What factors influence patient compliance with supportive periodontal therapy in a general practice setting?

Background The importance of supportive periodontal therapy following active treatment has been well documented but numerous studies have shown patient compliance to be poor. The aim of this study was to ascertain which factors affect patient compliance and whether this included routinely recorded periodontal indices.Methodology This was a five-year retrospective service evaluation study set within a private general dental practice. It utilised demographic and periodontal data from patients who attended the practice for chronic periodontal treatment in 2009 and ascertained whether there were links between this data and compliance with the supportive phase of periodontal treatment.Results Three hundred and ten patients satisfied the inclusion criteria of which 32.3% were categorised as compliant, 45.5% non-compliant and 22.3% erratic attenders. Patients who were statistically significantly more compliant were males (p = 0.03) and non-smokers (p = 0.01). There was a trend for older people to be more compliant; however this was not statistically significant. Plaque and bleeding scores were lower in the compliant group but only the bleeding scores were statistically significant (p = 0.03). The pocket probing depths were used as an indicator of disease severity and showed no significant relationship with compliance.Conclusion Although some of the periodontal parameters showed a statistically significant relationship with compliance, the difference between the parameters was clinically minimal suggesting that there is no definitive physical characteristic which is an indicator of patient compliance.

Immediate knowledge increase from an oral cancer information leaflet in patients attending a primary health care facility: a randomised controlled trial.

The aim was to determine the immediate influence of a validated patient information leaflet (PIL) on oral cancer and knowledge in primary care attenders. Participants were patients (n=800) attending their primary health care provider from 14 general practices (eight dental and six medical) in the north west of England. Measures were a previously validated knowledge questionnaire (36 dichotomous items), self-reported dental service attendance history and demographic variables. The results showed that patients who had read the oral cancer PIL demonstrated a significant increase in knowledge regardless of clinical setting (F[1,739]=246.24, P<0.0001). Patients showed improvements in selecting the correct signs and risk factors associated with disease. Immediate knowledge gain from a simple PIL about oral cancer was found and independent of the primary care facility, where the PIL was distributed.

Randomised trial of the psychological effect of information about oral cancer in primary care settings.

AIM: To determine the immediate influence of a validated patient information leaflet (PIL) on patient anxiety and intention to have a screen for oral cancer in primary care attenders. PARTICIPANTS: Patients (n=800) attending their primary health care provider. SETTING: Fourteen general practices (eight dental and six medical) in the northwest of England. DESIGN: Randomised controlled trial with two arms: leaflets provided in information group, leaflet was absent in control group. MEASURES: Single item ratings of (1) intention to have an oral cancer screen, and (2) anxiety towards a screen, (3) perceived risk of oral cancer. Knowledge of oral cancer, self-reported dental service attendance history and demographic variables were also collected. RESULTS: Patients who had read the oral cancer PIL demonstrated an increase in their intention to have a screen (Mann Whitney U test: z=-3.67, P<0.001) and reduced anxiety (Mann Whitney U test: z=-2.07, P<0.05). Subjective risk was not elevated by the extra information. Intention to have a screen was predicted by knowledge level and anxiety (odds ratios: 1.10 and 0.70 respectively, both P's<0.001). CONCLUSION: The influence of an information leaflet appeared to have a positive effect on anxiety level and intentions to agree to receive an oral cancer screen.

Initial experience of the ORATEL computerised information tools in general practice.

ORATEL (a telematic system for quality assurance indicators in oral health care) is a three-year project with the ultimate objective of improving the quality of oral health care through the use of appropriate computerised information systems. These tools are designed to promote quality assurance and quality of care development in oral health care by using common quality indicators/standards. ORATEL has developed three prototypes of computerised information systems: an interactive multimedia teach software on quality assurance in oral health care, ORATEL-TEACH; a proactive quality assurance support tool for real time use at the dental unit, ORATEL-PROACT; and an integrated set of modules for monitoring and self assessment at the clinical level and for the computerised reporting of aggregated data for evaluation at higher levels, ORATEL-REVAL. The initial experiences of using these tools was assessed during 1993 in general dental practice locations in Liverpool and clinics in for other European countries. Overall, the dentists were positive about the potential usefulness of the ORATEL tools but further improvements were considered necessary. Finding has been approved by the European Commission for further development under a new project called ORQUEST.

Clinical quality assurance indicators for oral status and treatment of a group of older adults.

OBJECTIVE: To record and comment on the oral status and treatment provision over a 3-year period for a group of 150 patients aged between 50 and 64 with special reference to the WHO (ORATEL) quality assurance indicators. DESIGN: 150 patients in the defined age group who were attending a general dental practitioner for a routine examination were sampled over a 3-month period. The oral status was recorded by the GDP at the time of attendance and a retrospective analysis of treatment provided over three years was carried out by reference to the patient case notes. RESULTS: An analysis of the data relating to oral health status and previous treatment provision suggested that some indicators were easy to accurately record while others lacked clear diagnostic criteria. There were also some inconsistencies in format. There was a lack of coverage in a few important areas and some additional indicators were suggested. CONCLUSIONS: The ORATEL indicators form a useful core dataset for GDPs to use to measure oral health change within the patient base of their practices. The recording and analysis of quality assurance indicators by the GDP could make a significant contribution to the monitoring of the oral health change of patients in general dental practice.

Clinical record keeping by general dental practitioners piloting the Denplan 'Excel' accreditation programme.

BACKGROUND: Denplan is a private capitation-based system of providing primary dental care in the UK. An additional programme called Denplan Excel has been developed which requires General Dental Practitioners to instigate various quality processes within their practices in order to become accredited. Clinical record keeping is one area where standards are monitored. This study reports changes in record keeping at patient recall appointments following the implementation of the Denplan Excel programme. METHOD: Fifty dentists participating in the Denplan Excel pilot programme from different areas of the UK were sampled by means of cluster sampling. Twenty records for each dentist were sampled and items recorded for patients recalled both pre- and post-pilot were compared. RESULTS: The majority of dentists recorded presenting complaint, diagnosis and treatment plan both pre- and post-pilot. However, post-pilot there were a number of improvements in record keeping. Caries recorded on a grid increased from 7% of records to 46%, basic periodontal examination increased from 48% to 85% of records and the updating of medical history increased from 51% to 65% of records. These findings were all significant at the p<0.01 level. CONCLUSION: Changes can be achieved by voluntary participation in a system of structured record keeping.

A study of prophylactic antibiotic prescribing in National Health Service general dental practice in England.

OBJECTIVE: To study the use of prophylactic antibiotics by general dental practitioners. DESIGN: A postal questionnaire of National Health Service (NHS) general dental practitioners in ten English Health Authorities. SUBJECTS: General dental practitioners (GDPs) (1544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside. MAIN OUTCOME MEASURES: The questionnaires were analysed and the responses to each question expressed as absolute frequencies. RESULTS: Responses to the questionnaires were received from 929 (60.1%) practitioners. Over 40% of general dental practitioners would prescribe prophylactic antibiotics for patients with no relevant medical history for minor oral surgery to prevent postoperative infection. Amoxicillin was the predominant choice of antibiotic in this situation. Between 15-67% of GDPs failed to prescribe prophylactic antibiotics for at risk medically compromised patients. GDPs also prescribed for patients with a medical history not known to be at risk from dental procedures. Over 50% of GDPs however, would seek specialist advice about prophylaxis if they were unsure of the indications and over 90% of GDPs indicated they would use the current recommended regime for antibiotic prophylaxis for patients at risk of infective endocarditis. CONCLUSIONS: The evidence from this study suggests that a significant number of the practitioners surveyed prescribe prophylactic antibiotics inappropriately, both for surgical procedures and for patients at risk from endocarditis. There is also evidence that practitioners prescribe antibiotic prophylaxis for clinical procedures and medical conditions for which there is little evidence. The results suggest that there is a need for the development of guidelines for practitioners on the appropriate prophylactic use of antibiotics.

A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England.

OBJECTIVE: To study the therapeutic prescribing of antibiotics by general dental practitioners. DESIGN: A postal questionnaire of National Health Service general dental practitioners in ten English Health Authorities. SUBJECTS: General dental practitioners (1,544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside. MAIN OUTCOME MEASURES: The questionnaires were analysed and the responses to each question expressed as absolute frequencies. RESULTS: Responses to the questionnaire were received from 929 (60.1%) practitioners. More than 95% of practitioners recognised the need for prescribing antibiotics where there was evidence of spreading infection. Some practitioners (12.5%) prescribed antibiotics for acute pulpitis and (3.3%) for chronic marginal gingivitis. Antibiotics were prescribed by practitioners before drainage of acute abscesses (69%) and by 23% after drainage. Practitioners were generally not influenced by patient's expectations of receiving antibiotics (92%), but would prescribe when under pressure of time (30.3%), if they were unable to make a definitive diagnosis (47.3%), or if treatment had to be delayed (72.5%). Amoxicillin was the most frequently prescribed antibiotic used for most clinical conditions apart from pericoronitis, acute ulcerative gingivitis and dry sockets where metronidazole was the drug of choice. There was a wide variety of dosage, frequency and duration for all the antibiotics used in the treatment of acute dental infections. CONCLUSIONS: The results obtained from this questionnaire support the conclusion that the therapeutic prescribing of antibiotics in general dental practice varies widely and is suboptimal. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of the antibiotics in National Health Service general dental practice.

A survey of general dental practitioners' postgraduate education activity and demand for extended modular postgraduate programmes.

The aim of this paper is to assess the level of involvement of general dental practitioners in postgraduate education and training, identify their speciality interests, preferred format of course presentation and assess the potential demand for modular postgraduate programmes. A questionnaire analysis of a one in three random sample of general dental practitioners on Health Authority lists in the North West of England and North Wales was designed and carried out. Out of a random sample of 799, 552 GDPs completed an anonymous questionnaire in 1998 which investigated their current postgraduate activity, the areas of specialist interest and their interest in extended modular postgraduate education courses with associated summative assessment. Fifty three percent of respondents attended more than four postgraduate sessions per year of whom the majority (59%) were in 35-44 year old age group. 79% identified Section 63 courses as their first preference and 63% preferred mixed didactic and 'hands on' courses. Seventy five percent of respondents expressed an interest in attending modular programmes which might lead to a postgraduate qualification. In conclusion, an enthusiasm to attend existing postgraduate courses was identified but a demand was also perceived for courses of longer duration possibly leading to additional postgraduate qualifications.

Clinical evaluation of three posterior composite and two amalgam restorative materials: 3-year results.

The clinical performance of three posterior composites and two amalgams was evaluated over 3 years. Three hundred and nine composites and 200 amalgams were reviewed at the 3-year recall. The following parameters were assessed: fractures, gingival condition, interproximal contacts, marginal adaptation, staining and colour match. Although there was no significant difference in the overall failure rate between the two types of material, there was a significantly higher incidence of fracture in the amalgam restorations. The amalgam failures were exclusively mechanical, whereas those affecting composites also included failures that were more biological in nature. A significantly higher proportion of the Class II composites failed to achieve an adequate approximal contact, but this was not reflected in a more adverse gingival response. Colour match, surface and marginal stain varied significantly within the composite group and appeared to be material-related. Overall, the materials Occlusion and P-30 were considered to be performing adequately. The clinical handling, colour match and radiopacity of Clearfil Posterior were considered to be unsatisfactory.

General dental practitioner advice regarding the use of fluoride toothpaste in two areas with a school-based milk fluoridation programme and one without such a programme.

OBJECTIVE: To describe the knowledge and practice of general denta practitioners (GDPs) working in Liverpool (where there is no milk fluoridation programme) and St Helens and Knowsley, and the Wirral (where children have fluoridated milk in schools and pre-schools) relating to the advice given for child patients regarding the use of fluoridated toothpaste. DESIGN: Data were collected via a postal questionnaire sent to all 329 GDPs working within the three areas. GDPs working in more than one of the areas and those working in specialist orthodontic or oral surgery practices were excluded. RESULTS: Two hundred and thirty-four (71%) questionnaires were completed and returned. Only 3% of dentists said that no-one in their practice gave advice on the concentration of fluoride toothpaste to be used. For caries free children under 7 years of age only 64% of GDPs gave advice concerning the concentration of toothpaste which coincided with the available clinical guidelines. Twenty eight per cent of GDPs also contradicted the guidelines by advising children under 7 with high caries to use a low fluoride toothpaste. Although 59% of GDPs in the fluoridated milk areas asked the child whether they had fluoridated milk at school, they did not appear to alter the advice given regarding the use of fluoridated toothpaste. CONCLUSION: The study showed that a significant number of GDPs did not adhere to clinical guidelines relating to the use of fluoride toothpaste when giving advice to their child patients. For evidence-based dentistry to become a reality in this area, ways must be found to disseminate the available guidelines more fully and increase their acceptance and use by practitioners.

A clinical minimum data set for primary dental care.

OBJECTIVE: To achieve consensus within primary dental care on the contents of a clinical minimum data set to measure oral health status. DESIGN: Using the Delphi process a simple random sample of 30 LDCs and 10 CDS services in England were asked to rank a list of existing clinical indicators in order of their perceived importance as a means of measuring oral health. A nominated panel representing the stakeholder organisations of primary dental care reviewed this ranking and identified a core group of clinical indicators to be included in a clinical minimum data set. RESULTS: An 80 percent response rate to the Delphi process was achieved. Consensus was reached on a core group of 10 indicators, which can provide information on patient's perceptions of pain, function and appearance, and professional measurements of caries, teeth present, periodontal disease, oral sepsis, presence of mucosal pathology and tooth wear. CONCLUSIONS: A representative sample of primary care dentists in England and the key representative organisations of primary dental care achieved consensus on the contents of a clinical minimum data set to record oral health status in primary dental care. This is a first step in standardising the measurement of oral health status across primary care.

The personal dental service as a setting for an undergraduate clinical programme.

OBJECTIVE: To investigate the feasibility and benefits of placing dental undergraduates into a general dental practice setting for part of their clinical programme. SETTING: Two six-surgery general dental practices in the North West of England operating within the personal dental service of the NHS. METHOD: Six volunteer final year students worked within the practices for one-day-per week for 11 weeks. Evaluation included patients', practitioners' and students' views obtained from questionnaires and/or interviews and an analysis of students' clinical records. RESULTS: The students saw a large positive impact from: working alongside a dental nurse; developing their clinical skills; working in a busy practice environment; and developing interpersonal skills. Patients were very positive with 98% (44/45) being complimentary about the treatment they received, and commenting that they would be willing to participate in future student training programmes. The practice principals would also welcome continuation of the programme. CONCLUSION: The programme was both feasible and educationally beneficial. The financial implications need further research.

The development and use of a triage protocol for patients with dental problems contacting an out-of-hours general medical practitioner cooperative.

PURPOSE OF THE STUDY: The number of patients contacting general medical practitioner (GMP) out-of-hours services with dental problems is perceived to be a significant problem by the medical profession. This study was undertaken to design and pilot a triage protocol that could be used by non-dental staff to refer callers with dental complaints for appropriate treatment. BASIC PROCEDURES: A triage protocol was designed to address the patient conditions considered to be relevant to emergency dental care. The triage protocol was piloted for three months at a GMP cooperative in North Wales, which provided an out-of-hours service for 61 GMPs. Baseline data were collected for three months prior to the introduction of the triage protocol. MAIN FINDINGS: The study showed that the number of dental callers contacting the out-of-hours service was not as great as GMPs imagined, and was similar to other studies. The introduction of the triage protocol resulted in a rise in the number of callers asked to call the general dental practitioner (GDP) support line. The number of unregistered patients given the name of a dentist also increased. The need to make a second telephone call seemed not to affect patient satisfaction since when patients were later questioned on their experience, those who had used the service since the introduction of the triage protocol were more likely to be satisfied with the service. PRINCIPAL CONCLUSIONS: This study provides some evidence that a triage protocol can be used successfully by non-dental staff to sift requests for out-of-hours emergency dental care.

Oral signs and symptoms as predictors of salivary gland hypofunction in general dental practice.

OBJECTIVE: To evaluate the signs and symptoms of oral dryness as predictors of salivary gland hypofunction (SGH) in general dental practice. DESIGN AND SETTING: Prospective study recruiting adult patients attending five general dental practices in Merseyside in 1999. MATERIALS AND METHOD: Patients were screened for subjective symptoms of oral dysfunction and clinical signs of oral dryness. Patients with oral symptoms or signs of SGH were invited to undergo sialometry. Results were analysed using multiple logistic regression. RESULTS: 1103 patients were screened for signs and symptoms of oral dryness, 115 reported continuous xerostomia, of these 65 were also clinically (subjectively) assessed as having a dry oral mucosa. One hundred and one patients attended for sialometry and 73% of these had objective evidence of SGH. Neither the patients' complaints of oral dryness or the assessment of dryness of the oral mucosa were significant predictors of SGH. CONCLUSIONS: Symptoms of oral dysfunction and clinical signs of oral dryness were not significant predictors of SGH in dental practice.

Dental photography in record keeping and litigation.

Dental photography is essential in record keeping and it is important for all members of the dental team to be appropriately trained and for each practice to have the appropriate equipment. This article provides an overview of the applications of dental photography and equipment, and highlights issues of consent and duty of care.

An investigation of antibiotic prophylaxis in implant practice in the UK.

BACKGROUND: There is increasing evidence of the inappropriate use of antimicrobials in dentistry and this may contribute to the problem of antimicrobial resistance. The research to date with regard to efficacy of antimicrobial prophylaxis in reducing failure of integration and postoperative complications when placing dental implants remains equivocal. The aim of this study was to investigate how dentists in the UK use antimicrobials prophylactically in implant practice. METHOD: An e-mail link was provided in 2011 to an anonymous online (Smart-Survey) questionnaire using three databases of dentists who, by being on them, had registered an interest in placing dental implants. Absolute frequencies were used to describe the study sample demographics and examine the distribution of responses for all the variables investigated. RESULTS: One hundred and nine completed questionnaires were received. Seventy-two percent (n = 76) routinely prescribed prophylactic antibiotics for all procedures. There was a wide variation in the pre-operative and postoperative prescription regimens with the majority (84%) stating that it was to prevent infection at the site of surgery or to reduce a bacteraemia. CONCLUSIONS: Although this was a small study with a low response rate, wide variations in antibiotic prescribing regimens with respect to drug, dose and duration were found. Further research is needed and guidelines developed to prevent antibiotic overprescribing and misuse.

The medical and dental attendance pattern of patients attending general dental practices in Warwickshire and their general health risk assessment.

BACKGROUND: The dental team could have an important role to play in general health risk assessment within primary and community healthcare.Aims To describe medical and dental attendance patterns, demographics and health profiles of patients routinely attending general dental practices in Warwickshire. To identify whether a subgroup attend dental practices regularly but attend medical practices infrequently and discuss whether preventive healthcare interventions delivered in general dental practice would be appropriate. METHODS: A self-completion questionnaire was administered to patients attending 16 dental practices in Warwickshire. RESULTS: Eight hundred and eleven completed questionnaires were returned (74% response). Seven hundred and eighty-nine (98%) respondents visited their dentist every one to two years or more frequently and of these a subgroup of 121 (15.3%) visited their general medical practice surgery or health centre less often than every two years. In the subgroup 9.5% reported high blood pressure, 17.6% currently smoked, 22% drank above recommended guidelines, 32.1% were overweight and 7.3% obese. DISCUSSION: The data suggest there may be a role for dental practitioners in identifying patients at risk of having undiagnosed or future general health problems and providing appropriate general health advice, screening or signposting the patient to relevant general healthcare facilities either within or external to the dental practice.