Remote clinical consultations in restorative dentistry: a clinical service evaluation study

Curriculum content for Environmental Sustainability in Dentistry

OBJECTIVES

(i) To identify suitable strategies and opportunities to embed Environmental Sustainability (ES) within an existing Oral Health Professional (OHP) curriculum through a series of focus groups with students and academic staff and (ii) To create high-level evidence-based and subject-specific ES content through an approach grounded in evidence and collaboration with key stakeholders in OHP education.

METHODS

Focus groups were used to explore academic staff and student views on appropriate teaching and assessment methods for ES. Content statements were developed from an extensive literature search, mapped to curriculum subjects, and validated through consultation with students, discipline-experts and education-experts.

RESULTS

Five themes were identified from the focus groups: ES transcends all disciplines of dentistry and oral healthcare; baseline knowledge transmission with relevant practical application; viewing and modifying existing teaching and assessment events through a different lens; normalising the topic of ES to support attitude and behaviour change and safeguarding against misinformation and disinformation. Forty-four content statements were developed and mapped to nineteen curriculum subjects.

CONCLUSIONS

This study identifies for the first time a comprehensive strategy for the inclusion and delivery of ES (method and content) in the curriculum. A novel method to define and map curriculum content has been explored and validated using a range of complementary methodologies. A comprehensive and robust list of evidence-based and subject-specific educational content statements have been defined in the field of Environmental Sustainability in dentistry and oral healthcare.

CLINICAL SIGNIFICANCE

Oral healthcare has a significant environmental impact, the key to all mitigation strategies is educating the profession at all levels.

The environmental consequences of oral healthcare provision by the dental team

OBJECTIVES

To undertake a comparative ecological impact (Total lifetime carbon footprint and single use plastics (SUP) waste generation) derived from the provision of professional oral healthcare (Dentists and hygienist) to five different patient categories up to the age of 50 years, representative of different levels of progressive dental disease and treatment experience.

METHOD

CO2e and SUP waste generated was calculated for five patient categories with common preventable diseases; that are representative of different levels of progressive dental disease and treatment experience. The assessment is based on the average restorative care levels for 50-year-olds in the UK. The number of appointments for each procedure was calculated using current evidence-based guidelines. The total lifetime carbon and the SUP waste analysis was calculated using published peer-reviewed data.

RESULTS

The total carbon footprint follows a progression with low impacts for individual persons with very low disease and treatment experience (285 KgCO2e), escalating to very high impacts (approximately 2,170 KgCO2e) for people with high levels of disease and treatment experience. SUP waste follows a similar linear rise across the different cohorts of dental experience over a lifetime (6-50 years), from 1,382 items and 4.6 Kg for patients in a the very low dental experience, to 12,200 items and 33.8 Kg for patients in the cohort of very high dental experience.

CONCLUSIONS

The provision of all oral healthcare carries an environmental impact in the form of carbon footprint and SUP waste. The cumulative lifetime environmental impact of oral healthcare is proportional to the disease and treatment experience of the individual person for these preventable diseases; with a x8 difference between the two extremes of experience.

CLINICAL SIGNIFICANCE

All forms of oral healthcare have an environmental impact. The most effective way to mitigate these impacts is through the promotion and provision of effective evidence-based preventive oral healthcare.

Patients' Readiness Towards Teledentistry in the Malaysian Urban Population Attending an Undergraduate Teaching University

Introduction: COVID-19 disease has resulted in suspension of all nonurgent routine dental treatments. In view of COVID-19 situation, social distancing, movement restriction orders, and affected health care systems, there is an urgent need to resume and deliver oral health care remotely. Hence, alternative means of dental care should be available for both patients and dentists. Therefore, this study aims to assess patients' readiness for teledentistry in Malaysian urban population attending an undergraduate teaching university. Methods: A cross-sectional study was conducted among 631 adult patients visiting the Faculty of Dentistry, SEGi University, from January 2020 to May 2021 in Selangor, Malaysia. A validated, self-administered, 5-point Likert scale online questionnaire comprising five domains was administered. (1) Patients' demographics and dental history, (2) patients' access to teledentistry, (3) patients' understanding towards teledentistry, (4) patients' willingness, and (5) barriers in using teledentistry were used to collect the required information. Results: Six hundred and thirty-one (n = 631) participants responded to the questionnaire. Ninety percent of patients were able to connect to Wi-Fi services independently and 77% participants were comfortable using online communication platforms. Seventy-one percent of the participants agreed that video and telephone clinics can reduce chances of infection rather than face-to-face consultation during the pandemic. Fifty-five percent of patients felt that virtual clinics would save time and 60% thought it could reduce travelling costs. Fifty-one percent showed their willingness to use video or telephone clinics when implemented at onsite clinics. Conclusion: Our study shows the readiness of patients to accept teledentistry as an alternative method of oral care if appropriate training and education are provided. The results of this study have prompted an increase in patients' education and shown a need to train clinicians and patients to integrate this technology at SEGi University. This might facilitate unhindered dental consultation and care in all situations.

Oral cancer diagnosis amid COVID-19 pandemic: Identifying tell-tale signs to avoid pitfalls in general dental practice

This article details the unusual presentation of an oral squamous cell carcinoma (SCC) referred to secondary care during the COVID-19 pandemic. The patient's chief complaints were trismus and pain from a lower left partially erupted third molar, which was assumed to be pericoronitis-related on referral. Intra-oral examination was difficult due to the patient's symptoms, but radiographic assessment of an orthopantomogram (OPG) showed a pathological fracture and poorly defined radiolucency in the lower left third molar region. Oral SCC was diagnosed after biopsy, and surgery and radiotherapy were swiftly carried out despite COVID-19 restrictions. General dental practitioners (GDPs) remain the frontline healthcare professionals in the screening and detection of oral cancer through detailed history taking and examinations. Primary care dental practitioners should always remain vigilant with patients at risk of oral cancer. Prompt referral to secondary care for further investigations and management should be made when a suspicion of oral malignancy is raised, to ensure a better treatment outcome. Video consultations have had their merits in dentistry amid the coronavirus pandemic, but face-to-face consultations are essential to establish quality patient care.

Remote clinical consultations in restorative dentistry-A survey

OBJECTIVES

To assess the patient experience of Remote Clinical Consultations (RCCs) for head and neck cancer and cleft lip and palate patients undergoing specialist restorative dentistry treatment in the context of a secondary care service.

METHODS

An online survey was designed; all ninety three patients were invited to participate in its completion following a video or telephone remote clinical consultation with one restorative consultant in Addenbrooke's Hospital between August 2020 and April 2021. The video consultations were carried out via NHS England's Attend Anywhere platform.

RESULTS

Sixty three responses were received. Over 70% of patients valued a video or telephone remote clinical consultation rather than an in-person attendance. Patients reported a good experience and would recommend a remote clinical consultation instead of an in-person attendance if no treatment would likely be required. Those who were less likely to recommend a remote clinical consultation were those who had difficulties logging-in to the remote platform or had technical issues.

CONCLUSION

While a number of patients still would have preferred a face-to-face attendance, both telephone and video remote consultations were highly valued by patients, and the overall patient experience was that of acceptance. Benefits of remote consultations perceived by patients included having set time to discuss concerns and queries, becoming familiar with a clinician prior to any treatment, saving time, minimising travel and reducing expenses. Barriers to a positive experience included technical difficulties. This survey contributes to the evidence supporting remote clinical consultations as a practical way of delivering specialist consultations in restorative dentistry, it highlights this virtual process largely relates to the practicalities of service provision and highlights the use of remote consultations for specific appointments.

CLINICAL SIGNIFICANCE

This study demonstrates patient feedback to a strategy implemented due to adaptations in working methods required as result of the Covid-19 pandemic. Patients were found to have a positive, accepting experience of both telephone and video remote clinical consultations. the study identifies a high patient acceptability and ability to overcome some of the disadvantages of an in-person attendance including saving time, travel and associated expenses while also contributing to a reduction in CO₂ emissions and potentially improving clinical efficiency and capacity. These findings add to existing evidence and are indicative that remote consultations provide a practical way of delivering specialist communication in restorative dentistry as part of a unique patient pathway.

The development of a restorative Managed Clinical Network within the defence primary healthcare organisation

The United Kingdom Armed Forces introduced a Managed Clinical Network to transform care provision for military patients referred with complex restorative treatment needs. This article discusses the processes that underpinned this transformation of service, from assessment of populations needs to implementation of clinical delivery.

Embedding environmental sustainability within the modern dental curriculum- Exploring current practice and developing a shared understanding

INTRODUCTION

Evidence concerning the interactions between human health and planetary health has grown extensively in recent years. In turn, the perceived importance of environmental sustainability within higher education is growing at a rapid rate. This paper provides a summary of key elements as they apply to dentistry, and provides an introduction to the reader of an early consensus of how sustainability could be included as part of the dental curriculum.

METHODS

The consensus opinion within this paper largely centres around discussion at the ADEE sustainability workshop at the annual conference in Berlin (August 2019). In order to help inform discussions at the workshop, a brief scoping questionnaire was circulated to potential participants regarding their understanding and current teaching practices in sustainability. An infographic was designed to help delegates remember the important elements of sustainable dentistry. Delegates discussed the concept of sustainability alongside the infographic, and how they could link these with the Graduating European Dentist (GED) curriculum.

RESULTS

The discussions within the workshop largely centred around 4 main themes: Disease prevention and health promotion, Patient education and empowerment, Lean service delivery and Preferential use of strategies with lower environmental impact.

DISCUSSION

It is apparent that there is a widespread need for teaching materials relating to environmental sustainability; this includes specific learning outcomes relating to the 4 educational domains of the Graduating European Dentist curriculum, and methods for teaching and assessing these outcomes.

CONCLUSION

This paper reports consensus on the first phase of a pan-European working group on Sustainability in dental education.

Patient and clinician satisfaction with video consultations in dentistry - part one: patient satisfaction

Introduction Although often used in medicine, video consultations are less commonly used in dentistry. During the COVID-19 pandemic, the orthodontic team at Croydon University Hospital introduced the use of video consultations to provide continued patient care at a time when face-to-face appointments were not possible.Aim To assess patient and clinician satisfaction with the Attend Anywhere video consultations used by the orthodontic team at Croydon University Hospital.Method Two separate satisfaction questionnaires were piloted and developed: one for patients and one for clinicians. All patients scheduled for a video consultation between 15 May 2020 and 15 June 2020 were invited to complete a patient satisfaction questionnaire at the end of their consultation.Results In total, 114 patients attended video consultations in the time period assessed, of which 111 completed a satisfaction questionnaire (97.4% response rate). Fifty-six percent of patients were female with an average age of 16.5 years. Patient satisfaction was highest for the video consultations being easy to use and convenient. Over 90% of patients strongly agreed or agreed with all of the satisfaction statements and in terms of whether they would recommend using video consultations. Approximately one-third of patients preferred the video consultation to a face-to-face appointment and one-third of patients were neutral.Conclusion This study found high levels of patient satisfaction with video consultations in orthodontics. Thoughtful consideration needs to be given to the application of video clinics, going forwards, to ensure that high standards of patient care are maintained.

Patient and clinician satisfaction with video consultations in dentistry - part two: clinician satisfaction

Introduction Video consultations are currently not commonly used in dentistry; therefore, most clinicians lack experience in using this technology and seeing patients in this way. When implementing video clinics, it is important to assess clinician satisfaction as well as patient satisfaction to allow for developments and improvements, and to ensure that the highest levels of care are provided.Aim To assess patient and clinician satisfaction with the Attend Anywhere video consultations used by the orthodontic team at Croydon University Hospital.Method Two separate satisfaction questionnaires were piloted and developed: one for patients and one for clinicians. For all patients scheduled for a video consultation between 15 May 2020 and 15 June 2020 in the orthodontic department, all clinicians were invited to complete a clinician satisfaction questionnaire at the end of the consultation to assess satisfaction with the encounter.Results In total, 114 patients attended video consultations, for which there were 128 clinician completed questionnaires, as some patients were seen by multiple clinicians on multidisciplinary clinics. Over 89% of clinicians strongly agreed or agreed with all of the satisfaction statements, with the highest levels of satisfaction being for ease of use and convenience. Over 95% of clinicians strongly agreed or agreed that they would recommend using video consultations and over 89% preferred using a video consultation, if appropriate, to a face-to-face appointment. Overall, the highest levels of satisfaction were for retainer reviews.Conclusion High levels of clinician satisfaction were found with the telemedicine clinics in orthodontics across a range of different appointment types and encounters. Satisfaction varied according to the type of appointment; therefore, this should be a factor for consideration when planning the most appropriate use of telemedicine clinics going forwards.

The impact of coronavirus lockdown on oral healthcare and its associated issues of pre-schoolers in China: an online cross-sectional survey

BACKGROUND

The sudden outbreak of coronavirus disease (COVID-19) epidemic influenced people's daily life. During lockdown of Wuhan city, the oral health and its associated issues of preschool children were investigated and guidance for dental clinics when the epidemic were controlled in the future were also provided.

METHODS

A national online survey was conducted among preschool children and completed by their caregivers. The questionnaire related to children's oral health status and care behaviour, caregivers' attitudes. The information was statistically analyzed between Wuhan residents and others residents.

RESULTS

4495 valid questionnaires were collected. In oral health status, during Wuhan lockdown, 60.8%, 35.5% and 18.3% children had self-reported dental caries, toothache and halitosis respectively. In oral health attitudes, respondents who would increase attention to oral health was more than that would decrease. In oral hygiene behaviour, compared to non-Wuhan children, the children in Wuhan became more active in brushing their teeth. In utilization of dental services in the future, less Wuhan residents would choose to have dental visit directly, 28.5% Wuhan residents and 34.7% non-Wuhan residents agreed all of procedures could be done if proper protected.

CONCLUSIONS

Oral health status and associated issues of preschool children in Wuhan were significantly different from that of others during lockdown of Wuhan city and in the future. Effective measures should be taken as early as possible to protect children's oral health.

The Modern and Digital Transformation of Oral Health Care: A Mini Review

Dentistry is a part of the field of medicine which is advocated in this digital revolution. The increasing trend in dentistry digitalization has led to the advancement in computer-derived data processing and manufacturing. This progress has been exponentially supported by the Internet of medical things (IoMT), big data and analytical algorithm, internet and communication technologies (ICT) including digital social media, augmented and virtual reality (AR and VR), and artificial intelligence (AI). The interplay between these sophisticated digital aspects has dramatically changed the healthcare and biomedical sectors, especially for dentistry. This myriad of applications of technologies will not only be able to streamline oral health care, facilitate workflow, increase oral health at a fraction of the current conventional cost, relieve dentist and dental auxiliary staff from routine and laborious tasks, but also ignite participatory in personalized oral health care. This narrative article review highlights recent dentistry digitalization encompassing technological advancement, limitations, challenges, and conceptual theoretical modern approaches in oral health prevention and care, particularly in ensuring the quality, efficiency, and strategic dental care in the modern era of dentistry.

Remote working in dentistry in a time of crisis – tools and their uses

This article provides an overview of tools which enable remote working in Dentistry. It assesses the availability of tools for use in three areas of remote working in healthcare: video conference calls between professionals, apps for patients to send photographs to clinicians and platforms for telemedicine clinics and highlights the main features of common tools.

CPD/Clinical Relevance: Remote working in healthcare has become increasingly popular during the COVID-19 pandemic and an understanding of how this remote working can be utilized in Dentistry, and the associated benefits, is relevant to all clinicians.

Managing emerging challenges of Coronavirus disease 2019 (COVID-19) in dentistry

Dental centers have been referred to as a hub or reservoir for infection, where healthcare professionals and other staff, patients and the public together may potentially spread pathogenic microorganisms. This may occur via saliva, skin or indirectly through air, water, and contaminated surfaces or instruments. Everyone should therefore be considered as potential sources of infection. During a pandemic, limiting unnecessary care has been adopted as a clinical measure for some patient's, to reduce the risk of cross-infection in the short term. However, in order to enable continuation of necessary and qualified care, dental processes need to follow specific infection control strategies in order to prevent transmission of emerging pandemic risks following COVID-19. In this article, we develop a tool with practical recommendations to mitigate infection risks before, during and following pandemics to enable ongoing dental care provision in primary and secondary care based on national and global recommendations.