Gender Inequalities in the Dental Workforce: Global Perspectives.

The aim of this review is to investigate the growth of diversity and inclusion in global academic dental research with a focus on gender equality. A diverse range of research methodologies were used to conduct this review, including an extensive review of the literature, engagement of key informants in dental academic leadership positions around the world, and review of current data from a variety of national and international organizations. Results provide evidence of gender inequalities that currently persist in dental academics and research. Although the gender gap among graduating dental students in North America and the two most populous countries in Europe (the United Kingdom and France) has been narrowed, women make up 30% to 40% of registered dentists in countries throughout Europe, Oceania, Asia, and Africa. In academic dentistry around the globe, greater gender inequality was found to correlate with higher ranking academic and leadership positions in the United States, United Kingdom, several countries in European Union, Japan, and Saudi Arabia. Further disparities are noted in the dental research sector, where women make up 33% of dental researchers in the European Union, 35% in North America, 55% in Brazil, and 25% in Japan. Family and societal pressures, limited access to research funding, and lack of mentoring and leadership training opportunities are reported as also contributing to gender inequalities. To continue advancing gender equality in dental academia and research, efforts should be geared toward the collection and public dissemination of data on gender-specific distributions. Such evidence-driven information will guide the selection of future strategies and best practices for promoting gender equity in the dental workforce, which provides a major pipeline of researchers and scholars for the dental profession.

Basal joint osteoarthritis of the thumb treated with Weilby arthroplasty: a prospective study on the early postoperative course of 106 consecutive cases.

One hundred and six consecutive cases of osteoarthritis of the trapeziometacarpal joint, treated by tendon interposition arthroplasty as described by Weilby, were followed prospectively, with assessment of pain, mobility, pinch and grip strength at 6, 12, 26 and 52 weeks. Patient satisfaction was reviewed at 26 and 52 weeks. Preoperative visual analogue scores for pain averaged 65 and decreased postoperatively to an average of 12 at 52 weeks. The main decrease in pain occurred during the first 3 months after operation. Mobility was improved or unaltered in 82%. Average grip and pinch strength reached preoperative values (41 kPa and 20 kPa respectively) between 12 and 26 weeks after surgery and were significantly greater (58 kPa and 34 kPa) at 52 weeks. Recovery after suspension arthroplasty takes 3-6 months, which may be a disadvantage to be considered when advising patients who are considering operative treatment.

Exploring opportunities for collaboration between the corporate sector and the dental education community.

The ultimate purpose of both dental industry and dental education is to improve the oral health of the public. This report provides background information on the different roles and objectives of the dental industry and dental education communities, the different operating environment of each sector and also areas of common interest where collaboration will be of mutual benefit. The report addresses five areas for potential collaboration between the dental industry and the dental education communities: 1. Contribution to joint activities. 2. Effectiveness and efficiency. 3. Workforce needs. 4. Middle- and low-income countries. 5. The future of International Federation of Dental Educators and Associations (IFDEA). The traditional areas of support and their limitations that have been provided by industry are outlined in the report and some new approaches for collaboration are considered. Industry-based research has been an important factor in developing new products and technologies and in promoting oral health. However there is a need to facilitate the introduction of these developments at an early stage in the education process. Industry has to operate in an efficient manner to remain competitive and maximise its returns and therefore survive. The academic sector operates in a different environment and under different governance structures; although some trends are noted towards adoption of greater efficiency and financial accountability similar to industry. Opportunities to jointly develop best business practices should be explored. Industry has responded well to the oral health needs of the public through the development of new products and technologies. The education community needs to respond in a similar way by examining different healthcare delivery models worldwide and developing programmes to train members of the dental team to cater for future needs and demands of communities in different regions of the world. The reputation of industry-based scientists and clinicians is high, and their role in contributing to the dental education process in practical ways needs to be explored and further developed. Closer relationships between industry scientists and faculty and students could assist industrys need and desire to develop new technologies for the broader dental care system. The corporate sector can play a key role in the future success of IFDEA by providing support and expertise in developing areas such as regional leadership institutes, a Global Faculty and Network and in collaborating in developing continuing education programmes as well as involvement in its governance. Thirteen recommendations are made in the report. These are considered to be important initial steps in developing the already strong relationship between the education and corporate sectors. Partnership and collaborating more effectively along the lines suggested should, almost certainly, generate mutually beneficial outcomes, whilst serving over the long term to elevate the publics oral health status on a global basis.

Completeness and accuracy of voluntary reporting to a national case registry of laparoscopic cholecystectomy.

OBJECTIVE: To validate completeness and accuracy of registry data reported from three randomly chosen departments contributing to The Danish National Registry of Laparoscopic Cholecystectomy, covering all departments offering chole cystectomy. DATA SOURCES: A total of 431 case reports representing cases of laparoscopic cholecystectomy in a 2-year period in three surgical departments. DESIGN: Comparison of case reports with reported data in The Danish National Registry of Laparoscopic Cholecystectomy. MAIN OUTCOME MEASURES: Rates of discrepancies, comparison of complication rates for cases in the registry and cases not reported to the registry. RESULTS: Completeness of registration was 69%, 80% and 99% respectively. A significantly higher degree of completeness was found in the only department with a formalized registration procedure. Inaccuracies were found in 28-49% of the cases, but none regarding serious complications such as bile duct injury or perioperative death. CONCLUSIONS: The information in the national registry may be accurate if the present findings can be extrapolated to the remaining departments in the country. The number of non-reported cases should be minimized by introducing a formalized procedure of handling and forwarding information to the registry. Continuous validation through external visits by registry staff to contributing departments may also be advisable.

The relevance of behavioural sciences in dental practice.

The aim of this paper is to illustrate how knowledge from behavioural sciences is necessary and relevant in creating a successful dental practice, benefitting patients and dental professionals. There are many ways to create a successful dental practice, the products of which are the various treatments performed by dentists or dental hygienists for their patients. Advanced technologies and methods are constantly improving these treatments and thus the technical and managerial aspects of dentistry. However, the success of dental practice is not only dependent on the technique applied or the technical skills of dental professionals, but also on patients, their attitudes and behaviour and the interaction between dental professionals and patients. It is well known that the success of dental treatments (for example, periodontal, orthodontic or implants) depends on the patient's behaviour, which includes compliance with certain oral hygiene regimens or specific dental visiting patterns. The outcome of the treatment depends on both the dental professional's knowledge and skills and the patient's skills, objectives and expectations. Furthermore, dental professionals and patients should be satisfied with the treatment plan as well as the outcome. This paper argues that in order for this to happen dental professionals need additional knowledge and skills from fields outside traditional dental sciences. In order to treat patients successfully, dental professionals must understand and change or modify patient behaviour, and the knowledge necessary for this is provided by the behavioural sciences.

Gastric intrinsic factor production and vitamin B12 absorption after oesophageal resection using stomach as substitute.

OBJECTIVE: To investigate whether the use of the stomach as a substitute after oesophageal resections causes disturbances in vitamin B12 absorption due to deficient intrinsic factor (IF) production. MATERIAL AND METHODS: Eleven patients operated upon with oesophageal resection a.m. Ivor Lewis, for malignant (10) or benign (1) conditions of the oesophagus were examined with a postoperative dual isotope technique 11-41 months (mean 25 months) after operation. RESULTS: In two patients the test showed abnormally low absorption of vitamin B12. One of these probably due to incomplete urine collection during the test period. However, no patient showed deficient intrinsic factor production with absorption ratios between vitamin B12 +/- IF of 0.87-1.14 (reference interval: 0.70-1.20). CONCLUSION: Deficiency of intrinsic factor is neither an obligatory nor a common occurrence after oesophageal resection with gastric substitute. However, vitamin B12 absorption may be low due to other factors, and should be looked for in all patients surviving more than a couple of months postoperatively.

A campaign encouraging dental attendance among adolescents in Scotland: the barriers to behaviour change.

Qualitative consumer research was used to develop a health promotion campaign for school pupils aged 15-17 years to encourage them to attend a dentist for examination. The campaign used a combination of conventional health education about the benefits of dental care together with incentives for attending. The emphasis throughout was to establish an association with young style and group norms of social attractiveness. This study was part of the evaluation of the campaign. The aim was to identify the characteristics of those who responded positively to the campaign and to identify barriers to behaviour change. Those who responded were mainly female, intended to stay on at school beyond the age of 16 years and were more likely to be frequent attenders. Apathy and a lack of felt need were the main barriers to responding. Easier access to care and targeting a younger age group might enhance the success of similar interventions.

Does dental health education affect inequalities in dental health?

The aim of the study was to evaluate the Lothian 1991 dental health campaigns on 5-year-old schoolchildren's oral hygiene and gingival health in relation to deprivation. A stratified random sample of 486 children was selected from 92 primary schools in the city of Edinburgh. Clinical examinations took place immediately before (T1), a month after (T2) and 4 months after the campaign (T3). A total of 342 (70 per cent) children received all 3 examinations. Oral hygiene and gingival health were examined using a modified Silness and Löe and the Ainamo and Bay Index. Toothbrushes and take-home materials were distributed to all children. Dental officers provided 20 minute information sessions for each class and encouraged teachers to continue dental health activities within the classes. For the purpose of the evaluation, schools were categorised as deprived and non-deprived according to established social indicators. The results showed a statistically significant improvement in plaque scores at T2 and T3 (P < 0.05, P < 0.01). Also gingival health improved at T2 and T3 (P < 0.01, P = 0.001). However, the improvements took place only in the non-deprived schools. Thirty-one per cent of children in non-deprived schools and 18 per cent in deprived schools had a total plaque score of 0 at T1 and 41 per cent and 19 per cent respectively at T3. The differences in gingival health scores between deprived and non-deprived schools were statistically significant at T2 and T3 but not at T1. The campaign was therefore successful when evaluating the population as a whole.(ABSTRACT TRUNCATED AT 250 WORDS)

The response of 1578 school leavers to a campaign combining commercial, Health Boards' and GDPs' sponsorship in an effort to improve dental attendance.

A dental health promotion campaign was developed by Forth Valley Health Board in conjunction with the Scottish Health Education Group and the Department of Marketing at Strathclyde University. The aim was to encourage dental attendance among early school leavers. The emphasis was on the contribution of dental care to appearance and attractiveness. To highlight the importance of appearance, a major clothing retailer offered discounts on clothes to participants who made a dental visit. The impact of the campaign was evaluated by a questionnaire 3 months after its close. Recall of the campaign was high at 62% and 16% actually initiated a dental visit. However, only 2% claimed that the campaign was their main reason for attending. The project demonstrated the feasibility of collaboration between a commercial company and a health board in a health promotion effort. The results underline the difficulties in initiating a behaviour change, overcoming apathy and modifying the lack of felt need for dental care among the age group concerned. It does, however, suggest that there is potential for a more prolonged marketing effort.

An exploratory study of barriers to promoting oral hygiene through carers of elderly people.

This paper outlines the main findings of an exploratory study into carers' attitudes towards looking after the oral hygiene needs of their elderly patients and relatives. The data were collected using eight group discussions covering a cross-section of carers and carer settings throughout central Scotland. A range of barriers to improving levels of care was identified. The paper concluded that to make positive progress, a comprehensive oral hygiene programme is required to break down these barriers. It is believed that a strong educational policy based upon carers' needs should form the main impetus of such a programme.

Deprivation and dental health. The benefits of a child dental health campaign in relation to deprivation as estimated by the uptake of free meals at school.

The objectives of the present study were to evaluate the overall effect of the 1989 Lothian dental health education campaign on 8-year-old school children's dental health knowledge and behaviour and to examine the relationship between free meals and the children's benefit from the campaign. Altogether 874 children were randomly selected and included in the study. Sugar-free meals and drinks were provided in all primary schools throughout the campaign week. Dental officers held 30-minute information sessions with each class and encouraged teachers to continue dental health activities. Dental knowledge and behaviour were evaluated by interviews immediately before and after the campaign. The results showed a significant increase in knowledge about diet and dental health and a significantly higher proportion of children claimed to choose non-cariogenic foods and drinks as a result of the campaign. Toothbrushing frequency also increased significantly. Ninety-eight per cent of the children enjoyed the campaign and 66 per cent discussed it with their family. Each school was classified according to the proportion of children receiving free school meals, and this showed a statistically significant negative correlation with the proportion of children who chose non-cariogenic meals and drinks before the campaign but not afterwards. Toothbrushing frequency showed a significant negative correlation with free meals both before and after the campaign. A positive correlation was found between free meals and the proportion of children who claimed to have received new information during the campaign and ate healthier food because of it.(ABSTRACT TRUNCATED AT 250 WORDS)

Qualitative study of oral health norms and behaviour among elderly people in Scotland.

This study was undertaken to examine oral health norms and behaviour among elderly people in Scotland. Qualitative methodology in the form of informal group discussions was used. The study population comprised 9 groups of 6-8 respondents aged 65 years and over, selected according to the quota criteria of sex, social class, level of dependency and oral health status. All groups were recruited by a professional market research interviewer, using a random route procedure. Discussions were conducted under the guidance of an experienced group moderator and tape recorded. Each group discussion lasted between 1 1/2 and 2 1/2 hours. The results showed that oral and denture hygiene was a sensitive issue and part of individual routine behaviour which most respondents were reluctant to change. Tooth loss was expected and accepted as part of a natural ageing process. Dental visits were regarded as problem-solving behaviour; self-care was preferred to professional care; non-attendance was explained by no perceived need, low interest, fear or expected high cost. Health was seen in an illness context or in a positive lifestyle context and not associated with oral health. The main conclusions were: oral health behaviour was characterised either as personal routine behaviour or as problem-solving behaviour. Tooth loss was expected. Oral health was perceived as unrelated to general health. The elderly saw no incentive or reason to change these norms and behaviours.

[Dental health concerns and advances in preventive dentistry in Great Britain]. / Zahnmedizinische Gesundheitsfürsorge und Förderung der Oralprophylaxe in Grossbritannien.

The structure, organisation and administration of the National Health Services in the UK including the General Dental Service, the Community Dental Service and the Hospital Service is being described, while emphasising that effective oral health promotion cannot be obtained within the limitations of current organised health services. It demands multidisciplinary and multidepartmental co-work which appears to be beyond traditionally based health services. Dental health education, preventive programmes, epidemiological surveys and dental screening are going to be the main working tasks within the Community Dental Service whereas most dental treatment should be carried out in General Dental Practice. The latter will, in the future, operate as a capitation system rather than fee-per-item system with respect to children. Dental health education, water fluoridation as well as the recommendation of fluoride supplements and attempts to reduce sugar intake are key factors in dental prevention in the UK. Some details are given.

Using a "lifestyle" perspective to understand toothbrushing behaviour in Scottish schoolchildren.

Using data from a wider survey of health related behaviour in 4,935 Lothian schoolchildren, 11, 13, and 15 yr old, this paper analysed toothbrushing frequency and its relation to "lifestyle" factors. Analysis of the results showed that girls brush more frequently than boys and that children with higher social class background brushed more frequently than children with low social class background. Further toothbrushing frequency was significantly related to the subjects' health perception, smoking and drinking habits, eating habits, bedtimes, and video-watching. Moreover, all these lifestyle factors were inter-related. The paper reinforced the concept of lifestyle as a meaningful descriptive term. The results demonstrated that the bivariate associations are pieces in a more complex mosaic. Toothbrushing thus seems to be an integrated part of a child's lifestyle and should be regarded as such in future health promotion efforts.

Dental health-related behaviour in Scottish schoolchildren aged 11, 13 and 15 from Edinburgh city.

The two most important individually-mediated factors for the control of dental decay and periodontal diseases are frequency of sugar consumption commonly in the form of sweets, and toothbrushing. Most dental health education efforts have therefore been concentrating on informing and motivating parents and children to restrict sugar intake and to brush their teeth twice a day. The present investigation was undertaken, as part of a wider survey of health related behaviour in Scottish schoolchildren, to determine the frequency of tooth brushing and sweet consumption in relation to age, gender and social background. Data was collected from 4,890 children aged 11, 13 and 15 years from independent and state schools in Lothian. Subjects completed a questionnaire, anonymously, in class.

Oral health promotion at worksites.

Many workplace-based health promotion programmes have been reported but only a few include or focus specifically on oral health. Although certain obstacles to oral health promotion in the workplace exist from the management side, from the dental profession and from the employees, these seem to be of a scale that can easily be overcome: moreover, numerous potential benefits exist. From the employer's point of view, the main arguments in favour are reduced health care costs, increased productivity and reduced absenteeism. The benefits to the dental profession are possible increases in utilization of services and less restraint from fee payment structures and physical environments. The immediate benefit to the employees is easy access to dental services. In addition, work-related dental hazards can be compensated for or prevented and screening activities can be more easily organized. The literature is at present sparse and there are few guidelines to actual strategies for effective oral health promotion. However, elements of strategies that have been successful in various geographical and economic environments include: active involvement of the work force, the use of dental auxiliaries, voluntary daily mouthrinsing, screening activities, use of mass media, oral hygiene instruction and prophylaxis and paraprofessional training. It is recommended that future research concentrates on these elements to build up a meaningful and relevant data base upon which effective oral health promotion programmes can be formulated.

Oral health promotion for institutionalised elderly.

The purpose of the present study was to develop and evaluate educational approaches specifically for improvement of oral hygiene behaviour amongst institutionalised elderly. A sample of 201 residents, 48-99 yr of age (mean age 82 yr), was selected from four different institutions in Lothian, Scotland. A clinical examination and a structured interview were conducted immediately before and 2 months after the termination of the programme. The four institutions were blind to the examiner and randomly allocated to a control group or one of the three programmes; 1) active involvement of staff only; 2) active involvement of residents only; 3) active involvement of both residents and staff. The programme comprised three 1-h sessions at monthly intervals in groups of five to six residents or members of staff. The analysis of the results showed poor oral health and oral hygiene, high objective need for oral care but low perceived need. The programme had little impact on most of the included variables and only about half of the participants remembered the programme 2 months after its termination. The implications of the study are that groups of elderly need to be differentiated further so that only well and not confused elderly participate in programmes such as this and less well and confused elderly receive regular professional support with oral hygiene.