NHS Dentists Research Articles

Have your say on NHS dentists' pay

Have your say on NHS dentists' pay

Does the NHS Dental Workforce Plan in England align with the UN Sustainable Development Goals?

Does the NHS Dental Workforce Plan in England align with the UN Sustainable Development Goals?

The impact of restricted access on the need and demand for specialist dental services - A consideration for future needs assessments.

The COVID-19 pandemic forced NHS Dental Services to adapt quickly and implement measures which would safeguard essential care provision, whilst mitigating COVID-19 transmission risks. However, these changes impacted on both dental access, and onward referrals for specialist care. A longitudinal study design is used to offer descriptive analysis of referrals sent across three referral groups (orthodontics, paediatric dentistry, suspected cancers) across three time-matched periods (1st July to 31st December in 2019, 2020 and 2021). Anonymised data, extracted from an electronic referral management system (eRMS), are considered. Number of referrals, reasons for referral, Indices of Multiple Deprivation for each referral are discussed. Referrals reduced from 2019 to 2020. Proportionally, the greatest reduction in onward referral was observed amongst individuals from the lowest socioeconomic positions, across all groups. Although mandated to conduct only 62.5% of the 2019 activity, the 2021 referrals exceeded 2019 figures. Proportions referred from the lowest socioeconomic position were still slightly lower across all three groups. Referrals from the lowest socioeconomic groups decreased in 2020, followed by a rebound in 2021, despite a reduction in mandated clinical activity. There are potential implications for future oral health needs assessments that should be considered when developing interventions to enhance access for vulnerable populations as we emerge from the COVID-19 pandemic.

Scottish NHS dentists issue open letter to new First Minister

Scottish NHS dentists issue open letter to new First Minister

P141 Periodontal assessment and treatment among individuals at-risk of rheumatoid arthritis: a qualitative study

Abstract Background/Aims Periodontitis is a chronic inflammatory disease affecting almost half of adults in the UK and is a leading cause of tooth loss. Current evidence suggests that periodontitis could be a causal risk factor for rheumatoid arthritis (RA) onset and progression, and periodontal treatment may improve disease activity in patients with established RA. Earlier periodontal intervention in individuals at-risk of RA could provide a unique opportunity to delay progression or prevent it entirely. This study aimed to explore the perceptions of oral health among individuals at-risk of developing RA and the perceived acceptability of preventive periodontal treatment. Methods This was a qualitative interview study employing a phenomenological approach. Anti-CCP positive at-risk individuals with musculoskeletal symptoms but no synovitis were recruited from the Leeds CCP cohort. Periodontal assessments and treatment were delivered by a dentist and/or oral hygiene therapist. Individual semi-structured interviews were conducted via video or telephone between March-June 2022. Interviews were audio-recorded and transcribed verbatim. Data were analysed using reflexive thematic analysis. Results Nineteen participants (ten women; age range 35-70) were interviewed. All had been offered periodontal assessment and treatment; four declined and nine had periodontal treatment. Three themes were identified: i) understanding risk; ii) oral health perceptions and experiences; iii) oral health treatment and maintenance. The majority of participants lacked awareness of the association between oral health and the risk of developing RA, and perceived lack of knowledge of this link among dentists. Preference for information provision relating to oral health as a risk factor varied extensively between participants. Negative perceptions towards dental appointments were common. Many participants identified the cost of dental treatment as an issue and expressed difficulty in accessing NHS dentists. Participants discussed oral health issues such as bleeding and sore gums, chipped and weak teeth, infections, and missing teeth. However, oral health was less of a priority when compared to comorbidities that had a bigger impact on daily life. Participation in a clinical trial involving preventive periodontal treatment was perceived to be acceptable for most participants. Facilitators included the personal benefits of being able to reduce risk, access a dentist, and not having to pay for treatment. Participants with dental phobia highlighted that seeing the same dentist at every visit was important. Perceived barriers included the location and time of appointments. Conclusion The impact of poor oral health may not be well understood by individuals at-risk of RA. Information relating to this risk factor should be tailored to the individual. Whilst periodontal disease is common in individuals at-risk of RA, seeking dental treatment can be hindered by dental phobia, treatment cost, or shortage of NHS dentists. A clinical trial involving preventive periodontal treatment is potentially acceptable for individuals at-risk of RA. Disclosure L.S. Chapman: None. K.A. Vinall-Collier: None. H.J. Siddle: None. Z. Mustufvi: None. K. Mankia: None. S. Serban: None.

Dentists' preparedness to provide Level 2 services in the North East of England: a mixed methods study.

Background Dentists capable of delivering Level 2 complexity treatments may benefit patient access to dental care and increase workforce morale. However, little is known about attitudes, capability and training needs relating to Level 2 dental services.Aims To examine attitudes to, and perceived readiness for delivery of Level 2 dental services by NHS dentists in the North East of England and North Cumbria.Method A sequential mixed methods study with an online survey and semi-structured interviews. Participants were general, community, and hospital-based dental practitioners. Descriptive statistics of survey and thematic analysis of qualitative data were undertaken.Results Overall, 56% of 124 respondents had a limited understanding of the Level 2 performer role. A minority felt they were already providing Level 2 care across all speciality areas; 9% (n = 11) had a professional portfolio suitable for Level 2 accreditation. Confidence to undertake Level 2 competencies varied by speciality area, being highest in paediatric dentistry, and lowest in endodontics and orthodontics. Qualitative data identified motivations, and personal, organisational and system factors that were seen as barriers or enablers to upskilling.Conclusion The regional NHS workforce is unprepared to provide Level 2 dental services. Successful introduction will require review of necessary infrastructure and transparency of accreditation and contracting processes.

Recruitment and retention in dentistry in the UK: a scoping review to explore the challenges across the UK, with a particular interest in rural and coastal areas.

Introduction There is currently reduced access to NHS dental services in the UK, particularly in England, with rural and coastal areas significantly affected. Recruitment and retention in dentistry has been highlighted as an issue contributing to the problem.Objectives To explore what is known or unknown about recruitment and retention of the dental workforce in the UK, with a particular focus on rural and coastal areas. We were keen to gain information relating to factors affecting recruitment and retention, geographical distribution of the workforce, anticipated challenges, strategies or proposals to assist workforce planning and the extent of empirical research.Methods Searches for peer-reviewed literature and reports were undertaken and included when they met the eligibility criteria. Data were extracted and the findings narratively synthesised.Discussion The findings suggested wide ranging recruitment and retention issues of the dental workforce in the UK. Most issues were associated with NHS dentists, followed by dental nurses across both the NHS and private sectors. The worst affected parts of the country were rural and coastal areas.Conclusion It appears from the evidence that there are many dental professionals discussing recruitment and retention issues, followed by stakeholders. However, there is limited research and data to initiate change.

Health-risk behaviours co-occur among children with untreated caries.

The aim of this study was to examine whether an aggregate of health risk behaviours is associated with the number of untreated dental caries among 12- and 15-year-old children in England, Wales and Northern Ireland. Data were from the Children's Dental Health Survey (CDHS) 2013, a nationally representative sample of England, Wales and Northern Ireland. The survey included assessment of oral health and data on socioeconomic, demographic and behavioural factors pertaining to children aged 12-15 years. Tooth condition (decayed, missing and filled) was assessed by NHS dentists. The survey included questions on age, sex, country, index of multiple deprivation, smoking, alcohol consumption, frequent sugar consumption and sweetened sodas, infrequent dental visit, infrequent toothbrushing and infrequent consumption of fresh fruits. Health risk behaviours were summed up to create an aggregate variable of health risk behaviour. The association between number of untreated caries and the aggregate of health risk behaviours was assessed using negative binomial regression and adjusting for age, sex, country and deprivation. The total number of children included in the analysis was 4414. The mean number of untreated caries was generally higher among children with health risk behaviours. The aggregate of risk behaviour was associated with greater prevalence of untreated dental caries with rate ratio (RR) 1.26 (95% confidence interval: 1.18, 1.36). This study demonstrated an association between an aggregate of health risk behaviours and untreated caries. The findings highlight the importance of addressing multiple risk factors not only those directly related to dental caries.

NHS dentists blast orders to return to virtually 'business as usual'

NHS dentists blast orders to return to virtually 'business as usual'

A qualitative exploration of decisions about dental recall intervals - part 2: perspectives of dentists and patients on the role of shared decision making in dental recall decisions.

Introduction Patients are sensitive to both the frequency and costs of dental recall visits. Shared decision making (SDM) is a principle of patient-centred care, advocated by the National Institute for Health and Care Excellence and policymakers, whereby joint decisions are made between clinicians and patients.Aims To explore NHS dentists' and patients' attitudes towards SDM in decisions about recall interval.Methods Semi-structured telephone interviews were conducted with 25 NHS patients and 25 NHS general dental practitioners in Wales, UK. Transcripts were thematically analysed.Results While many patients would be happy to accept changes to their recall interval, most wanted to be seen at least annually. Most patients were willing to be guided by their dentist in decisions about recall interval, as long as consideration was given to issues such as time, travel and cost. This contrasted with the desire to actively participate in decisions about operative treatment. Although the dentists' understanding of SDM varied, practitioners considered it important to involve patients in decisions about their care. However, dentists perceived that time, patient anxiety and concerns about potential adverse outcomes were barriers to the use of SDM.Conclusions Since there is uncertainty about the most clinically effective and cost-effective dental recall strategy, patient preference may play a role in these decisions.

NHS dental activity: a population marker for the effectiveness of community water fluoridation in children in England.

Aim To understand the possible beneficiary effects of artificial and naturally occurring water fluoridation on dental health of children, using routinely collected NHS Dental Statistics.Method A secondary analysis of the NHS Dental Statistics for England 2018-2019 dataset. The proportion of Band 1 courses of treatments are compared with Band 2, Band 3 and urgent treatments collectively, for children attending dental practices in naturally and artificially fluoridated local authorities compared with non-fluoridated authorities who are their statistical peers. Proportions of dental treatments are described by the levels of Index of Multiple Deprivation for the area in which the practice is located.Results The dataset had, 2,001,921 banded paediatric courses of treatment; 1,227,282 provided by dental practices in fluoridated local authorities and 774,639 in non-fluoridated local authorities. Water fluoridation was associated with a significant reduction in dental interventions in the most deprived populations. The proportions of active interventional treatments in the 10% most deprived decile (decile 1) are 0.243 (Cl 0.239-0.247) and 0.188 (Cl 0.184-0.191), in non-fluoridated and fluoridated local authorities, respectively.Conclusion Analysis of routinely collected NHS dental statistics shows potential utility as a tool for demonstrating the effects of community water fluoridation schemes in reducing oral health inequalities among the most deprived socioeconomic populations. The pattern of dental need and intervention is not as expected and therefore, further research is required to control for systematic confounding factors.

The 24-hour retirement rule for NHS dentists.

The 24-hour retirement rule for NHS dentists.

Audit and feedback with or without training in-practice targeting antibiotic prescribing (TiPTAP): a study protocol of a cluster randomised trial in dental primary care

BackgroundAntimicrobial resistance is an increasingly serious threat to global public health and patient safety. Overuse of antibiotics has aggravated this issue. Around 7% of all antibiotics in Scotland are prescribed by dentists. Audit and feedback has been shown to decrease these prescriptions, but there is evidence that dentists still prescribe unnecessarily. Our aim is to compare the effectiveness of a theory-informed in-practice training session (TiPTAP) in addition to individualised audit and feedback, with audit and feedback alone for reducing antibiotic prescribing by NHS dentists working in NHS primary care dental practices.MethodsWe will conduct a 2-arm parallel cluster randomised trial: out of 228 practices, 114 will be randomised to the theory-informed in-practice training session targeting antibiotic prescribing and individualised audit and feedback; 114 practices will be randomised to audit and feedback alone. The theory-informed session will include (a) an introductory session including several behaviour change techniques; (b) problem solving discussion, setting and recording action plans; (c) practice-level prescribing feedback discussion. The primary outcome is the number of antibiotic items per 100 NHS treatment claims over a 1-year period post-randomisation for each dentist. Secondary outcomes are the number of amoxicillin 3 g and broad spectrum antibiotics prescribed per 100 NHS treatment claims over a 1-year period; amoxicillin 3 g and broad spectrum antibiotics defined daily doses of antibiotics per 100 claims. Process measures include fidelity, knowledge, and confidence. Primary and secondary outcomes will be obtained using routine data.DiscussionThis study provides the opportunity to robustly assess the effect of adding an in-practice training co-intervention to audit and feedback. Its behaviour change theory-informed content will allow replication of the different components and can inform future training interventions.Trial registrationISRCTN, ISRCTN12345678. Registered 18 June 2020.

An Examination of Consistency in the Incremental Approach to Willingness to Pay: Evidence Using Societal Values for NHS Dental Services

IntroductionWillingness to pay (WTP) is used to generate information about value. However, when comparing 2 or more services using standard WTP techniques, the amounts elicited from participants for the services are often similar, even when individuals state a clear preference for one service over another. An incremental approach has been suggested, in which individuals are asked to first rank interventions and provide a WTP value for their lowest-ranked intervention followed by then asking how much more they are willing to pay for their next preferred choice and so on. To date, evaluation of this approach has disregarded protest responses, which may give information on consistency between stated and implicit rankings.MethodsA representative sample of the English population (n = 790) were asked to value 5 dental services adopting a societal perspective, using a payment vehicle of additional household taxation per year. The sample was randomized to either the standard or the incremental approach. Performance for both methods is assessed on discrimination between values for interventions and consistency between implicit and stated ranks. The data analysis is the first to retain protest responses when considering consistency between ranks.ResultsThe results indicate that neither approach provides values that discriminate between interventions. Retaining protest responses reveals inconsistencies between the stated and implicit ranks are present in both approaches but much reduced in the incremental approach.ConclusionThe incremental approach does not improve discrimination between values, yet there is less inconsistency between ranks. The protest responses indicate that objections to giving values to the dental interventions are dependent on a multitude of factors beyond the elicitation process.

Coronavirus advice for associates: what we know so far

The NHS has said that it will continue to pay NHS contract payments to NHS practices in England and Wales, and to NHS dentists in Scotland and Northern Ireland There are a number of conditions that apply to the continued contract payments Those conditions include: •That practices do not seek other assistance which would be considered duplicate •All available staff may be required to be redeployed

Oral antibiotic prescribing by NHS dentists in England 2010-2017.

Introduction Dentists prescribe a significant proportion of all antibiotics, while antimicrobial stewardship aims to minimise antibiotic-prescribing to reduce the risk of developing antibiotic-resistance and adverse drug reactions.Aims To evaluate NHS antibiotic-prescribing practices of dentists in England between 2010-2017.Methods NHS Digital 2010-2017 data for England were analysed to quantify dental and general primary-care oral antibiotic prescribing.Results Dental prescribing accounted for 10.8% of all oral antibiotic prescribing, 18.4% of amoxicillin and 57.0% of metronidazole prescribing in primary care. Amoxicillin accounted for 64.8% of all oral antibiotic prescribing by dentists, followed by metronidazole (28.0%), erythromycin (4.4%), phenoxymethylpenicillin (0.9%), clindamycin (0.6%), co-amoxiclav (0.5%), cephalosporins (0.4%) and tetracyclines (0.3%). Prescriptions by dentists declined during the study period for all antibiotics except for co-amoxiclav. This increase is of concern given the need to restrict co-amoxiclav use to infections where there is no alternative. Dental prescribing of clindamycin, which accounted for 43.9% of primary care prescribing in 2010, accounted for only 14.6% in 2017. Overall oral antibiotic prescribing by dentists fell 24.4% as compared to 14.8% in all of primary care.Conclusions These data suggest dentists have reduced antibiotic prescribing, possibly more than in other areas of primary-care. Nonetheless, opportunities remain for further reduction.

New dedicated mental health support for NHS dentists welcomed

New dedicated mental health support for NHS dentists welcomed

Inequalities in orthodontic outcomes in England: treatment utilisation, subjective and normative need.

To investigate inequalities in three aspects of access to orthodontic care: uptake of orthodontic treatment, normative need and subjective need in England. We used data from two surveys in England: 12 and 15-year-olds from the 2013 Child Dental Health Survey (CDHS 2013) and 12-year-olds from the 2008/2009 NHS Dental Epidemiology Programme for England (NDEP 2008/2009). Summary variables representing orthodontic status were calculated. Two regression-based summary measures of inequalities were used to investigate the relationship between deprivation level and orthodontic outcomes: Slope and Relative indices of Inequality. There were significant absolute and relative inequalities in uptake of orthodontic treatment. The least deprived were 1.9 times more likely to have received orthodontic treatment compared to the most deprived in both surveys. Normative need was not associated with deprivation in either the analyses of CDHS 2013 (SII= 0.03, 95% CI: -0.04, 0.1; RII=1.06, 95% CI: 0.91, 1.24) or the NDEP 2007/2008 (SII= 0.03, 95% CI: -0.02, 0.07; RII=1.06, 95% CI: 0.96, 1.18). There was greater willingness to have teeth straightened in more deprived children from CDHS 2013 (SII=-0.09, 95% CI: -0.16, -0.03; RII=0.85, 95% CI: 0.75, 0.96) but not in NDEP 2007/2008 (SII=0.03, 95% CI: 0, 0.06; RII=1.07, 95% CI: 0.99, 1.15). Being deprived was associated with lower uptake of orthodontic treatment. Normative need was not related to deprivation. The association between deprivation and subjective need was only partly established, with poorer children showing a greater desire to have their teeth straightened in one survey.

A feasibility study with embedded pilot randomised controlled trial and process evaluation of electronic cigarettes for smoking cessation in patients with periodontitis

BackgroundTobacco smoking is a major risk factor for several oral diseases, including periodontitis, and electronic cigarettes (e-cigarettes) are increasingly being used for smoking cessation. This study aimed to assess the viability of delivering and evaluating an e-cigarette intervention for smoking cessation within the dental setting, prior to a definitive study.MethodsA feasibility study, comprising a pilot randomised controlled trial and qualitative process evaluation, was conducted over 22 months in the Newcastle upon Tyne Hospitals NHS Dental Clinical Research Facility, UK. The pilot trial comprised a two-armed, parallel group, individually randomised, controlled trial, with 1:1 allocation. Participant eligibility criteria included being a tobacco smoker, having periodontitis and not currently using an e-cigarette. All participants received standard non-surgical periodontal therapies and brief smoking cessation advice. The intervention group additionally received an e-cigarette starter kit with brief training. Proposed outcomes for a future definitive trial, in terms of smoking behaviour and periodontal/oral health, were collected over 6 months to assess data yield and quality and estimates of parameters. Analyses were descriptive, with 95% confidence intervals presented, where appropriate.ResultsEighty participants were successfully recruited from a range of dental settings. Participant retention was 73% (n = 58; 95% CI 62–81%) at 6 months. The e-cigarette intervention was well received, with usage rates of 90% (n = 36; 95% CI 77–96%) at quit date. Twenty percent (n = 8; 95% CI 11–35%) of participants in the control group used an e-cigarette at some point during the study (against advice). The majority of the outcome measures were successfully collected, apart from a weekly smoking questionnaire (only 30% of participants achieved ≥ 80% completion). Reductions in expired air carbon monoxide over 6 months of 6 ppm (95% CI 1–10 ppm) and 12 ppm (95% CI 8–16 ppm) were observed in the control and intervention groups, respectively. Rates of abstinence (carbon monoxide-verified continuous abstinence for 6 months) for the two groups were 5% (n = 2; 95% CI 1–17%; control group) and 15% (n = 6; 95% CI 7–29%; intervention group).ConclusionsData suggest that a definitive trial is feasible and that the intervention may improve smoking quit rates. Insights were gained into how best to conduct the definitive trial and estimates of parameters to inform design were obtained.Trial registrationISRCTN, ISRCTN17731903; registered 19 September 2016 http://www.isrctn.com/ISRCTN17731903.

How, and why, does capitation affect general dental practitioners' behaviour? A rapid realist review

From a formal evaluation of a capitation-based NHS dental contract, as part of a National Institute of Health Research funded project (HS&DR 14/19/12), data collected from a series of qualitative interviews suggest that general dental practitioners may behave differently in ways that vary from the results of previous studies. Drawing on realist methodology, a rapid realist review was conducted, enabling a programme to be developed to explain the effect of a capitation pilot on NHS dentists working in primary care. In essence, the theory postulates that general dental practitioners are affected by a number of competing interests and incentives and that this can influence their behaviour in a variety of ways. For example, a capitation-based contract may result in some general dental practitioners focusing more on prevention, as opposed to treatment, but for others it may not. It may, in practice, disincentivise some general dental practitioners to perform certain treatments, while for others no change to their clinical practice would occur. Further research is required to fully understand the causal mechanisms associated with divergent behaviour, as well as the underlying contextual conditions through which these mechanisms are activated.