Challenges associated with implementation of a school-based tooth-brushing and fluoride varnish programme in a diverse and transient urban population.

Public health competencies being illustrated; Planning, delivery and evaluation of health improvement programmes, addressing health inequalities, awareness of cultural impacts on health and wellbeing. Smile4Life, a schools-based, evidence informed oral health promotion programme, was designed to address high levels of oral health need and inequality within a UK City. The aims of the pilot described were to test the feasibility of delivering the programme (supervised tooth-brushing, take home kits, educational resources and application of fluoride varnish) in six culturally diverse schools in disadvantaged neighbourhoods, and evaluate its impact on caries prevalence. High levels of participation were achieved (98% positive consent) however only 44% received more than one application of fluoride varnish. A reduction in decay prevalence and improved oral hygiene was observed. This paper examines the challenges faced in working with transient and culturally diverse population groups, working effectively with schools to deliver an effective intervention for this population, and in responding effectively across agencies to address safeguarding concerns.

Distribution of NHS resources for children's dental care in general dental practice in England.

OBJECTIVE: To determine the relationship between the distribution of NHS resources in general dental practice and dental need and access to services for the population in England under the age of 18 in different socio-economic areas. BASIC RESEARCH DESIGN: A proxy for the oral health of under 18 year olds was made from prevalence surveys undertaken on five year old children in each health authority area in 1999/2000. The level of spending per head of the population was ascertained from Dental Practice Board data. Health authorities were grouped according to the eleven United Kingdom Office of National Statistics socio-economic groups. Access was measured by using registration levels of children. SETTING: General dental practices providing National Health Service treatment for children aged 0-18 in England. RESULTS: There was no correlation (r = -0.03) between increasing need for dental care using mean dmft as a proxy and increasing spending per head of the population for each health authority. There was a correlation (r = 0.38) between increasing registration rates and increased spending per head. The populations under 18 had more spent on their oral health care living in areas classified as Mixed Economies, Services and Education and Most Prosperous. Those in Inner London, Manufacturing, Ports and Industry had proportionately the least. The difference between the highest and lowest group was 33%. The groups of Authorities were not homogenous in their level of resources with variations between Authorities in the same groups. CONCLUSIONS: The distribution of NHS resources to general dental practice for people under 18 does not reflect population need. The higher the registration rate for children the greater the amount resources deployed in an area.

Sedation in primary dental care: an investigation in two districts of northern England.

OBJECTIVE: To determine the current provision of sedation in primary dental care and investigate the knowledge and attitudes of dental practitioners and others on the use of sedation. DESIGN: Qualitative interviews and postal questionnaire survey. SETTING: Health districts of Bradford (West Yorkshire) and South Durham, UK in 1996. SUBJECTS AND MATERIALS: 15 key individuals associated with NHS primary dental services were interviewed. Questionnaires were sent to all 260 NHS general dental practitioners and community dental service clinicians. RESULTS: 208 questionnaires (80%) were returned. 42% of respondents reported current sedation use, with oral administration the favoured technique (26%). Significant differences were found between districts for intravenous sedation use (7% Bradford, 41% South Durham, P < 0.001). Almost all participants agreed the value of sedation in dental care for adults and children, for nervous, phobic patients or in association with unpleasant forms of treatment and 45% of dentists felt that provision should be expanded. Training, availability of referral services, finance and patient demand were seen as encouraging factors. CONCLUSIONS: Substantial variations in sedation provision between the two districts were associated with teaching at the nearest dental schools. Innovative use of resources could help the expansion of provision supported in this study.