Mercury hygiene and biomedical waste management practices among dental health-care personnel in public hospitals in Lagos State, Nigeria

BACKGROUND

Indiscriminate disposal of hospital wastes including mercury/amalgam wastes pose a serious threat to life and environment. There is a growing concern about biomedical waste (BMW) management among health care workers, however there are limited reports on BMW management by dental personnel in developing countries.

OBJECTIVES

This study investigated the level of knowledge of BMW, observance of proper mercury hygiene and BMW management practice among public dental personnel in Lagos State, Nigeria.

METHODS

A cross-sectional study regarding BMW management across public hospitals in Lagos State, Nigeria was conducted following institutional ethics committee approval. A self-administered questionnaire was utilized to obtain data from different facilities selected by purposive and simple random sampling techniques as applicable. The questionnaires were distributed among 437 respondents by convenience sampling. The resulting data were statistically tested using Chi-square and G-test with p-value < 0.05 indicating significant level.

RESULTS

Amongst 437 respondents, majority were females (62.5%) and the highest proportion fell within the age range of 25-34 years (44.4%). Only 17.2% of the respondents had good knowledge of BMW management/legislation and 4.1% had good BMW practice. Less than half (49.4%) of respondents disposed mercury-contaminated materials inside the trash and majority (92.2%) did not observe proper mercury hygiene. Significantly better mercury hygiene practices were observed in secondary facilities (p=0.040).

CONCLUSION

A minor proportion of public dental personnel had good knowledge and practice of proper mercury hygiene and BMW management. This shows there is an urgent need for training of health personnel on proper BMW handling and disposal in developing countries like Nigeria.

Psychological Distress and Post-Traumatic Symptomatology Among Dental Healthcare Workers in Russia: Results of a Pilot Study

The spread of SARS-CoV-2 infection has increased the risk of mental health problems, including post-traumatic stress disorders (PTSD), and healthcare workers (HCWs) are at greater risk than other occupational groups. This observational cross-sectional study aimed to explore the symptoms of depression, anxiety, and PTSD among dental HCWs in Russia during the coronavirus disease 2019 (COVID-19) pandemic. The survey was carried out among 128 dental HCWs from three dental clinics of Ekaterinburg, Russia. The mean age of the sample was 38.6 years. Depression, anxiety, and stress were assessed using the Depression Anxiety and Stress Scale-21 (DASS-21); PTSD was assessed using the PTSD Symptom Scale-Self-Report (PSS-SR); subjective distress was assessed using the Impact of Event Scale-Revised (IES-R). The results indicated that 20.3-24.2% HCWs had mild to extremely severe symptoms of psychological distress, and 7.1-29.7% had clinical symptoms of PTSD. No differences between females and males were revealed. HCWs working directly with patients had significantly higher levels of PTSD symptoms and the risk of PTSD development compared to those working indirectly, whereas older HCWs had significantly higher levels of both psychological distress and PTSD symptoms compared to younger HCWs. Thus, dental HCWs are at high risk for psychological distress and PTSD symptoms during the COVID-19 pandemic.

The opinions and attitudes of dental school academic staff towards oral healthcare education for older adults

The term 'oral health care for older adults' has various interpretations, and its meaning is not clear among dental school academic staff. Additionally, there are no theoretical or practical stand-alone courses on oral health care for older adults in Japanese dental schools. To improve oral health care education, we investigated the opinions and attitudes toward oral health care education for older adults among academic staff in dental schools. Data were collected in seven dental schools from May to September 2013 via an online questionnaire survey. Five-hundred-fifty-eight academics (428 male, 130 female) participated (response rate 57%). The average number of years since they had completed a university degree was 20.2 (SD 10.2) years. The majority (Over 90%) of participants perceived that oral health care should be provided in nursing facilities, hospitals, and at home. Its treatments and instructions should include, not only methods of keeping good oral hygiene, but also improvement of oral function such as swallowing training and salivary glands massage. The majority (84.2%) suggested oral health care education should be combined as a one-credit, stand-alone course. Findings indicate that dental academics have an understanding the need for a course in oral health care for older adults. Participants supported the need for further development of education in oral health care for older adults' in Japan, as a separate course on its own right. However there were some different views about content by teaching field. The need for a national core program for teaching oral health care education was suggested.

Quality management and job related factors predicting satisfaction of dental clinic staff in Estonia

OBJECTIVE

The aim of the study was to explore the role of managerial style, work environment factors and burnout in determining job satisfaction during the implementation of quality improvement activities in a dental clinic.

METHOD

Quantitative research was carried out using a prestructured anonymous questionnaire to survey 302 respondents in Kaarli Dental Clinic, Estonia. Dental clinic staff assessed job satisfaction, managerial style, work stress and burnout levels through the implementation period of ISO 9000 quality management system in 2003 and annually during 2006-2009. Binary logistic regression was used to explain the impact of satisfaction with management and work organisation, knowledge about managerial activities, work environment and psychosocial stress and burnout on job satisfaction.

RESULTS

The response rate limits were between 60% and 89.6%. Job satisfaction increased significantly from 2003 to 2006 and the percentage of very satisfied staff increased from 17 to 38 (p<0.01) over this period. In 2007, the proportion of very satisfied people dropped to 21% before increasing again in 2008-2009 (from 24% to 35%). Binary logistic regression analysis resulted in a model that included five groups of factors: managerial support, information about results achieved and progress to goals, work organisation and working environment, as well as factors related to career, security and planning. The average scores of emotional exhaustion showed significant decrease, correlating negatively with job satisfaction (p<0.05).

CONCLUSION

The implementation of quality improvement activities in the Kaarli Dental Clinic has improved the work environment by decreasing burnout symptoms and increased job satisfaction in staff.

Behaviour management of an anxious child

Children with dental anxiety may refuse treatment, which can lead to dental emergencies. Behavior management is an essential skill and should be acquired by all members of a dental team treating children. Dental surgery staff should be relaxed, welcoming and friendly. Make the child the centre of attention and smile. Use age-appropriate language and avoid the use of jargon. Decide who will talk to the child and when, as he/she may only be able to listen to one person at a time. Avoid non-dental conversations with colleagues during procedures.

Attitudes towards establishing a daily supervised school-based toothbrushing programme--determined by Q-sort methodology

OBJECTIVES

This study used Q-sort methodology to determine the views of staff involved in a national school-based daily toothbrushing programme.

METHODS

Q-methodology is a mixed-method approach in which participants are asked to sort a collection of statements according to degree of agreement with them. Factor analysis identified subgroups of like-minded participants and revealed areas of consensus and disagreement. 24 Community Dental Service staff managing or delivering the toothbrushing programme were asked to rank 49 statements derived from previous qualitative interviews.

RESULTS

Varimax rotation produced a three-factor solution with five/six participants loading significantly into each group. Groups divided largely according to staff role: Factor 1, mainly support workers (assistants with no oral-health background); Factor 2, managers; and factor 3, oral health educators (dental nurses with teaching qualifications). As staff new to the area of oral-health, the views of support workers were of particular interest. Unlike others, this group saw Designed to Smile as a unique health promotion scheme and wanted to involve as many children as possible, regardless of oral-disease risk. Managers' perceptions of issues affecting the establishment of the programme differed from those staff in day-to-day contact with the 515 schools in which the toothbrushing took place.

CONCLUSIONS

This study used a long established but little used technique to ascertain the commonality of views of staff These data may be of value not only in managing the current programme, but for anyone who may be considering developing such a toothbrushing scheme.

Facing a moral dilemma--introducing a dental care insurance within the public dental service

Through the reform entitled "Dental care insurance-dental care at a fixed price", patients are offered a dental insurance, a capitation plan, that ensures that they can visit the dentist regularly during a period of three years at a fixed price per month (Frisktandvård).This insurance may be offered to all patients. The aim of this study was to generate a theory explaining the main concern for the staff at the public dental service when they have to introduce and advocate dental care insurance to patients. Interview data from 17 persons, representing different professions within the public dental service, were collected and analyzed simultaneously in line with guidelines for grounded theory. The results indicated that dentists/dental hygienists experienced several difficult standpoints concerning the implementation of the dental insurance, somewhat of a moral dilemma. The staff generally had a "cautiously positive attitude" to the forthcoming dental care insurance, but had perceptions how and when the patients should be offered the insurance and what that may mean to the clinic.The respondents reflected about the economic aspects for the clinic and how the oral health may be affected over time for the patients.

Assessing health workers knowledge on the determinants of health: a study in Enugu Nigeria

BACKGROUND

Different social economic and personal factors have been touted as determining a person's health. This encompasses a person's living environment, economic status, genetic makeup, physical attributes and not just access to health services. It is important that health workers recognize that a person's socio-economic environment can have an adverse effect on the health status ofthe individual so as to capture this aspect in their choice of intervention.

METHODS

The study was carried out in two tertiary institutions in Enugu state selected purposively because they housed a dental clinic. It was a descriptive cross sectional study consisting of 87 participants which represented all the dental taff available during the study period. The participants were interviewed with a structured questionnaire used to elicit the knowledge of health workers on health determinants.

RESULTS

When individual factors were considered, a greater percentage of health workers, believed that safe drinking water (98.9%), where a person lives (96.6%) and a balanced diet, affect health more than availability of health services (59.8%) or the ability of the health care system to meet the needs of the people (55.2%). However when ranking the magnitude of the contribution of the various determinants of health the majority (37.9%) considered a good health care system the most important contributory factor to determining health of a community while social environment (14.9%) was the least.

CONCLUSION

The ranking of good healthcare system over social environment points to the emphasis being laid on curative instead of preventive management of diseases, which have been entrenched in our health workers. Considerations should therefore be made for public health institutions to dwell more on health promotion and education activites on the importance of the social determinatants on health.

Quality management and work environment in Swedish oral and maxillofacial surgery

This thesis attempts to describe the opinion of the work with quality, quality management, and work environment among the employees at Oral and Maxillofacial Surgery (OMFS) clinics in Sweden.

THIS THESIS AIMED TO

Analyse if the OMFS clinics in Sweden actively work with quality development and if so which systems they use. Explore the opinion of the employees about quality work. Describe how the employees of OMFS clinics in Sweden perceive good work, i.e., their image of the dimensions that the profession should contain to be really good work. Investigate whether there is a discrepancy between ideal and reality for this group. Describe how the employees of OMFS clinics in Sweden perceive their health. Analyse how work environment influenced attitudes to and knowledge of quality among employees of OMFS clinics in Sweden. The study was based on self-report questionnaires which in 2003 were sent to all OMFS clinics in Sweden. The response rate was 86%. Only at two clinics did all the respondents agree on their system. Surgeons rated intellectually stimulating work as most important, and the hazard-free work environment as least important. The nurses rated stimulating fellowship as most important, and the opportunity for career advancement as least important. The percentage unit differences between the ideal and the reality were largest for the item the work provides opportunities to have an influence on important decisions. There were significant differences between maxillofacial. surgeons and dental nurses and assistant nurses as to muscle- and joint trouble. The differences were also significant between men and women both as to muscle- and joint troubles and somatic trouble. Only work environment was significant for attitude towards quality work. Profession, gender, clinic size, and a factor for hard demand had significant associations to quality management system used or not.

IN CONCLUSION

More than half of the respondents stated that they worked with a quality system. The dental nurses and assistant nurses had a much more positive view on the potential of quality work as a means to improve their work than had the maxillo-facial surgeons. For a majority of the dental nurses the working situation concerning the physical environment was more important than for the maxillo-facial surgeons. The employees emphasized free, influential, and intellectually stimulating work, but the dissonance between ideal and reality was rather wide concerning good work. OMFS employees are feeling unhealthy, but no worse than other high-risk-groups in human service working and better than female general practice dentists. The women of OMFS employees feel worse than the men.

Changes in the levels of knowledge and attitudes of dental hospital staff about domestic violence following attendance at an awareness raising seminar

OBJECTIVES

To assess changes in dental team knowledge and awareness about domestic violence following attendance at a brief training intervention.

MATERIALS AND METHODS

Seventy-five dental hospital staff at the University of Manchester Dental Hospital attended a two-hour session delivered by Manchester's City Wide NHS Domestic Violence Project manager. Participants completed identical questionnaires immediately before and after the session. Paired t-tests were conducted to determine changes in responses to individual questions before and after training. Independent sample t-tests were also conducted to compare mean responses by sex.

RESULTS

Statistically significant improvements were seen in 50% of attitude questions and 100% of knowledge questions. After training, there was improved recognition that interpersonal violence was a health issue and that the dental profession should be more involved in identification of abuse. There was also improved comfort asking about abuse and respondents were less afraid of offending the patient and less likely to blame the victims for being abused. Statistically significant sex differences at baseline were also seen for several items: females obtaining more correct answers at baseline than males.

CONCLUSIONS

Brief domestic violence training interventions can be effective in improving knowledge and attitudes amongst a dental team but could lead to false confidence in staff and should be followed by in-depth practical training and the development of appropriate processes for dealing with abuse victims.

Dimensions of good work for employees in oral and maxillofacial surgery in Sweden

The aims of this study were to describe how the employees of Oral and Maxillofacial Surgery (OMFS) clinics in Sweden perceive "good work", i.e. their image of the good dimensions that the profession should contain and to investigate if there is a discrepancy between ideal and reality for this group. The study was based on a questionnaire with 67 questions, related to quality management at the clinic, health and the content of good work in two sections, one with the headline "defines good work" and the other "fulfilled 'in my present work' ". Each section was subdivided into 12 parts covering aspects of good work. The maxillo-facial surgeons rated "intellectually stimulating work" as most important (91%), and the "hazard-free work environment" as least important (48%). The nurses rated "stimulating fellowship" as most important (84%), and the "opportunity for career advancement" as least important (27%). The percentage unit differences between the ideal and the reality were largest for the item "the work provides opportunities to have an influence on important decisions". Maxillo-facial surgeons had the greatest differences for that question and nurses had the greatest differences in "the work is well paid". A principal components analysis was performed and three factors explained more than half of the variance (52%). The factors were interpreted as (1) aiming at moral values and possibilities for skill discretion, as (2) career development, and as (3) work environment. The employees of OMFS clinics in Sweden emphasized free, influential, and intellectually stimulating work, but the discrepancy between ideal and reality was rather wide. Three factors of work environment could be established.

Cultural and communicational traits of oral health care: results of a Finnish case study

PURPOSE

This paper aims to describe the cultural and communicational traits of Finnish oral health care. First, employees' views and experiences regarding their organization and their position within it are investigated and, second, relations between different individual and organizational factors are analyzed. Finally, a conceptual framework of organizational coherence is constructed.

DESIGN/METHODOLOGY/APPROACH

The paper shows that data collection (n = 58, 84 percent response rate) was carried out in 2002 at a Finnish dental clinic by using a semi-structured questionnaire. The data were analyzed statistically by using, among other things, non-parametric tests and a structural equation model (LISREL) and qualitatively by using content analysis.

FINDINGS

The paper finds that the organization was described as role-dependent and task-centered. Unidirectional chain of communication and responsibility for interaction were observed as the descriptive traits of communication, regardless of satisfaction or dissatisfaction with the communication. Developmental challenges involved opportunities to exert influence in the organization as well as giving and receiving feedback in leadership relations. It was found that a good sense of one's position in the organization was positively associated with several essential experiences (e.g. confidence, openness and equality), regarding organizational factors.

ORIGINALITY/VALUE

It appears in this paper likely that, by adopting the perspective of organizational coherence, it will be possible to approach the reality of an oral health care organization. As such a new and informative perspective is added.

Smoking cessation as a dental intervention--views of the profession

OBJECTIVE

To undertake a questionnaire-based survey to determine the attitudes and activities of dental professionals in primary care in the Northern Deanery of the UK in relation to providing smoking cessation advice.

METHODS

Questionnaires for dentists, hygienists and dental nurses were sent to hygienists to distribute to other members of the team. The information collected included: smoking status of the professionals and the practice; roles of the dental team in giving smoking cessation advice; levels of training received; and potential barriers to giving this brief intervention.

RESULTS

Over 90% of practices were smoke-free environments and significantly more dental nurses (23%) were smokers compared to dentists (10%) and hygienists (7%) (p<0.01). The majority of dentists and hygienists enquired about smoking status of their patients and all three groups believed that hygienists and dentists should offer brief smoking cessation advice. Potential barriers to delivering smoking cessation advice were identified: lack of remuneration; lack of time; and lack of training.

CONCLUSION

Dental teams in primary care are aware of the importance of offering smoking cessation advice and, with further training and appropriate remuneration, could guide many of their patients who smoke to successful quit attempts.

General health promotion in general dental practice — The involvement of the dental team Part 2: A qualitative and quantitative investigation of the views of practice principals in South Yorkshire

AIM

To investigate the factors that might influence the provision of general health promotion through seven different health interventions by dental teams in general dental practice.

METHOD

A mixed-method was used comprising cross-sectional qualitative research using semi-structured interviews of a purposive sample of 10 practice principals, and a cross sectional survey of a practice principal from every dental practice in South Yorkshire, using a self-complete questionnaire.

RESULTS

Two core categories emerged from the qualitative data: seeing health or disease and practitioners' views of the structure of dental practice. The former refers to the participants' general outlook and cut across many dimensions constituting the structure of dental practice. Health-orientated dentists were more likely to be involved in prevention and were more open-minded to expanding the dental team's role into general health promotion. However participants perceived that barriers existed to involvement such as time and financial factors, current workload and lack of personal skills. The response rate of useable questionnaires in the cross sectional survey was 84%. Reported levels of involvement in general health promotion were low. Most frequently reported barriers were 'insufficient funding' and 'poor use of time'. 'Poor use of time' and 'lack of training/knowledge' were reported less frequently for professionals complementary to dentistry (PCDs) than dentists (p<0.05). Most dentists agreed that PCDs could be trained to deliver health interventions and would be happy for PCDs to do so in their practice if reported barriers were removed.

CONCLUSIONS

Although dental teams' involvement in general health promotion is low, there is willingness to increase involvement, particularly among health-orientated dentists. Some reported barriers to involvement might be removed by impending changes to the GDS in England. Other important factors include a lack of education and workforce shortages of dentists and PCDs. Respondents indicated a high regard for PCDs and there was broad agreement that they were suitable to be involved in this work.

Smoking cessation and the dental team

Dental teams are in an ideal position to help smokers stop smoking. In spite of this, smoking cessation interventions are not often incorporated as a routine part of dental care. Surveys have shown that most dentists believe that helping patients stop smoking is important, but they are reluctant to provide smoking cessation services for their patients. However, comparatively little research has been carried out to examine the views and activities of other members of the dental team, with respect to the provision of smoking cessation support as part of dental care.This paper describes a self-administered, questionnaire-based study to investigate attitudes and practices amongst staff in the Birmingham Personal Dental Service, with respect to helping patients to stop smoking.

CLINICAL RELEVANCE

Dentists and their team members have an important role to play in smoking cessation.

Conflict resolution

The sooner conflict is identified and confronted, the more quickly it can be resolved (and the sooner, the better). When this is accomplished calmly and objectively, many areas of conflict will be eliminated. Addressing conflict as it arises also sends a clear message to the team that the practice seeks resolution, not punishment or negative consequences. In addition, the dentist and the office manager need to lead by example by avoiding gossip and encouraging open communication. The goal is to go from a parent-child relationship with the dental team to an adult-adult relationship using this series of managerial conflict resolution steps.

Self-disclosure of HIV status: perception of malaysian HIV-positive subjects towards attitude of dental personnel in providing oral care

The objective of this study was to assess the perceptions of Malaysian HIV-positive subjects towards the attitude of dental personnel in providing oral care to them. The study design was cross-sectional with the sampling frame comprising of 27 Government Drug Rehabilitation Centres throughout Malaysia. A convenience sample was then taken from 20 centres with the highest enrolment of HIV-positive subjects. A self-administered questionnaire was used to elicit information on the perception of HIV-positive subjects towards the attitude of dental personnel in providing oral care to the patient with HIV-positive. The study sample consisted of 509 HIV-positive individuals with a mean age of 31.3+/-12.9 years old. Of these, only 15.1% attended a dental clinic after confirmation of HIV-positive status. The study demonstrated that 67.5% of the HIV-positive subjects disclosed their status voluntarily to the dentists and majority of the dentists (76.9%) did not show any negative reaction on knowing their HIV positive status. There was also no difference in the attitude of auxiliary staff toward the above disclosure. In conclusion, the study showed that oral health care personnel are more receptive to the HIV-positive subjects receiving dental care and treatment.

Attractiveness ratings of anterior open bites and reverse overjets using the aesthetic component of the Index of Orthodontic Treatment Need

This study was carried out to determine the level of attractiveness of anterior open bites (AOB) and reverse overjets of varying severity. A sample of 180 non-dental students (101 females and 79 males; average age 20 +/- 0.75 years) and 45 dental professionals (12 females and 33 males; average age 35.5 +/- 5.07 years) was asked to complete a questionnaire to rate the level of attractiveness of AOB and reverse overjets of varying severity using the aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN). Photographs of mild and severe AOB and reverse overjets were projected onto a white screen in a lecture theatre (15 seconds each with a 5 second interval between images). The participants were asked to record the AC grade at which they thought the projected picture of the AOB or reverse overjets had similar attractiveness. Dental awareness of non-dental students was determined by asking them their opinion on how important it was to have straight teeth (very unimportant, unimportant, important, very important), about their personal or close family members' orthodontic experiences and if they thought they were in need of any orthodontic treatment. A chi-square test was applied to record any differences between sexes and between the different groups. Backward stepwise linear regression analysis was used to determine the relationship between the students' ratings of the photographs and their dental awareness. The majority of non-dental students rated a mild AOB (93 per cent) and mild reverse overjet (96 per cent) to be aesthetically acceptable. A mild AOB and mild reverse overjet were found to be acceptable by 40 and 58 per cent of dental professionals, respectively. The differences in the ratings between dental professionals and non-dental students were significant at P < 0.001.A severe AOB was considered unattractive by both students and dental professionals. However, dental professionals rated it at the more unattractive end of the scale (P < 0.001). A severe reverse overjet was rated by the majority of the subjects as aesthetically unacceptable (85 per cent of the non-dental students and 78 per cent of the dental professionals).

Enhancing relationships among dental team members: the application of research on marital interaction

BACKGROUND

Despite some important differences, relationships among dental team members bear striking similarities to marital relationships. Empirical research on marital interaction can be useful in enhancing relationships among dental team members.

CONCLUSIONS

As with marriage, it is unrealistic to expect that conflict and differences of opinion will never occur among dental team members. However, a set of principles derived from extensive, empirical, behavioral science research on marital interaction can provide dental teams with strategies for strengthening working relationships and managing conflict.

PRACTICE IMPLICATIONS

Benefits of using these principles may include a reduction in employee turnover, improvements in efficiency and productivity, and the creation of an environment that helps attract and retain patients.