Alcohol Screening and Brief Advice in NHS General Dental Practices: A Cluster Randomized Controlled Feasibility Trial.

AIM: To assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice to eligible patients attending NHS dental practices in London. METHODS: A two-arm cluster randomized controlled feasibility trial was conducted. Twelve dental practices were recruited and randomized to intervention and control arms. Participants attending for a dental check were recruited into the study and were eligible if they consumed alcohol above recommended levels assessed by the AUDIT-C screening tool. All eligible participants were asked to complete a baseline socio-demographic questionnaire. Six months after the completion of baseline measures, participants were contacted via telephone by a researcher masked to their allocation status. The full AUDIT tool was then administered. Alcohol consumption in the last 90 days was also assessed using the Form 90. A process evaluation assessed the acceptability of the intervention. RESULTS: Over a 7-month period, 229 participants were recruited (95.4% recruitment rate) and at the 6 months follow-up, 176 participants were assessed (76.9% retention rate). At the follow-up, participants in the intervention arm were significantly more likely to report a longer abstinence period (3.2 vs. 2.3 weeks respectively, P = 0.04) and non-significant differences in AUDIT (44.9% vs. 59.8% AUDIT positive respectively, P = 0.053) and AUDIT C difference between baseline and follow-up (-0.67 units vs. -0.29 units respectively, P = 0.058). Results from the process evaluation indicated that the intervention and study procedures were acceptable to dentists and patients. CONCLUSIONS: This study has demonstrated the feasibility and acceptability of dentists screening for alcohol misuse and providing brief advice.

Early childhood caries trends and surveillance shortcomings in the Czech Republic.

BACKGROUND: Despite the decline in childhood caries prevalence, seen particularly in 1980s, in recent years there have been reports that the declining trend has stopped or even reversed in some countries. The aim of the study was to analyse data from previous epidemiological studies on early childhood caries in the Czech Republic, conduct a secondary analysis of trend in dental caries prevalence, and discuss issues related to national oral health surveillance. METHODS: Since the 1990s, caries prevalence in preschool children was monitored by two independent bodies: Institute of Health Information and Statistics (IHIS) that conducted 5 cross-sectional surveys over the period 1994-2006, and Institute of Dental Research (IDR) that conducted 4 studies over the years 1998-2010. Both study series differed in methods of sample selection and approaches to examiner training. For the assessment of the caries prevalence trends, regression modelling was used for the following oral-health indicators: caries experience, mean number of teeth with untreated caries (dt) and percentage of caries-free children. RESULTS: In both study series, a significant overall trend of declining caries experience and level of untreated caries, and an increasing trend of percentage of caries-free children was observed (p < 0.05). In IHIS studies, caries experience reduced from 3.5 to 2.7; dt reduced from 2.2 to 1.5 and a proportion of caries-free children increased from 23.9 to 42.2%. In IDR studies, caries experience reduced from 3.7 to 2.98; dt reduced from 2.5 to 2.1 and a proportion of caries-free children increased from 26.7 to 44.9%. CONCLUSIONS: Both study series identified a significant decline of caries prevalence particularly in the 1990s and early 2000s. By the end of the investigated period, flattening of the caries decline was observed. The positive trend was observed in the absence of any systematic preventive initiatives on a population level. With respect to the above the authors assume that in the Czech Republic there still is a potential for further caries reduction in preschool population. This, however, cannot be expected without any health policy interventions. Oral health surveillance in the Czech Republic should be promoted by competent regulatory authorities.

Impact of treating dental caries on schoolchildren's anthropometric, dental, satisfaction and appetite outcomes: a randomized controlled trial.

BACKGROUND: There are no randomized controlled trials to assess the impact of treating dental caries on various aspects of children's health. This study was conducted to assess the impact of dental treatment of severe dental caries on children's weight, height and subjective health related outcomes, namely dental pain, satisfaction with teeth and smile, dental sepsis and child's appetite. METHODS: The study was a community-based, randomized, controlled trial in schoolchildren aged 6-7 years with untreated dental caries. Participants were randomly assigned to early (test) or regular (control) dental treatment. The primary outcome was Weight-for-age Z-score. Secondary outcomes were Height-for-age and BMI-for-age Z-scores, dental pain, dental sepsis, satisfaction with teeth and child's appetite. RESULTS: 86 children were randomly assigned to test (42 children) and control (44) groups. Mean duration of follow-up was 34.8 (± 1.1) weeks. There were insignificant improvements in anthropometric outcomes between the groups after treatment of caries. However, treated children had significantly less pain experience (P = 0.006) (OR 0.09, [0.01-0.51]) and higher satisfaction with teeth (P = 0.001) (OR 9.91, [2.68-36.51]) compared to controls. Controls had significantly poorer appetites (P = 0.01) (OR 2.9, [1.24-6.82]) compared to treated children. All treated children were free of clinical dental sepsis whereas 20% (9 of 44) of controls who were free of sepsis at baseline had sepsis at follow-up. CONCLUSIONS: Although dental treatment did not significantly improve the anthropometric outcomes, it significantly improved the dental outcomes and children's satisfaction with teeth, smile and appetite. This is the first study to provide evidence that treatment of severe dental caries can improve children's appetite. TRIAL REGISTRATION: Effect of Dental Treatment on Children's Growth. Clinical Trial Gov ID# NCT01243866.

Use of AUDIT-C alcohol screening tool in NHS general dental practices in North London.

Background The numerous health risks of excessive alcohol consumption are well documented. Individuals at risk of harm from alcohol consumption can be identified through alcohol screening tools; however, there is limited research regarding their use in general dental practices.Methods Data were collected as part of a feasibility trial evaluating delivery of brief alcohol advice in general dental practices in North London. Patient demographics and health-related behaviours were collected, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool was used to assess alcohol consumption patterns.Results The analytical sample comprised 552 dental patients, of whom approximately half (46%) were drinking alcohol at hazardous levels. Males, younger adults, those who consumed red meat weekly and smokers all had significantly increased risks of excessive alcohol consumption. Smokers were more likely to consume excessive levels of alcohol irrespective of smoking frequency. Notable sex differences in alcohol consumption were identified, with males being more likely to consume alcohol frequently and in larger quantities than females.Conclusion The AUDIT-C tool can be used in general dental practice to screen for harmful levels of alcohol consumption. Clear associations exist between patient demographics, health behaviours and excessive alcohol consumption.

Assessing the minimally important difference in the oral impact on daily performances index in patients treated for periodontitis.

AIM: To assess changes over time and determine the minimally important difference (MID) in the Oral Impact on Daily Performances (OIDP) index for patients with severe generalized periodontitis receiving periodontal treatment. METHODS: This study was nested in a larger randomized controlled trial and consisted of 45 consecutive subjects of the larger trial (17 receiving intensive and 28 receiving conservative periodontal care). The OIDP index assessed impacts on quality of life (QoL) at baseline and 1 month after treatment. Repeated-measures ANOVA was used for comparison over time and between treatment groups. To estimate the MID, two subjective global transition scales, related to periodontal and oral health, respectively, were used as anchors, whereas the effect size (ES), standardized response mean and standard error of measurement were also calculated. RESULTS: The mean OIDP score after treatment was significantly lower than at baseline, indicating improvement in QoL, but there were no differences between treatment groups. Based on an agreement between different methods, the MID of the OIDP index was around five scale points and corresponded to a moderate ES. CONCLUSION: The MID for the OIDP index among patients treated for severe generalized periodontitis provides meaning to change scores and facilitates interpretation of findings.

Relationship between parental locus of control and caries experience in preschool children - cross-sectional survey.

BACKGROUND: Due to high prevalence and serious impacts, childhood caries represents a public health issue. Behavioural risk factors such as locus of health control have been implicated in the development of the disease; however their association with childhood caries has not been thoroughly studied. The aim of this cross-sectional survey was to assess the relationship between parental locus of health control and caries experience and untreated caries of their preschool children in a representative sample in Czech Republic, adjusting for relevant sociodemographic characteristics. METHODS: A representative sample of 285 preschool children and their parents was recruited. Study data included children's dental status recorded in nurseries and parental questionnaires with 13 attitudinal items regarding locus of control (LoC) in caries prevention. The association between parental locus of control and children's caries experience and level of untreated caries was analysed using logistic regression, adjusting for the effect of key sociodemographic variables. RESULTS: There was a statistically highly significant linear trend between increased parental LoC and higher probability of the children to be free from untreated caries, independent from the effect of sociodemographic variables of children and parents. A similar highly statistically significant trend, although not entirely linear, and independent from sociodemographic variables was observed with respect to the chance of the children to be free from caries experience with increasing strength of parental LoC. After full adjustment, children in the strongest parental LoC quintile were 2.81 (1.23-6.42, p< 0.05) times more likely to be free from untreated caries in comparison to the weakest parental LoC quintile and 2.32 (1.02-5.25, p< 0.05) times more likely to be free from caries experience in comparison to the weakest parental LoC quintile. CONCLUSION: The findings support the hypothesis that higher internal parental LoC is associated with better control of both untreated caries and caries experience in their preschool children and highlight that a more internal LoC within the family is advantageous in the prevention of dental caries.

Assessing the feasibility of screening and providing brief advice for alcohol misuse in general dental practice: a clustered randomised control trial protocol for the DART study.

INTRODUCTION: Alcohol misuse is a significant public health problem with major health, social and economic consequences. Systematic reviews have reported that brief advice interventions delivered in various health service settings can reduce harmful drinking. Although the links between alcohol and oral health are well established and dentists come into contact with large numbers of otherwise healthy patients regularly, no studies have been conducted in the UK to test the feasibility of delivering brief advice about alcohol in general dental settings. METHODS AND ANALYSIS: The Dental Alcohol Reduction Trial (DART) aims to assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice in patients attending National Health Service (NHS) general dental practices in North London. DART is a cluster randomised control feasibility trial and uses a mixed methods approach throughout the development, design, delivery and evaluation of the intervention. It will be conducted in 12 NHS general dental practices across North London and will include dental patients who drink above the recommended guidance, as measured by the Alcohol Use Disorders Identification Test (AUDIT-C) screening tool. The intervention involves 5 min of tailored brief advice delivered by dental practitioners during the patient's appointment. Feasibility and acceptability measures as well as suitability of proposed primary outcomes of alcohol consumption will be assessed. Initial economic evaluation will be undertaken. Recruitment and retention rates as well as acceptability of the study procedures from screening to follow-up will be measured. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Camden and Islington Research Ethics Committee. Study outputs will be disseminated via scientific publications, newsletters, reports and conference presentations to a range of professional and patient groups and stakeholders. Based on the results of the trial, recommendations will be made on the conduct of a definitive randomised controlled trial. TRIAL REGISTRATION NUMBER: ISRCTN81193263.

Dental caries and growth in school-age children.

BACKGROUND AND OBJECTIVE: Dental caries in young children is commonly untreated and represents a public health problem. Dental caries in children is reported to affect their anthropometric outcomes, but the evidence is conflicting. Some studies found no association, whereas others found that caries was associated with underweight or overweight. The objective was to assess the relationship between dental caries status and height and weight in 6- to 8-year-old Saudi children with high caries prevalence. METHODS: This study was a cross-sectional survey in schoolchildren aged 6 to 8 years attending military primary schools in Jeddah, Saudi Arabia. Caries status was assessed by using the dmft (decayed, missing, filled, teeth [primary teeth]) index. Height and weight were assessed by using z scores of height-for-age (HAZ), weight-for-age (WAZ), and BMI-for-age (BAZ) calculated by World Health Organization standardized procedures. Relationships between caries and HAZ, WAZ, and BAZ were assessed by using regression models. RESULTS: A total of 417 of the 436 eligible schoolchildren with complete data were included, with a response rate of 95.6%. Their mean dmft index was 5.7 ± 4.2. There was an inverse linear relationship between caries status and children's HAZ, WAZ, and BAZ and significantly lower anthropometric outcomes for children at each consecutive group with higher levels of caries. The associations remained significant after adjusting for dental, social, and demographic variables. CONCLUSIONS: The inverse linear association between dental caries and all anthropometric outcomes suggests that higher levels of untreated caries are associated with poorer growth in Saudi schoolchildren.

Socioeconomic inequalities in oral health in different European welfare state regimes.

BACKGROUND: There is very little information about the relationship between welfare regimes and oral health inequalities. We compared socioeconomic inequalities in adults' oral health in five European welfare-state regimes: Scandinavian, Anglo-Saxon, Bismarckian, Southern and Eastern. METHODS: Using data from the oral health module of the Eurobarometer 72.3 survey, we assessed inequalities in two self-reported oral health measures: no functional dentition (less than 20 natural teeth) and edentulousness (no natural teeth). Occupational social class, education and subjective social status (SSS) were included as socioeconomic position indicators. We estimated age-standardised prevalence rates, ORs, the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). RESULTS: The Scandinavian regime showed the lowest prevalence rates of the two oral health measures while the Eastern showed the highest. In all welfare regimes there was a general pattern of social gradients by occupational social class and education. Relative educational inequalities in no functional dentition were largest in the Scandinavian welfare regime (RII=3.81; 95% CI 2.68 to 5.42). The Scandinavian and Southern regimes showed the largest relative inequalities in edentulousness by occupation and education, respectively. There were larger absolute inequalities in no functional dentition in the Eastern regime by occupation (SII=42.16; 95% CI 31.42 to 52.89) and in the Southern by SSS (SII=27.92; 95% CI 17.36 to 38.47). CONCLUSIONS: Oral health inequalities in adults exist in all welfare-state regimes, but contrary to what may be expected from theory, they are not smaller in the Scandinavian regime. Future work should examine the potential mechanisms linking welfare provision and oral health inequalities.

Considerations and lessons learned from designing a motivational interviewing obesity intervention for young people attending dental practices: a study protocol paper.

BACKGROUND: With the prevalence of child obesity increasing worldwide, and the consumption of sugar-sweetened beverages identified as a major contributor to obesity in adolescents, there is a need for effective interventions aimed at dietary behaviour change in this group. Primary dental care settings are in an ideal position to influence adolescents' dietary behaviours, yet have been under-utilised for this purpose. Motivational Interviewing (MI) has shown promise in influencing other health behaviours. However, there is lack of published methodologies on which to base the design of such interventions, and limited evidence on its effectiveness in influencing dietary change. We undertook a study to test the feasibility of a MI intervention aimed at reducing soft drink consumption in adolescents attending dental surgeries. We present the study design for the development and evaluation of the intervention. METHOD: Ten dental practices in north London were randomised into control or intervention. Adolescent participants in control settings received routine advice and intervention participants received a brief MI intervention. The intervention was designed using comprehensive stakeholder engagement and consisted of 3-4 short MI sessions and a maintenance phase delivered by trained researchers through the use of age-specific resources. Process evaluation was carried out using qualitative and quantitative methods to assess intervention feasibility in a primary dental care setting. DISCUSSION: By focussing on the development and evaluation of the intervention, this paper contributes to the limited available knowledge and identifies methodological considerations for undertaking a MI intervention for dietary change in adolescents in primary dental care settings.