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Hughes S, Davies L, Monaghan U, Stennett M. Implementation of a CBT-based dental anxiety management pathway for patients with learning disabilities. Br Dent J 2024; 237:40-44. [PMID: 38997369 DOI: 10.1038/s41415-024-7557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 07/14/2024]
Abstract
Dental anxiety is a common phenomenon in the general population and may be more prevalent in people with learning disabilities. There is growing interest in the use of cognitive behaviour therapy (CBT) approaches, including within dental anxiety management. However, relatively little is known regarding the application of CBT approaches in dental anxiety management for patients with learning disabilities. This paper outlines details of the implementation of a CBT-based dental anxiety pathway for patients with learning disabilities treated in a special care dental service in England. The pathway is modelled on the utilisation of skills from the dental team (dental nurses and dentists) to deliver a combination of talking sessions, desensitisation and positive affirmation in five distinct stages. Early feedback from service users following implementation of this pathway indicates successful acceptance of dental care with a decreased use of sedative adjuncts.
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Affiliation(s)
- Sadie Hughes
- Consultant in Special Care Dentistry, Hertfordshire Special Care Dental Service, Hertfordshire Community NHS Trust, Cheshunt Community Hospital, King Arthur Court, Cheshunt, Hertfordshire, EN8 8XN, UK.
| | - Lisa Davies
- Senior Dental Nurse and Lead Sedation Nurse, Hertfordshire Special Care Dental Service, Hertfordshire Community NHS Trust, Cheshunt Community Hospital, King Arthur Court, Cheshunt, Hertfordshire, EN8 8XN, UK
| | - Una Monaghan
- Clinical Director Hertfordshire Special Care Dental Service, Associate Medical Director Hertfordshire Community NHS Trust, Cheshunt Community Hospital, King Arthur Court, Cheshunt, Hertfordshire, EN8 8XN, UK
| | - Michelle Stennett
- Senior Dental Officer, Hertfordshire Special Care Dental Service, Hertfordshire Community NHS Trust, Cheshunt Community Hospital, King Arthur Court, Cheshunt, Hertfordshire, EN8 8XN, UK
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Holloway JA, Chestnutt IG. It's not just about the money: recruitment and retention of clinical staff in general dental practice - part 2: dental care professionals. Prim Dent J 2024; 13:55-63. [PMID: 38520193 DOI: 10.1177/20501684241232214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
As described in the first paper of this two-part series, increasing difficulties in recruitment and retention of dentists and dental care professionals (DCPs) in general dental practice in the UK is affecting delivery of NHS dental services. There is a significant risk to the future dental workforce supply which will affect access to dental care and worsen oral health inequalities. Understanding what factors contribute to job satisfaction and prevent job dissatisfaction of dental professionals would be useful in managing recruitment and retention issues. The aim of this literature review was to identify factors which contribute to job satisfaction of DCPs in general dental practice. Database searching was conducted systematically through PubMed/Medline, Scopus, Ovid, and the National Grey Literature Collection. Eleven relevant articles were identified, which were qualitatively analysed using Herzberg's motivation-hygiene theory as an analysis tool. Unfair remuneration is a major contributor to dissatisfaction of DCPs, but job satisfaction could be promoted through increased recognition, variety of work, and opportunities to progress. Dental contract reform in the UK should aim to minimise factors contributing to dissatisfaction and increase factors which increase satisfaction, including the development of an acceptable remuneration model for NHS dentistry that facilitates skill mix.
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Affiliation(s)
- Jessica A Holloway
- Jessica A. Holloway MChD/BChD, MPH, PhD, FHEA Specialty Registrar in Dental Public Health, Public Health Wales, Cardiff, UK
- Ivor G. Chestnutt BDS, MPH, PhD, FDS(DPH)RCSEd, FDS RCSEng, FDS RCPSGlas, FFPH, DDPH RCS ENG, FHEA Professor and Honorary Consultant in Dental Public Health, Cardiff University, Cardiff, UK
| | - Ivor G Chestnutt
- Jessica A. Holloway MChD/BChD, MPH, PhD, FHEA Specialty Registrar in Dental Public Health, Public Health Wales, Cardiff, UK
- Ivor G. Chestnutt BDS, MPH, PhD, FDS(DPH)RCSEd, FDS RCSEng, FDS RCPSGlas, FFPH, DDPH RCS ENG, FHEA Professor and Honorary Consultant in Dental Public Health, Cardiff University, Cardiff, UK
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Sandom F, Hearnshaw S, Grant S, Williams L, Brocklehurst P. The in-practice prevention programme: an example of flexible commissioning from Yorkshire and the Humber. Br Dent J 2022:10.1038/s41415-022-4140-y. [PMID: 35383286 PMCID: PMC8982659 DOI: 10.1038/s41415-022-4140-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
Introduction An In-Practice Prevention (IPP) programme was developed by the Local Dental Network in the North Yorkshire and the Humber area in England in response to an oral health needs assessment. The underpinning logic model drew on a flexible commissioning approach and aimed to incentivise dental teams with NHS contracts to promote the delivery of prevention. This used care pathways that involved the whole dental team and was cost-neutral.Aim The programme was evaluated using realist methodology to identify 'what works, in which circumstances, how and for who?'.Design Realist evaluations are explanatory in nature and attempt to understand the factors that appear to influence the success (or not) of an intervention, rather than demonstrating causality.Methods and results Following a review of the pertinent literature, semi-structured interviews and focus groups, five theory areas were considered to be critical to the delivery of IPP. In order of stated priority, these were: 1) clinical leadership; 2) 'skill mix'; 3) financial incentives; 4) institutional logic/practice culture; and 5) behaviour change.Conclusion The results appear to show that clinically-led programmes could offer value to dental commissioners within a flexible commissioning model, although this would need to be further tested using an experiment design.
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Affiliation(s)
- Fiona Sandom
- School of Health Sciences, Bangor University, UK
| | | | - Siobhan Grant
- Public Health England, North Yorkshire and the Humber Area, UK
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Lieffers JRL, Vanzan AGT, Rover de Mello J, Cammer A. Nutrition Care Practices of Dietitians and Oral Health Professionals for Oral Health Conditions: A Scoping Review. Nutrients 2021; 13:nu13103588. [PMID: 34684589 PMCID: PMC8539677 DOI: 10.3390/nu13103588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/02/2021] [Accepted: 10/02/2021] [Indexed: 02/04/2023] Open
Abstract
Background: Oral health conditions, such as dental caries, pose a substantial burden worldwide. Although there are many risk factors for poor oral health, diet is often implicated as a cause of these issues. The purpose of this scoping review was to identify and map studies that have captured information on the “real-world” nutrition care practices of oral health professionals (OHPs) and dietitians to optimize oral health, and specifically the dentition and periodontium. Methods: A search of peer-reviewed articles was conducted using MEDLINE, CINAHL, and Embase. Articles that addressed the review objective and met the following criteria were included: English language, published since 2000, and study conducted in a high-income country. Results: Overall, 70 articles were included. Most articles reported on cross-sectional survey studies and provided self-reported data on OHP practices; few articles reported on dietitians. Most articles reported only general/unspecific information on assessment and intervention practices, such as dietary analysis, nutrition counselling, and diet advice, and lacked specific information about the care provided, such as the dietary assessment tools used, type of information provided, and time spent on these activities. Barriers to the provision of nutrition care by OHPs were common and included time and lack of remuneration. Few studies reported on collaboration between dietitians and OHPs. Conclusions: Several studies have captured self-reported information on nutrition care practices of OHPs related to oral health; however, there is limited information available on the details of the care provided. Few studies have examined the practices of dietitians.
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Collaborative leadership with a focus on stakeholder identification and engagement and ethical leadership: a dental perspective. Br Dent J 2021; 231:355-359. [PMID: 34561590 PMCID: PMC8461145 DOI: 10.1038/s41415-021-3457-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/03/2020] [Indexed: 01/18/2023]
Abstract
The dental profession is susceptible to change. In order to cope and adapt, individuals and organisations will need to work together, now more than ever. One approach that may be beneficial in these times, and beyond, is collaborative leadership. This is where a mutually beneficial relationship is established between two or more parties, who work towards common goals by sharing authority, responsibility and accountability for achieving results. When groups of individuals look beyond their personal interests and instead collaborate, they may channel their efforts to successfully achieve shared goals. However, for this to be fruitful, stakeholders (to include different individuals or groups that have a vested interest) will need to be identified and engaged, and ethical values based on the objectives of the organisation and those advocated by professional and regulatory bodies must be upheld. This paper explores how the traditional practices of stakeholder identification and engagement, as well as ethical leadership, may be of relevance in attaining success through the contemporary collaborative leadership approach. In these times and beyond, embracing mutually beneficial relationships based on trust, integrity and empowerment shall be more important than ever; therefore, there is a great need for collaborative leadership within the dental profession. An awareness of, and ability to use, the traditional practices of stakeholder identification and engagement as well as ethical leadership may allow dental organisations and professionals to better exercise collaborative leadership. Alike with clinical knowledge and skills, dental organisations and professionals must self-reflect on their own leadership capabilities, be self-aware of their strengths and weaknesses, and aspire to improve themselves accordingly.
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Nguyen TM, Tonmukayakul U, Warren E, Cartwright S, Liew D. A Markov cost-effective analysis of biannual fluoride varnish for preventing dental caries in permanent teeth over a 70-year time horizon. Health Promot J Austr 2019; 31:177-183. [PMID: 31373066 PMCID: PMC7187475 DOI: 10.1002/hpja.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/27/2019] [Accepted: 07/28/2019] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Biannual application of fluoride varnish is effective for dental caries prevention, but its cost-effectiveness using quality-adjusted life years (QALY) is unknown. This study performed a cost-effectiveness analysis, from the Australian health care system perspective of biannual application of fluoride varnish versus current practice (non-routine application) for an individual aged 15 years and older over a 70-year time horizon. METHODS Health outcomes measured were the number of prevented decayed, missing, and filled teeth (prevented-DMFT) and QALY gained. The calculated incremental cost-effectiveness ratio (ICER) was compared against the reference cost-effectiveness ICER threshold of AUD$28 033 per QALY gained. A published Markov model capturing dental caries progression of eight permanent molars was used. This 6-monthly cycle model represented ten possible health states for an individual tooth. A 5% discount rate was applied with relevant sensitivity analysis. RESULTS In the base-case scenario, the net cost for the intervention was $3600 compared to $2303 in the current practice arm. The intervention arm yielded 13.99 DMFT and 15.44 QALY gained, whereas the current practice arm yielded 15.52 DMFT and 14.74 QALY gained. The estimated ICER was $849 per prevented-DMFT and $1851 per QALY gained. Sensitivity analysis shows the ICER ranged from $424-$1807 per prevented-DMFT and $1851-$3941 per QALY gained. CONCLUSION Biannual professional application of fluoride varnish appears to be a highly cost-effective strategy and should be considered for universal funding in Australia's health care system.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, Vic., Australia.,Melbourne Dental School, The University of Melbourne, Melbourne, Vic., Australia
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, Vic., Australia
| | | | | | - Danny Liew
- Nursing and Health Sciences, School of Public Health & Preventive Medicine, Faculty of Medicine, Monash University, Clayton, Vic., Australia
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Nguyen TM, Tonmukayakul U, Calache H. A dental workforce strategy to make Australian public dental services more efficient. HUMAN RESOURCES FOR HEALTH 2019; 17:37. [PMID: 31146760 PMCID: PMC6543641 DOI: 10.1186/s12960-019-0370-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/02/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Dental services can be provided by the oral health therapy (OHT) workforce and dentists. This study aims to quantify the potential cost-savings of increased utilisation of the OHT workforce in providing dental services for children under the Child Dental Benefits Schedule (CDBS). The CDBS is an Australian federal government initiative to increase dental care access for children aged 2-17 years. METHODS Dental services billed under the CDBS for the 2013-2014 financial year were used. Two OHT-to-dentist workforce mix ratios were tested: Model A National Workforce (1:4) and Model B Victorian Workforce (2:3). The 30% average salary difference between the two professions in the public sector was used to adjust the CDBS fee schedule for each type of service. The current 29% utilisation rate of the CDBS and the government target of 80% were modelled. RESULTS The estimated cost-savings under the current CDBS utilisation rate was AUD 26.5M and AUD 61.7M, for Models A and B, respectively. For the government target CDBS utilisation rate, AUD 73.2M for Model A and AUD 170.2M for Model B could be saved. CONCLUSION An increased utilisation of the OHT workforce to provide dental services under the CDBS would save costs on public dental service funding. The potential cost-savings can be reinvested in other dental initiatives such as outreach school-based dental check programmes or resource allocation to eliminate adult dental waiting lists in the public sector.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin University, 75 Pigdons Road, Waurn Ponds, Victoria 3216 Australia
- University of Melbourne, Parkville, Australia
- Peninsula Health, Frankston, Australia
- Coburg Hill Oral Care, Hill, Coburg, Australia
| | | | - Hanny Calache
- Deakin University, 75 Pigdons Road, Waurn Ponds, Victoria 3216 Australia
- University of Melbourne, Parkville, Australia
- La Trobe University, Bendigo, Australia
- North Richmond Community Health, North Richmond, Australia
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Holden ACL, Jean G, Tennant M, Spallek H. Professionalism by proxy: a case for the formal regulation of dental assistants in Australia. Br Dent J 2018; 225:482-486. [PMID: 30191903 DOI: 10.1038/sj.bdj.2018.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/09/2022]
Abstract
Dental assistants are the most numerous member of the dental team in Australia, responsible for many clinical and non-clinical duties. Despite this, dental assistants are not registered and regulated in the same manner as their clinical colleagues within the dental profession. In this article, the authors argue that this is an unacceptable situation within the Australian dental context. In the examination of events within the profession both within Australia and overseas, it becomes apparent that this is an untenable position with regards to promoting the safety of the public. The current stance towards dental assistants is often perpetuated by a dental profession whose motives would not seem to be free from issues of professional dominance. Dental assistants may also be an essential division of the dental profession in providing culturally competent, economically viable and sustainable oral healthcare to those communities that are traditionally difficult to access.
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Affiliation(s)
- A C L Holden
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, 2-6 Chalmers Street, Surry Hills, NSW 2010, Australia
| | - G Jean
- International Research Collaborative - Oral Health and Equity, School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - M Tennant
- International Research Collaborative - Oral Health and Equity, School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - H Spallek
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, 2-6 Chalmers Street, Surry Hills, NSW 2010, Australia
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