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Dental practices have a unique position as dental staff use a high number of dental materials and instruments on a daily basis. It is unclear how dentists' and dental care professionals' choices and behaviours around selecting and using materials impact on the amount of unnecessary waste production. Although there are a number of articles exploring the quality and quantity of waste in dental practices, there are no studies on organisational strategies to decrease unnecessary waste. There is no clear economic analysis of the impact on associated cost to dental practices which consequently can affect the access of dental care for disadvantaged groups.This study used an audit approach to explore the potential for sustainability in dental practice by measuring the nature and quantity of dental clinical waste, and assessing the feasibility of measuring the financial costs and potential carbon savings in the management of dental clinical waste.The data from our study would appear to support the view that it is possible to reduce carbon emissions and increase profitability. Successful implementation of an environmentally sustainable approach to waste management will be dependent on the practicalities involved and the financial incentives for adopting such practices.

Introduction: For dental practices to become more environmentally sustainable, the full cooperation of all practice staff can lead to greater engagement with proposed initiatives. Action Research is a participatory approach to change that involves participants in the decisions that affect them. Aim: The aim of this study was to collaboratively develop interventions to improve environmental sustainability at one dental practice. Methods: This was a mixed methods study following an Action Research process for intervention design. The study was set in a mixed NHS / private dental practice in England, UK. Results: Participants engaged in the process and were able to choose the measures they wished to implement. Feedback showed that whilst some measures had been discarded, others had led to changes both in professional and personal behaviour. Conclusion: Action Research offers an innovative and constructive method of engaging participants in developing their own sustainability strategies and can encourage positive change.

Introduction: The oral cavity, in palliative care patients, is commonly the first site of discomfort and loss of function. Oral care, however, is often overlooked for these patients. Palliative oral care is a poorly researched area and the experiences of patients, their carers and relatives are seldom explored. Aims: To explore the oral care experiences of palliative care patients, from the perspective of their carers and/or relatives. Methods: Blogs and discussion forums, on public internet sites, were used as the data source. Data were analysed using thematic analysis. Results: Eight blogs and eight discussion forums fulfilled the inclusion criteria and were analysed. Three main themes were identified: symptoms, procedures and emotions. Authors described oral symptoms that they could observe themselves and perceived as being distressing. There was an association between oral care procedures and the oral symptoms observed. However routine oral care procedures were poorly described. Conclusion: The data on oral care provided by the blogs and discussion forums included was scarce. It provided, however, preliminary insights into this poorly researched area. In this group, the importance of oral care for terminally-ill patients was frequently overlooked until the person’s quality of life became compromised by their oral symptomatology.

Objective To understand the attitudes and behaviour of staff in dental practice towards adopting a reduce, reuse, recycle approach to resource management.Design A qualitative interview study.Setting The site for the study was a mixed NHS/private dental practice in North Devon.Subjects All disciplines from one dental practice.Methods (1) A practice scoping exercise - provided context and identified an interview sample. (2) Qualitative interviews with practice staff - explored knowledge and attitudes about sustainability and identified opportunities and limitations for the sustainable management of resources.Results The main issue raised by staff was the amount of waste generated. There was a strong desire to implement changes, but deep concerns were expressed about the impact of challenging current guidance on infection control.Conclusions Primary care dentistry provides both surgical and non-surgical care to more than half the UK population. Therefore, lessons learned from general dental practice can encourage positive change. More research is needed across dental practice in order to generalise these findings.

Objectives To develop an understanding of the key features of person-centred care (PCC) in relation to general dental practice from a patient's perspective. Background PCC is acknowledged as an important dimension of quality with 'patient experience' increasingly used as a marker of quality within the NHS. A Dental Quality and Outcomes Framework (DQOF) is currently being piloted in the UK, which includes patient experience as one of the three domains. It is recognised that there is limited understanding of PCC within dentistry, with little evidence published on the subject. Methods This study uses qualitative methods to explore the views of 16 purposively sampled patients living in Southwest England. In-depth semi-structured interviews were recorded, transcribed, coded and analysed thematically. Results PCC was viewed as key in the delivery of high-quality care. Dimensions of PCC were identified and categorised as relational or functional aspects of care. Relational aspects of care were viewed as being central to the delivery of PCC with five components identified and named: connection, attitude, communication, empowerment and feeling valued. Functional aspects of care were identified as healthcare system and physical environment and were noted to influence PCC to a variable degree. Conclusion A model of PCC in dentistry is proposed which has been generated from empirical evidence that represents the views of patients. It is hoped that this may inform and influence development of a tool to measure PCC within any future version of the DQOF.

Objectives To demonstrate the feasibility of opportunistic oral cancer and precancer screening in general dental practice and to determine the prevalence of relevant lesions and risk habits in a population of general dental practice attenders. Design A prospective demonstration study, recruiting patients opportunistically. Setting General dental practices. Methods Eighteen general dental practitioners took part in this study. Each attended training sessions to be advised of the study protocol and the criteria of a positive and negative screen. Patients over the age of 35 years were prospectively and opportunistically recruited. Each patient was asked to complete a health questionnaire concerning age, gender, ethnicity, smoking and drinking habits. The dentist then examined the soft tissues and recorded the presence or absence of lesions independently on a second form. The forms were collated and data were analysed to determine prevalence of lesions and associations with risk habits. Results Data on 2,265 patients were available for analysis. Oral lesions were detected in 319 patients (14.1%). Ninety-four patients (4.2%) had lesions considered to be either malignant or potentially malignant. There was a significant association between positive lesions and male gender (IRR 1.86, 95% CI 1.22-2.82), heavy smoking (males: IRR 3.68, 95% CI 2.10-6.43: female; IRR 3.58, 95% CI 1.35–9.50) and heavy alcohol use in males (IRR 2.98, 95% CI 1.06–3.47). Conclusions The results suggest that patients attending general dental practices are representative of the general population both in terms of lesion prevalence and high risk habits such as smoking and drinking. This supports the view that opportunistic screening in a general dental practice setting may be a realistic alternative to population screening. Further research is needed to determine the cost effectiveness of this approach and to investigate the value of targeting high risk groups within this population. General dental practice is ideal for the evaluation of such systems prior to extending these studies to other healthcare settings.

Aim To model the inequalities in availability of National Health Service general dental practitioners in England and Wales in relation to key socio-demographic factors. Methods Current estimates of the numbers of NHS general dental practitioners for each health authority were related to data from the 1991 census using Poisson regression models, and generalised estimating equations to allow for correlation between results for neighbouring health authorities. Results An 'average' health authority, without a dental school, would be expected to have 2,138 residents for every NHS dentist. Controlling for relevant factors, health authorities with higher proportions of the following are associated with lower (better) population to dentist ratios by the amounts shown: each 1% higher female population (–11.8%; 95%CI –19.1%, –3.9% P = 0.004); each 1% greater South Asian population (–1.4%; 95%CI –2.1%, –0.7% P

Objectives To assess the feasibility of using electronic-mail as a tool for surveying dental practitioners; to determine both response rates and response times for this method; and provide baseline information on e-mail usage. Method Self-administered questionnaire distributed by e-mail to 309 practitioners on Monday morning, 1 June 1998. Results 53.4% response rate within 1 month; 10.2% of replies were sent within 2 hours; and nearly half the replies were sent within 48 hours. Qualified dentists were more likely to respond early than undergraduates. The most popular point of access for e-mail was home (69.1%). The majority of responders (56.8%) use e-mail every day with 1 in 7 (14.2%) using it at least four times a day. 72.4% stated that they found e-mail useful for communicating with professional bodies, while 41.3% used it to communicate with colleagues about patients and patient referrals. 34.0% found e-mail useful for ordering goods, and supplies and 14.6% were using electronic mail to make patient appointments at least some of the time. Conclusions Responses can be obtained at much greater speed than conventional postal techniques will allow, but response rates were only 53.4%. E-mail is predominately used at home and for inter-professional communications, only a small proportion of responders use it for direct communication with patients.

This paper explores the concept of patient-centred care as a dimension of quality as applied to dentistry and provides a systematic review of the literature. The new NHS dental contract, which is currently being piloted in England, is committed to delivering improvements in quality. The Dental Quality and Outcomes Framework has been developed as a tool to measure quality and focuses on three key dimensions: clinical effectiveness, safety and patient experience. A systematic review of the literature reveals a lack of information pertaining to patient-centred care within dentistry, and in particular general dental practice. It would also suggest that there is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient centredness.

There has been growing interest in the use of virtual learning environments (VLEs) by universities over the past decade to supplement traditional teaching methods. In this study a tutorial providing information about the temporomandibular joint (TMJ), temporomandibular disorders and teaching of a thorough TMJ examination was developed on a VLE platform to enable students to enhance their examination and diagnostic skills. The success of this VLE tutorial was compared with conventional teaching by a cross-over trial. Thirty students were initially randomly allocated to one of two groups; Group 1 completed the VLE tutorial and Group 2 attended the face-to-face seminar in the first instance. The groups then crossed over and had the other method of teaching provided. The findings from the cross-over trial and the students' feedback indicated that no differences were found between either teaching modes, and both are equally effective at delivering information to students. In addition, the order in which the students received the teaching did not make a difference, but giving the teaching twice reinforced their knowledge. There is a strong case to be made for introducing clinical lectures on a VLE platform, and this form of e-learning is, in general, well perceived by new generations of students.

Aim There is little information available concerning the impact of visual impairment upon oral health. The present study sought to identify the oral health and experiences of adults with a visual impairment together with the nature, source and access to oral health information. In addition the study evaluated the oral health status of a group of individuals with a visual impairment with respect to oral health markers, treatment choice and attendance patterns in comparison to a reference group from the general population in the United Kingdom. Method One hundred adults with a visual impairment were examined and completed a questionnaire concerning their experience of oral health care and available information sources. The information collected was directly compared with data from the Adult Dental Health Survey 1998 for the south region of England. Results The present group of individuals with a visual impairment had better oral hygiene practices, and similar levels of oral hygiene and hard tissue disease to those of a comparable group of the Adult Dental Health Survey 1998 (ADHS 1998). However 24% of those with a visual impairment were not registered with a dentist and 26% of the patients wished for appropriate information concerning oral health care. Conclusions There is a need to develop oral health promotion that ensures patients with a visual impairment have appropriate information regarding oral health care and its provision.

Objectives 1) To examine the orthodontic referral behaviour of dentists and 2) to examine dentists' familiarity with the Index of Orthodontic Treatment Need (IOTN). Design Postal questionnaire survey. Setting West Sussex Primary Care Trust (PCT) from September to December 2006. Subjects and methods Questionnaires were sent to all dentists listed on the West Sussex PCT database, except those assumed not to make orthodontic referrals (n = 325). Results Two hundred and twenty-nine questionnaires were returned, representing a 70% response rate. Fifty-two percent of dentists in West Sussex correctly identified which type of orthodontic provider to refer three different malocclusions using picture tests. Twenty percent of dentists made correct decisions on the timing of referral for three different malocclusions using picture tests. IOTN is not routinely used by 76% of West Sussex dentists when making an orthodontic referral. Conclusions This study provides evidence that there is a need for postgraduate training or the development of referral guidelines to assist West Sussex dentists in making referrals for orthodontic treatment to the most appropriate provider at the most appropriate time. If dentists are to act as gatekeepers of orthodontic provision on the NHS there is a need to provide more support and education for them about the use of IOTN.

Objective To determine the pattern of hospital admissions for dental care of children and adolescents between 1997 and 2006. Design Retrospective analysis of data from the Hospital Episodes Statistics (HES) database (1 April 1997 to 30 March 2006) if the patient was aged up to 17 years old and their primary diagnosis was a dental condition. Outcome measures Primary diagnosis, treatment provided, socioeconomic status. Results There were 517,885 NHS episodes of care for dental conditions in 470,113 children. Over half of the admissions were primarily for dental caries and 80% of all the admissions involved extractions. The peak age for caries-related extractions was five years old. There was a steady increase in the annual number of episodes of care with most of the increased activity attributable to a 66% increase in extractions for caries. More episodes of care were provided for children who lived in relatively deprived areas compared to more affluent areas. Conclusions Data from the HES highlights a major public health issue. Caries is a preventable disease yet the number of children being admitted for elective extractions of teeth due to caries was increasing yearly. Further investigation to determine some of the underlying reasons for this trend is required.

Objective The objective of this study was to undertake a clinical evaluation of the individual repeatability of three colour measuring devices. Design Clinical study. Setting Eastman Dental Hospital. Methods Under standardised clinical conditions, one trained operator using three colour measuring devices (Vita Easyshade, X-Rite ShadeVision and Spectroshade Micro) recorded three shade measurements (cervical, body and incisal) for each of the upper maxillary anterior teeth in 20 participants. This sequence of measurements was repeated for each of the shade machines. The output recorded from each sequence included Vita classic shades and CIE Lab co-ordinates. Ethical approval was obtained from the joint University College London and University College London Hospitals. Results Spectroshade Micro had good agreement Cohen Kappa score (0.80) for repeatability of Vita shades and also had 82.7% proportion of complete agreement for Vita shades. The proportion of complete agreement for Vita shades for the Easyshade and X-Rite ShadeVision machine were 50% and 59% respectively. For CIE Lab co-ordinates the Spectroshade Micro provided the narrowest range of 'Bland and Altman' agreement limits for all the co-ordinates recorded. Conclusion The Spectroshade Micro machine provided the most repeatable measurements. Narrower limits of agreement indicate greater consistency compared to Easyshade and X-Rite ShadeVision.

This study investigated the effect of a commonly used immersion disinfectant upon three different impression materials and any subsequent effects on the abrasion resistance, hardness and surface detail reproduction of gypsum casts.A laboratory study.Under standardised conditions a total of 120 impressions were made of a ruled test block using irreversible hydrocolloid (Alginoplast), an 'alginate alternative' addition-cure silicone (Position Penta) and a conventional addition-cure silicone (President). The impressions were examined for surface detail reproduction prior to and after disinfection with Perform-ID. The type III casts were evaluated for surface detail reproduction, surface hardness and abrasion resistance.(1) None of the disinfected alginate specimens could reproduce the 50 microm line. (2) Casts produced from the disinfected alginate were significantly less hard than from disinfected Position Penta and President (P0.001). (3) Disinfection significantly affected the abrasion resistance of casts made from Position Penta (P = 0.029). (4) Disinfection did not significantly affect President or its subsequent casts (P0.05).If disinfecting with Perform-ID, the impression should be made with a conventional addition-cured silicone if good surface detail reproduction of the impression material and a hard and abrasion resistant type III gypsum cast are required.

Objective To conduct a systematic review of the literature on the longevity of routine dental restorations in permanent posterior teeth, and to identify and examine factors influencing its variability. Method Accepted guidelines were followed. An advisory group oversaw the project. Simple Class I and Class II amalgam, composite resin, glass ionomer and cast gold restorations were covered. Comprehensive searching of electronic databases, hand-searching, and location of 'grey' literature, generated 124 research reports. Those considered relevant were assessed for validity and quality according to agreed criteria. The analysis was descriptive. Results Eight of 58 relevant research reports were categorised, according to agreed criteria, as being of satisfactory validity and quality. They suggested that 50% of all restorations last 10 to 20 years, although both higher and lower median survival times were reported. The findings were supported by the totality of studies reviewed. However, variability was substantial. Restoration type, materials, the patient, the operator, the practice environment and type of care system appeared to influence longevity. Conclusions Many studies were imperfect in design. Those considered to be the most appropriate for analysis were too limited to undertake a formal statistical exploration. Therefore there remains a need for definitive randomised controlled trials of restoration longevity, of sound design and adequate power, employing standardised assessments and appropriate methods of analysis.

Objective The aim of this study was to determine the influence of incisal edge embrasure space and interproximal contact area dimensions on perceived smile aesthetics. Design Cross-sectional study. Setting Postgraduate dental teaching hospital. Methods A photograph of a smiling female, displaying only the lips and maxillary teeth was digitally altered. First, the proportions of the incisal edge embrasure spaces were modified to produce five different images. Secondly, the lengths of the interproximal contact areas were altered to produce five different images. The two sets of photographs were ranked from 'most attractive' to 'least attractive' by 35 dentists, 35 dental technicians and 35 patients. Results An embrasure space arrangement where the size of the embrasures increases progressively distally from the midline was deemed most attractive; absence of embrasure spaces was deemed least attractive. In assessing the interproximal contact areas, all groups assessed an arrangement where the areas between the teeth were equal (and 50% the length of the central incisor) as most attractive, and where the contact areas increased in length progressively distally from the midline as least attractive. There were few statistically significant differences between the groups in these perceptions. Conclusion Whilst there is broad agreement in what the participant groups deem to be aesthetic, our findings do not wholly correspond to the 'ideals' that have been previously suggested in the dental literature.

Objective To describe factors which influence the current working patterns of orthodontists in the United Kingdom. Design and setting A cross-sectional postal questionnaire to orthodontic specialists in the United Kingdom. Subjects All those on the specialist list in orthodontics held by the General Dental Council in 2006-2007. Materials and methods The data gathered included demographic details (gender, ethnicity, age, professional status and number of children), calendar year of achieving professional qualifications and current working patterns, together with details of any career breaks taken and geographical location of work. Results The response rate was 81.5%. Male and female orthodontists were seen to have different working patterns. The difference was statistically significant with male orthodontists undertaking clinical work on average 1.5 sessions more per week than their female colleagues. The calendar year of completion of undergraduate studies and the number of children an orthodontist has can significantly affect the number of clinical sessions they work each week. In recent years it has been observed that there is greater ethnic diversity among the workforce but ethnic origin appeared to have a minimal effect on the number of clinical sessions worked each week. The amount and length of career breaks taken by female orthodontists was greater than their male colleagues. In addition, there continues to be an uneven distribution of orthodontists throughout the United Kingdom. Conclusion Many factors influence the current working patterns of orthodontists in the United Kingdom. However, it may be the inequitable regional distribution of orthodontists throughout the United Kingdom which is of greatest significance to orthodontic workforce planning for the future.

Objective To describe the gender and ethnic trends of the United Kingdom orthodontic workforce. Design and setting A cross-sectional survey using a postal questionnaire to specialist orthodontic practitioners in the United Kingdom (2006-2007). Subjects All those on the Specialist List in Orthodontics held by the General Dental Council in October 2006. Materials and methods The data collected using the questionnaire included demographic details (gender, ethnicity, current age, place of birth), undergraduate and postgraduate dental schools attended, calendar years in which professional qualifications were achieved, anticipated year of retirement and geographical location of work place. Results The response rate was 81.5%. There are more male (60.2%) than female (39.8%) orthodontists presently working in the United Kingdom. Minority ethnic groups are better represented amongst the orthodontic workforce than they are in the general population, however their distribution throughout the United Kingdom is uneven. The trends in the results indicate that the gender and ethnic balance of the specialist orthodontic workforce has been changing and the proportion of females and those from non-white ethnic groups has increased. In contrast, the majority of those retiring over the next few years will be white males (60%). Conclusion This study suggests that there will be greater ethnic diversity and more female orthodontists in the future workforce. Consequently, working patterns should be kept under regular review so that an optimal orthodontic service can be maintained in the United Kingdom.

Objective: To investigate awareness and practices of dental trauma first aid (DTFA) in hospital emergency settings and in primary and secondary schools in London. Design: A cross-sectional study using self-administered questionnaires and semi-structured interviews. Setting: Primary and secondary schools and casualty/emergency and walk-in casualty centres in London in 2005. Subjects and methods: A randomly selected sample of 125 schools and a total of 31 walk-in casualty centres, providing services for five randomly selected London boroughs. A person responsible for emergency care of children represented each of these study sites. Results: Response rates of 81.6% and 87% were achieved for schools and casualty/emergency centres respectively. The school respondents who had previously received advice on DTFA were three times more likely to be willing to replant an avulsed tooth compared to those who had not. A third of casualty personnel showed gaps in knowledge in DTFA. Results from schools showed an unwillingness to start emergency action mainly due to perceived inadequacy in knowledge/skills and also for legal reasons. Conclusion: There is the need for further studies focused on the barriers resulting in unwillingness to provide DTFA among school personnel and clarification regarding issues of responsibility and acceptable levels of competence of professionals other than dentists.