Exploring collaboration reasons and leadership styles in Dutch primary oral healthcare practices

AIMS

To outline the extent to which practice owners in Dutch oral healthcare practices (OHPs) use a directive and supportive leadership styles, to map out which goals practice owners in Dutch OHPs consider most important when choosing collaboration within the practice and to identify the reasons why oral healthcare professionals choose to engage in collaborative practice.

MATERIALS AND METHODS

A survey involving 802 general dental practitioners, dental hygienists, and prevention assistants was conducted. The questionnaire covered, among other subjects, leadership styles and reasons for collaboration. Data analysis included descriptive statistics, chi-square tests, one-way ANOVA, linear regression, and logistic regression.

RESULTS

Compared to employees, practice owners ascribe to themselves more characteristics of both directive and supportive leadership. The most frequently mentioned reasons for choosing a practice form that involves collaboration were the possibilities to provide the best care and the desire to focus on prevention. Healthcare providers chose to work in a collaborative practice for several reasons, which were associated with profession, age and gender.

CONCLUSIONS

The degree of directive and supportive leadership among practice owners in dental care practices in the Netherlands showed a strong correlation. The most frequently mentioned reasons for choosing collaboration were related to healthcare content.

Willingness for Medical Screening in a Dental Setting-A Pilot Questionnaire Study

An important way to manage noncommunicable diseases (NCDs) is to focus on prevention, early detection, and reducing associated risk factors. Risk factors can be detected with simple general health checks, which can also be performed in dental clinics. The purpose of this study was to investigate participants' willingness to participate in general health checks at the dentist, in particular the difference in opinion between medical patients and random healthy dental attendees. A total of 100 medical patients from an outpatient internal medicine clinic and 100 dental clinic attendees were included (total of 200 participants). The participants were asked for their opinion using six closed-ended questions. Overall, 91.0% of participants were receptive to information about the risk of diabetes mellitus (DM) and cardiovascular diseases (CVD). The majority (80-90%) was receptive to screening for DM and CVD risk, such as weight and height measurements, blood pressure measurement, saliva testing for CVD and to measure glucose and cholesterol via finger stick. No significant differences were found in the frequencies of the responses between the different groups based on health status, age, sex, or cultural background. This study shows that most participants are willing to undergo medical screening at the dentist for early detection and/or prevention of common NCDs.

Perception of recently graduated Dutch dentists of their education

INTRODUCTION

The curriculum of the three dental schools in the Netherlands consists of a three-year bachelor's and three-year master's course. The education programmes focus inter alia on clinical dental reasoning, thinking and acting scientifically, general oral healthcare activities, and communication and (inter)professional cooperation. This study examined how recently graduated dentists, in the light of their work experience, evaluate their education in retrospect.

MATERIALS AND METHODS

All 1074 dentists who graduated between 2012 and mid-2017 were invited by e-mail to answer a web survey. Of those, 314 (29%) took part in the study.

RESULTS

The majority of dentists were positive about their knowledge of general and clinical oral healthcare fields when they graduated (70% and 68%, respectively). Fewer dentists were satisfied with their skills in terms of some specific procedures (50%) and clinical professional areas (33%). By far, the majority (85%) were satisfied with the educational skills of their teachers. The majority (70%) felt that their education fitted in well with their professional practice. Nevertheless, 60% thought a year's trainee work experience would be a good idea. The overall evaluation of dentists who have their own practices was less positive than those who do not.

CONCLUSION

Knowledge and skills relating to managing a practice were not sufficiently addressed in the programme. The introduction of a practical internship would be desirable, preferably during the education. But when they look back, the majority of recently graduated dentists in the Netherlands are generally positive about the education they received.

Exploring the development, evaluation and implementation of complex health interventions to prevent early childhood caries in preschool children: A scoping review protocol

Objective

This scoping review aims to identify complex health interventions (CHI’s) to prevent early childhood caries (ECC), explore the level of complexity of the identified CHI’s, and explore the details of their development, evaluation, and implementation.

Introduction

Many interventions to prevent ECC have multiple interacting components and can be seen as CHI’s. Recent reviews on these interventions have found inconclusive effects, which may be due to differences in the development, evaluation, and implementation of CHI’s.

Inclusion criteria

This scoping review will consider clinical trials reporting CHI’s to prevent ECC that starts during pregnancy or in the first year of life. Studies in the English language will be included regardless of the country of origin, sociocultural setting, or context.

Methods

This review will follow the Joanna Briggs Institute methodology for scoping reviews. An initial search of PubMed identified keywords and Medical Subject Headings terms. A second search of PubMed, Embase, Clarivate Analytics/Web of Science Core Collection, ClinicalTrials.gov, and the Wiley/Cochrane Library will follow. Two independent reviewers will perform title and abstract screening, retrieve and review full-text studies, and extract data. The reference lists of all included sources will be screened for additional CHI’s or relevant publications about a specific CHI. Data charting will be utilised based on study characteristics and intervention complexity. A 39-item instrument will be used to explore the details in the description of the CHI’s development, evaluation, and implementation. The results will be presented in tables, visual outputs, and a narrative summary in response to the review questions.

Discussion

The proposed review will generate evidence which may provide a direction for the future design of studies on CHI’s to prevent ECC and more complete information for those who want to adopt successful interventions to prevent ECC.

Work situation and prospects of recently graduated dentists in the Netherlands

INTRODUCTION

Dentists who have graduated recently from a Dutch dental school work mainly in the Netherlands, where collaboration and differentiation are relevant factors. Furthermore, the Netherlands face regional undersupplies of dentists. The objective of this study was to describe choices and aims of recently graduated dentists for the near future.

MATERIALS AND METHODS

An invitation for the web questionnaire was sent by e-mail to 945 dentists who had graduated from a Dutch dental school between 2013 and 2017, of whom 230 (24.3%) participated in the survey.

RESULTS

Approximately three quarters (77%) of the recently graduated dentists worked as a general dentist in a practice of some else, primarily in urban areas. The choice for a practice was affected by location, earnings, and the opportunity to gain experience. Furthermore, the career choices were affected most by the desired length of the working week and financial security. The narrow majority (53%) of the recently graduated dentists believed that in 5 years they will be practice owner; 49% expected to be a differentiated dentist. Furthermore, 41% believed they will work in a smaller municipality.

DISCUSSION

Although recently graduated dentists seem receptive to work in smaller municipalities, the peripheral regions are conceivably less appealing. Practice ownership conceivably is an option for the near future for a narrow majority of the recently graduated dentists.

CONCLUSION

Recently graduated dentists have different preferences regarding their work situation in 5 years.

Assessed and perceived oral health of older people who visit the dental practice, an exploratory cross-sectional study

OBJECTIVES

To assess the oral health of older people who visit the community dental practice from both the dentists' and the patients' perspective.

MATERIALS AND METHODS

In this exploratory cross-sectional study the oral health of Dutch community dwelling older people was assessed. A representative sample of general dental practitioners was asked to randomly and prospectively select one older patient and describe this patient using a specially-developed registration form; in addition the patient was requested to complete a questionnaire. The oral health of older people was described from the perspective of the dentists and the perspective of the older people themselves based on the definition of oral health from the World Dental Federation (FDI]. Relations between oral health of older people and dentist and older patient characteristics were analysed using Spearman's rank correlation coefficient (rho) and an ordinal regression model.

RESULTS

In total, 923 dentists were asked to participate in the study; data was available for 39.4% dentist-patient pairs. Dentists assessed the oral health of older patients as good or acceptable in 51.4% of the cases while this was the case in 76.2% of older patients themselves. The assessment of the dentist gets more negative with high treatment intensity and with older patients having certain diseases and more medication, while the assessment is more positive for older patients who visit the dentist on a regular basis. Older people's assessment of their oral health gets more negative by being female and with high treatment intensity, having certain diseases and higher use of medication.

CONCLUSIONS AND CLINICAL RELEVANCE

Chronically illness as expressed by the number of diseases and the use of medication, seems to be a risk factor for poor oral health. Older patients themselves assess their oral health differently, mostly more positive, than their dentist.

Impact of the Coronavirus on Providing Oral Health Care in the Netherlands

OBJECTIVE

Transmission of SARS-CoV-2 during oral health care is potentially increased compared to regular social activities. Specific amendments to the Dutch national infection control guidelines were promulgated. This study aimed to map the impact of the coronavirus pandemic on providing oral health care during the first wave of the coronavirus pandemic in 2020 in the Netherlands.

METHODS

A cross-sectional web-based survey was sent via email to a representative sample of dental hygienists and dentists in the Netherlands.

RESULTS

Of the 1700 oral health care practitioners approached, 440 (25.9%) responded to the survey. Patient access to oral health care was severely restricted during the lockdown in the spring of 2020. A total of 1.6% of the oral health care practitioners had laboratory-confirmed COVID-19 during the study period, although this is likely to be an underrepresentation due to limited access to testing at that time. Over half of the participants perceived an increased risk of virus transmission during aerosol-generating treatments in their practices. A large majority (65.0%-87.1%) of the oral health care practitioners followed the COVID-19-specific amendments to the national infection control guidelines. Compared to the pre-pandemic period, additional personal protective equipment and protocols were applied. Factors related with compliance with the additional recommendations were age, employment status, and occupation.

CONCLUSIONS

The pandemic had a profound impact on both the accessibility and practice of oral health care. This survey study found that most Dutch oral health care practitioners paid extra attention to hygiene and infection control. Also, a low number of COVID-19 infections detected amongst Dutch oral health care practitioners was reported in the Netherlands. These overall outcomes suggest that safe oral health care can be provided when following the current infection control recommendations.

Oral Health of Older Patients in Dental Practice: An Exploratory Study

BACKGROUND

Some older people stop visiting the dentist when they get older. This study aims to identify the characteristics and oral health status of older people who do visit community dental practices.

METHODS

In this exploratory cross-sectional study, the oral health of Dutch community-dwelling older people was assessed. A random sample of general dental practitioners and older people who visit the dental practice was drawn. The dentists were asked to prospectively select one older patient and describe this patient using a specially developed registration form; the patient was requested to complete a questionnaire. Data were described for 3 distinct groups of older people. Statistical measures for distribution and dispersion were used to describe the oral health of community-dwelling older patients in relation to the age.

RESULTS

A total of 373 (40.4%) dentist registration forms and 372 (40.3%) patient questionnaires were returned. Data were available for 364 (39.4%) dentist-patient couples. Amongst the patients, 52.8% were female and most had a high socioeconomic status. About 65.7% had one or more problems related to general health, and 75.2% used medication. Regarding the overall oral health status, the average number of teeth was 20, 3.5% were edentulous. Oral health problems were more common in the older patient group (aged 75+), in whom frailty was also most common.

CONCLUSIONS

Older people who visit community dental practices are still relatively healthy, non-frail, and highly educated.  Even in this group, there is a turning point in both general and oral health from the age of 75.

[Good oral care deserves to be better integrated into primary care]

Oral and general health are inextricable. In primary care, the fields of care by general practioners, youth healthcare, healthcare for older people and oral care are all distinctly separated. Healthcare professionals are increasingly confronted with the complexity and increase in Noncommunicable diseases (NCD's) and an aging population. The aetiology of NCD's in primary care concern the professional fields of all healthcare professionals mentioned, meaning that lifestyle-related risks might be prevented more effectively through collaboration. In primary care, the number of medically compromised people is on the rise and healthcare professionals encounter each other's patients, whose risks remain invisible to them. Through collaboration such problems could be faced more effectively. Better integration of oral care into primary care can also contribute to the quality of care and safety of care receivers, and reduce further inequality. In order to better design this integration with the help of innovation, more practicebased research and implementation is needed.

[Impact of the coronavirus on Dutch oral health care and practice]

Among dental hygienists and dentists in the Netherlands, the impact of the SARS-CoV-2 pandemic on oral healthcare practices from March to July 2020 was investigated. Of the 1,700 healthcare providers approached, 433 completed questionnaires could be used. The results show that the pandemic has had a profound impact on both the accessibility of oral healthcare and on care provided in oral healthcare practices. Extra attention was paid to hygiene and infection prevention: the types of personal protective equipment and the protocols and procedures were adjusted by many oral healthcare providers. The confirmed prevalence of oral healthcare providers with COVID-19 in this study was 1.6%. However, testing was not available to all respondents with complaints during this initial period. Over half of the respondents estimated that even with additional measures there is an increased risk of infection to oral healthcare providers during their work. The efficacy of the various additional measures in oral healthcare practices related to COVID-19 is still unknown.

[Series: Education and the dentist in 2025. The external practical internship: a taste of professional dental practice]

The practical training in dental schools in the Netherlands is largely organised within the walls of the educational institution, while many other medical educational programmes provide practical training to a large extent in the professional environment. The external practical internship is a form of practical learning with which positive experience has been gained in foreign dental schools, both by students and dentist-supervisors. The Dutch dental schools have a joint plan to set up practical internships in dental practices for master's students in the final year of their education. The aim of such an internship is that students in the last phase of their programme learn to apply the acquired knowledge and skills in an actual professional environment. This includes both clinical and dental treatment and the ability to organise oral health care for patients and everything that comes with it. This article describes the outline of this programme.

Developments in oral health care in the Netherlands between 1995 and 2018

Background

Over the past several decades, changes in legislation and regulations have been implemented in oral health care in the Netherlands. In 1995, for example, a major transformation in the funding of oral health care was implemented, after which most oral health care for adults was no longer covered by national insurance. In 1997, the Individual Healthcare Professions Act, in which the authorizations of care providers were described, was established. The Healthcare Quality, Complaints and Disputes Act, established in 2016, concerns the accountability of professional behavior. Regulations concerning employment have changed several times since 1995. These changes have affected the work and practice situation of oral health care providers.

Methods

Data from many publicly available sources were gathered and combined with internal reports mainly derived from the Data Stations project of the Royal Dutch Dental Association. This project was established in 1995 and, since its initiation, 6716 dentists have participated an average of 6.7 times.

Results

Between 1995 and 2018, nearly all professional groups in oral health care increased, particularly those of dental hygienists and prevention assistants. The number of dental practices decreased, but practices got larger in terms of dental units, number of patients, and personnel. The percentage of inhabitants visiting oral health care professionals remained unchanged, but the type of care provided moved towards more prevention. Oral health care providers exploited new opportunities to enhance and express their professional behavior.

Conclusions

Oral health care in the Netherlands has evolved in recent years toward more collaboration in teams, and professions have established institutions to promote the quality and safety of care. Greater emphasis has been placed on prevention of dental diseases. These processes were influenced by new legislation and regulations, demographic changes within professional groups, and other social developments.

Are Dutch dental students and dental-care providers competent prescribers of drugs?

Dental students and dental‐care providers should be able to prescribe drugs safely and effectively. As it is unknown whether this is the case, we assessed and compared the prescribing competence of dental students and dental‐care providers in the Netherlands. In 2017, all Dutch final‐year dental students and a random sample of all qualified general dental practitioners and dental specialists (oral and maxillofacial surgeons and orthodontists) were invited to complete validated prescribing knowledge‐assessment and skills‐assessment instruments. The knowledge assessment comprised 40 multiple‐choice questions covering important drug topics. The skills assessment comprised three common clinical case scenarios. For the knowledge assessment, the response rates were 26 (20%) dental students, 28 (8%) general dental practitioners, and 19 (19%) dental specialists, and for the skills assessment the response rates were 14 (11%) dental students, eight (2%) general dental practitioners, and eight (8%) dental specialists. Dental specialists had higher knowledge scores (78% correct answers) than either dental practitioners (69% correct answers) or dental students (69% correct answers). A substantial proportion of all three groups made inappropriate treatment choices (35%–49%) and prescribing errors (47%–70%). Although there were some differences, dental students and dental‐care providers in the Netherlands lack prescribing competence, which is probably because of poor prescribing education during under‐ and postgraduate dental training. Educational interventions are urgently needed.

[Research agenda oral care for older people in the Netherlands and Flanders (Belgium)]

Oral care for older people is an underexposed topic in dentistry as well as in general healthcare, while oral care professionals are increasingly confronted with frail and multimorbid older people with complex care needs. The research agenda 'Oral care for the elderly' was developed to encourage the collaboration of researchers in the Netherlands and Flanders (Belgium) to do more research in this area and in this way, to achieve an expansion and implementation of knowledge. This will make possible the provision of a socially responsible and robust basis for sustainable oral care for frail older people. The focus of the agenda is on 3 themes, namely oral health and oral function for older people; multi/interdisciplinary collaboration within primary care and the costs, benefits and long-term effect(s) of oral care throughout the entire course of life. This article provides an overview of this research agenda and the way in which it has been established.

[A view on collective oral care for frail older people: united we stand]

Oral health in frail older people is often poor. There are a number of reasons for this, such as increased morbity and decreased motivation for (self) care. Good oral health is, however, very important. Studies have revealed poor oral health to cause or aggravate several medical and psychological problems. Illness and medication can, in turn, damage oral health. Oral health among the elderly should therefore be carefully monitored and maintained. This requires multidisciplinary and interprofessional collaboration on the part of healthcare professionals and others involved. Such collaboration is now still very limited; hardly anything has been written about how such collaboration in the area of oral care for frail older people should or could be organised. This article provides an overview of the possibilities and the relevant factors in the area of oral care for the elderly in promoting collaboration among healthcare professionals and others involved. All of this is under the banner of 'united we stand'.

Caries Progression Rates Revisited: A Systematic Review

Caries progression seems to follow universal, predictable rates, depending largely on the caries severity in populations: the higher the caries severity, the higher the progression rates. Quantification of these rates would allow prediction of future caries increments. Our aim was to describe caries progression rates in the primary and permanent dentition in Western populations (not in lesions) of children and adolescents. Therefore, we systematically searched MEDLINE-PubMed, Embase, CINAHL, and the Cochrane library for studies reporting caries progression data. Eligibility criteria were reporting empirical data from at least 2 full-mouth dental caries examinations in a closed cohort during a follow-up of at least 3 y, a first examination after 1974, a second examination before the age of 22 y, caries assessed as dentine caries (d₃/D₃), and caries reported in dmfs/DMFS (decayed, missing, and filled surfaces), dmft/DMFT (decayed, missing, and filled teeth), or caries-free participants. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we described the results for the primary and permanent dentition in a systematic review, performed a meta-analysis for the caries incidence rate in the permanent dentition, and conducted multivariate, hierarchical meta-regression analyses for the caries incidence rate and the increments in DMFS and DMFT. Of the 6,343 unique studies retrieved, 43 studies (56,376 participants) were included for systematic review and 32 for meta-analyses (39,429 participants). The annual decline in caries-free children in the permanent dentition ranged from 0.8% to 10.2%. The annual increment ranged from 0.07 to 1.77 in DMFS and from 0.06 to 0.73 in DMFT. The pooled caries incidence rate was 0.11 (0.09–0.13) per person-year at risk. Meta-regression analyses showed that the methods of individual studies influenced pooled caries incidence rates and increments in DMFS and DMFT. This should be taken into account in planning and evaluation of oral health care services. However, the caries incidence rate is promising for prediction of future caries increments in populations.

[Recognising and reporting child abuse by orthodontists]

In 2013, the child abuse and domestic violence reporting code was introduced in the Netherlands, which obliged caregivers to report suspicions of child abuse or domestic violence. In 2014, a survey was conducted among dentists on this subject. However, nothing was known about the use of the reporting code among orthodontists. In December 2015, a survey was sent to members of the Dutch Orthodontic Society (NVvO). The survey consisted of 20 items about applying the reporting code and experiences with patients. Most orthodontists were aware of the reporting code (83%) and had implemented this in their practice (64%). Nevertheless, orthodontists found it difficult to recognise signs of child abuse, mostly because of a lack of experience in this area. Most orthodontists who suspected child abuse took action, mainly by seeking advice from the foundation 'Veilig Thuis' ('Safe at Home').

Preferred and actual retirement age of oral and maxillofacial surgeons aged 55 and older in the Netherlands: a longitudinal study from 2003 to 2016

BACKGROUND

In workforce planning for oral and maxillofacial surgeons in the Netherlands, it is important to plan timely, as these dental specialists are required to earn both medical and dental degrees. An important factor to take into account in workforce planning is the outflow of the profession through retirement. In the workforce planning in the Netherlands, it was assumed that retirement plans are a predictor for the actual moment of retirement. The purpose of this study was to investigate this assumption.

METHODS

A standardised survey to investigate the work activity and retirement plans of oral and maxillofacial surgeons was conducted seven times between 2003 and 2016. With some minor variations, in every edition, all oral and maxillofacial surgeons aged 55 years and older who did not indicate to be retired in an earlier edition were invited to participate. The data of all seven editions was analysed to investigate what factors influence the actual retirement age. For the analyses of the data, ANOVA and linear regression were employed.

RESULTS

The response rate was at least 80% in all editions. For all editions combined, 185 surgeons were invited one or more times, of whom 170 responded at least once. Between 2003 and 2016, the mean preferred retirement age increased from 63.7 to 66.7. Two thirds of the respondents who participated in more than one edition had revised their preferred retirement age upwards. Regarding the difference between preferred and actual retirement age, 45% of the oral and maxillofacial surgeons retired at a higher age than originally preferred and another 14% was still working at the age the originally preferred to retire. Linear regression shows that preferred retirement age is associated with sex and the number of working hours and that actual retirement age is associated with preferred retirement age, earlier preference to decrease working hours and working in non-academic hospitals.

CONCLUSION

Altogether, it seems that in this group the preferred retirement age has some predictive value, but the oral and maxillofacial surgeons tend to retire at a higher age than they originally preferred to.

Dentists' opinions on knowledge, attitudes and barriers in providing oral health care to older people living independently in the Netherlands and Flanders (Belgium)

Objectives

The aim of this study was to investigate how dentists in the Netherlands and Flanders assessed their knowledge on oral health care to older people, what their attitude was and what barriers they experienced in rendering care to older people.

Methods

The survey data was collected from a random sample of Dutch and Flemish dentists. Five hundred ninety-five dentists (37%) of the Dutch sample and 494 dentists of the Flemish sample (41%) completed the online questionnaire. Dentists were asked to respond to 15 Likert type items, representing opinions on provision of oral health care to older people and to give information about the number of older patients treated and about some profession-specific and personal characteristics.

Results

The average number of patients treated per week was nearly twice as high in the Netherlands as in Flanders. Nevertheless, differences of opinions between dentists in the Netherlands and Flanders were relatively limited.

Conclusions

This survey shows that in particular the actual number of older patients treated appears to be related with differences of opinions between Dutch and Flemish dentists about oral health care provided to (vulnerable) older people who live at home.

Dentists' opinions on using digital technologies in dental practice

OBJECTIVES

To investigate which opinions among dentists are associated with level of technology use, when characteristics of the dentist and dental practice, as well as motivating work aspects are taken into account.

METHODS

A total of 1000 general dental practitioners in the Netherlands received a questionnaire on digital technologies they use, opinions on using technologies and related motivating work aspects. Questions were derived from expert interviews, the Dentists' Experienced Job Resources Scale and literature on technology implementation. Technology use was measured as the number of technologies used, and divided into three technology user groups: low (using 0-4 technologies, mostly administrative and radiographic technologies), intermediate (using 5-7, more varied technologies) and high technology users (using 8-12, including more innovative diagnostic technologies). Opinions on technology use and motivating work aspects were analysed using principal components analysis (PCA) and exploratory factor analysis. Scores on all components and factors were calculated for each respondent by computing the mean of all valid responses on the underlying items. Differences in these scale scores on opinions among the technology user groups were assessed using one-way analysis of variance and Kruskal-Wallis tests. A multiple linear regression analysis assessed the association of scale scores about opinions on technology use with the sum of technologies used, taking into account motivating work aspects and characteristics of the dentist and dental practice.

RESULTS

The response rate was 31%. Dentists who were high technology users perceived technologies as yielding more improvements in quality of care, adding more value to the dental practice and being easier to use, than low technology users. High technology users thought technologies added more value to their work and they reported higher skills and resources. They also focused more on technologies and thought these are more ready to use than low technology users. High technology users derived more motivation from "Immediate results" and "Craftsmanship" than low technology users. Personal and practice characteristics, motivating work aspects, and the opinion scales "Focus" and "Added value to dentist" explained 50% of the variance in the number of technologies a dentist uses.

CONCLUSION

Opinions on digital technologies among dentists and motivating work aspects vary with level of technology use. Being more focused on technologies and perceiving a higher added value from using them are associated with using more digital dental technologies, when taking into account motivating work aspects and characteristics of the dentist and dental practice.

The Data Stations Project of the Dutch Dental Association

Within the framework of the research project Data Stations, the Dutch Dental Association (NMT) periodically collects data about the care dentists render to patients, about the way in which they run their practices, and about views and/or wishes of dentists with regard to (current) issues within the dental profession. This paper focuses on the motives underlying the decision of the NMT to undertake the Data Stations Project, and on the way this project is organized. Particular attention will be given to the types of data and the kinds of information this project produces.

The impact of a formal complaint on Dutch dentists' professional practice: a survey study

Background

A complaint from a patient can have a serious impact on the well-being of dentists. Little is known, however, about the nature and the extent of this impact.

Methods

Therefore in 2013 an anonymous survey was conducted among 955 dentists and dental specialists who were involved in a complaints procedure dealt with by the Complaints Committee of the Royal Dutch Dental Association (KNMT) in the period of mid-2008 to mid-2013.

Results

In total 413 (43 %) of these dentists participated in the study. As a result of a formal complaint 71 % of the respondents experienced a considerable impact in their professional practising, while 52 % stated that it had (also) seriously influenced their attitude towards colleagues and patients. Furthermore, 60 % (also) mentioned effects of a complaints procedure regarding their mental and/or physical well-being.

Conclusions

Being confronted with a formal complaint from a patient leads to a considerable impact on dentists’ professional practice and personal well-being. It is remarkable this did not only pertain to a ‘negative’ impact, but also to a ‘positive’ impact. Despite unpleasant feelings, several dentists regarded the complaint as a ‘wake-up call’. Furthermore, given the relatively high number of successful mediation attempts it can be concluded that this form of complaint handling appears to be a successful way of solving problems that have arisen between patients and dentists.

Recognizing and reporting domestic violence: attitudes, experiences and behavior of Dutch dentists

BACKGROUND

On July 1(st) 2013 the Mandatory Reporting Code Act came into force in the Netherlands, making it compulsory for health professionals to adhere to a reporting code when they suspect patients to be victims of domestic violence (DV) or child abuse (CA). The Royal Dutch Dental Association (KNMT) developed a reporting code for dental professionals (RCD). Moreover, an e-learning module about DV has been developed. A web-survey was conducted to investigate how general dental practitioners (GDPs) deal with the RCD and what their experiences are with (signs of) DV and CA.

METHODS

In April 2014 1038 GDPs were invited by e-mail to participate in a web-survey consisting of 24 items, through the KNMT Data Stations Project. The data was analyzed using SPSS (RELIABILITY, CHISQ and ANOVA).

RESULTS

Of all GDPs invited to participate 264 (25 %) responded. 82 % of these GDPs are aware of their obligation to use the reporting code. 54 % of the GDPs are in favor of this obligation. 76 % of the GDPs have taken notice of the KNMT's RCD and 51 % of the GDPs have implemented the reporting code in one form or another in their practice. 24 % of the GDPs stated having suspected DV during the last twelve months in the case of 2.4 patients on average. 81 % took note of this in the patient's record and 58 % also took action in different ways. 54 % wants to complete the e-learning module.

CONCLUSIONS

Most GDPs are aware of the new legislation and have taken cognizance of the RCD. Even though the majority of GDPs are not opposed to using a reporting code, over half of them have not yet implemented the code in practice. An important factor in this regard seems to be that a substantial minority of the GDPs says they are not sufficiently informed about aspects of reporting a case and about the steps they have to take.

[A paradigmatic change in the management of caries in children: 'Gewoon Gaaf']

This is a position paper about 'Gewoon Gaaf' ['Just Smooth'], a paradigmatic change in the management of caries in children with a special focus onprevention. Caries is now considered a disease related to behaviour. Behavioural changes are essential in the prevention of caries because only patient's self care can keep caries under control. It is the task of the oral care provider to alert parents and child to their own influence on the development of caries and particularly on how to keep this process under control. Evaluations have revealed that the traditional form of preventive care has hardly improvedoral health. In contrast, various studies have shown the good results of the 'Gewoon Gaaf' approach. Moreover it fits in well with the public debate, which puts more and more attention on efficiency and transparency in the care.

[Evidence-based clinical practice guidelines in oral care 3. Support for the development of clinical practice guidelines]

Support is an important factor in the implementation of clinical practice guidelines. Data from 5 studies from 1998 through 2013 offer insight into the support for clinical practice guidelines among dentists, orthodontists, dental hygienists and denturists in the Netherlands. In these, attitudes, opinions, knowledge and behaviour were seen as indicators of support. Dentists have an increasingly positive attitude towards clinical practice guidelines. The majority is aware of and uses at least 1 of the guidelines available to them and are in favour of the development of clinical practice guidelines. Orthodontists and dental hygienists have available few such guidelines, but the majority of both groups favour their development. Among denturists, who also have little experience with clinical practice guidelines, there are fewer supporters for their development. All in all, among caregivers in oral healthcare in the Netherlands, support for the use and development of clinical practice guidelines is growing.

[Evidence-based clinical practice guidelines in oral care 2: process and content of evidence-based guideline development]

In 2014, an advisory report was published by a national working committee concerning how the current, applied method of evidence-based guideline development in healthcare can be used in oral care in a national guideline programme. In an independent Institute of Knowledge Translation in Oral Care, as yet to be established, primary and secondary oral care providers will participate in the programme in order to improve the quality of oral care in the Netherlands. With the launching of the Institute of Knowledge Translation in Oral Care, clinical guideline development will have the benefit of a structural approach, in which 3 successive steps can be distinguished: preparation, development and authorisation. In each of these steps, oral care providers and associations will be actively involved. In this way the aim is to give as much consideration as possible to the needs of those in the field of oral care in the choice of topics for guideline development and to secure the specific character of oral care in the actual establishment of guidelines for clinical practice.

Diagnosis and treatment of patients with halitosis by dental hygienists and dentists in the Netherlands

OBJECTIVES

The aims of this study were to ascertain the knowledge level of halitosis in dental hygienists and dentists in the Netherlands and to examine how they deal with patients with halitosis.

METHODS

A written survey (comprising 29 questions on personal and professional characteristics, clinical observation and treatment of halitosis, the referral of patients with halitosis and expert knowledge of halitosis) was randomly distributed to a sample of 327 Dutch dentist members of the Royal Dutch Dental Association (Koninklijke Nederlandse Maatschappij tot bevordering der Tandheelkunde; KNMT) and to a sample of 205 members of the Dutch Dental Hygienists' Association (members of the Nederlandse Vereniging van Mondhygiënisten; NVM). A total sample of 168 oral health professionals (92 NVM-dental hygienists and 76 dentists) was included.

RESULTS

This sample can be considered as representative of the population of dental hygienists and dentists working in the Netherlands. Knowledge of halitosis in NVM-dental hygienists and dentists was generally the same. In both professions, attention to, and treatment of, halitosis did not take place at every patient contact, even among those who were able to treat patients with halitosis.

CONCLUSIONS

This study supports the importance of training programmes aimed at increasing assertiveness, as well as the social and communication skills of dentists and dental hygienists to improve the diagnosis and treatment of patients with halitosis. A guideline on screening, diagnosis and treatment of halitosis may be useful to improve the attitude and behaviour of oral health-care professionals, ultimately aimed at stimulating optimal oral health care.

[The Data Stations project: a monitor of dental practice in The Netherlands]

Since 1995 the Dutch Dental Association (NMT) has carried out research on, in particular, the non-clinical aspects of dental practice with the Data Stations project. At present, within this research project 5 studies are conducted on a regular basis: the Dental Consumption Study, the Dental Practice Study, the Omnibus Survey, the Young Dentist Study and the Quality of Oral Care Study. From the results of this research project it appears that during the last decades dentists have increasingly been working cooperatively. This is expressed in dental practices with more dentists and more staff workers, with more dental chairs and more patients. The length of the working week, however, has changed very little over the years. Among both young people and adults gradual changes have taken place in dental consumption during the period 1997-2011. By intensifying the collaboration with clinical dental researchers the scope of the research within this project can be expanded to include the quality of oral care and the effects of care which has been provided on oral health in The Netherlands.

The risk of blood exposure incidents in dental practices in the Netherlands

OBJECTIVES

An awareness of the risk of blood-borne infections among dentists has been promoted by the Dutch Dental Association (NMT) as part of their quality and safety programme, and a nationally operating expert counselling centre was contracted to manage all reported incidents.

METHODS

We analysed data on hepatitis B vaccination status, sex and age for all reported incidents recorded by this centre during 2008. We compared this with data collected at same time during a national survey to assess the performance of the centre. The number of blood exposure injuries among dentists and their assistants, and reporting behaviour, were also assessed.

RESULTS

In 2008, 387 incidents were reported to the counselling centre. The percentage of high-risk incidents was 16, with a risk of hepatitis B, hepatitis C and HIV infections. In the hepatitis B cases, 12% had no or insufficient immunization. Eight per cent of those injured were unable to start HIV Post-Exposition Prophylaxis because they reported too late. Of the 1442 surveys sent, 487 (34%) were returned. Dentists estimated levels of hepatitis B vaccination at 98%. Thirty-two per cent reported to have had one or more injuries in their practice in 2008. Of these, 37% were counselled by the expert centre, 18% were counselled by others and 45% sought no medical attention. The performance of the counselling centre received a positive score (95%). A need for more information about vaccination and blood-borne infections in dentistry (52%) was reported.

CONCLUSIONS

Nationwide data show blood exposure incidents occur frequently in dental settings, with a considerable number of high-risk incidents. Administering anaesthetics and cleaning-up are major risk factors. There is a need to intensify measures for safe working conditions in dental care settings in the Netherlands, irrespective of the type of dental practice.

[Recently graduated dentists: working situation and future plans]

The Dutch Dental Association (NMT) surveyed dentists who graduated in 2004, 2005 or 2006 concerning their work situation and plans for the future. They were also asked about their experiences at the start of their career In general, the recently graduated dentists did not face difficulties at the start of their professional life. Most dentists worked in the practice of a colleague, but the majority ultimately wanted to have their own practice. The latter applied more to men than women. Furthermore, there was a clear preference for working within a team and most of them planned to specialize in a specific branch of dentistry. The survey also revealed that the delegation of tasks to dental hygienists and prevention assistants was more or less taken for granted by recently graduated dentists.

[The restorative care index in children 2. Factors concerning the dentist]

As part of a broader study of the restorative care index of 5- and 6-year-olds and 11- and 12-year-olds, a sample study was carried out among 1,361 dentists, who were surveyed by means of a web-questionnaire concerning this issue. In total 447 dentists (33%) filled in the questionnaire completely. Concerning the development of dental care of children, opinions differed widely: 46% of those questioned spoke of an increase in the incidence of caries during the past 5 years and 44% reported no change. Furthermore, dentists hold different views on the treatment of the primary dentition. There was no consensus of opinion about the necessity of treating caries in young children and there was a comparable lack of agreement about how and when treatment should be given. The majority of dentists express a need for support in their practice (possibilities for referral, protocols, informational material) concerning routine oral examination, the preventive and/or curative treatment of (young) children.

[The restorative care index in children 1. Factors concerning the child]

In 2007 a study was undertaken of the restorative care index of the teeth of children under the age of 18. The aim of this study was to gain insight into the factors associated with the restorative care index in children. Factors investigated were (post-) brushing, inspection frequency, sweets-consumption frequency, socio-economic status and treatment or lack thereof by a general practitioner or dentist who works in a clinic for child health care. This study made use of statistics assembled for an earlier study of children formerly covered by public health insurance in the municipality of The Hague and research carried out at child dental clinics. Socio-economic status and the level of oral care were correlated with dental quality. No patient-bound factors were significantly correlated with the level of care. There was however a positive correlation between the'type' of dentist (family dentist or dentist associated with a clinic for child dental care) and the chance of curative treatment (in the case of developing caries).

[Research in the general practice: a challenge for dentists]

The article offers an adapted translation in Dutch of an editorial essay in The journal of the American Dental Association concerning the benefits of practice-based research networks in dentistry. These are networks of dental practices in which general dental practitioners conduct clinical research in cooperation with university researchers. It is claimed that this approach to research better takes into account the role of the dentist in providing care because research results are developed in 'normal' practices and not in laboratories or university clinics. New insights emerging from this kind of research could be adopted more quickly in general practices. In a response to this editorial the possibilities of introducing practice-based research in a similar way in The Netherlands are considered.

[Patient education in a dental practice]

Patient education is an important part of the care provided in a dental practice. Explanations concerning dental treatments is in the majority of practices exclusively the responsibility of the dentist. Information about oral hygiene and prevention is generally provided by oral hygienists and prevention assistants. It is striking that agreements are made concerning the form and content of patient education, the division of responsibilities and the use of teaching aids in only 39% of practices. It is possible that this has to do with the relatively few hours that oral hygienists and/or prevention assistants are active each week in the practice, and the judgement of the dentists that sufficient time has to be devoted to discussing a proposed treatment with the patient.

[Dentists on continuing dental education]

In support of its quality policy, the Dutch Dental Association (NMT) has undertaken a survey to examine dentists'views on continuing education, accreditation, and their postgraduate course attendance. In December 2004 a written questionnaire was sent to a sample of 710 dentists, of whom 504 (71%) responded. The data were analysed using SPSS. Most dentists (93%) attended one or more courses since January 2003. They tend to concentrate on a few subjects, mainly on clinical procedures. About half (45%) of the respondents are in favour of continuing education accreditation for dentists. Compared to opponents, supporters are more positive about continuing education in general and spend more time reading specialist literature. Furthermore, the greater part of dentists indicates that it is important to have some kind of quality mark for postgraduate courses.

Routine oral examination: differences in characteristics of Dutch general dental practitioners related to type of recall interval

OBJECTIVES

The aim of this study was to explore differences in behaviour (characteristics and opinions) among general dental practitioners (GDPs), using either a fixed (Fx) or an individualized recall interval (Iv) between successive routine oral examinations (ROEs).

METHODS

In the year 2000, data were collected by means of a written questionnaire sent to a random stratified sample of 610 dentists of whom 521 responded, of which 508 (83%) were used for analysis.

RESULTS

Two groups of GDPs were distinguished based on their answer to the question: 'Do you apply for all patients a fixed recall interval between two successive ROEs?' Fifty-one per cent of the GDPs (n=257) applied Fxs for all patients, generally for a period of 6 months. Ivs were applied by 49% (n=251) of GDPs, depending on the determination of specific patient characteristics. Logistic regression analysis showed that GDPs applying Fxs also used fixed periods between successive bitewing radiographs for all patients. Furthermore, dentists applying Ivs required more time to conduct an ROE, partly because of a more extensive periodontal screening. GDPs applying Fxs, adhered more to the opinion that a fixed recall regime (every 6 months, as existed before 1995) should be re-introduced, whereas the GDPs in support of Ivs were more in favour to support the opinion that the ROE is 'an excellent instrument for effective, individualized oral care'.

CONCLUSIONS

Dutch GDPs differ in the way they deal with the determination of recall interval frequency. These are also specific differences in performance and opinions regarding ROE. With the changing prevalence of oral diseases and the skewed distribution within populations, further research is advocated on consistent decision making to determine the most appropriate recall policy in preventing oral disease.

[The routine oral examination in The Netherlands. An orientation from the perspective of general dental practitioners]

In The Netherlands the routine oral examination (ROE) can be characterized as an important tool in dental care. As a result of the changing prevalence of oral diseases of the Dutch population the content of the routine oral examination has changed over time. A representative survey among general dental practitioners has been carried out to investigate the professional performance in the routine oral examination. Participants consisted of a random, stratified sample of 619 dentists, of whom 521 (85%) responded. The Dutch general dental practitioners use the routine oral examination mainly for detecting dental caries and to asses the status of the restorations. About 50% of the responders use a standard recall interval for all patients whereas the other half takes individual patient factors into consideration when determining the recall interval. Both groups differ significantly on the variables: 'time spend on the routine oral examination', 'the amount of diagnostic activities', 'the registration in patient dental records' and 'the frequency of using bitewing radiographs'. In the perspective of quality of dental care a national reconsideration of the routine oral examination by professionals and patients is advocated. The instrument of choice would be the use of evidence-based clinical practice guideline development procedures.

Business orientation and the willingness to distribute dental tasks of Dutch dentists

AIM

Dentists have a dual professional role: they have to focus on good oral health in their patients and, at the same time, they have to organise their practices. The aim of this analysis was to assess the extent to which dentists can be seen as business-oriented and/or willing to delegate to dental team members and others, and to investigate which personal and practice characteristics of dentists can be regarded as determinants for these two aspects of their professional role.

METHOD

The data were collected in 2000 by means of a written questionnaire sent to a random stratified sample of 790 dentists.

RESULTS

607 (77 per cent) dentists responded. Multivariate regression analysis showed that business oriented dentists distinguish themselves by having larger practices and a higher level of professional satisfaction. Furthermore, although to a lesser extent, on a regular basis, they treat patients from colleagues in the practice. There are proportionately fewer women dentists in this category. Dentists oriented on task distribution can also be typified by working in larger practices, but in addition they have a greater preventive treatment philosophy and have more hours of support provided by oral hygienists.

CONCLUSION

Among Dutch dentists there exist clear differences in the way they take on their role as dentists with regard to business orientation and their willingness to distribute dental tasks.