Humanizing clinical dentistry through a person-centred model

oai:ojs.iwpc.mcgill.ca:article/2The clinical approach in dentistry stems from a biomedical model of health that is anchored in positivism. This biomedical model was never explicitly developed or reflected on, but rather implicitly acquired as a product of historical circumstance. A reductionist understanding of health served dentistry well in the past, when health afflictions were mostly acute. Today, however, in the age of chronic illnesses, the current clinical approach is no longer adequate: patients and dentists are both dissatisfied, and there are problems with dental education and dental public health. After a thorough review of the literature, highlighting the current state of the profession, we propose an alternative clinical model upon which updated approaches can be based. We call this model "Person-Centred Dentistry". Our proposed model is rooted on the notion of sharing of power between the dentist and the patient: a sharing of power in the relationship and epistemology. This leads to an expanded understanding of the person and the illness; a co-authoring of treatment plans; and interventions that focus not only on eliminating disease but also on patient needs.

What is preventing dentists from providing person-centred care?

Most healthcare professions have shifted the way they teach clinical approaches from a biomedical to a person-centred perspective. Yet, dentistry remains strongly anchored in a biomedical world.The objective of this project was to understand the barriers practicing dentists face to provide what we consider person-centred care. We conducted a qualitative descriptive study that comprised semi-structured interviews with dentists in private practice in the Greater Montreal area. After the analysis, we identified six barriers:•     Fear of interpersonal conflict: participants thought that engaging in genuine conversations with patients would lead to situations of disagreement and even conflicts.•     Fear of litigation: dentists considered that the legal and licensing infrastructure would judge the treatment they provide through a strict biomedical framework.•     Fear of loss of money: participants thought that providing person-centred care was more time consuming and thus financially penalizing. •    Pleasure to excel technically: some dentists did not consider offering interventions that provided less procedural pleasure than technical ones.•    Narrow interpretation of health: participants considered the biomedical dimension as the only important dimension.•    Lack of information: participants knew nothing or very little about person or patient-centred care. They seemed willing to integrate it into their practice had they had known more about it.These findings should help academic institutions to design their programs on person-centred care and respond to the fears expressed by professionals.Also, legal infrastructures must recognize the paradigm shift from the biomedical to the person-centred.

Person-Centered Care: Perspectives of free dental clinic users in Montréal, Canada

There has been a relatively slow incorporation of person-centered care into dental care. Despite the efforts to sustain this approach in dental health care delivery, the perspectives of patients have yet to be considered, especially those using free dental clinics. Our objectives were: (1) to describe the perspectives of adults unable to access private dental clinics when using free dental clinics, (2) to document their suggestions for improvements to dental care. This qualitative descriptive study included 13 adults using a free dental clinic. To select participants, we adopted a maximum variation sampling strategy regarding age, sex, marital status, education level and employment status. We used in-depth, semi-structured interviews to collect data and thematic content analysis to analyze the verbatim transcripts. Participants were generally satisfied with the dental care they received in private and free dental clinics. However, they did not appreciate the long wait times at free clinics, and were bothered by the cost at private clinics. They emphasized a desire for quality time with the dentist allowing for more informed and shared decisions about their care, regardless of the clinic they visited. Participants want to feel cared for through a trustworthy relationship with the clinician, and suggested incorporating a walk-in concept into free clinics to address access to care. Adults using free dental clinics have various experiences with private and public dentistry, but they all need clinicians who adopt a comprehensive approach when providing information. This could improve patients’experiences through a more person-centered approach to dental care

Effect of fixed orthodontic appliances on salivary microbial parameters at 6 months:a controlled observational study

Objective: The aim of this study was to assess the microbial changes in children with fixed orthodontic appliances compared with a control group of children without orthodontic treatment. Material and Methods: Ninety-five children, aged between 12 and 16 years, participated in this study. Forty-eight subjects were fitted with fixed orthodontic appliances and forty-seven were free of any such appliances. The follow-up was 6 months for all children. The association between orthodontic appliances and high levels of Streptococcus mutans and Lactobacillus spp was assessed with logistic regression models, taking age, sex, pH and buffer capacity into account. Results: Differences at baseline between the two groups were not statistically significant. We found that wearing a fixed orthodontic appliance was associated with high levels of Streptococcus mutans and Lactobacillus spp (adjusted OR: 6.65, 95% CI [1.98-22.37]; 9.49, 95% CI [2.57-35.07], respectively), independently of other variables. Conclusion: The originality of the present epidemiological study was to evaluate the evolution of salivary microbial parameters in a population of children with fixed orthodontic appliances. Our results show an increase of Streptococcus mutans and Lactobacillus spp values during the follow-up. The whole dental workforce should be aware that preventive measures are of paramount importance during orthodontic treatment

Periodontal treatment to improve glycaemic control in diabetic patients: study protocol of the randomized, controlled DIAPERIO trial

<p>Abstract</p> <p>Background</p> <p>Periodontitis is a common, chronic inflammatory disease caused by gram-negative bacteria leading to destruction of tissues supporting the teeth. Epidemiological studies have consistently shown increased frequency, extent and severity of periodontitis among diabetic adults. More recently, some controlled clinical trials have also suggested that periodontal treatment could improve glycaemic control in diabetic patients. However current evidence does not provide sufficient information on which to confidently base any clinical recommendations. The main objective of this clinical trial is to assess whether periodontal treatment could lead to a decrease in glycated haemoglobin levels in metabolically unbalanced diabetic patients suffering from chronic periodontitis.</p> <p>Methods</p> <p>The DIAPERIO trial is an open-label, 13-week follow-up, randomized, controlled trial. The total target sample size is planned at 150 participants, with a balanced (1:1) treatment allocation (immediate treatment vs delayed treatment). Periodontal treatment will include full mouth non-surgical scaling and root planing, systemic antibiotherapy, local antiseptics (chlorhexidine 0.12%) and oral health instructions. The primary outcome will be the difference in change of HbA1c between the two groups after the 13-weeks' follow-up. Secondary outcomes will be the difference in change of fructosamine levels and quality of life between the two groups.</p> <p>Discussion</p> <p>The DIAPERIO trial will provide insight into the question of whether periodontal treatment could lead to an improvement in glycaemic control in metabolically unbalanced diabetic patients suffering from periodontitis. The results of this trial will help to provide evidence-based recommendations for clinicians and a draft framework for designing national health policies.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN15334496</p

Frequency and Risk Indicators of Tooth Decay among Pregnant Women in France: A Cross-Sectional Analysis

INTRODUCTION: Little is known on the prevalence of tooth decay among pregnant women. Better knowledge of tooth decay risk indicators during pregnancy could help to develop follow-up protocols for women at risk, along with better prevention strategies. The aim of this study was to assess the frequency of tooth decay and the number of decayed teeth per woman in a large sample of pregnant women in France, and to study associated risk indicators. METHODS: A secondary cross-sectional analysis of data from a French multicentre case-control study was performed. The sample was composed of 1094 at-term women of six maternity units. A dental examination was carried out within 2 to 4 days post-partum. Socio-demographic and behavioural characteristics were obtained through a standardised interview with the women. Medical characteristics were obtained from the women's medical records. Risk indicators associated with tooth decay were identified using a negative binomial hurdle model. RESULTS: 51.6% of the women had tooth decay. The mean number of decayed teeth among women having at least one was 3.1 (s.d. = 2.8). Having tooth decay was statistically associated with lower age (aOR = 1.58, 95%CI [1.03,2.45]), lower educational level (aOR = 1.53, 95%CI [1.06,2.23]) and dental plaque (aOR = 1.75, 95%CI [1.27,2.41]). The number of decayed teeth was associated with the same risk indicators and with non-French nationality and inadequate prenatal care. DISCUSSION: The frequency of tooth decay and the number of decayed teeth among pregnant women were high. Oral health promotion programmes must continue to inform women and care providers about the importance of dental care before, during and after pregnancy. Future research should also assess the effectiveness of public policies related to oral health in target populations of pregnant women facing challenging social or economic situations

Improving Person-Centered Access to Dental Care: The Walk-In Dental Encounters in Non-Emergency Situations (WIDENESS)

Background: We hypothesized that access to dental care could be improved by the conceptualization of a new type of consultation: The walk-in dental encounter for non-emergency situations (WIDENESS). The aim of this study was to assess patient perspectives regarding walk-in dental consultations, with a particular focus on non-emergency situations. Methods: We followed a qualitative research approach using a semi-structured interview guide in a sample of random participants recruited from the dental department of the Toulouse University Hospital, France. We performed a thematic analysis of the interview transcripts. Data saturation was obtained after interviewing 11 participants. Results: When asked about walk-in dental consultations, three main topics emerged: (1) Walk-in dental consultation in general is important for emergency situations, but WIDENESS did not correspond to any specific long-standing need from participants; (2) WIDENESS could be a way to improve access to oral care (facilitating access to care relative to time constraints, reduction of dentist-related anxiety, better overall follow-up for the care pathway, and the complementary nature of consultations with and without appointments); and (3) WIDENESS has some potential drawbacks&mdash;apprehension about long waiting times was mentioned by several participants. Conclusions: Participants found the idea of WIDENESS promising, despite spontaneously mentioned reservations, which constitute major challenges to its implementation

Person-Centred Dentistry: When Do We Start?

Objectives: Although most health professions have adopted person-centred approaches in the last decades, dental professionals still rely on traditional paternalistic models. The objective of this research was to develop a model of person-centred care in dental practice.Methods: Adopting an action-research approach, we started our process by adapting Stewart and colleagues' model of person-centred care to the field of dentistry. We then implemented and tested the new clinical approach in a private dental office of Montreal, Canada. During several months, an academic researcher observed the clinical activities of a dental practitioner, who was also the first researcher. At the end of each appointment, the observer and the practitioner shared their observations about the encounter and evaluated the clinical approach. Both suggested improvements to the model and implemented solutions to the next patients. After 39 rounds of observation-evaluation-improvement, a form of saturation was reached in the development of the clinical approach.Results: The clinical encounter goes through four different stages. The first stage is how the relationship is built through an open dialogue on illness, fears and expectations. The second stage consists in gathering clinical information through examination, tests and questioning. The third stage is a disease-centered presentation of the results of the examination. The final stage is the development of a treatment plan after establishing a common ground through frank discussions and shared decision making. From this approach, a model emerged consisting in a stage of understanding, followed by planning, intervention, then back to understanding. This cycle takes place within the context of a patient-dentist relationship with mutual trust. This relationship, central to the encounter, acknowledges the whole-person dimension and psychosocial context of each party.Conclusions:  We hope this model will inspire other professionals and teaching institutions to develop their own approaches by using it as a theoretical framework

Étude de l’impact de l’évaluation « par patient traité » sur l’activité clinique des étudiants en chirurgie dentaire

Contexte :  L’évaluation clinique des étudiants en chirurgie-dentaire est traditionnellement basée sur des critères quantitatifs, correspondant à un nombre minimum d’actes spécifiques à réaliser. Ce type de méthode est remis en question, en raison de l’environnement comptable qu’il induit auprès des étudiants, et de la déshumanisation de la relation de soins qui s’ensuit. But : Ce travail a pour objectif d’évaluer l’impact de la mise en place d’une évaluation alternative, de type « patient-traité », pour laquelle l’objet de l’évaluation est le patient et non plus seulement l’acte technique. Méthodes : Il s’agit d’une étude unicentrique de type qualitatif, conduite à partir d’entretiens semi-dirigés auprès d’étudiants en dernière année d’étude de chirurgie dentaire, à la faculté de Toulouse durant l’année 2015–2016. Les données sont recueillies jusqu’à saturation des thèmes et analysées selon la méthode de l’analyse thématique. Résultats : Cette étude montre que l’évaluation quantitative est globalement acceptée par les étudiants et répond à certaines attentes sur le nombre d’actes réalisés. Elle confirme également les effets indésirables d’une évaluation clinique quantitative, comme les abandons de patients ou les modifications de plan de traitement. L’évaluation par patient-traité est perçue comme plus humaine, moins stressante et plus efficace. Conclusion : Des méthodes d’évaluation clinique nouvelles, mettant au centre du dispositif les étudiants et les patients, doivent être développées pour favoriser l’émergence de compétences en phase avec les évolutions sociétales