Linking routinely collected social work, education and health data to enable monitoring of the health and health care of school-aged children in state care ('looked after children') in Scotland: a national demonstration project.

BACKGROUND AND OBJECTIVES: Children in state care ('looked after children') have poorer health than children who are not looked after. Recent developments in Scotland and elsewhere have aimed to improve services and outcomes for looked after children. Routine monitoring of the health outcomes of looked after children compared to those of their non-looked after peers is currently lacking. Developing capacity for comparative monitoring of population-based outcomes based on linkage of routinely collected administrative data has been identified as a priority. To our knowledge there are no existing population-based data linkage studies providing data on the health of looked after and non-looked after children at national level. Smaller scale studies that are available generally provide very limited information on linkage methods and hence do not allow scrutiny of bias that may be introduced through the linkage process. STUDY DESIGN AND METHODS: National demonstration project testing the feasibility of linking routinely collected looked after children, education and health data. PARTICIPANTS: All children in publicly funded school in Scotland in 2011/12. RESULTS: Linkage between looked after children data and the national pupil census classified 10,009 (1.5%) and 1757 (0.3%) of 670,952 children as, respectively, currently and previously looked after. Recording of the unique pupil identifier (Scottish Candidate Number, SCN) on looked after children returns is incomplete, with 66% of looked after records for 2011/12 for children of possible school age containing a valid SCN. This will have resulted in some under-ascertainment of currently and, particularly, previously looked after children within the general pupil population. Further linkage of the pupil census to the National Health Service Scotland master patient index demonstrated that a safe link to the child's unique health service (Community Health Index) number could be obtained for a very high proportion of children in each group (94%, 95% and 95% of children classified as currently, previously, and non-looked after, respectively). In general, linkage rates were higher for older children and those living in more affluent areas. Within the looked after group, linkage rates were highest for children with the fewest placements and for those in permanent fostering. CONCLUSIONS: This novel data linkage demonstrates the feasibility of monitoring population-based health outcomes of school-aged looked after and non-looked after children using linked routine administrative data. Improved recording of the unique pupil identifier number on looked after data returns would be beneficial. Extending the range of personal identifiers on looked after children returns would enable linkage to health data for looked after children who are not in publicly funded schooling (i.e. those who are preschool or postschool, home schooled or in independent schooling).

Economic Evaluation of the Protecting Teeth @ 3 Randomized Controlled Trial.

INTRODUCTION: An economic evaluation (EE) was conducted alongside a randomized controlled trial (the Protecting Teeth @ 3 Study [PT@3]), exploring the additional preventive value of fluoride varnish (FV) application at 6-monthly intervals in nursery schools compared to treatment as usual (TAU) in the same nurseries. TAU represented a multicomponent national child oral health improvement intervention, the Childsmile program, apart from nursery FV. METHODS: The EE was a within-trial cost-utility analysis (CUA) comparing the FV and TAU groups. The CUA was conducted from a National Health Service perspective and followed relevant methods guidance. Within-trial costs included intervention costs and health care resource use costs. Health outcomes were expressed in quality-adjusted life years (QALYs) accrued over the 2-y follow-up period. The Child Health Utility 9 Dimensions questionnaire was used to obtain utility scores. National reference costs were used, a discount rate of 1.5% for public health interventions was adopted, multiple imputation methods for missing data were employed, sensitivity analyses were conducted, and incremental cost-utility ratios were calculated. RESULTS: Data from 534 participants from the 2014-2015 PT@3 intake were used in the EE analyses, n = 265 (50%) in the FV arm and n = 269 (50%) in the TAU arm. Mean incremental cost per child in the FV arm was £68.37 (P = 0.382; 95% confidence interval [CI], -£18.04 to £143.82). Mean incremental QALY was -0.004 (P = 0.636; 95% CI, -0.016 to 0.007). The probability that the FV intervention was cost-effective at the UK £20,000 threshold was 11.3%. CONCLUSION: The results indicate that applying FV in nurseries in addition to TAU (all other components of Childsmile, apart from nursery FV) would not be deemed cost-effective given current UK thresholds. In view of previously proven clinical effectiveness and economic worthiness of the universal nursery toothbrushing component of Childsmile, continuation of the additional, targeted nursery FV component in its pre-COVID-19 form should be reviewed given its low probability of cost-effectiveness. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by child oral health policy makers and dental public health professionals. They can form part of the evidence to inform the Scottish, UK, and international guidance on community-based child oral health promotion programs.

Changing clinicians' behavior: a randomized controlled trial of fees and education.

The fissure-sealing of newly erupted molars is an effective caries prevention treatment, but remains underutilized. Two plausible reasons are the financial disincentive produced by the dental remuneration system, and dentists' lack of awareness of evidence-based practice. The primary hypothesis was that implementation strategies based on remuneration or training in evidence-based healthcare would produce a higher proportion of children receiving sealed second permanent molars than standard care. The four study arms were: fee per sealant treatment, education in evidence-based practice, fee plus education, and control. A cost-effectiveness analysis was conducted. Analysis was based on 133 dentists and 2833 children. After adjustment for baseline differences, the primary outcome was 9.8% higher when a fee was offered. The education intervention had no statistically significant effect. 'Fee only' was the most cost-effective intervention. The study contributes to the incentives in health care provision debate, and led to the introduction of a direct fee for this treatment.

A randomised, observer-blind, clinical study investigating the effect of fluoridated milk on artificially created early enamel caries using transverse microradiography.

Much of the research regarding the efficacy of fluoridated milk was obtained prior to the routine use of fluoridated dentifrices. The aim was to investigate, in situ, the effect of fluoridated and non-fluoridated milk on mineral change in artificial caries lesions, with the additional use of fluoridated dentifrice. The roles of different milk fluoride concentrations, volumes and frequencies in mineral change were studied. In total, 29 edentulous subjects were recruited and tooth blocks, containing artificial caries lesions, were inserted into their full dentures at 4 areas (sites). Each subject followed 5 randomly ordered, 6-week beverage experiments: 0.5 mg of F in 200 ml of milk, 3 times per day; 1.5 mg of F in 200 ml of milk, once per day; 200 ml of milk, once per day; 200 ml of milk, 3 times per day, and no beverage (negative control). In addition, the subjects were allocated to 1 of 2 groups; experimental treatment only or treatment and dentifrice. Mineral change was measured with transverse microradiography. Statistical analysis was performed using 2-sample t tests and a general linear modelling procedure. For integrated mineral loss there was a statistically significant effect of group (p = 0.001), indicating fluoridated toothpaste significantly increased remineralisation. For lesion depth there was a statistically significant combined effect of 'group and site'. 'Experiment' had no statistically significant influence on change in integrated mineral loss or lesion depth. The study demonstrated that the use of fluoridated dentifrice twice per day had a positive effect on the remineralisation of caries lesions. However, no additional significant effect of fluoridated milk was observed.

Raising awareness of oral cancer from a public and health professional perspective.

Low public awareness of oral cancer and delays in symptomatic patients presenting to health services have been identified as contributing factors to poor survival rates. In order to promote diagnosis and treatment of oral cancer at an earlier stage, public awareness campaigns have been recommended, encouraging those with signs and symptoms to attend primary care services at an earlier stage. This article provides an overview of the evidence of effectiveness of interventions aimed at raising cancer awareness and explores the use of mass media for health behaviour change. The use of awareness campaigns to promote earlier diagnosis of oral cancer is also explored from both a patient and health professional perspective. The findings of the overview suggest that while awareness raising campaigns can increase knowledge of the disease and attendance at health services in the short-term, those at lesser risk often respond, and evidence of longer-term impact is very limited. The translation of knowledge into behaviour change is likely to require a more comprehensive, longer-term, multi-faceted approach, acknowledging the social determinants of health and health behaviour theory. More work is required to understand what needs to be included in campaigns to make them effective. Availability and access to appropriately trained and informed primary care personnel is important, particularly for high-risk groups. This is relevant for: supporting those with signs and symptoms to attend services; promoting opportunistic screening; enabling referral of patients to secondary care in a timely manner; and for provision of advice on the major risk factors associated with oral cancer.

Dental caries in 5-year-old children attending multi-ethnic schools in Greater Glasgow--the impact of ethnic background and levels of deprivation.

OBJECTIVE: To examine levels of dental caries of 5-year-olds attending multi-ethnic schools in Greater Glasgow and to explore the effects of deprived backgrounds and ethnic identity on their dental health. DESIGN: Between October 2001 and February 2002 a cross-sectional dental epidemiology survey of a sample of 721 5-year-olds was undertaken in schools having at least 25 per cent of pupils from black or minority ethnic groups. Background data on participating children were obtained from school records, including: ethnic origin, mothers' ability to speak English, religion, and demographics. Statistical analyses included two way analysis of variance to determine the effect of ethnicity after adjusting for socio-economic factors. RESULTS: Complete data were available for 649 (90%) children. The sample broadly divided into white (52%), Pakistani (33%), and other minority ethnic groups (15%). Based on repeat observations, diagnosis reliability was good (Kappa = 0.77). The caries experience of Pakistani children (d3mft = 4.1; 95% CI 3.6 to 4.6) was significantly higher (p < 0.001) than the white children (d3mft = 2.3; 95% CI 1.9 to 2.6). Only 25% (95% C1 17 to 34) of the Pakistani children had no obvious decay, significantly lower (p < 0.001) than their white contemporaries (48%, 95% CI 39 to 58). Pakistani ethnic origin was associated with significantly higher levels of dental caries (p < 0.001), after adjusting for socio-economic deprivation. CONCLUSION: Children from deprived backgrounds have worse dental caries levels than their affluent counterparts and, over and above this effect, minority ethnic children of Pakistani background have higher levels than their white peers.

Oral health care and status of elderly care home residents in Glasgow.

OBJECTIVES: To investigate variations in reported oral health care provision and unmet dental need within a sample of care homes for the elderly in Glasgow. BASIC RESEARCH DESIGN: Two-phase study of a 50% random sample of 120 care homes (n = 60). Phase 1: telephone interviews with care home managers. Phase 2: oral examinations of residents and face-to-face interviews with care staff, in a sub-sample of 10 homes. CLINICAL SETTING: Care homes in Greater Glasgow. PARTICIPANTS: Residents and staff. RESULTS: Phase 1: data were collected from 58 of 60 care home managers approached (response rate: 97%). Oral assessment of residents on admission was reported for 78% of nursing homes and 24% of residential homes, and annual screening by a dentist for 85% and 76% respectively. Only 58% of nursing homes and 8% of residential homes had a formal mouth care policy. Staff training in mouth care was not universal and often carried out "in-house". All managers believed dental support was available when required. Phase 2: 288 oral examinations and 22 staff interviews took place within 10 homes selected. Examinations revealed high levels of oral disease. When interviewed, staff accepted that mouth care was within their remit but failed to document it within patient care plans. Further training on oral health and disease was requested from all levels of staff. CONCLUSIONS: Oral disease is common among elderly care home residents in Glasgow. Increased emphasis on implementation of standard oral care protocols and improved education of staff is essential if the oral health of elderly institutionalised residents is to improve.

Incidence of oral and oropharyngeal cancer in United Kingdom (1990-1999) -- recent trends and regional variation.

This study aimed to determine whether the incidence of oral cancer is continuing to rise in the UK and if this varies geographically. A descriptive epidemiological study of oral cancer incidence in 12 UK cancer registries (1990-1999) was undertaken. Poisson regression models were employed to assess trends. There were 32,852 oral cancer cases registered (1990-1999). Statistically significant increases in incidence of 18% and 30% were seen in males and females respectively (p<0.01). The trend was observed in younger (<45 years) and older (45+ years) age groups (p<0.01) with 3.5% and 2.4% average annual increases respectively. These increases were consistent for the majority of regions in the older group. For the younger group the increases in incidence were more rapid and differed geographically. Incidence remains higher in men than women, in older compared with younger groups, and in northern regions. These findings provide evidence of a continuing increase in the burden of oral cancer across the UK.

General dental practitioners' perceptions of the West of Scotland Cancer Awareness Programme oral cancer campaign.

OBJECTIVES: The 2003/04 West of Scotland Cancer Awareness Programme (WoSCAP) oral cancer campaign was designed to raise public awareness of the signs and symptoms of oral cancer. The objectives of this study were to explore general dental practitioners' (GDPs) awareness and perceptions of the campaign, and its impact on local dental practices. METHODS: A self-completing questionnaire was sent to GDPs in the West of Scotland (N = 983) at the conclusion of the public awareness campaign. RESULTS: A response rate of 68.6% was achieved. Most dentists (92%) had heard of the campaign and a large percentage had displayed the promotional materials in their practice. The majority of respondents rated the campaign materials, including a television advertisement, in a very positive manner. Over 40% of dentists reported that, during the active phase of the campaign, patients had asked for information concerning the programme, and 66% indicated that registered patients had asked for advice regarding a specific lesion. Additionally, 41% of dentists reported non-registered patients had attended asking for advice regarding a 'worrying' lesion. Over 60% of dentists had referred a patient during the campaign and 40% of these practitioners indicated an increased referral rate during this period. CONCLUSIONS: Most respondents were positive in their assessment of the campaign and reported an increased awareness of oral cancer among patients.

Dental anxiety, distress at induction and postoperative morbidity in children undergoing tooth extraction using general anaesthesia.

OBJECTIVE: To report on the prevalence of postoperative morbidity in children undergoing tooth extraction under chair dental general anaesthetic (CDGA) in relation to pre-operative dental anxiety and anaesthetic induction distress. DESIGN: A prospective national study. SETTING: Twenty-five Scottish DGA centres in 2001. SUBJECTS AND METHOD: Four hundred and seven children (mean age 6.6 years; range: 2.3 to 14.8 years; 52% male). Before CDGA, the Modified Child Dental Anxiety (MCDAS) and Modified Dental Anxiety (MDAS) Scales were completed for children and accompanying adult respectively; the latter also returned a morbidity questionnaire 24 hours and one week post-operatively. Anaesthetic induction distress was scored immediately before CDGA induction using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). RESULTS: The mean MCDAS score was 24.2 (population norm 18.2); 21% of adults were anxious. Forty-two per cent of children had induction distress; this related to their MCDAS scores (r=0.43, p<0.001, Pearson Product Moment Correlation Coefficient). Morbidity at 24 hours and seven days was 63% and 24% respectively; this related to MCDAS scores (r=0.15, p=0.029 and r=0.17, p=0.009, Pearson Product Moment Correlation Coefficient) and to induction distress (chi2=7.14, p=0.007 and chi2=11.70, p=0.001). CONCLUSION: The majority of children suffered next day morbidity and many still had symptoms a week later. Most children were dentally anxious; this related to induction distress and postoperative morbidity.

Factors influencing referral of children for dental extractions under general and local anaesthesia.

OBJECTIVE: To investigate the relative importance of a range of explanatory variables concerning why child patients in Scotland enter pathways for tooth extractions under either Dental General Anaesthesia (DGA) or local anaesthesia (LA). BASIC RESEARCH DESIGN: A cross-sectional study was carried out involving DGA centres across Scotland. Data collected related to demographic characteristics of child DGA patients, reported anxiety and dental attendance levels of patients and parents, reasons given by referring practitioners for requesting DGA, number and type of teeth extracted and parental beliefs and attitudes to DGA. Similar data were collected relating to children having teeth extracted in primary care under LA. Multivariate analysis was performed to determine which factors were the best predictors of anaesthetic choice. RESULTS: 425 and 121 children having dental extractions under DGA and LA respectively participated. Ninety-six percent of DGA cases and 48% of LA patients had extractions for caries. For DGA cases, the mean age was 6.7 years, an average of 5.3 teeth were extracted and dental anxiety levels were higher than population norms. Multivariate analysis found the number of teeth extracted was the major predictor of anaesthetic type. On removing this variable, age became the most important factor, with 99% of children under 5.5 years receiving a DGA. Among DGA patients, 25% were reported to have had a previous DGA for tooth extraction. CONCLUSIONS: Future reductions in DGA numbers will be dependent on decreasing the number of young children presenting with advanced caries in multiple teeth. Consequently, guidelines are required concerning the prevention and appropriate management of caries in the primary dentition.

Provision of hepatitis B vaccination for primary care dental staff in Scotland.

OBJECTIVES: All dental surgeons should be protected from hepatitis B virus (HBV) infection by immunisation, ideally administered and monitored via occupational health services (OHS). This study examined relevant OHS systems in place for dental primary care healthcare workers (DHCW) across all Health Board Areas (HBAs) in Scotland. It also explored the DHCWs' knowledge of, and access to, these systems in three HBAs. METHODS: Data from senior staff in all Scottish Health Boards and Primary Care Trusts were collected by self-completing questionnaires. Information from DHCWs was collected via telephone interviews with General Dental Practitioners (GDPs) and Community Dental Officers (CDOs) in each of Ayrshire and Arran, Highland and Lothian Health Boards. RESULTS: Thirteen of the 15 HBAs had robust HBV vaccination and monitoring systems. However, only 7/15 (47%) of these covered all DHCWs. Seven HBAs provided vaccination and monitoring for CDOs only, leaving GDPs to undertake these responsibilities for themselves. Of the 105 DHCWs approached, 82 gave an interview. These interviews highlighted major differences between HBAs in relation to access of DHCWs to OHS and indicated that CDOs had greater access than GDPs to OHS. Overall, 31% of DHCWs were not satisfied with the OHS available. CONCLUSION: In order to safeguard both staff and patients, significant further work is required to ensure that all DHCWs have access to appropriate OHS support for provision and monitoring of immunisation procedures and related functions such as management of sharps injuries.

Glasgow nursery-based caries experience, before and after a community development-based oral health programme's implementation.

OBJECTIVE: To develop and evaluate NHS-based strategies likely to improve dental health and reduce inequalities in pre-5-year-old's oral health in Greater Glasgow, Scotland, by ecological study of community-based oral health promotion programmes in two of the area's most socio-economically deprived communities. BASIC RESEARCH DESIGN: Following an initial health service-based Oral Health Needs Assessment (OHNA) in a severely deprived community, culturally relevant dental health promotion interventions were initiated with multidisciplinary collaborative networks. Ecological studies to monitor dental health involved cross-sectional caries epidemiology of nursery children aged 36-59 months at baseline (1995/96), after two (1997/98) and four years (1999/00), in the G22 (pilot) and G33 post code areas. These areas had similar socio-economic status (SES), i.e. severe social deprivation. RESULTS: At the outset, mean dmft scores in the pilot area for the age groups 36-47 months and 48-59 months were respectively 3.9 (95% CI 2.8 5.1) and 5.9 (95% CI 5.1-6.8), with the proportions of caries-free children being 38% and 17%, respectively. Reductions in mean dmft of 46% for the 36-47 month-olds and 37% for the 48-59 month-olds occurred in the pilot public health programme area over the four-year period; the proportions of caries-free children increased to 51% and 40%, respectively. During the first two years of the programme, increases in the mean dmft of 36-47 month- and 48-59 month-olds in the G33 (comparator) area were recorded. However, this trend was reversed significantly two years later following the introduction of a similar community development-based caries-prevention programme. CONCLUSION: While not being able to attribute causation, a programme of community development to promote the dental health of pre-school children residing in two socio-economically disadvantaged areas of Glasgow was associated with significant improvements in the dental health of these pre-school populations.

An investigation into the use of bitewing radiography in children in Greater Glasgow.

AIM: In recent years there have been a number of reviews and guidelines published with respect to the diagnosis and management of caries in children. Bitewing radiography remains the recommended method of choice for caries diagnosis in most circumstances. The aims of the study were to investigate the usage of bitewing radiography by general dental practitioners (GDPs) in Greater Glasgow, for the diagnosis of caries in children and to assess the usefulness of the technique as perceived by these dental practitioners. DESIGN: A questionnaire for self completion was sent to all GDPs with an NHS list number in the Greater Glasgow area. RESULTS: An 80% response rate was obtained with 303 GDPs responding. Less than half the dentists (44%) indicated that they always carried out caries risk assessments for all children, but 71% reported doing this for 6 and 7-year-old children. Approximately 60% of dentists stated they had read the recent radiation and caries management guidelines. Only 72% stated that they used radiography as a caries diagnostic tool in children, with 12 GDPs (4%) indicating they would never consider using bitewing radiography in children. Only 17% would consider taking bitewing radiographs in children under 6 years, and the majority of dentists (61%) reported that they would first consider taking radiographs in the 6-11-year-old age group. However, only a low proportion of children in this age band had dental x-rays taken. Bitewing radiography was considered to be more important for 12-year-olds than for 6-year-olds. Recommended methods for decreasing radiation exposure such as rectangular collimation and film holders were not being used universally, with 41% and 58% respectively using these devices. CONCLUSIONS: A significant proportion of dentists in Greater Glasgow are not complying with recent guidelines and recommendations and it would appear that the value of bitewing radiography as a diagnostic tool in children is not being fully exploited.

The role of primary healthcare professionals in oral cancer prevention and detection.

AIM: To investigate current knowledge, examination habits and preventive practices of primary healthcare professionals in Scotland, with respect to oral cancer, and to determine any relevant training needs. SETTING: Primary care. METHOD: Questionnaires were sent to a random sample of 357 general medical practitioners (GMPs) and 331 dental practitioners throughout Scotland. Additionally, focus group research and interviews were conducted amongst primary healthcare team members. RESULTS: Whilst 58% of dental respondents reported examining regularly for signs of oral cancer, GMPs examined patients' mouths usually in response to a complaint of soreness. The majority of GMPs (85%) and dentists (63%) indicated that they felt less than confident in detecting oral cancer, with over 70% of GMPs identifying lack of training as an important barrier. Many practitioners were unclear concerning the relative importance of the presence of potentially malignant lesions in the oral cavity. A high proportion of the GMPs indicated that they should have a major role to play in oral cancer detection (66%) but many felt strongly that this should be primarily the remit of the dental team. CONCLUSION: The study revealed a need for continuing education programmes for primary care practitioners in oral cancer-related activities. This should aim to improve diagnostic skills and seek to increase practitioners' participation in preventive activities.

Salivary antimicrobial proteins associate with age-related changes in streptococcal composition in dental plaque.

Secretion of antimicrobial proteins (AMPs) and salivary antibodies can modify biofilm formation at host body surfaces. In adolescents, associations have been reported between dental caries and salivary AMPs. AMPs demonstrate direct antimicrobial effects at high concentrations, and at lower more physiological concentrations they mediate changes in host cell defenses, which may alter the local environment and indirectly shape local biofilm formation. The expression of salivary AMPs in preschool children, at an age when the oral bacteria are known to change, has not been investigated. We sought to investigate salivary AMP expression in the context of previously well-documented changes in the oral cavities of this age group including salivary immunoglobulin A (IgA), oral bacteria and dental caries. Dental plaque and saliva were collected from 57 children aged 12-24 months at baseline, of whom 23 children were followed-up at 3 years of age. At each time, saliva was assessed for LL37, human neutrophil peptides 1-3, calprotectin, lactoferrin, salivary IgA, total plaque bacteria and Streptococcus mutans. Over time, concentrations of AMPs, S. mutans and bacteria-specific salivary IgA increased. Caries experience was also recorded when children were 3 years old. Concentrations of AMPs were highest in the saliva of 3-year-old children with the greatest burden of S. mutans. These data suggest that salivary AMPs are variable over time and between individuals, and are linked with bacterial colonization. At follow up, the majority of children remained caries free. Larger longitudinal studies are required to confirm whether salivary AMP levels are predictive of caries and whether their modulation offers therapeutic benefit.

National supervised toothbrushing program and dental decay in Scotland.

We aimed to assess the association between the roll-out of the national nursery toothbrushing program and a reduction in dental decay in five-year-old children in a Scotland-wide population study. The intervention was supervised toothbrushing in nurseries and distribution of fluoride toothpaste and toothbrushes for home use, measured as the percentage of nurseries participating in each health service administrative board area. The endpoint was mean d(3)mft in 99,071 five-year-old children, covering 7% to 25% of the relevant population (in various years), who participated in multiple cross-sectional dental epidemiology surveys in 1987 to 2009. The slope of the uptake in toothbrushing was correlated with the slope in the reduction of d(3)mft. The mean d(3)mft in Years -2 to 0 (relative to that in start-up Year 0) was 3.06, reducing to 2.07 in Years 10 to 12 (difference = -0.99; 95% CI -1.08, -0.90; p < 0.001). The uptake of toothbrushing correlated with the decline in d(3)mft (correlation = -0.64; -0.86, -0.16; p = 0.011). The result improved when one outlying Health Board was excluded (correlation = -0.90; -0.97, -0.70; p < 0.0001). An improvement in the dental health of five-year-olds was detected and is associated with the uptake of nursery toothbrushing.

The behaviour of extended duties dental nurses and the acceptance of fluoride varnish application in preschool children.

BACKGROUND: Extended duties dental nurses (EDDNs) have been trained to deliver fluoride varnish applications to preschool children as part of the Childsmile initiative in Scotland. OBJECTIVES: To determine a detailed behavioural profile of the EDDNs during the administration of the fluoride varnish to confirm professional manner and identify differences in nurse behaviours between successful and unsuccessful application sessions. METHODS: Nurse-child interactions were video recorded and nurse behaviours coded and analysed using a specially developed coding scheme (SABICS). Behaviour frequency and duration were measured and correlations were calculated. Differences in behaviour were examined between successful and unsuccessful application sessions. RESULTS: Three hundred and three interactions were coded out of 456 recorded application sessions. No incident occurred where nurses threatened or placed undue stress on a child. In unsuccessful, compared with successful, application sessions, nurses demonstrated higher frequency and duration of the following behaviours: 'permission seeking', 'offer of task alternative', 'information seeking' and 'reassurance', controlling for length of procedure. Whereas with successful applications, 'praise', 'instruction' and 'information-giving' were used more frequently and for a longer duration, compared with unsuccessful applications. CONCLUSIONS: The EDDNs demonstrated a professional manner working with preschool children. They behaved differently between successful and unsuccessful application sessions. Sequential analysis is needed to examine causal effects of behaviours and its effects on delivery outcomes.