The views of examiners on the use of intra-oral photographs to detect dental caries in epidemiological studies.

AIM: The aim of the study was to obtain the views of examiners on their experience of using intra-oral photographs as a means of detecting caries in epidemiological studies compared to an established visual examination method. METHOD: A focus group discussion was conducted with five examiners experienced in an established visual examination method after they had performed visual dental examinations of a sample of children as well as assessed intra-oral photographs of the same children. RESULTS: The time taken by examiners to assess intraoral photographs becomes extended when compared to performing a visual examination. The ability to assess intra-oral photographs on a screen at a convenient time and place was considered advantageous. The examiners found it easier to make caries detection decisions on intra-oral photographs of primary teeth than permanent teeth. Adequate removal of debris and moisture control prior to obtaining the photographs were considered important. CONCLUSION: The views of examiners in this study suggest that to improve the utility of photographic method, further research is needed to determine adequate drying methods for use in the field. Consideration should be given to a time-limited, standardised presentation of the photographs including the size and resolution. Specific training on caries detection from photographs is also required.

Children's views on the experience of a visual examination and intra-oral photographs to detect dental caries in epidemiological studies.

AIM: To elicit children's views on the established visual examination method used for the epidemiological surveillance of dental caries and an experimental intra-oral photographic examination method. METHOD: Focus group interviews were conducted with 5-year-olds (with the aid of a puppet) and 10/11-year-olds (without puppet) after experiencing both methods. Ten focus groups were conducted in each cohort. RESULTS: The children's views on the methods related to the acceptability of their experience. The key factors affecting acceptability and preferences related to the combined effects of contextual factors prior to the examination and experiences during the examination. These included communication and children's expectations. These factors influenced the examination experience along with their feelings about the environment and the tactile sensation from instruments in the mouth. Most children preferred the experimental photographic method as a means of caries detection over the traditional visual examination. They also wanted feedback on their oral health and more communication on what was happening during the examination. CONCLUSION Appropriate communication, attention to the examination environment and handling of instruments can enhance the dental examination experience for children in the school setting. The children's preferences indicated that generally, the intra-oral camera was well received as a means of caries detection for epidemiological studies within the school setting. These results may have implications for seeking ethical approval and conducting epidemiological studies on children in the future.

Modelling the impact of process variables in community fluoridated milk schemes on a population of UK schoolchildren.

BACKGROUND: Dental caries is a public health problem. Fluoridated milk (FM) schemes are used as a preventive measure. The impact of process variables in these schemes is not understood. METHODS: Process variable data on the number of days of consumption, attendance, volume consumed, parental consent together with the proportion of children drinking FM at 7- and 11-years old were aggregated from eight schemes in the UK. The impact of process variables was modelled in an 'averaged' scheme (reduced in effectiveness by process variables) and compared with a notional 'ideal' one in which no process variables operate. Parental consent was analysed according to socio-economic groupings. RESULTS: Proportion of days per year FM was consumed: 0.52. Values for process variables were: attendance rate 0.94; proportion of milk consumed 0.91; proportion of children with parental consent at 5 years 0.65; proportion drinking FM at 7 and 11 years respectively 0.54 and 0.27. No clear trends were observed for parental consent across socio-economic groupings. CONCLUSION: Modelling suggests that due to the cumulative impact of process variables, there is cause for concern about the effectiveness of FM schemes as currently managed in the UK as a standalone public health measure for the prevention of caries.

Estimating the potential impact on dental caries in children of fluoridating a UK city.

OBJECTIVE: To estimate the potential reduction in dental caries among 5-6-year-old children in a city in the South West of England after six years of water fluoridation. METHOD: Thirteen out of 35 inner city wards and seven out of 43 outer city wards (sharing the same water supply) having the highest mean dmft of 5-6-year-olds (recorded in a census survey in 2005/6) and/or highest indexes of multiple deprivation (IMD) were the principal focal point. Population demographic data and 5-6-year-old caries prevalence and experience were examined. Mean IMD scores and aggregated, weighted mean values for dmft and caries prevalence were referred to previously published regression analyses of caries levels plotted against IMD for 34 fluoridated (F) and 233 non-fluoridated (NF) health districts in England in order to estimate potential caries reductions. RESULTS: Mean dmft of 5-6-year-olds in the 20 wards with the highest caries levels and/or social deprivation was 2.10 (95% CI 1.87, 2.33) and caries prevalence 49% (95% CI 47%, 52%). In three wards, mean dmft exceeded 2.60. Population of the selected wards was approximately 210,800 with a mean IMD score of 33.70 As a conservative estimate, after six years of fluoridation a caries reduction of > 40% could be expected in 5-6-year-olds for the conurbation overall and for the 20 high caries/high IMD wards, with a gain of 12 percentage points in the absolute proportion caries-free. The overall population of the 78 wards served by the three relevant water treatment works identified was approximately 700,000. CONCLUSIONS: On the basis of current caries levels and population demographics, it appears that a comprehensive fluoridation scheme covering the inner and outer city districts would substantially improve the dental health of the city's children.

Predictive tool for estimating the potential effect of water fluoridation on dental caries.

OBJECTIVE: To provide a tool for public health planners to estimate the potential improvement in dental caries in children that might be expected in a region if its water supply were to be fluoridated. BASIC RESEARCH DESIGN: Recent BASCD (British Association for the Study of Community Dentistry) dental epidemiological data for caries in 5- and 11-year-old children in English primary care trusts in fluoridated and non-fluoridated areas were analysed to estimate absolute and relative improvement in dmft/DMFT and caries-free measures observed in England. Where data were sufficient for testing significance this analysis included the effect of different levels of deprivation. RESULTS: A table of observed improvements was produced, together with an example of how that table can be used as a tool for estimating the expected improvement in caries in any specific region of England. Observed absolute improvements and 95% confidence intervals were: for 5-year-olds reduction in mean dmft 0.56 (0.38, 0.74) for IMD 12, 0.73 (0.60, 0.85) for IMD 20, and 0.94 (0.76, 1.12) for IMD 30, with 12% (9%, 14%) more children free of caries; for 11-year-olds reduction in mean DMFT 0.12 (0.04, 0.20) for IMD 12, 0.19 (0.13, 0.26) for IMD 20, 0.29 (0.18, 0.40) and for IMD 30, with 8% (5%, 11%) more children free from caries. CONCLUSIONS: The BASCD data taken together with a deprivation measure are capable of yielding an age-specific, 'intention to treat' model of water fluoridation that can be used to estimate the potential effect on caries levels of a notional new fluoridation scheme in an English region.