Referral from well-child care clinics to dental clinics leads to earlier initiation of preventive dental visits: A quasi-experimental study.

BACKGROUND: An ealy first preventive dental visit for children is recommended no later than twelve months. However, still many children have their first dental visit relatively late. AIM: To evaluate whether active or passive referral by a well-child care (WCC) physician of babies for a first preventive dental visit leads to earlier initiation of dental care. DESIGN: From WCC clinics in two Dutch regions, 629 parents of babies participated. Parents received an active referral from a WCC physician for a dental visit for their babies (n = 204) or received care as usual (CAU) (n = 136) in one region and a passive referral (n = 143) or CAU (n = 146) in the other region. Active referral involved parents receiving a scheduled appointment at the dental practice, and passive referral involved parents making an appointment themselves. During the WCC visit, parents completed a baseline questionnaire. At age 2.5 years, parents received a follow-up questionnaire about dental attendance. RESULTS: Of the active referral intervention group, 59.3% had their first preventive dental visit in their first year compared with 3.7% in the CAU group (p < .001); for the passive referral group, 46.9% compared with 9.6% (p < .001). CONCLUSION: Referral of babies by WCC for their first preventive dental visit leads to earlier initiation of dental care. An active referral had a larger effect than passive referral.

[To sedate or to confront? Sedation in adult dental treatment]. / Sederen of confronteren? Sedatie bij de tandheelkundige behandeling van volwassenen.

When patients are unable to undergo diagnostics or treatments for various reasons, sedation can be applied. A psychological approach and/or non-pharmacological sedation is preferred. When this is not possible, pharmacological sedation may be considered. In principle, the level of sedation applied, will be no deeper than is necessary for the patient to undergo the treatment and for the practitioner to be able to perform the treatment. Sedation is aimed at reducing agitation, anxiety, and/or lowering consciousness. However, it is not a pain treatment. Pain treatment will therefore always require adequate local anaesthesia. This article highlights the different levels of sedation, areas of indication, and sedatives used in dentistry. The application of pharmacological sedation will always have to be considered for each individual situation, within a total treatment plan that is aimed at lastingly increasing treatability.

Validity of data collection methods for time spent, professional involvement and treatment volume for the purpose of cost-effectiveness studies in dentistry.

OBJECTIVES: Economic evaluations can support provision of adequate and affordable oral care, requiring valid information on costs. The aim was to assess the validity of (a) patients' self-report (PS) and routine electronic patient records (EPR) regarding time spent per visit and (b) PS regarding types of treatment and type of dental professionals involved. METHODS: Data were collected in four dental clinics regarding time spent using PS and EPR, on types of treatment and dental professionals involved using PS. As reference standard for time spent, independent research assistants (RA) collected data on time per visit using stopwatches. As reference standard for types of treatment and of dental professionals involved, we used the dental clinic's Electronic Patient Files (DEPF). The two one-sided tests (TOST) equivalence procedure for the difference between paired means for time and kappa statistics for treatment and professional were used to assess agreement of data collection methods with the reference standards. RESULTS: Equivalence and agreement was good between (a) PS and RA registration concerning waiting time, appointment time and total time spent and (b) EPR and DEPF concerning appointment time. Agreement between PS and DEPF concerning types of treatment was moderate to fair (kappa values between 0.49 and 0.56 for preventive consultation, restoration, radiographs and extractions and between 0.15 and 0.26 for fluoride applications and sealants). Agreement between PS and DEPF for dental professional involved was fair (kappa = 0.41). CONCLUSIONS: Data collection regarding time using PS and EPR was valid. Data collection via PS on treatment and professionals involved were not sufficiently valid and should occur via DEPF.

[Collaboration of oral care and well-child care: for better preventive dentistry]. / Samenwerking mondzorg en jeugdgezondheidszorg; voor betere tandheelkundige preventie.

The new Dutch clinical practice guideline Oral Care for Children and Young People advises parents to visit the oral care professional before or from the eruption of the first tooth, because oral care starts with the first deciduous tooth. However, this is not yet standard for everyone. Still, almost all parents of newborns (> 95%) visit well-baby clinics with their newborn. This article describes how well-baby clinics and oral care can collaborate and how in the Netherlands, young children and their parents can be contacted earlier for (preventive) dental care. There are a few examples of projects in which well-child clinics and oral care collaborate, such as the Gezonde Peutermonden project (toddlers' healthy mouths project), the GigaGaaf project (giga whole project) and the case of a practice in Haarlem, in the Schalkwijk district. Because these projects are still in progress, it is not yet clear whether a collaboration between well-child clinics and oral care will also have an effect on the caries prevalence in children.

[Impact of the corona lockdown on daily oral health care behaviour of young children]. / Impact van corona-lockdown op het dagelijks mondgezondheidsgedrag van jonge kinderen.

This study explores the possible effects of the current corona pandemic and the ensuing measures on parental oral care behaviour, particularly during the lockdown period. Moreover, this study examines to what extent these effects differ according to the educational level of the parents. In total, 120 parents of children aged 4-5 years completed a digital questionnaire about parental oral care behaviour. The results show that during the coronavirus lockdown, 26% of parents skipped toothbrushing more often in the morning, 44% let their child snack more often, and 22% let their child drink sweetened drinks more often. In addition, parents with a high educational level skipped tooth brushing in the morning more often than parents with a low educational level. In contrast, parents with a low educational level skipped toothbrushing more often in the evening than parents with a high educational level. The results of this small study suggest that the coronavirus lockdown affected parental oral care behaviour.

[Kies-voor-Tanden Study: caries among 17-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 17-jarigen in Nederland.

This fourth in a series of 5 articles in the context of the 2017 Kies-voor-Tanden study presents the results for 17-year-olds. 34% of the 17-year-olds had flawless permanent teeth. In 2017, there were still differences in oral health among the socio-economic groups, to the advantage of the high socio-economic group. The oral health of 17-year-olds had stagnated during the previous 6 years and even appeared to be deteriorating according to some indicators. In addition, knowledge about the dental insurance system after the 18th birthday was poor. Conclusion: The oral health of 17-year-olds had not improved in the previous years. This trend must be followed by monitoring research. In addition, interventions to improve the oral health, knowledge and behaviour of adolescents should be set up and evaluated.

[Kies-voor-Tanden Study: caries among 23-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 23-jarigen in Nederland.

This fifth and final in a series of 5 articles in the context of the 2017 Kies-voor-Tanden study presents the results for 23-year-olds. 21% of the 23-year-olds had flawless permanent teeth. In 2017, there were still differences in oral health among the socio-economic (SES) groups, to the advantage of the high SES group. The oral health of the low SES group had shown some improvement in the previous 6 years, while this was not the case within the high SES group. The preventive dental behaviour of 23-year-olds was not optimal and the knowledge about the dental insurance system was poor. Conclusion: the oral health of 23-year-olds had partly improved, partly stagnated. Since not everyone will be able to access information through oral care professionals, other ways of providing information to them must be considered. In the context of public health, to be able to follow trends in oral health and dental preventive behaviour of (young) adults, research monitoring oral health is of great importance.

[Kies-voor-Tanden Study: the incidence of caries among 11-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 11-jarigen in Nederland.

In this third article in a series of 5 in the context of the 2017 Kies-voor-Tanden Study, the results for the 11-year-olds are presented. The study was conducted among 11-year-olds who lived in Alphen aan den Rijn, Gouda, Breda or Den Bosch and consisted of a clinical oral examination and a questionnaire completed by both them and their parents. Of the 11-year-olds, 61% had caries-free permanent teeth. In 2011, this percentage was 73%. In 2017, there were still differences in oral health among socio-economic groups, to the advantage of the higher socio-economic group. The conclusion is that the oral health of 11-year-olds has not improved in the last 6 years. Despite the low prevalence of DMFS, there appears to be a trend towards deterioration. For risk groups, interventions to keep the teeth intact should be aimed primarily at improving preventive behaviour and good oral health self-care.

[Kies-voor-Tanden Study of children and adolescents: motivation and study design]. / Kies-voor-Tandenonderzoek 2017 onder jeugdigen: aanleiding en onderzoeksopzet.

In 2017, Dutch research institute TNO carried out research commissioned by the National Health Care Institute intended to gain an up-to-date and representative picture of the oral health and the preventive dental behaviour of 5, 11, 17 and 23-year-olds in the Netherlands and to identify possible changes therein since previous measurements. Since the motivation, background, study design, material and method were identical for the 4 ages, and the same issues, to a certain extent, are to be considered in the discussion in each of a series of 5 articles, these identical and generic matters will be described in this article.Since there is no system in the Netherlands to structurally monitor oral health, these Kies-voor-Tanden studies are eminently important for following trends in oral health and preventive dental behaviour in children and adolescents over longer periods of time. Data of this kind are indispensable in formulating meaningful policy on oral health. The continuation of research monitoring oral health is therefore strongly recommended.

[Kies-voor-Tanden Study: the incidence of caries among 5-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 5-jarigen in Nederland.

This second in a series of 5 articles in the context of the 2017 Kies-voor-Tanden study presents the results for 5-year-olds. The study was conducted among 5-year-olds living in Alphen aan den Rijn, Gouda, Breda or Den Bosch and consisted of completing a questionnaire and undergoing a clinical oral examination. 76% of the 5-year-olds had a caries-free deciduous dentition. This percentage represented an increase compared to previous research. No change was seen in children with caries experience. In 2017, there were still differences in oral health among the socio-economic groups, in favour of the highest socio-economic group. Conclusion: the oral health of the 5-year-olds seems to be moving in the right direction, but there is still a social gradient and there is still room for improvement. For risk groups, interventions to keep the teeth intact should be aimed primarily at improving behaviour and oral health self-care to prevent caries.

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.

[Opinions about oral care: an online questionnaire among readers of NTvT]. / Meningen over mondzorg: een online-onderzoek onder NTVT-lezers.

By means of a brief online questionnaire with 12 statements about the organisation, quality and impact of oral care in the Netherlands, the readers of the Netherlands Journal of Dentistry (NTVT) were asked to express their opinions on a number of important subjects concerning oral care in the Netherlands with respect to health economic matters. A total of 237 readers (61% men, 39% women) completed the online questionnaire. 70% of them were working as dentists and had been active in a practice for between 31 and 40 years. According to the study, a shift from curing to prevention was considered to be necessary. Most of the respondents also thought inequality in oral health in the Netherlands is increasing and people avoid going to the dentist due to the associated costs. In conclusion, most oral care providers appear to be reasonably positive about Dutch oral care. Attention for prevention, appreciation of oral health and the reduction of inequality in oral care continue to be necessary.

[Sinking your teeth into economic evaluations: application and importance in oral health]. / Economische evaluaties aan de tand gevoeld: belang en toepassing in de mondzorg.

Health economics deals with issues about the use of scarce resources in healthcare. An important branch of health economics concerns economic evaluations, which consist of a comparison of the costs and effects of 2 or more treatments. The role and importance of economic evaluations in oral care are increasing but are not yet as evident as in other areas of healthcare (such as pharmacy). An economic evaluation provides a broad picture of the costs and health benefits of a particular diagnostic or treatment strategy, resulting in a cost-effectiveness ratio (expressed, for example, as costs per quality-adjusted life year gained). The results are intended for use in policy-making, such as decisions about in- or exclusion from the basic benefits package. To date, only a limited number of economic evaluations of oral care have been carried out, mainly focused on caries. It is important to be able to demonstrate that the treatment provided in oral care is cost-effective. Oral care may put itself in a vulnerable position in the distribution of scarce resources when the costeffectiveness of its treatments is uncertain.

[Socioeconomic differences in oral health outcomes among adults in the Netherlands]. / Sociaal-economische verschillen in mondgezondheidsuitkomsten van volwassenen in Nederland.

The aim of the present study was to describe the oral health situation of the adult Dutch population in terms of caries experience and the need for periodontal treatment. The research consisted of a clinical dental examination and a questionnaire on oral health and was carried out among 25- to 74-year-olds living in Den Bosch, distinguished according to age and educational level. The group with a low socioeconomic status (SES) had more teeth affected by caries, had undergone less extensive dental treatments and were more in need of periodontal treatment than the high SES group. On this basis, it can be concluded that socioeconomic statuswas also negatively correlated to several oral health indicators in 2013. One has to consider whether the picture sketched by this study matches Dutch society's expectations.

A Q-methodology study among caregivers of people with moderate intellectual disabilities on their clients' health care: An example in oral health.

BACKGROUND: People with intellectual disabilities have less favourable outcomes in-among others-oral health variables, compared to their peers without intellectual disabilities. Before being able to develop target interventions for caregivers, all their prevailing viewpoints regarding oral hygiene need to be identified. METHODS: This Q-methodology study-conducted among 40 caregivers of care-dependent Institutionalized living persons with moderate intellectual disability-used by-person factor analysis to reveal clusters of caregivers based on the way their statements were sorted. RESULTS: A 4-factor solution was chosen based on both the Q-sorting and the interviews. The four factors identified were responsible and perseverant, motivated but aware of obstacles, social minded and knowledgeable and concerned and insecure. CONCLUSION: Q-methodology can be used to determine the different attitudes that caregivers have regarding oral health care. Developing a tool to determine into which factor caregivers should be categorized may be the next step in tailoring oral health instruction.

[The prevalence of tooth wear in the Dutch adult population]. / De prevalentie van gebitsslijtage onder de volwassen Nederlandse bevolking.

This study, performed in 2013, aimed to assess the prevalence of tooth wear in the Dutch adult population. The prevalence of tooth wear was not only determined for different age groups but also according to gender, socioeconomic status and types of teeth. Results were compared with the outcomes of a previous study in a comparable population in 2007. The data were collected as part of a comprehensive dental-epidemiological research project. The 1,125 adults from the city of 's-Hertogenbosch who participated in the project were subdivided into 5 age groups. Tooth wear was quantified using a 5-point ordinal occlusal/incisal grading scale. The number of teeth affected by tooth wear was higher in older age groups. Men showed more tooth wear than women, as did individuals with lower socioeconomic status, among whom a similar tendency was observed. Tooth wear prevalence found in 2013 was higher in all age groups than in 2007. One can conclude that tooth wear is a common condition in the Dutch adult population.

Application of the Nexø method in a general dental practice in the Netherlands: 6-year results of a RCT.

OBJECTIVES: The aim of this study was to establish the effect of a non-operative caries treatment programme (the Nexø method) in a general dental practice on dental caries, oral hygiene and self-reported motivational factors for a 6-year period. METHODS: A randomized clinical controlled trial study on caries-preventive measures in 6- to 12-year-old children was performed among 3 groups of children: (i) care as usual (dental check-ups twice a year, accompanied by a professional fluoride application and the placement of occlusal sealants on a routine basis) (CONTROL); (ii) care as usual plus 2 extra professional fluoride applications (IPFA); or (iii) a non-operative caries treatment programme based on the Nexø method in which recall interval and caries-preventive measures were individualized based on caries activity, eruption stage and motivation of the parent (NOCTP). RESULTS: A total of 106 12-year-old children of the initial 230 6-year-olds completed the full-length study. Children in the NOCTP group developed 0.67 decayed, missing or filled surfaces (DMFS). This value was 0.86 in the IPFA group and 1.02 in control group. The level of oral hygiene was most favourable in the NOCTP group (OHI-s score 0.61 vs 0.87 [IPFA] and 0.70 [control]). Differences were not statistically significant. CONCLUSION: Children who followed the NOCTP programme in this general dental practice did not develop significantly fewer new caries lesions compared with children in the IPFA group or the control group after 6 years. However, the differences identified after the first 3 years of the trial remained apparent.

[A study to determine possible success variables in the treatment of gag reflex patients]. / Onderzoek naar mogelijke succesvariabelen bij de behandeling van kokhalspatiënten.

A disproportionately sensitive gag reflex can hamper adequate dental treatment. Because an evidence-based treatment for this condition is lacking at this moment, a study of patients and success variables for the treatment was carried out. The study was based on the clinical records of and interviews with 40 people who had been treated in a Centre for Special Dental Care (CBT) because of extreme gag problems two years earlier. It was found that the gag complaints of half of the respondents had disappeared or become manageable, while those of the other half had not changed. It did not matter which intervention had been adopted. In order to determine how patients can best be treated and which patients can best be treated, research among larger patient samples is needed.

Parental attitudes towards oral health and caries-risk in their children.

OBJECTIVES: The aim of this study was to investigate whether parents can be matched with attitudes towards oral health by means of a short vignette sheet, developed based on the results of an earlier Q-methodological study. Furthermore, this study aims to explore how the attitudes associate with diet and oral hygiene habits and with clinical outcomes in children. METHODS: A total of 170 parents of 6- to 9-year-old children completed a questionnaire including the vignette sheet and clinical scores (oral hygiene, caries) were retrieved from the follow-up measurement of a RCT on caries-preventive measures. RESULTS: Of the 170 respondents, 159 (93.5%) could be matched to a single best matching attitude. Respondents identified "well" to "very well" with at least one of the attitudes and seemed to be able to differentiate well the extent to which they matched to the different attitudes. Parents scoring high on different attitudes were found to be associated with different lifestyle patterns and clinical outcomes. CONCLUSIONS: It was concluded that using a self-assessed attitude tool, derived from the results of a Q-methodological study, it is possible to identify different groups of parents with different oral health-related risk factors. Of course, it is hardly likely that people are 100% only 1 type of parent; parents can be considered to be a mix of different typologies. However, information on the composition of that mix may be helpful for the dental professional to estimate risks and to deliver a more tailored prevention strategy in children.

[DSQ-13-youth: measuring instrument for patient satisfaction with dental attendance among adolescents, young adults and parents of young children]. / DSQ-13-jeugd: meetinstrument voor patiënt­tevredenheid van adolescenten, jongvolwassenen en ouders over tandartsbezoek.

The Dental Satisfaction Questionnaire (DSQ) is a questionnaire consisting of 31 items assessing patient satisfaction with dental attendance. By means of factor analysis (principal component analysis), the number of items of the DSQ was reduced to 13, which together constitute the DSQ-13-youth. The first objective was to investigate the psychometric properties of the DSQ-13-youth; the second was to compare the satisfaction scores on the various dimensions between and within subgroups (23-year-olds, 17-year-olds and parents of 5-year-olds). The DSQ-13-youth has 4 domains measuring patient satisfaction with dental attendance. The internal consistency of those domains was high; the correlation between the domains low to moderate and the factor structure was highly congruent in the various subgroups. The differences in satisfaction scores between and within subgroups were small. The DSQ-13-youth is a reliable instrument to assess patient satisfaction with dental attendance among adolescents, young adults and the parents of young children in urban areas.