Relative performance of different dental professional groups in screening for occlusal caries

Abstract

Even with minimal training, different members of the dental team show the potential to screen for occlusal caries to a similar standard as primary care dentists. This requires further testing in vivo, but has important implications for the productivity and design of the future dental workforce.

Direct access: lessons learnt from the Netherlands

“…22,25 There is evidence for the use of DCPs and clinicians other than GDPs to detect caries and to screen for oral cancer. [26][27][28][29] Judgement under uncertainty favours safety and the only randomised controlled trial (RCT) that has examined screening for oral cancer used allied health providers, not GDPs, to undertake the screen. 28,30 The interviews from the Netherlands also highlight the need for rigorous evaluation of direct access.…”

The Efficacy of Screening for Common Dental Diseases by Hygiene-Therapists

“…2). The reasons for this could be that in borderline cases where the periodontal pocket was close to the 3.5-mm threshold, H-Ts were inclined to report a positive index test result to ensure that nothing would be missed, a trend seen in other studies where, if in doubt, the patient is referred on for further investigation (Brocklehurst et al 2012). Alternatively, this may result from different judgment criteria being applied by GDPs and H-Ts when probing periodontal pockets (Velden and Vries 1980;Freed et al 1983).…”

“…This requires information on the expected sensitivity values of the new diagnostic test and the minimum acceptable lower confidence limit. Brocklehurst et al (2012) found that the sensitivity of different clinicians to assess photographs of potentially carious teeth was 85%. As clinicians were expected to find the judgment task in vivo easier, this was set at 90%.…”

“…GDP training was considered successful when values for sensitivity exceeded 85%, the threshold set by the World Health Organization (1997). Levels for specificity were set lower at 65%, based on the results of an earlier in vitro study (Brocklehurst et al 2012). The diagnostic threshold for dental caries was defined as any tooth in the patient's mouth that showed evidence of frank cavitation or shadowing and opacity that would indicate dental caries into the dentine (when clean and dried).…”

Assessing the efficacy and social acceptability of using hygienist-therapists as front-line clinicians

“…5,6 This raises a question about the rationale of using the most expensive resource (the GDP) to undertake this task, when other members of the dental team could be used safely, for example, dental hygienist-therapists (HTs). [7][8][9][10][11][12][13][14][15][16] Such an approach has the potential to release resources at a practice level and also increase the capacity to care for those who currently don't access services, thereby reducing the efficiency, cost-effectiveness and equity of NHS service provision. 5,17 HTs also adopt a more preventive approach, when compared to many GDPs, as their clinical training focuses on prevention rather than surgical intervention.…”