A J Morris

The oral cleanliness and periodontal health of UK adults in 1998.

Periodontal disease continues to be a major concern for dentists and patients. This paper reports the findings of the 1998 UK Adult Dental Health survey in relation to plaque, calculus, periodontal pocketing and loss of attachment. It is apparent from this study that moderate periodontal disease remains commonplace amongst UK adults and that the associated risk factors of plaque and calculus are in abundance, even amongst those who profess to be motivated about their oral health and attend the dentist regularly. The continued high prevalence of disease needs to be seen in the context of the far larger number of people who are now potentially at some risk, particularly in the older age groups, because of improvements in tooth retention. However, the cumulative effect of disease means that control of the periodontal diseases, even mild and slowly progressing disease, will be a key issue if large numbers of teeth are to be retained into old age. If that level of control is to be achieved we need a widespread improvement in our management of the disease, particularly in our ability to improve the oral cleanliness of the UK population.

Adult dental health survey: The oral cleanliness and periodontal health of UK adults in 1998

Periodontal disease continues to be a major concern for dentists and patients. This paper reports the findings of the 1998 UK Adult Dental Health survey in relation to plaque, calculus, periodontal pocketing and loss of attachment. It is apparent from this study that moderate periodontal disease remains commonplace amongst UK adults and that the associated risk factors of plaque and calculus are in abundance, even amongst those who profess to be motivated about their oral health and attend the dentist regularly. The continued high prevalence of disease needs to be seen in the context of the far larger number of people who are now potentially at some risk, particularly in the older age groups, because of improvements in tooth retention. However, the cumulative effect of disease means that control of the periodontal diseases, even mild and slowly progressing disease, will be a key issue if large numbers of teeth are to be retained into old age. If that level of control is to be achieved we need a widespread improvement in our management of the disease, particularly in our ability to improve the oral cleanliness of the UK population.

Non-carious tooth conditions in children in the UK, 2003

Background The 2003 Childrens Dental Health Survey is the fourth of the 10-yearly surveys of childrens oral health.Aim To report the prevalence of three non-carious tooth conditions in children in the UK.Method A representative sample of children five, eight, 12 and 15 years of age were examined by calibrated examiners in schools across the UK. The dental examination included accidental damage to incisors, tooth surface loss (TSL) and enamel opacities (age 12 only). A postal questionnaire sought parental and child views on marks on teeth which could not be removed by brushing.Results The proportion of children sustaining accidental damage to permanent incisors decreased to 11% of 12 and 13% of 15-year-olds, but the majority of accidental damage remained untreated. TSL was found on 53% of five-year-olds and on approximately a third of 12 and 15-year-olds. There was a statistically significant change for TSL on permanent teeth at age 15 where 27% upper incisors had TSL palatally in 1993 compared to 33% in 2003. Thirty-four per cent of 12-year-old children had enamel opacities on one or more of their teeth compared with 36% in 1993.Conclusions Tooth surface loss remains a common finding in children in the UK. A large proportion of accidental damage to teeth remains untreated.

The reported impact of oral condition on children in the United Kingdom, 2003

Background The 2003 Childrens Dental Health Survey is the fourth in a series of decennial national childrens dental health surveys of the United Kingdom.Aims This paper is concerned with how children are reported to have been affected by their oral condition during the 12 month period immediately preceding the survey and how this relates to the childrens experience of caries, their dental attendance behaviour and their social class.Method The information was gathered by self-completion questionnaire distributed to the parents of half of the sample who were clinically examined in the dental survey.Results Some form of impact was reported by the parents of 22% of five-year-olds, 26% of eight-year-olds, 34% of 12-year-olds and 28% of 15-year-olds. The pattern of responses to the eight impact questions was broadly similar across age groups. The most frequently reported type of impact was pain in all age groups. Impacts on oral function, self-confidence, orally related activity and on the childs emotions were experienced by 4-10% of children of all ages. Fewer children (1-2%) were reported to have experienced more far reaching impacts affecting their social functioning, general health and life overall.Conclusions Most children were reported not to have experienced any of the problems covered by the questionnaire. Of those who did, most reported a single problem and for most this was pain. Nevertheless there was a group of children for whom oral function, self-confidence, orally related activity, emotions, social functioning, their health or their life in general were reported to have been affected by their oral condition. The nature of dental care which is appropriate for such children needs to be determined.

health policy: Primary and secondary dental care: the nature of the interface

Specialist dental services are scarce resources and are often oversubscribed. A key element is how these services relate to their referral base, in other words the interface between primary and secondary dental care. Dentistry has several unique qualities when compared with medicine and the nature of the interface between primary and secondary dental care is consequently very different to the medical interface, whilst apparently sharing common features. This paper examines the nature of that interface, the drivers for patient flow between services and outlines the properties of an ideal interface. This model can then be used as a way of describing some of the problems facing specialist dental services and of assessing any proposed solutions.

health policy: Primary and secondary dental care: how ideal is the interface?

In our previous paper in this journal, we described an ideal interface between primary and secondary dental care in terms of equity, seamless care and efficiency and effectiveness. This paper examines the published evidence describing considerable ongoing problems with the interface under these headings and the ways in which those problems might be better described, quantified and addressed.

National evaluation of personal dental services (PDS) pilots: main findings and policy implications.

Personal dental services (PDS) are new forms of NHS dental care in England that employ a locally negotiated contract as opposed to one based on a nationally negotiated scale of fees. These schemes have been specifically designed to tackle local problems related to access and oral health needs. This practice paper examines the main findings of a Department of Health-funded evaluation from 20 first and second wave PDS pilots. The paper reveals that all PDS pilots changed treatment profiles in an attempt to meet local oral health needs and/or promote access to NHS dentistry. Moreover, PDS pilots appeared to encourage a new skill-mix, provide job satisfaction and improve working conditions. PDS pilots appear to have provided an opportunity to change the culture of primary dental care provision to one based on quality rather than on activity and cost. Their experiences should help inform the implementation of NHS Dentistry: Options for Change.

Dental practitioners and ill health retirement: causes, outcomes and re-employment

Aim The aim of this project was, by means of a questionnaire to ill health retirees, to determine the factors which have contributed to the premature retirement of general dental practitioners (GDPs) due to ill health.Methods A questionnaire was designed to determine the effects of illness and ill health retirement (IHR) on the lives of those dentists who were affected. This was distributed to 207 dentists who were known to have retired because of ill health but were not suffering from serious, debilitating or life-threatening illnesses.Results A total of 189 questionnaires were returned. The mean age at retirement of respondents was 51.5 years, with a range of 31 to 62 years. Of the respondents, 90% selected general dental practitioner as their last job title. The most common cause of IHR was musculoskeletal disorders (55%), followed by mental and behavioural disorders (28%). A majority of respondents (90%) considered that their ill health was work related. Sixty-three percent of respondents stated that they were able to keep working until their retirement, 34% of respondents stated that they would have liked to have been offered part-time work as an alternative to full retirement, and 27% of dentists reported to have found re-employment since their retirement. In univariate analyses, re-employment of dentists after IHR was significantly associated with age, having dependants, cause of IHR, health having improved and wanting to work again. Multiple logistic regression analyses showed that a combination of age, having dependents and cause of IHR was predictive of re-employment status (p = 0.024).Conclusion This study used a database of dentists who were ill health retired and who were not suffering from life threatening illnesses The results confirmed that the majority were able to work up to their retirement and a similar number would have liked to continue working, particularly if part-time work had been possible. It seems likely that many of the ill health retirees could have been retained in the dental workforce with better support or opportunities for more flexible working.

Facilitators and barriers to improving the quality of referrals for potential oral cancer.

The quality and content of referral letters are important for prioritisation of patients who may have oral cancer. Referrals letters to the Oral Medicine Clinic at Birmingham Dental Hospital were analysed and practitioners interviewed. Whilst acceptable for general purposes, most letters did not contain sufficient information to allow effective prioritisation. Interviews disclosed a misunderstanding amongst practitioners about the way in which referrals were handled. A number of barriers to increasing the information included in letters were identified. Referral guidelines and a standardised proforma might help improve the ability of the service to operate a fast-track system.

National evaluation of personal dental services: the perspective of dentists and professionals complementary to dentistry.

In 2001, research was carried out to investigate the views of dentists and professionals complementary to dentistry on their experiences as part of the personal dental services pilots. This article outlines the main messages from the survey. Before 1997, NHS general dental services could only be delivered by general dental practitioners via a national contract with a nationally negotiated scale of fees. The NHS (Primary Care) Act 1997 allowed for the voluntary establishment of personal dental services (PDS) pilot schemes to test alternative ways of delivering dental services, in particular general dental services, through local contracting arrangements. In the PDS scheme, the contract for dental services was agreed between the commissioners (health authority or primary care trust) and one or more providers of dental services. Since then, the involvement of professionals complementary to dentistry (PCDs) has become an increasingly important issue. This investigation seeks to shed some light on the effectiveness of attempts to integrate the dental team and improve the contribution made by PCDs.