treatment and unique patients seen are used as output measures, 82% and 68% respectively. Neither the input mix nor the patient case mix explained variations in the efficiency across Community Dental Services. CONCLUSIONS: Although large variations in performance exist across Community Dental Services, the data available was not able to explain these variations. A useful next step would be to undertake detailed case studies of several best and under-performing services to explore the factors that influence relative performance levels.

The technical efficiency of oral healthcare provision: Evaluating role substitution in National Health Service dental practices in England.

OBJECTIVES: In many countries increasing use is being made of dental care professionals (DCPs) to provide aspects of clinical activity previously undertaken by dentists. This study evaluates the differences in practice efficiency associated with the utilisation of DCPs in the provision of General Dental Services in the National Health Service (NHS) in England. METHODS: One hundred twenty-one NHS practices completed a questionnaire and shared practice information held at the NHS Business Services Authority. Practice efficiency was estimated using data envelopment analysis with the robustness of the findings checked using Stochastic Frontier Model estimation. RESULTS: Dental practices operated at an estimated mean level of technical efficiency of 64%. Variations among practices in the use of DCPs were not associated with variations in practice efficiency after controlling for other staffing levels, patient population characteristics and practice variables. CONCLUSIONS: The current NHS dental contract limits the potential for efficiency improvements by setting annual practice activity targets that produce little incentive for role substitution. Whilst DCPs may by practising efficiently, this is not reflected in practice-level efficiency, possibly because of dentists using the time released for other non-NHS activity.

A mixed-methods study of health worker migration from Jamaica.

BACKGROUND: This study sought to better understand the drivers of migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries-Jamaica, India, the Philippines, and South Africa-that have historically been 'sources' of health workers migrating to other countries. The aim of this paper is to present the findings from the Jamaica portion of the study. METHODS: Data were collected using surveys of Jamaica's generalist and specialist physicians, nurses, midwives, and dental auxiliaries, as well as structured interviews with key informants representing government ministries, professional associations, regional health authorities, healthcare facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. Multiple stakeholder engagement workshops were held across Jamaica to share and validate the study findings and discuss implications for the country. RESULTS: Migration of health workers from Jamaica continues to be prevalent. Its causes are numerous, long-standing, and systemic, and are largely based around differences in living and working conditions between Jamaica and 'destination' countries. There is minimal formal tracking of health worker migration from Jamaica, making scientific analysis of its consequences difficult. Although there is evidence of numerous national and international efforts to manage and mitigate the negative impacts of migration, there is little evidence of the implementation or effectiveness of such efforts. Potential additional strategies for better managing the migration of Jamaica's health workers include the use of information systems to formally monitor migration, updating the national cadre system for employment of health personnel, ensuring existing personnel management policies, such as bonding, are both clearly understood and equitably enforced, and providing greater formal and informal recognition of health personnel. CONCLUSION: Although historically common, migration of Jamaica's health workers is poorly monitored and understood. Improved management of the migration of Jamaica's health workers requires collaboration from stakeholders across multiple sectors. Indeed, participating stakeholders identified a wide range of potential strategies to better manage migration of Jamaica's health workers, the implementation and testing of which will have potential benefits to Jamaica as well as other 'source' countries.