Results of a two year dental health education program to reduce dental caries in young Aboriginal children in New South Wales, Australia.

OBJECTIVE: To assess the effectiveness of a dental health education program, 'Smiles not Tears' in preventing Early Childhood Caries in young Aboriginal children. BASIC RESEARCH DESIGN: Community trial. CLINICAL SETTING: Aboriginal Community Controlled Health Services in rural, remote and metropolitan areas in New South Wales, Australia. PARTICIPANTS: Aboriginal families who had a child six months of age. INTERVENTIONS: Aboriginal Health Workers from eight Aboriginal Community Controlled Health Services in rural, remote and metropolitan areas in New South Wales recruited Aboriginal families with young children to participate in the Smiles not Tears dental education program. A convenience sample of Aboriginal children from the same communities was recruited to form a historical control group. MAIN OUTCOME MEASURES: The caries prevalence at 30 months of age compared to children of a similar age in the control group. RESULTS: More children in the test group were caries free (n =104; 97.2%) when compared to the historical control group (n = 54; 65.9%). Only three children in the test group had caries which is less than the control group (n = 29). CONCLUSION: These results suggest that the Smiles not Tears dental education program has a positive impact on reducing the caries prevalence in young Aboriginal children.

Rural placement experiences in dental education and the impact on professional intentions and employment outcomes-A systematic review.

CONTEXT/INTRODUCTION: The availability of clinical dental services in rural locations is a major concern for many countries as dental care professionals gravitate to work in metropolitan areas. This systematic review examines the literature on Rural Placement Programs within dentistry and their impact on workforce intentions and employment outcomes. The review provides a detailed analysis of the methodological characteristics of the literature, considers the quality of the evidence and compares the outcomes within an international context. MATERIALS AND METHODS: The systematic review identified published literature between 2005 and 2016 from databases including EMBASE, MEDLINE, PubMed, NursingOVID and Cochrane. The PRISMA protocol was adopted for the development of the study, and the Health Gains Notation Framework was implemented to assess the quality of the selected research papers. RESULTS: Eleven studies considering Rural Clinical Placement Programs met the inclusion criteria. The studies were from Australia, South Africa, United States, Thailand and India. The evidence in this review indicates that well-designed, financially supported programmes that provide a perceived valuable clinical experience, good supervision and professional support in a rural environment can lead to dental students stating increased intentions to working in a rural location. However, there was a lack of evidence and research into whether these rural intentions result in positive action to take up employment in a rural location. CONCLUSION: The evidence suggests that well-prepared rural clinical placements, which have experienced clinical supervisors, good professional student support from the dental school, provide a valuable clinical experience and are sufficiently funded, can increase intentions to work in a rural location upon graduation. However, there is a lack of evidence in dentistry into whether intentions translate into practitioners taking clinical positions in a rural location. Future research should be planned, which will undertake longitudinal cohort studies to identify factors that have an important influence on rural job choice.

A qualitative study examining the preparedness of dental hygiene students for a service-learning placement in residential aged care.

INTRODUCTION: The aim of this qualitative study was to measure the effect of a specifically designed orientation re-enactment DVD used to facilitate dental hygiene students transition from the classroom to a Residential Aged Care Facility (RACF) service-learning placement with less personal anxiety and more confidence in their role during the placement. METHODOLOGY: Final year students (n = 47) were randomly allocated to one of 17 RACFs on the NSW, Central Coast, Australia. All students were then randomly allocated to a two-group study with the active group assigned to view the DVD prior to their placement. Students who viewed the DVD were asked not to discuss the content with students who were assigned to the control group. Post-placement focus groups were organized, recorded and transcribed verbatim. Data were collated, analysed and unitized into emergent themes. Representative quotes are presented in the results. The study was informed by 4 years of previous quantitative and qualitative process evaluation of the RACF programme. RESULTS: Focus group discussions identified that those students who had seen the DVD reported a shorter timeframe to successfully transition from the classroom to the RACF and stated that the DVD provided them with a realistic expectation of the RACF environment and their role in the placement experience. CONCLUSION: The orientation DVD reduced student anxiety and improved student confidence in their role during the placement by providing a realistic orientation of the RACF environment.

An assessment of the educational value of service-learning community placements in residential aged care facilities.

AIMS: The aim of this study was to determine whether dental hygiene students attending residential aged care facilities (RACFs) during a placement programme gained any knowledge about the oral care of elderly patients and the RACF environment. LOCATION: Aged Care Facilities on the Central Coast of New South Wales, Australia. METHODOLOGY: Final year dental hygiene students undertook a 12-week placement, one day per week, in one of 17 residential aged care facilities on the NSW Central Coast. They were asked to complete pre-placement and post-placement questionnaires, which recorded their knowledge of medical, dental and environmental issues related to older people. The placement questionnaires used five point Likert scales, ranging from strongly agree to strongly disagree, pre- and post-mean scores were produced for each question and P values calculated using a paired t-test. RESULTS: Thirty-three students attended the placement, 26 (79%) completed both the pre- and post-placement questionnaires. Post-placement mean scores as compared to pre-placement mean scores showed significant improvement in student knowledge of medical (P < 0.05) and dental (P < 0.05) conditions specific to the older person and improvement in knowledge (P < 0.05) about the residential aged care facility environment. CONCLUSION: The placement programme enhanced student knowledge across three subject categories; medical and dental conditions of the older person and the structure and services of the residential aged care environment.

The influence of a clinical rural placement programme on the work location of new dental graduates from the University of Sydney, NSW, Australia.

INTRODUCTION: In Australia, as in many other countries there is a disparity in the number of dentists working in rural locations compared with metropolitan areas, and this is a growing problem. The aim of the research was to monitor the location of recent graduates who undertook a rural clinical placement whilst in the final year of Sydney Dental School, to determine whether it influenced their choice of job location. MATERIALS AND METHODS: Students who graduated in 2008 and 2009 were followed up to ascertain their working location. Forty per cent of the 2009 graduates participated in a rural placement during their undergraduate degree and 60% did not. In 2008, none of the students went on a rural placement as the scheme had not been implemented. The Australian Health Practitioner Regulation Agency (AHPRA) internet website was used to find the working location of the graduates. The rural, remote and metropolitan areas (RRMA) classification system was used to classify which areas of Australia were metropolitan, regional, rural and remote zones. RESULTS: The graduates of 2008 and 2009 were followed up in 2011 and 2012 to ascertain their working location. In 2011, 12.7% of the 2008 graduates were employed in a rural location compared to 27.6% of the entire 2009 graduating class. In 2011, of those 2009 graduates who participated in the rural placement programme, 44.8% were working in a rural or remote region compared to 17% of the graduates who did not participate. In 2012, the second follow-up found that 18.6% of the 2008 graduates were working in a rural location compared to 25.9% of all the 2009 graduates. In 2012, 43.3% of the 2009 rural placement participants were found to be working in a rural location compared to 14.9% of the non-participants. CONCLUSIONS: The study followed up recent dental graduates' working locations to provide longitudinal evidence of the influence of an undergraduate rural placement programme on their work choices. It was found that a higher proportion of graduates who participated in the rural placement programme were working in a rural location when compared with those who had not been offered a placement.

Faculty staff and rural placement supervisors' pre- and post-placement perceptions of a clinical rural placement programme in NSW Australia.

INTRODUCTION: Staff views on a rural clinical placement involving 4th year dental undergraduates from the University of Sydney (Australia) were collected in order to monitor whether the programme was feasible and acceptable to the academic Faculty Staff and the rural clinical supervisors. MATERIALS AND METHODS: An evaluation of the rural placement programme was undertaken in 2009 at three rural sites in New South Wales (Australia). Semi-structured pre- and post-placement in person interviews recorded the views of three University Faculty Staff whilst similar data were collected by telephone interviews for three supervising clinicians at the rural clinical sites. Interviews gathered opinions on the organisation, implementation and outcomes of the rural placement programme. RESULTS: Eight qualitative analysis identified themes were specified and included communication, programme duration, effect on students and staff, benefits of the programme, rural intentions, programme sustainability and the success of the programme. Positive pre-placement aspects were potentially good clinical experience, new environment, sharing of knowledge and interaction with a rural community. Negative issues were anxieties about students' clinical ability to offer a service, missing lectures and maintaining clinical training quotas. The post-placement themes were generally positive; staff reported that the students enjoyed the rural community experience, their communication and clinical skills improved. CONCLUSION: According to the staff, the placement programme was feasible and provided acceptable positive clinical and personal development for the students. This research will help educators planning to incorporate a rural clinical programme into a University curriculum.

Reflective folios for dental hygiene students: what do they tell us about a residential aged care student placement experience?

INTRODUCTION: Community-based education programmes provide students with an experiential learning opportunity in a real-life context. The purpose of this study was to examine reflective journals to identify students' experiences and perceived learning during a 12-week placement programme in residential aged care facilities (RACF) on the NSW Central Coast, Australia. METHODOLOGY: All final year dental hygiene students from the University of Newcastle, Australia attended an aged care orientation workshop prior to commencing the RACF student placement programme. Throughout the placement, students were asked to record their educational experiences in reflective journals. Student reflections were based on the 'Gibbs Reflective Cycle', diarising experiences and feelings. Qualitative data was analysed using the constant comparative method and unitised to identify emergent themes. RESULTS: Sixty-seven students completed reflective journals during the placement programme; emergent themes indicated students felt ill-prepared for the placement programme despite attending the orientation workshop. They were apprehensive and nervous prior to commencement of the placement. The general consensus after week 6 was that the placement became a more positive experience where students began to feel comfortable in the RACF environment and residents, and staff started to respond more positively to their presence. Overall, they thought the placement was challenging and confronting, but had improved their skills and knowledge in care of older people and increased their confidence in working with other healthcare professionals. CONCLUSION: The reflective journals provided students with the opportunity to record and reflect on their experience and perceived learning during the placement programme. Student reflections identified negative experiences at the commencement of the placement, suggesting a need for additional orientation prior to the RACF programme.

The dental health of 5 year-old children living in Damascus, Syria.

OBJECTIVE: The aim was to record the dental health of 5 year old Syrian children attending nursery schools in Damascus City and to compare the dmft data with reported parental behaviors in relation to oral health. METHODS: Dental examination criteria were based on those published by WHO. A questionnaire was distributed to the parents of the child participants, which recorded, social information and oral health practices. Chi square tests and multiple logistic regressions were used to determine risk factors for dental caries. RESULTS: The mean dmft was 3.27 (sd 3.71) and 61% of the sample had caries present. Children with poor oral hygiene (p < 0.0001) and not attending a dental clinic for preventive advice (p = 0.001) were at risk for having caries regardless of all variables included in analysis. CONCLUSION: A high proportion of 5 year-olds suffer from dental caries and population based preventive programs should be implemented.

A cross-sectional survey investigating the care of the primary dentition by general dental practitioners working in Japan and England.

OBJECTIVE: To compare treatment decisions about primary dentistry made by Japanese and English general dental practitioners (GDPs). METHOD: Four clinical scenarios were used to ascertain the clinical opinions of GDPs about what treatment to offer a 6-year-old boy with a carious molar. The first and second scenarios were a single distal and a distalocclusal cavity in a vital tooth without pain. The third was a large distal-occlusal cavity in a non-vital tooth without pain. The fourth was large distal-occlusal cavity in a non-vital tooth with pain. The participants were 234 GDPs in Japan and 322 GDPs in England. RESULTS: In the first scenario, 62.2% of Japanese GDPs preferred traditional restorative care compared with 34.7% of English GDPs. In the second scenario, Japanese participants were less likely to offer atraumatic treatment (16.5% vs. 34.9%). In the third scenario, Japanese dentists displayed a greater tendency to open the pulp chamber (55.2% vs. 7.6%). In the final scenario, 71% of Japanese GDPs would open the pulp chamber, whereas 50.3% of English GDPs favoured extraction. CONCLUSION: Japanese and English GDPs differed substantially in their views about the best treatment for a young child with a carious molar.

A longitudinal workforce analysis of a Rural Clinical Placement Program for final year dental students.

BACKGROUND: There is little longitudinal evaluation of rural dental education outreach programs. This longitudinal research investigates the influence of a Rural Clinical Placement Program (RCPP) on workforce outcomes in terms of practice locations for five graduate years from the University of Sydney. METHODS: Work locations for the graduates from 2009-2013 were identified in 2015 and 2017 by rurality, using faculty contact lists, phone calls and online methods. A total of 397 graduate locations were identified out of 404 (98.2%) (267 RCPP participants and 137 non-RCPP participants). Semi-structured questionnaires were used to report on demographic and characteristic data. Univariate and multivariate statistical analyses were utilised to explore associations. RESULTS: Rural Clinical Placement Program participation in 2015 was significantly associated with an increased likelihood of working rurally (PR = 2.16), and almost two times the likelihood of rural retention in the period from 2015 to 2017 (PR = 1.93). In the multivariate analyses, both rural experience prior to the RCPP and pre-placement rural intentions were significant independent predictors of an increased likelihood for rural employment and rural retention. CONCLUSIONS: Participation in the RCPP was associated with increased rural employment and retention. Prior rural experience and pre-placement rural intentions were identified as significant independent predictors of rural employment.

Process evaluation of the midwifery initiated oral health-dental service program: perceptions of pregnant women.

BACKGROUND: Pregnant women in Australia seldom seek dental care and are unaware of its importance. To address these gaps the midwifery-initiated oral health dental service (MIOH-DS) program was comprehensive trialled and found effective. The aim of this study was to undertake a process evaluation of the MIOH-DS using the perspectives of pregnant women who participated in the trial. METHODS: A qualitative research design was utilized, whereby content analysis was undertaken on data from 11 semi-structured interviews with women who participated in the program. RESULTS: All participants were receptive of the MIOH-DS intervention, and found it to be an acceptable intervention that met their needs, and encouraged future positive oral health practices and health-seeking behaviours. They expressed that midwives were an appropriate professional to conduct oral health assessments, education and referrals to affordable dental services. Although some participants were initially apprehensive towards receiving treatment during pregnancy, dental staff members were able to appropriately educate and reassure them during treatment. CONCLUSIONS: The MIOH-DS represents a promising and acceptable intervention strategy for pregnant women to promote their oral health. Findings merit further investigation on whether positive outcomes achieved can be sustained when implemented in other national or international settings similar to the study setting.

Correlates of dental caries in 12-year-old children in Europe: a cross-sectional analysis.

OBJECTIVE: To investigate, from current cross-sectional data, the relationships between dental caries experience of 12-year-old children in 29 countries of Europe and four independent variables: national wealth (GDP), expressed as purchasing power parity (PPP x 1,000US$)/ capita/year; population per active dentist; sugar consumption, expressed as Kg/capita/year; and volume sales of toothpaste, expressed as litres/capita/year. METHOD: Most of the data were abstracted from relevant websites. Information on toothpaste sales was from personal communication and obtainable for 16 countries of Western Europe only. Relationships were examined using Spearman's rank correlation method. RESULTS: Mean DMFT showed a strong negative association with national GDP (rho = -0.729, p < 0.01), whilst toothpaste sales showed a statistically significant positive association with GDP (rho = 0.599, p < 0.05) as did sugar consumption (rho = 0.575, p < 0.01). Paradoxically, caries experience yielded a strong negative correlation with sugar consumption (rho = -0.561, p < 0.01) such that ranked increases in mean DMFT were significantly associated with decreasing levels of sugar consumption. None of the other rank correlations was statistically significant. CONCLUSIONS: Unavoidable shortcomings of the available data and their incompleteness meant that any conclusions that could be drawn were speculative. A possible explanation for the anomalous association of low mean DMFT with high sugar consumption in Western Europe is that the extensive use of, mainly fluoride containing, toothpaste neutralises the potential damage from high sugar consumption. Use of sugar principally as a commercial food or drink additive in modern times, with potential for buffering of its acidic fermentation products, together with a possibly more rapid oral clearance of sugar in additive form, may also be a contributory factor.

The occurrence of dental pain and extractions over a 3-year period in a cohort of children aged 3-6 years.

OBJECTIVES: To describe the occurrence of dental pain and extractions in young children in relation to the caries and restoration history of their primary molar teeth. METHODS: A prospective cohort study of 739 children aged 2.8 to 6.2 years attending 50 dental practices in the North West of England followed for 3 years. Incidence rates for pain and extraction in primary molar teeth were calculated for children with and without dental caries. Tooth years at risk of extraction or pain were calculated for each primary molar according to whether they were caries-free, carious and unrestored, or restored. RESULTS: A total of 119 (16.1 percent) children had caries at recruitment and 157 developed caries during follow-up. Each year approximately one in five children with caries, but only one in 100, who was caries-free, presented with dental pain. In the whole population, each year, approximately one in 40 children had a primary molar tooth extracted but in children with caries it was one in 10. In the total cohort, incidence.of pain was higher in unrestored carious teeth than restored, but incidence of extraction was higher in restored than in unrestored teeth. CONCLUSION: The majority of children attending general dental practice remained caries-free and did not experience pain or extraction over 3 years. Children with caries had a substantial risk of developing pain or having an extraction. The study was unable to demonstrate that restoring carious primary molar teeth prevents pain and extraction.

Psychological stress and health in undergraduate dental students: fifth year outcomes compared with first year baseline results from five European dental schools.

UNLABELLED: Psychological stress in undergraduate dental students: fifth year outcomes compared with first year baseline results from five European dental schools. OBJECTIVE: To compare the levels of a series of health-related indicators from a cohort of fifth year dental students from five European schools with their first year scores, and to investigate the relationship between these follow-up measures. METHODS: Burnout was measured using the Maslach Burnout Inventory (MBI), consisting of three scales: Emotional Exhaustion (EE, alpha = 0.90), Depersonalisation (alpha = 0.80) and Personal Accomplishment (alpha = 0.72). Physical health was measured by the Physical Symptoms Questionnaire (alpha = 0.82), psychological distress was measured using the General Health Questionnaire (GHQ, alpha = 0.89) and student stress was captured using seven subscales of the Dental Environment Stress questionnaire (DES, alpha = 0.92). A total of 132 fifth year students responded from five dental schools (Manchester, Belfast, Cork, Helsinki and Amsterdam), a 51% response. RESULTS: Fifth year students showed relatively high mean MBI scores when compared with first year results, especially on EE; 39% could be labelled 'high scorers'; 44% of the students met the criteria for 'cases' on the GHQ. Highest mean scores on the DES were obtained on the subscales: Study Obligations, Patient-Related Aspects and Study Pressure respectively. Between schools interesting differences were detected on all variables. As hypothesised, a clear direct effect of stress on both burnout and physical symptoms was shown. An indirect effect of stress on mental health via burnout was shown. CONCLUSIONS: Dental students showed a negative development through the years from first to fifth year with regard to EE and psychological distress. Both burnout constructs related to physical and mental health. It is recommended that dental faculty focus on the importance of prevention and intervention of stress amongst undergraduates.

Testing the effect of including oral health in general health checks for elderly patients in medical practice--a randomized controlled trial.

AIM: To test the feasibility and effectiveness of an oral health referral process for elderly patients (aged 75 years or over) attending a preventive health check (PHC) with their general medical practitioner. OBJECTIVES: To evaluate the effectiveness of the process in increasing dental attendance at baseline and 6 months after the intervention. To identify key characteristics of those who accepted an oral health visit (OHV). To determine the proportion of people attending the OHV who required treatment and subsequently attended a dentist. SETTING: Three general medical practices in east Cheshire, UK. DESIGN: A randomized controlled trial. METHOD: Elderly patients attending their general medical practice for PHCs were randomly assigned to a test group, who were invited to attend for an OHV, and to a control group, who received no intervention. Six months after the PHC the effectiveness of the process was measured. RESULTS: Some 50% of those invited for an OHV accepted. Those accepting were more likely to be edentulous, wear dentures or have a current oral health problem, than those declining. Regression analysis showed the best predictors of acceptance to be having a current dental problem or pain and not having a regular dentist. The mean time since their last dental visit was 8.1 years which was significantly longer than those declining the OHV. 63% of individuals attending the OHV were assessed as having a realistic treatment need and 70% of those referred went on to complete the course of treatment. In the test group a highly significant increase in reported dental visiting was found at sixth month evaluation. The primary care staff were happy to include the dental checklist and felt it was a valuable addition to the PHC. CONCLUSIONS: The offer of an OHV was taken up most readily by those with current oral problems, or pain and those with no regular dentist. The inclusion of a dental checklist within the PHC for elderly patients together with help with arranging a dental appointment shows promise as a way of ensuring the dental needs of this group are met.

The prescription and outcomes of fissure sealants applied to a group of high caries risk children by general dental practitioners working in the North West of England.

OBJECTIVE: To describe the use and outcomes of fissure sealants applied to the first permanent molars (FPMs) of children with high caries risk. DESIGN: Retrospective cohort study. SETTING: General dental practices in North West England. PARTICIPANTS: 677 children between the ages of 5 and 14 years who had dmfs > or =2, and regularly attended 50 general dental practitioners. OUTCOMES: Analyses were performed at patient level. Logistic regression models, taking into account the clustering of subjects within dental practices, were fitted to identify whether the decision to fissure seal FPMs was significantly associated with gender, socio-economic status, number of carious primary teeth and percentage of carious primary teeth filled. Similar logistic regression models were fitted for caries experience in FPMs. RESULTS: Poorer children were significantly (p < 0.05, OR = 0.84, 95% CI = 0.71, 0.99) less likely to receive fissure sealants than affluent children, whilst girls (p < 0.01, OR = 1.54, 95% CI = 1.12, 2.12) were more likely to have sealants than boys. The total number of carious primary teeth was also a significant (p < 0.01, OR = 1.15, 95% CI = 1.06, 1.25) independent predictor of dentists' decisions to fissure seal FPMs. For each carious primary tooth, the odds of having caries in FPMs increased by 1.16 (95% CI = 1.06, 1.26). Analysis showed that pit and fissure caries in FPMs was not affected by the presence or absence of fissure sealants. CONCLUSIONS: The decision to fissure seal FPMs is affected by caries experience in the primary dentition. Girls and affluent children were more likely to receive fissure sealants. It appears that the placement of fissure sealants by general dental practitioners was not effective in preventing pit and fissure caries in these high-risk children.

A comparison of two models of dental care for Aboriginal communities in New South Wales.

BACKGROUND: Aboriginal people, and particularly those in rural areas, continue to suffer very high levels of dental disease despite significant reductions in the wider Australian population in the past 30 years. Until recently, there has been a shortage of oral health clinicians and the majority have provided care in major cities. The NSW Government funded various models of care for rural and regional areas and vulnerable population groups including Aboriginal people. This study utilizes a comparative retrospective analysis to compare two models of oral health care for Aboriginal people including those living in rural NSW to inform future policy decisions. METHODS: Two models (Model A - Fly in Fly out and Model B - Collective impact) of public oral health care for Aboriginal patients in NSW were examined using publicly available descriptive information. Two years of funding and Dental Weighted Activity Units (DWAUs) data were analysed for the two different models and regression analysis was used to compare the trends of monthly time series of DWAUs. CONCLUSIONS: Based on the standardized national weighted pricing for public dentistry, model B offers significantly more services for less financial resources.

The effectiveness of school dental screening: a cluster-randomized control trial.

Dental screening of children in schools is undertaken in many countries. There is no evidence that this activity is effective. The objective of our study was to determine if school dental screening of children reduces untreated disease or improves attendance at the population level. A four-arm cluster-randomized controlled trial was undertaken in the northwest of England. In total, 16,864 children aged 6-9 years in 168 schools were randomly allocated to 3 test groups, which received screening according to different models, and a control, which received no intervention. There were no significant differences in caries increment in the primary and secondary dentitions or in the proportions of children attending a dentist after screening between the control group and the 3 intervention arms. School dental screening delivered according to 3 different models was not effective at reducing levels of active caries and increasing attendance in the population under study.

A survey of school dental screening practise in community dental services of England and Wales in 2003.

OBJECTIVE: To describe the school dental screening process in Community Dental Services across England and Wales. BASIC RESEARCH DESIGN: Cross-sectional study using a postal questionnaire. CLINICAL SETTING: Community Dental Services. PARTICIPANTS: Clinical Directors of Community Dental Services in England and Wales. MAIN OUTCOME MEASURES: Respondents answers about the objectives of school dental screening, criteria used for referring a child, methods of informing parents of screening results, and methods used to confirm subsequent dental attendance. RESULTS: The response rate for this study was 92.1%. Respondents identified dental registration (75.2%) and attendance at a dentist (82.9%) as objectives of school dental screening. Less than one third (29.5%) saw the activity as having a preventive role. Caries in the primary and secondary dentitions and soft tissue lesions were reported as key criteria for referral. Methods of follow-up of screened positive children differed and were often inadequate; approximately one third of respondents used a letter carried home by the child that did not allow parents to inform the CDS of action taken. Half of the respondents routinely collected data on the number of screened positive children who subsequently visit a dentist. CONCLUSIONS: School dental screening is delivered in a similar fashion throughout England and Wales but methods of informing parents of a positive screen and follow-up mechanisms for children with positive screens vary. Most school dental screening programmes do not collect sufficient data to evaluate the impact of their programmes on children's oral health.

Salaried services in the delivery of dental care in Western industrialised countries: implications for the National Health Service in England.

OBJECTIVE: To examine the provision of dental services by salaried personnel in the countries of Western Europe, together with Australia, Canada and New Zealand, and to weigh the merits of this method against alternatives, namely, capitation and fee for item of service. In light of the findings, to consider the future role of salaried dental services in the National Health Service (NHS) in England. METHOD: Information was gathered from published reports, the World Wide Web and by mailed questionnaire to national chief dental officers or equivalents. RESULTS: Narrative descriptions of service provision in the countries with salaried primary dental care services were compiled. Demographic, macro-economic, workforce, and oral health data for the broader spectrum of Western industrialised countries were tabulated. Examination of the quantitative data showed no strong associations between variables. CONCLUSIONS: Dental services delivered by a salaried workforce can be costly in relation to the volume of clinical activity produced. However, deployment of clinical auxiliary personnel can keep costs down. Salaried services foster a preventive approach to care and are particularly suitable where care is directed towards vulnerable groups within the community. Salaried staff generally receive a lower level of remuneration than private practitioners but usually work in an environment less subject to undue pressures of time.