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.

Service evaluation of the paediatric dental general anaesthesia service in NHS Lothian.

Objective To gain insight into the reasons for children undergoing dental treatment under general anaesthesia in NHS Lothian.Methods This service evaluation was based on a representative sample size of 294 patients, randomly selected from the 1,236 children seen for dental general anaesthesia (DGA) during 2017 in NHS Lothian. Data on patient and treatment descriptors were collected retrospectively from clinical records and analysed to identify significant correlations.Results The data indicated paediatric DGAs were mostly provided due to dental caries (88%, 260/294) and for children from the most deprived areas of Lothian. Most children were referred because they were of a very young age or had needs which precluded treatment under local anaesthesia (LA). Almost every child had teeth extracted under DGA (99%, 290/294) and a third of children received restorations (33%, 96/294).Discussion and conclusion This study highlighted the disproportionate increased risk of dental caries and DGA in children from more deprived backgrounds, despite a nationwide reduction of children with caries experience. There is a need for more holistic, whole-system approaches to reduce child dental caries, with opportunities for collaborative work with local stakeholders to follow-up children who have had DGA. More research is needed locally and nationally to inform the translation of evidence into effective interventions.

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.

Home visits for dietary advice reduce caries.

DESIGN: This was a randomised field trial using block randomisation. INTERVENTION: A control group received routine assistance from their paediatricians in the health service, with research assessment usually within 1 month of the child's 6- and 12-month anniversary, then dietary advice by a fieldworker after the 12-month research assessment. The intervention group received home visits to advise the mother about healthy breastfeeding and weaning within 10 days of the child's birth, then monthly up to 6 months, then at 8, 10 and 12 months. This group also received the 6-month and 12-month research assessment and routine assistance from their paediatricians. OUTCOME MEASURE: Outcome measures were early childhood caries (ECC), defined as one or more caries surface of a tooth, duration of breastfeeding and dietary behaviours. RESULTS: Of the intervention group, 10.2% (16 out of 157) babies had caries compared with 18.3% (40 out of 219) babies in the control group. The odds of dental caries was 48% lower for the intervention group than for the controls (odds ratio, 0.52; 95% confidence interval, 0.27-0.97), after adjustment for the confounding effect of number of teeth. The intervention group had a longer mean duration of exclusive breastfeeding (X(2) P 0.000), later introduction of sugar (X(2) P 0.005) and a lower probability of their baby ever having eaten honey (X(2) P 0.003), chocolate or sweets (X(2) P 0.001), soft drinks (X(2) P 0.020), biscuits (X(2) P 0.000) and fromage frais cheese (X(2) P 0.001). CONCLUSIONS: Home visits for dietary advice appear to help reduce dental caries in infants. Greater efforts are needed to tackle cariogenic dietary behaviours, however, and further studies are required to examine any longer-term effect.

Reported barriers to eating more fruit and vegetables before and after participation in a randomized controlled trial: a qualitative study.

This qualitative study compares the barriers to eating more fruit and vegetables reported before and after participation in a 6-month randomized controlled trial in primary care. At the initial intervention appointment of a primary care intervention to promote eating five or more portions of fruit and vegetables a day, participants were asked to identify the barriers that they thought they might encounter. Barriers were discussed again at the final appointment 6 months later. At the end of the study, a purposive sample of 40 of the trial participants was interviewed to explore their experiences in greater detail. Transcripts of tape recordings of the intervention appointments and the semi-structured interview were analysed using qualitative methods. This paper presents the results of a qualitative analysis of these appointment and interview transcripts (results of the trial are published elsewhere). Women reported that children and male partners were obstructive to their attempts to eat more fruit and vegetables, whilst men reported that their partners were supportive of the change. The perception that fruit and vegetables were expensive was a relatively intractable barrier for those with inflexible food budgets. Some barriers, including the problem of getting fruit and vegetables when travelling or when the daily routine is disrupted such as at weekends, were not anticipated and only encountered when participants tried to make changes. However, while all but three of the interview respondents described experiencing at least one barrier to eating more fruit and vegetables, three quarters (29 of 40) reported an increase in intake of between one and five daily portions. This study adds to the existing literature in that it investigates those barriers that were reported at the end of, as well as before, a 6-month trial of a dietary intervention. The findings show that trial participants were not always able to anticipate what might be a barrier to change at the initial intervention appointment. The flexible action plan meant that if participants found their initial plan hard to maintain, they were able to adapt it rather than give up. This suggests that health behaviour interventions that are negotiated and non-prescriptive may be more successful than those that are relatively inflexible.

Do referrals from primary dental care for treatment using general anaesthesia comply with General Dental Council guidelines?

OBJECTIVES: To investigate the quality of information in referrals for patients aged under 16 years referred for dental extraction under general anaesthesia (GA), to ascertain the knowledge and expectations of the parents of these patients, and to determine whether the number of teeth extracted in secondary care coincides with that of the referring dentist. DESIGN: Retrospective study of referrals of all patients aged under 16 years referred to community dental clinics in Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire over a 26-day period. RESULTS: The majority (62.2%) of the 251 referrals examined were for extractions under GA. Of these, 125 were by letter and 117 using a pro forma. Significantly more pro formas (33) than letters (8) contained a full medical history (P < 0.001). A treatment plan was included in significantly more pro formas (76) than letters (49) (P < 0.01). Few referrals contained a note about the discussion of alternatives to a GA procedure and only 37% (58/156) of parents reported that the referring general dental practitioner had discussed alternative treatments with them. A total of 551 primary teeth were indicated for removal but 846 teeth were eventually removed. CONCLUSIONS: Our findings indicate a need for parents of patients referred for GA procedures to be better informed about alternatives. Improvement in the quality of referrals, perhaps with the aid of standard pro formas, would also facilitate more effective management of referred patients.

Evaluation of a pilot hands-on course in surgical dentistry for primary care dental practitioners in Oxfordshire.

OBJECTIVES: To evaluate the impact of a course in surgical dentistry on the confidence of 32 general dental practitioners, each of whom attended a one-day hands-on course. DESIGN: Questionnaire survey. SETTING: General dental practitioners attending a course on surgical dentistry, which was run over a day, for eight participants per day. RESULTS: The course was rated highly by participants. The hands-on component was particularly well received. Confidence scores increased for several surgical procedures, particularly for removal of impacted teeth and for apicectomies of single-rooted teeth. There were concomitant decreases in the proportion of participants who said that they would refer patients requiring these surgical procedures. Confidence scores remained low for complex procedures such as molar apicectomies. However, it would be appropriate to refer these cases for specialist care. CONCLUSIONS: The results of this pilot study indicated that a course in surgical dentistry was successful in increasing the confidence of a small group of general dental practitioners. More research is needed to determine whether this is the most effective way of helping practitioners maintain and improve skills and confidence in surgical dentistry.