The teaching of Dental Public Health - 50 years on.

In 1966, James published an article in the British Dental Journal (and reprinted here) which made recommendations on the teaching of dental public health. The following commentary reviews the ideas put forward by James and how these relate to concepts of dental public health in the undergraduate dental curricula of 2016 .

A Rejoinder.

Three commentaries on the Nesselroade and Molenaar target article in this issue are responded to in the interest of elaborating and defending the points of view expressed in our article. The commentaries feature philosophy of science, general structural modeling, and broad behavioral research perspectives. Responding to the commentaries afforded us the opportunity to clarify further matters that we deem critical to the fundamental matter of measurement in behavioral science, especially as it emphasizes (properly, we believe) the individual as the primary unit of analysis.

Exploring motivational interviewing and its philosophical alignment to an undergraduate behavioural science programme in dentistry.

Motivational interviewing (MI) is a client-centred, directive, therapeutic approach that enhances clients' readiness to change by exploring their ambivalence about doing so, thus increasing their motivation to change, and by helping them to commit to the process of change. MI is now being applied to dentistry in the area of oral health e.g. smoking cessation and the prevention of early childhood caries. This aligns dentistry with other healthcare professions in their focus on utilising MI to bring about behavioural change. This paper focuses on how the profession of dentistry would benefit from examining how to integrate MI both in undergraduate teaching and practice. Currently the teaching focus in relation to MI has centred on the theoretical content and less on underlying philosophy. This paper explores how a teaching philosophy, as delivered in the behavioural science programme in the School of Dentistry, University College Cork, Ireland, can provide a framework for teaching MI. Key components within this teaching philosophy are: teaching for understanding, developing reflective practice and student-centred teaching.

Changes in orthodontic treatment modalities in the past 20 years: exploring the link between technology and scientific evidence.

STATEMENT OF THE ISSUE: Is there a link between the many perceived advances in orthodontic techniques/therapy and science in the past 20 years? The purpose of this paper is to take five topics and match the perceptions with the scientific evidence. The variety of appliances and the swings in treatment philosophy have been dramatic, including the swing from extraction to non-extraction therapy, the introduction of space-age wires, appliances that grow mandibles, the introduction and extraordinary growth of Invisalign, and reduced friction brackets to reduce treatment time, all with claims by manufacturers of better results than ever before. The focus is on faster treatment, reduced visits/appointments and superior results. Most of these 'advancements' represent what has been the 'juggernaut of technology'. Five questions are posed, and an evidence-based approach is used to critically examine the literature in these selected topics.

The feminization of dentistry: implications for the profession.

Over the last 40 years, the proportion of women in dentistry has been rising steadily, raising questions about the effects of this feminization on the profession. A review of the literature, although limited, highlights potentially important areas related to gender, including impact on work hours, practice models, professional incomes, the dentist-patient relationship, clinical philosophies, specialty practice, academia and leadership. Although cohorts of predominantly female dentists are only beginning to enter the workforce and, thus, it is difficult to predict the long-term effects, some trends are evident: women are less likely than men to own their practice; women may work 4-6 fewer hours a week and see fewer patients; there is a pay differential; female general practitioners and specialists appear more likely to work in urban centres; and women are less prominent in the specialties, academia and leadership roles. Thus, the profession may shift toward less entrepreneurship, more urbanization and, possibly, fewer clinical hours available to the population as a result of feminization. With the ultimate goal of excellence in patient care, this may entail increases in student enrolment, formal incentives for practice relocation to rural communities, more business education and policies to modify advanced education and training for women with children. This knowledge, although still not robust, is relevant for policy, educational institutions and professional governing bodies.

Ethics and the 'seasons of my life' as a dental educator.

Perhaps the first comprehensive ethics program in American dental schools was created in 1990 at the University of Kentucky by then dean David Nash. Nash recounts the emergence of his personal and professional interest in ethics using the structure of Daniel Levinson's book The Seasons of a Man's Life. Each season brings tasks of evolving and deepening ethical engagement. Being ethical is important; helping others to be so is special. Nash still teaches the course.

Because nice matters--surviving in a down economy.

Too many times, in our busy lives, we lose track of what really matters and neglect our practices to the point of not attracting new patients or even losing some of our current patients. Being nice to our patients, providing extraordinary service and spending a little extra time in our treatment rooms will pay huge dividends in terms of full schedules. This article will outline some simple techniques you can use immediately in your office to increase referrals and have your current patients "begging for more".

[Research and non-research. The values in the evaluation of epidemiological protocols]. / Recherche et non-recherche. Les valeurs à l'oeuvre dans l'évaluation des protocoles épidémiologiques.

BACKGROUND: Evaluation and ethical review of epidemiological research projects raises the problem of the limits between research and non-research. This ambiguous boundary reflects the status of this discipline at the crossroads between research and practical action. The question then is: in the field of health research, what gives data collection and analysis its quality of scientific activity? METHODS: A conceptual and empirical study has been conducted about the practices of epidemiological research evaluation, centred on the case of the French Consultative Committee for the data processing in health research (CCTIRS), which is a consultative board that permits the National commission for the personal data protection (CNIL) to take decision about health research protocols that process personal data. The study was realized from 2003 to 2006. RESULTS: It is shown that the evaluation of such research protocols processing personal data articulates intimately two kinds of criteria: methodology and relevance. By studying and characterizing the different kinds of protocols that are judged not to be "scientific research" (poor science, pseudo-science and non-science), it becomes possible to understand the motives that lead to distinguish between what is and what is not research in epidemiology. A special attention is given to two kinds of problematic cases: firstly, the case of conflict of interests into the protocols themselves (i.e. seeding trials or surveys); secondly, the problem of epidemiological registers and other databases which are not hypothesis-oriented. This last case leads to relate the conceptual frame of the committee with historical circumstances (the way which this discipline was introduced in France) and also mere epistemological considerations (the question of induction and generalizability). CONCLUSION: The activity of this committee illustrates a differentiated conception of what is research in epidemiology, influenced by explanatory analytical research paradigms. Finally, the field of epidemiological research appears to be structured by some values that appear through the elaboration and the application of the ethical and regulatory texts.

Knowledge, attitudes, and behaviors of federal service and civilian dentists concerning minimal intervention dentistry.

BACKGROUND: Although minimal intervention dentistry (MID) is on the increase, little is known about the patterns of knowledge, attitudes, and behaviors of dentists in the United States. METHODS: Federal service and civilian dentists who were active members of the American Dental Association (N = 1,500) received a pretested questionnaire about their knowledge, attitudes, and behaviors concerning MID. Descriptive statistics and bivariate analyses were conducted to assess dentist personal and practice characteristics associated with the knowledge, attitudes, and behaviors. RESULTS: Federal service dentists reported more knowledge of MID than civilian dentists (Cochrane Mantel Haenszel Ridit Scores), p < 0.0043, with similar attitudes toward fluoride (p = 0.11), and decisions regarding monitoring or restoring enamel caries (p = 0.22). Federal service dentists remineralized noncavitated carious lesions more (p < 0.0001) and had lower composite scores, indicating more MID tendency (Wilcoxon p < 0.0001). CONCLUSION: Federal service dentists reported more knowledge and clinical practices regarding minimal intervention dentistry compared to civilian dentists.

Personal construct psychology: a theory to help understand professional development, a philosophy to support it.

AIM: The aim of this paper is to introduce the reader to personal construct psychology as a theory to help understand the process of change in facilitative and mentoring relationships. BACKGROUND: Continuing professional development is critical if practitioners are to keep up to date with new ideas, techniques, and materials. However, is it important not only to consider what is learnt, it is also important to understand the how of learning in order to develop an approach that leads to lifelong learning. Mentoring, coaching, and appraisal are all facilitative processes that aim to encourage professionals to engage with their own development. This leads to differing degrees of both behavioural and attitudinal change. As a result, it is useful to have a theory that can help an individual to understand these changes and to identify any difficulties that are associated with them. APPROACH: Personal construct psychology has long been recognised as a potential framework for personal development. It has been used extensively in a broad range of domains, including clinical and educational psychology, management, and psychotherapy. CONCLUSION: Personal construct psychology is a useful theory for understanding the facilitative process because it enables the facilitator to form a conceptual framework to comprehend behavioural and attitudinal change. Its underlying philosophical approach also supports lifelong learning, given its emphasis on an enquiring mind and reflection, both of which are key to continuing professional development.

Turning points in removable partial denture philosophy.

This article discusses key turning points in removable partial denture (RPD) philosophy. Early advancements tended to focus upon improving the technical quality of the prosthesis itself. The beginning of the 20th century brought significant public pressure upon the dental profession due to consequences associated with poor quality fixed prostheses. The result was dramatic improvement and heavy demand for RPDs. Technical and efficiency issues conspired to temper this enthusiasm, eventually resulting in reduced respect for RPDs. By highlighting key writings and technical issues during these periods of change it is hoped the reader will gain a more precise understanding of the current status of RPD philosophy.

A question of value: a qualitative study of vocational dental practitioners' views on oral healthcare systems and their future careers.

BACKGROUND: New dental graduates in England and Wales spend one year as vocational dental practitioners (VDPs) preparing for independent clinical practice. In recent years, they have entered a state-funded healthcare system undergoing the greatest period of change since the inception of the National Health Service (NHS) and a profession in which there has been a significant shift of care to the private sector. Against this background, the objectives of this study were to investigate VDPs' vision of their future professional career and the influences that will impact on their choice of state-funded (NHS) and/or private dentistry, and to identify what factors may attract graduates to work for the NHS. METHODS: In 2004/2005, purposive sampling of a range of VDP training schemes across England and Wales was used to select the VDPs from ten schemes to take part in focus groups. To standardise data collection, a topic guide was used. Respondents' views were recorded on tape and field notes. The data were transcribed and analysed using framework methodology. RESULTS: Ninety-nine VDPs from all parts of England and Wales participated in ten focus groups. They identified three main categories of future practice: private, state-funded (NHS), and mixed. Private practice was perceived as providing 'professional independence', 'financial reward', 'time with patients' and 'clinical freedom'. NHS practice was associated with 'providing access to specialist training' and 'gaining clinical experience', often as preparation for private practice. Providing NHS care was attractive for VDPs who valued the ethos of public service. The VDPs considered that NHS practice could be made more attractive to young dentists by a range of factors, involving the funding, culture and philosophy of the system and the degree of fit with their personal and professional vision. They reported that they would welcome 'incentives to work in areas of high need', 'assistance with debt' and a 'culture of valuing NHS dentists'. CONCLUSIONS: The findings suggest that the commitment to healthcare systems of the VDPs who took part in this study was associated with being true to their values and being valued within the system. They perceived a tension between state-funded and private practice, considering the latter more likely to meet personal and professional expectations. However, they remained open to working in an enhanced and supportive state-funded system, should it correspond with their values, and demonstrate that they were valued healthcare professionals.

[The dentist between medicine and cosmetology. Ethical shortcomings of the esthetics boom in dentistry]. / Die Zahnmedizin zwischen Heilkunde und Beauty-Industrie. Zu den ethischen Unzulänglichkeiten des Asthetik-Booms in der Zahnheilkunde.

Dentistry has evolved from a genuine medical practice to a mere business. From an ethical point of view it is asked whether this evolution creates more problems than it solves. The paper elaborates four arguments against this evolution and shows that aesthetics in dentistry which works only according to market categories runs the risk of loosing the view for the real need of patients. Dentistry which comprehends itself as part of a market will be nothing else than a part of a beauty industry which has the only aim to sell something, but not the aim to help people. Such a dentistry makes profit from the ideology of a society which serves only vanity, youthfulness and personal success and which is losing the sight for real values. The real value of man cannot be reduced to his appearance and medicine as an art should feel the obligation to resist these modern ideologies and should help people to get a more authentic attitude to themselves. If modern dentistry fails to think about these implications it will lose its identity as medicine, which would be too great a loss.

EndoImplantology: a retrospective in the paradigm shift in endodontic therapy.

EndoImplantology is a clinical approach which essentially blends the knowledge of endodontics, 3-D radiography, bone grafting, and implantology; the LTP is central to the decision of "saving or not saving" a tooth. Initially created as an answer to challenging endodontic retreatments, the scope of EndoImplantology was soon extended to the full spectrum of endodontic treatments. Saving the tooth remains the primary objective, while preserving the site for successful implant placement is also given consideration.