Powered toothbrushes and toothbrushing resistance in young children: a qualitative content analysis of an online parenting forum.

BACKGROUND: Powered toothbrushes are an effective alternative to manual toothbrushes. Previous research found parents view powered toothbrushes as fun and motivating, although are less confident using them when children demonstrate resistant behaviour. Resistant child behaviour is a recognised barrier to achieving parental supervised brushing. Parents discuss strategies to address toothbrushing resistance on online parenting forums. OBJECTIVE: To explore how those posting on an online parenting forum discuss powered toothbrushes as a potential solution to toothbrushing resistance in young children. DESIGN: Qualitative content analysis of threads retrieved from the UK parenting forum Mumsnet. RESULTS: The Mumsnet sub-forums 'Behaviour/Development', 'Parenting' and 'Children's Health' were searched in April 2022. 204 relevant threads on toothbrushing resistance were identified and analysed. A further search of these threads identified posts on powered toothbrushes, yielding a sub-sample of 245 posts from 111 threads (of which 97 focused on resistant behaviour from a child/children aged under three). A coding frame was developed and included six categories: use of powered toothbrushes, descriptions of toothbrushes, positive aspects, reasons for not using, approaches to using, and discussions on Mumsnet. Posters suggested powered toothbrushes as a solution to toothbrushing resistance. Posters use Mumsnet to discuss the appropriateness of powered toothbrushes for young children. CONCLUSIONS: Powered toothbrushes offer a potential solution to toothbrushing resistance. Discussions on parenting forums can normalise the use of powered toothbrushes with under-threes. Further research on how parents and dental professionals use and recommend using powered toothbrushes with under-threes would be useful.

The oral health of adults with learning disabilities: A secondary analysis of the Adult Dental Health Survey 2009.

OBJECTIVES: Adults who have learning disabilities are a vulnerable group, little is known about their oral health and how this affects their quality of life. The aims of this secondary analysis of data from the 2009 Adult Dental Health Survey (ADHS) were to describe the oral health status of adults with learning disabilities, determine if severity of learning disability is associated with oral health and identify some of the methodological complexities of working with this population. The survey yields the most recent representative data on the oral health of adults with learning disabilities in England and importantly, contains information about oral health related quality of life (OHRQoL). BASIC RESEARCH DESIGN: Secondary analysis of data from a supplemental survey of adults with learning disabilities collected alongside the 2009 ADHS. PARTICIPANTS: 607 participants with a diagnosed learning disability aged 18 years and over. RESULTS: Adults with learning disabilities had similar levels of active dental caries, fewer natural teeth, and fewer fillings than comparable participants from the general population. Self-reported oral and general health were worse for adults with learning disabilities than the general population. Possible associations between the severity of learning disability and the numbers of decayed, missing or filled teeth were identified. However, large amounts of missing data limited the analysis. CONCLUSIONS: There are important questions relating to the accessibility of existing self-reported oral health questionnaires and the reliability of proxy-reported questions about OHRQoL that should be addressed to give a fuller picture of the oral health of adults with learning disabilities.

Effectiveness of strategies to increase participation in school-based epidemiological surveys: a rapid review.

OBJECTIVE: Rapid review of the literature on strategies to increase participation rates in school-based epidemiological surveys. BASIC RESEARCH DESIGN: Rapid review. MEDLINE and Embase databases were searched for articles written in English from 2000 onwards. Synthesised evidence and primary research were included as data sources from peer reviewed journals and reports. INTERVENTIONS: Any strategy aiming to increase participation in school-based health surveys. The comparator was usual procedure or an alternative strategy to increase participation. MAIN OUTCOME MEASURES: Primary outcomes included participation and consent rates. Secondary outcomes were feasibility, acceptability and adverse effects. RESULTS: The search identified 591 unique records, of which 587 were excluded. Four studies were suitable for inclusion, including one systematic review, one randomised controlled trial, one cross-sectional study and one retrospective analysis. Based on very low certainty evidence, recommendations for maximising participation rates in one systematic review of US studies included: promoting the survey to school staff, parents and students; disseminating study information using direct rather than mediated methods; offering incentives to schools, staff and participants; following up non-responders; and employing a research team member to co-ordinate and monitor recruitment. However, UK studies found that different strategies did not increase participation more than that achieved by a standard approach (delivery of covering letter/consent forms via the child with no follow-up of non-responders). CONCLUSION: Given the lack of evidence of effectiveness of alternative strategies in the UK, additional measures beyond existing standard approaches for active consent cannot be recommended.

Adolescent valuation of CARIES-QC-U: a child-centred preference-based measure of dental caries.

OBJECTIVES: This study develops an adolescent value set for a child-centred dental caries-specific measure of oral health-related quality of life (OHRQoL) based upon CARIES-QC (Caries Impacts and Experiences Questionnaire for Children). This study develops a new approach to valuing child health by eliciting adolescent preferences and anchoring these onto the 1-0 full health-dead QALY (quality adjusted life year) scale using ordinal adult preferences. METHODS: Two online surveys were created to elicit preferences for the CARIES-QC classification system. The first comprised best-worst scaling (BWS) tasks for completion by adolescents aged 11-16 years. The second comprised discrete choice experiment tasks with a duration attribute (DCETTO) for completion by adults aged over 18 years. Preferences were modelled using the conditional logit model. Mapping regressions anchored the adolescent BWS data onto the QALY scale using adult DCETTO values, since the BWS survey data alone cannot generate anchored values. RESULTS: 723 adolescents completed the BWS survey and 626 adults completed the DCETTO survey. The samples were representative of UK adolescent and adult populations. Fully consistent and robust models were produced for both BWS and DCETTO data. BWS preferences were mapped onto DCETTO values, resulting utility estimates for each health state defined by the classification system. CONCLUSION: This is the first measure with predetermined scoring based on preferences to be developed specifically for use in child oral health research, and uses a novel technique to generate a value set using adolescent preferences. The estimates can be used to generate QALYs in economic evaluations of interventions to improve children's oral health.

Anticipatory guidance and children's oral health: A scoping review.

BACKGROUND: Anticipatory guidance (AG) involves providing parents with information about developmental milestones and promoting optimal development. Oral AG was first introduced as a comprehensive approach to provide age-appropriate oral health information and preventive interventions. The literature regarding this important topic has not yet been reviewed and summarised. AIM: To describe the literature on AG provided to parents about their children's oral health and identify gaps in the current research. METHOD: The scoping review mapped the existing peer-reviewed and guideline documents about AG and children's oral health using the framework established by Arksey and O'Malley (2005) and modified by Levac et al. (2010). Firstly, we defined our research questions and searched the literature using Medline, Web of Science and Scopus. Secondly, we selected all types of literature and then applied the inclusion and exclusion criteria, and finally, we analysed and summarised the information using thematic analysis. RESULTS: Forty-three peer-reviewed articles and six guidelines were included. There was variation in how AG was described and defined. While some studies have evaluated the effectiveness of AG, most have investigated its short-term effectiveness only, with few interventional studies assessing this approach in the long-term. CONCLUSION: While the concept of AG shows promise, there is no consensus within the current literature on a defined definition and there is a lack of long-term evaluation.

"Strong Teeth": an early-phase study to assess the feasibility of an oral health intervention delivered by dental teams to parents of young children.

BACKGROUND: Tooth decay (caries) is a significant health burden in young children. There is strong evidence for the benefits of establishing appropriate home-based oral health behaviours in early childhood. Dental teams are well placed to provide this information and there is clear advice on what oral health information should be given to parents. However, research has shown that there is limited guidance, training and resources on how dental teams should deliver this advice. "Strong Teeth" is a complex oral health intervention, using evidence-based resources and training underpinned by behaviour change psychology, to support behaviour change conversations in dental practice. This early phase evaluation aims to assess the feasibility of this intervention, prior to a full-scale trial. METHODS: The study recruited 15 parents of children aged 0-2-years-old and 21 parents of children aged 3-5 years old, from five NHS dental practices across West Yorkshire. Participant demographics, self-reported brushing behaviours, dietary habits, a dental examination and three objective measures of toothbrushing were collected in a home-setting at baseline, then at 2-weeks and 2-months post-intervention. Recruitment, retention and intervention delivery were analysed as key process outcomes. Brushing habits were compared to national toothbrushing guidelines - the Delivering Better Oral Health toolkit (Public Health England). RESULTS: Strong Teeth was feasible to deliver in a General Dental Practice setting in 94% of cases. Feasibility of recruitment (37%) exceeded progression criterion, however retention of participants (75%) was below the progression criterion for the 0-2 age group. More than half of children recruited aged 3-5-years had caries experience (52%). Total compliance to toothbrushing guidance at baseline was low (28%) and increased after the intervention (52%), an improvement that was statistically significant. Dietary habits remained largely unchanged. Plaque scores significantly decreased in the 3-5-year-olds and toothbrushing duration increased in all age groups. CONCLUSION: "Strong Teeth" intervention delivery and data collection in the home setting was feasible. There was a positive indication of impact on reported toothbrushing behaviours. Some amendments to study design, particularly relating to the inclusion of the 0-2-year-old group, should be considered before progression to a full trial. Trial registration ISRCTN Register: ISRCTN10709150. Registered retrospectively 24/7/2019.

Socioeconomic Variation in the association between Malocclusion and Oral Health Related Quality of Life.

OBJECTIVES: Oral health related quality of life (OHRQoL) has been linked to malocclusion. We aimed (a) to investigate the association between malocclusion and OHRQoL among children, and (b) to examine whether this association varied by socioeconomic status. METHODS: Cross-sectional analysis of data for 4,217 children aged 12 & 15 years, who participated in the 2013 Children Dental Health Survey (CDHS); a nationally representative survey of children in England, Wales, and Northern Ireland. Malocclusion was determined using the modified Index of Orthodontic Treatment Need (IOTN). OHRQoL was measured using the Child Oral Impacts on Daily Performance (Child-OIDP). For socioeconomic status, we used the pupils' eligibility for free school meals (FSM) and Index of Multiple Deprivation (IMD). Adjusted marginal effects were estimated controlling for confounding variables. Separate analyses were carried out for the two age groups. RESULTS: Malocclusion was associated with 6% and 15% increases in the probability of reporting negative impact of OHRQoL for 12- and 15-year olds respectively, which was significant for 15-year olds (marginal effect=0.15, 95% CI=0.08-0.22). Malocclusion was associated with the prevalence of oral impacts for 12 year olds (marginal effect=0.1, 95% CI=0.02-0.17) and 15-year olds (marginal effect=0.2, 95% CI 95%=0.13-0.28) not eligible for FSM and for 15-year olds in the most (marginal effect=0.2, 95% CI=0.1-0.29) and least (marginal effect=0.26, 95% CI=0.13-0.4) deprived IMD quintiles. CONCLUSIONS: Malocclusion was associated with impacts on OHRQoL for 15-year olds. There was evidence of a relationship between SES, malocclusion and OHRQoL.

A systematic review of the quality and scope of economic evaluations in child oral health research.

BACKGROUND: Economic evaluations provide policy makers with information to facilitate efficient resource allocation. To date, the quality and scope of economic evaluations in the field of child oral health has not been evaluated. Furthermore, whilst the involvement of children in research has been actively encouraged in recent years, the success of this movement in dental health economics has not yet been explored. This review aimed to determine the quality and scope of published economic evaluations applied to children's oral health and to consider the extent of children's involvement. METHODS: The following databases were searched: CINAHL, Cochrane Library, Econlit, EThOS, MEDLINE, NHS EED, OpenGrey, Scopus, Web of Science. Full economic evaluations, relating to any aspect of child oral health, published after 1997 were included and appraised against the Drummond checklist and the Consolidated Health Economic Evaluation Reporting Standards by a team of four calibrated reviewers. Data were also extracted regarding children's involvement and the outcome measures used. RESULTS: Two thousand seven hundred fifteen studies were identified, of which 46 met the inclusion criteria. The majority (n = 38, 82%) were cost-effectiveness studies, with most focusing on the prevention or management of dental caries (n = 42, 91%). One study quantified outcomes in Quality Adjusted Life Years (QALYs), and one study utilised a child-reported outcome measure. The mean percentage of applicable Drummond checklist criteria met by the studies in this review was 48% (median = 50%, range = 0-100%) with key methodological weaknesses noted in relation to discounting of costs and outcomes. The mean percentage of applicable CHEERS criteria met by each study was 77% (median = 83%, range = 33-100%), with limited reporting of conflicts of interest. Children's engagement was largely overlooked. CONCLUSIONS: There is a paucity of high-quality economic evaluations in the field of child oral health. This deficiency could be addressed through the endorsement of standardised economic evaluation guidelines by dental journals. The development of a child-centred utility measure for use in paediatric oral health would enable researchers to quantify outcomes in terms of quality adjusted life years (QALYs) whilst promoting child-centred research.

Review and action plan for oral health improvement in Sheffield special schools.

A description of the process of a review of oral health improvement in special schools in Sheffield and the implementation of an action plan for these activities. Public health competencies encompassed: assessing the evidence on oral health and dental interventions, programmes and services; strategic leadership and collaborative working for health; oral health improvement.

The oral health of people with learning disabilities - a user-friendly questionnaire survey.

IMPETUS FOR ACTION: To conduct a user-friendly questionnaire survey of the oral health and service needs of adults with learning disabilities. SOLUTION: Researchers collaborated with local self-advocacy services to develop a questionnaire adapted from one used in a regional postal survey. The questionnaire, which covered dental status, oral health and dental services use, was sent to a random sample of people from the learning disability case register. OUTCOME: Of 2,000 questionnaires mailed, 117 were returned undelivered and 625 were completed (response rate 31.3%). The self-reported dental status of people with learning disabilities appeared similar to that of the 2008 postal survey of the general population in Sheffield. The major difference in dental status was 11.5% of people with learning disabilities wore upper dentures and 7.2% wore lower dentures, compared to 21.2% and 12.1% of the general population in Sheffield. CHALLENGES: Using the case register as a recruitment instrument may have excluded people with learning disabilities not registered. Time and finances only permitted one mailing. Analysis on the basis of deprivation could not be conducted. FUTURE IMPLICATIONS AND LEARNING POINTS: Contrary to current practice, it is possible to include people with learning disabilities in oral health surveys. A multidisciplinary team was essential for enabling the progression and implementation of inclusive research and for people with learning disabilities and their supporters to engage meaningfully. This level of collaboration appears necessary if we are committed to ensuring that people with learning disabilities and their supporters are made visible to policy and decision-makers.

Access to urgent dental care: a scoping review.

OBJECTIVE: To summarise the literature on urgent dental care and to identify research priorities on the organisation and delivery of urgent dental services. BASIC RESEARCH DESIGN: Scoping review using Andersen's behavioural model of health service utilisation for a framework analysis of the data. MAIN OUTCOME MEASURES: Gaps in the literature, defined as those factors and interactions identified by Andersen's model as having a contributory role in access to health services that were not evident in the source papers. RESULTS: Fifty-six papers met the inclusion criteria for the review. The factors most often considered were; demographic, socioeconomic, perceived and evaluated need, and health behaviours. Patient outcomes of evaluated health and quality of life following urgent dental care were the least studied variables, with the exception of patient satisfaction. No studies were identified on community values/norms of people accessing urgent dental care, on health economic evaluations or on studies of how urgent dental services mitigate use of other medical services. No studies were identified on urgent need for populations living in water fluoridated areas or on the relationship between service design and efficient or effective access as measured by patient outcomes. CONCLUSION: Future research on patient outcomes and the comparison of different service models for urgent dental care through measures of equity, effectiveness and efficiency of access are needed to inform future policy and organisation of these services.

A scoping review of the uses of the care index in children.

OBJECTIVE: To conduct a scoping review of literature to describe how the care index (CI) and restorative index (RI) are used in child populations and to determine whether they are fit for purpose. BASIC RESEARCH DESIGN: Scoping review conducted using the Arksey and O'Malley (2005) framework. METHOD: Electronic and manual literature searches (1980-2015) were conducted. Titles and abstracts were screened, full-texts of potential studies were reviewed two reviewers extracted data independently, followed by data charting and summarising. RESULTS: Out of 104 articles meeting all criteria, most were cross-sectional (92%), and 56% were conducted in UK and Brazil. Most commonly (63%) studies used CI and RI to obtain epidemiological data on dental care levels. Of the studies that defined CI and RI, most used and specified the standard definition. The CI and RI scores varied either due to patient related factors such as age, gender or dental care related factors including, cost of treatment and method of provider remuneration. CONCLUSION: Overall, it is recommended that future studies should clearly state the definitions and thresholds used to obtain CI and RI, which would enable comparison between communities and allow temporal trends to be studied. Additionally, deriving separate CI and RI scores for groups based on caries extent would help to highlight inequalities in the provision of care. Further research is needed to explore the applicability of CI and RI to changing approaches to caries management with current care recommendations emphasising on minimal treatment and secondary prevention.

The dental public health implications of cosmetic dentistry: a scoping review of the literature.

INTRODUCTION: The popularity of cosmetic surgery has seen a rapid increase recently, with the trend mirrored in dentistry. The Department of Health expressed concerns about the potential for biological and psychosocial harm of these cosmetic procedures. Furthermore, the dental public health implications (DPH) of the growing uptake of cosmetic dental procedures have not been explored. OBJECTIVES: Conduct a scoping review to explore the DPH implications of cosmetic dentistry and identify gaps for future research. METHODS: A fivestage scoping review was conducted of studies identified using the search terms cosmetic AND dentistry. Data from the studies meeting the inclusion criteria were extracted, collated and summarised into themes. RESULTS: Fifty-seven papers met the inclusion criteria (11 cross-sectional studies, 10 literature reviews and 36 opinion pieces). The DPH implications were summarised into five emergent themes: dento-legal and ethical, marketing, psychosocial, biological and workforce. These themes revealed patients' increased expectations, expanding commercialisation of the profession, psychological risks to vulnerable patients, the iatrogenic consequences of invasive cosmetic dental procedures and workforce implications of the current trends. CONCLUSIONS: The scoping review found that existing literature on cosmetic dentistry is predominately anecdotal - professional opinions and discussions. Despite this, our findings demonstrated workforce training and governance implications due to increased demand for cosmetic dentistry. Further empirical research is needed to understand the DPH implications of the increasing demand and uptake of cosmetic dental procedures to guide evidence-based policy to safeguard patients and improve the quality of dental services.

Evaluation of the telephone and clinical NHS urgent dental service in Sheffield.

OBJECTIVE: Evaluate an NHS in- and out-of-hours urgent dental service (UDS) including both a telephone triage provider (TTP) and a sole clinical provider (CP) using a quality framework. BASIC RESEARCH DESIGN: Analysis of activity and patient experience data. MAIN OUTCOME MEASURES: Ratio of volume of services to activity provided; distance and time travelled; appropriateness of referrals and treatments; equity of utilisation; patient experience; cost per patient. RESULTS: Almost all calls (96.6%) to the TTP were answered within 60 seconds and of people referred to the CP 96.0% needed treatment. Proportionately more people from deprived areas used the TTP. Highest utilisation of the TTP was by people aged 20 to 44 years and lowest was by people over 54 years. Cost per patient utilising the TTP was £5.06. Of the available appointments provided by the CP, 90.9% were booked the TTP. Travel time to the CP was less than 30 minutes for 78.0% of patients. Of treatments provided, 77.9% were clinical interventions and 18.1% were prescription only. Proportionately more people from deprived areas attended the CP. Highest utilisation was by people aged 20 to 44 years and lowest by people over 54 years. Nearly half (47.0%) of those attending reported they did not have a dentist. There was a high level of patient satisfaction. Cost per course of treatment at the CP was £67.41. CONCLUSION: Overall the UDS provided a high quality service in line with Maxwell's dimensions of quality. Timely advice and treatment was provided with high levels of patient satisfaction with the CP. Comparison with other urgent dental service models would determine the relative efficiency of the UDS.

What are the most accurate predictors of caries in children aged 5 years in the UK?

OBJECTIVE: To find the most accurate indicators of the distribution of dental caries in 5-year-olds in the city of Sheffield, UK, using a conceptual framework based on the social determinants of health. METHOD: A list of structural and intermediary indicators was compiled based on the Commission on the Social Determinants of Health's (CSDH) conceptual framework. To quantify these indicators, existing data on dental caries were obtained from the NHS Dental Epidemiology Programme, while data on social position, education, employment, income, material circumstances, social cohesion, psychosocial factors and individual behaviours were obtained from the Public Health Intelligence Team at Sheffield City Council. These data were mapped onto a simplified framework of the social determinants of dental caries. Regression analysis was conducted on this simplified framework to determine the amount of variance each indicator contributed to the distribution of dental caries at neighbourhood level. RESULTS: The total score for the 2010 Index of Multiple Deprivation contributed a significant amount of variance (60.4%) compared to the combined variance of the other 13 indicators (70.5%). CONCLUSION: The total IMD score has the potential to be used as an indicator for the targeting of oral health improvement programmes where survey data are not available. A large prospective study is required in the UK to investigate the full range of factors in the CSDH model to develop a new index which might better predict dental caries experience than IMD.

The self-reported oral health status and dental attendance of smokers and non-smokers.

AIM: To report the oral health status and dental attendance of smokers and non-smokers. METHODS: A postal survey enquiring about smoking status, stop smoking advice, dental attendance and perceptions of oral health was conducted in Yorkshire and the Humber, U.K., in 2008. To address potential biases data were weighted to account for variations in gender, age and deprivation. Data were analysed using descriptive statistics, chi-square tests and binary logistic regression. RESULTS: A response rate of 43.1% was achieved (n=10,864). Across all deprivation quintiles, smokers (17.5% of respondents) were more likely than non-smokers to report fair, poor or very poor oral health (p<0.001). Smokers in the least deprived areas were more likely than non-smokers to attend the dentist symptomatically (p<0.001). Advice to quit was most frequently gained from GP services followed by NHS Stop Smoking Services and dental teams. CONCLUSIONS: Smokers were more likely than non-smokers to have a poor self-rated oral health status and attend the dentist symptomatically, irrespective of deprivation.

Psychosocial predictors of children's oral health-related quality of life during transition to secondary school.

PURPOSE: Dental conditions have the potential to impact negatively on children's oral health-related quality of life (OHRQoL). However, little attempt has been made to investigate how psychosocial variables and significant life events affect children's OHRQoL. This research aimed to explore how children's dental status, coping, and self-esteem influenced OHRQoL during transition to secondary school. METHODS: All patients were undergoing treatment at a UK Dental Hospital. Self-report questionnaires obtained psychosocial data on self-esteem, coping styles and OHRQoL and were completed by children 3 months prior to secondary school entry and 3 months following educational transition. Data were extracted from the clinical records of the paediatric patients who agreed to participate in the research. RESULTS: A total of 92 children aged between 10 and 11 years participated at baseline (43% response rate) and 71 of these children participated in the follow-up investigation (77% response rate). Multiple lagged regression analyses revealed that clinical variables and children's self-perception of their physical appearance were significant predictors of OHRQoL following transition to secondary school. CONCLUSIONS: Children who were satisfied with their physical appearance reported fewer impacts on their OHRQoL. The mechanisms through which this domain of self-esteem impacts on OHRQoL warrants further investigation.

A service evaluation of patient pathways and care experiences of dentally anxious adult patients.

OBJECTIVE: To investigate the current patient pathways used by dentally anxious adults in Sheffield and identify how the patient experience could be improved. DESIGN: Questionnaires gathered stakeholder perceptions of referral pathways and services for dentally anxious adult patients. Completed questionnaires were returned by 113 dentally anxious patients who had engaged with specialised dental services and 111 general dental practitioners (GDPs) (28% and 52% response rates). RESULTS: The recommendations for improving dental care experience of the anxious were: increased guidance and information to GDPs regarding available care pathways; improved availability of psychological services; and more opportunities and choice for patients in the long-term management of dental anxiety. CONCLUSIONS: The findings from the service evaluation suggest ways in which dental services could be developed to improve the care experiences of dentally anxious adult patients.

HABIT: Health visitors delivering Advice in Britain on Infant Toothbrushing - an early-phase feasibility study of a complex oral health intervention.

OBJECTIVES: To conduct an early-phase feasibility study of an oral health intervention, Health visitors delivering Advice on Britain on Infant Toothbrushing (HABIT), delivered by Health Visitors to parents of children aged 9-12 months old. DESIGN: A mixed-methods, early-phase, non-controlled, feasibility study. PARTICIPANTS: Recruitment consisted of Group A-HABIT-trained Health Visitors (n=11) and Group B-parents of children aged 9-12 months old about to receive their universal health check (n=35). SETTING: Bradford, West Yorkshire, UK. INTERVENTION: A multidisciplinary team co-developed digital and paper-based training resources with health visitors and parents of young children. The intervention comprised of two components: (A) training for health visitors to deliver the HABIT intervention and (B) HABIT resources for parents, including a website, videos, toothbrushing demonstration and a paper-based leaflet with an oral health action plan. PRIMARY AND SECONDARY OUTCOME MEASURES: Recruitment, retention and intervention delivery were analysed as key process outcomes for Groups A and B. Group B demographics, self-reported toothbrushing behaviours, dietary habits and three objective measures of toothbrushing including plaque scores were collected at baseline, 2 weeks and 3 months post intervention. RESULTS: HABIT intervention delivery was feasible. Although the intended sample size was recruited (Group A=11 and Group B=35) it was more challenging than anticipated. Retention of Group B participants to final data collection was satisfactory (n=26). Total compliance with toothbrushing guidelines at baseline was low (30%), but significantly improved and was maintained 3 months after the intervention (68%). Plaque scores improved post intervention and participants found video recording of toothbrushing acceptable. Dietary habits remained largely unchanged. CONCLUSION: This feasibility study has demonstrated that HABIT is an appropriate oral health intervention. Adaptions to the study design are recommended to maximise recruitment and data collection in a definitive study. These quantitative findings have demonstrated an early signal of impact for improved oral health behaviours for young children at high risk of decay. TRIAL REGISTRATION NUMBER: ISRCTN55332414.

Seeking children's perspectives in the management of visible enamel defects.

AIM: To undertake a child-centred evaluation of treatment provision for visible enamel defects. DESIGN: Postal questionnaires, developed with children, were sent to 88 patients, aged 7-16 years, with visible enamel defects of permanent incisors and who had received microabrasion, with/without additional composite restoration at Sheffield Dental Hospital, UK. The questionnaires sought children's perceptions about their teeth before and after the intervention, as well as their evaluation of how they had been treated. Anonymised responses were graded using a 10 cm visual analogue scale (VAS) where a score of 10 indicated the most negative response, and zero the most positive response. RESULTS: Sixty three questionnaires were returned (72% response). Prior to treatment, children reported high levels of worry (VAS=6.8), embarrassment (VAS=6.9) and a perception that their teeth looked yellow and discoloured (VAS=7.3). Following treatment, children thought their teeth looked much better (VAS=1.6), felt happier (VAS=2.2) and more confident (VAS=1.6). They also felt very positive about their clinical experiences, rating the staff as extremely friendly and kind (VAS=0.4) and reporting that procedures were clearly explained (VAS=0.6). CONCLUSIONS: Simple non-invasive dental treatment can have a positive effect on appearance-related satisfaction. The use of child-centred approaches offers an invaluable insight into patient perspectives.