Dentist-patient relationships and oral health-related quality of life

The clinical encounter remains a key component of the healthcare service. Despite drastic/massive changes thanks to social and technical development, a therapeutic relationship between clinician and patient is still at the centre of healthcare encounters. As such, dentist-patient relationships (DPR) also play a pivotal role in dental encounters. There are, however, limited numbers of studies where predictors of DPR variables have been thoroughly analysed for their association with oral health outcomes. These studies were commonly based on the extrapolation from medicine or generic healthcare, leaving the dentistry-specific context uncharted. For the rationale to fill the gap of previous research findings, the aim of the thesis was to investigate associations between variables in DPR and oral health-related quality of life (OHRQoL). Four papers in the thesis were to explore the topic from a specific construct of trust in DPR to the general associations and extensive framework including psychosocial factors and structural validity. This thesis adopted two general approaches: reverse/inverted funnel structure and sequential hypotheses of articles. A comprehensive mapping review on a specific subtopic of trust led the theme to a wider scope of empirical analyses for the aim of the thesis. Among three empirical studies, the initial hypothesis tested in the first paper induced subsequent hypotheses for the second and culminated with examining the expansive causal model in the last. The data for the empirical analyses were sourced in self-complete questionnaires from the Dental Care and Oral Health study with a random sample of 12,245 adults aged 18 years or over living in South Australia in 2015-2016. Variables collected from multi-item scales were analysed in multivariable linear regression, exploratory/confirmatory factor analyses, cluster analysis, and structural equation modelling. The mapping review found three frameworks for the relevant concepts of trust in DPR: the continuum, beneficiaries, and transformational model of trust. Three thematic findings from the review were multidisciplinary approach, patient-centred care and quality of care, and insufficient empirical evidence. Empirical study 1 found general associations asked in the aim of the thesis – better DPR, mainly higher satisfaction and less dental fear, are associated with higher OHRQoL, presenting lower oral health impact. The significant association was consistent between favourable DPR and improved OHRQoL after adjusting for putative confounders. In empirical study 2, the analyses on factor structure showed that trust and satisfaction in dental care settings are unidimensionally different but highly correlated factors concurrently. The final model from structural validity suggested both scales with revision be applied together for further studies on DPR. The last empirical study indicated that psychosocial factors and DPR variables are associated with OHRQoL in both unique and mediated effects. Starting from psychosocial factors via DPR variables to OHRQoL, the ‘distal-to-proximal’ framework was empirically substantiated by the model. In conclusion, variables related to better DPR are associated with higher OHRQoL in both direct and indirect paths along with psychosocial factors. The biopsychosocial model of oral health with better DPR should be applied to improve health promotion as is justified by the theoretical and empirical findings from the thesis.Thesis (Ph.D.) -- University of Adelaide, Adelaide Dental School, 202

Adjusting the british triage system for dental care in South Korean correctional institutions: a cross-sectional study

Background The oral health status of inmates in South Korean correctional institutions is poor, mainly due to limited resources and an unestablished triage system. Hence, this study aimed to develop a newly structured dental triage system for South Korean correctional institutions, using the British triage system as a reference. Methods This study included 32 public health dentists working at correctional institutions in South Korea in 2020, accounting for the entire population of public health dentists that year. Data on the dentists evaluation of resources and perceptions of dental service items were collected using a self-administered online survey including 19 dental service items from the British triage system to assess the level of agreement on dental triage items. All responses were recorded within 1 week of request, and a hierarchical cluster analysis was performed to develop a new dental triage system. Results The survey included 31 respondents working at 47 correctional institutions; 16, 14, and one respondent provided dental services at one, two, and three institutions, respectively. Among the correctional institutions, 2%, 74%, and 23% were the National Forensic Hospital, prisons, and detention centres, respectively. The hierarchical cluster analysis identified four adjusted dental triage categories: emergency, urgent, routine, and checkups, mainly in accordance with those in the British system, but a few items were reallocated. The new dental triage system was compared to the existing system and found to have higher specificity and sensitivity, indicating that it may be more effective at meeting the oral health needs of inmates in South Korean correctional institutions. Conclusions This study developed a newly structured dental triage system by adjusting the British system and evaluated its efficacy compared to the existing system. The new system may help improve the oral health status of inmates in South Korean correctional institutions by providing a more organized approach to dental care provision.This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI19C1178)

Dentists attitudes toward patient-centered care and its predictors: a cross-sectional study in South Korea

Background Patient-centered care (PCC) has been one of medical practices most frequently discussed principles. However, attitudes toward PCC among dentists remain underexplored. This study focuses on examining dentists patient-centered attitudes and investigating their predictors. Methods The Patient–Practitioner Orientation Scale which consists of Sharing and Caring subscales was used to assess patient-centered attitudes. The statistical analysis included 217 dentists from South Korea. Hierarchical linear regression analysis was performed to examine the predictors such as sociodemographic aspects, academic factors, work-related factors, and empathy. Results A patient-centered attitude of Caring subscale (M = 4.29, SD = 0.56) emerged, but the provider-centered attitude was higher in Sharing subscale (M = 3.40, SD = 0.48). Work year, academic track, and empathy were associated significantly with an overall caring aspect of patient-centered attitude, while the gender effect remained insignificant. Empathy had a critical and significant impact on the patient-centered attitude. Conclusions Efforts to enhance patient-centeredness in Sharing are needed; post-graduate education and transition to a more patient-centered health system are recommended. Moreover, empathy still matters as it was found to be a significant predictor of patient-centered attitudes. The findings of this study support the need for efforts to enhance patient-centered attitudes among dentists, which will help generate discussion on improving the curriculum of post-graduate education and health system reform

Psychosocial factors, dentist-patient relationships, and oral health-related quality of life: a structural equation modelling

Abstract Background Psychosocial factors and dentist-patient relationships (DPR) have been suggested to be associated with oral health outcomes. This study aimed to test a conceptual model which hypothesised relationships among psychosocial factors, DPR variables, and oral health-related quality of life (OHRQoL) in the ‘distal-to-proximal’ framework. Methods A total of 12,245 adults aged 18 years or over living in South Australia were randomly sampled for the study. Data were collected from self-complete questionnaires in 2015–2016. The outcome variable of Oral Health Impact Profile was used to measure OHRQoL. Psychosocial domain consisted of psychological well-being, social support, and health self-efficacy. DPR domain included trust in dentists, satisfaction with dental care, and dental fear. The hypothesised model was tested using the two-step approach in structural equation modelling. Results Data were analysed from 3767 respondents after the screening/preparing process (adjusted valid response rate 37.4%). In the first step of the analysis, confirmatory factor analyses produced acceptable measurement models for each of the six latent variables (GFI = 0.95, CFI = 0.98, RMSEA = 0.04). The final structural model indicated that better well-being, higher self-efficacy, and more satisfaction were associated with lower oral health impact (β = − 0.12, − 0.07, − 0.14, respectively) whereas fear was positively associated (β = 0.19). Among intermediates, support was positively associated with satisfaction within a small effect size (β = 0.06) as compared to self-efficacy with trust (β = 0.22). The invariance of the final model was also confirmed on participants’ SES and dental service characteristics except the variable of ‘last dental visit’. Conclusions Psychosocial factors and DPR variables were associated with oral health impact in both direct and indirect paths. The framework of ‘distal-to-proximal’ actions is empirically supported from psychosocial factors via DPR variables to OHRQoL

Power in Dentistry: A Foucauldian Shift in South Korea

The established method of understanding power in dentistry is based on the early Foucauldian discourse that dentistry enforces oral health discipline to the people on behalf of state power. This exhibits the hierarchy between dentists and patients, which clearly appears in clinical dentistry and effectively explains the responsibility of oral care assigned to patients. However, there presents no way to becoming free from the framework in the discourse as a resistance. Beyond the political aspect of the medico-sociological framework, this paper seeks a different way to understand power in dentistry through ???care of the self???, a late Foucauldian concept. First, based on the current discussion of the dentist-patient relationship (DPR), the paper examines two trends of clinical dental treatments in South Korea. The high prevalence of dental implant and orthognathic surgery indicates that traditional prejudices including ableism and pursuit of Western beauty still remain in South Korea albeit with the society overcoming paternalism in DPRs. These dental phenomena, however, contain excesses that cannot be explained only by traditional prejudice, and this paper attempts to interpret them as the pursuit of care of the self that appears in the dentist???s professionalism and the patient???s self-determination. In dentistry, care of the self can be introduced in the form of empowerment, which is implemented through the improvement of oral health literacy and shared decision-making. This paper argues that this interpretation helps surmount the traditional dyadic model of the DPR and revise the understanding of power in dentistry.N

Dentist-patient relationships and oral health impact in Australian adults

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons LtdObjectives: Dentist-patient relationships (DPRs) are a key component in clinical encounters with potential benefits for oral health outcomes. This study aimed to investigate whether better DPR variables are associated with higher oral health-related quality of life (OHRQoL). Methods: A total of 12 245 adults aged 18 years or over were randomly sampled from South Australia in 2015-2016. Data were collected from self-complete questionnaires and analysed as a cross-sectional design. The outcome variable was the Oral Health Impact Profile (OHIP-14). Explanatory DPR variables included trust in dentists, satisfaction with dental care, and dental fear. Covariates comprising oral health behaviours, dental services, demographics, and socioeconomic status were included as potential confounding variables. Bivariate correlation analyses and multivariable linear regression were performed for the associations among explanatory, outcome variables and other covariates. Results: Response data were analysed from 4220 participants (response rate = 41.9%). Unadjusted mean total scores of DPR variables and OHIP-14 were associated with most of the study participants' characteristics (P <.05). Bivariate correlations among DPR variables and OHIP-14 showed a diverse range of coefficients (|r| or |ρ|=0.22-0.67). Multivariable regression analyses in both individual/clustered block entry and full model indicated that higher satisfaction and less dental fear (B = –0.039 and 0.316, respectively in the full model) were associated with lower OHIP-14 after adjusting for possible confounders (P <.01). Conclusions: This study found that favourable DPR variables, mainly greater satisfaction and less dental fear are positively associated with better OHRQoL. Further studies are warranted to investigate the causality and mediation/moderation of DPR variables on oral health outcomes.N

Trust in dentist-patient relationships: mapping the relevant concepts

© 2020 Eur J Oral SciTrust has a central role in healthcare encounters. This review explored concepts relevant to trust in dentist-patient relationships. The findings were demonstrated by drawing visual system maps for better understanding of the inherent complexity. A pragmatic approach was employed to search for evidence. The approach was initiated with a systematised searching protocol and followed by an iterative process of drawing maps and complementing references. The analysis-synthesis process found relevant key concepts and sub-concepts presented within three frameworks: the continuum of studying trust (utilisation, measurement, and establishment); beneficiaries of trust utilisation (patients, dentists, and oral health system); and a transformational model of trust development (identification-based, knowledge-based, and deterrence/calculus-based trust). Trust in dentist-patient relationships needs to be assessed in a multidisciplinary approach for interconnectedness among relevant concepts. The findings are represented in patient-centred care and quality of care with common underlying values. Despite the centrality of trust in medical/dental contexts, empirical evidence is insufficient beyond normative suggestions from previous studies. Based on the implications of thematic analysis and interpretation of the system maps, this paper can serve as a guide and source of information for further research of trust in dentist-patient relationships.N

Dentist-patient relationships and oral health impact in Australian adults

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons LtdObjectives: Dentist-patient relationships (DPRs) are a key component in clinical encounters with potential benefits for oral health outcomes. This study aimed to investigate whether better DPR variables are associated with higher oral health-related quality of life (OHRQoL). Methods: A total of 12 245 adults aged 18 years or over were randomly sampled from South Australia in 2015-2016. Data were collected from self-complete questionnaires and analysed as a cross-sectional design. The outcome variable was the Oral Health Impact Profile (OHIP-14). Explanatory DPR variables included trust in dentists, satisfaction with dental care, and dental fear. Covariates comprising oral health behaviours, dental services, demographics, and socioeconomic status were included as potential confounding variables. Bivariate correlation analyses and multivariable linear regression were performed for the associations among explanatory, outcome variables and other covariates. Results: Response data were analysed from 4220 participants (response rate = 41.9%). Unadjusted mean total scores of DPR variables and OHIP-14 were associated with most of the study participants' characteristics (P <.05). Bivariate correlations among DPR variables and OHIP-14 showed a diverse range of coefficients (|r| or |ρ|=0.22-0.67). Multivariable regression analyses in both individual/clustered block entry and full model indicated that higher satisfaction and less dental fear (B = –0.039 and 0.316, respectively in the full model) were associated with lower OHIP-14 after adjusting for possible confounders (P <.01). Conclusions: This study found that favourable DPR variables, mainly greater satisfaction and less dental fear are positively associated with better OHRQoL. Further studies are warranted to investigate the causality and mediation/moderation of DPR variables on oral health outcomes.N

Facial Emotion Recognition Analysis Based on Age-Biased Data

This paper aims to analyze the importance of age-biased data in recognizing six emotions using facial expressions. For this purpose, a custom dataset (adults, kids, mixed) was constructed using images that separated the existing datasets (FER2013 and MMA FACILE EXPRESSION) into adults (≥14) and kids (≤13). The convolutional Neural Networks (CNN) algorithm was used to calculate emotion recognition accuracy. Additionally, this study investigated the effect of the characteristics of CNN architecture on emotion recognition accuracy. Based on the variables of Accuracy and FLOP, three types of CNN architectures (MobileNet-V2, SE-ResNeXt50 (32 × 4 d), and ResNeXt-101 (64 × 4 d)) were adopted. As for the experimental result, SE-ResNeXt50 (32 × 4 d) showed the highest accuracy at 79.42%, and the model that learned by age obtained 22.24% higher accuracy than the model that did not learn by age. In the results, the difference in expression between adults and kids was greatest for fear and neutral emotions. This study presented valuable results on age-biased learning data and algorithm type effect on emotion recognition accuracy

Dental service sector and patient-reported oral health outcomes: Modification by trust in dentists

ObjectiveThe study aimed to examine the association between patient-reported oral health outcomes and the dental service sector and trust in dentists. The possible interaction effect of trust on this association was also explored.MethodsRandomly selected adults aged over 18 years living in South Australia were surveyed using self-administered questionnaires. The outcome variables were self-rated dental health and the evaluation outcome of the Oral Health Impact Profile. The dental service sector and the Dentist Trust Scale were included in bivariate and adjusted analyses with sociodemographic covariates.ResultsData from 4,027 respondents were analyzed. Unadjusted analysis showed that poor dental health and oral health impact were associated with sociodemographic characteristics, including lower income/education, public dental service, and lower trust in dentists (p ConclusionPatient-reported oral health outcomes were associated with sociodemographic characteristics, the dental service sector, and trust in dentists.Implications for public healthThe inequality of oral health outcomes between dental service sectors needs to be addressed both independently and in association with covariates including socioeconomic disadvantage.</p