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

The Modernising Medical Careers framework provides the opportunity for both medical specialists and general medical practitioners to follow training pathways that lead to appointments as National Health Service (NHS) consultants and to senior academic posts. Similar opportunities are available for dentists who wish to specialise. However, they are not available to dentists working in primary dental care who wish to become NHS consultants or senior academics in general dentistry. An alternative pathway is required that does not force committed primary care dentists who wish to become NHS consultants or senior academics down a path of specialisation. In this paper, the authors explore the situation in some detail and propose a career pathway with appropriate competencies for primary care dentists who aspire to become NHS consultants or senior academics. They justify why such posts should be created. The competencies have been developed using key guidelines and documents from the European Bologna Process and the Association for Dental Education in Europe, the Curriculum for UK Dental Foundation Programme Training, and the General Dental Council monospecialty curricula. It is hoped that the proposed pathway will produce highly trained generalists who will: (a) encourage and undertake research in primary dental care, where over 90% of dentistry is delivered, (b) support and lead outreach centres so that teaching and clinical cases reflect primary dental care, where students will spend their working lives post-qualification, and (c) provide a means of increasing the numbers of clinical dental academics, which have been in decline over the last 10 years.

This opinion paper reviews trends in oral disease and its management in older people, in response to a challenge, in an editorial in The Lancet, to the traditional curative model of dentistry and the publication of the most recent Adult Dental Health Survey. It highlights the challenge of an ageing population and its oral health needs and management. Professional issues in relation to preventive care are discussed with emphasis on the importance of identifying patient risk and providing preventive care, together with improving the uptake of dental care among older people.

Aims: The primary aims of the study were to investigate the use of bitewing radiography within primary dental care and adherence to guidelines on bitewing radiography by general dental practitioners (GDPs) in the West Kent Primary Care Trust (PCT) area. Within the overall aims, the study had objectives to investigate the use of radiographic guidelines, audit and caries risk assessment, the influence of private and National Health Service (NHS) practice, and the influence of the demographic profile of the GDPs on these variables.

Methods: Data were gathered via a piloted self-completion questionnaire, circulated to all GDPs listed on the NHS Choices website as practising in the West Kent PCT area. Three mailings and follow-up telephone calls were used. The resulting data were entered into a statistical software database and, where relevant, statistically tested, using the chi-square test.

Results: Of 223 GDPs, 167 responded (75%). GDPs with a high NHS commitment were significantly less likely to follow Faculty of General Dental Practice (UK) guidance on prescribing bitewing radiographs for adults (P<0.01) and children (P<0.05) than were mainly private GDPs. Mainly NHS GDPs were more likely 'always/mostly' to follow National Institute for Health and Clinical Excellence guidance (83 compared to 59) (P<0.05) and also to risk-assess patients (83 compared to 62). Only 115 (71%) had carried out a radio graphic audit or peer review in the preceding three years. Those with postgraduate qualifications were more likely (P<0.05) to carry out radiographic audit.

Conclusions: The study confirmed previous research reporting the under-use of radiography for caries detection and also the failure of some GDPs to comply with ionising radiation regulations. West Kent GDPs with a high NHS commitment were less likely to follow radiographic guidance than their private counterparts. This suggests that further efforts to disseminate information on radiographic guidelines and to educate GDPs are necessary to improve adherence with all aspects of radiography within general dental practice. Research into factors that influence GDPs' decision-making with regards to radiographic prescription may further inform the profession as to the best methods to lead to behavioural change. The dental profession and its regulators need to make a concerted effort to educate and inform GDPs so that this behaviour is modified.

Desmoplastic fibroma is a rare benign and locally aggressive myo fibroblastic tumour, frequently seen in the second or third decades of life. The mandible and the maxilla are infrequently involved, and the mandible is the most commonly affected of the facial bones. Nevertheless, reports of desmoplastic fibroma affecting the mandible are scarce in the literature. This article reports a rare case of desmoplastic fibroma affecting the angle of the mandible in a 10-year-old Indian male. In addition, a review of literature relating to desmoplastic fibroma affecting the angle of the mandible is presented.

Aims: To compare the intra- and inter-assessor agreement and operator preference of a modified (four-grade) quality rating system for dental radiographs with the current National Radiological Protection Board (NRPB) (three-grade) quality rating system.

Methods: Sixty radiographic images of varying quality were selected by retrospective review of dental records from a general dental practice. The images were sorted into groups to represent examples of radiographic quality (1=excellent, 2=diagnostically acceptable, 3=diagnostically compromised, 4=unacceptable). A 'gold standard' for radiological quality assessment was provided by a consultant in dental and maxillofacial radiology. A compact disc (CD) of the 60 images was produced and posted to a panel of 14 general dental practitioners (GDPs) who were asked to grade the quality of the images using two different systems on two occasions separated by a washout period of two days. The practitioners graded the radiographs using the currently accepted method for assessing radiographic quality (the three-grade NRPB system) and the alternative four-grade system. The quality of the images on the CD was deemed appropriate by the consultant.

Results: The strength of inter-assessor agreement was weaker when using a four-grade system in comparison to a three-grade system, reducing to a mean of k=0.51 from a mean of k=0.61 when using the original grading system. Mean agreement did not fall below 'moderate agreement' (k=0.41-0.60). Eleven of the 14 GDPs preferred the four-grade system.

Conclusion: The GDPs who participated in this study preferred the four-grade system to the three-grade system when comparing the quality of dental radiographs. However, the strength of agreement was weaker when using the four-grade system in comparison to the three-grade system. Overall, the results are equivocal. However, they should help to inform specialist dental radiology panels, should revision of quality grading be undertaken in the future.

Aim: The aim of this study was to survey patient satisfaction with dental care delivered in general practice and to compare the results with those obtained five years earlier using the same questionnaire.

Methodology: A previously piloted patient satisfaction question- naire was distributed to consecutive adult patients of one dentist at two general dental practices on completion of restorative or surgical treatment. The results were compared with those achieved by the same dentist using the same questionnaire five years previously during vocational training (VT).

Results: Thirty-nine questionnaires were distributed at one practice and 31 at the second. Thirty (77%) were returned at the first practice and 23 (74%) at the second. There were no statistically significant differences in answers to the questions between the two practices. The two sets of results were combined and compared with results from the previous survey. There was a statistically significant improvement (P<0.05) since the first survey for attributes relating to conveying cost information. There was a moderate correlation between patient perception of professionalism, oral hygiene advice and empathy and the patient's intent on returning for further services and recommending the dentist to others.

Conclusion: It appeared that patient satisfaction with dental care marginally increased with postgraduate experience gained over five years since VT by the dentist concerned. Patients' perception of the quality of dental care provision and their intent on re-accessing a dental service may be associated with a practitioner's professionalism, empathy and delivery of oral hygiene advice.