Dental anxiety prevalence and surgery environment factors: A questionnaire-based survey of attenders in Ireland

Aim: To identify and quantify anxious dental patientsand dental office environment factors that may influence anxiety. Objective: To develop and implement a questionnaire toinvestigate dental anxiety and identify factors thatenhance or lessen dental anxiety in the surgery setting. Methods: Data was collected from patients by a self completed questionnaire when attending dentists at a general dental practice and hospital clinics. Results: The estimated prevalence of dental anxiety in the totalsample was 17.0%. A higher proportion of females were highly anxious. Those attending the Dental Hospital were less likely to be anxious than those who were attending the Dental Practice. An inverse relationship between frequency of dental attendance and dental anxiety was found. Anxiety was significantly higher forthose respondents that indicated that a delay in their appointment would make them more anxious. Of the reported fears regarding their dental visit, 60% of respondents claimed that they were afraid it s going tohurt . When compared to non-anxious patients, more anxious patients feared feeling out of control , a negative experience , the needle, the drill, and being bothered by the smell associated with dental materials.The majority of respondents had a preference for a dentist that was young, friendly, talkative and native English speaking. In general, patients preferred the surgery temperature to be slightly cool. Regardless of anxiety level, 31.0% of patients said that they would prefer the chairside mouth rinse to be plain water with 49.1% not having a preference. Conclusions: This study demonstrates that a significant proportion of patients experience anxiety about visiting the dentist. Many of them have preferences about dentists and the surgery environment which may be modulators of their anxiety. Awareness by the dental profession of the causes of dental anxiety and measures taken by dentists tominimise these trigger factors could have a substantial impact on anxious patients

Do economic incentives influence the provision of dental services in a third-party funded dental scheme?

Objectives:To investigate whether the provision of dental services is influenced by economic incentives in a third-party funded dental service in the Republic of Ireland. Methods:Four treatment items were identified as outcome variables. These items were characterised by variation in regulation among administrative regions or variation in regulation over time. The items were Extra Oral Radiographs, Endodontics, Prolonged Periodontal Treatment, and Surgical Extractions. Claims data were obtained from the Primary Care Reimbursement Service (PCRS), formerly known as the General Medical Services Payments Board (GMSPB). Population data were obtained from the Central Statistics Office. Data were obtained from the Principal Dental Surgeons in Ireland who apply local regulatory or price controls for certain items of treatment. The data were analysed to determine the impact of the variation in regulatory approach on claims data among the eight regional health administrative areas whilst controlling for known clinical or population structural factors. Results There was a substantially lower than average provision of Extra-Oral Radiographs in regions where regulation was stringently applied.The provision of Prolonged Periodontal Treatment was positively correlated with price. The dentist-to-population ratio is positively correlated with claims for Surgical Extractions. ConclusionsThere is evidence from within the funding system that economic incentives, arising from either the contract itself or due to the geographical structure of the dentist workforce in Ireland, leads to variations in certain items of service provision which are potentially inefficient and independent of known treatment need

Predictors of utilisation of dental care services in a nationally representative sample of adults.

OBJECTIVE: The objective of this study was to identify the predictors of utilisation of dental care services in Ireland. PARTICIPANTS: The 2007 Irish Survey of Lifestyle, Attitudes and Nutrition is a cross-sectional study, conducted in 2006/2007 (n = 10,364), by interviews at home to a representative sample of adults aged 18 years or over. MAIN OUTCOME MEASURES: Multivariate logistic regression was used to investigate the influence of socioeconomic, predisposing and enabling factors on the odds of males and females having a dental visit in the past year. RESULTS: The significant predictors of visiting the dentist in the past year were for males: having 3rd level education, employment status, earning 50,000 euros or more, location of residence, use of a car, brushing frequently, and dentition status. For females, the predictors were being between 25-34 or 55-64 years-old, education level, earning 50,000 euros or more, location of residence, use of a car, brushing frequently and dentition status. CONCLUSIONS: Predictors of the use of dental services vary by gender. Predictors common to both genders were education level, higher income, location of residence, use of a car, brushing frequently and dentition status. Many of the predictors of dental visiting in the past year are also related to social inequalities in health. These predictors may be useful markers of impact for policies designed to address inequalities in access to oral health services

The effect of copayments for prescriptions on adherence to prescription medicines in publicly insured populations; a systematic review and meta-analysis.

INTRODUCTION: Copayments are intended to decrease third party expenditure on pharmaceuticals, particularly those regarded as less essential. However, copayments are associated with decreased use of all medicines. Publicly insured populations encompass some vulnerable patient groups such as older individuals and low income groups, who may be especially susceptible to medication non-adherence when required to pay. Non-adherence has potential consequences of increased morbidity and costs elsewhere in the system. OBJECTIVE: To quantify the risk of non-adherence to prescribed medicines in publicly insured populations exposed to copayments. METHODS: The population of interest consisted of cohorts who received public health insurance. The intervention was the introduction of, or an increase, in copayment. The outcome was non-adherence to medications, evaluated using objective measures. Eight electronic databases and the grey literature were systematically searched for relevant articles, along with hand searches of references in review articles and the included studies. Studies were quality appraised using modified EPOC and EHPPH checklists. A random effects model was used to generate the meta-analysis in RevMan v5.1. Statistical heterogeneity was assessed using the I(2) test; p>0.1 indicated a lack of heterogeneity. RESULTS: Seven out of 41 studies met the inclusion criteria. Five studies contributed more than 1 result to the meta-analysis. The meta-analysis included 199,996 people overall; 74,236 people in the copayment group and 125,760 people in the non-copayment group. Average age was 71.75 years. In the copayment group, (verses the non-copayment group), the odds ratio for non-adherence was 1.11 (95% CI 1.09-1.14; P = <0.00001). An acceptable level of heterogeneity at I(2) = 7%, (p = 0.37) was observed. CONCLUSION: This meta-analysis showed an 11% increased odds of non-adherence to medicines in publicly insured populations where copayments for medicines are necessary. Policy-makers should be wary of potential negative clinical outcomes resulting from non-adherence, and also possible knock-on economic repercussions

Immediate replacement of fishing with dairying by the earliest farmers of the NE Atlantic archipelagos

The appearance of farming, from its inception in the Near East around 12 000 years ago, finally reached the northwestern extremes of Europe by the fourth millennium BC or shortly thereafter. Various models have been invoked to explain the Neolithization of northern Europe; however, resolving these different scenarios has proved problematic due to poor faunal preservation and the lack of specificity achievable for commonly applied proxies. Here, we present new multi-proxy evidence, which qualitatively and quantitatively maps subsistence change in the northeast Atlantic archipelagos from the Late Mesolithic into the Neolithic and beyond. A model involving significant retention of hunter–gatherer–fisher influences was tested against one of the dominant adoptions of farming using a novel suite of lipid biomarkers, including dihydroxy fatty acids, ω-(o-alkylphenyl)alkanoic acids and stable carbon isotope signatures of individual fatty acids preserved in cooking vessels. These new findings, together with archaeozoological and human skeletal collagen bulk stable carbon isotope proxies, unequivocally confirm rejection of marine resources by early farmers coinciding with the adoption of intensive dairy farming. This pattern of Neolithization contrasts markedly to that occurring contemporaneously in the Baltic, suggesting that geographically distinct ecological and cultural influences dictated the evolution of subsistence practices at this critical phase of European prehistory

Organic residue analysis and the use of pottery from the Neolithic settlements of Drenovac and Motel-Slatina (Middle Morava Valley, Serbia)

The recognition of subsistence strategies, diet and culinary practices is one of the most important questions in the study of the development of Late Neolithic communities in the Middle Morava Valley. Pots serving as containers involved in many everyday activities related to preparing or the processing of food are an optimal and suitable source of information in this regard. However, the determination of vessel functions is usually a very problematic task, due to the preservation of the material, their fragmentation, scarcity of use-wear traces and heterogeneity of pot shape. Moreover, most of the Late Vin~a pots seem to have fulfilled more than just one established purpose. Thus, the aim of this paper is to present the results of organic residue analysis (GC, GC-MS and GC-C-IRMS) to examine the use of pottery involved in the preparation, storage and consumption of different types of foodstuffs by the Late Vin~a communities. Pottery from two Late Neolithic sites of Drenovac and Motel Slatina in the Middle Morava Valley, Central Serbia were chosen for the organic residue analysis. Vessels are shown to have been used to process a range of commodities including beeswax, ruminant dairy fats, ruminant adipose fats and nonruminant adipose fats. A predominance of the processing of dairy products was observed at both sites, in vessels of varying sizes and types.The Neolithic in the middle Morava valley, ISSN 1820-4724 ; no.

Intestinal Parasites in the Neolithic Population Who Built Stonehenge (Durrington Walls, 2500 BCE)

Durrington Walls was a large Neolithic settlement in Britain dating around 2500 BCE, located very close to Stonehenge and likely to be the campsite where its builders lived during its main stage of construction. Nineteen coprolites recovered from a midden and associated pits at Durrington Walls were analysed for intestinal parasite eggs using digital light microscopy. Five (26%) contained helminth eggs, 1 with those of fish tapeworm (likely Dibothriocephalus dendriticus) and 4 with those of capillariid nematodes. Analyses of bile acid and sterol from these 5 coprolites show 1 to be of likely human origin and the other 4 to likely derive from dogs. The presence of fish tapeworm reveals that the Neolithic people who gathered to feast at Durrington Walls were at risk of infection from eating raw or undercooked freshwater fish. When the eggs of capillariids are found in the feces of humans or dogs it normally indicates that the internal organs (liver, lung or intestines) of animals with capillariasis have been eaten, and eggs passed through the gut without causing disease. Their presence in multiple coprolites provides new evidence that internal organs of animals were consumed. These novel findings improve our understanding of both parasitic infection and dietary habits associated with this key Neolithic ceremonial site

Comparison of the salivary and dentinal microbiome of children with severe-early childhood caries to the salivary microbiome of caries-free children

peer-reviewedBackground The main objectives of this study were to describe and compare the microbiota of 1) deep dentinal lesions of deciduous teeth of children affected with severe early childhood caries (S-ECC) and 2) the unstimulated saliva of these children and 3) the unstimulated saliva of caries-free children, and to compare microbiota compositional differences and diversity of taxa in these sampled sites. Methods Children with S-ECC and without S-ECC were recruited. The saliva of all children with and without S-ECC was sampled along with the deep dentinal microbiota from children affected by S-ECC. The salivary microbiota of children affected by S-ECC (n = 68) was compared to that of caries-free children (n = 70), by Illumina MiSeq sequencing of 16S rRNA amplicons. Finally, the caries microbiota of deep dentinal lesions of those children with S-ECC was investigated. Results Using two beta diversity metrics (Bray Curtis dissimilarity and UniFrac distance), the caries microbiota was found to be distinct from that of either of the saliva groups (caries-free & caries-active) when bacterial abundance was taken into account. However, when the comparison was made by measuring only presence and absence of bacterial taxa, all three microbiota types separated. While the alpha diversity of the caries microbiota was lowest, the diversity difference between the caries samples and saliva samples was statistically significant (p < 0.001). The major phyla of the caries active dentinal microbiota were Firmicutes (median abundance value 33.5%) and Bacteroidetes (23.2%), with Neisseria (10.3%) being the most abundant genus, followed by Prevotella (10%). The caries-active salivary microbiota was dominated by Proteobacteria (median abundance value 38.2%) and Bacteroidetes (27.8%) with the most abundant genus being Neisseria (16.3%), followed by Porphyromonas (9.5%). Caries microbiota samples were characterized by high relative abundance of Streptococcus mutans, Prevotella spp., Bifidobacterium and Scardovia spp. Conclusions Distinct differences between the caries microbiota and saliva microbiota were identified, with separation of both salivary groups (caries-active and caries-free) whereby rare taxa were highlighted. While the caries microbiota was less diverse than the salivary microbiota, the presence of these rare taxa could be the difference between health and disease in these children