A qualitative study examining the preparedness of dental hygiene students for a service-learning placement in residential aged care.

INTRODUCTION: The aim of this qualitative study was to measure the effect of a specifically designed orientation re-enactment DVD used to facilitate dental hygiene students transition from the classroom to a Residential Aged Care Facility (RACF) service-learning placement with less personal anxiety and more confidence in their role during the placement. METHODOLOGY: Final year students (n = 47) were randomly allocated to one of 17 RACFs on the NSW, Central Coast, Australia. All students were then randomly allocated to a two-group study with the active group assigned to view the DVD prior to their placement. Students who viewed the DVD were asked not to discuss the content with students who were assigned to the control group. Post-placement focus groups were organized, recorded and transcribed verbatim. Data were collated, analysed and unitized into emergent themes. Representative quotes are presented in the results. The study was informed by 4 years of previous quantitative and qualitative process evaluation of the RACF programme. RESULTS: Focus group discussions identified that those students who had seen the DVD reported a shorter timeframe to successfully transition from the classroom to the RACF and stated that the DVD provided them with a realistic expectation of the RACF environment and their role in the placement experience. CONCLUSION: The orientation DVD reduced student anxiety and improved student confidence in their role during the placement by providing a realistic orientation of the RACF environment.

Preventive management plans recorded by dental therapists and oral health therapists using clinical vignettes for adolescents accessing public oral health services in New South Wales, Australia.

BACKGROUND: The aim of this study was to investigate factors that influence dental therapists and oral health therapists (therapists) plan preventive oral health care for adolescents attending New South Wales public oral health services. METHODS: A cross-sectional postal survey using two clinical vignettes was used to record the preventive care treatment plans offered by therapists working across 15 New South Wales local health districts. Data were tabulated and chi-square statistics used in the analysis. RESULTS: One hundred and seventeen therapists returned questionnaires, giving a 64.6% response rate. The participants highlighted the importance of offering oral hygiene instruction (97.0%), dietary advice (95.0%) and topical fluoride applications (74.0%). Recommended home use products included fluoride toothpaste 5000 ppmF (59.0%) and casein phosphopeptide-amorphous calcium phosphate plus fluoride (CPP-ACPF) paste (57.7%). Over 50% used fissure sealants. More respondents (88%) would utilize motivational interviewing strategies for a patient with dental caries concerns; however, only 63% would use this technique for a patient in pain (p < 0.001). CONCLUSIONS: Considerable variations were noted in therapists' recommendations for stabilizing and managing dental disease, suggesting a need for clinical directors to consider providing more advice to therapists on the scientific basis of preventing dental caries.

An assessment of the educational value of service-learning community placements in residential aged care facilities.

AIMS: The aim of this study was to determine whether dental hygiene students attending residential aged care facilities (RACFs) during a placement programme gained any knowledge about the oral care of elderly patients and the RACF environment. LOCATION: Aged Care Facilities on the Central Coast of New South Wales, Australia. METHODOLOGY: Final year dental hygiene students undertook a 12-week placement, one day per week, in one of 17 residential aged care facilities on the NSW Central Coast. They were asked to complete pre-placement and post-placement questionnaires, which recorded their knowledge of medical, dental and environmental issues related to older people. The placement questionnaires used five point Likert scales, ranging from strongly agree to strongly disagree, pre- and post-mean scores were produced for each question and P values calculated using a paired t-test. RESULTS: Thirty-three students attended the placement, 26 (79%) completed both the pre- and post-placement questionnaires. Post-placement mean scores as compared to pre-placement mean scores showed significant improvement in student knowledge of medical (P < 0.05) and dental (P < 0.05) conditions specific to the older person and improvement in knowledge (P < 0.05) about the residential aged care facility environment. CONCLUSION: The placement programme enhanced student knowledge across three subject categories; medical and dental conditions of the older person and the structure and services of the residential aged care environment.

Reflective folios for dental hygiene students: what do they tell us about a residential aged care student placement experience?

INTRODUCTION: Community-based education programmes provide students with an experiential learning opportunity in a real-life context. The purpose of this study was to examine reflective journals to identify students' experiences and perceived learning during a 12-week placement programme in residential aged care facilities (RACF) on the NSW Central Coast, Australia. METHODOLOGY: All final year dental hygiene students from the University of Newcastle, Australia attended an aged care orientation workshop prior to commencing the RACF student placement programme. Throughout the placement, students were asked to record their educational experiences in reflective journals. Student reflections were based on the 'Gibbs Reflective Cycle', diarising experiences and feelings. Qualitative data was analysed using the constant comparative method and unitised to identify emergent themes. RESULTS: Sixty-seven students completed reflective journals during the placement programme; emergent themes indicated students felt ill-prepared for the placement programme despite attending the orientation workshop. They were apprehensive and nervous prior to commencement of the placement. The general consensus after week 6 was that the placement became a more positive experience where students began to feel comfortable in the RACF environment and residents, and staff started to respond more positively to their presence. Overall, they thought the placement was challenging and confronting, but had improved their skills and knowledge in care of older people and increased their confidence in working with other healthcare professionals. CONCLUSION: The reflective journals provided students with the opportunity to record and reflect on their experience and perceived learning during the placement programme. Student reflections identified negative experiences at the commencement of the placement, suggesting a need for additional orientation prior to the RACF programme.

The views of dentists on their participation in a primary care-based research trial.

AIMS: To determine the attitudes and opinions of dentists undertaking research in primary care dental practices, about the value of research in primary care. METHOD: The data were collected during a face-to-face interview utilising a schedule of open and closed questions, which were used to guide the interview. RESULTS: Twenty-seven of the 40 primary care dentists (67.5%) who had participated in a five-year primary care clinical trial completed the interview. All the respondents believed that primary care research was important and should be of relevance to their practice, but only 12 (44%) thought it was important they carried out this research. The majority (96%) of respondents felt it did not pay financially to do research as a primary care practitioner and 12 (44%) thought research in primary care was too time consuming, but 25 (92%) were prepared to get involved in a primary care research group. Five (56%) salaried service (SS) practitioners and 14 (78%) general dental services (GDS) dentists felt they did not have enough experience, skills or knowledge to conduct their own research. Significantly more salaried dentists compared with GDS dentists felt adequately supported to do primary care research. CONCLUSION: Future research in primary care should be focused on topics primary care practitioners feel of use to their clinical practice. A method of funding practitioners and providing time for them to complete research away from their clinical duties is necessary. There is a need for collaborative working with an academic institution, which can provide training and academic support for practitioners.

A randomised controlled trial of the effect of outreach placement on treatment planning by dental students.

UNLABELLED: Undergraduate dental students' curricula are being supplemented with primary care placements. OBJECTIVE: To compare the effect of outreach placement and traditional hospital-based training alone on students' treatment planning ability. DESIGN: Randomised controlled trial.Setting Four existing primary care placements in England during 2004. SUBJECTS AND METHODS: At follow-up the fourth-year students took a history from a standard 'patient' then recorded a treatment plan. Interview skill was scored. The history and plan were assessed by clinicians blind to the intervention. INTERVENTION: Five-week block outreach placements for 25 of 49 students. MAIN OUTCOME MEASURES: Interviewing skill, quality of dental and social histories, the appropriateness of planned treatments and the consideration of wider issues. RESULTS: The two groups were similar in the scores for interviewing and taking a dental history. The outreach group scored higher for capturing a social history (outreach mean 4.4, SD = 2.1, n = 22 and hospital 2.8, SD = 1.9, n = 23; p = 0.01) and for developing an appropriate treatment plan (5.6 [SD = 2.1] and 3.9 [SD = 2.3]; p = 0.01). There were no differences in scores relating to the wider issues. CONCLUSION: Dental outreach training was significantly more effective than traditional training alone in improving students' ability to capture relevant points of social history from a patient and to consider them when planning treatment.

Developing dental education in primary care: the student perspective.

A pilot outreach course in restorative dentistry based in community clinics began in 2001. As part of the evaluation, 48 fourth year students completed a questionnaire about their opinions of the new course, and about restorative dentistry clinics in the dental hospital. Time management was the most frequently mentioned gain from outreach. In relation to the dental school, students most often saw the specialised teaching staff as a gain. Outreach was equally or more important for students' confidence in clinical diagnosis of dental caries, treatment planning, direct restorations, communicating with patients, and managing patients, time, and resources. The dental hospital was equally or more important for their confidence in the diagnosis of periodontal disease, root planing, crowns, bridges, dentures, and communicating effectively with laboratory staff. Patients in outreach were seen as different from those at the dental hospital because they were unselected, and had different treatment needs. Meeting course requirements was the most frequent concern about outreach. In relation to the dental hospital, students were most often concerned about the quality of teaching and support available. Outreach and the dental hospital provided complementary experiences and the new course met its educational objectives.

Caries among 3-year-olds in greater Manchester.

OBJECTIVE: To measure the prevalence of caries, including nursing caries, amongst 3-year-old children in three districts of Greater Manchester in the North West of England. DESIGN: A cross-sectional survey of 762 randomly selected 3-year-old children using the dmft and dmfs indices. Three definitions of nursing caries were used in order to assess the varying prevalence of the disease according to which definition was applied. SUBJECTS: Children, aged 36-48 months, attending day nurseries, play groups and nurseries attached to primary schools were examined by three trained examiners under standardised conditions in three health districts in Greater Manchester. A random selection process was used to produce a quota sample to reflect the balance of childcare provision in each district. RESULTS: The overall proportion of children affected by general caries was 32%. The mean dmft score was 1.4 (sd = 2.8) and the mean dmfs was 2.8 (sd = 7.3). There were significant differences across the three districts. The prevalence of nursing caries varied widely when differing definitions of types were applied; 1.6% of the children had nursing caries according to the narrow definition, 7.2% showed the wider definition type and 9.8% had nursing caries of the broadest definition. In total 19% of children had caries which affected their upper incisors. Children of Asian origin had the highest levels of nursing and overall caries. CONCLUSIONS: Caries is a widespread problem in some very young children in the districts involved. Caries of upper anterior teeth contributes significantly to the overall level of caries in each of the localities in question. The prevalence of nursing caries is highly dependent on the case definition used.

A profile of the dentists working in the community dental service in the United Kingdom in 1999.

AIM: To profile the staff in the community dental service (CDS) in terms of qualifications, clinical service provisions and gender. METHOD: Postal questionnaire to all clinical dental service managers in the United Kingdom. RESULTS: The response rate was in the order of 99%. A higher proportion (67.5%) of community dental staff are women, but they are more likely (P < 0.001) to work part time. There were a higher proportion of men (14.1%) in the most senior management grade when compared with women (6.1%). A postgraduate qualification is relatively common, but men are more likely (P < 0.001) to have a higher qualification. The CDS provides a wide range of services centering on clinical care for adults and children, special needs care, epidemiology and health promotion. Most managers tended to have a clinical role. CONCLUSIONS: Women play an important part in the CDS. They are more likely to work part time, tend to occupy lower positions in the organisation and are less likely to have a postgraduate qualification than men.

Dental attendance and dental health behaviour in children from deprived and non-deprived areas of Salford, north-west England.

AIMS: Firstly, to investigate reported oral health behaviours and changes in behaviour of 3-year-old children in deprived and non-deprived wards of Salford, UK. Secondly, to examine differences in this behaviour between symptomatic and non-symptomatic attenders. Thirdly, to note sources of dental health advice given to parents. DESIGN: Interviews using structured questionnaires. SETTING: Play groups and nurseries in Salford, North-West England. METHOD: Interviews with representative groups of mothers of 3-year-old children attending play groups and nurseries in selected deprived and non-deprived wards, enquiring about dental attendance, dental health behaviour and changes in these resulting from dental advice. RESULTS: Mothers of 284 children were interviewed. Over three-quarters of the children were reported to have a drink or food at bed-time, or during the night, often containing non-milk extrinsic sugars (NMES); more in the deprived wards. All parents reported a tooth brushing habit with over 90% using a fluoride toothpaste, those in non-deprived wards beginning earlier in life and brushing more frequently. Most parents claimed that their children had seen a dentist at some time; more in the non-deprived wards. More children in deprived wards were symptomatic attenders sometimes experiencing extractions under general anaesthesia. More parents in deprived wards remembered receiving dental health advice from the dental team and were more inclined to act on that advice. CONCLUSION: Children from deprived wards were reported to have different dental health habits from those from non-deprived wards. They were more likely to be fed NMES in food and drinks at bedtime, begin brushing later in life and brush less frequently and attend the dentist symptomatically. Their parents claimed to have received more dental health advice from the dental team and were more likely to act on that advice.

The aetiology of dento-alveolar injuries and factors influencing attendance for emergency care of adolescents in the north west of England.

The aims of the study were to determine the main aetiological factors involved in injuries to anterior teeth and to identify factors influencing the attendance for emergency care. This information is essential, first, for planning dental health education programmes aimed at reducing the incidence of dental trauma and, second, to devise strategies for its effective treatment. Of 2022 schoolchildren examined for evidence of dental trauma, 696 (34%) had experienced injury and were interviewed regarding this injury. Of these, 403 knew about their damaged front tooth, but only 330 recollected the incident causing the injury. Over one third of accidents occurred at home and a further 25% at school. The most common cause of injury was falling onto a hard surface or object (34%) with accidents involving bicycles or other sporting activities accounting for a further 30%. Factors found to be significantly related to attendance for emergency care were experience of pain, unattractive appearance of the injured tooth and social classification, with children from higher income, more affluent areas being more likely to seek treatment. The majority of dental injuries were the result of genuine accidents which were almost impossible to prevent. This study highlighted the need for attention to be brought to parents, children, lay people and health care professionals that all dental injuries should be examined by a dentist, not just those injuries resulting in pain or poor aesthetics.

A cluster randomized controlled trial testing the effectiveness of a school-based dental health education program for adolescents.

OBJECTIVES: This trial investigated the value of a school-based dental health education program in terms of changes in knowledge, reported behavior, and plaque scores. METHODS: A total of 2,678 pupils with a mean age of 12.1 years attending 28 schools participated in a school-based dental health education program. The study used a cluster randomized controlled study design. The health service administrators stipulated that all participants receive the intervention; to meet this requirement, a rolling program of two six-month periods was utilized. During the first six months, half the adolescents received the intervention program, the other half acting as controls. Throughout a further six-month period, all participants received the intervention program. This research design allowed comparisons between participants receiving the program for six and 12 months. At baseline, six, and 12 months, a random subsample of 40 children in each participating school had their plaque scores recorded and a questionnaire was used to record their knowledge of dental health and reported dental behavior. RESULTS: The analysis used the subjects clustered within the schools, which were the units of randomization. The intervention program produced statistically significant improvements (P < .001) in knowledge about periodontal disease and the frequency of sugar intake and dental caries in both assessment time periods. The reported frequency of brushing did not change, but the group who had received 12 months of the intervention were more likely (P < .05) to brush for over a minute. At six months the early intervention group had a statistically significant, 13 percent reduction in the mean proportion of sites with plaque compared with the late intervention group (P = .043). This difference was sustained at 12 months (P = .037). CONCLUSION: This cluster randomized control trial demonstrated that the intervention program resulted in an improvement in knowledge of dental disease and an increase in the reported duration of brushing. These improvements were accompanied by a significant improvement in oral hygiene and a reported reduction in gingival bleeding.