Macey R, Glenny A, Walsh T, Tickle M, Worthington H, Ashley J, Brocklehurst P
School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
School of Dentistry, University of Manchester, Oxford Road, Manchester, UK.
J Dent Res. 2015 Mar;94(3 Suppl):70S-78S. doi: 10.1177/0022034514567335. Epub 2015 Jan 20.
Regularly attending adult patients are increasingly asymptomatic and not in need of treatment when attending for their routine dental examinations. As oral health improves further, using the general dental practitioner to undertake the "checkup" on regular "low-risk" patients represents a substantial and potentially unnecessary cost for state-funded systems. Given recent regulatory changes in the United Kingdom, it is now theoretically possible to delegate a range of tasks to hygiene-therapists. This has the potential to release the general dental practitioner's time and increase the capacity to care. The aim of this study is to compare the diagnostic test accuracy of hygiene-therapists when screening for dental caries and periodontal disease in regularly attending asymptomatic adults who attend for their checkup. A visual screen by hygiene-therapists acted as the index test, and the general dental practitioner acted as the reference standard. Consenting asymptomatic adult patients, who were regularly attending patients at 10 practices across the Northwest of England, entered the study. Both sets of clinicians made an assessment of dental caries and periodontal disease. The primary outcomes measured were the sensitivity and specificity values for dental caries and periodontal disease. In total, 1899 patients were screened. The summary point for sensitivity of dental care professionals when screening for caries and periodontal disease was 0.81 (95% CI, 0.74 to 0.87) and 0.89 (0.86 to 0.92), respectively. The summary point for specificity of dental care professionals when screening for caries and periodontal disease was 0.87 (0.78 to 0.92) and 0.75 (0.66 to 0.82), respectively. The results suggest that hygiene-therapists could be used to screen for dental caries and periodontal disease. This has important ramifications for service design in public-funded health systems.
定期就诊的成年患者在进行常规牙科检查时越来越没有症状，也不需要治疗。随着口腔健康状况进一步改善，对于定期就诊的“低风险”患者，让普通牙科医生进行“检查”对国家资助系统来说是一笔巨大且可能不必要的费用。鉴于英国最近的监管变化，现在理论上有可能将一系列任务委托给口腔卫生治疗师。这有可能腾出普通牙科医生的时间并提高护理能力。本研究的目的是比较口腔卫生治疗师在对定期就诊的无症状成年检查者进行龋齿和牙周疾病筛查时诊断测试的准确性。由口腔卫生治疗师进行的视觉筛查作为指标测试，普通牙科医生作为参考标准。在英格兰西北部10家诊所定期就诊的无症状成年患者同意参与研究。两组临床医生都对龋齿和牙周疾病进行了评估。测量的主要结果是龋齿和牙周疾病的敏感度和特异度值。总共筛查了1899名患者。牙科护理专业人员在筛查龋齿和牙周疾病时敏感度的汇总点分别为0.81（95%CI，0.74至0.87）和0.89（0.86至0.92）。牙科护理专业人员在筛查龋齿和牙周疾病时特异度的汇总点分别为0.87（0.78至0.92）和0.75（0.66至0.82）。结果表明，口腔卫生治疗师可用于筛查龋齿和牙周疾病。这对公共资助卫生系统的服务设计具有重要影响。
