Dental Care Setting Research Articles

Screening for substance misuse in the dental care setting: findings from a nationally representative survey of dentists.

The dental setting is a potentially valuable venue for screening for substance misuse. Therefore, we assessed dentists' inquiry of substance misuse through their patient medical history forms and their agreement with the compatibility of screening as part of the dentists' professional role. A nationally representative survey of general dentists using a sampling frame obtained from the American Dental Association Survey Center (November 2010-November 2011). United States of America. A total of 1802 general dentists. A 38-item survey instrument assessing the relationship between dentists' practice, knowledge, behaviors and attitudes with their query about substance misuse and their belief that such screening is part of their professional role. Dentists who accepted substance misuse screening as part of their professional role were more likely to query about misuse with their patients (85.8%) compared with those who did not accept such screening as part of their role (68.2%) (P < 0.001). Prior experience and knowledge about substance misuse were the strongest predictors of dentists' inquiry about patient substance use/misuse and acceptance of screening as part of their role in their clinical practice (P < 0.05). While more than three-quarters of US dentists report that they ask their patients about substance misuse, two-thirds do not agree that such screening is compatible with their professional role.

Single-Session Computerized Cognitive Behavioral Therapy for Dental Anxiety

Therapy interventions for dental anxiety that can be easily implemented in dental health care settings are needed. A series of six case studies is presented to demonstrate the feasibility, acceptability, and initial efficacy of a single-session computerized cognitive behavioral therapy intervention for dental anxiety. Six patients at a community dental clinic (five females, Mage = 49.50, SD = 10.48) who were identified as having high dental anxiety on the Modified Dental Anxiety Scale (MDAS) participated in this uncontrolled pilot trial. All patients completed pre-treatment assessments of dental anxiety and the computerized therapy during the hour before a scheduled dental appointment, and five of six patients completed a 1-month follow-up assessment. All six of the patients were able to complete the intervention with minimal assistance and reported that they were very satisfied with the therapy. Three of the five patients available for follow-up assessment demonstrated clinically significant reductions in their dental anxiety, with MDAS scores dropping from the high range to the low range. Findings provide preliminary support for the feasibility, acceptability, and efficacy of this computerized dental anxiety intervention. Implications for the dissemination of this intervention within dental health care settings and improvement of anxious patients’ access to dental care are discussed.

Existing Screening Methods for Oral Cancer are Generally Acceptable to Patients in Non-dental Settings

Article Title and Bibliographic Information A systematic review of patient acceptance of screening for oral cancer outside of dental care settings. Paudyal P, Flohr FD, Llewellyn CD. Oral Oncol 2014 50(10):956–62. Reviewer Virginia J. Dodd, PhD, MPH, RDH Purpose/Question To determine the acceptability of screening for oral cancer outside of dental settings Source of Funding Information not available Type of Study/Design Systematic review Level of Evidence Level 2: Limited quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent or limited-quality patient-oriented evidence

Isolation of Raoultella planticola from refillable antimicrobial liquid soap dispensers in a dental setting

BackgroundLiquid antimicrobial soaps are commonly used in the dental health care setting for hand washing to minimize the potential spread of infectious agents to health care workers and patients. The purpose of the current study was to evaluate possible bacterial contamination of antimicrobial liquid soap dispensers located in 2 institutional comprehensive dental care clinics. MethodsFourteen soap dispensers and 16 original stock containers were sampled. A 1-milliliter aliquot was diluted in 10 mL of phosphate buffer (Tween-80; Acros). Serial dilutions were plated in duplicate on neutralizing agar and incubated for 7 days. Molecular identification was performed using 500 base pair comparisons of 16S ribosomal ribonucleic acid sequencing. Taq polymerase chain reaction was performed with sequence-specific primers for Raoultella species. ResultsBacterial growth was observed at 18 hours for 57% (8 of 14) of soap dispenser samples. Bacterial densities ranged from 4 × 102 to 6 × 109 colony-forming units per milliliter. Original commercial containers exhibited no growth. Isolates were identified as Raoultella (Klebsiella) planticola. ConclusionsThis is the first study to the authors' knowledge indicating recovery of R planticola from antimicrobial liquid soap dispensers. R planticola is a recognized environmental opportunistic pathogen that potentially poses a health concern. Practical ImplicationsThese findings indicate compliance problems with infection prevention recommendations and support the US Centers for Disease Control and Prevention’s recommendation that dispensers should not be topped off. High bacterial loads of R planticola are inconsistent with infection control practices and are a concern because transmission and possible infection to the health care worker or the patient may occur.

Impact of a risk management plan on Legionella contamination of dental unit water.

The study aimed to assess the prevalence of Legionella spp. in dental unit waterlines of a dental clinic and to verify whether the microbiological parameters used as indicators of water quality were correlated with Legionella contamination. A risk management plan was subsequently implemented in the dental health care setting, in order to verify whether the adopted disinfection protocols were effective in preventing Legionella colonization. The water delivered from syringes and turbines of 63 dental units operating in a dental clinic, was monitored for counts of the heterotrophic bacteria P. aeruginosa and Legionella spp. (22 °C and 37 °C). At baseline, output water from dental units continuously treated with disinfection products was more compliant with the recommended standards than untreated and periodically treated water. However, continuous disinfection was still not able to prevent contamination by Legionella and P. aeruginosa. Legionella was isolated from 36.4%, 24.3% and 53.3% of samples from untreated, periodically and continuously treated waterlines, respectively. The standard microbiological parameters used as indicators of water quality proved to be unreliable as predictors of the presence of Legionella, whose source was identified as the tap water used to supply the dental units. The adoption of control measures, including the use of deionized water in supplying the dental unit waterlines and the application of a combined protocol of continuous and periodic disinfection, with different active products for the different devices, resulted in good control of Legionella contamination. The efficacy of the measures adopted was mainly linked to the strict adherence to the planned protocols, which placed particular stress on staff training and ongoing environmental monitoring.

Feasibility of alcohol misuse screening and treatment in the dental setting

BackgroundDental specialists treat conditions such as facial trauma and oral cancer that can result from alcohol misuse. Visits to primary dental care professionals are oriented towards prevention. Interventions coordinated by specialist services but delivered strategically in primary care could therefore potentially help to reduce burdens on secondary care services. The aim of this study was to determine the feasibility of screening for alcohol misuse and providing brief intervention in a primary dental care setting. MethodsIn this randomised controlled trial, patients aged 18–65 years were recruited from a local general dental practice. Patients were stratified according to appointment (with a dentist or hygienist). Reception staff administered envelope packs containing screening materials (the Modified Single Alcohol Screening Question [M-SASQ]), consent forms, and a short survey collecting contact details to patients who agreed to take part in the study. Packs were randomly pre-allocated to control and intervention groups by strata using block randomisation before the start of the study. Consenting patients scoring positively on the M-SASQ for drinking hazardously and allocated to the intervention group received a motivational intervention to reduce alcohol intake from either the hygienist or dentist. Patients in the control group received usual care. The outcome assessor and patients were masked to allocations. The outcome measure at 3 months was M-SASQ score. This trial is registered with the ISRCTN registry, number ISRCTN18745862. FindingsOne hygiene patient and 106 dental patients were recruited. The hygiene patient did not score positively on the M-SASQ for alcohol misuse. Of the 106 dental patients, 46 (43%) scored positively, with 26 allocated to the intervention group and 20 to the control group. Follow-up data were available for 22 (48%) of the 46 patients (12 intervention, 10 control). M-SASQ scores changed from positive to negative for two patients in the intervention and five in the control group. InterpretationAlcohol misuse screening and treatment was feasible in a primary dental care setting; this suggests a new approach involving the general dental team, which could potentially reduce burdens on specialist dental services. Overall, in this practice, the dentist was best placed to deliver the intervention rather than the hygienist since these health-care professionals saw most of the patients recruited into the trial. Contamination might have been a problem because more patients in the control group changed M-SASQ score. Building on these findings, a multicentre, cluster randomised controlled trial is planned. FundingRoyal College of Surgeons of England.

Reflections on a training course reorienting dental teams towards prevention.

Prevention is a core element of routine dental practice. However, members of the dental team often lack the required knowledge and skills to deliver effective evidence-based advice and support to patients. This paper describes the development and delivery of an innovative course designed to develop the preventive capacity of dental teams working in dental foundation training practices across London. The course contents were based upon national guidelines on evidence-based preventive care delivered in primary dental care settings (Delivering better oral health). An experienced team of trainers from diverse backgrounds successfully designed and delivered the courses and the initial feedback from participants indicate strong support for the approach developed.

Fact or fiction: does a relationship exist between free sugars, dental caries and body weight?

This article is about dental caries and body weight. It will provide the reader with an overview of the complexity in the relationship between these and suggest the implications of taking a public health approach when addressing them within a primary dental care setting. Clinical Relevance: To provide dental care professionals with an update on the available evidence surrounding the relationship between free sugar, dental caries and body weight.

Reporting occupational exposure to blood and body fluids

Leavy P, Templeton A, Young L, McDonnell C (2014) Reporting of occupational exposures to blood and body fluids in the primary dental care setting in Scotland: an evaluation of current practice and attitudes. Br Dent J 217: E7

Summary of: Reporting of occupational exposures to blood and body fluids in the primary dental care setting in Scotland: an evaluation of current practice and attitudes.

Objectives To evaluate experience, practice and beliefs regarding occupational exposures to blood and oral fluids among a random sample of 300 dentists working in Scotland's NHS primary dental services. Method A cross-sectional postal survey assessed occupational exposure policies and procedures, recent occupational exposure incidence and current management. Beliefs were measured using constructs from the theory of planned behaviour, shown to influence behaviour in this population. Results Forty-two percent of dentists responded. Fourteen percent had sustained an occupational exposure in the previous 12 months; of those, 35% did not report their exposure. All respondents' practices had protocols in place for managing and reporting dental team member sharps injuries. Most (82%) had protocols for mucocutaneous exposures. Less than half (48%) had a protocol for managing and reporting patient exposures to blood or saliva. Dentists placed significantly more importance (z-score −4.44, p value <0.001) and necessity (z-score −4.17, p value <0.001) on reporting patient exposure than dentist occupational exposure. Conclusion This study suggests that while dentists generally have positive beliefs about reporting occupational exposures, there are gaps in practice.

Effectiveness of Health Belief Model in Motivating for Tobacco Cessation and to Improving Knowledge, Attitude and Behavior of Tobacco Users

There is an alarming increase in tobacco use in younger generation & it is responsible for 90% of oral cancers. A quasi-experimental study was conducted in dental health care settings to assess the effectiveness of health education in improving knowledge, attitude and behaviors of current tobacco users, towards tobacco use, among the patients visiting dental health settings. Study comprised of 20-35 years 88 current tobacco users. Health education was based on the Health Belief Model (HBM). Questionnaire was used to assess knowledge, attitude, and behavior of subjects. Leaflet and video were prepared for aid in health education Descriptive analysis, Paired t-test, Stratified analysis, Pearson Correlation analysis were employed. Improvement in decision to enl in to the tobacco cessation program was 33.7%. There was a statistical significant improvement in knowledge and attitude, of all subjects, in behavior domain significant improvement seen in subjects aged between 20-25 years, literate, smokers, and those utilizing dental health care services more than once in a year. Results of this study concluded that health education based on HBM was effective in motivating to enroll in to tobacco cessation program and improving knowledge and attitude of the tobacco users towards tobacco use and in improving behaviors of younger subjects, literates, smokers and subjects utilizing the dental health services more than once in year.

A survey of the perception of comprehensiveness among dentists in a large Brazilian city.

Objectives: To quantitatively identify the perception of dentists regarding comprehensiveness and its domains of “patient welcoming”, “bonding” and “quality of care” in primary dental care settings of a large Brazilian city. Methods: A questionnaire was administered to all dentists comprising the primary health care service to Belo Horizonte with tenured jobs and 40 work hours per week, totalling a population of 207 professionals. The response rate was 90.34%. A pilot test was conducted with 44 dentists working in primary care for at least two years and who did not participate in the main study. Descriptive statistical analysis involved calculating proportions. No confidence intervals were calculated because this was a census study. Results: In most items (79.0%), professionals’ perceptions about the comprehensiveness were overwhelmingly positive. When we stratified the analysis by domain and checked those items about which dentists had a less favourable perception, 22.7% were in the patient welcoming domain, 25.0% were in the bonding domain and 12.5% were in quality of care. Conclusions: Comprehensiveness, as an approach in health care practice, needs to be enhanced, and there is evidence that these dentists are aware of its importance.

Type 2 diabetes risk screening in dental practice settings: a pilot study.

Dental surgeries are highlighted in the 2012 NICE guidance Preventing type 2 diabetes: risk identification and interventions for individuals at high risk as a suitable setting in which to encourage people to have a type 2 diabetes risk assessment. To assess the feasibility of implementing a type 2 diabetes risk screening pathway in dental settings using the NICE guidance tool. The study was carried out over two weeks in June 2013. The validated tool in the NICE guidance was used to determine risk. This included a questionnaire and BMI measurement used to determine a risk score. Patients were rated low, increased, moderate or high risk. All patients were given written advice on healthy lifestyle. Patients who were moderate or high risk were referred to their general medical practitioners for further investigation. Participating dental teams were asked to nominate a member who would be responsible for overseeing the screening and training the other team members. A total of 166 patients took part in the pilot (58% male, 75% aged 49 years or younger and 77% were from BME groups). Twenty-six low risk patients (15.7%), 61 increased risk patients (36.7%), 49 moderate-risk patients (29.5%) and 30 high-risk patients (18.1%) were identified during the pilot. Fifteen of the 49 patients (30.6%) identified as moderate-risk and 6 of the 30 high-risk patients (20%) had visited their GP to discuss their type 2 diabetes risk in response to the screening. The pilot suggests that people at risk of developing type 2 diabetes could be identified in primary, community and secondary dental care settings. The main challenges facing dental staff were time constraints, limited manpower and the low number of patients who visited their GP for further advice.

Summary of: type 2 diabetes risk screening in dental practice settings: a pilot study.

Dental surgeries are highlighted in the 2012 NICE guidance Preventing type 2 diabetes: risk identification and interventions for individuals at high risk as a suitable setting in which to encourage people to have a type 2 diabetes risk assessment. To assess the feasibility of implementing a type 2 diabetes risk screening pathway in dental settings using the NICE guidance tool. The study was carried out over two weeks in June 2013. The validated tool in the NICE guidance was used to determine risk. This included a questionnaire and BMI measurement used to determine a risk score. Patients were rated low, increased, moderate or high risk. All patients were given written advice on healthy lifestyle. Patients who were moderate or high risk were referred to their general medical practitioners for further investigation. Participating dental teams were asked to nominate a member who would be responsible for overseeing the screening and training the other team members. A total of 166 patients took part in the pilot (58% male, 75% aged 49 years or younger and 77% were from BME groups). Twenty-six low risk patients (15.7%), 61 increased risk patients (36.7%), 49 moderate-risk patients (29.5%) and 30 high-risk patients (18.1%) were identified during the pilot. Fifteen of the 49 patients (30.6%) identified as moderate-risk and 6 of the 30 high-risk patients (20%) had visited their GP to discuss their type 2 diabetes risk in response to the screening. The pilot suggests that people at risk of developing type 2 diabetes could be identified in primary, community and secondary dental care settings. The main challenges facing dental staff were time constraints, limited manpower and the low number of patients who visited their GP for further advice.

Dentists United to Extinguish Tobacco (DUET): a study protocol for a cluster randomized, controlled trial for enhancing implementation of clinical practice guidelines for treating tobacco dependence in dental care settings.

BackgroundAlthough dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence.Methods/DesignGuided by a multi-level, conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery, the current protocol will use a cluster, randomized design and multiple data sources (patient exit interviews, provider surveys, site observations, chart audits, and semi-structured provider interviews) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City. The specific aims of this comparative-effectiveness research trial are to: compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines—staff training and current best practices (CBP), CBP + provider performance feedback (PF), and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay-for-performance, or P4P); examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The primary outcome is change in providers’ tobacco treatment practices and the secondary outcomes are cost per quit, use of tobacco cessation treatments, quit attempts, and smoking abstinence.DiscussionWe hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies (CBP, PF, and P4P) will be superior to CBP alone and CBP + PF in improving delivery of cessation assistance to smokers. The findings will improve knowledge pertinent to the implementation, dissemination, and sustained utilization of evidence-based tobacco use treatment in dental practices.Trial registrationNCT01615237.

Effect of Different Disinfection Protocols on Microbial and Biofilm Contamination of Dental Unit Waterlines in Community Dental Practices

Output water from dental unit waterlines (DUWLs) may be a potential source of infection for both dental healthcare staff and patients. This study compared the efficacy of different disinfection methods with regard to the water quality and the presence of biofilm in DUWLs. Five dental units operating in a public dental health care setting were selected. The control dental unit had no disinfection system; two were disinfected intermittently with peracetic acid/hydrogen peroxide 0.26% and two underwent continuous disinfection with hydrogen peroxide/silver ions (0.02%) and stabilized chlorine dioxide (0.22%), respectively. After three months of applying the disinfection protocols, continuous disinfection systems were more effective than intermittent systems in reducing the microbial contamination of the water, allowing compliance with the CDC guidelines and the European Council regulatory thresholds for drinking water. P. aeruginosa, Legionella spp, sulphite-reducing Clostridium spores, S. aureus and β-haemolytic streptococci were also absent from units treated with continuous disinfection. The biofilm covering the DUWLs was more extensive, thicker and more friable in the intermittent disinfection dental units than in those with continuous disinfection. Overall, the findings showed that the products used for continuous disinfection of dental unit waterlines showed statistically better results than the intermittent treatment products under the study conditions.

Mandibular Advancement Device Therapy in Obstructive Sleep Apnea and Snoring in Community Dental Care: Two-year Follow-up Study on Self-reported Sleep Quality, Side Effects, and Compliance

Study background: Obesity is constantly increasing health problem worldwide and so are its detrimental consequences, including obstructive sleep apnea (OSA). Mandibular advancement devices (MADs) are proven to be efficient in treating mild to moderate OSA and snoring. We followed for two years 103 patients treated with a titrable MAD in a Community Dental Care setting. Methods: A follow-up questionnaire was mailed in 2012 to 124 patients who had participated in a survey 2010 and given their consent for further study. Results: Of all the 103 respondents 85% (n=88) still used MAD. Subjective tiredness (p<0.05) and the presence of any snoring (p<0.01) were reported more often in the long-term study than in the short-term study. In contrast, difficulty in initiating sleep with the device in situ was seen less often (p<0.05). According to the logistic regression, reduced loud snoring was significantly associated with the compliance of frequent wear of MAD (p<0.05). The majority (82%) of the patients also reported a positive impact of MAD in social (family) life due to reduced loud snoring. Conclusion: Titrable MAD is a noteworthy treatment modality for mild to moderate OSA and especially snoring. Compliance in using MADs and reported subjective health seem to remain at good level. General dentists could probably perform a great part of the care. However, possible worsening of OSA and side effects of MADs should be borne in mind.

Dental care providers' and patients' perceptions of the effect of health information technology in the dental care setting

The use of electronic health records (EHRs) in dental care and their effect on dental care provider-patient interaction have not been studied sufficiently. The authors conducted a study to explore dental care providers' interactions with EHRs during patient visits, how these interactions influence dental care provider-patient communication, and the providers' and patients' perception of EHR use in the dental clinic setting during patient visits. The authors collected survey and interview data from patients and providers at three dental clinics in a health care system. The authors used qualitative and quantitative methods to analyze data obtained from patients and dental care providers. The provider survey results showed significant differences in perceptions of EHR use in patient visits across dental care provider groups (dentists, dental hygienists and dental assistants). Patient survey results indicated that some patients experienced a certain level of frustration and distraction because of providers' use of EHRs during the visit. The provider survey results indicated that there are different perceptions across provider groups about EHRs and the effect of computer use on communication with patients. Dental assistants generally reported more negative effects on communication with patients owing to computer use. Interview results also indicated that dental care providers may not feel comfortable interacting with the EHR without having any verbal or eye contact with patients during the patient's dental visit. A new design for dental operatories and locations of computer screens within the operatories should be undertaken to prevent negative nonverbal communication such as loss of eye contact or forcing the provider and patient to sit back to back, as well as to enhance patient education and information sharing.

Considerations and lessons learned from designing a motivational interviewing obesity intervention for young people attending dental practices: A study protocol paper

BackgroundWith the prevalence of child obesity increasing worldwide, and the consumption of sugar-sweetened beverages identified as a major contributor to obesity in adolescents, there is a need for effective interventions aimed at dietary behaviour change in this group. Primary dental care settings are in an ideal position to influence adolescents' dietary behaviours, yet have been under-utilised for this purpose. Motivational Interviewing (MI) has shown promise in influencing other health behaviours. However, there is lack of published methodologies on which to base the design of such interventions, and limited evidence on its effectiveness in influencing dietary change. We undertook a study to test the feasibility of a MI intervention aimed at reducing soft drink consumption in adolescents attending dental surgeries. We present the study design for the development and evaluation of the intervention. MethodTen dental practices in north London were randomised into control or intervention. Adolescent participants in control settings received routine advice and intervention participants received a brief MI intervention. The intervention was designed using comprehensive stakeholder engagement and consisted of 3–4 short MI sessions and a maintenance phase delivered by trained researchers through the use of age-specific resources. Process evaluation was carried out using qualitative and quantitative methods to assess intervention feasibility in a primary dental care setting. DiscussionBy focussing on the development and evaluation of the intervention, this paper contributes to the limited available knowledge and identifies methodological considerations for undertaking a MI intervention for dietary change in adolescents in primary dental care settings.

Breaking bad medical news in a dental care setting

Dental care providers may diagnose diseases and conditions that affect a patient's general health. The authors reviewed issues related to breaking bad medical news to dental practice patients and provide guidance to clinicians about how to do so. To help reduce the potentially negative effects associated with emotionally laden communication with patients about serious health care findings, the authors present suggestions for appropriately and sensitively delivering bad medical news to both patients and their families in a supportive fashion. Preparing to deliver bad news by means of education and practice is recommended to help prevent or reduce psychological distress. One form of communication guidance is the ABCDE model, which involves Advance preparation, Building a therapeutic relationship or environment, Communicating well, Dealing with patient and family reactions, and Encouraging and validating emotions. An alternative model is the six-step SPIKES sequence-Setting, Perception, Invitation or Information, Knowledge, Empathy, and Strategize and Summarize. Using either model can assist in sensitive and empathetic communication. For both practitioners' and patients' well-being, empathetic and effective delivery of bad medical news should be included in dental school curricula and continuing education courses. Dental care providers should be familiar with the oral manifestations of diseases and the care needed before the patient undergoes medical treatment and use effective communication necessary to share bad news with patients.