The relationship between professional and commercial obligations in dentistry: a scoping review

Holden, Alexander C L; Adam, Lee; Thomson, William

doi:10.1038/s41415-020-1195-5

Cited by 25 publications

(30 citation statements)

References 37 publications

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“…Watt (2020) identifies the need to reform service delivery in the context of Covid-19 in accordance with the above [44]. Many workers support change within the dental profession while identifying problematic issues for facilitating change [45][46][47][48]. NHS Business Services statistics show that the sixmonthly check-up continues to be a significant patient attendance pattern in general dental practice in England and Wales [43].…”

Section: Discussionmentioning

confidence: 99%

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

Richards¹,

Ameen²,

Coll³

et al. 2021

Integr J Med Sci

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Introduction: Reducing social inequality along with oral health inequality in Wales is a policy objective. In this ecological study the relationships between deprivation, dental workforce and oral health are explored. Method: Twenty two Unitary Authorities (UAs) serving the population of Wales were studied. The number of dentists were obtained from NHS Business Services as well as the 2019 population figures from StatsWales. As data for whole time equivalent General Dental Practitioner (GDP) workforce were not available, GDP sites were used. The condition of teeth at the age 12 years was used as a measure of oral health from the most recent epidemiological survey available. The relationship between oral health and workforce was established using the Welsh Index of Multiple Deprivation (WIMD).Results: Associations were observed between dental sites and population as well as between oral health and deprivation. A new composite variable called the University of South Wales Dental Index (USWDI) was introduced by combining the number of dentists with their corresponding WIMD of the most deprived 10% of the population. Using regression modelling the USWDI demonstrated its superiority in using either the number of dentists or the WIMD most deprived 10% alone to predict decayed, missing and filled teeth (DMFT).Conclusion: Workforce levels have increased and there has been a corresponding improvement in oral health over two decades. At the same time deprived subgroups continue to experience relatively higher levels of disease. A proportion of the general dental services delivered in Wales has continued to be based on the principle of supply induced demand for care rather than oral health need. Improving oral health in a diverse population like Wales cannot be achieved by increasing dental workforce alone. It is necessary to account for levels of deprivation. USWDI as a predictor of DMFT could be a useful tool to monitor the macro delivery of oral health care for the future in Wales.

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Section: Discussionmentioning

confidence: 99%

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

Richards¹,

Ameen²,

Coll³

et al. 2021

Integr J Med Sci

View full text Add to dashboard Cite

show abstract

“…This engagement enables the better identification and addressing of how social and economic forces impact the health of patients. The commercial realities of healthcare and dentistry in particular should be openly discussed in dental curricula, 12,48 with discussion being focused upon the scope and breadth of dental professionals’ social responsibilities to act as advocates for oral health for all in society. The role of dental students as agents of change against structural inequities should be a core component of all dental curricula 50 .…”

Section: Discussionmentioning

confidence: 99%

“…This review is limited to the context of dentistry, developing insights into how this nuanced discipline (often primarily embedded within commercial environments 12 ) has developed strategies for conveying to students the importance of the SDH. It was not anticipated that the literature base exploring this area would be expansive; a recent scoping article looking at how undergraduate medical courses integrated the social determinants of health into medical curricula included only 22 relevant studies in its final review 13 …”

Section: Methodsmentioning

confidence: 99%

How are the social determinants of health being taught in dental education?

Leadbeatter

Holden

2020

Journal of Dental Education

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Introduction The social determinants of health that influence how wellness and illness are experienced within society must be a core component of dental curricula where aspiring dental professionals are taught about the aetiology and social history of dental diseases. Through this scoping review, we examine the current approaches that have been employed to incorporate the social determinants of health within dental curricula. Methods Using a scoping review methodology, we searched the databases Scopus, PubMed, and Embase using keywords relevant to the social determinants of health and dental education. Results Following screening and sorting, 36 articles were included within this review. The majority of the articles described research that evaluated outcomes of educational interventions with relevance to the social determinants of health. The remainder of the included studies discussed attitudes and readiness relative to the social determinants of health and how this core competency could be taught effectively. Conclusion The included literature revealed that the social determinants of health frequently are not the focus of educational activities in dental curricula, with students frequently having little active guidance on how they might make sense of their educational experiences in this domain. The socioeconomic, cultural, political, geographic, and structural barriers that contribute to patients being impacted by the social determinants of health should be explicitly addressed and discussed with students as a foundation element of the dental curriculum.

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“…The interviews were conducted by one researcher (ACLH), recorded and transcribed verbatim. The interviews had a semi‐structured format, with questions developed from the results of a scoping review conducted prior to this research 2 . The interview guide is provided in Appendix.…”

Section: Methodsmentioning

confidence: 99%

“…Dentistry exists in a paradigm where practitioners must manage commercial and business considerations alongside practising as professional healers 1 . An examination of how the academic literature in dentistry reconciles this relationship between professional and commercial obligations exposed a lack of empirical exploration of this tension 2 . Commentaries on commercialism in dentistry have suggested that commercialism is a negative influence, citing issues such as predatory advertising, 3 increased professional competition 4,5 and a transactional attitude to care 6 as chief concerns.…”

Section: Introductionmentioning

confidence: 99%

Overtreatment as an ethical dilemma in Australian private dentistry: A qualitative exploration

Holden

Adam

Thomson

2020

Comm Dent Oral Epid

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Background The phenomenon of overtreatment in dentistry is under‐explored and has not been the subject of much research inquiry. Most dental care in Australia is provided by practitioners in private dental practice. This research expands understanding of how the nexus between professionalism and commercialism in dentistry is impacted by the phenomenon of overtreatment. Methods Data were collected through recorded interviews and written reflections from private dentists working in the Australian context. The data were then examined using thematic analysis to understand common themes and reveal deeper insights. Results A total of 20 participants were recruited for this study. Participants spoke of their experiences in practice where financial targets and pressure from practice owners to provide high‐cost treatments presented challenges to their professionalism. The participants expressed that the way in which dentistry is remunerated based on activity was a motivation towards engaging in overtreatment. The participants also spoke of finding a balance between commercialism and professionalism within private dental practice. Conclusions Participants’ reports provided insights into how the mismanagement of the commercial elements of private dental practice led to a transactional (‘buyer beware’) relationship between the consumers and providers of dental services, rather than a relationship founded upon professional altruism and trust. Consumer empowerment through the commercialization of dentistry has potential to be a positive influence on the patient experience in accessing dental care. However, this research has shown that the shift of power through consumerism also risks attenuating professional appreciation of the imbalanced nature of the patient‐clinician relationship in dentistry.

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The relationship between professional and commercial obligations in dentistry: a scoping review

Cited by 25 publications

References 37 publications

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

How are the social determinants of health being taught in dental education?

Overtreatment as an ethical dilemma in Australian private dentistry: A qualitative exploration

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