A review of a child population dental preventive programme in Halton and St Helens.

INTRODUCTION: An evaluation was undertaken to measure the dental health of five cohorts of 5-year-old children living in Halton and St Helens, each cohort having had a different length of time they were exposed to a population dental prevention programme before their fifth birthday. METHOD: The dental health of each of five consecutive cohorts of 5-year-old children was measured epidemiologically using standardised methods. RESULTS: The mean level of active decay (dt) in the cohort that had the greatest exposure to the preventive intervention (cohort 5, 2011/12) was 0.83, whereas the mean level of active decay in the cohort with no exposure to the preventive programme (cohort 1, 2007/8) was 1.07. This represents a reduction of 22% in the mean level of active decay in 5-year-olds. There was also a 5.9% absolute increase in the number of 5-year-old children free from decay experience between cohorts 5 and 1. Children living in Halton and St Helens with postcodes in the more socially deprived index of multiple deprivation (IMD) tertiles gained the most from the programme. Comparing cohort 5 and cohort 1, the increase in the proportion of children free from decay was greatest in IMD tertiles 1 and 2 and least in IMD tertile 3 (least socially disadvantaged). CONCLUSION: Following a four-year population dental preventive programme the dental health of 5-year-old children living in Halton and St Helens has improved and dental health inequalities have reduced. As there was no control group, the effects seen are associative and cannot be assumed to be causative.

Preventing decay in children: dare we risk the 'risk assessment' model in practice?

Encouraging dental prevention seems like a logical approach given that dental decay is a preventable disease and while the 2006 dental contract provides preventive opportunities, there is confusion about the best approach to the prevention of decay in those children that attend their dentist. Should we provide prevention for all children attending their dentist (the population approach) or should we target those children who are at greatest risk (risk assessment approach)?

A comparative needs assessment of the dental health of adults attending dental access centres and general dental practices in Halton & St Helens and Warrington PCTs 2007.

INTRODUCTION: Dental access centres (DACs) were introduced in England at the turn of the twenty-first century in response to a growing problem of access to NHS dental services. DACs were expected to offer NHS dental care primarily to those patients that were unwilling or unable to attend 'high street' dental practice. At the same time, the new NHS primary care dental contract in England, introduced in April 2006, has been associated in some areas with access difficulties, with routine dental patients having difficulty accessing NHS dental care. In light of these changes, have DACs become an alternative provider of NHS dental services to patients seeking routine dental care? METHOD: In summer 2007, a cross sectional dental epidemiological study was undertaken in Halton & St Helens PCT and Warrington PCT to compare the dental health and attitudes to dental visiting of adult patients attending DACs and neighbouring 'high street' dental practices. RESULTS: The results of the study showed that DAC patients: were younger and from a more disadvantaged background than patients attending 'high street' practices; had worse oral health than 'high street' dental patients; experienced more frequent episodes of dental pain than 'high street' dental patients and were more likely to be dentally anxious; had different attitudes to dental health than their 'high street' counterparts. CONCLUSIONS: The study suggests that the DACs in Halton, St Helens and Warrington are offering treatment to a different population of patients to that seen in neighbouring 'high street' practices and therefore the DACs are fulfilling the function expected of them locally.

The introduction of the new dental contract in England - a baseline qualitative assessment.

OBJECTIVE: To record immediately prior to its inception the views of key stakeholders about the new dental contract introduced in April 2006. METHOD: Nineteen participants (11 dental practice principals and eight primary care trust dental leads) were interviewed using a semi structured approach to find out their views and opinions about dental practice, the reasons for introducing the new dental contract, its implementation and content of the new dental contract. An analysis based upon the constant comparative method was used to identify the common themes about these topics. RESULTS: Practice principals expressed satisfaction with working under pilot Personal Dental Services schemes but there was a concern among dental leads about a fall in dental activity among some dentists. All participants believed the new contract was introduced for political, financial and management reasons. All participants believed that it was introduced to limit and control the dental budget. Participants felt that implementation of the contract was rushed and there was insufficient negotiation. There were also concerns that the contract had not been tested. Dental practitioners were concerned about the calculation and future administration of the unit of dental activity system, the fixing of the budget and the fairness of the new dental charge scheme. Dental leads were concerned about patient access and retention and recruitment of dentists under the new contract. CONCLUSIONS: The study found a number of reasons for unease about the new dental contract; it was not perceived as being necessary, it was implemented at speed with insufficient negotiation and it was seen as being untested. Numerous and varied problems were foreseen, the most important being the retention of dentists within the NHS. Participants felt the contract was introduced for financial, political and managerial reasons rather than improving patient care. The initial high uptake of the new dental contract should not be viewed as indicating a high level of approval of its content.

General dental practitioner's views on dental general anaesthesia services.

OBJECTIVE: Policy has recently changed on provision of dental general anaesthetic services in England. The aim of this study was to investigate general dental practitioners' views about dental general anaesthetics, the reduction in its availability and the impact on care of children with toothache. RESEARCH DESIGN: Qualitative study using semi-structured interviews and clinical case scenarios. PARTICIPANTS: General dental practitioners providing NHS services in the North West of England. RESULTS: 93 general dental practitioners were interviewed and 91 answered a clinical case scenario about the care they would provide for a 7-year-old child with multiple decayed teeth presenting with toothache. Scenario responses showed variation; 8% would immediately refer for general anaesthesia, 25% would initially prescribe antibiotics, but the majority would attempt to either restore or extract the tooth causing pain. Interview responses also demonstrated variation in care, however most dentists agree general anaesthesia has a role for nervous children but only refer as a last resort. The responses indicated an increase in inequalities, and that access to services did not match population needs, leaving some children waiting in pain. CONCLUSIONS: Most general dental practitioners support moving dental general anaesthesia into hospitals but some believe that it has widened health inequalities and there is also a problem associated with variation in treatment provision. Additional general anaesthetic services in some areas with high levels of tooth decay are needed and evidence based guidelines about caring for children with toothache are required.

Exploring factors that influence general dental practitioners when providing advice to help prevent caries in children.

OBJECTIVE: To increase understanding about how and to whom general dental practitioners provide preventive advice to reduce caries in young children. DESIGN: Qualitative study using semi-structured interviews. SETTING: The North West of England. Interviews took place between March and September 2003. SUBJECTS AND METHODS: Ninety-three general dental practitioners practising within the general dental service were interviewed about the care they provide to young children. The interviews were recorded, transcribed and analysed using a constant comparative method. RESULTS: Children with caries were more likely to be questioned about diet and oral hygiene and if dentists believed parents to be motivated they were more inclined to spend time providing advice. Most dentists seemed to believe that education was the key to preventing caries and gave preventive advice in the form of a short educative talk. There was little use of visual aids or material for parents to take home. CONCLUSION: Preventive advice is given in an ad hoc way with no formal targeting. Most dentists deliver preventive advice as a short educative talk with no props or additional materials. Use of visual aids, providing materials for parents to take home and greater emphasis on partnership might help improve the impact of advice.

The effectiveness of school dental screening: dental attendance and treatment of those screened positive.

OBJECTIVE: To determine dental attendance and treatment outcomes following two models of dental screening. DESIGN: An observational prospective cohort study. SETTING: Infant, primary and junior schools in the North West of England. SUBJECTS: Children aged six to nine years at the start of the study. INTERVENTIONS: Subjects received a screening examination according to either a 'Traditional model' or 'New model' of school dental screening. MAIN OUTCOME MEASURES: Attendance at a dentist within four months of the intervention and treatment received by children referred via the 'New model' with caries in their permanent teeth. RESULTS: In the 'New model' of school dental screening 46% of screened positive and 41% of screened negative children attended a dentist during the study period. Some 44% of children referred with caries in permanent teeth attended a dentist and 53% of those attending received treatment for the referred condition. Larger proportions of children from disadvantaged backgrounds were screened positive but higher proportions of children from more affluent backgrounds attended the dentist and subsequently received treatment. CONCLUSION: School dental screening has a minimal impact on dental attendance and only a small proportion of screened positive children receive appropriate treatment. The programme fails to reduce inequalities in utilisation of dental services.

The influences on preventive care provided to children who frequently attend the UK General Dental Service.

OBJECTIVES: To identify the relationship between the preventive and restorative care provided to children who frequently attend the General Dental Service in the UK after taking into account socio-economic status, gender and dental caries experience. SETTING: General dental practices in the North West of England. SUBJECTS AND MATERIALS: The study design involved a retrospective investigation of case notes of 677 children who regularly attended 50 general dental practitioners. The complete history of the dental care received by each child during the primary dentition period was recorded. Analyses took place at the patient level. Information was recorded on the total number of carious teeth and restorative and preventive care provided to the children. Preventive care was categorised as dietary advice, oral hygiene instruction, prescription of fluoride tablets and application of fluoride varnish. Socio-economic status was measured using the Townsend score of the electoral ward of residence of each subject. Logistic regression models, taking into account the clustering of the subjects within dental practices were fitted to identify whether or not socio-economic status was significantly associated with provision of each category of preventive care, after controlling for gender, the total number of teeth affected by caries and the proportion of carious teeth which were restored. RESULTS: Children from poorer backgrounds were significantly more likely to receive oral hygiene instruction than their more affluent peers. Socio-economic status did not influence dentists' decisions to prescribe fluoride tablets, but children from affluent backgrounds were significantly more likely to have fluoride varnish applied to their teeth than children from deprived backgrounds after controlling for other factors. The more teeth affected by decay significantly increased the odds of giving dietary advice, prescription of fluoride tablets and application of fluoride varnish, but had no effect on whether or not oral hygiene instruction was given. As the percentage of decayed but filled teeth decreased the odds of giving dietary advice or applying fluoride varnish increased significantly. Conclusion It would appear that dentists are providing appropriate preventive care according to the aetiological causes of dental disease. They also look to be providing preventive care in compensation for decisions not to restore carious primary teeth. However the preventive care provided seems to be reactive to disease patterns, and in this high risk group of patients does not seem to be particularly effective.

A comparison of normative and subjective assessment of the child prevalence of developmental defects of enamel amongst 12-year-olds living in the North West Region, UK.

Analysis of data from a 1996-97 cross sectional epidemiological study of the dental health of a sample of 12-y-old children living in Crewe, in north west England was used to compare normative and subjective assessment of developmental defects of enamel. Five hundred and twenty two 12-y-old children from secondary schools in Crewe were examined. One hundred and eighty two children (34.8%), had home post codes within the optimally fluoridated part of Crewe. Using the Developmental Defects of Enamel Index, 178 children (34%) in Crewe were normatively identified as having enamel defects present on their upper incisors. Thirty five children (6.7%), were unhappy with the appearance of their upper incisors because of marks that would not brush off. Neither the normative nor the subjective assessment of enamel defects demonstrated any difference in prevalence between the fluoridated and non-fluoridated areas. In Crewe, one in 20 children normatively diagnosed as being free from enamel defects were unhappy with the appearance of their upper incisors because of marks that would not brush off. There are differences in perception between dental professionals and 12-y-old children over the presence and relevance of developmental defects of enamel. Further research is required if we are to understand the difference in professional and lay perceptions of developmental defects affecting upper incisor teeth.

The relationship between registration and dental health benefit in 8- and 9-year-old children in Cheshire.

The dental treatment needs of 8- and 9-year-old children registered with a GDP for at least 6 months were compared with the dental treatment needs of children from a similar social background who were neither registered nor regularly attending the Community Dental Service. The children were examined by one of the authors without prior knowledge of registration status for evidence of treatment need. Unequivocal treatment need was defined as untreated dental caries in permanent teeth, sepsis associated with deciduous teeth, instanding maxillary incisors, and untreated permanent teeth fractured into dentine; untreated caries in the deciduous teeth was also recorded. Registration status of the children was subsequently obtained from the Dental Practice Board. Sixty-three per cent of the children had been registered with a GDP for at least 6 months at the time of the survey, 6% had been registered for less than 6 months and 31% had never been registered under the new dental contract. Of the children who had been registered for more than 6 months, 18.5% had unequivocal treatment need as against 17.5% in the unregistered group; 40.4% of the registered children had decay in their deciduous teeth, as against 36.5% of the unregistered children. Comparison of the dental treatment needs of registered and unregistered children showed no significant difference between the two groups.

Community dental service based out of hours emergency dental care--a pilot study.

Twenty-nine out-of-hours calls were received during the 6-week period. Advice was offered to 27 patients and two call-outs were made for treatment of acute abscesses in children. Eight patients claimed to be under treatment with the CDS, 17 claimed to be registered with a general dental practitioner, while four claimed not to be registered. A demand for an emergency service was demonstrated, as was the need to define accurately the categories of patients eligible for emergency treatment within the CDS. The pilot study also highlighted the requirement to fund this service adequately.