Experiences of dental care: what do patients value?

Background Dentistry in Australia combines business and health care service, that is, the majority of patients pay money for tangible dental procedures such as fluoride applications, dental radiographs, dental fillings, crowns, and dentures among others. There is evidence that patients question dentists’ behaviours and attitudes during a dental visit when those highly technical procedures are performed. However, little is known about how patients’ experience dental care as a whole. This paper illustrates the findings from a qualitative study recently undertaken in general dental practice in Australia. It focuses on patients’ experiences of dental care, particularly on the relationship between patients and dentists during the provision of preventive care and advice in general dental practices. Methods Seventeen patients were interviewed. Data analysis consisted of transcript coding, detailed memo writing, and data interpretation. Results Patients described their experiences when visiting dental practices with and without a structured preventive approach in place, together with the historical, biological, financial, psychosocial and habitual dimensions of their experience. Potential barriers that could hinder preventive activities as well as facilitators for prevention were also described. The offer of preventive dental care and advice was an amazing revelation for this group of patients as they realized that dentists could practice dentistry without having to “drill and fill” their teeth. All patients, regardless of the practice they came from or their level of clinical risk of developing dental caries, valued having a caring dentist who respected them and listened to their concerns without “blaming” them for their oral health status. These patients complied with and supported the preventive care options because they were being “treated as a person not as a patient” by their dentists. Patients valued dentists who made them aware of existing preventive options, educated them about how to maintain a healthy mouth and teeth, and supported and reassured them frequently during visits. Conclusions Patients valued having a supportive and caring dentist and a dedicated dental team. The experience of having a dedicated, supportive and caring dentist helped patients to take control of their own oral health. These dentists and dental teams produced profound changes in not just the oral health care routines of patients, but in the way patients thought about their own oral health and the role of dental professionals. Keywords: Qualitative research; Dentist-patient relationship; Preventio

How do dentists and their teams incorporate evidence about preventive care? An empirical study

Objectives: To identify how dentists and their teams adopt evidence-based preventive care. Methods: A qualitative study using grounded theory methodology was conducted. We interviewed 23 participants working in eight dental practices about their experience and work processes, while adopting evidence-based preventive care. During the study, Charmaz’s grounded theory methodology was employed to examine the social process of adopting preventive dental care in dental practices. Charmaz’s iteration of the constant comparative method was used during the data analysis. This involved coding of interview transcripts, detailed memo-writing and drawing diagrams. The transcripts were analysed as soon as possible after each round of interviews in each dental practice. Coding was conducted primarily by AS, supported by team meetings and discussions when researchers compared their interpretations. Results: Participants engaged in a slow process of adapting evidence-based protocols and guidelines to the existing logistics of the practices. This process was influenced by practical, philosophical, and historical aspects of dental care, and a range of barriers and facilitators. In particular, dentists spoke spontaneously about two deeply held ‘rules’ underpinning continued restorative treatment, which acted as barriers to provide preventive care: (i) dentists believed that some patients were too ‘unreliable’ to benefit from prevention; and (ii) dentists believed that patients thought that only tangible restorative treatment offered ‘value for money’. During the adaptation process, some dentists and teams transitioned from their initial state – selling restorative care – through an intermediary stage – learning by doing and educating patients about the importance of preventive care – and finally to a stage where they were offering patients more than just restorative care. Resources were needed for the adaptation process to occur, including: the ability to maintain the financial viability of the practice, appropriate technology, time, and supportive dental team relationships. Conclusions: The findings from this study show that with considerable effort, motivation and coordination, it is possible for dental practices to work against the dental ‘mainstream’ and implement prevention as their clinical norm. This study has shown that dental practice is not purely scientific, but it includes cultural, social, and economic resources that interfere with the provision of preventive care.NHMRC Project Grant 63271

Being Ritual in Mesolithic Britain and Ireland: Identifying Ritual Behaviour Within an Ephemeral Material Record

Acceptance of ritual as a valid interpretation of Mesolithic behaviour has slowly emerged over the past decade; the ‘silly season’ heralded by Mellars (Antiquity 83:502–517, 2009) has not materialised, though in Ireland and Britain difficulties persist in defining what might constitute ‘ritual’ away from the graveside. New discoveries from both the development-led and academic sectors enable Mesolithic archaeologists to better establish which elements of the archaeological record can be interpreted as ritual. This paper seeks to identify further strands of ritual behaviour, incorporating evidence from sites without organic remains. We consider the evidence for ritual at the site and feature scales, and in the special treatment of objects—an often overlooked body of data in understanding ritual. Thus the material signature of ritual will be questioned, and ways in which Mesolithic ritual can be rehabilitated and expanded will be explored

Homo sapiens lithic technology and microlithization in the South Asian rainforest at Kitulgala Beli-lena (c. 45 – 8,000 years ago)

Recent archaeological investigations in Sri Lanka have reported evidence for the exploitation and settlement of tropical rainforests by Homo sapiens since c. 48,000 BP. Information on technological approaches used by human populations in rainforest habitats is restricted to two cave sites, Batadomba-lena and Fa-Hien Lena. Here, we provide detailed study of the lithic assemblages of Kitulgala Beli-lena, a recently excavated rockshelter preserving a sedimentary sequence from the Late Pleistocene to the Holocene. Our analysis indicates in situ lithic production and the recurrent use of the bipolar method for the production of microliths. Stone tool analyses demonstrate long-term technological stability from c. 45,000 to 8,000 years BP, a pattern documented in other rainforest locations. Foraging behaviour is characterised by the use of lithic bipolar by-products together with osseous projectile points for the consistent targeting of semi-arboreal/arboreal species, allowing for the widespread and recurrent settlement of the wet zone of Sri Lanka.Introduction Mobility and hunter-gatherer tool-kits Kitulgala Beli-lena rockshelter Materials and methods Results - Late Pleistocene (c. 45,000–31,000 cal BP) - Terminal Pleistocene (17,157–11,314 cal BP) - Holocene (10,577–8,029 cal BP) Summary Discussio

Homo sapiens lithic technology and microlithization in the South Asian rainforest at Kitulgala Beli-lena (c. 45 – 8,000 years ago)

Recent archaeological investigations in Sri Lanka have reported evidence for the exploitation and settlement of tropical rainforests by Homo sapiens since c. 48,000 BP. Information on technological approaches used by human populations in rainforest habitats is restricted to two cave sites, Batadomba-lena and Fa-Hien Lena. Here, we provide detailed study of the lithic assemblages of Kitulgala Beli-lena, a recently excavated rockshelter preserving a sedimentary sequence from the Late Pleistocene to the Holocene. Our analysis indicates in situ lithic production and the recurrent use of the bipolar method for the production of microliths. Stone tool analyses demonstrate long-term technological stability from c. 45,000 to 8,000 years BP, a pattern documented in other rainforest locations. Foraging behaviour is characterised by the use of lithic bipolar by-products together with osseous projectile points for the consistent targeting of semi-arboreal/arboreal species, allowing for the widespread and recurrent settlement of the wet zone of Sri Lanka

Human interactions with tropical environments over the last 14,000 years at Iho Eleru, Nigeria

The Ihò Eléérú (or Iho Eleru) rock shelter, located in Southwest Nigeria, is the only site from which Pleistocene-age hominin fossils have been recovered in western Africa. Excavations at Iho Eleru revealed regular human occupations ranging from the Later Stone Age (LSA) to the present day. Here, we present chronometric, archaeobotanical, and paleoenvironmental findings, which include the taxonomic, taphonomic, and isotopic analyses of what is the only Pleistocene faunal assemblage documented in western Africa. Our results indicate that the local landscape surrounding Iho Eleru, although situated within a regional open-canopy biome, was forested throughout the past human occupation of the site. At a regional scale, a shift from forest- to savanna-dominated ecotonal environment occurred during a mid-Holocene warm event 6,000 years ago, with a subsequent modern reforestation of the landscape. Locally, no environmental shift was observable, placing Iho Eleru in a persistent forested “island” during the period of occupation