A Commemorative Issue of the Work of Prof. Dr. Ruth Freeman

A special issue of Dentistry Journal (ISSN 2304-6767).

Deadline for manuscript submissions: 5 May 2025 | Viewed by 14542

Special Issue Editor


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Guest Editor
Health Psychology, School of Medicine, University of St. Andrews, St. Andrews, UK
Interests: assessment of dental anxiety; psychometrics; frequent psychological evaluation; sequential analysis; patient-centred care; health care communication; emotional expression; clinical responsiveness
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Special Issue Information

Dear Colleagues,

At the untimely death of Professor Ruth Freeman on the 23rd September 2021, the internationally known dental public health specialist and academic had just entered her retirement from full-time work with the University of Dundee. Although the status of her retirement might have indicated a stepping back, she had many projects still being prosecuted indicating a continued active legacy. Her interests were extensive, and arguably a unique combination of both a psychological and physical focus.  She spear-headed the excluded individual, the status of their health— oral or general— and how services, health behaviour and environment could be altered systematically to improve their quality of life. The Dentistry Journal wishes to honour this remarkable scholar by supporting a Special Issue dedicated to her work. The Issue offers authors the opportunity to submit articles that acknowledge Ruth Freeman’s work (single perspective or across various fields). Authors might include reference to the many specific areas that her research touched and influenced. They include, but not exclusively, minority groups: the homeless, prisoners, dental phobics, chronic facial pain sufferers, young dental patient attendees, disability and burn out of dental staff.  In addition, she was interested in the psychological makeup of the individual from an in-depth perspective.  She drew on her undoubted skill as a trained and practising psychoanalytical psychotherapist.  This in-depth work revealed underlying features. These, she believed, needed to be translated into active study, channelled into theory, and targeted as possible factors to introduce into effective intervention in service development or individual behaviour change. There are many examples in her research to demonstrate this process.  Articles are invited, therefore, that adopt an area of Ruth Freeman’s published work and indicate how her particular interest has influenced the authorship and preferably how their current research is reflecting and extending some of the tenets of her public health philosophy.

The Editor of the Special Issue is Professor Emeritus Gerry Humphris (Ruth’s spouse and oral health researcher) from the University of St Andrews.

In her final years, she wrote a series of policy papers with other key academics to advance the principles of intersectionality, inclusion oral health and vulnerability. Dr Janine Doughty is one member of the writing group (also including Muirhead and MacDonald) and is one of the Issue’s Sub-Editors. Additional Sub-Editors include Professor Satu Lahti from University of Turku, Finland and Professor Barry Gibson (University of Sheffield). Both are prestigious and influential researchers with an extensive collaborative history of working with Ruth Freeman in the fields of dental anxiety and qualitative methodology applied to oral health, respectively. Finally, Professor Jan Clarkson of the University of Dundee was Ruth Freeman’s Co-Director of the Dental Health Services Research Unit responsible for world-class oral health research. Prof Clarkson is probably best known for her ground-breaking trials of dental service development and interventions, and the two Co-Director academics together proved to present a formidable profile of expertise in the paediatric and public health arenas.

The Journal looks forward to receipt of original work to celebrate a sorely missed inspirational colleague and collaborator, a truly unique leader of a major set of branches of dental public health. The Special Issue will provide a marker of the substantial body of work that Freeman conducted and demonstrate her influence in years ahead.

Prof. Dr. Gerry M. Humphris
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Dentistry Journal is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • dental public health
  • minority groups
  • health care communication
  • health education
  • staff support
  • burnout and occupational stress
  • dental fear

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Published Papers (8 papers)

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Research

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8 pages, 232 KiB  
Article
Association Between the Two-Year Trajectories of Dental Anxiety and the Changes in the Oral Health-Related Quality of Life in Parents of FinnBrain Birth Cohort Study
by Lily Yang, Auli Suominen, Katri Palo, Eeva-Leena Kataja, Vesa Pohjola, Mika Ogawa, Linnea Karlsson, Hasse Karlsson, Eero Laakkonen and Satu Lahti
Dent. J. 2024, 12(12), 398; https://doi.org/10.3390/dj12120398 - 6 Dec 2024
Viewed by 374
Abstract
Objectives: We evaluated associations between changes in dental anxiety and oral health-related quality of life (OHRQoL) in parents of the FinnBrain Birth Cohort Study. Methods: Two-year dental anxiety trajectories measured with Modified Dental Anxiety Scale from gestational weeks (gw) 14 and [...] Read more.
Objectives: We evaluated associations between changes in dental anxiety and oral health-related quality of life (OHRQoL) in parents of the FinnBrain Birth Cohort Study. Methods: Two-year dental anxiety trajectories measured with Modified Dental Anxiety Scale from gestational weeks (gw) 14 and 34, and 3 and 24 months after birth were used. OHRQoL was measured with the Oral Health Impact Profile 14-item questionnaire at gw34 and 4 years. Changes in the OHRQoL sum and dimension scores according to dental anxiety trajectories were analyzed with the Jonckheere–Terpstra test separately for mothers (n = 998) and fathers (n = 513). Results: Overall, OHRQoL decreased in all dental anxiety trajectory groups except the High decreasing group in mothers, and in the Stable high group in fathers. The decline in the overall OHRQoL was greatest in the Stable high trajectory group for both parents. In fathers, OHRQoL increased considerably but not statistically significantly in the High decreasing trajectory group. The changes in OHRQoL dimensions Psychological discomfort and Handicap differed according to dental anxiety trajectories for both of mothers and fathers, and also for the dimension Psychological disability for mothers. Conclusions: These findings highlight the need for targeted interventions in treating high dental anxiety and in preventing the increase in dental anxiety to improve oral health outcomes such as OHRQoL. Full article
(This article belongs to the Special Issue A Commemorative Issue of the Work of Prof. Dr. Ruth Freeman)
15 pages, 231 KiB  
Article
The Treatment Alliance and the Provision of Removable Dentures: Exploring the Emotional Work of the Dental Team
by Barry John Gibson, Sarah R. Baker, Tom Broomhead, Bilal El-Dhuwaib, Nicolas Martin, Heba R. Salama, Gerry McKenna and Anousheh Alavi
Dent. J. 2024, 12(11), 344; https://doi.org/10.3390/dj12110344 - 28 Oct 2024
Viewed by 852
Abstract
Background: Research has demonstrated that the loss of one or more natural teeth can be an emotionally traumatic experience that mirrors processes associated with bereavement. There remains scant literature examining the role of emotions in dental encounters. One such exception is the literature [...] Read more.
Background: Research has demonstrated that the loss of one or more natural teeth can be an emotionally traumatic experience that mirrors processes associated with bereavement. There remains scant literature examining the role of emotions in dental encounters. One such exception is the literature on the idea of the ‘treatment alliance’ in dental encounters. The aim of this paper is to explore the role of the ‘treatment alliance’ in dentist–patient encounters. Methods: Data were collected from clinical observations, semi-structured interviews and focus groups exploring the experience of tooth loss and how the treatment alliance shaped the patient journey. Data analysis was conducted using the grounded theory method influenced by phenomenology. Coding was conducted using NVIVO and the unit of analysis was the treatment alliance. Results: Twenty participants took part in the interviews (eleven male; nine female; 22–86 years; mean age = 58.9 years). Observations were carried out with a further fourteen participants (seven male; seven female; 50–101 years; mean age = 62.2 years). The paper draws on four cases taken from the observational data to illustrate important dynamics underpinning how the treatment alliance varied. These case studies are then used as the basis for a critical discussion of the importance of the treatment alliance in dentistry. Conclusions: The treatment alliance acted as an important moderator in the clinical encounter, helping to influence successful outcomes. An important foundational component of the treatment alliance was the degree of emotional work the dental team conducted when ‘getting to know’ unfamiliar patients. Whilst emotions were an important factor in dental encounters, their acknowledgement and management were not essential to all successful outcomes. Much more research is therefore needed into the role of emotional labour in dental encounters. Full article
(This article belongs to the Special Issue A Commemorative Issue of the Work of Prof. Dr. Ruth Freeman)
14 pages, 228 KiB  
Article
Exploring the Acceptability of HIV Testing in the UK Dental Setting: A Qualitative Study
by Janine Yazdi-Doughty, Anthony J. Santella, Stephen Porter, Richard G. Watt and Fiona Burns
Dent. J. 2024, 12(8), 246; https://doi.org/10.3390/dj12080246 - 2 Aug 2024
Viewed by 809
Abstract
HIV point of care testing (POCT) is a common approach to expanding testing into non-specialised settings. Dental services have untapped potential to screen for health conditions including HIV. However, the perspectives of UK dental patients, dental professionals, and people with HIV are unknown. [...] Read more.
HIV point of care testing (POCT) is a common approach to expanding testing into non-specialised settings. Dental services have untapped potential to screen for health conditions including HIV. However, the perspectives of UK dental patients, dental professionals, and people with HIV are unknown. Ten focus groups were undertaken with dental patients, professionals, and people with HIV. The Framework method was used to analyse the qualitative data. Six themes were generated from the focus group data. The themes explored perceptions of HIV, the purpose, appropriateness, and acceptability of HIV testing in dental settings, and new processes that would need to be established in order to successfully implement point of care HIV testing in UK dental settings. Training needs were identified including communication skills and updates to current knowledge about HIV. HIV testing in dental settings is generally acceptable to dental patients, dental professionals, and PWH. However, of concern were logistical challenges and the risk of patients surprised at being offered an HIV test during a visit to the dentist. Nonetheless, the public health benefits of the intervention were well understood, i.e., early detection of HIV and initiation of treatment to improve health outcomes. Dental teams were able to generate novel solutions that could help to overcome contextual and logistical challenges to implementing HIV testing in dental settings. Full article
(This article belongs to the Special Issue A Commemorative Issue of the Work of Prof. Dr. Ruth Freeman)
12 pages, 2192 KiB  
Article
Autonomic Nervous System Activity and Dental Anxiety in the Northern Finland Birth Cohort (NFBC1966) Population
by Atte Somero, Auli Suominen, Vesa Pohjola, Mika Ogawa, Kirsi Sipilä, Niklas Kakko, Mikko Tulppo and Satu Lahti
Dent. J. 2024, 12(3), 81; https://doi.org/10.3390/dj12030081 - 21 Mar 2024
Cited by 1 | Viewed by 1574
Abstract
Autonomic nervous system (ANS) activity may be associated with dental anxiety; however, no studies exist on the topic. The aim of this study was to assess if ANS activity and dental anxiety are associated. Data were collected as part of a Northern Finland [...] Read more.
Autonomic nervous system (ANS) activity may be associated with dental anxiety; however, no studies exist on the topic. The aim of this study was to assess if ANS activity and dental anxiety are associated. Data were collected as part of a Northern Finland Birth Cohort Study, NFBC1966, at the age of 46 years with eligible data on 1905 participants. Dental anxiety was measured using the Modified Dental Anxiety Scale (MDAS) categorized as follows: 19–25 = high, 10–18 = moderate, 5–9 = no to low dental anxiety. Heart rate variability (HRV) data were collected using an HR monitor and a standard lead-II electrocardiogram (ECG). Baroreflex sensitivity (BRS) was calculated from continuous ECG and blood pressure signals. Participants were categorized into three groups as follows: Low = the lowest 20th percentile, Mid = medium 21–79th percentile, and High = the highest 20th percentile according to their ANS variables. The associations between the MDAS and ANS activity parameters were evaluated using unordered multinomial logit models adjusted for comorbidities, β-blockers, BMI, smoking, and education. High heart rate, reduced HRV, low cardiac vagal modulation, and poor BRS were associated with moderate dental anxiety, and high cardiac vagal modulation and good BRS were associated with no to low dental anxiety. Poorer ANS activity might predispose some to dental anxiety, and better ANS activity might protect from dental anxiety. Full article
(This article belongs to the Special Issue A Commemorative Issue of the Work of Prof. Dr. Ruth Freeman)
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13 pages, 1144 KiB  
Article
Two-Year Trajectories of Dental Anxiety in Parents and Their Association with Parents’ and Children’s Oral Healthcare Procedures in FinnBrain Birth Cohort Study
by Satu Lahti, Eeva-Leena Kataja, Auli Suominen, Katri Palo, Mika Ogawa, Anu Kallio, Outi Räikkönen, Vesa Pohjola, Kari Rantavuori, Linnea Karlsson and Hasse Karlsson
Dent. J. 2024, 12(3), 72; https://doi.org/10.3390/dj12030072 - 7 Mar 2024
Viewed by 1796
Abstract
We aimed to identify parents’ dental anxiety trajectories and the association of the trajectories with the number of parents’ and their children’s oral healthcare procedures in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale at gestational [...] Read more.
We aimed to identify parents’ dental anxiety trajectories and the association of the trajectories with the number of parents’ and their children’s oral healthcare procedures in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale at gestational weeks (gw) 14 and 34, as well as 3 and 24 months (mo) after childbirth. Oral healthcare procedures from gw14 to 24 mo were obtained from the national patient data register and categorized as preventive and treatment. Trajectories were identified with latent growth mixture modelling for 2068 fathers and 3201 mothers. Associations between trajectories and procedures adjusted for education were analyzed using unordered multinomial logit models. Fathers’ trajectories were stable low (80.1%), stable high (3.4%), stable moderate (11.0%), moderate increasing (3.9%) and high decreasing (1.6%). Mothers’ trajectories were stable low (80.7%), stable high (11.2%), moderate increasing (5.3%) and high decreasing (2.8%). Mothers with decreasing dental anxiety had a higher number of preventive and treatment procedures. Fathers with decreasing dental anxiety had a higher number of preventive and treatment procedures, while fathers with increasing dental anxiety had fewer procedures. Children of mothers with stable low dental anxiety had higher number of preventive procedures. There seems to be a two-way association between dental anxiety trajectories and oral healthcare procedures. Full article
(This article belongs to the Special Issue A Commemorative Issue of the Work of Prof. Dr. Ruth Freeman)
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10 pages, 619 KiB  
Article
Concordance of Fathers and Mothers in the Assessment of Their 5-Year-Old Child’s Dental Fear
by Sanna Seppänen, Kukka Vuorenmaa, Auli Suominen, Mika Ogawa, Vesa Pohjola, Kari Rantavuori, Hasse Karlsson, Linnea Karlsson and Satu Lahti
Dent. J. 2024, 12(3), 53; https://doi.org/10.3390/dj12030053 - 27 Feb 2024
Viewed by 1713
Abstract
The aim of this study was to evaluate the concordance of parents’ assessments of their child’s dental fear. Cross-sectional secondary analysis used data from the multidisciplinary FinnBrain Birth Cohort Study. Child dental fear was assessed at age 5 with the Finnish translation of [...] Read more.
The aim of this study was to evaluate the concordance of parents’ assessments of their child’s dental fear. Cross-sectional secondary analysis used data from the multidisciplinary FinnBrain Birth Cohort Study. Child dental fear was assessed at age 5 with the Finnish translation of the modified Children’s Fear Survey Schedule Dental Subscale (CFSS-M) by both fathers (n = 588) and mothers (n = 1100). Reply alternatives were from 1 = not afraid to 5 = very afraid and 6 = no experience coded as missing and 1. In total, 514 mother–father pairs were eligible for the analyses. Descriptive statistics, percentage agreement and Cohen’s Kappa coefficients were used in the analyses. The concordance of parents’ assessments was poor (Kappa range 0.072–0.258). The majority of parents replied “No Experience” to items related to invasive treatment or being unable to breathe. Thus, coding of this reply alternative had a significant impact on the mean values of the child’s fear. When assessing the fear of a five-year-old child, it might not be safe to rely only on one parent’s assessment, and whether or not the child has experience with the question asked should also be considered. Full article
(This article belongs to the Special Issue A Commemorative Issue of the Work of Prof. Dr. Ruth Freeman)
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Review

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19 pages, 904 KiB  
Review
A Scoping Review of the Oral Health Status, Oral Health Behaviours and Interventions to Improve the Oral Health of Children and Young People in Care and Care Leavers
by Joelle Booth, Jo Erwin, Lorna Burns, Nick Axford, Jane Horrell, Hannah Wheat, Robert Witton, Jill Shawe, Janine Doughty, Sarah Kaddour, Skye Boswell, Urshla Devalia, Abigail Nelder and Martha Paisi
Dent. J. 2024, 12(2), 38; https://doi.org/10.3390/dj12020038 - 9 Feb 2024
Cited by 2 | Viewed by 3150
Abstract
Background: Children and young people (CYP) in care experience poorer physical health and overall wellbeing in comparison to their peers. Despite this, relatively little is known about what their oral health needs and behaviours are. The aim of this scoping review was to [...] Read more.
Background: Children and young people (CYP) in care experience poorer physical health and overall wellbeing in comparison to their peers. Despite this, relatively little is known about what their oral health needs and behaviours are. The aim of this scoping review was to provide a global perspective on the oral health status and behaviours of CYP in care and care leavers. It also aimed to synthesise interventions that have been trialled in this population to improve oral health. Methods: Five databases were searched, Ovid Embase, Ovid MEDLINE, CINAHL (EBSCOhost), SocINDEX (EBSCOhost) and Dentistry and Oral Sciences Source (EBSCOhost), alongside grey literature sources up to January 2023. Eligibility criteria were studies that (i) reported on children and adolescents aged 25 years or younger who are currently in formal/informal foster or residential care and care leavers, (ii) pertained to oral health profile, behaviours or oral health promotion interventions (iii) and were published in the English language. Thematic analysis was used to develop the domains for oral health behaviours and interventions. Results: Seventy-one papers were included. Most papers were published from very high or medium Human Development Index countries. CYP in care were found to experience high levels of decay, dental trauma, periodontal disease and poorer oral health-related quality of life. Oral health behaviours included limited oral health self-care behaviours and a lack of oral health-based knowledge. The trialled interventions involved oral health education, supervised brushing and treatment or preventative dental care. Conclusions: This scoping review reveals that CYP in care experience poorer oral health in comparison to their peers. They are also less likely to carry out oral health self-care behaviours. This review highlights a scarcity of interventions to improve the oral health of this population and a paucity of evidence surrounding the oral health needs of care leavers. Full article
(This article belongs to the Special Issue A Commemorative Issue of the Work of Prof. Dr. Ruth Freeman)
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18 pages, 471 KiB  
Review
Access to Dental Care for Children and Young People in Care and Care Leavers: A Global Scoping Review
by Jo Erwin, Jane Horrell, Hannah Wheat, Nick Axford, Lorna Burns, Joelle Booth, Robert Witton, Jill Shawe, Janine Doughty, Sarah Kaddour, Skye Boswell, Urshla Devalia, Abigail Nelder and Martha Paisi
Dent. J. 2024, 12(2), 37; https://doi.org/10.3390/dj12020037 - 8 Feb 2024
Cited by 5 | Viewed by 3042
Abstract
Aims: This scoping review aimed to explore three research questions: 1. What is the dental care access for children and young people (CYP) in care and care leavers? 2. What factors influence CYP in care and care leavers’ access to dental care? 3. [...] Read more.
Aims: This scoping review aimed to explore three research questions: 1. What is the dental care access for children and young people (CYP) in care and care leavers? 2. What factors influence CYP in care and care leavers’ access to dental care? 3. What pathways have been developed to improve access to oral health care for CYP in care and care leavers? Methods: Five databases (Ovid MEDLINE, Ovid Embase, CINAHL, SocINDEX and Dentistry and Oral Sciences Source) and grey literature sources were systematically searched. Articles relating to CYP in care or care leavers aged 0–25 years old, published up to January 2023 were included. Abstracts, posters and publications not in the English language were excluded. The data relating to dental care access were analysed using thematic analysis. Results: The search identified 942 articles, of which 247 were excluded as duplicates. A review of the titles and abstracts yielded 149 studies. Thirty-eight were eligible for inclusion in the review: thirty-three peer-reviewed articles, one PhD thesis and four grey literature sources. All papers were published from very high or medium Human Development Index countries. The studies indicate that despite having higher treatment needs, CYP in care and care leavers experience greater difficulty in accessing dental services than those not care-experienced. Organisational, psycho-social and logistical factors influence their access to dental care. Their experience of dental care may be impacted by adverse childhood events. Pathways to dental care have been developed, but little is known of their impact on access. There are very few studies that include care leavers. The voices of care-experienced CYP are missing from dental access research. Conclusions: care-experienced CYP are disadvantaged in their access to dental care, and there are significant barriers to their treatment needs being met. Full article
(This article belongs to the Special Issue A Commemorative Issue of the Work of Prof. Dr. Ruth Freeman)
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