Nitrous oxide occupational exposure in conscious sedation procedures in dental ambulatories: a pilot retrospective observational study in an Italian pediatric hospital.

BACKGROUND: Nitrous oxide has a proven clinical efficacy in conscious sedation. At certain environmental concentrations it may pose a health risk to chronically exposed healthcare workers. The present pilot study aims at evaluating the exposure to nitrous oxide of dental ambulatory personnel of a pediatric hospital. METHODS: A descriptive study design was conducted in two phases: a bibliographic analysis on the environmental safety policies and a gas concentration analysis in the dental ambulatories of a pediatric hospital, detected every 6 months from December 2013 to February 2017 according to law provisions. The surveys were carried out using for gas analysis a photoacoustic spectrometer Innova-B&K "Multi-gas monitor model 1312" and Innova-B&K "Multi-sampler model 1309". The biological analysis and monitoring have been carried out on staff urine. RESULTS: The analyses were performed during 11 dental outpatient sessions on pediatric patients. All the patients were submitted to the same dental procedures, conservative care and dental extractions. The pediatric patients were 47 (23 males, 24 females; age range 3-17 years; mean age 6,63, SD ± 2,69) for a mean of 4,27 (SD ± 1,49) per session., The mean environmental concentration of nitrous oxide during the sessions was 24.7 ppm (SD ±16,16). A correlation was found between urinary nitrous oxide concentration of dentists (Pearson's correlation 0.786; p = 0.007) and dental assistants urines (Pearson's correlation 0.918; p < 0.001) and environmental concentrations of nitrous oxide. Weak negative correlations were found between age and sex of patients and environmental concentrations of nitrous oxide. The mean values of the biological monitoring data referring to all the outpatient sessions are lower than the reference values foreseen in accordance to the regulations in force on nitrous oxide concentration. CONCLUSIONS: The mean environmental concentration values recorded in our study are below the limit of 50 ppm considered as a reference point, a value lower than those reported in other similar surveys. The results of the present study provide a contribution to the need to implement technical standards, criteria and system requirements for the dental ambulatories, to date not yet completely defined, and cannot be assimilated to the ones established for the surgical rooms.

Evaluation of dental therapists undertaking dental examinations in a school setting in Scotland.

OBJECTIVE: To measure agreement between dental therapists and the Scottish gold-standard dentist undertaking National Dental Inspection Programme (NDIP) examinations. METHODS: A study of interexaminer agreement between 19 dental therapists and the national gold-standard dentist was carried out. Pre-calibration training used the caries diagnostic criteria and examination techniques agreed by the British Association for the Study of Community Dentistry (BASCD). Twenty-three 5-year-old children (Primary 1) and 17 11-year-old children (Primary 7) children were examined. Agreement was assessed using kappa statistics on d3 mft and D3 MFT for P1 and P7 children, sensitivity and specificity values, and kappa statistics on d3 t/D3 T and ft/FT. Calibration data on P1 and P7 children from 2009-2012 involving dentists as examiners were used for comparison. Economic evaluation was undertaken using a cost minimization analysis approach. RESULTS: The mean kappa score was 0.84 (SD 0.07) ranging from 0.69 to 0.94. All dental therapists scored good or very good agreement with the gold-standard dentist. This compares with historic NDIP calibration data with dentists, against the same gold-standard dentist, where the mean kappa value was 0.68 (SD 0.22) with a range of 0.35-1.00. The mean sensitivity score was 0.98 (SD 0.04) (range 0.88-1.0) and mean specificity score was 0.90 (SD 0.06) (range 0.78-0.96). Health economic analysis estimated that salary costs would be 33.6% lower if dental therapists were substituted for dentists in the year 2013, with an estimated saving of approximately £103 646 per annum on the national budget. CONCLUSION: We conclude that dental therapists show a high level of interexaminer agreement, and with the appropriate annual training and calibration, they could undertake dental examinations as part of the NDIP programme.

A randomized controlled trial of cluster audit and feedback on the quality of dental sealant for rural schoolchildren.

THE OBJECTIVE: To examine whether audit and feedback could improve the quality of the application of dental sealant in rural Thai school children. RESEARCH DESIGN: A single blind, cluster randomized controlled trial was conducted. CLINICAL SETTING: Hospital-based and school-based school sealant applied by dental nurses in Southern province of Thailand. PARTICIPANTS: Dental nurses and school children who received dental sealant were involved. INTERVENTION: The intervention consisted of confidential feedback of data and tailor-made problem-solving workshops. MAIN OUTCOME MEASURES: Sealant quality was measured by sealant retention and caries on sealed surfaces at six-month after sealing. The teeth examinations were done among different groups of children prior and after the intervention. RESULTS: After the intervention, the sealant retention rate increased dramatically in the intervention group, whereas in the control group the rate was similar to that found at baseline. The rate of caries after the intervention was stable in the intervention group and increased slightly in the control group. At the beginning of the study, the adjusted odds ratio of complete sealant retention between the intervention and control group was 0.47 which increased to 1.99 at the end of the study. However, no effect on caries on sealed surfaces was observed. CONCLUSIONS: The intensive focus on actual problems during the audit and feedback improved the dental nurses' performance and the quality of the dental service, although it had no statistical impact on the incidence of caries.

The impact of General Dental Council registration and continuing professional development on UK dental care professionals: (1) dental nurses.

OBJECTIVE: To investigate the impact of GDC registration and mandatory CPD on dental nurses' views, job satisfaction and intention to leave. DESIGN: Postal/online survey, conducted in parallel with a survey of dental technicians. SETTING: UK private and NHS practices, community services, dental hospitals. SUBJECTS AND METHODS: Representative sample of General Dental Council registrants. MAIN OUTCOME MEASURES: Job satisfaction; intention to leave profession (dependent variable in regression analysis). RESULTS: Eleven were ineligible (left profession, moved abroad); 267 (44% of those eligible) responded, all female. Respondents' mean age was 38.2 years (sd 10.74). The general principle of registration was endorsed by 67%, and compulsory registration by 51%, but the fee level by only 6%. Most nurses did not feel that registration had affected their view of dental nursing as a career (56%), their role (74%) or status (86%) within the dental team, or that CPD helped them to do their job better (76%). Fifty-six percent were not satisfied with their job, and 22% intended to leave the profession. Intention to leave was predicted by younger age and greater dissatisfaction with physical working conditions and opportunities to progress. CONCLUSIONS: Widely held criticisms regarding the costs and relevance of registration and CPD coupled with a potentially high level of attrition from the profession suggest a review of the fee and salary structure and greater financial support for CPD is warranted.

Perfil de técnicos em higiene dental quanto à prática profissional, à educação permanente e ao trabalho em serviço público / Profile of dental hygienists regarding professional practices, continuing education, and work in public services

Objetivo: Os objetivos deste trabalho foram conhecer o perfil dos egressos do Curso Técnico de Higiene Dental (THD) da Universidade Estadual de Montes Claros (Unimontes), bem como verificar a eficácia e a adequabilidade dos binômios Técnico em Higiene Dental/Educação Permanente e Técnico em Higiene Dental/Serviço Público. Metodologia: O delineamento do estudo foi transversal e descritivo. Para coleta dos dados utilizou-se um instrumento semi-estruturado e auto-aplicável, que foi preenchido por 128 egressos do Curso Técnico de Higiene Dental da Unimontes, matriculados no período de 1994 a 2006. Resultados: Houve predominância de egressos do gênero feminino (94,5%), faixa salarial baixa (de um a dois salários mínimos: 57,0%), egressos trabalhando em empregos não relacionados com a formação de THD (22,7%), desvio de função (75,8%), índices intermediários de capacitação após a conclusão do curso técnico (47,7%) e reconhecimento de que o Programa de Saúde da Família é uma importante opção de trabalho para 93% dos participantes. Conclusão: Os resultados indicaram feminilização da profissão, predominância de inserção desse profissional no serviço público, baixa faixa salarial, desvio de função e constatação de que o THD conhece as suas atribuições no Programa de Saúde da Família, apesar de possuir baixa inserção nesse programa. Além disso, os egressos demonstraram interesse pela educação continuada.

Purpose: This study aimed to record the profile of the Dental Hygienists graduated from the Course of Dental Hygienist of the State University of Montes Claros (Unimontes) and evaluate their relationship with continuing education and the Brazilian network of public services. Methods: The study design was cross-sectional and descriptive. Data were collected by mean of a semi-structured instrument filled by 128 participants who graduated at Unimontes between 1994 and 2006. Results: Data showed predominance of females (94.5%), low wage band (1-2 minimum wages, 57%), lack of insertion in the job market (22.7% working in other jobs), shift of functions (75.8%), medium qualification after graduation (47.7%), and recognition that the Brazilian Family Health Program is a good job opportunity (93%). Conclusion: The majority of this sample of Dental Hygienists was female, had interest in continuing education, and worked in public services. However, the insertion of these professionals in the Brazilian Family Health Program was low.

Factors related to performance effectiveness of dental nurse in primary care unit in the northeastern part of Thailand.

OBJECTIVE: To investigate the relationships between job characteristics, motivation, role stress and performance effectiveness of dental nurses in primary care units in the northeastern part of Thailand. MATERIAL AND METHOD: A explanatory cross-sectional study was conducted in 326 dental nurses who were working in 310 PCUs of 19 provinces, 220 amphurs in the northeastern part of Thailand were taken as the study samples. Data were collected by using questionnaires. Pearson's Product Moment Correlation was applied to test between job characteristic model, motivation, role stress and performance effectiveness. RESULTS: The analysis showed that there was no relationship between job characteristics model and performance effectiveness as performing dental task needed 'dealing with others' and 'task significance'. There was a positive relationship between motivation and performance effectiveness at a low level. Role stress was not related to performance effectiveness; however, when the dental nurse had more stress caused by role conflict internal standard, several roles and their performance effectiveness was reduced. CONCLUSION: From the research result, it is necessary to help construct networks of dental tasks and other public health tasks in obvious forms, for some feedback from agents. Work allocation should be precisely arranged and professional skill should be determined responsibility. Lastly, recruiting dental nurses with proper characteristics in primary care units in the northeastern part of Thailand is crucial as well.