R. S. Ireland

Therapeutics: A study of prophylactic antibiotic prescribing in National Health Service general dental practice in England

Objective To study the therapeutic prescribing of antibiotics by general dental practitioners.Design A postal questionnaire of National Health Service general dental practitioners in ten English Health Authorities.Subjects General dental practitioners (1,544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside.Main outcome measures The questionnaires were analysed and the responses to each question expressed as absolute frequencies.Results Responses to the questionnaire were received from 929 (60.1%) practitioners. More than 95% of practitioners recognised the need for prescribing antibiotics where there was evidence of spreading infection. Some practitioners (12.5 %) prescribed antibiotics for acute pulpitis and (3.3 %) for chronic marginal gingivitis. Antibiotics were prescribed by practitioners before drainage of acute abscesses (69%) and by 23% after drainage. Practitioners were generally not influenced by patients expectations of receiving antibiotics (92%), but would prescribe when under pressure of time (30.3%), if they were unable to make a definitive diagnosis (47.3%), or if treatment had to be delayed (72.5 %). Amoxicillin was the most frequently prescribed antibiotic used for most clinical conditions apart from pericoronitis, acute ulcerative gingivitis and dry sockets where metronidazole was the drug of choice. There was a wide variety of dosage, frequency and duration for all the antibiotics used in the treatment of acute dental infections.Conclusions The results obtained from this questionnaire support the conclusion that the therapeutic prescribing of antibiotics in general dental practice varies widely and is suboptimal. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of the antibiotics in National Health Service general dental practice.

Immediate knowledge increase from an oral cancer information leaflet in patients attending a primary health care facility: a randomised controlled trial

The aim was to determine the immediate influence of a validated patient information leaflet (PIL) on oral cancer and knowledge in primary care attenders. Participants were patients (n=800) attending their primary health care provider from 14 general practices (eight dental and six medical) in the north west of England. Measures were a previously validated knowledge questionnaire (36 dichotomous items), self-reported dental service attendance history and demographic variables. The results showed that patients who had read the oral cancer PIL demonstrated a significant increase in knowledge regardless of clinical setting (F[1,739]=246.24, P<0.0001). Patients showed improvements in selecting the correct signs and risk factors associated with disease. Immediate knowledge gain from a simple PIL about oral cancer was found and independent of the primary care facility, where the PIL was distributed.

Clinical evaluation of three posterior composite and two amalgam restorative materials : 3-year results.

The clinical performance of three posterior composites and two amalgams was evaluated over 3 years. Three hundred and nine composites and 200 amalgams were reviewed at the 3-year recall. The following parameters were assessed: fractures, gingival condition, interproximal contacts, marginal adaptation, staining and colour match. Although there was no significant difference in the overall failure rate between the two types of material, there was a significantly higher incidence of fracture in the amalgam restorations. The amalgam failures were exclusively mechanical, whereas those affecting composites also included failures that were more biological in nature. A significantly higher proportion of the Class II composites failed to achieve an adequate approximal contact, but this was not reflected in a more adverse gingival response. Colour match, surface and marginal stain varied significantly within the composite group and appeared to be material-related. Overall, the materials Occlusion and P-30 were considered to be performing adequately. The clinical handling, colour match and radiopacity of Clearfil Posterior were considered to be unsatisfactory

Randomised trial of the psychological effect of information about oral cancer in primary care settings

AIM To determine the immediate influence of a validated patient information leaflet (PIL) on patient anxiety and intention to have a screen for oral cancer in primary care attenders. PARTICIPANTS Patients (n=800) attending their primary health care provider. SETTING Fourteen general practices (eight dental and six medical) in the northwest of England. DESIGN Randomised controlled trial with two arms: leaflets provided in information group, leaflet was absent in control group. MEASURES Single item ratings of (1) intention to have an oral cancer screen, and (2) anxiety towards a screen, (3) perceived risk of oral cancer. Knowledge of oral cancer, self-reported dental service attendance history and demographic variables were also collected. RESULTS Patients who had read the oral cancer PIL demonstrated an increase in their intention to have a screen (Mann Whitney U test: z=-3.67, P<0.001) and reduced anxiety (Mann Whitney U test: z=-2.07, P<0.05). Subjective risk was not elevated by the extra information. Intention to have a screen was predicted by knowledge level and anxiety (odds ratios: 1.10 and 0.70 respectively, both Ps<0.001). CONCLUSION The influence of an information leaflet appeared to have a positive effect on anxiety level and intentions to agree to receive an oral cancer screen.

Online orthodontic advice : a protocol for a pilot teledentistry system

A prototype teledentistry service was established that incorporated a PC-based expert system designed to assist in orthodontic cases. It guided the general dental practitioner (GDP) through the assessment of a patients malocclusion and helped ensure that all relevant clinical observations were made and details recorded. The resulting data file, containing radiographic images and clinical data, was then transferred via the Internet to a dental specialist. The specialists recommendations were returned by the same route or, where appropriate, a realtime videoconference was conducted. During an eight-month trial, six GDPs referred 158 cases through the teledentistry system; another 24 cases were referred directly to a local consultant. The protocol used during the trial worked satisfactorily. The GDPs found that it was straightforward and covered all aspects of the cases they submitted.

The development of an outreach training programme in orthodontics

Objective To describe the establishment of an outreach centre for the training of all members of the orthodontic team.The development of the orthodontic team The remit of orthodontic nurses and orthodontic therapists is described and how their training may be delivered and integrated within a primary care training centre.Outreach training The reasons for the development of outreach training are discussed and how these are particularly relevant for the development of orthodontic training in the UK.The University of Warwick orthodontic outreach centre This has been established in Leamington Spa in comprehensively equipped premises providing seven surgeries, a lecture theatre, clinical skills laboratory, and technical support. It currently provides an MSc course in orthodontics for general dental practitioners (GDPs) and training for qualified dental nurses leading to the award of an Orthodontic Nurses Certificate. It has also recently been approved by the General Dental Council (GDC) for the delivery of a course leading to the Diploma in Orthodontic Therapy commencing in July 2008.

An investigation of antibiotic prophylaxis in implant practice in the UK

Background There is increasing evidence of the inappropriate use of antimicrobials in dentistry and this may contribute to the problem of antimicrobial resistance. The research to date with regard to efficacy of antimicrobial prophylaxis in reducing failure of integration and postoperative complications when placing dental implants remains equivocal. The aim of this study was to investigate how dentists in the UK use antimicrobials prophylactically in implant practice.Method An e-mail link was provided in 2011 to an anonymous online (Smart-Survey) questionnaire using three databases of dentists who, by being on them, had registered an interest in placing dental implants. Absolute frequencies were used to describe the study sample demographics and examine the distribution of responses for all the variables investigated.Results One hundred and nine completed questionnaires were received. Seventy-two percent (n = 76) routinely prescribed prophylactic antibiotics for all procedures. There was a wide variation in the pre-operative and postoperative prescription regimens with the majority (84%) stating that it was to prevent infection at the site of surgery or to reduce a bacteraemia.Conclusions Although this was a small study with a low response rate, wide variations in antibiotic prescribing regimens with respect to drug, dose and duration were found. Further research is needed and guidelines developed to prevent antibiotic overprescribing and misuse.

Dental photography in record keeping and litigation

Dental photography is essential in record keeping and it is important for all members of the dental team to be appropriately trained and for each practice to have the appropriate equipment. This article provides an overview of the applications of dental photography and equipment, and highlights issues of consent and duty of care.

The medical and dental attendance pattern of patients attending general dental practices in Warwickshire and their general health risk assessment.

Background The dental team could have an important role to play in general health risk assessment within primary and community healthcare.Aims To describe medical and dental attendance patterns, demographics and health profiles of patients routinely attending general dental practices in Warwickshire. To identify whether a subgroup attend dental practices regularly but attend medical practices infrequently and discuss whether preventive healthcare interventions delivered in general dental practice would be appropriate.Methods A self-completion questionnaire was administered to patients attending 16 dental practices in Warwickshire.Results Eight hundred and eleven completed questionnaires were returned (74% response). Seven hundred and eighty-nine (98%) respondents visited their dentist every one to two years or more frequently and of these a subgroup of 121 (15.3%) visited their general medical practice surgery or health centre less often than every two years. In the subgroup 9.5% reported high blood pressure, 17.6% currently smoked, 22% drank above recommended guidelines, 32.1% were overweight and 7.3% obese.Discussion The data suggest there may be a role for dental practitioners in identifying patients at risk of having undiagnosed or future general health problems and providing appropriate general health advice, screening or signposting the patient to relevant general healthcare facilities either within or external to the dental practice.

Practice management: Clinical record keeping by general dental practitioners piloting the Denplan 'Excel' Accreditation Programme

Background Denplan is a private capitation-based system of providing primary dental care in the UK. An additional programme called Denplan Excel has been developed which requires General Dental Practitioners to instigate various quality processes within their practices in order to become accredited. Clinical record keeping is one area where standards are monitored. This study reports changes in record keeping at patient recall appointments following the implementation of the Denplan Excel programme.Method Fifty dentists participating in the Denplan Excel pilot programme from different areas of the UK were sampled by means of cluster sampling. Twenty records for each dentist were sampled and items recorded for patients recalled both pre- and post-pilot were compared.Results The majority of dentists recorded presenting complaint, diagnosis and treatment plan both pre- and post-pilot. However, post-pilot there were a number of improvements in record keeping. Caries recorded on a grid increased from 7% of records to 46%, basic periodontal examination increased from 48% to 85% of records and the updating of medical history increased from 51% to 65% of records. These findings were all significant at the p < 0.01 level.Conclusion Changes can be achieved by voluntary participation in a system of structured record keeping.