Why don't dental teams routinely discuss dentine hypersensitivity during consultations? A qualitative study informed by the Theoretical Domains Framework.

AIM: Although dentine hypersensitivity is widespread, can cause substantial pain and impact quality of life, it is not routinely discussed during dental consultations. This qualitative study aimed to develop an understanding of the barriers and facilitators to these discussions. MATERIALS AND METHODS: Using the Theoretical Domains Framework to shape the topic guide, N = 7 online focus groups were organized with a total N = 40 participants comprising experienced dentists, dental foundation trainees and dental care professionals. Inductive and deductive thematic analyses of the anonymized, transcribed focus group conversations were undertaken. RESULTS: An attitude-behaviour gap was observed in dental teams' accounts. Although they saw it as part of their professional role to routinely discuss sensitivity, and believed that such conversations were 'an easy win', in practice they experienced several behavioural barriers that hindered these conversations from taking place. These included competing priorities, a perceived lack of seriousness and assessment of dentine hypersensitivity and practical issues such as time. CONCLUSIONS: Systemic (e.g., lack of time and training, professional culture) and behavioural (e.g., dental teams' belief that conversations should take place only with patients likely to be adherent) barriers to dentine hypersensitivity conversations explain why these conversations do not routinely take place.

Diversifying the dental curriculum: A review of the Bachelor of Dental Surgery degree reading lists in a UK dental school.

INTRODUCTION: Analysis of the diversity of reading lists on courses offered by universities is one way to assess what is being taught and how it shapes our understanding of the world. Very little work has been carried out so far within dentistry on decolonising the curriculum. Existing work looks at the representation of women or ethnic minorities but not at the dental curriculum per se. This article starts to address this. METHODS: The reading lists within the 5 year Bachelor of Dental Surgery curriculum in a large UK dental school were collected and assessed. A data extraction spreadsheet was developed and journal articles on every course reading list across the 5 year curriculum were read in detail. Information on authorship and author affiliations, alongside patient and population representation within the article itself, were collected and collated. RESULTS: We found that there are 2.5 times more male authors than female authors, and almost three times more male lead authors in the articles evaluated. The majority of journal articles included in the reading lists are written by academics and/or clinicians affiliated with institutions in the United Kingdom and most articles are from the global north. In addition, 65% of articles do not specify the focus patient or population group studied. DISCUSSION: It is unlikely that current reading lists within dentistry fully reflect the composition of the profession itself, the variety of knowledge needed to provide evidence-based practice in a globalised oral health arena or the heterogeneous nature of the patient population.

Enhancing patient-centred care in dentistry: a narrative review.

INTRODUCTION: Patient-centred care (PCC) is widely used within the medical setting, but there is a need for more research on PCC implementation in dentistry. SOURCES OF DATA: A narrative review was conducted with literature identified from the Ovid Interface, including several databases such as Embase and Medline. AREAS OF AGREEMENT: PCC is associated with better health outcomes for patients, and greater work satisfaction among healthcare professionals. AREAS OF CONTROVERSY: Efforts to implement PCC in dentistry are lacking due to several issues including non-consensus about PCC definition and lack of explicit guidelines on how to implement PCC in dentistry. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH: A theory-derived model of PCC explicitly designed for the dental setting was identified. This serves as a starting point to enhance PCC in dentistry, though further research is needed to empirically test the implementation of this model.

Accreditation and professional integration experiences of internationally qualified dentists working in the United Kingdom.

INTRODUCTION: Regulatory processes for Oral health care professionals are considered essential for patient safety and to ensure health workforce quality. The global variation in their registration and regulation is under-reported in the literature. Regulatory systems could become a barrier to their national and international movement, leading to loss of skilled human resources. The General Dental Council is the regulatory authority in the UK, one of the nine regulators of health care overseen by the Professional Standards Authority. AIM: The aim of this paper is to present the professional integration experiences of internationally qualified dentists (IQDs) working in the UK, against the background of regulation and accreditation nationally. METHODS: Registration data were obtained from the General Dental Council to inform the sampling and recruitment of research participants. Semi-structured interviews of 38 internationally qualified dentists working in the United Kingdom were conducted between August 2014 and October 2017. The topic guide which explored professional integration experiences of the dentists was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis to detect themes. RESULTS: Internationally qualified dentist's professional integration was influenced by factors that could be broadly classified as structural (source country training; registration and employment; variation in practising dentistry) and relational (experiences of discrimination; value of networks and support; and personal attributes). The routes to register for work as a dentist were perceived to favour UK dental graduates and those qualifying from the European Economic Area. Dentists from the rest of the world reported experiencing major hurdles including succeeding in the licensing examinations, English tests, proving immigration status and succeeding in obtaining a National Health Service performer number, all prior to being able to practice within state funded dental care. CONCLUSION: The pathways for dentists to register and work in state funded dental care in UK differ by geographic type of registrant, creating significant inconsistencies in their professional integration. Professional integration is perceived by an individual IQD as a continuum dictated by host countries health care systems, workforce recruitment policies, access to training, together with their professional and personal skills. The reliance of the UK on internationally qualified dentists has increased in the past two decades, however, it is not known how these trends will be affected by UK's exit from the European Union and the COVID-19 pandemic.

Patient-Centred Care in Dentistry: Definitions and Models - Commentary.

Patient-centred care is an important approach that is currently being adopted, to varying degrees of success, in a number of healthcare settings, particularly in family medicine and nursing. However, patient-centred care is relatively understudied in dentistry. This commentary aims to provide a general overview of patient-centred care studies conducted in dentistry, of how the approach is defined in this setting, and of the different models that have aimed to operationalize the concept. This concept is particularly relevant to dental education as current guidelines for dentists encourage and require them to adopt different dimensions of this approach. In addition to policies and guidelines, there is evidence that suggests that the adoption of patient-centred care would result in positive outcomes.

Comparative optimism about infection and recovery from COVID-19; Implications for adherence with lockdown advice.

BACKGROUND: Comparative optimism, the belief that negative events are more likely to happen to others rather than to oneself, is well established in health risk research. It is unknown, however, whether comparative optimism also permeates people's health expectations and potentially behaviour during the COVID-19 pandemic. OBJECTIVES: Data were collected through an international survey (N = 6485) exploring people's thoughts and psychosocial behaviours relating to COVID-19. This paper reports UK data on comparative optimism. In particular, we examine the belief that negative events surrounding risk and recovery from COVID-19 are perceived as more likely to happen to others rather than to oneself. METHODS: Using online snowball sampling through social media, anonymous UK survey data were collected from N = 645 adults during weeks 5-8 of the UK COVID-19 lockdown. The sample was normally distributed in terms of age and reflected the UK ethnic and disability profile. FINDINGS: Respondents demonstrated comparative optimism where they believed that as compared to others of the same age and gender, they were unlikely to experience a range of controllable (eg accidentally infect/ be infected) and uncontrollable (eg need hospitalization/ intensive care treatment if infected) COVID-19-related risks in the short term (P < .001). They were comparatively pessimistic (ie thinking they were more at risk than others for developing COVID-19-related infection or symptoms) when thinking about the next year. DISCUSSION: This is one of the first ever studies to report compelling comparative biases in UK adults' thinking about COVID-19.

Denture use and osteoradionecrosis following radiotherapy for head and neck cancer: A systematic review.

BACKGROUND: It is strongly recommended to extract teeth with poor prognosis in head and neck cancer (HaNC) patients prior starting treatment with radiotherapy to avoid need for extraction post-radiotherapy and prevent development of osteoradionecrosis (ORN). Dental extraction means that patients are often left with insufficient teeth leading to psychological problems and reducing their quality of life post-radiotherapy. Some clinicians do not advocate the use of dentures in HaNC patients claiming that dentures might lead to soft tissue irritation followed by ORN when constructed on irradiated jaws. AIMS: This systematic review aimed to investigate the existing evidence regarding the impact of denture use on the development of ORN in HaNC patients post-radiotherapy. METHODS: This systematic review followed the Preferred Reporting Item for Systematic Review and Meta-analyses (PRISMA) guideline. Three database systems were used: Ovid Medline, EMBASE and PsycINFO. PROSPERO was searched for ongoing or recently completed systematic reviews. The https://ClinicalTrials.gov was searched for ongoing or recently completed trials. The Joanna Briggs Institute critical appraisal tools were used to assess quality of studies being reviewed. RESULTS: Only three retrospective case-control studies were included. Numbers of participants included in the three studies are limited with incomparable types of mucosal dentures. None of the studies described the method of measurement of the exposure (denture use) in a standard, validated and reliable way. CONCLUSION: The three included studies suggested no link between denture use and development of ORN. However, very little evidence exists and the robustness of the studies is questionable. Well-powered studies are needed.

Patients with cleft: Experiences, understanding and information provision during treatment.

OBJECTIVE: To explore the knowledge of late adolescent and adults affected with cleft lip and/or palate (CL/P) about their condition and their experiences with information about treatment options and outcomes within the cleft care pathway. SETTING AND SAMPLE POPULATION: Twenty-eight people with CL/P had recently finished or were about to finish their definitive orthodontic/orthognathic (OGN) treatment. Participants were purposively recruited from two cleft centres in the UK. MATERIALS AND METHODS: Qualitative, semi-structured interviews were conducted and all interviews were recorded and transcribed verbatim. Thematic analysis was undertaken using the framework method. RESULT: There are a broad range of interpretations and explanations for both the causes and implications of CL/P amongst those living with the condition. This resulted in confusion and left participants vulnerable to misinformation and unable to combat stigma. In addition, there was some confusion about the implication of different treatment options. Participants felt that they did not receive enough information about the nature of the treatment that they would be undergoing and the length and implications of recovery post-treatment. This was a source of concern for the participants. CONCLUSION: The findings of this study suggest that there is a mismatch between the information provided to the families of people with CL/P and the levels of knowledge they have, about both their condition and the treatment options available to them. It is essential that clear, accessible information is provided at the right times in the care pathway to ensure that patients are able to make informed decisions about treatment.

Dentists' perceptions of a practical model of patient-centred care: providing information and choice in a dental consultation.

Adopting a patient-centred approach when engaging with patients has been linked to positive outcomes in medicine. However, in the field of dentistry, patient-centred care (PCC) has been understudied. The aim of this study was to explore dentists' opinions about the usefulness of a theoretical model of PCC and its applicability to a dental setting. Twenty semi-structured interviews were conducted with dentists working at a major university hospital in south London. The interviews were audiotaped and analysed using thematic analysis. The analysis showed that dentists found the PCC model to be useful for practical application but mostly for 'other' dentists. They viewed the lowest and highest levels of PCC that the model advocates as 'out-dated' and 'ideal', respectively. Dentists felt that giving patients full choice and control over their treatment was not applicable to everyday clinical practice. They expressed that a tool developed on the basis of this hierarchy of PCC could be useful for self-assessment purposes, although with some reservations. In conclusion, dentists seemed to embrace the practice of PCC and felt that their provision of PCC was at an acceptable standard. They believed that a moderate level of information and choice was most suitable for patients.

Patient-centred care--what is it and how is it practised in the dental surgery?

OBJECTIVES: This paper explores the understanding and practice of patient-centred care (PCC) within dentistry. The aim of the research was to explore the nature of PCC, how PCC is taught and how it is practiced within a dental setting. METHODS: The results of a qualitative, interview-based study of dental professionals working across clinical and teaching positions within a dental school are presented. RESULTS: Results suggest that a shared understanding of PCC revolves round a basic sense of humanity ('being nice to patients'), giving information that is judged, by the clinician, to be in the patient's best interest and 'allowing' patient choice from a set of choices made available to patients by the clinicians themselves. CONCLUSIONS: This research suggests that significant work is needed if dentists are going to conform to the General Dental Council guidelines on patient-centred practice and a series of recommendations are made to this end.

Health system strengthening in fragile and conflict-affected states: A review of systematic reviews.

BACKGROUND: Globally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states present particular challenges. The aim of this study was to explore health system strengthening in fragile and conflict-affected states by synthesising the evidence from published literature. METHODS: We conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet's 'high-quality health system framework'. RESULTS: Twenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the 'foundations' domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the context and stage of the crisis situation was emphasised in order to strengthen fragile health systems. Overall, health system strengthening initiatives included policies encouraging the return and integration of displaced healthcare workers, building local healthcare workers capacity, strengthening education and training, integrating healthcare services, trust-building, supportive supervision, and e-Health utilisation. CONCLUSION: The emerging body of evidence on health system strengthening in fragile and conflict-affected states highlights its complexity. The findings underscore the significance of adopting a comprehensive approach and engaging various stakeholders in a coordinated manner considering the stage and context of the situation.

Oral health system strengthening in fragile and conflict-affected states: A systematic review.

Background: Oral diseases affect nearly half of the global population, presenting significant challenges in fragile and conflict-affected states. Despite comprising a population of over one billion people, oral health data and comprehensive evidence on oral health system strengthening on these countries are limited. This study, therefore, aims to explore oral health system strengthening in fragile and conflict-affected states by synthesising evidence from relevant global literature. Methods: We conducted a systematic review of literature across Ovid MEDLINE, EMBASE, Global Health, Scopus, Web of Science, and grey literature databases. The methodological quality of published literature was assessed using the relevant Joanna Briggs Institute critical appraisal tools. The findings were narratively synthesised and presented using the Lancet's high-quality health system framework. Results: The review included 23 papers from 12 countries. The evidence documented impacts of armed conflicts, political crisis, pandemics, and natural disasters on oral health systems, and initiatives to strengthen them focusing on the 'foundations' domain. The initiatives included: workforce development and career opportunities; health service platforms such as mobile dental services and teledentistry; integration of oral health into national health systems and emergency responses; contingency planning and adaptability; and effective governance such as financing systems and infrastructures. Collaborative action, both local and international, including monitoring and evaluation were emphasised as key strategies for health system strengthening to ensure an equitable distribution of responsibilities and resources. Conclusions: Whilst evidence on oral health system strengthening in fragile and conflict-affected states is limited, our findings suggest the need for integrated action, such as mobilising local resources and engaging stakeholders equitably. Further research, with particular focus in the area of processes of care and quality impacts, is necessary to explore comprehensive strategies for strengthening the oral health system.

A typology of internationally qualified dentists in the United Kingdom.

Introduction: The Global Strategy for Human Resources for Health 2030, requires member states to half their dependency on an international workforce by 2030. In order to design policies towards that goal, country-specific research on migration motivations of the health workforce is required. The United Kingdom (UK) is a net importer of health professionals and whilst there is a body of research on doctors' and nurses' migration, there is no research on the migration motivations of migrant dentists in the UK. This research explored the migration motivations of internationally qualified dentists (IQDs) in the UK and presents a typology to understand the global migration of dentists in the context of oral health workforce. Methods: The paper presents qualitative data from semi-structured interviews conducted between August 2014 and October 2017, of IQDs working in the United Kingdom. The topic guide for interviews was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis. Results: A total of 38 internationally qualified dentists (M = 18, F = 20), migrating from the five World Health Organization regions, and working in general practice, NHS hospitals and in community dental services across the four nations of the UK were interviewed. Seven types of internationally qualified dentists were identified working in the UK. They were livelihood migrants, career-orientated migrants, dependant migrants, backpacker migrants, commuter migrants, undocumented migrants, and education-tourist migrant. The categories were based on their migration motivations, which were complex, multifactorial, and included personal, professional, national, and international drivers. The typology, based on their migration motivations, offered a structured, comprehensive understanding of the migrant dental workforce. This typology involving dentists provides additional dimensions to commuter and undocumented migrants described in the context of other health professionals. The education-tourist migrant is a new category proposed as an extension to existing typology in health professional migration. Conclusions: The typology of internationally qualified dentists has congruency with other health professionals' typology in categories previously described and demonstrates that each of these categories are complex, fluid and change in response to policy changes. The new category of education-tourist migrant along with oral health dimensions of commuter and undocumented migrants adds to the existing typology in health professional migration.

Family functioning and preschool children's oral health-related quality of life.

INTRODUCTION: Identifying which aspects of how a family functions are relevant to child oral health provides opportunities for interventions targeting the family context. The aim of this study was to investigate the associations of general and domain-specific family functioning with oral health-related quality of life (OHRQoL) of 3-4-year-old children. METHODS: Cross-sectional data from 740 parent-child dyads from East London were analysed. Family functioning was assessed with the 60-item Family Assessment Device that yields scores for general functioning and six domains (roles, behaviour control, communication, affective involvement, affective responsiveness and problem solving). Children's OHRQoL was measured using the Early Childhood Oral Health Impact Scale (ECOHIS), which measures the lifetime impacts of children's oral conditions on the child (child impact section, CIS) and family (family impact section, FIS). The associations of family functioning with the ECOHIS total, CIS and FIS scores were assessed in negative binomial regression models (rate ratios [RR] and 95% confidence intervals [95% CI] were calculated), adjusting for parental sociodemographic factors and child demographic factors and caries experience. RESULTS: Children in families with unhealthy general functioning had 1.45 (95% CI: 0.87-2.43), 1.24 (95% CI: 0.73-2.13) and 2.19 (95% CI: 1.20-3.99) times greater ECOHIS total, CIS and FIS scores, respectively, than those in families with healthy general functioning after adjustment for confounders. Unhealthy functioning in the roles domain was associated with greater ECOHIS total and FIS scores. Unhealthy functioning in the problem solving, roles and affective involvement domains were also associated with greater FIS scores. CONCLUSIONS: Unhealthy family functioning was associated with worse child OHRQoL, especially in terms of disrupting family life. Effective assignment and undertaking of roles should be further explored as a target for intervention.

Developing a person-centred approach in dentistry beyond NHS recall intervals: a commentary.

Person-centred care (PCC) is acknowledged as a fundamental dimension of quality within health care and provides significant benefits for patients and clinicians. Models of PCC have primarily been developed from the medical literature, with limited consideration of their application within dentistry. The Personalised Care Institute was established to deliver education and training on PCC and is working with the Office of the Chief Dental Officer for England to develop resources on shared decision-making (SDM) to promote tailored recall intervals.This paper seeks to promote the value of PCC and SDM in delivering high-quality care but cautions against the use of generic models or training in view of the potential differences which may exist within dentistry, particularly general dental practice. The authors highlight the need to develop materials and training which are appropriate, contextualised and relevant to dentistry. The capacity and desire to deliver PCC is strongly influenced by the healthcare system which is in operation. The current units of dental activity (UDA) system operating in England would appear to act as a barrier to the delivery of PCC. Unless significant and rapid changes are introduced to the NHS Contract, UDA targets will continue to take precedence over PCC, SDM and tailored recall intervals.

Reconciling duty: a theory and typology of professionalism.

BACKGROUND: Professionalism is expected of health professionals and advocated by professional regulators in the United Kingdom (UK). Concepts of professionalism have evolved in sociological discourse and its meaning for dentistry is unclear. It is, none-the-less, considered a core domain of dental education and professional practice by the United Kingdom regulator, the General Dental Council. This paper reports the sense-making process, or social process, of professionalism in practice within England. AIM: To explore the research question 'What does dental professionalism mean in practice? METHODS: Taking a constructivist grounded theory approach, involving purposive and theoretical sampling, 24 dental professionals were recruited to participate in this qualitative study. In-depth, semi-structured interviews were conducted by one interviewer (AT). Interviews were recorded, transcribed verbatim, and analysed leading to the development of a theory grounded in the data. RESULTS: A focus on the social-professional constructs used by participants to make sense of their experiences, resulted in a grounded theory where Reconciling Duty emerged as the core category. This represents a process of meeting professional duties to different parties that are often mutually exclusive. It is comprised of three supporting categories: Applying order to the system, where individuals attempt to identify what constitutes professional attitudes and behaviours, Rationalising what is fair, where individuals make judgements on how the conflict between duties should be resolved, and finally Responding to the System, where individuals attempt to actualise these desired resolutions in the context of the complex social system in which they practice. Three dentist archetypes (typologies) emerged, which involved a personal (Type 1), patient (Type 2), or a societal (Type 3) compromise. CONCLUSION: Professionalism can be conceptualised as process of reconciling multiple, competing, legitimate duties to different parties, in seeking a fair solution. Once this has been identified, individuals need to work within the complex system of dentistry to make their identified outcome a reality. The findings suggest that using the theory of Reconciling Duty helps us to engage with the meaning that the participants drew from the term 'professionalism', and anchors it in the lived, everyday professional experiences and challenges faced. A novel typology is proposed, commensurate with calls for a systems approach to the topic.

Measuring oral health-How can the International Classification of Functioning help?

There is a need for a theoretically informed, contextualized approach to measuring oral health from a multidisciplinary perspective that goes beyond the commonly used clinical indices and sociodental measures. This commentary aims to discuss the potential for the WHO's International Classification of Functioning, Disability and Health (ICF) to provide a model for the development of indicators for oral health. It is suggested that the ICF might provide both a theoretical model and an operational classification for indicators of oral health. The ICF model states that human experience of physical, cognitive and social functioning is universal and, thus, can be described and qualified. Human function is given social and environmental context within the model at both an individual and population level. The ICF can not only capture data regarding oral health and function at the physiological level (e.g. chewing) but also at the social level (e.g. sharing meals). It is able not only to capture aspects of preventive behaviour (e.g. caring for teeth) but also aspects of social facilitation (e.g. economic self-sufficiency) or ability to fulfil a social role (e.g. remunerative employment). It also includes aspects of social environment, such as healthcare services or political, economic and legal systems. Case studies are given as examples of the potential use of the ICF in the oral health domain. Examples are also given of the first steps that have been made towards operationalization of the ICF in data collection and oral health research. The challenges of encompassing such a comprehensive model into a practical oral health measure are discussed.

Journey towards a dental career: the career decision-making journey and perceived obstacles to studying dentistry identified by London's secondary school pupils and teachers.

Objective To explore the career decision-making journey towards dentistry and identify possible challenges and supports in this process as perceived by academically able, science-minded, London school pupils and their careers teachers.Methods A mixed-methods study was conducted using a purposive sample of London schools. Focus groups (n = 13) with 91 pupils aged 14-18 years and a survey of career teachers (n = 12) were conducted at a range of school-types. A topic guide, informed by the literature and previous research, guided discussions. Ethical approval was obtained from King's College London Research Ethics Committee (BDM/10/11-17 and 14/15-40). School, teacher, parental and pupil written informed consent were obtained. Data were transcribed and analysed thematically using framework methodology.Results Four distinct phases of the career decision-making journey were identified: 1) initiation of aspiration, with wider influences promoting medicine as a primary aspirational career option; 2) exposure to dentistry as a career, leading to recognition of dentistry as an alternative; 3) exploration of the career; and 4) the application process. Dentistry received little early consideration in this process. Greater representation of dental professionals within the school, access to work experience, and support in the student application process were identified as possible supports.Conclusions The findings suggest a four-phase journey towards a dental career, which may be enhanced by engagement of dental professionals at each stage. This may be particularly helpful in widening participation from under-represented groups.

The mouth and oral health in the field of dementia.

An ageing population, an estimated 47 million people currently living with dementia, and predictions of a threefold increase in people living with a diagnosis by 2050 have led the WHO to declare dementia a public health priority. Emerging research also suggests that dementia is linked to poor oral health and that oral health declines alongside cognitive decline. Drawing on Bourdieu's concepts of field and capital, this paper presents an analysis of interview data from participants with dementia, carers and carer/diagnosed dyads participating in a qualitative study of the mouth and oral health. We argue that Bourdieu's conceptual toolkit provides a way of contextualising experiences of oral health within dementia and un-picking the multi-layered impact of structure, institutions, biology, resource mobilisation and self in the context of a progressive disease which ultimately challenges knowledge of the self and the ability to interact with the world around us.