Background: Inequalities in oral health disproportionately affect low and middle income countries and a pattern of increased prevalence of dental caries in children has been reported. Objectives: To determine the burden of disease and behavioural and toothache history of six- and 12-year-old Malawi schoolchildren. Methods: Ethical approval was granted by Malawi's National Health Sciences Research Committee. The survey was undertaken by nine Malawian dental therapists and three UK dentists in 24 schools. Stratified cluster sampling ensured that the children were representative of Malawi's three Regions. Dental caries (into dentine), fluorosis, oral hygiene and PUFA index data were collected via a dental examination. Questionnaires were completed by each child and by the Head Teacher from each school. Results: A total of 1,330 six-year-old and 1,611 12-year-old children were examined, evenly split between the sexes. Dental caries was identified in 47% of six-year-olds and 23% of 12-year-olds. None of the children had filled teeth. The mean dmft/DMFT for children with caries experience was 3.0 for six-year-olds and 1.8 for 12-year-olds. Dental fluorosis was recorded for 7% of 12-year-olds. A history of toothache was reported by 29% of six-year-olds and 42% of 12-year-olds. Conclusions: The prevalence of caries and absence of signs of past clinical care highlight the need to implement activities identified in Malawi's National Oral Health Policy around the provision of appropriate preventive and treatment services for children.

Background:Oral health is an essential component of overall well-being, yet it remains a neglected public health area in many low- and middle-income countries. Teachers play a vital role in shaping students' oral health behaviours, making their knowledge and practices crucial for school-based oral health promotion. This study assessed the knowledge, attitudes, and practices (KAP) regarding oral health among primary school teachers in Mchinji District, Malawi, to evaluate their readiness to support oral health education. Methods:A cross-sectional survey was conducted among 316 primary school teachers using a structured questionnaire. Descriptive statistics summarized demographic and KAP variables, while chi-square tests and Cramér's V measured associations between demographic characteristics and oral health knowledge and practices. Results:Among participants, 60.0% were male, 61.4% were aged 30-45 years, and 61.9% had more than 10 years of teaching experience. While 63.6% demonstrated average oral health knowledge and 29.4% showed good knowledge, awareness of preventive dental procedures such as dental scaling (26.7%) and flossing (14.2%) was low. Most teachers (82.2%) exhibited average oral hygiene practices, and only 10.2% had good practice scores. Although positive attitudes were widespread, with over 90% recognizing the importance of oral health and regular dental visits, only 26.4% had received oral health training, and 68.5% identified limited knowledge as a barrier to teaching oral health. Age was significantly associated with knowledge level (p = 0.007, Cramér's V = 0.152), while gender and teaching experience were not. Conclusion:Primary school teachers in Mchinji District hold positive attitudes toward oral health but display knowledge and practice gaps. Strengthening teacher training through structured oral health capacity-building programs could enhance school-based health education and inform policies that integrate oral health into Malawi's primary school curriculum.

Background:The development of Malawi's first National Oral Health Policy (MNOHP) in 2022 marked a milestone in strengthening the country's oral health system. However, the extent to which future oral health professionals are aware of and prepared to implement this policy remains unclear. This study explored the knowledge, perspectives, and interest of dental surgery students in Malawi regarding the MNOHP, with the aim of identifying educational and policy engagement gaps. Methods:A descriptive cross-sectional exploratory survey was conducted among all willing clinical-year dental students enrolled in Malawi's sole Bachelor of Dental Surgery (BDS) program at Kamuzu University of Health Sciences. Data were collected using a structured, self-administered questionnaire developed from validated tools and refined through expert review and piloting. Descriptive analyses summarized participants' demographic characteristics, policy knowledge, exposure, and perspectives on curriculum integration. Ethical approval was obtained from the College of Medicine Research and Ethics Committee (P.11/24-1270). Results:A total of 43 students participated (response rate 95.6%). Most participants were male (60.5%) and enrolled in Year 3 or 4. Awareness of the MNOHP was limited: only 27.9% correctly identified its launch year (2022) and 9.8% knew it had seven priority areas. Although 85.0% had never read the policy and 97.6% reported not being taught about it, all respondents expressed strong interest in learning more and participating in policy development. A majority (88.4%) believed oral health policy education should be compulsory, and over half (51.2%) preferred that it be introduced during the clinical years. Conclusion:Malawian dental students exhibit enthusiasm to engage in oral health policy but lack foundational knowledge of the MNOHP. Integrating structured policy education within the dental curriculum covering the policy's seven priority areas of leadership, prevention, access, workforce, financing, infrastructure, and research could bridge this gap. Building policy literacy among future dentists is essential for effective policy implementation and long-term improvement of oral health outcomes in Malawi.

# Background Policymakers in many low- and middle-income countries do not prioritize oral health and are inadequately informed about the burden of oral and maxillofacial problems, their connection with systemic health and the possible threat to human life. In Africa, the absence of oral health policies is a key problem contributing to increased oral disease burden, health workforce shortage, and inadequate oral health service provision. Context-relevant policies and research to determine needs and monitor progress are key components in eradicating oral health inequalities. This paper focuses on the work of Malawi to follow the direction of travel outlined at the 2021 World Health Assembly by developing its first National Oral Health Strategy and Implementation Plan. # Methods A case study approach examined the processes followed by Malawi to develop its National Oral Health Policy, launched in April 2022. The aim was to understand how oral health policy is being developed within the context of an African country. Specifically, the objectives were to identify how oral health policy was being developed in Malawi and the contributors to the development of that policy. Qualitative data were collected from semi-structured interviews (n=8) of purposively selected key informants from the Malawi National Oral Health Policy Taskforce team involved in the policy creation. Data were analyzed in the thematic areas within the Health Policy Triangle of actors, context, processes, and content. # Results The policy development process was guided by Malawi's Ministry of Health and involved a diverse group of actors, both local and international. The funding of the policy development process by the Scottish Government and Borrow Foundation provided critical support. Five groups of stakeholders have conducted the relevant background investigations and written the Oral Health Policy: international development partners, academics, policy experts, dental practitioners, and civil society organizations. The partnership skill-sharing and well-managed dynamics of the group, together with the reliable funding base, all contributed to a successful outcome. # Conclusions A multisectoral approach was used. Malawi is uniquely placed in its oral health policy development, having a solid stakeholder base (local and international) and resources to support the policy development and, partly, its implementation.

Hidden hot springs likely impact rural water supplies in Malawi's Rift Valley with excess dissolved fluoride leading to localised endemic severe dental fluorosis. Predicting their occurrence is a challenge; Malawi's groundwater data archive is sporadic and incomplete which prevents the application of standard modelling techniques. A creative alternative method to predict hidden hot spring locations was developed using a synthesis of proxy indicators (geological, geochemical, dental) and is shown to be at least 75% effective. An exciting collaboration between geoscientists and dentists allowed corroboration of severe dental fluorosis with hydrogeological vulnerability. Thirteen hidden hot springs were identified based on synthesised proxy indicators. A vulnerability prediction map for the region was developed and is the first of its kind in Malawi. It allows improved groundwater fluoride prediction in Malawi's rift basin which hosts the majority of hot springs. Moreover, it allows dentists to recognise geological control over community oral health. Collaborative efforts have proven mutually beneficial, allowing both disciplines to conduct targeted research to improve community wellbeing and health and inform policy development in their respective areas. This work contributes globally in developing nations where incomplete groundwater data and vulnerability to groundwater contamination from hydrothermal fluoride exist in tandem.

Objective: Robust scientific and clinical evidence of how to appropriately manage denture plaque is lacking. This two-part study (i) developed an in vitro model of denture plaque removal, and (ii) assessed effectiveness of these approaches in a randomised clinical trial. Method: (i) a complex denture plaque model was developed using the dominant microbial genera from a recent microbiome analyses. Biofilms formed on polymethylmethacrylate were brushed daily with a wet toothbrush, then either treated daily for 5 days or only on Days 1 and 5 with Polident® denture cleanser tablets (3 min soaking). Quantitative and qualitative microbiological assessments were performed. (ii), an examiner-blind, randomised, crossover study of complete maxillary denture wearers was performed (n = 19). Either once-daily for 7 days or on Day 7 only, participants soaked dentures for 15 min using Corega® denture cleansing tables, then brushed. Denture plaque microbiological assessment used sterilized filter paper discs. Results: The in vitro model showed daily cleaning with denture cleanser plus brushing significantly reduced microbial numbers compared to intermittent denture cleaning with daily brushing (p < 0.001). The clinical component of the study showed a statistically significant reduction in denture plaque microbial numbers in favour of daily versus weekly treatment (aerobic bacteria p = 0.0144). Both in vitro and in vivo studies showed that denture plaque biofilm composition were affected by different treatment arms. Conclusions: This study demonstrated that daily denture cleansing regimens are superior to intermittent denture cleansing, and that cleansing regimens can induce denture plaque compositional changes. Trial registration: ClinicalTrials.gov identifier: NCT02780661.

Dental UpdateVol. 46, No. 3 Guest Editoral/Developing World DentistryInternational healthcare volunteering: lessons learned from efforts to put a sustainable model for emergency dentistry and oral health education into rural tanzaniaAndrew James Paterson, John Gordon Milne, Joseph Edward Kazimoto, Jeremy BaggAndrew James PatersonSenior Clinical Lecturer/Honorary Consultant in Restorative Dentistry, Dundee Dental School, 2 Park Place, Dundee, DD1 4HRSearch for more papers by this author, John Gordon MilneGeneral Dental Practitioner/Senior National Dental Adviser, King's Medical Centre, King Edward Street, Normanton, Wakefield, West Yorkshire, WF6 2AZ; Care Quality Commission, 151 Buckingham Palace Road, London, SW1W 9SZSearch for more papers by this author, Joseph Edward KazimotoClinical Director Hope Dental Centre, Rock City Mall, Mwanza, United Republic of TanzaniaSearch for more papers by this author, Jeremy BaggProfessor of Clinical Microbiology/Head of Dental School, University of Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZSearch for more papers by this authorAndrew James Paterson; John Gordon Milne; Joseph Edward Kazimoto; Jeremy BaggPublished Online:28 Mar 2019https://doi.org/10.12968/denu.2019.46.3.197AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References 1. Pezella A. Volunteerism and humanitarian efforts in surgery. Curr Probl Surg 2006; 43: 848–929. Medline, Google Scholar2. Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Med Educ 2009; 43: 887–894. Medline, Google Scholar3. Shye S. The motivation to volunteer: a systematic quality of life theory. Soc Indic Res 2010; 98: 183–200. Google Scholar4. Hudson S, Inkson, K. Volunteer overseas development workers: the hero's adventure and personal transformation. Career Dev Int 2006; 11: 304–320. Google Scholar5. Olakanmi O, Perry P. Medical volunteerism in Africa: an historical sketch. AMA J Ethics 2006; 8: 863–870. Google Scholar6. Clary E, Copeland J, Haugen J, Miene P, Ridge R, Snyder M, Stukas A. Understanding and assessing the motivations of volunteers: a functional approach. J Pers Soc Psychol 1998; 74: 1516–1530. Medline, Google Scholar7. Green T, Green H, Scandlyn J, Kestler A. Perceptions of short-term medical volunteer work: a qualitative study in Guatemala. Global Health 2009; 5: 4–17. Medline, Google Scholar8. Seager G. When Healthcare Hurts: An Evidence Based Guide for Best Practices in Global Health Initiatives. Bloomington: Author House, 2012: p252. Google Scholar9. Ministry of Health and Social Welfare, United Republic of Tanzania. Strategic Oral Health Plan 2012–2017. Dar es Salaam: Ministry of Health and Social Welfare. Google Scholar10. Scheffler R, Liu J, Kinfuc Y, Dal Poz M. Forecasting the global shortage of physicians: an economic and needs-based approach. Bull World Health Organ 2008; 86: 516–523. Medline, Google Scholar11. Academy of Medical Royal Colleges. Statement on Volunteering: Health Professional Volunteers and Global Health Development. (Internet). 2013. (Cited February 19). Google Scholar12. Department of Health. The Framework for NHS Involvement in International Development. (Internet). 2010. (Cited February 19). Google Scholar13. Crump J, Sugarman J, the Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and Best Practice Guidelines for Training Experiences in Global Health. Am J Trop Med Hyg 2010; 83: 1178–1182. Medline, Google Scholar14. Suchdev P, Ahrens K, Click, E, Macklin L, Evangelista D, Graham E. A model for sustainable short-term international medical trips. Ambul Pediatr 2007; 7: 317–320. Medline, Google Scholar15. British Medical Association. Volunteering Abroad. (Internet). 2018. (Cited February 19). Google Scholar FiguresReferencesRelatedDetails 2 March 2019Volume 46Issue 3ISSN (print): 0305-5000ISSN (online): 2515-589X Metrics History Published online 28 March 2019 Published in print 2 March 2019 Information© George Warman Publications (UK) LimitedAcknowledgementsThe authors would like to thank past and present volunteers, founders, patrons, trustees, friends, funders, other charities and NGOs, individual and corporate practices, the UK dental industry, Bridge2Aid UK and Tanzanian staff, the Government of Tanzania, the Tanzania Dental Association, Tanzanian dental professionals and rural communities who have and continue to work collaboratively to try to make contributions to sustainably reducing health inequality in the developing world.PDF download

Background: The 2013 Sharps Regulations were introduced to minimise the risk of sharps injuries and blood borne virus transmission throughout healthcare. Occupational health (OH) services are pivotal for helping employers implement these regulations. Despite this, no research has been conducted on the prevalence of sharps injuries, underreporting of injuries or access to OH among primary care dental professionals in the UK since 2013. Aim: To estimate the prevalence of sharps injuries, the level of underreporting and of self-reported access to an OH service both for the care of sharps injuries and for general health and wellbeing. Method: A cross-sectional survey was administered at the 2017 British Dental Association (BDA) Conference and Exhibition in Manchester, and at the 2017 BDA Scottish Conference and Exhibition in Glasgow. The survey covered questions relating to sharps injuries and OH support. Statistical analyses were conducted using SPSS Version 22 (IBM Corp., 2013). Results: A total of 796 delegates participated, of whom 166 (20.8%) had experienced a sharps injury in the past year and 58 (35%) did not report the incident. Of the participants, 190 (23.9%) reported no, or uncertain, access to OH support. Most respondents' practices had a sharps safety policy (771; 96.9%), but fewer (611; 76.8%) had received training on the prevention of sharps injuries and neither policy nor training were associated with incident reporting. Conclusion: Despite the introduction of the sharps regulations, sharps injuries and underreporting of injuries remain prevalent among those practising in primary dental care. Our results also suggest that there are significant shortfalls in OH support, at a time when changes to guidance on health clearance and management of BBV infected healthcare workers, in addition to sharps injury management, increase the need for such services.

Aim: The purpose of this study was to investigate strain dependent differences of the cariogenic biofilm forming Streptococcus mutans within both simple and complex communities. Methods: A mono-species containing representative S. mutans clinical isolates (caries and non-caries), and a multispecies in vitro caries biofilm model containing Lactobacillus casei, Veillonella dispar, Fusobacterium nucleatum and Actinomyces naeslundii, and either of two representative S. mutans clinical isolates (caries and non-caries), was developed as a comparison model. Compositional analysis of total and live bacteria within biofilms, and transcriptional analysis of biofilm associated virulence factors were evaluated by live/dead PCR and quantitative PCR, respectively. Scanning electron microscopy (SEM) was used to analyze the architecture of biofilm. One-way analysis of variance and t-tests were used to investigate significant differences between independent groups of data. Results: Within a mono-species biofilm, different S. mutans strains responded similarly to one another during biofilm formation in different carbohydrate sources, with sucrose showing the highest levels of biofilm biomass and galactose showing the lowest. Within the polymicrobial biofilm system, compositional analysis of the bacteria within the biofilm showed that S. mutans derived from a caries-free patient was preferentially composed of both total and viable L. casei, whereas S. mutans derived from a caries patient was dominated by both total and viable S. mutans (p < 0.001). Normalized gene expression analysis of srtA, gtfB, ftf, spaP, gbpB, and luxS, showed a general upregulation within the S. mutans dominant biofilm. Conclusion: We were able to demonstrate that individual strains derived from different patients exhibited altered biofilm characteristics, which were not obvious within a simple mono-species biofilm model. Influencing the environmental conditions changed the composition and functionality S. mutans within the polymicrobial biofilm. The biofilm model described herein provides a novel and reproducible method of assessing the impact on the biofilm microbiome upon different environmental influences.

Background:Safer sharps devices (SSDs) are commercially available and their use is mandated through UK legislation.Aim:To identify the current usage of SSDs in UK primary care dentistry.Method:A cross-sectional survey was administered to delegates at the 2017 British Dental Association (BDA) Conference and Exhibition in Manchester, and at the 2017 BDA Scottish Conference and Exhibition in Glasgow. The survey covered a range of questions relating to sharps injuries and use of traditional and safety syringes for delivery of local anaesthesia. Statistical analyses were conducted using SPSS Version 22 (IBM Corp., 2013) and included chi-square and Fisher's exact tests.Results:Seven hundred and ninety-six delegates participated, of whom 396 (49.7%) were using safety syringes for delivery of local anaesthesia. Of the 166 participants who had experienced a sharps injury in the past year, 76 (45.8%) worked in facilities that most commonly used SSDs for delivery of local anaesthesia.Conclusion:Our results indicate that a significant number of dental practices in our sample have not adopted SSDs and suggest sharps injuries are still being sustained in some practices using SSDs. Further epidemiological research is required to provide strong evidence for the effectiveness of SSDs and reasons why SSDs have not been fully adopted in UK primary dental care.

This paper describes a voluntary anonymous survey to investigate the seroprevalence of Hepatitis C (HCV) in children in Glasgow, UK attending a Dental Hospital and the proportion of HCV positive mothers who have a child who is HCV seropositive. The study was undertaken among children and accompanying parents and household contacts attending a general anaesthetic assessment clinic at Glasgow Dental Hospital and School.Children were asked to provide an oral fluid specimen for HCV testing. Accompanying adults were asked to provide demographic data on the child and information on familial risk factors for HCV infection using a standardised questionnaire. Birth mothers were also asked to provide an oral fluid specimen. Specimens and questionnaires were linked by a unique anonymous study number.Between June 2009 and December 2011, samples were collected from 2141 children and 1698 mothers. None of the samples from the children were HCV seropositive but 16 (0.9%, 95% CI 0.6-1.5%) of the specimens from mothers were HCV antibody positive.In summary, the prevalence of HCV seropositivity in the birth mothers of the children was similar to that estimated in the general population served by the hospital and showed no evidence of mother-to-child transmission of HCV. (C) 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Limited. All rights reserved.

There is a recognised potential risk of transmission of blood-borne viruses (BBVs) from infected healthcare workers to patients during exposure prone procedures (EPPs). The restrictions placed on performance of EPPs by infected clinicians in the UK have had a particularly significant impact on dentists because of the exposure-prone nature of most dental procedures and the difficulties in identifying alternative career pathways in the profession that do not involve EPPs. More recently, the significant positive impact of antiviral drugs on viral load, together with a re-categorisation of EPPs in dentistry have resulted in evolution of the guidance with a consequent significant improvement to the career prospects of dentists infected with BBVs. This paper provides an update for practitioners on the progress that has been made and outlines the current position with respect to practice restrictions.

Abstract: This paper describes a student-centred, integrated teaching model in which oral pathology and oral medicine staff members jointly deliver tutorials in a combined online and face-to-face format. Students are provided with clinical and histopathological information, which they must review and use to answer questions via a Virtual Learning Environment before the tutorial takes place. By reviewing the students' answers online before the teaching session, staff can focus the tutorial itself on resolving knowledge gaps and afterwards post a set of gold standard answers online for students to reflect upon. CPD/Clinical Relevance: This article illustrates a combination of teaching methods and modern technologies which integrate clinical with laboratory sciences and enhance the access of students to histopathological materials without the need for access to a traditional microscopy facility.

The purpose of this study was to test the feasibility of undertaking a full population investigation into the prevalence, incidence, and persistence of oral Human Papilloma Virus (HPV) in Scotland via dental settings. Male and female patients aged 16-69 years were recruited by Research Nurses in 3 primary care and dental outreach teaching centres and 2 General Dental Practices (GDPs), and by Dental Care Teams in 2 further GDPs. Participants completed a questionnaire (via an online tablet computer or paper) with socioeconomic, lifestyle, and sexual history items; and were followed up at 6-months for further questionnaire through appointment or post/online. Saline oral gargle/rinse samples, collected at baseline and follow-up, were subject to molecular HPV genotyping centrally. 1213 dental patients were approached and 402 individuals consented (participation rate 33.1%). 390 completed the baseline questionnaire and 380 provided a baseline oral specimen. Follow-up rate was 61.6% at 6 months. While recruitment was no different in Research Nurse vs Dental Care Team models the Nurse model ensured more rapid recruitment. There were relatively few missing responses in the questionnaire and high levels of disclosure of risk behaviours (99% answered some of the sexual history questions). Data linkage of participant data to routine health records including HPV vaccination data was successful with 99.1% matching. Oral rinse/gargle sample collection and subsequent HPV testing was feasible. Preliminary analyses found over 95% of samples to be valid for molecular HPV detection prevalence of oral HPV infection of 5.5% (95%CI 3.7, 8.3). It is feasible to recruit and follow-up dental patients largely representative / reflective of the wider population, suggesting it would be possible to undertake a study to investigate the prevalence, incidence, and determinants of oral HPV infection in dental settings.

PurposeRecent studies have established a relationship between dental plaque and pulmonary infection, particularly in elderly individuals. Given that approximately one in five adults in the UK currently wears a denture, there remains a gap in our understanding of the direct implications of denture plaque on systemic health. The aim of this study was to undertake a comprehensive evaluation of putative respiratory pathogens residing upon dentures using a targeted quantitative molecular approach.Materials and MethodsOne hundred and thirty patients' dentures were sonicated to remove denture plaque biofilm from the surface. DNA was extracted from the samples and was assessed for the presence of respiratory pathogens by qunatitative polymerase chain reaction (qPCR). Ct values were then used to approximate the number of corresponding colony forming equivalents (CFEs) based on standard curves.ResultsOf the dentures, 64.6% were colonized by known respiratory pathogens. Six species were identified: Streptococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae B, Streptococcus pyogenes, and Moraxella catarrhalis. P. aeruginosa was the most abundant species followed by S. pneumoniae and S. aureus in terms of average CFE and overall proportion of denture plaque. Of the participants, 37% suffered from denture stomatitis; however, there were no significant differences in the prevalence of respiratory pathogens on dentures between healthy and inflamed mouths.ConclusionsOur findings indicate that dentures can act as a reservoir for potential respiratory pathogens in the oral cavity, thus increasing the theoretical risk of developing aspiration pneumonia. Implementation of routine denture hygiene practices could help to reduce the risk of respiratory infection among the elderly population.

Dentists prescribe significant volumes of antimicrobial drugs within primary care settings. There is good evidence that many of the prescriptions are not justified by current clinical guidance and that that there is considerable misuse of these drugs in dentistry. One of the risks associated with antibiotic administration is Clostridium difficile-associated disease (CDAD), an entity of which many healthcare workers, including dentists, have little knowledge or understanding. This review seeks to identify the extent and nature of the problem and provides an up to date summary of current views on CDAD, with particular reference to community acquired disease. As for all healthcare workers, scrupulous attention to standard infection control procedures and reducing inappropriate antibiotic prescribing are essential to reduce the risks of CDAD, prevent emergence of further resistant strains of microorganisms and maintain the value of the arsenal of antibiotics currently available to us.

The Francis Report into the deaths at Mid-Staffordshire NHS Trust highlighted the problems facing the NHS when patients, families, clinicians and nurses are not heard, and where the management, leadership and ensuing culture are focused on the system's business, not patient care. This paper, the first in a series based on the implications of the Francis Report, provides the background and context for the subsequent 'perspective' articles from a range of relevant stakeholders and care-providers. The overriding message is that in all areas of healthcare, dentistry included, the quality of patient care, especially patient safety, must be placed above all other aims. Clinical Relevance: The overriding importance of patient-centredness and quality of care, above all other aims, is the key message of clinical relevance from the Francis Report.

BACKGROUND:Dentists are responsible for 9-10% of all antibiotics dispensed in primary care in the UK, many of which may be provided contrary to clinical guidelines. Since antibiotic consumption has been identified as a major cause of antibiotic resistance, dental prescribing may be a significant contributor to this important public health problem.OBJECTIVE:This study aims to explore general dental practitioners' (GDPs) perceptions and attitudes towards antibiotic use and resistance.METHOD:Qualitative interview study with 19 purposively sampled GDPs working in Wales. A set of open-ended questions were developed and amended during semi-structured telephone interviews. Interviews were recorded, transcribed verbatim and codes were developed using thematic analysis.RESULTS:Perceptions of antibiotic use and resistance varied widely between practitioners, particularly with respect to the prevalence and impact of resistant strains on the management of dentoalveolar infection, and the impact of dental prescribing on the emergence of resistance. GDPs reported that their antibiotic prescribing decisions were driven by both clinical pressures and wider public health considerations.CONCLUSIONS:Interventions to enhance the quality of antibiotic prescribing in primary care dentistry should address issues associated with inappropriate prescribing as well as providing education about the causes, prevalence and impact of antibiotic resistance.

This article aims to explain the recent changes in the NHS research support system as it applies to dentistry; information that will be of value to all clinical academics and dentists considering taking part in research. The changes mean that investment goes where patient benefit research is happening. The system has put in place transparent mechanisms to reimburse NHS organisations including dental practices that take part in research and train clinicians in research skills. Through NHS investment in 'translational research', public funds are used directly to deliver improved and more cost effective patient care.