The effectiveness of out-of-hours dental services: II. patient satisfaction

OBJECTIVE: To compare patients' satisfaction with four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. BASIC DESIGN: Postal questionnaire survey of patients who had attended weekend emergency dental services. Patient satisfaction measured using an adapted version of a questionnaire developed for assessing out-of-hours medical services. SETTING: Two health authorities in South Wales, UK. SUBJECTS: The 411 patients who saw a dentist and completed the patient satisfaction questionnaire. RESULTS: The quality of the dentist-patient encounter was similar across services, with most patients being satisfied with the dentist's attitude and manner, the explanations and advice given, and having to see an unfamiliar dentist. Satisfaction was lower, and differed more across services in relation to service accessibility and delays in getting to see a dentist out-of-hours. The walk-in services were perceived as the least accessible: around 40% said they had problems contacting a dentist when the surgery was closed (compared with 16% and 29% in the other two, telephone-access services). Only 12-14% of telephone-access patients said they would be 'happy with advice plus a reliable appointment when surgeries re-opened', whereas almost half of walk-in patients thought this. CONCLUSIONS: Despite overall satisfaction with the dentist-patient encounter, there was relative dissatisfaction with the accessibility of all services, especially the walk-in services. Out-of-hours dental services should be better designed to reflect patients' needs: the need for telephone advice as well as face-to-face consultations, and greater awareness that theoretically available services may be difficult to access unless public expectations and awareness are raised.     

The effectiveness of out-of-hours dental services: I. Pain relief and oral health outcome

OBJECTIVE: To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. BASIC DESIGN: Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status. SETTING: Two health authorities in South Wales, UK. SUBJECTS: A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires. RESULTS: For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30-40% and 23-38% respectively). Although the 'rotas for all' - a telephone-access GDP-provided service for both registered and unregistered patients - achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care. CONCLUSIONS: Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.     

Out-of-hours emergency dental services--evaluation of the first year of a pilot project in Fife

The Scottish Executive Health Department approved funding in 2001 for Fife NHS Board to pilot an integrated model of out-of-hours dental services based upon a dental nurse-led triage system during the evenings, weekends and some public holidays. After one year of the pilot project the activity was evaluated by analysing the triage database. Nearly 4,000 calls were received--Fridays and Saturdays were the most popular days to telephone which resulted in nearly half of all callers being referred to an emergency weekend clinic. Thirty-nine percent of callers received advice only or were advised to contact their own dentist during working hours. A further 12% who were not registered with a dentist (n=479) were offered a next-day appointment with a dentist in their area--around half of these callers subsequently attended for an appointment. Only two out of every 100 callers were deemed to require emergency out-of-hours attention and were referred to oral surgery staff in a local hospital.     

HIV and dentistry. Part 9. HIV infection and dental care

Dental treatment of HIV-infected or AIDS patients can be safely performed in the dental office. In general, no special precautions are necessary. Only in case of severe illness a dental emergency may have to be referred to a dedicated clinic. Ideally, the dentist should have the possibility to treat his own patient in such a clinic.     

Service quality implications of dental undergraduate outreach teaching for Primary Care Trusts in England, UK

OBJECTIVE: Primary Care Trusts (PCTs) assumed new responsibilities for dentistry in 2005. In dental education it has been suggested that more emphasis is made of primary care outreach schemes. The paper considers the service quality implications of dental outreach teaching for PCTs with particular reference to access and acceptability. RESEARCH DESIGN AND CLINICAL SETTING: A pilot of outreach teaching for Manchester undergraduates in relation to adult dental care began in 2001. Six groups of eight students, working in pairs, spent one day per week in one of three community dental clinics in socially deprived areas. The evaluation of the first year used data from 908 patient treatment summaries, 139 patient questionnaires, and records of patient attendance. MAIN OUTCOME MEASURES: Access and acceptability measured by patients' demographic characteristics, patients' attendance at the clinics; patients' reasons for attendance, use of services and satisfaction with the service. RESULTS: In terms of access, the new service was used by local patients. Their main reasons for attending were convenience, a dental problem, free treatment, lack of access to a dentist, and lay referral. Some 41 percent attended initially because of an emergency, 30 percent said that if they had not attended the clinic they would have gone nowhere or did not know where they would have gone, and 49 percent had not attended a dentist for more than two years. In terms of acceptability most patients were positive about being treated by a student, 96 percent thought the quality of care excellent or good, and the same percentage said they would return to the clinic. The main areas of criticism were waiting times and appointments. CONCLUSIONS: Students can provide an accessible and acceptable local primary care dental service for adult patients in socially deprived areas as part of their undergraduate learning, and in a way that complements the existing services.     

Parent satisfaction with emergency dental treatment at a children's hospital

PURPOSE: This study evaluated parental satisfaction with emergency dental treatment. METHODS: One hundred twenty-two parents of children requiring emergency extraction of 1 or more primary teeth completed a survey designed to test the effect of provider, treatment, and demographic variables on parental satisfaction. RESULTS: Most parents (>80%) indicated satisfaction with the treatment provided. Parents were most satisfied with treatment during clinic hours, treatment provided by an attending pediatric dentist, and treatment provided by male dentists. Satisfaction was correlated with the clarity of the provider explanation. Explanations by male dentists were perceived most positively. Parents of children receiving molar extraction(s) were more satisfied than parents of children with incisor extraction(s). Satisfaction did not correlate with ethnicity of the parent or patient, parent education level, funding sources, or use of an immobilization device. Parents preferred sedation for behavior management of the emergency patient. CONCLUSIONS: To address the expectations and concerns of parents, dental professionals need to be attentive to the quality of dentist-parent communication and parental expectations during emergency services.     

Emergency trauma: treating the unexpected

Patients expect their dentist to be capable of priority management of their dental injury. However, unless a dentist regularly attends emergency calls at a hospital or clinic, he or she may be "rusty" when faced with the unexpected arrival of an injured, upset patient. The dentist must deal with the schedule disruption, prioritize treatment or referral, deal with informed consent for minors and adults, and sort out contradictory treatment protocols that are often out of date and inconsistent with scientific evidence.     

Patient receptivity to tobacco cessation counseling in an academic dental clinic: a patient survey

OBJECTIVE: This study investigated dental patient attitudes towards tobacco cessation counseling in the dental school setting. METHODS: Patients attending an academic dental clinic during a six-week period were asked to complete a 22-item self-administered survey. Means and frequency distributions were assessed on all variables as appropriate. RESULTS: Response rate was 71%. Twenty-nine percent of respondents reported that they currently used tobacco. Seventy-two percent of tobacco users agreed that the student dentist should ask patients whether or not they use tobacco, 67% agreed that the student dentist should advise tobacco users to quit, and 89% agreed that student dentists should offer quit tobacco information to patients who want to quit. Seventy percent of tobacco users were considering quitting or currently trying to quit. Of these, only 31% were aware of community resources to help them quit. CONCLUSIONS: The majority of tobacco users were positive in their attitudes toward delivery of tobacco cessation counseling and services in the dental setting. Many were considering or trying to quit, but few were aware of community resources to help them.     

Patients' expectations of an ideal dentist and their views concerning the dentist they visited: do the views conform to the expectations and what determines how well they conform?

Abstract A convenience sample of patients (n=271) from community health centres and private clinics in different parts of Finland were recruited for this study through their dental clinic. Equal numbers of regular and irregular clients were invited to participate. Before the treatment procedure, each patient filled out a questionnaire with forty Likertian statements dealing with their expectations of an ideal dentist, and nine about their own background, i.e., age. sex, regularity of dental visits, basic and professional education, and occupation. After the treatment subjects described their treating dentists' behaviour using similar statements. In the analyses two approaches were applied. First, factor analyses with orthogonal varimax rotation were conducted with the data about the ideal and actual dentist. For the ideal dentist, five factors were extracted: 1) mutual communication, 2) fair support, 3) personal appearance, 4) preferred type of practice, and 5) blaming; and for the actual dentist 5 factors were extracted: 1) mutual communication, 2) pain control, 3) fair support, 4) personal appearance, and 5) preferred type of practice. The factor structures were found to be similar when they were compared with transformation analysis. This justified the second analysis where the differences between the ideal and the actual factor scores were compared. The expectations of the patients were met on all the other dentist characteristics except mutual communication and fair support. There were not many differences between subgroups of patients. In further studies, other background variables, such as previous experiences of the patients, should be considered in order to obtain a more complete explanation of the variation in satisfaction. More attention should be paid to the communication skills of the dentists.     

Patients treated by dental students in outreach: the first year of a pilot project

This paper describes the patients treated by 4th year undergraduate students during the first year of a pilot outreach course to teach Restorative Dentistry in community clinics in 2001-02. Data were collected from 908 summaries of patient treatment completed by the students, and from 139 patient questionnaires. Some 75% of patients were aged between 16 and 64, 58% were female, and 16% had dental phobia or anxiety. Most lived locally to the clinic and 41% made their initial contact as an emergency or drop-in. Some 37% made only a single visit (including children treated as emergencies) but 22% made six or more visits. Did not attend (DNA) was a problem and 18% of patients DNA to complete their treatment. Students undertook the full range of restorative procedures, with the emphasis on direct restorations, preventive treatment and advice, scaling, extractions and emergency treatment. Patients' main reasons for attending the clinic were lay recommendation, the need for treatment, convenience, free treatment, or the lack of access to a dentist. Some 30% said they did not have or did not know of an alternative source of dental care, and half had not seen a dentist for at least 2 years. The study demonstrates that despite difficulties related to attendance, a suitable patient base can be established offering students the opportunity to provide comprehensive care for adults in a primary care setting.     

Utilization of a hospital for treatment of pediatric dental emergencies

PURPOSE: The purpose of this study was to investigate dental emergencies treated at a hospital clinic and emergency department (ED) to: (1) analyze emergency types; (2) determine reasons for seeking hospital care; and (3) examine trends compared to previous studies from this institution. METHODS: Records of 2,683 emergencies from 1995 to 2003 were reviewed. Demographics, reason for seeking care, and treatment details were analyzed overall by emergency type and for subgroups of patients with severe early childhood caries (S-ECC) and patients referred from other EDs. RESULTS: Emergencies were: 51% trauma, 40% caries, and 9% "other" emergencies unrelated to trauma or caries. Common patient characteristics were: (1) young age; (2) non-Caucasian ethnicity; (3) Medicaid as payer; (4) no dentist; and (5) proximity to the hospital. Caries emergencies increased significantly over the study period (P = .008), and 22% had S-ECC. Patients referred from other EDs were: 11% of trauma patients who commonly required sutures and/or extractions; and 3% of caries patients, 82% with extraoral swelling. CONCLUSIONS: Characteristics of patients seeking hospital care for dental emergencies were: (1) young age; (2) non-Caucasian ethnicity; (3) Medicaid as payer; (4) no dentist; and (5) proximity to CHRMC. Use differed by ethnic groups: Caucasians presented mostly for trauma; African Americans presented equally for caries and trauma; and Hispanics and Asians presented primarily for caries. Access to care, caries, and severe early childhood caries remain significant problems despite multiple programs targeting children's' oral health in Washington State.     

Cooperation between the dentist and the dental technician

In prosthetic dentistry the final result is mainly determined by the co-operation within the team: the dentist, the implantologist, the dental technician and the patient. The technician is more and more involved in the composition and colouring of the dental restorations. In many laboratories a dental unit is available to maximise the co-operation and to involve the patient if necessary. A plea is made to develop protocols to improve the co-operation between dentist and dental technician. At the same time new communication techniques can be used such as digital photography. As the costs are often high a treatment plan and an estimate of expenditure are necessary. It is advised that the dentist asks the technician to submit an offer. The dentist should realise that patients, because of the high costs, often have great expectations of the final result, which not always can be fulfilled.     

Out-of-hours dental services: a survey of current provision in the United Kingdom

OBJECTIVE: To describe the variety of arrangements for providing out-of-hours dental care in the UK. DESIGN: A telephone interview survey of health authorities and health boards. SETTING: United Kingdom. SUBJECTS: 104 health authority contacts, usually consultants in dental public health, dental advisers or others in a position to describe the local dental service arrangements. RESULTS: At weekends, 25 authorities have no formal dental care arrangements for unregistered patients, 55 have separate arrangements for registered and unregistered patients, and 44 have 'universal access' arrangements--for anyone in an area, regardless of their registration status. On weekday nights over two-thirds (82/124) of UK health authorities have no formal arrangements for unregistered patients. Where there are separate 'safety-net' services intended for unregistered patients only they are usually (in 48 of 55 authorities) emergency treatment sessions. A fifth of authorities reported planned changes to their local out-of-hours arrangements, including the introduction of telephone triage, and moves to make care available at more times, to more people or from centralised premises. CONCLUSIONS: There is extremely wide geographical variation in the organisation of out-of-hours dental services provided in the United Kingdom. In many parts of the UK there are no formal out-of-hours care arrangements for unregistered patients, even at weekends. This unequal provision will mean inequitable access for many unregistered patients. With increasing demands from a growing unregistered population, and various government initiatives to make primary care services more integrated and accessible, the highly fragmented pattern of provision in many areas may no longer be acceptable.     

Public knowledge of dental registration and management of common dental problems

The government has recently changed its policy on dental registration. There is now a requirement to attend a dentist within 15 months of the previous appointment or dental registration will lapse. The authors of this article undertook a survey of the patients attending for dental treatment at the accident and emergency department of their hospital to ascertain whether inappropriate attendance was due to ignorance about general dental services. Of the 501 respondents 14% had not seen their general dental practitioner within the last 15 months and were therefore no longer registered--only 21% realized that they had to keep regular appointments or dental registration would lapse. A proportion (30%) had tried to contact the dentist outside normal working hours; 27% of these were unhappy with the outcome. Telephone calls were unanswered in 38% of those expressing dissatisfaction and 45% subsequently attended hospital for treatment.     

Alcohol screening in dental patients: the prevalence of hazardous drinking and patients' attitudes about screening and advice

BACKGROUND: Because heavy drinking is a risk factor for oral cancer, dentists should screen patients for alcohol use. The authors investigated heavy drinking in dental patients and patients' attitudes about alcohol screening. METHODS: A convenience sample of 408 patients attending an emergency walk-in dental clinic served as subjects. Patients completed the Alcohol Use Disorders Identification Test-C (AUDIT-C), a three-item alcohol screening test, and an opinion survey regarding attitudes about the acceptability of alcohol screening and counseling by dentists. RESULTS: One in four patients had positive screening results for heavy alcohol use. The majority of subjects (> 75 percent) were in support of dentists' inquiries and advice about alcohol use. Age, sex and drinking status were not predictive of patients' opinions about alcohol screening. CONCLUSIONS: One hundred three of the dental patients exhibited evidence of hazardous alcohol consumption, a risk factor for oropharyngeal cancer. The majority of patients reported that they would readily accept alcohol screening and alcohol counseling by dentists. CLINICAL IMPLICATIONS: Because studies have shown that some dentists hesitate to screen for alcohol use because of a belief that screening is unacceptable to patients, these results may encourage a change in practice.     

Awareness of dental practitioners to cope with a medical emergency: a survey in Belgium

Objective: The aim of the study is to determine whether in Belgium dentists feel confident to diagnose a medical emergency situation in their dental practice. Methods: A questionnaire was completed by 7.0% of the active Belgian general dental practitioners (n = 548) including questions on the frequency and knowledge of medical emergency situations in the dental office, history of dental training to treat emergency situations and confidence level in treating emergency situations. Results: A medical history of each patient was taken by 55.3% of the dentists. A link was found between years since graduation and the systematic decline of a medical history in a new patient (P = 0.001): the older the dentist, the less consistent was the updating of medical history. Almost 50% of the dentists (49.4%) never participated in any basic life support (BLS) training during their undergraduate education. Moreover, 78.3% never had any paediatric BLS training during undergraduate education and BLS training after graduation was lacking by 37.2% of the dentists. Conclusion: Knowledge of BLS should be fundamental to medical professionals. The more BLS training a practitioner has experienced, the more self-secure they feel coping with an emergency situation.Key words: Basic life support (BLS) training, dentist and medical emergency situations, dentists and medical history     

Some Nigerian children's perceptions and involvement in consent to dental treatment

The objective of this study was to evaluate the perceptions of some Nigerian children regarding consenting to their dental treatment. The sample consisted of 100 child patients with an age range of 8–13 years. Children requiring emergency treatment were excluded from the study. A semi-structured questionnaire was administered and the dentists carried out interviews following dental treatment. The outcome of the study revealed that 64% of the respondents were of the opinion that children generally should be involved in deciding about their dental treatment. Results showed that 37% of these children were actually involved in the decision about the dental treatment they had received whereas 66% believed that they should have been part of the process. Responses from the children revealed that 49% wanted the dentist to talk to them about their dental treatment while 41% felt it was the responsibility of both their parents and the dentist. The results of this study have suggested that children want to be more involved in consenting to their dental treatment.     

A prospective survey of hospital ambulatory dental emergencies Part 1: Patient and emergency characteristics

Part 1 of this study describes the dental disorders and patient characteristics of 253 patients who presented as dental emergencies to the University Hospital dental clinic, Vancouver, BC, during a three-month period. Most patients had a true perception of what constitutes a dental emergency. Dental pain was the predominant reason for seeking help, and the pain existed for more than seven days prior to contact in more than 50% of patients. Patients were not always able to identify the number and location of painful teeth, and a perceived low cost for treatment was a major reason for contacting the hospital. Reliability of emergency patients in keeping scheduled appointments was very high. Almost 69% of patients did not see a dentist regularly. Referrals to the hospital dental service were most numerous in the summer months. Diagnosis of the complaints revealed infection to be the cause of pain in 76.7% of patients.     

Out-of-hours emergency dental services in Scotland--a national model

A model of out-of-hours telephone triage for patients with a dental emergency has been piloted in an area of Scotland since 2001. This is linked to an integrated patient booking service. The model has been developed into a national emergency dental service which is currently being made available to all NHS Board areas. This new national service incorporates a single point of telephone access, triage by trained dental nurses using a clinical decision support system and centralised patient booking arrangements. The new service is complemented by Emergency Dental Care Guidance published by the Scottish Dental Clinical Effectiveness Programme. This paper describes the model of out-of-hours dental care, its underlying principles and the process of development.     

Reliable local anesthesia in emergency treatment

Patients today expect and demand painless dentistry. Problems arise when a patient presents with a dental emergency, and the dentist is not able to meet the expectations and demands for painless dentistry because the "conventional" anesthetic blocks and infiltrations simply are not effective. This paper will examine some of the reasons for ineffective anesthesia and will explain several supplemental anesthetic injection techniques to better serve his/her patients' needs.