Oral care, loss of personal identity and dignity in residential care homes.

OBJECTIVE: The UK National Institute of Clinical Excellence (NICE) guidelines recommend that care staff who provide daily personal care to residents: "Understand the importance of residents' oral health and the potential effect on their general health, well-being and dignity." The aim of this study was to explore residents' views and perspectives of dental care in care homes in order to understand how to deliver this care. METHOD: Care homes were identified using care home inspection reports for Wales, the UK. Care homes for older people with residents having mental capacity to consent were invited to participate. Data were collected using semi-structured one-to-one interviews with care home residents, care home managers and oral healthcare leads. Interviews were audio recorded, transcribed and analysed using a thematic approach to data. Analysis was assisted by NVivo 10 software. Data collection was completed when no new themes emerged. RESULTS: This analysis presents findings from 26 interviews with residents, across five care homes. Going into care was associated with a loss of identity. Having teeth and looking after teeth (natural teeth or dentures) was part of keeping that identity. All prioritised privacy, pride and independence above effective oral hygiene. Oral hygiene was viewed as a very private event. Carers adapted oral care, to balance time constraints, care, privacy and dignity. Teeth were a part of personal pride to the extent that two residents said they did not want to die without dentures in their mouths. CONCLUSION: Whilst oral care is important to residents, dignity and privacy are often more important; care routines and practices are adapted around this. Carers need to adopt an individualised, pragmatic and sensitive approach to oral care to account for personal dignity when looking after residents to be able to provide appropriate oral care in accordance with guidance. Members of the dental team need to support carers to provide effective oral care, which allows dignified and effective care.

Aerosol and splatter generation with rotary handpieces used in restorative and orthodontic dentistry: a systematic review.

INTRODUCTION: The COVID-19 pandemic has caused major disruptions in dental care globally, in part due to the potential for contaminated aerosol to be generated by dental activities. This systematic review assesses the literature for changes in aerosol-contamination levels when rotary instruments are used, (1) as distance increases from patient's mouth; (2) as time passes after the procedure; and (3) when using different types of handpieces. METHODS: The review methods and reporting are in line with PRISMA statements. A structured search was conducted over five platforms (September 2021). Studies were assessed independently by two reviewers. To be eligible studies had to assess changes in levels of aerosol contamination over different distances, and time points, with rotary hand instruments. Studies' methodologies and the sensitivity of the contamination-measurement approaches were evaluated. Results are presented descriptively. RESULTS: From 422 papers identified, 23 studies were eligible. All investigated restorative procedures using rotary instruments and one study additionally looked at orthodontic bracket adhesive material removal. The results suggest contamination is significantly reduced over time and distance. However, for almost all studies that investigated these two factors, the sizes of the contaminated particles were not considered, and there were inconclusive findings regarding whether electric-driven handpieces generate lower levels of contaminated particles. CONCLUSION: Aerosol contamination levels reduce as distances, and post-procedure times increase. However, there was sparce and inconsistent evidence on the clearing time and no conclusions could be drawn. High-speed handpieces produce significantly higher levels of contamination than slow-speed ones, and to a lesser extent, micro-motor handpieces. However, when micro-motor handpieces were used with water, the contamination levels rose and were similar to high-speed handpiece contamination levels.

Professionalism and dental education: in search of a shared understanding.

Professionalism has profound historical origins; however, the current health care environment in the UK dental sphere is changing, which presents new professional dilemmas that require continued learning and debate. Professionalism is a key aspect of the education of dental students and the lifelong learning and development of dental practitioners. However, 'being' professional can be challenging because while it is recognised as a social good, there is much debate on what professionalism means and how best it can be learned and assessed. Since 2017, the UK Council for the Dental Teachers of Professionalism, consisting of educators from UK dental schools and dental therapy hygiene institutions, has been exploring and debating the role and place of professionalism, as well as sharing challenges and good practice within UK dental education. This paper includes a narrative overview of current thinking in the academic literature on professionalism to consider the use of a shared understanding of professionalism to facilitate conversations between various stakeholders.

Online videos: The hidden curriculum.

INTRODUCTION: Dental undergraduates will access the Internet searching for learning materials to complement their training; however, open access content is not generally recommended by dental schools. This study aimed to evaluate how dental students are using online video content. MATERIALS AND METHODS: Students from eight Universities (Athens, Birmingham, Brescia, Cardiff, Melbourne, Paris, Sao Paulo and Valdivia) representing three continents were invited to complete a survey on their access and learning from online videos. RESULTS: International students behave similarly when studying dental content online. Of 515 respondents, 94.6% use the Internet as a learning tool. It was observed that videos are not frequently recommended during didactic lectures (9.6%). But many students (79.9%) will use YouTube for their learning which includes clinical procedures. Students will check online content before performing procedures for the first time (74.8%), to understand what was explained in class (65.9%) or read in books (59.5%), to relearn clinical techniques (64.7%) and to visualise rare procedures (49.8%). More than half of the students do not fully trust the accuracy or the reliability of online content. This does not prevent students from watching and sharing dental videos with classmates (64.4%). The content watched is not shared with teachers (23.3%) even when it contradicts what was learnt in the school (38.2%). CONCLUSION: This study concludes that students regularly integrate open access digital resources into learning portfolios but are hesitant to inform their teachers about their viewing habits. Students wish to receive critical skills on how to evaluate the material they encounter outside their traditional learning space.

Development of a United Kingdom-centric cost-effectiveness model for denture cleaning strategies.

STATEMENT OF PROBLEM: Denture stomatitis is a prevalent condition in denture wearers. Economic evaluations of health care can help stakeholders, including patients, make better decisions about treatments for a given condition. Economic models to assess the costs and benefits of different options for managing denture stomatitis are lacking. PURPOSE: The purpose of this study was to explore the feasibility of developing a cost-effectiveness model to assess denture cleaning strategies aimed at preventing denture stomatitis from a denture-wearer perspective in the United Kingdom. MATERIAL AND METHODS: A model was developed to identify and estimate the costs and effects associated with 3 denture cleaning strategies. These were low care (LC)-cleaning by brushing and soaking overnight in water; medium care (MC)-brushing with toothpaste and soaking overnight in water; and optimum care (OC)-brushing and soaking overnight in water and antimicrobial denture cleanser. Costs, outcome measures (denture stomatitis-free days), and probabilities (incidence of stomatitis, unscheduled dentist visits, prescription charges, self-medication) associated with each strategy were defined. A sensitivity analysis was used to identify key drivers and test the robustness of the model. RESULTS: The model showed that the total costs for 2015 ranged from £1.07 (LC) to £18.42 (OC). Costs associated with LC were derived from unscheduled dentist visits and use of medication and/or prescription charges. Incremental costs per denture stomatitis-free day were £0.64 (MC) and £1.81 (OC) compared with LC. A sensitivity analysis showed that varying either or both key parameters (baseline incidence of denture stomatitis and relative effectiveness of MC and OC strategies) had a substantial effect. Incremental cost-effectiveness ratios ranged from £4.11 to £7.39 (worst-case scenario) and from £0.21 to £0.61 (best-case scenario). CONCLUSIONS: A model was developed to assess the relative cost-effectiveness of different denture cleaning strategies to help improve denture hygiene. An important finding of the study was the lack of evidence on the relative effectiveness of different cleaning strategies, meaning that several assumptions had to be incorporated into the model. The model output would therefore likely be considerably improved and more robust if these evidence gaps were filled.

Dental periodontal procedures: a systematic review of contamination (splatter, droplets and aerosol) in relation to COVID-19.

INTRODUCTION: The emergence of the SARS-CoV-2 virus and subsequent COVID-19 pandemic has had a significant effect on the delivery of routine dentistry; and in particular, periodontal care across the world. This systematic review examines the literature relating to splatter, droplet settle and aerosol for periodontal procedures and forms part of a wider body of research to understand the risk of contamination in relation to periodontal care procedures relevant to COVID-19. METHODS: A search of the literature was carried out using key terms and MeSH words relating to the review questions. Sources included Medline (OVID), Embase (OVID), Cochrane Central Register of Controlled Trials, Scopus, Web of Science and LILACS, ClinicalTrials.Gov . Studies meeting inclusion criteria were screened in duplicate and data extraction was carried out using a template. All studies were assessed for methodological quality and sensitivity. Narrative synthesis was undertaken. RESULTS: Fifty studies were included in the review with procedures including ultrasonic scaling (n = 44), air polishing (n = 4), prophylaxis (n = 2) and hand scaling (n = 3). Outcomes included bacterial (colony-forming units e.g. on settle plates) or blood contamination (e.g. visible splatter) and non bacterial, non blood (e.g. chemiluminescence or coloured dyes) contamination. All studies found contamination at all sites although the contamination associated with hand scaling was very low. Contamination was identified in all of the studies even where suction was used at baseline. Higher power settings created greater contamination. Distribution of contamination varied in relation to operator position and was found on the operator, patient and assistant with higher levels around the head of the operator and the mouth and chest of the patient. Settle was identified 30 min after treatments had finished but returned to background levels when measured at or after an hour. The evidence was generally low to medium quality and likely to underestimate contamination. CONCLUSION: Ultrasonic scaling, air polishing and prophylaxis procedures produce contamination (splatter, droplets and aerosol) in the presence of suction, with a small amount of evidence showing droplets taking between 30 min and 1 h to settle. Consideration should be given to infection control, areas of cleaning particularly around the patient and appropriate personal protective equipment, with particular attention to respiratory, facial and body protection for these procedures. In addition, the use of lower power settings should be considered to reduce the amount and spread of contamination.

Professional consensus on orthodontic risks: What orthodontists should tell their patients.

INTRODUCTION: Effective communication of risk is a requisite for valid consent, shared decision-making, and the provision of person-centered care. No agreed standard for the content of discussions with patients about the risks of orthodontic treatment exists. This study aimed to produce a professional consensus recommendation about the risks that should be discussed with patients as part of consent for orthodontic treatment. METHODS: A serial cross-sectional survey design using a modified electronic Delphi technique was used. Two survey rounds were conducted nationally in the United Kingdom using a custom-made online system. The risks used as the prespecified items scored in the Delphi exercise were identified through a structured literature review. Orthodontists scored treatment risks on a 1-9 scale (1 = not important, 9 = critical to discuss with patients). The consensus that a risk should be discussed as part of consent was predefined as ≥70% orthodontists scoring risk as 7-9 and <15% scoring 1-3. RESULTS: The electronic Delphi was completed by 237 orthodontists who reached a professional consensus that 10 risks should be discussed as part of consent for orthodontic treatment; demineralization, relapse, resorption, pain, gingivitis, ulceration, appliances breaking, failed tooth movements, treatment duration, and consequences of no treatment. CONCLUSIONS: A professional orthodontic consensus has been reached that 10 key risks should be discussed with patients as part of consent for orthodontic treatment. The information in this evidence base should be tailored to patients' individual needs and delivered as part of a continuing risk communication process.

A systematic review of contamination (aerosol, splatter and droplet generation) associated with oral surgery and its relevance to COVID-19.

INTRODUCTION: The current COVID-19 pandemic caused by the SARS-CoV-2 virus has impacted the delivery of dental care globally and has led to re-evaluation of infection control standards. However, lack of clarity around what is known and unknown regarding droplet and aerosol generation in dentistry (including oral surgery and extractions), and their relative risk to patients and the dental team, necessitates a review of evidence relating to specific dental procedures. This review is part of a wider body of research exploring the evidence on bioaerosols in dentistry and involves detailed consideration of the risk of contamination in relation to oral surgery. METHODS: A comprehensive search of Medline (OVID), Embase (OVID), Cochrane Central Register of Controlled Trials, Scopus, Web of Science, LILACS and ClinicalTrials.Gov was conducted using key terms and MeSH (Medical Subject Headings) words relating to the review questions. Methodological quality including sensitivity was assessed using a schema developed to measure quality aspects of studies using a traffic light system to allow inter- and intra-study overview and comparison. A narrative synthesis was conducted for assessment of the included studies and for the synthesis of results. RESULTS: Eleven studies on oral surgery (including extractions) were included in the review. They explored microbiological (bacterial and fungal) and blood (visible and/or imperceptible) contamination at the person level (patients, operators and assistants) and/or at a wider environmental level, using settle plates, chemiluminescence reagents or air samplers; all within 1 m of the surgical site. Studies were of generally low to medium quality and highlighted an overall risk of contaminated aerosol, droplet and splatter generation during oral surgery procedures, most notably during removal of impacted teeth using rotatory handpieces. Risk of contamination and spread was increased by factors, including proximity to the operatory site, longer duration of treatment, higher procedural complexity, non-use of an extraoral evacuator and areas involving more frequent contact during treatment. CONCLUSION: A risk of contamination (microbiological, visible and imperceptible blood) to patients, dental team members and the clinical environment is present during oral surgery procedures, including routine extractions. However, the extent of contamination has not been explored fully in relation to time and distance. Variability across studies with regards to the analysis methods used and outcome measures makes it difficult to draw robust conclusions. Further studies with improved methodologies, including higher test sensitivity and consideration of viruses, are required to validate these findings.

Exploring dentists' professional behaviours reported in United Kingdom newspaper media.

Aim Stories of dentists and their professional behaviours can be communicated around the world through news media. This may influence people's perceptions of dentistry and their trust in professionals. The aim of this study was to explore reports of dentists and their professional behaviours in newspaper media.Method All articles which included the term 'dentist' alongside 'professional' or 'misconduct' or 'behaviour' between 1 January 2016 and 31 October 2019 were retrieved from the ten most commonly read newspaper print media in the United Kingdom. Thematic analysis was undertaken following the application of inclusion and exclusion criteria.Results A total of 122 articles were identified. Key themes included poor practice, dishonesty and fraud, the killing of Cecil the lion, sexual misconduct, racism and crime. Many articles focused on a small number of extreme cases, labelling the dentists involved and sensationalising the stories. Reports did not reflect the majority of fitness to practise cases seen by the General Dental Council.Conclusion The sensationalist approach to the reporting of dental professional behaviours in the news may cause patients to have less trust in their dentist, and it is recommended that dentists and journalists work constructively together in the best interests of the public.

Relevance and paucity of evidence: a dental perspective on personal protective equipment during the COVID-19 pandemic.

The global COVID-19 pandemic, caused by the SARS-CoV-2 virus, has highlighted the importance of personal protective equipment (PPE) for health and social care personnel. This is a really important issue for dentistry, where we place great emphasis on infection control and universal precautions, given the nature of care provided. Cochrane have recently updated their review of PPE for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. It examined evidence on which type of full body PPE and which method of donning (putting on) or doffing (removing) are most effective, while having the least risk of contamination or infection for healthcare workers, as well as which training methods increase compliance with PPE protocols. The objective of this paper is to raise awareness of the above review of PPE, its findings and their relevance to dentistry as outlined in the Cochrane Oral Health website.The available evidence comes from healthcare generally, mostly involving simulation exercises, and is of low or very low certainty. None of the evidence specifically comes from dentistry.The findings in relation to the nature of PPE, methods of donning and doffing, and the importance of training are all of practical relevance to dentistry. Research is critically important to provide evidence for future decision making in support of patients and staff.

Professional standards in dental education.

The importance of quality-assured teaching development is recognised within the new 'Graduating European Dentist' curriculum. In addition, educators within higher education are now increasingly required to demonstrate good standing in terms of education and educating their profession. Standards and expectations exist within the discipline of medicine, but there is little in the way of a general professional standards document for dental education that accounts for the multitude of training and teaching development pathways available to the wider dental team. As such, this paper aims to examine models from established professional development frameworks that may be applied to standards for dental education, highlight important considerations for the development of standards for professional dental educational team development, and provide guidance for individuals wishing to plan, record, map and reflect on their professional educational development.

Dentistry: Studying for a chosen career and the role of family, friends and support in that journey.

INTRODUCTION: Well-being issues are increasing amongst dental students. Social relationships can be important for student support during their studies. The aim of the study was to explore dental students' feelings towards studying dentistry, social networks and chosen support during this journey. MATERIALS AND METHODS: An anonymous electronic cross-sectional survey was carried out. All dental students in a single dental school were invited to participate. Participation and answering questions was voluntary. Descriptive analyses were used for categorical data, and qualitative data were analysed thematically. RESULTS: In total, 109 students responded. One third reported having a family member from a healthcare profession but most were not related to dental professionals. The majority of students 83% liked the course, 14% said they felt "neutral", and 5% said they did not like it. The following three themes explained this: (a) demands of the course, (b) being suited to dentistry (eg patient care) and (c) passion for dentistry as a career (or lack of). Most felt their peers were friendly (92%) and supportive (78%) but also competitive (64%). Irrespective of stress, 70% of participants sought help from family and two thirds sought help from student peers. DISCUSSION: Most students enjoy studying dentistry despite the demands of the course. Support, workload, feeling suited to the course and a passion for dentistry as a career can affect the experience. CONCLUSIONS: Family and friends are an important source of support in this process. Further work is needed to explore mechanisms to help family and friends support students.

Work, Stress and Play: Students' perceptions of factors impacting on their studies and well-being.

INTRODUCTION: This study gathered information about life outside of the course for undergraduates studying at the School of Dentistry, Cardiff University. The aim was to explore how these external factors to the course may affect an individual's academic performance and well-being. MATERIALS AND METHODS: A cross-sectional study design was used. An online questionnaire designed for the purpose of the study was used to capture (quantitative and qualitative) data. Questions with dichotomous options, a range of statements with Likert scales (level of agreement) and open (free-text) questions were used. Data were analysed in SPSS using simple descriptive statistics and frequency distributions. Spearman's Rho was used to explore relationships for scaled categorical data. Content analysis was used for qualitative data. RESULTS: Two-thirds (n = 69, 63%) of participants reported being very stressed about their studies in the previous 12 months. The majority felt that external factors to their course (eg, lack of sleep, health issues, financial concerns, hobbies and issues with friends) had impacted on their academic lives with only 9% (n = 10) stating that their lives outside dentistry had no effect. DISCUSSION: Those who felt able to pursue hobbies and activities reported a better work-life balance and less stress. Questions about pursuing hobbies and sleep may help identify students at risk of being stressed or who may benefit from additional support in order to achieve a better work-life balance. CONCLUSION: This study has highlighted key areas for further investigation and opportunities for improving support to reduce student stress and improve well-being.

Family and friends: Supporting oral care in care homes.

OBJECTIVE: To consider the role of family and friends in supporting oral care. BACKGROUND: People who live in care homes are susceptible to oral health problems, which can be detrimental to their health and personal and social well-being. External support from family members and friends has been indicated as being important for maintaining oral health for this vulnerable group of care home residents. MATERIALS AND METHODS: Qualitative one-to-one interviews were undertaken with care home residents, in Cardiff, UK. Further interviews were undertaken with care home personnel with responsibility for oral health care in order to contextualise residents' interview data. Interviews were audio recorded, transcribed and analysed using a thematic approach. RESULTS: A total of 26 interviews were conducted with care home residents and four interviews with care home personnel, across five care homes. Three main themes emanated from the data relating to co-supporting oral care: supplying oral care products; accessing dental care and enabling self-management of oral care problems. There were no spouse caregivers; family and friends acted as co-supporters of oral care providing a link to residents' pre-care home lives by informing the care home personnel of their relatives' normal routines. An overarching theme "balancing roles - maintaining the equilibrium" emerged from the data reflecting the roles that both care home personnel and family and friends had in balancing the needs, care and well-being of the resident. CONCLUSION: This study suggests that there are opportunities to improve oral health by providing support for family and friends of those people who are living in care, especially in relation to supplying oral care products, enabling self-management of oral care problems and accessing dental care.

Adolescent perceptions of orthodontic treatment risks and risk information: A qualitative study.

INTRODUCTION: For effective risk communication, clinicians must understand patients' values and beliefs in relation to the risks of treatment. This qualitative study aimed to explore adolescent perceptions of orthodontic treatment risks and risk information. METHODS: Five focus groups were carried out with 32 school/college pupils aged 12-18 in Wales, UK. Participants were purposively selected and had all experienced orthodontic treatment. A thematic approach was used for analysis and data collection was completed at the point of data saturation. RESULTS: Four themes emerged from the data; (a) day-to-day risks of orthodontic treatment, (b) important orthodontic risk information, (c) engaging with orthodontic risk information and (d) managing the risks of orthodontic treatment. Day-to-day risks of orthodontic treatment that were affecting participants "here and now" were of most concern. Information about preventing the risks of treatment was deemed to be important. Participants did not actively seek risk information but engaged passively with information from convenient sources. Perceptions of risk susceptibility influenced participants' management of the risks of orthodontic treatment. CONCLUSIONS: This study demonstrates that adolescent patients can understand information about the nature and severity of orthodontic treatment risks. However, adolescent patients can have false perceptions if the risks are unfamiliar, perceived only to have a future impact or if seen as easy to control. Adolescent patients must be provided with timely and easily accessible risk information and with practical solutions to prevent the risks of treatment. CLINICAL SIGNIFICANCE: The views and experiences gathered in this study can assist clinicians to better understand their young patients' beliefs about treatment risks, facilitate effective risk communication and contribute to improved patient-centred care.

Dentist skill and setting to address dental treatment needs of care home residents in Wales.

OBJECTIVE: To explore the relationship between treatment plans, complexity anticipated in delivering those plans, and the special care dental skills and settings identified as appropriate. BACKGROUND: In older adults, many factors may complicate dental treatment including health and disability problems. Assessment of dental treatment needs amongst care home residents provides information about clinical care required and clinical experience needed for this population. MATERIAL AND METHODS: Analysis of dental data collected in a 2010 Welsh survey. Data analysed included treatment plan information, complexity assessment and dental expertise and settings required to deliver the treatment plans. RESULTS: The majority of participating residents needed simple dentistry, that is examinations, oral hygiene instruction, scaling of teeth, fillings, new dentures and fluoride application. Additional time was the commonest complexity factor. A large proportion of participants required dental treatment within a domiciliary setting. A similar proportion required care within a primary care setting (typically with care from a general dental practitioner) or a special care clinic (typically with care from a dentist with special care experience). Treatment plans involving specialists were more likely to be associated with poor general health, higher levels of interventional treatment and greater complexity. CONCLUSION: Most treatment need in care homes is basic restorative, periodontal and preventive care. Half of this could be managed by general dentists, some on a domiciliary basis and the rest in primary care dental clinics. The commonest complexity was additional time. More complex treatments were associated with care in clinics, skills in special care dentistry and multidisciplinary care.

Learning from a Special Care Dentistry Needs Assessment.

UNLABELLED: The General Dental Council recognised special care dentistry (SCD) as a speciality in 2008 and local service reviews have been carried out in order to develop SCD services. A needs assessment was completed to inform the implementation of recommendations from a 2010 review of SCD in Wales. AIM: The aim of this paper is to outline the process, findings and learning from the needs assessment and the implications for SCD. METHOD: A focused needs assessment approach was used. Stakeholder consultations were used to develop a working definition for the needs assessment. Data were collected from existing health and social care sources and analysed using descriptives and geographic information system (GIS) mapping. RESULTS: Data sources for needs assessment were limited. Analysis showed that health conditions were common in the population and increased with age. The majority of people who reported seeing a dentist were seen in general dental practice. Older people with health conditions were less likely to report seeing a dentist. Patients often needed to travel for specialist care services. CONCLUSION: General dental practice teams have a significant role in caring for SCD patients. Careful planning of specialist care, joint working and enhancing skills across the general practice team will reduce the burden of care and enhance patient safety. Improvements in data for assessment of SCD needs are required to help this process.

Dental decisions--an emotional experience?

UNLABELLED: This article discusses the psychological literature on emotion, highlighting the effect of emotion on decision-making. This is applied to the example of dentistry. CLINICAL RELEVANCE: This article explores how the everyday decisions of both the patient and the dentist are influenced by their emotions.