Exponential tooth decay curve.

OBJECTIVE: A review of the distribution of d3mft scores for Wales was undertaken to inform decisions on future reporting of decay experience. Visual examination of data from one survey suggested that caries in Wales is distributed along an exponential decay curve. BASIC RESEARCH DESIGN: Weighted d3mft data from 2007/8, 2011/12 and 2014/15 was utilised. The data was compared with a pragmatically chosen exponential decay model. Distribution curves for d3mft were plotted for each data set, correlation coefficients calculated and residuals plotted. RESULTS: The three surveys demonstrate similar exponential decay distributions across the range of d3mft scores. Plots of each curve against the exponential decay model demonstrated close correlation (0.9826 - 0.9871). The progressive shift of these similarly shaped curves suggest similar levels of caries reduction across the spectrum of caries experience and thus improved oral health without widening of health inequality. The close fit with this simple mathematical model suggests that caries prevalence could be used to generate a theoretical distribution and thereby and estimate of mean d3mft score. Such an approach could facilitate simplified oral health surveillance in areas where caries distributions are known from previous surveys. CONCLUSIONS: Within Wales caries does seem to be distributed in line with an exponential decay curve. As a result decay prevalence and mean d3mft are mathematically related. This finding may have potential to support simplified local oral health surveillance. The data provides evidence suggesting improvements in caries experience in Wales are not at the expense of increased inequality.

The caries experience of 5 year-old children in Scotland in 2013-2014, and in England and Wales in 2014-2015. Reports of cross-sectional dental surveys using BASCD criteria.

OBJECTIVE: We report the findings from and comment on the surveys of the oral health of 5-year-old children undertaken in Scotland (2013-14), Wales (2014-15) and England (2014-15). This was the fourteenth survey in Scotland since 1988. In England and Wales it is the third survey since 2007 when changes were required in consent arrangements. METHOD: Representative samples were drawn within Health Boards across Scotland and local authorities across England and Wales. Consent was sought via opt-out parental consent in Scotland and opt-in parental consent in England and Wales. Children examined were those aged five in England and those in Primary 1 (school year aged 5 to 6) in Scotland and Wales. Examinations were conducted in schools by trained and calibrated examiners. Caries was visually diagnosed at the dentinal threshold. RESULTS: There is a continuing decline in d3mft in all three countries. d3mft was 1.27 (opt-out consent) for Scotland, 0.84 for England (opt-in consent) and 1.29 for Wales (opt-in consent). Tooth decay levels remain higher in more deprived areas across Great Britain, with clear inequalities gradients demonstrated across all geographies. Attempts to measure changes in dental health inequalities across the three countries show no conclusive trends. CONCLUSION: Inter-country comparisons provide further oral health intelligence despite differences in approach and timing. The third surveys in England and Wales using the new consent arrangements have enabled trend analysis. Dental health inequalities gradients were shown across all geographies and all of the indicators of inequality.

Measuring oral health impact among care home residents in Wales.

OBJECTIVE: To explore inequalities in oral health impact among care home residents using OHIP-14 and ADHS criteria. BASIC RESEARCH DESIGN: Cross-sectional survey with structured interview and clinical examination using 2009 ADHS criteria including OHIP-14. Comparisons were made between groups of residents and with findings from the ADHS 2009. PARTICIPANTS: Care homes and residents were randomly selected. Those without capacity and non-English/Welsh speakers were excluded. 447 residents answered all OHIP-14 questions and had full oral examination. MAIN OUTCOME MEASURE: OHIP-14. RESULTS: Reporting of OHIP problems was more common among care home residents compared with older people examined in the ADHS 2009 (50% vs 40%). There was no difference in the mean number of impacts between residents who were: dentate/edentate; denture wearing/non-denture wearing; with/without caries. Residents reporting 'problems and pain in your mouth at the moment', or 'occasional or more frequent dry mouth', more often experienced OHIP-14 impacts. CONCLUSION: Compared with peers living in the community, both dentate and edentate care home residents are more likely to live with one or more impacts. Two simple questions related to 'Any problems and pain in your mouth?' and 'Do you have frequent dry mouth?' may help to target care home residents more likely to experience oral health impacts.

What proportion of caries into dentine at age 5 is present at age 3?

OBJECTIVE: To explore the proportion of decay at age 5 in Wales presenting by and after age 3 years from geographical and deprivation perspectives. BASIC RESEARCH DESIGN: Retrospective analysis of data from independent cross-sectional studies of 3-year-olds in early 2013 and 5-year-olds in school year 2014/5. This includes novel graphical presentation of caries at age 3 and estimated 3-5 caries increment at age 5. SETTING AND PARTICIPANTS: NHS oral health surveillance programme in Wales examining children in nurseries at age 3 and in schools two years later. MAIN OUTCOME MEASURES: %d3mft⟩0 at ages 3 and 5 years, plus estimated 3-5 caries increments for these two indices. Data are analysed using index of deprivation and Health Board population density (as a proxy for rurality). RESULTS: In most Health Boards and all deprivation quintiles there is a larger proportion of caries into dentine presenting between ages 3-5 than by age 3. In rural Health Boards the proportion of caries present by age 3 is much smaller. In one Health Board more caries presents by age 3 than after. In rural Health Boards the current prevention activity has potential to push reported caries prevalence at age 5 below 10%. In urban Health Boards action by age 5 will be required to push caries prevalence significantly below 20%. CONCLUSIONS: Findings from this analysis suggest need for earlier prevention activity in some Health Boards in Wales.

Emerging infections - implications for dental care.

Over the last 20 years the majority of emerging infections which have spread rapidly across the globe have been respiratory infections that are spread via droplets, a trend which is likely to continue. Aerosol spray generation in the dental surgery has the potential to spread such infections to staff or other patients. Although the diseases may differ, some common approaches can reduce the risk of transmission. Dental professionals should be aware of areas affected by emerging infections, the incubation period and the recent travel history of patients. Elective dental care for those returning from areas affected by emerging infections should be delayed until the incubation period for the infection is over.

What proportion of dental care in care homes could be met by direct access to dental therapists or dental hygienists?

BACKGROUND: Many care home residents require simple dental treatment which is complicated by the need for extra time to deliver dental care. The proportion of their care which could be delivered wholly by hygienists or therapists is unknown. METHOD: 2010 Welsh dental care home survey data on clinical opinion of treatment need and special care skill level required was cross referenced with General Dental Council guidance on direct access. RESULTS: Care home residents treatment needs could be wholly addressed by a generalist dental hygienist or therapist for 22% and 27% of cases respectively. With special care experience these figures increase to 43% and 53%. DISCUSSION: A large proportion of need in care homes could be wholly provided by hygienists or therapists, especially those with special care experience. The potential efficiency gain of direct access arises from individuals who do not need to see a dentist for any aspects of their care. Direct access to hygienists/therapists for dental care of care home residents should be piloted and evaluated. CONCLUSION: Hygienists and therapists could make a large contribution to addressing dental treatment needs of care home residents and direct access could be an efficient model of care for this setting.

Oral health status of older people living in care homes in Wales.

BACKGROUND: UK adult dental health surveys (ADHS) exclude care home residents from sampling. Aim To understand oral health status of care home residents in Wales using ADHS criteria. METHOD: Cross sectional survey of care home residents in Wales using a questionnaire and oral examination contemporaneous with, and paralleling, the ADHS 2009. 708 randomly selected participants from 213 randomly selected care homes participated including individuals with and without capacity. RESULTS: 72.8% of residents had tooth decay. Compared to older adults examined in the ADHS, residents are less likely to brush teeth/dentures twice a day (37% vs 63%), more likely to only attend a dentist when they have a problem (63% vs 26%), have more teeth with active decay (3.1 vs 0.9), more have current dental pain (13% vs 5%) and other morbidity (open pulp, ulceration, fistulae, abscess 27% vs 10%). High decay is present in both recently admitted and longer term residents. There was some regional variation in levels of oral hygiene. CONCLUSION: Oral health status of older people resident in care homes in Wales is poor. Findings suggest more could be done to improve preventive care both before and after admission to the care home.

Effect of second mailing for consent on child dental survey results.

INTRODUCTION: Written parental consent of young children has been required for dental surveys in Wales since 2006. The 2007/08 survey produced much lower caries scores than previous surveys, believed to be associated with low participation of children with caries experience. OBJECTIVE: To test the null hypothesis that decay variables from a second mailing of parental consent are no different from those generated from a first mailing. METHODS: Cross-sectional caries (d3mft) survey of children aged 5-6 during 2011/12. Survey criteria complied with British Association for the Study of Community Dentistry guidance. Comparison of dental epidemiological variables generated from data collected via first and second mailing for consent. RESULTS: The aggregate d3mft for all 7,734 children examined was 1.6. The mean d3mft for the first mailing was 1.5 (6,678 children) compared with a d3mft of 2.2 (1,056 children) for the second mailing. Equivalent data for d3mft(d3mft > 0) and %d3ft > 0 were: d3mft(d3mft > 0) 3.8 first mailing compared with d3mft (d3mft3 > 0) 4.1 second mailing; and %d3mft>0 39.5% first mailing compared with %d3mft > 054.1% second mailing. Mean d3mft and %d3mft > 0 showed statistically significant differences. CONCLUSIONS: Null hypothesis is rejected for d3mft and %d,mft>0O. The findings suggest non-responders to the first mailing do have higher prevalence of decay than responders. To facilitate comparisons of reported decay levels, future surveys using mailed forms for consent purposes should include at least two mailings and report the number of mailings used to facilitate comparisons of reported decay levels.

The caries experience of 5-year-old children in Scotland, Wales and England in 2011-2012: reports of cross-sectional surveys using BASCD criteria.

OBJECTIVE: This paper collates differences in methods and trends in caries prevalence in surveys of the oral health of young children undertaken in Scotland, Wales and England in 2011-12. For Wales and England this was the second survey carried out since changes were required in consent arrangements. METHOD: In compliance with BASCD criteria representative samples were drawn within the geographies of primary care organisations across the UK, and within Local Authorities across England and Wales. Consent was sought in two ways; via opt-in parental consent in England and Wales and opt-out parental consent in Scotland. Children aged five were examined in England and those aged 5 to 6 were examined in Wales and Scotland. Examinations were conducted in schools by trained and calibrated examiners and caries was diagnosed at the dentinal threshold using visual criteria. RESULTS: In Scotland there is a continuing decline in caries prevalence in young school children. Comparison with the previous survey using positive consent in England and Wales shows a decline in caries in both England and Wales although decay levels remain higher in more deprived areas. CONCLUSION: International comparisons assist in interpreting data and trends even if there are some differences in approach. A trend line is more useful than a single data point for monitoring of oral health. This second survey using positive parental consent in England and Wales has enabled trend analysis for the first time since the consent arrangements changed.

Does dental disease presence equate to treatment need among care home residents?

OBJECTIVES: This study aimed to explore the relationship between dental disease, complexity and dental treatment needs of care home residents. METHODS: Survey of residents in care homes in Wales. Random sample of participants from a random selection of care homes across Wales, UK. Data collection involved questionnaires and dental examinations. RESULTS: Data were collected from 655 care home residents in 213 care homes. Half of all residents reported good or very good oral health but most had dental treatment needs. 73% of dentate residents had active caries, of those, 53% required restorations and 37% needed extractions. All were deemed to require dental examination. 60% of dentate residents and 50% of edentate residents had case complexity, which influenced the delivery of care. CONCLUSIONS: There is significant unmet dental treatment need amongst care home residents. Dental disease presence alone is a poor indicator of the need for care and does not account for case complexity or the shift towards a patient centred rather than disease focussed approach to care. Measures for treatment needs and complexity are required when undertaking assessments of oral health needs in care homes. CLINICAL SIGNIFICANCE: Traditional oral health surveys measuring dental disease do not necessarily equate to treatments required for care home residents and do not reflect the complexity and difficulties involved in delivering dental care. This survey highlights dental needs in care homes, and the difficulties involved in delivering care to address these needs.

The caries experience of 11 to 12 year-old children in Scotland and Wales and 12 year-olds in England in 2008-2009: reports of co-ordinated surveys using BASCD methodology.

OBJECTIVE: This paper brings together summarised findings on surveys of 106,828 mainstream school pupils aged 11-12 years old undertaken in Scotland, Wales and England in 2008/09. These surveys are the latest in a series using common criteria for measurement and a range of consent arrangements which, for this age group, allow comparison between the three "countries" and over time. METHOD: Representative samples were drawn within the geographies of primary care organisations in the three countries and within English Local Authorities according to BASCD criteria for sampling. Consent was sought from pupils in Wales and England and passive consent was used in Scotland. Children aged twelve were examined in England and children in school year 7 (rising 12) were examined in Wales and Scotland. Examinations were conducted in schools by trained and calibrated examiners using BASCD standard criteria and caries was diagnosed at the dentinal threshold using visual criteria. RESULTS: The trend for reducing caries prevalence and severity continues in this age group in all three countries. Unlike data for 5 year old children, the impact of seeking positive consent from pupils does not appear to have introduced bias into the results. Variation in caries levels between and within geographical areas continues. CONCLUSION: Caries prevalence surveys of children aged 11-12 years have been conducted across Great Britain. Those carried out with positive consent appear to produce unbiased results, comparable with previous surveys. Health inequalities in this age group persist, as does the burden of disease for those with end-stage caries.

The caries experience of 5 year-old children in Scotland, Wales and England in 2007-2008 and the impact of consent arrangements. Reports of co-ordinated surveys using BASCD criteria.

OBJECTIVE: This paper brings together summarised findings and comment on surveys of young children undertaken in Scotland, Wales and England in 2007-08. These surveys are the latest in a series using common criteria for measurement but changes in the consent arrangements for Wales and England mean that these datasets are no longer directly comparable with Scottish data. METHOD: Representative samples were drawn within the geographies of primary care organisations in the three countries, and in England within Local Authorities also, according to BASCD criteria. Consent was sought in three different ways. Children aged five were examined in England and those in Primary 1 (rising 6) were examined in Wales and Scotland. Examinations were conducted in schools by trained and calibrated examiners and caries was diagnosed at the dentinal threshold using visual criteria. RESULTS: The impact of seeking positive consent appeared to depress the caries severity and prevalence in Wales and England whilst the reduced caries levels in Scotland may be attributed to the pro-active health improvement measures affecting this cohort. The results for positive consent suggest bias against participation of children with higher levels of tooth decay. CONCLUSION: Caries prevalence surveys of children at the start of formal education have been conducted in Great Britain. Those carried out with the need for positive parental consent have produced new baseline data. Data presented after 2007-08 should be annotated to show the participation rate and the inappropriateness of comparing data collected using different types of consent.

Do parents of children with caries choose to opt out of positive consent dental surveys in Wales?

BACKGROUND: Recently, positive consent has been required for dental surveys in some parts of the UK. Concerns have been raised that when positive consent is used participation is reduced in deprived areas and reported caries levels are biased as a consequence. This paper analyses caries data collected under positive and negative consent arrangements to explore this issue further. METHOD: Retrospective analysis of response rates by deprivation fifth and by caries experience of participating children in NHS coordinated dental surveys in Wales undertaken from 2001/2 until 2005/6 using negative consent and in 2007/8 using positive consent. RESULTS: Across Wales, the change from negative to positive consent was associated with greatly decreased participation. In comparison with previous surveys there was a large increase in children sampled but not examined. The decrease in the proportion of children sampled, who were examined and found to have no decay was similar across all deprivation fifths, with no obvious deprivation-related trend. There was a much larger reduction in the number of children with decay who participated across all quintiles of deprivation. CONCLUSION: Caries status could be a more important factor than deprivation regarding opting out of the survey. It appears that children with caries are more likely to be opted out of the survey than similarly deprived peers without caries. Parents appear to be more likely to opt children with caries out of dental surveys when positive consent is used. These findings have significant implications for targets aimed at improving oral health which were set before the change in consent procedures, but reported upon after.

BDA special care case mix model.

Routine dental care provided in special care dentistry is complicated by patient specific factors which increase the time taken and costs of treatment. The BDA have developed and conducted a field trial of a case mix tool to measure this complexity. For each episode of care the case mix tool assesses the following on a four point scale: 'ability to communicate', 'ability to cooperate', 'medical status', 'oral risk factors', 'access to oral care' and 'legal and ethical barriers to care'. The tool is reported to be easy to use and captures sufficient detail to discriminate between types of service and special care dentistry provided. It offers potential as a simple to use and clinically relevant source of performance management and commissioning data. This paper describes the model, demonstrates how it is currently being used, and considers future developments in its use.

Trends in childrens' ability to consent to a dental examination and the potential impact on reported caries indices.

UNLABELLED: New guidance on consent for England and Wales suggests that children aged over 11 should be asked to consent to the NHS child dental survey examinations. If they are "Gillick competent" then they can provide consent. Whether they are "Gillick competent" is a matter of clinical judgment of the examining dentist. This paper explores the level of understanding expressed after the examination by children apparently "Gillick competent". It considers issues how a dentist judges a child competent to make a decision to participate in a dental survey. OBJECTIVE: The objective of this investigation was to examine the possible impact on reported DMFT indicators if children who have not fully understood an explanation of the nature and purpose of the survey could be identified by further questioning and excluded from the survey. This information will be helpful in making a decision on an appropriate threshold of competence used when obtaining consent from children participating in these NHS coordinated child dental surveys. DESIGN AND SETTING: Questionnaire data from the 2002/3 survey of 6,393 13-14 year-old children and the 2004/5 survey of 6,749 11-12 year olds were used. Questions were asked of participating children post-examination. The children were asked if they had actually understood the explanation provided before the examination of what was to be done and why. This information together with the NHS child dental DMFT data was analysed. RESULTS: Approximately 15% of children in these age groups gave answers after the event which indicated that they had not understood either the nature or purpose of the survey. Deprived children were less likely to have understood an explanation and among 12 year olds the children who did not understand were more likely to have caries. There is potential for a small impact on DMFT indicators if higher thresholds of competence are used in future surveys. CONCLUSION: If different approaches to consent are used across England and Wales a small impact on DMFT indicators will result. Guidance on the judgment of capacity as part of the consent process will help to ensure comparability of data. A standard approach on consent method for use in NHS child dental surveys, in particular on how to judge competence, should be agreed.

Consent of older children participating in BASCD coordinated dental epidemiology surveys in Wales.

UNLABELLED: New guidance on consent for England and Wales, which has positive consent at its core, has implications for the UK-wide BASCD coordinated dental epidemiology programme. This paper describes a method used in Wales for obtaining consent from older children which is believed to comply with the new guidance. OBJECTIVE: The objective was to establish a more robust approach to gaining consent from 12 and 14 year olds taking part in the surveys, by building on existing "negative consent" practice and supplementing it with Gillick competent child consent. DESIGN AND SETTING: Questionnaire data from the 2002-03 survey of 6,393 13-14 year-old children and the 2004-05 survey of 6,749 11-12 year olds were used in this analysis. Questions specifically designed to establish competency to consent were asked of participating children. These ascertained whether children were happy to proceed and if so, whether they understood the nature and the purpose of the survey and whether they were happy with the outcome. RESULTS: Ninety-nine percent of those taking part in both survey years were happy to proceed with the examination and questionnaire. Whilst the majority of children, agreeing to take part, indicated that they had understood what was proposed and were happy with the outcome, approximately 15% of these age groups gave answers after the event which indicated that they had not understood either the nature or purpose of the survey. CONCLUSION: Use of "Gillick competent" consent in Wales did not affect participation rates adversely. The authors would suggest that indication of assent as used in Wales in these two surveys is appropriate and would only exclude 1% of children. The alternative, of examining only those children who answered questions on whether they understood the nature and purpose of what is proposed prior to assenting, would exclude 15% of children.

What is the role of dentists in smoking cessation?

The associations between tobacco use and diseases affecting the oral cavity, such as periodontal disease and cancer, are now well recognised. This has lead to proposals from some members of the profession and the BDA that members of the dental team should provide smoking cessation services. Many dentists have positive attitudes towards the idea of dentists encouraging patients to stop smoking. However the belief that members of the dental team should engage in delivering smoking cessation interventions is not held by all parties. More dentists believe that they should offer smoking cessation support than actually do provide it and reasons for not providing it include time and reimbursement issues, need for further training and poor co-ordination of dental and smoking cessation services.

Cognitive and linguistic profiles of specific language impairment and semantic-pragmatic disorder in bilinguals.

This study explored the notion that the extent to which language-impaired children can become bilingual depends on the type of language impairment. Single-case studies were conducted on two 7-year-old bilingual children, who had both been exposed to English and Afrikaans consistently and regularly from an early age. The subjects presented with specific language impairment (SLI) and semantic-pragmatic disorder (SPD), respectively. They were assessed on a battery of cognitive and linguistic tests in both their languages. Results indicate that the SLI subject, who presented with a deficit in successive processing on the Cognitive Assessment System, had difficulty in acquiring the surface features of both languages. She developed much better proficiency in English than in Afrikaans, despite substantial exposure to the latter. The SPD subject, whose cognitive profile was characterised by planning and attention deficits, but a strength in successive processing, presented with equal proficiency in both languages. The theoretical and clinical implications of this research are discussed.