Primary dental care : journal of the Faculty of General Dental Practitioners (UK)最新文献

This paper considers how dentistry has developed in the United Kingdom (UK) over the last 60 years and concludes that dentists have failed to be proactive and to shape the systems for the delivery of an optimal level of care to the population. It suggests that there is a need for far better leadership and for dentists, as individuals and as a profession, to rediscover the sense of vision that they once had and to shape their destinies, rather than accepting the current situation. The author goes on to explain how this might be done. Since the inception of the National Health Service (NHS), the dental profession in the UK has, to a large extent, been dominated by the politics of the NHS, by changing fee structures and contracts, by reports from the Review Body on Doctors' and Dentists' Remuneration (DDRB), and by strategies adopted by successive governments, especially during the last two decades. These strategies have resulted in cohorts of disillusioned dental practitioners reducing their commitment to, or opting out of, NHS contracts and committing themselves, to a greater or lesser extent, to private practice. It is now over three years since, for the first time, the proportion of dentistry provided under private contact in the UK, as measured by gross fees, exceeded that provided under NHS contract. The profession has shown a remarkable lack of imagination in organising itself to provide the best kind of care for patients. Instead of being proactive and visionary, it has allowed itself to become a political football. This has led to the progressive deskilling of many practitioners, and a manifest failure to secure the long-term oral health of patients. This paper considers how the situation could be improved and looks at four aspects, which are: 1. 21st century dentistry: state of the art versus reality? The contrast between what is clinically possible and what the profession currently delivers. 2. What are we here for? The need for a new vision for dentistry, the profession and the future, and the need for a new sense of mission. 3. A responsibility for the profession. The responsibility of the profession for providing patients (and funding bodies) with advice. 4. Leading the way: a new-look personal development plan. The personal development needs of dentists, with much more emphasis on interpersonal and leadership skills.

Aim: The aim of this survey was to assess the knowledge and perceptions of denture treatment among a group of patients who attended the Karnataka Lingayat Education Society's (KLES) Institute of Dental Sciences, Belgaum, Karnataka State, India.

Method: A questionnaire with four general questions and 14 statements/questions about denture construction and wearing was developed and piloted. Ethical approval was sought and granted. After some revisions, the questionnaire was given to all patients attending KLES over a two-month period.

Results: All 423 patients who attended KLES in the two-month period completed the questionnaire. Five questionnaires were not analysed because of ambiguity in the answers. The final patient sample was 418 (207 females and 211 males, mean age 40 +/- 15.3 years) of whom 140 (33.5%) were dentate and 278 (66.5%) edentulous in either one or both jaws. Among the 278 edentulous patients, 143 (51.4%) had not worn any kind of denture and 135 (48.6%) wore dentures. There was a wide variation in the accuracy of the patients' knowledge of denture treatment. In particular, more than 20% did not know that complete denture treatment requires five or more visits, that denture wearers may experience oral pain, whether or not dentures may cause more problems than natural teeth, or that dentures may make audible clicks and cause problems when speaking.

Conclusion: Patient education is an essential element in successful denture treatment. It should begin prior to the treatment, to ensure that the technical capability of the clinician matches the expectations of the patient. The initial appointment needs to be used as an educational tool to raise patients' level of understanding of prosthetic rehabilitation and how the proposed treatment will meet their needs.

Aim: To determine the level of domiciliary care currently provided for patients by general dental practitioners (GDPs) and to investigate factors that influence the provision of domiciliary dental care in an area of high socioeconomic deprivation in North and West Belfast.

Method: A descriptive study, involving a self-administered postal questionnaire sent to GDPs (n=89) in North and West Belfast.

Results: A valid response rate of 67% was achieved. Almost 20% of responding GDPs reported that they did not routinely offer domiciliary dental care. Of those who did, prosthetic treatment was undertaken most commonly, and other more time-consuming treatments such as fillings were referred to the Community Dental Services (CDS). Many GDPs reported not having a full range of domiciliary equipment, with only half of the GDPs surveyed carrying emergency drugs. Reasons cited for not providing the service were lack of time, the perception that patients would be too difficult to manage, and not having the appropriate equipment. The majority of responding dentists (85%) felt that domiciliary care should be referred to the community service.

Conclusion: The rate of domiciliary care provision in North and West Belfast appears to be falling, despite it being an area of high socioeconomic deprivation where the demand for the service is growing. The general perception was that domiciliary care is too time-consuming, that the patients are too difficult to manage, and that there was a lack of appropriate equipment. As a result, the majority of GDPs in North and West Belfast felt that the CDS should care for all domiciliary patients.

Aim: The aim of this research was to identify short-term career aspirations and goals of final-year dental students at a London dental school and the perceived factors that influenced these aspirations.

Methods: Two methods were used to collect data on final-year students' short-term career plans and influences. Qualitative data were collected through focus groups and analysed using 'framework methodology'. These findings informed a questionnaire survey of all students at the end of their final undergraduate year. Data were entered into and analysed using a statistical software package.

Results: Thirty-five students participated in focus groups, with recruitment continuing until data were saturated. Ninety per cent (n=126) of the total population (140) responded to the questionnaire survey; the majority were Asian (70%), female (58%), and aged 23 years (59%). Short-term professional expectations focused around 'achieving professional status within a social context', 'gaining professional experience', 'developing independence' and 'achieving financial stability'. 'Achieving financial stability' was ranked as the most important influence in decision-making about their career in the short term (77%), followed by 'balance of work and other aspects of life' (75%) and 'good lifestyle' (75%). Four out of ten intended to work towards membership of a Royal College and/or becoming a specialist. Proximity to family (81%) and friends (79%) was an important or very important influence on location in the short term. Asian students were significantly more likely to rate 'proximity to family' (p=0.042), working in an 'urban area' (p=0.001) and 'opportunities for private care' (p=0.043) of greater importance than their White counterparts.

Conclusions: Short-term aspirations involve 'achieving professional status within a social context', and personal, social, professional and financial goals. Location of future practice was significantly associated with ethnicity.

Purpose: The purpose of this survey was to identify the current level of competence of the Faculty of General Dental Practice (UK)'s [FGDP(UK)'s] Divisional Research Contacts (DRCs).

Methodology: The FGDP(UK)'s DRCs were each sent a copy the Faculty's Research Competencies Framework (RCF). A mutually convenient time for a telephone interview was then agreed between the DRCs and one of the Faculty's two National Research Facilitators. During the interview, a structured questionnaire was used and the DRCs' qualifications and research experience were recorded along with their perceived knowledge and skill levels for each of the 21 competencies in the RCF, using a five-point Likert scale.

Results: Eighteen of the 20 DRCs were interviewed, of whom 12 either possessed or were studying for higher research or partresearch degrees (PhD or MSc). All had some previous research experience. For 11 of the 15 competencies in the four domains of practical skills, problem-solving, attitudes and dissemination, DRCs rated their knowledge and skills levels as average or higher. For two of these 11 competencies (communication skills and understanding the need for research to support clinical practice), all 18 DRCs rated their levels of knowledge and skills as good or excellent. In the domain of roles and functions, DRCs rated their levels of knowledge and skills at a lower level. Seven rated their competence in designing and implementing a series of studies that address a significant issue and in writing research funding applications to major bodies as poor or very poor.

Conclusions: The present survey has provided the basis for a future, in-depth training needs analysis along with an insight into the research competency level of 18 of the Faculty's 20 DRCs.

Objective: To describe primary care referral networks relating to children's dental care and the main influences on referral decisions taken by dentists working in a primary care setting.

Design: A postal questionnaire to all 130 general dental practitioners (GDPs) in contract with Primary Care Trusts (PCTs), and 24 Community Dental Service (CDS) dentists in Liverpool.

Outcome measures: Characteristics of patient groups and factors influencing the choice of referral pathway of children referred from primary dental care.

Results: There were good responses rates (110 [85%] GDPs and 22 [92%] CDS dentists). The two main reasons why GDPs referred children to hospitals were (a) for treatment under general anaesthetic (GA) or relative analgesia (RA) and (b) for restorative care of dentally anxious children. GDPs also referred anxious children requiring simple restorative care and/or RA to the CDS. Only eight GDPs (7%) cited a lack of experience as a reason for referral of dentally anxious children for simple restorative care, compared to 53 (48%) who cited a lack of RA facilities, and 25 (23%) who cited financial considerations.

Conclusions: GDPs refer children to both hospital services and the CDS, and identify a lack of RA facilities and economic pressures as key reasons for referral.

Body dysmorphic dsorder (BDD) is characterised by a preoccupation with an imagined defect in one's appearance or, in the case of a minor physical anomaly, the individual's concern is markedly excessive, causing significant distress in their life. One of the most common areas of preoccupation is the dentofacial region, with up to 20% of patients diagnosed with BDD expressing specific concern regarding their dental appearance. With the increased ability to undertake dental aesthetic and reconstructive procedures, in addition to the use of facial aesthetic procedures, it is paramount for all dental clinicians to have an understanding of this condition. BDD patients often request multiple aesthetic procedures, but remain unsatisfied with their treatment results. It is imperative for the dental clinician to diagnose this condition prior to instigating clinical treatment, and to make an appropriate referral.

Opinions on occlusion and its link to oral health could not be more diverse. These opinions are used as justification for an equally diverse range of treatments for so-called occlusally related problems, from heavy wear to chronic orofacial pain. Many claim to have evidence to back up their opinions, although much of it appears to be from a very weak source or based on clinical experience. The strongest case appears to be made by those who believe there is no link, by virtue of a lack of evidence to support its existence. Yet for many clinicians, it is a self-evident truth that occlusion must be related in some way to the function and dysfunction of the stomatognathic system. This article uses historical research to highlight where the pro-occlusionists may be going wrong. It also offers a new concept, based on anthropological studies, that indicates occlusion's link to oral health, and explains why most patients appear to have no occlusal problems for most of the time. This theory needs to be tested by researchers to establish its validity. In the meantime, dentists who feel the need to treat occlusal problems will find it supports a very conservative approach to care.