Use In General Dental Practice Research Articles

Application and evolution of design in oral health: A systematic mapping study with an interactive evidence map.

There is increasing recognition of the value and capabilities of design in healthcare. Beyond the development of medical devices, design is increasingly being applied to intangible, complex and systemic healthcare problems. However, there is limited evidence on the use of design specifically in the field of oral health. This systematic mapping study aims to collate and catalogue evidence of design in oral health. A systematic search of academic databases and grey literature was performed. Duplicate results were removed, and publications relating to the same project were grouped. Reviewers from design and oral health independently screened a sample of the dataset. Projects of both relevance to oral health, and with input from a designer or clear implementation of a design methodology or approach were included. Projects were coded and plotted on a novel interactive evidence map. 119 design and oral health projects were included between 1973 and 2022. Interventional (n = 94, 79%), empirical (n = 46, 39%), methodological (n = 35, 29%) and theoretical (n = 7, 6%) design contributions were identified across the projects. The projects were categorized by four orders of design: first-graphics (n = 6, 5%), second-products (n = 41, 34%), third-interactions (n = 70, 59%), and fourth-systems (n = 2, 2%). Design was found in a diverse range of contexts in oral health; most commonly being relevant to general patients (n = 61, 51%), and for use in general dental practice (n = 56, 47%). Further design outcome categories (digital material; printed material; object; room or space; apparel; process; smart device; tangible interface; graphical interface; virtual reality; service; policy; system) and oral health themes (oral health literacy; oral care training; dental clinic design; dental instruments and equipment; personal oral care; dental appliance; clinician health and productivity; clinical information systems; informed consent; oral health promotion and prevention; oral care training; patient interactions and experience) were identified. The novel interactive evidence map of design in oral health created enables ongoing and open-ended multivariant documentation and analysis of the evidence, as well as identification of strategic opportunities. Future research and policy implications include; recognition and engagement with the full capabilities of design; integration of design experts; fostering inclusive engagement and collaboration; disentangling patient and public involvement; advancing human-centred systems approaches; adopting design-led approaches for policy-making.

The prevalence of potentially undiagnosed type II diabetes in patients with chronic periodontitis attending a general dental practice in London - a feasibility study.

Introduction In the UK alone, it is estimated that one in four people with type II diabetes are currently undiagnosed.Aim To investigate the prevalence of potentially undiagnosed type II diabetes in patients with chronic periodontitis attending a general dental practice in North London.Methods Patients aged 35 years and over, who had not been diagnosed with diabetes, attending for routine examination and diagnosed with chronic periodontitis, were offered screening for diabetes risk using the self-reporting Finnish Diabetes Risk Score (FINDRISC) questionnaire. If the score showed an increased risk of developing type II diabetes, a referral letter was sent to their general medical practitioner (GMP) for formal testing. The uptake and results of the test were recorded.Results Over the 12-month period, a total of 51 patients were eligible to take part, with 40 agreeing to participate (78% participation rate). Nineteen participants (48%) were found to be at a significantly increased risk of developing type II diabetes based on the recommended FINDRISC cut-off point and were referred to their GMP for formal testing. Eleven participants (58%) scored above the FINDRISC cut-off point and were categorised as high-risk. A further six participants (32%) fell into the moderate-risk category and two participants (10%) fell into the slightly elevated-risk category. Of the 19 participants who were referred for formal testing, four were not found to have type II diabetes, nine were found to have intermediate hyperglycaemia (or prediabetes) and two participants were diagnosed with type II diabetes.Conclusions This study confirmed a method of diabetes risk screening that has a good rate of uptake by patients and is practical for use in general dental practice. A moderate proportion of patients were identified as having an increased risk of developing diabetes and just under half were referred for formal testing. The study has shown an effective method for identifying undiagnosed type II diabetes and prediabetes in patients diagnosed with periodontitis who attend general dental practice.

Assessing periodontal health and the british society of periodontology implementation of the new classification of periodontal diseases 2017

Periodontal disease is a highly prevalent, chronic, inflammatory condition which is a major contributor to tooth loss and poor oral health-related quality of life. For the vast majority of patients, the disease is entirely preventable/manageable often aided by input from dental health professionals. As dental health professionals, understanding the periodontal disease process, the risk factors associated with it, standardized ways of detecting, diagnosing and monitoring the disease, along with the special tests needed to aid this process are essential skills for successful disease management. This article summarizes the need for assessing periodontal disease including key aspects of detection, a brief history of periodontal disease classification and the new classification. The paper goes on to discuss the British Society of Periodontology implementation plan of new classification and how this can be utilized for use in general dental practice. CPD/Clinical Relevance: This paper introduces the practitioner to the 2017 Classification of Periodontal Disease along with how this is implemented in general dental practice. The paper provides useful cases for practice as well as flowcharts to aid diagnosis.

Peri-implant tissue score (PITS) as a measure of success, applied to 869 dental implants from a retrospective clinical study.

This article presents a methodology of a comprehensive score for assessment and monitoring of dental implant success from the peri-implant tissue perspective. It involves only standard and minimally invasive techniques accessible to general dental practices, without the need for special equipment. The proposed score methodology combines existing consensual global knowledge regarding aspects of dental implant success with the standard examination tools accepted for regular recall assessment. The score is a sum of five three-grade parameters: bone level, peri-implant inflammation, amount of attached mucosa, tissues recession (ie, exposure of implant components to intraoral environment), and the horizontal buccal profile of the alveolar process. The name peri-implant tissue score (PITS) is derived from the intended primary use of monitoring the state of implants and the surrounding hard and soft tissues. With its emphasis on buccal-aspect tissues, the score is designed to aid the detection of early signs of tissues deterioration. The use of the score is demonstrated on a sample pool of 869 retrospectively evaluated implants with airborne-particle-abraded, acid-etched surfaces with time in service from 0 to 12 years. The parameters constituting the score were statistically tested on correlation with a reference set of success criteria, on mutual cross-correlations, and on the invariance to the implants' time-in-service. The PITS demonstrated to be highly representative of the success criteria, offering a fine scale from 0 to 10, and reversibility. The PITS withstood the tests. It responds to an existing need in the field, is widely accessible and inexpensive, and, thus, shows promise for use in general dental practice.

Practitioner evaluation of an online oral health and risk assessment tool for young patients.

Aim To test the validity and acceptability of an online oral health assessment and biofeedback tool for young patients (under 17) for use in general dental practice.Methods A convenience sample of thirteen practitioners were recruited to test the functionality of a novel version of the Denplan PreViser Patient Assessment tool (DEPPA) developed for young patients (YDEPPA). Dentists who had completed eight or more assessments during a one month window were sent a link to an online feedback survey, comprising eight statements about YDEPPA, with scoring options of 0-10, where a score of 10 indicated complete agreement with the relevant questions. Verbatim comments were encouraged. The clinical data submitted were held in a central database in an encrypted format so that only the user practice could identify individual patients.Results Twelve practitioners completed eight or more assessments and were included in the survey. A total of 175 patient assessments were received. Ten practitioners completed the on-line survey. The statement 'YDEPPA produces a valid measurement of each patient's oral health' received an average feedback score of 8.8. The statement 'The full YDEPPA report is a valuable communication aid' received a score of 9.6. Feedback was generally very positive with all scores >8.2. Constructive critical feedback was received for the caries risk aspect of the YDEPPA protocol, with suggestions made for improving objectivity of data inputs. Eighty-one percent of the verbatim comments received were positive.Conclusions Once the caries risk issues raised by pilot dentists have been addressed, YDEPPA appears suitable as a pragmatic analytical and biofeedback tool for use in general dental practice to assess the oral health of young patients, and to facilitate education and engagement of young patients and their parents/carers in positive health behaviours.

Hand-held dental x-ray equipment – an update

Hand-held dental X-ray equipment is increasingly being purchased for use in general dental practice. The aim of this paper is to update the practitioner with recently published recommendations on the requirements for hand-held devices. The article discusses the concerns often raised with the use of hand-held equipment including safety issues for the operator and the patient. CPD/Clinical Relevance: It is important for dentists to be aware of the current guidance if considering the use of hand-held X-ray devices in their practice.

Long-term validity and reliability of a patient survey instrument designed for general dental practice.

To consider the extent to which the validity and reliability of the Denplan Excel Patient Survey (DEPS) has been confirmed during its development and by its use in general dental practice and to explore methods by which any survey instrument used in general dental practice might be validated and tested for reliability. DEPS seeks to measure perceived practice performance on those issues considered to be of greatest importance to patients. Content validity was developed by a literature review and tested in a pilot study. Criterion validity was tested by comparing patient retention in a payment plan for practices achieving the highest DEPS scores with those attaining the lowest scores over a two year period (surveys completed between 2010 and 2012). Reliability was assessed using the test/re-test method for 23 practices with approximately a three year time interval between tests. Internal consistency was tested by comparing Net Promoter Scores (NPS - which is measured in DEPS) attained by practices with their Patient Perception Index (PPI) as measured by the ten core questions in DEPS. Practices in the pilot study strongly endorsed the content validity of DEPS. The 12 practices with the highest scores in the DEPS slightly increased their number of patients registered in Denplan payment plans during a two year period. The 12 lowest scoring practices saw 7% of their patients de-register during the same period. The 23 practices selected for the test/re-test study averaged more than 250 responses for both the test and re-test phases. The magnitude and pattern of their results were similar in both phases, while, on average, a modest improvement in results was observed. Internal consistency was confirmed as NPS results in DEPS closely mapped PPI results. The higher the measurement of perceived quality (PPI) the more likely patients were to recommend the practice (NPS). Both through its development and use over the last four years The DEPS has demonstrated good validity and reliability. The authors conclude that this level of validity and reliability is adequate for the clinical/general care audit purpose of DEPS and that it is therefore likely to reliably inform practices where further development are indicated. It is important and quite straightforward to both validate and check the reliability of patient surveys used in general dental practice so that dental teams can be confident in the instrument they are using.

Shall I go digital?

Dental radiographic imaging is slowly transferring to digital format. The decision to invest in this new technology should be based on a good understanding of the different types of digital imaging available within the dental field. This article outlines its use in general dental practice, highlighting the pros and cons of the various systems both for intra-oral and extra-oral radiography. An understanding of the mechanisms of digital imaging and their associated potential problems are required by any clinician moving to film-less imaging.

Diagnosis of erosive tooth wear.

The clinical diagnosis 'erosion' is made from characteristic deviations from the original anatomical tooth morphology, thus distinguishing acid-induced tissue loss from other forms of wear. Primary pathognomonic features are shallow concavities on smooth surfaces occurring coronal from the enamel-cementum junction. Problems from diagnosing occlusal surfaces and exposed dentine are discussed. Indices for recording erosive wear include morphological as well as quantitative criteria. Currently, various indices are used, each having their virtues and flaws, making the comparison of prevalence studies difficult. The Basic Erosive Wear Examination (BEWE) is described, which is intended to provide an easy tool for research as well as for use in general dental practice. The cumulative score of this index is the sum of the most severe scores obtained from all sextants and is linked to suggestions for clinical management. In addition to recording erosive lesions, the assessment of progression is important as the indication of treatment measures depends on erosion activity. A number of evaluated and sensitive methods for in vitro and in situ approaches are available, but the fundamental problem for their clinical use is the lack of reidentifiable reference areas. Tools for clinical monitoring are described.

The Contemporary Approach to Tooth Preservation: Minimum Intervention (MI) Caries Management in General Practice

The minimum intervention (MI) approach summarises a clinical, evidence-based rationale for the preventive and cause-related approach to oral diseases in general and to caries in particular. MI oral care with respect to the management of patients suffering from dental caries is a concept based on an updated understanding of the histopathological carious process as well as the development of diagnostic technologies and adhesive, bioactive restorative materials. A patient-centred MI care plan for use in general dental practice is described, detailing the four phases of identifying disease, controlling/preventing disease, refurbishing/repairing tooth surfaces/restorations and recall consultations.

Summary of: Evaluation of the basic erosive wear examination (BEWE) for use in general dental practice

The basic erosive wear examination (BEWE) is a relatively new index proposed for the screening and recording of tooth wear in adults. The aim of this study was to test the validity and reliability of the BEWE. Cross sectional study of a sample of 164 adult patients. General dental practice in East Lancashire, UK in 2010.Subjects Patients attending for routine examination or treatment. By screening patients with the BEWE and comparing the results to the established tooth wear index (TWI) the sensitivity and specificity of the BEWE was established. The BEWE predicted moderate to severe wear (BEWE grade 3) with a sensitivity of 48.6% and a specificity of 96.1%, and predicted severe wear with a sensitivity of 90.9% and a specificity of 91.5% (also BEWE score 3). Inter- and intra-examiner reliability for the BEWE were both moderate (κ(w) = 0.43 and 0.57 respectively). BEWE scores show a similar distribution to TWI scores and the examination is an effective screening test for severe tooth wear. The moderate levels of examiner reliability suggests the BEWE scores should be interpreted with some caution.

Evaluation of the basic erosive wear examination (BEWE) for use in general dental practice

The basic erosive wear examination (BEWE) is a relatively new index proposed for the screening and recording of tooth wear in adults. The aim of this study was to test the validity and reliability of the BEWE. Cross sectional study of a sample of 164 adult patients. General dental practice in East Lancashire, UK in 2010. Patients attending for routine examination or treatment. By screening patients with the BEWE and comparing the results to the established tooth wear index (TWI) the sensitivity and specificity of the BEWE was established.Results The BEWE predicted moderate to severe wear (BEWE grade 3) with a sensitivity of 48.6% and a specificity of 96.1%, and predicted severe wear with a sensitivity of 90.9% and a specificity of 91.5% (also BEWE score 3). Inter- and intra-examiner reliability for the BEWE were both moderate (κ(w) = 0.43 and 0.57 respectively). BEWE scores show a similar distribution to TWI scores and the examination is an effective screening test for severe tooth wear. The moderate levels of examiner reliability suggests the BEWE scores should be interpreted with some caution.

Vital Tooth Bleaching in Dental Practice: 3. Biological, Dental and Legal Issues

The final section of this series examines both the evidence for the safety of external bleaching with hydrogen peroxide and related products and the legal position in the UK with regard to their sale and use in general dental practice. Potential side-effects are examined, including biological effects and dental effects, with a review of the current evidence. The EU Cosmetics and Medical Device Directive are both described and their impact on the provision of tooth bleaching in the UK is explained. The legal position in the UK renders the sale and supply of solutions containing >0.1% peroxide illegal, and practitioners must be aware of the underlying legislation and the basis upon which a prosecution may be pursued. Clinicians considering using hydrogen peroxide products must be aware of the safety issues surrounding their use and be able to explain to patients the nature of the risk and also the likelihood of any given patient experiencing them.

A comparison of the performance of a compomer and an amalgam

Objectives To evaluate the clinical performance of a compomer material (Dyract®) in comparison with dental amalgam (Contour®) for management of proximal caries in primary molars in young children. Setting General dental practice, and a dental hospital paediatric clinic. Method This was a prospective study. A split mouth design was used with identical pairs of minimal Class II cavities, of matched tooth type in the same dental arch, usually diagnosed with the use of bitewing radiographs. Seventy-eight pairs of restorations were completed of which 60 pairs were available for evaluation after 24 months. Results Comparable retention rates were observed for both Dyract and amalgam. The retention rates were high for both materials, with only four amalgam and two Dyract restorations failing over 24 months. Significantly better marginal integrity (p < 0.05) was observed for Dyract compared with amalgam with no significant differences between the two materials for recurrent caries, wear or surface texture. Conclusions Dyract seemed to be a suitable alternative to amalgam for proximal restorations in primary molars of young children for use in general dental practice.

Management of needlestick injuries in general dental practice.

The objective of this paper is to advise on the development of practical policies for needlestick injuries in general dental practice. Policies for dealing with occupational exposure to chronic blood borne viruses, namely, hepatitis B, C and HIV are evolving. This article was particularly prompted by recent changes in post exposure prophylaxis for HIV infection. A flow chart is also included which should be of possible use in general dental practice. Needlestick injuries are of increasing concern to healthcare workers. Successful prophylaxis requires careful planning in advance. Whilst all practices should have a policy for sharps injuries, prevention of needlestick injuries remains the best policy.

A survey of in-dwelling intravenous cannula use in general dental practice.

A study to ascertain the use of in-dwelling intravenous cannulae in general dental practice was performed. A self-completion questionnaire was distributed to the 149 dental practitioners registered with the Cleveland Family Health Services Authority. A total of 131 dentists (88%) completed and returned the questionnaire: 58% of practitioners were practising either general anaesthesia (GA) or intravenous sedation (IVS) and 59% of these practitioners routinely used an in-dwelling intravenous cannula to administer the anaesthetic or sedative agents. This was supervised by a medically qualified anaesthetist in 100% of GA cases and 55% of IVS cases. Sixty per cent of respondents had received didactic instruction at undergraduate level on gaining intravenous access, but 72% of these stated that the teaching had been inadequate. Seventeen per cent of the practitioners had never received formal training in gaining intravenous access. These results suggest the need for formal practical instruction in obtaining intravenous access may have to be addressed.

An emergency drug cabinet for use in general dental practice.

An emergency drug cabinet for use in general dental practice.