J. T. Newton

The influence of tooth colour on the perceptions of personal characteristics among female dental patients: comparisons of unmodified, decayed and 'whitened' teeth

Objective Physical appearance plays a key role in human social interaction and the smile and teeth are important features in determining the attractiveness of a face. Furthermore, the mouth is thought to be important in social interactions. The purpose of this study was to determine the relationship between tooth colour and social perceptions.Methods Cross-sectional survey. One hundred and eighty female participants viewed one of six images, either a male or a female digitally altered to display one of three possible dental statuses (unmodified, decayed, or whitened). The images were rated on four personality traits: social competence (SC), intellectual ability (IA), psychological adjustment (PA), and relationship satisfaction (RS).Results Decayed dental appearance led to more negative judgements over the four personality categories. Whitened teeth led to more positive appraisals. The gender of the image and the demographic background of the participant did not have a significant effect on appraisals.Conclusion Tooth colour exerts an influence on social perceptions. The results may be explained by negative beliefs about dental decay, such as its link with poor oral hygiene.

Occupational burnout and work engagement: a national survey of dentists in the United Kingdom.

Objective To determine the levels of burnout and work engagement among dentists in the United Kingdom.Study design Postal survey of 500 dentists selected at random from the General Dental Council register.Methods Respondents completed a questionnaire pack comprising the Utrecht Work Engagement Scale (UWES-17) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), together with questions on demographic characteristics.Results Approximately 8% of respondents had scores suggestive of burnout on all three scales of the MBI-HSS and a further 18.5% had high scores in two of the domains. Eighty-three percent of respondents had work engagement scores suggestive of moderate or high work engagement. Dentists with postgraduate qualifications and those who work in larger teams had lower burnout scores and more positive work engagement scores. Dentists who spend a greater proportion of their time in NHS practice showed lower work engagement and higher levels of burnout.Conclusions Burnout affects a small but significant proportion of dental practitioners in the United Kingdom. A larger proportion of practitioners show low work engagement, suggesting a negative attitude to their work. Higher burnout scores and lower work engagement scores were found in dentists without postgraduate qualifications, those in small teams and in those who spend a greater proportion of their time in NHS practice.

The development of a patient-centered measure of the process and outcome of combined orthodontic and orthognathic treatment

Objective The aim of this study was to develop a patient-based measure of the process and outcome of combined orthodontic and orthognathic care in the National Health Service in the UK. Design Identification of relevant dimensions through qualitative methods, design of form, determination of psychometric properties of the scale, specific readability, reliability and validity. Setting NHS hospitals in the South West Region. Subjects The sample comprised patients who had received combined orthodontic and orthognathic treatment between 01 January1998 and 31 December 2000. Twenty-six participants (a 25% response rate) took part in four focus group meetings. Thirty subjects (65% response rate) took part in a pilot study to test the properties of the questionnaire. Main outcome measures Six broad themes emerged from the focus groups. These formed the basis of the sections in the questionnaire. Results The questionnaire developed had a Flesch reading ease score of 72.9 or US grade level 4 equivalent to aged 9–10 years. Test–retest reliability gave kappa values for most questions that exceeded 0.4. Criterion validity of the measure was established by comparing responses to the questionnaire over two periods with a telephone interview on a sample of 30 patients. Criterion related validity was poor for nine of the 16 items. By contrast the construct validity of the questionnaire was satisfactory. Conclusion A patient-based measure of the process and outcome of combined orthodontic and orthognathic treatment has been developed. This has sufficient validity and reliability for use in inter-center audit projects.

How to reduce the stress of general dental practice: The need for research into the effectiveness of multifaceted interventions

While the practice of dentistry has been demonstrated to be significantly stressful, there have been few published studies describing interventions to reduce the stress of dental practitioners. This article describes research into the prevention and alleviation of stress amongst a variety of healthcare professionals, including dental practitioners, and describes the findings from a small scale study of an intervention aimed at general dental practitioners who reported high levels of work related stress. It is argued that to be effective, interventions should be tailored to the individual needs of the practitioner, within a structured intervention framework. Further research into the effectiveness and cost-effectiveness of stress management for dental practitioners is required.

Changing the behavior of patients with periodontitis

Success in periodontal treatment is highly dependent upon the ability and willingness of the patient to maintain good oral hygiene. This is achieved through a combination of personal care and seeking professional help. Assistance provided by dental professionals includes removing deposits of plaque or calcified bacterial material (calculus) that may prevent effective self-care, as well as dealing with any associated secondary aetiological factors, such as smoking or dietary control (19, 51). However, even with professional help, poor oral hygiene can lead to treatment failure in the longer term (10, 46, 61, 67, 71). Furthermore, Turner et al. (87) concluded that periodontal outcomes can be improved in chronic periodontitis patients by the sole use of oral hygiene. Improving patients adherence to oral hygiene instructions requires changing patients behavior in terms of brushing, flossing and the use of additional oral hygiene techniques. There is a great need in dentistry for effective interventions to improve patients adherence to oral hygiene instructions (92), particularly to improve the long-term treatment success in periodontal patients (8). However, this is potentially challenging, as the behaviors that require adherence to oral hygiene in patients with periodontal disease display many characteristics that have been shown to predict low adherence (35, 54). Specifically, the effects of behavior change are only manifest after several weeks, thus it does not provide immediate relief of symptoms. Furthermore, flossing and brushing may exacerbate symptoms initially, and the patient might experience bleeding and pain. Inflammatory periodontal diseases require patients to make permanent lifestyle changes, because they are chronic conditions. Johansson et al. (39) assessed adherence in a sample of 44 patients with moderate periodontitis, and found that less than half reported still using interdental cleaning aides at the end of 3 years. Similarly, Strack et al. (80) assessed adherence to oral hygiene through patient interviews. This study reported that 30 days after receiving the oral hygiene instructions provided within the clinic, half of the patients (51%) were highly compliant , while 38% were moderately compliant and 11% completely failed to adhere to the instructions. There are a wide range of psychological models and theories that provide an important framework for increasing our understanding of the determinants of adherence to recommendations concerning health behaviors. Social cognition models in particular have been repeatedly applied to predict and explain behavior changes such as screening attendance, dieting and oral hygiene behavior (21). Social cognitions are beliefs, thoughts and attitudes concerning behaviors that are believed to be related to whether or not a person undertakes a particular behavior. All these models share the common assumption that an individual s behavior is best understood by examining their attitudes and beliefs. The following models will be reviewed in relation to oral hygiene behaviors: • health belief model. • protection motivation theory. • locus of control. • social learning theory. • theory of planned behavior. • implementation intentions. • stages of change model (or trans-theoretical model). For each model, an outline of the constructs involved in the model and their relationships will be given. This will be followed by a review of research exploring the relationship between the theory and healthrelated behaviors, including oral health-related behaviors where possible. Finally, intervention studies based on targeting the cognitions in the model will be discussed for each model. Overall, the application of social cognition models to behavior change

The working practices and job satisfaction of dental therapists: findings of a national survey

OBJECTIVE To describe the working practices and level of job satisfaction of dental therapists in the United Kingdom. DESIGN Postal questionnaire survey of 380 dental therapists registered with the General Dental Council. RESULTS Only 13% of dental therapists are also qualified as dental hygienists. Around 75% of those registered with the GDC are currently employed as dental therapists. Of those not currently working as dental therapists most were either working as hygienists or caring for their children at home. Over 90% of those working as therapists are employed within the Community Dental Service. About half work part-time. Part-time working is more common among respondents with childcare responsibilities. Most dental therapists are employed in clinical roles, and perform a limited range of treatments. A small proportion appear to have been asked to undertake duties which are not currently legal for them to perform. Three-quarters of those who were currently working as dental therapists had taken career breaks at some point, the most common reasons for such a break being a change in career and/or child rearing. The respondents expressed a high level of job satisfaction, particularly among older dental therapists. CONCLUSIONS Dental therapy offers a potentially rewarding career in terms of job satisfaction. Any planned increase in the numbers of training places for dental therapists should their role be expanded, for example to include working in general dental practice, would need to take cognisance of the high rate of part-time working and the proportion who could be expected to take career breaks at some point in their working lives, as is the case with female dental practitioners.

Social perceptions of adults wearing orthodontic appliances: a cross-sectional study

This study ascertained the influence of orthodontic appliances on subjective ratings for social competence (SC), intellectual ability (IA), psychological adjustment (PA), and attractiveness in young adult orthodontic patients. A cross-sectional analytical questionnaire study was conducted with 130 undergraduates from the UK. Each participant was asked to look at a single, randomly assigned colour photograph of a young adult female and then asked to make judgements concerning her personal characteristics. Five modified photographs of the same young adult female were used: (1) no appliance, (2) stainless steel fixed orthodontic appliance, (3) ceramic fixed orthodontic appliance, (4) gold fixed orthodontic appliance, and (5) clear colourless aligner. Likert scales with higher scores indicating more positive ratings were used. The results were analysed using chi-square test, one-way univariate analysis of variance, and post hoc Tukey-B and Kruskal-Wallis tests. The results showed that greater perceived IA was associated with the appearance of no appliance (mean values: 7.56) rather than steel (6.67) or ceramic appliances (6.65) but similar to the gold (7.35) and aligner (7.08) appliances. No significant differences between the different orthodontic appliance appearances were found for SC and PA. A trend existed where the no appliance image (resembling a lingual appliance) or clear aligner was considered more attractive than the visible buccal fixed appliances. In the absence of other information, the judgements an individual young adult makes concerning the personal characteristics of a young adult are influenced by dental appearance and orthodontic appliance design. This may influence orthodontic appliance choice.

The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London

OBJECTIVE To investigate whether the relationship between dental anxiety and referral for treatment under sedation is explained by attendance patterns and oral health. METHODS Structural Equation Modeling was used on the covariance matrix of the covariates to test hypothesized inter-relationships. Subsequently, we modeled the probability of referral for treatment under sedation with a multiple logistic regression taking into account inter-relationships between the independent variables. RESULTS A direct significant association of referral with dental anxiety and attendance patterns was detected, but not with oral health status. However, oral health and anxiety were highly correlated. Also signaled were correlations between age and education and between gender and bad past experience. CONCLUSION Referral for treatment under sedation appears to be motivated by both fear and irregular patterns of attendance. Coupled with behavioral treatments to address dental fear and attendance, sedation can be an important part of comprehensive care where curative treatments are long or unpleasant for patients.

STRESS IN DENTAL PRACTICE : A QUALITATIVE COMPARISON OF DENTISTS WORKING WITHIN THE NHS AND THOSE WORKING WITHIN AN INDEPENDENT CAPITATION SCHEME

A qualitative research methodology was used to compare the stress experienced by dentists working under two different systems of remuneration. No absolute difference was found in the levels of stress experienced by the two groups, as measured by a questionnaire measure of stress experience. Both groups of dentists identified patient management, time pressures and staff and practice management as sources of stress, though the independent capitation scheme dentists felt that they were under less time pressure and faced considerably less paperwork. Techniques for stress management identified by the dentists were limited and symptom-focused. The results suggest that, for dentists at least, changing from NHS to an independent capitation scheme is of great benefit

Interceptive orthodontic treatment in bullied adolescents and its impact on self-esteem and oral-health-related quality of life

The aim of this follow-up study was to measure the self-reported frequency and severity of bullying in orthodontic patients previously identified as being bullied, who have commenced interceptive orthodontic treatment, and to investigate the effect on an individuals self-esteem and oral-health-related quality of life (OHRQoL). Forty-three adolescents previously identified as being bullied due to the presence of a malocclusion were invited to take part in a follow-up study following commencement of orthodontic treatment at three UK Hospitals. Validated questionnaires were used to assess the self-reported frequency and severity of bullying, self-esteem and OHRQoL. The participation rate at follow-up was 63 per cent. Following commencement of orthodontic treatment, 21 (78 per cent) participants reported they were currently no longer being bullied due to the presence of their malocclusion. In comparison to their pre-treatment scores, participants reported fewer functional limitations (P = 0.013), decreased emotional (P < 0.001) and social impact (P < 0.001), and improved overall oral health (P = 0.03) and OHRQoL (P = 0.002). In addition, an improvement in functional limitations (P = 0.021), emotional (P = 0.008), social impact (P = 0.008) and OHRQoL (P = 0.02) was reported by participants who were no longer being bullied in comparison to those who continued to report bullying. There appears to be no effect on an individuals self-esteem. Orthodontic treatment may have a positive effect on adolescents experiencing bullying related to their malocclusion and their OHRQoL.