Patient adherence in orthodontics: a protocol for a scoping review.

BACKGROUND: Patient adherence is a key factor in achieving orthodontic success. While in recent years there have been changes in orthodontic healthcare, no recent comprehensive reviews regarding adherence in orthodontics are available. Therefore, the aim of this planned scoping review is to systematically map the available literature regarding patient adherence in orthodontics to identify factors associated with patient adherence and to investigate if there are knowledge gaps in the available literature. METHODS/DESIGN: This protocol was drafted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) statement and the PRISMA extension for Scoping Reviews (PRISMA-ScR). For the methods Arksey and O'Malley's framework and the Reviewer's Manual of the Joanna Briggs Institute for conducting scoping reviews were consulted. The inclusion criteria for this scoping review are studies of all designs assessing any form of adherence in orthodontics, published in English from 2006 onwards. The exclusion criteria are studies investigating adherence in the following patients: those with an intellectual or physical disability that could affect their ability to coincide with their therapist's recommendations and advice, those with oral cleft and craniofacial conditions, and those solely treated for obstructive sleep apnoea. Case reports and studies published in non peer reviewed journals will also be excluded. The following electronic databases will be searched: Embase, PubMed, and Web of Science Core Collection. The following key terms will be used in the search strategies: 'treatment adherence and compliance', and 'orthodontics'. Multiple reviewers will independently screen the results and perform the data charting process. A narrative description will be provided for the analysis of the included studies. The results will be categorized into multiple topics based on recommendations by previous studies into patient adherence. Identified knowledge gaps will be reported and recommendations for future research will be suggested. DISCUSSION: No systematic review has previously assessed this exact topic. Because of the broad-spectrum research questions and the expected widely scattered literature a scoping review approach was chosen over a systematic review approach. The Academic Centre for Dentistry Amsterdam (ACTA) has been conducting research in patient adherence in orthodontics up to 2006 and therefore only studies published from 2006 onwards will be researched in this review. Identifying knowledge gaps and summarizing and disseminating research findings on this topic is important for every dental professional performing orthodontic treatment. This protocol is registered in the Open Science Framework: https://osf.io/ec6qd.

[Insight into the prevalence of periodontitis: a challenge!] / Inzicht in de prevalentie van parodontitis: een uitdaging!

Current data on the prevalence of periodontitis is scarce. Moreover, in epidemiological research periodontitis is measured in different ways. However, for effective prevention and evaluation of curation, it is of great importance to have reliable prevalence figures on periodontitis, because serious periodontal infections show a strong correlation with several common diseases. In the case of the Netherlands, this means more effort to monitor the prevalence of periodontitis. This could, in any case, be carried out from dental practices, albeit that it would then be necessary to do so in a structured manner. This may not provide a full picture, but it will provide insight into the state of oral health and the outcomes of care for the vast majority of the population that visits a dental practice yearly.

[Good oral care deserves to be better integrated into primary care]. / Goede mondzorg verdient een betere integratie in de eerstelijnszorg.

Oral and general health are inextricable. In primary care, the fields of care by general practioners, youth healthcare, healthcare for older people and oral care are all distinctly separated. Healthcare professionals are increasingly confronted with the complexity and increase in Noncommunicable diseases (NCD's) and an aging population. The aetiology of NCD's in primary care concern the professional fields of all healthcare professionals mentioned, meaning that lifestyle-related risks might be prevented more effectively through collaboration. In primary care, the number of medically compromised people is on the rise and healthcare professionals encounter each other's patients, whose risks remain invisible to them. Through collaboration such problems could be faced more effectively. Better integration of oral care into primary care can also contribute to the quality of care and safety of care receivers, and reduce further inequality. In order to better design this integration with the help of innovation, more practicebased research and implementation is needed.

[Impact of the coronavirus on Dutch oral health care and practice]. / Impact van het coronavirus op de praktijkvoering van de Nederlandse mondzorg.

Among dental hygienists and dentists in the Netherlands, the impact of the SARS-CoV-2 pandemic on oral healthcare practices from March to July 2020 was investigated. Of the 1,700 healthcare providers approached, 433 completed questionnaires could be used. The results show that the pandemic has had a profound impact on both the accessibility of oral healthcare and on care provided in oral healthcare practices. Extra attention was paid to hygiene and infection prevention: the types of personal protective equipment and the protocols and procedures were adjusted by many oral healthcare providers. The confirmed prevalence of oral healthcare providers with COVID-19 in this study was 1.6%. However, testing was not available to all respondents with complaints during this initial period. Over half of the respondents estimated that even with additional measures there is an increased risk of infection to oral healthcare providers during their work. The efficacy of the various additional measures in oral healthcare practices related to COVID-19 is still unknown.

[Series: Education and the dentist in 2025. The external practical internship: a taste of professional dental practice]. / Serie: Onderwijs en de tandarts anno 2025. De externe praktijkstage: proeven aan de beroepsuitoefening als tandarts.

The practical training in dental schools in the Netherlands is largely organised within the walls of the educational institution, while many other medical educational programmes provide practical training to a large extent in the professional environment. The external practical internship is a form of practical learning with which positive experience has been gained in foreign dental schools, both by students and dentist-supervisors. The Dutch dental schools have a joint plan to set up practical internships in dental practices for master's students in the final year of their education. The aim of such an internship is that students in the last phase of their programme learn to apply the acquired knowledge and skills in an actual professional environment. This includes both clinical and dental treatment and the ability to organise oral health care for patients and everything that comes with it. This article describes the outline of this programme.

[Study stress, burnout and physical complaints among dental students]. / Studiestress, burn-out en lichamelijke klachten bij tandheelkundestudenten.

The study of dentistry is known to cause high levels of psychological stress and physical strain. The aim of the present study was to determine the degree to which dental students experience study stress, burnout and physical complaints. The study showed female students experience higher levels of study stress, on average, than male students. Students' mean level of emotional exhaustion was 'high'. In addition, 90% of the students had suffered from physical complaints in the year preceding the survey. A strong correlation was shown to exist between physical complaints and emotional exhaustion, and in addition, a strong wish for more (pre)clinical teacher support correlated with study stress, burnout and physical complaints. It can be concluded that dental students, on average, experience the study as taxing, feel emotionally exhausted and suffer from many physical complaints. In the dental practice, they will be confronted with many taxing factors. In the dental curriculum, therefore, adequate and frequent attention should be given to learning to cope with stressful situations and to maintain physical well-being.

[Burnout and work stress]. / Burn-out en werkdruk bij tandartsen.

Work stress and burnout among Dutch dentists have been studied in the past; since then, however, considerable changes have taken place in practicing dentistry. The aim of this study was to investigate whether these changes are reflected in reported burnout and stress. Also, the study sought to investigate whether burnout could be associated with making mistakes during treatment or being confronted with a formal complaint. 500 Dutch dentists were randomly selected for an online survey, 105 of whom responded (21%); 50.5% male and 49.5% female. Higher mean scores on emotional exhaustion (EE) and personal accomplishment (PA) were reported, compared to previous results, and to reference scores from the burnout measuring manual, and lower mean scores on depersonalisation (DP) compared to reference scores. No gender differences were found for burnout. Women reported more work stress on Patient Contacts and Considerations about work. The 36 to 45-year-old age group reported higher mean scores on burnout and work stress. Having been confronted with patient complaints was associated with higher scores on DP, while worrying about making mistakes was associated with higher scores on EE and DP. Burnout is a relevant topic for dentists, which appears to be most prominent at middle age. Recognising, and knowing how to deal with, demanding aspects of work is a crucial means to prevent burnout.

[Three estimations of the outflow of orthodontists from the field]. / Drie schattingen van de uitstroom van orthodontisten uit het vak.

The outflow of orthodontists through retirement is an important factor in the estimation of the required training capacity for this group of professionals. From 2002 through 2018, studies of the professional activity and retirement plans of orthodontists age 55 and older have been conducted fairly frequently, the most recent one dating from 2018. Based on the findings of these surveys, 3 estimations were obtained of the outflow through retirement. These were based on answers in earlier editions, the answers of their contemporaries and on the basis of the legal retirement age in the Netherlands. The number of active orthodontists in 2018 age 55 or older is estimated respectively to be 117, 116 and 102; according to all estimations, they will have retired in 2030. The estimations predict, respectively 56, 57 and 30 orthodontists will retire before 2023. According to 2 of the estimations, the outflow of orthodontists from the field will exceed the inflow from the universities in the coming years. The present training capacity in the Netherlands is not sufficient to compensate for the outflow of the first 2 estimations.

[Can dental students and dental care providers in the Netherlands effectively and safely prescribe drugs?] / Serie: Onderwijs en de tandarts anno 2025. Kunnen tandheelkunde­studenten en mondzorgverleners in Nederland effectief en veilig geneesmiddelen voorschrijven?

Dentists and dental specialists are qualified to prescribe drugs. In this study, we assessed and compared the pharmacotherapeutic knowledge and skills of final year dental students, dentists and dental specialists in the Netherlands. In 2017, a random sample of these three groups was invited to complete an assessment. The knowledge assessment comprised 40 multiple choice questions covering often prescribed drugs. The skills assessment comprised three patient cases for which participants had to write a treatment plan. For the knowledge assessment, the response rates were 26 (20%) dental students, 28 (8%) dentists and 19 (19%) dental specialists, and for the skills assessment the response rates were 14 (11%) dental students, eight (2%) dentists, and eight (8%) dental specialists. On average, all three groups had inadequate knowledge scores (smaller 80%) and only a small proportion (smaller 30%) of their treatment plans was assessed as correct. These results suggest that dental students, dentists and dental specialists lack prescribing competence, which could be caused by poor pharmacotherapy education during under- and postgraduate dental training.

[Research agenda oral care for older people in the Netherlands and Flanders (Belgium)]. / Wetenschapsagenda 'Mondzorg voor ouderen' in Nederland en Vlaanderen.

Oral care for older people is an underexposed topic in dentistry as well as in general healthcare, while oral care professionals are increasingly confronted with frail and multimorbid older people with complex care needs. The research agenda 'Oral care for the elderly' was developed to encourage the collaboration of researchers in the Netherlands and Flanders (Belgium) to do more research in this area and in this way, to achieve an expansion and implementation of knowledge. This will make possible the provision of a socially responsible and robust basis for sustainable oral care for frail older people. The focus of the agenda is on 3 themes, namely oral health and oral function for older people; multi/interdisciplinary collaboration within primary care and the costs, benefits and long-term effect(s) of oral care throughout the entire course of life. This article provides an overview of this research agenda and the way in which it has been established.

[A view on collective oral care for frail older people: united we stand]. / Visie op de collectieve mondzorg voor kwetsbare ouderen: eendracht maakt macht.

Oral health in frail older people is often poor. There are a number of reasons for this, such as increased morbity and decreased motivation for (self) care. Good oral health is, however, very important. Studies have revealed poor oral health to cause or aggravate several medical and psychological problems. Illness and medication can, in turn, damage oral health. Oral health among the elderly should therefore be carefully monitored and maintained. This requires multidisciplinary and interprofessional collaboration on the part of healthcare professionals and others involved. Such collaboration is now still very limited; hardly anything has been written about how such collaboration in the area of oral care for frail older people should or could be organised. This article provides an overview of the possibilities and the relevant factors in the area of oral care for the elderly in promoting collaboration among healthcare professionals and others involved. All of this is under the banner of 'united we stand'.

[Therapeutic prescription of antibiotics and NSAID's by dentists in the Netherlands]. / Therapeutisch voorschrijven van antibiotica en NSAID's door tandartsen in Nederland.

Late in 2015 the Royal Dutch Dental Association (KNMT) conducted a study of the therapeutic prescription of antibiotics and NSAIDs by dentists in general practice in the Netherlands and the factors influencing their decisions. Of the 1,087 dentists contacted 367 (34%) completed the online questionnaire. In the 4 weeks preceding the study they had prescribed an antibiotic to 1.3% of their patients on average. A fifth (20%) found it difficult to decide whether an anti-inflammatory drug is indicated and/or whether this should be an antibiotic or a NSAID. Questioned about medication decisions (whether or not antibiotics are indicated) in 11 fictional cases, 11% of respondents judged every case correctly. 39% undertreated, 24% overtreated and 26% both undertreated and overtreated. In the last two categories, dentists with non-Dutch degrees are overrepresented. More than half (55%) of the respondents say they need a guideline for prescribing antibiotics in dental treatment and 28% (also) need postgraduate education on this matter.

Caries Progression Rates Revisited: A Systematic Review.

Caries progression seems to follow universal, predictable rates, depending largely on the caries severity in populations: the higher the caries severity, the higher the progression rates. Quantification of these rates would allow prediction of future caries increments. Our aim was to describe caries progression rates in the primary and permanent dentition in Western populations (not in lesions) of children and adolescents. Therefore, we systematically searched MEDLINE-PubMed, Embase, CINAHL, and the Cochrane library for studies reporting caries progression data. Eligibility criteria were reporting empirical data from at least 2 full-mouth dental caries examinations in a closed cohort during a follow-up of at least 3 y, a first examination after 1974, a second examination before the age of 22 y, caries assessed as dentine caries (d3/D3), and caries reported in dmfs/DMFS (decayed, missing, and filled surfaces), dmft/DMFT (decayed, missing, and filled teeth), or caries-free participants. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we described the results for the primary and permanent dentition in a systematic review, performed a meta-analysis for the caries incidence rate in the permanent dentition, and conducted multivariate, hierarchical meta-regression analyses for the caries incidence rate and the increments in DMFS and DMFT. Of the 6,343 unique studies retrieved, 43 studies (56,376 participants) were included for systematic review and 32 for meta-analyses (39,429 participants). The annual decline in caries-free children in the permanent dentition ranged from 0.8% to 10.2%. The annual increment ranged from 0.07 to 1.77 in DMFS and from 0.06 to 0.73 in DMFT. The pooled caries incidence rate was 0.11 (0.09-0.13) per person-year at risk. Meta-regression analyses showed that the methods of individual studies influenced pooled caries incidence rates and increments in DMFS and DMFT. This should be taken into account in planning and evaluation of oral health care services. However, the caries incidence rate is promising for prediction of future caries increments in populations.

[Recognising and reporting child abuse by orthodontists]. / Herkenning en melding van kindermishandeling door orthodontisten.

In 2013, the child abuse and domestic violence reporting code was introduced in the Netherlands, which obliged caregivers to report suspicions of child abuse or domestic violence. In 2014, a survey was conducted among dentists on this subject. However, nothing was known about the use of the reporting code among orthodontists. In December 2015, a survey was sent to members of the Dutch Orthodontic Society (NVvO). The survey consisted of 20 items about applying the reporting code and experiences with patients. Most orthodontists were aware of the reporting code (83%) and had implemented this in their practice (64%). Nevertheless, orthodontists found it difficult to recognise signs of child abuse, mostly because of a lack of experience in this area. Most orthodontists who suspected child abuse took action, mainly by seeking advice from the foundation 'Veilig Thuis' ('Safe at Home').

[Musculoskeletal disorders among dentists and dental students in the Netherlands]. / Musculoskelettale aandoeningen onder tandartsen en tandheelkundestudenten in Nederland.

In this study, the prevalence of musculoskeletal symptoms among dentists and dental students in the Netherlands was inventoried by means of 2 corresponding web surveys. 196 (25% response) dentists and 359 (40% response) dental students participated. 80% of the dentists and 95% of the dental students reported to have suffered from pain in muscles and joints in the last 12 months. In particular, they mentioned complaints of the neck, the shoulders and the lower back. Dental students also frequently reported complaints of the upper back. Many physical complaints were more common among females than male students. In contrast, no gender difference was observed for dentists, but regarding this group stress proved to be an important risk factor for developing musculoskeletal complaints. Given the negative impact on the profession, further research into the prevention of musculoskeletal disorders is urgently needed, in particular about the efficiency of (postgraduate) education and occupational briefing in that domain.

[A woman at the chair is nothing out of the ordinary. Dental practice by female dentists in the Netherlands.] / Een vrouw aan de stoel is heel gewoon. De beroepsuitoefening van vrouwelijke tandartsen in Nederland.

Women currently make up 40% of the dentist population in the Netherlands. On the basis of enrolment in educational programmes their share can be expected to grow to more than half. The literature shows gender differences in preferences regarding work setting and duration of the working week. Men and women also differ from each other with respect to the way dental care is provided. The presented data demonstrate an increase in the number of women working in dentistry and research data have confirmed the presumed differences between male and female dentists. Women are less likely to be the owner of a practice, women who do own a practice are more likely to collaborate with colleagues and have a shorter working week. With regard to providing dental care, women seem to be slightly more orientated to the individual patient and are more likely to pay attention to the patient's general health. Theories about work values provide explanations for these gender differences. Women's preference for collaboration accords with the general development in dental care to work in teams.

Dentists' opinions on knowledge, attitudes and barriers in providing oral health care to older people living independently in the Netherlands and Flanders (Belgium).

OBJECTIVES: The aim of this study was to investigate how dentists in the Netherlands and Flanders assessed their knowledge on oral health care to older people, what their attitude was and what barriers they experienced in rendering care to older people. METHODS: The survey data was collected from a random sample of Dutch and Flemish dentists. Five hundred ninety-five dentists (37%) of the Dutch sample and 494 dentists of the Flemish sample (41%) completed the online questionnaire. Dentists were asked to respond to 15 Likert type items, representing opinions on provision of oral health care to older people and to give information about the number of older patients treated and about some profession-specific and personal characteristics. RESULTS: The average number of patients treated per week was nearly twice as high in the Netherlands as in Flanders. Nevertheless, differences of opinions between dentists in the Netherlands and Flanders were relatively limited. CONCLUSIONS: This survey shows that in particular the actual number of older patients treated appears to be related with differences of opinions between Dutch and Flemish dentists about oral health care provided to (vulnerable) older people who live at home.

[A paradigmatic change in the management of caries in children: 'Gewoon Gaaf']. / Een omslag in cariësbehandeling bij kinderen: 'Gewoon Gaaf'.

This is a position paper about 'Gewoon Gaaf' ['Just Smooth'], a paradigmatic change in the management of caries in children with a special focus onprevention. Caries is now considered a disease related to behaviour. Behavioural changes are essential in the prevention of caries because only patient's self care can keep caries under control. It is the task of the oral care provider to alert parents and child to their own influence on the development of caries and particularly on how to keep this process under control. Evaluations have revealed that the traditional form of preventive care has hardly improvedoral health. In contrast, various studies have shown the good results of the 'Gewoon Gaaf' approach. Moreover it fits in well with the public debate, which puts more and more attention on efficiency and transparency in the care.

[Evidence-based clinical practice guidelines in oral care 2: process and content of evidence-based guideline development]. / Evidencebased klinische praktijkrichtlijnen in de mondzorg 2. Proces en inhoud van evidencebased richtlijnontwikkeling.

In 2014, an advisory report was published by a national working committee concerning how the current, applied method of evidence-based guideline development in healthcare can be used in oral care in a national guideline programme. In an independent Institute of Knowledge Translation in Oral Care, as yet to be established, primary and secondary oral care providers will participate in the programme in order to improve the quality of oral care in the Netherlands. With the launching of the Institute of Knowledge Translation in Oral Care, clinical guideline development will have the benefit of a structural approach, in which 3 successive steps can be distinguished: preparation, development and authorisation. In each of these steps, oral care providers and associations will be actively involved. In this way the aim is to give as much consideration as possible to the needs of those in the field of oral care in the choice of topics for guideline development and to secure the specific character of oral care in the actual establishment of guidelines for clinical practice.

[The well-being of dentists following a complaint procedure]. / Het welbevinden van tandartsen na een klachtenprocedure.

It is known that a patient's complaint can have a serious impact on the well-being of dentists. But little is known on the nature and the extent of this impact. That's why in 2013 an anonymous survey was conducted among 955 dentists and dental specialists, for whom in the period mid-2008 to mid-2013 a complaint was handled through the Complaint Committee of the Royal Dutch Dental Association (KNMT). Altogether, 413 (43%) of them participated in the study. 71% of the respondents reported that the complaint had influenced their professional practice. 52% reported that it had (also) influenced their attitude towards colleagues and patients, and 60% (also) experienced an impact on their mental and/or physical condition. Altogether, 68% reported that they had unpleasant feelings and 75% stated that the treatment relationship with the patient was terminated as a result of the complaint.