The CALM trial protocol: a randomised controlled trial of a guided self-help cognitive behavioural therapy intervention to reduce dental anxiety in children.

BACKGROUND: Globally, around 13% of children experience dental anxiety (DA). This group of patients frequently miss dental appointments, have greater reliance on treatment under general anaesthesia (GA) and have poorer oral health-related quality of life (OHRQoL) than their non-dentally anxious peers. Recently, a low-intensity cognitive behavioural therapy (CBT)-based, self-help approach has been recommended for management of childhood anxiety disorders. A feasibility study conducted in secondary care found this guided self-help CBT resource reduced DA and a randomised controlled trial was recommended. The present study aims to establish the clinical and cost-effectiveness of a guided self-help CBT intervention to reduce DA in children attending primary dental care sites compared to usual care. METHODS: This 4-year randomised controlled trial will involve 600 children (aged 9-16 years) and their parent/carers in 30 UK primary dental care sites. At least two dental professionals will participate in each site. They will be assigned, using random allocation, to receive the CBT training and deliver the intervention or to deliver usual care. Children with DA attending these sites, in need of treatment, will be randomly allocated to be treated either by the intervention (CBT) or control (usual care) dental professional. Children will complete questionnaires relating to DA, OHRQoL and HRQoL before treatment, immediately after treatment completion and 12 months post-randomisation. Attendance, need for sedation/GA and costs of the two different approaches will be compared. The primary outcome, DA, will be measured using the Modified Child Dental Anxiety Scale. Scores will be compared between groups using a linear mixed model. DISCUSSION: Treating dentally anxious patients can be challenging and costly. Consequently, these children are frequently referred to specialist services for pharmacological interventions. Longer waiting times and greater travel distances may then compound existing healthcare inequalities. This research will investigate whether the intervention has the potential to reduce DA and improve oral health outcomes in children over their life-course, as well as upskilling primary dental healthcare professionals to better manage this patient group. TRIAL REGISTRATION: This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420).

Dental undergraduate students' perceptions about placements in primary dental care during the undergraduate dental curriculum: a qualitative evidence synthesis.

Introduction The General Dental Council has advised that undergraduate dental students spend time in primary care, with their experiences evaluated. A systematic review of medical students' primary care placements has been performed but no similar review of dental students is present. This review aimed to synthesise reported opinions of UK dental students on their placements in primary care.Methods Medline, Embase, Education Resources Information Center and Cumulative Index to Nursing and Allied Health Literature were searched for qualitative data studies involving UK dental students who had been on placement during training. The qualitative Critical Appraisal Skills Programme guidance was used to appraise studies and a best fit framework synthesis employed.Results Students generally portrayed positive accounts of placements. Themes relating to learning environment, support for learning, real world dentistry, preparation for practice life and competing cultures were developed.Discussion Students thrived when hierarchy between themselves and their supervisors was flattened but the competing cultures of the dental hospital and placements appear to be an area that needs addressing. There are vast differences in the placements being offered.Conclusions Undergraduates mostly enjoy and value their time on placement; however, further research in the area is needed to explore the different kinds of placements available and to inform policy on providing effective training.

Perceptions of foundation dentists on minor oral surgery teaching in dental foundation training.

AIMS: The aim of this service evaluation was to explore the experiences of foundation dentists (FDs) during their dental foundation year (DFT) in the field of oral surgery and surgical extractions. METHODS: A phenomenological approach was taken aiming to explore the FDs' experiences through a qualitative design. All FDs in the region deemed eligible for the evaluation were invited to attend a semi-structured interview or answer a qualitative questionnaire when attending for their exit interview at the completion of DFT. The interviews were then transcribed and thematic analysis was undertaken. RESULTS: 79 FDs took part in the evaluation, representing 86% of trainees eligible for inclusion. Findings showed that not all FDs had the opportunity to undertake surgical extractions independently during the year. Data was analysed and 4 main themes generated when evaluating FDs' experiences; specific learning encounters, influence of the educational supervisor, supportive learning environment and ready for independent practice. CONCLUSIONS: This evaluation shows that there are a number of factors associated with FDs' experience during DFT, and not all FDs are leaving the training with a positive experience, with a query as to whether they are fulfilling the aims of training to become an "independent practitioner." It poses questions about what can be done to improve future training and what exactly does DFT need to achieve in terms of experience in surgical extractions.