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.     

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.     

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.     

Dental emergencies in a university-based pediatric dentistry postgraduate outpatient clinic: a retrospective study

The purpose of this retrospective study was to determine the prevalence and types of dental emergencies occurring in a university-based, pediatric dentistry postgraduate outpatient clinic. All patients presenting for emergency dental care during scheduled clinic hours over a three year were identified, and their charts were retrieved. Each record was reviewed for demographic information, chief complaint and clinical diagnosis. Only those charts with both chief complaints and clinical diagnoses recorded were included in this study. A total of 816 patients received emergency care, representing 15.3 percent of all patient treated during the study period. The patient population had a slight female predilection (53 percent female, 47 percent male) and a mean age of 5.1 years (range 10 days to 15 years). Ethnicity (39 percent African-American, 36 percent Hispanic, 24 percent Caucasian <1 percent Asian-American) was similar to that for the clinic in general. Reimbursement for dental care was primarily via Medicaid (91 percent) with <10 percent covered by insurance or payment by responsible parents. For one quarter of the children, the emergency visit was their first dental visit. Reasons for seeking emergency included 1) pain or discomfort due to caries [30.1 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3) eruption difficulties [18 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3 eruption difficulties [18 percent];4) soft tissue pathoses [16 percent]; 5) problems with orthodontic appliances or space maintainers [10 percent]; and 6) lost restorations [2 percent]. Pain and bleeding were the most common reasons for seeking emergency dental care. Most causes for seeking outpatient emergency dental care are disease processes which may be avoided by infant oral health and preventive dentistry programs and early treatment intervention.     

Patient satisfaction in a dental school.

PURPOSE: The objective of this study was to measure patients' satisfaction with the facility, services and treatment received at a dental school clinic. METHOD: The 31-item questionnaire consisted of demographic items and items in a 5-point Likert-type format addressing issues such as security, satisfaction with the facility, helpfulness of the staff, progress of treatment, fees, universal precautions taken, quality of care and treatment with dignity and compassion. The questionnaire also asked whether the patient would recommend the school to others seeking dental care. In 1997, patients completed the survey in the clinic waiting room prior to their dental appointment for that day. The survey was conducted over 3 months until 500 patients had participated, representing about 16% of the active patient population. %s of responses were computed and cross tabulations were used to compare responses based on demographics. RESULTS: The most frequently reported reason for wanting to be a patient at the dental school was low cost (67%) followed by up-to-date care (19%). 45% of patients indicated that a friend, neighbour or relative referred them, followed by 34% indicating referral by a dentist. More than 90% responded positively to the items concerning issues related to treatment except for satisfaction with progress of treatment and comparison of care received at the school to care elsewhere. For these 2 items, at least 80% responded positively. 99% indicated they would recommend the dental school to others seeking dental care. CONCLUSION: Results indicate that the vast majority of the patients surveyed are satisfied with the facility, services and treatment received. Comments that addressed areas of concern included the length of time to get an appointment and the length of time the appointment took, and it was recommended that the process of treatment be expedited.     

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.     

Paracetamol overdose as a result of dental pain requiring medical treatment - two case reports

Two cases of unintentional paracetamol overdose are presented. Over a one month period these patients presented to an Accident and Emergency (A&E) department with symptoms of paracetamol toxicity, following the ingestion of large quantities of analgesia for the self treatment of dental pain. In one case the patient had no access to a dentist. Both patients required admission under the care of the medical on-call team and required anti-toxicity treatment to prevent permanent liver injury. Subsequent referrals were made to the oral and maxillofacial surgery team who provided emergency dental treatment and advice on further dental care. This paper highlights the significant signs and symptoms of paracetamol overdose about which dental practitioners should be aware. It also describes the management principles required to prevent potentially life threatening liver damage. Discussion is also made of the potential impact on patients struggling to cope with pulpal pain without access to a general dental practitioner.     

A prospective survey of hospital ambulatory dental emergencies Part 2: Follow-up to emergency treatment

Two hundred and fifty-three patients treated for dental emergencies at the University Hospital dental clinic over a three-month period were surveyed by telephone 24 to 48 hours and one year after treatment. The purpose was to investigate the success of treatment in resolving the chief complaint of pain and to determine the compliance with further dental care for the original dental problem. The results of the telephone survey showed that: patients available for questioning totaled 49.1% at 24 to 48 hours and 28.9% at one year; an 80.7% success rate was recorded in resolving pain within 24 to 48 hours; and the original emergency problem did not motivate a large number of these patients to seek further dental care.     

A cost-efficiency analysis of a mobile dental clinic in the public services.

During 1997, the Gauteng Oral Health Services implemented a Mobile Oral Health Care System (MOHCS) in the province. For the first year (1997/98) one mobile dental clinic was utilised in the West Rand region of the province and services were provided by dentists, dental therapists and oral hygienists. The purpose of the MOHCS is to provide an accessible and affordable comprehensive oral health care service of high quality and standard. The aim of this study was to determine the cost-efficiency of the mobile dental clinic utilised in the West Rand region over the first year of implementation. After consultation with all stakeholders, an operational plan was finalised. The plan included a traveling schedule, clinicians available for service delivery, and a management information system (MIS). Statistics on dental materials, consumables, treatment provided, etc. were collected and analysed. During the study period 2072 patients received dental treatment at 38 different sites in the region. At an average cost of R56.50 (+/- US$11) per patient, services to the value of R92.45 (+/- US$18) per patient were delivered during 104 working days. Of the 1477 patients treated by a dentist or dental therapist, 53% were treated by extracting 1026 teeth, and 27% by restoring 570 teeth. For oral hygiene patients, 67% received an oral hygiene procedure and 13% received fissure sealants. With a net margin ratio of 0,39 and a breakeven point of 1173,46 patients and 58,90 days, an accessible and cost-efficient service was provided to health districts in the West Rand region.     

Resource implications for oral care of patients with HIV

OBJECTIVES: The aim was to investigate the attitudes of people with HIV infection towards their own dental care provision and the possible implications for future resource allocation.
DESIGN: Sixty-nine HIV positive subjects attending support groups in London were interviewed. Past and current dental visiting behaviour, problems encountered in obtaining dental care and preferred site of delivery for dental care were investigated.
RESULTS: Showed that a majority (74%) changed dentist or stopped attending following diagnosis with HIV, either due to fear of or actual refusal of treatment, a desire to attend a more sympathetic dentist or to attend a specialist clinic. Forty-five per cent withheld information about their status. Subjects expressed a desire to receive regular dental care and had definite preferences as to the site of delivery, 45% preferring general practice, 48% specialist clinics.
CONCLUSIONS: Future resource allocation should be used for continued support and education of general dental practitioners willing to treat HIV positive patients, and for accessible specialist referral centres. Hospital clinics could also provide regular routine care, especially in areas of large HIV populations. An improved awareness of and access to community dental clinics appears to be needed, with efforts focused on achieving an informed and educated patient population through education programmes.     

Clinical Response to COVID-19 and Utilization of an Emergency Dental Clinic in an Academic Institution

IntroductionThe spread of coronavirus disease 2019 (COVID-19) in the spring of 2020 resulted in the temporary suspension of elective dental procedures and clinical dental education in academic institutions. This study describes the use of the Tufts University School of Dental Medicine emergency dental clinic during the peak surge in COVID-19 cases in Massachusetts, highlighting the number of endodontic emergencies.MethodsAggregate data from clinical encounters and call records to an emergency triage phone line from March 30 through May 8, 2020, were used to describe the characteristics of dental emergencies, clinical encounters, and procedures performed.ResultsA total of 466 patient interactions occurred during this period, resulting in 199 patients advised by phone and 267 clinical encounters. The most common dental emergencies were severe dental pain from pulpal inflammation (27.7% of clinical encounters) followed by a surgical postoperative visit (13.1%). The most frequent procedures were extractions (13.9% of clinical encounters) and surgical follow-up (13.5%); 50.2% of the clinical encounters were categorized as aerosol generating, and 86.1% of encounters would have required treatment in a hospital emergency department if dental care was not available. There were no known transmissions of severe acute respiratory syndrome coronavirus-2 among clinic providers, patients, or staff during this period.ConclusionsThese results highlight the importance of endodontic diagnosis and treatment in the provision of emergency dental care during a pandemic and demonstrate that dental treatment can be provided in a manner that minimizes the risk of viral transmission, maintaining continuity of care for a large patient population.     

Factors associated with early-stage diagnosis of oral and pharyngeal cancer

Abstract – Objectives: The objective of this study was to examine the characteristics and treatment‐seeking behaviors of patients diagnosed with oral and pharyngeal cancer (OPC) and to determine whether seeing an oral healthcare provider in the preceding year was associated with an earlier stage of diagnosis. Methods: Trained interviewers administered a pretested survey instrument to a sample of 131 patients newly diagnosed with OPC at two cancer centers in Florida. Analyses were conducted to compare characteristics of patients by cancer summary stage (early or advanced) on receipt of OPC examination, patterns of dental care, and number of initial signs and symptoms. In addition, analyses were also conducted for characteristics of patients’ dental care utilization (regular primary care dentist, time of most recent dental visit, and regular dental care) by receipt of OPC examination. Results: Overall, 25.3% of participants reported receiving an OPC examination at their last dental visit and participants who received an OPC examination were significantly more likely (79%) to be diagnosed at early stages than those who did not receive an oral cancer examination (48%). Patients with a regular primary care dentist were more likely to be diagnosed at early stages (65%) than those without a regular primary care dentist (41%). Factors significantly associated with receiving an OPC examination included having a regular primary care dentist (P < 0.001), having a dental visit in the preceding 12 months (P < 0.001), and receiving regular care (P < 0.001). The number of signs or symptoms reported by the patient was significantly associated with the stage at diagnosis (P = 0.002) and the most common initial symptom reported by patients was soreness in the mouth. Conclusions: These results emphasize the importance of periodic and thorough OPC examinations.     

Fee-paying systems and service patterns in a Hong Kong dental clinic

OBJECTIVE: This study aimed to describe and compare patients' consumption of dental services and dentists' productivity in a university campus clinic before and after changing from a time-based to an item-based fee-paying system. METHOD: Data were collected from the University of Hong Kong dental clinic which serves all university students and staff. A time-based fee-paying system had been in use up to February 1999 when it was switched to an item-based system. Computerised records of all patients in two 1-year periods starting from February 1996 and February 1999 were analysed. RESULTS: The percentages of eligible users who attended the University dental clinic were similar in the two study periods (30% in 96/97 vs 29% in 99/00). However, on average, patients consumed more dental service items in a year after the switch in fee-paying system (3.2 vs 4.1). There was also an increase in the mean number of dental service items provided by a dentist per working week after the change in fee-paying system (71.5 vs 99.4). CONCLUSION: On switching from a time-based to an item-based fee-paying system, dentists in the UHS dental clinic became more productive and the consumption of dental services per patient also increased.     

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.     

The involvement of Iowa dentists in hospice care

The relationships between dentist characteristics and professional education with involvement of Iowa dentists in hospice care were investigated. Using the 1999 Iowa Health Professional database, a survey requesting information regarding involvement in and training for care of hospice patients was mailed to all licensed dentists (N = 1,210). Two mailings yielded a 54.6% response rate. Of the 638 dentist respondents, the mean age was 47, 86% were male, 88% general dentists, and 295 (46%) reported providing some treatment for hospice patients. At least one dentist reported providing hospice patient care in 72 of Iowa's 99 counties. About 90% of dentists treating hospice patients were general practitioners. Males were more likely to provide treatment (p < 0.0313). Neither dentist age nor years in practice were significant predictors. Dentists were more likely to treat hospice patients in the office (IO, 40%). The most prevalent treatments were denture relines (31% IO; 71% OO), examinations (16% IO; 68% OO), and emergency treatment (12.5% IO; 53% OO). More than 86% of surveyed dentists indicated that their professional education did not adequately train them to meet the clinical, psychosocial, communication, or spiritual needs of hospice patients.     

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.     

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.     

Health literacy impact on patient-provider interactions involving the treatment of dental problems

Health literacy-related problems can interfere with effective doctor-patient communication and effective patient care. This study examined several health literacy-related markers for patients seeking treatment in hospital emergency departments and physician and dentist offices for dental problems and injuries. Participants consisted of low-income white, black, and Hispanic adults who had experienced a dental problem or injury during the previous twelve months and who visited a hospital emergency department, physician, or dentist for treatment. A stratified random sample of Maryland households participated in a cross- sectional telephone survey. Interviews were completed with 94.8 percent of 423 eligible individuals. Multivariable logistic regression analyses were performed. Only 10.0 percent of the respondents expressed a difficulty understanding what they were told by the health provider, while 4.9 percent expressed a difficulty understanding the dental or medical forms they were asked to complete and 6.9 percent reported that they had difficulty getting the health provider to understand their dental problem or injury. Logistic regression analysis found that males and Hispanics were significantly (p<0.05) more likely to experience health literacy-related problems. In general, respondents did not express health literacy-related problems. Additional research is needed to identify health literacy-related barriers to effective patient-provider communication.     

Preparing for the dental team: investigating the views of dental and dental care professional students.

There is growing evidence to support the contention that interprofessional education (IPE) at both pre and post-qualification levels will improve professionals' abilities to work more effectively in a team and to communicate more effectively with colleagues and patients. This body of evidence, however, is primarily concerned with nursing, medical and associated professionals and students, and there are few studies that include dental students and particularly where learning occurs with the dental care professions (DCP). The purpose of this study was to examine the attitudes of dental and DCP students to IPE and to highlight some of the barriers to developing programmes for these students. It was also intended to examine the students' awareness of dental and DCP roles and responsibilities. Two questionnaires, the Readiness for Interprofessional Learning Scale (RIPLS) and a dental roles and responsibilities questionnaire, were distributed to all 5 years of dental students (n = 189) based at Queen's University Belfast (QUB), both years of the dental hygiene students (n = 8) also based at QUB, as well as to final year dental nursing students based at Belfast Institute of Further and Higher Education (BIFHE) (n = 64). The results indicated that dental and DCP students had a positive attitude to IPE as a means to improve teamwork and communication skills but there are potential obstacles as demonstrated by the differing perceptions of each of the three groups about the roles of the other. Some aspects of practice, involving personal care and advice to patients, were regarded by all groups as a shared role but the dental hygiene students regarded themselves as having a shared role in several tasks identified by dental and dental nurse students as the sole role of the dentist. Dental hygiene students in this study did not see their role as primarily to support the dentist but more as a partner in care. Professional identity and its development are issues that must be considered by dental and DCP educators developing IPE initiatives.