Teaching Minimally Invasive Interventions in Paediatric Dentistry: A Cross-Sectional Survey of Dental Schools in Iran.

BACKGROUND: Dental caries is a significant public health problem in Iran. Teaching  minimally invasive interventions in paediatric dentistry may facilitate the provision of treatment for untreated dental caries in children. We evaluated the teaching of such interventions in both undergraduate dental curriculum and Paediatric Dentistry Specialty Training Programme (PDSTP) in Iran. METHODS: This was a cross-sectional questionnaire-based survey. Participants in this study were the directors of 40 undergraduate programmes and 15 PDSTPs in all Iranian dental schools (response rate = 100%). Descriptive statistics were reported. RESULTS: The most commonly taught methods were preventive fissure sealant and preventive resin restoration (PRR), which were taught 'both didactically and clinically' in all undergraduate dental programmes. The least commonly taught methods were silver diamine fluoride (SDF), the Hall technique and resin infiltration, which were taught 'both didactically and clinically' in less than 5% of dental schools. The same three methods were the least commonly approaches taught in PDSTP, further, they were less often perceived to be 'essential'. CONCLUSIONS: There was a notable variation in the teaching of the management of dental caries in Iran's dental education. Some minimally invasive approaches including SDF, the Hall technique and resin infiltration are not being commonly taught in Iranian dental schools despite the evidence base for these techniques.

Editorial - Child oral health; is there anything more to know?

It seems a strange thing to be writing about child oral health in the middle of a virus pandemic that has, in the UK at least, paused all routine dental care. Perhaps not; as thoughts turn to the return of "normal" opera- tion there are concerns over potential ongoing impacts from COVID-19 on health services including stricter infection-control requirements and economic impacts from the lockdown. It invites ridicule to try and predict what will happen in the coming years, but the economic and social impacts are likely to increase vulnerability among the already vulnerable and the delivery of dental care is likely to be more problematic and more expensive. More than ever we need to reduce the burden of avoidable dental disease.

Deprivation and child dental attendance in England: exploring the shape and moderators.

OBJECTIVE: To describe the shape of the relationship between area deprivation and dental attendance (DA) in children aged 5 years and under in England and the modifying effect of caries prevalence, ethnicity, family profile and dentist-to-population ratio. BASIC RESEARCH DESIGN: DA rates were calculated at lower-tier local authority level (LA, n=326) using NHS data for the year to March 2017. LA deprivation was determined by Index of Multiple Deprivation 2015. Caries prevalence was retrieved from the 2016/17 National Dental Epidemiology Programme; ethnicity and family profile from Census 2011 and dentist-to-population ratio from NHS statistics. Fractional polynomial (FP) models explored the shape of the relationship. Multivariable regression models were adjusted for covariates. The effect of moderators was estimated by adjusted marginal effects. CLINICAL SETTING: English Lower-tier LAs. MAIN OUTCOME MEASURE: Shape of the relationship between DA and deprivation and its moderators. RESULTS: Best-fitting second-order FP model (p=0.582) did not provide a better fit for the relationship than the linear model. Therefore, the linear model was selected for final analysis. Deprivation was associated with decreased DA rates (Coefficient=-0.39, 95%CI=-0.53,-0.24; p=⟨0.001); while White ethnicity (Coefficient=0.35, 95%CI=0.29, 0.41; p=⟨0.001), single parenthood (Coefficient = 2.21, 95%CI=0.91,3.51; p=0.001) and caries prevalence (Coefficient =0.34, 95%CI=0.25,0.44; p=⟨0.001) with increased rates. These moderated the relationship. CONCLUSIONS: We hypothesised that the shape of the relationship between deprivation and DA could be curvilinear with higher rates in the extreme ends of deprivation. However, the analysis showed a linear association, moderated by the effect of ethnicity, single parenthood and disease level.

Greater child dental health inequality in England compared to Wales and Northern Ireland, despite lower average disease levels.

INTRODUCTION: Dental caries and inequalities in dental health are major public health concerns. AIM: To report variation in dental caries experience across deprivation quintiles and the magnitude of inequalities between countries. DESIGN: Secondary analyses of cross-sectional data from the 2013 Child Dental Health Survey (CDHS) in England, Wales, and Northern Ireland. MATERIALS AND METHODS: Distribution of dental caries across deprivation quintiles were estimated using as proportions and means. The magnitude of inequalities was calculated using the Relative Index of Inequality (RII). MAIN OUTCOMES: Dental caries experience as indicated by the prevalence (%dmft/DMFT>0) and severity (dmft/DMFT) of 'obvious' and 'clinical' decay experience in both primary and permanent dentitions. RESULTS: Children from more deprived quintiles showed higher prevalence and severity of dental caries. RIIs for dental caries were greater in England than Wales or Northern Ireland, indicating greater relative inequalities despite lower average dental caries experience. The prevalence and severity of dental caries among the most deprived children in England were 1.7 to 3.7 times greater than those of the least deprived. CONCLUSION: There is a deprivation gradient in child dental caries in all three countries, with England showing the greatest inequalities.

Inequalities in orthodontic outcomes in England: treatment utilisation, subjective and normative need.

OBJECTIVE: To investigate inequalities in three aspects of access to orthodontic care: uptake of orthodontic treatment, normative need and subjective need in England. METHODS: We used data from two surveys in England: 12 and 15-year-olds from the 2013 Child Dental Health Survey (CDHS 2013) and 12-year-olds from the 2008/2009 NHS Dental Epidemiology Programme for England (NDEP 2008/2009). Summary variables representing orthodontic status were calculated. Two regression-based summary measures of inequalities were used to investigate the relationship between deprivation level and orthodontic outcomes: Slope and Relative indices of Inequality. RESULTS: There were significant absolute and relative inequalities in uptake of orthodontic treatment. The least deprived were 1.9 times more likely to have received orthodontic treatment compared to the most deprived in both surveys. Normative need was not associated with deprivation in either the analyses of CDHS 2013 (SII= 0.03, 95% CI: -0.04, 0.1; RII=1.06, 95% CI: 0.91, 1.24) or the NDEP 2007/2008 (SII= 0.03, 95% CI: -0.02, 0.07; RII=1.06, 95% CI: 0.96, 1.18). There was greater willingness to have teeth straightened in more deprived children from CDHS 2013 (SII=-0.09, 95% CI: -0.16, -0.03; RII=0.85, 95% CI: 0.75, 0.96) but not in NDEP 2007/2008 (SII=0.03, 95% CI: 0, 0.06; RII=1.07, 95% CI: 0.99, 1.15). CONCLUSIONS: Being deprived was associated with lower uptake of orthodontic treatment. Normative need was not related to deprivation. The association between deprivation and subjective need was only partly established, with poorer children showing a greater desire to have their teeth straightened in one survey.

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.

Low rates of dental attendance by the age of one and inequality between local government administrative areas in England.

OBJECTIVE: To describe child dental attendance (DA) by 1 year of age in England and its relationship with area deprivation. BASIC RESEARCH DESIGN: Analysis of National Health Service data for the 12 months to June 2017. Deprivation was measured by Index of Multiple Deprivation Rank of Average Score (2015) for upper-tier and unitary local authorities in England (LAs, n=151). DA rates were calculated for children under 1 year (⟨1yr) and children aged 1 year and under (⟨1yr). A Spearman's test assessed strength of association with deprivation. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) explored equity. CLINICAL SETTING: Upper-tier and unitary LAs in England. MAIN OUTCOME MEASURE: Attending an NHS primary care dental service. RESULTS: DA rates ranged from 0 to 12.3% (Median:2; IQR:1.4,3.9) in children ⟨1yr and from 3.7 to 37.6% (Median:10; IQR:7.4,17) in children ≤1yr. DA rates decreased as deprivation decreased (Spearman=-0.25, p=0.0019 in children ⟨1yr; Spearman=-0.21, p=0.0104 in children ≤1yr). The SII suggested a 2 percentage point difference in DA rate across the deprivation distribution in children ⟨1yr (SII=-0.02, 95% CI=-0.01,-0.04; p=⟨0.001); and a 5 point difference in children ≤1yr (SII=-0.05, 95% CI=-0.02,-0.09; p=0.003). The DA rate in the most deprived LA was 2.1 higher than the least deprived LA (RII=2.1, 95% CI=1.4,3.2; p=⟨0.001) in children ⟨1yr and 1.5 higher (RII=1.5, 95% CI=1.2,2; p=0.004) in children ≤1yr. CONCLUSIONS: DA rates were low for all LAs and only partially explained by deprivation. More deprived LAs were, unexpectedly, more likely to report higher DA rates.

A Randomised Controlled Trial of a Universal Bonding Agent at Three Years: Self Etch vs Total Etch.

General dental practice is increasingly being recognised as the ideal situation for the conduct of clinical trials into the longevity of restorations. The aim of this study was to investigate the survival of 64 nanofilled resin composite (Filtek Supreme XTE) restorations placed principally in loadbearing cavities using a Universal dentine bonding agent (Scotchbond Universal), in five UK dental practices by members of the UK-based practice-based research group, the PREP Panel. A split mouth design was used, comprising patients who required two restorations, with one of the restorations receiving a total etch approach using phosphoric acid and the other being placed using a self-etch approach. The results indicated good performance of the restorations examined, with no difference, in terms of marginal characteristics, between the restorations which received total etching and those which did not.

Comparison of the COHIP and OHIP- 14 as measures of the oral health-related quality of life of adolescents.

AIM: To compare the validity and reliability of the Oral Health Impact Profile-14 (OHIP-14) and the Child Oral Health Impact Profile (COHIP) for investigating oral health related quality of life (OHRQoL) of adolescents. METHOD: We studied 234 adolescents from two publicly funded schools in Hamedan, Iran. Participants completed questionnaires and had a clinical examination. We compared convergent and discriminative validity of the instruments by analyzing their association with self reported health indicators and number of decayed teeth. RESULTS: Both instruments showed good convergence with self-rated health and self-rated oral health. Those who perceived dental treatment needs, who had experienced dental pain in last month, were more dissatisfied with their oral health, or had more decayed teeth scored higher on both OHIP-14 and COHIP. The discriminative validity of the two instruments varied slightly and inconsistently. The convergent and discriminative validity of both instruments were established independent of their scoring methods. CONCLUSION: Both the OHIP-14 and COHIP were valid and reliable measures for investigating OHRQoL among 15-17 year old adolescents. The COHIP is preferable when the aim is identifying more impacts. Both measures have shown good convergent and discriminative validity, however, for practical reasons; the shorter instrument (OHIP-14) may be more suitable for epidemiological studies.

Persistent Socioeconomic Inequality in Child Dental Caries in England despite Equal Attendance.

INTRODUCTION: Despite a decline in the prevalence of dental caries among children in England and ongoing arrangements for the provision of free dental care up to the age of 18 y, there is limited information on the pattern and trend of socioeconomic inequalities in dental caries and dental attendance. METHODS: We estimated the magnitude of deprivation-related inequalities for dental caries and dental attendance in young children, using publicly available data and 2 regression-based summary measures of inequalities: slope index of inequality and relative index of inequality. RESULTS: We found no significant absolute or relative inequalities in dental attendance across English areas in the past decade, while there were persistent absolute and relative inequalities in dental caries. Socioeconomic inequalities in dental caries decreased between 2007 and 2012; thereafter, the relative inequalities increased. CONCLUSIONS: The apparent widening inequality in child dental caries in England despite equal access to dental care is a challenge for policy makers. KNOWLEDGE TRANSFER STATEMENT: While caries prevalence among English children has declined over the past decade, there has been an increase in socioeconomic inequalities in oral health despite there being no inequality in dental attendance. This has implications for the development of oral health strategy and planning dental services.

Comparing self-reported and clinically diagnosed unmet dental treatment needs using a nationally representative survey.

OBJECTIVES: To describe the validity and diagnostic accuracy of self-reported data compared with clinically assessed data for the ascertainment of clinical dental treatment needs in the Canadian population. METHODS: A secondary analysis of data from the Canadian Health Measures Survey (2007-2009) was undertaken. Clinical treatment needs were classified into preventive and diagnostic, restorative, endodontic, periodontic, surgical, and orthodontic categories. Sensitivity, specificity, positive and negative predictive values (NPVs), kappa statistics and likelihood ratios (LR) were calculated to compare self-reported and clinically determined needs. Survey weights were applied to generate nationally representative findings of the Canadian population. RESULTS: Generally across most dental need categories, agreement between self-reported and clinically-determined dental need was found to be moderate to poor (kappa <0.6). For most needs, self-reported data was found to be highly specific (>90 percent) but not very sensitive. Low positive (<60 percent) and high NPVs (>80 percent) revealed that self-reported information was found to be more precise in reassuring when most dental needs were not present, opposed to confirming needs that were required. High positive LRs were obtained for endodontic (+LR = 12.15) and orthodontic needs (+LR = 14.82), indicating good diagnostic accuracy of positive self-report for these outcomes. CONCLUSIONS: Our findings suggest that in general, self-reports are poor estimates for normative dental treatment needs but do have some merit in confirming non-needs. Exceptionally, self-reports do have suitable diagnostic accuracy for predicting orthodontic and endodontic needs.

In vitro cavity and crown preparations and direct restorations: A comparison of performance at the start and end of the FD programme.

Aim To assess the performance and thereby the progress of the FDs when they carried out a number of simulated clinical exercises at the start and at the end of their FD year.Methods A standardised simulated clinical restorative dentistry training exercise was carried out by a group of 61 recently qualified dental graduates undertaking a 12 months' duration foundation training programme in England, at both the start and end of the programme. Participants completed a Class II cavity preparation and amalgam restoration, a Class IV composite resin restoration and two preparations for a porcelain-metal full crown. The completed preparations and restorations were independently assessed by an experienced consultant in restorative dentistry, using a scoring system based on previously validated criteria. The data were subjected to statistical analysis.Results There was wide variation in individual performance. Overall, there was a small but not statistically significant improvement in performance by the end of the programme. A statistically significant improvement was observed for the amalgam preparation and restoration, and, overall, for one of the five geographical sub-groups in the study. Possible reasons for the variable performance and improvement are discussed.Conclusions There was variability in the performance of the FDs. The operative performance of FDs at the commencement and end of their FD year indicated an overall moderately improved performance over the year and a statistically significant improvement in their performance with regard to amalgam restoration.

Characteristics of children undergoing dental extractions under general anaesthesia in Wolverhampton: 2007-2012.

INTRODUCTION: Studying characteristics of children requiring extractions under dental general anaesthesia (DGA) can help identify trends, which can be used to facilitate future planning of healthcare services. OBJECTIVE: To report on the profile of children who underwent extractions under DGA between 2007 and 2012 at the New Cross Hospital in Wolverhampton, England.Methods Retrospective analyses of hospital records. RESULTS: Of the 2692 patients seen between 2007 and 2012, 49.6% were boys and 50.4% were girls. The mean age was 7.1 and 7 to 12 years was the largest age group (43%). The majority of the sample was White British (67%). Of the 8,286 teeth extracted, 85% were primary teeth and 15% permanent. More teeth were extracted in boys than girls (P = 0.002) and 'Other' ethnicities had a higher mean number of extractions compared to White British (P <0.001) and South Asians (P = 0.046). The mean age of the patients has decreased over the years (P = 0.001) and the mean number of primary teeth extracted has increased (P = 0.001). CONCLUSIONS: A clear dental public health issue has been reinforced through the relatively high level of DGA activity reported. Though rigorous caries prevention remains the ultimate goal, a better assessment and discharge process may help reduce the need for first time DGAs as well as repeats.

The impact of oral conditions on children in England, Wales and Northern Ireland 2013.

Background The 2013 Children's Dental Health survey is the fifth in a series of national surveys.Aim To summarise key findings on oral health perceptions, oral symptoms, and the impacts of oral conditions on the daily life of children and their families.Methodology A representative sample of children (aged 5, 8 12 and 15 years) and their parents in England, Wales and Northern Ireland completed relevant questionnaires.Results Oral symptoms, even more profound ones such as toothache, were prevalent among all age groups. Overall, 58% of 12- and 45% of 15-year-olds reported at least one oral impact in the past three months. The most prevalent oral impact was feeling embarrassed to smile or laugh, followed by difficulty eating. These symptoms and oral impacts were disproportionately high among children eligible for free school meals. Furthermore, one fifth to one third of parents reported that their children's oral conditions had some impact on their family life.Conclusion Oral symptoms were common and oral conditions had a negative impact on the quality of life of large proportions of children. There were clear and marked socioeconomic inequalities, with considerably worse oral health perceptions and higher levels of oral impacts among the more deprived children.

Oral health behaviours of children in England, Wales and Northern Ireland 2013.

Background The 2013 Children's Dental Health Survey is the fifth in a series of national surveys.Aim To describe the oral health behaviours in children and adolescents in England, Wales and Northern Ireland.Method A representative sample of children (aged 5, 8 12 and 15 years) in England, Wales and Northern Ireland were invited to participate in dental examinations. Children and parents were also invited to complete a questionnaire about oral health behaviours.Results Overall, the majority of children and young people reported good oral health behaviours. For example, more than three quarters of the 12- and 15-year-olds reported brushing their teeth twice a day or more often. However, a sizeable proportion of the sample reported less positive behaviours. Nearly 30% of 5-year-olds first started to brush their teeth after the age of one year. Among 15-year-olds, 11% were current smokers and 37% reported that they currently drank alcohol. Sixteen percent of 12-year-olds reported to consume drinks containing sugar four or more times a day. Of particular concern was the marked differences that existed by level of deprivation. Children living in lower income households (eligible for free school meals) were less likely to brush their teeth twice a day, more likely to start brushing after six months, more likely to be a smoker and more likely to consume frequent amounts of sugary drinks.Conclusion Despite some encouraging overall patterns of good oral health behaviours, a sizeable proportion of children and young people reported behaviours that may lead to poorer oral and general health. Preventive support should be delivered in clinical dental settings to encourage positive oral health behaviours. Public health strategies are also needed to reduce inequalities in oral health behaviours among children and young people.