The acceptability of care provided by dental auxiliaries: A systematic review.

BACKGROUND: Dental auxiliaries undertaking a limited range of intraoral clinical procedures normally performed by dentists could increase access to care and control costs, yet their acceptability to patients has been questioned. The aim of this study was to assess data on the social acceptability and patient satisfaction of dental auxiliaries performing intraoral clinical procedures. METHODS: The authors searched 14 electronic databases and 2 trial registries for studies of any design (from inception to November 2013). They searched gray literature databases (from inception to July 2014), reference lists of included studies, and high-yield journals (from January 2000 to December 2014). Risk of bias was assessed, and data were extracted. RESULTS: The authors identified 29 studies: 25 considered experiential and 4 on social acceptability. Twenty-three were cross-sectional, 2 were qualitative, 1 was mixed-methods, and 3 had unclear methods. The authors found that patients reported high acceptability of care, comparable or better than that from dentists. Social acceptability varied, with care for children being less acceptable. One-fifth of people were unwilling to receive any treatment from a dental auxiliary. All studies were at high risk of bias, and quality of the evidence was low. CONCLUSIONS: Experiential acceptability of dental auxiliaries by patients appeared high in this study, but their social acceptability varied. PRACTICAL IMPLICATIONS: Given the age of the studies, their settings, and their quality, generalizability to dental practices is limited. Additional high-quality, methodologically rigorous studies are needed.

The Implications of the New GDC Standards for Dental Professionals.

This article is about the publication by the General Dental Council in 2013 of the Standards expected of those members of the dental team who are registered with the Council, on each of their Registers, and discusses the implications of the new Standards for dental professionals.

Lack of high-quality studies comparing the effectiveness, and cost-effectiveness, of dental auxiliaries and dentists in performing dental care.

DATA SOURCES: Cochrane Effective Practice and Organisation of Care (EPOC) Group's Specialised Register; Cochrane Oral Health Group's Specialised Register; the Cochrane Central Register of Controlled Trials Medline; Embase; CINAHL; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effectiveness; five other databases and two trial registries. A number of dental journals were hand-searched and a grey literature search preformed. STUDY SELECTION: Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before and after studies (CBAs) and interrupted time series (ITSs) were considered. Selection was conducted independently by two reviewers. DATA EXTRACTION AND SYNTHESIS: Three reviewers extracted data and assessed risk of bias. Meta-analysis was not possible so a narrative summary was presented. RESULTS: Four studies evaluated sealant placement; three found no evidence of a difference in retention rates of those placed by dental auxiliaries and dentists over a range of follow-up periods (six to 24 months). One study found that sealants placed by a dental auxiliary had lower retention rates than ones placed by a dentist after 48 months (9.0% with auxiliary versus 29.1% with dentist); but the net reduction in the number of teeth exhibiting caries was lower for teeth treated by the dental auxiliary than the dentist (three with auxiliary versus 60 with dentist, P value < 0.001). One study showed no evidence of a difference in dental decay after treatment with fissure sealants between groups. One study comparing the effectiveness of dental auxiliaries and dentists performing ART reported no difference in survival rates of the restorations (fillings) after 12 months. CONCLUSIONS: We only identified five studies for inclusion in this review, all of which were at high risk of bias, and four were published more than 20 years ago, highlighting the paucity of high-quality evaluations of the relative effectiveness, cost-effectiveness and safety of dental auxiliaries compared with dentists in performing clinical tasks. No firm conclusions could be drawn from the present review about the relative effectiveness of dental auxiliaries and dentists.

The efficacy of screening for common dental diseases by hygiene-therapists: a diagnostic test accuracy study.

Regularly attending adult patients are increasingly asymptomatic and not in need of treatment when attending for their routine dental examinations. As oral health improves further, using the general dental practitioner to undertake the "checkup" on regular "low-risk" patients represents a substantial and potentially unnecessary cost for state-funded systems. Given recent regulatory changes in the United Kingdom, it is now theoretically possible to delegate a range of tasks to hygiene-therapists. This has the potential to release the general dental practitioner's time and increase the capacity to care. The aim of this study is to compare the diagnostic test accuracy of hygiene-therapists when screening for dental caries and periodontal disease in regularly attending asymptomatic adults who attend for their checkup. A visual screen by hygiene-therapists acted as the index test, and the general dental practitioner acted as the reference standard. Consenting asymptomatic adult patients, who were regularly attending patients at 10 practices across the Northwest of England, entered the study. Both sets of clinicians made an assessment of dental caries and periodontal disease. The primary outcomes measured were the sensitivity and specificity values for dental caries and periodontal disease. In total, 1899 patients were screened. The summary point for sensitivity of dental care professionals when screening for caries and periodontal disease was 0.81 (95% CI, 0.74 to 0.87) and 0.89 (0.86 to 0.92), respectively. The summary point for specificity of dental care professionals when screening for caries and periodontal disease was 0.87 (0.78 to 0.92) and 0.75 (0.66 to 0.82), respectively. The results suggest that hygiene-therapists could be used to screen for dental caries and periodontal disease. This has important ramifications for service design in public-funded health systems.

Dental therapists: evidence of technical competence.

Dental therapists are members of the dental team in many countries, where they perform a limited number of irreversible restorative procedures. In the United States, they practice only in Alaska and Minnesota, though other states are considering adding them in an effort to improve access to care. While critics of this workforce model cite concern for patient safety, proponents argue that dental therapists provide treatment that is as technically competent as that provided by dentists. Though nearly 2 dozen studies from industrialized countries address this subject, this article systematically reviews all 23 of them. Of these reports, all but 2 conclude that dental therapists perform at an acceptable level. Every study that directly compared the work of dental therapists with that of dentists found that they performed at least as well. Regardless of whether dental therapists would be the most effective intervention for improving access to oral health care in the United States, the evidence clearly suggests dental therapists are clinically competent to safely perform the limited set of procedures that falls within their scope of practice.

Are procedures performed by dental auxiliaries safe and of comparable quality? A systematic review.

The objective of the current study was to systematically evaluate the existing evidence in relation to the safety, quality, productivity or cost-benefit, and patient satisfaction of the procedures performed by the different groups of dental providers. Due to the diversity of the procedures performed and the outcomes measured, it was not possible to create pooled estimates in a meaningful manner. Therefore, summary results of individual studies are presented and critically evaluated.

Accreditation of emerging oral health professions: options for dental therapy education programs.

OBJECTIVES: The study explored the options for accreditation of educational programs to prepare a new oral health provider, the dental therapist. METHODS: A literature review and interviews of 10 content experts were conducted. The content experts represented a wide array of interests, including individuals associated with the various dental stakeholder organizations in education, accreditation, practice, and licensure, as well as representatives of non-dental accrediting organizations whose experience could inform the study. RESULTS: Development of an educational accreditation program for an emerging profession requires collaboration among key stakeholders representing education, practice, licensure, and other interests. Options for accreditation of dental therapy education programs include establishment of a new independent accrediting agency; seeking recognition as a committee within the Commission on Accreditation of Allied Health Education Programs; or working with the Commission on Dental Accreditation (CODA) to create a new accreditation program within CODA. These options are not mutually exclusive, and more than one accreditation program could potentially exist. CONCLUSIONS: An educational accreditation program is built upon a well-defined field, where there is a demonstrated need for the occupation and for accreditation of educational programs that prepare individuals to enter that occupation. The fundamental value of accreditation is as one player in the overall scheme of improving the quality of higher education delivered to students and, ultimately, the delivery of health services. Leaders concerned with the oral health workforce will need to consider future directions and the potential roles of new oral health providers as they determine appropriate directions for educational accreditation for dental therapy.

The principles, competencies, and curriculum for educating dental therapists: a report of the American Association of Public Health Dentistry Panel.

A panel of academicians was formed to develop an educational plan for dental therapists. The panel met over a 14-month period of time (2010-2011). The panel interviewed leadership from dental therapy educational programs in New Zealand, Canada, Alaska, and the University of Minnesota. The panel was structured into three subcommittees--principles, competencies, and curriculum to develop an educational plan for a 2-year postsecondary school dental therapy program. Reports from the three subcommittees are presented in this article along with introductory information and a discussion about the reports. A fourth subcommittee considered career pathways, and its report is presented as a separate article in this special issue. The final work of the panel was to consider accreditation issues regarding dental therapist programs, and its report is also presented in this issue.

Navigating career pathways--dental therapists in the workforce: a report of the career path subcommittee.

Creating career pathways to facilitate current dental and other healthcare providers becoming dental therapists can be an efficient means to expand the dental workforce and reduce barriers to access to oral health services. Career pathways are proposed to facilitate dental providers building on previously learned skills to broaden their scope of practice and become even more versatile and productive providers of oral health services. Creation of a unified and integrated curriculum will enable research to document the effectiveness of this new dental provider who will work as part of dental teams and with supervision by dentists. The goal of augmenting the current dental team and reducing barriers to access to dental services for underserved populations can be enhanced by offering alternative pathways to achieve the competencies required of dental therapists.

Performance of atraumatic restorative treatment (ART) depending on operator-experience.

OBJECTIVES: Oral health care is not of major interest in developing countries because of lack of infrastructure and professional manpower. Therefore, atraumatic restorative treatment (ART) was introduced by the World Health Organization to be performed by dental auxiliary personnel. The aim of this study was to evaluate the performance of ART depending on operator-experience in The Republic of The Gambia. METHODS: One hundred twenty-eight newly inserted restorations were followed up for 12 months using the clinical ART index in a prospective and blinded study design. The patients were randomly assigned to operators. The clinical performance was compared among three groups: trainees, experienced Community Oral Health Workers (COHW), and professional dentists. The difference in success rates was calculated at a 95 percent confidence interval. RESULTS: There was a statistically significant difference between trainees and dentists in performing leakage/gap-free one-surface restorations (P < 0.05). No significant differences were found between the two groups of auxiliaries (trainees versus experienced COHWs, P > 0.05). Finally, both groups--experienced COHWs and dentists--performed restorations not showing statistically significant differences (P > 0.05). CONCLUSIONS: For The Republic of The Gambia--especially for areas with underdeveloped medical infrastructure--training and assignment to perform ART can be recommended for auxiliary dental staff of Community Oral Health Workers.

A survey of dental hygiene program directors: summary findings and conclusions.

To assist the ADEA Council of Allied Dental Program Directors in focusing future goals and actions, an online survey was developed and administered to the directors of the 300 Commission on Dental Accreditation (CODA)-accredited U.S. dental hygiene programs in November 2008. The survey solicited directors' opinions about certain contemporary dental hygiene issues such as entry-level education, the use of articulation agreements, the advanced dental hygiene practitioner (ADHP) model proposed by the American Dental Hygienists' Association, and accreditation. Over three-quarters of survey respondents indicated it is "important" or "somewhat important" to advance the entry-level educational requirements for dental hygiene practice to the baccalaureate level. Educational setting (four-year versus two-year) was a significant determinant in whether a respondent thought a baccalaureate degree should result from a dental hygiene educational program. Fifty-six percent of respondents' programs either have or are in the process of developing articulation agreements with other institutions. Seventy percent of all respondents felt it was important to support advancing the ADHP model. Over 60 percent of respondents noted the importance of developing competencies for degree completion and graduate programs, and 42 percent of respondents indicated that it was important to have a separate accreditation process for graduate-level programs. Conclusions suggest advancing entry-level education for dental hygiene is desired if it can maintain a role for both four-year and two-year institutions.