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

Introduction: Patients attending for primary dental care may require oral surgery procedures beyond the capability of a generalist and thus need to be treated by a dentist with greater expertise. In the United Kingdom, it is increasingly accepted that such care may be provided in primary care settings by specialists or dentists with a special interest. In response to local pressures, an intermediate minor oral surgery (IMOS) service has been established in Croydon, south west London, to provide oral surgery treatment for non-urgent patients on referral.

Aim: To audit the appropriateness and quality of oral surgery referrals after triage to an IMOS service in Croydon and to set standards for future audits on this topic.

Methods: An audit tool was developed in line with the local referral guidelines and agreed with local stakeholders. Information on 501 (10%) triaged referrals to IMOS practices over a 24-month period was obtained through the referral management centre. A 10% sample of referrals per month to each practice was calculated and IMOS providers randomly selected the relevant patient records. Using an agreed audit pro forma, information on the indications for referral, treatment provided, and dates relating to patient management, in addition to the age and sex of patients, was collected from the IMOS providers by one investigator. Descriptive analysis of the data was performed.

Results: Of the 501 patient records that were examined, 99% of patients were treated in IMOS practices, with only three (less than 1%) patients being referred on to hospital consultant services. The largest proportion (237; 40%) of referrals was for the extraction of teeth considered to have special difficulty, followed by lower third molars (154; 26%). Almost one-third (159; 32%) of patients were referred for more than one procedure. One in eight (72; 13%) teeth removed by the IMOS providers were recorded as a simple extraction without medical complications.

Conclusions: In general, patients were referred appropriately to the primary care oral surgery service in Croydon, with only a minority recorded as receiving simple care that should not have required referral. The clinician-led triage process using a referral management system worked well in selecting appropriate patients for treatment by IMOS providers in primary care and reduced referrals to hospital. Suggested standards for future audits of IMOS referrals have been set.

This opinion paper considers obesity and its relationship to dental practice. Twenty-three per cent of people in England are estimated to be obese, a figure that is predicted to continue rising. It follows that obese patients are frequently encountered in general dental practice. The authors review the links between obesity and dental health, the possible barriers and challenges to providing dental care for obese people, and how these may be overcome. They also report the findings of a London survey investigating the current provision of specialist dental services for obese patients who cannot be treated in a standard dental chair. Services across London were highly variable and in some areas no provision was identified. The implications of the rising prevalence of obesity for service planners and practitioners are also discussed.

Aim: This prospective study was designed to establish the nature, frequency and sequelae of complications arising in patients receiving dental treatment under intravenous midazolam sedation.

Methods: All patients attending the Sedation Department at New-castle Dental Hospital for intravenous sedation over a six-month period were audited. A standardised data-collection pro forma was designed in order to collect data relating to the patient, the sedation episode, the dental treatment and any complications arising. The published standard used in this study states that the incidence of complications should be no more than 8%.

Results: Four hundred and one patients were included. The mean dose of midazolam administered was 7.6 mg with a mean titration rate of 0.9 mg/min. Complications were reported in 12 patients (3%), 11 of which were minor and one moderate. All complications were managed successfully within the department with no lasting sequelae. Treatment was completed in 382 (95.7%) patients, with failure to complete treatment in 17 (4.3%) patients due to disinhibition (1), poor cooperation (10), and the sedation wearing off (6).

Conclusion: The standard was met because complications arising were infrequent (3%) and predominantly minor in nature. Complications were managed conservatively and effectively, with all patients being discharged home the same day with no lasting sequelae. The study demonstrates that intravenous midazolam provides a safe sedation technique, suitable for adult dental patients in primary care, when administered by trained personnel on carefully selected patients and in accordance with nationally agreed protocols and guidelines.

Ehlers-Danlos syndrome (EDS) comprises a group of generalised connective tissue disorders. Deficiency or alteration of the collagen present in the tissues results in some classic signs such as skin hyper extensibility, joint hypermobility, and vascular fragility. Multiple supernumerary teeth, congenitally missing teeth, and odontogenic keratocysts have been reported in some patients with EDS. To the author's knowledge, transposition of permanent canines has not previously been reported in any case of EDS. This case report presents the dental findings of a sporadic case of classic-type EDS in a 14-year-old Chinese male who had transposition of a permanent maxillary canine as well as the presence of two supernumerary premolars in the mandible.

Aim: In order to assess the oral health status, oral behaviours and use of oral healthcare services of the adult population of Medway (Kent) in 2009, NHS Medway commissioned an assessment. Its aims were to understand oral health and impacts, behaviours and the use of dental services in order to inform future development of dental services.

Methods: A self-reported postal questionnaire survey using relevant questions from the 1998 national Adult Dental Health Survey (ADHS) was performed. A stratified sample was drawn from all those aged 16 years and over, living in Medway and registered with a general medical practice. Stratification was into the three areas within Medway (Chatham, Gillingham and Rainham, and Rochester and Strood). Where appropriate, respondents answered the questions using a five-point Likert scale. The resulting data were analysed by area of domicile, age, gender, and deprivation.

Results: Eight thousand questionnaires were sent out, of which 3101 (39%) were returned. Because of this low response and the need to weight responses to represent the distribution of the Medway population, this investigation must be considered as a service evaluation rather than a research project. Of respondents, 4% were edentate, 16% had 1-20 teeth, and 80% had 21 or more teeth. Fifty-one per cent of respondents reported at least one oral health impact; most commonly this was physical pain and psychological discomfort; least commonly, social disability and handicap. Sixteen per cent reported that their last dental visit was over 24 months ago and 31% reported that they attended only when in trouble or never (most commonly, because of anxiety and cost). There were marked variations in oral health status and use of dental services between those living in the most and least deprived areas.

Conclusions: • Medway adults were more likely than the 2009 national ADHS respondents to be dentate but less likely to have 21 or more teeth. •Oral health impacts have been substantial, especially the experience of physical pain. •Proportionately more people than the 2009 national ADHS respondents reported attending a dentist in the previous 24 months. The most common reasons for non-attendance were anxiety and cost. •These findings have implications for the future development of the Medway oral health strategy and for all those working in primary care dentistry.

Aim: This study´s aim was to assess whether the use of Short Message Service (SMS) text reminders sent to patients prior to their dental appointments improved attendance rates for two dentists at a dental access centre in Kirkcaldy, Fife, Scotland.

Method: Automated SMS text reminders were set up through practice management software at Kirkcaldy Dental Access Centre. Two audits, using a research methodology, were then performed. Failure to attend appointments with the two dentists at 150 consecutive appointments was assessed before and after implementing the SMS text reminders. The null hypothesis that SMS reminders do not improve attendance rates at the dental access centre was tested. The Yates´ corrected chi-square test was applied to the resulting data, with the level for statistical significance set at P<0.05.

Results: Patients readily accepted the text messages and found them to be non-intrusive. Failed attendance at appointments for the two dentists was reduced from 46/150 (31%) before the SMS text reminders were introduced to 21/150 (14%) after its introduction (P=0.00088). Thus the use of SMS text reminders resulted in a statistically significant reduction in the number of failed attendances at appointments for the two dentists.

Conclusions: In this preliminary study, SMS appointment reminders reduced the number of failed appointments significantly. They can provide an automated, non-intrusive, and cost-effective method of improving patient attendance at dental appointments.