British journal of health psychology, Jan 20, 2015
Persistent pain in the face, mouth, and jaws is a common presentation to dental and medical servi... more Persistent pain in the face, mouth, and jaws is a common presentation to dental and medical services. The aetiology remains unclear, but a growing evidence base recognizes the effectiveness of psychological rather than biomedical interventions. To understand how this approach might be implemented into clinical practice, knowledge is needed of patients' and clinicians' experience of chronic orofacial pain (COFP). The aim of this study was to explore the experience and understanding of COFP by patients and primary and secondary care medical and dental practitioners. Qualitative interview study. Audio-recorded semi-structured interviews with a purposive sample of 12 dentists, 11 general practitioners, and seven patients were thematically analysed. Clinicians and patients recognized the role that psychological factors could play in the development and maintenance of COFP, yet management and self-management strategies were largely limited to biomedical interventions. Achieving a ...
In contemporary healthcare settings, ensuring patient safety must be an underlying principal thro... more In contemporary healthcare settings, ensuring patient safety must be an underlying principal through which systems, teams, individuals and environments work in tandem to strive for. The adoption of a culture in the NHS where patient safety is given greater priority is key to improvement. Recent events at Mid-Staffordshire hospitals among others have brought patient safety into the minds of the public and it increasingly demands attention from clinicians, the press and governments. However, much of the work into patient safety has been completed in the secondary care field with very little work completed in primary care settings. In primary care dentistry, improving patient safety is a relatively new concept with a distinct lack of evidence base. In this article, we discuss what patient safety is and debate its relevance to primary care dentistry. We also look at previous work completed in this field and make recommendations for future work to address the current lack of research.
International Journal of Paediatric Dentistry, 2009
The development of dental anxiety in children is poorly understood. The aims of this study were t... more The development of dental anxiety in children is poorly understood. The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other factors. A prospective cohort study of children in the north-west of England followed from 5 to 9 years of age. The participants were clinically examined and their parents completed the same questionnaire at 5 and 9 years. The majority (54.3%N = 38) of participants who were anxious at 5 years were no longer anxious at 9 years, but a large proportion of children who were anxious at 5 remained anxious at 9 years of age (45.7%N = 32). During the follow-up period, a larger proportion of children developed anxiety (11.7%N = 85) than the proportion of children who were reported as being anxious at baseline (8.8%N = 70). At 9 years of age, dental anxiety was significantly associated with girls; parental anxiety; a history of extraction; and irregular, asymptomatic dental visiting. These factors were also significantly associated with dental anxiety at 5 years old. Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.
Tobacco and alcohol are major risk factors for upper aerodigestive tract (UADT) cancer and signif... more Tobacco and alcohol are major risk factors for upper aerodigestive tract (UADT) cancer and significant variation is observed in UADT cancer rates across Europe. We have estimated the proportion of UADT cancer burden explained by tobacco and alcohol and how this varies with the incidence rates across Europe, cancer sub-site, gender and age. This should help estimate the minimum residual burden of other risk factors to UADT cancer, including human papillomavirus. We analysed 1981 UADT cancer cases and 1993 controls from the ARCAGE multicentre study. We estimated the population attributable risk (PAR) of tobacco alone, alcohol alone and their joint effect. Tobacco and alcohol together explained 73% of UADT cancer burden of which nearly 29% was explained by smoking alone, less than 1% due to alcohol on its own and 44% by the joint effect of tobacco and alcohol. Tobacco and alcohol together explained a larger proportion of hypopharyngeal/laryngeal cancer (PAR=85%) than oropharyngeal (PAR=74%), esophageal (PAR=67%) and oral cancer (PAR=61%). Tobacco and alcohol together explain only about half of the total UADT cancer burden among women. Geographically, tobacco and alcohol explained a larger proportion of UADT cancer in central (PAR=84%) than southern (PAR=72%) and western Europe (PAR=67%). While the majority of the UADT cancers in Europe are due to tobacco or the joint effect of tobacco and alcohol, our results support a significant role for other risk factors in particular, for oral and oropharyngeal cancers and also for UADT cancers in southern and western Europe.
... children (DA5): Description and concurrent validity G M Humphris 1, K Milsom 2, M Tickle 3, H... more ... children (DA5): Description and concurrent validity G M Humphris 1, K Milsom 2, M Tickle 3, H Holbrook 4 and A Blinkhorn 5 ... 4Oral Health Promoter, Health Promotion Unit, Runcorn. 5Professor of Oral Health and Dean of Manchester Dental School, University of Manchester. ...
Aim To record English general dental practitioners' views on the new contract.Sample One tho... more Aim To record English general dental practitioners' views on the new contract.Sample One thousand and forty nine general dental practitioners working under the PDS or GDS contract.Locations Randomly selected general dental practitioners working within the NHS in England.Methods Postal questionnaire, made up of two components: closed questions and a free answer section. Three waves of mailings were undertaken.Results Poor response rate of 28.5 per cent. Dentists felt marginalized by the government and disillusioned with the new contract. The free answer section was characterized by angry responses and worry about the impact of the changes on patient care and income.Discussion The fact that the Dental Practice Board circulated the questionnaire made many of the respondents suspicious of the overall aim of the research. This factor may have contributed to the low response rate.Conclusion More care should have been taken when piloting the questionnaire as the researchers under estimated the difficulties of collecting information in a time of change.
A cross-sectional study was conducted to compare a visual dental examination method developed by ... more A cross-sectional study was conducted to compare a visual dental examination method developed by the British Association for the Study of Community Dentistry with assessment of intra-oral photographs as means of detecting dental caries in 5-year-olds and 10- to 11-year-olds. 130 5-year-olds and 140 10- to 11-year-olds were visually examined by five trained and calibrated examiners. The children also had intra-oral photographs of their teeth taken. The same five examiners assessed the photographs for caries. Both photographic and visual assessments were undertaken at 'caries into dentine' level. Weighted kappas for the outcome DMFT/dmft as a measure of intra-examiner reliability for the visual examinations ranged from 0.94 to 0.98 (median = 0.98) in the 5-year-olds and 0.80 to 1.00 (median = 0.93) in the 10- to 11-year-olds. Weighted kappas as a measure of intra-examiner reliability for the photographic assessments ranged from 0.83 to 1.00 (median = 0.93) in the 5-year-olds and 0.69 to 0.95 (median = 0.81) in the 10- to 11-year-olds. Sensitivity values for the photographic assessment method as compared to the gold standard of the visual examination scores of a benchmark examiner ranged from 87.8% to 95.8% in the 5-year-olds and 58.5% to 71.7% in the 10- to 11-year-olds. There was good intra-examiner reliability for both the visual and the photographic methods for all the examiners. There are no clinically significant differences between the photographic scores and the visual assessments using any of the metrics described. The photographic approach is therefore equivalent in diagnostic utility to the visual system and confers considerable advantages in terms of examiner bias reduction, remote scoring and archiving. These advantages must be weighed against the modest costs of the cameras and the increase time required to acquire the images.
The objective of the study was to investigate factors that influence pain intensities associated ... more The objective of the study was to investigate factors that influence pain intensities associated with routine dental procedures. Four hundred and fifty-one dental patients self-reported pain experienced during the procedure immediately after undergoing a variety of common dental interventions and 1 day after the completion of the procedure. Pain character was measured using the McGill short-form pain questionnaire and intensity using a numerical rating (NRS) scale. Information was collected on a number of factors that could influence pain: dental anxiety was measured using the Corah Dental Anxiety Scale to categorize patients into four domains (fearless, some unease, nervous and very anxious). Dentists provided information regarding the type(s) of procedure and use of local anaesthetic (LA). Seventy-five percent of patients (339/451) reported no pain during their procedure when the data were collected immediately postoperatively (NRS score = 0). Univariate analyses showed that dental anxiety, LA use and type of procedure (extractions) were significant (P < 0.05) predictors of reported intra-operative pain. However, when these factors were combined in a multivariate model, the strongest predictor of pain was dental anxiety [odds ratio (OR) = 4.98 (95% CI 1.42-17.44)] and LA use [OR = 2.79 (95% CI 1.39-5.61)]. Although the strongest predictor of postoperative pain on the next day was pain reported during the procedure [OR = 5.85 (95% CI 2.71-12.64)], LA remained a significant predictor of pain the day after the procedure [OR = 3.16 (95% CI 1.02-9.81)]. Dentists need to assess their patients both preoperatively for dental anxiety and intra-operatively for signs of suboptimal local anaesthesia so as to effectively align patient management and clinical techniques to control dental anxiety and produce adequate anaesthesia.
In the second paper of a series exploring quality in primary dental care a way to measure quality... more In the second paper of a series exploring quality in primary dental care a way to measure quality in dentistry is considered. Unless there are valid and reliable tools to measure quality then quality can never be improved. Measurement tools need to be acceptable to patients if they are to be employed, as well as to busy practices in terms of practicality and costs. Examples such as the General Medical Practitioner's Quality Outcome Framework need to be understood to see if they can be translated to dentistry.
British journal of health psychology, Jan 20, 2015
Persistent pain in the face, mouth, and jaws is a common presentation to dental and medical servi... more Persistent pain in the face, mouth, and jaws is a common presentation to dental and medical services. The aetiology remains unclear, but a growing evidence base recognizes the effectiveness of psychological rather than biomedical interventions. To understand how this approach might be implemented into clinical practice, knowledge is needed of patients' and clinicians' experience of chronic orofacial pain (COFP). The aim of this study was to explore the experience and understanding of COFP by patients and primary and secondary care medical and dental practitioners. Qualitative interview study. Audio-recorded semi-structured interviews with a purposive sample of 12 dentists, 11 general practitioners, and seven patients were thematically analysed. Clinicians and patients recognized the role that psychological factors could play in the development and maintenance of COFP, yet management and self-management strategies were largely limited to biomedical interventions. Achieving a ...
In contemporary healthcare settings, ensuring patient safety must be an underlying principal thro... more In contemporary healthcare settings, ensuring patient safety must be an underlying principal through which systems, teams, individuals and environments work in tandem to strive for. The adoption of a culture in the NHS where patient safety is given greater priority is key to improvement. Recent events at Mid-Staffordshire hospitals among others have brought patient safety into the minds of the public and it increasingly demands attention from clinicians, the press and governments. However, much of the work into patient safety has been completed in the secondary care field with very little work completed in primary care settings. In primary care dentistry, improving patient safety is a relatively new concept with a distinct lack of evidence base. In this article, we discuss what patient safety is and debate its relevance to primary care dentistry. We also look at previous work completed in this field and make recommendations for future work to address the current lack of research.
International Journal of Paediatric Dentistry, 2009
The development of dental anxiety in children is poorly understood. The aims of this study were t... more The development of dental anxiety in children is poorly understood. The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other factors. A prospective cohort study of children in the north-west of England followed from 5 to 9 years of age. The participants were clinically examined and their parents completed the same questionnaire at 5 and 9 years. The majority (54.3%N = 38) of participants who were anxious at 5 years were no longer anxious at 9 years, but a large proportion of children who were anxious at 5 remained anxious at 9 years of age (45.7%N = 32). During the follow-up period, a larger proportion of children developed anxiety (11.7%N = 85) than the proportion of children who were reported as being anxious at baseline (8.8%N = 70). At 9 years of age, dental anxiety was significantly associated with girls; parental anxiety; a history of extraction; and irregular, asymptomatic dental visiting. These factors were also significantly associated with dental anxiety at 5 years old. Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.
Tobacco and alcohol are major risk factors for upper aerodigestive tract (UADT) cancer and signif... more Tobacco and alcohol are major risk factors for upper aerodigestive tract (UADT) cancer and significant variation is observed in UADT cancer rates across Europe. We have estimated the proportion of UADT cancer burden explained by tobacco and alcohol and how this varies with the incidence rates across Europe, cancer sub-site, gender and age. This should help estimate the minimum residual burden of other risk factors to UADT cancer, including human papillomavirus. We analysed 1981 UADT cancer cases and 1993 controls from the ARCAGE multicentre study. We estimated the population attributable risk (PAR) of tobacco alone, alcohol alone and their joint effect. Tobacco and alcohol together explained 73% of UADT cancer burden of which nearly 29% was explained by smoking alone, less than 1% due to alcohol on its own and 44% by the joint effect of tobacco and alcohol. Tobacco and alcohol together explained a larger proportion of hypopharyngeal/laryngeal cancer (PAR=85%) than oropharyngeal (PAR=74%), esophageal (PAR=67%) and oral cancer (PAR=61%). Tobacco and alcohol together explain only about half of the total UADT cancer burden among women. Geographically, tobacco and alcohol explained a larger proportion of UADT cancer in central (PAR=84%) than southern (PAR=72%) and western Europe (PAR=67%). While the majority of the UADT cancers in Europe are due to tobacco or the joint effect of tobacco and alcohol, our results support a significant role for other risk factors in particular, for oral and oropharyngeal cancers and also for UADT cancers in southern and western Europe.
... children (DA5): Description and concurrent validity G M Humphris 1, K Milsom 2, M Tickle 3, H... more ... children (DA5): Description and concurrent validity G M Humphris 1, K Milsom 2, M Tickle 3, H Holbrook 4 and A Blinkhorn 5 ... 4Oral Health Promoter, Health Promotion Unit, Runcorn. 5Professor of Oral Health and Dean of Manchester Dental School, University of Manchester. ...
Aim To record English general dental practitioners' views on the new contract.Sample One tho... more Aim To record English general dental practitioners' views on the new contract.Sample One thousand and forty nine general dental practitioners working under the PDS or GDS contract.Locations Randomly selected general dental practitioners working within the NHS in England.Methods Postal questionnaire, made up of two components: closed questions and a free answer section. Three waves of mailings were undertaken.Results Poor response rate of 28.5 per cent. Dentists felt marginalized by the government and disillusioned with the new contract. The free answer section was characterized by angry responses and worry about the impact of the changes on patient care and income.Discussion The fact that the Dental Practice Board circulated the questionnaire made many of the respondents suspicious of the overall aim of the research. This factor may have contributed to the low response rate.Conclusion More care should have been taken when piloting the questionnaire as the researchers under estimated the difficulties of collecting information in a time of change.
A cross-sectional study was conducted to compare a visual dental examination method developed by ... more A cross-sectional study was conducted to compare a visual dental examination method developed by the British Association for the Study of Community Dentistry with assessment of intra-oral photographs as means of detecting dental caries in 5-year-olds and 10- to 11-year-olds. 130 5-year-olds and 140 10- to 11-year-olds were visually examined by five trained and calibrated examiners. The children also had intra-oral photographs of their teeth taken. The same five examiners assessed the photographs for caries. Both photographic and visual assessments were undertaken at 'caries into dentine' level. Weighted kappas for the outcome DMFT/dmft as a measure of intra-examiner reliability for the visual examinations ranged from 0.94 to 0.98 (median = 0.98) in the 5-year-olds and 0.80 to 1.00 (median = 0.93) in the 10- to 11-year-olds. Weighted kappas as a measure of intra-examiner reliability for the photographic assessments ranged from 0.83 to 1.00 (median = 0.93) in the 5-year-olds and 0.69 to 0.95 (median = 0.81) in the 10- to 11-year-olds. Sensitivity values for the photographic assessment method as compared to the gold standard of the visual examination scores of a benchmark examiner ranged from 87.8% to 95.8% in the 5-year-olds and 58.5% to 71.7% in the 10- to 11-year-olds. There was good intra-examiner reliability for both the visual and the photographic methods for all the examiners. There are no clinically significant differences between the photographic scores and the visual assessments using any of the metrics described. The photographic approach is therefore equivalent in diagnostic utility to the visual system and confers considerable advantages in terms of examiner bias reduction, remote scoring and archiving. These advantages must be weighed against the modest costs of the cameras and the increase time required to acquire the images.
The objective of the study was to investigate factors that influence pain intensities associated ... more The objective of the study was to investigate factors that influence pain intensities associated with routine dental procedures. Four hundred and fifty-one dental patients self-reported pain experienced during the procedure immediately after undergoing a variety of common dental interventions and 1 day after the completion of the procedure. Pain character was measured using the McGill short-form pain questionnaire and intensity using a numerical rating (NRS) scale. Information was collected on a number of factors that could influence pain: dental anxiety was measured using the Corah Dental Anxiety Scale to categorize patients into four domains (fearless, some unease, nervous and very anxious). Dentists provided information regarding the type(s) of procedure and use of local anaesthetic (LA). Seventy-five percent of patients (339/451) reported no pain during their procedure when the data were collected immediately postoperatively (NRS score = 0). Univariate analyses showed that dental anxiety, LA use and type of procedure (extractions) were significant (P < 0.05) predictors of reported intra-operative pain. However, when these factors were combined in a multivariate model, the strongest predictor of pain was dental anxiety [odds ratio (OR) = 4.98 (95% CI 1.42-17.44)] and LA use [OR = 2.79 (95% CI 1.39-5.61)]. Although the strongest predictor of postoperative pain on the next day was pain reported during the procedure [OR = 5.85 (95% CI 2.71-12.64)], LA remained a significant predictor of pain the day after the procedure [OR = 3.16 (95% CI 1.02-9.81)]. Dentists need to assess their patients both preoperatively for dental anxiety and intra-operatively for signs of suboptimal local anaesthesia so as to effectively align patient management and clinical techniques to control dental anxiety and produce adequate anaesthesia.
In the second paper of a series exploring quality in primary dental care a way to measure quality... more In the second paper of a series exploring quality in primary dental care a way to measure quality in dentistry is considered. Unless there are valid and reliable tools to measure quality then quality can never be improved. Measurement tools need to be acceptable to patients if they are to be employed, as well as to busy practices in terms of practicality and costs. Examples such as the General Medical Practitioner's Quality Outcome Framework need to be understood to see if they can be translated to dentistry.
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