Secondary analysis of child hospital admission data for dental caries in London, UK: what the data tells us about oral health inequalities.

OBJECTIVES: Dental caries is the most common reason for hospital admissions for children aged 6-10 years in England. The prevalence in the experience of hospital admission is not uniform across all populations. This paper reports on the analysis of secondary data on dental hospital episodes for children residing in London, and its association with oral health inequalities. DESIGN, SETTING AND PARTICIPANTS: Retrospective, non-identifiable patient data sourced from the Hospital Episode Statistics dataset was analysed. Finished consultant episodes (FCEs) were extracted for children aged 1-19 years, residing in London and admitted with a primary diagnosis of caries between 2015/2016 and 2020/2021. OUTCOME MEASURES: The number and rates of FCEs with a primary diagnosis of dental caries for children aged 1-19 years old was analysed for six consecutive financial years (2015/2016 to 2020/2021). To assess oral health inequalities in children experiencing hospital admission due to dental caries, several demographic variables were analysed: deprivation, age, and sex. RESULTS: Between the financial years of 2015-2016 and 2020-2021, there were a total of 57 055 hospital admissions for dental caries for children aged 1-19 years (average rate of admission was 465.1 per 100 000 of children). A year-on-year decline was noted between 2015-2016 and 2020-2021. Regression analysis demonstrated clear social gradients with significant oral health inequalities; those from the most deprived areas experienced over two times the number of hospital admissions (58%). Children aged 4-9 years accounted for 68.9% (39 325) for the total dental hospital episodes from 2015-2016 to 2020-2021. CONCLUSION: London's year-on-year reduction in hospital admission for dental caries is due to various factors including effective prevention interventions and an effective paediatric clinical care pathway. Sociodemographic factors remain to act as key predictors for hospital admission for child with dental caries. While health service level changes may reduce the number of hospital admissions, persistent child oral health inequalities continue to exist.

Oral health of people experiencing homelessness in London: a mixed methods study.

BACKGROUND: Those experiencing homelessness have significant health and oral health needs and are at the extreme of health inequalities. The aim of the study was to conduct an oral health needs assessment for those experiencing homeless in London and impacts on their oral health-related quality of life. METHODS: The oral health needs assessment consisted of quantitative and qualitative methods. This included a survey questionnaire to assess perceived oral health needs, and oral health related quality of life. In addition, a focus group was conducted with 13 peer advocates. RESULTS: Findings from the focus group revealed numerous challenges for homeless populations to maintain good oral health and access to dental care including mental ill-health, stigma, costs, and chaotic lifestyles. A response rate of 79% (n = 315) was achieved for the questionnaire survey. Results showed high levels of unmet dental needs and risky health behaviours including 60% reporting being smokers, 39% consuming high amounts of sugar and 52.4% brushing their teeth less than twice a day. More than a third (32.1%) had experienced toothache. The majority of respondents 80% (n = 224) were very or fairly concerned about their dental health. There were significant associations between perceived oral health status and oral health-related quality of life. CONCLUSION: Those experiencing homelessness in London were found to have high levels of unmet oral health needs, which significantly impacted on their oral health-related quality of life. Focusing on changing behaviours alone is insufficient and therefore addressing the structural determinants of homelessness is vital in improving oral and health outcomes of this vulnerable population.

Validation and minimally important difference of the Child-OIDP in a socioeconomically diverse sample of Indian adolescents.

INTRODUCTION: While different measures have been validated and used to assess the oral health related quality of life (OHRQoL) of children and adolescents, no previous study has tested the psychometric performance of OHRQoL amongst the most marginalized adolescents, living in extremely deprived neighbourhoods like urban slums and resettlement areas in modern cities. Our study assessed the internal consistency reliability, construct validity and Minimally Important Difference (MID) of the Child-OIDP in a sample of adolescents aged 12-15 years reporting oral health problems that lived in three different types (including two extremely vulnerable) of neighbourhoods (urban slums, resettlement colonies, and middle and upper middle-class neighbourhoods) in the National Capital Territory of Delhi. METHODS: We conducted data analysis on a cross-sectional study, comprising of 840 adolescents. The Child-OIDP was used as a measure of OHRQoL. Internal consistency reliability was tested using the standardized Cronbach's Alpha Coefficient. The Child-OIDP was also tested for content and construct validity (the latter through the median test), while a distribution-based approach was used to identify the MID. RESULTS: The Indian Child-OIDP showed good internal consistency, as the Cronbach's alpha coefficient was 0.77. Inter-item correlation coefficients among the items ranged from 0.13 to 0.50, with the mean inter-item correlation being 0.30. The corrected item-total correlations ranged from 0.30 (social contact) to 0.54 (speaking). For construct validity, the Child-OIDP extent was significantly associated with three subjective oral and general health variables in the expected direction. The calculated effect sizes for these differences indicated that they were moderate (0.50-0.79). We also calculated the standard error of measurement (SEM) of Child-OIDP extent as 0.75. CONCLUSION: This study demonstrated that the Indian Child-OIDP is a reliable and valid measure for the assessment of the oral health related quality of life among Indian adolescents especially from marginalised and socioeconomically vulnerable groups. This is an essential step towards assessing oral health and evaluating oral health promotion interventions in those populations and settings.

Brief Motivational Interviewing in Dental Practice.

Motivational Interviewing has been demonstrated to be effective for a wide range of health behaviors. It is an effective behavior change method, which can be utilized in the dental practice setting. It can be used as a brief intervention to increase motivation to improve patients' oral hygiene behaviors as well as providing a framework for delivering diet, smoking cessation, oral health changes, and alcohol advice. It involves four processes: engaging, focusing, evoking, and planning, guiding, which supports the patient towards a positive behavior change. Motivational Interviewing is a collaborative, patient-centered approach evoking the patient's own motivation to change, thereby enhancing the relationship between the clinician and patient and improving patient outcomes. This review will provide an overview on the topic for dental professionals as well as helpful suggestions for supporting a positive behavior change in their dental practices.

Predictors of dentists' behaviours in delivering prevention in primary dental care in England: using the theory of planned behaviour.

BACKGROUND: To explore the factors predicting preventive behaviours among NHS dentists in Camden, Islington and Haringey in London, using constructs from the Theory of Planned Behaviour. METHODS: A cross-sectional survey of NHS dentists working in North Central London was conducted. A self-completed questionnaire based on the theoretical framework of the Theory of Planned Behaviour was developed. It assessed dentists' attitudes, current preventive activities, subjective norms and perceived behavioural control in delivering preventive care. In model 1, logistic regression was conducted to assess the relationship between a range of preventive behaviours (diet, smoking and alcohol) and the three TPB constructs attitude, subjective norms and perceived behavioural control. Model 2 was adjusted for intention. RESULTS: Overall, 164 questionnaires were returned (response rate: 55.0%). Dentists' attitudes were important predictors of preventive behaviours among a sample of dentists in relation to asking and providing diet, alcohol and tobacco advice. A dentist was 3.73 times (95 % CI: 1.70, 8.18) more likely ask about a patient's diet, if they had a positive attitude towards prevention, when adjusted for age, sex and intention. A similar pattern emerged for alcohol advice (OR 2.35, 95 % CI 1.12, 4.96). Dentists who had a positive attitude were also 2.59 times more likely to provide smoking cessation advice. CONCLUSIONS: The findings of this study have demonstrated that dentists' attitudes are important predictors of preventive behaviours in relation to delivery of diet, smoking and alcohol advice.

Toothbrushing may reduce ventilator-associated pneumonia.

DATA SOURCES: The databases Embase, Medline, CINAHL, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, clinical trials.gov and controlled-trials.com were searched. Reference lists of reviewed articles and eligible trials were also searched, and toothpaste and toothbrush manufactures were contacted. STUDY SELECTION: Randomised controlled trials in adults over 18 years receiving mechanical ventilation were included where any kind of oral care involving toothbrushing was compared with any other kind of oral care or control with or without toothbrushing. DATA EXTRACTION AND SYNTHESIS: Data were extracted in duplicate and quality assessed using the Cochrane risk of bias tool. The results were combined using a random effects model. The main outcome was VAP. RESULTS: Six trials involving a total of 1408 patients were included. The risk of bias was high in four trials, low in one and unclear in the other. In four trials, there was a trend toward lower ventilator-associated pneumonia rates (risk ratio, 0.77; 95% confidence interval, 0.50-1.21; p = 0.26). The only trial with low risk of bias suggested that toothbrushing significantly reduced ventilator-associated pneumonia (risk ratio, 0.26; 95% confidence interval, 0.10-0.67; p = 0.006). Use of chlorhexidine antisepsis seems to attenuate the effect of toothbrushing on ventilator-associated pneumonia (p for the interaction = 0.02). One trial comparing electric vs. manual toothbrushing showed no difference in ventilator-associated pneumonia rates (risk ratio, 0.96; 95% confidence interval, 0.47-1.96; p = 0.91). Toothbrushing did not impact on length of ICU stay, or ICU or hospital mortality. CONCLUSIONS: In summary, randomised trials to date show that toothbrushing is associated with a trend toward lower rates of VAP in intubated, mechanically ventilated critically ill patients. There is no clear difference between electric and manual toothbrushing. Toothbrushing has no effect on ICU mortality, hospital mortality, or ICU length of stay.

Considerations and lessons learned from designing a motivational interviewing obesity intervention for young people attending dental practices: a study protocol paper.

BACKGROUND: With the prevalence of child obesity increasing worldwide, and the consumption of sugar-sweetened beverages identified as a major contributor to obesity in adolescents, there is a need for effective interventions aimed at dietary behaviour change in this group. Primary dental care settings are in an ideal position to influence adolescents' dietary behaviours, yet have been under-utilised for this purpose. Motivational Interviewing (MI) has shown promise in influencing other health behaviours. However, there is lack of published methodologies on which to base the design of such interventions, and limited evidence on its effectiveness in influencing dietary change. We undertook a study to test the feasibility of a MI intervention aimed at reducing soft drink consumption in adolescents attending dental surgeries. We present the study design for the development and evaluation of the intervention. METHOD: Ten dental practices in north London were randomised into control or intervention. Adolescent participants in control settings received routine advice and intervention participants received a brief MI intervention. The intervention was designed using comprehensive stakeholder engagement and consisted of 3-4 short MI sessions and a maintenance phase delivered by trained researchers through the use of age-specific resources. Process evaluation was carried out using qualitative and quantitative methods to assess intervention feasibility in a primary dental care setting. DISCUSSION: By focussing on the development and evaluation of the intervention, this paper contributes to the limited available knowledge and identifies methodological considerations for undertaking a MI intervention for dietary change in adolescents in primary dental care settings.

Developing a new self-reported scale of oral health outcomes for 5-year-old children (SOHO-5).

BACKGROUND: Information on the impact of oral health on quality of life of children younger than 8 years is mostly based on parental reports, as methodological and conceptual challenges have hindered the development of relevant validated self-reported measures. This study aimed to develop and assess the reliability and validity of a new self-reported oral health related quality of life measure, the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5), in the UK. METHODS: A cross-sectional study of two phases. First, consultation focus groups (CFGs) with parents of 5-year-olds and review by experts informed the development of the SOHO-5 questionnaire. The second phase assessed its reliability and validity on a sample of grade 1 (5-year-old) primary schoolchildren in the Greater Glasgow and Clyde area, Scotland. Data were linked to available clinical oral health information and analysis involved associations of SOHO-5 with subjective and clinical outcomes. RESULTS: CFGs identified eating, drinking, appearance, sleeping, smiling, and socialising as the key oral impacts at this age. 332 children participated in the main study and for 296 (55% girls, mean d3mft: 1.3) clinical data were available. Overall, 49.0% reported at least one oral impact on their daily life. The most prevalent impacts were difficulty eating (28.7%), difficulty sleeping (18.5%), avoiding smiling due to toothache (14.9%) and avoiding smiling due to appearance (12.5%). The questionnaire was quick to administer, with very good comprehension levels. Cronbach's alpha was 0.74 and item-total correlation coefficients ranged between 0.30 and 0.60, demonstrating the internal consistency of the new measure. For validity, SOHO-5 scores were significantly associated with different subjective oral health outcomes (current toothache, toothache lifetime experience, satisfaction with teeth, presence of oral cavities) and an aggregate measure of clinical and subjective oral health outcomes. The new measure also discriminated between different clinical groups in relation to active caries, pulp involvement, and dental sepsis. CONCLUSIONS: This is the first study to develop and validate a self-reported oral health related quality of life measure for 5-year-old children. Initial reliability and validity findings were very satisfactory. SOHO-5 can be a useful tool in clinical studies and public health programs.

Formation and shear-induced processing of quantum dot colloidal assemblies in a multiphase microfluidic chip.

The controlled self-assembly of polymer-stabilized quantum dots (QDs) into mesoscale aqueous spherical assemblies termed quantum dot compound micelles (QDCMs) using a two-phase gas-segmented microfluidic reactor is described. Self-assembly is initiated by the fast mixing of water (approximately 1 s) with a blend solution of polystyrene-coated QDs and amphiphilic polystyrene-block-poly(acrylic acid) stabilizing chains via chaotic advection within liquid plugs moving through a sinusoidal channel. Subsequent recirculating flow within a post-formation channel subjects the dynamic QDCMs to shear-induced processing, controlled via the flow rate and channel length, before a final quench into pure water. During processing, larger QDCMs within the initial population undergo breakup into smaller particles, resulting in smaller mean particle sizes, smaller relative standard deviations, and more skewed distribution shapes, as the overall shear exposure is increased. For these cases, shear-induced size reduction is sufficient to dominate surface tension-driven growth.

Controlled self-assembly of quantum dots and block copolymers in a microfluidic device.

The controlled self-assembly of polymer-stabilized quantum dots (QDs) into mesoscale aqueous spherical assemblies using microfluidics is described. In a flow-focusing configuration, self-assembly is initiated by the addition of water to a blended solution of polystyrene-coated QDs and amphiphilic polystyrene-block-poly(acrylic acid) stabilizing chains and terminated in a downstream quench step. The on-chip evolution of assemblies is monitored through fluorescence microscopy, and particle size distributions are determined off-chip by transmission electron microscopy. On-chip size control of the assemblies is demonstrated via both the average water concentration in the channel and the flow rate.

A hierarchical self-assembly route to three-dimensional polymer-quantum dot photonic arrays.

We demonstrate a new hierarchical self-assembly strategy for the formation of photonic arrays containing quantum dots (QDs), in which sequential self-assembly steps introduce organization on progressively longer length scales, ranging from the nanoscale to the microscale regimes. The first step in this approach is the self-assembly of diblock copolymers to form block ionomer reverse micelles (SA1); within each micelle core, a single CdS QD is synthesized to yield the hybrid building block BC-QD. Once SA1 is completed, the hydrophobic BD-QD building blocks are blended with amphiphilic block copolymer stabilizing chains in an organic solvent; water addition induces secondary self-assembly (SA2) to form quantum dot compound micelles (QDCMs). Finally, aqueous dispersions of QDCMs are slowly evaporated to induce the formation of three-dimensional (3D) close-packed arrays in a tertiary self-assembly step (SA3). The resulting hierarchical assemblies, consisting of a periodic array of hybrid spheres each containing multiple CdS QDs, exhibit the collective property of a photonic stop band, along with photoluminescence arising from the constituent QDs. A high degree of structural control is possible at each level of organization by judicious selection of experimental variables, allowing various parameters governing the collective optical properties, including QD size, nanoparticle spacing, and mesocale periodicity, to be independently tuned. The resulting control over optical properties via successive self-assembly steps should provide new opportunities for hierarchical materials for QD lasers and all-optical switching.

Size control of mesoscale aqueous assemblies of quantum dots and block copolymers.

Dropwise addition of water to blend solutions of block copolymer-stabilized quantum dots (QDs) and amphiphilic block copolymer stabilizing chains PS(665)-b-PAA(68) (PS = polystyrene, PAA = poly(acrylic acid)) in DMF induces self-assembly to form photoluminescent mesoscale QD/block copolymer colloids in water termed QD compound micelles (QDCMs). Here we demonstrate reproducible kinetic control of QDCM particle size and chain stretching within the external PAA stabilizing layer via changes in the initial polymer concentration and rate of water addition. By increasing the initial polymer concentration or decreasing the rate of water addition for a constant blend composition, larger QDCM particles are obtained. From a combination of transmission electron microscopy and dynamic light scattering, the thickness of the external PAA layer is determined for various QDCM sizes, showing that PAA stretching in the external brush layer increases with increasing particle size, reaching the limit of fully extended chains for sufficiently large particles. The photoluminescence spectra from QDCMs in pure water indicate that photoluminescence properties of the block copolymer-stabilized QD building blocks are retained during self-assembly. The demonstrated control of mesoscale particle size and conformation of the stabilizing PAA layer, among other related structural parameters, via simple variation of experimental conditions is a promising step toward the application of QDCM assemblies in photonics and biolabeling.

Validation of an English version of the Child-OIDP index, an oral health-related quality of life measure for children.

BACKGROUND: To evaluate the psychometric properties of the Child-OIDP for use among children in the UK and report on the prevalence of oral impacts in a sample of schoolchildren in Westminster. METHODS: Children aged 10-11 years in the final year of primary school (year 6) were selected from seven schools where annual screenings are carried out. A total of 228 children participated (99% response rate). A clinical examination was conducted followed by a questionnaire designed to measure oral health-related quality of life in children, namely the Child-OIDP. The psychometric properties of the Child-OIDP were evaluated in terms of face, content and concurrent validity in addition to internal and test-retest reliability. RESULTS: The Child-OIDP revealed excellent validity and good reliability. Weighted Kappa was 0.82. Cronbach's alpha coefficient was 0.58. The index showed significant associations with perceived oral treatment needs and perceived satisfaction with mouth and oral health status (p < 0.001). CONCLUSION: This study has demonstrated that the Child-OIDP is a valid and reliable index to be used among 10-11 year old schoolchildren in the UK.