Health workforce for oral health inequity: Opportunity for action.

Oral health is high on the global agenda following the adoption of the 2022 global strategy on oral health at the 75th World Health Assembly. Given the global burden of oral disease, workforce development to achieve universal health coverage [UHC] is crucial to respond to population needs within the non-communicable disease agenda. The aim of this paper is to present an overview of the oral health workforce [OHWF] globally in relation to key contextual factors. Data from the National Health Workforce Accounts and a survey of World Health Organization [WHO] member states were integrated for analysis, together with country-level data on population and income status. Data are presented using the WHO categorisation of global regions and income status categories established by the World Bank. Workforce densities for key OHWF categories were examined. Multiple regression was used to model workforce density and contextual influences. Challenges and possible solutions were examined by country income status. There are approximately 3.30 dentists per 10,000 population globally, and a combined OHWF [dentists, dental assistants/therapists and dental prosthetic technicians] of 5.31 per 10,000. Marked regional inequalities are evident, most notably between WHO European and African regions; yet both make greater use of skill mix than other regions. When adjusted by region, 'country income status' and 'population urbanization' are strong predictors of the workforce density of dentists and even more so for the combined OHWF. Maldistribution of the workforce [urban/rural] was considered a particular workforce challenge globally and especially for lower-income countries. Strengthening oral health policy was considered most important for the future. The global distribution of dentists, and the OHWF generally, is inequitable, with variable and limited use of skill mix. Creative workforce development is required to achieve the global oral health agenda and work towards equity using innovative models of care, supported by effective governance and integrated policies.

Health system strengthening in fragile and conflict-affected states: A review of systematic reviews.

BACKGROUND: Globally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states present particular challenges. The aim of this study was to explore health system strengthening in fragile and conflict-affected states by synthesising the evidence from published literature. METHODS: We conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet's 'high-quality health system framework'. RESULTS: Twenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the 'foundations' domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the context and stage of the crisis situation was emphasised in order to strengthen fragile health systems. Overall, health system strengthening initiatives included policies encouraging the return and integration of displaced healthcare workers, building local healthcare workers capacity, strengthening education and training, integrating healthcare services, trust-building, supportive supervision, and e-Health utilisation. CONCLUSION: The emerging body of evidence on health system strengthening in fragile and conflict-affected states highlights its complexity. The findings underscore the significance of adopting a comprehensive approach and engaging various stakeholders in a coordinated manner considering the stage and context of the situation.

A typology of internationally qualified dentists in the United Kingdom.

Introduction: The Global Strategy for Human Resources for Health 2030, requires member states to half their dependency on an international workforce by 2030. In order to design policies towards that goal, country-specific research on migration motivations of the health workforce is required. The United Kingdom (UK) is a net importer of health professionals and whilst there is a body of research on doctors' and nurses' migration, there is no research on the migration motivations of migrant dentists in the UK. This research explored the migration motivations of internationally qualified dentists (IQDs) in the UK and presents a typology to understand the global migration of dentists in the context of oral health workforce. Methods: The paper presents qualitative data from semi-structured interviews conducted between August 2014 and October 2017, of IQDs working in the United Kingdom. The topic guide for interviews was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis. Results: A total of 38 internationally qualified dentists (M = 18, F = 20), migrating from the five World Health Organization regions, and working in general practice, NHS hospitals and in community dental services across the four nations of the UK were interviewed. Seven types of internationally qualified dentists were identified working in the UK. They were livelihood migrants, career-orientated migrants, dependant migrants, backpacker migrants, commuter migrants, undocumented migrants, and education-tourist migrant. The categories were based on their migration motivations, which were complex, multifactorial, and included personal, professional, national, and international drivers. The typology, based on their migration motivations, offered a structured, comprehensive understanding of the migrant dental workforce. This typology involving dentists provides additional dimensions to commuter and undocumented migrants described in the context of other health professionals. The education-tourist migrant is a new category proposed as an extension to existing typology in health professional migration. Conclusions: The typology of internationally qualified dentists has congruency with other health professionals' typology in categories previously described and demonstrates that each of these categories are complex, fluid and change in response to policy changes. The new category of education-tourist migrant along with oral health dimensions of commuter and undocumented migrants adds to the existing typology in health professional migration.

Oral health system strengthening in fragile and conflict-affected states: A systematic review.

Background: Oral diseases affect nearly half of the global population, presenting significant challenges in fragile and conflict-affected states. Despite comprising a population of over one billion people, oral health data and comprehensive evidence on oral health system strengthening on these countries are limited. This study, therefore, aims to explore oral health system strengthening in fragile and conflict-affected states by synthesising evidence from relevant global literature. Methods: We conducted a systematic review of literature across Ovid MEDLINE, EMBASE, Global Health, Scopus, Web of Science, and grey literature databases. The methodological quality of published literature was assessed using the relevant Joanna Briggs Institute critical appraisal tools. The findings were narratively synthesised and presented using the Lancet's high-quality health system framework. Results: The review included 23 papers from 12 countries. The evidence documented impacts of armed conflicts, political crisis, pandemics, and natural disasters on oral health systems, and initiatives to strengthen them focusing on the 'foundations' domain. The initiatives included: workforce development and career opportunities; health service platforms such as mobile dental services and teledentistry; integration of oral health into national health systems and emergency responses; contingency planning and adaptability; and effective governance such as financing systems and infrastructures. Collaborative action, both local and international, including monitoring and evaluation were emphasised as key strategies for health system strengthening to ensure an equitable distribution of responsibilities and resources. Conclusions: Whilst evidence on oral health system strengthening in fragile and conflict-affected states is limited, our findings suggest the need for integrated action, such as mobilising local resources and engaging stakeholders equitably. Further research, with particular focus in the area of processes of care and quality impacts, is necessary to explore comprehensive strategies for strengthening the oral health system.

Impact of dental visiting patterns on oral health: A systematic review of longitudinal studies.

AIM: To systematically review longitudinal studies investigating the impact of dental visiting patterns on oral health across the life course. METHODS: Five databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL) were searched up to March 2023. Results were screened based on eligibility criteria in a two-stage process: title and abstract, and full-text review. A backward search of reference lists and a forward search of citations of the included papers was also conducted. The quality of the included papers was assessed using the Newcastle-Ottawa Scale. Key study information was extracted and a narrative synthesis of the findings was performed. RESULTS: Eleven papers from five longitudinal studies in five countries (Australia, Brazil, China, New Zealand, Sweden) met the inclusion criteria. Studies of moderate to high quality consistently reported that regular dental attendance was associated with having less dental caries experience, fewer missing teeth and better oral health-related quality of life. Inconsistent findings were observed for decayed teeth, and no association was found for periodontal condition. CONCLUSIONS: This review highlights an association between regular dental visiting pattern and improved oral health, notably less dental caries experience and better oral health-related quality of life. Dental attendance emerges as an important predictor of oral health across the life course, underscoring the importance of routine dental care. REGISTRATION INFORMATION: The PROSPERO registration number is CRD42023396380.

How to have healthy conversations: Contemporary Evidence and Behaviour Change Tools in support of Delivering Better (Oral) Health.

The aim of this paper is to provide dental professionals with insight into how the science of behaviour change can be used to support patients to change their oral health behaviours. The paper describes how the fourth version of Delivering Better Oral Health (DBOHv4) published in November 2021, brings together the theory plus key principles and practical tools in Chapter 3 "Behaviour change", to help front-line clinicians achieve the best effect. DBOH is freely available to all online at gov.uk and is a key resource for dental teams for the prevention of oral diseases.

Learning in conversation-A feasibility pilot study involving dental students and older people.

INTRODUCTION: Older people represent a growing proportion of the population in most high-income countries. The impact of oral diseases on health and well-being is far-reaching, and future graduates should be able to meet their needs in this phase of life. This research tested the feasibility of involving dental students in direct community engagement to explore older peoples' oral health concerns and information needs. MATERIALS AND METHODS: Seventeen older people were recruited locally to attend workshops with eight dental students in a health and well-being centre. First, older people selected oral health-related topics important to them, raising relevant questions and concerns. Students provided evidence-informed feedback on these selected topics at a subsequent workshop. Participants (students and older people) reflected on their involvement (via questionnaires, discussions and personal reflections). Qualitative data were analysed using thematic analysis. The structure, process and outcome of the study were explored. RESULTS: Structure: Both students and older people were willing to participate in workshops. Workshops in the community facilitated active engagement between both groups without the constraints of clinics. PROCESS: Students considered pre-workshop preparations adequate but raised issues about their ability to manage 'strong characters' within discussion groups. OUTCOME: Older people welcomed the initiative. Important topics raised by them were addressed by students giving them advice on maintaining their oral health. Students reported an improved understanding of how older people can be supported and expected a significant impact on future practice. CONCLUSION: Student involvement in direct community engagement was welcomed by all, demonstrating the feasibility and positive impact of the design whilst highlighting issues of importance for older people's oral health.

Telehealth technologies in care homes: a gap for dentistry?

BACKGROUND: Telehealth technologies are playing an increasing role in healthcare. This study aimed to review the literature relating to the use of telehealth technologies in care homes with a focus on teledentistry. METHODS: Khangura et al.'s (Evidence summaries: the evolution of a rapid review approach. Syst Rev 2012;1:10) rapid review method included an electronic database search on Embase, PubMed, Web of Science and OpenGrey. Out of 1525 papers, 1108 titles and abstracts were screened, and 75 full texts assessed for eligibility. Risk of bias was assessed using the Mixed Methods Assessment Tool 2018. RESULTS: Forty-seven papers (40 studies) from 10 countries, published 1997-2021, were included in the review, four studies related to teledentistry. Whilst some preferred in-person consultations, perceived benefits by stakeholders included reduced hospitalization rates (n = 14), cost-savings (n = 8) and high diagnostic accuracy (n = 7). Studies investigating teledentistry using intra-oral cameras reported that teleconsultations were feasible with potentially high diagnostic accuracy (n = 2), cost-savings (n = 1) and patient acceptability (n = 1). CONCLUSION: There is limited published research on teledentistry, but wider telehealth research is applicable to teledentistry, with findings suggesting that telehealth technologies play a role in care homes consultations that are acceptable, cost-saving and with potential diagnostic accuracy. Further research is needed on the mode, utility and acceptability of teledentistry in care homes.

Reconciling duty: a theory and typology of professionalism.

BACKGROUND: Professionalism is expected of health professionals and advocated by professional regulators in the United Kingdom (UK). Concepts of professionalism have evolved in sociological discourse and its meaning for dentistry is unclear. It is, none-the-less, considered a core domain of dental education and professional practice by the United Kingdom regulator, the General Dental Council. This paper reports the sense-making process, or social process, of professionalism in practice within England. AIM: To explore the research question 'What does dental professionalism mean in practice? METHODS: Taking a constructivist grounded theory approach, involving purposive and theoretical sampling, 24 dental professionals were recruited to participate in this qualitative study. In-depth, semi-structured interviews were conducted by one interviewer (AT). Interviews were recorded, transcribed verbatim, and analysed leading to the development of a theory grounded in the data. RESULTS: A focus on the social-professional constructs used by participants to make sense of their experiences, resulted in a grounded theory where Reconciling Duty emerged as the core category. This represents a process of meeting professional duties to different parties that are often mutually exclusive. It is comprised of three supporting categories: Applying order to the system, where individuals attempt to identify what constitutes professional attitudes and behaviours, Rationalising what is fair, where individuals make judgements on how the conflict between duties should be resolved, and finally Responding to the System, where individuals attempt to actualise these desired resolutions in the context of the complex social system in which they practice. Three dentist archetypes (typologies) emerged, which involved a personal (Type 1), patient (Type 2), or a societal (Type 3) compromise. CONCLUSION: Professionalism can be conceptualised as process of reconciling multiple, competing, legitimate duties to different parties, in seeking a fair solution. Once this has been identified, individuals need to work within the complex system of dentistry to make their identified outcome a reality. The findings suggest that using the theory of Reconciling Duty helps us to engage with the meaning that the participants drew from the term 'professionalism', and anchors it in the lived, everyday professional experiences and challenges faced. A novel typology is proposed, commensurate with calls for a systems approach to the topic.

Oral Health and Community Nursing: a Practical Guide to the Delivering Better Oral Health Toolkit for Adults.

Despite being largely preventable, oral diseases are the major contributor to chronic conditions nationally and globally. If left untreated, oral diseases have many harmful effects throughout life on our patients including pain and infection, and can lead to difficulties with eating, sleeping, socialising and wellbeing. Oral health inequalities exist across our population, and particularly affect vulnerable, disadvantaged and socially excluded groups in society. Oral health is a key indicator for overall health, and is inextricably interlinked with general health. Hence, existing health messages that community nursing teams provide contribute towards oral health. Community nurses are in an established position to provide and reinforce positive oral health messages to their patients, as well as signpost to available dental services. This paper aims to support community nurses with a practical resource for key evidence-based oral health preventative advice, and input into how their patients can access dental care.

Journey towards a dental career: the career decision-making journey and perceived obstacles to studying dentistry identified by London's secondary school pupils and teachers.

Objective To explore the career decision-making journey towards dentistry and identify possible challenges and supports in this process as perceived by academically able, science-minded, London school pupils and their careers teachers.Methods A mixed-methods study was conducted using a purposive sample of London schools. Focus groups (n = 13) with 91 pupils aged 14-18 years and a survey of career teachers (n = 12) were conducted at a range of school-types. A topic guide, informed by the literature and previous research, guided discussions. Ethical approval was obtained from King's College London Research Ethics Committee (BDM/10/11-17 and 14/15-40). School, teacher, parental and pupil written informed consent were obtained. Data were transcribed and analysed thematically using framework methodology.Results Four distinct phases of the career decision-making journey were identified: 1) initiation of aspiration, with wider influences promoting medicine as a primary aspirational career option; 2) exposure to dentistry as a career, leading to recognition of dentistry as an alternative; 3) exploration of the career; and 4) the application process. Dentistry received little early consideration in this process. Greater representation of dental professionals within the school, access to work experience, and support in the student application process were identified as possible supports.Conclusions The findings suggest a four-phase journey towards a dental career, which may be enhanced by engagement of dental professionals at each stage. This may be particularly helpful in widening participation from under-represented groups.

Yeast of Eden: microbial resistance to glyphosate from a yeast perspective.

First marketed as RoundUp, glyphosate is history's most popular herbicide because of its low acute toxicity to metazoans and broad-spectrum effectiveness across plant species. The development of glyphosate-resistant crops has led to increased glyphosate use and consequences from the use of glyphosate-based herbicides (GBH). Glyphosate has entered the food supply, spurred glyphosate-resistant weeds, and exposed non-target organisms to glyphosate. Glyphosate targets EPSPS/AroA/Aro1 (orthologs across plants, bacteria, and fungi), the rate-limiting step in the production of aromatic amino acids from the shikimate pathway. Metazoans lacking this pathway are spared from acute toxicity and acquire their aromatic amino acids from their diet. However, glyphosate resistance is increasing in non-target organisms. Mutations and natural genetic variation discovered in Saccharomyces cerevisiae illustrate similar types of glyphosate resistance mechanisms in fungi, plants, and bacteria, in addition to known resistance mechanisms such as mutations in Aro1 that block glyphosate binding (target-site resistance (TSR)) and mutations in efflux drug transporters non-target-site resistance (NTSR). Recently, genetic variation and mutations in an amino transporter affecting glyphosate resistance have uncovered potential off-target effects of glyphosate in fungi and bacteria. While glyphosate is a glycine analog, it is transported into cells using an aspartic/glutamic acid (D/E) transporter. The size, shape, and charge distribution of glyphosate closely resembles D/E, and, therefore, glyphosate is a D/E amino acid mimic. The mitochondria use D/E in several pathways and mRNA-encoding mitochondrial proteins are differentially expressed during glyphosate exposure. Mutants downstream of Aro1 are not only sensitive to glyphosate but also a broad range of other chemicals that cannot be rescued by exogenous supplementation of aromatic amino acids. Glyphosate also decreases the pH when unbuffered and many studies do not consider the differences in pH that affect toxicity and resistance mechanisms.

Oral Health Workforce in Africa: A Scarce Resource.

The World Health Organization (WHO) African Region (AFR) has 47 countries. The aim of this research was to review the oral health workforce (OHWF) comprising dentists, dental assistants and therapists, and dental prosthetic technicians in the AFR. OHWF data from a survey of all 47 member states were triangulated with the National Health Workforce Accounts and population data. Descriptive analysis of workforce trends and densities per 10,000 population from 2000 to 2019 was performed, and perceived workforce challenges/possible solutions were suggested. Linear regression modelling used the Human Development Index (HDI), years of schooling, dental schools, and levels of urbanization as predictors of dentist density. Despite a growth of 63.6% since 2010, the current workforce density of dentists (per 10,000 population) in the AFR remains very low at 0.44, with marked intra-regional inequity (Seychelles, 4.297; South Sudan 0.003). The stock of dentists just exceeds that of dental assistants/therapists (1:0.91). Workforce density of dentists and the OHWF overall was strongly associated with the HDI and mean years of schooling. The dominant perceived challenge was identified as 'mal-distribution of the workforce (urban/rural)' and 'oral health' being 'considered low priority'. Action to 'strengthen oral health policy' and provide 'incentives to work in underserved areas' were considered important solutions in the region. Whilst utilising workforce skill mix contributes to overall capacity, there is a stark deficit of human resources for oral health in the AFR. There is an urgent need to strengthen policy, health, and education systems to expand the OHWF using innovative workforce models to meet the needs of this region and achieve Universal Health Coverage (UHC).

Toxicity and assimilation of cellulosic copper nanoparticles require α-arrestins in S. cerevisiae.

The increased use of antimicrobial compounds such as copper into nanoparticles changes how living cells interact with these novel materials. The increased use of antimicrobial nanomaterials combats infectious disease and food spoilage. Fungal infections are particularly difficult to treat because of the few druggable targets, and Saccharomyces cerevisiae provides an insightful model organism to test these new materials. However, because of the novel characteristics of these materials, it is unclear how these materials interact with living cells and if resistance to copper-based nanomaterials could occur. Copper nanoparticles built on carboxymethylcellulose microfibril strands with copper (CMC-Cu) are a promising nanomaterial when imported into yeast cells and induce cell death. The α-arrestins are cargo adaptors that select which molecules are imported into eukaryotic cells. We screened α-arrestins mutants and identified Aly2, Rim8, and Rog3 α-arrestins, which are necessary for the internalization of CMC-Cu nanoparticles. Internal reactive oxygen species in these mutants were lower and corresponded to the increased viability in the presence of CMC-Cu. Using lattice light-sheet microscopy on live cells, we determined that CMC-Cu were imported into yeast within 30 min of exposure. Initially, the cytoplasmic pH decreased but returned to basal level 90 min later. However, there was heterogeneity in response to CMC-Cu exposure, which could be due to the heterogeneity of the particles or differences in the metabolic states within the population. When yeast were exposed to sublethal concentrations of CMC-Cu no resistance occurred. Internalization of CMC-Cu increases the potency of these antimicrobial nanomaterials and is likely key to preventing fungi from evolving resistance.

Methodology and outcome of trials involving older adults in UK care homes: A rapid review.

BACKGROUND: The United Kingdom (UK) has a well-developed health and social care system, and strong research governance. However, there is limited evidence to guide best research practice among vulnerable older people in care homes and there is no consensus on clinical trial methodology that is deliverable in this setting. OBJECTIVES: To review the literature on trials conducted among older adults residing in care homes within the UK and collate evidence on their methodological characteristics and outcomes. METHODS: A systematic rapid review methodology was employed. MEDLINE, EMBASE and CENTRAL were searched in two incremental stages: stage 1 searched for oral health-related trials conducted within the UK care homes up to July 2021, whereas stage 2 sought for general health-related trials in the same setting from 2011 to 2021. The quality of included studies was assessed using Cochrane's RoB 2 and ROBINS-I tools. Findings were summarised descriptively. RESULTS: Five oral health and 33 general health-related trials involving care home residents were included for analysis. The most common trial design was parallel group with two arms (n = 25) involving individual randomisation (n = 21). Consent was mainly obtained from residents and/or their proxies (n = 24), followed by residents only (n = 13) and care homes only (n = 1). Based on available data, the number needed to screen to recruit one participant ranged from 2 to 40 (median: 3; Q1-Q3: 2-9). Attrition rates ranged from 0% to 73% (median: 21%; Q1-Q3: 13%-32%) for follow-up periods between 1 and 52 weeks. The studies were of mixed methodological quality. CONCLUSION: This rapid review outlines the methodological characteristics and outcomes of trials conducted among older adults in UK care homes. The findings of this review provide valuable information to assist in navigating and designing future research in this complex setting.

The mouth and oral health in the field of dementia.

An ageing population, an estimated 47 million people currently living with dementia, and predictions of a threefold increase in people living with a diagnosis by 2050 have led the WHO to declare dementia a public health priority. Emerging research also suggests that dementia is linked to poor oral health and that oral health declines alongside cognitive decline. Drawing on Bourdieu's concepts of field and capital, this paper presents an analysis of interview data from participants with dementia, carers and carer/diagnosed dyads participating in a qualitative study of the mouth and oral health. We argue that Bourdieu's conceptual toolkit provides a way of contextualising experiences of oral health within dementia and un-picking the multi-layered impact of structure, institutions, biology, resource mobilisation and self in the context of a progressive disease which ultimately challenges knowledge of the self and the ability to interact with the world around us.

Professionalism in dentistry: deconstructing common terminology.

BACKGROUND: There is a social expectation that dentists demonstrate professionalism. Although the General Dental Council puts it at the heart of their regulatory agenda, there is not yet consensus on the meaning and implications of the term. OBJECTIVE: To explore practising dentists' understanding of the character traits commonly associated with professionalism and what these mean in practice. METHOD: Constructivist grounded theory was employed throughout this study. Qualitative, in-depth interviews were conducted with dental professionals in England recruited through theoretical sampling to saturation point. Interviews used a topic guide informed by the literature, and analysis was conducted through constant comparison during data collection. RESULTS: The study found that traits commonly associated with professionalism in the literature were difficult for dentists to define clearly or operationalise in a clinical setting. There was disagreement over how some traits should be understood, and it was unclear to participants how, or indeed if, the listed traits were directly relevant to practice in their current form. CONCLUSION: Rather than expecting unconditional adherence to an externally imposed definition, further exploration is required to understand how health professionals make sense of professionalism by reference to their lived experiences and worldviews. IN BRIEF: Institutional expectations of professionalism, defined through character traits and behaviours, do not appear to map neatly on to the experiences of dental professionals. Straightforward, apparently uncontroversial terms elicited a wide range of responses, including disagreement. This brought in to question whether achieving consensus is possible. Analysing how our respondents understood the terms by reference to the meanings they constructed from lived experience offers deeper insights.

Health and Wellbeing of Clinical Dental Care Professionals: A Systematic Review.

BACKGROUND: There has been much research relating to stressors in the dental environment and concerns over dentists' health and wellbeing. The determinants of dentists' health and wellbeing within the UK include macro-factors, such as healthcare systems and regulation; meso-factors, such as job specification and workplace characteristics; and micro-factors, such as personal aspects, professional career level, and personal and professional relationships. Given the challenges in dentistry, research is needed to investigate the key determinants relating to the health and wellbeing of clinical dental care professionals (DCPs) nationally. AIM: To review the literature on the key determinants of health and wellbeing among dental hygienists, dental therapists, clinical dental technicians, and orthodontic therapists in the UK. MATERIALS AND METHODS: A systematic review of the literature was conducted across seven databases. The records were screened by title, abstract and full text based on the study inclusion criteria. Extraction of data and a qualitative synthesis of the included studies was performed. A mixed methods appraisal tool was used to quality assess for risk of bias. RESULTS: Twelve studies were included in this review, eleven of which were medium to high quality (5*, 4*) and one low quality (2*). Ten studies focused on dental therapists, and/or hygienists, with only one each on orthodontic therapists and clinical dental technicians. Job satisfaction and professional careers were the primary factors explored in the included studies and clearly identified as determinants of health and wellbeing. However, there was evidence of these being associated and linked with a range of determinants at macro-, meso-, and micro-levels, with a general lack of evidence on the overall health and wellbeing. CONCLUSION: There is currently very limited evidence on the key determinants of health and wellbeing of clinical DCPs within the UK, but the available evidence maps to the same domains as dentists. Further well conducted research examining the overall health and wellbeing is required, with consideration of the full matrix of possible factors.

Dentistry as a professional career: the views of London's secondary school pupils (2011-2017).

Aim To explore young people's perceptions of dentistry as a potential future career, including features which would attract or deter them from wanting to become dentists and the perceived influences on these views.Methods Purposive sampling of London schools was undertaken. Exploration of academically-able, science-minded young people's (aged 14-18 years) perceptions of dentistry as a potential career was achieved through a series of focus groups conducted at various types of school in the Greater London region (13 focus groups and 91 students). A topic guide, informed by the literature and previous research, explored the perceived motivating and demotivating factors and associated influences, identified by these pupils, on studying dentistry at university. Data were analysed using framework methodology.Results Multiple factors were identified by London secondary school pupils that would attract them to dentistry. Pull factors were: 1) science-based; 2) status and security - extrinsic rewards; 3) structure of service provision; 4) career opportunities; 5) social interactions; 6) personal skills and care - intrinsic rewards; and 7) being a vocational degree. Push factors away from the career included lack of diversity within the job and the 'negative image' of dentists, with medicine having greater social status and more varied career options. Individual and wider influences on pupils' perceptions included their personal experience with dentistry, social and community networks, the school environment, as well as system and societal level influencers.Conclusions These findings suggest that a wide range of influences determine teenagers' perceptions of a dental career. Pupils in London schools report similar features of dentistry as being attractive as dental students, as well as its importance as a vocational degree, and although dentistry appears to lack status and profile when compared with medicine, it may be more acceptable in relation to its lifestyle. Individual sociodemographic characteristics and wider environmental factors may influence the relative importance of these features.

Accreditation and professional integration experiences of internationally qualified dentists working in the United Kingdom.

INTRODUCTION: Regulatory processes for Oral health care professionals are considered essential for patient safety and to ensure health workforce quality. The global variation in their registration and regulation is under-reported in the literature. Regulatory systems could become a barrier to their national and international movement, leading to loss of skilled human resources. The General Dental Council is the regulatory authority in the UK, one of the nine regulators of health care overseen by the Professional Standards Authority. AIM: The aim of this paper is to present the professional integration experiences of internationally qualified dentists (IQDs) working in the UK, against the background of regulation and accreditation nationally. METHODS: Registration data were obtained from the General Dental Council to inform the sampling and recruitment of research participants. Semi-structured interviews of 38 internationally qualified dentists working in the United Kingdom were conducted between August 2014 and October 2017. The topic guide which explored professional integration experiences of the dentists was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis to detect themes. RESULTS: Internationally qualified dentist's professional integration was influenced by factors that could be broadly classified as structural (source country training; registration and employment; variation in practising dentistry) and relational (experiences of discrimination; value of networks and support; and personal attributes). The routes to register for work as a dentist were perceived to favour UK dental graduates and those qualifying from the European Economic Area. Dentists from the rest of the world reported experiencing major hurdles including succeeding in the licensing examinations, English tests, proving immigration status and succeeding in obtaining a National Health Service performer number, all prior to being able to practice within state funded dental care. CONCLUSION: The pathways for dentists to register and work in state funded dental care in UK differ by geographic type of registrant, creating significant inconsistencies in their professional integration. Professional integration is perceived by an individual IQD as a continuum dictated by host countries health care systems, workforce recruitment policies, access to training, together with their professional and personal skills. The reliance of the UK on internationally qualified dentists has increased in the past two decades, however, it is not known how these trends will be affected by UK's exit from the European Union and the COVID-19 pandemic.