Developing, enabling and facilitating practice-based research in primary dental care. Report of a one-day seminar, held at the Royal College of Surgeons of England on Friday, 1st February 2008

As part of the Faculty of General Dental Practice (UK)'s strategy to develop a research base for primary dental care, a one-day seminar was held at The Royal College of Surgeons of England on Friday, 1st February 2008. The aims for the day were to bring together the Divisional Research Contacts (DRCs), Faculty members with an interest in research, and regional and national leaders in primary care research; to update DRCs and Faculty members on developments and opportunities in primary care research; and to raise awareness of the Faculty's work among the leaders of primary care research. Of the 33 who attended the seminar, 12 were DRCs.

An initial analysis of the research competency level of the Faculty of General Dental Practice (UK)'s Divisional Research Contacts. An in-house survey

PURPOSE

The purpose of this survey was to identify the current level of competence of the Faculty of General Dental Practice (UK)'s [FGDP(UK)'s] Divisional Research Contacts (DRCs).

METHODOLOGY

The FGDP(UK)'s DRCs were each sent a copy the Faculty's Research Competencies Framework (RCF). A mutually convenient time for a telephone interview was then agreed between the DRCs and one of the Faculty's two National Research Facilitators. During the interview, a structured questionnaire was used and the DRCs' qualifications and research experience were recorded along with their perceived knowledge and skill levels for each of the 21 competencies in the RCF, using a five-point Likert scale.

RESULTS

Eighteen of the 20 DRCs were interviewed, of whom 12 either possessed or were studying for higher research or partresearch degrees (PhD or MSc). All had some previous research experience. For 11 of the 15 competencies in the four domains of practical skills, problem-solving, attitudes and dissemination, DRCs rated their knowledge and skills levels as average or higher. For two of these 11 competencies (communication skills and understanding the need for research to support clinical practice), all 18 DRCs rated their levels of knowledge and skills as good or excellent. In the domain of roles and functions, DRCs rated their levels of knowledge and skills at a lower level. Seven rated their competence in designing and implementing a series of studies that address a significant issue and in writing research funding applications to major bodies as poor or very poor.

CONCLUSIONS

The present survey has provided the basis for a future, in-depth training needs analysis along with an insight into the research competency level of 18 of the Faculty's 20 DRCs.

Options for types of dental health personnel to train for ghana

SUMMARY OBJECTIVES

To explore the degree of agreement on issues surrounding the proposals for dental health personnel requirements among key oral health personalities who are central to determining policy on oral health personnel requirements for Ghana and to make recommendations to assist in the future development of dental health personnel requirements.

DESIGN

A review of the literature, published documents and in-depth semi-structured interviews.

SETTING

Dental health service in Ghana

PARTICIPANTS

Key oral health personalities who are central to determining policy on oral health personnel requirements for Ghana

RESULTS

There was a lack of consensus regarding key aspects of planning personnel requirements including the numbers and the kinds of professionals complementary to dentistry (PCDs) to develop, who should be responsible for their training, and which people to admit as trainees of PCDs.

CONCLUSION

Greater discussion between the various agencies involved should take place to help ensure consensus on the overall policy objectives.

A longitudinal study into changing ethical attitudes of newly-qualified dentists in South-East England

OBJECTIVE

To report the ethical stances taken by newly-qualified dental graduates working in the south-east of England and how these changed over their first two years in practice.

METHODS

A longitudinal self-completed questionnaire-based study using scenarios and closed questions was completed by an initial group of 135 vocational dental practitioners at the very beginning of their vocational training year, at the end of the year, and, finally, at the end of the subsequent year. Their answers were then analysed to see whether or not their views had changed during this period.

RESULTS

At the commencement of the study in 2003, 133 (99%) newly-qualified dental graduates completed the questionnaire and answered the closed questions. The following year, 129 (96%) completed these documents and in 2005, at the end of the study, this figure was 97 (72%). There was considerable variation in the attitudes taken by the responding dentists. Reported attitudes changed over the study period in seven of the nine scenarios. Responses to the scenarios used could be grouped into three categories: those in which there was no change; those in which the change happened following completion of vocational training; and those in which there was a continual change. Answers to the four closed questions indicated a growing negativity to practice within the National Health Service over the study period.

CONCLUSIONS

Dental educators need to be aware of the findings from this study. The importance of the ethical attitudes held and the reasons underpinning them should be explored if problems with delivery of care are to be avoided in the future.

A reassessment of recall frequency intervals for screening in low caries incidence populations

OBJECTIVES

To reassess the recall frequency interval for dental examinations for children, based on annual caries increments.

METHODS

Cross sectional data collected on school children in eight rural and urban schools through the national Incremental Dental Care Programme (IDCP) for one district in Malaysia were analysed to assess their annual caries increment and trend lines. The Restorative Index was calculated to assess the success of the IDCP in rendering children dentally fit.

RESULTS

The annual caries increments were low; the current caries levels were between 0.65 and 1.50 for 12 year-old children in Kota Tinggi District. Most of the caries experience was on pits and fissures. From 7 to 12 years old, the overall annual caries increment for the total study population was 0.19. The mean annual caries increment increased slightly between the ages of 12 to 14 years and 14 to 16 years and was 0.24 and 0.25 respectively. Two distinct caries incremental trend lines were observed for children aged 7 to 16 years. One group reached a mean DMFT of about 0.75 while the other group a mean DMFT of about 1.4 at 12 years. The trend lines continued over the next 4 years until the children were 16 years old. The Restorative Index was higher in urban schools that also had low DMFT levels.

CONCLUSIONS

Based on the low annual caries increments of between 0.65 and 1.50, yearly dental examination intervals can safely be extended to 2-yearly intervals or even longer. Such a change of screening recall intervals would help improve resource allocation. Resources saved by extending recall intervals can be redirected to the small proportion of children with higher disease levels. This will help render more school children dentally fit and reduce inequalities in oral health.

Informing Research in Primary Dental Care: Setting Priorities

This paper suggests that priorities for research in primary dental care should follow the examples set in other areas of primary healthcare. It reviews the history of research in primary dental care, since 1990, and goes on to explain how the Delphi exercise, initiated by the Faculty of General Dental Practice (UK), has identified five priority areas for research in primary dental care. These areas are:

1. Research into the application of evidence-based dentistry into practice.

2. The effects of different systems of remuneration on treatment patterns in practice.

3. The oral health assessment on determining recall intervals and its effect on oral health.

4. Factors that influence and affect dentists’ treatment modalities.

5. The evaluation of the cost benefits of whole team training.

Future Opportunities for Research in Primary Dental Care: Developing Research to Support the Commissioning of Care

On 23rd November 2005, there was a first for the Faculty of General Dental Practice (UK) [FGDP(UK)] when it hosted an open, national research study day, funded by the Department of Health. The study day followed on from a national Research and Development in Primary Dental Care meeting, ‘Reflection and Moving Forward’, held in Manchester in March 2004.1

The historical and political background to the proposals for local commissioning of primary dental care by primary care trusts

This paper provides a background to the changes that are about to occur in the system for primary oral healthcare delivery in the NHS. This is part of a far wider reform programme involving all public sector services. The challenges that the Government faces are not unique: all countries are striving to alter their care systems to address the changing expectations of the electorate while attempting to control both the costs and inequalities. What is unique to the United Kingdom is the historical legacy of the NHS and its political importance, which should not be underestimated. An overview of the agenda for change in all parts of the health sector is presented. This is followed by a more detailed analysis of the proposals for future delivery of primary oral care in the NHS and the subsequent issues arising. A consistent theme running throughout the Government's agenda is devolution. Indeed, the detailed programme discussed in this paper applies only to England and Wales. The fact that Scotland has different plans highlights the importance of the political and cultural setting to any reform programme.

The limitations of a 'high-risk' approach for the prevention of dental caries

The decline in the prevalence of caries has lead several authors to advocate the adoption of a 'high-risk' approach for caries preventive strategies. This paper analyses such an approach. It argues that the distribution of caries within a population follows certain laws: first, the mean caries score is a function of the prevalence; second, the variance is a function of the mean; and third, for a particular mean score, the distribution within the population is predetermined. Using data from the National Preventive Dentistry Demonstration Programme (NPDDP) in the US and the British Association for the Study of Community Dentistry (BASCD) epidemiological programmes in the UK the functions determining the distribution of caries within the population are examined. The findings indicate the changes in caries experience observed occurred throughout populations and are not confined to subgroups. Strategies limited to individuals 'at risk' would fail to deal with the majority of new lesions. The main emphasis should be centred on a population approach.

Does perceived risk of oral problems influence the use of dental services in university entrants?

OBJECTIVE

To assess if the self-perceived risk of oral problems is related to reported dental service usage in university entrants.

DESIGN

Self-completed questionnaire.

SAMPLE

1,180 university entrants with an average age of 19.1 years. Fifty-six per cent of the sample were female, 44% males; 16% were medical undergraduates, 27% arts students, and 52% science undergraduates.

RESULTS

Females rated their own dental health more positively than males. Overall, the perceived risk of future problems was low. Seventy-five per cent of graduates reported attending dentists on a regular basis. Females were more likely to attend dentists regularly. Those who reported attending on a regular basis rated their dental health higher than those reporting other dental attendance patterns. There was no significant difference between those who reported a regular attendance service pattern and their perceived likelihood of requiring a filling or getting gum disease within the next five years.

CONCLUSION

Differences in reported dental services usage were related to the perceived benefits of dental check-ups but not to the risk of future problems.

Issues concerning the development of a competency-based assessment system for dentistry

The issue of standards of competence and assessment is central to professions. For the dental profession there have been suggestions that a change from overall competence to specific fields of competence would be a more suitable mechanism to assess whether an individual was competent. This paper examines the implications of such proposed changes and highlights several key issues, answers to which need to be provided prior to adopting new proposals. Failure to do so may well provide additional problems without addressing shortcomings in the present system.

Health through oral health; guidelines for planning and monitoring for oral health care: a critical comment on the WHO model

Recently a joint working group of WHO/FDI published guidelines for planning and monitoring oral health care. In the report a model for calculations of future need for dental manpower was introduced as an effective planning tool. An analysis of whether the WHO model is appropriate to calculate the future need for manpower planning was carried out. It appears that the model has serious methodological shortcomings. The model expects the user to know the future oral care needs concerning preventive, special group, surgical, orthodontic, and periodontal care. In calculating future needs for restorative and prosthetic care, the model restricts itself to looking back in time and roughly calculating what has happened in the past, assuming this will happen again.