Perceptions and attitudes of dental practitioners towards impacts of Covid 19 pandemic on clinical dentistry: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic challenged all healthcare providers including dental practitioners. This cross-sectional study aimed to investigate the dental practitioners' perceptions and attitudes towards the impacts of COVID-19 on their professional practice, career decision and patient care. METHODS: Data was collected from dental practitioners registered in New South Wales (NSW), Australia using an online survey. RESULTS AND CONCLUSION: Responses received from 206 dental practitioners revealed their perceptions and attitudes towards COVID-19 infection risk, clinical guidelines, and measures adopted to deliver patient care. Majority of participants perceived the risk of infection in dentistry was higher compared with other health professionals. Most dental practices have followed guidelines received from professional associations and adopted multiple measures such as providing hand sanitizer, social distancing, and risk screen, to ensure safe delivery of oral health care. Over 80% of dental practitioners raised concerns on patients' accessibility to dental care during the pandemic. Despite tele-dentistry was introduced, almost half of the participants did not recognize tele-dentistry as an effective alternative. Moreover, negative impacts of COVID-19 pandemic on dental practitioner's professional career have been reported, including lower practice safety, reduction in working hours and income. Noteworthy, one quarter of participants even considered changing their practice environment, moving sectors or even leaving their career in dentistry. However, majority of the dental practitioners are willing to stay in their current practice environment and continue their career in dentistry. Our observations demonstrate the systematic disruption to dental practice faced in Australia due to the COVID-19 pandemic. Providing dental practitioners with timely educational training and support is important to minimise negative impacts of the challenges and to optimise dental care.

Is there a social justice to dentistry's social contract?

How should the dental profession of the 21st century frame its interactions with the society it is tasked to care for? What has this relationship looked like in the past, and what does it look like today? In this article, we examine these and other issues through the framework of the social contract, with a focus on exploring how social justice fits within the transaction of duties between the dental profession and society. We begin by describing the social contract and how this is uniquely defined within the context of dentistry; specifically, how the context of dentistry as, in part, an aesthetically driven discipline, impacts the social contract. We then consider how the nature of the profession's relationship with society, and the orientation by which it provides its services (which is sometimes critically unclear in its definitional terms), impacts the profession's contribution to ensuring social justice in oral health and oral healthcare. Through examining the nature of how the social contract has shifted (for example, by the attenuation of professional monopolies), we also ask whether this is evidence of a loss of confidence in the dental profession as an altruistic institution. We end by suggesting that the dental profession must engage with the tenets of social justice within the social contract. Failure to do so is likely to lead to erosion of dentistry as a high-status profession and societal willingness to seek solutions to oral health needs from other professional and non-professional sources.

Conceptualisations of the social determinants of health among first-year dental students.

BACKGROUND: Social conditions have a significant impact on the health of individuals and populations. While the dental curriculum is focused on teaching students about the diseases that affect the dentition and oral structures from a biomedical perspective, education about the social determinants of health is frequently regarded as less important. Thus, it occupies a smaller and disconnected part of the dental curriculum. The aim of this study was to explore the ways dental students conceptualised the social determinants of health after one year in dental school. METHODS: Reflective statements written by first year dental students at the end of the first year of study were collected. This qualitative study has an interpretivist basis and a thematic analysis of the reflections was conducted by two researchers. Metzl's structural competencies were used as a further analytic device. RESULTS: Four inter-related themes were identified: First, professional attitudes taken up by students influence their conceptions. Second, structural barriers to students understanding social determinants of health generate partial understandings. Thirdly, the social gulf that exists between the student body and people of different circumstances provides context to understanding the student's perspectives. Finally, we described how students were learning about the social determinants of health over the academic year. CONCLUSIONS: Dental students face several challenges when learning about the social determinants of health, and translating these learnings into actions is perhaps even more challenging. Metzl's structural competencies provide a framework for advancing students' understandings. One of the most important findings of this research study is that coming to an understanding of the social determinants of health requires sustained attention to social theories, practical experiences as well as institutionalised attitudes that could be achieved through an intentional curriculum design.

Exploring the evolution of a dental code of ethics: a critical discourse analysis.

BACKGROUND: What can the analysis of the evolution of a code of ethics tell us about the dental profession and the association that develops it? The establishment of codes of ethics are foundational events in the social history of a profession. Within these documents it is possible to find statements of values and culture that serve a variety of purposes. Codes of ethics in dentistry have not frequently presented as the subjects of analyses despite containing rich information about the priorities and anxieties within the profession's membership at the time that the code was written. MAIN TEXT: This essay uses critical discourse analysis to explore the 2012 and 2018 versions of the Code of Ethics produced by the New South Wales Branch of the Australian Dental Association. This method of discourse analysis examines contradictions between the discourses within the codes and how these relate to broader social realties that surround the dental profession in New South Wales. By analysing the 2012 and 2018 codes together, it is possible to understand how the dental profession views its commitments to society as established through the social contract. Through this assessment, it will be demonstrated that both codes suffer due to their failure to consider the public as a key stakeholder in the creation and curation of the Code of Ethics and how this this relates intimately with the social contract between the profession and the public. CONCLUSION: Without the public being the central consideration, both codes amount to declarations of professional privilege and dominance. Although the more recent 2018 Code of Ethics demonstrates insight into the changes in public trust placed in the professions, this analysis shows that that the current code of ethics is still reluctant to recognise and engage with the public as an equal stakeholder in the planning and provision of oral health care and the development of the profession's values and cultural trajectory.

A school fluoride varnish program for Aboriginal children in rural New South Wales, Australia.

ISSUE ADDRESSED: Australian Aboriginal children are less likely to access preventive oral health services such as fluoride varnish. The regular application of fluoride varnish can prevent dental caries. This study aims to determine if a school-based fluoride varnish program can provide Aboriginal children with at least three fluoride varnish applications over 12 months and whether the routine application of fluoride varnish for Aboriginal children in schools is a feasible approach for oral health promotion in Aboriginal communities. METHODS: A school fluoride varnish program was co-designed with Aboriginal communities in Central Northern New South Wales, Australia and implemented in three schools where majority of enrolled children are Aboriginal. Four "fluoride varnish days," 3 months apart, were held at each school over the 12-month study period. On each "fluoride varnish day" an oral health therapist applied fluoride varnish to all children included in the study. RESULTS: This study took place between January and December 2017. About 153 children were eligible to participate and 131 (86%) were consented into the program by a parent or guardian. A total of 104 children were enrolled for the entire 12-month study period and included in the analysis. Majority of children (65.4%) received at least three fluoride varnish applications, with an average of 70% of students receiving an application of fluoride varnish on each "fluoride varnish day." CONCLUSIONS: School-based fluoride varnish programs, co-designed with local Aboriginal communities, may be a feasible approach to oral health promotion aimed at improving the oral health of Aboriginal children. SUMMARY: This study aimed to improve access to fluoride varnish for Aboriginal children in Central Northern NSW. Four "fluoride varnish days," each three months apart, were held in three schools over 12 months. Majority of children (65.4%) received at least three fluoride varnish applications during the fluoride varnish program.

Consumed by prestige: the mouth, consumerism and the dental profession.

Commercialisation and consumerism have had lasting and profound effects upon the nature of oral health and how dental services are provided. The stigma of a spoiled dental appearance, along with the attraction of the smile as a symbol of status and prestige, places the mouth and teeth as an object and product to be bought and sold. How the dental profession interacts with this acquired status of the mouth has direct implications for the professional status of dentistry and the relationship between the profession and society. This essay examines the mouth's developing position as a symbol of status and prestige and how the dental profession's interaction and response to this may have important effects on the nature of dentistry's social contract with society. As rates of dental disease reduce in higher socioeconomic groups, dentistry is experiencing a reorientation from being positioned within a therapeutic context, to be increasingly viewed as body work. This is not in of itself problematic; as a discipline dentistry places a very high value upon the provision of enhanced or improved aesthetics. This position changes when the symbolic exchange value of an aesthetic smile becomes the main motivation for treatment, encouraging a shift towards a commercialised model of practice that attenuates professional altruism. The dental profession should not welcome the association of the mouth as a status and prestige symbol lightly; this article examines how this paradigm shift might impact upon the social contract and dentistry's professional status.

Incorporating Humanities in Dental Education is Essential, but Seldom Routine.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Humanities in Predoctoral Dental Education: A Scoping Review. Marti KC, Mylonas AI, MacEachern M, Gruppen L. J Dent Educ 2019;83(10):1174-1198. SOURCE OF FUNDING: None declared. TYPE OF STUDY/DESIGN: A scoping review.

"Preparedness for Practice" for Dental Graduates Is a Multifaceted Concept That Extends Beyond Academic and Clinical Skills.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Conceptual framework explaining "preparedness for practice" of dental graduates: a systematic review. Mohan M, Ravindran TKS. J Dent Educ 2018;82(11):1194-1202. SOURCE OF FUNDING: None declared. TYPE OF STUDY: Systematic review.

Limits to consent in cosmetic interventions: an update.

This update restates the legal limits of consent to medical treatment. It reviews the classic statement of law set down by the case of R v Brown, where 'proper medical treatment' was stated to be exempted from the ordinary laws of consent. This position has been recently developed further by the 2018 English case of R v BM where a non-medical body modification artist was convicted for having carried out substantive body modification procedures. This article considers how these developments may affect Australian law, particularly laws pertaining to cosmetic procedures.

Consent in Geriatric Dental Care and Research Is Important but Seldom Discussed.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Informed consent in dental care and research for the older adult population: A systematic review. Mukherjee A, Livinski AA, Millum J, Chamut S, Boroumand SB, Iafolla TJ, Adesanya, MR, Dye BA. J Am Dent Assoc 2017; 148(4):211-20. SOURCE OF FUNDING: Mukherjee: NIDCR; Livinski: NIH Library; Millum: Fogarty International Center and NIH; Chamut: NIDCR; Boroumand: NIDCR consultant on Science and Policy; Iafolla: NIDCR; Adesanya: NIDCR; and Dye: NIDCR. TYPE OF STUDY/DESIGN: Systematic review.

Cosmetic dentistry: A socioethical evaluation.

Cosmetic dentistry is a divisive discipline. Within discourses that raise questions of the purpose of the dental profession, cosmetic dentistry is frequently criticised on the basis of it being classified as a non-therapeutic intervention. This article re-evaluates this assertion through examination of ethics of care of the self, healthcare definitions and the social purpose of dentistry, finding the traditional position to be wanting in its conclusions. The slide of dentistry from a healthcare vocation towards being a predominantly business-focused interaction between clinician and consumer conflicts with traditional notions of dentistry as a profession. Whilst it is undeniable that cosmetic dental treatment particularly lends itself to the commercial paradigm, this is not exclusive to this area of professional practice. The cultural basis of dental appearance and the potential of the dental profession to exert coercive pressure upon the public to undergo treatment that is based upon social norms is discussed. This essay concludes that cosmetic dentistry is undeniably part of the professional purpose of 21st Century dentistry. However, the caveat that may be placed upon this, is that this status is conditional upon the professional conduct of dental practitioners remaining resilient to commercial practices not compatible with professional obligations.

An assessment of strategies to control dental caries in Aboriginal children living in rural and remote communities in New South Wales, Australia.

BACKGROUND: A community-led oral health service for Aboriginal people in Central Northern NSW identified the need for oral health promotion, as well as dental treatment; in three remote communities with limited access to dental services. A three-stage plan based on the Precede-Proceed model was used to develop a school-based preventive oral health program. The program will be piloted in three schools over 12 months aimed at improving the oral health of local Aboriginal children. METHODS: The proposed program includes four components: daily in-school toothbrushing; distribution of free fluoride toothpaste and toothbrushes; in-school and community dental health education and the installation of refrigerated and chilled water fountains to supply a school water bottle program. Primary school children will be issued toothbrushing kits to be kept at school to facilitate daily brushing using a fluoride toothpaste under the supervision of trained teachers and/or Oral Health Aides. School children, parents and guardians will be issued free fluoride toothpaste and toothbrushes for home use at three-monthly intervals. Four dental health education sessions will be delivered to children at each school and parents/guardians at local community health centres over the 12 month pilot. Dental education will be delivered by an Oral Health Therapist and local Aboriginal Dental Assistant. The program will also facilitate the installation of refrigerated and filtered water fountain to ensure cold and filtered water is available at schools. A structured school water bottle program will encourage the consumption of water. A process evaluation will be undertaken to assess the efficiency, feasibility and effectiveness of the pilot program. DISCUSSION: The proposed program includes four core evidence-based components which can be implemented in rural and remote schools with a high Aboriginal population. Based on the Precede-Proceed model, this program seeks to empower the local Aboriginal community to achieve improved oral health outcomes. TRIAL REGISTRATION: TRN: ISRCTN16110292 Date of Registration: 20 June 2018.

The Use of Students as Surrogates: The Ethical, Legal and Professional Issues of Student-Student Practical Learning in Dental Education.

For generations, dental students have been introduced to, and practised, clinical skills through the use of their fellow classmates as surrogate patients. These skills include verbal and communication skills such as the taking of medical and social histories, and practical skills such as the administration of local anaesthetic by injection. Largely such practices within dental education have been accepted through convention. This article aims to consider the use of students in dental education as surrogate patients and questions whether such practices may create issues relating to consent, coercion and confidentiality. Also examined within this article is whether practical surrogacy may lead to the introduction and development of unprofessional behaviours.

A Whiter Shade of Grey: Comparisons of the Legal and Professional Status of Tooth Whitening in Three Jurisdictions.

This article seeks to examine and compare the legal and professional positions of tooth whitening of three jurisdictions: the United Kingdom, Australia and New Zealand. Within each jurisdiction, a differing formula of legislation, case law and professional guidance dictates how tooth whitening is regulated and practised. Tooth whitening still holds curiosity as a procedure with regards to whether it does indeed warrant status as a professional activity and whether its practice should be limited to dental professionals. Through exploration of the differing positions of three different jurisdictions, it is possible to demonstrate that this issue is far greater than the common view within the profession that for reasons of public protection, access to tooth whitening should be controlled by the dental profession. The monopoly upon tooth whitening procedures that the dental profession often celebrates, where it exists, should be viewed to be fragile and not taken as an unending status quo.

Looking Gift-horses in the Mouth: Gift-giving, Incentives and Conflict of Interest in the Dental Profession.

Within medicine, there has been a protracted conversation relating to the appropriateness of accepting gifts and incentives from industry, professional colleagues and from patients. The general principle and anxiety in this debate relates to answering the question of whether accepting gifts or incentives compromises a health professional's duty to provide quality care. Within the dental profession, there is noticeably less discussion as to the effects of gifts and incentives upon the practice of dentistry. Given that dentistry is, like medicine, part of health care this status quo is not one that should persist. The authors hope that this article will stimulate discussion around dentistry's relationship with those who might seek to make commercial benefit out of our practice and how dental professionals should respond to patients bearing gifts - letters to the editor are explicitly invited; personal communication to the authors to compile a follow-up publication is welcome.

Dental Health Workforce Regulation - How Amendments to the Health Practitioner Regulation National Law Act May Shape the Future of the Dental Profession.

Recent amendments to the Health Practitioner Regulation National Law Act adopt a number of recommendations published in the final report of the Independent review of the National Registration and Accreditation Scheme. The adopted recommendations are of interest because of their potential effect on the regulation of the dental profession and how they demonstrate the potential attenuation of the influence of the health professions in general in the arena of healthcare regulation. The wide-reaching effects of these changes and the impact they may have on the future direction of the dental profession in Australia are still uncertain, but are sure to be significant. This article will consider the changing role of the Dental Board in regulation and health workforce reform and show that the Dental Board is no longer the driver of dental workforce policy but plays a subordinate role to facilitate and implement health policy on direction from the AHWMC.

Infection Control Standards in Private Dental Practice - The Role of Accreditation.

There are established standards for the management of infection control in private dental practices, but there is currently no proactive legislation to oversee correct adherence to those standards. The Australian Health Service Safety and Quality Accreditation Scheme (Scheme) promotes a quality and safety management program that includes attention to the prevention of healthcare acquired infections, but adoption of the Scheme is not compulsory for all. A recent case brought before the NSW Civil and Administrative Tribunal demonstrated the seriousness of breaches of infection control standards and the considerable costs of managing the consequences. This article discusses the role of quality and safety assurance programs in the context of private dental practice regulation; compares the different quality and safety assurance schemes operating in Australia, Canada, and the United Kingdom; and argues that the compulsory adoption of an appropriate scheme which focuses on infection control would be in the public interest.

How we view complainants; an ethical dilemma?

UNLABELLED: All too often, those patients who complain are thought to be unreasonable. Healthcare professionals often feel that patients do not have an understanding of the pressures and hardships that they struggle with on a day-to-day basis. When a patient complains, it is seen by the professional complained about as a wholly negative event, leading to loss of confidence and leaving that professional feeling demoralized. Often complaints are due to a breakdown in communication. Sometimes a patient is unhappy with a treatment charge or simply there is a perception that he/she has been poorly treated. The General Dental Council and Primary Care Trusts (and now their successors) take a dim view of dental practitioners who deal with complaints poorly. This article sets out to offer a different perspective on complaints, so that the complaint system can be used to build trust between dental professionals and patients, instead of instilling demoralization and fear of litigation into those on the receiving end of a complaint. CLINICAL RELEVANCE: This article is relevant to all dental professionals as complaints are an inevitability of practice.

How many of our patients can really give consent? A perspective on the relevance of the Mental Capacity Act to dentistry.

UNLABELLED: The different ways that clinicians perceive adult patients with dental phobia is varied and diverse. From treating the dental phobia as a separate illness to dismissing it as a neurosis, sometimes little consequence is attached to its existence. True dental phobia is classed as a psychological illness and therefore comes under the remit and guidance of the Mental Capacity Act 2005. Failure to assess the impact of dental phobia upon an individual's capacity to consent could lead to allegations of negligence or even assault. CLINICAL RELEVANCE: This paper highlights the importance of considering the capacity to consent of some of the most vulnerable dental

Investigation into the enablers and barriers of career satisfaction among Australian oral health therapists.

OBJECTIVES: This qualitative study explored the enablers and barriers of career satisfaction among Australian oral health therapists (OHTs) and the reasons behind career changes. METHODS: Participants were recruited in 2 ways: 1) recruitment posts were made on the Facebook pages of two professional groups; and 2) an email was sent to the Doctor of Dental Medicine students of the University of Sydney School of Dentistry, inviting those with OHT qualifications to participate. Each participant completed a semi-structured interview which was guided by open-ended questions. The average interview length was 45 min. All interviews were recorded, transcribed verbatim and manually coded. Thematic analysis of the qualitative data was completed using an inductive approach. RESULTS: Twenty-one OHTs participated in this study. The enablers of OHT career satisfaction include clinical practice, job variety, career flexibility, being in a supportive team environment and the opportunity for constant learning and growth. The barriers to career satisfaction include musculoskeletal problems, restrictions on the scope of practice use, psychological stress and lack of recognition from others. OHTs remain in the profession due to stable income and employment opportunities. The main reasons for retirement were burnout and pursuing dentistry. OHTs pursue dentistry to expand their scope of practice. CONCLUSION: This study revealed the enablers and barriers of OHT career satisfaction in an Australian context. OHTs are an important component of modern dental workforces, and reasons for attrition within the workforce are essential for maintaining responsiveness to community oral health needs.