Sustainable oral healthcare: what is it and how do we achieve it?

In recent years, there has been an increase in interest in what environmental sustainability means for healthcare, including oral health and dentistry. To help facilitate discussions among key stakeholders in this area, the Scottish Dental Clinical Effectiveness Programme held a workshop in November 2022. The purpose of this workshop was to explore current thinking on the subject of sustainability as it relates to oral health and to help stakeholders identify how to engage with the sustainability agenda. This paper presents an overview of the presentations and discussions from the workshop and highlights potential avenues for future work and collaboration.

Citizen science to improve patient and public involvement in GUideline Implementation in oral health and DEntistry (the GUIDE platform).

BACKGROUND: Citizen science is a way to democratise science by involving groups of citizens in the research process. Clinical guidelines are used to improve practice, but their implementation can be limited. Involving patients and the public can enhance guideline implementation, but there is uncertainty about the best approaches to achieve this. Citizen science is a potential way to involve patients and the public in improving clinical guideline implementation. We aimed to explore the application of citizen science methods to involve patients and the public in the dissemination and implementation of clinical guidelines in oral health and dentistry. METHODS: We developed GUIDE (GUideline Implementation in oral health and DEntistry), a citizen science online platform, using a participatory approach with researchers, oral health professionals, guideline developers and citizens. Recruitment was conducted exclusively online. The platform focused on prespecified challenges related to oral health assessment guidelines, and asked citizens to generate ideas, as well as vote and comment on other citizens' ideas to improve those challenges. Citizens also shared their views via surveys and two online synchronous group meetings. Data were collected on participant's demographics, platform engagement and experience of taking part. The most promising idea category was identified by an advisory group based on engagement, feasibility and relevance. We presented quantitative data using descriptive statistics and analysed qualitative data using inductive and deductive thematic analysis. RESULTS: The platform was open for 6 months and we recruited 189 citizens, from which over 90 citizens actively engaged with the platform. Most citizens were over 34 years (64%), female (58%) and had a university degree (50%). They generated 128 ideas, 146 comments and 248 votes. The challenge that led to most engagement was related to prevention and oral health self-care. To take this challenge forward, citizens generated a further 36 ideas to improve a pre-existing National Health Service oral care prevention leaflet. Citizens discussed motivations to take part in the platform (understanding, values, self-care), reasons to stay engaged (communication and feedback, outputs and impact, and relevance of topics discussed) and suggestions to improve future platforms. CONCLUSION: Citizen science is an effective approach to generate and prioritise ideas from a group of citizens to improve oral health and dental services. Prevention and oral health self-care were of particular interest to citizens. More research is needed to ensure recruitment of a diverse group of citizens and to improve retention in citizen science projects. PATIENT OR PUBLIC CONTRIBUTION: This project was inherently conducted with the input of public partners (citizen scientists) in all key aspects of its conduct and interpretation. In addition, two public partners were part of the research team and contributed to the design of the project, as well as key decisions related to its conduct, analysis, interpretation and dissemination and are co-authors of this manuscript.

The practices and beliefs of dental professionals regarding the management of patients taking anticoagulant and antiplatelet drugs.

AIM: This study aimed to inform the implementation of the updated Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance, 'Management of Dental Patients taking Anticoagulant or Antiplatelet Drugs', and to determine training needs by investigating dental professionals' current practice and beliefs regarding management of patients taking these medications. METHODS: Dental professionals were recruited via the NHS Education for Scotland Portal. The online questionnaire collected demographic information, data on current practice and information about beliefs regarding behaviours related to the management of patients on anticoagulant or antiplatelet medication. Quantitative data were analysed using SPSS and subjected to frequency calculations, t-tests, one-way ANOVA and linear regression. Qualitative data were collected via free text boxes and analysed using thematic analysis. RESULTS: One hundred and fifty-seven participants responded to the questionnaire. The majority of respondents stated they were aware of the guidance and always based their practice on it. The majority of respondents always assessed the patient's individual bleeding risk prior to dental procedures. Most respondents felt that they did not know how to appropriately manage patients taking low doses of low molecular weight heparins (LMWH), and only 38% of respondents always followed SDCEP guidance about direct oral anticoagulants (DOAC) medication and procedures with a low associated risk of bleeding. DISCUSSION: This study demonstrates a need for further educational support surrounding LMWHs and management of patients on DOAC medication. Time and remuneration represent barriers to guidance implementation in primary care. CONCLUSION: There is good awareness and adherence to the guidance in primary care settings, however training needs were identified to support implementation.

A qualitative analysis of dental professionals' beliefs and concerns about providing aerosol generating procedures early in the COVID-19 pandemic.

INTRODUCTION: In response to the COVID-19 pandemic, the Scottish Dental Clinical Effectiveness Programme (SDCEP) initiated a rapid review of the evidence related to the generation and mitigation of aerosols in dental practice. To support this review, a survey was distributed to better understand the provision of aerosol generating procedures (AGPs) in dentistry. METHODS: An online questionnaire was distributed to dental professionals asking about their current practice and beliefs about AGPs. Data were analysed using qualitative content analysis. RESULTS: Analysis revealed confusion and uncertainty regarding mitigation of AGPs. There was also frustration and scepticism over the risk of SARS-COV-2 transmission within dental settings, the evidence underpinning the restrictions and the leadership and guidance being provided, as well as concern over financial implications and patient and staff safety. DISCUSSION: The frustration and concerns expressed by respondents mirrored findings from other recent studies and suggest there is a need for reflection within the profession so that lessons can be learned to better support staff and patients. CONCLUSION: Understanding the profession's views about AGP provision contributed to the SDCEP rapid review and provides insights to help inform policymakers and leaders in anticipation not only of future pandemics but in considering the success of any large scale and/or rapid organisational change.

Patient-, organization-, and system-level barriers and facilitators to preventive oral health care: a convergent mixed-methods study in primary dental care.

BACKGROUND: Dental caries is the most common chronic disease of adult and childhood, a largely preventable yet widespread, costly public health problem. This study identified patient-, organization-, and system-level factors influencing routine delivery of recommended care for prevention and management of caries in primary dental care. METHODS: A convergent mixed-methods design assessed six guidance-recommended behaviours to prevent and manage caries (recording risk, risk-based recall intervals, applying fluoride varnish, placing preventive fissure sealants, demonstrating oral health maintenance, taking dental x-rays). A diagnostic questionnaire assessing current practice, beliefs, and practice characteristics was sent to a random sample of 651 dentists in National Health Service (NHS) Scotland. Eight in-depth case studies comprising observation of routine dental visits and dental team member interviews were conducted. Patient feedback was collected from adult patients with recent checkups at case study practices. Key informant interviews were conducted with decision makers in policy, funding, education, and regulation. The Theoretical Domains Framework within the Behaviour Change Wheel was used to identify and describe patient-, organization-, and system-level barriers and facilitators to care. Findings were merged into a matrix describing theoretical domains salient to each behaviour. The matrix and Behaviour Change Wheel were used to prioritize behaviours for change and plan relevant intervention strategies. RESULTS: Theoretical domains associated with best practice were identified from the questionnaire (N-196), case studies (N = 8 practices, 29 interviews), and patient feedback (N = 19). Using the study matrix, key stakeholders identified priority behaviours (use of preventive fissure sealants among 6-12-year-olds) and strategies (audit and feedback, patient informational campaign) to improve guidance implementation. Proposed strategies were assessed as appropriate for immediate implementation and suitable for development with remaining behaviours. CONCLUSIONS: Specific, theoretically based, testable interventions to improve caries prevention and management were coproduced by patient-, practice-, and policy-level stakeholders. Findings emphasize duality of behavioural determinants as barriers and facilitators, patient influence on preventive care delivery, and benefits of integrating multi-level interests when planning interventions in a dynamic, resource-constrained environment. Interventions identified in this study are actively being used to support ongoing implementation initiatives including guidance, professional development, and oral health promotion.

Perceptual Changes in Response to Two Regimens of Interval Training in Sedentary Women.

This study examined acute and chronic changes in perceptual measures (rating of perceived exertion [RPE], affect, and arousal) in response to 2 regimens of high-intensity interval training (HIIT). Twenty-three healthy sedentary women (mean ± SD age and V[Combining Dot Above]O2max = 23.0 ± 5.7 years and 30.1 ± 4.4 ml·kg·min, respectively) were randomized to complete 12 weeks of one of 2 HIIT regimes, whereas an additional 7 women served as sedentary controls. Training was performed 3 days per week on a cycle ergometer and consisted of up to ten 1-minute bouts at moderate (60-80%Wmax = moderate intensity [MOD]) or more intense (80-90%Wmax = HI) workloads separated by active recovery. At baseline and every 3 weeks, RPE, affect, and arousal were measured during training using validated scales. Repeated measures analysis of variance was used to examine acute and chronic changes in these variables to HIIT. Data revealed significant (p < 0.001) increases in RPE and arousal and decreases (p < 0.001) in affect during acute HIIT, with RPE responses differing (p ≤ 0.05) between HI and MOD. However, acute changes in affect and arousal were similar in HI and MOD. Training led to a significant reduction in RPE, whereas both affect and arousal were unchanged (p > 0.05) after HIIT. Completion of moderate or more intense interval training reduces perceptions of RPE during training yet does not alter arousal or affect. RPE was reduced via training, yet large dependence on anaerobic metabolism during HIIT may minimize training-induced changes in affect.

Magnitude and time course of changes in maximal oxygen uptake in response to distinct regimens of chronic interval training in sedentary women.

PURPOSE: This study aimed to compare changes in maximal oxygen uptake (VO2max) in response to two regimens of chronic interval training. METHODS: Twenty healthy sedentary women (mean ± SD age and VO2max = 23.0 ± 5.7 years and 30.1 ± 4.4 mL kg(-1) min(-1), respectively) were randomized to complete 12 weeks of one of two interval training regimes, while an additional seven women served as controls. Training was performed 3 days week(-1) on a cycle ergometer and consisted of 6-10 bouts of 1 min duration at lower (60-80 % W max = LO, n = 10) or more intense (80-90 % W max = HI, n = 10) workloads separated by a brief recovery. Every 3 weeks, measures of VO2max and W max were repeated to assign new training intensities. Changes in blood pressure and body composition were also examined. RESULTS: Data revealed significant (p < 0.001) improvements in VO2max in LO (22.3 ± 6.9 %) and HI (21.9 ± 11.6 %) that were similar (p > 0.05) between groups. Approximately 60 % of the increase in VO2max in HI was observed in the initial 3 weeks, compared to only 20 % in LO. No change (p > 0.05) in body weight or body composition was revealed in response to training. Results demonstrate that a relatively prolonged regimen of moderate or more intense interval training induces similar improvements in cardiorespiratory fitness, although HI induced greater increases in VO2max early on in training than LO. Completion of more intense interval training may be an effective means to expedite increases in VO2max soon after initiation of exercise training.

Effect of two doses of interval training on maximal fat oxidation in sedentary women.

INTRODUCTION: The primary aim of the current study was to determine the effect of two doses of chronic high-intensity interval training (HIT) on changes in maximal fat oxidation (MFO) and body composition. METHODS: Sedentary women (N = 23, age and V˙O2max = 24.2 ± 6.2 yr and 30.3 ± 5.2 mL·kg-1·min-1, respectively) completed either high (HI) (80%-90% maximal workload) or moderate (MOD) intensity (60%-80% maximal workload) HIT on a cycle ergometer 3 d·wk-1 for 12 wk consisting of 6-10 sixty-second bouts interspersed with active recovery. Seven women of similar age and fitness level served as controls. Every 3 wk, substrate oxidation was assessed during progressive exercise via indirect calorimetry to determine MFO and minimum fat oxidation, and body composition was assessed every 6 wk. Repeated-measures ANOVA was used to examine changes in substrate oxidation in response to training, with training group used as a between-subjects variable. RESULTS: Results revealed improved MFO (P = 0.04, 19%-25%) and minimum fat oxidation (P = 0.001, 22-24 W) in response to HIT, yet the magnitude of improvement was similar (P > 0.05) between training paradigms. No change (P > 0.05) in body weight, percent body fat, or waist-hip circumference was revealed with training. CONCLUSION: These data suggest that 12 wk of either moderate or more strenuous interval training similarly enhance fat oxidation in sedentary women but do not alter body weight or body composition.