Behaviour change intervention (education and text) to prevent dental caries in secondary school pupils: BRIGHT RCT, process and economic evaluation.

Background: The presence of dental caries impacts on children's daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae. Objectives: To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils. Design: A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations. Setting: Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school. Participants: Pupils aged 11-13 years at recruitment, who have their own mobile telephone. Interventions: Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils' mobile phones about toothbrushing, compared with routine education. Main outcome measures: Primary outcome: presence of at least one treated or untreated carious lesion using DICDAS4-6MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of DICDAS4-6MFT; presence and number of DICDAS1-6MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children). Results: Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05). The intervention had higher incremental mean costs (£1.02, 95% confidence interval -1.29 to 3.23) and lower incremental mean quality-adjusted life-years (-0.003, 95% confidence interval -0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging. The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution. Conclusions: Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility. Trial registration: This trial is registered as ISRCTN12139369. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/166/08) and is published in full in Health Technology Assessment; Vol. 28, No. 52. See the NIHR Funding and Awards website for further award information.

Tooth decay has an impact on children and young people's daily lives, particularly those living in deprived areas. For young children, programmes to improve toothbrushing with fluoride toothpaste help prevent tooth decay. The Brushing RemInder 4 Good oral HealTh trial (BRIGHT) investigated whether a secondary-school-based toothbrushing programme would work. We developed a new programme which included a lesson and twice-daily text messages sent to pupils' phones. In total, 4680 pupils, aged 11­13 years, from 42 secondary schools in the United Kingdom took part in the trial. At each school, one year group was randomly selected to receive the programme, while the other year group did not receive it. All pupils were followed up for 2.5 years to see whether there were any differences in levels of tooth decay, frequency of toothbrushing, plaque or quality of life. We also considered the programme's value for money and the views of pupils and school staff. We followed up 2383 pupils and found no difference in tooth decay, plaque or quality of life. We found those who had the programme were more likely to brush their teeth twice daily after 6 months than those who did not. The programme was not good value for money overall. However, the programme appeared to be of more benefit at preventing tooth decay in pupils eligible for free school meals compared to those not eligible. In the schools with more pupils eligible for free school meals, the chance of the programme representing good value for money increased. The programme was generally liked by the pupils and school staff. Some pupils found the text messages useful, although others said they were annoying. The programme helped pupils brush their teeth more frequently in the short term, but this did not lead to less tooth decay. Further research is needed to understand how to prevent tooth decay in secondary-school pupils.

A retrospective analysis of NHS patient dental charges in England, Scotland and Wales.

Objectives This analysis aimed to: i) review how patient dental charges (PDCs) changed over time in England, Scotland and Wales; ii) determine how these changes relate to a) inflation and b) minimum wages; and iii) how the charges have varied in the devolved administrations.Methods Data were obtained from NHS and Office for National Statistics (ONS) records and historical valuations of the national living wage (NLW). General inflation was calculated using the ONS Consumer Price Index.Results PDCs differed significantly between countries in relation to cost; which aspects of dental care require a charge; and value of payments (p <0.001). PDCs in England for simple, intermediate and more complex care rose from £15.90, £43.60 and £194.00 in 2007, to £25.80, £70.70 and £306.80 in 2023. Adjusted for inflation, the 2007 prices equate to £25.53, £70.02 and £311.55, demonstrating that the relative costs have remained constant in England. In Wales, 2007 prices (inflation-adjusted):2023 prices for the three complexities of treatment were £19.27:£14.80, £62.23:£47.33 and £284.25:£204.43. In Scotland, PDCs for the four treatment items fell marginally when adjusted for inflation. The ratio of PDC:NLW fell by an average of 13.8% in England and 30.7% in Wales.Conclusions There has been significant variation in the approach to PDCs across Great Britain both in terms of nominal costs and the degree to which these have kept pace with inflation.

Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults.

BACKGROUND: Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for these conditions should be removal of the source of inflammation or infection by local operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacteria. This review is the second update of the original version first published in 2014. OBJECTIVES: To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling, or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis and acute apical abscess in adults. SEARCH METHODS: We searched Cochrane Oral Health's Trials Register (26 February 2018 (discontinued)), CENTRAL (2022, Issue 10), MEDLINE Ovid (23 November 2022), Embase Ovid (23 November 2022), CINAHL EBSCO (25 November 2022) and two trials registries, and performed a grey literature search. There were no restrictions on language or date of publication. SELECTION CRITERIA: Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage, or endodontic treatment) and with or without analgesics. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias. We used a fixed-effect model in the meta-analysis as there were fewer than four studies. We contacted study authors to request missing information. We used GRADE criteria to assess the certainty of the evidence. MAIN RESULTS: There was one new completed trial on this topic since the last update in 2018. In total, we included three trials with 134 participants. Systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscess One trial (72 participants) compared the effects of a single preoperative dose of clindamycin versus a matched placebo when provided with a surgical intervention (endodontic chemo-mechanical debridement and filling) and analgesics to adults with symptomatic apical periodontitis. We assessed this study at low risk of bias. There were no differences in participant-reported pain or swelling across trial arms at any time point assessed. The median values for pain (numerical rating scale 0 to 10) were 3.0 in both groups at 24 hours (P = 0.219); 1.0 in the antibiotic group versus 2.0 in the control group at 48 hours (P = 0.242); and 0 in both groups at 72 hours and seven days (P = 0.116 and 0.673, respectively). The risk ratio of swelling when comparing preoperative antibiotic to placebo was 0.50 (95% confidence interval (CI) 0.10 to 2.56; P = 0.41). The certainty of evidence for all outcomes in this comparison was low. Two trials (62 participants) compared the effects of a seven-day course of oral phenoxymethylpenicillin (penicillin VK) versus a matched placebo when provided with a surgical intervention (total or partial endodontic chemo-mechanical debridement) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth. Participants in both trials also received oral analgesics. We assessed one study at high risk of bias and the other at unclear risk of bias. There were no differences in participant-reported pain or swelling at any time point assessed. The mean difference for pain (short ordinal numerical scale 0 to 3, where 0 was no pain) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours; and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The standardised mean difference for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours; and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The certainty of evidence for all the outcomes in this comparison was very low. Adverse effects, as reported in two studies, were diarrhoea (one participant in the placebo group), fatigue and reduced energy postoperatively (one participant in the antibiotic group) and dizziness preoperatively (one participant in the antibiotic group). Systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscess We found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults. AUTHORS' CONCLUSIONS: The evidence suggests that preoperative clindamycin for adults with symptomatic apical periodontitis results in little to no difference in participant-reported pain or swelling at any of the time points included in this review when provided with chemo-mechanical endodontic debridement and filling under local anaesthesia. The evidence is very uncertain about the effect of postoperative phenoxymethylpenicillin for adults with localised apical abscess or a symptomatic necrotic tooth when provided with chemo-mechanical debridement and oral analgesics. We found no studies which compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults.

It's not just about the money: recruitment and retention of clinical staff in general dental practice - part 1: dentists.

Increasing difficulties in recruitment and retention of dentists and dental care professionals in general dental practice in the UK is affecting delivery of NHS dental services. Reports of dissatisfaction among the general dental practice workforce indicate there is a significant risk to the future dental workforce supply which will affect access to dental care and worsen oral health inequalities. Understanding the factors related to job satisfaction and dissatisfaction of dental professionals would be useful in managing recruitment and retention issues and ensure a dental workforce exists which is able to meet the needs of the population. The aim of this literature review was to identify factors which contribute to job satisfaction and dissatisfaction of clinical staff in general dental practice. Database searching was conducted systematically through PubMed/Medline, Scopus, Ovid, and the National Grey Literature Collection. Part 1 of this two-part series discusses the factors relating to dentists. Twenty-two relevant articles were identified, which were qualitatively analysed using Herzberg's motivation-hygiene theory as an analysis tool. Target-driven and restrictive contractual arrangements are a major factor contributing to dissatisfaction of dentists, as well as time pressures, poor quality equipment, and unfair remuneration. Dental contract reform should aim to minimise factors contributing to dissatisfaction and increase factors which increase satisfaction, if sufficient numbers of dentists are to be persuaded to continue to provide state-funded dentistry.

It's not just about the money: recruitment and retention of clinical staff in general dental practice - part 2: dental care professionals.

As described in the first paper of this two-part series, increasing difficulties in recruitment and retention of dentists and dental care professionals (DCPs) in general dental practice in the UK is affecting delivery of NHS dental services. There is a significant risk to the future dental workforce supply which will affect access to dental care and worsen oral health inequalities. Understanding what factors contribute to job satisfaction and prevent job dissatisfaction of dental professionals would be useful in managing recruitment and retention issues. The aim of this literature review was to identify factors which contribute to job satisfaction of DCPs in general dental practice. Database searching was conducted systematically through PubMed/Medline, Scopus, Ovid, and the National Grey Literature Collection. Eleven relevant articles were identified, which were qualitatively analysed using Herzberg's motivation-hygiene theory as an analysis tool. Unfair remuneration is a major contributor to dissatisfaction of DCPs, but job satisfaction could be promoted through increased recognition, variety of work, and opportunities to progress. Dental contract reform in the UK should aim to minimise factors contributing to dissatisfaction and increase factors which increase satisfaction, including the development of an acceptable remuneration model for NHS dentistry that facilitates skill mix.

Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial.

OBJECTIVES: This multicentre, assessor-blinded, two-arm cluster randomized trial evaluated the clinical and cost-effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in UK secondary schools. METHODS: Pupils aged 11-13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomized (at year-group level) to receive a lesson and twice-daily text messages or to usual care. Year-groups (n = 84) from 42 schools including 4680 pupils (intervention, n = 2262; control, n = 2418) were randomized. RESULTS: In 2383 participants with valid data at baseline and 2.5 years, the primary outcome of presence of at least one treated or untreated carious lesion (D4-6 MFT [Decayed, Missing and Filled Teeth] in permanent teeth using International Caries Detection and Assessment System) was 44.6% in the intervention group and 43.0% in control (odds ratio [OR] 1.04, 95% CI 0.85-1.26, p = .72). There were no statistically significant differences in secondary outcomes of presence of at least one treated or untreated carious lesion (D1-6 MFT), number of D4-6 MFT and D1-6 MFT, plaque and bleeding scores or health-related- (Child Health Utility 9D) or oral health-related- quality of life (CARIES-QC). However, twice-daily toothbrushing, reported by 77.6% of pupils at baseline, increased at 6 months (intervention, 86.9%; control, 83.0%; OR 1.30, 95% CI 1.03-1.63, p = .03), but returned to no difference at 2.5 years (intervention, 81.0%; control, 79.9%; OR 1.05, 95% CI 0.84-1.30, p = .69). Estimated incremental costs and quality-adjusted life-years (QALYs) of the intervention, relative to control, were £1.02 (95% CI -1.29 to 3.23) and -0.003 (95% CI -0.009 to 0.002), respectively, with a 7% chance of being cost-effective (£20 000/QALY gained threshold). CONCLUSION: There was no evidence of statistically significant difference for caries prevalence at 2.5-years. The intervention's positive 6-month toothbrushing behaviour change did not translate into caries reduction. (ISRCTN 12139369). COVID-19 pandemic adversly affected follow-up.

The oral health of secondary school pupils: baseline data from the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial.

Background This paper describes the sociodemographics and oral health of UK secondary school pupils. They were participants of the BRIGHT trial, which was designed to evaluate the effectiveness of a toothbrushing intervention to reduce dental caries.Methods Overall, 4,680 pupils aged 11-13 years attending 42 secondary schools in England, Scotland and Wales with above average proportion of pupils eligible for free school meals, were recruited to the trial. Sociodemographic data were collected. Participants had a clinical assessment for caries, plaque and bleeding and completed measures of oral and general health-related quality of life and oral health behaviours (frequency of toothbrushing, dental attendance and cariogenic food/drinks consumed). Regression analyses were performed.Results Over one-third (34.7%) of participants had caries experience, with 44.5% reporting their oral health had an impact on their daily lives. Factors associated with a statistically significant increased likelihood of caries experience were older age, being female, eligibility for free school meals, worse oral health-related quality of life, higher cariogenic diet, less than twice-daily toothbrushing, living in a more deprived area and lower school attendance.Conclusions The prevalence and impact of dental caries on the lives of pupils remains high, with further oral health promotion activities needed in targeted secondary schools.

The implications of a cost-of-living crisis for oral health and dental care.

A cost-of-living crisis is currently affecting the UK. While this has been explored in terms of the effect on dental practice, the dental implications for patients and for population oral health have not received sufficient attention. This opinion piece discusses how: i) financial pressures leading to hygiene poverty may limit the ability to afford the basic products necessary to maintain oral hygiene; ii) food insecurity is associated with a diet high in sugar and lacking in appropriate nutrition; and iii) reduced disposable income may limit the ability to attend and successfully engage with dental care. The impact of the cost-of-living crisis on the lowest paid members of the dental team is also considered.The most common dental diseases are closely correlated with social and economic deprivation and the points discussed here act as a reminder of how the present financial circumstances have significant potential to widen oral health inequalities.

'It's their mouth at the end of the day': dental professionals' reactions to oral health education outcomes.

Introduction Research has established varying levels of efficacy of oral health education (OHE) efforts. However, little is known regarding how outcomes impact dental professionals and their OHE practice. This study explores dental professionals' reactions to varying OHE outcomes and their motivations to persist with their efforts.Methods Qualitative, semi-structured interviews were conducted with dental team members working in mainly NHS general dental practices in South Wales, UK. Interviews were conducted face-to-face pre-COVID-19 and then by telephone, transcribed and analysed thematically.Results In total, 30 interviews were conducted (17 dentists, 6 dental therapists and 7 dental nurses). Pleasure was gained from improved patient oral health. Responses to non-adherence included disappointment, frustration and acceptance. Acceptance centred around a shared responsibility for oral care between clinician and patient and reassurance that they had 'done their job'. The unpredictability of patient adherence aided OHE motivation; efforts might eventually inspire patient action or might align with patient readiness to change.Conclusions This study reveals how OHE outcomes impact on dental professionals' perceptions of their role and personal motivations for continued educational efforts with patients. Greater emphasis on both preventative dentistry and self-care, coupled with understanding of the complex factors influencing oral health behaviour, would aid motivation for OHE.

uSing rolE-substitutioN In care homes to improve ORal health (SENIOR): a study protocol.

BACKGROUND: Dental service provision in the care home sector is poor, with little emphasis on prevention. Emerging evidence suggests that the use of Dental Care Professionals (dental therapists and dental nurses) as an alternative to dentists has the potential to improve preventive advice, the provision of care and access to services within care homes. However, robust empirical evidence from definitive trials on how to successfully implement and sustain these interventions within care homes is currently lacking. The aim of the study is to determine whether Dental Care Professionals could reduce plaque levels of dentate older adults (65 + years) residing in care homes. METHODS: This protocol describes a two-arm cluster-randomised controlled trial that will be undertaken in care homes across Wales, Northern Ireland and England. In the intervention arm, the dental therapists will visit the care homes every 6 months to assess and then treat eligible residents, where necessary. All treatment will be conducted within their Scope of Practice. Dental nurses will visit the care homes every month for the first 3 months and then three-monthly afterwards to promulgate advice to improve the day-to-day prevention offered to residents by carers. The control arm will be 'treatment as usual'. Eligible care homes (n = 40) will be randomised based on a 1:1 ratio (20 intervention and 20 control), with an average of seven residents recruited in each home resulting in an estimated sample of 280. Assessments will be undertaken at baseline, 6 months and 12 months and will include a dental examination and quality of life questionnaires. Care home staff will collect weekly information on the residents' oral health (e.g. episodes of pain and unscheduled care). The primary outcome will be a binary classification of the mean reduction in Silness-Löe Plaque Index at 6 months. A parallel process evaluation will be undertaken to explore the intervention's acceptability and how it could be embedded in standard practice (described in a separate paper), whilst a cost-effectiveness analysis will examine the potential long-term costs and benefits of the intervention. DISCUSSION: This trial will provide evidence on how to successfully implement and sustain a Dental Care Professional-led intervention within care homes to promote access and prevention. TRIAL REGISTRATION: ISRCTN16332897 . Registered on 3 December 2021.

A qualitative exploration of decisions about dental recall intervals - part 2: perspectives of dentists and patients on the role of shared decision making in dental recall decisions.

Introduction Patients are sensitive to both the frequency and costs of dental recall visits. Shared decision making (SDM) is a principle of patient-centred care, advocated by the National Institute for Health and Care Excellence and policymakers, whereby joint decisions are made between clinicians and patients.Aims To explore NHS dentists' and patients' attitudes towards SDM in decisions about recall interval.Methods Semi-structured telephone interviews were conducted with 25 NHS patients and 25 NHS general dental practitioners in Wales, UK. Transcripts were thematically analysed.Results While many patients would be happy to accept changes to their recall interval, most wanted to be seen at least annually. Most patients were willing to be guided by their dentist in decisions about recall interval, as long as consideration was given to issues such as time, travel and cost. This contrasted with the desire to actively participate in decisions about operative treatment. Although the dentists' understanding of SDM varied, practitioners considered it important to involve patients in decisions about their care. However, dentists perceived that time, patient anxiety and concerns about potential adverse outcomes were barriers to the use of SDM.Conclusions Since there is uncertainty about the most clinically effective and cost-effective dental recall strategy, patient preference may play a role in these decisions.

A qualitative exploration of decisions about dental recall intervals - Part 1: attitudes of NHS general dental practitioners to NICE guideline CG19 on the interval between oral health reviews.

Introduction The National Institute for Health and Care Excellence (NICE) Guideline CG19 recommends that the intervals between oral health reviews should be tailored to patients' disease risk. However, evidence suggests that most patients still attend at six-monthly intervals.Aim To explore facilitators and barriers to the implementation of CG19 in general dental practice.Methods Semi-structured telephone interviews were conducted with 25 NHS general dental practitioners (GDPs) in Wales, UK. Transcripts were thematically analysed.Results Dentists described integrating information on clinical risk, patients' social and dental history, and professional judgement when making decisions about recall interval. Although most GDPs reported routinely using risk-based recall intervals, a number of barriers exist to recall intervals at the extremes of the NICE recommendations. Many practitioners were unwilling to extend recall intervals to 24 months, even for the lowest-risk patients. Conversely, dentists described how it could be challenging to secure the agreement of high-risk patients to three-month recalls. In addition, time and workload pressures, the need to meet contractual obligations, pressure from contracting organisations and the fear of litigation also influenced the implementation of risk-based recalls.Conclusions Although awareness of the NICE Guideline CG19 was high, there is a need to explore how risk-based recalls may be best supported through contractual mechanisms.

Acceptability of the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial intervention: a qualitative study of perspectives of young people and school staff.

BACKGROUND: The Brushing RemInder 4 Good oral HealTh (BRIGHT) trial is investigating the clinical and cost-effectiveness of a multi-component behaviour change intervention to reduce the prevalence of dental caries in young people from deprived areas aged 11-13 years. Mobile health has gained popularity in delivering behaviour change interventions for improving oral health. The intervention, based on behaviour change theory, consists of two components; a single classroom-based session embedded in the school curriculum and a series of follow-up text messages (SMS) delivered twice daily to participants. This element of the process evaluation aimed to explore the acceptability of the BRIGHT intervention for pupils and school staff. METHODS: Qualitative study, based on the concept of acceptability. Focus groups were conducted with 50 pupils, from six secondary schools across the UK, who had received the intervention. Semi-structured interviews were conducted with 12 members of staff. Purposive maximum variation sampling was used. Interviews were transcribed verbatim and analysed using a framework approach. RESULTS: In line with the theoretical framework of acceptability, affective attitude, perceived effectiveness, ethicality, burden and self-efficacy were identified as factors that affect the acceptability of the BRIGHT intervention. Pupil participants appreciated learning about the consequences of inadequate brushing particularly the photographs of carious teeth during the classroom-based session. More detailed information on brushing techniques and follow-up lessons on oral health were recommended by pupils. In terms of the SMS, the data suggest that pupil participants found them to be helpful reminders for brushing their teeth. To further improve acceptability, more choice over the timing of the messages and greater interactivity to reduce tedium were suggested. Staff participants recognised the value of the lesson and reported that in general the content was suitable for their pupils. Having the lesson material prepared for them, having the necessary support and whether it was included in the curriculum, were factors that improved acceptability. CONCLUSION: Overall, pupils and staff found the BRIGHT intervention acceptable and made some suggestions which could be adopted in any subsequent implementation of the intervention.

Formulation and fluoride content of dentifrices: a review of current patterns.

Introduction Consumer oral hygiene products play a key role in improving and maintaining population oral health. The oral personal care market is rapidly diversifying; a growing number of dentifrices marketed a 'natural' and fluoride-free are entering mainstream retailers, which may have implications for the oral health of the population 'with regards to caries risk.Aims To investigate the range of fluoride concentrations, flavour formulations and delivery mechanisms of dentifrices available on the UK market.Methods A cross-sectional survey was used to catalogue dentifrices sold in a range of supermarkets, high-street pharmacy and health chains, and specialist online retailers. In addition, a standard search engine was used to examine dentifrice brands being sold in the UK. The fluoride content was recorded as parts per million (ppm) and the product name data were analysed for key terms using Microsoft Excel. Excluded from the survey were mouthwashes, rinses and non-dentifrice whitening products.Results Five hundred different toothpaste, tooth powder and tablet products from 95 different brands were recorded. Sixty percent of these contained a fluoride concentration of 1,000 ppm or above. Forty-five percent of all products had the recommended adult concentration of at least 1,350 ppm. Almost one-third (31%) contained no fluoride and 4% of products did not specify the absence, presence or concentration of fluoride.Conclusions This study has quantified and confirmed the increasingly diverse range of dentifrices for sale in the UK. A large number of fluoride-free products exist within a growing 'natural' and 'organic market'. The study also gives oral health professionals an insight into the diverse types of products available to consumers in order to appropriately advise patients on caries prevention.

Factors associated with dental fluorosis among Malaysian children exposed to different fluoride concentrations in the public water supply.

OBJECTIVES: To determine the prevalence of dental fluorosis, and factors associated with its occurrence in two cohorts of children exposed to different fluoride concentrations in the Malaysian water supply. METHODS: A cross-sectional study was conducted among lifelong residents (n = 1,155) aged 9 and 12 years old living in fluoridated and nonfluoridated areas. Malaysian children aged 12 years were born when the level of fluoride in the public water supply was 0.7 ppm while those aged 9 years were born after the level was reduced to 0.5 ppm. Fluorosis was blind scored using standardized photographs of maxillary central incisors using Dean's criteria. Fluoride exposures and other factors were assessed by parental questionnaire. Data were analyzed using descriptive statistics, Chi-squared analyses, and logistic regression. RESULTS: Fluorosis prevalence was lower (31.9 percent) among the younger children born after the reduction of fluoride concentration in the water, compared to a prevalence of 38.4 percent in the older cohort. Early tooth brushing practices and fluoridated toothpaste were not statistically associated with fluorosis status. However, the prevalence of fluorosis was significantly associated with parents' education level, parents' income, fluoridated water, type of infant feeding method, age breast feeding ceased, use of formula milk, duration of formula milk intake, and type of water used to reconstitute formula milk via simple logistic regression. Fluoridated water remained a significant risk factor for fluorosis in multiple logistic regression. CONCLUSIONS: Fluorosis was lower among children born after the adjustment of fluoride concentration in the water. Fluoridated water remained as a strong risk factor for fluorosis after downward adjustment of its fluoride concentration.

The impact of stopping or reducing the level of fluoride in public water supplies on dental fluorosis: a systematic review.

OBJECTIVE: The increased availability of fluoride and concern over the impact of fluorosis, have led to guidance suggesting a decrease or cease in the optimal concentration of fluoride in water fluoridation schemes. To date there have been no systematic reviews looking at both impact of fluoride reduction and total cessation. This review aimed to examine the impact of stopping or reducing the level of fluoride in public water supplies on dental fluorosis. CONTENT: Multiple databases were searched (MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Web of Science). Two reviewers independently screened sources, extracted data and assessed study quality. Results were synthesised qualitatively and quantitatively. The main outcome measure was the prevalence of dental fluorosis. SUMMARY: Six studies of cross-sectional design were included. Two studies were scored as evidence level B (moderate) and the remaining four publications were evidence level C (poor). Meta-analysis indicated fluorosis prevalence was significantly decreased following either a reduction in the concentration of fluoride or cessation of adding fluoride to the water supply (OR:6.68; 95% CI:2.48 to 18.00). OUTLOOK: The evidence suggests a significant decrease in the prevalence of fluorosis post cessation or reduction in the concentration of fluoride added to the water supply. However, this work demonstrates that when studies are subject to current expectations of methodological and experimental rigour, there is limited evidence with low methodological quality to determine the effect of stopping or reducing the concentration of fluoride in the water supply on dental fluorosis.

A whole-team approach to optimising general dental practice teamwork: development of the Skills Optimisation Self-Evaluation Toolkit (SOSET).

Introduction Studies across the health service reveal benefits of teamwork and barriers to its optimal use. Drawing upon the established Maturity Matrix Dentistry method, the Skills Optimisation Self-Evaluation Toolkit (SOSET) was developed to enable the whole dental team to critically review how they address skill-mix in delivery of patient-centred oral healthcare in their practice. This paper outlines the development of the SOSET and explores its usefulness to general dental practice teams.Methods Research literature and interview data from general dental practice teams were coded for high-level factors (positive and negative) influencing teamwork. We used this coding to identify skill-mix domains, and within each, define criteria. The SOSET process was refined following consultations with dental professionals and piloting.Results Eighty-four papers were coded and 38 dental team members were interviewed across six sites. The SOSET matrix was developed containing nine domains reflecting the use of skill-mix, each containing six development-level criteria. The domains addressed factors such as team beliefs on skill-mix and knowledge of team members' scope of practice, patient demand, the business case, staffing and training, and the practice premises. The process was piloted in 11 practices across South Wales, and feedback was received from 92 staff members. Results showed that the SOSET process was straightforward, that the whole team could contribute to discussion and that it would be used to improve practice. Following piloting, four domains were merged into two new domains, and the number of criteria within all domains was reduced and the wording simplified (seven domains, with four criteria each).Conclusion We used a systematic and rigorous process to develop the SOSET to support dental teams to progress their teamwork practices. Its usefulness was demonstrated in the pilot. The SOSET is now being offered to general dental practices across Wales.

Dental therapists in general dental practice. A literature review and case-study analysis to determine what works, why, how and in what circumstances.

INTRODUCTION: In the United Kingdom, policy and guidance changes regarding the role of dental therapists (DTs) were implemented in recent years with a view to changing dental care to a more preventive-focussed, teamwork approach. However, success in the adoption of this model of working has been varied. AIMS: Adopting a realist approach, our aim was, to examine the use of DTs in general dental practices in Wales, exploring what works, why, how and in what circumstances. MATERIALS AND METHODS: The research comprised two stages. (a) A structured literature search, dual-coding papers for high-level factors describing the conditions or context(s) under which the mechanisms operated to produce outcomes. From this, we derived theories about how skill-mix operates in the general dental service. (b) Six case studies of general dental practices (three with a dental therapist/three without a dental therapist) employing a range of skill-mix models incorporating semi-structured interviews with all team members. We used the case studies/interviews to explore and refine the theories derived from the literature. RESULTS: Eighty-four papers were coded. From this coding, we identified seven theories which reflected factors influencing general dental practices within three broad contexts: the dental practice as a business, as a healthcare provider and as a workplace. We tested these theories in interviews with 38 dental team members across the six care studies. As a result, we amended five of the theories. CONCLUSION: Our analysis provides theory about outcomes that DTs may facilitate and the mechanisms that may assist the work of DTs within different contexts of general dental practice.

Are fluoride-containing sealants more effective than non-fluoride sealants?

Design Multi-centre split mouth randomised controlled trial. Intervention Following prophylaxis, isolation, etching and drying the allocated resin-based fissure sealant (RBS) was applied according to the manufacturer's instructions. Reviews were undertaken by a blinded observer at 6,12,18 and 24 months. Operators and observers were calibrated for ICDAS . Outcome measure The primary outcome was the presence of an ICDAS (International Caries Detection and Assessment System) 3-6 lesion on sealed tooth during the two-year follow-up. Sealant retention was a secondary outcome.Results Four hundred children (663 tooth pairs) were randomised, 290 children (483 tooth pairs) completed the two-year follow up. There was a lower risk of ICDAS 3-6 lesions in sealed molars; Hazard ratio [HR] = 0.16 (95% CI: 0.14 - 0.19). The effect was similar for both fluoride; HR= 0.15 (95% CI: 0.12 - 0.19) and non-fluoride sealants; HR= 0.18 (95% (CI: 0.15 - 0.21) Conclusions Sealant placement reduced the risk of ICDAS 3-6 lesions at 24 months; similar reductions in caries were seen for fluoride and non-fluoride sealants.