Oral Health Care Providers Research Articles

Evaluation of Clinical Communicational Skill Training Period in Isfahan Dental School 2014

Introduction: Professional ethics in any field of medical specialties lead to better communication between patient and doctor and ultimately improve the quality of health care and patient satisfaction will follow. So, we aimed to evaluate the professional communication skills in students before and after training in an attempt to improve the clinical skills in all students of medicine and dentistry.
 Materials & Methods: This quasi experimental study had 100 dental students from Isfahan University of Medical Sciences enrolled in the year 2016 before and after taking the course and were rated using valid and reliable questionnaires and then the scores were compared. The data was analysed via independent-t test and co-variance. P value = 0.05 was considered statistically significant.
 Results: Based on the results of data analysis a difference between the level of students' knowledge before and after the lessons were observed. Moreover, the mean score for men and women after completing the course did not significantly differ. Based on the results of independent t test scores in men and women's clinical skills before taking the course, there was no significant difference (p value = 0.689). There was no significant relationship between other subscales and gender before and after training (p value = 0.2).
 Conclusion: According to the results of data analysis, the theoretical presentation of the course has improved students' perceptions of clinical skills. Therefore, taking into account the views of dental students is one of the necessary elements in improving the education and training of oral health care providers in the community in the future.

Does the socioeconomic status predict health service utilization in persons with enhanced health care needs? Results from a population-based survey in persons with spinal cord lesions from Switzerland

BackgroundEvidence suggests that the socioeconomic status (SES) affects individuals’ health service utilization. Spinal cord injury is a condition that often leads to physical impairments and enhanced health care needs. It therefore presents an informative and yet under-researched case in point to investigate social inequalities in health service utilization. This study aims to describe associations between SES and health service utilization in adults with spinal cord injury from Switzerland.MethodsWe use cross-sectional data from 1,294 participants of the Swiss Spinal Cord Injury Cohort Study community survey 2017. SES was operationalized with education, household income, perceived financial hardship, subjective status, and granting of supplementary financial benefits. Health service utilization was assessed with information on visits to 13 different health care providers and four health care institutions (inpatient stays, outpatient clinics, emergency departments, specialized spinal cord centers) during the past 12 months. The dichotomized outcomes on service utilization (visited vs. not visited) were regressed on SES indicators, including adjustments for sociodemographics, lesion characteristics, and health status.ResultsPersons with higher SES reported higher likelihood for specialist, dentist, and dental hygienist visits and reported utilizing a larger number of different care providers. Further, specific SES indicators were associated with certain care provider visits (i.e., higher education and subjective status: higher odds for pharmacist visits; higher income: higher odds for natural healer visits; higher subjective status: higher odds for chiropractor visits; supplementary benefit granting: higher odds for general practitioner and home care service visits). We found statistically non-significant trends towards lower likelihood for inpatient stays, outpatient clinic and emergency department visits and enhanced likelihood for specialized spinal cord-center visits in higher SES groups.ConclusionsThis study generally supports the claim that basic health care provision is guaranteed for all patients with spinal cord injury in Switzerland, independently of their SES. However, social inequalities were still observed for the utilization of specific providers, such as oral health care providers. Given that oral health is key for health maintenance in persons with spinal cord injury, specific interventions to enhance regular dental check-ups in lower SES groups are highly recommended.

The Outcome of a New Teledentistry Initiative in Response to the COVID-19 Pandemic: A Cross-sectional Study

The purpose of this study was to assess the overall satisfaction of a new learning experience and evaluate the outcome of LLUSD's educational teledentistry initiative through a survey based on Kirkpatrick's multidimensional model of training evaluation. An IRB application was approved (#5210385) for a cross-sectional study that included Loma Linda University School of Dentistry (LLUSD) dental students of the class of 2022 and 2023. The 9-question survey consisted of three sections. The first section included demographic questions on gender and the graduating class. The second section was related to perceived teaching effectiveness, attitude, behavior, and significance. The third section included an open-ended question. The survey was distributed by three student investigators. Descriptive statistics were calculated, and categorical variables were compared using the Chi-squared test (χ2 test). The perceived teaching effectiveness of the newly implemented educational initiative was high for increasing the ability to communicate with patients and for screening and identifying the need for referrals. A majority of students believed that teledentistry is an important means to improve patients' access to dental care and that the School has been providing a good educational environment in providing teledentistry sessions to patients. There were no significant differences in the frequencies of positive and negative responses to all questions (N = 6) by gender and by class (p >0.05, in all instances). Teledentistry eVisits allowed the continuation of patient contact and initial assimilation of patient information. There is potential for this educational initiative to be more actively and comprehensively implemented in the future. New educational initiatives allow the continuation of patient contact that will ensure that students will graduate as competent oral health care providers despite challenges imposed by the pandemic.

Dealing from Scratch: Pre-Appointment Behaviour Guidance

Background: One major aspect of child management in the dental set up is managing anxiety, a barrier to oral health care and service provision worldwide. Management involves either in prevention or abolishing fear/anxiety in uncooperative children. Behavior guidance needs to be implemented before the patient enters the dental clinic for the first dental visit. Pre-appointment preparations requires euphemistic approach to convey the treatment information to the children specially the one with poor cognition. So the study aimed to evaluate general dentist's perception in Jabalpur city regarding pre- appointment behavior guidance when dealing with child patients. Materials & method: A closed-ended questionnaire prepared on Google format was send to general dentists practicing in Jabalpur city, to take their perception on pre-appointment behavior guidance when dealing with children who come for dental care at their dental office. Results: Out of 209 general dentists, 129 participants treat children in their set up. Majority of general dentists believed that pre- appointment behaviour modification of the child helps in achieving positive behavior in the operatory. The most frequent means of reducing the anxiety of child before treatment as told by the practitioner was you tube video option (21.7%). Results also revealed that the post graduate participants were better aware about the pre- appointment behavior guidance than the graduate participants. Conclusion: Pre- appointment behaviour guidance for the child helps to alleviate patient’s anxiety and fear, delivering our services in a better and thereby instilling positive dental attitude in children. Educational programs should be planned for general dentists to improve their knowledge and skills in providing treatment to children. Keywords: Pre-appointment behaviour guidance, behavior guidance, pre- appointment preparations.

Analysis of Oral Leukoplakia and Tobacco-Related Habits in Population of Chengalpattu District- An Institution-Based Retrospective Study.

ObjectiveThe study aimed to evaluate the prevalence of oral leukoplakia and to assess the risk of developing oral leukoplakia in patients with tobacco-related habits among the populations of Chengalpattu district, Tamil Nadu, India. Materials and MethodsIncidence and prevalence of oral leukoplakia differ among different populations in India due to cultural and demographic diversities. The results obtained from this study can be used as a reference in future research and policy-making for tobacco control. Data for this study were manually ascertained from the Department of Oral Pathology and Microbiology, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Chengalpet district, Tamil Nadu, India. The medical records of the patients diagnosed with the abnormalities and diseases of the oral mucosa, especially the white lesions of the oral cavity, between January 2011- March 2021 (10 years). The basic inclusion criteria for this study were to include the histopathology reports of the white lesions with no malignant changes during clinical diagnosis. The data was analyzed based on age, gender, tobacco-related habits, and histopathological diagnosis. The exclusion criteria for the study were the cases reported as carcinoma, patients associated with syndromes, biopsies outside the mentioned period, and those patients with incomplete clinical or histopathological details.ResultsAmong 141 white lesions, about 85 cases [60.2%] were confirmed as oral leukoplakia, of which the study population had 55 (64.7%) males and 30 (35.3%) females. The age group which was commonly seen was 41-60 years. About 80% of the population with oral leukoplakia had the habit of tobacco consumption. The use of tobacco products was seen more commonly in the male population than the female, and consumption of tobacco and alcohol was seen in 6% of the population. In our study, we found the study population had the habit of using smokeless tobacco rather than smoking cigarettes and bidis. About 20% of the population diagnosed with leukoplakia did not have any habits. The most commonly affected site was buccal mucosa (67%), followed by the tongue (12%).ConclusionOur study shows a statistical association between oral leukoplakia and tobacco product consumption among the population of Chengalpattu district. The oral health care providers must take utmost care and vigilance to diagnose the lesion at its earliest stage and give appropriate treatment modalities and effective tobacco interventions.

Patient Characteristics in Oral Cancer Staging

BackgroundOral cancer is a largely preventable malignancy with many modifiable risk factors, such as tobacco use and proper oral hygiene. Early detection of oral cancer is an important goal for oral healthcare providers, as survival rates for oral cancers diagnosed at an advanced stage are less than half the rates for cancers diagnosed in early stages. As many patients are asymptomatic in early stages, it is crucial for oral healthcare providers to have a high index of suspicion while treating patients at risk for late diagnosis.ObjectivesTo identify characteristics associated with early vs. late stage diagnosis of oral cancer.MethodsWe performed a retrospective chart review using the TriNetX database. We identified two cohorts of interest: patients with an initial diagnosis of stage 1 oral cancer, and patients with an initial diagnosis of stage 3 or 4 oral cancer. Statistical comparison of cohort characteristics was completed through the TriNetX statistical software platform.ResultsWe identified 386 patients diagnosed at stage 1 and 869 patients diagnosed at stage 3 or 4. We identified several characteristics not previously reported in the literature. Race, BMI between 20 and 29, malnurition, anemia were all associated with late stage diagnosis. Certain medications were also associated with late stage diagnosis, such as heparin derivatives and diclofenac. Our findings also reinforced prior research for characteristics such as nicotine use and ethnicity.ConclusionOur findings offer new characteristics that may aid oral healthcare providers in detecting oral cancer at an early stage. Increasing provider awareness of factors that they may not have considered previously could increase the rates of early stage cancer detection, improving overall patient mortality and curative outcomes.

ORAL MANIFESTATIONS OF COVID-19 INFECTION: AN ANALYTICAL CROSS SECTIONAL STUDY

TYPE: Abstract TOPIC: Chest Infections PURPOSE: The current COVID 19 pandemic has created a huge impact across the globe. Recent literature has reported the occurrence of varied oral lesions in COVID 19 patients in the form of sporadic case reports. This analytical cross-sectional study was carried out to gauge and understand the pattern of oral lesions in qualitative RT-PCR confirmed COVID 19 patients. METHODS: A cross-sectional study involving a total of 500 qualitative RT-PCR confirmed, hospitalized COVID-19 patients were meticulously scanned for any hard and soft tissue lesions developing concomitantly with the disease occurrence. RESULTS: This study included a total of 367 (73.4%) males and 133 (26.6%) female patients with a mean age of 53.46 ± 17.50 years. Almost 51.2% of patients presented with gustatory disturbance, 28% with xerostomia, and 15.4% of patients were found to have oral findings like erythema, ulcers, depapillation of the tongue. There was a statistically significant correlation between oral manifestations and disease severity (p= <0.001). CONCLUSIONS: COVID-19 is found to affect oral health with greater probability in patients with severe diseases (SARI) which may be due to disease itself, immune response, and lack of motivation for personal hygiene measures. CLINICAL IMPLICATIONS: COVID 19 infection is definitely found to have a significant effect on the oral health of the patients with increased findings in the severe form of the disease. As oral health care providers, it is important for us to understand the common presentations so that we can screen such patients and direct them to appropriate screening and testing centers. DISCLOSURE: Nothing to declare. KEYWORD: Covid 19, oral

COVID-19 and dentistry: Identifying the challenges of dentist during the coronavirus outbreak

Since the beginning of 2020, the COVID-19 pandemic has intensely influenced different clinical specialty lines [1]. Nonetheless, a number of medical practitioners such as different types of oral health care providers are more susceptible to COVID-19 infection than others. The nature of the dental procedures (including the potential of aerosol generation from dental instruments), and prolonged close contacts of the dental team with patients are two important factors that can help COVID-19 occurring and spreading from infected patients to the dental team, and vice versa. Moreover, the causative agent of COVID-19 is a respiratory virus that mainly transmitted through respiratory droplets and can be detected in different body fluids and sites such as saliva and oral mucosa. These characteristics can increase the risk of getting or transmitting COVID-19 in the dental office.

Resin-based composite materials: elution and pollution

Pollution arises from all human activity and the provision of oral healthcare using resin-based composite restorative materials (RBCs) should be considered. This paper aims to provide a comprehensive review of the potential pollutant risk to the environment from the chemical compounds found in resin-based restorative materials, by including: 1) the principal pollutant compounds present in the resin matrix; 2) the degradation process of RBCs and its consequences; 3) the methods used for the detection and quantification of monomer elution and RBC microparticles; and 4) a review of the release mechanisms of eluates and RBC microparticles into the environment.RBCs are pollutants by virtue of the compounds created during the degradation processes. These are in the form of the constituent eluted monomers and microparticles. Their impact on the environment and biodiversity is unknown. These materials are currently one of the main direct-placement restorative materials and their success is unquestionable when used and maintained correctly. Mitigation strategies for reducing the impact of pollution on the environment should be considered and implemented by all stakeholders and processes in the supply chain, from manufacturing, clinical use and waste management.

Implementation of Gewoon Gaaf in practice; what are the experiences of oral healthcare professionals?

In 2019, a questionnaire study was started in which the experiences, barriers and needs of users of the Gewoon Gaaf caries prevention method were investigated. The survey was distributed via social media, an email list and the Dutch Ivory Cross newsletter. In total,188 people completed the survey. The results showed that the dental practices using this method are satisfied with it and that prevention assistants apply this method most often in practice, often in collaboration with a dental hygienist and/or a dentist. The participants reported positive experiences: the method provides clear tools for daily practice. However, there is a need to share knowledge and experiences with other oral healthcare providers, for example via digital modules or written information. One of the tips given by many users was to spend a lot of time motivating and educating parents. Users' tips derived from this research can be included in the further development of the method.

Oral Health Service Access in Racial/Ethnic Minority Neighborhoods: A Geospatial Analysis in Washington, DC, USA.

Previous studies on individual-level variables have improved our knowledge base of oral health service use. However, environmental or contextual variables are also important in understanding oral health disparities in racial and ethnic neighborhoods. Based on Bronfenbrenner’s ecological framework, this study examines the geographic availability of oral health providers in Washing-ton DC, U.S.A. Census tract-level data were drawn from the American Community Survey, joined with tract-level shapefiles, and overlaid with the geographic location of dental services throughout the city. Visual maps, descriptive statistics, and spatial lag regression models showed that census tracts with higher concentrations of African Americans were significantly farther from their nearest oral health providers (r = 0.19, p < 0.001), after controlling for neighborhood poverty rate, median age, and gender. Such findings confirm that in urban areas with highly di-verse populations such as Washington DC, racial disparities in oral health care access are signifi-cant. The study highlights that identifying neighborhoods with limited oral health care providers should be a priority in diminishing racial disparities in oral health service access. Improving access to racial/ethnic minority communities, especially African American neighborhoods, will require changes in health policies and programs, workforce development, resource allocation, community outreach, and educational programs.

ORAL WALDENSTROM MACROGLOBULINEMIA

<h3>Objective</h3> Waldenstrom macroglobulinemia (WM) is a rare B-cell lymphoproliferative disorder that is characterized by bone marrow infiltration with lymphoplasmacytic cells and immunoglobulin M monoclonal gammopathy. The extramedullary infiltration of WM is uncommon but predicts a worse prognosis. To date, there has been only 1 reported case of biopsy-proven oral manifestation of WM. <h3>Case Summary</h3> A 72-year-old man with a medical history significant for hypertension and WM, which was in good clinical and laboratory control on ibrutinib, a Bruton tyrosine kinase inhibitor, for the past 4 years, was referred by his dentist for evaluation of an asymptomatic palatal mass. The patient was known to have medication-related osteonecrosis of the jaw stage 1 of left mandible. This was secondary to Zometa prescribed to address skeletal involvement of WM. Intraoral examination demonstrated a firm, nontender, 3 × 3 cm sessile mass with surface ulcerations involving the right hard and soft palate. A panoramic radiograph did not reveal any right maxillary sinus pathology, any central lesion, or any periapical radiolucency associated with the right maxillary teeth. A biopsy of the lesion was obtained. The pathology report indicated diffuse infiltration of small to intermediate-sized lymphoplasmacytic cells within the lamina propria that were positive for B-cell markers CD19, CD20, and CD22 (on immunoperoxidase studies) with kappa light chain restriction (with in situ hybridization) confirming the diagnosis of WM. This extramedullary manifestation of WM held great importance because it indicated disease progression in the context of his current management with ibrutinib. He underwent a bone marrow biopsy that demonstrated a previously undetected Bruton tyrosine kinase mutation. He was enrolled in a Phase 1 trial of dasatinib, a tyrosine kinase inhibitor. There was almost complete resolution of the palatal mass after 6-month systemic treatment with dasatinib. However, despite noted improvement in oral WM, the patient died 7 months later. <h3>Conclusions</h3> Although rare, oral health care providers should be cognizant of potential oral manifestation of WM and should communicate the findings to the oncology team because it can be of vital importance in the overall treatment plan. As in this case, the diagnosis of oral WM signified the progression of underlying malignancy.

Secondary Syphilis Occurring on the Tongue: Report of a Case

<h3>Objective</h3> According to the Centers for Disease Control the rate of syphilis has steadily increased nearly every year since 2001. Tertiary syphilis is associated with serious complications that can be avoided by early diagnosis and treatment. Although primary and secondary syphilis typically involve the genitals, the oral cavity may be the initial site of disease. Given the recent increase in incidence, it is critical to recognize this disease to aid in prevention of life-threatening complications. Here, we report a case of oral syphilis and present the clinical, histopathological and immunohistochemical features. <h3>Clinical Presentation</h3> A 21-year-old female presented to an oral and maxillofacial pathologist for evaluation of a lesion on the tongue of one-month duration. Her medical diagnoses included bipolar disorder and genital herpes. Her social history included smoking and cocaine abuse. Upon examination, a mildly erythematous elevated plaque of the posterior dorsal tongue measuring 2.0 × 1.5 cm was identified. <h3>Intervention and Outcome</h3> An incisional biopsy was performed under intravenous sedation by an oral and max- illofacial surgeon. Microscopic review showed oral mucosa demonstrating papillary hyperparakeratosis, neu- trophilic microabscesses and a moderateto-intense chronic inflammatory infiltrate possessing an abundance of plasma cells in the underlying connective tissues. These features were suspicious for a diagnosis of secondary syphilis. Tissue was sent to the Mayo Clinic for <i>Treponema pallidum</i> study by immunohistochemistry. Review of the stained slides showed numerous spirochetal organisms throughout the epithelium, confirming the diagnosis. The patient's primary care provider was contacted to initiate therapy. The NYC Department of Health and Mental Hygiene was notified of this diagnosis fulfilling mandatory reporting requirements. <h3>Conclusion</h3> The rate of syphilis diagnosis is on the rise. Presentation in the oral cavity, while rare, is important for oral healthcare providers to be familiar with as early diagnosis and treatment are likely to prevent serious complications.

The dentogenic inflammation, diagnosis, course and treatment

Inflammation begins as a response of the immune system to an external, harmful stimulus. This stimulus can be chemical, mechanical or bacterial in nature. The inflammatory response is necessary to create optimal conditions for healing. In case of pulpitis, a peri-apical granuloma, peri-coronitis or periodontitis, complaints arise as a result of an inflammatory reaction. With further progression, such as an infiltrate or a submucosal abscess, the bacteria will eventually invade the tissues and develop an infection. Given the high prevalence of dental diseases, oral health care providers are regularly confronted with the consequences of dentogenic inflammation and subsequent infections. Each specific stage of dentogenic inflammation presents symptoms that are important for making the correct diagnosis. This is important in applying the optimal dental, surgical or medical treatment.

Can you afford to smile? The Economic disparities in oral health care provision

Tooth loss can have a negative impact on a patient’s quality of life. However, many patients cannot afford the treatment necessary to restore their dentition optimally. Their final choice may be dictated by what they can afford rather than consideration of the advantages, disadvantages or biological sacrifices associated with proposed options. At the same time, clinicians often express feelings of helplessness and stress when confronted with having to decide on, and provide treatment that is within the patient’s financial means, rather than according to what they deem to be “best practice”. This paper uses a patient case to illustrate how the four-principle approach proposed by Beauchamps and Childress (1983) can be used during treatment planning, and to justify the final decision making process.

Oral healthcare management practices in Brazil

Universal health coverage is a global target included in the United Nations Sustainable Development Goals agenda for 2030. Healthcare in Brazil has universal coverage through the Unified Health System (SUS), which guarantees health as basic right to the Brazilian population. Considering the principles of SUS, public oral healthcare management is a huge challenge. Aim: To identify good management practices for quality care adopted by local public oral healthcare managers and teams around Brazil. Methods: This study was registered with PROSPERO (CRD42017051639). Five databases (PubMed, Embase, Web of Science, Scopus and Lilacs) as well as the reference lists and citations of the included publications were searched according to PRISMA guidelines. Results: A total of 30,895 references were initially found, which were evaluated according to the defined eligibility criteria. Twenty qualitative studies, eight surveys and two mixed-model studies were selected. The practices (codes) were organized into three main groups (families), and the Frequency of the Effect Size (FES) of each code was calculated. Among the 20 codes identified, the most relevant ones were: Diagnosis and Health Planning (FES=80%) and Family Health Strategy (FES=66,7). The Intensity of the Effect Size of each study was also calculated to demonstrate the individual contribution of each study to the conclusions. Conclusion: The evidence emerging from this review showed that healthcare diagnosis, planning, and performance based on the family health strategy principles were the most relevant practices adopted by public oral healthcare managers in Brazil. The widespread adoption of these practices could lead to improved oral healthcare provision and management in Brazil.

Food insecurity and oral health care experiences during pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System

BackgroundFood insecurity has emerged as a salient risk factor for poor oral health in adult populations. A separate area of research also details that both poor oral health and food insecurity during pregnancy can have adverse consequences for maternal and infant well-being. The authors examine the connection between food insecurity and women’s oral health care experiences during pregnancy. MethodsData from 2016 through 2019 came from the Pregnancy Risk Assessment Monitoring System (N = 21,080). Multivariable logistic regression analyses were used to assess the association between food insecurity and 6 indicators of oral health care experiences during pregnancy. ResultsFood-insecure women reported worse oral health care experiences during pregnancy, including being more likely to need to see a dentist for a problem, going to see a dentist for a problem, not receiving dental prophylaxis, not talking with an oral health care provider about dental health, not knowing it was important to care for teeth, and having unmet oral health care needs. ConclusionsFood-insecure women exhibit worse overall oral health outcomes and unmet oral health care needs during pregnancy. Practical ImplicationsConsidering the risk that both food insecurity and oral health problems pose for maternal and infant health, interventions that can reduce food insecurity and improve oral health and oral health care access among pregnant women are important steps in promoting greater health equity.

Patterns of radiograph use in a population of commercially insured children

BackgroundThe objective of this study was to evaluate differences in number and type of radiographs used among 3 age groups (0-5, 6-12, 13-18 years) by general dentists, pediatric dentists, and other specialists, and to determine the association between number and type of radiographs and clinical need. MethodsA retrospective analysis of insurance claims by age group and oral health care provider type included children aged 0 through 8 years in 2005 who had a minimum of 10 years of continuous eligibility. Indicator claim variables were calculated to identify high-risk, high-need patients. ResultsA total of 6,712,155 records from 105,010 patients and 34,406 providers were analyzed. There was a significant effect (P < .001) of age on the number of radiographs obtained per visit. The estimated rates of radiographs per visit for ages 0 through 5, 6 through 12, and 13 through 18 were 0.373, 0.492, and 0.393, respectively. There was a significant interaction effect between age and provider type. For patients younger than 13 years, general dentists had lower rates of obtaining radiographs than did pediatric dentists, with no significant difference between providers for the 13- through 18-year age group. Treatments received, except for extractions and prosthodontics, were significantly associated with rate of radiographs per visit, with “number of restorations” as an indicator of increased risk, need, or both showing an inverse association with radiograph use. ConclusionsChild age and provider type had an effect on number of radiographs obtained per visit. Lack of caries diagnostic codes and uncommon use of risk codes hindered interpretation of whether use, frequency, or both is associated with need. Practical ImplicationsRadiograph use should follow existing guidelines or recommendations based on clinical need.

A qualitative exploration of preventive dental advice for parents of children with congenital heart disease

Background/Aims Children with congenital heart disease are at an increased risk of developing oral disease, which can negatively impact their general health and increase the risk of infective endocarditis. This study explored the preventive oral health advice given to parents of children with congenital heart disease and any barriers that exist to the implementation of this advice. Methods Four semi-structured interviews were conducted with parents of children with congenital heart disease, which followed a topic guide that explored personal experiences of oral healthcare provision and the advice received. Interviews were audio recorded and transcribed verbatim. Thematic analysis was undertaken by one researcher, with themes reviewed by a second. Results Improving awareness of oral health was highlighted as being important to participants. The prioritisation of the child's heart condition was also discussed, and participants felt that there were opportunities to develop the multidisciplinary collaboration between dental and cardiac teams. The consistency of messages could also be enhanced, as health advice sometimes contradicted oral health guidance, which could unintentionally increase the child's risk of tooth decay. Conclusions Enhancing collaboration between the various disciplines involved in the care of children with congenital heart disease is needed to ensure that appropriate advice and support is given to parents regarding oral health.

Quantification of single use plastics waste generated in clinical dental practice and hospital settings

ObjectivesTo quantify (by number and mass) single use plastic waste generated from the provision of oral healthcare in primary and secondary care clinical dental settings in the UK. MethodsAn observational study of four dental practices and the clinics of a UK undergraduate dental teaching hospital was conducted. A range of routine common procedures were observed by trained and calibrated observers; these were: Examinations, endodontics, periodontics, direct placement restorations, fixed and removable prosthodontics and oral surgery. The PPE items used before and during the COVID-19 pandemic were also included. ResultsRoutine ‘surgery set up’ generic items present a significant proportion of SUP plastic waste as these are used in every instance of patient treatment. An average of twenty-one (n = 21) SUP plastic waste items are used for every procedure with a mean mass of 354 g per procedure (including set up and clean up). The use of PPE increased from 14 items (pre-COVID -19) to 19 items during the pandemic. SUP items are constructed from a single plastic or from multiple plastics forming compound structures (heteropolymers); with an approximate 50:50 distribution. ConclusionsThe dental profession, at the point of care, uses a high volume of single use plastic that becomes clinical waste. The use of personal protective equipment (PPE) significantly increased during the COVID 19 pandemic and this accounts for the single greatest contribution of single use plastic, as this is used for every clinical procedure. Clinical SignificanceManufacturers, distributors and oral healthcare providers have an opportunity to consider and implement approaches that include effective waste management with reduction, recovery and recycling at its core, towards transforming oral healthcare to a circular plastics economy.