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Marshman Z, Rodd H, Fairhurst C, Porritt J, Dawett B, Day P, Innes N, Vernazza C, Newton T, Ronaldson S, Cross L, Ross J, Baker SR, Hewitt C, Torgerson D, Ainsworth H. The CALM trial protocol: a randomised controlled trial of a guided self-help cognitive behavioural therapy intervention to reduce dental anxiety in children. Trials 2023; 24:15. [PMID: 36609355 PMCID: PMC9817252 DOI: 10.1186/s13063-022-07046-6] [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: 11/10/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Globally, around 13% of children experience dental anxiety (DA). This group of patients frequently miss dental appointments, have greater reliance on treatment under general anaesthesia (GA) and have poorer oral health-related quality of life (OHRQoL) than their non-dentally anxious peers. Recently, a low-intensity cognitive behavioural therapy (CBT)-based, self-help approach has been recommended for management of childhood anxiety disorders. A feasibility study conducted in secondary care found this guided self-help CBT resource reduced DA and a randomised controlled trial was recommended. The present study aims to establish the clinical and cost-effectiveness of a guided self-help CBT intervention to reduce DA in children attending primary dental care sites compared to usual care. METHODS This 4-year randomised controlled trial will involve 600 children (aged 9-16 years) and their parent/carers in 30 UK primary dental care sites. At least two dental professionals will participate in each site. They will be assigned, using random allocation, to receive the CBT training and deliver the intervention or to deliver usual care. Children with DA attending these sites, in need of treatment, will be randomly allocated to be treated either by the intervention (CBT) or control (usual care) dental professional. Children will complete questionnaires relating to DA, OHRQoL and HRQoL before treatment, immediately after treatment completion and 12 months post-randomisation. Attendance, need for sedation/GA and costs of the two different approaches will be compared. The primary outcome, DA, will be measured using the Modified Child Dental Anxiety Scale. Scores will be compared between groups using a linear mixed model. DISCUSSION Treating dentally anxious patients can be challenging and costly. Consequently, these children are frequently referred to specialist services for pharmacological interventions. Longer waiting times and greater travel distances may then compound existing healthcare inequalities. This research will investigate whether the intervention has the potential to reduce DA and improve oral health outcomes in children over their life-course, as well as upskilling primary dental healthcare professionals to better manage this patient group. TRIAL REGISTRATION This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420).
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Affiliation(s)
- Zoe Marshman
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Helen Rodd
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Caroline Fairhurst
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Jenny Porritt
- grid.5884.10000 0001 0303 540XCentre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Bhupinder Dawett
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Peter Day
- grid.9909.90000 0004 1936 8403 Leeds Dental Institute, University of Leeds, Leeds, UK
| | - Nicola Innes
- grid.5600.30000 0001 0807 5670School of Dentistry, Cardiff University, Cardiff, UK
| | - Christopher Vernazza
- grid.1006.70000 0001 0462 7212School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Tim Newton
- grid.13097.3c0000 0001 2322 6764Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
| | - Sarah Ronaldson
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Liz Cross
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Jennie Ross
- Richmond Dental Care, 427-429 Richmond Road, Sheffield, UK
| | - Sarah R. Baker
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Catherine Hewitt
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David Torgerson
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Hannah Ainsworth
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
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Comparing how patients value and respond to information on risk given in three different forms during dental check-ups: the PREFER randomised controlled trial. Trials 2020; 21:21. [PMID: 31907022 PMCID: PMC6945632 DOI: 10.1186/s13063-019-3824-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/22/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study aims to compare patient preference for, and subsequent change in, oral health behaviour for three forms of risk information given at dental check-ups (verbal advice compared to verbal advice accompanied by a traffic light (TL) risk card; or compared to verbal advice with a quantitative light fluorescence (QLF) photograph of the patient's mouth). METHODS A multi-centre, parallel-group, patient-randomised clinical trial was undertaken between August 2015 and September 2016. Computer-generated random numbers using block stratification allocated patients to three arms. The setting was four English NHS dental practices. Participants were 412 dentate adults at medium/high risk of poor oral health. Patients rated preference and willingness to pay (WTP) for the three types of information. The primary outcome was WTP. After receiving their check-up, patients received the type of information according to their group allocation. Follow-up was by telephone/e-mail at 6 and 12 months. Mean and median WTP for the three arms were compared using Wilcoxon signed-rank tests. Tobit regression models were used to investigate factors affecting WTP and preference for information type. Secondary outcomes included self-rated oral health and change in oral health behaviours (tooth-brushing, sugar consumption and smoking) and were investigated using multivariate generalised linear mixed models. RESULTS A total of 412 patients were randomised (138 to verbal, 134 to TL and 140 to QLF); 391 revisited their WTP scores after the check-up (23 withdrew). Follow-up data were obtained for 185 (46%) participants at 6 months and 153 (38%) participants at 12 months. Verbal advice was the first preference for 51% (209 participants), QLF for 35% (145 participants) and TL for 14% (58 participants). TL information was valued lower than either verbal or QLF information (p < 0.0001). Practice attended was predictive of verbal as first preference, and being older. Practice attended, preferring TL the most and having fewer than 20 teeth were associated with increased WTP; and living in a relatively deprived area or having low literacy decreased WTP. There were no significant differences in behaviour change on follow-up. CONCLUSIONS Although a new NHS dental contract based on TL risk stratification is being tested, patients prefer the usual verbal advice. There was also a practice effect which will needs to be considered for successful implementation of this government policy. TRIAL REGISTRATION ISRCTN, ISRCTN71242343. Retrospectively registered on 27 March 2018.
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Willingness of general dental practices in South East London to engage with research. Prim Health Care Res Dev 2019; 20:e118. [PMID: 32799989 PMCID: PMC6691998 DOI: 10.1017/s1463423618000944] [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: 11/18/2022] Open
Abstract
This study assessed the willingness of general dental practices (GDPs) to
participate in research. All 263 GDPs in South East London that provide dental
care under National Health Service (NHS) contracts were invited. The survey
instrument was adapted from previous studies and piloted before administration.
Geographical factors and practice characteristics associated with willingness to
participate in research were explored in logistic regression models. A total of
77 responses were received (response rate: 29%). Of them, 40 (53%)
expressed interest in being involved in primary care research. They saw their
main role as collecting data and facilitating access to patients. Time,
bureaucracy and lack of energy were the main reasons behind a decision not to
engage with research. Those spending more time in NHS services were more likely
to be willing to participate in research. Other possible indicators were
single-handed GDPs, participation in the dental foundation training programme
and location in more affluent areas.
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Marshman Z, Innes N, Deery C, Hall M, Speed C, Douglas G, Clarkson J, Rodd H. The management of dental caries in primary teeth - involving service providers and users in the design of a trial. Trials 2012; 13:143. [PMID: 22913464 PMCID: PMC3487973 DOI: 10.1186/1745-6215-13-143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 07/09/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is a lack of evidence for the effective management of dental caries in children's primary teeth. The trial entitled 'Filling Children's Teeth: Indicated Or Not?' (FiCTION) was designed to examine the clinical and cost effectiveness, in primary dental care, of three different approaches to the management of caries in primary teeth. However, before the FiCTION main trial commenced, a pilot trial was designed. Service provider (dentists and other members of the team including dental nurses and practice managers) and participant (child participants and their parents) involvement was incorporated into the pilot trial. The aim of this study is to describe service providers' and users' perspectives on the pilot trial to identify improvements to the conduct and design of the FiCTION main trial. METHODS Qualitative interviews (individual and group) were held with dentists, dental team members, children and parents involved in the FiCTION pilot trial. Individual interviews were held with four dentists and a group interview was held with 17 dental team members. Face-to-face interviews were held with four parents and children (four- to eight-years old) representing the three arms of the trial and five telephone interviews were conducted with parents. All interviews were transcribed verbatim. Framework analysis was used. RESULTS Overall, service providers, children and parents found the pilot trial to be well conducted and an interesting experience. Service providers highlighted the challenges of adhering to research protocols, especially managing the documentation and undertaking new clinical techniques. They indicated that the time and financial commitments were greater than they had anticipated. Particular difficulties were found recruiting suitable patients within the timeframe. For parents recruitment was apparently more related to trusting their dentist than the content of information packs. While some of the older children understood what a study was, others did not understand or were not aware they were enrolled. CONCLUSIONS The findings provided valuable recommendations to improve the method of recruitment of dental practices and patients, the timing and content of the training, the type of support dentists would value and ways to further engage children and parents in the FiCTION main trial. TRIAL REGISTRATION ISRCTN77044005.
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Affiliation(s)
- Zoe Marshman
- School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Nicola Innes
- School of Dentistry, Park Place, Dundee, DD1 4HN, UK
| | - Chris Deery
- School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Melanie Hall
- School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Chris Speed
- Newcastle Clinical Trials Unit 4th Floor, William Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Gail Douglas
- Leeds Dental Institute, Clarendon Way, Leeds, LS2 9LU, UK
| | - Jan Clarkson
- Dental Health Services Research Unit, School of Dentistry, Park Place, Dundee, DD1 4HN, UK
| | - Helen Rodd
- School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK
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