Communication strategies to encourage child participation in an oral health promotion session: An exemplar video observational study.

BACKGROUND: The oral health promotion sessions for young children and parents in a clinical setting pose challenges to the dental team. AIM: To apply PaeD-TrICS (Paediatric dental triadic interaction coding scheme) to investigate the interaction of child, parent and dental nurse and determine the effect of nurse and parental behaviours on child participation within an oral health promotion session. METHOD: A video observational study was applied. The sample consisted of a dental nurse and 22 children aged 2-5 years in a general dental practice in Scotland. Behaviours were catalogued with time stamps using PaeD-TrICS. Analysis of behavioural sequences with child participation as the dependent variable was conducted using multilevel modelling. RESULTS: Children varied significantly in their participation rate. The statistical model explained 28% of the variance. The older the child and longer consultations significantly increased child participation. Both nurse and parental behaviour had immediate influence on child participation. Parental facilitation had a strong moderating effect on the influence of the nurse on child participation. CONCLUSIONS: Child participation was dependent on nurse and parent encouragement signalling an important triadic communication process. The coding scheme and analysis illustrates an important tool to investigate these advisory sessions designed for delivering tailored messages to young children and parents. PATIENT OR PUBLIC CONTRIBUTION: The dental staff, child patients and their parents were involved closely in the conduct and procedures of the present study.

Implementing the Smile4life intervention for people experiencing homelessness: a path analytical evaluation.

BACKGROUND: People experiencing homelessness have high levels of dental decay, oral cancer and poor oral health-related quality of life. The Scottish Government sought to address these issues by developing a national oral health improvement programme for people experiencing homelessness, named Smile4life. The aim was to investigate implementation behaviours and the role of work-related beliefs upon the delivery of the Smile4life programme across NHS Board areas in Scotland. METHODS: Non-probability convenience sampling, supplemented by snowball sampling, was used to recruit practitioners working across the homelessness sector. The overall evaluation of the implementation of the Smile4life programme was theoretically informed by the Behaviour Change Wheel. The questionnaire was informed by the Theoretical Domains Framework and was divided into three sections, demography and Smile4life Awareness; Smile4life Activities; and Smile4life work-related beliefs. A psychometric assessment was used to develop Smile4life Awareness, Smile4life Activities, Ability to Deliver and Positive Beliefs and Outcomes subscales. The data were subjected to K-R20, exploratory factor analysis, Cronbach's alpha, t-tests, ANOVA, Pearson's correlation analysis and a multivariate path analysis. RESULTS: One hundred participants completed the questionnaire. The majority were female (79%) and worked in NHS Boards across Scotland (55%). Implementation behaviour, constructed from the Delivering Smile4life scale and the summated Smile4life activities variable, was predicted using a linear model a latent variable. The independent variables were two raw variables Positive Beliefs and Outcomes, and Ability to deliver Smile4life. Results showed relatively good model fit (chi-square (1.96; p > 0.15), SRMR (< 0.08) and R2 (0.62) values). Positive and highly significant loadings were found describing the Implementation Behaviour latent variable (0.87 and 0.56). The two independent variables were associated (p < 0.05) with Implementation Behaviour. CONCLUSIONS: Work-related factors, such as positive beliefs and outcomes and ability to deliver are required for implementation behaviours associated with the delivery of the Smile4life programme. Future work should include training centred on the specific needs of those involved in the homelessness sector and the development of accessible training resources, thereby promoting implementation behaviours to assist the progression and sustainability of the Smile4life programme.

Dental professionals' experiences of managing children with carious lesions in their primary teeth - a qualitative study within the FiCTION randomised controlled trial.

BACKGROUND: The lack of evidence for the effective management of carious lesions in children's primary teeth has caused uncertainty for the dental profession and patients. Possible approaches include conventional and biological management alongside best practice prevention, and best practice prevention alone. The FiCTION trial assessed the effectiveness of these options, and included a qualitative study exploring dental professionals' (DPs) experiences of delivering the different treatment arms. This paper reports on how DPs managed children with carious lesions within FiCTION and how this related to their everyday experiences of doing dentistry. METHODS: Overall, 31 DPs from FiCTION-trained dental surgeries in four regions of the UK participated in semi-structured interviews about their experiences of the three treatment arms (conventional management of carious lesions and prevention (C + P), biological management of carious lesions and prevention (B + P) or prevention alone (PA)). A theoretical framework, drawing on social practice theory (SPT), was developed for analysis. RESULTS: Participants discussed perceived effectiveness of, and familiarity with, the three techniques. The C + P arm was familiar, but some participants questioned the effectiveness of conventional restorations. Attitudes towards the B + P arm varied in terms of familiarity, but once DPs were introduced to the techniques, this was seen as effective. While prevention was familiar, PA was described as ineffective. DPs manage children with carious lesions day-to-day, drawing on previous experience and knowledge of the child to provide what they view as the most appropriate treatment in the best interests of each child. Randomisation undermined these normal choices. Several DPs reported deviating from the trial arms in order to treat a patient in a particular way. Participants valued evidence-based dentistry, and expect to use the results of FiCTION to inform future practice. They anticipate continuing to use the full range of treatment options, and to personally select appropriate strategies for individual children. CONCLUSIONS: RCTs take place in the context of day-to-day practices of doing dentistry. DPs employ experiential and interpersonal knowledge to act in the best interests of their patients. Randomisation within a clinical trial can present a source of tension for DPs, which has implications for assuring individual equipoise in future trials.

Children and parents' perspectives on the acceptability of three management strategies for dental caries in primary teeth within the 'Filling Children's Teeth: Indicated or Not' (FiCTION) randomised controlled trial - a qualitative study.

BACKGROUND: The Filling Children's Teeth: Indicated Or Not? (FiCTION) randomised controlled trial (RCT) aimed to explore the clinical- and cost-effectiveness of managing dental caries in children's primary teeth. The trial compared three management strategies: conventional caries management with best practice prevention (C + P), biological management with best practice prevention (B + P) and best practice prevention alone (PA)-based approaches. Recently, the concept of treatment acceptability has gained attention and attempts have been made to provide a conceptual definition, however this has mainly focused on adults. Recognising the importance of evaluating the acceptability of interventions in addition to their effectiveness, particularly for multi-component complex interventions, the trial design included a qualitative component. The aim of this component was to explore the acceptability of the three strategies from the perspectives of the child participants and their parents. METHODS: Qualitative exploration, based on the concept of acceptability. Participants were children already taking part in the FiCTION trial and their parents. Children were identified through purposive maximum variation sampling. The sample included children from the three management strategy arms who had been treated and followed up; median (IQR) follow-up was at 33.8 (23.8, 36.7) months. Semi-structured interviews with thirteen child-parent dyads. Interviews were transcribed verbatim and analysed using a framework approach. RESULTS: Data saturation was reached after thirteen interviews. Each child-parent dyad took part in one interview together. The participants were eight girls and five boys aged 5-11 years and their parents. The children's distribution across the trial arms was: C + P n = 4; B + P n = 5; PA n = 4. Three key factors influenced the acceptability of caries management in primary teeth to children and parents: i) experiences of specific procedures within management strategies; ii) experiences of anticipatory dental anxiety and; iii) perceptions of effectiveness (particularly whether pain was reduced). These factors were underpinned by a fourth key factor: the notion of trust in the dental professionals - this was pervasive across all arms. CONCLUSIONS: Overall children and parents found each of the three strategies for the management of dental caries in primary teeth acceptable, with trust in the dental professional playing an important role.

The psychometric properties of the CFSS-DS for schoolchildren in Saudi Arabia: A confirmatory factor analytic approach.

AIM: To test the psychometric properties of an Arabic version of the Child Fear Survey Schedule-Dental Subscale (CFSS-DS) a using confirmatory factor analysis. METHODS: Two convenience samples were obtained: Sample [1]: 600 boys (33%) and girls attending 4 public schools in Onizah and Sample [2] 800 girls attending 8 public schools in Buridah. The questionnaire asked the participant's age, gender, and completion of the CFSS-DS. The data were subjected to exploratory factor analysis (EFA), parallel factor analysis, Cronbach's alpha, confirmatory factor analysis (CFA), and goodness of fit statistics. RESULTS: A total of 513 children in Sample [1] and 503 children in Sample [2] participated giving a valid response rate of 86% and 67%, respectively. From the EFA, 3 factors were identified and confirmed statistically using parallel factor analysis. The internal consistency of the 3 factors, Dental Fear Subscale (0.86), Hospital Fear Subscale (0.77), and Stranger Fear Subscale (0.71), was good. The CFA showed that the current EFA model was an equivalent fit to the El Housseiny et al (BMC Oral Health 2016;16:49). model; however, the solution using El Housseiny et al's structure was distorted. CONCLUSIONS: A 3-factor structure with acceptable reliability exists for this Arabic version of the CFSS-DS, confirmed by a CFA using an additional data set.

Development of an interaction coding scheme (PaeD-TrICS) to record the triadic communication behaviours in preventive dental consultations with preschool child patients and families: a video-based observational study.

BACKGROUND: There is a paucity of research concerning paediatric dental consultations in primary care. This is potentially due to the difficulty of measuring the communication behaviours in the complex triadic consultations. The present study aims to describe the development and refinement of a coding scheme to record the triadic communication between dental professionals, child patients and parents. METHODS: The PaeD-TrICS was developed from video observation of triadic communications and refined through an iterative process. Its practical applicability was assessed via implementation of the scheme on specialised behavioural coding software. Reliability was calculated using Cohen's Kappa. RESULTS: The PaeD-TrICS contains 45 codes. Forty-four dental professional-child-parent communications were successfully coded through administering the scheme on The Observer XT 10.5 system. Cohen's Kappa was 0.83 (inter-coder) and 0.90 (intra-coder). "Parental verbal facilitation" (mean = 1.68/min) was the most frequent behaviour. Dental professionals' "dentally engaging talk" (mean = 1.24/min), "praise" (mean = 1.10/min) and "instruction" (mean = 0.62/min) were frequently seen. Children's common behaviours included "speech other" (mean = 0.66/min) and non-verbal behaviour i.e. "non-verbal agreement" and verbal behaviour "speech yes" (mean = 0.26/min). CONCLUSIONS: The PaeD-TrICS is developed to capture the communication behaviour of the triadic consultations in a preventive dental setting. It demonstrates satisfactory intra- and inter-coder reliability and has been successfully used in paediatric dental consultations.

Dental students' perceptions of learning communication skills in a forum theatre-style teaching session on breaking bad news.

INTRODUCTION: Communication skills are an integral component of dental undergraduate education. Due to the complex nature of these skills, didactic teaching methods used in other educational contexts can be limited. Interactive and participative methods rooted in modern adult learning theories, such as Forum Theatre, may be more effective in the teaching of communication skills. AIM: To explore the usefulness of Forum Theatre in teaching clinical undergraduate dental students how to break bad news to their patients. METHODS: A purposive sample of 4th-year undergraduate dental students was invited to participate. An evaluation questionnaire was given to the students and collected after the Forum Theatre interactive session. Participants were asked to provide self-reported accounts on the most and least useful parts of the session, as well as the most important learning outcome. Usefulness of the session in clinical work, increasing confidence and ability in breaking bad news, were evaluated via a 5-point Likert-scale type question. Qualitative data were analysed using Framework Analysis to explore the themes found in the open-text component. Descriptive statistics were used to analyse the Likert-scale items. RESULTS: One hundred and fifteen completed questionnaires were collected from the 2015 and 2016 classes. Most students gave the Forum Theatre session a rating of 3 or above on a 5-point Likert scale; indicating that they found it useful. Qualitative results also showed that most participants liked the teaching session thanks to its interactive nature, the use of actors and the input of the facilitators. The majority of students showed preference towards smaller groups which give everyone equal opportunity to participate without unnecessary repetition. CONCLUSION: The results seem to confirm previous findings. Students rated their learning experience involving Forum Theatre favourably. Smaller groups and trained facilitators are required for the success of this teaching method. Further research is needed to assess the long-term educational benefits of Forum Theatre.

Dental students' and patients' perceived importance and knowledge of dental anxiety.

AIM: To examine the perceived importance and knowledge of the dental students' in their treatment of dental anxiety according to their year of study and to find out patients' perceived importance of the dental students' knowledge of dental anxiety according to their level on dental fear. METHODS: Dental students (N = 219) at the University of Turku and non-probability convenience sample of 100 of patients attending the Dental Teaching Clinic were given questionnaires with multiple choice and open-ended questions. Students were categorised into three groups according to the year of study (1-3, 4, 5). Patients were categorised into three groups using the established cut points for Modified Dental Anxiety Scale (no fear = 5-9, low fear = 10-18, high fear = 19-25). The differences between groups were evaluated using cross-tabulations, chi squared and Fisher's exact tests. The open-ended questions were subjected to content analysis. RESULTS: Students' perceived importance of dental anxiety did not differ between three groups. Students with greater undergraduate education and clinical experience were more likely to have excellent or quite good knowledge (P < .001). Patients' perceived importance of dental students' knowledge of dental anxiety was greater in patients with high level of fear. The overlapping category that emerged from the open-ended question analysis was communication skills. This appeared to be important for patients with dental anxiety and for dental students in their management of dental anxiety. CONCLUSION: Clinical communication skills should be part of dental anxiety management teaching. Dental students should be able to gain sufficient knowledge and skills in treating dental anxiety before graduating.

Music therapy for depression.

BACKGROUND: Depression is a highly prevalent mood disorder that is characterised by persistent low mood, diminished interest, and loss of pleasure. Music therapy may be helpful in modulating moods and emotions. An update of the 2008 Cochrane review was needed to improve knowledge on effects of music therapy for depression. OBJECTIVES: 1. To assess effects of music therapy for depression in people of any age compared with treatment as usual (TAU) and psychological, pharmacological, and/or other therapies.2. To compare effects of different forms of music therapy for people of any age with a diagnosis of depression. SEARCH METHODS: We searched the following databases: the Cochrane Common Mental Disorders Controlled Trials Register (CCMD-CTR; from inception to 6 May 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; to 17 June 2016); Thomson Reuters/Web of Science (to 21 June 2016); Ebsco/PsycInfo, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and PubMed (to 5 July 2016); the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, the National Guideline Clearing House, and OpenGrey (to 6 September 2016); and the Digital Access to Research Theses (DART)-Europe E-theses Portal, Open Access Theses and Dissertations, and ProQuest Dissertations and Theses Database (to 7 September 2016). We checked reference lists of retrieved articles and relevant systematic reviews and contacted trialists and subject experts for additional information when needed. We updated this search in August 2017 and placed potentially relevant studies in the "Awaiting classification" section; we will incorporate these into the next version of this review as appropriate. SELECTION CRITERIA: All randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing music therapy versus treatment as usual (TAU), psychological therapies, pharmacological therapies, other therapies, or different forms of music therapy for reducing depression. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated standardised mean difference (SMD) for continuous data and odds ratio (OR) for dichotomous data with 95% confidence intervals (CIs). We assessed heterogeneity using the I2 statistic. MAIN RESULTS: We included in this review nine studies involving a total of 421 participants, 411 of whom were included in the meta-analysis examining short-term effects of music therapy for depression. Concerning primary outcomes, we found moderate-quality evidence of large effects favouring music therapy and TAU over TAU alone for both clinician-rated depressive symptoms (SMD -0.98, 95% CI -1.69 to -0.27, 3 RCTs, 1 CCT, n = 219) and patient-reported depressive symptoms (SMD -0.85, 95% CI -1.37 to -0.34, 3 RCTs, 1 CCT, n = 142). Music therapy was not associated with more or fewer adverse events than TAU. Regarding secondary outcomes, music therapy plus TAU was superior to TAU alone for anxiety and functioning. Music therapy and TAU was not more effective than TAU alone for improved quality of life (SMD 0.32, 95% CI -0.17 to 0.80, P = 0.20, n = 67, low-quality evidence). We found no significant discrepancies in the numbers of participants who left the study early (OR 0.49, 95% CI 0.14 to 1.70, P = 0.26, 5 RCTs, 1 CCT, n = 293, moderate-quality evidence). Findings of the present meta-analysis indicate that music therapy added to TAU provides short-term beneficial effects for people with depression if compared to TAU alone. Additionally, we are uncertain about the effects of music therapy versus psychological therapies on clinician-rated depression (SMD -0.78, 95% CI -2.36 to 0.81, 1 RCT, n = 11, very low-quality evidence), patient-reported depressive symptoms (SMD -1.28, 95% CI -3.75 to 1.02, 4 RCTs, n = 131, low-quality evidence), quality of life (SMD -1.31, 95% CI - 0.36 to 2.99, 1 RCT, n = 11, very low-quality evidence), and leaving the study early (OR 0.17, 95% CI 0.02 to 1.49, 4 RCTs, n = 157, moderate-quality evidence). We found no eligible evidence addressing adverse events, functioning, and anxiety. We do not know whether one form of music therapy is better than another for clinician-rated depressive symptoms (SMD -0.52, 95% CI -1.87 to 0.83, 1 RCT, n = 9, very low-quality evidence), patient-reported depressive symptoms (SMD -0.01, 95% CI -1.33 to 1.30, 1 RCT, n = 9, very low-quality evidence), quality of life (SMD -0.24, 95% CI -1.57 to 1.08, 1 RCT, n = 9, very low-quality evidence), or leaving the study early (OR 0.27, 95% CI 0.01 to 8.46, 1 RCT, n = 10). We found no eligible evidence addressing adverse events, functioning, or anxiety. AUTHORS' CONCLUSIONS: Findings of the present meta-analysis indicate that music therapy provides short-term beneficial effects for people with depression. Music therapy added to treatment as usual (TAU) seems to improve depressive symptoms compared with TAU alone. Additionally, music therapy plus TAU is not associated with more or fewer adverse events than TAU alone. Music therapy also shows efficacy in decreasing anxiety levels and improving functioning of depressed individuals.Future trials based on adequate design and larger samples of children and adolescents are needed to consolidate our findings. Researchers should consider investigating mechanisms of music therapy for depression. It is important to clearly describe music therapy, TAU, the comparator condition, and the profession of the person who delivers the intervention, for reproducibility and comparison purposes.

METFORMIN-SUSTAINED WEIGHT LOSS AND REDUCED ANDROID FAT TISSUE AT 12 MONTHS IN EMPOWIR (ENHANCE THE METABOLIC PROFILE OF WOMEN WITH INSULIN RESISTANCE): A DOUBLE BLIND, PLACEBO-CONTROLLED, RANDOMIZED TRIAL OF NORMOGLYCEMIC WOMEN WITH MIDLIFE WEIGHT GAIN.

OBJECTIVE: To assess 12-month body weight (BW) and body composition changes in normoglycemic women with midlife weight gain, after dietary and pharmacologic interventions targeting hyperinsulinemia. METHODS: EMPOWIR (Enhance the Metabolic Profile of Women With Insulin Resistance; NCT00618072) was a double-blind, placebo-controlled, 12-month trial of women with >20-pound weight gain, normal glucose tolerance test, and increased area-under-the-curve insulin. Subjects (mean ± SD, 46.7 ± 6.5 years of age; body mass index, 30.8 ± 2.8 kg/m(2); 50% white) attended 4 nutrition workshops to introduce a novel carbohydrate-modified diet (CMD) and were then randomized to one of three arms for 6 months (phase 1): CMD alone (D), or in combination with metformin (M), or metformin + rosiglitazone (MR), with rerandomization of the D group to one of the active treatment arms (phase 2, months 7 through 12). Repeated measure analysis of variance was used to assess BW at baseline, 6 months, and 12 months in 32 subjects with 12-month data; paired t tests compared baseline and 12-month dual-energy X-ray absorptiometry-derived body composition. RESULTS: Mean (±SD) BW decreased significantly at 12 months in the M arm: 85.1 ± 8.5 kg to 79.8 ± 9.0 kg (P = .0003), with 54% of variance in weight over time explained by M treatment. Mean (±SD) percent android fat decreased significantly in the M and D arms: 53.5 ± 4.8% to 49.3 ± 7.6% (P = .010) and 52.9 ± 6.2% to 48.1 ± 8.7% (P = .021). CONCLUSION: In combination with a novel carbohydrate modified diet, metformin enhanced 12-month weight loss and improved body composition in ethnically diverse normoglycemic, hyperinsulinemic women with midlife weight gain. These findings suggest that EMPOWIR's easily implemented dietary interventions, alone and in combination with pharmacotherapies that target hyperinsulinemia, merit additional investigation in larger, long-term studies.

Exploring the benefits of Smile4life training: Findings from a pilot study.

Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness. Following an oral health and psychosocial needs assessment of 853 homeless people across Scotland, the Smile4life intervention was developed and rolled out across all NHS boards. Dental health and health and social care practitioners were invited to attend a training event at the launch of the Smile4life: Guide for Trainers - a training guide for practitioners working with homeless people. This paper presents results from HoPSCOTCH, a pilot study that took place in four NHS boards to examine the benefits of training for practitioners regarding their awareness of homelessness and the oral health needs of homeless people. Dental health (baseline: 10; follow-up: 8) and health and social care practitioners (baseline: 13; follow-up: 12) completed questionnaires about their knowledge, attitudes and behaviours. The results showed that there were increases in practitioner knowledge, confidence and motivation to help service users access dental care, to provide oral health education and to use motivational interviewing. The authors recommend that future training for practitioners who work with homeless people should include communication skills and advice on how to deliver tailored interventions, with the aim of strengthening practitioners' confidence and motivation to deliver the Smile4life intervention.

Reducing the volume, exposure and negative impacts of advertising for foods high in fat, sugar and salt to children: A systematic review of the evidence from statutory and self-regulatory actions and educational measures.

PURPOSE: To identify and review evidence on 1) the effectiveness of statutory and self-regulatory actions to reduce the volume, exposure or wider impact of advertising for foods high in fat, sugar and salt (HFSS) to children, and 2) the role of educational measures. DESIGN/METHODOLOGY/APPROACH: A systematic review of three databases (Medline, CINAHL and PsycINFO) and grey literature was carried out. Relevant evidence included studies evaluating advertising bans and restrictions, advertising literacy programmes and parental communication styles. Relevant media included TV, internet, radio, magazines and newspaper advertising. No studies were excluded based on language or publication date. FINDINGS: Forty-seven publications were included: 19 provided evidence for the results of statutory regulation, 25 for self-regulation, and six for educational approaches. Outcome measures varied in approach, quality and results. Findings suggested statutory regulation could reduce the volume of and children's exposure to advertising for foods HFSS, and had potential to impact more widely. Self-regulatory approaches showed varied results in reducing children's exposure. There was some limited support for educational measures. DISCUSSION: Consistency in measures from evaluations over time would assist the development and interpretation of the evidence base on successful actions and measures to reduce the volume, exposure and impact of advertising for foods HFSS to children.

Storytelling, sugar snacking, and toothbrushing rules: a proposed theoretical and developmental perspective on children's health and oral health literacy.

BACKGROUND: Health literacy has been conceptualised to explain how health information facilitates the maintenance of health. What are the clinical implications of children's health literacy? Children have language skills, numeracy, and reading skills that are in a state of flux - how do they decipher and encode adult health messages to make them their own? AIM: To explore children's health and oral health literacy and discover what processes they use to convert adult health messages into useable information. METHODS: Observations and descriptive case study approach. RESULTS: A theoretical and developmental perspective on children's health and oral health literacy, based upon the ability of the adult to provide a health message with a common shared element, is proposed. It is this common element that the child uses to make adult words understandable and to generate health action. CONCLUSIONS: Children's health and oral health literacy development is achieved, through, a torturous path, supported by the way adults provide health messages to children. Taking time to identify this common element, helping children to encode and reflect upon the health message will help children convert adult oral health messages into their own oral health practices, and support their emerging health and oral health literacy.

Training and fairer payments would increase caries prevention in practice.

DATA SOURCES: PubMed, Embase, PsycoInfo, Scielo, Scopus, Web of Science, BBO, Lilacs and York databases supplemented by Google scholar. STUDY SELECTION: Qualitative studies with findings derived from individual or group interviews and structured questionnaires reporting factors that drove dentists towards or away from incorporating caries preventive measures were considered. Two reviewers conducted selection independently. DATA EXTRACTION AND SYNTHESIS: Data were abstracted independently by two reviewers and a qualitative metasummary carried out. This involves the extraction, grouping and formatting of findings and the calculation of frequency and intensity effect sizes in order to provide mixed research syntheses and to conduct a posteriori analyses of the relationship between reports and findings. RESULTS: Seven qualitative studies and 41 surveys (36,501 participants) were included. The reports were grouped together into six categories that were judged to be topically similar; education and training, personal beliefs, work conditions, remuneration, gender, place of residence and patients. Biologicism (27%), low remuneration (25%), length of time since graduation (22%) and male dentists (19%) were found to be the highest frequency effect size driving dentists away from using preventive approaches, and team work (21%), post-graduation (12%) and professional understanding of the benefits (12%) were identified as the main reasons for dentists' adherence to preventive measures. CONCLUSIONS: Despite the questionable quality of the included reports the evidence that emerged seems to indicate that further education and training coupled with a fairer pay scheme would be a reasonable approach to change the balance in favour of the provision of dental caries preventive measures by dentists. The results of this review could be of value in the planning and decision-making processes aimed at encouraging changes in professional dental practice that could result in the improvement of the oral health care provided to the population in general.

Why are people afraid of the dentist? Observations and explanations.

OBJECTIVE: The aim of this review was to explore the peer-reviewed literature to answer the question: 'Why are people afraid of the dentist?' METHOD: Relevant literature was identified by searching the following on-line databases: PubMed, PsycInfo, the Cochrane Library and Google Scholar. Publications were extracted if they explored the causes and consequences of dental fear, dental anxiety or dental phobia. RESULTS: The research evidence suggests that the causes of dental fear, dental anxiety or dental phobia are related to exogenous factors such as direct learning from traumatic experiences, vicarious learning through significant others and the media, and endogenous factors such as inheritance and personality traits. Each individual aetiological factor is supported by the evidence provided. CONCLUSIONS: The evidence suggests that the aetiology of dental fear, anxiety or phobia is complex and multifactorial. The findings show that there are clear practical implications indicated by the existing research in this area: a better understanding of dental fear, anxiety and phobia may prevent treatment avoidance.

The relationship of dental caries and dental fear in Malaysian adolescents: a latent variable approach.

BACKGROUND: To investigate the role of geography (place of residence) as a moderator in the relationship between dental caries disease and treatment experience and dental fear in 16-year-olds living in Malaysia. METHODS: A multi-stage-stratified sampling method was employed. Five hundred and three, 16-year-olds from 6 government secondary schools participated in this study. The questionnaire examined participants' demographic profile and assessed their dental fear using the Dental Fear Survey (DFS). The clinical examination consisted of the DMFT as the outcome measure of dental caries disease and treatment experience by a single examiner (ICC = 0.98). Structural equation modelling inspected the relationship between dental fear and dental caries disease and treatment experience. RESULTS: The mean DMFT was 2.76 (SD 3.25). The DT, MT and FT components were 0.64 (SD 1.25), 0.14 (SD 0.56) and 1.98 (SD 2.43) respectively. Rural compared with urban adolescents had significantly greater mean numbers of decayed and missing teeth. The mean DFS score was 40.8 (SD 12.4). Rural compared with urban adolescents had significantly higher mean scores for physical symptoms of dental fear. The correlation between dental fear (DFS) and dental caries disease and treatment experience (DMFT) was 0.29, p < 0.0001. The structural equation model fitted the raw data well (χ2 = 9.20, df = 8, p = 0.34). All components of DMFT were closely associated in equal strength to the unidimensional hypothetical latent variable of dental caries disease and treatment experience. The strength of the relationship between dental fear and dental caries disease and treatment experience varied in accordance with place of residence. CONCLUSION: In conclusion a relationship between dental fear and dental caries disease and treatment experience was shown to exist in 16-year-old adolescents living in Malaysia. This study showed that the rural-urban dichotomy acted as a moderator upon this relationship.

Moderate evidence support a relationship between sugar intake and dental caries.

DATA SOURCES: Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), LILACS (Latin American and Caribbean Health Sciences), CNKI (China National Knowledge Infrastructure), Wanfang (China) and the South African Department of Health databases were searched. In addition the archives at the WHO Collaborating Centre for Nutrition and Oral Health at Newcastle University and reference lists of reviews were searched and experts contacted for further relevant papers. STUDY SELECTION: Intervention, cohort population or cross sectional studies were considered where there was any intervention to alter the intake of sugar or the intake of sugars or change of sugar intake was monitored. The main outcome was caries incidence. The GRADE (Grading of Recommendations Assessment Development and Evaluation) system was used to assess study quality. DATA EXTRACTION AND SYNTHESIS: Separate data abstraction forms were designed for RCTs and observational studies and meta-analyses were to be conducted where possible. RESULTS: Sixty-five papers reporting 55 studies were included. No RCTs were identified. Three studies (four papers) were interventional, eight (12 papers) were prospective cohort, 20 (25 papers) were population based and 24 (25 papers) were cross-sectional. Data variability limited meta-analysis. Of the studies, 42 out of 50 of those in children and five out of five in adults reported at least one positive association between sugars and caries.Five of the eight cohort studies allowed comparison of dental caries development when sugars consumption was equivalent to a level < 10% E (Energy) or > 10% E. All eight studies found higher caries with sugars intake > 10% E compared with < 10% E. CONCLUSIONS: This in-depth systematic review shows consistent evidence of moderate quality supporting a relationship between the amount of sugars consumed and dental caries development. There is evidence of moderate quality to show that dental caries is lower when free-sugars intake is < 10% E. Dental caries progresses with age, and the effects of sugars on the dentition are lifelong. Even low levels of caries in childhood are of significance to levels of caries throughout the life course. Analysis of the data suggests that there may be benefit in limiting sugars to < 5% E to minimise the risk of dental caries throughout the life course.

Dental therapists/hygienists working in remote-rural primary care: a structured review of effectiveness, efficiency, sustainability, acceptability and affordability.

AIM: To examine the use of dental therapist/hygienists to provide primary dental treatment in remote-rural areas with regard to their effectiveness, efficiency, sustainability, acceptability and costs (affordability). METHOD: The structured literature review of studies indexed in Medline, Embase and CinAHL was conducted using search terms relevant to 'dental therapists' and 'remote-rural'. Remote-rural was defined as 'those (individuals) with a greater than 30-minute drive time to the nearest settlement with a population of greater than 10,000'. RESULTS: From 1,175 publications screened, 21 studies from 19 publications were initially included. Only seven studies were included that explicitly focused on remote-rural areas. Four were surveys and three were qualitative studies. All of the included studies were reported within the last 7 years. The methodological quality of the surveys varied, particularly with regard to their response rates. All three of the qualitative studies were assessed as potentially weak methodologies. Regarding the research question, none of the studies included provided data relevant to understanding efficiency, cost issues or the acceptability of dental therapists. The available empirical evidence contained only indirect indicators about the sustainability of dental therapy in rural areas. CONCLUSIONS: The available data indicates that dental therapist/hygienists have suitable skills and could constitute a valuable asset to meet the dental demands in remote-rural areas. However, the evidence base is limited and of a poor quality. There is a need to put in place 'well-designed interventions with robust evaluation to examine cost-effectiveness and benefits to patients and the health workforce'.

UK population norms for the modified dental anxiety scale with percentile calculator: adult dental health survey 2009 results.

BACKGROUND: A recent UK population survey of oral health included questions to assess dental anxiety to provide mean and prevalence estimates of this important psychological construct. METHODS: A two-stage cluster sample was used for the survey across England, Wales, and Northern Ireland. The survey took place between October-December 2009, and January-April 2010. All interviewers were trained on survey procedures. Within the 7,233 households sampled there were 13,509 adults who were asked to participate in the survey and 11,382 participated (84%). RESULTS: The scale was reliable and showed some evidence of unidimensionality. Estimated proportion of participants with high dental anxiety (cut-off score = 19) was 11.6%. Percentiles and confidence intervals were presented and can be estimated for individual patients across various age ranges and gender using an on-line tool. CONCLUSIONS: The largest reported data set on the MDAS from a representative UK sample was presented. The scale's psychometrics is supportive for the routine assessment of patient dental anxiety to compare against a number of major demographic groups categorised by age and sex. Practitioners within the UK have a resource to estimate the rarity of a particular patient's level of dental anxiety, with confidence intervals, when using the on-line percentile calculator.

The Associations among Dental Anxiety, Self-Esteem, and Oral Health-Related Quality of Life in Children: A Cross-Sectional Study.

BACKGROUND: The current evidence on the relationships among child oral health-related quality of life, dental anxiety, and self-esteem indicates that we need to investigate these relationships to improve our understanding of the associations. Therefore, the current research aimed to enhance this evidence and provide an overview of the participating children's oral-health-related quality of life (as measured by the CPQ8-10), self-esteem (as measured by the Coopersmith SEI-SF), and dental anxiety (as measured by the CFSS_DS) and how these child-related outcome measures interacted and were related to one another. METHOD: A cross-sectional survey was conducted on a random sample of school children (n = 1900) aged 8 to 10 years. The questionnaire was collected through validated self-report measures: dental anxiety, COHRQoL, and self-esteem. Structural equation modelling (SEM) was used to test the strength of the association of our model to explore the relationships among these three psychological constructs. The moderating effects of age, gender, location, and the educational board were analysed for their possible influence on these relationships. RESULTS: Significant relationships between COHRQoL and child dental anxiety and between COHRQoL and SE were detected. The relationship subscale between COHRQoL and child dental anxiety was 0.24, (p < 0.001). A stronger correlation between COHRQoL, and SE was found, with B = -0.77, (p < 0.001). Although the association between CDA and SE was small, it was statistically significant (p = 0.03). These findings provide some important background information for designing effective educational programs for children.