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

This paper describes the innovative use of National Health Service (NHS) dental commissioning powers to develop specialist primary care based oral surgery services. The outcomes, after one full year of the scheme, have been substantial improvement in access and reduced waiting times for patients, further development of NHS primary care dental services through commissioning processes, increased use and engagement of oral surgery specialists outside of a hospital setting, and considerable ongoing savings to the NHS. Collaborative working between hospital consultants and managers, Primary Care Trust dental commissioners, general dental practice providers, specialist oral surgeons and a dental public health consultant has resulted in sustainable benefits to patients and the NHS within the World Class Commissioning framework.

Aims: The aim of this audit was to quantify the number of patients that received a dental general anaesthetic (DGA) between 1999 and 2007 following referral from a general dental practice. It also aimed to establish the deprivation status of those referred and to investigate further dental treatment pathways of these patients.

Methods: Data were collected from all patient records held by the practice. The information collected included: postcode, gender, age at the close of the study, age at time of DGA, reason for DGA, number of teeth extracted, and details of further ongoing care. In the absence of individual level socioeconomic data, a deprivation score (derived from the Welsh Index of Multiple Deprivation [WIMD]) was appended to each record in order to provide a measure of deprivation based on the postcode of the patient.

Results: Two hundred and eighty-seven patients were referred for DGA during the nine-year period. Their mean age was 9.4 years (95% confidence interval [CI] = 8.4, 10.4) and 30.7% were children aged five years or younger. The most common reason for DGA was dental caries. The mean number of teeth extracted was 4.5 (95% CI = 4.1, 4.9). Patients living in deprived areas were more likely to be referred for DGA. Of the 87 who did not subsequently attend for continuing care, 72 were from deprived areas compared with 15 from more affluent areas (P=0.003).

Conclusions: In proportion to the number of patients registered at a practice, the number of referrals for DGAs was relatively low. Patients categorised as deprived (based on their residential postcode) received more referrals for DGAs than those from more affluent areas. Patients from deprived locations were significantly more likely not to attend for continuing care after their DGA than those from more affluent areas.

Introduction: A new dental contract was introduced in the National Health Service (NHS) General Dental Services (GDS) in April 2006. Responsibility for clinical audit activities was devolved to Primary Care Trusts (PCTs) as part of their clinical governance remit. In July 2003, an NHS Modernisation Agency pilot scheme for clinical audit was launched by Southend PCT.

Aim: The aim of this study was to evaluate this scheme.

Methods: A qualitative research method was used. It used audiotape recorded semi-structured research interviews with eight general dental practitioners (GDPs) who had taken part in the scheme. The evaluation focused on dentists' experiences of the scheme.

Results: Dentists appreciated the central PCT-based coordinator for the scheme and found that the streamlining of design, analysis and report writing within the audit projects enabled efficient use of time. The design by an outside agency appeared to add credibility to the scheme. Participants felt that comparability of data derived from clinical audit was enhanced by the scheme and could lead to comparison across PCT patch, regional or even national levels. The use of feedback mechanisms within the scheme was appreciated and thought to help produce maximum value from a clinical audit project. There was evidence of beneficial change occurring within practices and for patients.

Conclusions: This study provided an evaluation of a particular clinical audit scheme, several aspects of which differed from the traditional GDS scheme. Organisations proposing to undertake clinical audit activities in conjunction with dentistry in the future may benefit from incorporating elements of this scheme into their project design.

Aims: The aims of this pilot study were to determine the prevalence of head, face and dental injuries sustained by schoolboys while playing cricket and to compare the prevalence of those injuries in England and Australia.

Methods: A questionnaire that determined distribution and prevalence of orofacial injuries sustained when playing cricket was distributed to all players (n=411) who played cricket in four private schools in England and four private schools in Australia. There was a 100% response rate.

Results: Fifty subjects (24.1%) from English schools and 52 subjects (25.5%) from Australian schools reported injury/injuries to the head, face and teeth. Australian cricketers reported more injuries per player. The distribution of injuries between the two countries was similar. Sixteen players had sustained loosened or broken teeth. Two players reported avulsed teeth.

Conclusion: It was concluded that there was a high prevalence of head and orofacial injuries among the schoolboy cricketers but relatively few dental injuries. The distribution of types of head, face and dental injury in England and Australia were similar.

Introduction: Soft liners have been developed to offer comfort to denture wearers. However, this comfort is compromised when there is a change in the properties of the material, causing colour change, solubility, absorption and hardening. These characteristics can compromise the longevity of soft liners.

Aim: The aim of this in vitro study was to investigate the effect of ageing on both the hardness and colour change of two soft liners following accelerated ageing.

Methods: Two denture liners, one resin based (Trusoft, Bosworth, Illinois, USA) and one silicone based (Ufi Gel P, Voco GMBH, Cuxhaven, Germany), were tested in this study for both hardness (using the Shore A scale) and colour change (using the CIE L*a*b* colour scale), initially and after 1008 hours (6 weeks) of accelerated ageing. Statistical analysis was performed using the unpaired t-test with the Welch correction.

Results: These indicated that both materials increased in hardness and underwent colour change after accelerated ageing. The initial hardness of Trusoft was far lower than that of Ufi Gel P (18.2 Shore A units vs 34.8 Shore A units). However, for Trusoft the changes for both hardness (from 18.2 to 52.1 Shore A units) and colour change (16.85 on the CIE L*a*b* colour scale) were greater than those for Ufi Gel P, for which hardness changed from 34.8 to 36.5 Shore A units and the colour change was 5.19 on the CIE L*a*b* colour scale.

Conclusions: Ufi Gel P underwent less hardness and colour change after accelerated ageing than Trusoft. On the other hand, the use of Trusoft may be preferable in cases where initial softness is a major consideration, such as when relining an immediate denture after implant surgery.

The presence of three or more supernumerary teeth in one patient is uncommon. Genetic as well as environmental causes have been suggested as possible aetiological factors in the pathogenesis of supernumerary teeth. This report describes the dental findings and management of multiple supernumerary premolars in two siblings. The number and locations of the supernumeraries in both cases were almost identical. The findings from these cases give further support to the important role of genetic factors in the aetiology of supernumerary teeth. Primary care dentists who treat children should be aware of the possibility of familial occurrence of supernumerary teeth.

Unlabelled: A collaborative audit of clinical record-keeping standards was performed among Worcestershire dentists.

Aims: Its aims were to improve the quality of National Health Service (NHS) patient care and to assist dentists to perform well during Dental Reference Service practice visits.

Methods: Worcestershire dentists with NHS contracts were invited to take part in this audit. Each dentist audited a random selection of 30 of their dental clinical records against a common framework comprising eight domains. Record-keeping, and the presence or absence of key diagnostic and treatment planning details were recorded. Grading was applied in four categories, in which grades 1 and 2 were good (1) and adequate (2), captured on data-collection sheets and centrally analysed for frequency of each grade.

Results: Out of a total of 184 Worcestershire general dental practitioners, 161 (87.5%) submitted usable responses. The audit revealed wide variation between dentists in clinical record-keeping. The recording of soft tissues (36% below grade 2), periodontal status (30%), radiographic review (27%), and note-taking (25%) all fell below the standard that had been set (brackets show proportion not meeting the standard).

Conclusions: The results provided baseline information about the standard of record-keeping in NHS dental practices in Worcestershire. The collaborative nature of the audit enabled dissemination of individual results to participants, to facilitate comparison (anonymously) against their peers. The audit provided impetus for the Primary Care Trust (PCT) to arrange postgraduate education on record-keeping and to raise awareness among local dentists about record-keeping. The subsequent report to dentists explored the record-keeping standards expected during practice inspections undertaken by the Dental Reference Service. Worcestershire PCT's method of collaborative dental audit could potentially replace the previous national programme of dental audit, formerly coordinated locally.

Aim: To quantify the way that oral diseases affect the lives of homeless and vulnerable people in Swansea, using the short-form Oral Health Impact Profile (OHIP-14).

Method: A convenience sample of people using the services of a healthy living centre for the homeless was surveyed using a questionnaire and the short-form OHIP-14.

Results: One hundred subjects were recruited to the study. The mean score for the OHIP-14 was 21.8 (SD 17.0). The most commonly reported impacts experienced were problems with toothache, discomfort, ability to relax, and feeling ashamed regarding the appearance of teeth. Of the different categories of homeless people, rough sleepers experienced higher levels of impact (P=0.004). Those having more than 20 teeth were more likely to experience lower levels of impact (P=0.001).

Conclusion: The survey highlighted an increased prevalence of oral health impacts in this special needs group. In addition to physical factors, psychosocial factors must be considered, particularly with regard to appearance and psychological disability and discomfort, in the development of services.