Perspectives of oral health therapists on the barriers to oral care provision in nursing homes in Singapore: A qualitative analysis

INTRODUCTION

Oral health therapists (OHTs) are a valuable resource for increasing access to dental care for the frail elderly in nursing homes (NHs). However, OHTs face several barriers and their skill-set continues to be under-utilized.

AIMS

To evaluate the perceptions of OHTs regarding the barriers towards oral care provision for the elderly residents in NHs.

METHODOLOGY

Semi-structured interviews were conducted with 11 OHTs to discuss the factors that may hinder them from providing oral health services in NHs. An inductive thematic analysis directed by the grounded theory approach was performed.

RESULTS

Four major themes emerged: (i) lack of opportunity, (ii) lack of adequate education and training, (iii) limited work scope and registration status, and (iv) lack of adequate financial remuneration and adequate equipment. OHTs also raised the lack of awareness among OHTs and the various stakeholders, of how the skill-set of OHTs may be relevant for oral care provision in NHs.

CONCLUSION

Findings revealed underlying educational and regulatory barriers which need to be addressed in tandem. Addressing these barriers can be impactful in informing future strategies for the greater utilization of the skill-set of OHTs in Singapore.

Investigation into the enablers and barriers of career satisfaction among Australian oral health therapists

OBJECTIVES

This qualitative study explored the enablers and barriers of career satisfaction among Australian oral health therapists (OHTs) and the reasons behind career changes.

METHODS

Participants were recruited in 2 ways: 1) recruitment posts were made on the Facebook pages of two professional groups; and 2) an email was sent to the Doctor of Dental Medicine students of the University of Sydney School of Dentistry, inviting those with OHT qualifications to participate. Each participant completed a semi-structured interview which was guided by open-ended questions. The average interview length was 45 min. All interviews were recorded, transcribed verbatim and manually coded. Thematic analysis of the qualitative data was completed using an inductive approach.

RESULTS

Twenty-one OHTs participated in this study. The enablers of OHT career satisfaction include clinical practice, job variety, career flexibility, being in a supportive team environment and the opportunity for constant learning and growth. The barriers to career satisfaction include musculoskeletal problems, restrictions on the scope of practice use, psychological stress and lack of recognition from others. OHTs remain in the profession due to stable income and employment opportunities. The main reasons for retirement were burnout and pursuing dentistry. OHTs pursue dentistry to expand their scope of practice.

CONCLUSION

This study revealed the enablers and barriers of OHT career satisfaction in an Australian context. OHTs are an important component of modern dental workforces, and reasons for attrition within the workforce are essential for maintaining responsiveness to community oral health needs.

A global review of the education and career pathways of dental therapists, dental hygienists and oral health therapists

Introduction With ongoing needs in oral healthcare being unmet, dental therapists, dental hygienists and oral health therapists have the potential to assume greater roles and responsibilities in the provision of care. This review provides a global overview of the education and career opportunities of these professions, contributing to the discussion on the future trajectories of all three professions.Methods A scoping review was conducted to collate and summarise the current available evidence from peer-reviewed journal articles, published reports and books, and websites of professional associations and government agencies.Results Of the 145 sources identified and reviewed, 53 were included in the qualitative synthesis. The themes were categorised into domains: 1) dental therapy; 2) dental hygiene; and 3) oral health therapy.Conclusion The results of this review indicated that, although there has been continuous advocacy for dental therapists, dental hygienists and oral health therapists to assume roles beyond the traditional clinical practice, the majority of the professionals still mainly practise as clinicians. Many dental therapists, dental hygienists and oral health therapists felt limited by their scope of practice and were dissatisfied with the lack of career pathways. Additional research is needed to examine the influences behind career development for all three professions.

In Defense of Dental Therapy: An Evidence-Based Workforce Approach to Improving Access to Care

This article addresses new systems and practice models in community-based dentistry. Its purpose is twofold: to identify strategies and policies that support health equity and access to care; and to identify promising efforts that serve as new models for change in the dental workforce. Dental therapy meets both of these purposes and is the major focus of this article. The fundamental premises explored are threefold. First, the dental care system in the U.S. is broken for many people who then suffer the consequences of poor oral health; this is especially true for racial and ethnic minorities and lower income populations. Second, dental therapy is a proven, safe, high-quality, cost-effective, and ethical way to improve access to oral health care and oral health in general. Third, opposition to dental therapy comes only from the leadership of organized dentistry and is without an evidence base to support objections and criticism. This article reviews each of these three premises in detail. Based on this review, the article concludes that dental therapy is a safe, high-quality, effective, and ethical approach to improve the oral health workforce, increase access to dental care, and achieve oral health equity.

Validity and reliability of remote dental screening by different oral health professionals using a store-and-forward telehealth model

Objective This study was conducted to evaluate the validity and reliability of intraoral photographic assessments by different members of a dental team as a means for dental screening in children.Methods The intraoral photographic records of 126 children (2 to 18 years old) were obtained from routine clinical records taken before dental treatment. Intraoral photographs were obtained using a DSLR camera and then uploaded to a cloud-based server using store-and-forward telehealth technology. Images were reviewed by an expert panel to formulate a benchmark screening baseline, to which the screeners' data were compared. The photographic assessments conducted by a mid-level dental practitioner (MLDP) and dentist, were compared to the benchmark expert panel assessment.Results The screeners' assessments by means of intraoral photography, when compared to the expert panel assessment had a sensitivity value of 82-89% and specificity value of 97%. The inter-examiner agreement between the expert panel assessment and photographic method (assessed by a dentist and MLDP), was almost perfect, with a kappa score ranging from 0.82 to 0.88. The mean DFT/dft score for the children as determined by the expert panel's review and photographic assessment ranging from 5.41 to 5.79, with mean scores between the two assessment methods not significantly different (P = 0.746).Conclusion Our results suggested that oral health professionals (other than dentists) have the potential to screen for caries from intraoral photographs with the same diagnostic accuracy and reliability as dentists. This strategy has implications for supporting the use of MLDPs such as dental therapists or hygienists to screen for oral disease using telehealth.

Cost savings from a teledentistry model for school dental screening: an Australian health system perspective

Objective The aim of the present study was to compare the costs of teledentistry and traditional dental screening approaches in Australian school children. Methods A cost-minimisation analysis was performed from the perspective of the oral health system, comparing the cost of dental screening in school children using a traditional visual examination approach with the cost of mid-level dental practitioners (MLDPs), such as dental therapists, screening the same cohort of children remotely using teledentistry. A model was developed to simulate the costs (over a 12-month period) of the two models of dental screening for all school children (2.7 million children) aged 5–14 years across all Australian states and territories. The fixed costs and the variable costs, including staff salary, travel and accommodation costs, and cost of supply were calculated. All costs are given in Australian dollars. Results The total estimated cost of the teledentistry model was $50 million. The fixed cost of teledentistry was $1 million and that of staff salaries (tele-assistants, charters and their supervisors, as well as information technology support was estimated to be $49 million. The estimated staff salary saved with the teledentistry model was $56 million, and the estimated travel allowance and supply expenses avoided were $16 million and $14 million respectively; an annual reduction of $85 million in total. Conclusions The present study shows that the teledentistry model of dental screening can minimise costs. The estimated savings were due primarily to the low salaries of dental therapists and the avoidance of travel and accommodation costs. Such savings could be redistributed to improve infrastructure and oral health services in rural or other underserved areas. What is known about the topic? Caries is a preventable disease, which, if it remains untreated, can cause significant morbidity requiring costly treatment. Regular dental screening and oral health education have the great potential to improve oral health and save significant resources. The use of role substitution, such as using MLDPs to provide oral care has been well acknowledged worldwide because of their ability to provide safe and effective care. The teledentistry approach for dental screening offers a comparable diagnostic performance to the traditional visual approach. What does this paper add? The results of the present study suggest that teledentistry is a practical and economically viable approach for mass dental screening not only for isolated communities, but also for underserved urban communities. The costs of the teledentistry model were substantially lower than the costs associated with a conventional, face-to-face approach to dental screening in both remote and urban areas. The primary driver of net savings is the low salary of MLDPs and avoidance of travel and overnight accommodation by MLDPs. What are the implications for practitioners? The use of lower-cost MLDPs and a teledentistry model for dental screening has the potential to save significant economic and human resources that can be redirected to improve infrastructure and oral care services in underserved regions. In the absence of evidence of the economic usefulness of teledentistry, studies such as the present one can increase the acceptance of this technology among dental care providers and guide future decisions on whether or not to implement teledentistry services.

Role of telemedicine and mid-level dental providers in expanding dental-care access: potential application in rural Australia

Despite great progress in oral health over the past three decades, the rates of caries remain high in Australia, particularly among underserved populations. The reasons for poor oral health amongst underserved populations are multiple, but rests with socio-economic determinants of health. The present review considers international workforce models that have been created to enhance the recruitment and retention of dental providers in rural areas. Several strategies have been developed to address care access problems in rural areas, including the use of telemedicine and mid-level dental providers (MLDPs). Despite ongoing opposition from dentistry organisations, the Alaska and Minnesota workforce models have proven that developing and deploying dental therapists from rural communities has the potential to address the unmet needs of underserved populations. It is more efficient and cost-effective for MLDPs to perform triage and treat simple cases and for dentists to treat complicated cases. The use of MLDPs is intended to increase the capacity of the dental workforce in areas that are too isolated to entice dentists. Telemedicine has emerged as one solution to address limited access to health care, particularly in locations where there is a lack of providers. Telemedicine not only provides access to care, but also offers support, consultations and access to continuing education for practicing dental providers in rural areas. This strategy has the potential to free up resources to increase care access and reduce oral health disparities, thereby contributing to closing the rural-urban oral health gap.