Perceived stress and well-being in UK and Australian dental hygiene and dental therapy students.

INTRODUCTION: This study aimed to explore United Kingdom (UK) and Australian (Aus) dental hygiene and dental therapy students' (DHDTS) perception of stress and well-being during their undergraduate education. Upon qualification, DHDTS in the UK register as dental therapists (DT), and in Australia, they register as Oral Health Therapists (OHT). MATERIALS AND METHODS: A questionnaire was distributed to years 1, 2 and 3 DHDTS at the University of Portsmouth Dental Academy (UPDA) in the UK and La Trobe Rural Health School in Australia. The questionnaire consisted of 5 well-used measurement instruments which included the following: Dental Environment Stress questionnaire (DES); Depression Anxiety Stress Scales (DASS-21); Scales of Psychological Well-Being (SPWB); Valuing Questionnaire (VQ); and the Adult Hope Scale (AHS) to collect data on students' perception of levels of stress and well-being. RESULTS: A response rate of 58% (UK) and 55% (Australia) was achieved. Clinical factors and academic work were perceived as stressful for DHDTS in both the UK and Australia. The Australian DHDTS-perceived stress in the educational environment was significantly higher (P < .002) than the UK DHDTS. The majority of respondents reported levels of depression, anxiety and stress to be within the normal-to-moderate range. All students reported high levels of positive well-being, with no significant differences between the 2 groups. CONCLUSIONS: DHDTS in the UK and Australia identified sources of stress within their undergraduate education, but also perceived themselves as positively functioning individuals.

Attitudes of the first cohort of student groups trained together at the University of Portsmouth Dental Academy towards dental interprofessional education.

OBJECTIVE: This study explored, and compared, the attitudes of student groups trained at the University of Portsmouth Dental Academy (UPDA) in 2010/2011 towards dental interprofessional education (IPE). METHODS: The study population consisted of fifth-year student dentists (n = 80) from King's College London Dental Institute, second- and third-year dental hygiene and therapy (n = 38) and first-year dental nursing (n = 14) students from UPDA. A 19-item, validated and dentally modified questionnaire, 'Readiness for Inter-Professional Learning Scale (RIPLS)', was administered. RIPLS contains three subscales: teamwork and collaboration, professional identity and roles and responsibilities. Mean (x¯) and standard deviation (SD) of the scores were calculated, following reversal of negative items. All the analyses were carried out using SPSS version 20 and STATA version 11. RESULTS: An overall response rate of 71% (n = 94) was achieved. In reference to teamwork and collaboration, all groups strongly indicated that IPE can contribute to learning teamwork skills (x¯ = 24.98, SD = 3.5) and improving relationships with team members (x¯ = 12.93, SD = 1.63); however, the scores did not differ between the groups (P = 0.09 and P = 0.16, respectively). Concerning professional identity, student dentists had significantly higher preference for a discipline-based approach (P = 0.002); were more likely to agree that 'it is not necessary for undergraduate dental and dental care professional students to learn together' (P = 0.01); and perceived that 'clinical problem-solving skills can only be learnt effectively with other students from their own discipline' (P = 0.02) than dental hygiene and therapy students. In relation to roles and responsibilities, participants demonstrated a strong sense of their own professional role. Student dentists reported that they had 'to gain more knowledge and skills' than dental hygiene and therapy (P = 0.01) and dental nursing (P = 0.01) students. Dental hygiene and therapy students were less likely than student dentists to agree that 'the role of dental nurses and hygienists was to mainly provide support for dentists' (P = 0.001). CONCLUSION: The findings suggest that IPE was perceived as beneficial in relation to teamwork; however, the study raises issues regarding professional identity and roles. Educators should consider differing perceptions of professional roles and identities when planning and delivering interprofessional programmes.

Outreach clinical dental education: the Portsmouth experience - a 4-year follow-up study.

BACKGROUND: The Portsmouth Dental Academy (UPDA) was opened in September 2010 and was a development from the highly successful School of Professionals Complementary to Dentistry (2004-2010). The aim of the Academy was to provide integrated team education for all dental professionals in a primary care setting. The dental students are on outreach from King's College London, and the dental care professional students are registered at the University of Portsmouth. OBJECTIVES: To evaluate the dental students response to the residential outreach educational experience at the UPDA. METHODS: A 49-item questionnaire divided into nine domains that provided both qualitative data and quantitative data were administered at the end of the longitudinal 10-week placement, to four successive cohorts of students in 2010-2014. RESULTS: A 95% return rate was achieved. Students valued highly the quality of the clinical teaching. Through their experience, they felt they understood fully the role of the dentist in care planning in primary care and felt well prepared for dental foundation training. This educational success is unpinned with successful maintenance factors including a well-organised induction period and giving the students a sense of belongingness, empowerment and autonomy for their personal development as new graduates. CONCLUSION: Within the limitations of the questionnaire study over the 4-year period, the students were very positive about all the aspects of this residential outreach education at the UPDA but particularly valued the immersion in clinical dentistry and the bridging from dental school to their dental foundation training.

The relationship between access to and use of dental services following expansion of a primary care service to embrace dental team training.

OBJECTIVES: To investigate changes in the patient population and treatment case-mix within an expanded primary care dental training facility in Southern England. STUDY DESIGN: Cross-sectional analysis of patient management system data. METHOD: Electronic data for patients with a closed/completed treatment plan in the 12-month period prior to, and following, dental service expansion were extracted for analysis (n = 4343). Descriptive analysis involved age, sex, payment status, deprivation status and treatment activity. Logistic regression was used to model the likelihood of treatment involving laboratory constructed devices (crowns, bridges, dentures), in relation to demography and deprivation in each time period. RESULTS: The volume of patients using the service increased by 48.3% (1749 cf 2594). The average age increased from 31.97 (95%CI: 30.8, 32.5) to 36.4 years (95%CI: 35.6, 37.1); greatest increase was in the over 75 years age-group (96%). The patient base became less deprived: patients exempt from payment reduced from 43.2% (n = 755) to 28.6% (n = 741) (P = 0.001) and the mean population deprivation score (IMD) reduced from 24.5 (95%CI: 23.8, 25.2) to 22.3 (95%CI: 21.7, 22.8). The volume and proportion of care involving laboratory constructed devices increased from 8.3% (n = 145) to 15.8% (n = 411) whilst assessments without interventive care decreased (34.5%-26.3%). On a logistic regression, the odds of having treatment involving laboratory constructed devices, increased with increasing age in both time periods 7% (95% CI: 1.06-1.08) and 6% (95% CI: 1.05-1.07) respectively. Furthermore, the odds increased by 38% OR: 1.38 (95% CI: 1.01-1.89) in period 2, for white patients. After adjusting for these effects, the odds of having care that involved laboratory constructed devices were less in period 2 than period 1 (100% cf 43%) for those who were technically exempt from payment (OR = 2.0; 95% CI 1.34 to 2.90 cf, OR = 1.43; 95% CI 1.13-1.81). CONCLUSION: The patient population altered in relation to age and socio-economic status. The expanded service had greater uptake by older people while users were less likely to be deprived. The expanded service, free at the point of delivery, attracted a higher proportion of patients who would normally have to pay health service charges. The service also showed an increase in treatment case-mix that involved laboratory constructed dental devices.

The effect of monomer/polymer mixing ratio, time between mixing and packing of heat cured acrylic resin denture base material and bond assisting agents on the bond strength to acrylic resin denture teeth.

The aim of the study was to investigate the effect of varying the monomer/polymer mixing ratio, the time from mixing to packing heat cured acrylic resin and the effect of two bond assisting agents on the strength of the bond between denture base acrylic resin and acrylic resin denture teeth. Statistical differences were found in bond strength with monomer/polymer ratio and time between mixing and packing with one of the heat cured resins investigated. The benefit of using the bonding agents was not demonstrated.

Effect of welding parameters of the Nd:YAG laser on the penetration depth of cobalt chromium alloys.

The aim of the investigation was to study the effect of the laser welding parameters of energy and spot diameter on the penetration depth of the weld of cast Co-Cr alloy when a single weld was performed. Within the limitations of the study as voltage increased and the spot diameter decreased, penetration depth increased. However, SEM investigation showed more defects in the welded area under these circumstances. The clinical significance is that during selection of the welding parameters the thickness of the components to be welded should be considered to achieve an extended welded area without the induction of micro-structural defects.

Flexural strength and degree of polymerization of a proprietary denture base acrylic resin designed to be cured using long or short cycles.

The flexural strength and degree of polymerization of Diamond D acrylic resin prepared with a long cure monomer and a short cure monomer were investigated using Trevalon as a control. Flexural strength and degree of polymerization of Diamond D acrylic resin were not affected by either using a long cure monomer or the short cure monomer. There was no significant difference in the glass transition temperature Tg between the long and slow cure Diamond D. Provided the manufacturer's instructions are followed the flexural strength, degree of polymerization and glass transition temperature are comparable with more traditional products.

The retentive forces of the locator attachment system at different angulations.

The change of retentive force of three types of Locator inserts when the implant analogue was positioned perpendicular to horizontal, 5 degrees and 10 degrees to perpendicular after 4,200 cycles in vitro was measured using an EnduraTech fatigue testing machine lubricated with artificial saliva. The more rapid decrease in retention occurred up to three months and stabilized after one year of simulated use. The Locator inserts provided more retention when the analogue was placed at 5 degrees to perpendicular compared to 0 degrees and 10 degrees after 9 months of simulated clinical use. After 2 years of simulated clinical use, there was a reduction in retention for all the three inserts of between 70% and 80%.

Effect of curing cycles on the mechanical properties of heat cured acrylic resins.

Traditionally long curing cycles have been recommended for heat cured acrylic resin denture base materials. Recently manufacturers have produced materials for which they recommend short curing cycles. Specimens conforming to British Standards Specification were made using three different brands of heat cured acrylic resin denture base material. Each material was processed in three batches using either the manufacturer's recommended short curing cycle, an arbitrary medium curing cycle or a traditional long cycle. Specimens were subjected to a three point bending test. With one exception using the arbitrary medium curing cycle, all specimens achieved the British Standard suggesting that the manufacturers' recommended cycles should be followed.

The importance of communication in the construction of partial dentures.

Removable partial dentures (RPDs) are still a very important treatment modality in general dentistry to replace missing teeth. With the increase in popularity of implants, RPDs are sometimes seen as an 'old-fashioned' treatment option and if not carefully designed can be damaging to oral tissue and aesthetically less favourable. However, there is still a significantly large cohort of patients for whom RPDs are the best option for replacement of teeth either due to a failing dentition, inappropriate anatomy or financial considerations. This article explores the importance of effective three way communication with the patient, the laboratory and the dental nurse to support the provision of reliable and predictable prosthodontic outcomes.

Teaching stress management in undergraduate dental education: are we doing enough?

Dentistry is recognised as a stressful profession. A number of studies focusing on undergraduate education have shown high levels of stress in dental students. However, despite calls to do so, little has been published on methods to teach future dental professionals about stress and how to manage it on a personal level. Psychological stress which is uncontrolled may have an effect on general health. It is recognised, however, that stress can be beneficial if channelled appropriately. Techniques and ways to teach management of potential stresses of a career in dentistry have still not been widely reported in either dental undergraduate or postgraduate education. An intervention used with final year dental students at the University of Portsmouth for the last four years has highlighted some of the problems raised by students coping with a stressful programme of study. Students' comments indicated the need for an educational intervention on recognising and reducing stress to be introduced earlier on in their curriculum and that it should be universally taught.

An evaluation of defensive dentistry: w(h)ither the profession?

Introduction Defensive dentistry has become a popular choice for dentists in practice over the past decade, partly in response to the supposed increasing risks to patient safety, of litigation and of health and safety concerns to patients and staff.Methods Using a quantitative analysis, care plans of 96 dentists were examined from one day in April 2017 and compared against these known risks. One thousand four hundred and seventeen care plans were coded by treatment type. The risks of completing each item were coded as high or low for either clinical risk, health and safety risk and risk of litigation. Subsequently, semi structured interviews were conducted with 12 participants; five practitioners of over 25 years' experience and seven practitioners of less than five years' experience.Results All assessments and treatments, including no treatment, had recognised risks. 'Doing nothing' also carried a risk of litigation. Four themes were identified from the interviews: 'there by the grace of God, go I', 'limitations on the scope of practice', 'fear' and 'c'est la vie'.Discussion The profession is at a crossroads. The options for the future are discussed, including immediate retraining for all dental care professionals.Conclusion Within the limitations of this study, it is concluded that increasingly, no risk or only low risk treatments will be undertaken by the profession, with both experienced and less experienced practitioners limiting their scope of practice, with possible deleterious consequences on the dental health of the population.

Empowerment in a model of outreach undergraduate dental education.

Aim To undertake a quantitative and qualitative examination into what aspects of the students' experience in outreach at University of Portsmouth Dental Academy (UPDA) are encouraging their empowerment as autonomous practitioners, ready to graduate as 'safe beginners'.Methods The study was devised as part of the educational service evaluation of outreach education at the UPDA. For the two most recent cohorts of 160 students (2014-16) an additional domain was added specifically investigating the students' sense of how their experience of outreach at the UPDA has impacted on their development to be ready for independent practice (safe beginner). The questionnaire was completed anonymously in their last week of attendance just before graduation.Results A 91% response rate for the questionnaire was achieved. To the question about 'being given an opportunity to become an independent dentist', 83% of the respondents strongly agreed. Two themes with seven subthemes were identified from the free text responses. The two themes were 'self-actualisation: developing self-awareness and self-confidence' and 'delivery of care as a dentist'.Conclusion Within the limitations of this educational evaluation, students enjoyed the increase of autonomy they gained during the year-long placement and felt that the clinical teachers empowered, encouraged and supported them to develop as autonomous dental practitioners and as 'safe beginners', to deliver holistic care in the National Health Service.

Does stress in a dental hygiene and dental therapy undergraduate programme contribute to a sense of well-being in the students?

Aims To use a qualitative approach to further explore the stress and well-being of dental hygiene and dental therapy students (DHDTS) during their undergraduate training.Subjects and methods Semi-structured individual interviews to explore motivation, goals, and perceived stress, were conducted with eight DHDTS from across all three years of study at the University of Portsmouth Dental Academy (UPDA). Thematic analysis of the data was undertaken using Braun and Clarke's (2006) six phases of thematic analysis.Results Three main themes of 'fulfilment', 'the learning environment', and 'perception of stress' were identified. Within these themes, a further 12 sub-themes were identified. Analysis suggested that a strong sense of passion to become a clinician mitigated most, but not all, of the stressful experiences of the DHDTS undergraduate learning environment.Conclusions DHDTS' perceived sources of stress during their undergraduate programme were strongly linked to a sense of meaningfulness.Listen to the author talk about the key findings in this paper in the associated video abstract. Available in the supplementary information online and on the BDJ Youtube channel via http://go.nature.com/bdjyoutube.

Perceived stress and well-being among dental hygiene and dental therapy students.

Aims To explore dental hygiene and dental therapy students' (DHDTS') perception of stress and well-being during their undergraduate education and establish base-line data for further studies of this group of dental professionals.Subjects and methods A questionnaire was distributed to Years 1, 2 and 3 DHDTS and final year outreach dental students (DS) (as a comparison group), at the University of Portsmouth Dental Academy (UPDA), during summer 2015. Data were collected on students' perception of levels of stress and well-being. Statistical analyses were undertaken using SPSS software. Mann-Whitney U tests with Bonferroni corrections were used and the level for a statistically significant difference was set at p <0.002.Results A response rate of 81% (DHDTS) and 85% (DS) was achieved. Clinical factors and academic work were perceived as stressful for both DHDTS and DS, with no significant difference between the groups. The majority of respondents reported levels of depression, anxiety, and stress to be within the normal range. All students reported high levels of positive well-being, with DHDTS scoring significantly higher than DS in the dimensions of personal growth, purpose in life, self-acceptance and positive relations with others (p <0.002).Conclusions DHDTS and DS identified sources of stress within their undergraduate education, but also perceived themselves as positively-functioning individuals.

Belongingness in undergraduate dental education.

Objective To undertake a detailed educational evaluation into dental students' experience of the concept of belongingness and their development as 'safe beginners' on an outreach placement at the University of Portsmouth Dental Academy (UPDA).Method The participants were asked two questions: Did you feel belongingness at UPDA?; and When in your year rotation did you feel this? They completed the educational evaluation anonymously in their last week of attendance. The quantitative data was handled with descriptive statistics and the qualitative data was analysed for recurring themes.Results A 95% response rate was achieved. Eighty six percent of respondents strongly agreed to feeling belongingness and 56% felt it after their first two weeks. Four themes were identified: 'Interaction with the preexisting people environment' (1a. Initial welcoming and warmth 1b. Continued interest in me as an individual); 'Developing collegiality' (2a. My group of fellow students 2b. Working with the dental team as a dentist 2c. The team of everyone at UPDA); 'In the clinical environment' (3a. Being a dentist with responsibility and respect 3b. The physical environment 3c. Becoming a reflective independent practitioner); and 'Leadership'.Conclusion Belongingness in dental education should be defined as:- a deeply personal and contextually mediated experience in which a student becomes an essential and respected part of the dental educational environment where all are accepted and equally valued by each other and which allows each individual student to develop autonomy, self-reflection and self-actualisation as a clinician.

The profile of patients referred to an outreach restorative dentistry clinic over the last 10 years has changed.

The aim of the study was to compare the profile of the patients referred to a Restorative Dentistry consultant clinic at Scarborough General Hospital (SGH) in 1991 and 2001. The clinical records from 80% of a cohort of the new patients referred for consultation and who attended in 1991 and 2001 were examined. In total 55 clinical records were examined from 1991 and 84 from 2001. Data on reason for referral, time of wait before assessment and outcome of the consultation was recorded. The number of patients seen for consultation increased considerably between 1991 and 2001. Mean waiting times from the date of referral to the date when assessed trebled (p = 0.016). Referral for denture problems (notably complete dentures) was the main reason for referral in 2001 (25%). Tooth wear was the most common reason for referral in 1991 (22%). It was concluded that the demand for the services of a Restorative Dentistry consultant at Scarborough General Hospital increased considerably between 1991 and 2001. This resulted in considerably longer waiting times for a consultation. In 2001 there was a greater percentage of referrals for appearance, complete dentures and implants. A higher percentage of patients in this study were referred back to their GDP for treatment as compared to other studies.