Mental health and wellbeing interventions in the dental sector: a systematic review.

Introduction UK dentists experience high levels of stress, anxiety and burnout. Poor mental health can lead practitioners to exit the profession, contributing to workforce and service loss. Therefore, there is a need to focus on interventions to protect the mental health and wellbeing of dental teams. Three levels of intervention can be deployed in the workplace to support mental health and wellbeing: primary prevention, secondary prevention, and tertiary prevention.Aim The aim of this systematic review was to identify evidence on interventions used to prevent, improve or tackle mental health issues among dental team members and dental profession students in countries of very high development.Methods This systematic review was conducted according to a predefined protocol and reported according to PRISMA guidelines. The MEDLINE, Embase CINAHL, DOSS, Scopus, and PsycINFO databases were searched. Prospective empirical studies were considered for inclusion. The Effective Public Health Practice Project Quality Assessment Tool (EPHPP) was used to assess the methodological quality of the included studies. The identified interventions were categorised according to level of prevention.Results The search yielded 12,919 results. Eight studies met the inclusion criteria. All of the studies concerned dentists or dental students. There were no studies for other groups of dental professionals. No primary prevention-level studies were identified. Secondary prevention-level studies (n = 4) included various psychoeducational interventions aiming to raise awareness and improve coping skills and led to significant improvements in stress levels and burnout of dentists and dental students. Tertiary prevention-level studies (n = 4) mainly employed counselling which was shown to be beneficial for dentists and students experiencing psychological ill-health.Conclusions Mental wellbeing awareness should be put at the centre of dental education and the workplace. Leadership and innovation are required to design primary-level interventions which can be implemented in the UK dental sector, with its distinct organisational and service characteristics.

Oral care experiences of palliative care patients, their relatives/carers and healthcare professionals.

AIM: To explore the oral care experiences of palliative care patients and of those who support or deliver oral care to these patients: nurses, doctors, dentists, their relatives and carers. DATA SOURCES: An electronic search of the databases included: Embase, MEDLINE, DOSS, AMED and PsycINFO was performed. DATA SELECTION: Six articles were included in the final synthesis. DATA EXTRACTION: Thematic analysis was applied by two researchers. DATA SYNTHESIS: Three themes were identified: 'performing oral care', 'effects on oral health' and 'challenges in palliative care'. CONCLUSIONS: Despite similarities of oral care experiences, this review identified some differences, crucially in terms of the wider impact of oral symptoms, namely social interactions with others and challenges to oral care. This confirms the need to investigate these topics further in relation to different stakeholders, such as nurses; and to have consistent guidance to facilitate the provision of effective oral care to palliative care patients.

Frontline experiences and perceptions of Urgent Dental Care centre staff in England during the COVID-19 pandemic: a qualitative study.

Introduction Following the World Health Organisation declaration of COVID-19 as a global pandemic, routine dental care in the UK ceased, and Urgent Dental Care centres (UDCs) were established to offer remote and face-to-face urgent dental treatment for those in need.Aim To explore perceptions and psychosocial experiences of frontline staff providing care at UDCs in England during COVID-19.Method A qualitative research study using a phenomenological approach. Semi-structured interviews were conducted remotely. Using line-by-line coding, data were analysed using a hybrid approach that incorporated both a deductive, theoretical process and an inductive, data-driven process.Results Participants included 29 dentists and nine dental nurses from UDCs across England. Twelve themes were identified and grouped into positive and negative experiences. Positive experiences were: role fulfilment and having a sense of purpose; team unity and collective coping strategies; and strategic teamwork and preparedness for effective organisation of care. Negative experiences included: feeling undervalued and frustrated due to fragmented guidance and communication; sense of unfairness generated by relational challenges; patient demand outstripping UDC capacity; complex decision-making; uncertainty over safety; suffocating PPE hindering effective communication; ineffective communication channels across healthcare sectors; lack of commitment to remote video consultations; and variable referral quality.Conclusions Participants reported experiencing a number of emotional challenges that appeared to be exacerbated by an unsupportive environment, often due to lack of leadership. However, positive experiences and coping strategies were also identified. Collective and sustained efforts at system level to improve the resilience and mental wellbeing of the current and future dental workforce and integration of dentistry into wider healthcare infrastructures are needed.

The future of dentistry post-COVID-19: perspectives from Urgent Dental Care centre staff in England.

Introduction While routine dentistry was suspended during the COVID-19 pandemic, Urgent Dental Care centres (UDCs) were established to support patients with urgent dental needs.Aim The study aimed to provide insights and recommendations on future dental reform based on the perspectives of frontline staff delivering dental care in UDCs.Method A qualitative research study using a phenomenological approach. A hybrid approach that incorporated both a deductive and an inductive approach to analysis was adopted.Results The sample included 29 dentists and nine dental nurses providing care at UDCs in England during the pandemic. The following predominant themes were identified: patient care and access, practice viability, workforce sustainability, identity of dentistry and contract reform.Conclusions The pandemic has highlighted the desire from the dental profession for urgent reform of the current NHS dental contract in England. This was directed towards a more resilient, responsive and equitable dental service that is better prepared for current and future challenges.

What is the global prevalence of dental healthcare needs and unmet dental needs among adolescents?

Data sources Databases searched included Web of Science, PubMed and Scopus.Study selection Cross-sectional studies that estimated dental healthcare needs and unmet dental needs in young people, aged 10-19 years were considered for inclusion. No limitations in terms of year of publication, language, location of the study, gender and race of the participants, or the type of dental health needs and unmet needs were applied. The papers were screened on title and abstract, and then on full text by two reviewers. Any disagreements were resolved through discussion and consultation with a third reviewer.Data extraction and synthesis Data were extracted by three reviewers. Critical appraisal was conducted by two reviewers using the Joanna Briggs Institute critical appraisal checklist. A PRISMA flowchart was used to present the study selection results. Summary measures on the prevalence of dental health needs and unmet needs were calculated. For the meta-analysis, the inverse variance method was used to obtain pooled summary measures.Results Fifty-seven studies were included in the review. The overall prevalence of dental healthcare needs was 49% (95% CI: 42-56) across all types of dental care. The highest prevalence was that for periodontal treatment needs (71%; 95% CI: 46-96 as reported in four studies), followed by that of general treatment needs (59.0%; 95% CI: 42-75 as reported in 12 studies), orthodontic treatment (46%; 95% CI: 38-53 as reported in 32 studies) and lastly that of malocclusion treatment needs (39%; 95% CI: 28-50 as reported in nine studies). The pooled prevalence of unmet dental needs as reported in nine studies was 34% (95% CI: 27-40) with the highest prevalence found in Southeast Asia (72.3%; 95% CI: 70.1-74.5) and the lowest in Europe (11.8%; 95% CI: 3.4-20.3).Conclusions The results of this review showed that the prevalence of dental healthcare needs was higher in America and Europe while unmet needs were more prevalent in Southeast Asia and Africa. The former could partly be explained by the lower number and sample sizes of studies conducted in developing countries.Commentary.

Is there an association between drug use and oral health conditions?

Data sources Databases searched included PsycINFO, PubMed, SciELO, Scopus and Web of Science.Study selection Cross-sectional, longitudinal and retrospective studies that compared caries, periodontal disease or tooth loss in people who use drugs as compared to those who do not. Studies that included psychiatric populations and alcohol or tobacco users were not included in the review. Qualitative studies, in vitro investigations, animal studies, reviews, case reports and series, letters to editor and conference abstracts were also excluded. The authors included only English studies published before 1 July 2019. Two independent reviewers screened the papers on title and abstract and then full text. In case of disagreements, these were discussed between the two reviewers and a third one was consulted if needed.Data extraction and synthesis Two reviewers extracted the data and contacted the primary authors for necessary clarifications, if needed. The unweighted kappa was applied to examine inter-examiner agreement. The Joanna Briggs Institute Critical Appraisal Checklist for observational studies was used to critically appraise the studies. The study selection results were presented through a flowchart. For the meta-analysis, the authors considered adjusted data. In some cases, crude estimates were used. Heterogeneity was estimated using the I2 statistic. The 'meta' package was used for the meta-analysis.Results Ten studies were included in the meta-analysis. Drug use was associated with higher risk of periodontal disease (OR 1.44; 95% CI 0.8-2.6) and higher DMFT index (OR 4.11; 95% CI 2.07-8.15).Conclusions The review showed high risk of periodontal disease and caries among people who use drugs. The authors concluded that this association may be explained by irregular tooth brushing and long history of drug use. It is important to develop programmes that aim to improve oral hygiene practices among people who use drugs.

Is there an association between oral health-related quality of life and Alzheimer's disease?

Data sources PubMed, Medline, Embase, CINAHL, Cochrane Library database and ProQuest databases were searched.Study selection Observational and non-randomised studies in English language were considered for inclusion. Two reviewers independently selected the relevant studies. Any disagreement was resolved by discussion with a third reviewer. The outcome of interest for this review was oral health-related quality of life (OHRQoL) in patients with Alzheimer's disease.Data extraction and synthesis Data extraction was conducted independently by two reviewers. Critical appraisal was conducted by two reviewers using the Joanna Briggs Institute 'Meta-Analysis of Statistics Assessment and Review Instrument'.Results Six studies were included in the review, of which five were cross-sectional and one was a non-randomised controlled trial. OHRQoL was measured by the Oral Health Impact Profile (OHIP) in one study and the Geriatric Oral Health Assessment Index (GOHAI) in the other five included studies. All six studies were judged as methodologically strong. When the results of four studies which used the GOHAI were pooled together in a meta-analysis, no statistically significant differences in the GOHAI scores between patients with Alzheimer's disease and controls were found (SMD = 0.09; 95%CI: -0.66 to 0.85).Conclusions The results of this review showed no significant difference in OHRQoL between patients with Alzheimer's disease and healthy controls.

Barriers and facilitators to dental care access among asylum seekers and refugees in highly developed countries: a systematic review.

BACKGROUND: Dental diseases are prevalent among asylum seekers and refugees (ASRs). Despite significant treatment needs, access to dental care in host countries is often limited. The aim of this systematic review was to identify the barriers and enablers to dental care access for ASRs in host countries of very high development. METHODS: Five health and social care databases and eight grey literature sources of information were searched. The Critical Appraisal Skills Programme tool was used to critically appraise included studies. Thematic analysis was undertaken to identify common themes. These were then deductively organised according to Penchansky and Thomas's modified access model. All review stages were conducted by two independent reviewers. RESULTS: Nine papers were included in the review. ASRs encounter significant challenges to accessing dental care in their host countries. These include affordability, communication difficulties, insufficient interpretation, limited knowledge of the healthcare systems and healthcare rights, and negative encounters with healthcare teams. The views and experiences of dental care teams providing care to ASRs were explored in only one study. CONCLUSIONS: Both population and healthcare characteristics influence access to dental care for ASRs. Affordability, awareness and accommodation are most frequently described as barriers to dental access for this population. The diverse needs of this population need to be recognised by policy makers, commissioners and practitioners alike. Cultural competence needs to be incorporated into dental services and any interventions to improve access to dental care for this population. Registration PROSPERO- International prospective register of systematic reviews (CRD42019145570).

Strategies to improve oral health behaviours and dental access for people experiencing homelessness: a qualitative study.

Objectives The present study aimed to identify strategies to improve oral health behaviours as well as access to and provision of dental care for people experiencing homelessness.Method We conducted focus groups with people living in a residential homeless centre and semi-structured interviews with other stakeholders working with or supporting people experiencing homelessness. Following an inductive approach, thematic analysis was used to synthesise the findings on NVivo software.Results Participants included 11 British males experiencing homelessness and 12 other stakeholders from various professional backgrounds. Themes identified included: awareness and empowerment; supportive environment and dental health system; flexible and holistic care; outreach and community engagement; collaboration with other health and social services; and effective communication.Conclusions Efforts to improve oral health among people experiencing homelessness via improved oral health habits and engagement with services need to be directed at both the recipients of care and the healthcare teams. Well-powered empirical studies are needed to evaluate whether the strategies identified can improve engagement and care provision for this population.

Is there an association between children's screen use and cariogenic diet?

Data sources Databases searched included the International Database for Medical Research MEDLINE/Pubmed, ISI Web of Science, Scopus, Scientific Electronic Library Online (SciELO), and Latin American and Caribbean Health Sciences (LILACS).Study selection Studies of observational design that examined the association between any screen-time behaviour and dietary intake in preschool and school-aged children (younger than 12 years) were selected by two independent reviewers. If a consensus could not be reached, a third reviewer was consulted.Data extraction and synthesis Data were extracted independently by two reviewers using a pre-tested data extraction form. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale for cross-sectional studies. A PRISMA flow chart was used to present the study selection results. The GRADE system was used to evaluate the strength of evidence. A qualitative synthesis was used to report the results. A meta-analysis was not conducted.Results Nineteen studies were included in the review, all of which were of cross sectional design or conducted cross-sectional analysis. Fourteen studies were assessed as high quality, three as moderate quality and two as low quality. All studies found a significant positive association between television and/or total screen-time viewing and poor quality diet including lower intake of fruit and vegetables and higher intake of unhealthy foods. Screen-based sedentary behaviour was positively associated with cariogenic foods consumption in 15 studies. Based on the GRADE rating, there was moderate evidence of an association between TV viewing and intake of potentially cariogenic diet.Conclusions Although there could be an association between TV viewing and poor quality cariogenic diet in preschool and school-aged children, the authors conclude that the strength of evidence is limited.Commentary.

'Teeth Matter': engaging people experiencing homelessness with oral health promotion efforts.

People with experience of homelessness commonly suffer from poor oral health and are likely to have low-level engagement with dental services. 'Teeth Matter' was a pilot study developed to examine whether peer education could result in improved plaque management among people who are experiencing homelessness. Based on the experience gained from developing and implementing the study, and taking into consideration the views of everyone involved, this paper provides a list of suggestions and resources that can be used to improve engagement of this population with oral health promotion activities. Some of the learning points are also applicable in the clinical setting.

Management of plaque in people experiencing homelessness using 'peer education': a pilot study.

Introduction People who experience homelessness have poor oral health and limited access to dental services.Aim To examine whether 'peer education' could yield improved plaque management among people experiencing homelessness.Methods A quasi-experimental, one-group pre-test-post-test study was conducted, with follow-up at one and two months. Participants were living in temporary accommodation in Plymouth, UK. Plaque levels were assessed using the simplified oral hygiene index. A questionnaire and the oral health impact profile (OHIP-14) were administered. Patient satisfaction and barriers to dental care were explored by interviews.Results The baseline sample included 24 people with a mean age of 36.88 ± 10.26 years. The mean OHIP-14 score was 25.08 ± 19.56; finding it uncomfortable to eat and being embarrassed attracted the highest values (2.46 ± 1.53 and 2.33 ± 1.63, respectively). Plaque levels decreased by month one and month two, though the changes were not statistically significant. Positive changes in confidence in toothbrushing at month two were identified (p = 0.01).Conclusion Experiencing pain and the opportunity to access treatment were key drivers of study participation. The study indicated that it is feasible to conduct oral health promotion projects for people in temporary accommodation. Adequately powered studies examining the impact of peer education on improving homeless people's oral health are warranted.

Impact of time pressure on dentists' diagnostic performance.

OBJECTIVES: Although stress is prevalent amongst dentists, there is a paucity of data on the impact of stressors on dentists' clinical performance. To address this gap in the literature, the aim of the present study was to explore the role of time pressure, representing one common stressor, on dentists' radiographic diagnostic performance. METHODS: Forty dentists were randomised to examine and provide a radiographic report on two sets of radiographs (six bitewings in each set) under two conditions on a cross-over basis: time-pressure vs. no-time-pressure. The radiographic report of an experienced consultant was considered the gold standard against which participants diagnostic decisions were compared to calculate sensitivity and specificity. Participants rated their stress after each experimental condition using a 100 mm visual analogue scale (VAS). RESULTS: The VAS scores for stress were significantly higher in the time pressure condition vs. no time pressure condition (mean: 55.78 versus 10.73, p < 0.0001), indicating that the time pressure acted as a source of stress. Dentists' diagnostic performance was affected; the sensitivity was significantly lower under time pressure (median: 0.50 versus 0.80, p < 0.0001), but by contrast, the median diagnostic specificity was 1.00 under both conditions. CONCLUSIONS: Time pressure negatively impacts one aspect of dentists' diagnostic performance, namely sensitivity (increased diagnostic errors and omissions of pathology), which can potentially affect patient safety and the quality of care delivered. However, time pressure was found to have less influence on diagnostic specificity. CLINICAL SIGNIFICANCE: The present study demonstrated a significant deterioration of dentists' diagnostic performance (sensitivity) under time-pressure when examining bitewing radiographs. Diagnostic errors may put patient safety at risk, with patients potentially being harmed if pathology is missed. Such errors can have medicolegal implications on the dentists' practice.

Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review.

OBJECTIVES: The aim of this systematic review was to identify and conceptualize the barriers and enablers to accessing dental services for people experiencing homelessness in the United Kingdom. METHODS: A literature search for studies relevant to homelessness and dental care was conducted. The PRISMA and ENTREQ guidelines were followed. Electronic databases (EMBASE, MEDLINE, DOSS, CINAHL, SOCINDEX and PsycINFO) and grey literature sources (Electronic Theses Online Service - EThOS, Kings Fund, NICE Evidence, Open Grey, Google and the Health Foundation) were searched up to 28 August 2018. The critical appraisal was conducted using CASP and an adjusted version of a JBI Critical Appraisal tool. Thematic analysis was used to develop the themes and domains. RESULTS: Twenty-eight papers were included. Barriers to homeless people accessing dental care stemmed both from the lived experience of homelessness and the healthcare system. Within homelessness, the themes identified included complexity, emotions and knowledge. Regarding the healthcare system, identified themes included staff encounter, accessibility and organization issues. CONCLUSION: Homelessness can actively contribute to both an increased need for dental care and barriers to accessing that care. The arrangement of dental healthcare services can also act as barriers to care. This is the first systematic review to conceptualize the factors associated with access to dental care for people who are homeless. It provides a set of recommendations for overcoming the main barriers for homeless people to accessing dental care. It also offers directions for future research, policy and commissioning.

Radiographic bone loss in a Scottish non-smoking type 1 diabetes mellitus population: A bitewing radiographic study.

BACKGROUND: The dental complications of uncontrolled diabetes include reduced salivary flow rate, candidiasis and periodontal manifestations. A recent meta-analysis concluded that diabetes patients have a significantly higher severity, but not extent, of destructive periodontal disease than non-diabetics. The authors reported that most type-1 diabetes studies using dental radiographic data have not controlled for confounding factors such as smoking. The aim of this cross-sectional study was to compare radiographic alveolar bone loss between type 1 diabetes (T1DM) and non-diabetes (NDM) participants in a Scottish non-smoking population. METHODS: Digital bitewing radiographs for 174 Scottish adults never or ex-smoker (>5 years) participants (108 T1DM, 66 NDS), recruited from outpatient clinics throughout Greater Glasgow and Clyde, were included in the analysis. A single blinded, trained, and calibrated examiner recorded the radiographic bone loss seen on bitewing radiographs using the digital screen caliper (Screen Calliper ICONICO version 4.0 (Copyright (C) 2001-6 Iconico), New York). The bone loss was measured as the distance between the cemento-enamel junction (CEJ) and the deepest radiographic alveolar bone margin interproximally of each tooth. RESULTS: T1DM participants had more radiographic alveolar bone loss throughout the all teeth measured (median:1.27 mm versus 1.06 mm, P < 0.001) and more than a two-fold increase in the risk of having sites with ≥2 mm periodontal destruction (OR = 2.297, 95%CI 1.058 to 4.986, P = 0.036) compared with non-diabetes subjects. CONCLUSIONS: Patients suffering from type 1 diabetes are at higher risk of periodontitis even when controlling for multiple possible confounding factors and this difference can be detected on routine dental radiographs at an early stage. These data confirm radiographically the previously reported association between T1DM and periodontal bone loss.

Computerized Virtual Reality Simulation in Preclinical Dentistry: Can a Computerized Simulator Replace the Conventional Phantom Heads and Human Instruction?

STATEMENT: In preclinical dental education, the acquisition of clinical, technical skills, and the transfer of these skills to the clinic are paramount. Phantom heads provide an efficient way to teach preclinical students dental procedures safely while increasing their dexterity skills considerably. Modern computerized phantom head training units incorporate features of virtual reality technology and the ability to offer concurrent augmented feedback. The aims of this review were to examine and evaluate the dental literature for evidence supporting their use and to discuss the role of augmented feedback versus the facilitator's instruction. Adjunctive training in these units seems to enhance student's learning and skill acquisition and reduce the required faculty supervision time. However, the virtual augmented feedback cannot be used as the sole method of feedback, and the facilitator's input is still critical. Well-powered longitudinal randomized trials exploring the impact of these units on student's clinical performance and issues of cost-effectiveness are warranted.

Nonsurgical periodontal treatment: review of the evidence.

An increasing number of patients have become aware of the detrimental effects of periodontal disease and tooth-loss and they seek periodontal care. The cornerstone of management of chronic periodontitis is the non-surgical periodontal treatment. The primary goal of periodontal therapy is to preserve the natural dentition by achieving and maintaining a healthy functional periodontium. Many adjunctive treatment modalities have been introduced lately to enhance the therapeutic outcome of periodontal treatment. The aim of this review is to search for systematic reviews which evaluate these therapeutic modalities and discuss their efficacy. The databases of Medline via Ovid, Embase and the Cochrane Database of Systematic Reviews were searched for up to date systematic reviews in English language. The results and conclusions of the systematic reviews found in the periodontal literature are discussed in this paper. The efficacy of different oral hygiene regimens in maintaining and improving gingival health, the efficacy of the nonsurgical periodontal treatment, the full mouth disinfection, the systematic antimicrobial therapy, the local adjunctive therapies, the host modulation treatment, the Photodynamic and laser therapy are discussed. It appears that there is no certain magnitude of initial probing pocket depth where nonsurgical periodontal therapy is no longer effective. Some of the aforementioned modalities have been found to offer statistical significant benefit in clinical outcomes than the scaling and root planing alone. If this statistical significance is clinically significant needs to be critically assessed by the clinician upon the treatment planning and decision making.