Dentistry responding in domestic violence and abuse (DRiDVA) feasibility study: a qualitative evaluation of the implementation experiences of dental professionals.

BACKGROUND: Domestic Violence and Abuse (DVA) is a persistent public health problem in the UK. Healthcare settings offer an opportunity to ask patients about DVA, either opportunistically or in response to the presence of injuries. However, it has been suggested that dental practices and dental teams have not been actively involved supporting adult patients when presenting with injuries that might have resulted from DVA. This qualitative study was conducted to satisfy the evaluative component of the Dentistry Responding in Domestic Violence and Abuse (DRiDVA) feasibility study. METHODS: In total, 30 participants took part in the study; nine associate dentists and practice principals/owners took part in one-to-one interviews and 21 auxiliary staff took part across two focus group discussion sessions. Data were analysed using the seven step Framework Analysis process. RESULT: Three key themes were identified from the data, focusing on barriers to enquiring about domestic violence and abuse, Facilitators of identification and referral of DVA in dental settings, and recommendations for further adaptation of intervention to dental settings. CONCLUSION: DVA training coupled with robust referral pathways to a named specialist DVA advocate increases knowledge and awareness of the signs of DVA and confidence in making onward referrals. Further research is needed to understand how to increase dental professional willingness to ask patients about DVA.

Dental Public Health in Action: Experiences and Responses of Oral Health Care Professionals during the First Wave of the COVID-19 Pandemic in Malta.

Initial impetus for action: Maltese Oral Health Care Professionals (OHCP) experienced changes to clinical practice and redeployment during the COVID-19 pandemic. In the early stages, there were few data on the resultant changes to the provision of dental services or their impact on the wellbeing of dental professionals. Solutions Suggested: Two questionnaires were designed to explore different domains in OHCP working on the frontline of the COVID-19 pandemic as well as in other areas/sectors. The findings were intended to inform guidance documents and to better support the profession. Findings: Anxiety-provoking factors, challenges, and areas of concern of OHCP were identified and practical recommendations to support transitioning to the 'new normal' were presented. OHCP expressed anxiety about contracting COVID-19 from their workplace and passing infection to other family members, friends, or patients. As a result, OHCP expressed the need for better protective clothing, workplace ventilation, and air filtration systems. Future implications: Provision of adequate PPE for OHCP was a priority. New guidelines for dental practice were informed by the experiences of the particpating OHCP. University modules to enhance the resilience of OHCP were among the recommendations to support practitioners.

Clinical dental technicians in the United Kingdom: A qualitative understanding of the experiences, of practices and challenges of communication for dental professionals.

AIM: To investigate the roles and relationships of registered Clinical Dental Technicians (CDTs) in the dental team and healthcare systems, and their perspective as a professional group in the United Kingdom (UK). METHODS: This qualitative study was conducted following a national questionnaire survey of CDTs, 18 of whom participated in semi-structured interviews; they were purposively sampled to represent the diversity and demography of CDTs. A topic guide, informed by the literature and survey findings, guided discussions which were recorded and transcribed verbatim. Drawing upon phenomenological and cultural relativistic theories, thematic analysis was conducted, thus enabling an "analytic story" of the lived experience to emerge. RESULTS: Clinical dental technicians expressed pride, passion and satisfaction in their work yet feel misunderstood in their role. Experiences of being accepted and incorporated into the wider dental profession are strained. Ultimately, there is a complex web of inter-dependence between all actors-a triadic relationship-bounded by policymakers and regulators which directly impacts on best practice and the balance between collaboration and autonomy. Looking to the future, Ideal practice may involve different models of care, with examples of good practice emerging. CONCLUSION: This paper provides a unique examination of the lived experience, feelings and relationships of CDTs. The perceptions of their role, their inter-professional relations and the progression as a professional group must be addressed, and their potential to work collaboratively actively engaged to serve our ageing population.

Attitudes of the first cohort of student groups trained together at the University of Portsmouth Dental Academy towards dental interprofessional education.

OBJECTIVE: This study explored, and compared, the attitudes of student groups trained at the University of Portsmouth Dental Academy (UPDA) in 2010/2011 towards dental interprofessional education (IPE). METHODS: The study population consisted of fifth-year student dentists (n = 80) from King's College London Dental Institute, second- and third-year dental hygiene and therapy (n = 38) and first-year dental nursing (n = 14) students from UPDA. A 19-item, validated and dentally modified questionnaire, 'Readiness for Inter-Professional Learning Scale (RIPLS)', was administered. RIPLS contains three subscales: teamwork and collaboration, professional identity and roles and responsibilities. Mean (x¯) and standard deviation (SD) of the scores were calculated, following reversal of negative items. All the analyses were carried out using SPSS version 20 and STATA version 11. RESULTS: An overall response rate of 71% (n = 94) was achieved. In reference to teamwork and collaboration, all groups strongly indicated that IPE can contribute to learning teamwork skills (x¯ = 24.98, SD = 3.5) and improving relationships with team members (x¯ = 12.93, SD = 1.63); however, the scores did not differ between the groups (P = 0.09 and P = 0.16, respectively). Concerning professional identity, student dentists had significantly higher preference for a discipline-based approach (P = 0.002); were more likely to agree that 'it is not necessary for undergraduate dental and dental care professional students to learn together' (P = 0.01); and perceived that 'clinical problem-solving skills can only be learnt effectively with other students from their own discipline' (P = 0.02) than dental hygiene and therapy students. In relation to roles and responsibilities, participants demonstrated a strong sense of their own professional role. Student dentists reported that they had 'to gain more knowledge and skills' than dental hygiene and therapy (P = 0.01) and dental nursing (P = 0.01) students. Dental hygiene and therapy students were less likely than student dentists to agree that 'the role of dental nurses and hygienists was to mainly provide support for dentists' (P = 0.001). CONCLUSION: The findings suggest that IPE was perceived as beneficial in relation to teamwork; however, the study raises issues regarding professional identity and roles. Educators should consider differing perceptions of professional roles and identities when planning and delivering interprofessional programmes.

Disparity in perception of the working condition of dental hygienists between dentists and dental hygiene students in Japan.

OBJECTIVES: In Japan, there continues to be a shortage of active dental hygienists. The scope of dental hygienists' practice is also considered to be unclear. One of the reasons for this is that dental hygienists find the working conditions during dental hygiene education different from those in reality. The purpose of this study was to clarify the actual working condition of dental hygienists in dental clinics, as well as evaluate the awareness of dental hygiene students and dentists regarding the working condition of dental hygienists. METHODS: Questionnaires were sent by post to 481 dentists and were distributed to 89 dental hygiene students. The awareness about the working condition of dental hygienists was compared between dentists and dental hygiene students. RESULTS: Two hundred twenty-two dentists and 89 dental hygiene students responded to questionnaires. Dental hygiene students considered the team of 'dental hygienist, dental technician and clerk' to be more effective in providing dental care than dentists (P < 0.001). Among the dentists, 37.1% did not find any clear distinction between hygienists and assistants in their clinics. However, 97.4% of dental hygiene students answered that dental team members should clearly inform patients of the distinction between hygienists and assistants. CONCLUSIONS: This study indicated that there was disparity between dentists' and dental hygiene students' perception of dental hygienists' working conditions, and dental team work was not always effective. For training high quality dental hygienists, all educational institutions related to dentistry must educate students regarding the more realistic dental hygienists' working condition, as well as benefits.

The hygienist's role in the management of the implant patient in primary care.

The scope of practice for dental hygienists includes the care of implants and peri-implant tissues. Hygienists in primary care settings must therefore be competent and confident in assessing, managing, and treating implant restorations and their peri-implant health. Dental hygienists also play a key role in the education of patients on oral health as part of their daily practice, a recognised and valued aspect of their clinical care responsibilities. Dental hygienists and therapists therefore have a pivotal role as adjunct support in a patient's implant journey where they can offer essential support throughout their treatment period and can provide guidance and education at regular intervals.Using current guidelines, dental hygienists and therapists can create and implement practice protocols to help deliver the necessary clinical care during pre-implant, peri-implant, and post-implant phases of care. This article discusses the processes required to achieve a healthy implant patient, how the dental team can support the patient, and how clinicians can work together to achieve the best possible clinical outcome. This article will explore current evidence-based guidance and how to implement guidance in a practice setting, with protocols for all members of the dental team, with the final goal of a dentally healthy, motivated patient.

Functional assessment and evaluation of health problems with the cervical spine among dental assistants and hygienists.

Purpose: The aim of the study was to evaluate the mobility of the cervical spine, pain and function according to Neck Disability Index (NDI) scores among dental assistants and hygienists. Comparison between dental professionals and a control group was also performed. Methods: In the study, 338 dental assistants and hygienists with a mean age of 35.8 were evaluated. Of these, 195 were measured with the CROM 3 device, and 143 with a classic tape measure, for the range of motion of their cervical spine. A non-dental professional group consisting of 60 women (whose work was not related to repetitive movements of cervical spine) was also tested, 30 with the CROM 3 device, and 30 with a classic tape measure. The dental and control groups were also surveyed with the NDI questionnaire and Visual Analogue Scale (VAS). Results: Dental assistants and hygienists had significantly reduced functional ROM in all directions in comparison to the control group. Among the 338 volunteers form the study group the VAS pain score was higher than in the control group. NDI scores were also worse in the study group, compared to the control group. Functional results in all subgroups of the NDI questionnaire were better in the control group. Among dental workers the cervical spine typically demonstrated significantly greater mobility in right-rotation, resulting from the position occupied at the unit at which they work. Conclusions: Our findings confirm a decrease in the mobility of the cervical spine, lower functional scores involving various everyday activities and greater intensity of pain among dental assistants and hygienists in comparison to participants whose work does not involve cervical spine overuse.

Self-Assessment of Knowledge on the Treatment of Children and Adolescents with Special Care Needs: Results of a Survey amongst German Dentists with Key Expertise in Paediatric Dentistry.

BACKGROUND: The treatment of children and adolescents with disabilities (CA-Dis) and psycho-emotional disorders (CA-Psy) places special demands on dentists. AIM: To explore German dentists' (with key expertise in paediatric dentistry) perception of their competence and comfort levels in dealing with these patients, and implications for access to care. METHODS: Online questionnaire surveying demographic information and self-assessment of training, knowledge, and comfort in dealing with CA-Dis and CA-Psy among 1725 members of the German Society of Paediatric Dentistry (DGKiZ). RESULTS: Ninety-two participants (11 male, 81 female) completed the questionnaire: 17.4% (n = 16) treated CA-Dis once or more a day; CA-Psy were rarely treated on a daily basis (7.6%; n = 7). In regard to CA-Dis, 62% (n = 57) rated their level of expertise as "good" or "very good"; for CA-Psy this was 40.2% (n = 37). Overall, 76.1% (n = 70), respectively, 88.0% (n = 81) of the respondents felt they had been inadequately prepared to treat CA-Dis or CA-Psy. Although the physical burden of treating CA-Psy was rated as "not at all stressful" or only "slightly stressful" by 45.7% of the participants, 31.5% rated the psychological distress as "very stressful" or "extremely stressful". The better their self-assessed expertise in treating CA-Dis was, the lower their own psychological distress was rated (r = -0.34). Training on this topic seems to have an impact on the perceived burden of treating such patients. CONCLUSIONS: A core curriculum in special care dentistry needs to be embedded in the German dental curriculum. The results permit the development of health programs for workplace health management in dentistry.

Overview of education system for oral hygienists in Taiwan.

Background/purpose: Currently, Taiwan has a very complete education system of oral hygiene, but there is still no licensing system for oral hygienists. This study explored mainly the profile of education system for oral hygienists in Taiwan from 2017 to 2021. Materials and methods: This study used the documentary analysis and secondary data analysis to survey mainly the development of oral hygiene education system in Taiwan, and the changes of oral hygiene students and graduates from 2017 to 2021. Results: In Taiwan, currently, there are 8 oral hygiene schools which offer associate, bachelor, and master degrees in oral hygiene. The oral hygiene enrollment quotas determined by the Ministry of Education increased from 343 quotas in 9 programs in 2017 to 500 quotas in 13 programs in 2021, while new oral hygiene students who completed registration increased from 282 students in 2017 to 353 students in 2021. The registration rate of the five-year training program of junior college was significantly higher than the other programs. The number of oral hygiene students with official student status increased from 604 students in 2017 to 1349 students in 2021. The total increase was 745 students from 2017 to 2021 with a total increase rate of 123.34%. Conclusion: In Taiwan, although the manpower of oral hygienists is important for public oral health, they usually work as dental assistants or change their careers. It is imperative to continue to promote the certification system for oral hygienists to improve the professionalism of this occupation.

HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing): a qualitative exploration of the acceptability of a complex oral health intervention.

BACKGROUND: To explore the acceptability of the oral health intervention, HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing) to parents with young children aged 9-12 months and health visitors. METHODS: Following the delivery of the universal oral health intervention called HABIT, qualitative semi-structured interviews with parents and focus groups with health visitors were undertaken. Interviews were audio-recorded and transcribed. Health visitors completed self-reported diaries after delivering the HABIT intervention with parents. The qualitative data was analysed using framework analysis (guided by a theoretical framework of acceptability). RESULTS: Seventeen parents were interviewed, and five health visitors and three nursery nurses participated in two focus groups. Parents reported health visitors to be 'trusted' and valued the reassurance provided during the HABIT visit. Health visitors found the HABIT training and resources useful and valued the consistency and increased confidence in undertaking oral health conversations. There were, however, challenges in changing behaviour where families faced competing demands on time and resources. Both health visitors and parents described the importance of the intervention's timing and suggested that multiple visits may be needed to support optimal oral health habits. CONCLUSION: The HABIT intervention was acceptable to parents and health visitors. Health visitors would welcome a further refinement to enhance intervention delivery that specifically achieves a balance between using a guided script and retaining the flexibility to adapt the conversation to suit the needs of individual families. This, in turn, will maximise impact and enable parents of young children to adopt and maintain optimal home-based oral health behaviours for their child.

Interprofessional Clinical Education in Dentistry.

Interprofessional education within a team is a concept that is readily occurring within clinical dental practice, however, the theoretical underpinnings are rarely understood. Now more than ever, dental healthcare professionals are required to deliver holistic care planning for patients working collaboratively and synchronously with other healthcare professionals. This paper highlights the importance of understanding other team members' ethics, values and beliefs as well as their remit to effectively communicate and collaborate to elevate a positive experience for both the patient and the clinician.

Perception of Women with Lived Experience of Domestic Violence and Abuse on the Involvement of the Dental Team in Supporting Adult Patients with Lived Experience of Domestic Abuse in England: A Pilot Study.

While there is existing evidence highlighting the important roles of health care professionals and the health care system in supporting patients with lived experience of domestic violence and abuse (DVA), there is a dearth of knowledge on the perception of dental patients on the involvement of the dental team, as health care professionals, in supporting adult patients experiencing domestic abuse. Data were collected from 24 women withs lived experience of domestic abuse using mixed methodological approaches and analysed using relevant analytic techniques. Results from this pilot study show that patients want to be asked about their experience of domestic abuse. Although there were barriers to disclosing to the dentist, evidence from this pilot study highlights that the dental practice is an avenue that can be used for appropriately signposting patients to relevant services. Evidence from this pilot study contributes to the existing knowledge on the need to raise awareness among the patient population with lived experience of DVA that the dental team can support them. In addition, there is a need for on-going training to enhance the capacity of the dental team for appropriately supporting their adult patients with lived experience of DVA.

Dental Emergencies: Perceived impact of the COVID-19 pandemic on the mental health and wellbeing of dental teams in the UK.

The burden of the COVID-19 pandemic has and continues to stretch the healthcare systems and the workforce alike, both nationally and internationally. This is equally true of the dental care systems and the dental workforce which had to respond and act promptly.This paper examines the perceived impact of the COVID-19 pandemic on the mental health and wellbeing of dental teams in the UK and provides insight into not only this impact, but the early signs of mental ill health commonly triggered by life events, anxiety and fear, and often exacerbated by stresses. A sample of an established body of literature and recognised sources are considered. Finally, extracts of common threads from meaningful conversations will be alluded to, shining a light on the current state of the mental health and wellbeing of many in dentistry and the need for intervention and longer-term plans. We are often reminded that this period in time is a marathon not a sprint, the same could perhaps be said about a national response to mental health and wellbeing, as it will take time, but the time to begin is now.

Corrigendum: The Dental Team: An Additional Resource for Delivering Vaccinations.

[This corrects the article DOI: 10.3389/fmed.2020.606242.].

Exploring the Effect of the COVID-19 Pandemic on the Dental Team: Preparedness, Psychological Impacts and Emotional Reactions.

Background: The COVID-19 pandemic has placed increased demands on clinical staff in primary dental care due to a variety of uncertainties. Current reports on staff responses have tended to be brief enquiries without some theoretical explanation supported by developed measurement systems. Aim: To investigate features of health and well-being as an outcome of the uncertainties surrounding COVID-19 for dentists and dental health professionals in primary dental care and for those in training. In addition, the study examined the well-being indices with reference to normative values. Finally a theoretical model was explored to explain depressive symptoms and investigate its generalisability across dentists and dental health professionals in primary dental care and those in postgraduate training. Methods: A cross-sectional survey of dental trainees and primary dental care staff in Scotland was conducted in June to October 2020. Assessment was through "Portal," an online tool used for course bookings/management administered by NHS Education for Scotland. A non-probability convenience sample was employed to recruit participants. The questionnaire consisted of four multi-item scales including: preparedness (14 items of the DPPPS), burnout (the 9 item emotional exhaustion subscale and 5 items of the depersonalisation subscale of the MBI), the 22 item Impact of Event Scale-Revised, and depressive symptomatology using the Patient Health Questionnaire-2. Analysis was performed to compare the levels of these assessments between trainees and primary dental care staff and a theoretically based path model to explain depressive symptomology, utilising structural equation modelling. Results: Approximately, 27% of all 329 respondents reported significant depressive symptomology and 55% of primary care staff rated themselves as emotionally exhausted. Primary care staff (n = 218) felt less prepared for managing their health, coping with uncertainty and financial insecurity compared with their trainee (n = 111) counterparts (all p's < 0.05). Depressive symptomology was rated higher than reported community samples (p < 0.05) The overall fit of the raw data applied to the theoretical model confirmed that preparedness (negative association) and trauma associated with COVID-19 (positive association) were significant factors predicting lowered mood (chi-square = 46.7, df = 21, p = 0.001; CFI = 0.98, RMSEA = 0.06, SRMR = 0.03). Burnout was indirectly implicated and a major path from trauma to burnout was found to be significant in primary care staff but absent in trainees (p < 0.002). Conclusion: These initial findings demonstrate the possible benefit of resourcing staff support and interventions to assist dental staff to prepare during periods of high uncertainty resulting from the recent COVID-19 pandemic.

Dental team and infection control for the COVID-19: (A short review of the current guidelines).

BACKGROUND: In December 2019, a series of unusual pneumonia has been reported in Wuhan, China. This pneumonia was related to beta-coronavirus cluster which was named COVID-19. The aim of this study is to review the published paper on COVID-19 protections guide lines and attempt to summarize different suggested guide lines in order to help dental/oral healthcare to have better protection against COVID -19. MATERIALS AND METHODS: An electronic literature search was conducted via google scholar, PubMed, and dental associations' of different countries' website using the key word "COVID-19, Dental team, Guide lines and Recommendation".A total of seven guidelines were found suitable to be included in this review. CONCLUSION: Individuals with 'possible' or 'confirmed' COVID-19 should not be seen for routine dental care. Multi-step approach should begin before the patient arrives on the office and includes guidance regarding their arrival and it should be completed duration of the affected patient's presence in the practice. Accurate travel history, fever or history of fever, acute respiratory infection and severe respiratory infection without fever requiring hospitalization should be checked by staff via patients telephoning to make an appointment and finally the primary infection control goal is to prevent transmission of disease. These treatment guidelines are based on very limited evidence from the literature and should be revised as soon as more evidence about the infection control advices for dental team regarding COVID-19.

Practice Patterns and Attitudes of Expanded Function Dental Auxiliaries in the State of Maine.

Purpose: Various workforce models, including the expanded function dental auxiliary (EFDA), have been created as a means to address the crisis in oral health access. Limited assessments have been conducted regarding the effectiveness of the EFDA. The purpose of the study was to assess the implementation, geographic practice patterns and attitudes regarding the education of EFDAs in the state of Maine.Methods: Licensure information on the Expanded Function Dental Auxiliaries (EFDA) in Maine was obtained from the Board of Dental Practice. A 19-item survey consisting of closed and open-ended questions pertaining to practice demographics, settings, procedures and attitudes towards basic and ongoing continuing education was sent both via email and traditional mail to all EFDAs licensed in Maine (n=75). Descriptive statistics were used to analyze the data.Results: A response rate of 59% (n=43) was achieved. A majority of EFDAs (60%, n=26) were employed in private dental practices; 12% (n=5) practiced in a community/public health setting. Regarding access to care, 51% (n=22) stated that their practice did not accept Medicaid coverage. However, over half indicated feeling that they were making moderate to significant impact on increasing access. A little more than one third (35%, n=17) reported working in Penobscot County, which is not a designated provider shortage area. A majority of respondents reported less than half of their continuing education courses were relevant to EFDA practice.Conclusions: EFDA practitioners are providing needed oral health care services, however they may not be providing access to care for the intended at-risk and underserved populations in designated geographic areas. Practice patterns of EFDAs in Maine should be assessed in greater depth.

"Strong Teeth"-a study protocol for an early-phase feasibility trial of a complex oral health intervention delivered by dental teams to parents of young children.

BACKGROUND: Dental attendance provides an important opportunity for dental teams to explore with parents the oral health behaviours they undertake for their young children (0-5 years old). For these discussions to be effective, dental professionals need to be skilled in behaviour change conversations. The current evidence suggests that dental teams need further support, training and resources in this area. Therefore, the University of Leeds and Oral-B (Procter & Gamble Company) have worked with the local community and dental professionals to co-develop "Strong Teeth" (an oral health intervention), which is delivered in a general dental practice setting by the whole dental team. The protocol for this early phase study will explore the feasibility and acceptability of the Strong Teeth intervention to parents and the dental team, as well as explore short-term changes in oral health behaviour. METHODS: Forty parents (20 of children aged 0-2 years old, and 20 of children aged 3-5 years old) who are about to attend the dentist for their child's regular dental check-up will be recruited to the study. Parents and children will be recruited from 4 to 8 different dental practices. In the home setting, consent and baseline oral health behaviour data will be collected. The researchers will ask parents questions about their child's oral health behaviours, including toothbrushing and diet. Three different proxy objective measures of toothbrushing will be collected and compared with self-report measures of parental supervised toothbrushing (PSB). DISCUSSION: The parent and child will then attend their dental visit and receive the Strong Teeth intervention, delivered by the dental team. This intervention should take 5-15 min to be delivered, in addition to the routine dental check-up. Furthermore, children aged 0-2 years old will receive an Oral-B manual children's toothbrush, and children aged 3-5 years old will receive an Oral-B electric rechargeable children's toothbrush. At 2 weeks and 2-3 months following the Strong Teeth intervention, further self-report and objective measures will be collected in the parent/child's home. This data will be supplemented with purposively sampled qualitative interviews with parents (approximately 3 months following the intervention) and dental team members (following delivery of the intervention). TRIAL REGISTRATION: ISRCTN Register, (ISRCTN10709150).