Timings and skill mix in primary dental care: a pilot study

Ganbavale, Suruchi; Aukett, James W.; Gallagher, Jennifer E.

doi:10.1038/s41415-019-0938-7

Cited by 8 publications

(15 citation statements)

References 21 publications

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“…The concept for this OR tool was informed by the ICCMS dental caries management system [ 40 ], clinical timings on treatment and prevention [ 41 ], current evidence on managing the oral disease using three scenarios [ 42 , 43 ], and an advisory panel on relevant care for a low-income country which consisted of dental experts from King’s and the public sector in SL. The data for modelling were obtained from: (a) the SL national 2015 census [ 44 ]; (b) a weighted sample from a national oral health survey of schoolchildren [ 12 , 45 ]; and, (c) the views of key individuals [ 13 ], as part of a programme of doctoral research [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…First, estimates of treatment needs were established using recent dental caries data from three key age groups (6-, 12- and 15-year-old school children) in line with the ICCMS approach to disease management [ 40 ]. Second, total clinical hours required to deliver oral health promotion and basic preventive and surgical (tooth extraction) treatment by DTs were estimated, informed by past research relating to dentists and DCPs [ 41 ]. Third, the number of DTs needed to manage oral disease across the three key age groups nationally was calculated assuming that they would work full time (37.5 h a week) per year (46 weeks).…”

Section: Methodsmentioning

confidence: 99%

“…The care elements in this scenario were proposed at three levels: ‘ Oral health promotion and prevention at child level’; ‘restoration at tooth level’ and ‘surgical (tooth extraction) treatment at tooth level’. The estimated time to deliver all three elements of care was adapted through clinical timings for DTs reported in the UK study carried out in primary care [ 41 ]. ‘ Oral health promotion and individualised prevention at child level’ included measures such as oral examination, oral hygiene and diet advice, and fluoride varnish which were considered applicable and beneficial to all schoolchildren, as the proportion of children with no visual caries was very small across all three age groups.…”

Section: Methodsmentioning

confidence: 99%

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Needs-led human resource planning for Sierra Leone in support of oral health

Ghotane

Don-Davis

Kamara³

et al. 2021

Hum Resour Health

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Background In Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL. Methods A dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the ‘International Caries Classification and Management System (ICCMS)’ tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S5&6P and S6P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need. Results To meet the needs of a single year-group of childrens’ needs, an average of 163 DTs (range: 133–188) would be required to deliver Conventional care (CC); 39 DTs (range: 30–45) to deliver basic Surgical and Preventive care (S6P); 54 DTs for more extended Surgical and Preventive care (S5&6P) (range 38–68); and 27 DTs (range: 25–32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565–6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255–1438 DTs) to deliver basic Surgical and Preventive care (S6P); 2,000 DTs (range 1590–2236) for more extended Surgical and Preventive care (S5&6P) (range 1590–2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016–1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251–488) for the S6P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586–1179) would be needed for the S5&6P scenario in which all teeth with distinctive and extensive caries into dentine are extracted. Conclusion The study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Needs-led human resource planning for Sierra Leone in support of oral health

Ghotane

Don-Davis

Kamara³

et al. 2021

Hum Resour Health

View full text Add to dashboard Cite

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“…Consequently, here we have papers on substance abuse and conscious sedation, body dysmorphic disorder and facial aesthetics, and timing and skills mix in primary dental care. 1,2,3 When so listed there is little apparent connection between them and yet what emerges is a story of how good patient care requires time to achieve. At the centre of the experience conveyed in these separate works is the unifying description of how we are providing oral care, not just dentistry, for individuals not just a homogenous bunch plucked from the general public.…”

mentioning

confidence: 99%

“…The skill mix paper also reports that 'perceived influences on the length of time required to complete dental procedures were patient complexity, system of care, type of remuneration system and philosophy of care emphasising quality, together with practice environment…' 3 This speaks not only to the generality of care but to the specifics of diverse patients described in the other papers. 1,2 One is left in little doubt that the current UDA system of remuneration in England, for example, fails utterly to address such important shifts in emphasis.…”

mentioning

confidence: 99%