What factors influence patient compliance with supportive periodontal therapy in a general practice setting?

Background The importance of supportive periodontal therapy following active treatment has been well documented but numerous studies have shown patient compliance to be poor. The aim of this study was to ascertain which factors affect patient compliance and whether this included routinely recorded periodontal indices.Methodology This was a five-year retrospective service evaluation study set within a private general dental practice. It utilised demographic and periodontal data from patients who attended the practice for chronic periodontal treatment in 2009 and ascertained whether there were links between this data and compliance with the supportive phase of periodontal treatment.Results Three hundred and ten patients satisfied the inclusion criteria of which 32.3% were categorised as compliant, 45.5% non-compliant and 22.3% erratic attenders. Patients who were statistically significantly more compliant were males (p = 0.03) and non-smokers (p = 0.01). There was a trend for older people to be more compliant; however this was not statistically significant. Plaque and bleeding scores were lower in the compliant group but only the bleeding scores were statistically significant (p = 0.03). The pocket probing depths were used as an indicator of disease severity and showed no significant relationship with compliance.Conclusion Although some of the periodontal parameters showed a statistically significant relationship with compliance, the difference between the parameters was clinically minimal suggesting that there is no definitive physical characteristic which is an indicator of patient compliance.

Dental photography in record keeping and litigation.

Dental photography is essential in record keeping and it is important for all members of the dental team to be appropriately trained and for each practice to have the appropriate equipment. This article provides an overview of the applications of dental photography and equipment, and highlights issues of consent and duty of care.

An investigation of antibiotic prophylaxis in implant practice in the UK.

BACKGROUND: There is increasing evidence of the inappropriate use of antimicrobials in dentistry and this may contribute to the problem of antimicrobial resistance. The research to date with regard to efficacy of antimicrobial prophylaxis in reducing failure of integration and postoperative complications when placing dental implants remains equivocal. The aim of this study was to investigate how dentists in the UK use antimicrobials prophylactically in implant practice. METHOD: An e-mail link was provided in 2011 to an anonymous online (Smart-Survey) questionnaire using three databases of dentists who, by being on them, had registered an interest in placing dental implants. Absolute frequencies were used to describe the study sample demographics and examine the distribution of responses for all the variables investigated. RESULTS: One hundred and nine completed questionnaires were received. Seventy-two percent (n = 76) routinely prescribed prophylactic antibiotics for all procedures. There was a wide variation in the pre-operative and postoperative prescription regimens with the majority (84%) stating that it was to prevent infection at the site of surgery or to reduce a bacteraemia. CONCLUSIONS: Although this was a small study with a low response rate, wide variations in antibiotic prescribing regimens with respect to drug, dose and duration were found. Further research is needed and guidelines developed to prevent antibiotic overprescribing and misuse.

The medical and dental attendance pattern of patients attending general dental practices in Warwickshire and their general health risk assessment.

BACKGROUND: The dental team could have an important role to play in general health risk assessment within primary and community healthcare.Aims To describe medical and dental attendance patterns, demographics and health profiles of patients routinely attending general dental practices in Warwickshire. To identify whether a subgroup attend dental practices regularly but attend medical practices infrequently and discuss whether preventive healthcare interventions delivered in general dental practice would be appropriate. METHODS: A self-completion questionnaire was administered to patients attending 16 dental practices in Warwickshire. RESULTS: Eight hundred and eleven completed questionnaires were returned (74% response). Seven hundred and eighty-nine (98%) respondents visited their dentist every one to two years or more frequently and of these a subgroup of 121 (15.3%) visited their general medical practice surgery or health centre less often than every two years. In the subgroup 9.5% reported high blood pressure, 17.6% currently smoked, 22% drank above recommended guidelines, 32.1% were overweight and 7.3% obese. DISCUSSION: The data suggest there may be a role for dental practitioners in identifying patients at risk of having undiagnosed or future general health problems and providing appropriate general health advice, screening or signposting the patient to relevant general healthcare facilities either within or external to the dental practice.

The development of an outreach training programme in orthodontics.

OBJECTIVE: To describe the establishment of an outreach centre for the training of all members of the orthodontic team. THE DEVELOPMENT OF THE ORTHODONTIC TEAM: The remit of orthodontic nurses and orthodontic therapists is described and how their training may be delivered and integrated within a primary care training centre. OUTREACH TRAINING: The reasons for the development of outreach training are discussed and how these are particularly relevant for the development of orthodontic training in the UK. THE UNIVERSITY OF WARWICK ORTHODONTIC OUTREACH CENTRE: This has been established in Leamington Spa in comprehensively equipped premises providing seven surgeries, a lecture theatre, clinical skills laboratory, and technical support. It currently provides an MSc course in orthodontics for general dental practitioners (GDPs) and training for qualified dental nurses leading to the award of an Orthodontic Nurse's Certificate. It has also recently been approved by the General Dental Council (GDC) for the delivery of a course leading to the Diploma in Orthodontic Therapy commencing in July 2008.

Digital clinical records and practice administration in primary dental care.

Usually, a 'computerised dental practice' has included a series of diagnostic instruments, intra-oral cameras, digital radiographic systems, treatment planning systems, CAD-CAM systems, management systems etc. However, these 'island solutions' have not been integrated into one system. Nevertheless, it is possible to produce fully integrated systems for digital clinical records, based on established physiologic and cognitive-ergonomic concepts. The first part of this paper outlines the philosophy behind the development of such a totally integrated system for digital clinical records. The second--digital practice administration--considers how the 'digital revolution' has impacted upon practice administration.

The personal dental service as a setting for an undergraduate clinical programme.

OBJECTIVE: To investigate the feasibility and benefits of placing dental undergraduates into a general dental practice setting for part of their clinical programme. SETTING: Two six-surgery general dental practices in the North West of England operating within the personal dental service of the NHS. METHOD: Six volunteer final year students worked within the practices for one-day-per week for 11 weeks. Evaluation included patients', practitioners' and students' views obtained from questionnaires and/or interviews and an analysis of students' clinical records. RESULTS: The students saw a large positive impact from: working alongside a dental nurse; developing their clinical skills; working in a busy practice environment; and developing interpersonal skills. Patients were very positive with 98% (44/45) being complimentary about the treatment they received, and commenting that they would be willing to participate in future student training programmes. The practice principals would also welcome continuation of the programme. CONCLUSION: The programme was both feasible and educationally beneficial. The financial implications need further research.

General dental practitioner advice regarding the use of fluoride toothpaste in two areas with a school-based milk fluoridation programme and one without such a programme.

OBJECTIVE: To describe the knowledge and practice of general denta practitioners (GDPs) working in Liverpool (where there is no milk fluoridation programme) and St Helens and Knowsley, and the Wirral (where children have fluoridated milk in schools and pre-schools) relating to the advice given for child patients regarding the use of fluoridated toothpaste. DESIGN: Data were collected via a postal questionnaire sent to all 329 GDPs working within the three areas. GDPs working in more than one of the areas and those working in specialist orthodontic or oral surgery practices were excluded. RESULTS: Two hundred and thirty-four (71%) questionnaires were completed and returned. Only 3% of dentists said that no-one in their practice gave advice on the concentration of fluoride toothpaste to be used. For caries free children under 7 years of age only 64% of GDPs gave advice concerning the concentration of toothpaste which coincided with the available clinical guidelines. Twenty eight per cent of GDPs also contradicted the guidelines by advising children under 7 with high caries to use a low fluoride toothpaste. Although 59% of GDPs in the fluoridated milk areas asked the child whether they had fluoridated milk at school, they did not appear to alter the advice given regarding the use of fluoridated toothpaste. CONCLUSION: The study showed that a significant number of GDPs did not adhere to clinical guidelines relating to the use of fluoride toothpaste when giving advice to their child patients. For evidence-based dentistry to become a reality in this area, ways must be found to disseminate the available guidelines more fully and increase their acceptance and use by practitioners.

Clinical record keeping by general dental practitioners piloting the Denplan 'Excel' accreditation programme.

BACKGROUND: Denplan is a private capitation-based system of providing primary dental care in the UK. An additional programme called Denplan Excel has been developed which requires General Dental Practitioners to instigate various quality processes within their practices in order to become accredited. Clinical record keeping is one area where standards are monitored. This study reports changes in record keeping at patient recall appointments following the implementation of the Denplan Excel programme. METHOD: Fifty dentists participating in the Denplan Excel pilot programme from different areas of the UK were sampled by means of cluster sampling. Twenty records for each dentist were sampled and items recorded for patients recalled both pre- and post-pilot were compared. RESULTS: The majority of dentists recorded presenting complaint, diagnosis and treatment plan both pre- and post-pilot. However, post-pilot there were a number of improvements in record keeping. Caries recorded on a grid increased from 7% of records to 46%, basic periodontal examination increased from 48% to 85% of records and the updating of medical history increased from 51% to 65% of records. These findings were all significant at the p<0.01 level. CONCLUSION: Changes can be achieved by voluntary participation in a system of structured record keeping.

Paediatric antibiotic prescribing by general dental practitioners in England.

OBJECTIVES: The inappropriate use of antibiotics is known to be a major contributory factor to the problem of antimicrobial resistance. No information is available on how practitioners prescribe antibiotics for children. This study investigated the prescribing of liquid-based antibiotics for children by general dental practitioners in England. DESIGN: Analysis of National Health Service liquid-based prescriptions issued by general dental practitioners in England. SAMPLE AND METHODS: All prescriptions issued by practitioners in 10 Health Authorities in England for February 1999 were collected. All the liquid-based antibiotic prescriptions for children were selected and we investigated the type of antibiotic prescribed, whether sugar free, the dose, frequency and duration. RESULTS: A total of 18,614 prescriptions were issued for antibiotics. Of the 1609 liquid-based paediatric prescriptions 88.3% were for generic and 11.7% for proprietary antibiotics, of which 75.5% were for amoxicillin, 15.2% for phenoxymethylpenicillin, 6.6% for erythromycin, 1.7% for metronidazole. Cephalexin, ampicillin, cephadrine and combinations of two antibiotics were also prescribed. There was a wide variation in dosages for all the antibiotics prescribed. A significant proportion of practitioners prescribed at frequencies inconsistent with manufacturers' recommendations and for prolonged periods, with some practitioners prescribing for periods up to 10 days. Only 29.1% of all the prescriptions issued were sugar free. CONCLUSIONS: The results of this study show that some practitioners prescribe liquid-based antibiotics inappropriately for children. This may contribute to the problem of antimicrobial resistance. Clear guidelines on the choice of antibiotic, dose, frequency and duration along with educational initiatives for GDPs might reverse this trend.

Randomised trial of the psychological effect of information about oral cancer in primary care settings.

AIM: To determine the immediate influence of a validated patient information leaflet (PIL) on patient anxiety and intention to have a screen for oral cancer in primary care attenders. PARTICIPANTS: Patients (n=800) attending their primary health care provider. SETTING: Fourteen general practices (eight dental and six medical) in the northwest of England. DESIGN: Randomised controlled trial with two arms: leaflets provided in information group, leaflet was absent in control group. MEASURES: Single item ratings of (1) intention to have an oral cancer screen, and (2) anxiety towards a screen, (3) perceived risk of oral cancer. Knowledge of oral cancer, self-reported dental service attendance history and demographic variables were also collected. RESULTS: Patients who had read the oral cancer PIL demonstrated an increase in their intention to have a screen (Mann Whitney U test: z=-3.67, P<0.001) and reduced anxiety (Mann Whitney U test: z=-2.07, P<0.05). Subjective risk was not elevated by the extra information. Intention to have a screen was predicted by knowledge level and anxiety (odds ratios: 1.10 and 0.70 respectively, both P's<0.001). CONCLUSION: The influence of an information leaflet appeared to have a positive effect on anxiety level and intentions to agree to receive an oral cancer screen.

Oral signs and symptoms as predictors of salivary gland hypofunction in general dental practice.

OBJECTIVE: To evaluate the signs and symptoms of oral dryness as predictors of salivary gland hypofunction (SGH) in general dental practice. DESIGN AND SETTING: Prospective study recruiting adult patients attending five general dental practices in Merseyside in 1999. MATERIALS AND METHOD: Patients were screened for subjective symptoms of oral dysfunction and clinical signs of oral dryness. Patients with oral symptoms or signs of SGH were invited to undergo sialometry. Results were analysed using multiple logistic regression. RESULTS: 1103 patients were screened for signs and symptoms of oral dryness, 115 reported continuous xerostomia, of these 65 were also clinically (subjectively) assessed as having a dry oral mucosa. One hundred and one patients attended for sialometry and 73% of these had objective evidence of SGH. Neither the patients' complaints of oral dryness or the assessment of dryness of the oral mucosa were significant predictors of SGH. CONCLUSIONS: Symptoms of oral dysfunction and clinical signs of oral dryness were not significant predictors of SGH in dental practice.

The development and use of a triage protocol for patients with dental problems contacting an out-of-hours general medical practitioner cooperative.

PURPOSE OF THE STUDY: The number of patients contacting general medical practitioner (GMP) out-of-hours services with dental problems is perceived to be a significant problem by the medical profession. This study was undertaken to design and pilot a triage protocol that could be used by non-dental staff to refer callers with dental complaints for appropriate treatment. BASIC PROCEDURES: A triage protocol was designed to address the patient conditions considered to be relevant to emergency dental care. The triage protocol was piloted for three months at a GMP cooperative in North Wales, which provided an out-of-hours service for 61 GMPs. Baseline data were collected for three months prior to the introduction of the triage protocol. MAIN FINDINGS: The study showed that the number of dental callers contacting the out-of-hours service was not as great as GMPs imagined, and was similar to other studies. The introduction of the triage protocol resulted in a rise in the number of callers asked to call the general dental practitioner (GDP) support line. The number of unregistered patients given the name of a dentist also increased. The need to make a second telephone call seemed not to affect patient satisfaction since when patients were later questioned on their experience, those who had used the service since the introduction of the triage protocol were more likely to be satisfied with the service. PRINCIPAL CONCLUSIONS: This study provides some evidence that a triage protocol can be used successfully by non-dental staff to sift requests for out-of-hours emergency dental care.

A clinical minimum data set for primary dental care.

OBJECTIVE: To achieve consensus within primary dental care on the contents of a clinical minimum data set to measure oral health status. DESIGN: Using the Delphi process a simple random sample of 30 LDCs and 10 CDS services in England were asked to rank a list of existing clinical indicators in order of their perceived importance as a means of measuring oral health. A nominated panel representing the stakeholder organisations of primary dental care reviewed this ranking and identified a core group of clinical indicators to be included in a clinical minimum data set. RESULTS: An 80 percent response rate to the Delphi process was achieved. Consensus was reached on a core group of 10 indicators, which can provide information on patient's perceptions of pain, function and appearance, and professional measurements of caries, teeth present, periodontal disease, oral sepsis, presence of mucosal pathology and tooth wear. CONCLUSIONS: A representative sample of primary care dentists in England and the key representative organisations of primary dental care achieved consensus on the contents of a clinical minimum data set to record oral health status in primary dental care. This is a first step in standardising the measurement of oral health status across primary care.

Antibiotic prescribing knowledge of National Health Service general dental practitioners in England and Scotland.

The inappropriate use of antibiotics has contributed to the worldwide problem of antimicrobial resistance. Information on the knowledge, understanding and training of dental practitioners in the use of antibiotics in clinical practice is scarce. This study assessed the level of knowledge of general dental practitioners and the need for educational initiatives. An anonymous postal questionnaire was sent to National Health Service dental practitioners working in 10 Health Authorities in England (1544) and four Health Boards in Scotland (672). Each correct answer to the questionnaire was given a score of one mark; there were 84 questions. The scores for each section of the questionnaire were compared. Responses were received from 1338 (60.4%) of practitioners, of whom 22.1% had attended postgraduate courses in the previous 2 years on antibiotic prescribing. Practitioners who had attended courses had a significantly greater knowledge of antibiotic use (P < 0.05) than those who had not. There was no significant difference in knowledge between all age groups under 60 years of age. There were significant differences in knowledge between dentists practising in English Health Authorities and Scottish Health Boards (P < 0.01). Knowledge was good for clinical signs that are indicators for prescribing antibiotics and for a number of non-clinical factors, e.g. patient expectation. Knowledge of therapeutic prescribing for commonly presenting clinical conditions and prophylactic prescribing for medically compromised patients, however, was generally poor. This study has shown that an urgent review of dental undergraduate and postgraduate education in antibiotic prescribing is required. Provision of prescribing guidelines may improve knowledge and encourage the appropriate use of antibiotics in clinical dental practice.

Immediate knowledge increase from an oral cancer information leaflet in patients attending a primary health care facility: a randomised controlled trial.

The aim was to determine the immediate influence of a validated patient information leaflet (PIL) on oral cancer and knowledge in primary care attenders. Participants were patients (n=800) attending their primary health care provider from 14 general practices (eight dental and six medical) in the north west of England. Measures were a previously validated knowledge questionnaire (36 dichotomous items), self-reported dental service attendance history and demographic variables. The results showed that patients who had read the oral cancer PIL demonstrated a significant increase in knowledge regardless of clinical setting (F[1,739]=246.24, P<0.0001). Patients showed improvements in selecting the correct signs and risk factors associated with disease. Immediate knowledge gain from a simple PIL about oral cancer was found and independent of the primary care facility, where the PIL was distributed.

Age and medication are significant risk factors for xerostomia in an English population, attending general dental practice.

OBJECTIVE: To study the prevalence of xerostomia in an English population, attending general dental practice and relate it to age, medication and gender. DESIGN STUDY: Cross-sectional. SETTING: Five General Dental Practices in Merseyside, North of England. SUBJECTS: 1,103 adult patients attending for routine dental care. INTERVENTION: Questionnaire administered by dentists. MAIN OUTCOME MEASURES: Age, gender, systemic medication, reported oral dryness. RESULTS: 1,103 patients (654 females) were recruited, of whom 427 (39%) were aged 60 years or older. 26% of patients reported taking medication. The overall prevalence of xerostomia was 12.7% (males--10.3%, females 14.4%). Age, medication and female gender were found to be significant risk factors for xerostomia, using logistic regression analysis. CONCLUSIONS: The prevalence of xerostomia (12.7%) in an English population was lower than reported in previous North American and Swedish studies. Medication was a significant risk factor for xerostomia and a better predictor of risk status, than either age or gender.

An analysis of antibiotic prescriptions from general dental practitioners in England.

The aim of this study was to determine the antibiotics prescribed by general dental practitioners (GDPs). Adult antibiotic prescriptions issued by GDPs from 10 Health Authorities (HAs) in England were analysed. The type of antibiotic prescribed, dose, frequency and duration were investigated. Most of the 17007 prescriptions were for generic antibiotics; nine different antibiotics were prescribed. Many practitioners prescribed antibiotics inappropriately with inconsistent frequency and dose, and for prolonged periods.