What are the public health benefits of community-based education in dentistry? A scoping review.

Aim To examine what is known about the public health benefits of community-based education in dentistry.Method A scoping review was conducted using a modified Arksey and O'Malley framework. Database searches were undertaken on PubMed, Medline via Ovid, CINAHL via EBSCO and ERIC, and a grey literature search was undertaken on OpenGrey, Medlar, BASE and the British Library. Reference lists of included studies were also searched. Although no formal quality assessment was undertaken, observations on methodological rigour were recorded.Results In total, 31 studies from nine countries met the inclusion criteria. Most were from high-income countries. Methodologies of included studies varied: quantitative (n = 17); qualitative (n = 5); mixed methods (n = 6); and reviews (n = 3). Several potential public health benefits were reported: increased access to dental services (including improvements in their availability, affordability, acceptability, accessibility, and accommodation); improved awareness/health literacy of students and communities; and improved clinical outcomes. The overall quality of the evidence was low and had little community engagement.Conclusion Notwithstanding the methodological limitations of the included studies, several potential public health benefits have been associated with community-based education in dentistry. Rigorously designed, methodologically appropriate research is needed, which should include engagement with communities.

A five-year evaluation of an NHS dental practice-based specialist minor oral surgery service.

OBJECTIVE: To report the findings of an evaluation of an NHS dental practice-based minor oral surgery service. BASIC RESEARCH DESIGN: Service evaluation. CLINICAL SETTING: NHS specialist practice in England. PARTICIPANTS: Patients and referring practitioners. INTERVENTIONS: analysis of activity, patient and referring practitioner satisfaction data. MAIN OUTCOME MEASURES: Numbers and case-mix treated; non-attendance; antibiotic prescribing; complication rates; patients and referring practitioner satisfaction. RESULTS: 5,796 treatment appointments were arranged, with a median waiting time from receipt of referral to treatment of 35 days. Treatment provided included: surgical removal of third molars and non-third molars, surgical endodontics and other surgical and oral medicine cases (28.3%, 53.3%, 3.5%, and 15.0% of cases, respectively). Antibiotics were prescribed at 13.1% of all treatment appointments and 2.5% required appointments for post-operativecomplications. All but one patient reported overall satisfaction and over 98% strongly agreed/agreed with positive attitudinal statements about the oral surgeon's communication/information giving, technical competence and understanding/acceptance. 70.1% of patients were seen on time and under 1% were seen more than 15 minutes late. Some 83.1% felt the standard of service was better than expected from a hospital and none felt it was worse. More than 85% of referring practitioners agreed that: waiting times were shorter than at the hospital; urgent problems were seen quickly; and, the referral process was easy and understandable. Over 98% either strongly agreed or agreed that they were happy with the service provided. CONCLUSIONS: A range of minor oral surgery procedures can be provided with low complication rates, short waiting times, acceptable accessibility and high levels of patient and referring practitioner satisfaction from a specialist NHS dental practice-based service.

'The dental nurse played a vital role in helping to manage the patient': a thematic analysis of undergraduate dental students' reflective journals from outreach placements.

Introduction Community-based dental education, or 'outreach', forms a key part of dental courses in some high-income countries. Its educational benefits are well-established and once graduated, participants feel better prepared for their early career. Yet, it is less clear what students actually learn while on placements.Materials and method Qualitative document and thematic analysis of a convenience sample of anonymised dental student reflective journals (n = 51).Results The reflective journals described varied and broadly positive learning experiences. Analysis identified a number of themes of learning. Most related to the process and outcomes of care, but two key themes - dental anxiety and teamworking - were interrelated with both. Within teamworking, dental nurses appeared important in students' learning. Three process interrelated themes of learning were identified in the data. These were: tailoring your approach; communication and time; and evidence-based dentistry and minimising risk. Two broad interrelated themes relating to outcomes for patients and students were also identified: trust and confidence; and professionalism and personal development.Conclusion This research identified important and potentially transformative learning from outreach placements. This included how dental anxiety impacts patients and the dental team, the importance of teamworking, and the role of dental nurses in students' experiential learning.

Sustainability as part of a quality framework for the organisation of oral healthcare.

This paper aims to highlight to the reader that the organisation of dentistry at a system level lags behind other healthcare professions in regulation, policy, education and research. It argues that seeing sustainability as being as important as safety in oral healthcare quality would begin to rectify this. For the practitioner, it also identifies existing guidance on practising sustainably and reinforces that it does not require radical change but evidence-based care.

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.

The acceptability of care provided by dental auxiliaries: A systematic review.

BACKGROUND: Dental auxiliaries undertaking a limited range of intraoral clinical procedures normally performed by dentists could increase access to care and control costs, yet their acceptability to patients has been questioned. The aim of this study was to assess data on the social acceptability and patient satisfaction of dental auxiliaries performing intraoral clinical procedures. METHODS: The authors searched 14 electronic databases and 2 trial registries for studies of any design (from inception to November 2013). They searched gray literature databases (from inception to July 2014), reference lists of included studies, and high-yield journals (from January 2000 to December 2014). Risk of bias was assessed, and data were extracted. RESULTS: The authors identified 29 studies: 25 considered experiential and 4 on social acceptability. Twenty-three were cross-sectional, 2 were qualitative, 1 was mixed-methods, and 3 had unclear methods. The authors found that patients reported high acceptability of care, comparable or better than that from dentists. Social acceptability varied, with care for children being less acceptable. One-fifth of people were unwilling to receive any treatment from a dental auxiliary. All studies were at high risk of bias, and quality of the evidence was low. CONCLUSIONS: Experiential acceptability of dental auxiliaries by patients appeared high in this study, but their social acceptability varied. PRACTICAL IMPLICATIONS: Given the age of the studies, their settings, and their quality, generalizability to dental practices is limited. Additional high-quality, methodologically rigorous studies are needed.

The influence of population oral health on the dental team.

This presentation focuses on the use of dental therapists as substitutes for dentists in the provision of some aspects of dental care. Our premise is that the use of therapists is a 'good thing' if it delivers a higher quality service. The care that may be provided by therapists is appropriate to population needs. They have been used to increase access to care in a number of countries by supplementing the volume and reach of services, which enhances equity. Therapists are socially acceptable where they are integrated into existing dental systems, but concerted work may be necessary to increase their acceptability if their use is to be introduced or expanded elsewhere. There is no reason to suspect that therapists offer less effective care than dentists, and available data are compatible with this view. More data may be required to lend political support for their greater use. The efficiency of teams is sensitive to the way in which they are organized and funded. Substitution of dentists by therapists within small dental teams creates complexities and costs that reduce efficiency. Conversely, where therapists can work with relative independence, diagnosing and treating patients without direct supervision, then efficiency may be high. Despite opportunities for improving the quality of care, the main barrier for increasing their use is the dental profession. Dental organizations tend to act as guilds, preventing or restricting the deployment of therapists. Dental public health practitioners therefore have a role as advocates for their greater use. At present, the use of therapists does not appear to be influenced by the health of the population.