Low rates of dental attendance by the age of one and inequality between local government administrative areas in England.

OBJECTIVE: To describe child dental attendance (DA) by 1 year of age in England and its relationship with area deprivation. BASIC RESEARCH DESIGN: Analysis of National Health Service data for the 12 months to June 2017. Deprivation was measured by Index of Multiple Deprivation Rank of Average Score (2015) for upper-tier and unitary local authorities in England (LAs, n=151). DA rates were calculated for children under 1 year (⟨1yr) and children aged 1 year and under (⟨1yr). A Spearman's test assessed strength of association with deprivation. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) explored equity. CLINICAL SETTING: Upper-tier and unitary LAs in England. MAIN OUTCOME MEASURE: Attending an NHS primary care dental service. RESULTS: DA rates ranged from 0 to 12.3% (Median:2; IQR:1.4,3.9) in children ⟨1yr and from 3.7 to 37.6% (Median:10; IQR:7.4,17) in children ≤1yr. DA rates decreased as deprivation decreased (Spearman=-0.25, p=0.0019 in children ⟨1yr; Spearman=-0.21, p=0.0104 in children ≤1yr). The SII suggested a 2 percentage point difference in DA rate across the deprivation distribution in children ⟨1yr (SII=-0.02, 95% CI=-0.01,-0.04; p=⟨0.001); and a 5 point difference in children ≤1yr (SII=-0.05, 95% CI=-0.02,-0.09; p=0.003). The DA rate in the most deprived LA was 2.1 higher than the least deprived LA (RII=2.1, 95% CI=1.4,3.2; p=⟨0.001) in children ⟨1yr and 1.5 higher (RII=1.5, 95% CI=1.2,2; p=0.004) in children ≤1yr. CONCLUSIONS: DA rates were low for all LAs and only partially explained by deprivation. More deprived LAs were, unexpectedly, more likely to report higher DA rates.

Oral health education and disease prevention in primary dental care: insight from a pilot intervention targeting children aged 0-7 years in northeast England.

This paper outlines a number of issues arising from a primary-care and community-based oral health education (OHE) and disease prevention pilot targeting children aged 0-7 years in County Durham and Darlington during a six month period in 2011-12. The paper highlights the key practical challenges experienced by the NHS dental practices that provided OHE predominantly in community venues and the issues arising for those involved in managing the pilot on a day to day basis. Finally, the paper suggests potential solutions and learning points for dental public health practitioners. The work described in this paper relates to three relevant dental public health competencies: strategy development and implementation; strategic leadership and collaborative working for health and oral health improvement.

Targeting dental resources to reduce inequalities in oral health in the North East of England - a health equity audit methodology to evaluate the effects of practice location, practice population and deprivation.

AIM: To use nationally available data sets to undertake an equity audit to support the targeting of resources to meet the needs of patients from deprived communities, in areas where levels of poor oral health remain higher than the rest of the population as a whole. METHODS: Postcodes of 224,107 patients in County Durham were matched to Lower Super Output Areas (LSOA) for each practice. Deprivation scores were identified for each LSOA. The postcode of dental practices (59) was matched to the LSOA and the practice population divided into quintiles from the most to the least deprived areas. RESULTS: Results indicated that the more deprived the area in which a dental practice was located, the greater the proportion of the practice population accessing care from the most deprived quintile. The size of the practice alone was not directly related to meeting the needs of a more deprived population. CONCLUSIONS: The methodology used in this study can be used to identify inequalities and inequities in oral health in different areas. In the audit area improving access to dental services for those in most need, was best tackled by targeted investment into dental practices located in deprived communities. Audits are recommended to insure a fare distribution of resources to meet local population needs.

Are restrictive NHS contracts of benefit in addressing health inequalities? An ecological evaluation of their value in the North East of England.

AIM: To determine if restrictive NHS contracts are of benefit in addressing health inequalities in oral health, by using an ecological approach based upon an area measure of material deprivation. METHODS: Postcodes of patients seen under all the restrictive contracts (49) within the North East of England were identified and matched to lower super output areas. The deprivation scores were identified for each area using the Index of Multiple Deprivation 2007. The proportion of patients within each area was calculated and divided into deciles for England, from the most to the least deprived areas. RESULTS: 33,341 postcodes were identifiable from datasets supplied for the study in the North East; a further 4% were invalid. There was inequity in the distribution of patients, with proportionately more patients from the least deprived deciles and less patients from the more deprived deciles seen under the contracts. However, many thousands of patients identified lived in the most deprived areas. CONCLUSIONS: Restrictive contracts may be of benefit in addressing health inequalities. PCTs need to carefully consider the impact of ending restrictive contracts on their local populations.

The equity of access to primary dental care for children in the North East of England.

OBJECTIVES: To determine the equity of access to dental care from general dental practitioners for children aged 0 to 17 years. BASIC RESEARCH DESIGN: Postcode data was obtained from the Dental Practice Board for children registered with an NHS dentist. There were 146,180 children aged 0 to 17 years old resident in the study area, these were mapped to their ward of residence. The child registration rate for wards was calculated, using 2001 census data. The level of deprivation for wards was obtained using a standard indicator, the Index of Multiple Deprivation. SETTING: The Durham and Tees Valley Strategic Health Authority area in the North East of England. The Authority has a population of 1.13 million, of which 260,000 were aged 0 to 17, in 2001. There are approximately 170 dental practices in the Authority area contained in 251 Wards. RESULTS: The range of child registration rates in wards was, 11% to 90%. There was a significant negative association between the number of children registered with a dental practice and increasing deprivation. For every 10 point increase in the deprivation score the probability of registration reduced by 5% of the overall rate. The probability of registration reduced less in those wards with a dental practice compared to those without a dental practice with increasing deprivation. CONCLUSIONS: There are significant inequalities in access to dental care. Children living in deprived wards access general dental practices less than those living in wealthier wards. The location of dental practices may reduce inequalities in access.

An evaluation of the role played by community pharmacies in oral healthcare situated in a primary care trust in the north of England.

OBJECTIVES: To determine the existing state of oral healthcare advice, products and information provided by community pharmacies in Durham Dales Primary Care Trust area, and determine their potential role in the provision of oral healthcare services. METHODS: A semi-structured questionnaire was devised to examine the current role of community pharmacies in oral healthcare. An interview was arranged with each of the pharmacies. RESULTS: Ninety per cent of pharmacies participated from the Trust area. Common presenting complaints were ulcers and toothache/pain relief. Pharmacists advised customers to see a dentist in 94.1% of cases, 23.5% to see a doctor, 41.2% gave oral hygiene advice and 100% gave short-term pain relief. Pharmacists were keen to improve oral health knowledge. Most were aware of the nearest dental practices but few knew arrangements for emergencies/appointments. There were 14 pharmacists wanting active roles in promotional activities and national campaigns. Issues raised were lack of known key contacts for referrals/advice and lack of support on integration into primary healthcare teams. CONCLUSION: Through new pharmacy contracts and support/education, pharmacists could perform an increased role in oral healthcare provision.

The relationship between children's dental caries experience and the prescription of general anaesthetics. an evaluation of the effectiveness of a Personal Dental Service Pilot.

OBJECTIVES: To determine if there was a high correlation between the prescription of a general anaesthetic for dental treatment in young children by a Personal Dental Services (PDS) general anaesthetic pilot and the dental health of children at a ward level. BASIC RESEARCH DESIGN: Postcode data from an audit of the single dental general anaesthetic provider in an area was extracted and mapped to individual wards. A proxy for the oral health population was obtained by using the results of a large-scale dental prevalence study of five-year-olds. The wards were ranked into quintiles by dmft and a mean dmft calculated for each. There were 1,406 patients who had a general anaesthetic, 74% were aged 11 years or less. SETTING: A personal dental service dental general anaesthetic pilot in the north of England providing services for a population of approximately 300,000 residents in a non-fluoridated area. RESULTS There was a positive correlation between increasing levels of dental decay in the population and increasing intervention ratios for dental treatment under general anaesthesia (r2 = 0.90). CONCLUSIONS: The PDS pilot provided dental care under general anaesthesia for more patients from wards with poor dental health than from wards with better dental health.

Distribution of NHS resources for children's dental care in general dental practice in England.

OBJECTIVE: To determine the relationship between the distribution of NHS resources in general dental practice and dental need and access to services for the population in England under the age of 18 in different socio-economic areas. BASIC RESEARCH DESIGN: A proxy for the oral health of under 18 year olds was made from prevalence surveys undertaken on five year old children in each health authority area in 1999/2000. The level of spending per head of the population was ascertained from Dental Practice Board data. Health authorities were grouped according to the eleven United Kingdom Office of National Statistics socio-economic groups. Access was measured by using registration levels of children. SETTING: General dental practices providing National Health Service treatment for children aged 0-18 in England. RESULTS: There was no correlation (r = -0.03) between increasing need for dental care using mean dmft as a proxy and increasing spending per head of the population for each health authority. There was a correlation (r = 0.38) between increasing registration rates and increased spending per head. The populations under 18 had more spent on their oral health care living in areas classified as Mixed Economies, Services and Education and Most Prosperous. Those in Inner London, Manufacturing, Ports and Industry had proportionately the least. The difference between the highest and lowest group was 33%. The groups of Authorities were not homogenous in their level of resources with variations between Authorities in the same groups. CONCLUSIONS: The distribution of NHS resources to general dental practice for people under 18 does not reflect population need. The higher the registration rate for children the greater the amount resources deployed in an area.

The provision of general anaesthesia in dental practice, an end which had to come?

31 December 2001 was the final day on which a general anaesthetic could be given in a dental practice in UK. Henceforth all dental treatment requiring a general anaesthetic will have to take place in a hospital setting, which has immediate access to critical care facilities. This will mark the end of the association between dental practice and general anaesthesia which dates back to the very first recorded clinical procedure performed under general anaesthesia, when in 1844, Horace Wells an American dentist, had a tooth removed by his assistant using nitrous oxide in Hartford, Connecticut, USA.

The relationship between dental health and variations in the level of third molar removals experienced by populations.

OBJECTIVE: To determine the relationship between the dental health of populations and the removal of impacted third molars. DESIGN: Data were obtained for the reported episodes of care undertaken in NHS hospitals in England for the surgical removal of third molar teeth and also for the number of removals undertaken in NHS general dental practices in 1994/95. The dental health of the population within the at risk age group for removal of third molars was estimated by using the results of a large scale epidemiological study of twelve-year-old children which took place in 1988/9. The 12-year-old cohort examined would have been 18 years of age in 1994/95. The hospital and general practice data were standardised for age and size of health authority populations and combined on a weighted basis. SETTING: Data were identified which enabled levels of third molar surgery undertaken in the NHS for 23 health authorities in England, to be matched to the estimated dental health of their 18 year old populations. RESULTS: A negative correlation of r2 = 0.24 was demonstrated between the reported prevalence of third molar surgery and the dental health of populations. Surgery increased as the dental health of populations improved. CONCLUSIONS: This study demonstrates that a quarter of the variations in the provision of third molar surgery across health authorities in England is related to differences in the dental health of their populations.

Prophylactic removal of impacted third molars: an assessment of published reviews.

OBJECTIVE: To evaluate published reviews of the appropriateness of prophylactic removal of impacted third molars. DESIGN: Systematic review and critical appraisal of relevant reviews. METHODS: Computerised databases (Medline and Embase), the Index to Dental Literature, and the references of articles were searched to identify relevant reviews. MAIN OUTCOME MEASURES: Pathologies associated with impacted third molars and outcomes following surgical removal of third molars. RESULTS: Twelve published reviews were assessed. Major methodological problems in these include that authors did not describe review methods such as literature search strategy and criteria for inclusion of primary studies. Reviews with similar aims included different sets of primary studies as evidence. Details of primary studies quoted were seldom sufficient for readers to judge the reliability of the evidence. With the exception of two reviews with poorer quality, the reviews concluded that there is a lack of evidence to support the prophylactic removal of impacted third molars. Two decision analyses also concluded that, on average, patients' long-term wellbeing is maximised if extraction is confined to those impacted third molars with pathology. CONCLUSIONS: In the absence of good evidence to support prophylactic removal, there appears to be little justification for the removal of pathology-free impacted third molars.

The role of pre-general anaesthetic assessment for patients referred by general dental practitioners to the Community Dental Service.

The first aim of this study was first to investigate the effectiveness of seeing patients at a separate appointment prior to any subsequent appointment for the administration of an anaesthetic, for patients referred from general dental practitioners to the Community Dental Service for dental extractions under general anaesthesia. The second aim was to assess the technical adequacy of the information contained in the referrals from general practitioners for the safe provision of extractions under general anaesthesia. The purposes of the assessments were to reduce the number of patients receiving a general anaesthetic, to ensure that the anaesthetist had a satisfactory medical history for the safe administration of an anaesthetic and that the dental officer undertaking the extractions had satisfactory clinical information to undertake the proposed dental care. A sample of records of patients seen at assessment appointments was drawn from a twelve month period. Five hundred and ninety-three patients records were used. One hundred and five cases required further investigations before an anaesthetic could be given. In 264 cases extractions were undertaken as requested by their own dentist, 208 patients had their treatment plans altered, 49 cases had extractions performed with local anaesthesia and 41 cases were discharged without any treatment. The pre-general anaesthetic assessment appointments prevented the need for a general anaesthetic for 15 per cent of referrals from general dental practitioners.

Provision of primary dental care during periods of severe water shortages.

The drought suffered by many parts of the UK in 1995, brought home that it is not always possible to rely on there being a constant supply of safe water. Had cuts been necessary dental practices in the affected areas would either have had to cease working or install clean water systems to protect patients for the risks of water-borne infections. Dentists should consider taking action to safeguard their ability to provide dental care during periods when their mains water supply is compromised.

Demand for dental extractions performed under general anaesthesia for children by Leicestershire Community Dental Service.

A study was undertaken on a sample of children who had teeth removed under general anaesthesia by Leicestershire Community Dental service over a six month period. Three hundred and nine subjects were included in the study. The age range was from 2-15 years, 83 per cent of subjects were of European origin and 13 per cent were of Asian origin. Sixty two per cent lived at postal addresses which had positive Jarman scores. Some 52 per cent had been attending their referring clinician for more than a year, while 25 per cent had attended their referring dentist for the first time with the acute problem for which they were referred. Twenty three per cent had had a dental general anaesthetic on a previous occasion, while 46 per cent had never had any restorative care. There is some evidence to show that demand for general anaesthesia is related to positive Jarman scores. The demand for repeat general anaesthesia could be reduced by a more aggressive prescribing of extractions, in children under four.