The acceptability of fluoride varnish and fissure sealant treatments in children aged 6-9 delivered in a school setting.

OBJECTIVE: To assess the acceptability of fluoride varnish and fissure sealant treatments for children. To investigate the acceptability of delivering this treatment in a school setting for children, parents, clinicians and school staff. BASIC RESEARCH DESIGN: Semi-structured interviews (with children, parents, clinicians and school staff) and a questionnaire (for school staff) as part of a two-arm, randomised clinical trial. PARTICIPANTS: Children aged 6-9, their parents, clinical staff and school staff. INTERVENTIONS: Fluoride varnish or fissure sealant was delivered to children from the ages of 6 to 9 years for 36 months, by a community dental service in a school setting. Fluoride varnish was re-applied every 6 months; fissure sealant was applied once to first permanent molars and re-applied as required. RESULTS: Interviews with children a few days after treatment indicated little difference in preference; acceptability at this point was driven by factors such as finding it fun to visit 'the van' (i.e. mobile dental unit) and receiving a "sticker" rather than specific treatment received. Interviews with parents, clinicians and school staff indicated high acceptability of delivering this type of intervention in a school setting; this may have been partly due to the service being delivered by a well-established, child-oriented community dental service which delivered the clinical trial. CONCLUSIONS: Preventive fluoride varnish and fissure sealant treatments in a school setting has high overall acceptability.

Fissure Seal or Fluoride Varnish? A Randomized Trial of Relative Effectiveness.

Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- to 7-y-olds. The study design was a randomized clinical trial, with 2 parallel arms. The setting was a targeted-population program that used mobile dental clinics in schools located within areas of high social and economic deprivation in South Wales. A total of 1,016 children were randomized 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-mo intervals. FV was applied at baseline and at 6-mo intervals for 3 y. The main outcome measures were the proportion of children developing caries into dentine (D4-6MFT) on any 1 of up to 4 treated FPMs after 36 mo. At 36 mo, 835 (82%) children remained: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV ( n = 73, 17.5%) versus FS ( n = 82, 19.6%) developed caries into dentine on at least 1 FPM (odds ratio [OR] = 0.84; 95% CI, 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly decayed teeth (OR = 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR = 0.85; 95% CI, 0.59 to 1.21) were examined. In a community oral health program, semiannual application of FV resulted in caries prevention that was not significantly different from that obtained by applying and maintaining FS after 36 mo (EudraCT: 2010-023476-23; ISRCTN: ISRCTN17029222).

Exploratory study to evaluate the provision of additional midwifery support to teenage mothers.

OBJECTIVE: To evaluate the provision of psychosocial interventions of potential benefit to pregnant teenage women. STUDY DESIGN: Pre-test/post-test, controlled, experimental design. METHODS: One hundred and sixty-four pregnant teenage women received usual midwifery care or usual midwifery care plus additional psychosocial support. Four outcomes were measured at baseline and 4 weeks after delivery: self-esteem (Rosenberg Self-Esteem Scale), physical activity (International Physical Activity Questionnaire), social support (Short Form Social Support Questionnaire) and smoking behaviour (yes/no). RESULTS: At follow-up, there were no significant differences in any of these outcomes between the 65 women in the intervention group and the 64 women in the control group who completed both assessments (mean age 17.5 years). There was no difference in use of National Health Service (NHS) services, but the intervention group made greater use of non-NHS services, such as family planning or help with housing or benefits problems. CONCLUSION: The very low self-esteem of the women in the study may indicate that the intervention was not sufficiently robust to impact on mental health and lifestyle, although a longer follow-up may be needed to confirm this. Discrepancy in the evidence provided by formal and informal data suggests that project benefits may have been more evident if the evaluation had included a qualitative element to address the complexity of the client group and intervention.