General Dental Practitioner, Farsley Dental Practice, Town St, Farsley, LS28 5HX, UK.
Visiting Professor, University College London and Honorary Professor, University of Kent, UK.
Br Dent J. 2020 Mar;228(5):366-370. doi: 10.1038/s41415-020-1316-1.
Introduction Restoring complex tooth wear (TW) cases is technically challenging and not well-remunerated under the NHS General Dental Service (GDS) contract. Therefore, numbers of referrals to secondary care are increasing, but these are often rejected as dental hospitals have a high workload. This may make it difficult for patients with TW to access appropriate care unless paying privately, which may be costly for them.Aim The aim of this investigation was to understand how general dental practitioners (GDPs) in Leeds manage complex TW cases.Methods A postal questionnaire was designed and piloted before postal distribution to all GDPs with a Leeds postcode (n = 289). Non-responders were sent reminders to complete the questionnaire. The questionnaire included questions on the place of qualification and experience of the dentists, their management of an example complex TW case and the potential barriers to management of similar cases. The resulting data were statistically tested using Kruskal-Wallis and Mann-Whitney tests.Results A total of 148 (51%) responded to the questionnaire. There was low confidence in restoring complex TW cases with a mean score of 4.65 out of 10 (0 being not confident at all and 10 being very confident). Only 30 respondents (21%) reported that they would treat complex TW cases under the current NHS GDS contract, and 90 (62%) reported that they had experienced difficulty referring these cases to hospital. Kruskal-Wallis testing showed increased confidence in restoring by those with a diploma or MSc (p = 0.004 and p = 0.014 respectively). Mann-Whitney testing showed those undertaking a higher percentage of NHS work were less likely to restore these cases (U = 2,100; p = 0.02).Conclusion These results suggest that Leeds patients with complex TW may have difficulty in accessing appropriate care under the current NHS GDS contract. The results highlight the benefits of postgraduate education on confidence in restoring complex TW cases.
介绍
在国民保健制度（NHS）一般牙科服务（GDS）合同下，修复复杂的牙齿磨损（TW）病例具有技术挑战性，且报酬不高。因此，向二级保健的转诊数量不断增加，但由于牙科医院工作量大，这些转诊往往被拒绝。这可能使得 TW 患者难以获得适当的护理，除非自费，这可能对他们来说费用高昂。
目的
本研究旨在了解利兹的全科牙医（GDP）如何管理复杂的 TW 病例。
方法
设计了一份邮寄问卷，并在向所有具有利兹邮编的 GDP（n = 289）邮寄之前进行了试点。未回复者被发送提醒以完成问卷。问卷包括牙医的资格和经验、他们对一例复杂 TW 病例的管理以及管理类似病例的潜在障碍等问题。使用 Kruskal-Wallis 和 Mann-Whitney 检验对所得数据进行统计学检验。
结果
共有 148 人（51%）对问卷做出了回应。修复复杂 TW 病例的信心较低，平均得分为 10 分中的 4.65 分（0 表示完全没有信心，10 表示非常有信心）。只有 30 名受访者（21%）表示他们会根据现行 NHS GDS 合同治疗复杂 TW 病例，90 名（62%）表示他们在向医院转诊这些病例方面遇到了困难。Kruskal-Wallis 检验显示，具有文凭或硕士学位的人在修复方面的信心增强（p = 0.004 和 p = 0.014）。Mann-Whitney 检验显示，从事更多 NHS 工作的人不太可能修复这些病例（U = 2100；p = 0.02）。
结论
这些结果表明，利兹的 TW 复杂患者可能难以在现行 NHS GDS 合同下获得适当的护理。结果突出了研究生教育对修复复杂 TW 病例信心的益处。
