Do health provider-patient relationships matter? Exploring dentist-patient relationships and oral health-related quality of life in older people.

BACKGROUND: patient experience is now a key parameter in health care. Yet, very little is known about the possible impact of dentist-patient relationships on patient-centred outcomes including older peoples' oral health-related quality of life (OHRQoL). OBJECTIVE: this study assessed the relationship between OHRQoL and dentist-patient relationships related to perceived unmet dental needs; shared decision-making; time spent discussing oral health problems; respect and confidence and trust. PARTICIPANTS: older people aged 65 years and over living in East London, U.K. in 2011. METHODS: a cross-sectional study using stratified random sampling recruited a representative sample of older people (n = 772). PARTICIPANTS completed an oral examination and a structured questionnaire including the Oral Health Impact Profile-14 (OHIP-14) measuring OHRQoL and five dentist-patient relationship questions taken from the U.K. 2009 Adult Dental Health Survey. Multivariate Poisson regressions modelled the association between OHRQoL and dentist-patient factors adjusting for socio-demographic factors, clinical oral indicators, and dental attendance. RESULTS: having a perceived unmet need for dental treatment (PRR = 1.84; 95% CI: 1.32, 2.56) and expressing a lack of trust and confidence in one's dentist (PRR = 1.74; 95% CI: 1.01, 2.98) were significant predictors of poor OHRQoL among older people. CONCLUSIONS: these findings suggest that older people with unmet dental needs and those who expressed a lack of trust and confidence in their dentist were more likely to experience poor OHRQoL reinforcing the importance of the dental patient experience in healthy ageing and well-being.

Are there more women in the dentist workforce? Using an intersectionality lens to explore the feminization of the dentist workforce in the UK and US.

In this paper, we seek to understand feminization of the dentist workforce moving beyond previous research that has looked at gender in isolation. We contend that little consideration has been given to how gender interacts with other important social identities such as race/ethnicity to influence the opportunities and barriers that female dentists encounter during their dental career. We argue that the scholarly debate about the feminization of the dentistry has not acknowledged the intersectionality of women's lives. Intersectionality describes how multiple social identities (such as race/ethnicity, gender, and class) overlap and interact to inform outcomes, creating disadvantages and/or privileges. Our thesis is that the increasing feminization of the dentist workforce is complicated and paradoxical, creating both opportunities for women and gender imbalances and blockages within the profession. To support our thesis, we critically reviewed the literature on feminization and analysed UK and US workforce data. While the female dentist workforce in both the UK and the US has increased significantly over the past decade, the growth in the number of female dentists was not equal across all racial/ethnic groups. The largest increase in the number of female dentists was among White and Asian women. Viewing the feminization of the dentist workforce through an intersectionality lens exposes the multiple and complex experiences of women, as well as the power dynamics in dentistry. Feminization in dentistry demonstrates the importance of presence, privilege, and power. Based on our assessment of the dentist workforce, dentistry may be less inclusive, despite being perceived as more diverse. Further research should explore how power and privilege may operate in dentistry. Dentistry should embrace intersectionality to provide an inclusive evaluation of equity in the workforce.

Children's toothache is becoming everybody's business: where do parents go when their children have oral pain in London, England? A cross-sectional analysis.

OBJECTIVES: To assess the number of parents who visited community pharmacies in London seeking pain medications for their children's pain and specifically for oral pain, to identify which health services parents contacted before their pharmacy visit and to estimate the cost to the National Health Service (NHS) when children with oral pain who visit pharmacies also see health professionals outside dentistry. DESIGN: A cross-sectional study. SETTING: 1862 pharmacies in London in November 2016-January 2017. PARTICIPANTS: Parents, carers and adolescents purchasing over-the-counter pain medications or collecting pain prescriptions for children (0-19 years). BRIEF INTERVENTION: A survey administered by pharmacy staff to participants and a guidance pack. MAIN OUTCOME MEASURES: The number of parents who visited pharmacies seeking pain medications for their children's pain and oral pain and the number of parents who contacted health professionals outside dentistry before their pharmacy visit. Estimated costs of visits by children with oral pain to health professionals outside dentistry. RESULTS: One in two (951) pharmacies participated collecting information from 6915 parents seeking pain medications for their children. The majority (65%) of parents sought pain medications to relieve their children's oral pain. Only 30% of children with oral pain had seen a dentist before the pharmacy visit, while 28% of children had seen between one and four different health professionals. The cost to the NHS of children contacting health professionals outside dentistry was £36 573, extrapolated to an annual cost of £373 288. Replicating these findings across all pharmacies in England could mean that the NHS spends an estimated £2.3 million annually when children with oral pain inappropriately use multiple health services. CONCLUSION: Most parents who visited pharmacies for children's pain medications in London sought pain medications for children's oral pain. Children's inappropriate contact with multiple health services when they have oral pain adds significant costs to the NHS.