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Han DH, Kang HY, Ryu JI. The role of income and frequency of dental visits in the relationship between dental sealant use and resin fillings after extended coverage: a retrospective cohort study. BMC Oral Health 2023; 23:807. [PMID: 37891584 PMCID: PMC10612205 DOI: 10.1186/s12903-023-03387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship. METHODS This retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA). RESULTS The ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency. CONCLUSIONS Income and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.
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Affiliation(s)
- Dong-Hun Han
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry, Seoul, Republic of Korea
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hee-Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Jae-In Ryu
- Department of Preventive and Social Dentistry, Kyung Hee University College of Dentistry, Seoul, Republic of Korea.
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2
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Agius AM, Gatt G, Cortes ARG, Attard NJ. Patterns in Oral Hygiene and Dietary Habits in School Children during the COVID-19 Pandemic. Int J Clin Pediatr Dent 2023; 16:205-210. [PMID: 37519977 PMCID: PMC10373763 DOI: 10.5005/jp-journals-10005-2397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Aim To assess oral hygiene and dietary patterns in school children participating in a school-based preventive oral health program during the COVID-19 pandemic. Materials and methods In this cross-sectional study, an anonymous questionnaire exploring oral hygiene and dietary patterns during the COVID-19 pandemic was completed by parents of school children. Data were compared among different schools, school years, and between genders using nonparametric tests. Associations among further nominal and categorical variables related to oral hygiene and dietary habits were also assessed using the chi-square test. Results Only 26% (n = 32) of parents reported that their children brushed their teeth the recommended amount of twice or more per day during the pandemic. In addition, 17.2% of the parents reported less brushing than before the pandemic. A total of 40 parents (32.8%) reported that their child consumed unhealthy beverages once a day or more. Comparison between genders revealed that male participants were drinking significantly unhealthier than female (p = 0.038). Sugary foods were consumed once a day or more by 63.1% of children. No significant differences were found between public and church schools. Significant direct associations were found between changes in dietary habits and brushing frequency (p = 0.017), between parental concern regarding the interruption of the school program and decreased brushing frequency (p = 0.005), and negative changes in dietary habits (p = 0.013). Clinical significance Within the limitations of this study, the present significant findings observed during the pandemic support the importance of school programs in promoting oral hygiene and healthy dietary habits of children. How to cite this article Agius A-M, Gatt G, Cortes ARG, et al. Patterns in Oral Hygiene and Dietary Habits in School Children during the COVID-19 Pandemic. Int J Clin Pediatr Dent 2023;16(2):205-210.
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Affiliation(s)
- Anne-Marie Agius
- Department of Oral Rehabilitation and Community Care, Faculty of Dental Surgery, University of Malta, Msida, Malta
| | - Gabriella Gatt
- Department of Child Dental Health and Orthodontics, Faculty of Dental Surgery, University of Malta, Msida, Malta
| | | | - Nikolai J Attard
- Department of Oral Rehabilitation and Community Care, Faculty of Dental Surgery, University of Malta, Msida, Malta
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3
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Ross AJ, Sherriff A, Kidd J, Deas L, Eaves J, Blokland A, Wright B, King P, McMahon AD, Conway DI, Macpherson LMD. Evaluating childsmile, Scotland's National Oral Health Improvement Programme for children. Community Dent Oral Epidemiol 2023; 51:133-138. [PMID: 36753390 DOI: 10.1111/cdoe.12790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/08/2022] [Accepted: 08/15/2022] [Indexed: 02/09/2023]
Abstract
In the early 2000s, a Scottish Government Oral Health Action Plan identified the need for a national programme to improve child oral health and reduce inequalities. 'Childsmile' aimed to improve child oral health in Scotland, reduce inequalities in outcomes and access to dental services, and to shift the balance of care from treatment to prevention through targeted and universal components in dental practice, community and educational settings. This paper describes how an embedded, theory-based research and evaluation arm with multi-disciplinary input helps determine priorities and provides important strategic direction. Programme theory is articulated in dedicated, dynamic logic models, and evaluation themes are as follows: population-level data linkage; trials and economic evaluations; investigations drawing from behavioural and implementation science; evidence reviews and updates; and applications of systems science. There is also a growing knowledge sharing network internationally. Collaborative working from all stakeholders is necessary to maintain gains and to address areas that may not be working as well, and never more so with the major disruptions to the programme from the COVID-19 pandemic and response. Conclusions are that evaluation and research are synergistic with a complex, dynamic programme like Childsmile. The evidence obtained allows for appraisal of the relative strengths of component interventions and the reach and impact of Childsmile to feed into national policy.
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Affiliation(s)
- Alastair J Ross
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Andrea Sherriff
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Jamie Kidd
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Leigh Deas
- Public Dental Service, NHS Lanarkshire, Glasgow, UK
| | - Jenny Eaves
- Public Dental Service, NHS Lanarkshire, Glasgow, UK
| | - Alex Blokland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Bill Wright
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Peter King
- Public Dental Service, NHS Lanarkshire, Glasgow, UK
| | - Alex D McMahon
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - David I Conway
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Lorna M D Macpherson
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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Burgette JM, Randall CL, Neta G, Rindal DB, Ross AJ, Weiner BJ. Perspectives on the future of dissemination and implementation research in oral and craniofacial sciences. Community Dent Oral Epidemiol 2023; 51:143-148. [PMID: 36779640 PMCID: PMC10364975 DOI: 10.1111/cdoe.12828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 02/14/2023]
Abstract
Dissemination and implementation science is a field of research that promotes the adoption and maintenance of evidence-based interventions in healthcare delivery and community settings and seeks to understand the processes by which such adoption and maintenance occur. While dissemination and implementation science is an established field in health services research, it is relatively new and making inroads in dental, oral and craniofacial research. This article summarizes the proceedings from a scientific panel on 'Dissemination and Implementation Science for Oral and Craniofacial Health' that was held during the international Behavioral and Social Oral Health Sciences Summit. The panelists were four experts on dissemination and implementation science in dental and non-dental academic settings in the United States and Scotland, with affiliations ranging from schools of dentistry and public health to the National Institutes of Health and a healthcare system with integrated dental services. The panel discussion addressed how dissemination and implementation science can be used to further oral health research. The narrative report presented here aims to describe the panelists' reflections and insights on their current initiatives in dissemination and implementation research to inform future research endeavors within the oral and craniofacial sciences. Specifically, this article focuses on six discussion topics: (1) how organizational determinants can serve as facilitators or barriers to the implementation of evidence-based dental practice; (2) how dentistry can 'de-implement' practices that are not effective; (3) how implementation science can support the delivery of evidence-based dental practice using adaptation; (4) how to get started in implementation science; (5) how the broader environment can support large-scale implementation efforts; and (6) how oral and craniofacial science is well suited for advancing dissemination and implementation research.
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Affiliation(s)
- Jacqueline M. Burgette
- Departments of Dental Public Health and Pediatric Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cameron L. Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Gila Neta
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | | | - Alastair J. Ross
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, Washington, USA
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El-Yousfi S, Marshman Z, Albers PN, Watt S, Kipping R, Williams JG. Health visiting teams and children's oral health: a scoping review. BMC Oral Health 2022; 22:594. [PMID: 36496377 PMCID: PMC9741786 DOI: 10.1186/s12903-022-02611-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent policies have recommended early-life interventions to prevent caries. The four nations of the UK each have a national universal children's health programme, through which health visitors and their wider team (HVTs) promote health in the early years. HVT visits offer an opportunity to support parents to improve their child's oral health. A scoping review was conducted to provide a descriptive synthesis of the current literature related to the role of HVTs in improving the oral health of children 0-5 years old and to identify significant gaps for future research. This review informed the feasibility study of the First Dental Steps Intervention, a targeted health visitor-led infant oral health intervention in England. METHODS Electronic database searches for peer-reviewed literature were performed using Medline via Ovid and Web of Science (1946-2021). The quality of included intervention studies was assessed using the Effective Public Health Practice Project tool. Additionally, a grey literature search was conducted (key organisations, bibliographic and thesis databases, forwards and backwards citation, Google). RESULTS Thirty-nine publications, published between 1980 and 2021, were included. The majority of included papers were from the UK. The quality of intervention studies (n = 7) ranged from weak to strong. Thematic analysis identified the following themes: (1) professional knowledge, education, and training; (2) involvement of HVs in the delivery of oral health interventions; (3) effectiveness of interventions; (4) perspectives of HVs providing oral health advice and acceptability; and (5) barriers and facilitators to promoting oral health. The grey literature search identified 125 sources. HVT involvement was reported in a variety of source types: reports, guidance documents, evaluations, reviews, and training resources. HVTs were involved in oral health by providing oral health packs, brushing and oral health advice, registration and attendance, oral health training, risk assessment, and referral to dental services. CONCLUSION The current literature suggests that HVTs are well placed to improve children's oral health. Facilitators and barriers are encountered by HVTs in promoting oral health which should be considered by commissioners. There is a need for future high-quality studies that address the inadequacies found and provide further evidence of the effectiveness of HVT's oral health interventions.
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Affiliation(s)
- Sarab El-Yousfi
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Zoe Marshman
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Patricia N. Albers
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Samantha Watt
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruth Kipping
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna G. Williams
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Wang MC, Marshman Z, Chen WH, Shih WY. A qualitative study of barriers and facilitators to the implementation of a pilot school-based, toothbrushing programme. BMC Oral Health 2022; 22:451. [PMID: 36280822 PMCID: PMC9590216 DOI: 10.1186/s12903-022-02494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 10/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background While supervised toothbrushing programmes have been established in many countries of the world, little is known about different perspectives on their implementation. The aim of the study was to explore stakeholders' barriers and facilitators to implementation of a school-based toothbrushing programme in Taiwan.
Methods Focus groups and interviews were used to explore the views of elementary school students, teachers, staff, and nurses in a piloted school-based toothbrushing programme. The topic guides were developed according to the Theoretical Domains Framework (TDF) to cover the behavioural factors systematically and comprehensively. Data were analysed with content analysis. Results Overall, 36 students, 29 teachers/staff, and five school nurses (N = 65) were included. The overarching theme was the importance of habit formation for both staff and children to ensure that toothbrushing as part of the programme was embedded into the school schedule and routine. While children did not necessarily appear to retain the dental knowledge which was taught in the programme, the provision of fluoride toothpaste and toothbrush for their use in schools allowing teachers and staff to choose the timing of the brushing and engaging classmates to supervise each other were found to be key factors. Conclusions Implementing a school-based toothbrushing programme with the support of staff and active engagement of children can help children to develop a toothbrushing habit. Classmate-supervised toothbrushing may reduce the burden on teachers and staff to implement the programme. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02494-7.
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Affiliation(s)
- Ming-Ching Wang
- grid.412896.00000 0000 9337 0481Division of Dentistry, Taipei Municipal Hospital, WanFang Branch, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Xing-Long Road, Taipei, 116 Taiwan ,grid.260539.b0000 0001 2059 7017Department of Dentistry, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Beitou District, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Department of Stomatology, Taipei Veterans General Hospital, No.201, sec. 2, Shipai Rd., Beitou District, 112 Taipei, Taiwan
| | - Zoe Marshman
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, The University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA UK
| | - Wei-Han Chen
- grid.260539.b0000 0001 2059 7017Department of Dentistry, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Beitou District, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Department of Stomatology, Taipei Veterans General Hospital, No.201, sec. 2, Shipai Rd., Beitou District, 112 Taipei, Taiwan
| | - Wen-Yu Shih
- grid.260539.b0000 0001 2059 7017Department of Dentistry, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Beitou District, Taipei, 112 Taiwan ,grid.278247.c0000 0004 0604 5314Department of Stomatology, Taipei Veterans General Hospital, No.201, sec. 2, Shipai Rd., Beitou District, 112 Taipei, Taiwan
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7
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Celis A, Conway DI, Macpherson LMD, McMahon AD. Data Resource Profile: National Child Oral Health Improvement Programmes for Chile. Int J Epidemiol 2022; 52:e110-e115. [PMID: 36264249 PMCID: PMC10115402 DOI: 10.1093/ije/dyac191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/21/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrés Celis
- Community Oral Health, University of Glasgow Dental School, Glasgow, Scotland, UK.,Faculty of Dentistry, University of Chile, Santiago, Chile
| | - David I Conway
- Community Oral Health, University of Glasgow Dental School, Glasgow, Scotland, UK
| | - Lorna M D Macpherson
- Community Oral Health, University of Glasgow Dental School, Glasgow, Scotland, UK
| | - Alex D McMahon
- Community Oral Health, University of Glasgow Dental School, Glasgow, Scotland, UK
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van Spreuwel PCJM, Jerković-Ćosić K, van Loveren C, van der Heijden GJMG. Oral Health Coaches at Well-Baby Clinics to Promote Oral Health in Preschool Children From the First Erupted Tooth: Protocol for a Multisite, Pragmatic Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e39683. [PMID: 36044251 PMCID: PMC9475409 DOI: 10.2196/39683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Early childhood caries is considered one of the most prevalent diseases in childhood, affecting almost half of preschool-age children globally. In the Netherlands, approximately one-third of children aged 5 years already have dental caries, and dental care providers experience problems reaching out to these children. Objective Within the proposed trial, we aim to test the hypothesis that, compared to children who receive usual care, children who receive the Toddler Oral Health Intervention as add-on care will have a reduced cumulative caries incidence and caries incidence density at the age of 48 months. Methods This pragmatic, 2-arm, individually randomized controlled trial is being conducted in the Netherlands and has been approved by the Medical Ethics Research Board of University Medical Center Utrecht. Parents with children aged 6 to 12 months attending 1 of the 9 selected well-baby clinics are invited to participate. Only healthy children (ie, not requiring any form of specialized health care) with parents that have sufficient command of the Dutch language and have no plans to move outside the well-baby clinic region are eligible. Both groups receive conventional oral health education in well-baby clinics during regular well-baby clinic visits between the ages of 6 to 48 months. After concealed random allocation of interventions, the intervention group also receives the Toddler Oral Health Intervention from an oral health coach. The Toddler Oral Health Intervention combines behavioral interventions of proven effectiveness in caries prevention. Data are collected at baseline, at 24 months, and at 48 months. The primary study endpoint is cumulative caries incidence for children aged 48 months, and will be analyzed according to the intention-to-treat principle. For children aged 48 months, the balance between costs and effects of the Toddler Oral Health Intervention will be evaluated, and for children aged 24 months, the effects of the Toddler Oral Health Intervention on behavioral determinants, alongside cumulative caries incidence, will be compared. Results The first parent-child dyads were enrolled in June 2017, and recruitment was finished in June 2019. We enrolled 402 parent-child dyads. Conclusions All follow-up interventions and data collection will be completed by the end of 2022, and the trial results are expected soon thereafter. Results will be shared at international conferences and via peer-reviewed publication. Trial Registration Netherlands Trial Register NL8737; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8737 International Registered Report Identifier (IRRID) DERR1-10.2196/39683
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Affiliation(s)
- Peggy C J M van Spreuwel
- Research Group Innovation in Preventive Care, Hogeschool Utrecht University of Applied Science, Utrecht, Netherlands.,Oral Public Health Department, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Katarina Jerković-Ćosić
- Research Group Innovation in Preventive Care, Hogeschool Utrecht University of Applied Science, Utrecht, Netherlands
| | - Cor van Loveren
- Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Geert J M G van der Heijden
- Oral Public Health Department, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
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Aljafari A, ElKarmi R, Nasser O, Atef A, Hosey MT. A Video-Game-Based Oral Health Intervention in Primary Schools—A Randomised Controlled Trial. Dent J (Basel) 2022; 10:dj10050090. [PMID: 35621543 PMCID: PMC9139898 DOI: 10.3390/dj10050090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Poor oral health practices and high levels of dental caries have been reported among children in the developing world. Video games have been successful in promoting oral health in children. The aim of this study was to assess the impact of an oral-health-education video game on children’s dietary knowledge and dietary and toothbrushing practices; Methods: Two Schools in Amman, Jordan were randomly selected and assigned to either intervention or control. Six- to eight-year old children took part. The intervention group played the oral-health-education video game; the control group received no intervention. The groups were compared in terms of changes in: child dietary knowledge, dietary and toothbrushing practices, plaque scores, and parental familiarity with preventive treatments. Data were submitted to statistical analysis with the significance level set at p ≤ 0.05. Results: Two hundred and seventy-eight children took part. Most (92%) had carious teeth. At baseline, children reported having more than one sugary snack a day and only 33% were brushing twice a day. Most parents were unaware of fluoride varnish (66%) or fissure sealants (81%). At follow-up, children in the intervention group had significantly better dietary knowledge, and parents in both groups became more familiar with fluoride varnish. There were no significant changes in children’s plaque scores, toothbrushing and dietary practices, or parental familiarity with fissure sealants in either group. Conclusions: Using an oral-health-education video game improved children’s dietary knowledge. However, future efforts should target children together with parents, and need to be supplemented by wider oral-health-promotion.
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Affiliation(s)
- Ahmad Aljafari
- Department of Paediatric Dentistry, Orthodontics, and Preventive Dentistry, School of Dentistry, The University of Jordan, Amman 11942, Jordan;
- Correspondence:
| | - Rawan ElKarmi
- Department of Paediatric Dentistry, Orthodontics, and Preventive Dentistry, School of Dentistry, The University of Jordan, Amman 11942, Jordan;
| | - Osama Nasser
- Department of Dentistry, Jordan University Hospital, Amman 11942, Jordan; (O.N.); (A.A.)
| | - Ala’a Atef
- Department of Dentistry, Jordan University Hospital, Amman 11942, Jordan; (O.N.); (A.A.)
| | - Marie Therese Hosey
- Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London WC2R 2LS, UK;
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10
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Rodriguez GA, Cabello RA, Borroni CP, Palacio RA. Cost-effectiveness of probiotics and fluoride varnish in caries prevention in preschool children. J Public Health Dent 2022; 82:280-288. [PMID: 35567374 DOI: 10.1111/jphd.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/11/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the cost-effectiveness of two preventive interventions aimed at increasing the proportion of caries-free preschool children of low socioeconomic status using a decision analytic model. METHODS Two scenarios were tested, one with a school milk program (SMP) and one without (non-SMP). Fluoride varnish (FV) and a probiotic (PB) were compared to a do-nothing alternative among children in public nurseries/schools over a 4-year period. FV was applied biannually and a PB (Lactobacillus rhamnosus) added to milk powder prepared daily. A Markov decision tree model was utilized. Several sources of data were used to populate the model. Probabilistic and deterministic sensitivity analyses were performed, and a public provider perspective was used. RESULTS In the SMP scenario, PB was more effective and less costly than FV and, compared with do-nothing, increased the proportion of caries-free children by 14.5%, with a cost of USD 12.5 per child (June 2018). PB presented an incremental cost-effectiveness ratio (ICER) or cost per extra caries-free child of USD 86.2. In the non-SMP scenario, both interventions were cost-effective. FV (compared with do-nothing) increased the percentage of caries-free children by 8.3% with an ICER of USD 338.3 and PB (compared with FV) increased the effect by 6.2% with an ICER of USD 1400.2. CONCLUSIONS The findings showed that PB was most effective and less costly than FV in the SMP scenario only. This type of analysis and its results provide essential information for decision-makers to improve the oral health of preschool children.
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Affiliation(s)
| | | | - Catalina P Borroni
- School of Dentistry, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Raul A Palacio
- School of Dentistry, Pontificia Universidad Catolica de Chile, Santiago, Chile
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11
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Natapov L, Dekel D, Pikovsky V, Zusman SP. Dental health of preschool children after two-years of a supervised tooth brushing program in Southern Israel. Isr J Health Policy Res 2021; 10:42. [PMID: 34294158 PMCID: PMC8296643 DOI: 10.1186/s13584-021-00479-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Supervised tooth brushing is an important part of leading national oral health improvement programs in different countries. With the cessation of water fluoridation in 2014, a new program was immediately required to provide community-based caries prevention, especially amongst young children. The aim of this study was to determine whether a supervised tooth brushing program (STBP) in kindergartens could reduce dental caries amongst preschool children, when compared with children from the same community who did not participate in the program. The study was performed 2 years after the start of the program. Methods Two Jewish and two Arab local authorities (one participating and one control) were randomly chosen. In each local authority, 4 kindergartens (children aged 5) were randomly chosen, giving a total of 16 kindergartens. Children in the intervention group brushed once daily at kindergartens, with fluoridated toothpaste, for two school- years. All the children were examined using the WHO Oral Health Survey Methods Ed.4. Results Two hundred eighty-three five-year-old children were examined, 157 of them Jewish (86 participants in STBP, 71 non-participants) and 126 Arab (59 vs 67 respectively). Among Jewish children, the fraction of untreated decayed teeth was 61% in the participant group and 65% for non-participants, and amongst the Arab children 69% vs. 90% respectively. The fraction of treated decayed teeth for the participant group was 37% compared to 29% for the non-participants among Jewish children, whilst for the Bedouin group it was 23% vs. 8% respectively. Conclusions After 2 years, supervised tooth brushing with fluoride toothpaste shows a favorable effect. This study suggests that dental health of children participating in STBP was better than the control group. Fewer carious teeth and more treated carious lesions were recorded in this group. This program can be applied to low SES communities nationwide. Guidelines for fluoride concentration in toothpaste for children should be re-considered based on high caries levels.
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Affiliation(s)
- Lena Natapov
- Dental Health Division, Ministry of Health, Jerusalem, Israel
| | - Dan Dekel
- Dental Health Division, Ministry of Health, Jerusalem, Israel.
| | - Vadim Pikovsky
- Ashkelon Regional Health Office, Ministry of Health, Ashkelon, Israel
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12
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A service evaluation of an intervention to increase application of topical fluoride varnish in general dental practice in South Yorkshire. Eur Arch Paediatr Dent 2021; 22:93-97. [PMID: 32418054 DOI: 10.1007/s40368-020-00539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/03/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Dental caries is still common in children in the UK despite many available preventative interventions. Application of topical fluoride varnish can reduce caries experience. National and international guidance recommends at least twice-yearly application of topical fluoride varnish, however guidance is not always followed. This project aimed to first identify the proportion of patients receiving fluoride varnish by their primary care dental practitioner prior to their referral to a secondary care service and subsequently increase this rate by introducing an intervention. METHODS The intervention required the referring practitioner to document the date of which topical fluoride was applied prior to referral. Referrals without this information were rejected. Data were collected pre and post this change in policy to ascertain fluoride application rates. Parents and children were questioned about the frequency of application, and referral forms were reviewed for practitioner-reported application. RESULTS Topical fluoride application rates improved by 19% points for patient-reported application, and 31% points for practitioner-reported application. The biggest increase in application rate was in the cohort of patients receiving 6-monthly fluoride application. CONCLUSION This study demonstrated that a simple intervention, mandating that primary care dental practitioners record the most recent application of topical fluoride before referring a patient to secondary care, can improve the rates of topical fluoride varnish application in the UK.
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Kidd JB, McMahon AD, Sherriff A, Gnich W, Mahmoud A, Macpherson LM, Conway DI. Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland. BMJ Open 2020; 10:e038116. [PMID: 33234620 PMCID: PMC7689100 DOI: 10.1136/bmjopen-2020-038116] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Child dental caries is a global public health challenge with high prevalence and wide inequalities. A complex public health programme (Childsmile) was established. We aimed to evaluate the reach of the programme and its impact on child oral health. SETTING Education, health and community settings, Scotland-wide. INTERVENTIONS Childsmile (national oral health improvement programme) interventions: nursery-based fluoride varnish applications (FVAs) and supervised daily toothbrushing, community-based Dental Health Support Worker (DHSW) contacts and primary care dental practice visits-delivered to the population via a proportionate universal approach. PARTICIPANTS 50 379 children (mean age=5.5 years, SD=0.3) attending local authority schools (2014/2015). DESIGN Population-based individual child-level data on four Childsmile interventions linked to dental inspection survey data to form a longitudinal cohort. Logistic regression assessed intervention reach and the independent impact of each intervention on caries experience, adjusting for age, sex and area-based Scottish Index of Multiple Deprivation (SIMD). OUTCOME MEASURES Reach of the programme is defined as the percentage of children receiving each intervention at least once by SIMD fifth. Obvious dental caries experience (presence/absence) is defined as the presence of decay (into dentine), missing (extracted) due to decay or filled deciduous teeth. RESULTS 15 032 (29.8%) children had caries experience. The universal interventions had high population reach: nursery toothbrushing (89.1%), dental practice visits (70.5%). The targeted interventions strongly favoured children from the most deprived areas: DHSW contacts (SIMD 1: 29.5% vs SIMD 5: 7.7%), nursery FVAs (SIMD 1: 75.2% vs SIMD 5: 23.2%). Odds of caries experience were markedly lower among children participating in nursery toothbrushing (>3 years, adjusted OR (aOR)=0.60; 95% CI 0.55 to 0.66) and attending dental practice (≥6 visits, aOR=0.55; 95% CI 0.50 to 0.61). The findings were less clear for DHSW contacts. Nursery FVAs were not independently associated with caries experience. CONCLUSIONS The universal interventions, nursery toothbrushing and regular dental practice visits were independently and most strongly associated with reduced odds of caries experience in the cohort, with nursery toothbrushing having the greatest impact among children in areas of high deprivation.
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Affiliation(s)
- Jamie Br Kidd
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - Alex D McMahon
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - Andrea Sherriff
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - Wendy Gnich
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | | | - Lorna Md Macpherson
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - David I Conway
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
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Does the Registered Dentists' Program Alleviate the Socioeconomic Gap in the Use of Dental Sealants? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217828. [PMID: 33114677 PMCID: PMC7662614 DOI: 10.3390/ijerph17217828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022]
Abstract
Many countries provide preventive dental care for children to reduce inequalities. In Korea, the registered dentists' program was implemented to promote oral health and prevent oral diseases in primary school students. This study aimed to evaluate the registered dentist program through the sealant utilization rate using national cohort data and to compare the socioeconomic gap of the cohorts by participation. The sample cohort data were obtained from the National Health Insurance Sharing Service (NHISS) in South Korea. The utilization of dental sealants was analyzed using the chi-square test according to the independent variables of each year. To identify the independent effects of participation in the registered dentists' program, a panel logistic regression analysis of the utilization of dental sealants was performed. The participants were 1.35 times more likely to have dental sealants than non-participants. The significance of income quintiles disappeared in the case groups. The gap became more obvious in the employees of the control group even after adjusting for all variables. Implementing oral health programs can alleviate inequality with a relative increase in utilization in vulnerable populations.
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15
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McMahon A, Wright W, Anopa Y, McIntosh E, Turner S, Conway D, Macpherson L. Fluoride Varnish in Nursery Schools: A Randomised Controlled Trial – Protecting Teeth @3. Caries Res 2020; 54:274-282. [DOI: 10.1159/000509680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/22/2020] [Indexed: 11/19/2022] Open
Abstract
Studies suggest that fluoride varnish (FV) application can reduce dental caries in child populations. The multiple-component national child oral health improvement programme in Scotland (Childsmile) includes nursery-based universal supervised toothbrushing and deprivation-targeted FV applications, together with community and dental practice prevention interventions. This trial, a double-blind, two-arm randomised control trial, aimed to assess the effectiveness and cost-effectiveness of the nursery-based FV applications plus treatment-as-usual (TAU) Childsmile programme interventions, compared to TAU Childsmile interventions alone, in children not targeted to receive nursery FV as part of the programme. Participating children in the first year of nursery (aged three), with or without existing caries, were randomised to either FV or TAU and followed up for 24 months until the first year of primary school. Treatments were administered at six-monthly intervals. The primary endpoint was “worsening of d3mft” from baseline to 24 months. Secondary endpoints were worsening of d3mfs, d3t, mt, and ft. Individual record-linkage captured wider programme activities and tertiary endpoints. A total of 1,284 children were randomised, leading to 1,150 evaluable children (n = 577 FV, n = 573 TAU, 10% dropouts). Mean age was 3.5 years, 50% were female (n = 576), 17% had caries at baseline (n = 195), all balanced between the groups. Most children received three/four treatments. Overall, 26.9% (n = 155) had worsened d3mft in the FV group, and 31.6% (n = 181) in the TAU group, with an odds ratio (OR) of 0.80 (0.62–1.03), p = 0.078. The results for worsening of the secondary endpoints were: d3mfs 0.79 (0.61–1.01) p = 0.063, d3t 0.75 (0.57–0.99) p = 0.043, mt 1.34 (0.75–2.39) p = 0.319, and ft 0.77 (0.53–1.14) p = 0.191. We calculated a number needed to treat of 21 and a cost of GBP 686 to prevent a single worsening of d3mft. There was a modest non-significant reduction in the worsening of d3mft in the nursery FV group compared to TAU, suggesting that this intervention is unlikely to represent an effective or cost-effective addition to the population oral health improvement programme.
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16
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Lau KTR, John J, Eaton KA, Keightley AJ. Service evaluation of the paediatric dental general anaesthesia service in NHS Lothian. Br Dent J 2020:10.1038/s41415-020-1982-z. [PMID: 32855519 PMCID: PMC7451226 DOI: 10.1038/s41415-020-1982-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective To gain insight into the reasons for children undergoing dental treatment under general anaesthesia in NHS Lothian.Methods This service evaluation was based on a representative sample size of 294 patients, randomly selected from the 1,236 children seen for dental general anaesthesia (DGA) during 2017 in NHS Lothian. Data on patient and treatment descriptors were collected retrospectively from clinical records and analysed to identify significant correlations.Results The data indicated paediatric DGAs were mostly provided due to dental caries (88%, 260/294) and for children from the most deprived areas of Lothian. Most children were referred because they were of a very young age or had needs which precluded treatment under local anaesthesia (LA). Almost every child had teeth extracted under DGA (99%, 290/294) and a third of children received restorations (33%, 96/294).Discussion and conclusion This study highlighted the disproportionate increased risk of dental caries and DGA in children from more deprived backgrounds, despite a nationwide reduction of children with caries experience. There is a need for more holistic, whole-system approaches to reduce child dental caries, with opportunities for collaborative work with local stakeholders to follow-up children who have had DGA. More research is needed locally and nationally to inform the translation of evidence into effective interventions.
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Affiliation(s)
- Kirstie T-R Lau
- Senior House Officer, Oral and Maxillofacial Surgery, Torbay Hospital, Newton Road, Torquay, Devon, TQ2 7AA, UK.
| | - Jeyanthi John
- Consultant, Dental Public Health, Wessex & Thames Valley, Public Health England South East, Wellington House, 133-155 Waterloo Road, Lambeth, London, SE1 8UG, UK
| | - Kenneth A Eaton
- Honorary Professor, University of Kent, Centre for Professional Practice, Compass Centre South, Chatham Maritime, Kent, ME4 4YG, UK
| | - Alexander J Keightley
- Consultant, Paediatric Dentistry, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh, EH2 9HA, UK
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17
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Marquillier T, Lombrail P, Azogui-Lévy S. [Social inequalities in oral health and early childhood caries: How can they be effectively prevented? A scoping review of disease predictors]. Rev Epidemiol Sante Publique 2020; 68:201-214. [PMID: 32631663 DOI: 10.1016/j.respe.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/20/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Early childhood caries represent a major public health problem. In addition to their individual impact, the massive social inequalities in oral health that are at the roots and result from the disease have largely underestimated consequences for the child, his family and the community. In response to the question of "how and where to act?", this scoping review identifies the individual characteristics associated with the disease on which it would be possible to act, using appropriate prevention strategies. METHODS This scoping review is aimed at describing and analyzing available data in the literature on the different factors associated with early childhood caries. RESULTS The predictors of early childhood caries are represented by mediating (knowledge, attitudes and parents' oral health practices) and moderating (psychosocial parameters, parental health literacy and alcohol consumption) factors. Twenty-eight articles fulfilled the selection criteria, twenty of which studied mediators related to early childhood caries, and fourteen of which dealt with moderators. The lower the parents' level of knowledge and literacy in oral health, the higher a child's dmft index. Additional studies are needed to assess the role of psychosocial parameters. CONCLUSION Parents' knowledge and oral health literacy are the key predictors to be preferentially targeted in view of reducing social inequalities in health through actions undertaken on a local scale. The prevention of early childhood caries necessitates a combination of generic and targeted interventions.
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Affiliation(s)
- T Marquillier
- Pediatric Dentisry, CHU de Lille, university of Lille, 59000 Lille, France; Educational and Health Practices Laboratory, LEPS, UR 3412, Université Sorbonne Paris Nord, 74, rue Marcel-Cachin, 93017 Bobigny, France.
| | - P Lombrail
- Educational and Health Practices Laboratory, LEPS, UR 3412, Université Sorbonne Paris Nord, 74, rue Marcel-Cachin, 93017 Bobigny, France
| | - S Azogui-Lévy
- Educational and Health Practices Laboratory, LEPS, UR 3412, Université Sorbonne Paris Nord, 74, rue Marcel-Cachin, 93017 Bobigny, France; Public health Department, Dentistry Faculty, university of Paris, 75006 Paris, France
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18
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Perception of Dental Caries and Parental Difficulties in Implementing Oral Hygiene for Children Aged Less Than 6 Years: A Qualitative Study. Dent J (Basel) 2020; 8:dj8030062. [PMID: 32629828 PMCID: PMC7559996 DOI: 10.3390/dj8030062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite extensive prevention programs, dental hygiene remains inadequate, particularly among children under the age of six, and early childhood caries (ECC) are still a concern. Oral hygiene behavior and preventive practices seem difficult to change at a family level. AIM The present study aimed to better understand the reasons behind this behavior and to identify the different barriers to the implementation of adequate preventive measures. METHODS A qualitative study was conducted in the pediatric dentistry service of the Montpellier University Hospital (France) in 2019. A thematic analysis concerning three domains was performed: family environment, dental literacy, and oral hygiene. RESULTS The main barriers encountered by the parents were, respectively, (1) a weakness in the organization of familial life, together with a low-medium family income and a lack of authority, (2) ignorance of the necessity of treating carious primary teeth, and (3) a lack of time for brushing or supervising their children's teeth. CONCLUSION These results showed that oral hygiene and primary teeth care could not be easily achieved in the family environment of the participants, and oral health strategies should be focused not only on children but also on their parents.
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19
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Duane B, Stancliffe R, Miller F, Sherman J, Pasdeki-Clewer E. Sustainability in Dentistry: A Multifaceted Approach Needed. J Dent Res 2020; 99:998-1003. [DOI: 10.1177/0022034520919391] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
This article provides an introduction to environmentally sustainable dentistry and offers perspectives on managing drivers to reduce carbon emissions and make dentistry more environmentally sustainable. A sustainable world must meet the needs of the present without compromising the ability of future generations to meet their own needs. Global commitment to sustainability and demands for a sustainable world are growing. Within dentistry, travel creates the highest carbon emissions and also contributes to human health damage. Internally, there are a number of ways to reduce impact by decreasing travel and energy use, as well as carefully considering the types of items purchased (and how they are disposed of). Larger dental organizations can influence their suppliers and industry by choosing to purchase from sustainable companies with environmentally friendly products. From an external driver perspective policy, guidance and research are essential. Governments need to reevaluate decontamination policy from an environmental perspective. Decontamination documents need revision to consider both planetary and public health. Dental organizations need to support dental teams in this area. Insurance providers and health care purchasers should review policies to influence the sustainability of dental providers. Sustainability education needs to be considered as part of the curriculum of undergraduate and postgraduate students. Guidance could also be developed for the dental industry to produce sustainable products. Research needs to be prioritized. Identifying hot spots or areas of high environmental contributions using other assessments such as life cycle analysis (LCA) would allow dentistry to identify products or practices that have a disproportionate adverse impact on the environment and might be prioritized for change. This should include an analysis of single-use instruments, chemicals, and products. Building research capacity by training students and creating virtual or physical centers for sustainability is essential. Financial support is needed for priority areas of research.
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Affiliation(s)
| | - R. Stancliffe
- Centre for Sustainable Healthcare, Oxford, Oxfordshire, UK
| | - F.A. Miller
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - J. Sherman
- Yale School of Medicine, New Haven, CT, USA
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20
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Implementation and impact of a dental preventive intervention conducted within a health promotion program on health inequalities: A retrospective study. PLoS One 2020; 15:e0230639. [PMID: 32208466 PMCID: PMC7093001 DOI: 10.1371/journal.pone.0230639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/04/2020] [Indexed: 11/19/2022] Open
Abstract
Background The objective of this retrospective survey was to evaluate after one year, the conditions and impacts of a dental sealant intervention conducted in New Caledonia, within a health promotion program. A greater or at least equivalent quality and impact of the intervention was expected for children living in socially deprived regions with the greatest health needs. Methods The study population was the schoolchildren, aged 6 years in 2016, who benefited from the dental sealant program (n = 2532). The study sample was randomly selected in 2017 from that population (n = 550). The children's dental status was evaluated at school in 2017 and compared with that recorded in 2016 during the sealant intervention allowing the calculation of the retention rates and one-year carious increment on first permanent molars. Socio-demographic variables (gender, public/private school) and conditions of sealant placement (school/dental office, presence of a dental assistant) were recorded. The carious increment was explained using a mixed multiple random-effects regression. A mediation analysis was conducted to assess the respective contributions of the retention rates and the region of origin on caries increment. Results The participation rate was very high (89%) and on average, children had 83% of their dental sealants present after one year, 31% fully and 52% partially present. Caries increment varied depending on the sealant retention rate as well as on the region (North, South, Islands). The mediation analysis showed that living in a deprived area (The Islands) was a strong determinant for high caries increment particularly when the retention rates were low. Conclusions This study showed a high participation rate and acceptable effectiveness as measured with the one-year retention rates, for a fissure sealant intervention conducted in real-life conditions and integrated in a large health promotion program. Nevertheless, the intervention was not effective enough to totally balance the influence of health determinants, especially in socially deprived sectors characterized by greater dental needs.
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21
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Likar Ostrc L, Suklan J, Pavlič A. The effectiveness of completely and incompletely sealed first permanent molars on caries prevention. Clin Exp Dent Res 2020; 6:363-372. [PMID: 32059088 PMCID: PMC7301393 DOI: 10.1002/cre2.280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/25/2019] [Accepted: 12/27/2019] [Indexed: 11/18/2022] Open
Abstract
Fissure sealants are effective caries preventive measure. However, a dilemma has been expressed more than once, whether incompletely sealed fissures provides sufficient protection against caries. Dental examinations were performed in 88 children, aged 8 and then 4 years later at 12 years. All first permanent molars (FPMs), as diagnosed at the age of 8, were divided into three groups: nonsealed, incompletely and completely sealed. Four years later caries incidence and changes in presence and quality of fissure sealant were analyzed. At the age of 8 and 12 mean DMFT were 0.73 ± 1.24 and 3.48 ± 3.04, respectively. 71.59% of the 8‐year‐olds and 78.41% of the 12‐year‐olds had at least one sealed FPM. At the age of 8, 154 FPMs were completely sealed and 42 FPMs were incompletely sealed. Four years later, 81.17%, 71.43% and 69.4% of FPMs were healthy (sound or with noncavitated caries) in the baseline groups completely sealed, incompletely sealed and nonsealed FPMs, respectively. Incompletely sealed fissures were more susceptible to caries development than completely sealed fissures. It is important that incompletely sealed fissures are resealed as soon as possible.
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Affiliation(s)
- Lenka Likar Ostrc
- Department of Paediatric and Preventive Dentistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jana Suklan
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle in vitro Diagnostics Co-operative, Newcastle upon Tyne, UK
| | - Alenka Pavlič
- Department of Paediatric and Preventive Dentistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Unit of Paediatric and Preventive Dentistry, University Medical Centre Ljubljana, Ljubljana, Slovenia
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22
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Skafida V, Chambers S. Positive association between sugar consumption and dental decay prevalence independent of oral hygiene in pre-school children: a longitudinal prospective study. J Public Health (Oxf) 2019; 40:e275-e283. [PMID: 29301042 PMCID: PMC6166585 DOI: 10.1093/pubmed/fdx184] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/11/2017] [Indexed: 11/13/2022] Open
Abstract
Background Few studies explore how the longitudinal cumulative and combined effects of dietary habits and oral hygiene habits relate to dental decay in very young children. Methods Using longitudinal survey data, logistic regression models were specified to predict dental decay by age 5. Predictor variables included questions on diet and oral hygiene from ages 2 to 5. Results Compared to mainly eating meals, children who snacked all day but had no real meals had a higher chance of dental decay (odds ratios (OR) = 2.32). There was an incremental association between a decreasing frequency of toothbrushing at age 2 and higher chances of dental decay at age 5 (OR range from 1.39 to 2.17). Among children eating sweets or chocolate more frequently (once/day or more), toothbrushing more often (once/day; twice/day or more) reduced the chance of decay (OR of 2.11–2.26 compared to OR 3.60 for the least frequent brushing group). Compared to mothers in managerial and professional occupations, those who had never worked had children with a much higher chance of decay (OR = 3.47). Conclusion This study has shown that toothbrushing can only in part attenuate the association between snacking and long term sugar consumption on dental decay outcomes in children under 5.
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Affiliation(s)
- V Skafida
- Social Policy, School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK
| | - S Chambers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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23
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Yuan S, Humphris G, MacPherson L, Ross A, Freeman R. Development of an interaction coding scheme (PaeD-TrICS) to record the triadic communication behaviours in preventive dental consultations with preschool child patients and families: a video-based observational study. BMC Oral Health 2019; 19:162. [PMID: 31340799 PMCID: PMC6657161 DOI: 10.1186/s12903-019-0836-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/27/2019] [Indexed: 11/26/2022] Open
Abstract
Background There is a paucity of research concerning paediatric dental consultations in primary care. This is potentially due to the difficulty of measuring the communication behaviours in the complex triadic consultations. The present study aims to describe the development and refinement of a coding scheme to record the triadic communication between dental professionals, child patients and parents. Methods The PaeD-TrICS was developed from video observation of triadic communications and refined through an iterative process. Its practical applicability was assessed via implementation of the scheme on specialised behavioural coding software. Reliability was calculated using Cohen’s Kappa. Results The PaeD-TrICS contains 45 codes. Forty-four dental professional-child-parent communications were successfully coded through administering the scheme on The Observer XT 10.5 system. Cohen’s Kappa was 0.83 (inter-coder) and 0.90 (intra-coder). “Parental verbal facilitation” (mean = 1.68/min) was the most frequent behaviour. Dental professionals’ “dentally engaging talk” (mean = 1.24/min), “praise” (mean = 1.10/min) and “instruction” (mean = 0.62/min) were frequently seen. Children’s common behaviours included “speech other” (mean = 0.66/min) and non-verbal behaviour i.e. “non-verbal agreement” and verbal behaviour “speech yes” (mean = 0.26/min). Conclusions The PaeD-TrICS is developed to capture the communication behaviour of the triadic consultations in a preventive dental setting. It demonstrates satisfactory intra- and inter-coder reliability and has been successfully used in paediatric dental consultations.
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Affiliation(s)
- Siyang Yuan
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HN, UK.
| | - Gerry Humphris
- Health Psychology, University of St Andrews, St Andrews, UK
| | - Lorna MacPherson
- Community Oral Health Unit, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Al Ross
- Community Oral Health Unit, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HN, UK.,Public Health, NHS Tayside, Dundee, UK
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24
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Bergström EK, Davidson T, Moberg Sköld U. Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention among 12- to 15-Year-Olds in Sweden. Caries Res 2019; 53:339-346. [DOI: 10.1159/000495360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/10/2018] [Indexed: 11/19/2022] Open
Abstract
Since 2008, FRAMM has been a guideline for caries prevention for all 3- to 15-year-olds in the Västra Götaland Region in Sweden and a predominant part is school-based fluoride varnish applications for all 12- to 15-year-olds. The aims were to evaluate dental health-economic data among 12- to 15-year-olds, based on the approximal caries prevalence at the age of 12, and to evaluate cost-effectiveness. Caries data for 13,490 adolescents born in 1993 who did not take part and 11,321 adolescents born in 1998 who followed this guideline were extracted from dental records. Those with no dentin and/or enamel caries lesions and/or fillings on the approximal surfaces were pooled into the “low” subgroup, those with 1–3 into the “moderate” subgroup and those with ≥4 into the “high” subgroup. The results revealed that the low subgroup had a low approximal caries increment compared with the moderate and high subgroups during the 4-year study period. In all groups, there were statistically significant differences between those who took part in the guideline and those who did not. The analysis of cost-effectiveness revealed the lowest incremental cost-effectiveness ratio (ICER) for the high subgroup for decayed and/or filled approximal surfaces (DFSa) and approximal enamel lesions together and the highest ICER for the low subgroup for DFSa alone. To conclude, the FRAMM Guideline reduced the caries increment for adolescents with low, moderate and high approximal caries prevalence. The subgroup with the most favourable cost-effectiveness comprised those with a high caries prevalence at the age of 12.
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Hodgins F, Sherriff A, Gnich W, Ross AJ, Macpherson LMD. The effectiveness of Dental Health Support Workers at linking families with primary care dental practices: a population-wide data linkage cohort study. BMC Oral Health 2018; 18:191. [PMID: 30463549 PMCID: PMC6249895 DOI: 10.1186/s12903-018-0650-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Link workers (lay health workers, health support workers) based in the community provide additional support to individuals and families to facilitate engagement with primary care and other services and resources. This additional support aims to tackle the wider socio-economic determinants of health that lead to inequalities. To date, there is no clear evidence of the effectiveness of these programmes. This study evaluates the effectiveness of Dental Health Support Workers (DHSW) at linking targeted families with young children to primary care dental practices. The DHSW role is one component of Childsmile, the national oral health improvement programme in Scotland. METHODS A quasi-experimental approach captured the natural variation in the rollout of the DHSW intervention across Scotland in a cohort of children born between 2010 and 2013. Survival analysis explored "time to attendance" at primary care dental practice. Cox's regression models compared attendance rates and time until first attendance between those families who received support from the DHSW and those who did not. RESULTS The cohort consisted of 35236 children. Thirty-three percent of the cohort (n = 11495) were considered to require additional support from a DHSW. Of these, 44% (5087) received that support. These families were more likely to attend a dental practice (Hazard Ratio [95% Confidence Interval] =1.87 [1.8 to 1.9]) and, on average, did so 9 months earlier (median time until first attendance: 8.8 months versus 17.8 months), compared to families not receiving additional support. CONCLUSIONS Link workers (DHSW) within the Childsmile programme are effective at linking targeted children to primary care dental services and, most notably, at a younger age for prevention. This is the first study of its kind to evaluate the effectiveness of link-worker programmes using a robust quasi-experimental design on three, population-wide, linked datasets. These results will inform future health programmes which aim to improve health and reduce inequalities by reaching and supporting families from more disadvantaged backgrounds.
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Affiliation(s)
- Faith Hodgins
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, Edinburgh, UK. .,Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of MVLS, University of Glasgow, 378 Sauchiehall Street, Glasgow, UK.
| | - Andrea Sherriff
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of MVLS, University of Glasgow, 378 Sauchiehall Street, Glasgow, UK.
| | - Wendy Gnich
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of MVLS, University of Glasgow, 378 Sauchiehall Street, Glasgow, UK
| | - Alastair J Ross
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of MVLS, University of Glasgow, 378 Sauchiehall Street, Glasgow, UK
| | - Lorna M D Macpherson
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of MVLS, University of Glasgow, 378 Sauchiehall Street, Glasgow, UK
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26
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Macpherson LMD. Raising awareness of oral cancer from a public and health professional perspective. Br Dent J 2018; 225:809-814. [DOI: 10.1038/sj.bdj.2018.919] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 11/09/2022]
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Stock NM, Sharratt ND, Heath J, Nankivell D, Martindale A, Ridley M, Ahmed A, McMullin A, Cunniffe C. Falling through the gap: Dental treatment experiences of patients affected by cleft lip and/or palate. Br Dent J 2018; 225:218-222. [PMID: 30072784 DOI: 10.1038/sj.bdj.2018.542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/09/2022]
Abstract
Introduction In the UK, one in 600–700 infants is born with a cleft lip and/or palate (CL/P). Previous research has identified patients with CL/P to be at high risk of long-term oral health issues. Yet, few of these patients are currently accessing community dental care. Aims To assess patients' dental treatment experiences and their suggestions for improving services. Materials and methods Five focus groups were conducted with 24 adults with CL/P. Thematic analysis was performed on the data. Results Participants perceived local dental practitioners to lack knowledge about CL/P and its treatment. Consequently, some participants had stopped visiting a dental practice altogether. Participants were also largely unaware of the specialist CL/P services they are entitled to. Discussion Suggestions are made for the integration of improved training and resources for local dental practitioners. Closer communication between specialist cleft teams and local dental practitioners could also help to bridge the gap in knowledge and improve patients' engagement with dental services. The tertiary sector has a crucial role to play in empowering patients to take more control of their oral health and dental treatment.
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Affiliation(s)
- N M Stock
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - N D Sharratt
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - J Heath
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - D Nankivell
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
| | - A Martindale
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
| | - M Ridley
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - A Ahmed
- University of Liverpool School of Dentistry, Liverpool, L69 7ZX, United Kingdom
| | - A McMullin
- Cleft Lip & Palate Orthodontics, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - C Cunniffe
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
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Ross A, Sherriff A, Kidd J, Gnich W, Anderson J, Deas L, Macpherson L. A systems approach using the functional resonance analysis method to support fluoride varnish application for children attending general dental practice. APPLIED ERGONOMICS 2018; 68:294-303. [PMID: 29409648 PMCID: PMC5817000 DOI: 10.1016/j.apergo.2017.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 11/16/2017] [Accepted: 12/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND All children attending General Dental Practice in Scotland are recommended to receive twice-yearly applications of sodium fluoride varnish to prevent childhood caries, yet application is variable. Development of complex interventions requires theorizing and modelling to understand context. This study applies the Functional Resonance Analysis Method (FRAM) to produce a sociotechnical systems model and identify opportunities for intervention to support application. METHODS The FRAM was used to synthesise data which were: routine monitoring of fluoride varnish application in 2015/16; a longitudinal survey with practitioners (n = 1090); in-depth practitioner and key informant interviews (n = 43); and a 'world café' workshop (n = 56). RESULTS We describe a detailed model of functions linked to application, and use this to make recommendations for system-wide intervention. CONCLUSIONS Rigorous research is required to produce accessible models of complex systems in healthcare. This novel paper shows how careful articulation of the functions associated with fluoride varnish application can support future improvement efforts.
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Affiliation(s)
- Al Ross
- Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
| | - Andrea Sherriff
- Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
| | - Jamie Kidd
- Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
| | - Wendy Gnich
- Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
| | - Janet Anderson
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Leigh Deas
- Public Dental Services, NHS Lanarkshire, Hospital Street, Coatbridge, ML5 4DN, UK.
| | - Lorna Macpherson
- Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
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McMahon AD, Elliott L, Macpherson LM, Sharpe KH, Connelly G, Milligan I, Wilson P, Clark D, King A, Wood R, Conway DI. Inequalities in the dental health needs and access to dental services among looked after children in Scotland: a population data linkage study. Arch Dis Child 2018; 103:39-43. [PMID: 28855231 DOI: 10.1136/archdischild-2016-312389] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 06/28/2017] [Accepted: 07/09/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is limited evidence on the health needs and service access among children and young people who are looked after by the state. The aim of this study was to compare dental treatment needs and access to dental services (as an exemplar of wider health and well-being concerns) among children and young people who are looked after with the general child population. METHODS Population data linkage study utilising national datasets of social work referrals for 'looked after' placements, the Scottish census of children in local authority schools, and national health service's dental health and service datasets. RESULTS 633 204 children in publicly funded schools in Scotland during the academic year 2011/2012, of whom 10 927 (1.7%) were known to be looked after during that or a previous year (from 2007-2008). The children in the looked after children (LAC) group were more likely to have urgent dental treatment need at 5 years of age: 23%vs10% (n=209/16533), adjusted (for age, sex and area socioeconomic deprivation) OR 2.65 (95% CI 2.30 to 3.05); were less likely to attend a dentist regularly: 51%vs63% (n=5519/388934), 0.55 (0.53 to 0.58) and more likely to have teeth extracted under general anaesthesia: 9%vs5% (n=967/30253), 1.91 (1.78 to 2.04). CONCLUSIONS LAC are more likely to have dental treatment needs and less likely to access dental services even when accounting for sociodemographic factors. Greater efforts are required to integrate child social and healthcare for LAC and to develop preventive care pathways on entering and throughout their time in the care system.
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Affiliation(s)
- Alex D McMahon
- Community Oral Health, University of Glasgow Dental School, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Md Macpherson
- Community Oral Health, University of Glasgow Dental School, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Katharine H Sharpe
- Community Oral Health, University of Glasgow Dental School, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Graham Connelly
- Community Oral Health, CELCIS (Centre for Excellence for Looked After Children in Scotland), School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Ian Milligan
- Community Oral Health, CELCIS (Centre for Excellence for Looked After Children in Scotland), School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Philip Wilson
- Community Oral Health, University of Aberdeen, Centre for Rural Health, Inverness, UK
| | - David Clark
- Community Oral Health, Division of Information Services, NHS National Services Scotland, Edinburgh, UK
| | - Albert King
- Education Analytical Services, Scottish Government, Edinburgh, UK
| | - Rachael Wood
- Community Oral Health, Division of Information Services, NHS National Services Scotland, Edinburgh, UK
| | - David I Conway
- Community Oral Health, University of Glasgow Dental School, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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30
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Godson J, Csikar J, White S. Oral health of children in England: a call to action! Arch Dis Child 2018; 103:5-10. [PMID: 29025702 DOI: 10.1136/archdischild-2017-312725] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Jenny Godson
- Dental Public Health, Public Health England, London, UK
| | - Julia Csikar
- Dental Public Health, Public Health England, London, UK.,Dental Public Health, The University of Leeds, Leeds, UK
| | - Sandra White
- Dental Public Health, Public Health England, London, UK
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31
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Bonetti DL. Evidence not practised: the underutilisation of preventive fissure sealants. Br Dent J 2016; 216:409-13. [PMID: 24722094 DOI: 10.1038/sj.bdj.2014.248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 11/09/2022]
Abstract
International and UK professional organisations, Cochrane systematic reviews, and international and UK guidance documents all support the application of preventive fissure sealants (PFSs) as an effective treatment for reducing caries. However, PFSs are well known to be underutilised in primary care. This paper collates data from PFS-relevant studies in Scotland, which has a large population of children at caries risk, to identify the beliefs and factors dentists perceive as influencing their decision not to provide this treatment. This information provides a platform to suggest how to increase the application of PFSs in this region (a standardised audit incorporating evidence-based behaviour change techniques, supplemental guidance on how to implement gold-standard recommendations in practice, training). This may also be relevant outside of Scotland, as well as to the implementation of other evidence-based behaviours in practice.
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Affiliation(s)
- D L Bonetti
- Dental Health Services Research Unit, DDEC, Frankland Building, University of Dundee, Small's Wynd, Dundee, DD1 4HN
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A school-based oral health intervention in East London: the Happy Teeth fluoride varnish programme. Br Dent J 2016; 215:E14. [PMID: 24157788 DOI: 10.1038/sj.bdj.2013.997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Community Dental Services of Barts Health NHS Trust in City and Hackney and Tower Hamlets PCTs in East London have provided a school-based oral health intervention since 2009. OBJECTIVE The aim of this paper is to present the programme development, outcomes and evaluation. SUBJECTS AND METHODS The programme consists of fluoride varnish applications linked to school dental screenings for three to six-year-olds, combined with oral health promotion for parents/carers. An outreach linkworker works closely with schools to help identify and support vulnerable families into the programme. RESULTS In the first year of the programme 160 of the target children (42%) had one FV application and 81 children (21%) had two applications. In the second year 149 children (39%) had one FV application, and 113 (29%) had two applications. Amendments to the protocol increased programme participation in the third year, with 1,822 of the target children (61%) having one FV application and 1,586 (53%) having two applications. CONCLUSIONS The programme proved acceptable to the school staff, participating parents/carers and children. The Happy Teeth programme is proposed as a model for school-based fluoride varnish programmes.
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Templeton AR, Young L, Bish A, Gnich W, Cassie H, Treweek S, Bonetti D, Stirling D, Macpherson L, McCann S, Clarkson J, Ramsay C. Patient-, organization-, and system-level barriers and facilitators to preventive oral health care: a convergent mixed-methods study in primary dental care. Implement Sci 2016; 11:5. [PMID: 26753791 PMCID: PMC4710040 DOI: 10.1186/s13012-015-0366-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/23/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Dental caries is the most common chronic disease of adult and childhood, a largely preventable yet widespread, costly public health problem. This study identified patient-, organization-, and system-level factors influencing routine delivery of recommended care for prevention and management of caries in primary dental care. METHODS A convergent mixed-methods design assessed six guidance-recommended behaviours to prevent and manage caries (recording risk, risk-based recall intervals, applying fluoride varnish, placing preventive fissure sealants, demonstrating oral health maintenance, taking dental x-rays). A diagnostic questionnaire assessing current practice, beliefs, and practice characteristics was sent to a random sample of 651 dentists in National Health Service (NHS) Scotland. Eight in-depth case studies comprising observation of routine dental visits and dental team member interviews were conducted. Patient feedback was collected from adult patients with recent checkups at case study practices. Key informant interviews were conducted with decision makers in policy, funding, education, and regulation. The Theoretical Domains Framework within the Behaviour Change Wheel was used to identify and describe patient-, organization-, and system-level barriers and facilitators to care. Findings were merged into a matrix describing theoretical domains salient to each behaviour. The matrix and Behaviour Change Wheel were used to prioritize behaviours for change and plan relevant intervention strategies. RESULTS Theoretical domains associated with best practice were identified from the questionnaire (N-196), case studies (N = 8 practices, 29 interviews), and patient feedback (N = 19). Using the study matrix, key stakeholders identified priority behaviours (use of preventive fissure sealants among 6-12-year-olds) and strategies (audit and feedback, patient informational campaign) to improve guidance implementation. Proposed strategies were assessed as appropriate for immediate implementation and suitable for development with remaining behaviours. CONCLUSIONS Specific, theoretically based, testable interventions to improve caries prevention and management were coproduced by patient-, practice-, and policy-level stakeholders. Findings emphasize duality of behavioural determinants as barriers and facilitators, patient influence on preventive care delivery, and benefits of integrating multi-level interests when planning interventions in a dynamic, resource-constrained environment. Interventions identified in this study are actively being used to support ongoing implementation initiatives including guidance, professional development, and oral health promotion.
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Macpherson LMD, Ball GE, King P, Chalmers K, Gnich W. CHILDSMILE: THE CHlLD ORAL HEALTH IMPROVEMENT PROGRAMME IN SCOTLAND. Prim Dent J 2015; 4:33-37. [PMID: 26966770 DOI: 10.1308/205016815816682236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Anopa Y, McMahon AD, Conway DI, Ball GE, McIntosh E, Macpherson LMD. Improving Child Oral Health: Cost Analysis of a National Nursery Toothbrushing Programme. PLoS One 2015; 10:e0136211. [PMID: 26305577 PMCID: PMC4549338 DOI: 10.1371/journal.pone.0136211] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/31/2015] [Indexed: 11/19/2022] Open
Abstract
Dental caries is one of the most common diseases of childhood. The aim of this study was to compare the cost of providing the Scotland-wide nursery toothbrushing programme with associated National Health Service (NHS) cost savings from improvements in the dental health of five-year-old children: through avoided dental extractions, fillings and potential treatments for decay.
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Affiliation(s)
- Yulia Anopa
- Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Health Economics and Health Technology Assessment, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Alex D. McMahon
- Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David I. Conway
- Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Emma McIntosh
- Health Economics and Health Technology Assessment, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Lorna M. D. Macpherson
- Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Deery C, Owen J, Welbury R, Chadwick B. Dental caries in children and the level of repeat general anaesthetics for dental extractions. a national disgrace. ACTA ACUST UNITED AC 2015; 42:305-6. [DOI: 10.12968/denu.2015.42.4.305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jayne Owen
- Somerset Partnership NHS Foundation Trust
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Blair YI, McMahon AD, Gnich W, Conway DI, Macpherson LMD. Elimination of 'the Glasgow effect' in levels of dental caries in Scotland's five-year-old children: 10 cross-sectional surveys (1994-2012). BMC Public Health 2015; 15:212. [PMID: 25879616 PMCID: PMC4352263 DOI: 10.1186/s12889-015-1492-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/29/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in health within Glasgow, Scotland, are among the widest in the world. This is largely attributed to socio-economic conditions. The 'Glasgow Effect' labels the finding that the high prevalence of some diseases cannot be fully explained by a conventional area-based socio-economic metric. This study aimed to investigate whether differences in dental caries between Glasgow's resident children and those in the Rest of Scotland could be explained by this metric and whether differences were of fixed magnitude, over time. METHODS Scotland's National Dental Inspection Programme (NDIP) cross-sectional data for five-year-old children in years: 1994, 1996, 1998, 2000, 2003, 2004, 2006, 2008, 2010, and 2012 (n = 92,564) were utilised. Endpoints were calculated from the mean decayed, missing and filled teeth score (d3mft) and percentage with obvious decay experience. Socioeconomic status was measured by DepCat, a Scottish area-based index. The Glasgow Effect was estimated by the odds-ratio (OR) of decay for Glasgow versus the Rest of Scotland adjusted by age, gender and DepCat. Inequalities were also assessed by the Significant Caries Index (SIC), SIC 10, and Scottish Caries Inequality Metric (SCIM 10). RESULTS Decay levels for deprived Glasgow children have reduced to be similar to those in the Rest of Scotland. In 1993, OR for d3mft > 0 for those living in the Glasgow area was 1.34(1.10, 1.64), p = 0.005. This reduced below unity in 2012, OR = 0.85(0.77, 0.93), p < 0.001. There were downward trends (p < 0.001) in absolute inequality measured by SIC and SIC 10 in each of the geographic areas. The SCIM 10 demonstrated further reductions in inequality across the population. The downward trends for all the inequality measures were larger for Glasgow than the Rest of Scotland. CONCLUSIONS Over the interval, Glasgow has eliminated the earlier extra health inequalities. When comparing 'like for like' by socioeconomic status there is now no higher level of dental caries in the Greater Glasgow area.
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Affiliation(s)
- Yvonne I Blair
- Oral Health Directorate, NHS Greater Glasgow & Clyde, Glasgow Dental Hospital, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
| | - Alex D McMahon
- Community Oral Health Section, University of Glasgow Dental School, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
| | - Wendy Gnich
- Community Oral Health Section, University of Glasgow Dental School, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
| | - David I Conway
- Community Oral Health Section, University of Glasgow Dental School, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
| | - Lorna M D Macpherson
- Community Oral Health Section, University of Glasgow Dental School, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
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Gnich W, Bonetti D, Sherriff A, Sharma S, Conway DI, Macpherson LMD. Use of the theoretical domains framework to further understanding of what influences application of fluoride varnish to children's teeth: a national survey of general dental practitioners in Scotland. Community Dent Oral Epidemiol 2015; 43:272-81. [PMID: 25656749 DOI: 10.1111/cdoe.12151] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 12/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite recent improvements in the oral health of Scotland's population, the persistence of childhood dental caries underscores a need to reduce the disease burden experienced by children living in Scotland. Application of fluoride varnish (FV) to children's teeth provides an evidence-based approach to achieving this goal. Despite policy, health service targets and professional recommendations supporting application, not all children receive FV in line with guidance. The objective of this study was to use the theoretical domains framework (TDF) to further an understanding of what may influence fluoride varnish application (FVA) in General Dental Practice in Scotland. METHODS A postal questionnaire assessing current behaviour (frequency of FVA) and theoretical domains (TDs) was sent to all General Dental Practitioners (GDPs) in Scotland. Correlations and linear regression models were used to examine the association between FVA and the TDs. RESULTS One thousand and ninety (53.6%) eligible GDPs responded. Respondents reported applying FV more frequently to increased risk and younger children (aged 2-5 years). Higher scores in eight TDs (Knowledge, Social/professional role and identity, Beliefs about consequences, Motivation and goals, Environmental context and resources, Social influences, Emotion and Behavioural regulation) were associated with greater frequency of FVA. Four beliefs in particular appear to be driving GDPs' decision to apply FV (recognizing that FVA is a guideline recommended behaviour (Knowledge), that FVA is perceived as an important part of the GDPs' professional role (Professional role/identity), that FV is something parents want for their children (Social influences) and that FV is something GDPs really wanted to do (Emotion). CONCLUSIONS The findings of this study support the use of the TDF as a tool to understand GDPs application of FV and suggest that a multifaceted intervention, targeting dental professionals and families, and more specifically those domains and items associated with FVA may have the greatest likelihood of influencing the evidence-based behaviour.
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Affiliation(s)
- Wendy Gnich
- Community Oral Health Section, Faculty of Medicine, Glasgow Dental School, University of Glasgow, Glasgow, UK
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Elouafkaoui P, Bonetti D, Clarkson J, Stirling D, Young L, Cassie H. Is further intervention required to translate caries prevention and management recommendations into practice? Br Dent J 2015; 218:E1. [DOI: 10.1038/sj.bdj.2014.1141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/09/2022]
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40
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Reflections on a training course reorienting dental teams towards prevention. Br Dent J 2015; 218:25-8. [DOI: 10.1038/sj.bdj.2014.1140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/08/2022]
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41
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Gnich W, Deas L, Mackenzie S, Burns J, Conway DI. Extending dental nurses' duties: a national survey investigating skill-mix in Scotland's child oral health improvement programme (Childsmile). BMC Oral Health 2014; 14:137. [PMID: 25421225 PMCID: PMC4280710 DOI: 10.1186/1472-6831-14-137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 11/04/2014] [Indexed: 11/23/2022] Open
Abstract
Background Childsmile is Scotland’s national child oral health improvement programme. To support the delivery of prevention in general dental practice in keeping with clinical guidelines, Childsmile sought accreditation for extended duty training for dental nurses to deliver clinical preventive care. This approach has allowed extended duty dental nurses (EDDNs) to take on roles traditionally undertaken by general dental practitioners (GDPs). While skill-mix approaches have been found to work well in general medicine, they have not been formally evaluated in dentistry. Understanding the factors which influence nurses’ ability to fully deliver their extended roles is necessary to ensure nurses’ potential is reached and that children receive preventive care in line with clinical guidance in a cost-effective way. This paper investigates the supplementation of GDPs’ roles by EDDNs, in general dental practice across Scotland. Methods A cross-sectional postal survey aiming to reach all EDDNs practising in general dental practice in Scotland was undertaken. The survey measured nurses’: role satisfaction, perceived utility of training, frequency, and potential behavioural mediators of, preventive delivery. Frequencies, correlations and multi-variable linear regression were used to analyse the data. Results Seventy-three percent of practices responded with 174 eligible nurses returning questionnaires. Respondents reported a very high level of role satisfaction and the majority found their training helpful in preparing them for their extended role. While a high level of preventive delivery was reported, fluoride vanish (FV) was delivered less frequently than dietary advice (DA), or oral hygiene advice (OHA). Delivering FV more frequently was associated with higher role satisfaction (p < 0.001). Those nurses who had been practising longer reported delivering FV less frequently than those more recently qualified (p < 0.001). Perceived difficulty of delivering preventive care (skills) and motivation to do so were most strongly associated with frequency of delivery (p < 0.001 for delivery of FV, DA and OHA). Conclusions This study has provided insight into EDDNs’ experiences and demonstrates that with appropriate training and support, EDDNs can supplement GDPs’ roles in general dental practice in Scotland. However, some barriers to delivery were identified with delivery of FV showing scope for improvement. Electronic supplementary material The online version of this article (doi:10.1186/1472-6831-14-137) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wendy Gnich
- Community Oral Health Section, Glasgow Dental School, Faculty of Medicine, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK.
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Woodall J, Woodward J, Witty K, McCulloch S. An evaluation of a toothbrushing programme in schools. HEALTH EDUCATION 2014. [DOI: 10.1108/he-12-2013-0069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to assess the effectiveness of a toothbrushing intervention delivered in primary schools in Yorkshire and the Humber, a Northern district of England. The toothbrushing intervention was designed with the intention of improving the oral health of young children. The paper reports the effectiveness of the intervention and explores process issues related to its co-ordination and delivery.
Design/methodology/approach
– The evaluation had three data gathering approaches. These were: in-depth case studies of three selected schools participating in the toothbrushing programme; interviews with oral health promoters responsible for the programme in the district; and a small scale questionnaire-based survey which was sent to the 18 schools participating in the intervention.
Findings
– The intervention was accepted by children and they enjoyed participating in the toothbrushing scheme. Children had often become more knowledgeable about toothbrushing and the consequences of not regularly cleaning their teeth. The scheme was contingent on key staff in the school and the programme was more successful where school's embraced, rather than rejected the notion of improving children's health alongside educational attainment. Whether the intervention made differences to brushing in the home requires further investigation, but there is a possibility that children can act as positive “change agents” with siblings and other family members.
Practical implications
– This paper suggests that schools can be an effective setting for implementing toothbrushing interventions.
Originality/value
– Toothbrushing in schools programmes are a relatively new initiative that have not been fully explored, especially using qualitative approaches or focusing on the views of children. This paper makes a particular contribution to understanding the process and delivery of toothbrushing interventions delivered in primary schools. The implications for programmes outside of the UK context are discussed.
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Malcolm J, Sherriff A, Lappin DF, Ramage G, Conway DI, Macpherson LMD, Culshaw S. Salivary antimicrobial proteins associate with age-related changes in streptococcal composition in dental plaque. Mol Oral Microbiol 2014; 29:284-93. [PMID: 24890264 DOI: 10.1111/omi.12058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2014] [Indexed: 11/27/2022]
Abstract
Secretion of antimicrobial proteins (AMPs) and salivary antibodies can modify biofilm formation at host body surfaces. In adolescents, associations have been reported between dental caries and salivary AMPs. AMPs demonstrate direct antimicrobial effects at high concentrations, and at lower more physiological concentrations they mediate changes in host cell defenses, which may alter the local environment and indirectly shape local biofilm formation. The expression of salivary AMPs in preschool children, at an age when the oral bacteria are known to change, has not been investigated. We sought to investigate salivary AMP expression in the context of previously well-documented changes in the oral cavities of this age group including salivary immunoglobulin A (IgA), oral bacteria and dental caries. Dental plaque and saliva were collected from 57 children aged 12-24 months at baseline, of whom 23 children were followed-up at 3 years of age. At each time, saliva was assessed for LL37, human neutrophil peptides 1-3, calprotectin, lactoferrin, salivary IgA, total plaque bacteria and Streptococcus mutans. Over time, concentrations of AMPs, S. mutans and bacteria-specific salivary IgA increased. Caries experience was also recorded when children were 3 years old. Concentrations of AMPs were highest in the saliva of 3-year-old children with the greatest burden of S. mutans. These data suggest that salivary AMPs are variable over time and between individuals, and are linked with bacterial colonization. At follow up, the majority of children remained caries free. Larger longitudinal studies are required to confirm whether salivary AMP levels are predictive of caries and whether their modulation offers therapeutic benefit.
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Affiliation(s)
- J Malcolm
- Infection and Immunity Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Humphris GM, Zhou Y. Prediction of nursery school-aged children who refuse fluoride varnish administration in a community setting: a Childsmile investigation. Int J Paediatr Dent 2014; 24:245-51. [PMID: 24750483 DOI: 10.1111/ipd.12068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Young children of pre-school age may find a minimal intervention (fluoride varnish application) difficult to tolerate. AIM To determine the significant predictors for refusing a fluoride varnish application from child, parental and nurse behaviour factors. DESIGN Data included videos from 238 children (52% female, aged 3-5 years) receiving a fluoride varnish application in a Scottish nursery school setting. The St Andrews Behavioural Interaction Scheme (SABICS) was used for video coding and retrieved child refusal status, initial anxious behaviour, and nurse behaviour. A parental survey collected parent's dental anxiety [Modified Dental Anxiety Scale (MDAS)] and the child's home behaviour [Strengths and Difficulties Questionnaire (SDQ)]. Child demographics, dental status, and previous varnish application experience were recorded. Multivariate binary logistic regression was applied to predict child refusal of the varnish application. RESULTS The response rate was 79%. Twelve children refused. The significant predictors of varnish refusal included initial anxious child behaviour (β = 5.14, P = 0.001), no previous varnish application (β = -3.89, P = 0.04), and no nurse praise (β = -1.06, P = 0.02). Information giving (P = 0.06) and reassurance (P = 0.08) were borderline significant. CONCLUSION Initial anxiety behaviour, previous varnish experience, and not using praise by the nursing staff predicted fluoride varnish application refusal.
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Direct access to DCPs: what are the potential risks and benefits? Br Dent J 2013; 215:577-82. [DOI: 10.1038/sj.bdj.2013.1145] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 11/09/2022]
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Eaves J, Gnich W. Can programme theory be used as a 'translational tool’ to optimise health service delivery in a national early years’ initiative in Scotland: a case study. BMC Health Serv Res 2013; 13:425. [PMID: 24139309 PMCID: PMC3854547 DOI: 10.1186/1472-6963-13-425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 10/09/2013] [Indexed: 11/30/2022] Open
Abstract
Background Theory-based evaluation (TBE) approaches are heralded as supporting formative evaluation by facilitating increased use of evaluative findings to guide programme improvement. It is essential that learning from programme implementation is better used to improve delivery and to inform other initiatives, if interventions are to be as effective as they have the potential to be. Nonetheless, few studies describe formative feedback methods, or report direct instrumental use of findings resulting from TBE. This paper uses the case of Scotland’s, National Health Service, early years’, oral health improvement initiative (Childsmile) to describe the use of TBE as a framework for providing feedback on delivery to programme staff and to assess its impact on programmatic action. Methods In-depth, semi-structured interviews and focus groups with key stakeholders explored perceived deviations between the Childsmile programme 'as delivered’ and its Programme Theory (PT). The data was thematically analysed using constant comparative methods. Findings were shared with key programme stakeholders and discussions around likely impact and necessary actions were facilitated by the authors. Documentary review and ongoing observations of programme meetings were undertaken to assess the extent to which learning was acted upon. Results On the whole, the activities documented in Childsmile’s PT were implemented as intended. This paper purposefully focuses on those activities where variation in delivery was evident. Differences resulted from the stage of roll-out reached and the flexibility given to individual NHS boards to tailor local implementation. Some adaptations were thought to have diverged from the central features of Childsmile’s PT, to the extent that there was a risk to achieving outcomes. The methods employed prompted national service improvement action, and proposals for local action by individual NHS boards to address this. Conclusions The TBE approach provided a platform, to direct attention to areas of risk within a national health initiative, and to agree which intervention components were 'core’ to its hypothesised success. The study demonstrates that PT can be used as a 'translational tool’ to facilitate instrumental use of evaluative findings to optimise implementation within a complex health improvement programme.
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Intelligent policy making? Key actors' perspectives on the development and implementation of an early years' initiative in Scotland's public health arena. Soc Sci Med 2013; 96:1-8. [DOI: 10.1016/j.socscimed.2013.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 04/09/2013] [Accepted: 07/03/2013] [Indexed: 11/18/2022]
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The behaviour of preschool children receiving fluoride varnish application in a community setting. Br Dent J 2013; 215:E11. [PMID: 24113989 DOI: 10.1038/sj.bdj.2013.990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND The behaviour of young children receiving mildly invasive dental preventive procedures in a community setting warrants more extensive research due to limitations in the literature.Objectives To document the behavioural profile of preschool children undergoing a preventive oral health intervention (fluoride varnish application) and to investigate this behaviour across children with different previous experience of the procedure, ages and initial anxiety states. METHOD Nurse-child interactions were video recorded and child behaviours coded and analysed using a specially developed coding scheme (SABICS). Behaviour frequency was measured and presented diagrammatically, followed by independent sample non-parametric tests to distinguish behavioural group differences. RESULTS Three hundred and three interactions were coded out of 456 recorded application sessions. 'Nonverbal agreement' behaviour was observed most frequently compared to disruptive behaviours. Younger preschool children tended to exhibit 'interact with instrument' behaviour more frequently than older children regardless of whether they had had previous application experience. Children who showed signs of initial anxiety were likely to display more disruptive behaviours during the later stage of the procedure compared with non-anxious children. CONCLUSIONS Dental staff working with preschool children are recommended to use encouragement-centred strategies to promote nonverbal cooperative behaviours in children. In addition, procedure instruments could be considered as a tool to gain child cooperation. Evidence of an autocorrelation effect of child behaviour was found, indicating that the early presentation of child behaviour predicted the behaviour of the child at later stages.
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Recruitment and participation in pre-school and school-based fluoride varnish pilots – the South Central experience. Br Dent J 2013; 215:E8. [DOI: 10.1038/sj.bdj.2013.834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2013] [Indexed: 11/08/2022]
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Brewster L, Sherriff A, Macpherson L. Effectiveness and reach of a directed-population approach to improving dental health and reducing inequalities: a cross sectional study. BMC Public Health 2013; 13:778. [PMID: 23978217 PMCID: PMC3765943 DOI: 10.1186/1471-2458-13-778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 08/16/2013] [Indexed: 11/29/2022] Open
Abstract
Background Childsmile School adopts a directed-population approach to target fluoride varnish applications to 20% of the primary one (P1) population in priority schools selected on the basis of the proportion of enrolled children considered to be at increased-risk of developing dental caries. The study sought to compare the effectiveness of four different methods for identifying individuals most in need when a directed-population approach is taken. Methods The 2008 Basic National Dental Inspection Programme (BNDIP) cross-sectional P1 Scottish epidemiological survey dataset was used to model four methods and test three definitions of increased-risk. Effectiveness was determined by the positive predictive value (PPV) and explored in relation to 1-sensitivity and 1-specificity. Results Complete data was available on 43470 children (87% of the survey). At the Scotland level, at least half (50%) of the children targeted were at increased-risk irrespective of the method used to target or the definition of increased-risk. There was no one method across all definitions of increased-risk that maximised PPV. Instead, PPV was highest when the targeting method complimented the definition of increased-risk. There was a higher percentage of children at increased-risk who were not targeted (1-sensitivity) when caries experience (rather than deprivation) was used to define increased-risk, irrespective of the method used for targeting. Over all three definitions of increased-risk, there was no one method that minimised (1-sensitivity) although this was lowest when the method and definition of increased-risk were complimentary. The false positive rate (1-specificity) for all methods and all definitions of increased-risk was consistently low (<20%), again being lowest when the method and definition of increased-risk were complimentary. Conclusion Developing a method to reach all (or even the vast majority) of individuals at increased-risk defined by either caries experience or deprivation is difficult using a directed-population approach at a group level. There is a need for a wider debate between politicians and public health experts to decide how best to reach those most at need of intervention to improve health and reduce inequalities.
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Affiliation(s)
- Lynn Brewster
- Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, Scotland.
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