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Mira R, Newton JT, Sabbah W. The association between edentulism and progress of multimorbidity over 12 years among older American adults. Community Dent Health 2024; 41:39-43. [PMID: 38078646 DOI: 10.1922/cdh_00150mira05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVES To examine the relationship between edentulism and the progress of multimorbidity, and the role of nutritional intake and behaviours among older Americans. METHODS We used 7 waves (2006-2018) of the Health and Retirement Study, a longitudinal survey of older Americans (number included in analysis 2,224). Edentulism was assessed in 2006 and 2012. Multimorbidity was indicated by 5 self-reported conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Behavioural factors were smoking, excessive alcohol consumption, physical activity, and body mass index. Nutritional intake was calculated by summing 10 nutrients (Protein, Vitamins C, D, B12, E, Calcium, Zinc, Polyunsaturated fatty acids, Folate and ß- carotene). Multilevel models for analysis of longitudinal data were used to assess the association between change in repeated measures of multimorbidity (between 2006 and 2018) and edentulism (2006) adjusting for nutritional intake, behavioural and socioeconomic factors. RESULTS Participants who were edentate in 2006 and 2012 had higher rate-ratios (RR) for change in multimorbidity between 2006 to 2018 (RR: 1.29 and 1.28, respectively). After adjusting for socioeconomic factors, total nutrients and behavioural factors, these RR attenuated to 1.12 (95%CI: 1.06, 1.18) and 1.10 (95%CI: 1.05, 1.16), respectively. Total nutrition was negatively associated with progress of multimorbidity, but after adjusting for socioeconomic and behavioural factors the association became insignificant. Total nutrients rates in 2013 were significantly lower among those who were edentate in 2006 and 2012. CONCLUSION There was a longitudinal association between edentulism and progress of multimorbidity. The relationship appeared to be mediated be behaviours and nutrition.
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Affiliation(s)
- R Mira
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, United Kingdom
| | - J T Newton
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, United Kingdom
| | - W Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, United Kingdom
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Newton JT. Expert commentary: J. T. Newton. Br Dent J 2022; 233:488. [PMID: 36151174 DOI: 10.1038/s41415-022-5036-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J T Newton
- Professor of Psychology as Applied to Dentistry, King´s College London, UK
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McNeil DW, Randall CL, Baker S, Borrelli B, Burgette JM, Gibson B, Heaton LJ, Kitsaras G, McGrath C, Newton JT. Consensus Statement on Future Directions for the Behavioral and Social Sciences in Oral Health. J Dent Res 2022; 101:619-622. [PMID: 35043742 DOI: 10.1177/00220345211068033] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The behavioral and social sciences are central to understanding and addressing oral and craniofacial health, diseases, and conditions. With both basic and applied approaches, behavioral and social sciences are relevant to every discipline in dentistry and all dental, oral, and craniofacial sciences, as well as oral health promotion programs and health care delivery. Key to understanding multilevel, interacting influences on oral health behavior and outcomes, the behavioral and social sciences focus on individuals, families, groups, cultures, systems, societies, regions, and nations. Uniquely positioned to highlight the importance of racial, cultural, and other equity in oral health, the behavioral and social sciences necessitate a focus on both individuals and groups, societal reactions to them related to power, and environmental and other contextual factors. Presented here is a consensus statement that was produced through an iterative feedback process. The statement reflects the current state of knowledge in the behavioral and social oral health sciences and identifies future directions for the field, focusing on 4 key areas: behavioral and social theories and mechanisms related to oral health, use of multiple and novel methodologies in social and behavioral research and practice related to oral health, development and testing of behavioral and social interventions to promote oral health, and dissemination and implementation research for oral health. This statement was endorsed by over 400 individuals and groups from around the world and representing numerous disciplines in oral health and the behavioral and social sciences. Having reached consensus, action is needed to advance and further integrate and translate behavioral and social sciences into oral health research, oral health promotion and health care, and the training of those working to ensure oral health for all.
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Affiliation(s)
- D W McNeil
- West Virginia University, Morgantown, WV, USA
| | | | - S Baker
- University of Sheffield, Sheffield, S. Yorkshire, UK
| | - B Borrelli
- Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | | | - B Gibson
- University of Sheffield, Sheffield, S. Yorkshire, UK
| | - L J Heaton
- University of Washington, Seattle, WA, USA
| | - G Kitsaras
- The University of Manchester, Manchester, UK
| | - C McGrath
- University of Hong Kong Faculty of Dentistry, Hong Kong
| | - J T Newton
- Kings College London, London, England, UK
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Pitts NB, Newton JT, Pow R, Miller N, Mayne C. Dental Policy Lab 3: towards oral and dental health through partnership. Br Dent J 2021; 231:764-768. [PMID: 34921274 PMCID: PMC8683370 DOI: 10.1038/s41415-021-3733-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
The third and last of the successful Alliance for a Cavity-Free Future (ACFF)/King's College London Dental Policy Lab series, held in 2019, focused on outlining how dental and oral health industries could benefit from enabling positive behaviour change in patients and the public, allowing progress towards caries reduction. During a two-day event, experts from across public health, dentists, global multi-national corporations and dental industry start-ups discussed the issue, collaboratively developing ideas around policy, technology, messaging and engagement for change. An analysis of the current trends in oral health laid out how the implications for industry and corporate social responsibility were identified as crucial. The report and accompanying infographic explored in this paper have been well received and acted as a catalyst for future developments in the area. Many elements must be focused on to successfully influence public and patient behaviour change. Prevention-focused practice models must be implemented to ensure patients are provided with optimal preventive interventions, minimising caries risk and the need for future treatment. Changes in regulation and public policy must be seen to free up the dental and oral health industries to innovate and push for developments in caries-reducing technology. Oral health must be placed on corporate social responsibility agendas to ensure that industry is focused on seeing health improvements.
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Affiliation(s)
- Nigel B Pitts
- Faculty of Dentistry, Oral & Craniofacial Sciences, King´s College London, Tower Wing, Guy´s Hospital, London, SE1 9RT, UK.
| | - J Tim Newton
- Faculty of Dentistry, Oral & Craniofacial Sciences, King´s College London, Tower Wing, Guy´s Hospital, London, SE1 9RT, UK
| | - Ross Pow
- Power of Numbers, Cambridgeshire, UK
| | - Nicholas Miller
- Faculty of Dentistry, Oral & Craniofacial Sciences, King´s College London, Tower Wing, Guy´s Hospital, London, SE1 9RT, UK
| | - Catherine Mayne
- Faculty of Dentistry, Oral & Craniofacial Sciences, King´s College London, Tower Wing, Guy´s Hospital, London, SE1 9RT, UK
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Tallamraju H, Newton JT, Fleming PS, Johal A. Intervention to enhance adherence to mandibular advancement appliance in patients with obstructive sleep apnoea: study protocol for a randomised clinical trial. Trials 2021; 22:699. [PMID: 34645490 PMCID: PMC8511865 DOI: 10.1186/s13063-021-05582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background Obstructive sleep apnoea (OSA) is a sleep-related breathing disorder characterised by the repeated episodic collapse of the upper airway during sleep, resulting in sleep deprivation, giving rise to apnoeas and hypopnoeas. Based on the severity of OSA, there are two primary treatment modalities, continuous positive airway pressure (CPAP) and mandibular advancement appliances (MAA); both are adherence-dependent. MAA is offered to those with mild to moderate OSA and is prescribed as an alternative to patients intolerable to CPAP. However, adherence to MAA treatment is variable and declines over time. Hence, the current study aims to assess the effectiveness of the stage-matched intervention, the Health Action Process Approach (HAPA), on adherence to MAA in patients with OSA. Methods A single-centre randomised clinical trial will be undertaken at Bart’s Health NHS Trust. Fifty-six participants with newly diagnosed OSA are planned to be enrolled in the study and randomised to intervention care (IC) and standardised care (SC) groups. Participants in the SC group will receive routine care whilst participants in the IC group will receive the stage-matched intervention, developed using the HAPA model. Data indicating MAA adherence will be collected both objectively and subjectively, from micro-sensors embedded in the MAA design and sleep diaries, respectively at 3, 6, 18 and 36 months. In addition, a range of questionnaires designed to assess risk perception, outcome expectancy, and self-efficacy (SEMSA) and quality of sleep (PSQI and ESS) and life (EQ-5DL), socio-economic and social support scales will be used. Discussion The currently available treatments for obstructive sleep apnoea depend entirely on the patient’s acceptance and use. There are several factors that affect cooperation and wear for example patients’ awareness of their condition, social support and psychological behaviour. In addition, mood, such as anxiety, stress, and depression, may affect wear. At the same time, we know that interventions involving more education and behaviour approaches can help patients adapt more easily to some treatments. As a result, the present trial aims to explore the potential role of these factors to maximise treatment success and minimise side effects. Trial registration ClinicalTrials.gov NCT04092660. Registered on September 6, 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05582-1.
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Affiliation(s)
- Harishri Tallamraju
- Centre of Oral Bioengineering, Institute of Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD, UK.
| | - J Tim Newton
- Department of Population and Patient Health, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Padhraig S Fleming
- Centre of Oral Bioengineering, Institute of Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD, UK
| | - Ama Johal
- Centre of Oral Bioengineering, Institute of Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD, UK
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Tallamraju H, Newton JT, Fleming PS, Johal A. Factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med 2021; 17:1485-1498. [PMID: 33660611 DOI: 10.5664/jcsm.9184] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVES The review aimed to identify the factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea. METHODS The protocol was initially registered with the International Register of Systematic Reviews (Prospero: CRD42019122615) prior to undertaking a comprehensive electronic search of databases and references without language and date restrictions. Quality assessment was undertaken using the Cochrane Collaboration's risk of bias tool and Quality in Prognosis Studies (QUIPS) tool. RESULTS Studies exhibited low or unclear risk of bias for the domains assessed by the respective quality assessment tools. The influence of independent variables such as disease characteristics, patient characteristics, appliance features, and psychological and social factors on adherence levels was also assessed. There was a total of 31 included studies, which consisted of 8 randomized controlled trials, 2 controlled clinical trial, 7 prospective cohorts, 11 retrospective cohorts, and the remaining 3 studies were a case-series, case-control, and a mixed-methods. All 31 included studies were subject to qualitative analysis, with only 4 studies included in the quantitative analysis. Results of the meta-analysis demonstrated increased adherence with custom-made appliances, with a pooled mean difference of -1.34 (-2.02 to -0.66) and low levels of heterogeneity (I² = 0%). CONCLUSIONS A weak relationship was observed between objective adherence and patient and disease characteristics, such as age, sex, obesity, apnea-hypopnea index, and daytime sleepiness, to oral appliance therapy. Nonadherent patients reported more side effects with oral appliance therapy than users and tended to discontinue the treatment within the first 3 months. Custom-made oral appliances were preferred and increased adherence reported in comparison to ready-made appliances. Further research is imperative to examine the relationship between psychosocial factors and adherence to oral appliance therapy.
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Affiliation(s)
- Harishri Tallamraju
- Department of Oral Bioengineering, Institute of Dentistry, Queen Mary University of London, London, United Kingdom
| | - J Tim Newton
- Department of Population and Patient Health, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Padhraig S Fleming
- Department of Oral Bioengineering, Institute of Dentistry, Queen Mary University of London, London, United Kingdom
| | - Ama Johal
- Department of Oral Bioengineering, Institute of Dentistry, Queen Mary University of London, London, United Kingdom
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Newton JT, Subramanian SS, Westland S, Gupta AK, Luo W, Joiner A. The impact of tooth colour on the perceptions of age and social judgements. J Dent 2021; 112:103771. [PMID: 34363891 DOI: 10.1016/j.jdent.2021.103771] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/14/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Psychological research has established that the presence of dental anomalies negatively impact social judgements. This study sought to determine the effects of tooth colour on the subjective ratings of social judgements in a group of Caucasian adults. METHODS A cross sectional experimental analogue design comprised fifty Caucasian adults: 25 women and 25 men. A total of 54 digitally modified photographs of Caucasian males and females (darkened, natural, whitened teeth) were evaluated. All participants evaluated each of the images on 12 characteristics: popularity, friendliness, social life, success, graduation, happiness, intelligence, perceived age, introversion/extraversion, self-confidence, attractiveness and satisfaction with the tooth shade. Analysis of variance (ANOVA) was used to compare ratings. RESULTS Participants associated darkened teeth with poorer subjective ratings, with the highest ratings been given to whitened teeth, and natural teeth being intermediate. These trends were similar across all participant age groups and gender. Further, the gender and age groups of the images had a significant effect on the appraisals. Faces of younger models received higher ratings than the faces of older models and female images were rated higher than the males. CONCLUSION In the absence of other information, tooth colour exerts an influence upon the appraisals made in social situations. It appears that whitened tooth appearance is preferred to natural tooth appearance, irrespective of age and gender of the judge. The faces with more whitened dentition are perceived to be younger across all age groups and gender of the judges. Participants dissatisfied with their own tooth shade drew out more stereotypic behaviour. CLINICAL SIGNIFICANCE STATEMENT This research used standardised tooth colour as a basis to investigate perceived age and social functioning. As clinicians face daily challenges to achieve patient satisfaction with respect to dental aesthetics, standardizing the colour may enhance the patients' satisfaction. Further, participants dissatisfied with their own tooth shade drew out more stereotypic behaviour. The whitened dentition may impair the psychological well-being of the individuals and is probably a reason for the increasing demand for cosmetic dental procedures. These results may be instructive for the development of a psycho-educational intervention to prevent any unrealistic expectations.
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Affiliation(s)
- J T Newton
- King's College London Dental Institute, London, UK
| | | | - S Westland
- University of Leeds, School of Design, Leeds, UK
| | - A K Gupta
- Unilever Oral Care, Bangalore, India
| | - W Luo
- Unilever Oral Care, Bebington, UK
| | - A Joiner
- Unilever Oral Care, Bebington, UK
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Costa LR, Bendo CB, Daher A, Heidari E, Rocha RS, Moreira APDSC, Moura LS, Banerjee A, Newton JT, Hosey MT. A curriculum for behaviour and oral healthcare management for dentally anxious children-Recommendations from the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE). Int J Paediatr Dent 2020; 30:556-569. [PMID: 32112461 DOI: 10.1111/ipd.12635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/11/2020] [Accepted: 02/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dentists need training in the management of children's anxiety (DA), fear (DF) and behaviour management problems (DBMP) but little is known of their competence on this topic. AIM To report dentists' opinions and attitudes about protective stabilisation and pharmacological techniques for the management of children with DA/DF/DBMP; to propose a postgraduate curriculum focussing on DA/DF/DBMP. DESIGN A survey of 301 Brazilian dentists and later a modified Delphi process to outline the curriculum in two phases: (a) face-to-face discussions with 33 early career researchers mentored by six researchers, both from UK and Brazil; (b) online discussions by eight early and senior researchers on the knowledge, experience, and competencies necessary for a specialist in paediatric dentistry in Brazil that should be included in the core curriculum of postgraduate courses. RESULTS Almost all (99.0%) of the survey respondents provide treatment to children with DA/DF/DBMP, and 91.2% do not systematically diagnose these conditions; 94.3% use protective stabilisation, and 20.0%-30.0% have training in pharmacological techniques. The four-domain framework supporting the proposed curriculum is as follows: DA/DF/DBMP assessment, non-pharmacological and pharmacological approaches, and decision-making. CONCLUSION Dental curricula should be customised to solve the misconceptions and promote a comprehensive and positive attitude to DA/DF/DBMP by paediatric oral healthcare practitioners.
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Affiliation(s)
- Luciane R Costa
- Paediatric Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | - Cristiane B Bendo
- Department of Children's and Adolescents' Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Anelise Daher
- Paediatric Dentist, Brazilian Dental Association - Goiás section, Goiânia, Brazil
| | - Ellie Heidari
- Department of Sedation and Special Care Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, UK
| | - Renata Sá Rocha
- Faculty of Dentistry, Universidade Federal de Campina Grande, Patos, Brazil
| | | | | | - Avijit Banerjee
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, UK
| | - J Tim Newton
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Marie T Hosey
- Paediatric Dentistry Centre of Oral Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Abstract
OBJECTIVES To identify an empirical method for identifying patients with 'high expectations' of orthodontic treatment with fixed appliances using a questionnaire-based approach. DESIGN Secondary analysis of data from four studies which collected data on patients' expectations of orthodontic treatment using the same questionnaire. SETTING Secondary care orthodontic services. PARTICIPANTS All four datasets comprised new patients aged 12-15 years, with no history of orthodontic treatment, who fulfilled the criteria for NHS treatment using the Index of Orthodontic Treatment Need (IOTN). Unpublished dataset 1 comprised 100 participants, while dataset 2 had 70 participants, dataset 3 had 67 participants and dataset 4 comprised 40 participants. METHODS The questionnaire utilised in all studies had a question which asked respondents to rate seven different expectations of outcome relating to straight teeth, better smile, ease of eating, speaking, cleaning teeth, improved career prospects and social confidence. Dataset 1 was analysed to determine the proportion of patients who had rated all seven outcome expectation items at a maximum score. Similar analyses were performed for the other three datasets to explore the trend in the proportion of patients with high expectations over time. RESULTS For dataset 1, 2.0% of participants had high expectations, as defined by their scores on the questionnaire. The proportions for the datasets 2, 3 and 4 were 4.0%, 4.5% and 2.5%, respectively. CONCLUSION The method outlined provides an empirical basis for identifying patients with statistically infrequent high expectations. This can potentially help clinicians in the management of such patients.
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Affiliation(s)
- Mark S Sayers
- Department of Orthodontics, Queen Mary's Hospital, Sidcup, King's College Hospital NHS Foundation Trust/King's College, London, UK
| | - Susan J Cunningham
- Department of Orthodontics, University College London, Eastman Dental Institute, London, UK
| | - J Tim Newton
- Centre for Oral, Clinical and Translational Sciences, King's College London, London, UK
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Sampson A, Jeremiah HG, Andiappan M, Newton JT. The effect of viewing idealised smile images versus nature images via social media on immediate facial satisfaction in young adults: A randomised controlled trial. J Orthod 2020; 47:55-64. [DOI: 10.1177/1465312519899664] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: The objective of this randomised controlled trial (RCT) is to investigate the effect of a social networking site (SNS) on body dissatisfaction, facial and smile dissatisfaction, and face-related discrepancy, and whether these effects differ from the use of appearance-neutral Instagram images. We also aimed to investigate whether there are trends in increased self-reported use of social media and increased body dissatisfaction, facial and smile dissatisfaction, and face-related discrepancy. Methods: Undergraduate students were randomly allocated to an experimental group with idealised smile images or to a control group with neutral nature images. They completed pre-exposure questionnaires, then perused for 5 min their allocated images on individual Apple iPads via the Instagram application. Participants then completed the post-exposure surveys. The main outcome was facial dissatisfaction. Body dissatisfaction and total facial and body dissatisfaction were secondary outcomes. Simple randomisation was achieved with a computerised random number generator. Data were analysed using repeated measures ANOVA and multivariate regression analyses. Results: A total of 132 participants (mean age = 20.50 ± 2.21 years) were randomised to either the experimental group with idealised smile images (n=71) or the control group with neutral nature images (n=61). Baseline characteristics were similar between groups and no participants were lost. Exposure to ‘ideal’ facial images on social media decreases facial satisfaction (95% confidence interval [CI] = 0.85–1.05; P < 0.0001). Individuals with high baseline self-discrepancy scores are less satisfied with their facial features and body appearance (95% CI = 0.04–1.16; P = 0.036). Conclusion: This study shows that viewing SNSs with high visual media reduces satisfaction with facial appearance in the short term in men and women. This effect is greater in those with high self-discrepancy scores. Increased media usage was not correlated with increased dissatisfaction. Wearing braces or having had braces was shown not to influence post-exposure dissatisfaction.
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Affiliation(s)
- Ariane Sampson
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
| | - Huw G Jeremiah
- Orthodontic Department, Addenbrooke’s Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Manoharan Andiappan
- Biostatistics and Research Methods Centre, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
| | - J Tim Newton
- Department of Population and Patient Health, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
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Coxon JD, Hosey MT, Newton JT. The oral health of dentally phobic 12- and 15-year-olds: a descriptive analysis of the 2013 Child Dental Health Survey. Br Dent J 2019; 226:595-599. [PMID: 31028328 DOI: 10.1038/s41415-019-0196-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Dental anxiety has been shown to be related to poorer oral health. Limited data exist exploring the relationship between oral health status and dental anxiety in non-clinical populations in children.Aim To compare the oral health of phobic and non-phobic children aged 12 and 15 years.Design Secondary analysis of data from 12-year-old and 15-year-old children in the Child Dental Health Survey 2013.Materials and methods Participants were grouped into non-phobic and phobic groups, depending on their self-reported dental anxiety (MDAS). Descriptive analyses compared the two groups on social demographic factors, clinical status, self-reported oral health status, oral health-related behaviours and oral health impact.Results A total of 601 children were classed as dentally phobic with 4,144 classed as non-phobic. Dental phobic children were more likely to be female, had more active decay and untreated dental disease, and rated their dental health as poorer. Phobic children were more likely to report that their oral health had a negative effect on their everyday life. This group were less likely to brush their teeth regularly or attend the dentist for check-ups.Conclusions Dentally phobic children have more dental disease and express greater impact on their everyday life.
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Affiliation(s)
- James D Coxon
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK.
| | - Marie-Therese Hosey
- Paediatric Dentistry Centre of Oral Clinical and Translational Science Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK
| | - J Tim Newton
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK
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Newton JT, Awojobi O, Nasseripour M, Warburton F, Di Giorgio S, Gallagher JE, Banerjee A. A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum in Dental Caries. JDR Clin Trans Res 2019; 5:214-223. [PMID: 31743654 DOI: 10.1177/2380084419887178] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the difference in level of dental caries in adults and children who chew sugar-free gum (SFG), compared with those who do not chew SFG or use alternatives such as lozenges, candies, rinses, tablets, and other nonchewing controls. METHODS Systematic review of published literature. RESULTS Twelve studies of interventions of SFG for dental caries outcomes were included. SFGs were found to significantly reduce caries increment, giving a preventative fraction (PF) of 28% (95% CI, 7% to 48%). Including the 8 trials that used xylitol gum only as the basis of the intervention, the PF was 33% (95% CI, 4% to 61%). No adverse effects were recorded. There was a high level of heterogeneity among the trials included. CONCLUSION The findings of this review provide tentative evidence that chewing SFG reduces caries increment in comparison to nonchewing controls. However, there is a considerable degree of variability in the effect and the trials included were generally of moderate quality. There is a need for future research to explore the acceptability and feasibility of the use of SFG as a public health intervention (PROSPERO 2018 CRD42018094676). KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by clinicians when deciding how best to implement dental caries prevention regimes for their patients. With consideration of cost and patient preference, this information could help to develop national policy directives on caries prevention and dictate the direction of future clinical research.
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Affiliation(s)
- J T Newton
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, UK
| | - O Awojobi
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, UK
| | - M Nasseripour
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, UK
| | - F Warburton
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, UK
| | - S Di Giorgio
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, UK
| | - J E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, UK
| | - A Banerjee
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, UK
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Ben Gassem A, Foxton R, Bister D, Newton JT. Patients' Acceptability of Computer-Based Information on Hypodontia: A Randomized Controlled Trial. JDR Clin Trans Res 2019; 3:246-255. [PMID: 30938602 DOI: 10.1177/2380084418773992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare patients' acceptability of a hypodontia-specific interactive computer-based education material (ICB-EM) versus a British Orthodontic Society (BOS) hypodontia leaflet. TRIAL DESIGN Two-arm parallel randomized controlled trial, 1:1 allocation ratio. METHODS The study was conducted at a specialized secondary care facility in the Greater London area. Ninety-six new hypodontia patients aged 14 y and older were randomly assigned to the control group ( n = 49) receiving the BOS leaflet or the intervention group ( n = 47) receiving the ICB-EM. The main outcome measure was patients' evaluation of the intervention measured by the treatment evaluation inventory. RESULTS The analyzed sample comprised 76 participants: control group ( n = 38) and intervention group ( n = 38). The mean age of the sample was 19 y (SD = 7.24) and 20.3 y (SD = 6.9) for the control and intervention group, respectively. The intervention group was significantly more satisfied with the ICB-EM than individuals who received the BOS leaflet ( t = -3.53, P = 0.001). CONCLUSION Patients preferred the computer-based information. KNOWLEDGE TRANSFER STATEMENT Patients attending dental care in the 21st century are adept in the use of computerised facilities for obtaining information. The results of the study will provide valuable evidence for clinicians on the level of acceptability of the patients toward interactive computer based health education as opposed to traditional paper leaflets.
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Affiliation(s)
- A Ben Gassem
- 1 Taibah University, Dental College, Madinah, Saudi Arabia
| | - R Foxton
- 2 Kings College London, Dental Institute, Guys Hospital, London, UK
| | - D Bister
- 2 Kings College London, Dental Institute, Guys Hospital, London, UK
| | - J T Newton
- 3 Kings College London, Dental Institute, Denmark Hill, London, UK
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Eliyas S, Briggs PFA, Newton JT, Gallagher JE. Feasibility of assessing training of primary care dental practitioners in endodontics of moderate complexity: mapping process and learning. Br Dent J 2018; 225:325-334. [PMID: 30141484 DOI: 10.1038/sj.bdj.2018.644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 12/28/2022]
Abstract
Objectives To explore the feasibility of measuring quality of endodontic care provided by general dental practitioners (GDPs), using clinical, radiographic and patient-related outcomes, as well as understanding practitioner views and estimating financial costs. Methods Multi-faceted mixed-methods two-part study involving retrospective analysis of the educational component (course assessments, endodontic training blocks and analysis of a sample of teeth treated at the beginning and end of training), and prospective analysis of patients treated by these dentists after completion of training. Participant Dentists working in and patients treated in primary dental care in London. Intervention Twenty-four-month training in endodontics. Comparison Dentists enrolled in the training at different time points. Outcome Measuring outcome of endodontic treatment. Results Eight dentists (mean 36 years, SD = 8.2 years) participated in training. Subsequently, five of these dentists (mean 34.2 years, SD = 7.08 years) contributed to the prospective study and recruited 135 patients. Thirty-five patients completed all patient-related outcome questionnaires, and of these there were 16 cases with complete clinical and radiographic data (12%) at follow-up (10.1–36.4 months). Preliminary analysis revealed that a minimum of 45 cases of complete data would be required for multivariate analysis, requiring the recruitment of in excess of 375 patients to future studies to account for this level of loss to follow-up. Conclusions Findings suggest it is possible to carry out mixed-methods and treatment-related outcome-based research in primary care. Measurement/data capture tools developed were tested and used successfully in measuring the adherence to treatment processes and outcome of endodontic treatment.
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Affiliation(s)
- S Eliyas
- St George's University Hospital's NHS Foundation Trust and Hodsoll House Specialist Practice, Kent, UK
| | - P F A Briggs
- Barts Health NHS Trust, Whitechapel, London, UK.,Health Education England London and South East, Stewart House, Russell Square London, UK
| | - J T Newton
- King's College London Dental Institute, Population and Patient Health Division, London, UK
| | - J E Gallagher
- King's College London Dental Institute, Population and Patient Health Division, London, UK
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Affiliation(s)
- Adina Rosten
- Dental Institute, King’s College London, London, UK
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Faulks D, Dougall A, Ting G, Ari T, Nunn J, Friedman C, John J, Daly B, Roger-Leroi V, Newton JT. Development of a battery of tests to measure attitudes and intended behaviours of dental students towards people with disability or those in marginalised groups. Eur J Dent Educ 2018; 22:e278-e290. [PMID: 28940883 DOI: 10.1111/eje.12292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Recommended curricula in Special Care Dentistry (SCD) outline learning objectives that include the domain of attitudes and behaviours, but these are notoriously difficult to measure. The aims of this study were (i) to develop a test battery comprising adapted and new scales to evaluate values, attitudes and intentions of dental students towards people with disability and people in marginalised groups and (ii) to determine reliability (interitem consistency) and validity of the scales within the test battery. MATERIALS AND METHODS A literature search identified pre-existing measures and models for the assessment of attitudes in healthcare students. Adaptation of three pre-existing scales was undertaken, and a new scale was developed based upon the Theory of Planned Behaviour (TPB) using an elicitation survey. These scales underwent a process of content validation. The three adapted scales and the TPB scale were piloted by 130 students at 5 different professional stages, from 4 different countries. RESULTS The scales were adjusted to ensure good internal reliability, variance, distribution, and face and content validity. In addition, the different scales showed good divergent validity. DISCUSSION These results are positive, and the scales now need to be validated in the field. CONCLUSIONS It is hoped that these tools will be useful to educators in SCD to evaluate the impact of teaching and clinical exposure on their students.
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Affiliation(s)
- D Faulks
- Université Clermont Auvergne, EA4847 CROC, and CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
| | - A Dougall
- Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - G Ting
- Dental Institute, King's College Hospital NHS Foundation Trust, London, UK
| | - T Ari
- Division of Paediatric dentistry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - J Nunn
- Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - C Friedman
- Paediatric Oral Health & Dentistry, London, ON, Canada
| | - J John
- Faculty of Dentistry, Department of Restorative Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - B Daly
- Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - V Roger-Leroi
- Université Clermont Auvergne, EA4847 CROC, and CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
| | - J T Newton
- Department of population and Patient Health, King's College London Dental Institute, London, UK
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Al-Kharboush GH, Asimakopoulou K, AlJabaa AH, Newton JT. The role of social comparison in social judgments of dental appearance: An experimental study. J Dent 2017; 61:33-38. [DOI: 10.1016/j.jdent.2017.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022] Open
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Abstract
To examine the perceived acceptability of compulsory detention in treatment of an individual with severe anorexia nervosa amongst a sample of members of the general population, 151 participants read vignettes describing the compulsory detention of a female patient with a Body Mass Index of 12.4. The vignettes systematically varied along three dimensions: patients' reaction, immediate outcome (psychological state), and long-term outcome (attendance at out-patient appointments). Acceptability was measured using the Treatment Evaluation Inventory. There were significant main effects of psychological outcome and the long-term treatment outcome. The main effect of the patients' reaction to the detention was not significant, but there was a significant interaction for psychological outcome and long-term outcome, such that good attendance at out-patient appointments increased ratings of acceptability more markedly when a good psychological outcome had been secured. The outcome of treatment exerts a strong influence on ratings of acceptability. Individuals who have no direct experience with eating disorders endorse treatments that are effective irrespective of the patients' feelings about the treatment.
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Affiliation(s)
- J T Newton
- Division of Dental Public Health and Oral Health Services Research, GKT Dental Institute, King's College London, King's College Hospital, London SE5 9RW, UK.
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Aljabaa A, McDonald F, Newton JT. A Randomized Controlled Trial to Compare 3 Methods Designed to Enhance Adherence among Orthodontic Patients. JDR Clin Trans Res 2016; 1:59-68. [PMID: 30931694 DOI: 10.1177/2380084415627130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to compare 3 methods designed to enhance adherence to oral hygiene instructions in orthodontic patients: mind map, if-then plan, and leaflet. The study was a 3-arm parallel trial involving 90 orthodontic patients. The 3 groups were mind mapping, if-then planning, and patient information tools (leaflet). Group allocation was randomized in a 1:1:1 ratio. Allocation was concealed using sealed envelopes. The participant and their parents as well as the researcher undertaking the intervention and assessing the outcomes were not blinded. The statistician undertaking the analysis was blinded. Primary outcomes were plaque levels and bleeding point index. Secondary outcomes were patients' knowledge of behaviors deemed important during orthodontic treatment and self-reported behavior. Participants were assessed at 4 time points: at the fitting of the fixed appliance (T1), at initial follow-up 6 wk later (T2, at which time they were randomly allocated to the 3 groups of intervention), 6 wk after the intervention (T3), and 18 wk postintervention (T4). Mean levels of buccal and lingual plaque, as well as the proportion of sites with bleeding sites, showed no significant differences over time (buccal plaque, Ftime = 3.74, P = 0.06; lingual plaque, Ftime = 2.78, P = 0.06; bleeding on probing, Ftime = 0.68, P = 0.51) or between interventions over time (buccal plaque, Fint × Ftime = 0.38, P = 0.68; lingual plaque, Fint × Ftime = 0.30, P = 0.88; bleeding on probing, Fint × Ftime = 0.70, P = 0.59). There were no harmful consequences detected for any of the interventions. No single method of presenting the information proved superior to any other. This trial was registered with the Guy's & St Thomas's NHS Trust Research & Development Database. Knowledge Transfer Statement: Enhancing patient adherence to advice given by their clinician is an important component of orthodontic treatment. This study explored the use of structured techniques to enhance adherence. All 3 techniques enhanced adherence over the 18-wk study period when orthodontic treatment was being provided, but no single method proved superior to any other.
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Affiliation(s)
- A Aljabaa
- 1 Social & Behavioural Sciences, Division of Population & Patient Health, King's College London, London, UK
| | - F McDonald
- 2 Division of Craniofacial Development and Stem Cell Biology, King's College London, London, UK
| | - J T Newton
- 1 Social & Behavioural Sciences, Division of Population & Patient Health, King's College London, London, UK
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Al-Dabaan R, Asimakopoulou K, Newton JT. Effectiveness of a web-based child protection training programme designed for dental practitioners in Saudi Arabia: a pre- and post-test study. Eur J Dent Educ 2016; 20:45-54. [PMID: 25655568 DOI: 10.1111/eje.12141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2015] [Indexed: 06/04/2023]
Abstract
AIM Safeguarding children is an integral part of dental training and practice. The purpose of this research was to evaluate a web-based training program in child protection on dental practitioners' knowledge and practice in Saudi Arabia. In addition, participants' views of the course were also assessed. METHOD Pre-, immediately post-training, and one month post-training knowledge and self reported behaviour were assessed following completion of an online training course in child protection by 82 dental practitioners working in Saudi Arabia. RESULTS Eighty-two participants completed the whole training package and 62 completed the one month post-training survey. A significant increase in knowledge was found immediately after taking part in the child protection training program in comparison to baseline knowledge (P < 0.001). The course was highly rated by those who completed it. At one month following the training program, 21% have or intend to adopt a child protection policy in their practice, 29% identified a staff member to lead on child protection since completing the program, almost all participants have been aware of child abuse and neglect (CAN) signs in their daily practice and 27.4% have made a report of a suspected case of CAN in the last month since the training. CONCLUSION The web-based training program in child protection was appraised positively and was effective in increasing knowledge and changing attitudes towards safeguarding children.
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Affiliation(s)
- R Al-Dabaan
- Paediatric Dentistry Division, Department of Paediatric Dentistry and Orthodontics, King Saud University College of Dentistry, Riyadh, Saudi Arabia
- Unit of Social & Behavioural Sciences, King's College London Dental Institute, London, UK
| | - K Asimakopoulou
- Unit of Social & Behavioural Sciences, King's College London Dental Institute, London, UK
| | - J T Newton
- Unit of Social & Behavioural Sciences, King's College London Dental Institute, London, UK
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Abstract
This study explored the association between income inequality and use of dental services and the role that investment in health care plays in explaining that association. We pooled individual-level data from 223,299 adults, 18 years or older, in 66 countries, who participated in the World Health Organization (WHO) World Health Surveys with country-level data from different international sources. Income inequality was measured at the national level using the Gini coefficient, and use of dental services was defined as having received treatment to address problems with mouth and/or teeth in the past year. The association between the Gini coefficient and use of dental services was examined in multilevel models controlling for a standard set of individual- and country-level confounders. The individual and joint contributions of 4 indicators of investment in health care were evaluated in sequential modeling. The Gini coefficient and use of dental services were inversely associated after adjustment for confounders. Every 10% increase in the Gini coefficient corresponded with a 15% lower odds of using dental services (odds ratio: 0.85; 95% confidence interval: 0.70-0.99). The association between the Gini coefficient and use of dental services was attenuated and became nonsignificant after individual adjustment for total health expenditure, public expenditure on health, health system responsiveness, or type of dental health system. The 4 indicators together explained 80% of the association between the Gini coefficient and use of dental services. This study suggests that more equal countries have greater use of dental services. It also supports the mediating role of investment in health care in explaining that association.
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Affiliation(s)
- B Bhandari
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, London, UK
| | - J T Newton
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, London, UK
| | - E Bernabé
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, London, UK
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Travess HC, Newton JT, Sandy JR, Williams AC. The development of a patient-centered measure of the process and outcome of combined orthodontic and orthognathic treatment. J Orthod 2014; 31:220-34; discussion 201-2. [PMID: 15489366 DOI: 10.1179/146531204225022434] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this study was to develop a patient-based measure of the process and outcome of combined orthodontic and orthognathic care in the National Health Service in the UK. DESIGN Identification of relevant dimensions through qualitative methods, design of form, determination of psychometric properties of the scale, specific readability, reliability and validity. SETTING NHS hospitals in the South West Region. SUBJECTS The sample comprised patients who had received combined orthodontic and orthognathic treatment between 01 January 1998 and 31 December 2000. Twenty-six participants (a 25% response rate) took part in four focus group meetings. Thirty subjects (65% response rate) took part in a pilot study to test the properties of the questionnaire. MAIN OUTCOME MEASURES Six broad themes emerged from the focus groups. These formed the basis of the sections in the questionnaire. RESULTS The questionnaire developed had a Flesch reading ease score of 72.9 or US grade level 4 equivalent to aged 9-10 years. Test-retest reliability gave kappa values for most questions that exceeded 0.4. Criterion validity of the measure was established by comparing responses to the questionnaire over two periods with a telephone interview on a sample of 30 patients. Criterion related validity was poor for nine of the 16 items. By contrast the construct validity of the questionnaire was satisfactory. CONCLUSION A patient-based measure of the process and outcome of combined orthodontic and orthognathic treatment has been developed. This has sufficient validity and reliability for use in inter-center audit projects.
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Abstract
OBJECTIVE To describe patients' and their parents' expectations of orthodontic treatment. DESIGN A questionnaire survey of 100 patients and their primary care-givers attending a new patient orthodontic consultant clinic, at a teaching hospital. SETTING GKT Orthodontic Department, King's College Dental Hospital, London, UK. SUBJECTS The sample consisted of 100 participants who completed the questionnaire, including 50 patients aged 12-14 years who had been referred to the orthodontic department for treatment. One parent of each patient was also invited to participate. MATERIALS AND METHODS Participants completed a valid questionnaire measure of orthodontic expectations that was tested for reliability and validity. Descriptive analysis of the responses was undertaken, and comparisons of children's and parents' expectations, in addition to ethnicity, were made. RESULTS Patients and parents have similar expectations of treatment, with the exception of expectations of duration of orthodontic treatment (P<0.01), having a brace fitted at the initial visit (P<0.05), and restrictions with regard to what one can eat and drink as a result of orthodontic treatment (P<0.05). Among the patient participants, different ethnic groups displayed different expectations of the initial orthodontic assessment visit, the likelihood of wearing headgear, the impact of orthodontic treatment on diet, and the reaction of peers to treatment (P<0.05). For patients, ethnic group differences were reported for expectations regarding the initial visit, headgear and dietary restrictions (P<0.05). CONCLUSIONS Patients and their parents share similar expectations of orthodontic treatment for most aspects of care, although parents are more realistic in their estimation of the duration of treatment and the initial visit. The expectations of patients differ from those of their parents with regard to dietary and drink restrictions in relation to orthodontic treatment. Ethnicity significantly influences expectations of orthodontic treatment, and this may relate to differences in the patients' and their parents' assessed outcome of care.
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Affiliation(s)
- M S Sayers
- Orthodontic Department, Eastman Dental Institute, London WC1X 8LD, UK.
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Abstract
The objectives of this study were 1) to provide an estimate of the value of the intraclass correlation coefficient (ICC) for dental caries data at tooth and surface level, 2) to provide an estimate of the design effect (DE) to be used in the determination of sample size estimates for future dental surveys, and 3) to explore the usefulness of multilevel modeling of cross-sectional survey data by comparing the model estimates derived from multilevel and single-level models. Using data from the United Kingdom Adult Dental Health Survey 2009, the ICC and DE were calculated for surfaces within a tooth, teeth within the individual, and surfaces within the individual. Simple and multilevel logistic regression analysis was performed with the outcome variables carious tooth or surface. ICC estimated that 10% of the variance in surface caries is attributable to the individual level and 30% of the variance in surfaces caries is attributable to variation between teeth within individuals. When comparing multilevel with simple logistic models, β values were 4 to 5 times lower and the standard error 2 to 3 times lower in multilevel models. All the fit indices showed multilevel models were a better fit than simple models. The DE was 1.4 for the clustering of carious surfaces within teeth, 6.0 for carious teeth within an individual, and 38.0 for carious surfaces within the individual. The ICC for dental caries data was 0.21 (95% confidence interval [CI], 0.204-0.220) at the tooth level and 0.30 (95% CI, 0.284-0.305) at the surface level. The DE used for sample size calculation for future dental surveys will vary on the level of clustering, which is important in the analysis-the DE is greatest when exploring the clustering of surfaces within individuals. Failure to consider the effect of clustering on the design and analysis of epidemiological trials leads to an overestimation of the impact of interventions and the importance of risk factors in predicting caries outcome.
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Affiliation(s)
- M Masood
- Centre of Population Oral Health & Clinical Prevention Studies, Faculty of Dentistry, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Y Masood
- Centre of Studies for Oral Pathology, Faculty of Dentistry, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - J T Newton
- Unit of Dental Public Health and Oral Health Services Research, King's College Dental Institute, King's College London, Denmark Hill, London, UK
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Affiliation(s)
- J T Newton
- Unit of Social and Behavioral Sciences, King's College London Dental Institute, Bessemer Road, London, UK
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Moore R, Newton JT. The role of the general dental practitioner (GDP) in the management of abuse of vulnerable adults. ACTA ACUST UNITED AC 2012; 39:555-6, 558-9, 562-4. [DOI: 10.12968/denu.2012.39.8.555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R Moore
- Unit of Social and Behavioural Sciences, King's College London Dental Institute, Floor 26 Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - J T Newton
- Unit of Social and Behavioural Sciences, King's College London Dental Institute, Floor 26 Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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Bernabé E, Newton JT, Uutela A, Aromaa A, Suominen AL. Sense of coherence and four-year caries incidence in Finnish adults. Caries Res 2012; 46:523-9. [PMID: 22889725 DOI: 10.1159/000341219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/17/2012] [Indexed: 11/19/2022] Open
Abstract
This study assesses whether sense of coherence (SOC) predicts incidence of tooth decay over 4 years and the role of dental behaviours in explaining the effect of SOC on incidence of tooth decay. Data from 994 adults who participated in both the Health 2000 survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed for this study. At baseline, participants provided information on demographic characteristics, education level, the SOC scale and dental behaviours (tooth brushing frequency, dental attendance and sugar intake frequency). The 4-year incidence of tooth decay was calculated using data from baseline and follow-up clinical oral examinations. Baseline SOC was significantly related to 4-year incidence of tooth decay after adjustment for demographic factors and education (relative risk: 0.79, 95% CI: 0.63-0.98). This effect was fully attenuated after further adjustment for the three dental behaviours. Tooth brushing frequency and dental attendance were the only dental behaviours significantly related to incidence of tooth decay. This prospective study suggests that SOC predicts incidence of tooth decay and that dental behaviours may help explaining why adults with strong SOC have lower risk of developing tooth decay than those with weak SOC.
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Affiliation(s)
- E Bernabé
- Unit of Dental Public Health, King's College London Dental Institute, London, UK.
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Soheilipour S, Scambler S, Dickinson C, Dunne SM, Burke M, Jabbarifar SE, Newton JT. Antibiotic prophylaxis in dentistry: part II. A qualitative study of patient perspectives and understanding of the NICE guideline. Br Dent J 2011; 211:E2. [PMID: 21738165 DOI: 10.1038/sj.bdj.2011.525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND The National Institute for Health and Clinical Excellence (NICE) recommendations in 2008 for antibiotic prophylaxis before dental treatment contradict previous practice. There is a potential difficulty in explaining the new guidance to patients who have long believed that they must receive antibiotics before their dental treatment. AIM This study investigated the patient-related barriers and facilitating factors in implementation of the NICE guidance. METHODS In-depth interviews were conducted with nine patients concerning their views about barriers and factors that could influence the implementation of the NICE guidance on antibiotic prophylaxis before dental treatment. Data were analysed using framework analysis. RESULTS For patients the rationale for the NICE guidance was unclear. They understood that at the population level the risk of infective endocarditis was less than the risk of adverse reaction to antibiotics. However, on an individual level they felt that the latter risk was negligible given their previous experience of antibiotics. They were aware that standards of care change over time but were concerned that this may be an example where a mistake had been made. Patients felt that the characteristics of the person advising them about the new guidance were important in whether or not they would accept them - they wished to be advised by a clinician that they knew and trusted, and who was perceived as having appropriate expertise. CONCLUSIONS Patients generally felt that they would be most reassured by information provided by a clinician who they felt they could trust and who was qualified to comment on the issue by respecting their autonomy. The implications of the findings for the development of patient information are discussed.
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Affiliation(s)
- S Soheilipour
- Department of Oral Health Services Research & Dental Public Health, GKT Dental Institute, King's College London, Caldecot Road, Denmark Hill, London, SE5 9RW.
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Affiliation(s)
- J Tim Newton
- Professor of Psychology as Applied to Dentistry, King's College London, Oral Health Services Research & Dental Public Health, Denmark Hill Campus, London, UK
| | - Crispian Scully
- Harley St Clinic, UCL, and Universities of Bristol, UK and Granada
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Abstract
UNLABELLED This paper outlines the features and presentation of body dysmorphic disorder (BDD), a psychological syndrome which results in patients seeking treatment for an imagined defect in appearance. The assessment of patients with suspected body dysmorphic disorder is outlined, as well as management strategies. CLINICAL RELEVANCE Clinicians working in the field of aesthetic dentistry should be aware that some patients presenting for treatment may have body dysmorphic disorder. Aesthetic dental treatment for such patients is not beneficial and carries some risks. Advice for clinicians on assessment and management is outlined.
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Affiliation(s)
- Suzanne E Scott
- King's College London Dental Institute, Denmark Hill Campus, Bessemer Road, London SE5 9RW, UK
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Fedorowicz Z, Newton JT. Evidence based healthcare: encouraging the adoption of a new philosophy of care. J Appl Oral Sci 2010; 18:S1678-77572010000400001. [PMID: 20835564 PMCID: PMC5349076 DOI: 10.1590/s1678-77572010000400001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Affiliation(s)
- H G Jeremiah
- Department of Orthodontics, King's College London Dental Institute, UK.
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Somani A, Newton JT, Dunne S, Gilbert DB. The impact of visible dental decay on social judgements: comparison of the effects of location and extent of lesion. Int Dent J 2010; 60:169-174. [PMID: 20684442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Previous research has established that people can make social judgements about someone else based on the condition of that person's teeth. The characteristics of visible tooth decay, with respect to the effect on such social judgements, have not, however, been subject to extensive investigation. This study sought to determine whether the position of visible decay and/or the extent of the lesion are determining factors in such social judgements of each other. METHOD In a between subjects design, 100 young people were randomly divided into 4 groups of 25 and each group shown a differently computer-modified photograph of the same person. Extent and location of the lesion were varied systematically. Participants were asked to rate the person in the photograph with respect to intellectual ability, social competence and psychological adjustment. The scores from those questions were analysed with one way analysis of variance (ANOVA) then Tukey's HSD where ANOVA revealed significant differences. RESULTS The data confirmed previous studies that have shown that poor dental condition is highly correlated with perceived poor social performance and intellectual ability. Further, the data showed that with respect to the constructs of intellectual ability, extraversion and care for one's personal appearance, a more central position of caries is more predictive of poor social judgements than just the presence of visible decay, or even twice the amount of decay. We discuss the possible evolutionary and ontological reasons for making social judgements that are influenced by a person's dental health as well as considering the implications of our findings for dentists.
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Affiliation(s)
- A Somani
- King's College London Dental Institute, London, UK
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Newton JT, Scambler S. Use of qualitative data in oral health research. Community Dent Health 2010; 27:66-67. [PMID: 20648881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
OBJECTIVE The objective of this study was to describe the patterns of dental service use among homeless people using a targeted dental service from 1992 to 2001. METHOD A case-note review of a selection of patients (n = 204) was undertaken using a pre-designed data abstraction form. RESULTS For those presenting at their first contact, 40 percent (n = 68) expressed need in relation to oral pain and disease/tissue damage, and 28 percent (n = 33) in relation to dental checking and oral prophylaxis. Most homeless people had normative need for dental treatment (93 percent: n = 153). The dental service was delivered using a mix of outreach and fixed site clinics, with 75 percent (n = 153) of all first contacts made at outreach clinics. The targeted service was moderately successful at getting people to attend the fixed site service for continuing care, with 51 percent (n = 87) attending for subsequent visits. Location of first contact with the targeted dental service did not predict subsequent attendance. Those who did attend for further care tended to have normative needs for periodontal disease and dental decay and have their presenting complaint met. Only 23 percent (n = 46) of people completed a treatment plan, over a mean of 8.2 (standard deviation +/- 9.4) visits. No factors appeared to predict completion of treatment. CONCLUSIONS While the small sample limits the findings in this study, it is hypothesized that the presence of the dental service promoted uptake of dental care. Flexible attendance tended to result in multiple visits and delayed outcomes, which themselves could have acted as barriers to care.
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Affiliation(s)
- Blánaid Daly
- The Oral Health, Workforce & Education Group, Kings College London Dental Institute, Denmark Hill Campus, UK.
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Abstract
Effective communication has benefits for both patients and members of the health care team. Five main communication tasks in head and neck cancer are identified: Screening for head and neck cancer and communicating risk; Communicating the diagnosis of head and neck cancer; Providing information about treatment and pre-treatment; Communicating following treatment and dealing with fear of recurrence; Discussing the end of life. For each specific aspects of the communication situation are discussed. Underpinning each is the use of core communication skills.
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Affiliation(s)
- J Tim Newton
- King's College London, Oral Health Services Research and Dental Public Health, Denmark Hill Campus, London SE5 9RW, UK.
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Blum IR, Jagger DC, Newton JT, Wilson NHF. The Opinions of Manufacturers of Resin-Based Composite Materials towards the Repair of Failing Composite Restorations. ACTA ACUST UNITED AC 2009; 16:149-53. [DOI: 10.1308/135576109789389487] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aim To investigate the opinions of manufacturers of resin-based composite (RBC) towards the repair of their materials. Methods Representatives of 20 manufacturers of RBC were electronically mailed a questionnaire seeking information on aspects of the repair of direct composite restorations. Results The response rate was 100%. The findings indicated that although the majority of respondents regarded repair as a viable option for managing failing direct RBC restorations, marked variations were found to exist regarding recommendations for and contra-indications to performing repairs of RBC restorations. Conclusions Within the limitations of the current study, the following conclusions can be drawn: (1) the majority of manufacturers of RBC materials are aware and in favour of repair as opposed to replacement of defective composite restorations; (2) there is a need for manufacturers to produce guidelines for repair of their materials; and (3) there is a need for robust randomised controlled dental practice-based clinical studies in the field of repair of composite restorations.
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Affiliation(s)
- Igor R Blum
- Bristol Dental Hospital & School, University of Bristol, UK
| | | | - J Tim Newton
- King's College London Dental Institute at Guy's, King's College and St Thomas’ Hospitals, London, UK
| | - Nairn HF Wilson
- King's College London Dental Institute at Guy's, King's College and St Thomas’ Hospitals, London, UK
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Abstract
AIM This study sought to explore whether viewing a leaflet explaining the benefits of dental treatment would have a significant impact on children's anticipatory anxiety. METHOD Fifty children aged 8-12, attending the paediatric dental clinic of King's College Hospital, London, took part in this triple-masked, randomized control study. The participants were randomly allocated to one of two groups and either shown an intervention leaflet containing child-friendly dental information (the experimental group) or a leaflet with child-friendly information on the benefits of healthy eating (the control group). Using the Facial Image Scale, anxiety was measured when the children arrived for their dental appointment, once before reading the leaflet and again after reading the leaflet. RESULTS There was no statistically significant effect of the experimental leaflet on self-reported anxiety levels in this study, although anxiety levels did drop slightly in both groups after reading a leaflet. CONCLUSIONS Providing paediatric patients with preparatory information about what to expect from a visit to the dentist had no effect on anticipatory anxiety in comparison to reading a leaflet about healthy eating. We speculate that reading, or cognitive processing, may have some beneficial effect. Future work should investigate this possibility.
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Affiliation(s)
- Funmi Olumide
- King's College London Dental Institute, Department of Oral Health Services Research & Dental Public Health, King's College London, London SE5 9RW, UK
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Denton DA, Newton JT, Bower EJ. Occupational burnout and work engagement: a national survey of dentists in the United Kingdom. Br Dent J 2009; 205:E13; discussion 382-3. [PMID: 18849939 DOI: 10.1038/sj.bdj.2008.654] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the levels of burnout and work engagement among dentists in the United Kingdom.Study design Postal survey of 500 dentists selected at random from the General Dental Council register. METHODS Respondents completed a questionnaire pack comprising the Utrecht Work Engagement Scale (UWES-17) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), together with questions on demographic characteristics. RESULTS Approximately 8% of respondents had scores suggestive of burnout on all three scales of the MBI-HSS and a further 18.5% had high scores in two of the domains. Eighty-three percent of respondents had work engagement scores suggestive of moderate or high work engagement. Dentists with postgraduate qualifications and those who work in larger teams had lower burnout scores and more positive work engagement scores. Dentists who spend a greater proportion of their time in NHS practice showed lower work engagement and higher levels of burnout. CONCLUSIONS Burnout affects a small but significant proportion of dental practitioners in the United Kingdom. A larger proportion of practitioners show low work engagement, suggesting a negative attitude to their work. Higher burnout scores and lower work engagement scores were found in dentists without postgraduate qualifications, those in small teams and in those who spend a greater proportion of their time in NHS practice.
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Affiliation(s)
- D A Denton
- Oral Health Services Research & Dental Public Health, King's College London Dental Institute, King's College Hospital, London
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Abstract
DESIGN A block randomised controlled trial was conducted. INTERVENTION Patients in the music (test) group listened to selected sedative music using headphones throughout the root canal treatment procedure. The control group subjects wore headphones but without the music. OUTCOME MEASURE Anxiety was measured before the study and at the end of the treatment procedure. Patients' heart rate, blood pressure and finger temperature were measured before the study and every 10 min until the end of the root canal treatment procedure. RESULTS The results revealed that there were no significant differences between the two groups for baseline data and procedure-related characteristics, except for gender. The subjects in the music group, however, showed a significant increase in finger temperature and a decrease in anxiety score over time compared with the control group. The effect size for state anxiety and finger temperature was 0.34 and 0.14, respectively. CONCLUSIONS Relaxing music administered through headphones to subjects during root canal treatment decreased the procedure-related anxiety of the patients and significantly increased finger temperature, but does not significantly affect blood pressure and heart rate over the procedure.
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Martinelli E, Palmer RM, Wilson RF, Newton JT. Smoking behaviour and attitudes to periodontal health and quit smoking in patients with periodontal disease. J Clin Periodontol 2008; 35:944-54. [DOI: 10.1111/j.1600-051x.2008.01324.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Background In order to comply with clinical governance requirements and receive payments under the Qualities and Outcomes Framework, GPs are required to undertake an annual survey of patient experience using a validated assessment tool. Dentists, in contrast, have embryonic clinical governance structures. The provision of quality dental services was identified in NHS Dentistry: Options for Change as a priority for the future. In anticipation of the PCT role in commissioning quality NHS dental care, Croydon PCT has developed an instrument to examine various aspects of the patient experience. Methods A review of existing literature identified five generic dimensions of patient satisfaction with dental care: technical competence, interpersonal factors, convenience, costs and facilities. The dental practice assessment questionnaire was developed to cover all of these dimensions using a number of validated measures and modified questions. A small scale pilot was undertaken before the questionnaire was sent to a 10% random stratified sample of the PCT population. Results Validation analyses were undertaken in conjunction with the GKT Dental Institute. Cronbach's alpha demonstrated very high levels of internal consistency, and factor analysis and correlation coefficients demonstrated high levels of factorial and concurrent validity respectively. Subgroup analysis revealed differences in reported satisfaction by age and ethnic group, and that those who attend because of pain or a dental emergency are generally less satisfied with the care they receive. These results are consistent with previous research findings. Conclusion The dental practice assessment questionnaire is a valid and consistent measurement tool. Its use could be extended across the NHS without difficulty.
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Ayers K, Thomson WM, Whyman RA, Rich AM, Newton JT. Changes in the New Zealand dentist workforce over a nine-year period. N Z Dent J 2008; 104:19-26. [PMID: 18401940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To identify and describe trends in the NZ dentist workforce over a nine-year period. METHODS Data from the 1997, 2001 and 2005 DCNZ workforce questionnaires were collated and analysed using both cross-sectional and longitudinal methods. RESULTS 2088 dentists completed the workforce questionnaire in at least one of these years, and 1026 (49.1%) did so in all three of them. Substantial changes occurred in the NZ dentist workforce over the observation period. The proportion of women and overseas-trained dentists in the workforce continued to increase, along with the mean age of dentists. There was a large decrease in the number of hours worked per week by specialist dentists (who still worked more hours than dentists), but there was no clear trend for general dentists. Increasing numbers of dentists appear to be opting for part-time work; the main reasons for doing so included personal choice, parental responsibilities, and semi-retirement. There was a trend for fewer dentists to be working in small towns, mainly through dentists leaving (or retiring) and not being replaced, rather than dentists moving from towns to the cities. Rural dentists and female practitioners were less likely to achieve the continuing professional development (CPD) target than their colleagues. In 1997, fewer overseas-qualified dentists (than NZ graduates) were self-employed and had undertaken 20 hours CPD, and a larger proportion worked in small towns. However, these differences were not evident in the later years. CONCLUSION The New Zealand dental workforce continues to change, particularly with respect to gender mix, age, work circumstances and CPD activities.
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Abstract
The Treatment Evaluation Inventory (TEI) is a commonly used 19-item measure of treatment acceptability. It yields a total score and Patient Progress and Acceptability subscales. The internal consistency and factor structure of the TEI were assessed in two samples, 218 members of the general public and 131 dental students. The total and both subscales had very high internal consistency (alpha for total scale = .96 and .94 in the two samples; alphas for Patient Progress .95 and .92; alphas for Acceptability .90 and .86). Factor analysis yielded a two-factor solution that accounted for 64.4% and 54.0% of the variance, but which did not correspond to the two existing subscales. A second analysis examined the distribution of TEI scores and correlations with two other measures of treatment acceptability (a thermometer rating scale and a 5-point Likert-type scale) in a sample of 222 undergraduate students. All measures were negatively skewed. There were large, significant correlations between the full scale TEI and the other measures, so the full TEI has concurrent validity. However, the TEI did not meet Anastasi's (1976) criterion for independent and useful subscales, therefore only the full scale score should be used.
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Affiliation(s)
- J T Newton
- Oral Health Services Research & Dental Public Health, King's College London Dental Institute, King's College London, UK.
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Abstract
BACKGROUND Submucous cleft palate (SMCP) is a common congenital malformation of the soft palate which may present as velopharyngeal insufficiency (VPI), which can affect the quality and intelligibility of speech. Surgical techniques, which can be used to reconstruct these structural or anatomical defects and to correct velopharyngeal insufficiency, include palatal repair and procedures that rearrange the muscle attachments of the soft palate. OBJECTIVES To provide reliable evidence regarding the effectiveness of surgical interventions to treat velopharyngeal insufficiency and improve speech in patients with submucous cleft palate. SEARCH STRATEGY We searched the Cochrane Oral Health Group Trials Register (to 21st December 2006); Cochrane Developmental, Psychosocial and Learning Problems Group Trials Register (on 12th March 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4); MEDLINE (from 1966 to 21st December 2006); EMBASE (from 1980 to 21st December 2006); and CINAHL, ERIC, PsycINFO (on 7th March 2007). SELECTION CRITERIA Randomised controlled trials comparing surgical interventions to correct velopharyngeal insufficiency in submucous cleft palate. DATA COLLECTION AND ANALYSIS Limited data from one included trial precluded pooling of data, and only a descriptive summary is presented. MAIN RESULTS This review included one trial, involving 72 participants aged 4 to 7 years with submucous cleft palate associated velopharyngeal insufficiency, which compared minimal incision palatopharyngoplasty (MIPP) to MIPP with additional velopharyngeal surgery, either pharyngeal flap (32) or sphincter pharyngoplasty (3). The trial provided no information about post-operative speech assessment, very limited data on any instrumental assessments and there were no reports of obstructive sleep apnoea or other adverse effects after the interventions. Complete closure occurred in 32 (86%) of the participants in the MIPP group and in 31 (89%) in the additional treatment group, P > 0.05. After eliminating the nine patients with residual velopharyngeal insufficiency, the post-operative gap size during closure was 7.4 +/-3.2% in the MIPP group and 8 +/-4.1% in the additional intervention group (P > 0.5). AUTHORS' CONCLUSIONS The trial provided some weak and unreliable evidence that there was no significant difference in the effectiveness of minimal incision palatopharyngoplasty versus the same procedure performed simultaneously with an individually tailored pharyngeal flap or sphincter pharyngoplasty for correcting velopharyngeal insufficiency associated with submucous cleft palate.
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Affiliation(s)
- M Nasser
- Shaheed Beheshti University of Medical Sciences, Dental School, Afrigha Street, West Ghobadian, No 4.58, App 4, Tehran, Iran, 1968936118.
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Ayers KMS, Meldrum A, Thomson WM, Newton JT. The working practices and career satisfaction of dental therapists in New Zealand. Community Dent Health 2007; 24:257-263. [PMID: 18246845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To describe the working practices and level of career satisfaction of dental therapists in New Zealand. DESIGN Postal survey of dental therapists identified from the New Zealand Dental Council's dental therapy database. One mailing with one follow-up. PARTICIPANTS Questionnaires were sent to 683 registered dental therapists. Replies were received from 566 (82.9%). OUTCOME MEASURES Current working practice, career breaks, continuing education, career satisfaction. RESULTS Respondents had a high career satisfaction, but were much less satisfied with their remuneration. After controlling for age and income satisfaction, therapists who felt that they were valued members of the dental community had over four times the odds of having higher overall job satisfaction. There were no differences in the mean career satisfaction scale score by age, but respondents aged 45 and over had a lower mean income satisfaction scale score than their younger counterparts (p<0.05). Older respondents were more likely to report regularly placing fissure sealants (p<0.05), participating in peer review (p<0.05), and playing a role in team management/coordination (p<0.05) than younger respondents. Most therapists (412; 82.2%) had taken at least one career break, usually for child rearing. A mean of 6.5 years (SD 5.9; range six weeks to 25 years) had been taken in career breaks. Younger therapists were more interested in moving into private practice than their older colleagues (p<0.05). More than half of respondents planned to retire from dental therapy within 10 years. CONCLUSION Urgent action is required to improve the recruitment and retention of dental therapists in the New Zealand School Dental Service. Measures to reduce the time taken in career breaks could increase the productivity of this workforce. Remuneration and career progression are key issues; therapists need to feel that they are valued members of the dental profession.
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Affiliation(s)
- K M S Ayers
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, New Zealand.
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Bower E, Newton JT. Oral health acculturation in Albanian-speakers in south London. Community Dent Health 2007; 24:149-155. [PMID: 17958075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To explore the processes involved in oral health acculturation for Albanian-speakers in south London. BASIC RESEARCH DESIGN A qualitative study utilizing 10 in-depth, semi-structured interviews and two focus groups with a purposive sample of 23 Albanian-speakers. Participants were recruited through community groups and by a snowball technique. Data were analysed using the constant comparative method. RESULTS Participants attended the dentist more regularly and brushed their teeth more frequently in the U.K., particularly those from lower social class groups. However, young people consumed more sweet foods and drinks than in Kosovo. The priority of oral health was higher in the U.K. for most participants. Mothers of young children were more interested in prevention in the U.K., mainly as a result of receiving oral health information from health visitors and agencies such as Sure Start. However, oral health priorities generally remained treatment focused. Participants mainly attributed behavioural and attitudinal changes to structural and material factors such as the absence of war, higher living standards, better access to oral health information, products and dental services, and the greater availability of highly desirable sweet foods and drinks in the U.K. CONCLUSIONS Understanding changes in social context may be crucial for comprehending the processes of oral health acculturation in immigrant populations. Material and structural changes which impact on oral health behaviours may be overlooked. Improving oral health knowledge can be a crucial step in shifting oral health priorities from a treatment to a prevention focus. However, unhealthy choices may persist due to the impact of wider cultural norms.
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Affiliation(s)
- E Bower
- Department of Oral Health Services Research & Dental Public Health, GKT Dental Institute, London.
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Abstract
BACKGROUND Recognition of some of the limitations of titanium plates and screws used for the fixation of bones has led to the development of plates manufactured from bioresorbable materials. Whilst resorbable plates appear to offer clinical advantages over metal plates in orthognathic surgery, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions. OBJECTIVES To compare the effectiveness of bioresorbable fixation systems with titanium systems used during orthognathic surgery. SEARCH STRATEGY We searched the following databases: Cochrane Oral Health Group Trials Register (to 26th January 2006); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4); MEDLINE (without filter) (from 1966 to 26th January 2006); and EMBASE (without filter) (from 1980 to 26th January 2006). SELECTION CRITERIA Randomised controlled trials comparing resorbable versus titanium fixation systems used for orthognathic surgery. DATA COLLECTION AND ANALYSIS Clinical heterogeneity between the included trials precluded pooling of data, and only a descriptive summary is presented. MAIN RESULTS This review included two trials, involving 103 participants, one compared titanium with resorbable plates and screws and the other titanium with resorbable screws, both provided very limited data for the primary outcomes of this review. All patients in one trial suffered mild to moderate postoperative discomfort with no statistically significant difference between the two plating groups at different follow-up times. Mean scores of patient satisfaction were 7.43 to 8.63 (range 0 to 10) with no statistically significant difference between the two groups throughout follow up. Adverse effects reported in one study were two plate exposures in each group occurring between the third and ninth months. Plate exposures occurred mainly in the posterior maxillary region, except for one titanium plate exposure in the mandibular premolar region. Known causes of infection were associated with loosened screws and wound dehiscence with no statistically significant difference in the infection rate between titanium (3/196), and resorbable (3/165) plates P = 0.83 (published as P = 0.67). AUTHORS' CONCLUSIONS This review provides some evidence to show that there is no statistically significant difference in postoperative discomfort, level of patient satisfaction, plate exposure or infection for plate and screw fixation using either titanium or resorbable materials in orthognathic surgery.
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Affiliation(s)
- Z Fedorowicz
- Bahrain Branch of the UK Cochrane Centre, Box 25438, Awali, Bahrain.
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Abstract
OBJECTIVE The development of a questionnaire to measure patients' and their parents' expectations before orthodontic treatment, and to test the reliability and validity of this measure. DESIGN A two-stage methodology, with open-ended interviews to identify themes and concepts followed by development and testing of the questionnaire. SETTING GKT Orthodontic Department, King's College Dental Hospital. SUBJECTS The sample consisted of 140 participants, 70 patients aged 12-14 years, who had been referred to the orthodontic department for treatment. One parent of each patient was also recruited. MATERIALS AND METHODS The study was in two phases. In the first phase 30 participants (15 new patients and their 15 parents) participated in open-ended interviews, which were analysed qualitatively. Information from these interviews was used to construct a questionnaire. During the second phase, the questionnaire was piloted on 10 participants, five new consecutive patients and their parents. The questionnaire was then distributed to 174 subjects (87 new patients and their 87 parents). Seventy-eight subjects (39 new patients and their 39 parents) completed the questionnaire before their orthodontic consultation. Another 96 subjects (48 new patients and their 48 parents) were invited to complete the questionnaire prior to and at their orthodontic consultation. Test-retest analysis was conducted on 22 participants (11 patients and their 11 parents), who completed the questionnaire previous to and at their orthodontic consultation, and contributed to the psychometric validation of this questionnaire. MAIN OUTCOME MEASURES A questionnaire was devized using the key themes and concepts identified in the open-ended interviews. As a result, 10 questions, some with sub-questions were constructed using a visual analogue scale as the response format. RESULTS The questionnaire developed had good face validity. Internal consistency of the questionnaire using Cronbach's alpha, produced an overall inter-item reliability > 0.7 along with item-total correlations > 0.3 in over 50% of questions. Test-retest reliability was statistically significant using Spearman's correlation. CONCLUSION This study provides a valid and reliable measure of orthodontic expectations in participants aged 12-14 years and their parents.
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Affiliation(s)
- M S Sayers
- Orthodontic Department, Eastman Dental Institute, 257 Gray's Inn Road, London WC1X 8LD, UK.
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