Contemporary issues in the provision of restorative dentistry

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.

Novel tier 2 service model for complex NHS endodontics

Aim The use of tier 2 practitioners has been suggested as an intermediate tier in the NHS workforce completing cases of moderate difficulty previously referred to secondary care. Provision of such services varies depending on speciality and local commissioning priorities. This service evaluation investigated reasons for and outcomes of endodontic referrals to an NHS tier 2 service in Powys, Wales.Methods A sample of endodontic referrals was analysed with reasons for referral, referral outcome, requests for consultant support and patient demographic data recorded producing results with frequencies and percentage distributions.Results Of 401 referrals evaluated, common reasons for referral were management of post-treatment disease (56.4%) followed by inability to locate or negotiate root canals (26.9%). Mandibular molar teeth were the most frequently referred. Additionally, 44.1% of patients referred went on to receive treatment. Consultant advice and/or treatment was required in the management of 3.5% of referrals, most frequently relating to referral of traumatic dental injuries, root resorption and immature apices.Conclusions Results demonstrate tier 2 practitioners can effectively manage and treat the majority of NHS endodontic referrals. Remote consultant advice is effective in supporting tier 2 practitioners in the management of complex presentation, allowing effective treatment delivery.

Acute endodontic and dental trauma provision during the COVID-19 crisis

COVID-19 (also known as coronavirus) has had a profound impact on dentistry, with all elective treatment grinding to a halt initially and a slow phased return to normal services. The guidance available regarding treating dental emergencies is currently advice, analgesia and antimicrobials, where indicated in the first instance. Some patients cannot be managed successfully with this approach and require face-to-face consultation. Unless dental practices have the appropriate PPE and follow strict infection prevention and control guidance, face-to-face consultation may not be possible. If treatment is required, this is based on minimum intervention and avoidance of aerosol generating procedures (AGPs) on patients who are free of COVID-19. COVID-19-positive or suspected patients still require treatment at designated Urgent Dental Care centres.The aim of this article is to provide an insight into the COVID-19 pandemic and its implications on current emergency dental care. Commonly presenting dental conditions which require endodontic management will be discussed. Finally, an endodontic management protocol is suggested. The intention of the protocol is to describe practical techniques to minimise potential viral load and reduce risk of COVID-19 transmission when AGPs are instigated.

Interactive treatment planning in toothwear: are we doing it right?

Toothwear is now common, especially in younger patients, with high demand for the restoration of the damaged teeth which is likely to increase further over time. Fixed prosthodontic options range from direct composite resin to conventional tooth preparation and cemented indirect restorations. This paper summarizes the views of a variety of clinicians on a plan delivered to a patient with toothwear in secondary care and explores the possible reasons for the variation in decision-making in the treatment of toothwear.

CLINICAL RELEVANCE

With levels of toothwear increasing, the clinician needs to be aware of the different treatment modalities which are appropriate.