Wayne Richards

The impact of attendance patterns on oral health in a general dental practice

Objective The aim of this study was to examine the impact of attendance patterns on oral health in the context of government policy on dental care and registration in the UK.Method The data involved 643 consecutive patient responses to a questionnaire on dental health taken from a survey that was conducted during 1998 in an urban area of Swansea. The survey continued for a period of six months and covered patients of 18 years of age and over, responding to a questionnaire on the subjective oral health status indicators including the pattern of their attendance to dental practices.Results Regular dental care attendance has a significant positive impact on dental health while its impact on the number of teeth present is insignificant. Regular attendees also suffer significantly less from the severity, prevalence, social and psychological impacts of dental health problems.Conclusion Regular dental attendance is associated with better oral health when regularity of care is defined as a visit within a two-year period. The rationality of a 15 month registration period is therefore debatable in the context of developing equitable services.

Reasons for tooth extraction in four general dental practices in South Wales.

Tooth retention has been one of the main aims of oral care which in turn could have contributed to the social oral health divide. To investigate this issue further, data collected for a group audit was used to study the reasons for tooth extraction for patients attending for routine treatment at four dental practices. The practices served populations in areas with different levels of deprivation in South Wales. In 558 teeth extracted over 417 visits, the reasons for extractions were: caries 59%, periodontal disease 29.1%, pre-prosthetic 1%, wisdom teeth 4.6%, orthodontic 5.5%, trauma 1.2%, patient request 2.4% and 6.2% other reason. The number of extraction visits per day within the group of dental surgeons varied with three practitioners performing more than three extraction visits per day while one practitioner had only 0.51. These reasons did not significantly depend on levels of deprivation. However, significantly more teeth were extracted for caries in the most deprived group in comparison to the least deprived. Therefore, could there be a case for appropriate extractions in the quest for equitable care?

The use of geographical information systems in examining variations in sociodemographic profiles of dental practice catchments: a case study of a Swansea practice.

Aim The aim of this paper is to use a case study approach to illustrate the potential for using geographical information systems (GIS) to examine the provision of dental services in the UK. A major benefit of using GIS to examine sociodemographic profiles of patients on a dental register is to inform policy makers. Method We illustrate the advantages of such an approach by using a post-coded list of registered patients for a dental practice in Swansea. To be of value in this context, the maintenance of up-to-date and fully postcoded information by practitioners is vital. We draw attention to the advantages (and current limitations) of using deprivation indices in conjunction with such lists. Result GIS has significant potential in analysing patterns of registration, and utilisation, of such services but, to date, there has been a relative dearth of studies that have developed such systems. Conclusion We conclude by drawing attention to wider benefits of such software tools in the dental profession and outline a research agenda to take these issues further.

An audit of dental general anaesthetic referral from a general dental practice in South Wales.

Aims The aim of this audit was to quantify the number of patients that received a dental general anaesthetic (DGA) between 1999 and 2007 following referral from a general dental practice. It also aimed to establish the deprivation status of those referred and to investigate further dental treatment pathways of these patients. Methods Data were collected from all patient records held by the practice. The information collected included: postcode, gender, age at the close of the study, age at time of DGA, reason for DGA, number of teeth extracted, and details of further ongoing care. In the absence of individual level socioeconomic data, a deprivation score (derived from the Welsh Index of Multiple Deprivation [WIMD]) was appended to each record in order to provide a measure of deprivation based on the postcode of the patient. Results Two hundred and eighty-seven patients were referred for DGA during the nine-year period. Their mean age was 9.4 years (95% confidence interval [CI] = 8.4, 10.4) and 30.7% were children aged five years or younger. The most common reason for DGA was dental caries. The mean number of teeth extracted was 4.5 (95% CI = 4.1, 4.9). Patients living in deprived areas were more likely to be referred for DGA. Of the 87 who did not subsequently attend for continuing care, 72 were from deprived areas compared with 15 from more affluent areas (P=0.003). Conclusions In proportion to the number of patients registered at a practice, the number of referrals for DGAs was relatively low. Patients categorised as deprived (based on their residential postcode) received more referrals for DGAs than those from more affluent areas. Patients from deprived locations were significantly more likely not to attend for continuing care after their DGA than those from more affluent areas.

Oral ill-health and deprivation among patients of a general dental practice in South Wales.

Purpose of study This study aims to establish and report on whether individuals from deprived areas suffer more ill health than adults from areas considered not to be deprived when visiting a general dental practice. Basic procedures Between December 1998 and June 1999 registered dental patients over 18 years of age attending for routine care completed a questionnaire measuring functional, experiential and psychosocial impact of oral ill health. In addition the clinical impact of ill health was established from the patient examination and record card. Clinical outcome was assessed by numbers of standing teeth, oral health was assessed using the Subjective Oral Health Status Indicators (SOHSI). The patients postcode was used to categorise individuals from areas of different deprivation states. Main findings 99% were dentate with 88.4% having more than 20 teeth. A total of 71.8% were able to eat satisfactorily, 88.2% were able to speak satisfactorily, 54.6% were discontent, 99.4% were worried about their oral health and appearance, 62.8% were satisfied with their oral health, 44.8% experienced discomfort, 65.8% experienced other symptoms, and 86.8% experienced ‘general well-being’. No differences were observed for clinical measures between the deprived groups. Only three out of eight oral health measures showed any differences between the deprived groups, namely, ability to speak, discontent and general well-being. More individuals from deprived areas experienced these impacts. Principal conclusions It was anticipated that individuals from deprived areas would experience greater ill-health: this outcome was not as marked as expected.

An effective oral health promoting message

This paper questions the effectiveness of current oral health promoting activities in reducing social inequalities in oral health. An attempt is made to address the needs of dental professionals and nutritionists in communicating an understanding of biological aspects of the aetiology of caries and erosion. With a clear understanding of the disease process oral health promoters can possibly reduce social inequalities in oral health. A clear common message which satisfies both dental and nutritional professionals is presented. The issues of commonality and ambiguity are fundamental to effective behavioural/teaching practice. Currently the evidence base suggests that dietary messages are inconsistent and ambiguous. Therefore, a clear common and unambiguous dietary message, based on science, could go some way to improving oral health inequalities.

Improving oral health with the new dental contract.

The challenge for the twenty-first century for oral health is to reduce the social inequality observed in populations. This challenge has been made explicit by the Department of Health (DH) in England. Turning rhetoric into reality is difficult for all concerned whatever field or profession. A cohesive model that embraces philosophical ideals can help individuals achieve change as it provides structure on which to develop ideas. This paper describes a model of care in general dental practice that fits the requirements of the DoH in addressing social inequalities, in the context of developing general dental services.

Changes in the balance between dentists, patients and funders in the NHS and their consequences.

This paper explores aspects of professional culture in dentistry that may impact on the delivery of equitable dental services in the future. After 2009, commissioners will have to ration National Health Service budgets for health services and dentistry will compete with other services. Therefore, the delivery of equitable oral health services may be an advantage in the case for dentistry and subsequent funding. We report our opinions on the changes currently occurring in dentistry in England and Wales, based on the evidence available to us from the literature, and consider the risks and opportunities that have arisen.

Homeless who accessed a healthy living centre in Swansea, South Wales: an assessment of the impact of oral ill-health.

Aim To quantify the way that oral diseases affect the lives of homeless and vulnerable people in Swansea, using the short-form Oral Health Impact Profile (OHIP-14). Method A convenience sample of people using the services of a healthy living centre for the homeless was surveyed using a questionnaire and the short-form OHIP-14. Results One hundred subjects were recruited to the study. The mean score for the OHIP-14 was 21.8 (SD 17.0). The most commonly reported impacts experienced were problems with toothache, discomfort, ability to relax, and feeling ashamed regarding the appearance of teeth. Of the different categories of homeless people, rough sleepers experienced higher levels of impact (P=0.004). Those having more than 20 teeth were more likely to experience lower levels of impact (P=0.001). Conclusion The survey highlighted an increased prevalence of oral health impacts in this special needs group. In addition to physical factors, psychosocial factors must be considered, particularly with regard to appearance and psychological disability and discomfort, in the development of services.

A specialism of primary dental care

This opinion paper contends that a wide gap exists between the theory and practice of preventive dentistry. The reasons for this lie partly in the lack of recognition given to the potential for general dental practitioners (GDPs) to deliver health-focused care to their community of patients. This lack of recognition begins at undergraduate level and is also found among GDPs themselves. The creation of a specialism of primary dental care would help to bridge the gap between theory and practice, and help practitioners to create significantly improved levels of oral health within their respective communities.