Primary Dental Journal

Since the introduction of the 2006 NHS dental contract, various waiting list initiatives and the subsequent release of NHS commissioning guidance for dental services, there has been a remarkable and rapid shift towards the provision of intermediate services within the profession. The complexity surrounding those non-specialist providers working within these services has lead to much confusion and the further development of competencies required to work within these settings. This paper focuses on explaining and exploring the topics that arise from an area that has attracted much discussion and debate.

This paper examines antibiotic prescribing by dental practitioners delivering private dental care in the UK. An online questionnaire utilising the online SurveyMonkey tool was used to collate data on aspects of therapeutic and prophylactic antibiotic prescribing in private dental practice. In total, 53 private dental practitioners registered with Simplyhealth Professionals (formerly DENPLAN Ltd) responded to this study. All respondents recognised that an elevated temperature associated with a dental infection requires a prescription of systemic antibiotics. Other reported indications for prescribing antibiotics, as an adjunct to definitive management of the cause, included gross diffuse swelling (50%), difficulty in swallowing (48%) or closure of the eye due to swelling (51%). The majority of respondents were found to prescribe the appropriate antibiotic at the correct dose, frequency and duration. Overall, private dental practitioners prescribed or dispensed fewer than six courses of antibiotics each month and just less than half the respondents did not audit their prescribing.

The results of this limited pilot study suggest that most dental practitioners providing private dental care prescribe appropriately and at lower levels than NHS dental practitioners. A definitive larger study of private dental practitioners antibiotic prescribing would be of value in determining their contribution to reducing the development of antimicrobial resistance.

Changes in social structure and advances in technology will influence oral healthcare and the dental workforce. The Council of European Dentists (CED) acknowledges distinct differences between existing dentists and dentists of the future, identifying skills and competencies necessary to make the dentist of the future fit for purpose. These skills and competences are discussed in the context of the profile of the dentist of the future, highlighting the need to review arrangements for the recruitment and retention of future dental workforce.

This study was carried out to evaluate the difference in prices for dental treatments carried out privately in general dental practice within the Birmingham area. Ten different practices were chosen at random, which were spread across Birmingham, in order to get a better insight into the differences across the districts. Their prices for pre-determined dental procedures were procured off the practices’ respective websites or through telephoning. The findings of this study have shown a wide variation in prices for each dental procedure, with the greatest variation in prices between practices being £850 for dental implants. The procedures with the lowest average cost were fissure sealants at £23.14. The procedure with the highest average cost was dental implants at £2,261.11. This study also showed that as more dental treatment was required, the mean cost for the dental intervention increased, regardless of the tooth being treated.

Despite the growing body of evidence-based knowledge, evidence-based restoration repair is not always applied in the clinical setting. This article is intended to give an evidence-based insight into the indications, importance, benefits and long-term success of resin composite restoration repair, together with details of relevant operative techniques aimed at conserving as much sound tooth structure as possible.

Dentine hypersensitivity is a frequently encountered patient complaint that can present with a number of associated factors including erosion and abrasion. The hydrodynamic mechanism responsible for dentine hypersensitivity is intimately related to the anatomical and physiological composition of teeth. Alterations to the integrity of the enamel and dentine through processes of trauma, decay and toothwear can increase dentine permeability. This gives rise to symptoms of sensitivity as dentinal fluid movement in response to thermal, chemical and mechanical cues stimulate the pulpal Aδ fibres. Restorative procedures can also rapidly change the architecture of the protective enamel and dentine layers leading to pulpal inflammation and increased thermal sensitivity of the tooth.

Patient-reported symptoms of dentine hypersensitivity can be attributed to a number of possible causes and a definitive diagnosis can therefore be difficult. A full history including social and medical factors such as occupation, diet and/or medication is likely to provide significant information to aid a diagnosis. Consideration of occlusal factors should not be overlooked as these may contribute to symptoms arising from a cracked tooth.

Management strategies are linked to the diagnosis – from topically applied desensitising pastes and resin bonding agents to direct restorations and possibly more advanced restorative procedures such as root canal treatment. Management should, however, be staged to enable more conservative strategies to prevail prior to considering irreversible dental interventions.

The increasing prescription of metal-free dental restorations has come about as a result of various patient demands and somewhat narcissistic expectations. However, some dental professionals have contributed to the rise in popularity of these materials and techniques. This article highlights the potential pitfalls of undertaking inherently destructive procedures, particularly when performed for questionable “cosmetic” reasons.