Workplace health in dental care - a salutogenic approach.

OBJECTIVE: The purpose was to explore self-reported psychosocial health and work environments among different dental occupations and workplaces from a salutogenic perspective. A further purpose was to analyse possible associations between three salutogenic measurements: The Sense of Coherence questionnaire (SOC), the Salutogenic Health Indicator Scale (SHIS) and the Work Experience Measurement Scale (WEMS). METHODS: Employees in the Public Dental Service in a Swedish county council (n = 486) were invited to respond to a self-reported web survey including demographics, work-related factors, the SOC, the SHIS and the WEMS. RESULTS: This study showed positive associations between employee characteristics and self-reported overall psychosocial health as well as experienced work environment. Autonomy was reported more among men than women (P < 0.000) and to a higher degree by dentists and dental hygienists than dental nurses (P < 0.000). Meaningfulness, happiness, job satisfaction, autonomy and positive to reorganization were reported by personnels aged less than 40 years (P ≤ 0.047). Clinical coordinators reported significant better health (SOC, SHIS) and experienced more autonomy, better management and more positive to reorganization than other dental professions. Dental hygienists and nurses experienced less time pressure than dentists (P ≤ 0.007). Better health and positive work experiences were also seen in smaller clinics (P ≤ 0.29). CONCLUSION: Dental professionals reported a high degree of overall psychosocial health as well as a positive work experience. Some variations could be seen between employee characteristics such as gender, years in dental care, professionals, managing position and workplace size. Identify resources and processes at each workplace are important and should be included in the employee's/employers dialogue.

Oral mucosal screening and referral attitudes of Australian oral health therapists and dental hygienists in Queensland.

OBJECTIVES: The aim of this study was to describe oral mucosal screening and referral attitudes of Australian oral health therapists (OHTs) and dental hygienists (DHs). METHODS: Questionnaires were distributed to participants who attended dental hygiene courses run in both regional and metropolitan Queensland. RESULTS: One hundred and two participants comprised 58 OHTs and 44 DHs, with a mean of 8.9 years since graduation. Thirty-four participants worked in regional locations, while 68 were from metropolitan areas. 97% of participants agreed that mucosal screening should be performed for all new and recall patients, while a minority (5%) agreed that patients will detect an oral mucosal change themselves. The majority (77%) agreed that oral cancer would be encountered in their practising career. Most participants (81%) felt comfortable discussing the presence of a suspicious lesion with patients and 88% agreed that it was their role to screen. In terms of barriers to oral cancer screening, lack of training was seen as the most prevalent barrier (56%) followed by lack of confidence (51%). Lack of time was seen as the third most prevalent barrier (40%), and lack of financial incentives was the least prevalent barrier (16%). CONCLUSIONS: Oral health therapists and DHs understand the importance of oral mucosal screening and are likely to be alert to oral mucosal changes. While lack of time and financial incentives was perceived to be impediments to mucosal screening, lack of confidence and training was the most prevalent barriers. This issue should be addressed through implementation of effective continuing education courses targeting oral cancer screening and referral practices.

Job satisfaction and perceived future roles of Malaysian dental therapists: findings from a national survey.

OBJECTIVE: To assess Malaysian dental therapists' perceptions of their job satisfaction and future roles. METHODS: A nationwide postal survey involving all Malaysian dental therapists who met the inclusion criteria (n = 1726). RESULTS: The response rate was 76.8%. All respondents were females; mean age 35.4 years (SD = 8.4). Majority were married (85.5%) and more than one-half had a working experience of <10 years (56.1%). Majority worked in community dental service (94.3%) and in urban areas (61.7%). Overall, they were highly satisfied with most aspects of their career. However, they were least satisfied with administrative workload (58.1%), career advancement opportunities (51.9%) and remuneration package; specifically income (45.2%), allowances (45.2%) and non-commensurate between pay and performance (44.0%). Majority perceived their role as very important in routine clinical tasks such as examination and diagnosis, preventive treatment, extraction of deciduous teeth and oral health promotion. However, fewer than one-half consider complex treatment such as placement of preformed crowns on deciduous teeth (37.1%) and extraction of permanent teeth (37.2%) as very important tasks. CONCLUSION: Majority expressed high career satisfaction with most aspects of their employment but expressed low satisfaction in remuneration, lack of career advancement opportunities and administrative tasks. We conclude that most Malaysian dental therapists have positive perceptions of their current roles but do not favour wider expansion of their roles. These findings imply that there was a need to develop a more attractive career pathway for therapists to ensure sustainability of effective primary oral healthcare delivery system for Malaysia's children.

Dental fear affects adolescent perception of interaction with dental staff.

The main purpose of this study was to explore whether subjective perception of interaction with dental staff is associated with dental fear in a population-based sample of 18-yr-old adolescents (n = 773). The interaction was measured using the Patient Dental Staff Interaction Questionnaire (PDSIQ), validated with exploratory and confirmatory factor analyses, which yielded the factors of 'kind atmosphere and mutual communication', 'roughness', 'insecurity', 'trust and safety', and 'shame and guilt'. Dental fear was measured using the Modified Dental Anxiety Scale (MDAS). Gender and sense of coherence (SOC) were included as potential confounding variables. Adolescents with high dental fear more often perceived their interaction with dental staff negatively and more often felt insecure than others. This difference persisted after adjustment for gender and SOC. In conclusion, adolescents with high dental fear may perceive their interaction with dental staff more positively if the staff succeed in creating a positive, trusting, approving, and supportive atmosphere with kindness, calmness, and patience. The communication and interaction skills of dental staff may play a particularly important role when encountering highly fearful dental patients.

Knowledge, attitudes and practices of oral health care workers in Lesotho regarding the management of patients with oral manifestations of HIV/AIDS.

Lesotho has the third highest prevalence of HIV in the world with an estimated 23% of the adult population infected. At least 70% of people living with HIV/AIDS (PLWHA) have presented with oral manifestation of HIV as the first sign of the disease. Oral health workers regularly encounter patients presenting with oral lesions associated with HIV disease and therefore need to have adequate knowledge of these conditions for diagnosis and management. The aim of the present study was to determine the knowledge, attitudes and practices of oral health care workers (OHCW) of Lesotho regarding the management of oral manifestations of HIV/AIDS. A descriptive cross-sectional survey was conducted on all 46 OHCW in 26 public and private care facilities in all ten districts of Lesotho. A self-administered questionnaire was used to gather information. The response rate was 100%. Nearly all (94.7%) agreed that oral lesions are common in people living with HIV and/or AIDS. The majority (91.3%) named oral candidiasis (OC) as the most common lesion found in PLWHA while Kaposi's Sarcoma (KS) (34.7%) and Oral Hairy Leukoplakia (OHL) (32.6%) were mentioned as the least common oral lesions of HIV. Most correctly identified the images of oral candidiasis (97.8%), angular cheilitis (86.9%) and herpes zoster (80.4%). Only 16.7% felt they had comprehensive knowledge of oral HIV lesions, although 84.8% reported having previously received training. Almost three quarters (71%) reported that there was no need to treat HIV positive patients differently from HIV negative patients. OHCW in Lesotho demonstrated high confidence levels in their competence in managing dental patients with oral lesions associated with HIV, however, they lacked an in-depth knowledge in this regard. Amongst this group there is a need for comprehensive training with regards to diagnosis and management of oral lesions of HIV including the training of other cadres of health care workers together with nurses and community health workers.

Changes in Bachelor of Oral Health students' perceptions of their dental education environment.

This study used the Dundee Ready Educational Environment Measure (DREEM) to examine how a cohort of Bachelor of Oral Health (BOH) students at the University of Otago's Faculty of Dentistry perceived their educational environment. Four DREEM questionnaires were administered over the three-year programme; a modified version at the beginning of the first year asked students what they expected their year would be like, while questionnaires at the end of each subsequent year surveyed students on their actual experiences within the BOH programme. All four questionnaires were completed by 78% of students (N=31). Overall, the students' perceptions of their educational environment were more positive than negative, and they identified both strengths and weaknesses in the BOH programme. Both positive and negative shifts occurred between the 'Expected' and 'Actual' individual DREEM outcomes. The difference between students' 'Expected' and 'Actual' DREEM responses indicates, in some areas, that BOH students expected more from their educational environment than what they actually experienced. The changes in BOH students' perception of their educational environment over the three years can be explained, in part, by changes in the curriculum from year to year.

Managing HIV/hepatitis positive patients: present approach of dental health care workers and students.

People with HIV/HBsAg in India frequently encounter discrimination while seeking and receiving health care services. The knowledge and attitudes of health care workers (HCWs) influences the willingness and ability of people with HIV/HBsAg to access care, and the quality of the care they receive. The objective of this study was to asses HIV/HBsAg-related knowledge, attitudes and risk perception among students and dental HCWs. A cross-sectional survey was conducted on 250 students and 120 dental HCWs in the form of objective questionnaire. Information was gathered regarding demographic details (age, sex, duration of employment, job category); HIV/ HBsAg-related knowledge and attitudes; risk perception; and previous experience caring for HIV-positive patients. The HCWs in this study generally had a positive attitude to care for the people with HIV/HBsAg. However, this was tempered by substantial concerns about providing care, and the fear of occupational infection with HIV/HBsAg. A continuing dental education program was conducted to resolve all the queries found interfering to provide care to HIV/HBsAg patients. But even after the queries were resolved the care providing capability was not attained. These findings show that even with advanced knowledge and facilities the attitude of dental HCWs and students require more strategic training with regards to the ethics and moral stigma associated with the dreaded infectious diseases (HIV/HBsAg).

Risk for dental healthcare professionals during the COVID-19 global pandemic: An evidence-based assessment.

OBJECTIVES: Heightened anxiety among dental healthcare professionals (DHPs) during the COVID-19 pandemic stems from uncertainties about the effectiveness of personal protective equipment (PPE) against dental aerosols and risk levels of asymptomatic patients. Our objective was to assess the risks for DHPs providing dental care during the pandemic based on available scientific evidence. METHODS: We reviewed the best available evidence and estimated the annualized risk (p=das(1-1-p0p1(1-e)yn) for a DHP during the COVID-19 pandemic based on the following basic parameters: p0, the prevalence of asymptomatic patients in the local population; p1, the probability that a DHP gets infected by an asymptomatic patient; e, the effectiveness of the PPE; s, the probability of becoming symptomatic after getting infected from asymptomatic patient; da, the probability of dying from the disease in age group a; n, number of patients seen per day; and y, number of days worked per year. RESULTS: With the assumption that DHPs work fulltime and wear a N95 mask, the annualized probability for a DHP to acquire COVID-19 infection in a dental office, become symptomatic, and die from the infection is estimated at 1:13,000 (0.008 %) in a medium sized city in the US at the peak of the pandemic. The risk estimate is highly age-dependent. Risk to DHPs under the age of 70 is negligible when prevalence of asymptomatic cases is low in the local community. CONCLUSIONS: Risk of COVID-19 transmission in dental office is very low based on available evidence on effectiveness of PPE and prevalence of asymptomatic patients. Face shields and pre-procedure oral rinses may further reduce the risks. CLINICAL SIGNIFICANCE: DHPs should follow guidelines on pre-appointment protocols and on PPE use during dental treatments to keep the risk low.

Willingness of New England dental professionals to provide assistance during a bioterrorism event.

A bioterrorism attack could overwhelm medical personnel and facilities, suggesting a need for aid from nonmedical personnel. The American Dental Association suggests that dental professionals should assist in such cases, utilizing their strong scientific and technical skills. This study describes New England dental professionals' willingness, potential roles, motivators, and barriers to providing this aid. This cross-sectional study used a self-administered survey to collect data addressing the knowledge and opinions of dental professionals concerning acting as responders. The survey was distributed to 370 attendees of the 2005 Yankee Dental Conference, in Boston, Massachusetts. Most dental professionals expressed willingness to help during an attack (N = 340, 92%), reporting that dental professionals, in general, should perform a mean number of 6 roles. Three-quarters of dentists and dental students were personally willing, with proper training, to give immunizations, and 54% would perform triage. Knowledge was weak, but most dental professionals were interested in obtaining further education (83%). Since dental professionals are willing to assist during a bioterrorism attack and are motivated to obtain disaster response training, government officials and local directors and managers of disaster/emergency response agencies should consider incorporating dental professionals into their disaster management plans.

Duties and training of dental nurses: how do Irish practices conform to European standards?

AIM: The dental nurse is a key member of the dental team, having an important role in the delivery of oral healthcare. Despite this, there is considerable variation throughout Europe in relation to the level of training, permitted duties, and statutory registration of dental nurses. The purpose of this paper is to describe the opinions and attitudes of dental nurses to their roles and suitability of training in one European member state, Ireland, where statutory registration has recently been introduced. METHOD: A postal questionnaire was sent to 150 dental practitioners selected from the Irish Register of Dentists. The dentists were asked to distribute questionnaire to dental nurse(s) working in their practice. Information sought from the dental nurses included their employment setting, the nature of their employment, their level of training, additional qualifications held, their views on the key duties and responsibilities of a dental nurse, and the appropriate duration and content of a dental nurse training programme. RESULTS: Replies were received from 96 dental nurses (response rate = 64%). Fifty-five percent of respondents (n = 53) were employed in private practice, 39% (n = 37) were employed in the Health Board Dental Service, and 6% (n = 6) were employed in a dental hospital. Two thirds of respondents (n = 62) had been employed as dental nurses for more than five years. Eighty-six percent of respondents (n = 83) were in full-time employment. Seventy-three percent of respondents (n = 70) held a recognised dental nurse qualification. Sixty-five percent of respondents (n = 70) who held a dental nurse qualification felt that the appropriate duration of a dental nurse training programme was one year or less. Thirty-two percent of respondents (n = 30) had completed additional training in practice management, administration or computer skills. Ninety-five percent of respondents (n = 91) were interested in attending continuing education courses. Eighty-five percent of respondents (n = 82) felt that assistance at the administration of local anaesthetics was a key duty/responsibility for dental nurses, while only 20% of respondents (n = 19) felt that infection control procedures was a key duty. CONCLUSIONS: Within the group of dental nurses surveyed, there was a lack of clarity surrounding their perception of their key duties. This could present challenges to the effective delivery of oral healthcare regimens within Ireland. Further investigation of this situation in other European countries is indicated.

Exploring the social acceptability of skill-mix in dentistry.

AIM: To explore lay views on skill-mix in dentistry and the experiences and social acceptability of care provided by operating dental auxiliaries. DESIGN: Qualitative semistructured interviews and focus groups. SETTINGS: Participants' homes and neutral public venues. PARTICIPANTS: Purposive sample of 27 adults ensuring varieties of age, social and cultural backgrounds. RESULTS: Three main themes emerged from the data. The first two (Perceptions of the Nature of Dental Services and Anxiety about Dental Treatment) influenced views in the third (Support for Skill-mix). Perceptions of the nature of services varied between and within participants and depended on the context in which they were being discussed. Consumerist views and greater dental anxiety tended to be related to lower support for skill-mix. However, the possibility of lower treatment costs was seen as beneficial. Public service views saw increased efficiency and access to services as benefits of skill-mix. Views on auxiliaries treating children varied from overt opposition to reluctant acceptance. The need for careful communication of the rationale for skill-mix was highlighted. CONCLUSION: Views on skill-mix varied. Dental anxiety and perceptions of the nature of dental services appeared to influence support of its use. Careful communication of the rationale and potential benefits of skill-mix is needed.

Attitudes of South African dental therapy students toward compulsory community service.

Compulsory community service (CCS) was introduced into the health service by the South African government to address the shortage and maldistribution of health professionals within the public sector. The aim of this study was to determine the attitudes of dental therapy students regarding CCS. A self-administered questionnaire was delivered to the two dental schools that train dental therapists in South Africa. There was a 64 percent response rate; 56 percent of the respondents were female. The average age was 20.3 years. There was no difference in the variables between the two dental schools, so the results were combined. The majority (81 percent) supported the introduction of CCS and preferred to carry it out in Kwa-Zulu Natal. Most students opted to perform oral health promotional (64 percent) and clinical (15 percent) activities. By aligning these requirements with the current dental needs and priority strategies of the South African Department of Health, this support would add much value to the delivery of oral health services.

An investigation of trainers' and VDPs' views in the Mersey Deanery of the FGDP(UK) key skills in primary dental care and assessment of vocational training.

OBJECTIVE: To investigate the views of vocational dental practitioners (VDPs) and trainers in the Mersey Deanery on the Faculty of General Dental Practice (UK) Key Skills in Primary Dental Care and other means of assessing satisfactory completion of vocational training (VT). DESIGN: An anonymous four-part questionnaire survey was delivered to all 48 dental vocational trainers and VDPs at the final day of the educational day-release programme in the Mersey Deanery. RESULTS: There was a 100% response rate from VDPs and a 91% response rate from their trainers. Overall the VDPs and trainers thought the FGDP(UK) Key Skills were a good idea but the VDPs felt completion of all the key skills during the VT year was time-consuming. Eighty-one per cent of trainers but only 52% of VDPs felt there should be a formal assessment of the VT year. Neither group unanimously agreed that completion of key skills alone was a marker of successful completion of the VT year. For assessment of clinical performance the only areas of agreement were direct observation of performance, review of patients following treatment, and tutorial sessions. CONCLUSIONS: The FGDP(UK) Key Skills have an important role in assessing competence in a number of important areas for VDPs. However, satisfactory completion of the key skills alone fails to assess clinical performance. Other methods of assessment of completion of VT will need to be considered in the light of the principles of assessment as laid down by the Postgraduate Medical Education and Training Board (PMETB).

Discriminatory attitudes towards patients with HIV/AIDS by dental professionals in Nigeria.

AIMS AND OBJECTIVES: The study sought to investigate whether there are discriminatory practices towards HIV/AIDS patients among dental professionals in Nigeria, how receptive are dental professionals and institutions to treating People Living With Aids (PLWA), and what underlying factors if any that may contribute to any discriminatory practices. METHODS AND MATERIALS: It was a cross-sectional study conducted in one randomly selected State in each of the six geo-political zones of Nigeria. Data collection was by self administered questionnaire. The questionnaire asked about demographic information, general knowledge of HIV/AIDS, adequacy of infection control, fear of occupational exposure, attitudes towards HIV positive patients and areas of need for further training. A total of 75 dental professionals participated in the study. RESULTS: The results of the study suggest that significant number of dental professionals in Nigeria reported attitudes and behaviour towards HIV patients which are discriminatory. CONCLUSION: Further efforts should be made to promote accessibility of discrimination-free quality oral and dental care to this population.

The working practices and career satisfaction of dental therapists in New Zealand.

OBJECTIVE: To describe the working practices and level of career satisfaction of dental therapists in New Zealand. DESIGN: Postal survey of dental therapists identified from the New Zealand Dental Council's dental therapy database. One mailing with one follow-up. PARTICIPANTS: Questionnaires were sent to 683 registered dental therapists. Replies were received from 566 (82.9%). OUTCOME MEASURES: Current working practice, career breaks, continuing education, career satisfaction. RESULTS: Respondents had a high career satisfaction, but were much less satisfied with their remuneration. After controlling for age and income satisfaction, therapists who felt that they were valued members of the dental community had over four times the odds of having higher overall job satisfaction. There were no differences in the mean career satisfaction scale score by age, but respondents aged 45 and over had a lower mean income satisfaction scale score than their younger counterparts (p<0.05). Older respondents were more likely to report regularly placing fissure sealants (p<0.05), participating in peer review (p<0.05), and playing a role in team management/coordination (p<0.05) than younger respondents. Most therapists (412; 82.2%) had taken at least one career break, usually for child rearing. A mean of 6.5 years (SD 5.9; range six weeks to 25 years) had been taken in career breaks. Younger therapists were more interested in moving into private practice than their older colleagues (p<0.05). More than half of respondents planned to retire from dental therapy within 10 years. CONCLUSION: Urgent action is required to improve the recruitment and retention of dental therapists in the New Zealand School Dental Service. Measures to reduce the time taken in career breaks could increase the productivity of this workforce. Remuneration and career progression are key issues; therapists need to feel that they are valued members of the dental profession.

Drivers of professional mobility in the Northern Territory: dental professionals.

INTRODUCTION: Attracting and retaining an efficient allied health workforce is a challenge faced by communities in Australia and overseas. High rates of staff turnover in the professional workforce diverts resources away from core business and results in the loss of valuable skills and knowledge. Understanding what attracts professionals to a particular place, and why they leave, is important for developing effective strategies to manage turnover and maximise workforce productivity. The Northern Territory (NT) faces particular workforce challenges, in part because of its geographic location and unusual demography. Do these factors require the development of a tailored approach to recruitment and retention? This article reports on a study undertaken to examine the motivations for coming to, staying in and leaving the NT for dental professionals, and the implications of results on workforce management practices. METHODS: In 2006, dentists, dental specialists, dental therapists and dental hygienists who were working or had worked in the NT, Australia, in the recent past were surveyed to collect demographic and workforce data and to establish the relative importance of social and work-related factors influencing their migration decisions. Multivariate logistic regression models were generated to describe the demographic characteristics of dental professionals who stayed in the NT for more than 5 years and to analyse why dental professionals left. The analyses, based on a 42% response rate, explained 60-80% of the variation in responses. RESULTS: Generally dental professionals who had stayed for more than 5 years were older, had invested in the purchase of homes and were more involved in social and cultural activities. Those who moved to the NT as a result of financial incentives or who had strong expectations that working in the NT would be an exciting, novel experience tended to stay for no more than 5 years, often leaving because they found the work environment too stressful. In contrast, those who stayed longer came because they had existing social networks and were familiar with the NT environment, staying primarily because they have enjoyed the NT lifestyle, particularly the sense of community and the opportunities available through living in smaller centres. CONCLUSION: There are benefits in actively engaging newly recruited professionals and their families in social networks. Work related stress and departure was associated with administrative deficiencies within the management system. Despite the NT's unusual demographic profile, the factors influencing recruitment and retention are not markedly different from those reported elsewhere.

ADEA/AAL Institute for Allied Health Educators: Program Evaluation.

Revised accreditation standards for dental and dental hygiene education programs have increased emphasis on faculty development that can improve teaching and learning, foster curricular change including use of teaching and learning technologies, and enhance retention and satisfaction of faculty. The American Dental Education Association (ADEA) and Academy for Academic Leadership (AAL) established the Institute for Allied Health Educators (IAHE) in 2007 to address faculty development needs for allied dental and allied health educators. In 2009, it was transitioned to an online program, which resulted in increased enrollment and diversity of participants. After seven years, a comprehensive program evaluation was warranted. The authors developed an online questionnaire based on Kirkpatrick's four-level model of training evaluation; for this study, levels one (satisfaction), two (knowledge and skill acquisition), and three (behavior change) were examined. Of the 400 program participants invited to take part in the study, a 38% response rate was achieved, with the majority indicating full-time faculty status. Nearly all (95-97%) of the respondents agreed or strongly agreed the program contributed to their teaching effectiveness, and 88-96% agreed or strongly agreed it enhanced their knowledge of educational concepts and strategies. In addition, 83% agreed or strongly agreed the program helped them develop new skills and confidence with technology, with 69% agreeing or strongly agreeing that it helped them incorporate technology into their own educational setting. Nearly 90% were highly positive or positive in their overall assessment of the program; 95% indicated they would recommend it to a colleague; and 80% agreed or strongly agreed they had discussed what they learned with faculty colleagues at their home institutions who had not attended the program. Positive findings from this evaluation provide evidence that the IAHE has been able to meet its goals.

Survey of Australian oral health practitioners and their smoking cessation practices.

BACKGROUND: Smoking is a significant health and economic burden in Australia. Studies of smoking cessation practices in dental settings have primarily concentrated on dentists rather than other oral health practitioner (OHP) groups (dental hygienists, dental therapists and oral health therapists). The aim of this study was to measure Australian OHPs' attitudes, behaviours, interest and barriers to delivering smoking cessation interventions. METHODS: Members of the two peak professional bodies representing Australian OHPs were invited to participate in an anonymous online questionnaire. RESULTS: There were discrepancies between practitioner attitudes and current smoking cessation practices. While the majority of practitioners (90.1%) frequently screened for smoking behaviour, fewer (51.1%) assisted patients to quit smoking. The principal form of assistance was referral to Quitline (45.7%) or to a general medical practitioner (44.4%). The most prevalent barriers identified were lack of knowledge of pharmacological treatments (45.8%) and lack of access to smoking cessation resources (44.2%). Contrary to international studies, time and financial incentive were not commonly cited barriers to delivering smoking cessation interventions. CONCLUSIONS: This survey identifies a need for continuing education in smoking cessation practice. Dissemination of policies, guidelines and resources may assist OHPs to become more engaged and confident in delivering smoking cessation interventions as part of their routine practice.

Radiographic caries diagnosis by clinicians in Norway and Western Australia.

In connection with continuing education courses in Norway and Western Australia (WA), dealing with caries diagnosis and treatment decisions, pre-tests were conducted. The pre-tests involved 433 dentists in Norway (ND), and 62 dentists (WAD) and 108 dental therapists (WAT) in WA, altogether 603 clinicians. Radiographs of 68 approximal surfaces were to be diagnosed and a treatment proposal was requested for each surface. ND showed the best overall diagnostic quality measured by the area beneath ROC-curve (P < 0.00001). The frequency of false-positive diagnoses (over-registrations) on sound surfaces varied between 7.1% (ND) and 11.9% (WAT) while the frequency of true-positive scores for lesions in the outer half of dentine varied from 57.4% (ND) to 48.1% (WAT). The mean numbers of restorations suggested by the three groups of clinicians were: ND: 14.3; WAD: 13.0; and WAT: 14.5. None of the differences was statistically significant. The proportion of sound surfaces proposed filled varied considerably between the groups, from 4.3% among Norwegian dentists to 10.6% among WAT (P < 0.0001). Of the lesions penetrating the outer half of dentine, the ND group would have restored 34.5% and the Australian clinicians somewhat fewer: WAD 25.6% and WAT 26.5%. The 11.3% of the ND who proposed more than two fillings on sound surfaces were responsible for 51.2% of the total number of filling proposals on sound surfaces. The corresponding numbers in the Australian group were 19.4% (WAD) and 33.3% (WAT) who made 73.6% and 75.7% of the restorative proposals on sound surfaces respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Exploring dental operators' perceptions of their clinical tasks.

Clinical variation is a result of the complex interaction of operator, operating environment and client variables. This study explores intra-operator characteristics by applying a technique from psychology known as Repertory Grid to New Zealand dental therapists, in order to elicit the ways in which they view their work. Individual interviews were conducted with 13 dental therapists to elicit the full range of tasks that they perform and the various ways that they describe them. Each therapist then rated her own work activities or tasks on her personal set of bipolar descriptions (personal constructs). Principal components analyses of each individual's set of ratings produced graphs which portrayed the pattern of meanings which therapists attributed to their work activities. Common features among the 13 therapists' work perceptions were then identified and categorised according to five types of variables (therapist, client, procedural, time and interpersonal). Common features included operator perceptions of painfulness of procedures, complexity of decision-making, interaction with people, stress for the therapist, preventive care for the client, routineness of task and challenge for the therapist. This detailed information gives a better understanding of the complex ways in which therapists view their tasks and therefore make decisions in the clinical setting. It could be conveniently used to develop a questionnaire to assess the empirical relationships between intra-operator factors and clinical outputs.