Assessing professionalism within dental education; the need for a definition

Professionalism is a broad competency needed by dentists to act effectively and efficiently and is seen as a central part of both undergraduate and postgraduate curricula. Assessment is vital in education to assess progress and direct future learning. It is also an essential part of good professional regulation, which depends upon high quality assessment to maintain credibility. Educators must produce clear expectations that students can strive for. Thus dental educators are required to understand precisely what is meant by "professionalism" in relation to dentistry in order to both teach and assess it. The aim of this paper is to explain the importance of professionalism, explore its features and its assessment as described in the literature. The paper concludes that without a validated definition of this construct, assessment of professionalism within dental education will be compromised.

Psychometric properties of long and short forms of the Child Perceptions Questionnaire (CPQ11-14) in a Thai population

OBJECTIVES

The aim of this study was to compare the psychometric properties of different forms of the Child Perceptions Questionnaires (CPQ11-14) for use in Thai adolescents.

METHODS

Cross-sectional questionnaire and clinical analytical study conducted at 2 schools in Chonburi province, Thailand. Clinical data were collected for 95 students (64 female, 31 male) aged 11-14 years. Data from the Thai version of CPQ11-14 were used to analyze the measurement properties of the original and 4 short forms of the CPQ11-14.

RESULTS

Participants found it difficult to remember that they should assess the impact only in relation to the problems of their teeth, lips, mouth or jaws. The Thai versions of the CPQ11-14 have satisfactory internal consistency and test-retest reliability except for the CPQ11-14 - ISF:8. The criterion validity of all versions was acceptable except for the CPQ11-14 - RSF:8. No CPQ11-14 scores correlated with clinical status, otherwise construct validity was acceptable for the original CPQ11-14 and the 16-item questionnaires.

CONCLUSION

The original scale of the CPQ11-14 indicates the highest validity and reliability among the 5 forms of the CPQ11-14 but has weak relations with clinical data. If it is to be used in low disease populations larger samples will be required. The 16-item questionnaires show some acceptable validity and reliability properties. The findings for the 8-item versions do not support their use in Thailand.

Outreach training: the special interest group's report

Following three sessions at ADEE Annual Meetings, the special interest group on outreach training presents a brief report of its proceedings. Outreach, here, is clinical teaching away from the home dental school. After covering the diversity and benefits of programmes, the report considers different models and the relationship between contexts and outcomes. It concludes that: outreach provides access to additional resources; programmes prepare students for the demands of the profession; a programme's design should harmonise with both its context and its objectives; and, the educational benefits warrant the additional organisation involved.

Social aspects of HIV and their relationship to craniofacial problems: workshop 4C

The oral research community needs an understanding of the social causes, consequences, and costs of disease in relation to oral health. This workshop concluded that HIV infection constitutes a special dental need requiring specific arrangements to facilitate oral care for infected persons. Oral manifestations of HIV infection affect everyday life, but more evidence is needed on the effects of interventions to alleviate these impacts. Other oral health habits add to the burden of HIV/AIDS-associated oral diseases and compete with them for resources. These problems are most acute where the prevalence of HIV is high and resources are scarce. Effective health promotion is therefore important in these areas. Without data on the utility of oral health care in developing countries, practical approaches are guided by societal and multidisciplinary principles. There are also important ethical considerations.

Teaching dental public health to undergraduates using community profiles and patient case studies

OBJECTIVE

Provide an example of how dental public health can be taught to undergraduates.

RESEARCH DESIGN

Educational case study.

CLINICAL SETTING

General dental practice.

INTERVENTION

Dental outreach placement and supporting project work. One project required students to study patients in the context of their environment via the social history.

RESULTS

The student learned about the social determinants of health and differentiated between the causes of disease in the patient and the determinants of health affecting the practice population.

CONCLUSIONS

Outreach training can help students learn about the social determinants of health. Dental schools may have missed an opportunity to use outreach to help their students learn from and about their environment and its impact on the health of their patients.

The success of fissure sealants placed by dentists and dental care professionals

OBJECTIVE

To obtain preliminary data on the effectiveness of fissure sealants placed by dentists and dental care professionals (DCPs).

RESEARCH DESIGN

Case-note review of fissure sealants provided for paediatric patients within primary dental services in South Yorkshire.

PARTICIPANTS

Records were retrieved for 1,100 fissure sealants, placed on first and second permanent molars of 312 children by 25 participating dentists and 25 DCPs during 2001-2003.

MAIN OUTCOME MEASURES

Independent variables included operator details and patient-related factors including: caries experience at baseline, age, gender, and socio-economic status. The outcome variables were sealant retention and progression to caries at three years. Bivariate analyses were used to explore the role of potential factors associated with the success of fissure sealant survival. Kaplan-Meier survival analysis and Cox's regression models were used to estimate the probability of sealant success for both operator groups.

RESULTS

Retention rates at three years for fissure sealants placed by dentists and DCPs were 62.4% (SD = 22.1) and 58.1% (SD = 21.5) respectively. After three years, 87.1% (SD = 9.8) and 84.2% (SD = 11.6) of teeth sealed by dentists and DCPs remained sound. Exploratory analysis found no significant difference in sealant retention or caries transformation rates according to operator type.

CONCLUSIONS

On the basis of these preliminary findings, delegation of fissure sealants to DCPs would seem to be justified in view of the comparable sealant success rates achieved by dentists and DCPs. These data can now be used to inform future randomised controlled trials on the effectiveness of fissure sealants by different operator groups.

Students' clinical experience on outreach placements

Primary care outreach placements increasingly feature in UK undergraduate dental curricula. The profile of clinical work undertaken on placement may differ from traditional hospital-based programmes and between outreach settings. An appreciation of any differences could inform curriculum development.

OBJECTIVE

To compare the profiles of clinical work experienced on a traditional hospital-based programme and outreach placements in different settings.

SETTING

One dental hospital and eight existing primary care block placements in England.

SUBJECTS AND METHODS

Subjects were four cohorts of senior dental students in one UK dental school. Departmental records provided data on students' clinical experience in different settings and their achievement of placement learning objectives. Descriptive statistics for groups were compared.

MAIN OUTCOME MEASURES

(1) Counts of patients encountered and of clinical procedures completed in the following categories: simple plastic restorations, endodontics, cast restorations, dentures, extractions and children's dentistry. (2) Student perceptions of placement learning reported via Likert scales.

RESULTS

Outreach students encountered twice as many patients and typically completed about three times as much clinical work as students in the hospital, e.g. 44 cf 16 simple plastic restorations, seven cf two endodontic procedures. There were variations in profiles by setting. For example, amalgam being more likely to be used on outreach especially in the General Dental Service; more children's dentistry in community services and more extractions in Dental Access Centres. Students reported learning outcomes generally being achieved (average 94%) although with some variation by setting.

CONCLUSION

Dental outreach training greatly increases the quantity of students' clinical experience in everyday dentistry compared to a hospital-based programme. Placements also increase awareness of service delivery and develop clinical skills. There are appreciable variations between outreach settings possibly reflecting their purposes. Multiple contrasting outreach placements for each student might increase the uniformity of learning experiences.

Public awareness and social acceptability of dental therapists

OBJECTIVES

To investigate public awareness and the social acceptability of the use of dental therapists in dental care.

METHOD

A telephone survey of a representative quota sample of 500 adults (>18 years of age) in South Yorkshire, England.

RESULTS

Fifteen per cent of participants were aware of dental therapists as a professional group, of whom only three people correctly identified their 'permitted duties'. Those without problems of access to care were more likely to report awareness (P < 0.05). Fifty-seven per cent were willing to receive simple restorative treatment from a therapist, with acceptability predicted by being younger [OR 1.016 (95% CI: 1.015-1.017)] and having a perceived need for treatment [OR 1.301 (1.053-1.607)]. Fewer were willing to allow a therapist to restore a child's tooth (47%, P < 0.001, test for paired proportions) with acceptability predicted by being younger [OR 1.016 (1.015-1.017)] and being an irregular attender at the dentist [OR 1.309 (1.138-1.697)]. Forty per cent of participants expected to pay less for treatment provided by therapists with the acceptability of equal costs predicted by having access to care [OR 1.346 (1.017-1.781)].

CONCLUSION

These findings have implications for the use of dental therapists. They question patients' and the public's ability to provide informed consent for the treatment provided by them and identify a need for education of the public on the training and competence of therapists and the rationale for employing skill-mix in dentistry.

RCT of the effects of block absence for outreach placements on dental students' finals grades

Undergraduate dental curricula are being supplemented with primary care placements requiring periods away from the dental school. These absences may impact negatively on students' other studies.

OBJECTIVE

To compare the effect of outreach placement and traditional hospital-based training alone on students' final examination scores. Existing primary care placements in northern England about one year from students' qualification.

SUBJECTS AND METHODS

Analysis of secondary outcomes in a randomised controlled trial with students' final examination marks being compared on qualification. To reduce Type I error only 4 of 24 available scores were considered and multiple testing correction applied. Five-week block outreach placements for 25 of 49 students. Honours awarded and examination scores for children's dentistry, overall clinical work and theory.

RESULTS

Groups' final exam scores were similar: children's dentistry - outreach 64.9 (SD 2.1), hospital-based 65.0 (3.0); overall clinical work 58.3 (3.4) cf 60.7 (4.8) and theory 54.6 (3.5) cf 56.5 (4.0). The numbers of students awarded honours (outreach 1, hospital 4) showed no significant difference (Fisher's exact text P = 0.19).

CONCLUSION

Dental outreach training involving several weeks' absence from the school had no negative impact on students' finals scores.

Evaluation of the Parental Perceptions Questionnaire, a component of the COHQoL, for use in the UK

OBJECTIVE

To assess the reliability and validity of the Parental Perceptions Questionnaire (PPQ) for use in the UK and to investigate whether different approaches to the treatment of 'don't know' (DK) responses have any effect on the psychometric properties.

METHODS

The parents of 89 children attending for an examination at a dental teaching hospital and a general dental practice completed the Parental-Caregiver Perceptions Questionnaire (PPQ), global oral health and global impact ratings. Clinical data were also collected. Four approaches were taken to the management of DK responses, one approach involved exclusion of DK responses and three approaches involved adjustment of DK responses (item mean, mean items answered and replacement of DK responses with zero).

RESULTS

All four approaches demonstrated acceptable internal consistency and test-retest reliability of the total scale. The mean items answered and replacement approaches had optimal internal consistency of the subscales of the PPQ. Assessments of criterion validity in relation to global oral health rating were similar when the DK responses were adjusted, but the exclusion of DK responses had a detrimental effect. Construct validity of PPQ in relation to global impact rating and clinical data was acceptable only when responses were adjusted.

CONCLUSION

These data suggest that if DK responses are adjusted, the reliability and validity of this measure are acceptable for use in the UK.

Fulminant hepatitis from herpes simplex virus type 2 in an immunocompetent adult

Herpes simplex virus (HSV) is regarded as a common viral pathogen that produces a wide variety of diseases. After a primary infection, which usually occurs during childhood and may or may not be clinically evident, the virus establishes a latent infection in the local sensory ganglia and can reactivate throughout the life of the individual. Fulminant hepatic failure (FHF) due to HSV infection is a clinical condition well known in pediatric, immunocompromised, and pregnant patients. It is rare in immunocompetent hosts. We report the case of a 51-year-old man with no significant past medical history who developed FHF with disseminated intravascular coagulopathy and septic shock secondary to HSV infection. The initial diagnosis was made through a frozen section of a needle liver biopsy and the presence of HSV was confirmed in the permanent section with immunohistochemistry. HSV was grown in cell culture from liver tissue obtained through an autopsy.

The effect of a domiciliary denture service on oral health related quality of life: a randomised controlled trial

OBJECTIVES

To assess the effectiveness of a domiciliary denture service on the oral health related quality of life (OHQoL) of older patients requiring complete dentures.

DESIGN

Community based single-blind randomised controlled trial.

SUBJECTS AND METHODS

133 edentate adults aged 65 years and over referred to a community dental service for domiciliary care were assigned to study and control groups using block randomisation. Treatment to provide the study group with complete dentures commenced immediately. Treatment for the control group was deferred to the normal waiting list but in the interim participants received three home visits from the dental team. Follow up data were collected three months after dentures had been fitted in the study group.

OUTCOME MEASURES

Prevalence, extent of impacts and total scores using Oral Impacts on Daily Performance (OIDP).

RESULTS

The study and control groups (n = 65 and 68 respectively) had similar OHQoL at baseline. Two and five participants were lost to the study and control groups respectively. In ANCOVA and intention to treat analysis, the presence of impact, number of impacts and total scores for OIDP at follow up were predicted by group allocation (b = 0.28, b = 0.30, and b = 0.32 respectively. All p <0.001). In all cases the study group showed significantly improved OHQoL compared to the control group.

CONCLUSION

A domiciliary denture service improved oral health related quality of life of housebound edentulous older people.

Perspectives of dentists in primary care ahead of the 'new ways of working'

OBJECTIVE

To determine the future intentions and motivations of general dental practitioners (GDPs) relating to NHS dental practice in South Yorkshire.

DESIGN

Focus group discussions.

SETTING

General dental practices providing NHS care within South Yorkshire, United Kingdom.

SUBJECTS (MATERIALS) AND METHODS

Twenty-nine dental practitioners were purposively sampled and invited to take part in a series of focus groups. Focus groups were transcribed and data analysed to identify themes and concepts.

MAIN OUTCOME MEASURES

Themes and concepts relating to the current and future provision of dentistry and the proposed 'new ways of working' of the new dental contract.

RESULTS

The data fell into three broad categories: the organisational structures of dentistry; the future of dentistry; and the CDS. This paper focuses largely on the second category, the future of NHS dentistry. The first category related to the organisational structures of dentistry, and encompassed perceptions that dentistry was not a high priority for the Government and that current changes were politically motivated and to be implemented by PCTs with a lack of capacity for the management of such wide-reaching changes. The second category covered the future of NHS dentistry. For some, NHS dentistry was in a precarious and uncertain position, coupled with a lack of clarity and information on the 'new ways of working' and exacerbated by problems in the recruitment and retention of future dental practitioners. The last category dealt with views in connection with the CDS.

CONCLUSION(S)

In this 'snapshot in time' there was considerable uncertainty and instability within the general dental service against a backdrop of major organisational change. There was a need for information, guidance, openness and communication between the Government, PCTs and GDPs surrounding the implementation of the new contract.

Psychological interventions to improve adherence to oral hygiene instructions in adults with periodontal diseases

BACKGROUND

Adherence to oral hygiene is an important aspect of the treatment of periodontal disease. Traditional educational interventions have been shown to be of little value in achieving long term behaviour change.

OBJECTIVES

The aim of this review was to determine the impact of interventions aimed to increase adherence to oral hygiene instructions in adult periodontal patients based on psychological models and theoretical frameworks. This review considered the following outcomes: Observational measures of oral health related behaviour Self reported oral health related behaviours, beliefs and attitudes towards oral health related behaviour Clinical markers of periodontal disease.

SEARCH STRATEGY

The Cochrane Oral Health Group's Trials Register (2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2004, Issue 4), MEDLINE (from 1966 to December 2004), EMBASE (from 1980 to December 2004), PSYCHINFO (from 1966 to December 2004), Ingenta (from 1998 to December 2004) and CINAHL (from 1966 to December 2004). Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information. No language restriction was applied.

SELECTION CRITERIA

Randomised controlled trials testing the effectiveness of interventions based on psychological models compared with educational, attention or no active intervention controls to improve adherence to oral hygiene in adults with either gingivitis or periodontitis.

DATA COLLECTION AND ANALYSIS

Titles and abstracts of studies that were potentially relevant to the review were independently screened by two review authors. Those that were clearly ineligible were rejected. For the remaining studies, the full paper was reviewed by two review authors and where necessary further information was sought from the author to verify eligibility. Included studies were assessed on their quality using standard criteria.

MAIN RESULTS

The review identified four studies (including 344 participants) in which a psychological model or theory had been explicitly used as the basis for the design of the intervention. The overall quality of trials was low. Due to the hetereogeneity between studies, both in terms of outcome measures and psychological models adopted, a meta-analysis was not possible. The four studies adopted four different theoretical frameworks, though there was some overlap in that three of the studies incorporated elements of Operant and Classical Conditioning. Psychological interventions resulted in improved plaque scores in comparison to no intervention groups, and in one study in comparison to an attention control group. One study found decreased gingival bleeding in the active intervention group but no change in pocket depth or attachment loss after 4 months. Psychological interventions were associated with improved self reported brushing and flossing in both studies which assessed these behaviours. Only one study explored the impact of psychological interventions on beliefs and attitudes, the psychological intervention, in comparison to educational and no intervention controls, showed improved self efficacy beliefs in relation to flossing, but no effect on dental knowledge or self efficacy beliefs in relation to tooth brushing.

AUTHORS' CONCLUSIONS

There is tentative evidence from low quality studies that psychological approaches to behaviour management can improve oral hygiene related behaviours. However, the overall quality of the included trials was low. Furthermore, the design of the interventions was weak and limited, ignoring key aspects of the theories. Thus, there is a need for greater methodological rigour in the design of trials in this area.

The relevance of oral health for attenders and non-attenders: a qualitative study

BACKGROUND

Low expectations of health mean that oral health becomes a low priority for some people, an appreciation of which would help dentists when a non-attender does come to the surgery.

OBJECTIVE

To provide an insight into why oral health is not important to some people and how this attitude might hinder access to dental care.

METHOD

In this qualitative study, purposive sampling was used to recruit two groups of participants with sociably visible missing, decayed or broken teeth but apparently differing responses to that status. The data analysis used social systems theory as operationalised by grounded theory techniques.

RESULTS

The core category that emerged from the data was that people constructed their own 'margins of the relevance' of oral health. For some people oral health was highly relevant whilst for others it was not very relevant. The degree of relevance of oral health was organised along seven dimensions: the perceived 'normal' state of oral health, the perceived causes of oral health and disease, the degree of trust held in dentistry, perceptions of oral 'health' as a commodity, perceptions of the accessibility of oral health care, perceptions of 'natural' oral health and judgements of character.

CONCLUSIONS

If certain aspects of oral health are not relevant, little that is said about those aspects will be meaningful to people. The key is to either emphasize or gently challenge those ideas and beliefs that allow or hinder the margins of relevance.

The feminisation of the orthodontic workforce

OBJECTIVE

To describe the status and activity of women in the UK orthodontic workforce.

DESIGN AND SETTING

Postal questionnaire based on the UK orthodontic workforce.

SUBJECTS

All orthodontic providers in the UK.

MATERIALS AND METHODS

A questionnaire was circulated to the total study population. The variables studied relating to sex were numbers, age, number of sessions worked, productivity, professional status and retirement intentions.

RESULTS

The response rate was 72.7%. 31.4% of the participants were female. The average age of female providers was 42.7 (SE 0.48) years, who were on average 4 years younger than males. Sixty-six percent of specialist trainees are women and 34% men. 41.5% of male providers and 31.6% of female providers plan to retire in the next 15 years. The mean number of sessions worked by women was 7.2 (SE 0.1) and men 8.2 (SE 0.1). Women completed 24.2 (SE 1.9) cases per session and men 25.6 (SE 1.3).

CONCLUSIONS

The orthodontic workforce is becoming increasingly feminised. The cumulative effect of more women completing fewer cases will mean that workforce planners will need to consider increasing numbers to allow for this feminisation.

A randomised controlled trial of the effect of outreach placement on treatment planning by dental students

Undergraduate dental students' curricula are being supplemented with primary care placements.

OBJECTIVE

To compare the effect of outreach placement and traditional hospital-based training alone on students' treatment planning ability.

DESIGN

Randomised controlled trial.Setting Four existing primary care placements in England during 2004.

SUBJECTS AND METHODS

At follow-up the fourth-year students took a history from a standard 'patient' then recorded a treatment plan. Interview skill was scored. The history and plan were assessed by clinicians blind to the intervention.

INTERVENTION

Five-week block outreach placements for 25 of 49 students.

MAIN OUTCOME MEASURES

Interviewing skill, quality of dental and social histories, the appropriateness of planned treatments and the consideration of wider issues.

RESULTS

The two groups were similar in the scores for interviewing and taking a dental history. The outreach group scored higher for capturing a social history (outreach mean 4.4, SD = 2.1, n = 22 and hospital 2.8, SD = 1.9, n = 23; p = 0.01) and for developing an appropriate treatment plan (5.6 [SD = 2.1] and 3.9 [SD = 2.3]; p = 0.01). There were no differences in scores relating to the wider issues.

CONCLUSION

Dental outreach training was significantly more effective than traditional training alone in improving students' ability to capture relevant points of social history from a patient and to consider them when planning treatment.

General health promotion in general dental practice — The involvement of the dental team Part 2: A qualitative and quantitative investigation of the views of practice principals in South Yorkshire

AIM

To investigate the factors that might influence the provision of general health promotion through seven different health interventions by dental teams in general dental practice.

METHOD

A mixed-method was used comprising cross-sectional qualitative research using semi-structured interviews of a purposive sample of 10 practice principals, and a cross sectional survey of a practice principal from every dental practice in South Yorkshire, using a self-complete questionnaire.

RESULTS

Two core categories emerged from the qualitative data: seeing health or disease and practitioners' views of the structure of dental practice. The former refers to the participants' general outlook and cut across many dimensions constituting the structure of dental practice. Health-orientated dentists were more likely to be involved in prevention and were more open-minded to expanding the dental team's role into general health promotion. However participants perceived that barriers existed to involvement such as time and financial factors, current workload and lack of personal skills. The response rate of useable questionnaires in the cross sectional survey was 84%. Reported levels of involvement in general health promotion were low. Most frequently reported barriers were 'insufficient funding' and 'poor use of time'. 'Poor use of time' and 'lack of training/knowledge' were reported less frequently for professionals complementary to dentistry (PCDs) than dentists (p<0.05). Most dentists agreed that PCDs could be trained to deliver health interventions and would be happy for PCDs to do so in their practice if reported barriers were removed.

CONCLUSIONS

Although dental teams' involvement in general health promotion is low, there is willingness to increase involvement, particularly among health-orientated dentists. Some reported barriers to involvement might be removed by impending changes to the GDS in England. Other important factors include a lack of education and workforce shortages of dentists and PCDs. Respondents indicated a high regard for PCDs and there was broad agreement that they were suitable to be involved in this work.

General health promotion in general dental practice — The involvement of the dental team Part 1: A review of the evidence of effectiveness of brief public health interventions

OBJECTIVES

To review the evidence of the effectiveness of dentists, dental teams and other healthcare workers in seven different brief public health interventions that might contribute to Government targets in cancer and circulatory disease. The interventions were: smoking prevention, smoking cessation, advice on alcohol consumption, diet counselling, advice on physical exercise, advice on skin cancer prevention and blood pressure monitoring.

METHOD

A series of literature reviews, using a generic systematic approach, were undertaken to investigate the effectiveness of dentists, dental teams and other healthcare workers in each intervention.

RESULTS

Apart from smoking cessation and dietary advice, no studies were identified on the effectiveness of dentists or dental teams in the interventions investigated. There is some evidence that dentists and dental teams can be effective in smoking cessation. There is minimal evidence for effectiveness in dietary counselling, and that which exists shows only a transient effect. There is evidence that other healthcare workers can have some effect in all interventions, though the effect in preventing skin cancer is questionable.

CONCLUSIONS

Due to the paucity of studies undertaken, there is minimal evidence of effectiveness of dentists and dental teams in any of the seven interventions. However other healthcare workers are effective in most of them. Dentists and dental teams' involvement in such brief general health promotion interventions might contribute to Government targets on cancer and circulatory disease.

Student perspectives on their recent dental outreach placement experiences

BACKGROUND

Dental schools are developing new curricula, with outreach placements enhancing the hospital-based training.

OBJECTIVES

To assess the students' experience of outreach as one component of determining the value and feasibility of outreach placements.

INTERVENTION

Six-week block placements for 10 undergraduates and 3 weeks for 11 hygiene and hygiene and therapy students in existing primary care clinics, in areas of need, to work supervised by local dentists.

METHODS

Semi-structured interviews with 20 students by staff independent of the course team. Interviews were audio-recorded, transcribed and content analysed before being verified by a second observer. Findings were triangulated against a peer-run focus group and students' clinical records.

RESULTS

Students were very positive about their experience and the potential role of outreach training in dental education. They described: gaining greater experience of new types of patients and their communities; learning from broader clinical experience, alternative approaches and practicing or observing dentistry in different settings; the benefits of team working; and, acquiring a more holistic and pragmatic view of health care. Many students reported gaining greater confidence, wider awareness of potential careers in dentistry and a greater sense of realism in their experience. Some reflected on their own training needs. Students also discussed the importance of preparation for the placements and the merits of different styles of supervision.

CONCLUSION

Dental outreach training can provide students with valuable learning experience in a range of areas. It requires careful management to ensure those experiences match individuals' needs and the programme's purposes.

Perspectives of staff on student outreach placements

OBJECTIVE

To explore the perspectives of placement staff on outreach training.

INTERVENTION

Block clinical placements in primary care settings for dental undergraduates and hygiene and therapy students.

METHOD

After completion of the placements, 32 participating staff across nine primary care locations took part in qualitative interviews and focus groups. The staff provided data on placement organisation, the students' development and their supervision, and any effects on themselves as hosts.

RESULTS

The major themes included the learning environment, supervision and communication. The staff saw benefits to students in working in a smaller primary care clinic with nursing support and immediately available supervision by a dental generalist. Other benefits included increased confidence, broader clinical experience and applying theoretical learning to new communities. Effective communication and adequate resourcing were critical success factors. There was some disruption of clinics' normal working, but many unanticipated benefits. Staff supported the outreach placements in primary care settings to enhance students' dental education.

CONCLUSIONS

These findings provide a planning and evaluation framework for dental educators involved in outreach.

An evaluation of the Child Perceptions Questionnaire in the UK

OBJECTIVE

To assess the reliability and validity of the Child Perceptions Questionnaire (CPQ11-14), an oral health related quality of life measure for 11-14 year old children, for use in the UK.

BASIC RESEARCH DESIGN

Cross-sectional questionnaire and clinical analytical study.

CLINICAL SETTING

Orthodontic and paediatric dentistry clinics at a dental hospital and one general dental practice.

PARTICIPANTS

Eighty-nine children between 11 and 14 years of age attending for an examination.

MAIN OUTCOMES MEASURES

The children were invited to complete the CPQ11-14, global oral health and impact on life overall ratings. Clinical data on caries status, malocclusion and presence of dental opacities and gingivitis were collected. CPQ11-14 was summarised as the total score (sum of the item codes) and the number of impacts reported often or every day.

RESULTS

The Cronbach's alpha for the total scale was 0.87 and ranged from 0.59 to 0.83 for the subscales indicating acceptable internal consistency. The intraclass correlation coefficient on repeated application of the measure was 0.83 (95% CI = 0.76-0.90) suggesting almost perfect agreement. Summary measures of CPQ11-14 correlated with the global oral health rating indicating acceptable criterion validity. Impact on life overall was related to all summary measures of CPQ11-14. Number of impacts correlated with the total number of missing teeth and missing teeth due to caries. No other relationships between clinical and CPQ11-14 data were apparent.

CONCLUSION

The CPQ11-14 shows acceptable reliability, criterion and construct validity in relation to life overall. Relationships with clinical data were more tenuous. If this measure is to be used to compare the impacts of oral diseases in similar settings in the UK a large sample will be required.

Manual versus powered toothbrushing for oral health

BACKGROUND

Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this.

OBJECTIVES

To compare manual and powered toothbrushes in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group Trials Register (to 17/06/2004) and Central Register of Controlled Trials (The Cochrane Library Issue 2, 2004); MEDLINE (January 1966 to week 2 June 2004); EMBASE (January 1980 to week 2 2004) and CINAHL (January 1982 to week 2 June 2004). Manufacturers were contacted for additional data.

SELECTION CRITERIA

Trials were selected for the following criteria: design-random allocation of participants; participants - general public with uncompromised manual dexterity; intervention - unsupervised manual and powered toothbrushing for at least 4 weeks. Primary outcomes were the change in plaque and gingivitis over that period.

DATA COLLECTION AND ANALYSIS

Six authors independently extracted information. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using random-effects models. Potential sources of heterogeneity were examined, along with sensitivity analyses for quality and publication bias. For discussion purposes SMD was translated into percentage change.

MAIN RESULTS

Forty-two trials, involving 3855 participants, provided data. Brushes with a rotation oscillation action removed plaque and reduced gingivitis more effectively than manual brushes in the short term and reduced gingivitis scores in studies over 3 months. For plaque at 1 to 3 months the SMD was -0.43 (95% CI: -0.72 to -0.14), for gingivitis SMD -0.62 (95% CI: -0.90 to -0.34) representing an 11% difference on the Quigley Hein plaque index and a 6% reduction on the Loe and Silness gingival index. At over 3 months the SMD for plaque was -1.29 (95% CI: -2.67 to 0.08) and for gingivitis was -0.51 (-0.76 to -0.25) representing a 17% reduction on the Ainamo Bay bleeding on probing index. There was heterogeneity between the trials for the short-term follow up. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. There was no evidence of any publication bias. No other powered designs were as consistently superior to manual toothbrushes.Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and temporary.

AUTHORS' CONCLUSIONS

Powered toothbrushes with a rotation oscillation action reduce plaque and gingivitis more than manual toothbrushing. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.

Drug users: oral health-related attitudes and behaviours

AIM

Explore oral health-related attitudes and behaviours of drug users.

DESIGN

Qualitative study using focus groups and semi-structured interviews.

SETTING

Facilities for treatment and recovery of drug users in South London.

PARTICIPANTS

Twenty-six male and 14 female recovering drug users.

RESULTS

Participants described many changes in lifestyle associated with drug use including the physical effects of drugs, dietary habits, organisational and time constraints and unfavourable social conditions, which were not conducive to oral health. There was considerable health consciousness. They associated general health problems and problems with teeth, gums and oral soft tissues to both direct and indirect effects of drug use. Use of dental services was inhibited by low priority for oral health relative to the need to obtain and use drugs, experientially induced fear of dentists, the acceptability of dental services, needle-phobia, ability to self-medicate and organisational factors in their lifestyles.

CONCLUSIONS

The lifestyles of drug users may contribute to oral health problems and low use of services. Drug users therefore comprise a group with special dental needs and need greater access to dental care than most people. Much of this care could be provided in general practice where appropriate dental care can contribute to recovery from drug use.