Adequately Prepared? A Study Using an Innovative Computer Application to Measure Clinical Crown Convergence Angles Achieved by Students at a UK Dental School.

This study examined the total occlusal convergence angles created for full coverage crown preparations by students at a UK dental school. Working casts of 82 clinical crown preparations were scanned using a 3D scanner. Stereolithographic files were uploaded to Preppr, a crown preparation analysis application. Mean bucco-lingual convergence angle were 19.6° (+/-11.7) and mesial-distally 17.8° (+/-11.1). Smallest bucco-lingual convergence angles were achieved for canine teeth with the largest on molar teeth. The smallest mesio-distal values were on canine teeth with the largest on molar teeth. Ideal total convergence angles (4-14°) were achieved in 23% of bucco-lingual preparations and 33% of mesio-distal preparation. Results for clinically acceptable angles (10-20°) were 30% and 40% respectively. There were no statistically significant differences between tooth types for mean bucco-lingual values. (p=0.623), mesio-distal mean values were statistically different by tooth type (p=0.003). Mean values for mandibular molars were significantly higher than for maxillary incisors (p=0.001) and mandibular molars had significantly higher values than maxillary canines (p=0.045). Results in this study were comparable to those of other students and qualified clinicians, with a minority of preparation achieving ideal values.

Educational needs and employment status of Scottish dental nurses.

OBJECTIVE: To investigate the educational needs and employment status of dental nurses in Scotland. SUBJECTS: One thousand, seven hundred and thirty dental nurses with postal addresses in Scotland. DESIGN: Structured questionnaire. RESULTS: A 65% response rate was achieved following three mailings. The majority of respondents were employed in the central belt of Scotland although comparatively, substantial numbers were also recorded as being employed in Highland and Grampian regions. A total of 70% of dental nurses stated they were in full-time employment, with 74% of all participants reporting they were qualified. Of those who were unqualified, 17% (n = 191) were not in the process of formal training which may mean they are unable to work in the future, unless they conform to the GDC 'grandparenting' requirements. Induction training had only been received by 34% (n = 377) of this group, and a mere 21% (n = 234) reported regular CPD involvement. Of the 75% (n = 832) who responded to a question on funding for CPD, only 50% (412) received financial assistance. Geographical location for many nurses generated a number of difficulties in accessing education, and the possibility of distance or e-learning was requested by 65% of the sample. CONCLUSIONS: This study demonstrates clearly that there are many well-qualified dental nurses in employment in Scotland. However, unless structured career pathways are developed, access to education is simplified, and the problem of poor remuneration is addressed, then foreseeable problems may arise where there is insufficient enticement to encourage people to join what is an already underpopulated profession.

Educational needs and employment status of Scottish dental technicians.

OBJECTIVE: To investigate the educational needs and employment status of dental technicians in Scotland. SUBJECTS: Two hundred and fifty dental technicians with postal addresses in Scotland. DESIGN: Structured questionnaire. RESULTS: An 83% response rate was achieved following three mailings. The majority of respondents were employed in commercial dental laboratories largely within the 'central belt' of Scotland, with 96% stating they were in full-time employment. Only 33% of these essential health-care workers were voluntarily registered with the Dental Technicians' Association, suggesting that a significant number had not felt it necessary or beneficial to do so. A lack of educational structure was identified, as was poor remuneration and an absence of opportunity for career progression. Although the prospect of continuing professional development was desirable, many respondents reported that they would be penalised financially for undertaking this and, in addition, may not be given the opportunity to pursue education because of lack of co-operation from their employer. Only 47% had attended an educational event within the preceding year, and of those who had not done this, a period of two-32 years had elapsed since any CPD involvement. Of the respondents, only 34% stated that any financial assistance had been available for educational purposes, with access to education being highlighted as problematic by 68%. A total of 64% of subjects felt they were out-of-date with professional education. CONCLUSIONS: This study highlights a number of real and potential problems in the field of education in dental technology. It is apparent that change within the structure of education and professional status, although largely welcomed, may be difficult to implement. The profession, as a whole, must realise that these changes in education and employment are not optional, and should be embraced as a positive step which will hopefully raise the profile and status of dental technicians throughout the UK.

Educational needs and employment status of Scottish dental hygienists.

AIMS AND OBJECTIVES: To investigate the educational needs and employment status of registered dental hygienists in Scotland. SUBJECTS: Three hundred and eighty one registered dental hygienists with postal addresses in Scotland. DESIGN: Structured questionnaire. RESULTS: A 76% response rate was achieved following two mailings. Of the respondents, 43% were in full-time employment albeit in more than one setting, mostly in the 'central belt' of Scotland. It was reported that 41% were employed in general dental practice with both NHS and private lists and 39% worked in a purely private setting. The introduction of extended clinical duties had been well received and 59% of subjects were interested in additional training in dental therapy, should this become available. Absence of funding for CPD was raised repeatedly, with only 41% reporting a degree of financial assistance. Greater accessibility to continuing education via distance learning, particularly in remote and rural settings, was requested by 73% of hygienists. CONCLUSIONS: This study identifies a number of issues in relation to this increasingly important group of healthcare professionals, which will inform the providers of oral healthcare. Although hygienists' involvement in CPD was commendable, results indicated that despite commitment to their profession, respondents did not always feel respected in terms of their employment status or support for continuing professional development.

Dental anomalies--are adhesive castings the solution?

Adhesive cast restorations placed without tooth preparation were used to restore the teeth of patients affected by either amelogenesis or dentinogenesis imperfecta. Twelve patients aged between 7 and 18 years were treated and in total 64 cast restorations were placed. At the time of cementation, the vertical dimension was increased by the thickness of restorative material placed on the functioning surfaces of the restored teeth. Full occlusion was restored for all individuals, with only one casting being lost. The castings have been placed for intervals between 10 and 54 months.

A laboratory evaluation of the construction of resin-bonded cast restorations.

OBJECTIVE: To compare the effect of two construction techniques and two pattern materials on the fit of resin-bonded cast restorations. DESIGN: In-vitro study carried out by one operator. SETTING: Postgraduate university hospital. SUBJECTS AND METHODS: 65 nickel-chrome castings were constructed using refractory die and lift-off techniques with wax and acrylic resin pattern material. They were cemented onto master silver dies, embedded in self-curing acrylic resin and sectioned along their long axes. Interfacial distance between the master silver die and casting was measured. RESULTS: A significant different between the range of figures in each group (Mann-Whitney Test, P < 0.01) was found. Construction techniques can be ranked in order of fit of castings: 1. Refractory die, wax patterns: 42.6 microns (SD 12.03). 2. Refractory die, acrylic resin patterns: 53.7 microns (SD.16.06).3. Conventional technique, acrylic resin patterns: 85.5 microns (SD 31.62). 4. Lift-off technique, wax patterns: 139 microns (SD 53.15).5. Lift-off technique, acrylic patterns: 172.8 microns (SD 74.04). CONCLUSIONS: Castings constructed using refractory die technique and subsequently cemented resulted in a more accurate and less variable fit than those produced with the lift-off technique. Wax patterns lead to more accurate castings than acrylic resin and locating indentations may interfere with the cementation of castings when lift-off techniques are used.

Variations in planning fixed bridgework--a group of dentists at a case-based postgraduate course.

Variations in treatment planning and prescription have been described in relation to routine restorative dentistry. This study examined dentists' decisions regarding treatment planning for fixed bridgework. Fifty five dentists who attended a Continuing Education course on fixed bridgework were given standard information about a patient in the form of study casts, photographs of radiographs and a clinical history. They were asked to design a bridge where a previous one had failed and to complete a proforma which was returned to the course organisers in advance of the event. The response rate was 65%. The data showed wide variation in identification of features of diagnostic importance. Seventy percent of respondents chose to use again as abutments teeth which were extensively damaged and had failed to retain the previous bridge: while only 30% noted features of the occlusion which if left unchanged would have precluded a successful bridge from being made. A further feature was that nearly 70% chose to use multiple abutments to support the bridge. The implications of these results were discussed with respect to current concepts of bridge design.

Retrospective survey of resin-retained cast-metal palatal veneers for the treatment of anterior palatal tooth wear.

Anterior palatal tooth wear is easily recognized, but its precise pathogenesis remains unknown. Treatment of this condition with cast-alloy palatal veneers used in combination with an adhesive cement is described. Forty-eight patients, aged 11 to 71, were treated with a total of 210 cast metal veneers over a period of 56 months. Twenty-three of the restorations failed, resulting in an overall success rate of 89%. All failures were confined to 13 patients. A glass polyalkenoate cement was less effective than a chemically active resin composite luting agent. Nickel-chromium veneers cemented with activated resin composite recorded a survival probability of 0.74 at 56 months. Adhesive cast-alloy veneers provided a useful method of restoring maxillary anterior teeth affected by acid erosion.

Effect of die relief on the seating, fit and retention of cast gold crowns cemented on human teeth.

Die relief, by means of a paint-on die spacing material, is the most common method of achieving sufficient space between metal castings and tooth surfaces for cement to flow during seating. Several studies have determined the influence of cementing variables on crowns made for metal and plastic test dies. This study assessed the influence of die relief upon the seating and retention of cast gold crowns constructed for natural human teeth. Standard full crown preparations were made for 10 matched pairs of extracted human third molars, one each of which had been relieved with die spacer of approximately 40 microns thickness. Crowns were made by the indirect technique and were cemented with zinc phosphate cement in a static/dynamic jig. Seating behaviour and vertical discrepancies were measured electronically. Tensile bond strengths were determined in a universal testing machine. Results showed that die relief reduced vertical seating discrepancy associated with cementation by up to 79 microns. Differences between paired relieved and unrelieved samples were significant (p < 0.05). There were no statistically significant differences in tensile bond between paired relieved and unrelieved crowns.

Anterior veneers for the adolescent patient: 2. Porcelain veneers and conclusions.

Composite and porcelain veneers offer a conservative method of masking discolouration of the teeth of younger patients. Composite veneers are the less destructive of tooth tissue, but also the less durable. This two-part article reviews the use of veneers in treating the adolescent patient. Part 1 described the clinical procedure for veneering with composites. Part 2 now gives a guide to porcelain veneer technique, and then draws some overall conclusions.

Treatment of the worn dentition: 2.

This is the second of two articles concerning the practical techniques involved in reconstruction of the worn dentition. Part 1 discussed approaches to managing occlusion, and practical techniques for restoring worn anterior teeth. This second article will describe the procedures involved when both anterior and posterior teeth are worn, and then give a guide to the management of the short clinical crown.

Treatment of the worn dentition. 1.

This is the first of two articles concerning the practical techniques involved in reconstruction of the worn dentition. The authors describe some of the procedures available and assess the appropriateness of 'conformative' versus 'reorganized' approaches to the occlusion. They continue by describing some practical aspects of reconstructive work. Part 2 will look at other practical techniques.

Anterior veneers for the adolescent patient: 1. General indications and composite veneers.

Composite and porcelain veneers offer a conservative method of masking discolouration of the teeth of younger patients. Composite veneers are the less destructive of tooth tissue, but also the less durable. This two-part article reviews the use of veneers in treating the adolescent patient. Part 1 examines indications for treatment and gives a step-by-step guide to the clinical procedure for veneering with composite. Next month, Part 2 will cover porcelain veneers and draw some overall conclusions.

The impact of General Dental Council registration and continuing professional development on UK dental care professionals: (2) dental technicians.

OBJECTIVE: To investigate the impact of General Dental Council (GDC) registration and mandatory CPD on dental technicians' views, job satisfaction and intention to leave the profession. DESIGN: Postal/online survey, conducted in parallel with a survey of dental nurses. SETTING: UK private and NHS practices, community services, dental hospitals. SUBJECTS AND METHODS: Representative sample of GDC registrants. MAIN OUTCOME MEASURES: job satisfaction; intention to leave profession (dependent variable in regression analysis). RESULTS: 605 were sampled: 40 were ineligible (left the register in July 2011, re-qualified in another dental care profession, shared a practice address with another selected DT); 193 responded (response rate 34%). 22% were female (mean age 38.2 years) and 78% male (mean age 49.4 years). The general principle of registration was endorsed by 52%, and compulsory registration by 54%, but the fee level by only 13%. Most technicians felt that registration had had either no effect or a negative effect on their view of their career (80%), role (78%) or status within the dental team (85%), and 66% did not agree that training helped them to do their job better. Fifty-one percent were not satisfied with their job and 20% intended to leave the profession. Intention to leave was predicted by greater dissatisfaction with remuneration. CONCLUSIONS: Criticisms regarding the cost and relevance of registration and the cost, relevance and accessibility of CPD, coupled with potentially high level of attrition from the profession, suggest a review of the fee and salary structure and greater support for CPD is warranted.

The impact of General Dental Council registration and continuing professional development on UK dental care professionals: (1) dental nurses.

OBJECTIVE: To investigate the impact of GDC registration and mandatory CPD on dental nurses' views, job satisfaction and intention to leave. DESIGN: Postal/online survey, conducted in parallel with a survey of dental technicians. SETTING: UK private and NHS practices, community services, dental hospitals. SUBJECTS AND METHODS: Representative sample of General Dental Council registrants. MAIN OUTCOME MEASURES: Job satisfaction; intention to leave profession (dependent variable in regression analysis). RESULTS: Eleven were ineligible (left profession, moved abroad); 267 (44% of those eligible) responded, all female. Respondents' mean age was 38.2 years (sd 10.74). The general principle of registration was endorsed by 67%, and compulsory registration by 51%, but the fee level by only 6%. Most nurses did not feel that registration had affected their view of dental nursing as a career (56%), their role (74%) or status (86%) within the dental team, or that CPD helped them to do their job better (76%). Fifty-six percent were not satisfied with their job, and 22% intended to leave the profession. Intention to leave was predicted by younger age and greater dissatisfaction with physical working conditions and opportunities to progress. CONCLUSIONS: Widely held criticisms regarding the costs and relevance of registration and CPD coupled with a potentially high level of attrition from the profession suggest a review of the fee and salary structure and greater financial support for CPD is warranted.

Job satisfaction among dually qualified dental hygienist-therapists in UK primary care: a structural model.

OBJECTIVE: To investigate job satisfaction among hygienist-therapists. Increasing numbers of hygienist-therapists work in UK primary dental care teams. Earlier studies suggest a clinical remit/clinical activity mismatch, without investigating any link with job satisfaction. METHODS: A UK-wide survey of dental hygienist-therapists using a random sample of the General Dental Council Register of Dental Care Professionals. Factors associated with job satisfaction (measured by the Warr-Cook-Wall ten-dimension scale) were entered into a series of multiple regression analyses to build up a path model. RESULTS: Analysis was undertaken on 183 respondents (response rate: 60%). Mean score for overall satisfaction was 5.36 (SD 1.28) out of a range of 1-7. Multiple regression analysis confirmed the following direct predictors of overall job satisfaction: satisfaction with colleagues, remuneration, variety of work; rating of hygiene work as rewarding; and not being self-employed (R(2) = 0.69). Satisfaction with variety of work was the strongest predictor, itself strongly predicted by the extent the clinical remit was undertaken. Dentists' recognition of their remit, quality of clinical work and qualifications had a strong indirect effect on overall job satisfaction. CONCLUSIONS: The study suggests both greater use of the therapy skills these individuals possess, and better recognition of their remit, qualifications and quality of work by their dentist colleague, may be linked to higher job satisfaction. The implications for the policy of greater team working in dental primary care are discussed.

Dental hygienists and therapists: how much professional autonomy do they have? How much do they want? Results from a UK survey.

OBJECTIVES: To investigate autonomous working among singly and dually qualified dental hygienists and therapists in UK primary care. Earlier studies and policy papers suggest that greater autonomy for these groups may be a desirable workforce planning goal. METHODS: UK-wide postal surveys of hygienists, hygienist-therapists and therapists. Respondents were asked whether they undertook 15 clinical activities on their own initiative, how comfortable they would feel undertaking such clinical activities if referral from a dentist were not required, and how they perceived dentists' reactions. RESULTS: Overall response rate was 65% (n = 150 hygienists, 183 hygienist-therapists and 152 therapists). Over 80% of hygienists and hygienist-therapists reported undertaking BPEs, history-taking, pocket charting, mucosal examinations and recall interval planning autonomously. Similarly high proportions of hygienist-therapists and therapists reported giving local analgesia and choosing restorative materials autonomously. However, fewer than 50% of all three groups said they undertook dental charting, fissure sealing, resin restorations, taking radiographs, and tooth whitening autonomously. While confidence in undertaking such activities without a dentist's referral was generally high, it was lower in respect to mucosal examinations, identifying suspicious lesions, interpreting radiographs, tooth whitening, and (except for singly qualified dental therapists) diagnosing caries. CONCLUSIONS: Results suggest high levels of experience and confidence in their ability to work autonomously across a wide range of investigative activities, treatment decision-making and treatment planning. The exceptions to this pattern are appropriate to the different clinical remit of these groups.

The impact of teamworking on the knowledge and attitudes of final year dental students.

AIMS: To relate final year UK dental undergraduates' experience of teamwork-related training to their knowledge of the clinical role of dental hygienist-therapists, and their views of the clinical roles of dental care professionals. METHODS: A postal questionnaire was sent to the ten UK dental schools which had agreed to participate. Analysis was based on standard non-parametric statistical tests. RESULTS: Of the 705 final year students in the ten schools, 358 (51%) returned questionnaires. Numbers from each school ranged from 79 to 6 (mean 35.8). Eighty-nine percent of students reported receiving information on roles of dental team members; 61% had experienced joint teaching sessions with DCPs; 53% had shared clinical treatment of patients with student hygienists or hygienist-therapists. Thirty-two percent of respondents had experienced all three elements. Views on this experience were generally positive, particularly in relation to shared clinical treatment sessions. Students who had received such training were more knowledgeable about the clinical remit of dental hygienist-therapists. However, training experience was not related to their views on the appropriate clinical activity of DCPs which tended to be dentist-centric even for many procedures within the legal remit of hygienists and hygienist-therapists. CONCLUSIONS: The study suggests that acceptance of non-dentists providing patient care lags behind the comparable situation within the primary care medical team. If we are to succeed in the delivery of a modernised dental care system, it is crucial that dental education promotes awareness and acceptance of the professional status and ability of DCP colleagues.