Accelerated partial breast irradiation in early stage breast cancer.

Accelerated partial breast irradiation (APBI) is increasingly used to treat select patients with early stage breast cancer. However, radiation technique, dose and fractionation as well as eligibility criteria differ between studies. This has led to controversy surrounding appropriate patients for APBI and an assessment of the toxicity and cosmetic outcomes of APBI as compared to whole breast irradiation (WBI). This paper reviews existing data for APBI, APBI delivery at our institution, and ongoing research to better define patient selection, treatment delivery, dosimetric considerations and toxicity outcomes.

Barriers and facilitators to health visiting teams delivering oral health promotion to families of young children: a mixed methods study with vignettes.

OBJECTIVE: To explore the potential barriers and facilitators to health visiting (HV) teams delivering oral health promotion during the 9-12-month old child mandated visit in Ealing, England. BACKGROUND: HV schemes and their counterparts worldwide share similar priorities to discuss oral health at 6-12 months of age. The HV programme in England stipulates at 9-12 months old, diet and dental health should be discussed. HVs believe dental decay is important however oral health knowledge is varied. Further, little is understood about what drives HVs to deliver oral health advice. An appropriate theoretical model to explore these factors is the Theoretical Domains Framework (TDF). METHODS: An opportunistic sample of HV team members was drawn from three hubs to allow for maximum variation. First, participants completed a questionnaire to establish baseline knowledge. Secondly, participants were invited to take part in focus groups (FGs) with vignettes. Thirdly, face-to-face interviews were conducted. FGs were subject to thematic analysis and the interviews to framework analysis. RESULTS: Thirty-six participants provided written informed consent and completed baseline questionnaires. Three FGs were conducted with an average of seven participants (n=21) followed by 13 interviews. Perceived facilitators: good levels of knowledge and skills, sense of professional role, emotions, belief in capability, organisational structure and resources. Perceived barriers: gaps in knowledge, conflicting advice from other professionals, conflicting issues for parents/ carers, use of interpreters. CONCLUSIONS: These findings can be harnessed to support oral health promotion delivered by HV teams.

Dental RECUR Randomized Trial to Prevent Caries Recurrence in Children.

The purpose of this study was to determine the efficacy of a dental nurse-delivered intervention-the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI)-in reducing the recurrence of dental caries in children who have a primary tooth extracted. It was based on a 2-arm multicenter randomized controlled trial with blinded outcome assessment. Participants were 5- to 7-y-old children (n = 241) scheduled to have primary teeth extracted in 12 UK centers. Test intervention parents (n = 119) received DR-BNI led by trained dental nurses. DR-BNI is a 30-min structured conversation informed by motivational interviewing with a forward focus to prevent future caries. Preventive goals are agreed, and a review appointment is made with child's general dental practitioner, who is advised to treat the child as being at high caries risk. The control intervention (n = 122) was a parent-nurse conversation about child's future tooth eruption, with advice given to visit a general dental practitioner as usual. At baseline, the DR-BNI group's mean dmft was 6.8, and the control group's was 6.3. A median of 5 teeth were extracted, mainly under general anesthesia. Final dental assessments were conducted by a single examiner visiting 189 schools 2 y after intervention; 193 (80%) of 241 children were examined. In the control group, 62% developed new caries in teeth that were caries-free or unerupted at baseline, as compared with 44% in the test group, a significant reduction (P = 0.021). The odds of new caries experience occurring were reduced by 51% in the DR-BNI group as compared with control. There was a 29% decrease in the relative risk of new caries experience in the DR-BNI group as compared with control. This single low-cost, low-intensity intervention was successful in significantly reducing the risk of recurrence of dental caries in children. This trial has implications for changing pediatric dental practice internationally. Training in and implementation of a motivational interviewing-informed brief intervention provides opportunities for dental nurses to facilitate behavior change improving the oral health of children at high caries risk (ISRCTN 24958829).

Free Sugars Consumption around Bedtime and Dental Caries in Children: A Systematic Review.

This systematic review aimed to assess the association between food and drink consumption around bedtime-specifically, food and drinks containing free sugars-and the risk of dental caries in children. Five electronic databases were searched (PubMed, Ovid Medline, EMBASE, Web of Science, and Scopus) to identify studies that investigated any relationship between food and drink around bedtime and dental caries in 3- to 16-y-old children. The Agency for Healthcare Research and Quality domain guidelines were used to assess the quality of the individual studies, while GRADE guidelines assessed the quality of studies based on the body of evidence. From 1,270 retrieved titles, 777 remained after removal of duplicates. Of these, 72 were reviewed in full. Eighteen studies fulfilled the inclusion criteria and were included in the analysis: 13 cross-sectional, 4 cohort, and 1 case-control. Studies were categorized into 3 age groups: 3- to 5-y-old, 6- to 11-y-old, and 12- to 16-y-old children. Based on the Agency for Healthcare Research and Quality criteria, 6 of the 18 studies were rated as providing good-quality evidence; 8 were rated as fair; and 4 were categorized as being of poor quality. It was not possible to conduct a meta-analysis, because of the considerable variations in the type of bedtime exposure and outcome measures. The studies showed a consistent positive association across the 3 age groups, with all 7 studies on preschool children reporting significant positive associations. However, the quality of the body of evidence pertaining to the consumption of food and drinks at bedtime (specifically, food and drinks containing free sugars) and risk of caries was rated as "very low." The results suggest that restricting free sugars before and at bedtime may reduce the risk of caries, but studies with improved design are needed to confirm this. Knowledge Transfer Statement: This is the first systematic review of the evidence assessing the association between caries risk in children and the consumption of food or drinks at bedtime-specifically, foods and drinks containing free sugars. Although the data showed a consistent positive association, the quality of evidence was very low. This means that the current recommendation to restrict food and drinks containing free sugars before bedtime in children, while based on a sound physiologic premise, is supported only by very low-quality published evidence as measured by GRADE guidelines.

Statistical power of multilevel modelling in dental caries clinical trials: a simulation study.

Outcome data from dental caries clinical trials have a naturally hierarchical structure, with surfaces clustered within teeth, clustered within individuals. Data are often aggregated into the DMF index for each individual, losing tooth- and surface-specific information. If these data are to be analysed by tooth or surface, allowing exploration of effects of interventions on different teeth and surfaces, appropriate methods must be used to adjust for the clustered nature of the data. Multilevel modelling allows analysis of clustered data using individual observations without aggregating data, and has been little used in the field of dental caries. A simulation study was conducted to investigate the performance of multilevel modelling methods and standard caries increment analysis. Data sets were simulated from a three-level binomial distribution based on analysis of a caries clinical trial in Scottish adolescents, with varying sample sizes, treatment effects and random tooth level effects based on trials reported in Cochrane reviews of topical fluoride, and analysed to compare the power of multilevel models and traditional analysis. 40,500 data sets were simulated. Analysis showed that estimated power for the traditional caries increment method was similar to that for multilevel modelling, with more variation in smaller data sets. Multilevel modelling may not allow significant reductions in the number of participants required in a caries clinical trial, compared to the use of traditional analyses, but investigators interested in exploring the effect of their intervention in more detail may wish to consider the application of multilevel modelling to their clinical trial data.

Analysis of health behaviour change interventions for preventing dental caries delivered in primary schools.

To improve oral health in children, the key behaviours (tooth brushing and sugar control) responsible for development of dental caries need to be better understood, as well as how to promote these behaviours effectively so they become habitual; and, the specific, optimal techniques to use in interventions. The aim of this paper is to describe and analyse the behaviour change techniques that have been used in primary school-based interventions to prevent dental caries (utilizing a Cochrane systematic review that we have undertaken) and to identify opportunities for improving future interventions by incorporating a comprehensive range of behaviour change techniques. Papers of five interventions were reviewed and data were independently extracted. Results indicate that behaviour change techniques were limited to information-behaviour links, information on consequences, instruction and demonstration of behaviours. None of the interventions were based on behaviour change theory. We conclude that behaviour change techniques used in school interventions to reduce dental caries were limited and focused around providing information about how behaviour impacts on health and the consequences of not developing the correct health behaviours as well as providing oral hygiene instruction. Establishing which techniques are effective is difficult due to poor reporting of interventions in studies. Future design of oral health promotion interventions using behaviour change theory for development and evaluation (and reporting results in academic journals) could strengthen the potential for efficacy and provide a framework to use a much wider range of behaviour change techniques. Future studies should include development and publication of intervention manuals which is becoming standard practice in other health promoting programmes.

Family relationships as an explanatory variable in childhood dental caries: a systematic review of measures.

It is widely acknowledged that parental beliefs (self-efficacy) about oral health and parental oral health-related behaviours play a fundamental role in the establishment of preventative behaviours that will mitigate against the development of childhood dental caries. However, little attention has been given to the wider perspective of family functioning and family relationships on child oral health. For oral health researchers, exploration of this association requires the use of reliable, valid and appropriate assessment tools to measure family relationships. In order to promote methodologically sound research in oral health, this systematic review aims to provide a guide on self-report psychometric measures of family functioning that may be suitable to utilize when exploring childhood dental caries. This systematic review has identified 29 self-report measures of family functioning and evaluated them in terms of their psychometric support, constructs measured and potential utility for oral health research. The majority of the measures reported adequate levels of reliability and construct validity. Construct evaluation of the measures identified five core domains of family functioning, namely 'communication', 'cohesion/engagement', 'control', 'involvement' and 'authoritative/rigid parenting style'. The constructs were subsequently evaluated with respect to their potential relevance to child oral health. Herewith this review provides a framework to guide future research to explore family functioning in furthering our understanding of the development of childhood dental caries.

Randomised controlled trial of the efficacy of a high-fluoride gel self-applied by toothbrushing in children at high caries risk.

The primary objective of this clinical trial was to assess the caries-preventive efficacy of 2 years of twice weekly supervised brushing with a self-applied gel containing 12,500 ppm fluoride on schooldays compared with weekly supervised use in children at high caries risk (with prior caries experience on first permanent molars). The secondary objective was to assess efficacy compared with similar children who continued with their usual oral hygiene care. This was a single-centre, single-blind, randomised, parallel-groups trial comprising two test groups and one untreated control group. 1,075 pupils aged 12-13 years at baseline received a baseline and final examination 2 years later. For all children completing the trial no significant difference was found between groups. For children compliant with study protocol no significant difference was found in the primary outcome (D(1)FS caries increment), but significant differences were found between the three groups overall in the secondary outcome, D(3)FT caries increment, with a significant pairwise difference between control and twice per week gel brushing (29%, p = 0.023 D(3)FT visual + fibre-optic transillumination). Analysis of the relationship between number of gel applications and caries showed that children who brushed with the gel at least 60 times over a 2-year period developed significantly fewer carious lesions into dentine than children who followed their usual oral hygiene routine. Some caution is needed as greatest benefit was shown by compliant children. Where schools are co-operative, it is recommended that the gel be used twice a week within a school-based programme over a 2-year period.

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.

Prevalence and risk indicators of erosion in thirteen- to fourteen-year-olds on the Isle of Man.

AIMS: The aim was to determine the prevalence of erosion in 13- to 14-year-old children on the Isle of Man and to investigate the strength of association with dietary risk factors. METHODS: Exposed dentine was assessed on smooth surfaces of incisors/canines and occlusal surfaces of first molars. A questionnaire assessed the consumption frequency of foodstuffs. RESULTS: Of 629 children examined, 124 (20%) had dentine exposed labially, palatally or occlusally. More males had dentine exposed on these surfaces (OR = 1.7, 95% CI = 1.2-2.6). Palatal dentine exposure was present in 3% of the children and occlusal dentine exposure in 18%. In bivariate analyses, drinking fizzy drinks more than once a day was associated with erosion (OR = 1.6, 95% CI = 1.1-2.3). The mean DMFT scores were not statistically different for the children with smooth surface/occlusally exposed dentine (1.37) compared to those without (1.58). Multiple regression analysis showed age, gender and toothbrushing to be significant predictors of erosion. CONCLUSION: This study has found a higher proportion of 13- to 14-year-old children with exposed dentine in molars than previous studies. The results corroborate previous reports that males have more erosion than females.

The pharmacological chaperone 1-deoxygalactonojirimycin increases alpha-galactosidase A levels in Fabry patient cell lines.

Fabry disease is an X-linked lysosomal storage disorder caused by mutations in the gene encoding alpha-galactosidase A (alpha-Gal A), with consequent accumulation of its major glycosphingolipid substrate, globotriaosylceramide (GL-3). Over 500 Fabry mutations have been reported; approximately 60% are missense. The iminosugar 1-deoxygalactonojirimycin (DGJ, migalastat hydrochloride, AT1001) is a pharmacological chaperone that selectively binds alpha-Gal A, increasing physical stability, lysosomal trafficking, and cellular activity. To identify DGJ-responsive mutant forms of alpha-Gal A, the effect of DGJ incubation on alpha-Gal A levels was assessed in cultured lymphoblasts from males with Fabry disease representing 75 different missense mutations, one insertion, and one splice-site mutation. Baseline alpha-Gal A levels ranged from 0 to 52% of normal. Increases in alpha-Gal A levels (1.5- to 28-fold) after continuous DGJ incubation for 5 days were seen for 49 different missense mutant forms with varying EC(50) values (820 nmol/L to >1 mmol/L). Amino acid substitutions in responsive forms were located throughout both structural domains of the enzyme. Half of the missense mutant forms associated with classic (early-onset) Fabry disease and a majority (90%) associated with later-onset Fabry disease were responsive. In cultured fibroblasts from males with Fabry disease, the responses to DGJ were comparable to those of lymphoblasts with the same mutation. Importantly, elevated GL-3 levels in responsive Fabry fibroblasts were reduced after DGJ incubation, indicating that increased mutant alpha-Gal A levels can reduce accumulated substrate. These data indicate that DGJ merits further evaluation as a treatment for patients with Fabry disease with various missense mutations.

Modelling the bilateral symmetry of caries incidence.

BACKGROUND/AIMS: Past caries experience has been shown to be the best predictor of the development of caries in the future, and clinical observations suggest that caries develops symmetrically in similar teeth on each side of the mouth. This study investigates whether caries on a given surface can be used as a predictor of future caries on the corresponding surface on the other side of the mouth. METHODS: The data come from a 3-year trial examining the caries-preventive efficacy of chlorhexidine varnish on adolescents. A logistic multilevel model was fitted with 3 levels; participant, tooth and surface. The outcome variable was the development of caries into enamel or dentine, after 3 years. Covariates were tooth position, the caries status of the contralateral surface at baseline, the caries status of the corresponding surface in the opposing jaw at baseline, the caries status of adjacent teeth and the total number of decayed, missing, filled surfaces at baseline. RESULTS: The effect of caries at baseline on the contralateral surface was highly significant (odds ratio = 4.80, 95% CI = 4.38-5.38). The effect of caries at baseline on the corresponding surface in the opposing jaw was also significant, but smaller in magnitude (odds ratio = 1.66, 95% CI = 1.49-1.83). CONCLUSION: Multilevel modelling provides a clinically useful method of estimating the probability of a surface developing caries over a period of time, based on the caries status of the contralateral surface and the corresponding surface in the opposing jaw, while controlling for the natural clustering in tooth surface data.

Caries prevalence four years after the end of a randomised controlled trial.

This study measured dental caries in children after cessation of a 30-month randomised clinical trial in which the intervention group received supervised toothbrushing once a day at school with 1,000 ppm fluoride toothpaste and a home support package encouraging twice-daily toothbrushing. The non-intervention group did not brush at school or receive the home support package. Children were aged 5 years at baseline and were examined every 6 months during the trial, then at 6, 18, 30 and 54 months after the end of the trial. Significantly less caries developed in first permanent molars of intervention children at the end of the trial. Of the 428 children who were examined at the end of the trial 329 (77%) were examined 54 months later when the children were aged 12 years on average. The intervention group still had less caries (D3FS caries increment 1.62) than the non-intervention children (D3FS caries increment 2.65, p < 0.05). Prolonged benefits have been found for intervention children principally in less caries in first permanent molars. Further follow-up at an age when the second molars and premolars have all erupted will help determine whether this benefit is due to a long-term behavioural change or a prolonged biological effect.

The dental caries experience of 5-year-old children in Great Britain (2005/6). Surveys co-ordinated by the British Association for the study of community dentistry.

OBJECTIVE: This paper reports the results of standardized clinical caries examinations of 5-year-old children from across England, Wales and Scotland in 2005/6. These co-ordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating strategic health authorities (SHAs), primary care trusts (PCTs) and health boards (HBs). Caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: 239,389 five and six year-old children from across England, Wales, Scotland and the Isle of Man were examined in 2005/2006. The results again demonstrated a wide variation in disease prevalence and care strategies across Great Britain. Mean d3mft across England was 1.47 (d3t = 1.10, mt = 0.20, ft = 0.16), across Wales the corresponding values were 2.38 (d3t = 1.70, mt = 0.43, ft = 0.25) and in Scotland 2.16 (d3t = 1.45, mt = 0.51, ft = 0.20). Overall, 39.4% of children in Great Britain had evidence of caries experience in dentine (d3mft > 0, including visual dentine caries). The distribution of caries was highly skewed. Thus the mean caries experience for those with dentinal decay was 3.99, as opposed to the overall mean of 1.57. Trends over time demonstrate a small change in mean d3mft since 2003/4 when the mean was 1.62, although the mean value for those with dentine decay experience remained constant (4.00 vs 3.99). The care index has also fallen marginally from 12% to 11%. The BASCD co-ordinated NHS Epidemiology Programme will evolve in coming years as differing priorities in the frequency of inspecting particular age groups is being seen as well as a desire to measure other aspects of oral health in addition. CONCLUSION: Overall, there has been only a small overall improvement in the dental health of 5-year-old children over the last 2 years and no diminution of the level of disease in those affected for some time, although in Scotland a pattern of continuing steady progress from previously high levels is seen. While many children enjoy good oral health, sizable groups remain within the population of 5-year-old children who have a clinically significant burden of preventable dental disease.

The application of multilevel modelling to dental caries data.

Clinical studies of dental caries experience generate multiple outcome data for each participant, with information collected for each individual tooth surface. This paper investigates multilevel modelling as a method of analysis for dental caries data, allowing for full use of the data collected at surface level. Data from a clinical trial of a caries preventive agent in adolescents are modelled. The effect of tooth position within the mouth on the development of dental caries is investigated, with the results showing the importance of differentiating between the upper and lower arches, when modelling the probabilities of caries developing on teeth. Calculation of the intracluster correlation using the threshold model is suggested for use in multilevel logistic regression modelling of caries data. This model, which assumes that a dichotomous outcome is based on an underlying continuous variable with a threshold point where the outcome changes from zero to one, is identified to be appropriate for the analysis of caries which is a continuous process, but is only identified as present in a clinical trial when it has reached a certain level of severity.

Statistical aspects of design and analysis of clinical trials for the prevention of caries.

This paper considers the methods used in design and analysis of recent clinical trials of topical fluoride interventions designed to prevent the development of dental caries in children, with particular consideration given to issues related to cluster-randomized trials. Studies which met the inclusion criteria were recent clinical trials of topical fluoride interventions published since 1990, conducted in children under 16 years of age, with caries as the outcome variable. Papers not published in English were translated. Information was extracted from the published trial reports on the units of randomization and analysis. The papers were also studied to assess if reporting allowed the assessment of potential consent bias in cluster-randomized trials and the reproduction of sample size calculations. Fifteen trials published since 1990 were included, of which five were cluster randomized. Only 1 of the 5 accounted for the clustering in the analysis. For the other four trials, it was possible to calculate that values from 0.002 (for DMFS) and 0.08 (for being caries free) for the intracluster correlation coefficient within schools could result in statistically non-significant findings. 3 of the 5 cluster-randomized trials did not report the consenting procedure in enough detail to judge whether consent bias could be present. Only 1 of the total 15 trials reported a sample size calculation. In summary, researchers should be aware of the importance of correctly analyzing cluster-randomized data and thorough reporting of clinical trials according to the CONSORT guidelines.

The dental caries experience of 11-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 2004 / 2005.

OBJECTIVE: This paper reports the results of standardized clinical caries examinations of 11-year-old children from across England and Wales, Scotland, Isle of Man, and Jersey in 2004/5. These co-ordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating strategic health authorities (SHAs), primary care trusts (PCTs), health boards (HBs), and local health boards (LHBs). Caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: The results again demonstrated a wide variation in disease prevalence and care strategies across Great Britain. Mean values for D3MFT within the current English strategic health authorities ranged from 0.19 in Harlow to 1.32 in North Manchester and in Salford; in Wales mean values ranged from 0.69 in Vale of Glamorgan to 2.09 in Blaenau Gwent; while in Scotland they ranged from 0.59 in Orkney to 1.77 in Western Isles. Mean D3MFT across England was 0.64 (D3T = 0.32, MT = 0.06, FT = 0.25), across Wales it was 1.09 (D3T = 0.48, MT 0.11, FT = 0.50), and across Scotland values were 1.29 (D3T = 0.52, MT = 0.17, FT = 0.60). Overall, 31.3% of children in England & Wales and 47.1% of children inspected in Scotland had evidence of caries experience in dentine (D3MFT > 0, including visual dentine caries). As in previous surveys, the distribution of caries was highly skewed. Thus the mean caries experience for those with dentinal decay in England and Wales was 2.12, as opposed to the overall mean of 0.66; in Scotland the corresponding values were 2.74 and 1.29. Trends over time demonstrate an improvement in overall mean D3MFT for England and Wales since the 2000/2001 of 12-year-olds, although part of this difference is accountable to the younger age, at examination, in this survey. The mean value for those with dentine decay experience was also marginally less at 2.12 compared with 2.35 in the previous survey. (Figures for Scotland were not included in the 2000/2001 survey.) The care index was also found to be marginally lower than previously at 41% compared with 48% but again the younger age of the children would influence this value. CONCLUSION: Dental health of 11-year-old children has been surveyed in Great Britain, Jersey, and the Isle of Man: being a slightly younger mean age than in previous BASCD surveys. Geographic variation in oral health is marked at both the local and national levels. Overall, the provision of operative care for those with dentinal decay is around 42%. While many children enjoy good oral health, sizable groups remain within the population of 11-year-old children who have a clinically significant burden of preventable dental disease.

An investigation of the relationship between untreated decayed teeth and dental sepsis in 5-year-old children.

OBJECTIVES: To investigate the prevalence of dental sepsis in 5-year-old children in Scotland and the relationship between sepsis, treated and untreated decayed teeth, oral cleanliness (visible plaque on anterior teeth) and socio-economic deprivation. SUBJECTS AND METHODS: Six thousand, nine hundred and ninety-four children of mean age 5.3 years were examined as part of a survey conducted under the Scottish Health Board's Dental Epidemiological Programme. The presence of dental sepsis was recorded, in addition to caries status, and presence of plaque. Postal code information was used to obtain a measure of material deprivation. Relationships between sepsis and its possible contributory factors were explored using stepwise logistic regression. MAIN RESULTS: In the whole sample, 4.8% of children examined had dental sepsis, ranging from 2% in the most affluent areas to 11% in the most deprived. Children with sepsis had much higher caries experience (mean dmft 6.30) than those without sepsis (mean dmft 2.36). However, when these factors and the presence of plaque were entered into a logistic regression model to predict presence or absence of dental sepsis, the most important factor was not deprivation, but untreated decay. CONCLUSIONS: The proportion of children with sepsis increases markedly with caries experience. This disadvantage can be mitigated if more of the caries experience is treated. These findings would not support a policy of non-intervention for deciduous caries if oral sepsis is to be minimised.