An interview study of pregnant women who were provided with indoor air quality measurements of second hand smoke to help them quit smoking.

BACKGROUND: Maternal smoking can cause health complications in pregnancy. Particulate matter (PM2.5) metrics applied to second hand smoke (SHS) concentrations provide indoor air quality (IAQ) measurements and have been used to promote smoking behaviour change among parents of young children. Here, we present the qualitative results from a study designed to use IAQ measurements to help pregnant women who smoke to quit smoking. METHODS: We used IAQ measurements in two centres (Aberdeen and Coventry) using two interventions: 1. In Aberdeen, women made IAQ measurements in their homes following routine ultrasound scan; 2. In Coventry, IAQ measurements were added to a home-based Stop Smoking in Pregnancy Service. All women were invited to give a qualitative interview to explore acceptability and feasibility of IAQ measurements to help with smoking cessation. A case study approach using grounded theory was applied to develop a typology of pregnant women who smoke. RESULTS: There were 39 women recruited (18 in Aberdeen and 21 in Coventry) and qualitative interviews were undertaken with nine of those women. Diverse accounts of smoking behaviours and experiences of participation were given. Many women reported changes to their smoking behaviours during pregnancy. Most women wanted to make further changes to their own behaviour, but could not commit or felt constrained by living with a partner or family members who smoked. Others could not envisage quitting. Using themes emerging from the interviews, we constructed a typology where women were classified as follows: 'champions for change'; 'keen, but not committed'; and 'can't quit, won't quit'. Three women reported quitting smoking alongside participation in our study. CONCLUSIONS: Pregnant women who smoke remain hard to engage,. Although providing IAQ measurements does not obviously improve quit rates, it can support changes in smoking behaviour in/around the home for some individuals. Our typology might offer a useful assessment tool for midwives.

The influence of a short training program on the clinical examination of dental restorations.

PURPOSE: To investigate how a simple restoration evaluation training program affected restoration replacement decision making by a group of 16 dentists. METHOD: The clinical examination of 66 dental restorations in nine female patients was carried out by two groups of dentists: one having previously received training in restoration assessment. The results of these assessments were compared to a gold standard for restoration integrity determined by two experienced clinicians applying US Public Health Service criteria. All evaluations were completed under controlled clinical conditions with standard equipment and lighting. The results of the clinical examinations between the trained (test) group and the untrained (control) group were compared to each other and the gold standard. RESULTS: The trained group scheduled fewer restorations for replacement (6.00±3.01 and 9.71±3.15; p=0.034), in a shorter time (27.86±3.45 mins and 36.71±3.74 mins; p=0.003) and showed greater agreement with the study's gold standard for restoration replacement (0.85±0.27 and 0.79±0.06; p=0.002). CONCLUSION: Within the limits of this study, examiner training can significantly improve the reliability of restoration replacement decision making by dentists.

Fluoride-containing orthodontic adhesives and decalcification in patients with fixed appliances: a systematic review.

INTRODUCTION: Our objectives were to (1) systematically review the literature on the effectiveness of fluoride-containing adhesives in controlling decalcification in fixed orthodontic patients, (2) determine which fluoride-containing adhesives provide protection against decalcification, and (3) make recommendations on the usage of fluoride-containing adhesives in patients with fixed orthodontic appliances. METHODS: In this systematic review, we searched published and unpublished material in any language using general and specialist databases; key orthodontic journals were searched by hand. Predefined inclusion criteria based on objective outcome measures for decalcification, presence of a comparison group, and the study design were applied to select the studies. Included studies were double extracted onto predesigned data extraction sheets. RESULTS: A qualitative analysis of 5 randomized controlled trials and 5 clinical trials is presented. CONCLUSIONS: It is impossible to make recommendations on the use of fluoride-containing orthodontic adhesives during fixed orthodontic treatment. However, there is evidence to suggest that (1) glass ionomer cement is more effective than composite resin in preventing white spot formation, but the evidence is weak; (2) further research is required to determine the effectiveness of the various fluoride-containing orthodontic adhesives; and (3) common outcome measures and reporting standards would assist future researchers.

Factors influencing the career aspirations and preferred modes of working in recent dental graduates in Wales.

INTRODUCTION: In England and Wales, National Health Service (NHS) primary dental care services are now commissioned on a local basis. In planning for the future, it is important that commissioning authorities have a clear understanding of the perspectives of recent dental graduates: vocational dental practitioners (VDPs). OBJECTIVES: This study investigated the career aspirations and preferred modes of working of VDPs in Wales. METHODOLOGY: Data were collected via a postal questionnaire, comprising 37 closed and open questions, mailed to all 59 VDPs in Wales. RESULTS: A total of 53 (90%) VDPs participated, of whom 47 saw their future in general dental practice: 5, 35, and 7 indicating a preference to work in the NHS, mixed (NHS and private), and private sector, respectively. None selected the Community Dental Service as their preferred vocation. More than half of all respondents intended to undertake a postgraduate qualification within the next five years and 22 wished to specialise. Of the 53 VDPs, 44 were concerned that lack of NHS contracts would limit where they could practise, and agreed that family and other social commitments were a significant influence on choice of practice location. Access to high-quality premises and continuing professional development were agreed as important by 41 VDPs. A majority (37) agreed that private dentistry was an attractive alternative to NHS dentistry. Of the respondents, 38 (22 females, 16 males) expected to work part-time at some point in the future and 14 said they would consider a career outside dentistry. Only nine VDPs agreed that they would be happy working in a single-handed practice and even fewer (six) indicated they would be happy working for a corporate body. CONCLUSIONS: Numerous factors impact on the career aspirations of VDPs. These factors have been quantified in this study, and healthcare-commissioning bodies need to be aware of them when planning future dental care provision in Wales.

Utilisation of dental auxiliaries--attitudinal review from six developed countries.

OBJECTIVE: To identify reasons for the development of dental auxiliaries across six developed countries and to explore attitudes towards them. DESIGN: Literature review; semistructured interviews with key informants. SETTING: Interviews in each selected country; Belgium, Greece, Finland, U.K., Canada and New Zealand. MATERIALS AND METHODS: For each country, representatives of key informants were interviewed. RESULTS: The introduction of dental auxiliaries in many countries was as a result of workforce shortages. There has been no development of dental auxiliaries in Belgium or Greece largely because of perceived lack of need by the representative respondents. In Canada, Finland, New Zealand and the U.K. the introduction of clinical dental auxiliaries was a result of shortages of workforce and high levels of disease. Concerns amongst dentists were about the pace of the increased scope of practice for auxiliaries and by auxiliaries about lack of career development. CONCLUSIONS: Two distinct professional attitudes towards dental auxiliaries were found--in Belgium and Greece, there is little or no support compared with the other countries, where, in general, professional attitudes support the use of dental hygienists but are less supportive of therapists and denturists.

Perceptions and attitudes to a fundamental reform of general dental services in Wales.

BACKGROUND: The greatest reform of state-funded dental care in England and Wales, since the inception of the National Health Service (NHS) in 1948, occurred on 1st April 2006. It encompassed the dissolution of a universal national contract and the introduction of locally commissioned primary dental care services in England and Wales. Suggested advantages included the elimination of the fee-for-item-of-service 'treadmill', an increased emphasis on prevention, and improved access-at a time when many practitioners were opting to provide care outside the NHS system. OBJECTIVES: This study investigated the perceptions and attitudes to the new contract, in the three months immediately prior to its implementation. METHODOLOGY: Data were collected via a postal questionnaire, comprising a combination of 56 closed and open questions. The questionnaire was mailed to all general dental practitioners in Wales. RESULTS: 691 (64.5%) questionnaires were returned. Just 140 (23%) dentists agreed or strongly agreed that they would have more time to spend with patients under the new contract. The majority of respondents, 361 (59.3%), disagreed that they would be able to spend more time on prevention. Three hundred and sixty-six (60.2%) disagreed that they were strongly attracted by the new method of remuneration and only 62 (10.2%) perceived a reduced level of administration. Of the 608 dentists who provided NHS dental services, 418 (68.6%) indicated they would continue to do so, 130 (21.4) were undecided, and 55 (9%) stated that they would not take up the new contract. Allowing for the number of days worked per week and the percentage time spent on NHS patients, these equate to 72.3%, 21% and 5.9% of NHS capacity respectively. CONCLUSIONS: This study has established baseline perceptions of reform in state-funded dental care in Wales. As the new contract evolves, it will be interesting to determine whether the largely negative perceptions of new ways of working expressed in this study are realised.

Evaluating oral health promotion: need for quality outcome measures.

Oral health promotion effectiveness reviews have identified the need to improve the quality of the evaluation of interventions. A project was undertaken to identify and assess the quality of available outcome measures. This paper describes the methodology adopted and highlights the need for further development of oral health promotion outcome measures. Initially a thorough and comprehensive search of both the published and unpublished literature was undertaken to identify potential outcome measures. A set of quality criteria was then developed and used to assess the identified measures. The search identified a total of 1202 outcome measures of which 39% (n = 466) were developed for use with schoolchildren. A high proportion of the identified measures were classified as health literacy and healthy lifestyle outcomes, appropriate for the evaluation of oral health education activities. Only 1% (n = 12) of measures identified were classified in the healthy public policy category. When reviewed against the quality criteria, 49% (n = 594) of the measures were considered satisfactory. The poorest performing measures were those classified as healthy lifestyle and health literacy measures in which only 33% (n = 72) and 41% (n = 240), respectively, were deemed to be of satisfactory quality. In conclusion, a significant number of oral health promotion evaluation outcome measures have been identified although their quality is highly variable. Very few high-quality outcome measures exist for use in the evaluation of oral health policy and environmental interventions. The lack of appropriate and high-quality outcome measures is hampering the development of oral health promotion.

Summary measures of caries prevalence to describe high-risk communities.

STUDY OBJECTIVE: This investigation compared the Significant Caries Index (SiC) with alternative summary measures of caries prevalence, designed to highlight high-risk communities and examined the implications of their use in health policy and planning in Wales. DESIGN: Data from the 2001 BASCD survey of 7,412, 12-year-old Welsh children were used in this analysis. As an alternative to the 33% cut-off value utilised in the SiC, the mean DMFT of children with the 10, 20 and 25% highest caries scores were calculated for 22 local health board areas, as was the mean DMFT for the whole population, %DMFT >0, and the mean for those with DMFT >0, >1, >2, and >3. SETTING: Examinations for the childhood epidemiology programme took place in Welsh secondary schools. PARTICIPANTS: 12-year-old children examined in the 2000/01 survey. MAIN RESULTS: The mean DMFT for the whole population was 1.31, and the mean DMFT of those with caries was 2.56. The mean DMFT for SiC 33%, 25%, 20% and 10% was: 3.39, 3.85, 4.28, and 5.31 respectively. When local health board areas were ranked according to mean DMFT score at different percentage cut-off points, variation in rank order was observed, the greatest difference in rank order being 6. Furthermore, when compared with summaries based on DMFT scores traditionally used in Wales, even greater rank differences were noted (up to 14 places). CONCLUSIONS: Rank order of geographical area is influenced by the definition of the index chosen when describing high risk populations using a variety of caries indices. This has implications for health policy planning and resource allocation.

Summary of: Differences by age and sex in general dental practitioners' knowledge, attitudes and behaviours in delivering prevention.

PURPOSE: To assess sex and age differences in NHS dentists' knowledge, attitudes and behaviours in providing preventive care. MATERIALS AND METHODS: A cross-sectional questionnaire survey was conducted with dentists working in North London, UK. RESULTS: The sample displayed limited knowledge in certain key aspects of prevention, but expressed generally positive attitudes towards preventive care. More female and younger dentists reported that a child should attend the dentist before the age of 3 years (p = 0.03 and p = 0.04, respectively). No other differences in knowledge or attitudes were found by age and sex. The majority of the sample reported routinely providing oral hygiene (95.7%), diet (85.4%) and smoking cessation advice (76.7%), but provision of alcohol advice was much less common (38%). A significantly higher proportion of younger dentists were more likely to give diet advice (p = 0.03) and smoking cessation support (p = 0.009) than their older colleagues. Female dentists were more likely to provide fissure sealants (p = 0.04), diet advice (p = 0.02) and smoking cessation support (p = 0.03). The main perceived barriers were related to organisational factors including insufficient remuneration (86.3%), lack of time (84%) and poor patient compliance (66%). There were no significant differences in perceived barriers by sex, but younger dentists were significantly more likely to identify poor patient compliance as a barrier (p = 0.02). CONCLUSION: Although dentists in this study may lack some core preventive knowledge, many expressed very positive attitudes towards prevention and reported to be routinely offering a range of preventive measures. Younger and female dentists tended to engage more frequently in preventive activities.

A retrospective study of dental general anaesthesia carried out in children living in North Wales 1995-1998.

OBJECTIVES: To determine the reasons for referral for dental general anaesthesia (DGA) in children in North Wales and to ascertain the level of repeat DGA. RESEARCH DESIGN: Retrospective study of the clinical records for a random sample of 10-year-old children who had a DGA before November 1998. SETTING: DGAs carried out at two centres within the Community Dental Service (CDS) in the former county of Clwyd, North Wales. METHOD: A random sample of children who had a DGA between April 1995 and November 1998 from whose records data was collected regarding the reason for referral and outcome. RESULTS: It was found that 26.6% of children had received an additional DGA, but the total of 203 additional episodes (including third and fourth DGAs) represents a true rate of 31.8%. The General Dental Service (GDS) referred more than double the numbers of children than the CDS but the referral rate per dentist was reversed with the GDS referring an average of 5.2 subjects and the CDS 11.9 subjects. Around half of all referrals did not include a medical history. CONCLUSIONS: The repeat DGA rate was cause for concern as was the quality of referrals.

Mapping caries prevalence and water distribution in Wales-- Iechyd Morgannwg Health Authority as a case study.

STUDY OBJECTIVE: To investigate the use of mapping in targeting water fluoridation to areas of high need in lechyd Morgannwg Health Authority, as defined by the upper quintile of the distribution of the percentage with dmft > 0 in dental planning areas. DESIGN: Data from the 1997/98 childhood dental epidemiological survey and the Welsh Water Company water supply zones (as at 1997) were plotted. Maps were generated to identify the relationship between water supply areas, water supply sources and areas of high caries prevalence. SETTING: Maps focussed upon one Welsh health authority, Iechyd Morgannwg Health Authority. Examinations for the childhood epidemiology programme took place in schools. PARTICIPANTS: 5-year-old children examined in the 1997/98 survey. MAIN RESULTS: Data presented by very different geographical boundaries were compared without having to carry out complex mathematical transformations. It was possible to quickly identify areas of Iechyd Morgannwg Health Authority with high levels of oral disease, the associated water supply zones and their water treatment centres with a view to possible future targeting of fluoridation. The maps identify the possibility of dilution, when a particular water supply zone was served by more than one treatment works. CONCLUSIONS: This technique enables disparate and complex data bases to be combined enabling visual analysis of the results. The maps facilitate decision making as to the most beneficial areas to fluoridate. The results will be of value in determining the feasibility and targeting of water fluoridation in Wales.

Shaping the next generation of 'population oral healthers'.

OBJECTIVE: The aim of this paper is to discuss the training and development needs of those people who will form the next generation working in the field of population oral health. METHOD: The paper represents the personal views of the author based upon an analysis of current training programmes in a number of countries and variation in the international working conditions. DISCUSSION: The next generation of population oral healthers will need to be versatile in their approach to the oral health problems they encounter. The simple problems may well have been solved or have stopped improving. The future generation will work in a variety of roles: commissioning and designing services, providing and evaluating services, educating or researching. The working environment will also show considerable variation and diversity from entirely private systems through mixed economies to public systems and, of course, no system at all. Current curricula vary but tends to emphasis traditional epidemiological and statistical skills as well as service delivery. There is also some evidence that training opportunities are limited to those with clinical backgrounds. Universities continue to emphasis high quality, high impact and high financial value research as they seek to maximize income and climb international league tables. National research funding bodies are seeking to address major issues such as global warming, food security and international security. Health research appears to have a number of foci: increasingly complex biomedical research, economic and effectiveness research and the complex questions around diseases of poverty and lifestyle. Access to funding will be increasingly competitive. CONCLUSIONS: The next generation will need to access and understand an increasing range of disciplines using a wide range of transferable and political skills as they work across a diverse range of social situations and disease states. A key issue will be the requirement for them to be adaptable and flexible as they work to improve oral health.

The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances: a systematic review.

INTRODUCTION: Decalcification is a significant problem during fixed orthodontic treatment. Topical Fluorides can reduce or eliminate the problem, but the relative effectiveness of different treatments or combinations of topical fluoride preparations is unknown. This systematic review was undertaken to determine the effectiveness of topical fluoride preparations in preventing decalcification during fixed orthodontic treatment. METHODS: A wide search of published and unpublished material in any language was undertaken by using general and specialist databases; key dental journals were searched by hand. Predefined inclusion criteria based on objective outcome measures of decalcification, duration of treatment, presence of a comparison group, and study design were applied to determine study selection. Included studies were double extracted onto pre-designed data extraction sheets. RESULTS AND CONCLUSIONS: By screening titles and abstracts, we identified 143 articles; after the inclusion criteria were applied, 7 reports (of 6 studies) remained. Differences in the methodologies and reporting made statistical analysis impossible. However, the use of topical fluorides in addition to fluoride toothpaste reduced the incidence of decalcification in populations with both fluoridated and non-fluoridated water supplies. Different preparations and formats appear to decrease decalcification, but there was no evidence that any 1 method was superior. There was some evidence that the potency of fluoride preparations might be important.