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

Aims: This audit aimed to quantify the number of smokers attending two general dental practices. It also aimed to establish the demographic characteristics of these smokers in terms of age, gender and deprivation status, and to raise the awareness of practice staff about smoking cessation.

Methods: Data were collected from consecutive patients (aged over 16 years) attending two general dental practices over a period of one month. The information collected included smoking status, number of cigarettes smoked, age, gender, and postcode. A deprivation score (derived from the Welsh Index of Multiple Deprivation [WIMD] for 2008) was appended to each patient record in order to provide a measure of deprivation based on the postcode of the patient. Staff at both practices were involved in the audit. Staff were given a brief pre- and post-audit questionnaire to test their knowledge on smoking cessation. The audit standard was that no more than 29% of patients should be smokers. Where relevant, data were statistically tested using the chi-square test.

Results: Five hundred and sixty-one patients provided data on their smoking habits. It was found that 159 (28.3%) were smokers, smoking on average 12 cigarettes per day. The average age of the sample was 46 years and 242 (43.1%) were male. Forty-eight per cent of the sample was shown to be resident in a postcode considered to be deprived. Older patients were more likely to be nonsmokers (P=0.0001). Following the final audit meeting, correct answers among staff for knowledge of the National Institute for Health and Clinical Excellence guidelines regarding effective smoking-cessation practices improved from 6% to 71%.

Conclusion: The issue of smoking cessation has been highlighted for two dental teams. Whether the audit will result in the delivery of smoking-cessation procedures within the dental practice settings cannot be established. It is clear that the desired smoking-cessation behaviours can now be contemplated by the dental teams. Further monitoring is required to establish outcomes as a result of the actions of the teams.

This paper follows the recent series published in Primary Dental Care on the subject of mentoring. It is intended to place mentoring in a broader societal, professional, ethical and philosophical context. The introduction of the mentoring approach into human affairs in general, and the workplace in particular, is evidence of a fundamental shift both in the way we work together as individuals and in how we view and value ourselves as human beings. This paper reflects on the changes in thinking and attitudes in society that have led to the emergence of mentoring and coaching as elements in the approach of positive psychology. It then seeks to learn from the experience of the adoption of mentoring and coaching in other areas of work and society. It goes on to consider what impact this might have on underlying beliefs and attitudes within the profession of dentistry, and who might become the mentors and the mentees. Finally, it presents mentoring as an expression of the values and the culture of a caring profession seeking to promote the 'good life' both for its patients and for its practitioners.

Aims: Health policy in England is seeking to minimise hospital use and provide access to services in a primary healthcare setting and maximise skill-mix, driven by issues such as cost and access. The aim of this review was to determine the effectiveness of increased use of skill-mix and service transfer within general and oral healthcare. Secondary outcome measures were related to cost, quality, access, health outcomes and satisfaction.

Methods: Data sources were the Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination DARE, British Nursing Index, CINAHL, EMBASE, MEDLINE, and PsycINFO from 1996 to August 2008. The reference lists of relevant papers were scanned to identify additional studies.

Data selection: A rapid appraisal of systematic reviews, randomised controlled trials, controlled trials and service evaluations in relation to specialist services, practitioners with a special interest, medical and dental, nursing and dental care professionals, together with evidence of service shifts from secondary to primary care was undertaken.

Results: A total of 206 papers were reviewed. All titles and abstracts of articles and papers found were extracted and validated according to predefined criteria. They were screened for relevance by two researchers, who assessed trial quality and extracted data. Twenty-six papers met the inclusion criteria. The literature demonstrated limited evidence of the cost-effectiveness and health outcomes associated with changes in setting and skill-mix. However, there was evidence of improved access, patient and professional satisfaction.

Conclusions: There is an overwhelming need for well-designed interventions with robust evaluation to examine cost-effectiveness and benefits to patients and the health workforce.

Aim: To assess the quality of information included in referral letters sent to the orthodontic department at Kingston Hospital, Surrey, UK.

Methods: Referral letters sent by both general dental practitioners (GDPs) and specialist orthodontists were analysed retrospectively in order to ascertain the percentage meeting the inclusion criteria as suggested by Mossey (2006) and the British Orthodontic Society (2008) for the quality of information included in an ideal orthodontic referral letter. Thirty-five consecutive letters sent between May and September 2005 and 206 letters sent in the same period in 2008 were collected by hand and analysed against the inclusion criteria. The numbers of referral letters received from GDPs, specialist orthodontists, and others sources were also determined.

Results: Most of the referrals sent in 2005 and 2008 included 40-50% of the referral inclusion points. This was despite an almost twofold increase in the number of referral letters received from specialist orthodontic practitioners in 2008. The majority of the letters, from both GDPs and specialists, did not include details of the oral hygiene or caries status of the patient, or an indication of their motivation towards treatment. None of the referral letters included a plaque score.

Conclusion: The main weaknesses in the quality of information provided in referral letters were that in more than 80% of the letters there was no mention of the patient's medical history and no comment on caries status, the standard of oral hygiene, patient motivation for treatment, or an Index of Orthodontic Treatment Need score. The quality of information included in referral letters sent to Kingston Hospital orthodontic department needs to be improved.

Aim: To audit the quality of external referral communications sent to the Department of Sedation at Newcastle Dental Hospital.

Methods: A retrospective analysis was undertaken of a sample of 226 consecutive external referrals received by the sedation department of Newcastle Dental Hospital during May-July 2008. A data-collection form was used to record information provided in referrals relevant to the practice of sedation and the set standard was based on the recommendations of the Scottish Intercollegiate Guidelines Network (SIGN).

Results: Of the 226 referrals sampled, the majority (222; 98.2%) were from general dental practitioners. Seventy-six per cent were by letter and 24% by pro forma. Although of particular relevance to sedation referrals, a medical history was provided in only 59.0% of referrals and details of previous dental treatment in only 27.5%. The use of a pro forma significantly increased the provision of information compared to a letter in the following areas: patient's telephone number, patient's medication, doctor's name and doctor's address. Significantly less information was provided in the pro forma compared to the letters concerning the name of the referring practitioner and referring practitioner's telephone number. No difference was found between letter and pro forma referrals for medical history, treatment already attempted and reason for referral.

Conclusions: The findings indicate a need to improve the amount of information provided in referrals to the sedation department of Newcastle Dental Hospital in order to ensure appropriate allocation to sedation services. The quality of referrals may be improved by the distribution of referral guidelines, the use of electronic referral templates or changes to the current pro forma.

The importance of detecting oral malignant disease is paramount. Recent government strategies have placed an emphasis on the early detection of cancer. This paper presents a brief account of the current debate around the role of oral cancer screening and provides a summary of the results of three practice-based studies that were supported by the British Society for General Dental Surgery and the Faculty of General Dental Practice (UK). Overall, there appears to be a lack of rigour among some general dental practitioners when screening for potentially malignant disorders and their incidence in dental practice is perceived to be low. Barriers remain to the implementation of smoking-cessation schemes and many general dental practitioners feel out of their depth in tackling the abuse of alcohol, despite recognising its importance as a risk factor. Patients continue to present to their general medical practitioner (GMP) when they are concerned about something in their mouth that is not related to their teeth. GMPs' ability to manage early oral cancer is discussed. A prospective randomised controlled trial (RCT), or a demonstration study, is recommended to investigate the numbers of cases of oral cancer diagnosed in primary dental care and primary medical care and to develop standardised referral criteria for early cases of this disease to reduce under- and over-referral. The RCT could also examine the potential of using auxiliary healthcare workers and examine the impact of such a programme upon secondary care services.

This 'in my opinion' paper uses two case studies to highlight the importance of making an early diagnosis of unexplained orofacial pain. Patients with this condition can present with symptoms that can easily be confused with more common dental pain that is related to an organic pathology. An incorrect diagnosis can lead to invasive and irreversible treatment using advanced surgical or restorative techniques that are not evidence-based. Current evidence supports the use of non-invasive techniques such as behavioural interventions; for example, cognitive behaviour therapy. It is therefore imperative that patients with this condition are recognised early in primary care so that management is appropriate from the outset. This will prevent unnecessary invasive intervention, protecting the patient from harm and the practitioner from litigation.

Introduction: Intravenous sedation is the most commonly used method of sedation for the provision of adult dental care. However, disparity exists in pre-operative fasting times in use for patients throughout the United Kingdom.

Aims: The aims of the study were to obtain information on the effects of existing extended pre-operative fasting regimens, to canvas patient opinions on the fasting process, and to record their positive and negative experiences associated with it.

Methods: A prospective cross-sectional descriptive study using survey methodology was conducted of adult patients attending a dental hospital for operative treatment under intravenous sedation. Sixty-four questionnaires were distributed over a four-month period, beginning 2nd October 2007.

Results: The surveyed patient pool consisted of 38 females and 14 males with a mean age of 32.4 years. The response rate achieved was 81.2%. Seventy-one per cent of patients indicated that normally they consumed something for breakfast, the most common items being tea and toast. Fifty-one per cent of patients indicated that they would wish to eat the same as normal prior to their appointment and 59% wished to drink as normal. Only 19% of respondents reported that they did not wish to eat anything, with 8% preferring not to drink anything at all. Seventy-nine per cent of the patients reported that they had experienced at least one adverse symptom after fasting and 42% had experienced two or more such symptoms. In general, those patients with more experience of sedation found fasting less unpleasant than those attending for the first time (P<0.05). In addition, one-quarter of all patients indicated that the fasting process had made them feel more nervous about their sedation appointment.

Conclusions: The extended fasting regimen prior to intravenous sedation appeared to affect patients' wellbeing, as the majority reported adverse symptoms.

Aims: The aims of this study were to investigate and describe the views of a group of general dental practitioners (GDPs) on their use of preformed metal crowns (PMCs) with the conventional method and the Hall Technique. The practitioners involved had previously taken part in a clinical trial of the Hall Technique.

Methods: The dentists' views were explored using a semi-structured interview (transcribed and analysed using a framework approach) and their use of crowns investigated (for conventional and Hall Technique) using a short questionnaire.

Results: Fourteen out of 17 dentists who participated in the trial were interviewed and completed the questionnaire. Prior to the trial, only three of the GDPs had been using conventional PMCs at all and this was 'infrequently'. None had been using them routinely. The semi-structured questionnaires revealed three main themes reflecting positively on the GDPs' experiences with the Hall Technique: its ease of use, its high patient acceptability, and the dentists' perceived clinical effectiveness of the technique. Thirteen of the 14 GDPs stated that they would continue to use the Hall Technique routinely and only one thought that he would not use it.

Conclusion: Among a small group of GDPs with little experience or training in the use of the Hall Technique, it was perceived to be easy to use routinely, acceptable to patients and effective.