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Davidovich E, Ccahuana-Vasquez RA, Grender J, Timm H, Gonen H, Zini A. A 4-week randomized controlled trial evaluating plaque and gingivitis effects of an electric toothbrush in a paediatric population. Int J Paediatr Dent 2024; 34:246-255. [PMID: 37864381 DOI: 10.1111/ipd.13130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/21/2023] [Accepted: 09/15/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Few extended studies have explored oscillating-rotating (O-R) toothbrush efficacy in young children. AIM To compare the efficacy between O-R and manual toothbrushes in reducing plaque and gingivitis after 4 weeks in children. DESIGN This was a randomized, parallel-group, examiner-blind, clinical trial. In two 50-subject cohorts (3-6 years, primary dentition, parental brushing; 7-10 years, mixed dentition, self-brushing), subjects used Oral-B Kids O-R toothbrush per manufacturer's instructions or Paro Junior manual toothbrush in a customary manner. Plaque and Modified Gingival Index (MGI; primary variable) scores were assessed at baseline and Week 4 for all subjects and within each age group. RESULTS Both toothbrushes significantly reduced whole mouth and posterior plaque and MGI versus baseline (p < .001). Combined groups: O-R showed greater plaque and MGI reductions versus manual for all measures (p ≤ .003). Three- to 6-year-olds: O-R demonstrated significantly (p < .032) greater whole-mouth (55.7%) and posterior (34.3%) plaque reductions at Week 4 versus manual. Seven- to 10-year-olds: O-R showed significantly (p < .001) greater whole-mouth (94.5%) and posterior (108.4%) plaque reductions and greater (p ≤ .016) whole-mouth (14.1%) and posterior (18.8%) MGI reductions versus manual. There were no adverse events. CONCLUSION The O-R toothbrush, used per manufacturer's instructions, reduced plaque and gingivitis better than a manual toothbrush used in a customary manner among children.
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Affiliation(s)
- Esti Davidovich
- Faculty of Dental Medicine, Hebrew University & Hadassah, Jerusalem, Israel
| | | | | | - Hans Timm
- Procter & Gamble Service GmbH, Kronberg, Germany
| | - Hila Gonen
- Faculty of Dental Medicine, Hebrew University & Hadassah, Jerusalem, Israel
| | - Avi Zini
- Faculty of Dental Medicine, Hebrew University & Hadassah, Jerusalem, Israel
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Lee J, Lee T, Jung HI, Park W, Song JS. Effectiveness of an Oral Health Education Program Using a Smart Toothbrush with Quantitative Light-Induced Fluorescence Technology in Children. CHILDREN 2023; 10:children10030429. [PMID: 36979987 PMCID: PMC10047114 DOI: 10.3390/children10030429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
This randomized controlled trial aimed to educate patients and manage oral hygiene remotely via a smart toothbrush (ST) by using mobile applications and to improve oral hygiene and habits by evaluating the plaque state via images from a Q-ray cam, which is a quantitative light-induced fluorescence (QLF) digital imaging device. In total, 68 children (aged 6–12 years) were randomly divided into three groups. Group I was assigned an electro-toothbrush (ET), group II was assigned a smart toothbrush (ST), and group III used a manual toothbrush (MT). Each group used an assigned toothbrush and was checked after 1 and 3 months. Oral hygiene status was evaluated using the patient hygiene performance (PHP) index and fluorescent plaque index (FPI), which are presented in the QLF program. In addition, questionnaires on oral health behaviors and attitudes were also evaluated. There was a 0.24 decrease in the PHP index and a 1.40 decrease in the simple hygiene score three months later compared with the baseline in the ST group, with no significant difference between the three methods (p = 0.518, p = 0.626). Many group II participants said that ST helped with oral hygiene, and they were willing to use it continuously. In addition, all participants’ brushing times and attitudes toward oral hygiene improved after oral hygiene education using a Q-ray cam. Therefore, the use of STs provided good dental health education and a plaque-decreasing effect to children aged 6–12 years old. Furthermore, the QLF device can be used as a useful tool for maintaining good oral hygiene in children.
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Affiliation(s)
- Jihyun Lee
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea
| | - Taeyang Lee
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea
| | - Hoi-In Jung
- Department of Preventive Dentistry & Public Oral Health, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea
- Innovation Research and Support Center for Dental Science, Yonsei University Dental Hospital, Seoul 03722, Republic of Korea
| | - Wonse Park
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea
| | - Je Seon Song
- Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea
- Oral Science Research Center, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea
- Correspondence: ; Tel.: +82-2-2228-3170; Fax: +82-2-369-7420
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Sandom F, Hearnshaw S, Grant S, Williams L, Brocklehurst P. The in-practice prevention programme: an example of flexible commissioning from Yorkshire and the Humber. Br Dent J 2022:10.1038/s41415-022-4140-y. [PMID: 35383286 PMCID: PMC8982659 DOI: 10.1038/s41415-022-4140-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
Introduction An In-Practice Prevention (IPP) programme was developed by the Local Dental Network in the North Yorkshire and the Humber area in England in response to an oral health needs assessment. The underpinning logic model drew on a flexible commissioning approach and aimed to incentivise dental teams with NHS contracts to promote the delivery of prevention. This used care pathways that involved the whole dental team and was cost-neutral.Aim The programme was evaluated using realist methodology to identify 'what works, in which circumstances, how and for who?'.Design Realist evaluations are explanatory in nature and attempt to understand the factors that appear to influence the success (or not) of an intervention, rather than demonstrating causality.Methods and results Following a review of the pertinent literature, semi-structured interviews and focus groups, five theory areas were considered to be critical to the delivery of IPP. In order of stated priority, these were: 1) clinical leadership; 2) 'skill mix'; 3) financial incentives; 4) institutional logic/practice culture; and 5) behaviour change.Conclusion The results appear to show that clinically-led programmes could offer value to dental commissioners within a flexible commissioning model, although this would need to be further tested using an experiment design.
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Affiliation(s)
- Fiona Sandom
- School of Health Sciences, Bangor University, UK
| | | | - Siobhan Grant
- Public Health England, North Yorkshire and the Humber Area, UK
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Fakhruddin KS, Samaranayake LP, Hamoudi RA, Ngo HC, Egusa H. Diversity of site-specific microbes of occlusal and proximal lesions in severe- early childhood caries (S-ECC). J Oral Microbiol 2022; 14:2037832. [PMID: 35173909 PMCID: PMC8843124 DOI: 10.1080/20002297.2022.2037832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Severe-early childhood caries (S-ECC) a global problem of significant concern, commonly manifest on the occlusal, and proximal surfaces of affected teeth. Despite the major ecological differences between these two niches the compositional differences, if any, in the microbiota of such lesions is unknown. Methods Deep-dentine caries samples from asymptomatic primary molars of children with S-ECC (n 19) belonging to caries-code 5/6, (ICDAS classification) were evaluated. Employing two primer pools, we amplified and compared the bacterial 16S rRNA gene sequences of the seven hypervariable regions (V2—V4 and V6—V9) using NGS-based assay. Results Bray-Curtisevaluation indicated that occlusal lesions (OL) had a more homogeneous community than the proximal lesions (PL) with significant compositional differences at the species level (p = 0.01; R- 0.513). Together, the occlusal and proximal niches harbored 263 species, of which 202 (76.8%) species were common to both , while 49 (18.6%) and 12 (4.6%) disparate species were exclusively isolated from the proximal and occlusal niches, respectively. The most commonl genera at both niches included Streptococcus, Prevotella, and Lactobacillus. S. mutans was predominant in PL (p ≤ 0.05), and Atopobium parvulum (p = 0.01) was predominant in OL. Conclusions Distinct differences exist between the caries microbiota of occlusal and proximal caries in S-ECC.
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Affiliation(s)
- Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, UAE
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Sendai-city, Japan
| | | | - Rifat Akram Hamoudi
- Sharjah Institute for Medical Research, College of Medicine, University of Sharjah, Sharjah, UAE
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Hien Chi Ngo
- Uwa Dental School, The University of Western Australia, Perth, Australia
| | - Hiroshi Egusa
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Sendai-city, Japan
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Duangthip D, He S, Gao SS, Chu CH, Lo ECM. Effectiveness of Silver Diamine Fluoride in Preventing Occlusal Caries in Primary Teeth of Preschool Children: a Study Protocol for a Randomized Clinical Trial (Preprint). JMIR Res Protoc 2021; 11:e35145. [PMID: 35604758 PMCID: PMC9171591 DOI: 10.2196/35145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/21/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tooth decay is a significant public health problem globally. The caries-arrest effectiveness of 38% silver diamine fluoride (SDF) has been well documented. However, information on the caries-preventive effect of SDF on primary teeth is insufficient. Objective The aim of this trial is to investigate the effectiveness of semiannual application of 38% SDF and that of 5% sodium fluoride (NaF) varnish when compared with placebo control for preventing occlusal caries in the primary molars of preschool children over 30 months. Methods This 3-arm, parallel design, double-blind, randomized controlled trial involves 791 preschool children. Children are randomly allocated to receive 1 of 3 interventions as follows: Group 1, 38% SDF; Group 2, 5% NaF varnish; and Group 3, placebo control (tonic water). The intervention and dental examination will be carried out every 6 months. A parent-administered questionnaire, including the children’s demographic background and oral health–related behaviors, has been collected at baseline. Follow-up examinations to detect new caries development will be conducted every 6 months by a masked examiner. Caries development will be diagnosed at the cavitation level. Chi-square tests and logistic regression analyses will be adopted. A 2-level logistic regression analysis will be performed to investigate the effects of the study interventions and other potential confounding factors on the development of occlusal caries. Results This study was started on September 1, 2020, and the recruitment process ended on September 30, 2021. At present, a total of 791 children are participating in the study. This 30-month clinical trial is expected to be completed in March 2024. Conclusions If SDF application is more effective than NaF varnish for preventing caries on occlusal surfaces of primary teeth, it can be a preferred choice for caries prevention in a kindergarten-based program. Results of this trial will provide valuable clinical evidence for the development of oral health strategies and policies on the promotion of child oral health. Trial Registration HKU Clinical Registry HKUCTR-2844, https://tinyurl.com/bdhz9yuk; ClinicalTrials.gov NCT05084001, https://clinicaltrials.gov/ct2/show/NCT05084001 International Registered Report Identifier (IRRID) DERR1-10.2196/35145
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Affiliation(s)
- Duangporn Duangthip
- Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Shuyang He
- Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Sherry Shiqian Gao
- Department of Stomatology, School of Medicine, Xiamen University, Xiamen, China
| | - Chun Hung Chu
- Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Edward Chin Man Lo
- Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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Loy F, Underwood B, Stevens C. Watch and learn? A systematic review comparing oral health educational videos with written patient information aimed at parents/carers or children. Br Dent J 2021:10.1038/s41415-021-3616-5. [PMID: 34815480 PMCID: PMC8609984 DOI: 10.1038/s41415-021-3616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022]
Abstract
Introduction Childhood caries remains a major UK health issue. The COVID-19 pandemic has necessitated rapid introduction of innovative practice to minimise footfall into dental clinics. Video-based oral health education could help promote oral health advice remotely and has been included in national guidance. This systematic review evaluates the impact of video education versus written patient leaflets on knowledge and oral health behaviours in parents/carers or children.Method PubMed and Medline were searched. In total, 47 articles were identified and relevance assessed by examining titles and abstracts. Seven full-text articles were assessed and reference lists manually screened for additional publications. Three studies met the inclusion criteria.Results Only one study assessed participant knowledge gain and found no statistical significance between scores at baseline and after video, leaflet or hygienist-led education. For oral health behaviour change, one study demonstrated no significant difference in plaque score improvements between video and leaflet groups. The other showed significant improvements in plaque and bleeding scores for both leaflet and video groups compared to the control.Conclusion This review identified too few studies with heterogeneity to make conclusions on the impact of written versusvideo oral health education. A standardised outcome measurement tool is needed to evaluate the impact of current educational videos on oral health behaviour and knowledge. There is potential for video to educate the masses as we navigate through this pandemic.
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Affiliation(s)
- Fionnuala Loy
- Dental Core Trainee 2, North West, Maxillofacial Surgery Department, Royal Preston Hospital, Preston, PR2 9HT, UK.
| | - Ben Underwood
- General Dental Practitioner, Founder and CEO of Brush DJ Ltd, UK
| | - Claire Stevens
- Consultant in Paediatric Dentistry, Manchester University NHS Foundation Trust, Manchester, M15 6FH, UK
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Davidovich E, Ccahuana-Vasquez RA, Timm H, Grender J, Zini A. Randomised clinical study of plaque removal efficacy of an electric toothbrush in primary and mixed dentition. Int J Paediatr Dent 2021; 31:657-663. [PMID: 33225464 PMCID: PMC10015989 DOI: 10.1111/ipd.12753] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/27/2020] [Accepted: 10/22/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Clinical investigations of electric toothbrushes in young children are limited. AIM To assess plaque reduction efficacy of an oscillating-rotating electric versus manual toothbrush in a paediatric population in primary and mixed dentitions. DESIGN In this randomised, single-brushing, 2-treatment, 4-period, replicate-use crossover study, subjects were divided into 2 age groups (3-6 years; 7-9 years) and assigned to a treatment sequence involving an Oral-B Kids electric brush and a manual brush control. Plaque was assessed pre- and post-brushing (Turesky Modified Quigley-Hein Plaque Index). Parents brushed the teeth of their children aged 3-6 years, whereas children aged 7-9 years brushed their own teeth under supervision. Plaque removal scores were analysed for brush differences in each age group separately using an analysis of covariance for crossover design. RESULTS Forty-one children (n = 20, 3-6 years; n = 21, 7-9 years) completed the study. For the primary dentition in children 3-6 years, the electric brush reduced 32.3% more plaque than the manual brush (P = .005). For the mixed dentition in children 7-9 years, the electric brush reduced 51.9% more plaque than the manual brush (P < .001). CONCLUSIONS An electric toothbrush reduced significantly more plaque than a manual toothbrush in 2 paediatric age groups.
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Affiliation(s)
- Esti Davidovich
- Faculty of Dental Medicine, Hebrew University & Hadassah, Jerusalem, Israel
| | | | - Hans Timm
- Procter & Gamble Service GmbH, Kronberg, Germany
| | | | - Avi Zini
- Faculty of Dental Medicine, Hebrew University & Hadassah, Jerusalem, Israel
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Paszynska E, Pawinska M, Gawriolek M, Kaminska I, Otulakowska-Skrzynska J, Marczuk-Kolada G, Rzatowski S, Sokolowska K, Olszewska A, Schlagenhauf U, May TW, Amaechi BT, Luczaj-Cepowicz E. Impact of a toothpaste with microcrystalline hydroxyapatite on the occurrence of early childhood caries: a 1-year randomized clinical trial. Sci Rep 2021; 11:2650. [PMID: 33514787 PMCID: PMC7846568 DOI: 10.1038/s41598-021-81112-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/01/2021] [Indexed: 12/30/2022] Open
Abstract
The aim of this trial was to determine whether a toothpaste with microcrystalline hydroxyapatite is not inferior to a fluoride toothpaste in prevention of caries in children. This double-blinded randomized control trial compared two toothpastes regarding the occurrence of caries lesions using International Caries Detection and Assessment System (ICDAS) ≥ code 1 on the primary dentition within 336 days. The test group used a fluoride-free hydroxyapatite toothpaste three times daily while control group used a toothpaste with fluoride. 207 children were included in the intention-to-treat analysis; 177 of them finished the study per protocol. An increase in caries ICDAS ≥ code 1 per tooth was observed in 72.7% of the hydroxyapatite-group (n = 88), compared with 74.2% of the fluoride-group (n = 89). The exact one-sided upper 95% confidence limit for the difference in proportion of participants with ICDAS increase ≥ 1 (-1.4%) was 9.8%, which is below the non-inferiority margin of 20% demonstrating non-inferiority of hydroxyapatite compared to the fluoride control toothpaste. This RCT showed for the first time, that in children, the impact of the daily use of a toothpaste with microcrystalline hydroxyapatite on enamel caries progression in the primary dentition is not inferior to a fluoride control toothpaste (Clinical Trials NCT03553966).
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Affiliation(s)
- Elzbieta Paszynska
- Department of Integrated Dentistry, Poznan University of Medical Sciences, Poznan, Poland.
| | - Malgorzata Pawinska
- Department of Integrated Dentistry, Medical University of Bialystok, Białystok, Poland
| | - Maria Gawriolek
- Department of Integrated Dentistry, Poznan University of Medical Sciences, Poznan, Poland
| | - Inga Kaminska
- Department of Integrated Dentistry, Medical University of Bialystok, Białystok, Poland
| | | | | | - Szymon Rzatowski
- Department of Integrated Dentistry, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Aneta Olszewska
- Department of Facial Malformation, Pediatric Dentistry Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Ulrich Schlagenhauf
- Department of Conservative Dentistry and Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Theodor W May
- Society for Biometrics and Psychometrics, Bielefeld, Germany
| | - Bennett T Amaechi
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, San Antonio, TX, USA
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Davidovich E, Grender J, Zini A. Factors Associated with Dental Plaque, Gingivitis, and Caries in a Pediatric Population: A Records-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228595. [PMID: 33228082 PMCID: PMC7699320 DOI: 10.3390/ijerph17228595] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 12/14/2022]
Abstract
This retrospective, cross-sectional study evaluated dental records of 1000 healthy children to determine factors associated with plaque, gingivitis, and caries. A logistic model for plaque and gingivitis (mild versus moderate/severe) and caries (yes/no) was carried out separately for each variable using the following potential factors: Age, Gender, Brush Type, Starting Age of Brushing, Brushing Frequency, and Bite Type. Data from 998 children (median age: 4 years, 10 months (range: 2.5-7 years)) were analyzed. Sixty-four percent were manual toothbrush users; 36% were oscillating-rotating electric toothbrush users. For plaque and gingivitis, but not caries, Brush Type was more impactful than Brushing Frequency. Age influenced the severity of plaque and gingivitis, with increases in the odds of having moderate/severe plaque or gingivitis associated with increasing age. The probability of caries increased until approximately age 5 and then decreased until age 7. Oscillating-rotating brush users were more likely to present with less plaque, gingivitis, and caries, with 6.0, 5.1, and 1.4 times greater odds of having mild (versus moderate/severe) plaque, less severe gingivitis, and being caries-free, respectively, than manual brush users. Similarly, brushing twice daily and starting brushing at an earlier age were associated with better oral health outcomes. Children with anterior bite abnormalities had increased odds of developing moderate/severe plaque and gingivitis than children with normal anterior bites. Gender was not a statistically significant factor associated with plaque, gingivitis, or caries. Children's oral health is influenced by toothbrush type, starting age of brushing, compliance with twice-daily brushing, and bite abnormalities.
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Affiliation(s)
- Esti Davidovich
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Hebrew University & Hadassah, Jerusalem 91120, Israel;
| | - Julie Grender
- Statistics and Data Management, The Procter & Gamble Company, Mason, OH 45040, USA;
| | - Avi Zini
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Hebrew University & Hadassah, Jerusalem 91120, Israel;
- Correspondence: ; Tel.: +972-26-758569
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Early Childhood Caries: Epidemiology, Aetiology, and Prevention. Int J Dent 2018; 2018:1415873. [PMID: 29951094 PMCID: PMC5987323 DOI: 10.1155/2018/1415873] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/03/2018] [Accepted: 05/09/2018] [Indexed: 02/06/2023] Open
Abstract
Early childhood caries (ECC) is one of the most prevalent diseases in children worldwide. ECC is driven by a dysbiotic state of oral microorganisms mainly caused by a sugar-rich diet. Additionally, poor oral hygiene or insufficient dental plaque removal leads to the rapid progression of ECC. ECC leads not only to dental destruction and pain with children, but also affects the quality of life of the caregivers. Children with extensive ECC are at high risk to develop caries with the permanent dentition or will have other problems with speaking and/or eating. To prevent ECC, several strategies should be taken into account. Children should brush their teeth with toothpastes containing gentle ingredients, such as mild surfactants and agents showing antiadherent properties regarding oral microorganisms. Parents/caregivers have to help their children with brushing the teeth. Furthermore, remineralizing and nontoxic agents should be included into the toothpaste formulation. Two promising biomimetic agents for children's oral care are amorphous calcium phosphate [Cax(PO4)yn H2O] and hydroxyapatite [Ca5(PO4)3(OH)].
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Tickle M, O'Neill C, Donaldson M, Birch S, Noble S, Killough S, Murphy L, Greer M, Brodison J, Verghis R, Worthington HV. A randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: the Northern Ireland Caries Prevention In Practice (NIC-PIP) trial. Health Technol Assess 2018; 20:1-96. [PMID: 27685609 DOI: 10.3310/hta20710] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Dental caries is the most common disease of childhood. The NHS guidelines promote preventative care in dental practices, particularly for young children. However, the cost-effectiveness of this policy has not been established. OBJECTIVE To measure the effects and costs of a composite fluoride intervention designed to prevent caries in young children attending dental services. DESIGN The study was a two-arm, parallel-group, randomised controlled trial, with an allocation ratio of 1 : 1. Randomisation was by clinical trials unit, using randomised permuted blocks. Children/families were not blinded; however, outcome assessment was blinded to group assessment. SETTING The study took place in 22 NHS dental practices in Northern Ireland, UK. PARTICIPANTS The study participants were children aged 2-3 years, who were caries free at baseline. INTERVENTIONS The intervention was composite in nature, comprising a varnish containing 22,600 parts per million (p.p.m.) fluoride, a toothbrush and a 50-ml tube of toothpaste containing 1450 p.p.m. fluoride; plus standardised, evidence-based prevention advice provided at 6-monthly intervals over 3 years. The control group received the prevention advice alone. MAIN OUTCOME MEASURES The primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were the number of decayed, missing or filled tooth surfaces in primary dentition (dmfs) in caries-active children, the number of episodes of pain, the number of extracted teeth and the costs of care. Adverse reactions (ARs) were recorded. RESULTS A total of 1248 children (624 randomised to each group) were recruited and 1096 (549 in the intervention group and 547 in the control group) were included in the final analyses. A total of 87% of the intervention children and 85% of control children attended every 6-month visit (p = 0.77). In total, 187 (34%) children in the intervention group converted to caries active, compared with 213 (39%) in the control group [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.64 to 1.04; p = 0.11]. The mean number of tooth surfaces affected by caries was 7.2 in the intervention group, compared with 9.6 in the control group (p = 0.007). There was no significant difference in the number of episodes of pain between groups (p = 0.81). However, 164 out of the total of 400 (41%) children who converted to caries active reported toothache, compared with 62 out of 696 (9%) caries-free children (OR 7.1 95% CI 5.1 to 9.9; p < 0.001). There was no statistically significant difference in the number of teeth extracted in caries-active children (p = 0.95). Ten children in the intervention group had ARs of a minor nature. The average direct dental care cost was £155.74 for the intervention group and £48.21 for the control group over 3 years (p < 0.05). The mean cost per carious surface avoided over the 3 years was estimated at £251.00. LIMITATIONS The usual limitations of a trial such as generalisability and understanding the underlying reasons for the outcomes apply. There is no mean willingness-to-pay threshold available to enable assessment of value for money. CONCLUSIONS A statistically significant effect could not be demonstrated for the primary outcome. Once caries develop, pain is likely. There was a statistically significant difference in dmfs in caries-active children in favour of the intervention. Although adequately powered, the effect size of the intervention was small and of questionable clinical and economic benefit. FUTURE WORK Future work should assess the caries prevention effects of interventions to reduce sugar consumption at the population and individual levels. Interventions designed to arrest the disease once it is established need to be developed and tested in practice. TRIAL REGISTRATION Current Controlled Trials ISRCTN36180119 and EudraCT 2009-010725-39. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 71. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin Tickle
- School of Dentistry, University of Manchester, Manchester, UK
| | - Ciaran O'Neill
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | | | - Stephen Birch
- Centre for Health Economics, University of Manchester, Manchester, UK
| | | | - Seamus Killough
- General Dental Practitioner, Ballycastle, UK.,British Dental Association Northern Ireland, Belfast, UK
| | - Lynn Murphy
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - Margaret Greer
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | | | - Rejina Verghis
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
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Factors Associated with Dental Caries in Primary Dentition in a Non-Fluoridated Rural Community of New South Wales, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121444. [PMID: 29168780 PMCID: PMC5750863 DOI: 10.3390/ijerph14121444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 11/16/2022]
Abstract
Dental caries persists as one of the most prevalent chronic diseases among children worldwide. This study aims to determine factors that influence dental caries in primary dentition among primary school children residing in the rural non-fluoridated community of Lithgow, New South Wales, Australia. A total of 495 children aged 5–10 years old from all the six primary schools in Lithgow were approached to participate in a cross-sectional survey prior to implementation of water fluoridation in 2014. Following parental consent, children were clinically examined for caries in their primary teeth, and parents were requested to complete a questionnaire on previous fluoride exposure, diet and relevant socio-demographic characteristics that influence oral health. Multiple logistic regression analysis was employed to examine the independent risk factors of primary dentition caries. Overall, 51 percent of children had dental caries in one or more teeth. In the multiple logistic regression analysis, child’s age (Adjusted Odd’s Ratio (AOR) = 1.30, 95% CI: 1.14–1.49) and mother’s extraction history (AOR = 2.05, 95% CI: 1.40–3.00) were significantly associated with caries experience in the child’s primary teeth. In addition, each serve of chocolate consumption was associated with 52 percent higher odds (AOR = 1.52, 95% CI: 1.19–1.93) of primary dentition caries.
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O’Neill C, Worthington H, Donaldson M, Birch S, Noble S, Killough S, Murphy L, Greer M, Brodison J, Verghis R, Tickle M. Cost-Effectiveness of Caries Prevention in Practice: A Randomized Controlled Trial. J Dent Res 2017; 96:875-880. [DOI: 10.1177/0022034517708968] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 2-arm parallel-group randomized controlled trial measured the cost-effectiveness of caries prevention in caries-free children aged 2 to 3 y attending general practice. The setting was 22 dental practices in Northern Ireland. Participants were centrally randomized into intervention (22,600 ppm fluoride varnish, toothbrush, a 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized prevention advice) and control (advice only), both provided at 6-monthly intervals during a 3-y follow-up. The primary outcome measure was conversion from caries-free to caries-active states assessed by calibrated and blinded examiners; secondary outcome measures included decayed, missing, or filled teeth surfaces (dmfs); pain; and extraction. Cumulative costs were related to each of the trial’s outcomes in a series of incremental cost effectiveness ratios (ICERs). Sensitivity analyses examined the impact of using dentist’s time as measured by observation rather than that reported by the dentist. The costs of applying topical fluoride were also estimated assuming the work was undertaken by dental nurses or hygienists rather than dentists. A total of 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 in the intervention group and 547 in the control group) were included in the final analyses. The mean difference in direct health care costs between groups was £107.53 (£155.74 intervention, £48.21 control, P < 0.05) per child. When all health care costs were compared, the intervention group’s mean cost was £212.56 more than the control group (£987.53 intervention, £774.97 control, P < 0.05). Statistically significant differences in outcomes were only detected with respect to carious surfaces. The mean cost per carious surface avoided was estimated at £251 (95% confidence interval, £454.39–£79.52). Sensitivity analyses did not materially affect the study’s findings. This trial raises concerns about the cost-effectiveness of a fluoride-based intervention delivered at the practice level in the context of a state-funded dental service (EudraCT No: 2009-010725-39; ISRCTN: ISRCTN36180119).
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Affiliation(s)
- C. O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - H.V. Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M. Donaldson
- Health & Social Care Board of Northern Ireland, Belfast, UK
| | - S. Birch
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Health Economics and Policy Analysis, McMaster University, Ontario, Canada
| | - S. Noble
- Northern Health & Social Care Trust, Antrim, UK
| | | | - L. Murphy
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - M. Greer
- hVIVO, Queen Mary BioEnterprises Innovation Centre, London, UK
| | - J. Brodison
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - R. Verghis
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - M. Tickle
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Tickle M, O'Neill C, Donaldson M, Birch S, Noble S, Killough S, Murphy L, Greer M, Brodison J, Verghis R, Worthington HV. A Randomized Controlled Trial of Caries Prevention in Dental Practice. J Dent Res 2017; 96:741-746. [PMID: 28375708 DOI: 10.1177/0022034517702330] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a parallel group randomized controlled trial of children initially aged 2 to 3 y who were caries free, to prevent the children becoming caries active over the subsequent 36 mo. The setting was 22 dental practices in Northern Ireland, and children were randomly assigned by a clinical trials unit (CTU) (using computer-generated random numbers, with allocation concealed from the dental practice until each child was recruited) to the intervention (22,600-ppm fluoride varnish, toothbrush, 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized, evidence-based prevention advice) or advice-only control at 6-monthly intervals. The primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were number of decayed, missing, or filled teeth (dmfs) in caries-active children, number of episodes of pain, and number of extracted teeth. Adverse reactions were recorded. Calibrated external examiners, blinded to the child's study group, assessed the status of the children at baseline and after 3 y. In total, 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 intervention, 547 control) were included in the final analyses. Eighty-seven percent of intervention and 86% of control children attended every 6-mo visit ( P = 0.77). A total of 187 (34%) in the intervention group converted to caries active compared to 213 (39%) in the control group (odds ratio, 0.81; 95% confidence interval, 0.64-1.04; P = 0.11). Mean dmfs of those with caries in the intervention group was 7.2 compared to 9.6 in the control group ( P = 0.007). There was no significant difference in the number of episodes of pain between groups ( P = 0.81) or in the number of teeth extracted in caries-active children ( P = 0.95). Ten children in the intervention group had adverse reactions of a minor nature. This well-conducted trial failed to demonstrate that the intervention kept children caries free, but there was evidence that once children get caries, it slowed down its progression (EudraCT No: 2009-010725-39; ISRCTN: ISRCTN36180119).
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Affiliation(s)
- M Tickle
- 1 Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - C O'Neill
- 2 Centre for Public Health, Queens' University Belfast, Belfast, Northern Ireland
| | - M Donaldson
- 3 Health & Social Care Board of Northern Ireland, Belfast, Northern Ireland
| | - S Birch
- 4 School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,5 Centre for Health Economics and Policy Analysis, McMaster University, Canada
| | - S Noble
- 6 Northern Health & Social Care Trust, Northern Ireland, Antrim, Northern Ireland
| | - S Killough
- 7 British Dental Association, Belfast, Northern Ireland
| | - L Murphy
- 8 Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - M Greer
- 9 hVIVO, Queen Mary BioEnterprises Innovation Centre, London, UK
| | - J Brodison
- 10 DJ Maguire and Associates, Portadown, Northern Ireland
| | - R Verghis
- 8 Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - H V Worthington
- 1 Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Goodwin M, Emsley R, Kelly M, Rooney E, Sutton M, Tickle M, Wagstaff R, Walsh T, Whittaker W, Pretty IA. The CATFISH study protocol: an evaluation of a water fluoridation scheme. BMC Oral Health 2016; 16:8. [PMID: 26831505 PMCID: PMC4736087 DOI: 10.1186/s12903-016-0169-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/25/2016] [Indexed: 11/16/2022] Open
Abstract
Background Tooth decay is the commonest disease of childhood. We have known for over 90 years that fluoride can prevent tooth decay; it is present in nearly all toothpastes and can be provided in mouthwashes, gels and varnishes. The oldest method of applying fluoride is via the water supply at a concentration of 1 part per million. The two most important reviews of water fluoridation in the United Kingdom (the York Review and MRC Report on water fluoridation and health) concluded that whilst there was evidence to suggest water fluoridation provided a benefit in caries reduction, there was a need to improve the evidence base in several areas. Methods/Design This study will use a natural experiment to assess the incidence of caries in two geographical areas, one in which the water supply is returned to being fluoridated following a discontinuation of fluoridation and one that continues to have a non-fluoridated water supply. The oral health of two discrete study populations will be evaluated - those born 9 months after the water fluoridation was introduced, and those who were in their 1st year of school after the introduction of fluoridated water. Both populations will be followed prospectively for 5 years using a census approach in the exposed group along with matched numbers recruitment in a non-exposed control. Parents of the younger cohort will complete questionnaires every 6 months with child clinical examination at ages 3 and 5, whilst the older cohort will have clinical examinations only, at approximately 5, 7 and 11 years old. Discussion This project provides a unique opportunity to conduct a high quality evaluation of the reintroduction of a water fluoridation scheme, which satisfies the inclusion criteria stipulated by the York systematic review and can address the design issues identified in the MRC report. The research will make a major contribution to the understanding of the costs and effects of water fluoridation in the UK in the 21st Century. Its findings will help inform UK policy on this important public health intervention and may have a significant impact on public health policy in other developed countries. There is currently true equipoise in relation to the effectiveness of water fluoridation in contemporary populations and while the biological plausibility is well established, there is a need to examine impact on the changing epidemiological status of dental decay.
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Affiliation(s)
- Michaela Goodwin
- The Dental Health Unit, School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, Manchester, M15 6SE, UK.
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 1.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Michael Kelly
- Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 OSR, UK.
| | - Eric Rooney
- Dental Observatory, NHS Central Lancashire, Preston Business Centre, Watling Street Road, Fulwood, PR2 8DY, UK.
| | - Matthew Sutton
- Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Martin Tickle
- , Coupland 3 Building, Oxford Road, Manchester, M15 6FH, UK.
| | - Rebecca Wagstaff
- Public Health England, North West, 1st Floor, York House, Ackhurst Business Park, Foxhole Road, Chorley, PR7 1NY, UK.
| | - Tanya Walsh
- , Coupland 3 Building, Oxford Road, Manchester, M15 6FH, UK.
| | | | - Iain A Pretty
- The Dental Health Unit, School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, Manchester, M15 6SE, UK.
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Afuakwah C, Welbury R. WHY DO YOU NEED TO USE A CARIES RISK ASSESSMENT PROTOCOL TO PROVIDE AN EFFECTIVE CARIES PREVENTIVE REGIME? Prim Dent J 2015; 4:56-66. [PMID: 26966775 DOI: 10.1308/205016815816682155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Clinical guidelines recommend an individual is given a caries risk status based on analysis of defined clinical and social criteria before implementing a tailored preventive plan. AIMS Improve documentation of caries risk assessment (CRA) in a general dental practice setting, using a systems-based approach to quality improvement methods. Investigate the impact of quality improvement efforts on subsequent design and delivery of preventive care. Identify barriers to delivery of CRA and provision of preventive care. DESIGN Data for patients aged 0-16 years was collected over two cycles using standard audit methodology. The first cycle was a retrospective analysis (n = 400) using random sampling. The second cycle a prospective analysis (n = 513) using consecutive sampling over a 15-week period. Five staff meetings with feedback occurred between cycles. RESULTS In cycle one, no specific CRA system was identified. CRA status was not stated widely, risk factors were not analysed and there was variation with respect to the prescription and delivery of preventive strategies. These discrepancies were demonstrable for all four participating dentists and at all ages. In cycle two, 100% recorded CRA. All risk factors were analysed and individual caries risk was correctly annotated. There was 100% compliance with the protocol for preventive plans. CONCLUSIONS The use of CRA improved documentation of caries risk status. This has improved subsequent prescription of age specific evidence-based preventive care appropriate to the risk status of that individual. Barriers were identified to the delivery of CRA and the provision of comprehensive preventive care by the dentists and other healthcare professionals.
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Raphael S, Blinkhorn A. Is there a place for Tooth Mousse in the prevention and treatment of early dental caries? A systematic review. BMC Oral Health 2015; 15:113. [PMID: 26408042 PMCID: PMC4583988 DOI: 10.1186/s12903-015-0095-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022] Open
Abstract
Background It is important for Dental Professionals to consider the evidence for the effectiveness of the preventive strategies used to maintain good oral health and reduce the risk of caries in their patients. Whilst many of the traditional preventive activities, including the recommendation and use of fluoride products and the placement of fissure sealants have a wealth of clinical evidence to support their use, some of the newer preventive agents have a more limited evidence base. In order to investigate the level of scientific support behind one such technology, a systematic literature review was carried out to assess the effectiveness of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) in the prevention and treatment of early dental caries. Methods A broad search strategy using Medline via OvidSP and EMBASE was performed in order to capture all published studies to related Casein Phosphopeptide-Amorphous Calcium Phosphate. In addition to the above searches the terms “CPP ACP” and “casein phosphopeptide amorphous calcium phosphate” were searched using PREMEDLINE and the Cochrane Central Register of Controlled Trials. Inclusion criteria were clinical trials of participants of any age, comparing the use of Tooth Mousse® (MI Paste®) or Tooth Mousse Plus® (MI Paste Plus®) to a routine oral care regimen and reporting recognised clinical outcome measures for early caries lesions. Only research studies in English were selected. Results 7576 articles were identified, but the majority were duplicates. Once these were removed 172 articles were inspected and the focus on ‘CPP-ACP formulations of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) resulted in 29 articles being selected, and of these 12 studies met the inclusion criteria and were considered acceptable for the systematic review. Discussion The overall findings of this review did not show any significant benefits of using Tooth Mousse® (MI Paste®) products over brushing with a fluoride toothpaste for the prevention of early dental caries. With regard to the regression of white spot lesions in orthodontic patients there is a tendency towards a benefit for the use of Tooth Mousse® (MI Paste®) but the quality of evidence is limited. There is a lack of evidence to support the use of Tooth Mousse Plus® (MI Paste Plus®) over Tooth Mousse® (MI Paste®) at this time. Conclusion This review suggests that further well-designed randomized controlled trials are required prior to the widespread recommendation of Tooth Mousse® products for the prevention and treatment of early dental caries in the general population. Electronic supplementary material The online version of this article (doi:10.1186/s12903-015-0095-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Raphael
- Department of Population Oral Health, Faculty of Dentistry, The University of Sydney, 1 Mons Road, Westmead, NSW, 2145, Australia. .,Colgate Palmolive Pty. Ltd, 345 George Street, Sydney, NSW, 2000, Australia.
| | - Anthony Blinkhorn
- Department of Population Oral Health, Faculty of Dentistry, The University of Sydney, 1 Mons Road, Westmead, NSW, 2145, Australia.
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18
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Aljafari A, Rice C, Gallagher JE, Hosey MT. An oral health education video game for high caries risk children: study protocol for a randomized controlled trial. Trials 2015; 16:237. [PMID: 26016586 PMCID: PMC4451717 DOI: 10.1186/s13063-015-0754-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background Tooth decay is the most common chronic disease of childhood in the world. Many children develop caries early in their lives, and go on to develop further caries and sepsis as they grow up, indicating failure in prevention. As a result, many end up requiring general anaesthesia to undergo treatment for a disease that is completely preventable. Previous studies have suggested that the families of these children need better oral health education as well as better support in implementing healthy practices at home, as they feel impeded by broader life challenges. Parents of these children have suggested utilizing modern technologies, such as the internet, DVDs and video games as methods of delivery of education that might fit in with their busy lifestyles. The aim of this investigation is to assess the acceptability and efficiency of an oral health education video game directed at these children and their families. Methods/Design A two-armed phase-II randomized controlled trial will assess a children’s oral health education video game in comparison with verbal oral health education in terms of: family satisfaction, effect on oral health knowledge, and effect on dietary and oral hygiene habits. Up to 110 four- to ten-year-old children, referred for tooth extraction under general anaesthesia due to caries, will be recruited. A sample of 45 participants in each group will be needed to provide 80 % statistical power. The primary outcome measures for this study are: (1) parent and child satisfaction with the intervention, as indicated using a visual analogue scale; (2) improvement in the child’s dietary knowledge measured by a pictorial dietary quiz; and (3) changes in the child’s diet and oral hygiene habits, measured using a children’s dietary questionnaire completed by the parent, and snacking and toothbrushing diaries completed by the child. Measures will be taken at baseline, directly after the intervention, and three months later. Discussion This study is a phase-II randomized controlled trial of an oral health education video game for high caries risk children and their families. Few protocols such as this are available in this much-needed research area. Trial registration ISRCTN94617251.
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Affiliation(s)
- Ahmad Aljafari
- Division of Population and Patient Health, King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK.
| | - Colm Rice
- Western Isles Dental Centre, MacAulay Road, Stornoway, Isle of Lewis, HS1 2BB, UK.
| | - Jennifer Elizabeth Gallagher
- Division of Population and Patient Health, King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK.
| | - Marie Therese Hosey
- Division of Population and Patient Health, King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK.
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Aljafari AK, Gallagher JE, Hosey MT. Failure on all fronts: general dental practitioners' views on promoting oral health in high caries risk children--a qualitative study. BMC Oral Health 2015; 15:45. [PMID: 25888427 PMCID: PMC4403841 DOI: 10.1186/s12903-015-0032-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/25/2015] [Indexed: 11/25/2022] Open
Abstract
Background Despite overall improvements in oral health, a large number of children in United Kingdom (UK) are affected by dental caries; and the implementation of oral health promotion in some families remains a challenge. As such, children from those families suffer high caries rates, and are frequently referred for tooth extraction under General Anaesthesia (GA), one of the commonest reasons for paediatric hospital admissions. The aim of this investigation is to explore referring primary care General Dental Practitioners’ (GDPs) views and experiences in trying to promote better oral health for those children. Method A qualitative study, utilizing face-to-face, semi-structured interviews with GDPs in three London boroughs who refer children for extraction of decayed teeth under GA selected based on referral rate. Qualitative Framework Analysis was used to present the results. Results Eighteen GDPs (56% male) were interviewed: average age 42 years (range: 26–73 years). informants reported challenges to promotion of oral health categorised as: (1) child’s young age, poor cooperation, and high treatment need; (2) parental skills to face up to modern day challenges and poor attitudes towards good oral health (3); social inequality, exclusion and cultural barriers in immigrant families; (4) National Health Services (NHS) primary care practice remuneration, constraints and training; (5) inadequate secondary care communication and engagement; and (6) failure in establishing national policy to grasp the width and depth of the problem. Conclusion GDPs feel frustrated and isolated in their efforts to promote oral health in those children. These findings suggest difficult challenges on all fronts. Reform of preventive dentistry funding and delivery, as well as a multiagency multidimensional approach that is mindful of the social determinants of children’s oral health and barriers to application of oral and wider health initiatives are needed to address this important public health issue.
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Affiliation(s)
- Ahmad K Aljafari
- Division of Population and Patient Health, King's College London Dental institute, Bessemer Road, London, SE5 9RS, UK.
| | - Jennifer Elizabeth Gallagher
- Division of Population and Patient Health, King's College London Dental institute, Bessemer Road, London, SE5 9RS, UK.
| | - Marie Therese Hosey
- Division of Population and Patient Health, King's College London Dental institute, Bessemer Road, London, SE5 9RS, UK.
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Macey R, Glenny A, Walsh T, Tickle M, Worthington H, Ashley J, Brocklehurst P. The efficacy of screening for common dental diseases by hygiene-therapists: a diagnostic test accuracy study. J Dent Res 2015; 94:70S-78S. [PMID: 25604256 PMCID: PMC4541095 DOI: 10.1177/0022034514567335] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Regularly attending adult patients are increasingly asymptomatic and not in need of treatment when attending for their routine dental examinations. As oral health improves further, using the general dental practitioner to undertake the "checkup" on regular "low-risk" patients represents a substantial and potentially unnecessary cost for state-funded systems. Given recent regulatory changes in the United Kingdom, it is now theoretically possible to delegate a range of tasks to hygiene-therapists. This has the potential to release the general dental practitioner's time and increase the capacity to care. The aim of this study is to compare the diagnostic test accuracy of hygiene-therapists when screening for dental caries and periodontal disease in regularly attending asymptomatic adults who attend for their checkup. A visual screen by hygiene-therapists acted as the index test, and the general dental practitioner acted as the reference standard. Consenting asymptomatic adult patients, who were regularly attending patients at 10 practices across the Northwest of England, entered the study. Both sets of clinicians made an assessment of dental caries and periodontal disease. The primary outcomes measured were the sensitivity and specificity values for dental caries and periodontal disease. In total, 1899 patients were screened. The summary point for sensitivity of dental care professionals when screening for caries and periodontal disease was 0.81 (95% CI, 0.74 to 0.87) and 0.89 (0.86 to 0.92), respectively. The summary point for specificity of dental care professionals when screening for caries and periodontal disease was 0.87 (0.78 to 0.92) and 0.75 (0.66 to 0.82), respectively. The results suggest that hygiene-therapists could be used to screen for dental caries and periodontal disease. This has important ramifications for service design in public-funded health systems.
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Affiliation(s)
- R Macey
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
| | - A Glenny
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
| | - T Walsh
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
| | - M Tickle
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
| | - H Worthington
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
| | - J Ashley
- General Dental Practitioner, Woodlands Dental Practice, Wirral, UK
| | - P Brocklehurst
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
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Goodwin M, Sanders C, Davies G, Walsh T, Pretty IA. Issues arising following a referral and subsequent wait for extraction under general anaesthetic: impact on children. BMC Oral Health 2015; 15:3. [PMID: 25595299 PMCID: PMC4324052 DOI: 10.1186/1472-6831-15-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 01/05/2015] [Indexed: 11/26/2022] Open
Abstract
Background Untreated caries in young children can result in a referral for extraction in hospital under general anaesthetic (GA). This study aims to explore the impact of caries during the ensuing wait for GA on children resident in the North West of England. Methods The study involved 456 respondents referred to six hospitals in the Northwest of England. Over a two-month period each of these children/ families completed a questionnaire and gave permission to access their referral and consultation notes. Results Children (6.78 years old: 1.50 to 16.42) had on average five teeth extracted (ranging from one to a full clearance, with all teeth removed). Sixty seven per cent of parents reported their child had been in pain, 26% reported schools days being missed and 38% having sleepless nights. The average time from referral to operation was 137 days. Results indicated that children could be in discomfort during their wait, as pain was experienced, on average, 14 days before the operation. Wait time significantly predicated the number of sleepless nights b = .004, t(340) = 2.276, p = .023. Conclusions It is clear that pain, sleepless nights and missed school are a feature during a wait for dental GA and can be exacerbated by an extended wait. These data support the need for not only effective prevention of caries within primary care to reduce wait times and experience of GA but also effective management of pain and infection during a prolonged wait for treatment.
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Affiliation(s)
- Michaela Goodwin
- The Dental Health Unit, School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, M15 6SE Manchester, England.
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Blinkhorn F, Wallace J, Smith L, Blinkhorn AS. Developing leaflets to give dental health advice to Aboriginal families with young children. Int Dent J 2014; 64:195-9. [PMID: 24827698 DOI: 10.1111/idj.12108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Dental caries (decay) is a serious problem for young Aboriginal children, causing pain and stress. Treatment often involves extraction of teeth under a general anaesthetic. However, dental caries can be prevented by reducing the frequency of sugar consumption and brushing teeth twice a day with fluoride toothpaste. Such straightforward advice could be given to families by Aboriginal Health Workers who are trusted by their communities and have an existing advisory role. This paper reports on the development of dental health advice leaflets for use in Aboriginal communities. METHODS An Aboriginal reference panel was recruited to comment on dental health advice leaflets prepared by an Aboriginal graphic designer. The panel was asked to consider the design, cultural appropriateness and practicality of the leaflets. Comments were collected through email and face-to-face discussions, which were collated and the leaflets altered accordingly. RESULTS The advice from the panel resulted in greater use of pictures. For example large green ticks and red crosses highlighted healthy and unhealthy behaviours, respectively. The tooth brushing leaflet was amended to emphasise the safe storage of toothpaste in order to keep it out of reach of young children. The panel stated that all leaflets should incorporate the Aboriginal flag, and proposed that fridge magnets might be beneficial as all family members would benefit from seeing the messages every day. CONCLUSION The consultation process refined dental advice leaflets to reflect the views of an Aboriginal Reference Panel, in terms of design, cultural competence and practicality.
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Affiliation(s)
- Fiona Blinkhorn
- Faculty of Health, School of Health Sciences, The University of Newcastle, Ourimbah, NSW, Australia
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Milsom KM, Rice A, Kearney-Mitchell P, Kellett L. A review of a child population dental preventive programme in Halton and St Helens. Br Dent J 2014; 216:E18. [DOI: 10.1038/sj.bdj.2014.334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Davies RM, Blinkhorn AS. Preventing dental caries: part 1. the scientific rationale for preventive advice. ACTA ACUST UNITED AC 2013; 40:719-20, 722, 724-6. [DOI: 10.12968/denu.2013.40.9.719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Robin M Davies
- Dental School, Coupland III, Manchester University, Higher Cambridge Street, Manchester M15 6FH, UK
| | - Anthony S Blinkhorn
- Professor and NSW Health Chair – Population Oral Health, Faculty of Dentistry, University of Sydney, 1 Mons Road, Westmead, NSW 2145, Australia
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Protocol for diagnostic test accuracy study: the efficacy of screening for common dental diseases by dental care professionals. BMC Oral Health 2013; 13:45. [PMID: 24053760 PMCID: PMC3849956 DOI: 10.1186/1472-6831-13-45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 09/13/2013] [Indexed: 12/27/2022] Open
Abstract
Background The bulk of service delivery in dentistry is delivered by general dental practitioners, when a large proportion of patients who attend regularly are asymptomatic and do not require treatment. This represents a substantial and unnecessary cost, given that it is possible to delegate a range of tasks to dental care professionals, who are a less expensive resource. Screening for the common dental diseases by dental care professionals has the potential to release general dental practitioner’s time and increase the capacity to care for those who don't currently access services. The aim of this study is to compare the diagnostic test accuracy of dental care professionals when screening for dental caries and periodontal disease in asymptomatic adults aged eighteen years of age. Methods/design Ten dental practices across the North-West of England will take part in a diagnostic test accuracy study with 200 consecutive patients in each practice. The dental care professionals will act as the index test and the general dental practitioner will act as the reference test. Consenting asymptomatic patients will enter the study and see either the dental care professionals or general dental practitioner first to remove order effects. Both sets of clinicians will make an assessment of dental caries and periodontal disease and enter their decisions on a record sheet for each participant. The primary outcome measure is the diagnostic test accuracy of the dental care professionals and sensitivity, specificity, positive predictive value and negative predictive values will be reported. A number of clinical factors will be assessed for confounding. Discussion The results of this study will determine whether dental care professionals can screen for the two most prevalent oral diseases. This will inform the literature and is apposite given the recent policy change in the United Kingdom towards direct access.
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Brewster L, Sherriff A, Macpherson L. Effectiveness and reach of a directed-population approach to improving dental health and reducing inequalities: a cross sectional study. BMC Public Health 2013; 13:778. [PMID: 23978217 PMCID: PMC3765943 DOI: 10.1186/1471-2458-13-778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 08/16/2013] [Indexed: 11/29/2022] Open
Abstract
Background Childsmile School adopts a directed-population approach to target fluoride varnish applications to 20% of the primary one (P1) population in priority schools selected on the basis of the proportion of enrolled children considered to be at increased-risk of developing dental caries. The study sought to compare the effectiveness of four different methods for identifying individuals most in need when a directed-population approach is taken. Methods The 2008 Basic National Dental Inspection Programme (BNDIP) cross-sectional P1 Scottish epidemiological survey dataset was used to model four methods and test three definitions of increased-risk. Effectiveness was determined by the positive predictive value (PPV) and explored in relation to 1-sensitivity and 1-specificity. Results Complete data was available on 43470 children (87% of the survey). At the Scotland level, at least half (50%) of the children targeted were at increased-risk irrespective of the method used to target or the definition of increased-risk. There was no one method across all definitions of increased-risk that maximised PPV. Instead, PPV was highest when the targeting method complimented the definition of increased-risk. There was a higher percentage of children at increased-risk who were not targeted (1-sensitivity) when caries experience (rather than deprivation) was used to define increased-risk, irrespective of the method used for targeting. Over all three definitions of increased-risk, there was no one method that minimised (1-sensitivity) although this was lowest when the method and definition of increased-risk were complimentary. The false positive rate (1-specificity) for all methods and all definitions of increased-risk was consistently low (<20%), again being lowest when the method and definition of increased-risk were complimentary. Conclusion Developing a method to reach all (or even the vast majority) of individuals at increased-risk defined by either caries experience or deprivation is difficult using a directed-population approach at a group level. There is a need for a wider debate between politicians and public health experts to decide how best to reach those most at need of intervention to improve health and reduce inequalities.
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Affiliation(s)
- Lynn Brewster
- Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, Scotland.
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Caries incidence in a cohort of primary school students in Lagos State, Nigeria followed up over a 3 years period. Eur Arch Paediatr Dent 2013; 13:312-8. [PMID: 23235132 DOI: 10.1007/bf03320833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To describe the progression of dental caries in pupils who had access to an education intervention programme over a three years period. STUDY DESIGN This was a prospective cohort study. METHODS A school-based study consisting of 251 children aged 2-10 years old attending three primary schools in Lagos State, Nigeria. Baseline and exit dental examinations were conducted. Study exit examination was conducted 3 years after the baseline. The deft and DMFT index was used to assess caries severity. The key outcome measure recorded in the study was the development of new cavities in any of the previously caries-free teeth. The presence or absence of caries was represented by the change in deft and or DMFT status. STATISTICS In the analyses, the incidence of new cavities was recorded at both the subject and tooth levels. Incidence rates for the development of new caries were calculated for all children who: were caries-free at recruitment had caries at recruitment were caries-free at recruitment but developed caries during follow up. Relative risk (RR) analysis was also computed for caries-risk estimation. RESULTS The caries incidence for the study cohort was 9.9%. About 11.0% of children who were caries free at inception of the study developed caries three years later. The cumulative incidence of caries for the cohort of children who were caries-free at the commencement of the study was 105 new cases per 1,000 persons. Of the 40 children who had caries at the inception of the study, 21 (52.5%) developed new caries lesions. The cumulative incidence of caries for the cohort of children who had caries at the commencement of the study was 525 new cases per 1,000 persons. The relative risk of developing caries over a three year period was significantly higher (RR=4.99; 95% CI = 2.88 - 8.64; p< 0.001) in those who had caries at baseline than those who were caries-free at baseline. Caries severity remained stable over the 3 years period. CONCLUSIONS Caries incidence and severity was low for the study cohort. The relative risk of developing new caries lesion was significantly higher in those with caries when compared with those without caries.
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Leroy R, Declerck D. Impact of caries onset on number and distribution of new lesions in preschool children. Int J Paediatr Dent 2013; 23:39-47. [PMID: 22276749 DOI: 10.1111/j.1365-263x.2012.01222.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Caries in preschool children remains an important public health issue. AIM To determine (i) which teeth and tooth surfaces are most susceptible to dental caries by age 3, (ii) where do caries lesions develop during 2-year follow-up, and (iii) to evaluate the impact of caries onset on the distribution of new caries experience. DESIGN One thousand and fifty seven consecutively born children were recruited in Flanders (Belgium). Parents completed validated questionnaires on oral health-related behaviour and trained dentists examined the children at ages 3 and 5. RESULTS Children with visible caries experience at age 3 were significantly more vulnerable in developing additional caries during follow-up. In this group, new caries experience developed primarily in the occlusal and distal surfaces of the mandibular first molars and the occlusal surfaces of the maxillary second and first molars, whereas in the caries-free group, the occlusal surfaces of both mandibular and maxillary second molars ranked first. CONCLUSIONS This paper confirms the higher vulnerability for further caries development in those children with caries experience at age 3. Visible caries develops most frequently in the occlusal surfaces of the second molars: in high-risk children already by age 3 and in children who were caries free at baseline by age 5.
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Affiliation(s)
- Roos Leroy
- Department of Oral Health Sciences, KU Leuven, Belgium.
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Blinkhorn F, Brown N, Freeman R, Humphris G, Martin A, Blinkhorn A. A phase II clinical trial of a dental health education program delivered by aboriginal health workers to prevent early childhood caries. BMC Public Health 2012; 12:681. [PMID: 22909327 PMCID: PMC3520707 DOI: 10.1186/1471-2458-12-681] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/14/2012] [Indexed: 11/22/2022] Open
Abstract
Background Early Childhood Caries (ECC) is a widespread problem in Australian Aboriginal communities causing severe pain and sepsis. In addition dental services are difficult to access for many Aboriginal children and trying to obtain care can be stressful for the parents. The control of dental caries has been identified as a key indictor in the reduction of Indigenous disadvantage. Thus, there is a need for new approaches to prevent ECC, which reflect the cultural norms of Aboriginal communities. Methods/Design This is a Phase II single arm trial designed to gather information on the effectiveness of a dental health education program for Aboriginal children aged 6 months, followed over 2 years. The program will deliver advice from Aboriginal Health Workers on tooth brushing, diet and the use of fluoride toothpaste to Aboriginal families. Six waves of data collection will be conducted to enable estimates of change in parental knowledge and their views on the acceptability of the program. The Aboriginal Health Workers will also be interviewed to record their views on the acceptability and program feasibility. Clinical data on the child participants will be recorded when they are 30 months old and compared with a reference population of similar children when the study began. Latent variable modeling will be used to interpret the intervention effects on disease outcome. Discussion The research project will identify barriers to the implementation of a family centered Aboriginal oral health strategy, as well as the development of evidence to assist in the planning of a Phase III cluster randomized study. Trial registration ACTRN12612000712808
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Affiliation(s)
- Fiona Blinkhorn
- School of Health Sciences, University of Newcastle, Ourimbah, New South Wales 2258, Australia
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dos Santos APP, Nadanovsky P, de Oliveira BH. A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dental caries in the primary dentition of preschool children. Community Dent Oral Epidemiol 2012; 41:1-12. [DOI: 10.1111/j.1600-0528.2012.00708.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Paulo Nadanovsky
- Department of Epidemiology; Institute of Social Medicine; University of the State of Rio de Janeiro; Brazil
| | - Branca Heloisa de Oliveira
- Department of Community and Preventive Dentistry; School of Dentistry; University of the State of Rio de Janeiro; Brazil
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Tickle M, Milsom KM, Donaldson M, Killough S, O'Neill C, Crealey G, Sutton M, Noble S, Greer M, Worthington HV. Protocol for Northern Ireland Caries Prevention in Practice Trial (NIC-PIP) trial: a randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services. BMC Oral Health 2011; 11:27. [PMID: 21985746 PMCID: PMC3196725 DOI: 10.1186/1472-6831-11-27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 10/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental caries is a persistent public health problem with little change in the prevalence in young children over the last 20 years. Once a child contracts the disease it has a significant impact on their quality of life. There is good evidence from Cochrane reviews including trials that fluoride varnish and regular use of fluoride toothpaste can prevent caries. The Northern Ireland Caries Prevention in Practice Trial (NIC-PIP) trial will compare the costs and effects of a caries preventive package (fluoride varnish, toothpaste, toothbrush and standardised dental health education) with dental health education alone in young children. METHODS/DESIGN A randomised controlled trial on children initially aged 2 and 3 years old who are regular attenders at the primary dental care services in Northern Ireland. Children will be recruited and randomised in dental practices. Children will be randomised to the prevention package of both fluoride varnish (twice per year for three years), fluoride toothpaste (1,450 ppm F) (supplied twice per year), a toothbrush (supplied twice a year) or not; both test and control groups receive standardised dental health education delivered by the dentist twice per year. Randomisation will be conducted by the Belfast Trust Clinical Research Support Centre ([CRSC] a Clinical Trials Unit). 1200 participants will be recruited from approximately 40 dental practices. Children will be examined for caries by independent dental examiners at baseline and will be excluded if they have caries. The independent dental examiners will examine the children again at 3 years blinded to study group.The primary end-point is whether the child develops caries (cavitation into dentine) or not over the three years. One secondary outcome is the number of carious surfaces in the primary dentition in children who experience caries. Other secondary outcomes are episodes of pain, extraction of primary teeth, other adverse events and costs which will be obtained from parental questionnaires. DISCUSSION This is a pragmatic trial conducted in general dental practice. It tests a composite caries prevention intervention, which represents an evidence based approach advocated by current guidance from the English Department of Health which is feasible to deliver to all low risk (caries free) children in general dental practice. The trial will provide valuable information to policy makers and clinicians on the costs and effects of caries prevention delivered to young children in general dental practice. TRIAL REGISTRATION EudraCT No: 2009 - 010725 - 39 ISRCTN: ISRCTN36180119 Ethics Reference No: 09/H1008/93:
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Affiliation(s)
- Martin Tickle
- School of Dentistry, the University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Keith M Milsom
- School of Dentistry, the University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Michael Donaldson
- Health and Social Care Board, County Hall. 182 Galgorm Road, Ballymena, County Antrim, Northern Ireland, BT42 1QB, UK
| | - Seamus Killough
- British Dental Association, 2 Woodstock Link, Belfast, County Antrim, Northern Ireland, BT6 8DD, UK
| | - Ciaran O'Neill
- Department of Economics, National University of Ireland, University Road Galway, County Galway, Ireland
| | - Grainne Crealey
- Northern Ireland Clinical Research Support Centre, Education and Research Centre, Royal Group of Hospitals Trust, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, UK
| | - Matthew Sutton
- School of Community Based Medicine, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Solveig Noble
- Northern Health and Social Care Trust, Greenmount Avenue, Ballymena, County Antrim, Northern Ireland, BT43 6DA, UK
| | - Margaret Greer
- Northern Ireland Clinical Research Support Centre, Education and Research Centre, Royal Group of Hospitals Trust, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, UK
- Northern Health and Social Care Trust, Greenmount Avenue, Ballymena, County Antrim, Northern Ireland, BT43 6DA, UK
| | - Helen V Worthington
- School of Dentistry, the University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Is skill mix profitable in the current NHS dental contract in England? Br Dent J 2011; 210:303-8. [PMID: 21475274 DOI: 10.1038/sj.bdj.2011.238] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2010] [Indexed: 11/08/2022]
Abstract
The use of skill mix in medicine is now widespread, yet it appears that its use in dentistry is not as prominent. Unlike doctors, dentists are required to mitigate the financial risk produced by their capital investment and ensure an adequate cash flow to cover their annual running costs. Examining the financial incentives for employing dental care professionals is therefore an important step to understand why dentistry appears to lag behind medicine in skill mix. It is also apposite, given the announcement of the coalition government to develop a new contract, which could introduce incentives for the use of dental care professionals in this way. The purpose of this short paper is to examine whether skill mix is profitable for general dental practices under the existing NHS contract in England.
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Arora A, Schwarz E, Blinkhorn AS. Risk factors for early childhood caries in disadvantaged populations. ACTA ACUST UNITED AC 2011; 2:223-8. [PMID: 25426892 DOI: 10.1111/j.2041-1626.2011.00070.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Early childhood caries is a significant international public health problem. The aim of this paper was to review the current evidence of the risk factors for dental caries in disadvantaged children under 6 years of age. Medline, Cochrane, and PubMed database searches were conducted. Systematic reviews were used where available, or meta-analyses; randomized, controlled trials; and cohort, case-control, and cross-sectional studies (in that order). Studies were restricted to those published in English from 1990 to October 2010. Early childhood caries has a complex etiology with biological, behavioral, and sociodemographic influences. Evidence suggests that young children are most likely to develop caries if Streptococcus mutans is acquired at an early age, although this is influenced by other factors, such as oral hygiene, fluoride, diet, dental visit patterns, socioeconomic status, ethnicity, and health literacy. Etiological pathways should be taken into consideration when designing interventions to prevent dental caries in disadvantaged preschool children.
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Affiliation(s)
- Amit Arora
- Department of Population Oral Health, Faculty of Dentistry, The University of Sydney, Sydney, NSW, Australia Department of Community Dentistry, School of Dentistry, Oregon Health and Science University, Portland, OR, USA
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Brocklehurst PR, Ashley JR, Tickle M. Patient assessment in general dental practice – risk assessment or clinical monitoring? Br Dent J 2011; 210:351-4. [PMID: 21509009 DOI: 10.1038/sj.bdj.2011.284] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2011] [Indexed: 11/09/2022]
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Abstract
UNLABELLED Water fluoridation schemes have been employed for over 50 years. Water fluoridation has been a source of continuous debate between those who advocate its use as a public health measure and those who oppose it. There have been no new fluoridation schemes in the U.K. for nearly 30 years owing to principally legislative, but also geographic, financial, and political reasons. However, in early 2008, the U.K. Secretary of State for Health promoted the use of water fluoridation schemes for areas in England with the highest rates of decay. This article, the third and final article of three, aims to discuss the arguments surrounding water fluoridation and its continued relevance as a public health measure. CLINICAL RELEVANCE This article aims to provide an update for general practitioners for the background and the current status of the water fluoridation debate and to enable them to answer non-clinical questions raised by patients.
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Affiliation(s)
- Michael G McGrady
- Dental Public Health, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK
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Preventing decay in children: dare we risk the 'risk assessment' model in practice? Br Dent J 2010; 209:159-60. [DOI: 10.1038/sj.bdj.2010.720] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2010] [Indexed: 11/08/2022]
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Page J, Weld JA, Kidd EAM. Caries control in health service practice. Br Dent J 2010; 208:449-50. [PMID: 20489764 DOI: 10.1038/sj.bdj.2010.447] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2010] [Indexed: 11/09/2022]
Abstract
It is suggested that it makes sense for dentists providing care for individual patients to take account of caries risk (as assessed by presentation of active, non-cavitated lesions) when deciding how to allocate time and effort of themselves and their staff. However, there is a question as to how realistic it is to ask the dental team to provide a full diagnostic assessment and all the preventive treatment required for a patient for the payment provided by 1 UDA. It is to be hoped that one or more of the Steele pilots will come up with a practical solution for controlling caries in NHS practice.
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Affiliation(s)
- J Page
- Paediatric Dentistry, Seagull Apartment, 13A Broad Street, Portsmouth, PO1 2JD.
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Tickle M, Milsom K. The whole population approach to caries prevention in general dental practice. Br Dent J 2008; 205:521. [DOI: 10.1038/sj.bdj.2008.985] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Change the bathwater. Br Dent J 2008; 205:413. [DOI: 10.1038/sj.bdj.2008.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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