Socioenvironmental sugar promotion and geographical inequalities in dental health of 5-year-old children in England.

OBJECTIVES: To investigate the relationship between socioenvironmental sugar promotion and geographical inequalities in the prevalence of dental caries amongst 5-year-olds living across small areas within England. METHODS: Ecological data from the National Dental Epidemiology Programme (NDEP) 2018-2019, comprising information on the percentage of 5-year-olds with tooth decay (≥1 teeth that are decayed into dentine, missing due to decay, or filled), and untreated tooth decay (≥1 decayed but untreated teeth), in lower-tier local authorities (LAs) of England. These were analysed for association with a newly developed Index of Sugar-Promoting Environments Affecting Child Dental Health (ISPE-ACDH). The index quantifies sugar-promoting determinants within a child's environment and provides standardized scores for the index, and its component domains that is, neighbourhood-, school- and family-environment, with the highest scores representing the highest levels of sugar promotion in lower-tier LAs (N = 317) of England. Linear regressions, including unadjusted models separately using index and each domain, and models adjusted for domains were built for each dental outcome. RESULTS: Participants lived across 272 of 317 lower-tier LAs measured within the index. The average percentage of children with tooth decay and untreated tooth decay was 22.5 (SD: 8.5) and 19.6 (SD: 8.3), respectively. The mean index score was (0.1 [SD: 1.01]). Mean domain scores were: neighbourhood (0.02 [SD: 1.03]), school (0.1 [SD: 1.0]), and family (0.1 [SD: 0.9]). Unadjusted linear regressions indicated that the LA-level percentage of children with tooth decay increased by 5.04, 3.71, 4.78 and 5.24 with increased scores of the index, and neighbourhood, school and family domains, respectively. An additional model, adjusted for domains, showed that this increased percentage predicted by neighbourhood domain attenuated to 1.37, and by family domain it increased to 6.33. Furthermore, unadjusted models indicated that the LA-level percentage of children with untreated tooth decay increased by 4.72, 3.42, 4.45 and 4.97 with increased scores of the index, and neighbourhood, school, and family domains, respectively. The model, adjusted for domains, showed that this increased percentage predicted by neighbourhood domain attenuated to 1.24 and by family domain rose to 6.47. School-domain was not significantly associated with either outcome in adjusted models. CONCLUSIONS: This study reveals that socioenvironmental sugar promotion, particularly within neighbourhood- and family-environments, may contribute to geographical inequalities in dental caries in children. Further research involving data on individual-level dental outcomes and confounders is required.

Views of homecare staff and carers on oral needs and dental care for people living with dementia: A qualitative study.

OBJECTIVE: People living with dementia are at risk of mouth and dental problems. Many receive help with this aspect of personal care from family carers or homecare workers. We explored the views of homecare providers and carers on how this aspect of personal care is addressed and implemented. MATERIALS AND METHODS: In this qualitative study we conducted semi-structured interviews with carers (all family members), homecare workers and managers providing support to people living with dementia in their own homes. Interview questions focused on daily care practices, exploring barriers and facilitators to oral care. Interviews were recorded online or over the telephone, transcribed, and thematically analysed. RESULTS: Carers (n = 8), homecare workers (n = 9) and homecare managers (n = 15) were recruited from across England in 2021-2022. Across interviews, two main themes were identified: (i) Missed opportunities to address oral care, which is not always seen as a priority despite the importance and potential risk of neglect. (ii) Challenges in delivering oral care, including factors related to the person living with dementia (such as cognitive and physical decline) and factors related to the care infrastructure and policies such as training, perception of roles, allocated time, and consistency of care. DISCUSSION: More emphasis could be given to the training and skills of homecare providers to identify and prevent dental problems and to assist carers. Several strategies and tools (oral care checklists, greater detail around oral care in care assessments and care plans) could be used to enhance this aspect of personal care for people living with dementia.

Frailty index and ten oral conditions in the Coyoacan cohort study: A cross-sectional analysis.

OBJECTIVES: To analyse the relationship between the Frailty Index and 10 oral conditions controlling for nutritional status among Mexican community-dwelling older people. BACKGROUND: Studies suggest that the association between frailty and oral conditions are mediated by nutrition. MATERIALS AND METHODS: This cross-sectional analysis includes 487 community-dwelling men and women aged ≥70 years old. Interview and clinical examinations were performed at participants' homes. Objective (number of natural teeth, root remnants, dental condition, utilisation and functionality of removable dental prostheses and periodontitis) and subjective (utilisation of dental services, self-rated oral health, chewing difficulties and xerostomia) oral variables were collected by trained personnel. The Frailty Index was calculated considering 35 deficits. Nutritional status measured with the Mini-Nutritional assessment (MNA), age, sex, education, and marital status were included as covariates. We fitted 11 multivariate generalised linear models (one for each oral condition), assuming gamma distribution for Frailty Index as the outcome. RESULTS: Participants average age was 78.1 years, 52.1% were women. We observed a higher Frailty Index among those rating their oral health as worse than others their age (5.1%), reporting chewing difficulties often (4.9%) and fairly and very often (7.0%), and xerostomia (4.8%). Age, gender and MNA were consistently associated with the Frailty Index. CONCLUSION: Subjective oral conditions are compatible with the Frailty Index after controlling for older people's nutritional status and covariates.

Oral Health-Related Quality of Life of Refugees in Settlements in Greece.

INTRODUCTION: The objective of this cross-sectional study was to investigate the oral health-related quality of life (OHQoL) amongst refugees at emergency dental clinics in settlements in Northern Greece. METHODS: A self-reported survey was undertaken in 7 settlements. The American Dental Association questionnaire on oral health (OH) was adapted and distributed to adults attending a mobile dental clinic between July and August 2017. Data were collected on sociodemographics, length of stay in settlement, utilisation of dental service, and OHQoL. Statistical analysis included descriptive analysis and Chi-square tests of associations. RESULTS: Of 156 participants, the majority were male (73%), were aged 18 to 34 (59%), and had education up to high school (48%). Most of the participants rated OH as fair or poor (76%) and had spent more than 6 months in the settlements (45%). A majority of the participants (85%) had no access to dental care without the mobile clinic. Negative impact on OHQoL was significantly (P < .05) related to settlement location and time spent, smoking status, frequency of cleaning teeth and use of fluoridated toothpaste, perceived OH, and time since last dental visit. Those who spent less than 1 month in the settlement reported a higher negative OHQoL impact related to chewing, anxiety, smiling, daily activity, and sleeping (range, 48%-73%) compared to those who had spent more than 6 months (range, 17%-41%) (P < .05). CONCLUSIONS: To the best of our knowledge, this is the first cross-sectional study assessing the OHQoL of refugees seeking emergency dental care in settlements in Greece. There is evidence that the refugees who were new arrivals to the settlements when provided with access to dental care reported a negative impact on their OHQoL. There is an urgent need for further research to understand the OH needs of refugees in Europe in order to design and deliver targeted and effective interventions.

e-Oral health interventions for older patients in an outreach primary dental care centre: A pilot trial nested acceptability study.

OBJECTIVE: To compare the acceptability and perceived helpfulness of an e-Oral Health intervention in form of text messages versus standard dental leaflets provided after a dental visit to patients aged 65 years and over. BACKGROUND: Oral health care needs for older people are increasing. Remote interventions using e-Health can ensure oral care is provided despite physical hindrances or situations where dental appointments are limited such as has happened more widely during the COVID-19 pandemic. MATERIALS AND METHODS: Mixed-method nested study within a pilot trial. Dental patients (n = 150) at an outreach primary dental care centre, ≥ 65 years old, were recruited and randomly allocated to e-Oral health text messages or leaflet intervention arms. Post-intervention (6 months), participants responded to open and closed-ended two-way survey phone texts. Survey questions investigated: (a) whether they would recommend the intervention, (b) intervention helpfulness and (c) OPEN feedback. Average helpfulness scores (Scale:1= Very Helpful to 5= Not Helpful at All) were compared for each arm using Independent Sample t-test. Percentage of participants providing positive recommendations in each arm were compared using chi-squared tests. Qualitative findings were analysed using thematic analysis. RESULTS: N = 68 (45%) responded. Mean helpfulness scores in text group M = 2.2, SD=1.1) and leaflet group M = 2.3, SD=1.9, P = .29. Amongst the text arm respondents, 89% compared with 68.2% in leaflet arm; P = .005 would recommend the intervention. Four qualitative themes were outlined: intervention approach, content, behavioural impact and recommendations. CONCLUSION: e-Oral Health text interventions are acceptable and helpful to older people, but these messages need to be tailored.

Effect of improved cookstove intervention on childhood acute lower respiratory infection in Northwest Ethiopia: a cluster-randomized controlled trial.

BACKGROUND: Household air pollution exposure is linked with over 3.5 million premature deaths every year, ranking highest among environmental risk factors globally. Children are uniquely vulnerable and sensitive to the damaging health effects of household air pollution which includes childhood acute lower respiratory infection (ALRI). The use of improved cookstoves has been widely encouraged to reduce these health burdens. It is, however, unclear as to whether it is possible to prevent household air pollution-related disease burdens with biomass-fuelled improved cookstove intervention and the evidence regarding its child health effect still attracts wide debate. Therefore, we investigated the child health effect of improved baking stove intervention compared with the continuation of the open burning traditional baking stove. METHODS: A cluster-randomized controlled trial was conducted to assess the health effect of improved baking stove intervention. A total of 100 clusters were randomly allocated to both arms at a 1:1 ratio, and a total of four follow-up visits were carried out within 1 year immediately after the delivery of the intervention to all households allocated into the intervention arm. Data were analyzed in SPSS-22, and the intervention effect was estimated using a Generalized Estimating Equations modeling approach among the intention-to-treat population. RESULTS: A total of 5508 children were enrolled in the study across 100 randomly selected clusters in both arms, among which data were obtained from a total of 5333 participants for at least one follow-up visit which establishes the intention-to-treat population dataset. The intervention was not found to have a statistically significant effect on the longitudinal childhood ALRI with an estimated odds ratio of 0.95 (95% CI: 0.89-1.02). Nevertheless, the longitudinal change in childhood ALRI was significantly associated with age, baseline childhood ALRI, location of cooking quarter, secondary stove type and frequency of baking event measured at baseline. CONCLUSIONS: We found no evidence that an intervention comprising biomass-fuelled improved baking stove reduced the risk of childhood ALRI compared with the continuation of an open burning traditional baking stove. Therefore, effective cooking solutions are needed to avert the adverse health effect of household air pollution, particularly, childhood ALRI. TRIAL REGISTRATION: The trial was registered on August 2, 2018 at clinical trials.gov registry database (registration identifier number: NCT03612362).

A retrospective clinical study on the survival of posterior composite restorations in a primary care dental outreach setting over 11years.

OBJECTIVES: To investigate the survival in terms of time to re-intervention of composite restorations in posterior teeth among patients attending for treatment at a primary care dental outreach setting over an 11-year period and to determine whether dental, patient or operator factors influenced this. METHODS: Electronic primary dental care data were collected on individual patients, including information on their dental treatment and socio-demographics as well as service provision, key performance indicators and student activity. RESULTS: A total of 1086 patients had at least one posterior composite placed between 2007 and 2018. This amounted to 3194 restorations placed of which 308 had a re-intervention within the 11-year period. For all restorations, the annual failure rate at 1 year was 5.73 %, at 5 years was 16.78 % and at 10 years was 18.74 %. A logistic regression showed that when compared to the least deprived 5th quintile, the most deprived 1st and 2nd quintiles were significantly less likely to have a re-intervention, being 49.2 % (p = 0.022) and 53.2 % (p = 0.031) less likely, respectively. CONCLUSIONS: The survival rates of posterior composite restorations placed at a single outreach centre providing undergraduate dental training in the South of England, mirrors other studies. The new findings presented suggest similar re-intervention rates between dental students and dental hygiene-therapy students. This study's findings around patient deprivation and rate and time of re-intervention raises important questions related to the need for targeted dental and after care for certain groups in the population. CLINICAL SIGNIFICANCE: Understanding the factors associated with re-intervention of restorations provided to patients has an impact on patients and dental practices. Also, as we consider widening use of skill mix in dentistry to increase access to care, parity in provision of treatments within the dental team increases opportunities for delegation of tasks.

Facilitators and barriers to improved cookstove adoption: a community-based cross-sectional study in Northwest Ethiopia.

BACKGROUND: Among the environmental risk factors, household air pollution exposure from traditional cooking practices is one of the biggest killers globally, which mainly impacts developing countries where many families rely on traditional cooking practices. Although improved cookstove adoption is central to tackle this public health issue, the efforts to disseminate cookstove technologies have faced challenges, and the adoption rates are reported to be very low in many developing countries including Ethiopia. Therefore, this study aimed to determine the magnitude and identify potential factors that may act as facilitators or barriers to adoption from users' point of view. METHODS: As part of the wider stove trial project, a cross-sectional study was conducted among a total of 5830 households under randomly selected clusters. The required data were collected through face-to-face interviews, and a backward stepwise logistic regression analysis technique was applied to evaluate the effect of potential predictor variables on adoption using adjusted odds ratio (AOR) as measures of effect. RESULTS: The prevalence of adoption was found to be 12.3% (95% CI 11.5-13.2), and households headed by females (AOR 1.96; 95% CI 1.24-3.10), private house ownership (AOR 4.58; 95% CI 3.89-6.19), separate cooking location (AOR 1.84; 95% CI 1.49-2.78), fuel purchasing (AOR 2.13; 95% CI 1.64-2.76), health benefit (AOR 1.76; 95% CI 1.15-2.70), optimistic social interaction (AOR 1.81; 95% CI 1.46-2.26), traditional suitability (AOR 1.58; 95% CI 1.28-1.95), stove use demonstration experience (AOR 2.47; 95% CI 1.98-3.07), cheap price (AOR 2.48; 95% CI 1.91-3.21), availability (AOR 1.81; 95% CI 1.5-1, 2.17), fuel-saving benefit (AOR 1.63; 95% CI 1.18-2.24), and more durable stove (AOR 1.71; 95% CI 1.30-2.26) of cookstove played a significant role as facilitators to adoption. In addition, lower educational level of head (AOR 0.31; 95% CI 0.23-0.42) and fuel processing requirement (AOR 0.55; 95% CI 0.44-0.70) of cookstove were found to be barriers for adoption. CONCLUSIONS: Extremely lower improved cookstove adoption was observed due to household- and setting-related, cookstove technology-related, user knowledge- and perception-related, and financial- and market development-related factors. Therefore, to gain successful adoption, implementers and policymakers should consider those important factors in the implementation of clean cooking solutions to the community.

Prevalence and risk factors of acute lower respiratory infection among children living in biomass fuel using households: a community-based cross-sectional study in Northwest Ethiopia.

BACKGROUND: Childhood acute lower respiratory infection in the form of pneumonia is recognized as the single largest cause of childhood death globally accounting for 16% of the overall deaths. Some studies also reported a higher prevalence of childhood acute respiratory infection in Ethiopia, which ranges from 16% up to 33.5%. Concerning the risk factors, there are limited community-based studies in Ethiopia in general, and in the current study region in particular. Therefore, the present study was conducted to investigate the prevalence of childhood acute respiratory infection and associated factors in Northwest Ethiopia. METHODS: As part of the wider stove trial project, a cross-sectional study was conducted in May 2018 among a total of 5830 children aged less than 4 years old in randomly selected clusters. Binary logistic regression was applied to identify factors linked with childhood acute lower respiratory infection and adjusted odds ratios were used as measures of effect with a 95% confidence interval. RESULTS: A total of 5830 children were included in the study within 100 clusters. Out of which 51.7% were male and 48.3% female. The prevalence of childhood lower acute respiratory infection was 19.2% (95% CI: 18.2-20.2) and found to decrease among children living in homes with chimney, eaves space and improved cookstove than children living in households with no chimney, eaves space and improved cookstove with estimated AOR of 0.60 (95% CI: 0.51-0.70), 0.70 (95% CI: 0.60-0.84) and 0.43 (95% CI: 0.28-0.67) respectively. It was also associated with other cooking-related factors such as cow dung fuel use [AOR = 1.54 (95% CI: 1.02-2.33)], child spending time near stove during cooking [AOR = 1.41 (95% CI: 1.06-1.88), presence of extra indoor burning events [AOR = 2.19 (95% CI: 1.41-3.40)] and with frequent cooking of meals [AOR = 1.55 (95% CI: 1.13-2.13)]. CONCLUSION: High prevalence of childhood acute lower respiratory infection was demonstrated by this study and it was found to be associated with household ventilation, cooking technology, and behavioral factors. Therefore, we recommend a transition in household ventilation, cooking technologies as well as in child handling and in the peculiar local extra indoor burning practices.

Co-design of an oral health promotion animated film with families in the South of England.

Introduction Oral health promotion interventions should be evidence-based and designed with community involvement. In England, Family Hubs are attended by families from a range of social backgrounds and provide an ideal setting for co-design of health interventions.Aim To co-design and evaluate an animated film for promoting oral health in community settings.Methods Families attended two co-design workshops at a Family Hub in Portsmouth, during which they discussed oral health priorities and commented on the animation design. A before-and-after survey questionnaire assessed its impact on oral health knowledge in another Family Hub in Portsmouth. Qualitative data were analysed using the Framework method, while the survey data were analysed descriptively.Results Families prioritised evidence-based advice for inclusion in the film and contributed to the film storyline. This enabled relevant alterations to ensure the animation was engaging and age-appropriate. Although the survey response rate was low for inferential statistics, descriptive analysis indicated variation in the oral health knowledge of parents and carers.Conclusion Families can offer valuable contributions to the design of health promotion interventions. A co-design method provides an approach for communicating health advice in a form that is relevant and applicable to target audiences.

Deprivation, demography and missed scheduled appointments at an NHS primary dental care and training service.

Background Patients often do not attend planned routine dental appointments. This leads to unmet dental needs, under-utilisation of dental services, lost revenue for dental practice owners and lost educational opportunities when this occurs in centres of training. The aim of this project was to use electronic dental health records to investigate the factors associated with failing to attend dental appointments in an NHS primary dental care service provided free at the point of delivery.Method Electronic patient data over a one-year period were extracted. Data included: patients' age, sex, deprivation status and whether they missed at least one appointment. Deprivation status was derived from patients' postcodes converted to the indices of multiple deprivation quintiles (IMD). Data were analysed descriptively and analytically. Chi square tests were used to identify statistically significant associations (p <0.05) between patient characteristics and a record of a missed dental appointment. Logistic regression was used to model the patient-related factors which predict failure to attend scheduled appointments while controlling for confounding factors.Results A total of 3,678 patients aged between 2 and 98 years had at least one appointment offered within the 12-month period studied. Of these, 627 (17%) had at least one instance of 'Did Not Attend' ('DNA') on record. The age group with the highest proportion of patients with a 'DNA' were the 6-12 year olds (23.6%), and the lowest proportion were the >75 years olds (10.4%). A higher proportion of patients had a 'DNA' in the two most deprived quintiles (IMD Quintile 1-32.4% and IMD Quintile 2-33.3%), when compared with the least deprived quintile (IMD Quintile 5-6.5%). Logistic regression showed that males were 20% more likely to have a 'DNA' than females, the most deprived were twice more likely to have a 'DNA' than least deprived (p <0.05) and younger patients were more likely to not have a 'DNA' on record.Conclusion Routinely collected electronic primary dental care records from individual patients who were representative of the full spectrum of age and social status, when analysed, revealed patterns that predicted missed appointments. These patterns were independently associated with patients' age, deprivation and sex. Understanding these patterns can influence how poor dental access is addressed, the effective delivery of comprehensive care, child safeguarding, patient outcomes and primary dental care practice financing.

Electronic primary dental care records in research: A case study of validation and quality assurance strategies.

BACKGROUND: In dentistry, the use of electronic patient records for research is underexplored. The aim of this paper is to describe a case study process of obtaining research data (sociodemographic, clinical and workforce) from electronic primary care dental records, and outlining data cleaning and validation strategies. This study was undertaken at the University of Portsmouth Dental Academy (UPDA), which is a centre of education, training and provision of state funded services (National Health Services). UPDA's electronic patient management system is R4/Clinical +. This is a widely used system in general dental practices in the UK. METHOD: A two-phase process, involving first Pilot and second Main data extraction were undertaken. Using System Query Language (SQL), data extracts containing variables related to patients' demography, socio-economic status and dental care received were generated. A data cleaning and validation exercise followed, using a combination of techniques including Maletic and Marcus's (2000) general framework for data cleaning and Rahm and Haido's (2010) principles of data cleaning. RESULTS: The findings of the case study support the use of a two-phase data extraction process. The data validation processes highlighted the need for both manual and analytical strategies when cleaning these data. Finally, the process demonstrated that electronic dental records can be validated and used for epidemiological and heath service research. The potential to generalise findings is great due to the large number of records. There are, however, limitations to the data which need to be considered, relating to quality (data input), database structure and interpretation of data codes. CONCLUSION: Electronic dental records are useful in health service research, epidemiological studies and skill mix research. Researchers should work closely with clinicians, managers and software developers to ensure that the data generated are accurate, valid and generalisable. Following data extraction the researchers need to adapt stringent validation and data cleaning strategies to guarantee that the extracted electronic data are accurate.

Promoting access to dental care in South London: adult patients' perspectives.

OBJECTIVE: To evaluate patients' views on health service initiatives established to improve uptake of NHS primary dental care amongst adult patients in a socially deprived area, comparing practices with extended and regular contract capacity. STUDY DESIGN: Service evaluation and cross-sectional survey. METHOD: Questionnaire survey of patients attending a random sample of dental practices in three inner-metropolitan boroughs of south London following initiatives to improve access to dental care (across dental practices delivering regular and extended contracts for services) exploring attendance patterns and the influence and awareness of local initiatives to promote access. RESULTS: Four hundred fifty adults across 12 dental practices completed questionnaires: 79% reported attending for routine and 21% for urgent care. Patients were most aware of banners outside practices, followed by dental advertisements in newspapers. Vouchers for free treatments were considered of the highest possible influence, followed by vouchers for reduced treatment costs and an emergency out-of-hours helpline. Awareness and influence were not aligned, and there was no evidence of difference by practice contract type whilst there were differences by age and type of attendance. CONCLUSION: The findings suggest that financial incentives and emergency services are considered the most influential initiatives for adult patients whose attendance patterns appear to be related to personal circumstances rather than merely being influenced by the provision of information.

Dental Treatment in a State-Funded Primary Dental Care Facility: Contextual and Individual Predictors of Treatment Need?

OBJECTIVE: This study examined individual and contextual factors which predict the dental care received by patients in a state-funded primary dental care training facility in England. METHODS: Routine clinical and demographic data were extracted from a live dental patient management system in a state-funded facility using novel methods. The data, spanning a four-year period [2008-2012] were cleaned, validated, linked by means of postcode to deprivation status, and analysed to identify factors which predict dental treatment need. The predictive relationship between patients' individual characteristics (demography, smoking, payment status) and contextual experience (deprivation based on area of residence), with common dental treatments received was examined using unadjusted analysis and adjusted logistic regression. Additionally, multilevel modelling was used to establish the isolated influence of area of residence on treatments. RESULTS: Data on 6,351 dental patients extracted comprised of 147,417 treatment procedures delivered across 10,371 courses of care. Individual level factors associated with the treatments were age, sex, payment exemption and smoking status and deprivation associated with area of residence was a contextual predictor of treatment. More than 50% of children (<18 years) and older adults (≥65 years) received preventive care in the form of 'instruction and advice', compared with 46% of working age adults (18-64 years); p = 0.001. The odds of receiving treatment increased with each increasing year of age amongst adults (p = 0.001): 'partial dentures' (7%); 'scale and polish' (3.7%); 'tooth extraction' (3%; p = 0.001), and 'instruction and advice' (3%; p = 0.001). Smokers had a higher likelihood of receiving all treatments; and were notably over four times more likely to receive 'instruction and advice' than non-smokers (OR 4.124; 95% CI: 3.088-5.508; p = 0.01). A further new finding from the multilevel models was a significant difference in treatment related to area of residence; adults from the most deprived quintile were more likely to receive 'tooth extraction' when compared with least deprived, and less likely to receive preventive 'instruction and advice' (p = 0.01). CONCLUSION: This is the first study to model patient management data from a state-funded dental service and show that individual and contextual factors predict common treatments received. Implications of this research include the importance of making provision for our aging population and ensuring that preventative care is available to all. Further research is required to explain the interaction of organisational and system policies, practitioner and patient perspectives on care and, thus, inform effective commissioning and provision of dental services.

Conscious sedation: is this provision equitable? Analysis of sedation services provided within primary dental care in England, 2012-2014.

AIM: Patients receiving primary dental care may occasionally require conscious sedation as an adjunct to care. It is one of a range of options to support anxious patients or those undergoing difficult procedures. The aim of this study was to examine patterns of conscious sedation within primary dental care in relation to patient demography, deprivation status, geography (local authority, region) and type of care (Band) within England to examine equity in distribution of service provision. MATERIALS AND METHODS: Descriptive analysis of cross-sectional primary dental care data, obtained from national claims held by the National Health Service (NHS) Business Services Authority, on patients who had received one or more courses of care involving sedation. RESULTS: Just under 137,000 episodes of care involving sedation are provided for over 120,000 patients per year, the majority of which are for adults. Four out of ten (41%) patients were children, with 6-12-year-olds forming the largest group; 6% were aged under six years. Eleven per cent of patients had more than one course of care involving sedation, with adults aged 25-34 years having the highest rate: 1.17 (s.d.: 0.887) in 2012/2013 and 1.16 (s.d.: 0.724) in 2013/2014. There was a clear social gradient, whereby the most deprived quintile had the highest volume of patients that had received sedation at least once in primary dental care in both years (31.5%). Whilst there was a clear social gradient amongst children and young adults who received sedation, the gradient flattened among middle-aged and was flat amongst older adults. The majority of courses of care involving sedation were associated with Band 2 claims for care (88.6% in 2012/2013; 88.8 in 2013/2014). Whilst one or more patients in all higher tier local authorities received care involving sedation, there were marked geographic inequalities. DISCUSSION: Patients receive sedation in support of NHS primary dental care across the life course and social spectrum. Whilst the pattern of uptake of care parallels the social gradient in younger age groups overall, there are clear geographical inequalities in provision. As sedation is only one of a series of adjuncts to care which may be provided across different sectors of the health system, a wider systems analysis should be undertaken as the findings raise important issues about equitable access to appropriate care. Furthermore, there should be a greater emphasis on prevention to reduce the need for care. The implications for child oral health, access and quality are discussed.

Alternative scenarios: harnessing mid-level providers and evidence-based practice in primary dental care in England through operational research.

BACKGROUND: In primary care dentistry, strategies to reconfigure the traditional boundaries of various dental professional groups by task sharing and role substitution have been encouraged in order to meet changing oral health needs. AIM: The aim of this research was to investigate the potential for skill mix use in primary dental care in England based on the undergraduate training experience in a primary care team training centre for dentists and mid-level dental providers. METHODS: An operational research model and four alternative scenarios to test the potential for skill mix use in primary care in England were developed, informed by the model of care at a primary dental care training centre in the south of England, professional policy including scope of practice and contemporary evidence-based preventative practice. The model was developed in Excel and drew on published national timings and salary costs. The scenarios included the following: "No Skill Mix", "Minimal Direct Access", "More Prevention" and "Maximum Delegation". The scenario outputs comprised clinical time, workforce numbers and salary costs required for state-funded primary dental care in England. RESULTS: The operational research model suggested that 73% of clinical time in England's state-funded primary dental care in 2011/12 was spent on tasks that may be delegated to dental care professionals (DCPs), and 45- to 54-year-old patients received the most clinical time overall. Using estimated National Health Service (NHS) clinical working patterns, the model suggested alternative NHS workforce numbers and salary costs to meet the dental demand based on each developed scenario. For scenario 1:"No Skill Mix", the dentist-only scenario, 81% of the dentists currently registered in England would be required to participate. In scenario 2: "Minimal Direct Access", where 70% of examinations were delegated and the primary care training centre delegation patterns for other treatments were practised, 40% of registered dentists and eight times the number of dental therapists currently registered would be required; this would save 38% of current salary costs cf. "No Skill Mix". Scenario 3: "More Prevention", that is, the current model with no direct access and increasing fluoride varnish from 13.1% to 50% and maintaining the same model of delegation as scenario 2 for other care, would require 57% of registered dentists and 4.7 times the number of dental therapists. It would achieve a 1% salary cost saving cf. "No Skill Mix". Scenario 4 "Maximum Delegation" where all care within dental therapists' jurisdiction is delegated at 100%, together with 50% of restorations and radiographs, suggested that only 30% of registered dentists would be required and 10 times the number of dental therapists registered; this scenario would achieve a 52% salary cost saving cf. "No Skill Mix". CONCLUSION: Alternative scenarios based on wider expressed treatment need in national primary dental care in England, changing regulations on the scope of practice and increased evidence-based preventive practice suggest that the majority of care in primary dental practice may be delegated to dental therapists, and there is potential time and salary cost saving if the majority of diagnostic tasks and prevention are delegated. However, this would require an increase in trained DCPs, including role enhancement, as part of rebalancing the dental workforce.

Dental skill mix: a cross-sectional analysis of delegation practices between dental and dental hygiene-therapy students involved in team training in the South of England.

BACKGROUND: Research suggests that health professionals who have trained together have a better understanding of one another's scope of practice and are thus equipped for teamwork during their professional careers. Dental hygiene-therapists (DHTs) are mid-level providers that can deliver routine care working alongside dentists. This study examines patterns of delegation (selected tasks and patients) by dental students to DHT students training together in an integrated team. METHODS: A retrospective sample of patient data (n = 2,063) was extracted from a patient management system showing the treatment activities of two student cohorts (dental and DHT) involved in team training in a primary care setting in the South of England over two academic years. The data extracted included key procedures delegated by dental students to DHT students coded by skill-mix of operator (e.g., fissure sealants, restorations, paediatric extractions) and patient demography. χ2 tests were conducted to investigate the relationship between delegation and patient age group, gender, smoking status, payment-exemption status, and social deprivation. RESULTS: A total of 2,063 patients managed during this period received treatments that could be undertaken by either student type; in total, they received 14,996 treatment procedures. The treatments most commonly delegated were fissure sealants (90%) and restorations (51%); whilst the least delegated were paediatric extractions (2%). Over half of these patients (55%) had at least one instance of delegation from a dental to a DHT student. Associations were found between delegation and patient age group and smoking status (P <0.001). Children under 18 years old had a higher level of delegation (86%) compared with adults of working age (50%) and patients aged 65 years and over (56%). A higher proportion of smokers had been delegated compared with non-smokers (45% cf. 26%; P <0.001). CONCLUSIONS: The findings suggest that delegation of care to DHT students training as a team with dental students, involved significantly greater experience in treating children and adult smokers, and providing preventive rather than invasive care in this integrated educational and primary care setting. The implications for their contribution to dentistry and the dental team are discussed, along with recommendations for primary care data recording.

Using the verona coding definitions of emotional sequences (VR-CoDES) and health provider responses (VR-CoDES-P) in the dental context.

OBJECTIVE: To show if cues, concerns and provider responses (defined in VR-CoDES and VR-CoDES-P manuals) are present, can be reliably coded and require additional advice for adoption in a dental context. METHODS: Thirteen patients in a dental practice setting were videoed with either their dentist or hygienist and dental nurse present in routine treatment sessions. All utterances were coded using the Verona systems: VR-CoDES and the VR-CoDES-P. Rates of cue, concerns and provider responses described and reliability tested. RESULTS: The VR-CoDES and VR-CoDES-P were successfully applied in the dental context. The intra-rater ICCs for the detection of cues and concerns and provider response were acceptable and above 0.75. A similar satisfactory result was found for the inter-rater reliability. CONCLUSION: The VR-CoDES and the VR-CoDES-P are applicable in the dental setting with minor supporting guidelines and show evidence of reliable coding. PRACTICE IMPLICATIONS: The VR-CoDES and the VR-CoDES-P may be helpful tools for analysing patient cues and concerns and the dental professionals' responses in the dental context.

A systematic review and meta-analysis of face-to-face communication of tailored health messages: implications for practice.

OBJECTIVE: To conduct a systematic review of the effect of face-to-face delivered tailored health messages on patient behavior and applications for practice. DESIGN: A systematic literature review and meta-analysis. METHODS: Systematic searches of a number of electronic databases were conducted and criteria for selection of studies were specified. RESULTS: 6 experimental studies published between 2003 and 2009 were included. The studies were all randomized controlled trials to evaluate the effectiveness of a face-to-face tailored messaging intervention. There were variation in their research design and methods used to randomize. All participants were aged at least 18 years. All of the studies reported positive changes in participants' health behavior with varying degrees of effect size and duration. A meta-analysis of the available data also confirmed an overall positive effect of tailored messaging on participants' health behaviors. CONCLUSION: The systematic review and the meta-analysis demonstrate a significant and positive effective of face-to-face tailored messaging upon participants' health behaviors. PRACTICE IMPLICATIONS: Health practitioners should be encouraged to allot time in their work routines to discover their patients' psycho-social characteristics and felt needs in order that they can provide a tailored health message to enable the patient to adopt health-promoting regimes into their lifestyle.