A review of water fluoridation studies and the effect on dental caries and treatment costs, undertaken in Scotland.

Objectives This review aimed to investigate the effect of water fluoridation on the dental health of Scottish people by comparing results of starting and discontinuing fluoridation in Scotland.Data sources Data sources were retrieved from electronic databases. The grey literature was also searched. Articles were selected if the population of interest was Scottish. The objective was to evaluate the influence of water fluoridation on dental caries using the dmft/s, DMFT/S (decayed, missing and filled teeth/surfaces) or deft/s indices (decayed, extraction needed, filled teeth/surfaces).Data extraction Name of the authors, publication years, location of the study, sample size, type of study design, age of participants, method of assessing the outcome, data related to the exposure and the outcome, and the overall result of each study were extracted. The data were collected based on the effect of water fluoridation and its cessation on dental caries and the type of dentition.Results Nine studies were included in the review. The findings revealed that the introduction of water fluoridation led to reductions in caries. Moreover, after the cessation of fluoridation, caries levels continued to remain lower in the fluoridated groups. Additionally, fluoridation had the effect of reducing the cost of dental treatment.Conclusion Water fluoridation was effective in improving dental caries among the Scottish child population. New studies are required to provide contemporary evidence for water fluoridation in Scotland.

Public attitudes to water fluoridation in Scotland.

Introduction Currently, no-one in Scotland benefits from artificial water fluoridation and there have been no recent reports published about public opinion on this issue. We conducted a robust public survey consultation on community water fluoridation to address this absence.Aims To gauge public attitudes in three urban areas of Scotland to determine respondents' sources of information, awareness of the current fluoridation status of their local water supply and attitude to community water fluoridation.Methods A face-to-face quota sample with proportions set for age and sex using six closed questions, plus demographics. The questions and sample size were based on earlier similar studies.Results A random on-street survey of 410 people was completed. The vast majority (88%, n = 360) of the total sample had not read or heard anything about water fluoridation in the previous 12 months. A minority (36%) believed, incorrectly, that their water supply was already fluoridated compared to 47% who did not know and a smaller minority of 17% who correctly said no. Of those who answered either 'yes' or 'no' to the question 'do you think fluoride should be added to water if it can reduce tooth decay?' (n = 292), 88% were in favour of adding fluoride to water to reduce tooth decay, with 12% stating that they were not in favour of water fluoridation. When people who recorded they don't know were included (n = 410), 63% said 'yes', 28% stated 'don't know' and 9% said 'no'.Conclusion Public opinion in Scotland, gauged through a random on-street representative survey, remains strongly in favour of community water fluoridation. Monitoring public opinion should be conducted on a regular basis by individual health boards and the Scottish Government to allow them to take forward this effective and safe public health measure within the existing permissive water fluoridation legislation.

The role of extended duties dental nurses in applying fluoride varnish for the prevention and control of dental caries.

UNLABELLED: The role of extended duties dental nurses (EDDNs) in undertaking preventive dental care has provided an opportunity for their direct involvement in patient care, both at an individual patient level and as part of a population wide health improvement initiative. The article describes the developing role of the dental nurse in the clinical application of fluoride varnish, with associated evidence of effectiveness for the prevention and control of dental caries. The use of fluoride varnish as being central to caries preventive programmes for individual patients judged at risk of future dental caries is considered. A Scottish dental public health initiative which utilizes these extended skills and the benefits of fluoride varnish application is described. CLINICAL RELEVANCE: This paper illustrates how EDDNs can help to foster a greater team approach to overall patient care and preventive practice by applying fluoride varnish as part of an effective caries preventive programme.

Evaluation of dental therapists undertaking dental examinations in a school setting in Scotland.

OBJECTIVE: To measure agreement between dental therapists and the Scottish gold-standard dentist undertaking National Dental Inspection Programme (NDIP) examinations. METHODS: A study of interexaminer agreement between 19 dental therapists and the national gold-standard dentist was carried out. Pre-calibration training used the caries diagnostic criteria and examination techniques agreed by the British Association for the Study of Community Dentistry (BASCD). Twenty-three 5-year-old children (Primary 1) and 17 11-year-old children (Primary 7) children were examined. Agreement was assessed using kappa statistics on d3 mft and D3 MFT for P1 and P7 children, sensitivity and specificity values, and kappa statistics on d3 t/D3 T and ft/FT. Calibration data on P1 and P7 children from 2009-2012 involving dentists as examiners were used for comparison. Economic evaluation was undertaken using a cost minimization analysis approach. RESULTS: The mean kappa score was 0.84 (SD 0.07) ranging from 0.69 to 0.94. All dental therapists scored good or very good agreement with the gold-standard dentist. This compares with historic NDIP calibration data with dentists, against the same gold-standard dentist, where the mean kappa value was 0.68 (SD 0.22) with a range of 0.35-1.00. The mean sensitivity score was 0.98 (SD 0.04) (range 0.88-1.0) and mean specificity score was 0.90 (SD 0.06) (range 0.78-0.96). Health economic analysis estimated that salary costs would be 33.6% lower if dental therapists were substituted for dentists in the year 2013, with an estimated saving of approximately £103 646 per annum on the national budget. CONCLUSION: We conclude that dental therapists show a high level of interexaminer agreement, and with the appropriate annual training and calibration, they could undertake dental examinations as part of the NDIP programme.

Dental health of prisoners in the north west of England in 2000: literature review and dental health survey results.

BACKGROUND: A caries prevalence study of prisoners in the North West of England was conducted to allow comparisons with results of the 1998 United Kingdom Adult Dental Health Survey. METHOD: A random sample of prisoners in the North West of England was interviewed and examined using the same criteria as the 1998 United Kingdom Adult Dental Health Survey. RESULTS: From a random sample of 316 prisoners, 279 (88%) were interviewed and 272 (86%) received a dental examination. Prisoners enter prison with twice as many decayed teeth (mean 4.2) than found in the general population in the North West of England (mean 1.9). Prisoners also have fewer restored teeth. There was little difference between the mean DMFT of adult male prisoners and young offender male prisoners. There was little difference in the mean DMFT of those in prison for more or less than two years. CONCLUSIONS: Prisoners in the North West of England had more decayed or unsound teeth, and fewer restored teeth than both non-institutionalised adults in the North West of England and social classes IV and V in England. Attempts to improve the effectiveness and efficiency of the Prison Dental Service in the North West of England may render the prison population dentally fit more speedily.

Fluoride rinsing and dental health inequalities in 11-year-old children: an evaluation of a supervised school-based fluoride rinsing programme in Edinburgh.

OBJECTIVES: Previous studies have shown that fluoride mouthrinsing programmes are effective in reducing caries among children and adolescents. National surveys of child dental health in the UK confirm that there is variation in oral health. In particular, children of low socioeconomic status in Scotland have a disproportionately high share of dental disease. This study aimed to evaluate an existing school-based fluoride mouthrinsing programme on dental caries in populations stratified by socioeconomic status. METHODS: A random sample of 1333 children surveyed by the National Dental Inspection Programme with average age 11.4 years was included in the study. Caries prevalence data were collected for the 661 rinsers and 672 nonrinsers. Chi-squared tests and t-tests were carried out to test differences in proportion and in mean D(3)MFT, respectively. The data were modelled using multilevel logistic regression, adjusting for age, sex, deprivation and rinse status. RESULTS: There is a strong negative association between deprivation and prevalence of D(3)MFT = 0. There is no significant difference in prevalence of D(3)MFT between rinsers and nonrinsers, however, mean D(3)MFT is greater for nonrinsers within each deprivation category. After adjusting for age, sex and deprivation, the odds of a tooth being decayed missing or filled for a child who rinsed are 0.79 (0.64, 0.98) compared with those of a child who did not. CONCLUSIONS: Fluoride rinsing can be effectively targeted at children from deprived areas through school-based initiatives. There are some difficulties in recruiting all children from the more deprived backgrounds, but overall reductions in D(3)MFT were observed.