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Review of visceral throat and chest disorders causing nonodontogenic orofacial pain. J Am Dent Assoc 2022; 153:769-775. [DOI: 10.1016/j.adaj.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 11/24/2022]
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Currie CC, Stone SJ, Brocklehurst P, Slade G, Durham J, Pearce MS. Dental Attendances to General Medical Practitioners in Wales: A 44 Year-Analysis. J Dent Res 2021; 101:407-413. [PMID: 34582311 PMCID: PMC8935529 DOI: 10.1177/00220345211044108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
One-third of the UK population is composed of problem-oriented dental attenders, seeking dental care only when they have acute dental pain or problems. Patients seek urgent dental care from a range of health care professionals, including general medical practitioners. This study aimed to identify trends in dental attendance at Welsh medical practices over a 44-y period, specifically in relation to dental policy change and factors associated with repeat attendance. A retrospective observational study was completed via the nationwide Secure Anonymised Information Linkage (SAIL) Databank of visits to general medical practice in Wales. Read codes associated with dental diagnoses were extracted for patients attending their general medical practitioner between 1974 and 2017. Data were analyzed with descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 439,361 dental Read codes, accounting for 288,147 patient attendances. The overall attendance rate was 2.60 attendances per 1,000 patient-years (95% CI, 2.59 to 2.61). The attendance rate was negligible through 1987 but increased sharply to 5.0 per 1,000 patient-years in 2006 (95% CI, 4.94 to 5.09) before almost halving to 2.6 per 1,000 in 2017 (95% CI, 2.53 to 2.63) to a pattern that coincided with changes to National Health Service policies. Overall 26,312 patients were repeat attenders and were associated with living in an area classified as urban and deprived (odds ratio [OR], 1.22; 95% CI, 1.19 to 1.25; P < 0.0001) or rural (OR, 0.84; 95% CI, 0.83 to 0.85; P < 0.0001). Repeat attendance was associated with greater odds of having received an antibiotic prescription (OR, 2.53; 95% CI, 2.50 to 2.56; P < 0.0001) but lower odds of having been referred to another service (OR, 0.75; 95% CI, 0.70 to 0.81; P < 0.0001). Welsh patients’ reliance on medical care for dental problems was influenced by social deprivation and health policy. This indicates that future interventions to discourage dental attendance at medical practitioners should be targeted at those in the most deprived urban areas or rural areas. In addition, health policy may influence attendance rates positively and negatively and should be considered in the future when decisions related to policy change are made.
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Affiliation(s)
- C C Currie
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S J Stone
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - P Brocklehurst
- School of Health Sciences, Bangor University, Bangor, UK
| | - G Slade
- Division of Pediatric and Public Health, UNC Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - J Durham
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M S Pearce
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Abstract
Introduction Many patients present to doctors with oral health conditions and it is, therefore, important that they have the knowledge and skills to give advice and signpost appropriately. Aim To ascertain the baseline knowledge and confidence of doctors in managing oral conditions and to identify topic areas for training.Design A baseline survey was conducted. Two training programmes were then delivered based on the finding of this survey, followed by a post-training survey. Setting North West London training programme for foundation year 1 (FY1) doctors and general medical practitioner (GP) trainees. Intervention The FY1 doctors had a didactic teaching session. The GP trainees had a training session combined with foundation dentists (FDs), comprised of a lecture and small, mixed group work.Main outcomes measured i) post-training confidence in managing oral conditions, answering patients' questions regarding oral health and signposting patients; ii) the most useful and relevant topics of the training for their daily practice.Results The majority of the doctors had previously received no oral health teaching. Furthermore, the majority did not feel confident at managing oral conditions or signposting patients appropriately. Common topic areas were identified where doctors wanted more oral health teaching. Conclusions FY1 and GP trainees lack knowledge and confidence with regard to the management of oral health issues and recognise that there is a need to know about oral health. This work highlights the need for structured training to equip doctors with appropriate oral health knowledge and skills.
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Aggarwal VR, Fu Y, Main CJ, Wu J. The effectiveness of self‐management interventions in adults with chronic orofacial pain: A systematic review, meta‐analysis and meta‐regression. Eur J Pain 2019; 23:849-865. [DOI: 10.1002/ejp.1358] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/20/2018] [Accepted: 12/30/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Vishal R. Aggarwal
- Faculty of Medicine & Health, School of Dentistry University of Leeds Leeds UK
| | - Yu Fu
- Faculty of Medicine & Health, School of Healthcare University of Leeds Leeds UK
| | - Chris J. Main
- Research Institute for Primary Care & Health Keele University Keele UK
| | - Jianhua Wu
- Faculty of Medicine & Health, School of Dentistry University of Leeds Leeds UK
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Patients' reasons for consulting a GP when experiencing a dental problem: a qualitative study. Br J Gen Pract 2018; 68:e877-e883. [PMID: 30348888 DOI: 10.3399/bjgp18x699749] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/14/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND There are approximately 380 000 dental consultations in UK general practice every year. AIM To explore the reasons why patients may consult a GP rather than a dentist when experiencing problems with their teeth or gums. DESIGN AND SETTING A qualitative semi-structured interview study with adults who had consulted a UK GP with a dental problem in the previous 12 months. METHOD Participants were recruited via print and social media; internet adverts; HealthWise Wales, the Welsh national population research cohort; and word of mouth. In total, 39 telephone interviews were conducted, and transcripts thematically analysed. RESULTS Participants' consultation behaviour was influenced by their interpretation of their symptoms; their perceptions of the scope of practice of primary care practitioners; the comparative ease of navigating medical and dental care systems; previous experiences of dental care, including dental anxiety and dissatisfaction with prior treatment; and willingness and ability to pay for dental care. CONCLUSION There are several reasons why patients may consult a GP with a dental problem. Effective interventions will need to break down the barriers preventing access to dental care. Accessible public-facing information on where to seek care for dental problems is required, and general practice teams should be able to signpost patients who present with dental problems, if appropriate. Dental providers should also be encouraged to maintain timely access to urgent care for their patients.
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Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study. Br J Gen Pract 2016; 66:e329-36. [PMID: 27025554 DOI: 10.3399/bjgp16x684757] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/30/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The frequency of consulting for dental problems in general medical practice, and antibiotic prescribing associated with these consultations, is poorly described. AIM To describe consultation rates and antibiotic use for dental problems in UK general medical practice, and explore factors associated with antibiotic prescribing for dental conditions. DESIGN AND SETTING A retrospective cohort study using Clinical Practice Research Datalink, a database of general practice patient records in the UK. METHOD All dental consultations between 2004 and 2013 were identified. The main outcome was the prescription of an antibiotic during a dental consultation. Multilevel logistic regression was conducted to examine factors associated with antibiotic prescription. RESULTS In all, 288 169 dental consultations were included in the cohort. The average rate of dental consultations was 6.06 consultations per 1000 patient-years. Rates of dental consultation decreased from 6.84 consultations per 1000 patient-years in 2008, to 4.23 consultations per 1000 patient-years in 2013. Consultation rates were higher among females than males and highest in patients aged 20-29 years. An antibiotic was prescribed in 57.1% of consultations. Significant predictors (P<0.001) of antibiotic prescribing included: patient middle age, male sex, and previous consultations for tooth-related problems. Antibiotics were more likely to be prescribed during consultations in December (odds ratio [OR] 1.18, 95% confidence interval [CI] = 1.13 to 1.24, P<0.001, reference month: June) and on a Monday (OR 1.10, 95% CI = 1.07 to 1.13, P<0.001) or a Friday (OR 1.15, 95% CI = 1.12 to 1.18, P<0.001, reference day: Wednesday). CONCLUSION Consultation rates for dental problems in UK general practice are relatively low but more than half result in the prescription of an antibiotic. This raises concerns about patient morbidity and contributions to antimicrobial resistance.
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Cope AL, Wood F, Francis NA, Chestnutt IG. General practitioners' attitudes towards the management of dental conditions and use of antibiotics in these consultations: a qualitative study. BMJ Open 2015; 5:e008551. [PMID: 26428331 PMCID: PMC4606392 DOI: 10.1136/bmjopen-2015-008551] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study aimed to produce an account of the attitudes of general practitioners (GPs) towards the management of dental conditions in general practice, and sought to explore how GPs use antibiotics in the treatment of dental problems. DESIGN Qualitative study employing semistructured telephone interviews and thematic analysis. PARTICIPANTS 17 purposively sampled GPs working in Wales, of which 9 were male. The median number of years since graduation was 21. Maximum variation sampling techniques were used to ensure participants represented different Rural-Urban localities, worked in communities with varying levels of deprivation, and had differing lengths of practising career. RESULTS Most GPs reported regularly managing dental problems, with more socioeconomically deprived patients being particularly prone to consult. Participants recognised that dental problems are not optimally managed in general practice, but had sympathy with patients experiencing dental pain who reported difficulty obtaining an emergency dental consultation. Many GPs considered antibiotics an acceptable first-line treatment for acute dental problems and reported that patients often attended expecting to receive antibiotics. GPs who reported that their usual practice was to prescribe antibiotics were more likely to prioritise patients' immediate needs, whereas clinicians who reported rarely prescribing often did so to encourage patients to consult a dental professional. CONCLUSIONS The presentation of patients with dental problems presents challenges to GPs who report concerns about their ability to manage such conditions. Despite this, many reported frequently prescribing antibiotics for patients with dental conditions. This may contribute to both patient morbidity and the emergence of antimicrobial resistance. This research has identified the need for quantitative data on general practice consultations for dental problems and qualitative research exploring patient perspectives on reasons for consulting. The findings of these studies will inform the design of an intervention to support patients in accessing appropriate care when experiencing dental problems.
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Affiliation(s)
- Anwen L Cope
- Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - Fiona Wood
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Nick A Francis
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Ivor G Chestnutt
- Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
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Do LG, Spencer AJ, Dost F, Farah CS. Oral mucosal lesions: findings from the Australian National Survey of Adult Oral Health. Aust Dent J 2014; 59:114-20. [PMID: 24494603 DOI: 10.1111/adj.12143] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of oral mucosal lesions (OMLs) and factors associated with these has not previously been reported in the Australian population. This study aimed to report on the prevalence of OMLs in Australian adults and to evaluate their association with socio-demographic factors. METHODS This study utilized data from the Australian National Survey of Adult Oral Health 2004-06, which employs a multi-stage, stratified random sample selection procedure. Information on socio-demographics, smoking and presence of OMLs were collected using telephone interview, self-reported questionnaires and comprehensive oral examination. A multivariate regression model was generated to estimate effect of factors on the prevalence of non-ulcerated OMLs. RESULTS A total of 3551 dentate adult Australians had complete data for this analysis. Over 20% of study participants presented with an OML on the day of examination. The prevalence of suspected malignancy was less than 1% and over 17% for non-ulcerated OMLs. Prevalence of non-ulcerated OMLs was associated with age, gender, residential location, household income and smoking. CONCLUSIONS The study reported that epidemiological survey can provide useful information on OMLs. Certain population groups had a higher risk of having the condition. Preventing smoking uptake and smoking cessation can reduce the prevalence of OMLs in the population.
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Affiliation(s)
- L G Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia
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Au TSY, Wong MCM, McMillan AS, Bridges S, McGrath C. Treatment seeking behaviour in southern Chinese elders with chronic orofacial pain: a qualitative study. BMC Oral Health 2014; 14:8. [PMID: 24460663 PMCID: PMC3903442 DOI: 10.1186/1472-6831-14-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 01/23/2014] [Indexed: 11/15/2022] Open
Abstract
Background Chronic orofacial pain (OFP) is common in general adult populations worldwide. High levels of psychological distress and impaired coping abilities are common among Western people with chronic OFP but limited information was found in southern Chinese people. This study aimed to explore the perceptions and experiences of community dwelling elderly people with chronic OFP symptoms and their treatment seeking behaviour in Hong Kong. Methods An exploratory qualitative interview study was conducted. Elderly people experiencing chronic OFP symptoms were invited to take part in an individual semi-structured interview. A total of 25 semi-structured interviews were performed for 25 participants. Results Pertinent issues relating to the treatment seeking behaviour emerged from the interviews, many of which were inter-related and overlapping. They were organized into three major themes: (i) Impact of chronic OFP on daily life; (ii) Personal knowledge and feeling of chronic OFP; (iii) Management of chronic OFP. The participants were found to have the intention to seek professional treatment, but there were barriers which discouraged them continuing to seek professional treatment. They also received complementary treatment for chronic OFP, such as acupuncture, massage and “chi kung”. Moreover, a wide range self-management techniques were also mentioned. On the other hand, those who did not seek professional treatment for the chronic OFP claimed that they had accepted or adapted to the pain as part of their lives. Conclusions This qualitative study observed that elderly people affected by chronic OFP symptoms in Hong Kong sought many different ways to manage their pain including traditional and complementary approaches. The role of the dentist in dealing with chronic OFP is unclear. Multiple barriers exist to accessing care for chronic OFP. The findings may be used to inform future chronic OFP management strategies in Hong Kong.
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Affiliation(s)
| | - May C M Wong
- Dental Public Health, Faculty of Dentistry, University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong SAR, China.
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Shephard MK, Macgregor EA, Zakrzewska JM. Orofacial pain: a guide for the headache physician. Headache 2013; 54:22-39. [PMID: 24261452 DOI: 10.1111/head.12272] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 12/19/2022]
Abstract
Orofacial pain represents a significant burden in terms of morbidity and health service utilization. It includes very common disorders such as toothache and temporomandibular disorders, as well as rare orofacial pain syndromes. Many orofacial pain conditions have overlapping presentations, and diagnostic uncertainty is frequently encountered in clinical practice. This review provides a clinically orientated overview of common and uncommon orofacial pain presentations and diagnoses, with an emphasis on conditions that may be unfamiliar to the headache physician. A holistic approach to orofacial pain management is important, and the social, cultural, psychological and cognitive context of each patient needs to be considered in the process of diagnostic formulation, as well as in the development of a pain management plan according to the biopsychosocial model. Recognition of psychological comorbidities will assist in diagnosis and management planning.
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Affiliation(s)
- Martina K Shephard
- Oral Medicine Unit, Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
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Dunleavy D. Re: L.A. Shanks, T.W. Walker, P.J. McCann, M.J. Kerin, Oral cavity examination: beyond the core curriculum? [Br J Oral Maxillofac Surg 2011]. Br J Oral Maxillofac Surg 2012; 50:279. [DOI: 10.1016/j.bjoms.2011.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 11/04/2011] [Indexed: 11/29/2022]
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Loster BW, Likeman PR. Teaching of dentistry to medical students in English at the Jagiellonian University, Krakow, Poland. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2012; 16:e1-e2. [PMID: 22251330 DOI: 10.1111/j.1600-0579.2011.00685.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The significance of teaching dental subjects to medical students as well as medicine to dental students is considered. The authors' experience in teaching dentistry to medical students in English at the University of Krakow is described.
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Affiliation(s)
- B W Loster
- Department of Orthodontics, Jagiellonian University, Krakow, Poland
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