A 4-year assessment of a new water-fluoridation scheme in New South Wales, Australia.

OBJECTIVE: To monitor the changes in dental caries prevalence of 5- to 7-year-old children living in a fluoridated area, a newly fluoridated area and in an area without water fluoridation, in NSW, Australia. METHODS: Dental caries prevalence was recorded for 5- to 7-year-old children, living in the three study locations, by six trained and calibrated examiners in 2008, 2010 and 2012. A questionnaire recorded demographic data, toothbrushing behaviour and sugary drink consumption. Caries experience was measured using the decayed, missing, and filled teeth (dmft) index for primary teeth, the percentage of children who were caries free and the significant caries index. Univariate analysis was undertaken to determine independent predictors of caries. RESULTS: The caries prevalence changed over time. In 2008, the mean dmft index was 1.40 for the fluoridated area, 2.02 for the area about to fluoridate and 2.09 for the unfluoridated control. By 2012, these mean dmft scores were 0.69, 0.72 and 1.21, respectively. In the two areas where children received fluoridated water, the significant caries index was 2.30 for the fluoridated area and 2.40 for the newly fluoridated area. The significant caries score for children in the unfluoridated location was 3.93. Multivariate analysis showed that over time the differences in dental caries prevalence between the established fluoride area and the newly fluoridated area diminished. However, children in the unfluoridated control area continued to demonstrate significant differences in the mean number of decayed teeth compared with children in the fluoridated comparator sites, and the proportions of children free from decay were significantly higher in the fluoridated areas than in the unfluoridated area. CONCLUSION: Fluoridation of public water supplies in Gosford and Wyong offers young children better dental health than those children who do not have access to this public health measure.

An assessment of preventive care offered to orthodontic patients by oral health therapists in NSW Australia.

OBJECTIVE: The aim of this study was to record preventive oral health care planned by dental therapists and oral health therapists (therapists) for patients with poor oral hygiene undergoing orthodontic treatment. MATERIALS AND METHODS: A cross-sectional survey, using a clinical vignette of a patient with poor oral hygiene undergoing therapy with a fixed appliance, was undertaken to record the preventive care offered to this individual by therapists working across 15 Local Health Districts (LHDs). This orthodontic vignette was inserted between two dental caries-related vignettes. Data were coded and descriptive statistics were used to report the findings. RESULTS: One-hundred and seventeen therapists returned questionnaires (giving a response rate of 64.6%), of whom 82.0% (n = 95) completed the orthodontic vignette. Adopting motivational interviewing techniques to facilitate communication with the patient and their parent was recommended by 88.4% (n = 84) respondents, 98.0% (n = 93) offered oral-hygiene instruction, 70.5% (n = 67) recorded plaque levels and used disclosing solution and 60.0% (n = 57) offered dietary advice. Products recommended for use at home included fluoride toothpaste [1,450 ppm F (80.0%; n = 76) and 5,000 ppm F (59.0%; n = 24)] and casein phosphopeptide amorphous phosphates plus fluoride (CPP-ACPF) paste (33.3%; n = 32). Less than 20% offered fissure sealants. CONCLUSION: Preventive advice and care was offered inconsistently by therapists in this study. To ensure that all therapists adopt a scientifically based approach to prevention, LHD clinical directors should implement continuous professional education programmes for therapists to improve patient's health outcomes.

The Dental Health of primary school children living in fluoridated, pre-fluoridated and non-fluoridated communities in New South Wales, Australia.

BACKGROUND: The Local Government Area of Gosford implemented a water fluoridation scheme in 2008. Therefore the opportunity was taken to record the dental health of primary school children aged 5-7 years prior to the fluoridation and compare the results with other communities in NSW with different access to fluoridated water. The aim was to compare the oral health of New South Wales (Australia)s 5-7 year olds living in fluoridated, and non- fluoridated communities. One of the areas was due to implement water fluoridation and is termed the pre-fluoridation site. METHODS: Pupils in the first year of Public and Catholic Schools in three areas of NSW were recruited. Class lists were used to draw a sample of approximately 900 per area. This number allowed for a non-response rate of up to 30 per cent and would give a sample sufficient numbers to allow statistical inferences to be drawn. Children whose parents consented received a dental examination and the clinical data was collected on mark sense cards. RESULTS: In the 3 areas the proportion of children who received a dental examination varied; 77.5% (n = 825) for the fluoridated area, 80.1% (n = 781) for the pre-fluoridated area and 55.3% (n = 523) for the non-fluoridated area. The mean dmft was 1.40 for the fluoridated area, 2.02 for the pre-fluoridated area and 2.09 for the non-fluoridated area. These differences were statistically significant (p < 0.01). Differences were also noted in the proportion of children who were caries free, 62.6% fluoridated area, 50.8% for the pre-fluoride area and 48.6% for the non-fluoride location. CONCLUSION: The children living in the well-established fluoridated area had less dental caries and a higher proportion free from disease when compared with the other two areas which were not fluoridated. Fluoridation demonstrated a clear benefit in terms of better oral health for young children.

Developing leaflets to give dental health advice to Aboriginal families with young children.

OBJECTIVES: Dental caries (decay) is a serious problem for young Aboriginal children, causing pain and stress. Treatment often involves extraction of teeth under a general anaesthetic. However, dental caries can be prevented by reducing the frequency of sugar consumption and brushing teeth twice a day with fluoride toothpaste. Such straightforward advice could be given to families by Aboriginal Health Workers who are trusted by their communities and have an existing advisory role. This paper reports on the development of dental health advice leaflets for use in Aboriginal communities. METHODS: An Aboriginal reference panel was recruited to comment on dental health advice leaflets prepared by an Aboriginal graphic designer. The panel was asked to consider the design, cultural appropriateness and practicality of the leaflets. Comments were collected through email and face-to-face discussions, which were collated and the leaflets altered accordingly. RESULTS: The advice from the panel resulted in greater use of pictures. For example large green ticks and red crosses highlighted healthy and unhealthy behaviours, respectively. The tooth brushing leaflet was amended to emphasise the safe storage of toothpaste in order to keep it out of reach of young children. The panel stated that all leaflets should incorporate the Aboriginal flag, and proposed that fridge magnets might be beneficial as all family members would benefit from seeing the messages every day. CONCLUSION: The consultation process refined dental advice leaflets to reflect the views of an Aboriginal Reference Panel, in terms of design, cultural competence and practicality.

Preventive and clinical care provided to adolescents attending public oral health services New South Wales, Australia: a retrospective study.

BACKGROUND: Dental Therapists and Oral Health Therapists (Therapists) working in the New South Wales (NSW) Public Oral Health Service are charged with providing clinical dental treatment including preventive care for all children under 18 years of age. Adolescents in particular are at risk of dental caries and periodontal disease which may be controlled through health education and clinical preventive interventions. However, there is a dearth of evidence about the type or the proportion of clinical time allocated to preventive care.The aim of this study is to record the proportion and type of preventive care and clinical treatment activities provided by Therapists to adolescents accessing the NSW Public Oral Health Service. METHODS: Clinical dental activity data for adolescents was obtained from the NSW Health electronic Information System for Oral Health (ISOH) for the year 2011. Clinical activities of Therapists were examined in relation to the provision of different types of preventive care for adolescents by interrogating state-wide public oral health data stored on ISOH. RESULTS: Therapists were responsible for 79.7 percent of the preventive care and 83.0 percent of the restorative treatment offered to adolescents accessing Public Oral Health Services over the one year period. Preventive care provided by Therapists for adolescents varied across Local Health Districts ranging from 32.0 percent to 55.8 percent of their clinical activity. CONCLUSIONS: Therapists provided the majority of clinical care to adolescents accessing NSW Public Oral Health Services. The proportion of time spent undertaking prevention varied widely between Local Health Districts. The reasons for this variation require further investigation.

Preventing Dental Caries: Part 1 the scientific rationale for preventive advice.

UNLABELLED: This article highlights the fundamental issues which the primary care team should consider when developing preventive dental advice for their patients. Although it is important to have a clear understanding of the carious process, this knowledge must take account of social influences on health when assessing the preventive strategy for individuals. A key factor is that caries is a lifelong process involving fluctuations in demineralization and remineralization. The dental team should ensure that the oral environment favours remineralization and avoids irreversible loss of enamel and dentine. An understanding of this'see-saw' process will influence not only our preventive philosophy but how we, as health professionals, diagnose and treat dental caries. CLINICAL RELEVANCE: Preventing dental caries is an essential skill for all dental professionals. This article brings together the scientific basis of the appropriate advice.

Preventing dental caries: part 2. Case studies in prevention.

UNLABELLED: This article seeks to bring together the preventive messages given in Paper 1 and apply them to specific individual patients. The key elements are the appropriate advice on fluorides, fissure sealants, diet and formulating advice in terms of an individual's educational background. CLINICAL RELEVANCE: This article offers practical advice on the prevention of dental caries using individual patient-based scenarios.

'I can't relate it to teeth': a qualitative approach to evaluate oral health education materials for preschool children in New South Wales, Australia.

BACKGROUND: Early Childhood Caries is a significant public health issue worldwide. Although much is known about the aetiology of dental caries, there is limited evidence on the understanding of caregivers on readily available early childhood oral health education materials. AIM: The purpose of this study was to record how parents cope with dental health education materials for preschool children commonly available in New South Wales, Australia. DESIGN: This qualitative study was nested within a large cohort study in South Western Sydney. English-speaking mothers (n = 24) with young children were approached for a face-to-face, semi-structured interview at their homes. Two dental leaflets designed by NSW Health to give advice on monitoring young children's oral health were sent to mothers prior to the interview. Interviews were recorded and subsequently transcribed verbatim. Transcripts were analysed by interview debriefing and a thematic coding. RESULTS: Mothers generally reported that the leaflets were easy to read but noted that the information pertaining to bottle feeding was confusing. Furthermore, they were unable to understand terms such as 'fluoride' and 'fissure sealants'. Early childhood nutrition and infant teething were inadequately addressed, and mothers preferred pictorial presentations to improve their understanding of oral health. CONCLUSIONS: Producers of health education leaflets should keep the messages simple and straightforward, avoid the use of medical jargon, and use pictorial aids to improve communication with parents.

A review of dental caries in Australian Aboriginal children: the health inequalities perspective.

INTRODUCTION: The purpose of this study was to: (1) describe caries prevalence and experience among Aboriginal children; and (2) investigate the disparity in dental caries between Aboriginal and non-Aboriginal Australian children. As background, dental caries is a widespread disease within Aboriginal communities and it has a particularly severe impact on children. In recognition of the extent and severity of this disease, its impact on childhood nutrition, socialisation and schooling, the control of dental caries has been identified as a key indicator in the reduction of disadvantage among Aboriginal communities. METHODS: Medline was the primary database used in the literature search. Other databases included: PubMed, Web of Science and Google Scholar. Australian National and State departments of health websites were also searched for relevant documents. Articles were included in the review if they reported information on either caries prevalence rates or experience scores or both, for Aboriginal children in Australia. Articles were excluded if the study sample was special needs children, and/or caries statistics were reported only for children over 12 years. RESULTS: Caries prevalence among 6-year-olds in rural non-fluoridated Western Australia in 1963 was 27%, and in 2004 was 85% among 6-year-olds in rural non-fluoridated Queensland. There was a corresponding increase in caries experience scores in this period from 2.07 in 1963 to 6.37 in 2004. National estimates for 2000-2003 reported a caries prevalence of 72% and caries experience (dmft: decayed, missing and filled primary teeth) of 3.68 for 6-year-old Aboriginal Australian children. For 12-year-olds the national estimates were a caries prevalence of 45% and experience (DMFT, Decayed, Missing and Filled Permanent Teeth) of 1.25 (SE=0.07). The magnitude of disparity (relative difference) in 6-year-old caries experience between Aboriginal and non-Aboriginal children was relatively consistent over the period 1983-2007, with Aboriginal children having an approximately two-fold higher caries experience score. The 2000-2003 national estimates for caries experience showed that Aboriginal 6-year-olds had a dmft score that was 2.38 times higher than non-Aboriginal children (3.68 vs 1.54). For the 12-year-olds, the magnitude of disparity was not as marked, though the direction was similar. CONCLUSION: Both caries prevalence and experience are higher in the primary dentition. In rural Queensland and the Northern Territory there are high caries rates for both 6- and 12-year-olds. Rural Aboriginal children are generally at a disadvantage compared with their urban counterparts. The magnitude of disparity in caries rates appears to be relatively unchanged over time but there is indication that it may be increasing. This raises the issue of health inequity and the need to fund practical, culturally appropriate and sustainable preventive programs. It also indicates the urgent need for more research on the determinants of oral health inequalities.

Early childhood feeding practices and dental caries in preschool children: a multi-centre birth cohort study.

BACKGROUND: Dental caries (decay) is an international public health challenge, especially amongst young children. Early Childhood Caries is a rapidly progressing disease leading to severe pain, anxiety, sepsis and sleep loss, and is a major health problem particularly for disadvantaged populations. There is currently a lack of research exploring the interactions between risk and protective factors in the development of early childhood caries, in particular the effects of infant feeding practises. METHODS/DESIGN: This is an observational cohort study and involves the recruitment of a birth cohort from disadvantaged communities in South Western Sydney. Mothers will be invited to join the study soon after the birth of their child at the time of the first home visit by Child and Family Health Nurses. Data on feeding practices and dental health behaviours will be gathered utilizing a telephone interview at 4, 8 and 12 months, and thereafter at 6 monthly intervals until the child is aged 5 years. Information collected will include a) initiation and duration of breastfeeding, b) introduction of solid food, c) intake of cariogenic and non-cariogenic foods, d) fluoride exposure, and e) oral hygiene practices. Children will have a dental and anthropometric examination at 2 and 5 years of age and the main outcome measures will be oral health quality of life, caries prevalence and caries incidence. DISCUSSION: This study will provide evidence of the association of early childhood feeding practices and the oral health of preschool children. In addition, information will be collected on breastfeeding practices and the oral health concerns of mothers living in disadvantaged areas in South Western Sydney.

Reorienting a paediatric oral health service towards prevention: lessons from a qualitative study of dental professionals.

ISSUE ADDRESSED: Reorienting primary care dental services towards prevention is a priority for improving the oral health of Australian children with extensive dental caries. We explored the attitudes and beliefs of dental staff about the factors that helped or hindered the establishment and implementation of a hospital-based parent counselling program to manage existing, and prevent new, carious lesions in children. A further aim was to explore the influence of the program on the hospital's reorientation to prevention. METHODS: Eight of nine program staff participated in two focus group interviews, and two co-ordinating staff participated in semi-structured interviews. Interviews were audio-recorded and transcribed. Interview recordings and transcripts were analysed by qualitative thematic analysis. RESULTS: The participants identified a number of factors that they felt influenced the establishment and implementation of the program, including the dental team's support of the initiative, the advantages of building on existing clinic infrastructure and procedures, the utility of harnessing dental assistants as a resource for oral health promotion, and the confidence of dental professionals to provide parent counselling. CONCLUSION: Efforts to establish a preventive program in a public paediatric dental service should ensure that all members of the dental team are engaged during all phases of the program, that dental assistants are trained and supported to deliver parent counselling, and that interprofessional partnerships with services such as dietetics are fostered.

Student opinions on a rural placement program in New South Wales, Australia.

INTRODUCTION: Australia's dental workforce is largely metropolitan, with a corresponding lack of dentists in rural areas. Some evidence from the discipline of medicine suggests that providing a rural placement program for undergraduates may encourage them work in a rural area post-graduation. Therefore, the University of Sydney Faculty of Dentistry implemented a rural placement program for final year dental undergraduates with funding provided by the Australian Government Department of Health and Ageing. METHODS: In 2009, a one-month Rural Placement Program was introduced for 4th (final) year dental undergraduates. Of the 80 fourth year students, 40% volunteered to participate in the program. Their views on the program were collected in pre- and post-questionnaires which were self-completed. Framework analysis was used to identify common themes in the student responses. This article focuses on the placement experience of the participants with particular emphasis on the factors and barriers which influenced their intention to work in a rural location post-graduation. RESULTS: Participants' characteristics included a mean age of 27 years, 59% female and 77% had been raised in a city environment. All the participants completed the pre- and post-placement questionnaires. The most common pre-placement hopes were to increase their clinical skills and to experience a rural environment. Pre-placement concerns related to missing lecture time at the university and having less time there to complete their clinical quota requirements. Over half of the students (57%) were considering employment in a rural location prior to the placement. Post-placement the students reported being pleased with the clinical experience provided, with increased time management skills and clinical confidence emphasised. The rural clinical supervisors and staff were highly rated by students for their support, helpfulness and teaching ability. After the placement the majority of students (97%) were considering working in a rural environment once qualified. Positive factors identified as influencing their decision were the broad clinical range of procedures available, good clinical mentors, reduced commuting and a quieter lifestyle. Barriers to working in a rural location were identified as missing friends, partners and the number of available job opportunities. All participants would recommend the placement to future students. CONCLUSIONS: In this successful undergraduate Rural Placement Program the students valued both personal and educational components. They became more aware of the potential advantages of working in a rural location and almost all would consider working in a rural area after graduation.

Successful fluoride plebiscite in the township of Deniliquin, New South Wales, Australia.

OBJECTIVES: This article describes the strategies adopted to influence the outcome of a plebiscite held in March 2004 in favor of water fluoridation in Deniliquin, a rural town in New South Wales, Australia. METHODS: The health promotion strategies undertaken included the following: a) the skillful use of media to educate the community on the benefits of water fluoridation; b) disseminating contemporary local data to demonstrate oral health disparities with neighboring fluoridated townships; and c) a well-established lobbying machine to mobilize the community. RESULTS: Out of a total population of 5,280 on the electoral roll, 4,539 residents voted, giving a response rate of 86 percent. The wording of the plebiscite was "Do you support the addition of fluoride to Deniliquin town water supply?" There were 2,533 "yes" votes (55.8 percent), 1,879 "no" votes (41.4 percent), and 127 spoiled votes (2.8 percent). CONCLUSIONS: The council resolved to implement water fluoridation and the residents received fluoridated water in January 2005.

Oral health in the Pacific Islands.

OBJECTIVE: To assess the variability of caries prevalence throughout the Pacific Islands region. METHOD: Search conducted using Medline database for relevant journal articles (in English) from 1970 documenting oral health status in the region. Further material and statistics accessed through World Health Organization website and Secretariat of the Pacific Community. Available literature reviewed. RESULTS: There is a lack of recent data. Marked geographical differences in caries experience were reported with high DMFT values in urban areas compared to rural areas. The rise in caries prevalence was linked to an increase in sugar consumption. This was demonstrated in Tokelau where the mean number of decayed and filled teeth of children aged 5-10 years rose from approximately 3 in 1963 to 5 in 1999; sugar imports increased by up to 8 times over this period. IMPLICATIONS FOR ACTION: Standardised epidemiological surveys are needed to document current oral health status in the region. A collaborative approach to health promotion should be adopted with cooperation between nations, healthcare professionals and other agencies to ensure effective preventative strategies are developed.

A prospective study of dental anxiety in a cohort of children followed from 5 to 9 years of age.

BACKGROUND: The development of dental anxiety in children is poorly understood. AIMS: The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other factors. DESIGN: A prospective cohort study of children in the north-west of England followed from 5 to 9 years of age. The participants were clinically examined and their parents completed the same questionnaire at 5 and 9 years. RESULTS: The majority (54.3%N = 38) of participants who were anxious at 5 years were no longer anxious at 9 years, but a large proportion of children who were anxious at 5 remained anxious at 9 years of age (45.7%N = 32). During the follow-up period, a larger proportion of children developed anxiety (11.7%N = 85) than the proportion of children who were reported as being anxious at baseline (8.8%N = 70). At 9 years of age, dental anxiety was significantly associated with girls; parental anxiety; a history of extraction; and irregular, asymptomatic dental visiting. These factors were also significantly associated with dental anxiety at 5 years old. CONCLUSIONS: Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.

Comparison of the dental health of adults and children living in NSW with their counterparts in the US and UK.

This paper aims to place the findings of the NSW Adult and Child Dental Health Surveys in an international context. The comparator countries are the US and the UK, both of which have well-documented epidemiological dental health data. The US has a mainly private system of dental care, similar to NSW, whereas the UK has primarily a government-funded dental care program. The adult data collected in the last 20 years in all three locations indicates greatly improved oral health with a decline in the proportions of people with no natural teeth. The majority of children have few dental problems but inequality remains with some children in lower socioeconomic groups still having high levels of dental ill health, which contributes to a lower quality of life. Improving population levels of oral health in all three countries will require collective decision-making by stakeholders and politicians to finance plans for action and manage change to help those individuals for whom dental disease is still a major problem.

Child Dental Health Survey 2007: a snapshot of the oral health status of primary school-aged children in NSW.

OBJECTIVES: The Child Dental Health Survey 2007 was commissioned to establish the oral health status of school children in NSW aged 5-12 years, to provide reliable regional oral health statistics and contribute to national population-based data collections. METHODS: A total of 7975 children were clinically examined at 107 public, catholic and independent schools across NSW. RESULTS: Key findings from the survey include: mean dmft for 5-6-year-olds of 1.53; mean DMFT for 11-12-year-olds of 0.74; 61.2% of 5-6-year-olds and 65.4% of 11-12-year-olds have never experienced decay in their primary and permanent teeth, respectively. These figures compare favourably to national benchmarks set in 2001. CONCLUSIONS: Data from the survey will be used as a baseline to measure the success of early intervention and prevention programs, for international comparisons, to provide solid evidence to support population oral health planning and for ongoing surveillance of populations of interest.

Interleukin-10 haplotype frequencies in children with gingivitis.

BACKGROUND: Polymorphisms in the promoter region of the interleukin (IL)-10 gene have been identified at positions -1082 (G-->A), -819 (C-->T), and -592 (C-->A). Linkage disequilibrium between alleles -819*C, and -592*C was observed. A previous study addressed the association between the -1082*A allele and gingivitis in white Caucasian children. The aim of this case-control study was to test whether differences could exist between children with and without gingivitis in the distribution of IL-10 alleles and haplotypes at positions -1082, -819, and -592. METHODS: A total of 248 subjects aged 8 to 12 years from the University Dental Hospital of Manchester were enrolled in this study. According to gingival and bleeding on probing indices, 84 children were classified as controls and 164 as children with gingivitis. Amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) was used for genotyping IL-10 polymorphisms. Allele and haplotype frequencies were calculated by direct counting and by a haplotype frequency estimation (EH) program. Differences between subjects with gingivitis and controls in the frequency of haplotypes were determined by a chi2 test of homogeneity. RESULTS: The GCC/GCC genotype, which has been associated with increased production of IL-10, was significantly more frequent in controls than in children with gingivitis (36% versus 23%) (P=0.036). In addition, there was a marginally significant difference between controls and cases in the frequency of haplotypes (P=0.06). The GCC haplotype was more frequent in controls than in children with gingivitis (60% versus 50%). In contrast, the ACC and ATA haplotypes were more frequent in children with gingivitis (27% and 23% versus 19% and 21% in controls). CONCLUSION: These findings suggest that IL-10 gene promoter polymorphisms could have an active role in the pathogenesis of gingivitis in Caucasian children.

Service quality implications of dental undergraduate outreach teaching for Primary Care Trusts in England, UK.

OBJECTIVE: Primary Care Trusts (PCTs) assumed new responsibilities for dentistry in 2005. In dental education it has been suggested that more emphasis is made of primary care outreach schemes. The paper considers the service quality implications of dental outreach teaching for PCTs with particular reference to access and acceptability. RESEARCH DESIGN AND CLINICAL SETTING: A pilot of outreach teaching for Manchester undergraduates in relation to adult dental care began in 2001. Six groups of eight students, working in pairs, spent one day per week in one of three community dental clinics in socially deprived areas. The evaluation of the first year used data from 908 patient treatment summaries, 139 patient questionnaires, and records of patient attendance. MAIN OUTCOME MEASURES: Access and acceptability measured by patients' demographic characteristics, patients' attendance at the clinics; patients' reasons for attendance, use of services and satisfaction with the service. RESULTS: In terms of access, the new service was used by local patients. Their main reasons for attending were convenience, a dental problem, free treatment, lack of access to a dentist, and lay referral. Some 41 percent attended initially because of an emergency, 30 percent said that if they had not attended the clinic they would have gone nowhere or did not know where they would have gone, and 49 percent had not attended a dentist for more than two years. In terms of acceptability most patients were positive about being treated by a student, 96 percent thought the quality of care excellent or good, and the same percentage said they would return to the clinic. The main areas of criticism were waiting times and appointments. CONCLUSIONS: Students can provide an accessible and acceptable local primary care dental service for adult patients in socially deprived areas as part of their undergraduate learning, and in a way that complements the existing services.