Dental Practitioners In England Research Articles

The development of digital dentistry in the UK: An overview.

The COVID-19 pandemic has highlighted the benefits which digital technology offers to all aspects of dental practice and education. This paper provides an overview of how digital technology has enhanced clinical and administrative procedures within dental practice, including computer-aided design/computer-aided manufacture (CAD/CAM), digital radiography, 3D printing, patient records, electronic patient referrals and electronic communications from dental practices. It then considers the development of teledentistry (mHealth) and its benefits in enabling distant consultations with patients, who for one reason or another are unable to visit dental practices easily. It then goes on to consider how and why digital dental distance learning materials were provided to general dental practitioners in England by the Department of Health (DoH) (England) and how they evolved. Finally, this paper considers the use of digital technology in dental education by dental schools.

Impact of the Covid pandemic on health care equity in NHS General Dental Practice.

Oral health inequalities existed before Covid, but the pandemic presented an unprecedented challenge for health services. Our aim was to determine whether patient groups at risk of health care inequality due to the pandemic could be identified from NHS dental claims. Secondary analysis of routinely collected NHS Business Services Authority data for patients treated by General Dental Practitioners in England and Wales between April 2019 and January 2022 to assess the effect of the Covid pandemic on claims for patients attending general dental practices. Data for treatment items claimed after the start of the first lockdown were compared to the pre-lockdown period. The proportion of claims for child fillings, child extractions and child fluoride varnish application after March 2020 were lower than equivalent proportions for adults, in both England and Wales. Similarly, there were consistently fewer claims for fillings and extractions for patients claiming pension credit guarantee credit than all pensioners in both England and Wales. The Covid pandemic may have caused health care inequality for children and patients claiming pension credit guarantee credit. This may compound the inequality in oral health for these patients.

Molar-incisor hypomineralisation combat: exploratory qualitative interviews with general dental practitioners in England regarding the management of children with molar-incisor hypomineralisation.

Introduction Molar-incisor hypomineralisation (MIH) presents as a spectrum, with severe cases becoming increasingly complex to manage. This study aimed to investigate the perceptions and experience of general dental practitioners (GDPs) in England when managing children with MIH.Method Semi-structured telephone interviews with GDPs who regularly treat children took place in May 2020. A sample of four male and six female GDPs with 1-15 years of experience was achieved through purposively sampling interested parties following advertisement via professional groups. Thematic analysis using a realist and inductive approach was used in analysis.Results The overarching theme was of managing uncertainty, with four subthemes: setting the scene; fighting the tooth; working within the system; and self and interpersonal insight. Despite being knowledgeable, participants expressed varying levels of confidence in many aspects while managing children with MIH. There was a great deal of uncertainty surrounding 'doing the right thing' across the themes. Systemic barriers to managing children with MIH within the general dental service were identified.Conclusion The challenges of managing children with MIH was experienced as 'uncertainty'. Barriers within the general dental service made managing children with MIH difficult and participants relied on colleagues in secondary care to manage severe cases.

The effect of SARS-CoV-2 on the prescribing of antimicrobials and analgesics by NHS general dental practitioners in England.

Aims To ascertain the effect of SARS-CoV-2 on the utilisation of antibacterial agents and analgesics in primary dental care.Methods Antibacterial agents and analgesics (eg paracetamol, aspirin) prescribed in England by general dental practitioners for the periods April-July 2019 and April-July 2020 were analysed.Results Antibacterial agents prescribed during COVID-19 restrictions in 2020 (799,282) were higher than a similar time period in 2019 (654,332) by 22%. Amoxicillin was used the most (2020 = 65.0%; 2019 = 66.3%) followed by metronidazole (2020 = 30.2%; 2019 = 28.7%). Erythromycin was prescribed at a similar rate, with lincosamides (clindamycin) prescribed more frequently in 2020 (2020 = 0.6%; 2019 = 0.5%). Clarithromycin was prescribed twice more often in 2020 (0.6%) in comparison to 2019 (0.3%). Co-amoxiclav (0.5%) and phenoxymethylpenicillin (0.3%) were prescribed at a similar rate. Analgesics use increased by 84% (2020 = 28,563; 2019 = 15,507). Use of dihydrocodeine tartrate increased (2020 = 40.9%; 2019 = 32.9%), followed by diclofenac sodium (2020 = 24.6%; 2019 = 12.8%). The opposite trend was seen in relation to ibuprofen with use decreasing (2020 = 19.4%; 2019 = 39.8%) while paracetamol use only slightly increasing (2020 = 15.1%; 2019 = 14.6%).Conclusions COVID-19 restrictions on dental care in England resulted in a marked increase in prescribing antibacterial agents and a very marked increase in prescription-only analgesics.

Clinical oral microbiology and antimicrobial susceptibility – does it matter?

ABSTRACTLittle surveillance data is undertaken on the antimicrobial susceptibility of isolates from acute dento-alveolar infections. We present data collated from routine diagnostic microbiology specimens submitted over a 27 year period in Glasgow, UK. Over the study period isolates were identified using the API system, VITEK 2 and MALDI-TOF. Antimicrobial susceptibility tests were undertaken using combinations of Stokes method and/or E-tests. Baseline data based on Lewis et al., (JAC 23,69-77 1989) and compared to isolates from 1998-2015. From 621 specimens, we isolated Anginosus group streptococci (n = 196), Mitis group Streptococci (n = 448), anaerobic streptococci (n = 116), Fusobacteria (n = 121) and Prevotella (n = 140) species. No discernable increase in resistance patterns over the 27 year time period of analysis was observed. A 6 month audit (May-Oct 2016) in Glasgow recorded 37 patients hospital admissions for 142 bed days (mean 3.5 days) to incise and drain severe odontogenic infections. But, dental practitioners in England (2015) prescribed 10,717 items of cephalosporins and 18, 630 items of augmentin (Source: Health and Social Care Information Centre) – why?Diagnostic oral microbiology matters in guiding antimicrobial stewardship programs but more collaborative working on processing methods and routine susceptibility data would help overcome limited data from single centers.

Embracing an evidence-based toolkit for prevention – personal accounts

Recent changes in healthcare include a shift from mainly restorative or operative-focused healthcare towards more preventive models of patient care. Oral diseases are common and yet largely controllable, thus it is increasingly a priority for dental professionals to support patients in order to promote good health and control disease in an evidence-informed manner. The publication of the first edition of Delivering Better Oral Health – An Evidence-based Toolkit for Prevention, in England in 2007, 1 was an important milestone in this process. It provided dental practitioners in England with a clear synthesis of contemporary evidence. These practical guidelines, now updated, offer the potential for consistency in practice and emphasize the importance of delivering preventive dentistry for everyone in the population, together with special measures for high-risk patients. Clinical Relevance: This article provides an overview of the key messages in Delivering Better Oral Health and explores how these evidencebased guidelines may be implemented by dental professionals across education, policy and practice, based on personal examples from previous editions. 1 , 2 This article is of relevance for all dental professionals and can act as a guide to implementing the recently published updated Toolkit. 3

An Investigation of the Attitudes and Fears of Vocational Dental Practitioners in England and Wales in 2007

The aim of this study was to investigate whether recent changes in the National Health Service (NHS) dental contract may have caused increased anxiety and concern among vocational dental practitioners (VDPs). A total of 606 questionnaires, which had previously been piloted, were distributed to VDPs across England and Wales at the end of the vocational training (VT) year in 2007. The questionnaires contained a range of questions about VDPs' attitudes and fears, the influence that they perceived the new dental contract for the General Dental Services of the NHS had on their VT training experience, and their expectations for the future. A 71% response rate was achieved. The results reflected changes in opinion about the dental profession among VDPs between when they applied for university and six years later on their completion of VT. During this period, they reported that their feelings of job security had declined from 93.1% (n=390) to 34.1% (n=145) and financial security from 94.8% (n=405) to 51.5% (n=219). Anxiety about the potential lack of funding in the NHS was felt by 77.6% (n=330). The effect of increasing numbers of dental graduates on employment prospects produced anxiety in 72.5% (n=305) of VDPs. On completion of VT, 19.4% (n=83) of VDPs did not have employment for the following year. At present, the future is more uncertain for new dental graduates than in the past. The dental profession needs to become more aware of the pressures that graduates are facing and further research is needed to investigate them and the effects that they are having on the future of dentistry.

Post-impact evaluation of an e-learning cross-infection control CD-ROM provided to all general dental practitioners in England

To carry out a post-impact evaluation of a cross-infection control CD-ROM, developed for NHS dental teams as a continuing professional development e-learning tool. The program was commissioned by the Department of Health and developed by a project team through the UK Committee of Postgraduate Dental Deans. The Dental Practice Board had originally sent one copy of the CD-ROM to each dental practice in England in 2004. A quantitative statistical analysis of the results of 326 online respondents to the learning package and a survey of 118 dental practitioners drawn from the Dental Practice Board database. Practitioners felt the CD-ROM in this instance was well-designed and appropriate for their needs. It is inclusive and accessible to a wide range of dental professionals including nurses and hygienists. This form of continuing professional development is popular with dental practitioners, although it should not be the only form of continuing professional development available. However, whilst the project was generally regarded as successful, there were problems with the distribution of the CD-ROM. This suggests that an online resource should be made available in the future.

Radiographic equipment and techniques used in general dental practice. A survey of general dental practitioners in England and Wales

Objectives. The aims of this study were to determine the self-reported use of panoramic radiography, D- and E-speed film, rectangular collimation, film holders, equipment fitted with a long spacer cone (>200 mm) and the bisecting angle and paralleling techniques by general dental practitioners and to see if use was related to the dentists’ age and postgraduate qualifications. Methods. Three mailings of a self-completion questionnaire were circulated to 800 general dental practitioners working in the National Health General Dental Service in England and Wales. Results. A response rate of 74% was achieved. Sixty-one percent of general dental practitioners reported use of panoramic equipment. Fifty percent of dentists always used E-speed film and 18% always used rectangular collimation. Sixty-eight percent of dentists always used bitewing film holders though fewer (37%) used periapical film holders. Sixty-three percent of dentists always used a long cone. The bisecting angle technique was used by 70% of dentists with 22% always using this technique for periapical radiographs. Thirty-one percent always used the paralleling technique. Use of panoramic equipment, periapical film holders, bisecting angle and paralleling techniques were associated with the dentists' age. Use of periapical film holders, bisecting angle and paralleling techniques and rectangular collimation were associated with dentists' postgraduate qualifications. Conclusions. There are several features of radiographic equipment and techniques that can aid high quality imaging and reduce patient dose. Although a number of these are being used in general dental practice in England and Wales they have yet to achieve universal adoption.

Paediatric antibiotic prescribing by general dental practitioners in England.

The inappropriate use of antibiotics is known to be a major contributory factor to the problem of antimicrobial resistance. No information is available on how practitioners prescribe antibiotics for children. This study investigated the prescribing of liquid-based antibiotics for children by general dental practitioners in England. Analysis of National Health Service liquid-based prescriptions issued by general dental practitioners in England. All prescriptions issued by practitioners in 10 Health Authorities in England for February 1999 were collected. All the liquid-based antibiotic prescriptions for children were selected and we investigated the type of antibiotic prescribed, whether sugar free, the dose, frequency and duration. A total of 18,614 prescriptions were issued for antibiotics. Of the 1609 liquid-based paediatric prescriptions 88.3% were for generic and 11.7% for proprietary antibiotics, of which 75.5% were for amoxicillin, 15.2% for phenoxymethylpenicillin, 6.6% for erythromycin, 1.7% for metronidazole. Cephalexin, ampicillin, cephadrine and combinations of two antibiotics were also prescribed. There was a wide variation in dosages for all the antibiotics prescribed. A significant proportion of practitioners prescribed at frequencies inconsistent with manufacturers' recommendations and for prolonged periods, with some practitioners prescribing for periods up to 10 days. Only 29.1% of all the prescriptions issued were sugar free. The results of this study show that some practitioners prescribe liquid-based antibiotics inappropriately for children. This may contribute to the problem of antimicrobial resistance. Clear guidelines on the choice of antibiotic, dose, frequency and duration along with educational initiatives for GDPs might reverse this trend.

Inequalities in availability of National Health Service general dental practitioners in England and Wales

Inequalities in availability of National Health Service general dental practitioners in England and Wales

Inequalities in availability of National Health Service general dental practitioners in England and Wales.

To model the inequalities in availability of National Health Service general dental practitioners in England and Wales in relation to key socio-demographic factors. Current estimates of the numbers of NHS general dental practitioners for each health authority were related to data from the 1991 census using Poisson regression models, and generalised estimating equations to allow for correlation between results for neighbouring health authorities. An 'average' health authority, without a dental school, would be expected to have 2,138 residents for every NHS dentist. Controlling for relevant factors, health authorities with higher proportions of the following are associated with lower (better) population to dentist ratios by the amounts shown: each 1% higher female population (-11.8%; 95%CI -19.1%, -3.9% P = 0.004); each 1% greater South Asian population (-1.4%; 95%CI -2.1%, -0.7% P <0.001). A health authority with a dental school is associated with a more favourable ratio compared with one without such a facility (-9.2%; 95%CI -16.2%, -1.6% P = 0.019). Each additional 1% of the following are associated with a worse ratio by the amounts shown: children aged 0 to 14 years old (+5.2%; 95% CI +2.4%, +8.1% P < 0.001); adults aged over 65 years old (+2.8%, 95%CI +1.0%, +4.7% P =0.002); households without a car (+0.8%; 95%CI 0.0%, +1.6% P =0.042). Ensuring access to dental care may be a more complex issue than simply providing adequate numbers of dentists at a national level. Any manpower planning exercise should additionally consider local factors that may act as incentives or disincentives to those professionals who provide care.

Reasons for extraction by dental practitioners in England and Wales: a comparison with 1986 and variations between regions

Objectives: To compare reasons for extraction in 1997 and 1986, and to consider regional variations for the 1997 data. Methods: Random samples of general dental practitioners (GDPs) completed questionnaires for all extractions for 4 weeks in 1986 and in 1997. Reasons for extraction by region were compared for the 1997 data. Results: 220 and 562 GDPs participated in 1986 and 1997, respectively, averaging 24 extractions in 1986 and 20 in 1997. ‘Caries’ remained the commonest reason for ≤50-year-olds (excluding ‘ortho’), but peaked a decade later than in 1986. One-third of ‘perio’ extractions in both studies were for 51–60-year-olds, but in 1997 there were fewer such extractions for ≤40-year-olds and more for >70-year-olds than in 1986. In 1997 ‘caries’ and ‘perio’ extractions remained equally common for patients >50 years, but there were far more extractions for both reasons for >80-year-olds. Patients ≤30 years in S. England and in the Midlands/E. Anglia had more ‘ortho’ than ‘caries’ extractions, whereas ‘caries’ predominated in N. England and in Wales. ‘Caries’ exceeded ‘perio’ for patients >40 years in Wales, whereas in the three English regions the two reasons were equally frequent. Conclusions: Comparisons of results of two studies conducted a decade apart indicate that there have been some changes in reasons for extraction. Overall, mean number of extractions per dentist has declined, and it appears that the trend is for extractions due to the common dental diseases to be carried out later in life. The 1997 data also suggest that young patients in Wales and N. England are relatively disadvantaged, having more caries and less orthodontic treatment than those in other parts of England.

Modelling inequalities in the availability of National Health Service GDPs to socio-demographic factors

Aim To model the inequalities in availability of National Health Service general dental practitioners in England and Wales in relation to key socio-demographic factors. Methods Current estimates of the numbers of NHS general dental practitioners for each health authority were related to data from the 1991 census using Poisson regression models, and generalised estimating equations to allow for correlation between results for neighbouring health authorities. Results An 'average' health authority, without a dental school, would be expected to have 2,138 residents for every NHS dentist. Controlling for relevant factors, health authorities with higher proportions of the following are associated with lower (better) population to dentist ratios by the amounts shown: each 1% higher female population (–11.8%; 95%CI –19.1%, –3.9% P = 0.004); each 1% greater South Asian population (–1.4%; 95%CI –2.1%, –0.7% P <0.001). A health authority with a dental school is associated with a more favourable ratio compared with one without such a facility (–9.2%; 95%CI –16.2%, –1.6% P = 0.019). Each additional 1% of the following are associated with a worse ratio by the amounts shown: children aged 0 to 14 years old (+5.2%; 95% CI +2.4%, +8.1% P < 0.001); adults aged over 65 years old (+2.8%, 95%CI +1.0%, +4.7% P =0.002); households without a car (+0.8%; 95%CI 0.0%, +1.6% P =0.042). Conclusions Ensuring access to dental care may be a more complex issue than simply providing adequate numbers of dentists at a national level. Any manpower planning exercise should additionally consider local factors that may act as incentives or disincentives to those professionals who provide care.

Antibiotic prescribing knowledge of National Health Service general dental practitioners in England and Scotland.

The inappropriate use of antibiotics has contributed to the worldwide problem of antimicrobial resistance. Information on the knowledge, understanding and training of dental practitioners in the use of antibiotics in clinical practice is scarce. This study assessed the level of knowledge of general dental practitioners and the need for educational initiatives. An anonymous postal questionnaire was sent to National Health Service dental practitioners working in 10 Health Authorities in England (1544) and four Health Boards in Scotland (672). Each correct answer to the questionnaire was given a score of one mark; there were 84 questions. The scores for each section of the questionnaire were compared. Responses were received from 1338 (60.4%) of practitioners, of whom 22.1% had attended postgraduate courses in the previous 2 years on antibiotic prescribing. Practitioners who had attended courses had a significantly greater knowledge of antibiotic use (P < 0.05) than those who had not. There was no significant difference in knowledge between all age groups under 60 years of age. There were significant differences in knowledge between dentists practising in English Health Authorities and Scottish Health Boards (P < 0.01). Knowledge was good for clinical signs that are indicators for prescribing antibiotics and for a number of non-clinical factors, e.g. patient expectation. Knowledge of therapeutic prescribing for commonly presenting clinical conditions and prophylactic prescribing for medically compromised patients, however, was generally poor. This study has shown that an urgent review of dental undergraduate and postgraduate education in antibiotic prescribing is required. Provision of prescribing guidelines may improve knowledge and encourage the appropriate use of antibiotics in clinical dental practice.

An analysis of antibiotic prescriptions from general dental practitioners in England.

The aim of this study was to determine the antibiotics prescribed by general dental practitioners (GDPs). Adult antibiotic prescriptions issued by GDPs from 10 Health Authorities (HAs) in England were analysed. The type of antibiotic prescribed, dose, frequency and duration were investigated. Most of the 17007 prescriptions were for generic antibiotics; nine different antibiotics were prescribed. Many practitioners prescribed antibiotics inappropriately with inconsistent frequency and dose, and for prolonged periods.

Factors associated with skin irritation of the hands experienced by general dental practitioners

Practising dental surgeons are now wearing gloves for longer periods of time than any other comparable group. As part of a study to assess dentists' attitudes to cross-infection, a questionnaire was sent to 1950 randomly selected general dental practitioners in England and Wales, with information being requested concerning the incidence of skin irritation of the hands considered to be associated with glove wearing. The response to the questionnaire was 61%, with 29% of respondents indicating that they experienced skin irritation. A strong association was identified between pattern of glove wearing and incidence of skin irritation, with routine glove wearers being more likely to suffer skin irritation than occasional glove wearers. Female respondents were also more likely to have experienced skin irritation than male respondents. No association was identified between reported incidence of skin irritation and practising arrangements, years since graduation and number of years of glove wearing.

Consultant opinion on orthodontic treatment plans used by dental practitioners: a pilot study

Prior to 1987, dental practitioners in England and Wales intending to carry out all but the simplest orthodontic treatment within the National Health Service, were required to submit pretreatment study models, details of the orthodontic assessment and the proposed treatment plan to the Dental Estimates Board prior to starting treatment. Models taken at the end of treatment were required by the Board to enable payment to be made. In this pilot study, the acceptability of orthodontic treatment plans used by practitioners working in the General Dental Services was assessed by eight hospital consultants, using information about 40 cases submitted to the Dental Estimates Board in 1987/88. All consultants considered a high proportion of plans to be unacceptable, but agreement between the consultants was variable and some agreed with one another on very few plans. A single scorer used the weighted PAR (Peer Assessment Rating) index to assess the degree of departure from normal occlusion of both pre- and post-treatment models. Using accepted standards, only nine cases were greatly improved (PAR reduction > 70%) and the mean percentage reduction in PAR score was low. Consultant opinion on the appropriateness of treatment planning was not related to the outcome of orthodontic treatment.

Reasons given for extraction of permanent teeth by general dental practitioners in England and Wales.

Reasons given for extraction of permanent teeth by general dental practitioners in England and Wales

Aspects of general dental practice in the national health service

This paper is concerned with the pattern of care delivered by general dental practitioners in England and Wales under the aegis of the National Health Service. The main feature of the results is the high degree of variability in the extent and content of the workload of individual practitioners. The most important factors include geographical location, sex, age and partnership arrangements. The emphasis given to conservation is highest in regions with the highest per capita proportions of practitioners and vice versa. Female dentists carry out only about three-fifths of the numbers of courses of treatment, fill only about three-fifths of the numbers of permanent teeth and extract only about two-fifths of the numbers of permanent teeth as do their male colleagues of the same age. For male practitioners the average number of courses of treatment reaches a peak in the 35–39 years age-group and subsequently decreases with increasing age. There is a general tendency for the age of the dentist to be positively correlated with the age of his or her patients. Even when this effect is taken into account, there is a marked difference in the content of the workload with the age of the dentist, younger male practitioners giving greater emphasis to conservation than older male practitioners. In all age groups, the emphasis given to conservation tends to decrease as the size of the workload increases. The pattern of care is also associated with partnership arrangements. On average, dentists working in partnerships carry out about ten per cent more courses of treatment than colleagues of the same age and sex working single-handed, and the ratio of permanent teeth filled to permanent teeth extracted tends to be lower in partnerships.