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Tantimahanon A, Sipiyaruk K, Tantipoj C. Determinants of dietary behaviors among dental professionals: insights across educational levels. BMC Oral Health 2024; 24:724. [PMID: 38914973 PMCID: PMC11197208 DOI: 10.1186/s12903-024-04502-4] [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: 04/08/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Healthy dietary behaviors are fundamental for maintaining optimal health. Understanding the dietary behaviors of dentists is vital for designing effective interventions to foster healthier behaviors. However, investigations into dietary behaviors and their associations among dental professionals have been limited. OBJECTIVE To investigate the dietary behaviors of dental professionals, along with the associated factors influencing their dietary options. MATERIALS AND METHODS A self-administered online questionnaire was constructed to collect data from three groups of dental professionals: undergraduates (UG), postgraduates (PG), and practicing dentists (DT). The questionnaire encompassed inquiries regarding demographic characteristics, knowledge assessment, evaluation of attitudes, and examination of dietary behaviors. Data analysis procedures included descriptive statistics, Spearman's rank correlation, and multiple linear regression. RESULTS A total of 842 individuals participated in the study (UG: 264, PG: 247, DT: 331). Attitude emerged as the strongest association of healthy dietary behaviors across all groups (UG: ß=0.370, PG: ß=0.512, DT: ß=0.642; P < 0.001), while alcohol consumption showed a negative correlation with healthy dietary behaviors (UG: ß=-0.135, PG: ß=-0.220, DT: ß=-0.216; P < 0.001). CONCLUSION Significant variations in dietary behaviors across diverse educational levels of dental professionals were observed. Attitude emerged as the predominant factor influencing dietary behaviors, while knowledge was found to have a weak association. Tailored interventions addressing individual challenges at different career stages should be considered to enhance dietary behaviors and overall well-being in dental practice settings.
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Affiliation(s)
- Athikom Tantimahanon
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, 6 Yothi Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Kawin Sipiyaruk
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, 6 Yothi Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Chanita Tantipoj
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, 6 Yothi Road, Ratchathewi, Bangkok, 10400, Thailand.
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Goyal V, Damle S, Puranik MP, Nuvvula S, Kakanur M, Marwah N, Asokan S, Suprabha BS, Sreenivasan P, Wadgave U, Shyam S, Thakur D. Arginine: A New Paradigm in Preventive Oral Care. Int J Clin Pediatr Dent 2023; 16:698-706. [PMID: 38162235 PMCID: PMC10753110 DOI: 10.5005/jp-journals-10005-2693] [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: 01/03/2024] Open
Abstract
Dental caries is ubiquitous and one of the most prevalent oral diseases and the foremost cause of dental pain and poor quality of life (QoL). Fluoride is an effective caries preventive agent; however, despite its use, there remain some gaps in prevention of dental caries. Arginine, an amino acid, helps to maintain a noncariogenic plaque. It shows synergistic effects with fluoride in dental caries and can help nourish the tooth by enhancing the remineralization effect of fluoride. Supplementing fluoride dentifrices with arginine can bridge the gap in caries prevention. Several clinical studies with 1.5% arginine + fluoride provide evidence for its use in prevention of dental caries. This report throws light on the benefits of arginine in dental caries and guides on its use with fluoride. Recommendations given in the report will help in effective prevention of dental caries. How to cite this article Goyal V, Damle S, Puranik MP, et al. Arginine: A New Paradigm in Preventive Oral Care. Int J Clin Pediatr Dent 2023;16(5):698-706.
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Affiliation(s)
- Varinder Goyal
- Department of Pediatric and Preventive Dentistry, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
| | - Satyawan Damle
- Department of Paediatric Dentistry, M.M. College of Dental Sciences and Research, Maharishi Markandeshwar University, Ambala, Haryana, India
| | - Manjunath P Puranik
- Department of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India
| | - Sivakumar Nuvvula
- Department of Pediatric Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Madhu Kakanur
- Department of Pediatric and Preventive Dentistry, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Nikhil Marwah
- Department of Pediatric and Preventive Dentistry, Mahatma Gandhi Dental College & Hospital, Jaipur, Rajasthan, India
| | - Sharath Asokan
- Department of Pediatric and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
| | - Baranya S Suprabha
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Manipal, Mangaluru, India
| | - Prathima Sreenivasan
- Department of Oral Medicine and Radiology, Kannur Dental College, Kannur, Kerala, India
| | - Umesh Wadgave
- Department of Public Health Dentistry, Wadgave's Dental Home, Bidar, Karnataka, India
| | - S Shyam
- Department of Public Health Dentistry, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Dewakshi Thakur
- Department of Pediatric and Preventive Dentistry, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India
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Veiga N, Figueiredo R, Correia P, Lopes P, Couto P, Fernandes GVO. Methods of Primary Clinical Prevention of Dental Caries in the Adult Patient: An Integrative Review. Healthcare (Basel) 2023; 11:healthcare11111635. [PMID: 37297776 DOI: 10.3390/healthcare11111635] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
AIM Preventive approaches to oral health diseases, mainly dental caries, require individual and collective policies. Thus, this review was conducted to identify the primary prevention methods of dental caries in adults to improve oral health at the clinical and community levels. METHODS This review followed the PICO strategy with the research question: "What are the methods of primary prevention of dental caries, in adults, for improving and maintaining oral health integrating clinical and community-based strategies?" Electronic screening was carried out by two independent reviewers in five databases (MedLine/PubMed, SciELO, Web of Science, Cochrane Library, and LILACS) to find relevant publications between 2015-2022. We applied eligibility criteria for selection of the articles. The following MeSH terms were used: "Primary Prevention"; "Adult"; "Oral Health"; "Dental Caries"; "Fluorides, Topical"; "Fluoride Varnishes"; "Pit and Fissure Sealants"; "Preventive Dentistry". Although the term "Prevention strategy" is not a MeSH descriptor, several correlated terms appeared and were used in the search engines: "Preventative Care", "Disease Prevention, Primary", and "Prevention, Primary". The tool provided by the JBI organization (Joanna Briggs Institute) was used to assess the quality of the included studies. RESULTS Nine studies were included. Overall, it was found that the main primary prevention methods applied in dentistry in adults are the application of pit and fissure sealants, topical application of fluoride performed in the dental clinic, use of fluoridated toothpaste, mouthwash with chlorhexidine at home, use of xylitol, the recommendation for regular appointments with the dentist, and the need to inform patients about the saliva buffer capacity and adoption of a non-cariogenic diet. For that purpose, preventive policies should be taken to prevent dental caries. These include three major challenges: providing the adult population with more knowledge regarding their oral health, empowering patients through adopting healthy lifestyles, and developing new preventive strategies and awareness campaigns aimed at the adult population to promote proper oral health habits. CONCLUSIONS A small number of studies were found whose participants were adult patients. There was some consistency regarding primary prevention methods in our studies. However, good quality randomized control studies are still required to define the best intervention strategies for adult caries prevention.
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Affiliation(s)
- Nélio Veiga
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
| | - Ricardo Figueiredo
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
| | - Patrícia Correia
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
| | - Pedro Lopes
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
| | - Patrícia Couto
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
| | - Gustavo Vicentis Oliveira Fernandes
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
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Crystal YO, Campus G, Cunha-Cruz J. Editorial: Frontiers in oral health: Highlights in preventive dentistry 2021/2. FRONTIERS IN ORAL HEALTH 2023; 3:1105724. [PMID: 36704238 PMCID: PMC9872145 DOI: 10.3389/froh.2022.1105724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Yasmi O. Crystal
- Department of Pediatric Dentistry, New York University College of Dentistry, New York, NY, United States,Correspondence: Yasmi O. Crystal
| | - Guglielmo Campus
- Department of Pediatric and Preventive Dentistry, University of Bern, Bern, Switzerland
| | - Joana Cunha-Cruz
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States
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Gund MP, Bucher M, Hannig M, Rohrer TR, Rupf S. Oral hygiene knowledge versus behavior in children: A questionnaire‐based, interview‐style analysis and on‐site assessment of toothbrushing practices. Clin Exp Dent Res 2022; 8:1167-1174. [PMID: 35713561 PMCID: PMC9562490 DOI: 10.1002/cre2.607] [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: 11/09/2021] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Oral hygiene plays an important role in eliminating biofilms and preventing dental caries. However, the implementation of oral health knowledge that children learn from their parents and through school dental health programmes remains poorly studied. This study aimed to investigate oral hygiene knowledge and its practical utilization in children and young adolescents (CYAs) aged 2–15 years. Material and methods This was a questionnaire‐based, interview‐style community survey and on‐site practical assessment of CYAs' toothbrushing skills conducted during two 1‐day public science‐promoting events held at a major German university hospital in consecutive years. CYAs first answered questions on toothbrushing frequency, dental aids used, and dental care. They subsequently underwent diagnostic staining and demonstrated their brushing technique and method. CYAs' responses (percentages) to questionnaire items addressing oral hygiene knowledge and practice, and on‐site assessment of toothbrushing skills served as the main outcome measures. Results Of 244 participating CYAs, 178 (73%) CYAs had no caries experience, the percentage increasing with age from 5% in 2–5‐year‐olds to 40% in those aged > 10 years. Of 117/244 (48%) indicating that teeth should be brushed three times daily, 80/117 (68%) self‐reported twice‐daily brushing, 32/117 (27%) reported brushing three times, and 4/117 (3%) stated doing so only once. Although 131/244 (54%) considered that teeth should be brushed for 3 min, 77/131 (59%) self‐reported actually doing so and 41/131 (31%) reported brushing for 2min. Seventeen of 42 (40%) participants aged > 10 years showed no systematic brushing method, with 21/42 (50%) failing to clean their teeth completely. Participants aged 6–10 years exhibited the highest proportion (97/134, 72%) of complete cleaning. One hundred and forty‐six of 244 (60%) of CYAs knew about floss; 63/134 (43%) reported using it. Good adherence to oral health recommendations (i.e., brushing ≥ 2/day for ≥2min) was observed in 212/244 (87%) CYAs, the remaining 32/244 (13%) exhibiting poor adherence. Conclusion CYAs knew about the importance of oral hygiene and cleaned their teeth frequently. However, translation of their knowledge into practice showed deficiencies. Repeated encouragement to put oral health knowledge into practice is important.
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Affiliation(s)
- Madline P. Gund
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry Saarland University Homburg Germany
| | - Marina Bucher
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry Saarland University Homburg Germany
| | - Matthias Hannig
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry Saarland University Homburg Germany
| | - Tilman R. Rohrer
- University Children's Hospital, Saarland University Medical Centre Homburg Germany
| | - Stefan Rupf
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry Saarland University Homburg Germany
- Department of Synoptic Dentistry Saarland University Homburg Germany
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“(Meth) Will Hurt You and Hurt Your Teeth”: Teen, Parent, and Dental Practitioner Perspectives on Implementing Crystal Meth Use Prevention Messaging in the Dental Office Setting. Int J Dent 2022; 2022:6933091. [PMID: 35572358 PMCID: PMC9095351 DOI: 10.1155/2022/6933091] [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: 10/20/2021] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Crystal methamphetamine (“meth”) use among youth living in rural areas is higher than the national average. Given how drastically meth affects teeth (i.e., “meth mouth”), engaging dental professionals as one of multiple channels in rural areas to deliver meth prevention messaging is a novel approach. The objective of this research was to assess the feasibility and acceptability of incorporating meth use prevention messaging into dental visits with teenagers. Methods We conducted phenomenological, qualitative research with dental practitioners, teens, and parents/guardians in three communities in North Idaho, from 2015 to 2016. We recruited practitioners using a snowball sampling strategy and placed phone calls to dental practices and contacted teens and parents through schools, libraries, local sporting events, and word-of-mouth. Using NVivo 12-Plus, parent- and teen-specific codebooks and themes were developed from guides and transcripts. Transcripts of the dentists and hygienists were reviewed to ascertain the main ideas and themes. Results Overall, practitioner, teen, and parent participants viewed meth prevention messages delivered by dental professionals as acceptable and feasible. Compared to those in private practice, public health dental providers were invested in meth prevention and were eager to help. Barriers to overall acceptability and feasibility included hygienists' low self-efficacy to deliver a communication-based intervention, infrequency of dental visits impacting the ability to reach enough teens through this venue, and the fact that teens could feel “targeted” by providers. Teens also raised concerns about scary messages exacerbating preexisting dental visit anxiety. Facilitators included the following: dental practitioners already engaging in health education with their patients, parents, and teens seeing dental professionals as appropriate purveyors of antimeth messaging and support for increased meth prevention efforts given the impact of meth use in their communities. Conclusions Well-crafted, developmentally appropriate meth prevention messages would likely be well received by teens and supported by parents in dental offices. These data are being used to develop a novel, theory-based communication and behavioral strategy to integrate dental professionals into the delivery of messages aimed at preventing the initiation of meth use among rural Idaho teens.
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Veerasamy A, Lyons K, Crabtree I, Brunton P. Knowledge of nursing graduates on oral health care for older people in the long-term care. J Dent Educ 2022; 86:830-838. [PMID: 35129837 DOI: 10.1002/jdd.12895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/16/2021] [Accepted: 01/15/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Oral health self-care deteriorates in older adults due to a decreasing level of cognition increasing disability and/or a reduction in manual dexterity. Older adults in hospital care or residential care therefore increasingly need assistance for oral health care. There is an increase in dentate patients entering residential care due to advances in dentistry. It is suggested therefore that nurses in aged care increasingly need advanced knowledge to care for their older dentate patients to prevent and minimize progression of oral diseases, given the impact of poor oral health on general health. The current study was conducted to investigate the oral health care knowledge of nursing graduates across Aotearoa New Zealand. METHODS A cross-sectional study was conducted among third year nursing graduates in 18 nursing institutes in New Zealand. Oral health care knowledge and oral-systemic connection knowledge, and predictors of oral health care knowledge were investigated. RESULTS Total 148 students participated in the student's survey, making it 15% of 2020 graduates. The students' survey results suggested that nursing graduates have good basic oral health knowledge, however, their knowledge of the oral-systemic disease connection and the value of an examination of the oral cavity were poor. CONCLUSION The oral health care knowledge of nursing students and their ability to care for older adults relies on oral health care education in their nursing programs. A revision of curricula to improve oral health education in nursing programs is strongly recommended.
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Affiliation(s)
- Arthi Veerasamy
- Faculty of Dentistry, University of Otago, Dunedin, Otago, New Zealand
| | - Karl Lyons
- Faculty of Dentistry, University of Otago, Dunedin, Otago, New Zealand
| | - Ian Crabtree
- Nursing, Midwifery, OT and Sports Institute, Otago Polytechnic, Dunedin, Otago, New Zealand
| | - Paul Brunton
- Division of Health Sciences, University of Otago, Dunedin, Otago, New Zealand
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Vernazza CR, Pitts NB, Mayne C, Mazevet ME. Dental Policy Lab 1 - towards a cavity-free future. Br Dent J 2021; 231:754-758. [PMID: 34921272 PMCID: PMC8683374 DOI: 10.1038/s41415-021-3723-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/20/2021] [Indexed: 01/10/2023]
Abstract
Although many dental professionals argue that prevention of oral diseases, including dental caries, will benefit both the patient and public finances, a paradigm shift has yet to happen in most countries. The literature has demonstrated that caries prevention and control is possible, but authorities have yet to implement health systems that allow patients to stay in a good health state. 'Policy Labs' are an innovative policy-making initiative that allow a positive collaboration between the many stakeholders around a given policy issue. In July 2017, 24 international experts, including representatives of both international and European Chief Dental Officers associations, were gathered for the first Alliance for a Cavity-Free Future/King's College London Dental Policy Lab to identify the main barriers for a change, and concrete actions to facilitate a policy shift towards increased resource allocation in prevention. A comprehensive report and well-received infographic summarising the key recommendations (explored in this paper) were produced to explain the situation and highlight the value of a cavity-free world to policymakers, demonstrating where change is needed. The first Dental Policy Lab proved to be an efficient way to generate new ideas and concrete ways to implement them, and has led to several subsequent initiatives worldwide.
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Affiliation(s)
- Christopher R Vernazza
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Nigel B Pitts
- Faculty of Dentistry, Oral & Craniofacial Sciences, King´s College London, Tower Wing, Guy´s Hospital, London, SE1 9RT, UK
| | - Catherine Mayne
- Faculty of Dentistry, Oral & Craniofacial Sciences, King´s College London, Tower Wing, Guy´s Hospital, London, SE1 9RT, UK
| | - Marco E Mazevet
- Faculty of Dentistry, Oral & Craniofacial Sciences, King´s College London, Tower Wing, Guy´s Hospital, London, SE1 9RT, UK
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Dental Practitioners' Knowledge, Attitude, and Practice in Caries Risk Assessment and Management: A Cross-sectional Survey in Kampala Metropolitan, Uganda. J Contemp Dent Pract 2021; 22:1377-1385. [PMID: 35656674 PMCID: PMC9395258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The objective of this study was to determine the knowledge, attitude, and practices regarding caries risk assessment (CRA) and management among dental practitioners in Kampala Metropolitan, Uganda. MATERIALS AND METHODS This cross-sectional study was conducted among 270 dental practitioners in Kampala Metropolitan, Uganda, in May 2021. The participants were dental surgeons and public health dental officers. A self-administered structured questionnaire was used to collect data. The questionnaire included items about participants' sociodemographic characteristics, knowledge, attitude, and practices in CRA and management. Attitude and practices were rated using different Likert scales. Descriptive statistics, Chi-square/Fisher's exact and one-way analysis of variance (ANOVA) with post-hoc Bonferroni tests were used to analyze the data. The significance level was set at p <0.05. RESULTS About 60.7% of the participants were public health dental officers with a median age of 30 years (interquartile range [IQR], 27-60). Overall, the participants were familiar with the current concepts regarding CRA and management. More than 70% of the participants correctly identified risk factors and indicators of dental caries. Most participants (98.5%) had a positive attitude toward performing CRA. However, their practices regarding caries management were inadequate as majority (>75%) of participants reported that they never or occasionally recommended evidence-based products like topical fluoride, probiotics, or xylitol products in the prevention and management of dental caries. Dental surgeons had significantly better knowledge and practices than public health dental officers (p <0.05). CONCLUSION In the present study, the participants were familiar with the current concepts about CRA and had a positive attitude toward CRA. However, their practices regarding caries prevention and management were inadequate. CLINICAL SIGNIFICANCE The study provided baseline data about knowledge, attitude, and practices regarding CRA and caries management among dental practitioners in Uganda. It is recommended to design training courses in evidence-based protocols in the prevention and management of dental caries for dental practitioners in Uganda.
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Rajendra Santosh AB, Jones T. Tropical Oral Disease: Analysing Barriers, Burden, Nutrition, Economic Impact, and Inequalities. Front Nutr 2021; 8:729234. [PMID: 34881277 PMCID: PMC8647765 DOI: 10.3389/fnut.2021.729234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022] Open
Abstract
Traditionally, a healthy mouth is a good indicator of good general health. Poor oral hygiene reflects the health of the oral cavity and is a risk factor for overall health. Although oral diseases like dental decay and periodontitis are prevalent, awareness of oral diseases is still limited. Oral disorders include a wide range of diseases that may not be confined to the oral anatomical structures but may be manifestations of systemic diseases. Identification of the risk factors of dental and oral diseases, including socio-economic determinants, plays a major role in the type of oral health care, and in the promotion of dental health awareness. This article reviews oral diseases in the Caribbean and aims to raise awareness of this subject while suggesting a research agenda for the region.
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Abstract
Despite the recognized need to change the emphasis of health services by shifting the balance from treatment to prevention, limited progress has been made in many settings. This is true in oral health, where evidence for preventive interventions that work has not been systematically exploited in oral health services. While reorienting health services is complex and context specific, economics can bring a helpful perspective in understanding and predicting the impact of changes in resource allocation, provider remuneration systems, and patient payments. There is an increasing literature on the economics of different prevention approaches. However, much of this literature focuses on the costs and potential savings of alternative approaches and fails to take into account benefits. Even where benefits are taken into account, these tend to be narrowly focused on clinical outcomes using cost-effectiveness analysis, which may be of little relevance to the policy maker, patient, and the public. Some commonly used economic approaches (such as quality-adjusted life years and incremental cost-effectiveness ratios) may also not be appropriate to oral health. Using alternative techniques, including wider measures of benefit and employing priority setting and resource allocation tools, may provide more comprehensive information on economic impact to decision makers and stakeholders. In addition, it is important to consider the effects of provider remuneration in reorienting services. While there is some evidence about traditional models of remuneration (fee for service and capitation), less is known about pay for performance and blended systems. This article outlines areas in which economics can offer an insight into reorientation of health systems toward prevention, highlighting areas for further research and consideration.
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Affiliation(s)
- C.R. Vernazza
- School of Dental Sciences,
Newcastle University, Newcastle Upon Tyne, UK
| | - S. Birch
- Centre for the Business and
Economics of Health, University of Queensland, Saint Lucia, Queensland,
Australia
- Centre for Health Economics,
University of Manchester, Manchester, UK
| | - N.B. Pitts
- Faculty of Dentistry, Oral and
Craniofacial Sciences, Kings College London, London, UK
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Samohyl M, Babjakova J, Vondrova D, Jurkovicova J, Stofko J, Kollar B, Hirosova K, Filova A, Argalasova L. Factors Associated with Non-Attendance at Dental Preventive Care in Slovak High School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031295. [PMID: 33535551 PMCID: PMC7908624 DOI: 10.3390/ijerph18031295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to determine the factors associated with the avoidance of dental preventive care in high school students and their parents in the framework of The Youth and Parents Risk Factor Behavior Survey in Slovakia, the ongoing cross-sectional school-based survey of students and their parents or legal representatives. The data were collected using two separate standardized questionnaires: (i) the questionnaire for students (n = 515) and (ii) the questionnaire for parents (n = 681). The study group included 57 high school students (54.4% males) who did not visit the dentist for preventive care in the previous year. The control group included 458 students (35.8% males) who visited a dentist for preventive care at least once in the previous year. A significantly higher number of males (54.4%), older adolescents, and young adults (21.8%; 20.0%) were not visiting dental preventive care regularly. Incomplete family (56.1%), stressful situations at home (17.5%), and feeling unwell were the factors contributing to the avoidance of dental preventive care. More than 34.5% of adolescents and young adults were not visiting either dental preventive care or pediatric preventive care (adjusted odds ratio (AOR) = 5.14; 95% confidence interval (CI) = 2.40, 10.99). Children of divorced mothers and mothers with household income lower than EUR 900 had significantly higher dental care avoidance in bivariate analysis. A significantly higher percentage of fathers from the exposed group were not visiting dental preventive care regularly (47.8%, p < 0.05). The results of the study can be used as an educational intervention step focusing on the parental influence on adolescent and young adults' behavior and as a challenge for the improvement of dental preventive care in older adolescents and young adults.
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Affiliation(s)
- Martin Samohyl
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Jana Babjakova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Diana Vondrova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Jana Jurkovicova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Juraj Stofko
- Institute of Physiotherapy, Balneology and Medical Rehabilitation, The University of St. Cyril and Methodius in Trnava, Námestie Jozefa Herdu 577/2, 917 01 Trnava, Slovakia;
| | - Branislav Kollar
- Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Mickiewiczova 13, 813 69 Bratislava, Slovakia;
| | - Katarina Hirosova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Alexandra Filova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
| | - Lubica Argalasova
- Institute of Hygiene, Faculty of Medicine, Comenius University in Bratislava, Spitalska 24, 813 72 Bratislava, Slovakia; (M.S.); (J.B.); (D.V.); (J.J.); (K.H.); (A.F.)
- Correspondence: ; Tel.: +421-905-209-114
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13
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Schmalz G, Krause F, Grzelkowski M, Merle C, Rotzoll D, Haak R, Ziebolz D. Evaluation of an educational concept for risk-oriented prevention in undergraduate dental education. BMC MEDICAL EDUCATION 2020; 20:298. [PMID: 32917184 PMCID: PMC7488547 DOI: 10.1186/s12909-020-02218-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Aim of this observational study with a three-month follow-up was to evaluate an educational concept for risk-oriented prevention applied by fifth-year undergraduate dental students. METHODS Dental students from two clinical treatment courses of the last undergraduate year were included. The subjects were divided into two groups according to their assignment to the two clinical classes. Group A received a sequence of seminars, including the basics of a risk classification system (RCS) with the theoretical background and case studies in the context of preventive dentistry. Thereby, 1) a theoretical seminar (background, RCS, cases) and 2) the transfer of the RCS on a clinical patient case chosen by the student, and its presentation within a discussion round was applied. Group B served as a comparison group with students who did not receive any of teaching events in terms of RCS. The self-perceived knowledge and importance of RCS, as well as objective knowledge (qualitative questions), were assessed with a standardized questionnaire at baseline and after 3 months. RESULTS Out of 90 students at baseline, 79 (group A: 39, group B: 40) were re-evaluated after 3 months. At this follow-up, Group A estimated their confidence in handling the medication (p = 0.02), the RCS (p < 0.01), and in identifying the risk of oral diseases (p = 0.02) higher than group B. Furthermore, group A felt it was more important to identify patients at risk (p = 0.02), the risk of complications (p = 0.02) and to apply an RCS (p = 0.03). At follow-up, group A exhibited more correct answers of qualitative questions than group B regarding risk of complications (p < 0.01) and bacteremia (p < 0.01). Group A felt more confident with at-risk patients and more competent concerning RCS than group B (p < 0.01). CONCLUSION The concept for educating risk-oriented prevention increased the self-perceived skills and the knowledge of undergraduate dental students after 3 months within a clinical treatment course.
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Affiliation(s)
- Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Felix Krause
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - Martin Grzelkowski
- Department of General Medicine, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Cordula Merle
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Daisy Rotzoll
- University of Leipzig, Medical Faculty, LernKlinik Leipzig, Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
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14
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Brian Z, Weintraub JA. Oral Health and COVID-19: Increasing the Need for Prevention and Access. Prev Chronic Dis 2020; 17:E82. [PMID: 32790606 PMCID: PMC7458118 DOI: 10.5888/pcd17.200266] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Populations disproportionately affected by coronavirus disease 2019 (COVID-19) are also at higher risk for oral diseases and experience oral health and oral health care disparities at higher rates. COVID-19 has led to closure and reduced hours of dental practices except for emergency and urgent services, limiting routine care and prevention. Dental care includes aerosol-generating procedures that can increase viral transmission. The pandemic offers an opportunity for the dental profession to shift more toward nonaerosolizing, prevention-centric approaches to care and away from surgical interventions. Regulatory barrier changes to oral health care access during the pandemic could have a favorable impact if sustained into the future.
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Affiliation(s)
- Zachary Brian
- North Carolina Oral Health Collaborative, Foundation for Health Leadership and Innovation, 2401 Weston Parkway, Suite 203, Cary, NC 27513.
| | - Jane A Weintraub
- University of North Carolina at Chapel Hill Adams School of Dentistry and Gillings School of Global Public Health, Chapel Hill, North Carolina
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15
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Changing the Focus to the Whole Patient instead of One Oral Disease: The Concept of Individualized Prevention. Adv Prev Med 2020; 2020:6752342. [PMID: 32518697 PMCID: PMC7256733 DOI: 10.1155/2020/6752342] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/14/2020] [Accepted: 05/06/2020] [Indexed: 12/18/2022] Open
Abstract
Oral diseases are highly prevalent and a global burden. Accordingly, their prevention appears essential. Recently, different strategies have been developed, mainly focusing on the presence of singular oral diseases or conditions. This article aims to construct a contemporary concept of individualized preventive care in dentistry whereby the focus is switched from viewing oral health in isolation to viewing the patient as a whole. The basis for individualized prevention measures is the case-oriented profile, including the synthesis of risk- and need-oriented parameters. The risk profile comprises different risk factors within the fields of systemic diseases, medications, and lifestyle that inherently pose a potential risk of complications (e.g., infectious endocarditis) and/or oral diseases (e.g., periodontitis). The needs profile includes factors originating from the aspects of oral diseases, dental restorations/appliances, and dental results with a potential risk of pathogenesis (e.g., the de novo development of caries) and/or the potential progression of oral diseases (e.g., an existing caries lesion). Based on these parameters, the general framework and content of prevention measures, as well as the maintenance interval, should be adapted to the individual patient. The implications of this concept might increase the safety, effectiveness, and efficiency of prevention in dental care. A further area of focus is primary prevention, that is, a focus on the preservation of oral health instead of a disease-related approach. However, clinical validation is needed to prove the benefits of the model presented. Individualized prevention promotes a shift from a disease-focused model to a whole-patient-focused model and provides a potential approach for establishing a contemporary concept for preventive care in dentistry.
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16
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Taha F. Aggrieved of Jeddah. Br Dent J 2020; 228:138. [DOI: 10.1038/s41415-020-1269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Rosing K, Leggett H, Csikar J, Vinall-Collier K, Christensen LB, Whelton H, Douglas GVA. Barriers and facilitators for prevention in Danish dental care. Acta Odontol Scand 2019; 77:439-451. [PMID: 30905244 DOI: 10.1080/00016357.2019.1587503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To explore barriers and facilitators to oral disease prevention in Danish dental care from a multi-stakeholder perspective. Methods: Eleven semi-structured focus groups and interviews about Danish oral healthcare were conducted with 27 stakeholders (general public, dental teams, dental policy makers) in Copenhagen. Transcripts were analyzed using deductive thematic analysis independently by KR and HL, supervised by JC and KVC. Results: Seven broad themes were identified, including both barriers and facilitators: Knowledge and attitudes, Education and training, Regulation, Incentivization, Multidisciplinary approach, Access to care and the Dental professional-patient relationship. Whilst all themes were relevant to each group of stakeholders, the salient driver within each theme was different for each group. Conclusions: Stakeholder perspectives on the Danish Oral health care system suggest the following are important features for a preventively focused system: (a) Involving all stakeholders in oral healthcare planning. (b) Securing sufficient and ongoing briefing regarding disease prevention for all stakeholders. (c) Regulatory support and creation of incentives to promote and facilitate implementation of disease prevention. (d) Appropriate prevention for disadvantaged groups within society which may be possible to a higher degree by means of multidisciplinary collaboration. (e) Personal relations between the patient and the professional based on mutual trust.
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Affiliation(s)
- K. Rosing
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - H. Leggett
- School of Dentistry, University of Leeds, Leeds, UK
| | - J. Csikar
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - L. B. Christensen
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - H. Whelton
- Oral Health Services Research Centre, College of Medicine & Health, University College Cork, Cork, Ireland
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18
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Yon MJY, Gao SS, Chen KJ, Duangthip D, Lo ECM, Chu CH. Medical Model in Caries Management. Dent J (Basel) 2019; 7:dj7020037. [PMID: 30939816 PMCID: PMC6631812 DOI: 10.3390/dj7020037] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 12/01/2022] Open
Abstract
The current mode of dental caries management mainly operates through irreversible and symptomatic treatment by means of drilling and filling, while caries prevention is largely overlooked or omitted. Focus should be redirected through a medical model towards elimination of the disease through tackling its causes and risk factors to address current and future caries initiation. Caries is the demineralisation of dental hard tissues by bacterial acids when periodically exposed to fermentable carbohydrates. The medical model of caries management is a philosophy that steers sustainable caries management through controlling bacterial infection, a reduction of risk levels, remineralisation of teeth and long-term follow-up. Its goal is to prevent new and recurrent caries, arrest ongoing caries processes by alteration of the cariogenic environment, and support the healing of remineralisable enamel and dentine. The mechanism involves dietary counselling and plaque control, placement of dental sealants, administration of fluoride agents and chemotherapeutic medications and use of chewing gum. This paradigm shift from a surgical to a medical model aims to pursue the ultimate intention of maintaining a caries-free dentition and is anticipated to promote true oral health-related quality of life. The objective of this paper is to discuss the medical model of caries management.
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Affiliation(s)
| | | | - Kitty Jieyi Chen
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | | | | | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
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19
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Chiang HM, Tranaeus S, Sunnegårdh-Grönberg K. Caries as experienced by adult caries active patients: a qualitative study. Acta Odontol Scand 2019; 77:15-21. [PMID: 30084696 DOI: 10.1080/00016357.2018.1493218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: In the western world, increased oral health has resulted in a skewed occurrence of caries disease where relatively few individuals now account for most caries disease. This study examines how adults with recurrent caries activity experience caries disease and treatment.Materials and methods: The study is based on qualitative data from individual interviews, which were subjected to qualitative content analysis. The interviews were semi-structured and thematic and an interview guide was used that consisted of two main areas with open ended questions. Meaning units were condensed and labelled with a code which preserved the core content of the reduced text. Codes were assigned to different subcategories according to their similarities or differences. Subcategories formed categories which describe the manifest content of the text.Results: The domain "experience with caries" consisted of four subcategories that formed the main category Caries - an unwelcomed acquaintance. The domain "experience with caries treatment" consisted of three subcategories that formed the category Caries treatment - pain for gain.Conclusion: Comprehensive non-operative treatment and close follow-ups should precede restorations; this would probably gain insight in how to avoid new cavities to a greater extent. If to be supportive, information and advice about self-care given to individuals with recurrent cavities should be delivered with respect to the patient's feelings about their experience of dental caries.
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Affiliation(s)
- Huei-Min Chiang
- Public Dental Service, Folktandvården Vännäs, Vännäs, Sweden
| | - Sofia Tranaeus
- Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
- Division of Cariology and Endodontology Department of Dental Medicine, Karolinska institutet, Huddinge, Sweden
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20
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Tickle M, O'Neill C, Donaldson M, Birch S, Noble S, Killough S, Murphy L, Greer M, Brodison J, Verghis R, Worthington HV. A randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: the Northern Ireland Caries Prevention In Practice (NIC-PIP) trial. Health Technol Assess 2018; 20:1-96. [PMID: 27685609 DOI: 10.3310/hta20710] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Dental caries is the most common disease of childhood. The NHS guidelines promote preventative care in dental practices, particularly for young children. However, the cost-effectiveness of this policy has not been established. OBJECTIVE To measure the effects and costs of a composite fluoride intervention designed to prevent caries in young children attending dental services. DESIGN The study was a two-arm, parallel-group, randomised controlled trial, with an allocation ratio of 1 : 1. Randomisation was by clinical trials unit, using randomised permuted blocks. Children/families were not blinded; however, outcome assessment was blinded to group assessment. SETTING The study took place in 22 NHS dental practices in Northern Ireland, UK. PARTICIPANTS The study participants were children aged 2-3 years, who were caries free at baseline. INTERVENTIONS The intervention was composite in nature, comprising a varnish containing 22,600 parts per million (p.p.m.) fluoride, a toothbrush and a 50-ml tube of toothpaste containing 1450 p.p.m. fluoride; plus standardised, evidence-based prevention advice provided at 6-monthly intervals over 3 years. The control group received the prevention advice alone. MAIN OUTCOME MEASURES The primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were the number of decayed, missing or filled tooth surfaces in primary dentition (dmfs) in caries-active children, the number of episodes of pain, the number of extracted teeth and the costs of care. Adverse reactions (ARs) were recorded. RESULTS A total of 1248 children (624 randomised to each group) were recruited and 1096 (549 in the intervention group and 547 in the control group) were included in the final analyses. A total of 87% of the intervention children and 85% of control children attended every 6-month visit (p = 0.77). In total, 187 (34%) children in the intervention group converted to caries active, compared with 213 (39%) in the control group [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.64 to 1.04; p = 0.11]. The mean number of tooth surfaces affected by caries was 7.2 in the intervention group, compared with 9.6 in the control group (p = 0.007). There was no significant difference in the number of episodes of pain between groups (p = 0.81). However, 164 out of the total of 400 (41%) children who converted to caries active reported toothache, compared with 62 out of 696 (9%) caries-free children (OR 7.1 95% CI 5.1 to 9.9; p < 0.001). There was no statistically significant difference in the number of teeth extracted in caries-active children (p = 0.95). Ten children in the intervention group had ARs of a minor nature. The average direct dental care cost was £155.74 for the intervention group and £48.21 for the control group over 3 years (p < 0.05). The mean cost per carious surface avoided over the 3 years was estimated at £251.00. LIMITATIONS The usual limitations of a trial such as generalisability and understanding the underlying reasons for the outcomes apply. There is no mean willingness-to-pay threshold available to enable assessment of value for money. CONCLUSIONS A statistically significant effect could not be demonstrated for the primary outcome. Once caries develop, pain is likely. There was a statistically significant difference in dmfs in caries-active children in favour of the intervention. Although adequately powered, the effect size of the intervention was small and of questionable clinical and economic benefit. FUTURE WORK Future work should assess the caries prevention effects of interventions to reduce sugar consumption at the population and individual levels. Interventions designed to arrest the disease once it is established need to be developed and tested in practice. TRIAL REGISTRATION Current Controlled Trials ISRCTN36180119 and EudraCT 2009-010725-39. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 71. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin Tickle
- School of Dentistry, University of Manchester, Manchester, UK
| | - Ciaran O'Neill
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | | | - Stephen Birch
- Centre for Health Economics, University of Manchester, Manchester, UK
| | | | - Seamus Killough
- General Dental Practitioner, Ballycastle, UK.,British Dental Association Northern Ireland, Belfast, UK
| | - Lynn Murphy
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - Margaret Greer
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | | | - Rejina Verghis
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
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21
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Tickle M, O'Neill C, Donaldson M, Birch S, Noble S, Killough S, Murphy L, Greer M, Brodison J, Verghis R, Worthington HV. A Randomized Controlled Trial of Caries Prevention in Dental Practice. J Dent Res 2017; 96:741-746. [PMID: 28375708 DOI: 10.1177/0022034517702330] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a parallel group randomized controlled trial of children initially aged 2 to 3 y who were caries free, to prevent the children becoming caries active over the subsequent 36 mo. The setting was 22 dental practices in Northern Ireland, and children were randomly assigned by a clinical trials unit (CTU) (using computer-generated random numbers, with allocation concealed from the dental practice until each child was recruited) to the intervention (22,600-ppm fluoride varnish, toothbrush, 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized, evidence-based prevention advice) or advice-only control at 6-monthly intervals. The primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were number of decayed, missing, or filled teeth (dmfs) in caries-active children, number of episodes of pain, and number of extracted teeth. Adverse reactions were recorded. Calibrated external examiners, blinded to the child's study group, assessed the status of the children at baseline and after 3 y. In total, 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 intervention, 547 control) were included in the final analyses. Eighty-seven percent of intervention and 86% of control children attended every 6-mo visit ( P = 0.77). A total of 187 (34%) in the intervention group converted to caries active compared to 213 (39%) in the control group (odds ratio, 0.81; 95% confidence interval, 0.64-1.04; P = 0.11). Mean dmfs of those with caries in the intervention group was 7.2 compared to 9.6 in the control group ( P = 0.007). There was no significant difference in the number of episodes of pain between groups ( P = 0.81) or in the number of teeth extracted in caries-active children ( P = 0.95). Ten children in the intervention group had adverse reactions of a minor nature. This well-conducted trial failed to demonstrate that the intervention kept children caries free, but there was evidence that once children get caries, it slowed down its progression (EudraCT No: 2009-010725-39; ISRCTN: ISRCTN36180119).
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Affiliation(s)
- M Tickle
- 1 Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - C O'Neill
- 2 Centre for Public Health, Queens' University Belfast, Belfast, Northern Ireland
| | - M Donaldson
- 3 Health & Social Care Board of Northern Ireland, Belfast, Northern Ireland
| | - S Birch
- 4 School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,5 Centre for Health Economics and Policy Analysis, McMaster University, Canada
| | - S Noble
- 6 Northern Health & Social Care Trust, Northern Ireland, Antrim, Northern Ireland
| | - S Killough
- 7 British Dental Association, Belfast, Northern Ireland
| | - L Murphy
- 8 Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - M Greer
- 9 hVIVO, Queen Mary BioEnterprises Innovation Centre, London, UK
| | - J Brodison
- 10 DJ Maguire and Associates, Portadown, Northern Ireland
| | - R Verghis
- 8 Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - H V Worthington
- 1 Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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