Managing the phase-down of amalgam: part II. Implications for practising arrangements and lessons from Norway.

The announcement of the Minamata Convention has triggered the lead into a phase-down in the use of dental amalgam. This paper considers aspects of this development in the context of the experience of banning the use of dental amalgam in Norway. It is suggested that strong top-down leadership and joined-up working by all relevant stakeholders, including patients, may be one of the most important keys to an effective, seamless transition to the provision of preventatively orientated, patient-centred, minimally interventive operative dentistry, based on state-of-the-art selection and application of tooth-coloured restorative materials. The benefits of such a transition are considered to be an important goal for dentistry in the UK.

Teaching of direct posterior resin composite restorations in UK dental therapy training programmes.

AIM: With the numbers of dental therapists involved in the delivery of dental care within the UK on the increase, and the trend towards the use of direct resin composites (composites) for the restoration of posterior teeth, this study was undertaken to describe the teaching of posterior composites in dental therapy training programmes in the UK. A secondary aim was to identify differences in techniques for posterior composites taught within these dental therapy training programmes. METHODS: In 2008/9, a questionnaire seeking information on the teaching of posterior composites was distributed by email to 13 centres with dental therapy training programmes in the UK. This questionnaire sought information relating to the teaching of direct posterior composites to dental therapy students, including the amounts of preclinical and clinical teaching in respect of deciduous and permanent teeth, numbers of restorations placed, contraindications to placement, and details in respect of operative techniques. RESULTS: Ten completed responses were received (response rate = 77%). In ten programmes, student dental therapists received clinical training in the placement of composite restorations in the occlusal surfaces of premolar and permanent molar teeth, and nine programmes included such training for two and three surface occlusoproximal restorations. The mean proportions of posterior restorations placed clinically by the trainee dental therapists in permanent teeth using dental amalgam and composite were 52% and 46% respectively (range: amalgam = 20-95%; composite = 5-70%). CONCLUSION: With the exception of one programme, the teaching of posterior composites is a well established element of dental therapy training. Some variations were noted in the teaching of clinical techniques between respondent training centres. It is suggested that to ensure harmony in approaches to treatments provided by graduated therapists that training centres look to relevant consensus documents, such as those of the British Association for the Teaching of Conservative Dentistry. The findings of our study are important for the future provision of oral healthcare, given the growing evidence base in favour of minimally invasive dentistry.

Widening access? Characteristics of applicants to medical and dental schools, compared with UCAS.

AIM: The aim of this paper is to compare the demography (age, sex, ethnicity, social status) and academic experience (school type, tariff scores) of focused and successful applicants to preclinical dentistry with preclinical medicine, and with higher education in general in the UK. METHOD: Retrospective analyses of anonymised University and College Admissions Services (UCAS) data for focused applicants whose preferred subject was preclinical dentistry or medicine, and accepted (successful) applicants to the same programmes in 2006. These data were compared with publicly available data on applicants and accepted applicants through UCAS. Information for each medical, dental and general UCAS applicant included age, sex, ethnicity, socio-economic group, region, school type and tariff score. Logistic regression was used to model the probability of being accepted in relation to all explanatory variables and interactions. RESULTS: In total there were 2,577 focused applicants to dentistry; 1,114 applicants were accepted, 4% (n = 46) of whom did not have it as their preferred subject choice. There were seven times as many focused applicants for medicine (18,943) when compared with dentistry; 8,011 applicants were accepted, 2.7% of whom did not have medicine as their preferred subject choice (n = 218). Just over half of the applicants to dentistry were from minority ethnic backgrounds (50.5%), exceeding medicine (29.5%), and higher education in general (19%). The proportion of female applicants was similar across all three groups at around 55%. Only one fifth (21%) of focused applicants to dentistry were mature compared with one third (33%) to medicine and one quarter (25.5%) of all UCAS applicants. Greater proportions of applicants to medicine (25.8%) and dentistry (23.5%) were from upper socio-economic backgrounds, compared with higher education in general (15.5%). When all other factors are controlled, the odds of being accepted for medicine, and for dentistry, are lower if mature, male, from a lower social class, from a minority ethnic group and have attended a further/higher education college. CONCLUSIONS: Focused and successful applicants for preclinical medicine and dentistry are more likely to be from higher social classes and a minority ethnic background than applicants to higher education in general. Dentistry attracts twice the level of Asian applicants as medicine and four times that of universities in general. Controlling for other factors, there is evidence that gender, ethnicity, maturity, and school type are associated with probability of acceptance for medicine and dentistry. Higher social status is particularly associated with acceptance for medicine. The implications of these findings are discussed in terms of widening access and social justice.

The future dental workforce?

The Editor-in-Chief of the BDJ has previously raised important questions about dental workforce planning and the implications for dental graduates of recent changes and pressures. It is now time to revisit this issue. Much has changed since the last workforce review in England and Wales, and the rate of change is in all probability set to increase. First, at the time of writing this paper the momentous step of including dental care professionals (DCPs) on General Dental Council (GDC) registers in the United Kingdom has recently been completed. Second, the Scope of Practice of all dental professionals has been under consultation by the General Dental Council, and research evidence suggests that greater use should be made of skill-mix in the dental team. Third, within England, Lord Darzi has just published the 'Final Report of the NHS Next Stage Review', which emphasises 'quality care' and 'team-working' as key features of healthcare; this report was accompanied by an important document entitled 'A High Quality Workforce', in which plans for local workforce planning within the NHS are outlined, placing responsibilities at national, local and regional levels. Fourth, policy makers across the UK are wrestling with addressing oral health needs, promoting health and facilitating access to dental care, all of which have implications for the nature and shape of the dental workforce. Fifth, with the impact of globalisation and European policies we are net gainers of dentists as well as having more in training. Sixth, although there have been reviews and policy initiatives by regulatory, professional and other bodies in support of shaping the dental workforce, there has been little serious consideration of skill-mix and funding mechanisms to encourage team-working. Together, these events demand that we enter a fresh debate on the future dental workforce which should extend beyond professional and national boundaries and inform workforce planning. This debate is of great importance to future generations of dental healthcare professionals, funders, commissioners and providers of both dental services and dental education and training, and most importantly our patients and the public whom we serve. Furthermore, workforce planning must be linked to a philosophy of care which promotes promotion of health and embraces quality care, rather than merely treatment of disease, and addresses oral health needs and demands.

New horizons in the regulation of dentistry.

I'm delighted to have the opportunity to share with you my understanding of the much-needed and long-awaited reform of the General Dental Council. Change is moving apace and the new, modern GDC, for which the existing Council has been working so hard, is taking shape as part of widespread fundamental reforms in the regulation of healthcare.

Influence of the method of funding on the age of failed restorations in general dental practice in the UK.

OBJECTIVE: This study examined the effect of the method of funding treatment on the age of restorations at the time of replacement. METHOD: A group of general dental practitioners were recruited to take part in the study. Each participant was asked to record the reason for placement and replacement of restorations. The age and class of the restoration being replaced was also recorded, together with details of the material being used and the material being replaced. Details of the method of payment of the failed restoration were recorded. RESULTS: Details of the reason for placement/replacement were received for 3,196 restorations from 32 GDPs. Of the restorations placed, 54% were amalgam, 32% composite, 8% compomer and 7% glass ionomer. The age of restorations at the time of replacement was significantly associated with the method of payment for the restoration, with restorations placed in the Armed Forces having been in service significantly longer at the time of their replacement than restorations placed under NHS regulations. CONCLUSION: Statistical analysis indicated that restorations placed within the NHS regulations were replaced at a significantly lower age than restorations placed under the other funding arrangements investigated.