BDA PPE Presentations
Jill Anne O'Driscoll
A service evaluation of the use of Teledentistry in Orthodontic Assessment during Covid-19: From a clinician and patient perspective
Introduction: Throughout the Covid-19 pandemic, Orthodontic treatment has been significantly affected as it involves a large population who need routine return-visits which are not classified as essential treatments. This has led to an unprecedented number of patients being left without treatment. In order to provide a service to patients, it was decided to utilise teledentistry to assess and examine Orthodontic patients within a Hospital Orthodontic Department, using the NHS Attend Anywhere Platform.
Methods: Data was collected over a series of virtual Orthodontic clinics. Twenty orthodontic patients were chosen at random from departmental waiting list. These patients included emergency orthodontic patients and patients whose orthodontic appointments had been cancelled/treatments postponed. One clinician assessed and examined patients. A questionnaire which recorded patient demographics and asked nine questions (using a Likert Scale), was completed by clinician and patients. Responses and observations were entered into Microsoft Excel spreadsheet and data was analysed. Descriptive statistics were used to compile and organise the characteristics of data set.
Results/Discussion: There was a response rate of 100%. From a clinician’s perspective, it was possible to establish an appropriate diagnosis for 85% patients, and they felt that they were able to deliver information to the patient quickly and accurately for 100% patients. From a patient’s perspective 100% felt they were able to effectively communicate and 100% patients found appointment reassuring. Overall, both clinicians (100%) and patients (95%) found the system easy to use.
Conclusion: Teledentistry is not without its shortcomings however, our results found that there was a high acceptability for the use of teledentistry amongst patients and clinicians alike. Although teledentistry has served as a temporary solution, beyond the crisis it has the potential to provide access to dental care for millions of patients. In a post-Covid-19 world, perhaps integrated teledentistry will become part of the ‘‘new normal’’.
Lucy Malcolm, Lauren Pengilley
Hall Crown Technique : An Educational Tool
The COVID-19 Pandemic has impacted dentistry significantly with online learning and mitigation of AGPs now an important consideration. During our DCT1 post we developed and filmed a Hall Crown Technique instructional video with the aim to educate dental/dental therapy students and provide a free guide for GDPs. This technique is an established method in treating carious primary molars and, using separators, avoids an AGP. Searches revealed limited UK based online video resources incorporating evidence, phantom head demonstration and patient interaction. Feedback from a recent NES webinar support the exigency for this video with GDPs expressing limited familiarity regarding Hall technique.
During development we utilised a variety of information sources (referenced in video) to discuss the effectiveness of Hall technique, indications/contraindications, phantom head simulation and a live patient demonstration. NHS Medical Illustration and Data Protection were consulted ensuring appropriate consent.
Editing complete, the 10 minute comprehensive video was presented at NHS Highlands monthly trainee discussion meeting gaining valuable local feedback from PDS and HDS colleagues. Positive comments stated the video was professional and delivered an appropriate level of information. Contact with the NES CPD Adviser reiterated this feedback, highlighting content and delivery method.
Moving forward, we are in the process of uploading onto the NES website for professional CPD. Presentation at the University of Highlands and Islands Therapy Conference took place in March and we are currently gathering feedback from this. We then plan to write a narrative report for publication in the Dental Therapy Journal - something the journal is keen for us to execute. To expand our teaching experience, tutorials with final year Dundee dental students will be organised.
The finished educational video demonstrates creative virtual learning enabling undergraduate, GDP, PDS and HDS inter-professional teaching.
Kirsty Dickson, Prof Ruth Freeman, Dr Andrea Rodriguez, Dr Ekta Gupta and Clare Walkden
The importance of a Reflexive Mapping Exercise, of services and organisations working with people experiencing homelessness or at risk of becoming homeless, to dental practitioners
Introduction: The Scottish Oral Health and Psycho-social well-being programme, Smile4life, identified there is a lack of knowledge of the health and social services available, including referral pathways, for those who are homeless or at risk of becoming homeless. The Public Bodies (Joint Working) (Scotland) Act 2014 aims integrate health and social care in Scotland to meet the needs of vulnerable populations. However, there is still a clear need to create coordinated access to information and services for users and healthcare professionals. The Reflective Mapping Exercise (RME) aims to increase the communication and integration of services for practitioners. This project forms a framework to map services identifying geographic distribution, types of support and how they relate to deprivation levels.
Methods: The first RME was carried out in Dundee and Aberdeen and is now being replicated in Edinburgh, and Glasgow. The methodology is participatory including online search, telephone calls and, where it is possible, informal visits. Service location is then related to deprivation.
Results: The mapping covers eight areas including: housing support; Information, Advice and Advocacy; food assistance; Furniture assistance; Health and Psycho-social wellbeing support; Employment and Education and Training. From the Mapping in Dundee and Aberdeen it was observed a lack of services are allocated in the most deprived areas, the majority seek to address crisis period’s, and little are aimed towards early intervention/prevention and sustainable tenancy.
Conclusions: The mapping process identified the need to take a prophylactic approach and provide services not only as a reactionary response, while also aiming to create a more equitable distribution of services. The RME helps to provide a framework which simplifies communication and integration of health and social care services amongst practitioners and vulnerable services users. The knowledge of its importance and use relies on educating practitioners through public health campaigns and integration into dental education.
Jill Sweeney, Simon Hobson, Callum Wemyss, Pei Rong Chua, Siti Binti Mohd Khairi, Shauna Culshaw
Improving patient and staff engagement in a COVID-19 Surveillance Programme in a Dental Setting: Lessons learned and implications for such programmes in future
Introduction: In August 2020, Public Health Scotland commenced a prospective surveillance study to monitor the prevalence of COVID-19 among asymptomatic outpatients attending dental clinics across 14 health boards in Scotland. One of these participating centres was Glasgow Dental Hospital. A quality improvement project was undertaken to increase the number of samples, identifying barriers to patient and staff engagement with the programme and seeking to address them.
Methods: A working group was established with leads assigned for each department of the dental hospital. This group met weekly and was responsible for the collecting of data in order identify specific barriers to staff and patient engagement in the project from which change ideas could be developed.
Results/Discussion: Over the 16 week period of the quality improvement project 969 tests were carried out. With the number of tests completed per week increasing from 23 in week one to a 126 in week 16. Reasons for non-participation were multi-factorial with the most common for patients being fear that swabs would hurt and the most common for staff being lack of time and forgetting to ask patients.
Conclusion: Dental care settings provide an ideal environment for rapid implementation of public health surveillance programmes. This is due to ready accessibility to patients, national distribution and availability of medically trained staff. Significant challenges may still need to be overcome in order to make such programmes cost effective and sustainable in the long term or outside the context of a pandemic.
Lauren Crowder, Francesca Capaldi
A Pandemic A Pandemic Problem: Review of the Comprehensive Oral Care General Anaesthetic Waiting List during COVID 19 (NHS Greater Glasgow and Clyde) Pandemic Problem: Review of the Comprehensive Oral Care General Anaesthetic Waiting List during COVID 19 (NHS Greater Glasgow and Clyde)
In March 2020, as part of the UK Government’s response to the COVID 19 pandemic, elective dental care in the UK ceased. As a result the waiting time for a comprehensive care general anaesthetic increased.
- To review the number of patients on the Comprehensive Care General Anaesthetic Waiting List (CCGAWL)
- To prioritise the patients on the CCGAWL by clinical need
- To determine whether alternative treatment modalities were feasible
A waiting list report was generated on the 9th November 2020.
Children who had been on the waiting list for >4weeks, with no appointed operation date (TCI date) were selected.
A telephone survey was carried out. This included questions on dental symptoms, analgesia use and antibiotic use. There was also discussion regarding the potential feasibility of other treatment modalities.
61 patients had been on the CCGAWL >4 weeks on the 9th of November.
The time on the waiting list ranged from 42 – 354 days.
47 patients were contacted and a telephone consultation was completed.
5 had their treatment priority increased.
2 required urgent review.
8 opted to try alternate treatment modalities.
26 had been in pain but only 13% were currently taking analgesia.
1 child protection concern was raised.
1 social worker referral was made.
COVID-19 has led to increased waiting times on the CCGAW, and so a myriad of circumstances may have changed. Some of these children, now older may be amenable to other treatment modalities, others no longer require treatment and others require treatment soon.
- The CCGAWL review demonstrated a method of prioritising patients based on their social, medical and dental needs.
- Child protection concerns can be raised through waiting list review projects.
- After long waiting times, some children may no longer need treatment or may now be able to try alternative treatment modalities.
Head and neck cancer is the 8th most common cancer diagnosis in the UK. Early diagnosis and treatment are paramount for increasing survival rates. Limitations and restrictions of face to face (FTF) appointments due to the COVID-19 pandemic have led to adaptations in patient consultation to prevent further delay in diagnosis.
Oral and Maxillofacial (OMFS) case report. Prior to the COVID-19 pandemic, the patient attended regular FTF reviews for lichen planus. In May 2020, a telephone review was conducted, and photographs were emailed for comparison to previous clinical photographs. An urgent biopsy was ordered and revealed malignant change.
The patient was diagnosed with pT4 N0, right mandibular alveolus squamous cell carcinoma. Treatment involved mandibular resection and flap reconstruction with the aid of a 3-D planner, treatment might have been less extensive with an earlier diagnosis which may had been achieved without the restrictions caused by the COVID-19 pandemic. A limit in the number of staff members in theatre was enforced, resulting in only one DCT being permitted to observe the surgery; full PPE was mandatory for all staff members.
This case report highlights:
1) The potential delay in diagnosing and treating a progressing squamous cell carcinoma due to the COVID-19 pandemic.
2) The impact of the pandemic on DCT training and development. A local audit showed FTF appointments were significantly reduced during COVID-19, limiting DCTs exposure to oral cancer clinics and managing post-operative patients.
3) The importance of OMFS adaptation to the pandemic with the introduction of ‘Near Me’ video consultations and the increase of patient photography. Modern technology allows careful monitoring and visualisation of oral lesions with additional educational benefit to DCTs.
1) Continue to utilise remote consultations; NHS Grampian covers a wide geographical area.
2) Allow DCTs to lead remote clinics.
Saiba Ghafoor, K. Ryan
Please Mind the Bumps: The Clinical Presentation of Cowden Syndrome and its Diagnostic Challenges
Introduction: Cowden Syndrome is an autosomal dominant condition characterised by benign overgrowths called hamartomas in various parts of the body. Most cases are caused by a mutation in the PTEN tumour suppressor gene and there is an increased lifetime risk of developing certain cancers, including breast, thyroid and endometrial. The infrequency with which it is encountered makes it a diagnostic challenge. In this case, the patient was invited to attend prior to her review appointment to give further consideration to Cowden Syndrome when her clinical presentation was deemed not to fit with the initial diagnosis of florid papillary hyperplasia.
Case: A 62-year-old female patient was referred by her GP to ENT, complaining of a ‘hot-potato’ voice and difficulty breathing and speaking sometimes. She was found to have polypoidal appearance in the pharynx and epiglottis, and an MRI was requested and the patient referred to Oral Medicine for an opinion, especially regarding the appearance of the tongue. She complained of ‘cracks’ in the tongue, which she had for many years, without symptoms. On examination, there were two polyps on the buccal mucosa in addition to significant papillary hyperplasia of the buccal mucosa, palate and tongue.
At the expedited review appointment an online tool - the Cleveland Clinic PTEN Score - was used and a risk of 24% calculated of having the PTEN mutation. The patient was referred onwards to the Genetics Service who subsequently confirmed the patient had PTEN mutation and offered surveillance regarding cancer risk (thyroid; breast & endometrial) and extended family genetic testing.
Conclusion: This case illustrates the importance of interrogating presumed diagnoses, particularly when the clinical picture does not entirely fit. In addition, this case demonstrates the benefit of using an online clinical scoring system as an adjunct to assist prior to considering referral to the Genetics Service.
The impact of Covid-19 restrictions’ led bonding protocol on bracket failure rate in the Orthodontic Department at Dumfries and Galloway Royal Infirmary
INTRODUCTION: This audit looks at the impact of the new non-AGP protocol on the bracket failure rate. Literature search and previous audit looking at bracket failure was taken into account to agree on standard.
Gold standard was set at no more than 6%.
This project consists of retrospective audit and the first cycle of prospective audit. In the retrospective audit bracket bonding failure rate was analysed while using protocol that strictly follows manufacturer instructions, thus generating aerosols. Prospective audit analyses bracket bonding failure with amended bond-up protocol which avoids creating aerosols.
METHODS: All patients with full or sectional bond-ups in the analysed period of time were included in the audit.
22 patients who had full or sectional bond-ups provided between 01/09/2019 to 31/12/2019 were included in the retrospective audit cycle.
24 patients with full or sectional bond-ups provided between 01/09/2020 and 31/12/2020 were included in the first prospective audit cycle.
Patients in both audit cycles were followed up for 3 months.
The Gold Standard was met in the retrospective audit.
290 brackets were bonded in the retrospective audit cycle.15 brackets debonded within the first 3 months following bond-up. This gives bracket failure rate at 5.2% in 3months following bond-up when using AGP protocol.
1st cycle of prospective audit
The Gold Standard wasn’t met in the first cycle of prospective audit.
231 brackets were bonded using amended bond-up protocol between September and December 2020. 17brackets debonded within the first 3 months following bond-up. This gives bracket failure rate at 7.4%, which exceeds Gold Standard figure.
CONCLUSION: Although we cannot be absolutely certain that patients' compliance hasn’t contributed to the results due to the incomplete data, an increase in bracket failure was observed when Covid-19 pandemic led bond-up protocol, avoiding aerosol generating procedures was introduced.