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.

Planning the Future Oral Health Workforce: A Rapid Review of Supply, Demand and Need Models, Data Sources and Skill Mix Considerations.

Over the last decade, there has been a renewed interest in oral health workforce planning. The purpose of this review is to examine oral health workforce planning models on supply, demand and needs, mainly in respect to their data sources, modelling technique and use of skill mix. A limited search was carried out on PubMed and Web of Science for published scientific articles on oral health workforce planning models between 2010 to 2020. No restrictions were placed on the type of modelling philosophy, and all studies including supply, demand or needs based models were included. Rapid review methods guided the review process. Twenty-three studies from 15 countries were included in the review. A majority were from high-income countries (n = 17). Dentists were the sole oral health workforce group modelled in 13 studies; only five studies included skill mix (allied dental personnel) considerations. The most common application of modelling was a workforce to population ratio or a needs-based demand weighted variant. Nearly all studies presented weaknesses in modelling process due to the limitations in data sources and/or non-availability of the necessary data to inform oral health workforce planning. Skill mix considerations in planning models were also limited to horizontal integration within oral health professionals. Planning for the future oral health workforce is heavily reliant on quality data being available for supply, demand and needs models. Integrated methodologies that expand skill mix considerations and account for uncertainty are essential for future planning exercises.

Timings and skill mix in primary dental care: a pilot study.

Aim The aim of this pilot study was to explore the time taken to complete key contemporary dental procedures by dentists and dental hygienists/therapists (DH/DTs) working in primary dental care and their views on the factors that influence the length of time taken to complete individual dental procedures.Materials and methods An exploratory mixed methods study of linear design, involving a questionnaire survey followed by focus group discussions exploring time required to complete dental procedures and influences, was conducted using a purposive sample of dental professionals working in primary dental care within the south east of England. Descriptive analysis of absolute timings was performed, together with thematic analysis of their reported influences.Results Twenty-nine dental professionals completed the questionnaire survey, 11 of whom participated in subsequent focus group discussions to explore the initial findings. While dentists reported higher average times and a wider range for clinical examination and treatment planning, DH/DTs reported spending longer on prevention. Average timings for restorations and extractions were similar across both professional groups. Perceived influences on the length of time required to complete dental procedures were patient complexity, system of care, type of remuneration system and philosophy of care emphasising quality, together with practice environment, including the level of nursing support and surgery-location within the building; individual clinician factors relating to the type of dental professional, their interests and expertise were also identified. Whilst there was general agreement amongst respondents over the range of influencing factors, DH/DTs reported being particularly affected by the current type of remuneration system and level of support within practice.Conclusions Within the limits of a pilot study, this research suggests patterns in timings of the delivery of primary dental care procedures and identifies multiple diverse influences. Further research at national level is required to develop a deeper understanding of the time taken to deliver primary dental care and the impact of various influences to confirm the findings and inform human resource considerations in addressing population oral health needs.