An alternative marker for the effectiveness of water fluoridation: hospital extraction rates for dental decay, a two-region study.

BACKGROUND: Contemporary evidence for the effectiveness of water fluoridation schemes in the U.K. is sparse. The utility of routinely collected data in providing evidence warrants further research. OBJECTIVES: To examine inpatient hospital episodes statistics for dental extractions as an alternative population marker for the effectiveness of water fluoridation by comparing hospital admissions between two major strategic health authority (SHA) areas, the West Midlands SHA-largely fluoridated--and the North West SHA--largely unfluoridated. METHOD: Hospital episodes statistics (HES) were interrogated to provide data on admissions for simple and surgical dental extractions, which had a primary diagnostic code of either dental caries or diseases of pulp and periapical tissues for financial years 2006/7, 2007/8 and 2008/9. Data was aggregated by SHA area and quinary age group. Directly standardised rates (DSR) of admissions purchased for each primary care trust (PCT) were calculated and ranked by index of multiple deprivation (IMD). RESULTS: A significant difference in DSRs of admission between PCTs in the West Midlands and North West was observed (Mann-Whitney U test [p <0.0001]) irrespective of IMD ranking. The difference in rates between the two most deprived PCTs was 27-fold. CONCLUSIONS: After ranking by IMD, DSRs of hospital admissions for the extraction of decayed or pulpally/periapically involved teeth is lower in areas with a fluoridated water supply. The analysis of routinely collected HES data may help identify the impact of water fluoridation schemes.

Attitudes and opinions of NHS general dental practitioners towards clinical governance.

AIM: To assess the attitudes and opinions of NHS general dental practitioners towards clinical governance. DESIGN: This was a questionnaire based study, sent to NHS principal dentists within the West Midlands area. METHOD: A Likert scale questionnaire was developed, consisting of 26 statements in four subject areas. It was internally and externally validated, and sent to 208 practices within four geographic areas. RESULTS: A total of 150 questionnaires were returned; a response rate of 72%. For each question, no significant difference was found between areas. The cost and time involved with clinical governance emerged as the most important issues, with many respondents considering that costs of implementation might make more dentists leave the NHS. Dentists were largely positive about the principles of clinical governance and evidence based practice, but were concerned about the possibility of increasing complaints and some doubted that it would result in improved patient care. Many respondents claimed to be still confused about clinical governance and the majority considered that more guidance should be available to assist with development within dental practice. CONCLUSIONS: This survey showed that some problems exist around the introduction of clinical governance within NHS general dental practice.

Making the best use of consultant orthodontic services, Part 2: How to undertake the referral.

The previous article in this series dealt with the selection of patients who would benefit from referral to a consultant orthodontist. It is equally important to access consultant services in a manner which allows the referral to be processed efficiently. This paper discusses factors related to the actual mechanism of referral.

Making the best use of consultant orthodontic services. Part 1: Determining which patients require referral.

General dental practitioners and community dental officers may need to consider several factors when referring patients to the consultant orthodontic service. In Birmingham, a local professional group incorporating representatives from both primary care and secondary care (consultant) services have drawn up a set of formal referral guidelines. The purpose of the exercise was to encourage the most appropriate use of the consultant service so that its resources could be directed towards those in greatest need. In this paper, the factors which determine the patients requiring referral are discussed; a second article will deal with the actual process of referral.

A comparison of consecutive orthodontic referrals seen by a consultant unit and specialist orthodontic practitioners.

It has been suggested that the consultant orthodontic service and specialist practitioner service should have different roles, with the former concentrating its treatment input on the management of severe malocclusions. In an attempt to determine whether referring dental practitioners appeared to be aware of these differences, 100 consecutive orthodontic referrals seen at a consultant orthodontist's clinic were compared and contrasted with the same number seen at each of four specialist orthodontic practices located in the same city, and within 4 miles of the consultant unit. Comparisons were made both on the basis of clinical information obtained from study models and from analysis of referral letters. The consultant sample contained a greater proportion of requests for treatment plans, but there were few differences in terms of the range and severity of the actual malocclusions referred to each of these specialist services. The implications of these findings are discussed in relation to possible future developments of orthodontic services in the U.K.

The use of a classification of residential neighbourhoods (ACORN) to demonstrate differences in dental health of children resident within the south Birmingham health district and of different socio-economic backgrounds.

This study was undertaken to evaluate variations in the dental health of children living within fluoridated South Birmingham, using a classification of residential neighbourhoods (ACORN) as a descriptor of socio-economic status, and to evaluate the change in these differences over time. Five-year-old children were examined as part of the rolling programme of epidemiological surveys co-ordinated by the British Association for the Study of Community Dentistry (BASCD) in 1987 and 1989/90. The ACORN classification of each child was determined from the postal code of the home address. ACORN groups were amalgamated into three ranked divisions. There was a variation in dental health both in 1987 and 1989/90; children from disadvantaged groups had the poorest dental health. There was more marked variation in 1987 than in 1989/90. The reduction in inequality during this period was due to a relatively greater improvement in the dental health of the children from the more socially deprived areas.