Primary Dental Care Setting Research Articles

Development and external validation of a head and neck cancer risk prediction model.

Head and neck cancer (HNC) incidence is on the rise, often diagnosed at late stage and associated with poor prognoses. Risk prediction tools have a potential role in prevention and early detection. The IARC-ARCAGE European case-control study was used as the model development dataset. A clinical HNC risk prediction model using behavioral and demographic predictors was developed via multivariable logistic regression analyses. The model was then externally validated in the UK Biobank cohort. Model performance was tested using discrimination and calibration metrics. 1926 HNC cases and 2043 controls were used for the development of the model. The development dataset model including sociodemographic, smoking, and alcohol variables had moderate discrimination, with an area under curve (AUC) value of 0.75 (95% CI, 0.74-0.77); the calibration slope (0.75) and tests were suggestive of good calibration. 384 616 UK Biobank participants (with 1177 HNC cases) were available for external validation of the model. Upon external validation, the model had an AUC of 0.62 (95% CI, 0.61-0.64). We developed and externally validated a HNC risk prediction model using the ARCAGE and UK Biobank studies, respectively. This model had moderate performance in the development population and acceptable performance in the validation dataset. Demographics and risk behaviors are strong predictors of HNC, and this model may be a helpful tool in primary dental care settings to promote prevention and determine recall intervals for dental examination. Future addition of HPV serology or genetic factors could further enhance individual risk prediction.

COVID-19 case management in primary dental care settings in Yorkshire and the Humber.

Introduction Emerging guidance during the COVID-19 pandemic aimed to minimise transmission risk within dental settings. This service evaluation provides an overview of reported cases of COVID-19 among primary dental care staff within Yorkshire and the Humber.Methods Data for COVID-19 cases reported within dental practices between November 2020 and August 2021 were extracted from the Public Health England, Health Protection Zone database and summarised using descriptive statistics.Results In total, 421 cases across 223 dental practices were reported, with 221 close contacts and 77 outbreaks identified. Cases/contacts were highest among dental nurses (51/49%). Household and community (42/22%) were the most frequently reported sources of transmission, with the majority of staff-to-staff contacts (60%) occurring in communal/non-clinical areas.Discussion There was a low number of reported COVID-19 cases/contacts among dental professionals, with most cases suspected to have acquired the infection from outside of the dental setting. The majority of personal protective equipment breaches occurred within communal/non-clinical areas. When infection prevention and control guidance was followed, there were no incidences of staff or patients becoming contacts or cases.Conclusion With adherence to strict protocols, the risk of COVID-19 transmission in the dental setting was low within the context of this review. The evaluation highlighted the importance of collaborative working during the pandemic.

Precision Prosthodontic Rehabilitation of Flabby Ridge with a Modified Window Technique: Case Report

Flabby ridge, also known as a soft (mobile), movable, or displaceable ridge, presents a common clinical challenge in dental practice. It primarily affects the alveolar ridges of the upper (maxillary) or lower (mandibular) arches. The anterior region of the maxilla is especially susceptible in edentulous patients. The flabby ridge lacks the firmness and stability required, leading dentures to become loose and unstable. Consequently, this instability can result in discomfort, speech and eating difficulties, and reduced quality of life for denture wearers. The flabby ridge often does not provide the necessary contour and resilience needed to establish an effective seal and maintain suction between the denture base and the underlying tissues. This compromises denture retention, making them susceptible to dislodgement during typical oral functions. Therefore, rehabilitating a completely edentulous patient with flabby tissue presents a formidable challenge for prosthodontists, as it undermines the retention, stability and support of complete dentures. Methods for managing flabby ridges encompass surgical removal, ridge augmentation, specialized impression techniques, balanced distribution of occlusal loads and implant therapy. Various impression techniques have been proposed to address the complexities of such cases. By carefully applying the principles of complete denture construction, a palliative treatment approach can be achieved. Special impressions often employ the window technique to capture a static impression of the flabby area, which introduces its own set of challenges. This innovative case report introduces a modified window technique that incorporates precise record transfer of the flabby ridge using tissue (blotting) paper. Specifically designed for the anterior mandibular flabby ridge, the technique employs a custom tray with a window positioned over the flabby tissues. A mucostatic impression material is utilized to minimize pressure on the flabby tissue, thereby reducing potential tissue distortion during the impression process. The procedure is executed in two steps: first, stable structures are recorded, followed by capturing the mobile tissues using light-body polyvinyl siloxane (PVS) elastomeric impression material within the window area. This method ensures an accurate record of the denture-supporting structures while maintaining the contour and details of the flabby tissues without displacement. Importantly, the technique is crafted for straightforward implementation by general dental practitioners within a primary dental care setting.

The use of medicaments in the management of symptomatic irreversible pulpitis: A community-based cohort study.

To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom. All patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre-operatively, data regarding patients' numerical ratings scale (NRS), pain score (0-10), analgesic use, oral-health impact profile-14 (OHIP-14) and need for time away from work were collected. For 7 days post-operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed-effects model with post hoc Tukey's multiple comparisons test for continuous data and chi-squared or Fisher's exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel-Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre- and post-operative data, whereby overall treatment success was defined as: (i) patients did not return for treatment due to pain by day seven; (ii) at day three, there was a 33% (or 2-points) reduction in NRS pain score; (iii) there was a change score of +3 in global rating; (iv) the patient was no longer using analgesia and able to return to work. Eighty-five participants were recruited, with 83 completing follow up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p = .645), although patients self-reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p = .015). This study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue.

Impact of Non-surgical Periodontal Therapy on Oral Health-related Quality of Life amongst Primary Dental Care Patients: A Prospective Cohort Study

Abstract Aim: The aim of this study was to determine the impact of non-surgical periodontal therapy (NSPT) on oral health-related quality of life (OHRQoL) of a selected group of the Malaysian population at the primary dental care setting. Participants and Methods: This study was conducted from year 2021 to 2022. Patients attending four government dental clinics in Kinta district were included in the study after basic periodontal examination was conducted. The sample size was calculated using the NCSS PASS 11 power analysis and sample size, and a final sample size of 94 was used. A short version of the Malaysian Oral Health Impact Profile (S-OHIP[M]) questionnaire was given as a baseline before the intervention. NSPT was provided in a single session or by a quadrant approach. Patients were then called for review after 6 weeks during when they were required to complete the S-OHIP(M) questionnaire again. All data were then entered and analysed using SPSS version 26.0. Results: The prevalence of impact decreased significantly post-treatment (n [%] pre vs. post: 91 [96.8%] vs. 70 [74.5%]; P < 0.001). A significant decrease was observed in the severity of impact (additive score) (median [interquartile range (IQR)] pre vs. post: 8.5 [5.0–15.0] vs. 2.0 [0.0–6.0]; P < 0.001) and extend of impact (simple count score) (median [IQR] pre vs. post: 0.5 [0.0–2.0] vs. 0.0 [0.0–0.0]; P < 0.001) post-treatment compared to pre-treatment too. Conclusion: The OHRQoL status amongst gingivitis and mild-to-moderate periodontitis patients in primary care has improved after treatment.

A Case-Finding Protocol for High Cardiovascular Risk in a Primary Care Dental School—Model with Integrated Care

National Health Service (NHS) strategies in the United Kingdom (UK) have highlighted the need to maximise case-finding opportunities by improving coverage in non-traditional settings with the aim of reducing delayed diagnosis of non-communicable diseases. Primary care dental settings may also help to identify patients. Case-finding appointments took place in a primary care dental school. Measurements of blood pressure, body mass index (BMI), cholesterol, glucose and QRisk were taken along with a social/medical history. Participants with high cardiometabolic risk were referred to their primary care medical general practitioner (GP) and/or to local community health self-referral services, and followed up afterwards to record diagnosis outcome. A total of 182 patients agreed to participate in the study over a 14-month period. Of these, 123 (67.5%) attended their appointment and two participants were excluded for age. High blood pressure (hypertension) was detected in 33 participants, 22 of whom had not been previous diagnosed, and 11 of whom had uncontrolled hypertension. Of the hypertensive individuals with no previous history, four were confirmed by their GP. Regarding cholesterol, 16 participants were referred to their GP for hypercholesterolaemia: 15 for untreated hypercholesterolaemia and one for uncontrolled hypercholesterolaemia. Case-finding for hypertension and identifying cardiovascular risk factors has high acceptability in a primary dental care setting and supported by confirmational diagnoses by the GP.

Clinical Practice Guidelines for Oral Frailty

The associations between lowered oral health status and frailty in elderly have been previously reported in many studies. Despite the increasing number of elderly populations in Korean society, there have been no attempt to develop clinical practice guideline and diagnostic criteria for oral frailty. Hence, this study reviewed the previous cohort studies and systematic reviews about oral frailty and proposed 15 recommendations as an oral frailty guideline for Korean elderly on the basis of the evidence-based methodology. This clinical practice guideline will provide overall guidance on the identification, diagnosis, and management of oral frailty in pri-mary dental care setting and finally help to achieve healthy aging in elderly.

Oral potentially malignant disorders: advice on management in primary care

Introduction: The diagnosis of and risks associated with oral potentially malignant disorders (OPMD) have been widely reported, but little has been published on the management of OPMDs in a primary dental care setting. Hospital services face ongoing pressures due to long-term follow-up, with a need for surveillance to be jointly undertaken with primary dental care clinicians. In a primary care setting, identification and surveillance of OPMDs can be challenging as no universal guidance exists on recommended recall intervals. Corpus: In this article, an update on OPMDs is provided and, based on the practices of six Oral Medicine units in Europe (London (United Kingdom), Milan (Italy), Bordeaux (France), Porto (Portugal), Zagreb (Croatia) and Santiago de Compostela (Spain)), aiming to provide guidance on monitoring in a primary care setting in Europe. Conclusion: Oral medicine clinicians can provide guidance to general dental practitioners (GDPs) on recommended recall intervals. It is important that they feel confident in monitoring these conditions and, when concerned, to arrange referral to a hospital or appropriate specialist. GDPs should document descriptions of lesions and, if possible, take clinical photographs. Patients should be counselled on modifiable lifestyle factors and directed to oral medicine society websites to access patient information leaflets.

Hospitalization for Oral Health-Related Conditions of the Australian Ageing Population: Two Decades of Analysis.

The burden of oral health care increases among older people, with a profound challenge in utilising dental services in primary dental care settings. This study aimed to analyse two decades of nationwide hospital separation patterns due to oral health-related conditions among older people. Ageing population data were obtained from the Australian Bureau of Statistics, including people aged 65 years and older. All principal diagnoses of oral health conditions (ICD-10-AM) were analysed in this study. The hospitalisation data included all separations of older people for the financial years 1998–1999 to 2018–2019. A total of 205,461 hospital separations were recorded for older people over a period of twenty-one years. More than 60% of these separations were collectively attributed to dental caries, disorders of teeth and supporting structures, diseases of the jaws, diseases of the pulp and periapical tissues. However, the average rate of separations per 10,000 people due to dental caries was the highest among the dental conditions (8.68). Furthermore, the remaining oral health-related conditions predict an annual percentage increase in the rate that would compromise their oral health quality of life. Dental caries and its sequela seem to be the leading cause for oral health-related hospital admissions in Australia for people aged 65 and older. This could be an indicator of the inadequacy of disease management in the primary dental care setting.

Perceptions of general dental practitioners in Northern Ireland on the clinical management of patients taking direct oral anticoagulants

##Statement of the problem Despite guidance advocating the management of patients taking direct oral anticoagulants (DOACs) in primary dental care settings, evidence from clinical audit in Northern Ireland suggested that a high proportion of patients were being referred to secondary and tertiary care settings for dental procedures with a bleeding risk. ##Purpose of the study The aim of this study was to evaluate the perceptions of general dental practitioners (GDPs) working in the health service in Northern Ireland on the clinical management of patients taking DOACs in primary dental care. ##Materials and methods: A questionnaire was distributed to the 1,167 registered GDPs in Northern Ireland, assessing perceptions of the clinical management of DOAC patients in primary dental care. The data obtained was analysed using SPSS statistical software. Qualitative data underwent thematic analysis. ##Results A total of 344 questionnaires were analysed. Some 83% (285) of responding GDPs were aware of the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance. Some 98% (337) believed that patients taking DOAC medication could potentially be managed in primary care but that additional training was required. Some 80% (275) of GDPs had referred patients to secondary care. Procedures presenting a low risk of postoperative bleeding complications accounted for 12% (41) of referrals. ##Conclusions A lack of GDP confidence and experience in the management of DOAC patients are motivating factors in referral to secondary care settings for treatment. Some 12% of the referrals analysed were potentially inappropriate, given the low risk of associated postoperative bleeding complications. Additional training and support for GDPs, as well as enhanced awareness of the SDCEP guidance, is essential.

The impact of COVID-19 on paediatric dental services and tips for patient management.

Managing paediatric patients in primary dental care while awaiting treatment by the specialist paediatric dental services can be tricky. COVID-19 has had a significant impact on dental services meaning wait times to be seen by a paediatric dental service may have been delayed. This article will discuss the management of paediatric patients in primary dental care and provide an update on some of the latest techniques in paediatric dentistry. It also covers tips that can be employed in the primary dental care setting such as the use of tooth mousse and silver diamine fluoride.

A patient information video for treatment under intravenous conscious sedation: considerations, challenges and prospects

This article describes the use of a newly developed animation for the delivery of patient information pertinent to dental treatment performed under intravenous conscious sedation, and provides an understanding of how digital health-related information impacts upon the patient experience. This article provides insight into the rationale for using animation as a means to deliver healthcare-related information, the process undertaken to develop this animation and how the themes and imagery in the animation can be used more broadly to further enhance the patient experience in primary and secondary dental care settings. CPD/Clinical Relevance: This article outlines the process of developing an animation for patient information and the impact animation can have upon patient experience locally as an aid to delivering instructions.

A retrospective cross-sectional study of early patient-reported failures of direct restorations placed in a primary dental care setting.

Introduction A retrospective cross-sectional study of early patient-reported failures of restorations was initiated to understand the reasons and factors associated with early failure. Early patient-reported failures are defined as restorations requiring replacement within three months of placement.Aim To investigate if restorative material placed or any other tooth/restoration/patient factors may be associated with early patient-reported failures.Methods In total, 360 restorations were replaced from January 2016 to December 2017. Multivariable analyses (logistic regression model) were used to identify any patient/tooth/restoration factors that were associated with early patient-reported failures.Results Dislodgement, fracture and pain/sensitivity were the three main failure modes. There was significant association between restorative material type and dislodgement and restoration fracture. The odds of dislodgement for composite resin (CR) were 4.3 times higher compared to amalgam. The odds of dislodgement for glass-ionomer cement (GIC) and resin-modified GIC were 3.7 times higher compared to amalgam. The odds of fracture for CR were ten times lower compared to amalgam. The odds of pain for teeth with a history of restoration failure for a particular tooth were five times lower compared to no history of restoration failure for a particular tooth.Conclusions Restorative material type affected patient-reported failures.

Experiential learning without prior vicarious learning: an insight from the primary dental care setting

ABSTRACT The vicarious learning method (by observation) is used to help learners emulate their teachers’ behaviours. The experiential learning method (by experience) is traditionally used thereafter, so that learners can apply these behaviours to a given situation. Both methods are widely utilised within clinical skills training. A clinical teacher may well face the question of whether a learner can complete a certain clinical task without having seen it performed before. Therefore, clinical teachers will need to determine which method, vicarious or experiential, is most effective for their learners. To help explore this, the author reflects on two examples from dental teaching practice, followed by discussion of the need to also observe soft skills; provide meaningful feedback; be a good role model; facilitate deep learning; know our learners, and implement learner-centred learning. Collectively, this reveals that although experiential learning may be possible and beneficial by itself, further research is required to fully support this.

HIV screening in dental settings: Challenges, opportunities, and a call to action.

HIV is responsible for tremendous suffering and loss around the world, but many advances in HIV screening, diagnosis, treatment, and prevention provide hope for an end to the HIV epidemic. Global and national campaigns facilitate access to these HIV advances, but some individuals and communities still lack access, particularly in developing countries. To reach those who remain under-served, campaigns encourage greater integration of HIV services with non-HIV services. As members of the healthcare team with a clinical stake in HIV, dental care providers have a unique contribution to make. Much research on the role of dental care providers in HIV has focused on HIV screening in the dental setting, and researchers have identified possible ways forward but also daunting challenges. Approaches for screening, brief intervention, and referral to treatment used in primary care and dental care settings for other health risks may help overcome challenges related to provider scope of practice and need for training. Approaches to managing distress and uncertainty in other clinical contexts may help overcome challenges related to patient acceptability, equipping providers to manage sensitive topics and emotional aspects of HIV screening. While not panaceas, these approaches may be useful to dental care providers interested in answering the global "call to action" for contributing to ending the HIV epidemic.

The Establishment of an Intravenous Conscious Sedation Service for Adult Patients in a Primary Dental Care Setting

Dental anxiety is common within the population and can detrimentally affect the delivery of dental care for those patients affected. Non-pharmacological-based behaviour management techniques are available to the clinician but may not be sufficient or applicable for every patient. In such cases, intravenous conscious sedation with midazolam has been demonstrated to be safe, effective and well tolerated. The present article reviews the criteria and guidance which must be addressed by the dental team when establishing an intravenous conscious sedation service in a primary dental care setting. CPD/Clinical Relevance: General dental practitioners may wish to consider establishing a conscious sedation service in their practices to facilitate the care of nervous patients or those undergoing prolonged, unpleasant treatments such as surgical procedures. The present paper aims to highlight the considerations which require to be addressed in order to establish such a service for adult patients using intravenous midazolam.

Sepsis Decision Support Tool for Primary Dental Care

A guide for managing suspected sepsis in patients in the primary dental care setting.

Can we deliver effective alcohol-related brief advice in general dental practice?

Design Two-arm cluster randomised controlled feasibility trial. Intervention Twelve NHS dental practices were randomised to the intervention and control arms. Patients consuming alcohol above the recommended levels were eligible to participate in the trial. The intervention was delivered by the dentists in the participating practices and entailed the delivery of a short tailored alcohol-related advice tool and a leaflet, which included information about the effects of alcohol on oral health and the benefits of reducing alcohol intake to both oral and general health. Patients in the control arm were given a mouth cancer prevention leaflet only. The level of alcohol consumption was measured by validated tools (AUDIT: Alcohol Use Disorders Identification Test and AUTID-C: Alcohol Use Disorders Identification Test for Consumption). The patients were followed-up after six months by a telephone interview. Outcome Measures The feasibility trial outcomes were the recruitment, retention, eligibility and delivery rate. The primary outcome of the trial was the impact of the intervention in lowering the level of alcohol consumption as captured by the AUDIT tool. Secondary outcomes included health related quality of life and alcohol consumption and abstinence in the last 90 days. The acceptability of the intervention was also assessed.Results The recruitment and retention rate were high (95.4% and 76.9% respectively). At the follow-up, participants in the intervention arm were significantly more likely to report a longer abstinence period (3.2 vs. 2.3 weeks respectively, P = 0.04). Non-significant differences in AUDIT (44.9% vs. 59.8% AUDIT positive respectively, P = 0.053) and AUDIT-C between baseline and follow-up (-0.67 units vs. -0.29 units respectively, P = 0.058) were observed. Results from the process evaluation indicated that the intervention and study procedures were acceptable to dentists and patients.Conclusion According to this study, dentists offering screening for alcohol misuse and brief advice in a primary dental care setting is not only feasible but also well-welcomed by both the dental team and patients.

The effect of risk communication on periodontal treatment outcomes: A randomized controlled trial.

This study determines the effects of a routine assessment (Treatment as Usual, TAU) versus a risk communication intervention (Risk) versus a Goal-Setting, Planning and Self-Monitoring (GPS) intervention on periodontal disease patients' clinical and psychological outcomes. In a three-arm randomized controlled trial (RCT; registration: ISRCTN59696243) adults (N=97) judged to have moderate oral hygiene attended a primary dental care setting for a standard consultation. Intervention participants received an individualized calculation of their periodontal disease risk using only the Previser Risk Calculator (Risk group) or supplemented with a GPS-behavioral intervention (GPS group). Clinical, behavioral and psychological measures were obtained at baseline, 4 and 12weeks later. Percent plaque reduced significantly (P<0.05) in intervention groups but not in TAU group. Percent of sites bleeding-on-probing reduced in all groups, but the effect was more pronounced in the intervention groups. Interdental cleaning frequency improved only in the intervention groups (P<0.05). Brushing frequency and probing depths showed little variation across time/groups. Disease risk and most thoughts about periodontal disease changed across time (P<0.05). A simple behavioral intervention using individualized periodontal disease risk communication, with or without GPS, reduced plaque and bleeding and increased interdental cleaning over 12weeks. This is the first study in the field to show that risk communication and behavioral techniques such as Goal-Setting, Planning and Self-Monitoring can improve periodontal outcomes.

An analysis of effective dose optimization and its impact on image quality and diagnostic efficacy relating to dental cone beam computed tomography (CBCT)

The potential of high resolution, three-dimensional (3D) images which overcome limitations such as superimposition and anatomical noise of two-dimensional (2D) conventional imaging, has made cone beam computed tomography (CBCT) an increasingly popular imaging modality in many dental applications. It is in light of the increasingly prevalent use of CBCT, particularly in a primary dental care setting, that the goal of this review is to investigate what evidence-based guidance is available to the clinician to justify and reduce radiation risk of this higher dose imaging modality while maintaining diagnostically acceptable images. To this end, the literature on radiation dose and related patient risk was comprehensively investigated, before an analysis of the ways in which dose can be optimized and the implications that optimization has on image quality was discussed. Finally, although it is accepted that CBCT has the potential to improve diagnosis, it is uncertain if its use has positive ramifications on issues of diagnostic efficacy, including clinical decision-making and patient outcome. In order to investigate these issues, the levels of evidence of the existing studies and their validity were assessed. On review of the available literature, it is evident that there is limited practical advice available to dentists regarding dose optimization and any existing protocols may not be readily transferable to every CBCT machine, the manufacturers' role is not often conducive to dose limitation and that the bulk of evidence is at lower levels of evidence. Furthermore, there is minimal supporting evidence to suggest an impact of CBCT on diagnostic thinking and consequent choice of treatment and no evidence of a positive effect of CBCT on patient outcome.