Primary Care Dentists' management of permanent dentition traumatic dental injuries in 7- to 16-year-olds: A sequential mixed-methods study.

BACKGROUND/AIMS: Primary care dentists play a pivotal role in the management of traumatic dental injuries in children, despite little evidence on the barriers they face in providing care. The aim of this study was to explore and contextualize the knowledge and attitudes of general dental practitioners regarding their management of permanent dentition traumatic dental injuries in children aged 7-16 years old. MATERIAL AND METHODS: A two-phase sequential mixed-methods study included a questionnaire that was disseminated to all 619 primary care dentists, identified via a triangulated sampling strategy, based across the north-east of England (Phase I). Statistical analyses were performed using Mann-Whitney U- and Kruskal-Wallis tests, Spearman's correlation and chi-square test. Multivariate factor analysis, with principal components extraction, was used to test between multiple ordinal variables. Respondents were invited to a face-to-face or telephone semi-structured interview (Phase II). Interviews were transcribed verbatim and analysed using inductive thematic analysis. RESULTS: Primary care dentists were less confident in managing complex dental trauma. Inadequate financial remuneration was the main reason for not providing care, often prompting a referral to the local dental hospital. This was more apparent for those who qualified before 2000. More recently qualified dentists felt the long-term costs, related to traumatic dental injuries, were insufficiently remunerated. Most still provided emergency management, irrespective of remuneration, as long as they had the requisite knowledge and skills. Four major themes arose: impact of traumatic dental injuries on patients, parents and primary care dentists; barriers to providing treatment; educational opportunities for primary care dentists; and interactions between primary and secondary care services. CONCLUSIONS: There is high confidence in managing simple traumatic dental injuries but less for complex injuries. A lack of sufficient financial remuneration associated with the long-term management of dental trauma was the main barrier for dentists to manage these cases.

Prevalence and severity of dental caries in Libyan schoolchildren.

OBJECTIVES: To assess prevalence and severity of dental caries, examine gender differences and assess the relationship of dental caries to socioeconomic status in a group of Libyan schoolchildren. DESIGN AND SETTING: A cross sectional observational study with cluster sampling within schools. PARTICIPANTS: A random sample of 791, 12-year-olds in 36 elementary public schools in Benghazi. METHODS AND MAIN OUTCOME MEASURES: Dental caries was assessed using the DMFT and DMFS indices and WHO (1997) criteria. Information about socioeconomic status was collected through a dental health questionnaire. RESULTS: The prevalence of dental caries was 57.8%. The mean DMFT and DMFS indices were 1.68 (SD ± 1.86) and 2.39 (SD ± 3.05) for all subjects and 2.90 (SD ± 1.56) and 4.14 (SD ± 2.97) for subjects with caries experience. Dental caries was more prevalent amongst girls (P = 0.002). There was a statistically significantly negative association between dental caries and the level of father's education (P = 0.015). CONCLUSIONS: While dental caries prevalence in 12 year-old Libyan children was high, the mean DMFT was low compared with other developing countries, but higher than the WHO goal for year 2020. The high level of untreated caries is a cause for concern, representing a high unmet treatment need.

Transatlantic engagement: a novel dental educational exchange.

Introduction Newcastle University School of Dental Sciences (NUSDS) and Indiana University School of Dentistry in the United States of America (IUSD) are like-minded institutions committed to civic engagement. Over the last 15 years, both universities have built civic engagement into the dental curricula, however each institution operates within significantly different healthcare systems.Aim Co-development of unique collaborative dental education; the first UK/US educational exchange programme engaged with the dental student community.Design A dental educational exchange was developed enabling NUSDS and IUSD students to learn alongside each other within dental and community settings in both countries. Students participate in a unique face-to-face collaborative and interdisciplinary education programme within respective dental schools and by a series of video conferences scheduled before on-site visits. They gain mutual awareness of delivery, access to care and possible barriers facing patients relating to the oral healthcare systems in England, the state of Indiana and the USA. Logistical considerations were significant, aided by scoping visits to the respective partner school and video conferencing. Planning encompassed timetable restrictions, scheduling student video conferences, students' clinical access/observerships, occupational health clearances, overall educational content, student/staff evaluation and potential areas for education research.Conclusions Currently in its fourth year, this is a unique example of a collaborative educational exchange between the UK and USA.

Obtaining patient feedback for quality assurance of undergraduate dental teaching.

Introduction In order to achieve the educational standards of the General Dental Council, providers of UK dental education programmes are required to demonstrate that feedback from patients is collected and used to inform programme development. Aims To determine areas of undergraduate dental training programmes that patients feel able to comment upon, allowing development of a patient feedback questionnaire. Methods Patients receiving treatment from undergraduate students were recruited to focus groups (n = 5, n = 6) where their experience of receiving student care was explored. Audio transcriptions were analysed for emergent themes. These themes informed the design of a questionnaire which was presented to a further patient focus group (n = 4) for content and face validity testing. Staff (n = 4) and student (n = 8) focus groups discussed its delivery. Results Patients were able to comment upon treatment quality, safety, the student-teacher interaction, and appointment times. An 18-question questionnaire was developed to include free text comments and answers on a visual analogue scale. It was modified following focus groups with patients, staff, and students. Conclusion Patients undergoing student treatment identified aspects of the clinical teaching programme that could be included in a feedback questionnaire. Following a pilot, the questionnaire will form part of the teaching quality assurance process.

Diet and dental erosion in young people in south-east Brazil.

BACKGROUND: The regular consumption of acidic foods and drinks may be associated with dental erosion, and soft drink consumption appears to be increasing both in developed and developing countries. Dentists are aware that an acidic diet can contribute to the development of erosion; however, there may be confusion within the profession concerning the general health message of eating five portions of fruits and vegetables each day. OBJECTIVE: The aim of this study was to investigate associations between dental erosion and the consumption of acidic foods and beverages in schoolchildren in south-east Brazil. The objective was to gather information, by means of a dietary questionnaire, on frequency of intake and patterns of consumption of acidic foods and drinks in a group of schoolchildren. The hypothesis was that the experience of dental erosion among the study sample was associated with the frequency and pattern of consumption of soft drinks, fruit juices, fruits, and yogurt. METHODS: A cross-sectional study was conducted in Três Corações, south-east Brazil. A sample of 458 schoolchildren, mean age 13.8 (SD 0.39) years, completed the study. Information about potential dietary risk factors for dental erosion was collected through a questionnaire survey completed by the schoolchildren. For the dental examinations, the subjects were examined for dental erosion in a school room. Associations between dental erosion and the variables under study were investigated through processes of bivariate and multivariate analyses. The statistical significance level was set at 5%. RESULTS: Analysis of the questionnaire surveys showed that the frequency of consumption of sugared carbonated drinks was the only variable independently associated with the erosive process, with subjects who had a daily consumption of such drinks having a greater likelihood of having erosion (P = 0.015, odds ratio 1.752, 95% confidence interval 1.116-2.750). CONCLUSIONS: Of all tested factors in this sample of schoolchildren the consumption of sugared carbonated drinks is most associated with dental erosion.

Dental erosion amongst 13- and 14-year-old Brazilian schoolchildren.

OBJECTIVES: To assess the prevalence of dental erosion in a sample of 13- and 14-year-old Brazilian schoolchildren and to assess the relationship of dental erosion and socio-demographic characteristics. METHODS: A convenience sample of 458 children (190 boys and 268 girls) from 14 schools in Três Corações, south east Brazil, was examined. Socio-demographic data were collected by self-completion questionnaires. RESULTS: Dental erosion was observed in 34.1% of subjects, involving enamel only and showing a symmetrical distribution. The palatal surfaces of the upper incisors were the most commonly affected surfaces. Erosion experience was higher in boys; pupils from Government funded schools; those resident in rural areas and those from the high economic class, but none of these were statistically significant. CONCLUSION: These data are the first to show that in a cohort of 13-14-year old Brazilian schoolchildren, approximately one third of those examined showed mild erosion, requiring clinical preventive counselling. No statistically significant association was observed between erosion, gender and socioeconomic factors.

Qualifying the lapped enamel surface: a profilometric, electron microscopic and microhardness study using human, bovine and ovine enamel.

OBJECTIVE: When enamel specimens are prepared for erosion and abrasion studies, the assumption is often made that specimens prepared in the same way will have the same baseline surface characteristics. This study aimed to test the null hypothesis that there are no significant differences in baseline surface characteristics of human, ovine and bovine enamel specimens prepared using the same method. DESIGN: Twenty enamel slabs were prepared from bovine, human and ovine incisor crowns and polished with 3µm aluminium oxide paste. Roughness average (Ra), bearing parameters (MR1, MR2, Rpk, Rk, Rvk), surface microhardness and scanning electron microscopy (SEM) were used to compare the different tissues. One way Analysis of Variance (ANOVA) was used to quantitatively compare surface characteristics between tissue types. RESULTS: Human, bovine and ovine enamel roughness and microhardness were significantly different to one another at baseline (P<0.001); ovine enamel was the roughest and softest, and bovine enamel was the smoothest and hardest. SEM allowed a visual comparison to be made between tissue types, confirming the quantitative data. CONCLUSIONS: Enamel from human, bovine and ovine specimens showed significantly different surface characteristics after lapping and polishing. The null hypothesis is rejected, recognising that the same preparation techniques will not necessarily result in consistent baseline roughness or surface characteristics between tissue types. Surface studies should lap and polish samples with a standardised approach, whilst ensuring that baseline data are recorded for comparison.