Although these publications span clinical practice, education, public health, and behaviour change, they are connected by a common question:
How do interacting conditions shape the outcomes we observe?
My research explores how systems shape health, education, and professional practice. Through clinical research, educational scholarship, and systems thinking, I examine how interacting conditions influence behaviour, professional roles, and health outcomes. The publications below represent different perspectives on this continuing programme of research.
Peer Reviewed Publications
Systems, Education & Professional Practice
Preparing for Evolving Roles: Variation in Dental Hygiene and Therapy Practice
Journal of Dental Education (2026)
Key Question
If dental hygiene and therapy education is becoming increasingly standardised, why do professional roles remain so variable in practice?
Summary
Across many countries, dental hygiene and therapy programmes are becoming increasingly consistent through shared competencies, accreditation standards, and curriculum design. Yet the roles graduates enter continue to vary according to healthcare systems, regulation, and workforce needs.
This Perspective article argues that professional roles are shaped not only by education, but by the interaction of multiple systems. Educational programmes may define professional identity, but the way roles are enacted continues to evolve in response to changing contexts.
The paper suggests that preparing graduates for variability may become as important as preparing them for defined scopes of practice.
Read the full article: Wiley Share Link
Citation
Ives T. Preparing for Evolving Roles: Variation in Dental Hygiene and Therapy Practice. Journal of Dental Education. 2026. https://doi.org/10.1002/jdd.70286
Clinical Practice & Health
When Plaque Doesn't Explain the Clinical Picture: Understanding Variability in Periodontal Inflammation
BDJ Team (2026)
Key Question
Why do patients with similar levels of plaque often present with very different periodontal outcomes?
Summary
Plaque remains the essential trigger for periodontal disease, yet it does not fully explain the variation clinicians observe in everyday practice. Patients with similar plaque levels can show markedly different inflammatory responses, disease progression, and treatment outcomes.
This article explores how periodontal inflammation may be better understood by considering the interaction between plaque, host response, systemic and dietary influences, and time. Rather than proposing a new treatment model, it offers a practical framework to help clinicians interpret variability and support more meaningful conversations with patients.
The article suggests that recognising the wider context in which periodontal disease develops can complement existing clinical approaches and encourage a more personalised understanding of periodontal health.
Read the full article: BDJ Link
Citation
Ives T. When Plaque Doesn't Explain the Clinical Picture: Understanding Variability in Periodontal Inflammation. BDJ Team. 2026.
Public Health & Policy
Tap Water Talk: The Continuing Debate over Water Fluoridation
BDJ Team (2025)
Key Question
How should dental professionals evaluate the continuing debate over water fluoridation in the context of modern public health?
Summary
Water fluoridation remains one of the most widely debated public health interventions in dentistry. This article provides an evidence-based overview of current arguments surrounding fluoridation, examining effectiveness, safety, policy, sugar consumption, and alternative preventive approaches.
Rather than advocating a single position, the article encourages dental professionals to critically evaluate the evidence, recognise the wider public health context, and consider how prevention strategies evolve alongside changing patterns of disease, policy, and public opinion.
The article argues that informed discussion and critical appraisal remain essential components of evidence-based practice.
Read the full article: BDJ Link
Citation
Ives T. Tap Water Talk: The Continuing Debate over Water Fluoridation. BDJ Team. 2025. https://doi.org/10.1038/s41407-025-3001-3
Behaviour Change & Community
The 28-Day No-Added-Sugar Challenge
Annals of Clinical Journal of Dental Health (2021)
Key Question
What do clinicians discover when they attempt the same behaviour change they routinely recommend to their patients?
Summary
This action research project invited an international group of dental hygienists and dental therapists to eliminate added sugar from their diets for 28 days. Rather than studying patients, the project explored what clinicians themselves could learn by experiencing behaviour change first-hand.
Participants encountered a wide range of challenges, including stress, social situations, hidden sugars in processed foods, and the habitual nature of dietary choices. Regardless of whether they completed the challenge, participants reported gaining new insights into the complexity of behaviour change and a greater appreciation of the barriers their patients face.
The study suggests that experiencing behaviour change directly may deepen empathy, enhance patient communication, and provide valuable insights into the realities of supporting long-term dietary change.
Read the full paper: Research Gate Link
Citation
Ives T. An Investigation into What Dental Hygienists and Dental Therapists Would Discover if They Attempted to Stop Consuming Added Sugar for 28 Days. Ann Clin J Dent Health. 2021;10:11–15.
The No Added-Sugar Tribe Study
Annual Clinical Journal of Dental Health (2022)
Key Question
What role does community play in sustaining long-term behaviour change?
Summary
This follow-up action research study explored whether peer support could help dental professionals sustain reductions in added sugar consumption over time. Participants joined a three-month online community that met regularly to discuss challenges, motivation, relapse, and practical strategies for reducing added sugar and highly processed foods.
Beyond changes in diet, participants consistently described the value of belonging to a supportive community. Many reported improvements in wellbeing and recognised that sustained behaviour change depended not only on individual motivation, but also on the social environment in which change occurred.
The study suggests that community identity and peer support may be important conditions for maintaining long-term health behaviour change, particularly for behaviours with addictive characteristics.
Read the full paper: Research Gate Link
Citation
Ives T. The No Added-Sugar Tribe Study. Annual Clinical Journal of Dental Health. 2022;11:50–55.
Social Presence in Online Learning
Masters Dissertation (MA Medical Education, University of Bedfordshire)
Key Question
What conditions make online learning communities feel real, connected, and effective?
Summary
This research formed part of my Master's in Medical Education and explored how social presence develops within synchronous online learning environments. The study examined an international community of dental hygienists, investigating how relationships, communication, and technology influence learning experiences in virtual classrooms.
Participants included students, facilitators, and curriculum designers who took part in recorded group discussions exploring interaction, connection, and engagement. The findings suggested that successful online learning depends on more than technology alone. Community, communication, and emotional connection emerged as important conditions that shape meaningful learning experiences.
Although undertaken within dental hygiene education, the research raised a broader question that continues to influence my work: how do the environments we create shape behaviour, learning, and professional practice?
Full Masters dissertation (10,793 words) available on request.
Continuing Research
Each of these publications explores a different aspect of the same underlying question:
How do interacting conditions shape the outcomes we observe?
My current work continues to explore this question across health, education, and professional practice, examining how systems influence behaviour, learning, clinical outcomes, and the possibilities for change.