School dental screening programmes for oral health.

BACKGROUND: School dental screening refers to visual inspection of children's oral cavity in a school setting followed by making parents aware of their child's current oral health status and treatment needs. Screening at school intends to identify children at an earlier stage than symptomatic disease presentation, hence prompting preventive and therapeutic oral health care for the children. This review evaluates the effectiveness of school dental screening in improving oral health status. It is an update of the original review, which was first published in December 2017. OBJECTIVES: To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 4 March 2019), the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Register of Studies, to 4 March 2019), MEDLINE Ovid (1946 to 4 March 2019), and Embase Ovid (15 September 2016 to 4 March 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases; however, the search of Embase was restricted to the last six months due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL. SELECTION CRITERIA: We included randomised controlled trials (RCTs) (cluster or parallel) that evaluated school dental screening compared with no intervention or with one type of screening compared with another. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included seven trials (five were cluster-RCTs) with 20,192 children who were 4 to 15 years of age. Trials assessed follow-up periods of three to eight months. Four trials were conducted in the UK, two were based in India and one in the USA. We assessed two trials to be at low risk of bias, two trials to be at high risk of bias and three trials to be at unclear risk of bias.None of the trials had long-term follow-up to ascertain the lasting effects of school dental screening.None of the trials reported the proportion of children with untreated caries or other oral diseases, cost effectiveness or adverse events.Four trials evaluated traditional screening versus no screening. We performed a meta-analysis for the outcome 'dental attendance' and found an inconclusive result with high heterogeneity. The heterogeneity was found to be, in part, due to study design (three cluster-RCTs and one individual-level RCT). Due to the inconsistency, we downgraded the evidence to 'very low certainty' and are unable to draw conclusions about this comparison.Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening and showed a pooled effect estimate of RR 1.07 (95% CI 0.99 to 1.16), suggesting a possible benefit for screening (low-certainty evidence). There was no evidence of a difference when criteria-based screening was compared to traditional screening (RR 1.01, 95% CI 0.94 to 1.08) (very low-certainty evidence).In one trial, a specific (personalised) referral letter was compared to a non-specific one. Results favoured the specific referral letter with an effect estimate of RR 1.39 (95% CI 1.09 to 1.77) for attendance at general dentist services and effect estimate of RR 1.90 (95% CI 1.18 to 3.06) for attendance at specialist orthodontist services (low-certainty evidence).One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation, with an effect estimate of RR 3.08 (95% CI 2.57 to 3.71) (low-certainty evidence).Only one trial reported the proportion of children with treated dental caries. This trial evaluated a post screening referral letter based on the common-sense model of self-regulation (a theoretical framework that explains how people understand and respond to threats to their health), with or without a dental information guide, compared to a standard referral letter. The findings were inconclusive. Due to high risk of bias, indirectness and imprecision, we assessed the evidence as very low certainty. AUTHORS' CONCLUSIONS: The trials included in this review evaluated short-term effects of screening. We found very low-certainty evidence that is insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening, there is no evidence of a difference in dental attendance (very low-certainty evidence).We found low-certainty evidence to conclude that personalised or specific referral letters may improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) may improve dental attendance in comparison to screening alone. For children requiring treatment, we found very-low certainty evidence that was inconclusive regarding whether or not a referral letter based on the 'common-sense model of self-regulation' was better than a standard referral letter.We did not find any trials addressing possible adverse effects of school dental screening or evaluating its effectiveness for improving oral health.

School dental screening programmes for oral health.

BACKGROUND: School dental screening refers to visual inspection of children's oral cavity in a school setting followed by making parents aware of their child's current oral health status and treatment needs. Screening at school intends to identify children at an earlier stage than symptomatic disease presentation, hence prompting preventive and therapeutic oral health care for the children. This review evaluates the effectiveness of school dental screening in improving oral health status. OBJECTIVES: To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 March 2017), the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Register of Studies, to 15 March 2017), MEDLINE Ovid (1946 to 15 March 2017), and Embase Ovid (15 September 2016 to 15 March 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases; however, the search of Embase was restricted to the last six months due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL. SELECTION CRITERIA: We included randomised controlled trials (RCTs) (cluster or parallel) that evaluated school dental screening compared with no intervention or with one type of screening compared with another. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included six trials (four were cluster-RCTs) with 19,498 children who were 4 to 15 years of age. Four trials were conducted in the UK and two were based in India. We assessed two trials to be at low risk of bias, one trial to be at high risk of bias and three trials to be at unclear risk of bias.None of the six trials reported the proportion of children with untreated caries or other oral diseases.Four trials evaluated traditional screening versus no screening. We performed a meta-analysis for the outcome 'dental attendance' and found an inconclusive result with high heterogeneity. The heterogeneity was found it to be, in part, due to study design (three cluster-RCTs and one individual-level RCT). Due to the inconsistency, we downgraded the evidence to 'very low certainty' and are unable to draw conclusions about this comparison.Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening and showed a pooled effect estimate of RR 1.07 (95% CI 0.99 to 1.16), suggesting a possible benefit for screening (low-certainty evidence). There was no evidence of a difference when criteria-based screening was compared to traditional screening (RR 1.01, 95% CI 0.94 to 1.08) (very low-certainty evidence).In one trial, a specific (personalised) referral letter was compared to a non-specific one. Results favoured the specific referral letter with an effect estimate of RR 1.39 (95% CI 1.09 to 1.77) for attendance at general dentist services and effect estimate of RR 1.90 (95% CI 1.18 to 3.06) for attendance at specialist orthodontist services (low-certainty evidence).One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation, with an effect estimate of RR 3.08 (95% CI 2.57 to 3.71) (low-certainty evidence).None of the trials had long-term follow-up to ascertain the lasting effects of school dental screening.None of the trials reported cost-effectiveness and adverse events. AUTHORS' CONCLUSIONS: The trials included in this review evaluated short-term effects of screening, assessing follow-up periods of three to eight months. We found very low certainty evidence that was insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening there was no evidence of a difference in dental attendance (very low-certainty evidence).We found low-certainty evidence to conclude that personalised or specific referral letters improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) improves dental attendance in comparison to screening alone.We did not find any trials addressing cost-effectiveness and adverse effects of school dental screening.

[The Intensified Dental Preventive Programme in Rhineland-Palatinate: Investigations on first-grade school-children in 2013/2014]. / Die zahnärztliche selektive Intensivprophylaxe in Rheinland-Pfalz: Untersuchungen an Erstklässlern im Schuljahr 2013/2014.

Aim: For children and adolescents at increased risk of caries, the "Selective Intensive Prophylaxis" (SIP) programme was established in Rhineland-Palatinate in 2004, as well as in the most other German states. This study compares the results of the school dentists' evaluations of first grade school children in 2013/2014 participating in the "Selective Intensive Prophylaxis" (SIP) programme or the "Standard Programme" (SP). Methods: The d3mft/D3MFT index was recorded by school dentists according to the WHO criteria; caries was diagnosed if dentin was affected; no radiography or fiber-optic transillumination was used. The examinations were performed once under the SP and twice under the SIP. Children and parents were informed in case of a need for treatment and reminded if the did not see the family dentist. Out of the evaluated d3mft/D3MFT values, the Significant Caries Index (SiC) was calculated. Statistical computing was performed using SPSS 22.00. Results: Of all first graders, n=25 020 were evaluable for d3mft/D3MFT. Altogether n=1 164 first graders were included into the SIP in the 2013/2014 term; for n=1 002 of those, the results for both examinations were available. The caries experience of those pupils participating in the SIP was clearly higher than in the SP (41.8% naturally healthy vs. 61.7%, p<0.0001). There was significant difference between the first and second examination in the SIP, especially with respect to individual (16.0 vs. 23.0%, p<0.0001) and tooth-related (43.2 vs. 54.2%, p<0.0001) level of restoration. Conclusion: The results show that the SIP in Rhineland-Palatinate is conducted in a population with high caries experience. The significant difference concerning the dental restoration level, both individual- and teeth-related - leads to the conclusion that children frequently sought dental treatment if a need for treatment was diagnosed by the school dentist.

Identifying and prioritising areas of child dental service need: a GIS-based approach.

AIM: To identify and prioritise areas of high need for dental services among the child population in metropolitan Western Australia. DESIGN: All children hospitalised due to an oral-condition from 2000 to 2009, at metropolitan areas of Perth were included in the analysis of a 10-year data set. QGIS tools mapped the residential location of each child and socioeconomic data in relation to existing services (School Dental Service clinics). RESULTS: The tables and maps provide a clear indication of specific geographical areas, where no services are located, but where high hospital-admission rates are occurring, especially among school-age children. The least-disadvantaged areas and areas of high rates of school-age child hospital-admissions were more likely to be within 2km of the clinics than not. More of high-risk-areas (socio-economically deprived areas combined with high oral-related hospital admissions rates), were found within 2km of the clinics than elsewhere. CONCLUSION: The application of GIS methodology has identified a community's current service access needs, and assisted evidence based decision making for planning and implementing changes to increase access based on risk.

[Evaluation of an Intensified Dental Preventive Programme Aimed at Children with Increased Caries Risk]. / Evaluation eines zahnmedizinischen Präventionsprogramms für Kinder mit erhöhtem Kariesrisiko.

Our study investigated the effect of a selective intensive prevention (SIP) programme on dental health of pupils in comparison to a control group. While no differences were observed in respect to dental health of first graders, the DMF-T values of fourth and 6 graders participating in SIP were significantly lower. Concerning the psychometric variables only few differences were found. The fourth and 6 graders in the test group reported less dental fear than the pupils in the control group.

Childhood oral health and SES predictors of caries in 30-year-olds.

BACKGROUND/AIMS: To assess whether childhood socio-economic status modifies the relationship between childhood caries and young adult oral health. METHODS: In 1988-1989, a total of 7,673 South Australian children aged 13 years were sampled, with 4,604 children (60.0%) and 4,476 parents (58.3%) responding. In 2005-2006, 632 baseline study participants responded (43.0% of those traced and living in Adelaide). RESULTS: Adjusted analyses showed significant interactions for card status by DMFT at age 13 for decayed, missing and filled teeth at age 30, but not for DMFT. Higher DMFT at age 13 was associated with more decayed teeth at age 30 for those with no health card, while there were similar numbers of decayed teeth for card holders regardless of their DMFT at age 13. While higher DMFT at age 13 was associated with more missing teeth at age 30 for card holders, there were similar numbers of missing teeth for those with no card regardless of their DMFT at age 13. The interaction for filled teeth showed that even though higher DMFT at age 13 was associated with more fillings at age 30 for both card holders and those with no card, this relationship was more pronounced for card holders. CONCLUSIONS: SES modified the relationship between child oral health and caries at age 30 years. Card holders at age 13 were worse off in terms of their oral health at age 30 controlling for childhood oral health, supporting social causation explanations for oral health inequalities.

National survey on school-based fluoride mouth-rinsing programme in Japan: regional spread conditions from preschool to junior high school in 2010.

AIMS: We surveyed the state of implementation of the school-based fluoride mouth-rinsing programme (S-FMR) in schools in Japan from March 2010. METHODS: Questionnaires on the implementation status of S-FMR in each type of school (including preschool and kindergarten) were sent by post to the oral health administration departments of all 47 prefectures and 89 cities (18 ordinance-designated cities, 23 special wards, 41 core cities and seven public health centres in ordinance-designated cities) with public health centres. RESULTS: The S-FMR implementation rate was low, at only 11% of all schools in Japan and only 6% of all participating school children aged 4-14 years. In many regions, the S-FMR was implemented more widely and received higher participation from children in either elementary schools and junior high schools or preschools and kindergartens. CONCLUSIONS: Inter-prefectural disparities were seen in S-FMR implementation, as some prefectures and cities did not include topical fluoride application in their health promotion plans, and some local public bodies did not include targets for fluoride mouth-rinsing. To reduce this disparity in Japan where systemic fluoride application is not performed, each local public body must consider implementing the S-FMR as a public health measure. We propose using the results of this survey as basic data for formulating S-FMR goals (numerical targets) and adopting S-FMR as a concrete measure in the second Healthy Japan 21, to be launched in the fiscal year for 2013, and within the basic matters of the Act Concerning the Promotion of Dental and Oral Health.

Clinical oral health of Australia's rural children in a sample attending school dental services.

OBJECTIVE: To examine the association between children's clinical oral health status and their residential location using the latest available data (2009) and to ascertain whether poor oral health among rural children is related to being Indigenous, having less access to fluoridated water or being of lower socioeconomic status (SES), than children from urban areas. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANT: Data were collected on 74, 467 children aged 5-12 years attending school dental services in Australia (data were not available for Victoria or New South Wales). MAIN OUTCOME MEASURES: Clinical oral health was determined by the mean number of permanent teeth with untreated caries, missing and filled permanent teeth, and the mean decayed, missing and filled permanent teeth index (DMFT) of 8 to 12-year-old-children and the mean number deciduous teeth with untreated caries, missing and filled deciduous teeth, and the mean decayed, missing and filled deciduous teeth index (dmft) of 5-10-year-olds. RESULTS: The multivariable models that included coefficients on whether the child was Indigenous, from an area with fluoridated water and SES, were controlled for age and sex. The mean DMFT of 8-12-year-old children and the mean dmft of 5-10-year-old-children were significantly higher in rural areas compared with urban centres after accounting for Indigenous status, fluoridated water and SES. CONCLUSION: Children's oral health was poorer in rural areas than in major city areas.

Promoting oral health of children through schools--results from a WHO global survey 2012.

This paper reviews the range of school-based approaches to oral health and describes what is meant by a Health Promoting School. The paper then reports the results of a World Health Organization global survey of school-based health promotion. Purposive sampling across 100 countries produced 108 evaluations of school oral health projects spread across 61 countries around the globe. The Ottawa Charter for Health Promotion noted that schools can provide a supportive environment for promoting children's health. However, while a number of well-known strategies are being applied, the full range of health promoting actions is not being used globally. A greater emphasis on integrated health promotion is advised in place of narrower, disease- or project-specific approaches. Recommendations are made for improving this situation, for further research and for specifying an operational framework for sharing experiences and research.

[Evaluation of a school-based intensified preventive program for high caries risk children in the Eneppe-Ruhr district]. / Evaluation eines zahnärztlichen Intensivprophylaxeprogramms für Kinder mit einem erhöhten Kariesrisiko im Ennepe-Ruhr-Kreis.

The aim of the present study was to assess the dental health of high caries risk elementary students from the Ennepe-Ruhr district (Westphalia) who were involved in school-based basic and intensified preventive programs. Furthermore, the efficacy of the intensified preventive program (IPP) was evaluated in comparison to the basic preventive program (BPP). Students with intensified preventive care and their parents were asked about their ethnic background, social status, oral health attitudes, and behavior as well as the perception and acceptance of the IPP. A total of 127 students involved in the IPP took part in this study; 106 students participating in the BPP served as the control group. Dental caries were scored according to the 1997 WHO standard. Caries prevalence and experience did not differ between students participating in the BPP or IPP. Migration-related shortcomings in terms of dental self-reliance and the use of fluoridated salt were found. Future IPPs should focus on a holistic and setting-based preventive strategy considering migration-related characteristics.

Opportunities and challenges to promoting oral health in primary schools.

UNLABELLED: Inequalities in oral health in areas of socio-economic disadvantage are well recognised. As children spend a considerable proportion of their lives in education, schools can play a significant role in promoting children's health and oral health. However, to what extent schools are able to do this is unclear. The aim of this study was therefore to investigate opportunities and challenges to promoting oral health in primary schools. METHODS: A purposive sample of 20 primary schools from socially and economically disadvantaged areas of Cardiff, UK were selected to participate in this qualitative study. Data were collected through semi-structured interviews conducted with head teachers or their nominated deputies. RESULTS: General awareness of health and oral health was good, with all schools promoting the consumption of fruit, water and milk and discouraging products such as carbonated drinks and confectionaries. Health promotion schemes wereimplemented primarily to improve the health of the children, although schools felt they also offered the potential to improve classroom behaviour and attendance. However, oral health was viewed as a separate entity to general health and perceived to be inadequately promoted. Successful health promotion schemes were also influenced by the attitudes of headteachers. Most schools had no or limited links with local dental services and, or oral health educators, although such input, when it occurred, was welcomed and highly valued. Knowledge of how to handle dental emergencies was limited and only two schools operated toothbrushing schemes, although all expressed an interest in such programmes. CONCLUSION: This study identified a positive predisposition to promoting health in primary schools. The challenge for the dental team, however, is to promote and integrate oral health into mainstream health promotion activities in schools. The paper also makes recommendations for further research.

The oral health status of adolescents in northern Manhattan.

Objectives. This study was designed to describe the oral health status of adolescents residing in northern Manhattan. Methods. Clinical, demographic, and behavioral data were collected from 3,282 youths who ranged in age from 12 to 16 years. Clinical examinations were performed by two trained examiners. Demographic and behavioral data were self-reported. Results. The adolescents were predominantly Hispanic/Latino and Black/African American (94%), with 6% falling into other racial categories. Caries were discovered in a significant proportion of these youths (52% of Hispanics, 54% of Blacks and 54% of others). Despite similar caries experiences, the oral health disease burden was not evenly distributed across groups. In many cases, Hispanic youths demonstrated less disease and more frequent engagement in oral health promoting behaviors than their non-Hispanic peers. Gender differences were less consistent. Conclusions. Economically disadvantaged and minority youths, such as those residing in northern Manhattan, continue to be unduly burdened by untreated dental disease. Further, our data suggest that certain subpopulations may be particularly vulnerable to dental disease. This vulnerability underscores the need for accessible services addressing the oral health needs of these segments of the population. Finally, effective community-based oral disease prevention and health promotion programs are sorely needed to improve these youths' oral health.

The effectiveness of school dental screening: a cluster-randomized control trial.

Dental screening of children in schools is undertaken in many countries. There is no evidence that this activity is effective. The objective of our study was to determine if school dental screening of children reduces untreated disease or improves attendance at the population level. A four-arm cluster-randomized controlled trial was undertaken in the northwest of England. In total, 16,864 children aged 6-9 years in 168 schools were randomly allocated to 3 test groups, which received screening according to different models, and a control, which received no intervention. There were no significant differences in caries increment in the primary and secondary dentitions or in the proportions of children attending a dentist after screening between the control group and the 3 intervention arms. School dental screening delivered according to 3 different models was not effective at reducing levels of active caries and increasing attendance in the population under study.

The effectiveness of school dental screening: dental attendance and treatment of those screened positive.

OBJECTIVE: To determine dental attendance and treatment outcomes following two models of dental screening. DESIGN: An observational prospective cohort study. SETTING: Infant, primary and junior schools in the North West of England. SUBJECTS: Children aged six to nine years at the start of the study. INTERVENTIONS: Subjects received a screening examination according to either a 'Traditional model' or 'New model' of school dental screening. MAIN OUTCOME MEASURES: Attendance at a dentist within four months of the intervention and treatment received by children referred via the 'New model' with caries in their permanent teeth. RESULTS: In the 'New model' of school dental screening 46% of screened positive and 41% of screened negative children attended a dentist during the study period. Some 44% of children referred with caries in permanent teeth attended a dentist and 53% of those attending received treatment for the referred condition. Larger proportions of children from disadvantaged backgrounds were screened positive but higher proportions of children from more affluent backgrounds attended the dentist and subsequently received treatment. CONCLUSION: School dental screening has a minimal impact on dental attendance and only a small proportion of screened positive children receive appropriate treatment. The programme fails to reduce inequalities in utilisation of dental services.

The dental safety net in Connecticut.

BACKGROUND: Many poor, medically disabled and geographically isolated populations have difficulty accessing private-sector dental care and are considered underserved. To address this problem, public- and voluntary-sector organizations have established clinics and provide care to the underserved. Collectively, these clinics are known as "the dental safety net." The authors describe the dental safety net in Connecticut and examine the capacity and efficiency of this system to provide care to the noninstitutionalized underserved population of the state. METHODS: The authors describe Connecticut's dental safety net in terms of dentists, allied health staff members, operatories, patient visits and patients treated per dentist per year. The authors compare the productivity of safety-net dentists with that of private practitioners. They also estimate the capacity of the safety net to treat people enrolled in Medicaid and the State Children's Health Insurance Program. RESULTS: The safety net is made up of dental clinics in community health centers, hospitals, the dental school and public schools. One hundred eleven dentists, 38 hygienists and 95 dental assistants staff the clinics. Safety-net dentists have fewer patient visits and patients than do private practitioners. The Connecticut safety-net system has the capacity to treat about 28.2 percent of publicly insured patients. CONCLUSIONS: The dental safety net is an important community resource, and greater use of allied dental personnel could substantially improve the capacity of the system to care for the poor and other underserved populations.

Effects of School Dental Care Service in Hong Kong--primary teeth.

The aim of this study was to describe the effects of the School Dental Care Service on the dental status of primary teeth, against the background of the water fluoridation program. A representative sample of Chinese children aged 6-12 yr was selected for a dental examination for caries and treatment needs. Thirty-two percent of the children aged 6-8 yr were caries free. The dmft indices for 6, 7, and 8-yr-olds were 2.8, 3.1, and 2.9 respectively, and the ratio of decayed to filled teeth declined from 3.2 at age 6 to 1.0 at age 9. The average child aged 6-8 yr needed treatment for caries on just fewer than two teeth. More teeth were in need of 1-surface fillings and such complex treatment as pulpotomy than other treatment types. It was concluded that 1) dental caries prevalence and severity in primary teeth of Hong Kong children continues to decline, 2) there has been an obvious improvement in dental fitness as a result of establishing the School Dental Care Service, 3) the risk to dental caries appears to be associated with the preschool time-frame and therefore 4) the dental service should redirect its attention to preschool children and 5) replace its restorative policy with a preventive policy.

Oral health of children in South Australia by socio-demographic characteristics and choice of provider.

UNLABELLED: Australia has a highly developed school dental program for providing dental care to schoolchildren which operates alongside well-established private practice delivery of dental care. While free school-based dental care has high utilisation where offered, little is known about the oral health outcomes of groups of children across different providers of dental care, or patterns of service use. This paper investigates the effects of socio-demographic characteristics and choice of dental provider on oral health amongst a random sample of secondary school students residing in Adelaide, South Australia. OBJECTIVES: To describe the oral health of children by different dental provider groups, to describe the association of socio-demographic characteristics with oral health outcomes; and to describe the differences in oral health that remained after controlling for socio-demographic confounding, by dental provider group. METHODS: The study included metropolitan Adelaide schoolchildren from Year 9 and 10 school grades (n = 373). RESULTS: Children who received care from the School Dental Service (SDS) and from both the SDS and private dentists (Mixed) had significantly lower caries experience (DMFS) than children who received care from private dentists (Private) or who had not received any care for at least 2 years (No Recent Care). There were differences in the socio-demographic characteristics between children who used different dental providers, and these socio-demographic characteristics were significantly associated with levels of decayed, missing and filled surfaces and surfaces which had been fissure sealed. After controlling for socio-demographic characteristics using multiple regression, significant differences were seen in mean caries experience (DMFS) and mean numbers of decayed surfaces and filled surfaces. CONCLUSION: Although from less advantaged backgrounds, children seen through the SDS had more favourable oral health outcomes than children seen by a private dentist.

The outcome of school dental screening in two suburban districts of Greater Manchester, UK.

School dental screenings have been carried out in the community dental service for over eighty years but there have been very few evaluations of their outcome. The community dental service is now required to provide treatment only for those who have experienced difficulty in obtaining treatment in the general dental service. A follow up procedure to school dental screenings was designed to ensure that as many children in need of treatment as possible attended a general dental practitioner. The objective of this study was to evaluate the effectiveness of this procedure in persuading school children to attend a general dental practitioner. Data on the outcome of this follow up procedure were collected between May 1990 and March 1991 in Oldham and Tameside and Glossop. Of the 47,776 pupils screened, 10,925 were considered to require treatment. General dental practitioners confirmed subsequent attendance by 2,083 (19 per cent) and attendance at community dental service clinics was confirmed for a further 363 (3 per cent). A further 2,161 (20 per cent) were found to have received treatment at a rescreening held two to three months later. Of those referred for treatment, 4,607 children (42 per cent) had received it within the three months following the screening, the majority having received care in the general dental service.

Secular changes in treatment in a school dental service.

The caries decline has affected child dental treatment in many countries. There has been a change towards fewer extractions and pulpotomies in deciduous teeth, and restorative techniques and restorations in deciduous and permanent teeth have become less complex. New materials, particularly glass ionomer cements (GIC), have found acceptance. The School Dental Service (SDS) in Western Australia (WA), one of the world's largest dental care organisations, holds good data on children's dental health and on the types of treatment provided since 1980. This paper reports these data. Oral health is recorded as caries experience on a random sample of patients. Treatment provided is recorded by operators after each patient visit and collated monthly. About 240,000 children (> 90 per cent of those eligible) and currently enrolled in the SDS and the clinical staffing is about 150-160 dental therapists and 27 dentists. Caries experience has fallen in all age groups in recent years, except that in 1992 and 1993 dmft rose slightly in six-year-old children. All types of operative treatment are used less frequently now than in 1980. In deciduous teeth restorations, GIC dominates but amalgam remains the most widely chosen material in permanent teeth. The use of fissure sealants (using GIC) peaked in 1988 and, as a result of management decisions, has declined since then. The decline in the need for dental treatment has reduced costs and enabled the SDS to offer care to an expanding group of children in WA. The results achieved by the SDS in WA demonstrate that a service based primarily on dental auxiliaries is viable and efficient.

British Association for the Study of Community Dentistry (BASCD) guidance on sampling for surveys of child dental health. A BASCD coordinated dental epidemiology programme quality standard.

The British Association for the Study of Community Dentistry (BASCD) is responsible for the coordination of locally based surveys of child dental health which permit local and national comparisons between health authorities and regions. These surveys began in 1985/86 in England and Wales, 1987/88 in Scotland and 1993/94 in Northern Ireland. BASCD has taken an increasing lead in setting quality standards in discussion with the NHS Epidemiology Coordinators of the Dental Epidemiology Programme. This paper comprises guidance on the sampling for these surveys.