Pro-CAD: una alternativa para profesionalizar al personal auxiliar del odontólogo / Pro-CAD: a professionalizing alternative for the dentist's auxiliary staff

El presente artículo es el resultado de una investigación orientada a la implantación de un modelo educativo, que sustenta una propuesta para la capacitación de recursos humanos de apoyo técnico en el campo de la salud. Para este propósito se denominaron: Asistentes Dentales a quienes son el personal auxiliar que se desempeña con profesionales que ejercen la odontología en forma privada en México, y que no cuentan con escuelas para su formación, considerando sus diferencias individuales e involucrando las áreas cognoscitiva (conocimientos), psicomotriz (habilidades y destrezas) y afectiva (comportamientos). Los recursos humanos compiten fuertemente por encontrar un espacio de desempeño en un mercado altamente exigente, razón por la cual el eje principal de la investigación se fundamentó en el planteamiento del Consejo Normalizador y Certificador de Competencias Laborales (CONOCER). El modelo fue diseñado durante la formación doctoral, enmarcado en la línea de innovación curricular para la calidad total como consecuencia del interés personal por evaluar las competencias del personal auxiliar que se desempeña apoyando al gremio de la odontología; la población está organizada en un colegio local de profesionales filial a la Asociación Dental Mexicana. Se utilizó el método mixto, y la herramienta para recolección de datos fue la encuesta, misma que aportó información relevante para construir una propuesta denominada modelo Pro-CAD (Programa de Capacitación Asistente Dental), que se incluye brevemente al final de este artículo (AU)

This article is the result of research aimed at the implementation of an educational model, which supports a proposal for the training of human resources of technical support in the field of health. For this purpose they were called: Dental Assistants, who are the auxiliary staff who work with professionals who practice dentistry privately in México, and who do not have schools for their training considering their individual differences and involving the cognitive areas (knowledge), psychomotor (skills and skills), affective (behaviors). Human resources compete strongly to find a performance space in a highly demanding market, which is why the main focus of the research was based on the approach of the Standardizing Council and Labour Skills Certificater (CONOCER). The model was designed during my doctoral training framed in the line of curriculum innovation for total quality as a result of the personal interest in evaluating the work skills of the auxiliary staff who perform supporting the dental guild, the population is organized in a local college of professionals affiliated with the Mexican Dental Association. The mixed method was used, and the data collection tool was the survey, which provided relevant information to build a proposal called the Pro-CAD (Dental Assistant Training Program) model that is briefly included at the end of this article (AU)

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.

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.

Dental skill mix: a cross-sectional analysis of delegation practices between dental and dental hygiene-therapy students involved in team training in the South of England.

BACKGROUND: Research suggests that health professionals who have trained together have a better understanding of one another's scope of practice and are thus equipped for teamwork during their professional careers. Dental hygiene-therapists (DHTs) are mid-level providers that can deliver routine care working alongside dentists. This study examines patterns of delegation (selected tasks and patients) by dental students to DHT students training together in an integrated team. METHODS: A retrospective sample of patient data (n = 2,063) was extracted from a patient management system showing the treatment activities of two student cohorts (dental and DHT) involved in team training in a primary care setting in the South of England over two academic years. The data extracted included key procedures delegated by dental students to DHT students coded by skill-mix of operator (e.g., fissure sealants, restorations, paediatric extractions) and patient demography. χ2 tests were conducted to investigate the relationship between delegation and patient age group, gender, smoking status, payment-exemption status, and social deprivation. RESULTS: A total of 2,063 patients managed during this period received treatments that could be undertaken by either student type; in total, they received 14,996 treatment procedures. The treatments most commonly delegated were fissure sealants (90%) and restorations (51%); whilst the least delegated were paediatric extractions (2%). Over half of these patients (55%) had at least one instance of delegation from a dental to a DHT student. Associations were found between delegation and patient age group and smoking status (P <0.001). Children under 18 years old had a higher level of delegation (86%) compared with adults of working age (50%) and patients aged 65 years and over (56%). A higher proportion of smokers had been delegated compared with non-smokers (45% cf. 26%; P <0.001). CONCLUSIONS: The findings suggest that delegation of care to DHT students training as a team with dental students, involved significantly greater experience in treating children and adult smokers, and providing preventive rather than invasive care in this integrated educational and primary care setting. The implications for their contribution to dentistry and the dental team are discussed, along with recommendations for primary care data recording.

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.

Continuing dental education in radiation protection: monitoring the outcomes.

OBJECTIVES: To evaluate an evolving radiation protection dental postgraduate course run in Wales between 2003 and 2007. METHODS: We compared three standardized course series. Course content was enhanced in 2006 to target areas of weakness. In 2007, a single best answer multiple choice questionnaire instrument superseded a true/false format. Practitioners' performance was studied pre- and immediately post-training. 900 participants completed identical pre- and post-course validated multiple choice questionnaires. 809 (90%) paired morning-afternoon records, including those of 52 dental care professionals (DCPs), were analysed. RESULTS: Mean (standard error) pre- and post-course percentage scores for the three courses were 33.8 (0.9), 35.4 (1.4), 34.6 (1.0) and 63.6 (0.9), 59.0 (1.4), 69.5 (0.9). Pre-training, only 2.4%, 3.1% and 4.9% of participants achieved the pass mark compared to 57.7%, 48.4% and 65.9% post-training, indicating a rather greater pass rate and gain in the most recent series than earlier ones. In recent series, older more experienced candidates scored slightly higher; however, their gain from pre- to post-training was slightly less. CONCLUSIONS: Baseline levels of radiation protection knowledge remained very low but attending an approved course improved this considerably. Targeting areas of weaknesses produced higher scores. Current radiation protection courses may not be optimal for DCPs.

Odontologia e Letras: avaliação de um estágio supervisionado interdisciplinar / Dentistry and the Arts (Letters): evaluation of an international interdisciplinary supervised internship at UFPB

A proposta de reestruturação curricular dos cursos de graduação em Odontologia é um item relevante das Diretrizes Curriculares Nacionais, pois oferece base para a formação profissional contextualizada com a realidade social. Destaca-se, como estratégia, a instituição de práticas pedagógicas que relacionem o ensino, a pesquisa e a extensão. O presente estudo teve por objetivo avaliar a experiência de um estágio supervisionado interdisciplinar dos cursos de Odontologia e Letras da Universidade Federal da Paraíba(UFPB), que buscou contextualizar o aprendizado dos acadêmicos à problemática social da região. Utilizou-se como campo de estágio um projeto de pesquisa sobre restaurações atraumáticas (ART) junto as escolas da cidade de João Pessoa, PB, o qual foi desenvolvido em 12 meses, quando os alunos de Odontologia estrangeiros e brasileiros atuaram como cirurgiões-dentistas e auxiliares odontológicos, respectivamente,e os alunos de Letras atuaram como intérpretes. Participaram desse estágio 24 estudantes,entre graduandos e pós-graduandos das duas áreas,sendo 17 brasileiros e 7 estrangeiros. Como forma de avaliação do estágio, aplicou-se um questionário a todos os participantes. Observou-se que o desenvolvimentodo Projeto favoreceu a integração entre ensino,pesquisa e extensão, sob uma ótica interdisciplinar(Odontologia e Letras), além de oferecer recursos para uma formação profissional capaz de despertar um perfil humanitário e social nos futuros graduados

"Scheduling delay" in oral cancer diagnosis: a new protagonist.

Diagnostic delays in oral cancer have been classified as "patient delay" and "delay by the clinicians". However, the influence of the accessibility (scheduling delay) to the health care system in oral cancer diagnosis has not been studied before. To assess scheduling delay, a descriptive, cross-sectional study was designed. This study was based upon role-play telephone conversations with two standardised patients (lingual ulceration-SP1 and patient seeking fixed prosthodontics-SP2). that followed a structured script. The variables considered in the study were days to go until the arranged appointment, professional degree of the contacted person and referral to other provider of care. The scheduling delay for SP1 reached a median value of 1 day, and for SP2 was 6 days. When the professional degree (receptionist vs GDP) of the person arranging the appointment for the patient with lingual ulceration was considered, the scheduling delay was significantly shorter when the appointment was fixed by the GDP (X approximately i-X approximately j=4.5; 95%CI=-7.48,-1.51). GDPs gave priority to the patients with lingual ulcerations over those demanding fixed bridgework (X approximately i-X approximately j=6.48; 95%CI=-9.46,-3.50). The GDPs showed a high level of awareness of the oral cancer, however, educational interventions seem to be necessary for dental surgery receptionists.

Assessing cross infection prevention measures at the Dental Clinic, University College Hospital, Ibadan.

The dental clinic is an environment where disease transmission occurs easily. Prevention of cross infection in the dental clinic is therefore a crucial aspect of dental practice and dental clinic workers must adopt certain basic routines while practising. This study evaluates basic routines in prevention of cross-infection in the dental clinic, University College Hospital Ibadan. The sample comprised 77 dental clinic workers, who completed closed-ended questionnaires. The questionnaires enquired into practices of the workers in the clinic as well as in the laboratories Physical inspection of dental equipment, instruments and materials was also carried out. The results highlight poor compliance of workers, especially the dental surgeons and students, with the hepatitis B vaccination programme of the Hospital. History to identify high risk individuals was often overlooked and was practised by less than 50% of the clinic workers. Barrier technique with the exception of the use of eye shield, was well practised by all the clinic workers. Aseptic technique was well practised in the dental clinic. Inadequate number of dental surgery assistants, faulty sterilizing equipment, poor monitoring of sterilization, coupled with inadequate number of instruments contributed to the poor success of prevention of contamination and instrument processing procedures. Less than 30% of dental surgeons and fewer than 50% of students discarded sharp materials into the yellow/sharp bin. Liquid waste was well disposed off through the drain for onward flow into the sewer, whilst the disposal of solid contaminated waste did not conform to stipulated international standard. The study found that successful infection control in the dental clinic was highly dependent on the dental surgery assistants, because highly technological equipment were lacking. The management/administration also plays an important role in the number of physical and human resources available and in the overall surveillance of nosocomial infections.

Cross-infection control in dental practice in the Republic of Ireland.

OBJECTIVE: The purpose of this study was to examine the infection control procedures used in general dental practices in the Republic of Ireland. DESIGN: Postal survey. SETTING: The Republic of Ireland. PARTICIPANTS: 250 general dental practices. METHODS: Postal questionnaire. MAIN OUTCOME MEASURES: Use of infection control procedures; gloves, masks, sterilisation of instruments, staff training. RESULTS: A 74% response rate (n = 177), with 162 wearing gloves for all patients, 97% of whom used latex gloves. Routine glove use by 69% of dental nurses. Approximately one third of respondents complained of hand skin irritation attributed to the wearing of latex gloves. Routine mask wearing during treatment was reported by 68% of respondents. The method of choice for sterilising instruments was the steam autoclave for 97%. Time spent on surgery cleaning between patients was less than one minute in 12 per cent of practices. CONCLUSIONS: Cross-infection control procedures practiced by a high proportion of the respondents to the survey conform to guidelines suggested by various authorities. Further education may be appropriate in a number of areas such as mask wearing and the need to change gloves between patients.

The question of cost: reimbursement and remuneration.

Dentists and the dental team have been encouraged to become an important part of the effort to curb tobacco use. Many health insurance policies, however, do not cover tobacco cessation programs, especially by dentists. The generosity of insurance for tobacco cessation has been found to influence the use of these programs. The dental profession can help by: 1) training more dental students, dental hygienists, and dental practitioners to provide tobacco cessation counseling; 2) increasing the number of practices routinely monitoring tobacco use and providing tobacco cessation programs; 3) increasing the utilization of the available procedure codes for tobacco cessation, whether it is a covered service or not; and 4) stimulating demand for more tobacco cessation coverage by employees.

HIV infection and oral health care in South Africa.

This study determined the knowledge, attitude and practice of oral health care workers in public clinics in South Africa towards HIV/AIDS and investigated the implementation of infection control measures. A total of 727 questionnaires were distributed to dentists, dental therapists, oral hygienists and chairside assistants in the public dental clinics of 9 provinces, of which 276 were returned from 8 provinces, giving a response rate of 38%. The questionnaire covered demographic factors and assessed issues such as knowledge, infection control practices, continuing education, legal, ethical and psychosocial issues and available support for HIV/AIDS. The common oral manifestations seen by respondents were candidiasis, acute necrotising ulcerative gingivitis (ANUG), hairy leukoplakia and Kaposi's sarcoma. Of the 174 who had a previous HIV test, 48% were for insurance purposes and 21% for post-needle-stick injury. Over 10% of the respondents indicated that gloves were not available at all, that there was an inadequate supply of water, and that there was no autoclave in their clinic. Nearly 50% of the clinicians had not had hepatitis B vaccination in the last 3 years. Fifteen respondents (5.4%) were not willing to treat HIV-positive patients. Only 48% had access to a written post-exposure management protocol and post-exposure medication was available to only 36.6%. The vast majority of the respondents clearly expressed a need for additional education on HIV/AIDS. The study demonstrated a need to add knowledge, enhance personal skills and improve the application of universal precautions.