Economic evaluation of a community dental care model for people experiencing homelessness

Aim The study aims to conduct economic evaluation of the Peninsula Dental Social Enterprise (PDSE) programme for people experiencing homelessness over an 18-month period, when compared to a hypothetical base-case scenario (‘status quo\u27). Methods A decision tree model was generated in TreeAge Pro Healthcare 2024. Benefit-cost analysis and cost-effectiveness analysis were performed using data informed by the literature and probabilistic sensitivity analysis (Monte Carlo simulation with 1,000 cycles). The pre-determined willingness-to-pay threshold was estimated to be £59,502 per disability-adjusted life year (DALY) averted. Costs (£) and benefits were valued in 2020 prices. Health benefits in DALYs included dental treatment for dental caries, periodontitis and severe tooth loss. Results The hypothetical cohort of 89 patients costs £11,502 (SD: 488) and £57,118 (SD: 2,784) for the base-scenario and the PDSE programme, respectively. The health outcomes generated 0.9 (SD: 0.2) DALYs averted for the base-case scenario, and 5.4 (SD: 0.9) DALYs averted for the PDSE programme. The DALYs averted generated £26,648 (SD: 4,805) and £163,910 (SD: 28,542) in benefits for the base-scenario and the PDSE programme, respectively. The calculated incremental benefit-cost ratio was 3.02 (SD: 0.5) and incremental cost-effectiveness ratio was £10,472 (SD: 2,073) per DALY averted. Uncertainty analysis demonstrated that the PDSE programme was 100% cost-effective. Conclusions Funding a targeted dental programme from the UK healthcare perspective that provides timely and affordable access to dental services for people experiencing homelessness is cost-effective

Me, we, they:identifying the key stressors affecting the dental team

Introduction The mental health and wellbeing of the dental workforce is essential in providing oral healthcare services which are sustainable, safe and of the highest quality. Yet, there remains a lack of qualitative studies exploring the factors that negatively affect wellbeing in dentistry in the United Kingdom, not least in regard to the views and experiences of the wider dental team.Aim The aim of this paper is to identify and explore the factors that contribute to stress and burnout within dental teams as reported through the MINDSET U.K. Survey 2023.Method Qualitative data were collected in an online questionnaire which provided an opportunity for respondents to provide a free-text response. Following an inductive approach, thematic analysis was used to synthesise the findings.Results In total, 1,507 responses were received, of which 287 included a valid free-text response. The sample included 203 dentists, 69 dental care professionals, 13 practice managers/receptionists and two respondents who did not select a professional group. Six themes were identified from the data: workload; NHS system; regulatory compliance, patient complaints and litigation; financial pressures; leadership and management; and self-worth.Conclusion Current reactive approaches to dealing with the mental health and wellbeing of dental healthcare workers are insufficient. Measures need to be urgently developed and implemented to reduce or mitigate the contributing factors at the macro (system) level. These need to be considered as a priority in order to create the working conditions necessary to allow all members of the dental team to develop, flourish and feel valued.</p

Same difference:a qualitative exploration of stressors experienced by dental team members across the UK

Introduction Poor mental health and wellbeing in dental team members is increasingly recognised. The practise of dentistry is linked to high levels of self-reported stress, burnout and psychological distress. Different dental systems operate across the four United Kingdom (UK) countries and there is currently a lack of exploration of the impacts these different systems have on the stressors and challenges dental teams experience.Aim The aim of this paper is to explore and provide a UK country comparison of dental team members' experiences and stressors reported through the MINDSET U.K. survey 2023.Method Qualitative data were collected in an online questionnaire which provided opportunity for respondents to provide a free-text response. Following an inductive approach, thematic analysis was used to synthesise the findings.Results In total, 1,507 responses were received of which 287 included a valid free-text response. The sample included 203 dentists, 69 dental care professionals, 13 practice managers/receptionists and two respondents who did not select a professional group. Eight main themes were identified across each of the UK countries: workforce; mental health and wellbeing; regulation and litigation; NHS dentistry; COVID-19; financial pressures; leadership and management; and patients. There was more agreement among respondents from different UK countries than divergence.Conclusions Despite the different dental systems and environmental conditions, there was a high degree of thematic convergence between countries. Dental teams, irrespective of the country or system they operate within, reported significant stressors regarding their practice of dentistry. A sense of fatalism, with anticipation of worsening conditions, was shared across the UK

Factors Affecting the Integration of Dental Services Into Health and Social Care for People With Complex Needs

Background: People with complex social and medical needs require a high level of support and face multiple barriers in accessing health and social care services. With limited access to dental care, their high oral health needs go largely unaddressed. Integration of oral healthcare into primary care, alongside improved cross-sector working, has been advocated to bring together services across the system to achieve oral health equity. Aim: To explore the factors affecting integration of dental services into health and social care for people with complex needs. Methods: A qualitative research study was undertaken across two sites in the southwest of England, involving pathways designed to address the oral health needs of those with complex needs. Semi-structured interviews took place with three groups: patients with experience of each pathway, service providers and community support staff. These interviews were analysed through reflexive thematic analysis. Results: Forty-two individuals (15 males and 27 females) agreed to participate in the study. Key themes included (i) the need for services to be co-developed according to population need, (ii) for service coordination to be managed by a central hub, (iii) the important role of support workers and (iv) the requirement for collaboration between organisations to develop multi-agency pathways of communication. Conclusion: The objectives of integration should be addressed at all stages of service planning from design to delivery of the pathway. To develop integrated dental care pathways, it is recommended that a codesign approach is used harnessing community expertise, patient experience and the involvement of all service providers in the planning process. Patient and Public Involvement Statement: The authors were guided by the Peninsula Dental Social Enterprise Community Clinic Patient and Public Involvement (PPI) group, which includes people with lived experience of complex social and medical needs and those supporting them, who meet twice yearly as a focus group. The group explored aspects of the services offered to this cohort to aid the identification of research aims and outcomes for the study. Further to this, the original interview guides were reviewed and edited by a community link worker

Online training for substance misuse workers:A systematic review

Effective dissemination from researchers to clinicians can improve outcomes for people using substance misuse services by providing the knowledge and skills necessary to deliver best practice. The internet has the potential to facilitate quick, accurate and affordable learning on a large scale. However, the quality of online resources for substance misuse worker training is rarely evaluated. Aim: To review the available literature on the learning outcomes, qualitative descriptions and costs of online learning. Methods: The literature on online learning, staff training and substance misuse were reviewed following PRISMA guidelines. Findings: Sixteen articles were identified with large variation in study quality and design. Descriptions of online interventions were insufficient for replication or comparison. Good quality online training should meet the needs of substance misuse workers whilst acknowledging that these needs will differ according to worker and context. Conclusions: Published research into online learning for the substance misuse workforce should be sufficient in detail to enable replication and direct comparison. More qualitative research about the needs and preferences of the workforce using online learning would fill a notable gap in the literature

Exploring Barriers and Facilitators to Dietary Assessment and Advice in the Paediatric Population Attending Dental Clinics: A Scoping Review

OBJECTIVES: This scoping review aimed to identify barriers and facilitators, from both dental clinic staff and caregivers, to effectively providing and implementing dietary assessment and advice (for both oral and/or systemic health) in dental clinics managing paediatric patients. METHODS: A protocol was developed a priori (Open Science Framework- https://osf.io/bp4ts.) and followed the PRISMA-ScR guidelines. Studies published in English from 1990 to December 2024 in MEDLINE, Cochrane Library, Embase and CINAHL databases were searched. Additional journal searches targeted articles on dietary assessment or advice in dental clinics treating paediatric patients (aged ≤ 18 years), exploring barriers and facilitators for caregivers and dental clinic staff. RESULTS: Of 4736 studies identified, 32 were included, with 5 additional studies included from manual searching. Sixteen studies were quantitative, 13 were qualitative, and 8 mixed methods. Across studies, 77 barriers and 45 facilitators were identified in providing and implementing dietary assessment and advice in the paediatric population attending dental clinics. Results were mapped to the Theoretical Domains Framework. Common barriers for dental staff included time constraints and financial compensation, while caregivers cited controlling children\u27s dietary habits as a major barrier. CONCLUSIONS: Understanding the main barriers and facilitators in providing and implementing dietary assessment and advice in dental clinics treating paediatric patients is crucial to improving preventive healthcare

A Dental Student Perspective on the Impacts of an Inter-professional Engagement Module

Community engagement, defined as the process of getting communities involved in decisions that affect them (NICE, 2008), is paramount to the development and governance of services and activities that promote health and target inequalities (Buck, Baylis, Dougall, & Robertson, 2018; NICE, 2008). The inter-professional engagement module is an integral part of the curriculum of Peninsula Dental School, University of Plymouth, United Kingdom. It enables second-year undergraduate dental and dental therapy and hygiene students to develop and deliver an oral health intervention targeted at disadvantaged groups in the community. These groups commonly experience higher levels of dental disease (Public Health England, 2018; Office of the Director of Public Health, Plymouth City Council, 2018). As part of this module, we, a second-year group of undergraduate dental students, worked alongside the Family Intensive Intervention Project (FIIP) and its beneficiaries to improve vulnerable families’ awareness of oral and general health, and to break down barriers toward accessing dental care. FIIP provides holistic support to families with complex needs who may have difficulties with issues such as substance misuse, mental health and evidence of neglectful parenting (W. Kirby, personal communication, 2018)

A five-year retrospective analysis (2017-2022) of reported incidents from a primary care-based education provider.

Background Patient safety incident reporting and analysis are often confined to secondary care, despite 95% of dentistry occurring in primary care. Peninsula Dental Social Enterprise (PDSE) delivers primary care dentistry in education-based settings and uses a report-review-action process to underpin its patient safety framework.Aim This article analyses trends in clinical incident data, reflecting on learning to improve overall patient safety.Methods A retrospective observational study was employed to analyse incidents over a five-year period (2017-2022) using anonymised data from the PDSE reporting system.Results Over the five-year reporting period, there were an average of 13.1 total incidents per 1,000 appointments. Sub-analysis of reported incidents revealed 1.5 clinical incidents and 0.9 'near miss' incidents. A soft-tissue injury rate of 0.6, a contamination injury rate of 0.9, and 0.3 written complaints were reported per 1,000 appointments.Conclusion Patient safety is a key component of quality dental care, especially when delivering clinical dental education. PDSE fosters an environment of transparency, enabling the provider to monitor incidents and learn from them. This results in systems improvements sitting at the heart of the clinical service. With a lack of data published from similar settings, comparison to the sector is limited. Further sharing of data is encouraged to enable standardisation and quality benchmarking.The authors would also like to thank Rebecca Anderson, Clinical Governance and Operations Manager at PDSE, for her contributions to this work, facilitating access to data and educational interventions

Dental Pain in Care Homes: Is It a Phenomenon? A Systematic Review of the Literature.

Background: Evidence suggests that 80% of residents living in nursing homes have moderate to severe pain, could dental causes be an under reported contributory factor. The evidence suggests that this is an under-researched area. Our project aims were to explore and consolidate the current literature and conduct some stakeholder groups with care home managers and dentists. Our stakeholder group will be reported elsewhere. Methods: We used the SPIDER framework to set out key search terms. Which included “dementia” OR “cognitively-impaired” OR “carehome residents” AND “dental pain” OR “oralfacial pain” OR “mouth pain” AND “pain assessment” OR “pain identification”. A literature search was carried out on 8 and 9 March 2022 in the electronic databases: Cochrane, PubMed, Medline, Dental &amp; Oral Sciences Source, CINAHL, Global Health, SocINDEX, Ovid (Medline) and Scopus. Restrictions were placed on dates and language (2012–2022 and English only). Results: The search yielded 775 papers up to the year 2020. After screening and exclusion, we were left with five papers: four quantitative and one qualitative. Conclusions: This review demonstrates that there has been very little research into oral health and/or dental pain in adults with dementia. Furthermore, the recommendations have yet to be taken forward. Identifying pain in older adults with dementia remains challenging. There is a need to develop an algorithm in conjunction with care home staff and dental practitioners in order to identify and address the pain associated with dental disease in adults with dementia

Obesity and caries in four-to-six year old English children: a cross-sectional study.

BACKGROUND: Obesity and caries are common conditions in childhood and can have significant implications on children's wellbeing. Evidence into their association remains conflicting. Furthermore, studies examining the ssociation between obesity and caries commonly focus on individual-level determinants. The present study aimed to examine the association between obesity and caries in young English children and to determine the impact of deprivation and area-level characteristics on the distribution of the two conditions. METHODS: This was a cross-sectional study among children in Plymouth city aged four-to-six years. Anthropometric measurements included weight and height (converted to Body Mass Index centiles and z-scores), and waist circumference. Caries was assessed by using the sum of the number of teeth that were decayed, missing or filled. A questionnaire was used to obtain information on children's demographic characteristics, oral hygiene, and dietary habits. The impact of deprivation on anthropometric variables and caries was determined using Linear and Poisson regression models, respectively. Multiple logistic regression was used to assess the association between different anthropometric measures and caries. Logistic regression models were also used to examine the impact of several demographic characteristics and health behaviours on the presence of obesity and caries. RESULTS: The total sample included 347 children aged 5.10 ± 0.31 (mean ± SD). Deprivation had a significant impact on caries and BMI z-scores (p < 0.05). Neither BMI- nor waist circumference z-scores were shown to be significantly associated with dental caries. Among the neighbourhood characteristics examined, the percentage of people dependent on benefits was found to have a significant impact on caries rates (p < 0.05). Household's total annual income was inversely related to caries risk and parental educational level affected children's tooth brushing frequency. CONCLUSIONS: No associations between any measure of obesity and caries were found. However, deprivation affected both obesity and caries, thus highlighting the need to prioritise disadvantaged children in future prevention programmes