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Victory E, Rhiannon ET, Girvan B, Pauline A, Cynthia PM. Cost-effectiveness Analysis of the Dental RECUR Pragmatic Randomized Controlled Trial: Evaluating a Goal-oriented Talking Intervention to Prevent Reoccurrence of Dental Caries in Children. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:431-445. [PMID: 35298778 PMCID: PMC9021113 DOI: 10.1007/s40258-022-00720-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The formation of dental caries is the most common chronic disease in children, and is preventable. The oral health-related quality of life has an immense impact on an individual's daily functioning, well-being or overall quality of life. OBJECTIVES This study aims to investigate the cost effectiveness of the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI). This 30-minute therapeutic "talk" by a dental nurse with a parent/guardian was compared with a placebo-controlled intervention in preventing reoccurrence of dental caries in children who have had a primary tooth extracted. METHODS An economic model was developed to simulate the clinical progression of dental caries among children who have previously had a primary tooth extracted. The analysis was conducted using the UK NHS perspective. The main outcome was the incremental cost-effectiveness ratio (ICER) based on the quality-adjusted life years (QALYs). Estimates of costs and probabilities were obtained from the DR-BNI multicentre randomised controlled trial (RCT), while QALY values were obtained from published literature. Univariate and probabilistic sensitivity analyses were conducted to assess the uncertainty of the result and robustness of the model. Affordability and risk-aversion of the intervention were investigated to help decision makers make the best possible choices. RESULTS With an intervention cost of £6.47, the results from the RCT showed the healthcare cost for the DR-BNI intervention was £115.90 per child while the control had a healthcare cost of £119.46 per child. The QALYs gained for the prevention of reoccurrence of dental caries was higher in the DR-BNI intervention arm by 0.023 QALYs; thus, the DR-BNI was the dominant intervention. At willingness to pay threshold of £3500/QALY gained, a maximum probability of being cost effectiveness is achieved at 86%. The secondary analysis showed a cost-savings of £20.94 per participant for the prevention of at least one filling or extraction. Affordability results showed that the DR-BNI programme is affordable to the UK health system at a moderately low budget. CONCLUSIONS This study shows the proactive talking intervention to have a very moderate cost and to be effective in providing better health related quality-of-life gains. The intervention is cost savings with a dominant ICER even with a 200% increase in the cost of intervention. The NHS will be providing better oral health for children at a better net monetary benefit-to-risk ratio by adopting the DR-BNI intervention in preventing the reoccurrence of dental fillings and extractions for each participant. TRIAL REGISTRATION This trial was registered prospectively on 27th September 2013 with the trial registration number ISRCTN 24958829.
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Affiliation(s)
- Ezeofor Victory
- Centre for Health Economics and Medicines Evaluations, Bangor University, Bangor, UK.
| | - Edwards T Rhiannon
- Centre for Health Economics and Medicines Evaluations, Bangor University, Bangor, UK
| | - Burnside Girvan
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Adair Pauline
- School of Psychology, Queen's University, Belfast, UK
| | - Pine M Cynthia
- School of Psychology, Queen's University, Belfast, UK
- Salford Royal NHS Foundation Trust, Salford, England
- Kippax Design Ltd, Colchester, Essex, UK
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Lieffers JRL, Vanzan AGT, Rover de Mello J, Cammer A. Nutrition Care Practices of Dietitians and Oral Health Professionals for Oral Health Conditions: A Scoping Review. Nutrients 2021; 13:nu13103588. [PMID: 34684589 PMCID: PMC8539677 DOI: 10.3390/nu13103588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/02/2021] [Accepted: 10/02/2021] [Indexed: 02/04/2023] Open
Abstract
Background: Oral health conditions, such as dental caries, pose a substantial burden worldwide. Although there are many risk factors for poor oral health, diet is often implicated as a cause of these issues. The purpose of this scoping review was to identify and map studies that have captured information on the “real-world” nutrition care practices of oral health professionals (OHPs) and dietitians to optimize oral health, and specifically the dentition and periodontium. Methods: A search of peer-reviewed articles was conducted using MEDLINE, CINAHL, and Embase. Articles that addressed the review objective and met the following criteria were included: English language, published since 2000, and study conducted in a high-income country. Results: Overall, 70 articles were included. Most articles reported on cross-sectional survey studies and provided self-reported data on OHP practices; few articles reported on dietitians. Most articles reported only general/unspecific information on assessment and intervention practices, such as dietary analysis, nutrition counselling, and diet advice, and lacked specific information about the care provided, such as the dietary assessment tools used, type of information provided, and time spent on these activities. Barriers to the provision of nutrition care by OHPs were common and included time and lack of remuneration. Few studies reported on collaboration between dietitians and OHPs. Conclusions: Several studies have captured self-reported information on nutrition care practices of OHPs related to oral health; however, there is limited information available on the details of the care provided. Few studies have examined the practices of dietitians.
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Soldani FA, Lamont T, Jones K, Young L, Walsh T, Lala R, Clarkson JE. One-to-one oral hygiene advice provided in a dental setting for oral health. Cochrane Database Syst Rev 2018; 10:CD007447. [PMID: 30380139 PMCID: PMC6516798 DOI: 10.1002/14651858.cd007447.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Effective oral hygiene measures carried out on a regular basis are vital to maintain good oral health. One-to-one oral hygiene advice (OHA) within the dental setting is often provided as a means to motivate individuals and to help achieve improved levels of oral health. However, it is unclear if one-to-one OHA in a dental setting is effective in improving oral health and what method(s) might be most effective and efficient. OBJECTIVES To assess the effects of one-to-one OHA, provided by a member of the dental team within the dental setting, on patients' oral health, hygiene, behaviour, and attitudes compared to no advice or advice in a different format. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 November 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 10) in the Cochrane Library (searched 10 November 2017); MEDLINE Ovid (1946 to 10 November 2017); and Embase Ovid (1980 to 10 November 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were also searched for ongoing trials (10 November 2017). No restrictions were placed on the language or date of publication when searching the electronic databases. Reference lists of relevant articles and previously published systematic reviews were handsearched. The authors of eligible trials were contacted, where feasible, to identify any unpublished work. SELECTION CRITERIA We included randomised controlled trials assessing the effects of one-to-one OHA delivered by a dental care professional in a dental care setting with a minimum of 8 weeks follow-up. We included healthy participants or participants who had a well-defined medical condition. DATA COLLECTION AND ANALYSIS At least two review authors carried out selection of studies, data extraction and risk of bias independently and in duplicate. Consensus was achieved by discussion, or involvement of a third review author if required. MAIN RESULTS Nineteen studies met the criteria for inclusion in the review with data available for a total of 4232 participants. The included studies reported a wide variety of interventions, study populations, clinical outcomes and outcome measures. There was substantial clinical heterogeneity amongst the studies and it was not deemed appropriate to pool data in a meta-analysis. We summarised data by categorising similar interventions into comparison groups.Comparison 1: Any form of one-to-one OHA versus no OHAFour studies compared any form of one-to-one OHA versus no OHA.Two studies reported the outcome of gingivitis. Although one small study had contradictory results at 3 months and 6 months, the other study showed very low-quality evidence of a benefit for OHA at all time points (very low-quality evidence).The same two studies reported the outcome of plaque. There was low-quality evidence that these interventions showed a benefit for OHA in plaque reduction at all time points.Two studies reported the outcome of dental caries at 6 months and 12 months respectively. There was very low-quality evidence of a benefit for OHA at 12 months.Comparison 2: Personalised one-to-one OHA versus routine one-to-one OHAFour studies compared personalised OHA versus routine OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis, plaque or dental caries (very low quality).Comparison 3: Self-management versus professional OHAFive trials compared some form of self-management with some form of professional OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis or plaque (very low quality). None of the studies measured dental caries.Comparison 4: Enhanced one-to-one OHA versus one-to-one OHASeven trials compared some form of enhanced OHA with some form of routine OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis, plaque or dental caries (very low quality). AUTHORS' CONCLUSIONS There was insufficient high-quality evidence to recommend any specific one-to-one OHA method as being effective in improving oral health or being more effective than any other method. Further high-quality randomised controlled trials are required to determine the most effective, efficient method of one-to-one OHA for oral health maintenance and improvement. The design of such trials should be cognisant of the limitations of the available evidence presented in this Cochrane Review.
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Affiliation(s)
- Francesca A Soldani
- Bradford District Care NHS Foundation TrustCommunity Dental ServiceBradfordUK
| | - Thomas Lamont
- University of Dundee, Dental School & HospitalPark PlaceDundeeTaysideUKDD1 4HN
| | | | - Linda Young
- NHS Education for ScotlandScottish Dental Clinical Effectiveness ProgrammeDundee Dental Education CentreSmall's WyndDundeeUKDD1 4HN
| | - Tanya Walsh
- The University of ManchesterDivision of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Rizwana Lala
- School of Clinical Dentistry, University of SheffieldUnit of Dental Public HealthClaremont CrescentSheffieldUKS10 2TA
| | - Janet E Clarkson
- Dundee Dental School, University of DundeeDivision of Oral Health SciencesPark PlaceDundeeScotlandUKDD1 4HR
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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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Patil RU, Sahu A, Kambalimath HV, Panchakshari BK, Jain M. Knowledge, Attitude and Practice among Dental Practitioners Pertaining to Preventive Measures in Paediatric Patients. J Clin Diagn Res 2016; 10:ZC71-ZC75. [PMID: 28209009 DOI: 10.7860/jcdr/2016/22300.9122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/17/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prevention at primary level is of great value in Paediatric Dentistry. Since use of preventive measures can prevent future complications, dental professionals share an important responsibility toward early screening, prompt referral and treatment and this knowledge must transfer into the practice of dentistry. AIM To evaluate Knowledge, Attitude and Practice (KAP) among dental practitioners in Bhopal city (central part of India) pertaining to sealants, topical fluorides usage and orthodontic consideration in paediatric patients. MATERIALS AND METHODS A descriptive cross-sectional survey was conducted using a 20-item self-administered, closed ended, structured questionnaire. A total of 200 available private dental practitioners of Bhopal city made up the sampling frame of study. RESULTS Out of 200 practicing dentists, 147 participated with response rate of 73.5% in which 69.4% were males and 30.6% were females. A total of 83% dentists were less than 35 years of age, while 17% were equal to or more than 35 years of age. Qualification distribution revealed 67.3% dental graduate and 32.6% dental specialist. A highly significant difference in knowledge in relation to age was observed. The mean±SD were found for Knowledge as 8.46±1.82, Attitude as 2.65±0.780, and Practice as 1.66±1.57. Statistically significant correlations were found between attitude and practice (r=0.58, p<0.001). CONCLUSION Dentists in Bhopal city have vast knowledge towards preventive dentistry. The attitude is highly commendable but underutilized in practice, which needs to be improved.
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Affiliation(s)
- Raju Umaji Patil
- Professor and Head, Department of Paedodontics, STES Sinhgad Dental College and Hospital , Vadgoan, Pune, Maharashtra, India
| | - Amitkumar Sahu
- Postgraduate Student, Department of Paedodontics, Rishiraj College of Dental Sciences , Bhopal, Madhya Pradesh, India
| | - Halaswamy V Kambalimath
- Professor and Head, Department of Paedodontics, Rishiraj College of Dental Sciences , Bhopal, Madhya Pradesh, India
| | | | - Manish Jain
- Assistant Professor, Department of Public Health Dentistry, Peoples Dental Academy , Bhopal, Madhya Pradesh, India
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Masoe AV, Blinkhorn AS, Taylor J, Blinkhorn FA. Factors that influence the preventive care offered to adolescents accessing Public Oral Health Services, NSW, Australia. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2015; 6:101-13. [PMID: 26124689 PMCID: PMC4476312 DOI: 10.2147/ahmt.s84332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Many adolescents are at risk of dental caries and periodontal disease, which may be controlled through health education and clinical preventive interventions provided by oral health and dental therapists (therapists). Senior clinicians (SCs) can influence the focus of dental care in the New South Wales (NSW) Public Oral Health Services as their role is to provide clinical support and advice to therapists, advocate for their communities, and inform Local Health District (LHD) managers of areas for clinical quality improvement. The objective of this study was to record facilitating factors and strategies that are used by SCs to encourage therapists to provide preventive care and advice to adolescent patients. METHODS In-depth, semistructured interviews were undertaken with 16 SCs from all of the 15 NSW LHDs (nine rural and six metropolitan). A framework matrix was used to systematically code data and enable key themes to be identified for analysis. RESULTS All SCs from the 15 NSW Health LHDs participated in the study. Factors influencing SCs' ability to integrate preventive care into clinical practice were: 1) clinical leadership and administrative support, 2) professional support network, 3) clinical and educational resources, 4) the clinician's patient management aptitude, and 5) clinical governance processes. Clinical quality improvement and continuing professional development strategies equipped clinicians to manage and enhance adolescents' confidence toward self-care. CONCLUSION This study shows that SCs have a clear understanding of strategies to enhance the therapist's offer of scientific-based preventive care to adolescents. The problem they face is that currently, success is measured in terms of relief of pain activities, restorations placed, and extraction of teeth, which is an outdated concept. However, to improve clinical models of care will require the overarching administrative authority, NSW Health, to accept that the scientific evidence relating to dental care has changed and that management monitoring information should be incorporated into NSW Health reforms.
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Affiliation(s)
- Angela V Masoe
- School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia
| | - Anthony S Blinkhorn
- Department of Population Oral Health, Faculty of Dentistry, University of Sydney, Westmead, NSW, Australia
| | - Jane Taylor
- School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia
| | - Fiona A Blinkhorn
- School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia
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Masoe AV, Blinkhorn AS, Taylor J, Blinkhorn FA. An assessment of preventive care offered to orthodontic patients by oral health therapists in NSW Australia. Int Dent J 2015; 65:196-202. [PMID: 25931011 DOI: 10.1111/idj.12169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to record preventive oral health care planned by dental therapists and oral health therapists (therapists) for patients with poor oral hygiene undergoing orthodontic treatment. MATERIALS AND METHODS A cross-sectional survey, using a clinical vignette of a patient with poor oral hygiene undergoing therapy with a fixed appliance, was undertaken to record the preventive care offered to this individual by therapists working across 15 Local Health Districts (LHDs). This orthodontic vignette was inserted between two dental caries-related vignettes. Data were coded and descriptive statistics were used to report the findings. RESULTS One-hundred and seventeen therapists returned questionnaires (giving a response rate of 64.6%), of whom 82.0% (n = 95) completed the orthodontic vignette. Adopting motivational interviewing techniques to facilitate communication with the patient and their parent was recommended by 88.4% (n = 84) respondents, 98.0% (n = 93) offered oral-hygiene instruction, 70.5% (n = 67) recorded plaque levels and used disclosing solution and 60.0% (n = 57) offered dietary advice. Products recommended for use at home included fluoride toothpaste [1,450 ppm F (80.0%; n = 76) and 5,000 ppm F (59.0%; n = 24)] and casein phosphopeptide amorphous phosphates plus fluoride (CPP-ACPF) paste (33.3%; n = 32). Less than 20% offered fissure sealants. CONCLUSION Preventive advice and care was offered inconsistently by therapists in this study. To ensure that all therapists adopt a scientifically based approach to prevention, LHD clinical directors should implement continuous professional education programmes for therapists to improve patient's health outcomes.
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Affiliation(s)
- Angela V Masoe
- School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia
| | - Anthony S Blinkhorn
- Department of Population Oral Health, Faculty of Dentistry, University of Sydney, Westmead, NSW, Australia
| | - Jane Taylor
- School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia
| | - Fiona A Blinkhorn
- School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia
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Masoe AV, Blinkhorn AS, Taylor J, Blinkhorn FA. Preventive management plans recorded by dental therapists and oral health therapists using clinical vignettes for adolescents accessing public oral health services in New South Wales, Australia. Aust Dent J 2015; 61:21-28. [PMID: 25912297 DOI: 10.1111/adj.12336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to investigate factors that influence dental therapists and oral health therapists (therapists) plan preventive oral health care for adolescents attending New South Wales public oral health services. METHODS A cross-sectional postal survey using two clinical vignettes was used to record the preventive care treatment plans offered by therapists working across 15 New South Wales local health districts. Data were tabulated and chi-square statistics used in the analysis. RESULTS One hundred and seventeen therapists returned questionnaires, giving a 64.6% response rate. The participants highlighted the importance of offering oral hygiene instruction (97.0%), dietary advice (95.0%) and topical fluoride applications (74.0%). Recommended home use products included fluoride toothpaste 5000 ppmF (59.0%) and casein phosphopeptide-amorphous calcium phosphate plus fluoride (CPP-ACPF) paste (57.7%). Over 50% used fissure sealants. More respondents (88%) would utilize motivational interviewing strategies for a patient with dental caries concerns; however, only 63% would use this technique for a patient in pain (p < 0.001). CONCLUSIONS Considerable variations were noted in therapists' recommendations for stabilizing and managing dental disease, suggesting a need for clinical directors to consider providing more advice to therapists on the scientific basis of preventing dental caries.
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Affiliation(s)
- A V Masoe
- School of Health Sciences, Faculty of Health and Medicine, Oral Health Discipline, The University of Newcastle, Ourimbah, New South Wales, Australia
| | - A S Blinkhorn
- Population Oral Health Unit, Faculty of Dentistry, The University of Sydney, Westmead, New South Wales, Australia
| | - J Taylor
- School of Health Sciences, Faculty of Health and Medicine, Oral Health Discipline, The University of Newcastle, Ourimbah, New South Wales, Australia
| | - F A Blinkhorn
- School of Health Sciences, Faculty of Health and Medicine, Oral Health Discipline, The University of Newcastle, Ourimbah, New South Wales, Australia
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Masoe AV, Blinkhorn AS, Taylor J, Blinkhorn FA. Preventive and clinical care provided to adolescents attending public oral health services New South Wales, Australia: a retrospective study. BMC Oral Health 2014; 14:142. [PMID: 25432193 PMCID: PMC4266880 DOI: 10.1186/1472-6831-14-142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/04/2014] [Indexed: 11/20/2022] Open
Abstract
Background Dental Therapists and Oral Health Therapists (Therapists) working in the New
South Wales (NSW) Public Oral Health Service are charged with providing clinical
dental treatment including preventive care for all children under 18 years of age.
Adolescents in particular are at risk of dental caries and periodontal disease
which may be controlled through health education and clinical preventive
interventions. However, there is a dearth of evidence about the type or the
proportion of clinical time allocated to preventive care. The aim of this study is to record the proportion and type of preventive care
and clinical treatment activities provided by Therapists to adolescents accessing
the NSW Public Oral Health Service. Methods Clinical dental activity data for adolescents was obtained from the NSW Health
electronic Information System for Oral Health (ISOH) for the year 2011. Clinical
activities of Therapists were examined in relation to the provision of different
types of preventive care for adolescents by interrogating state-wide public oral
health data stored on ISOH. Results Therapists were responsible for 79.7 percent of the preventive care and 83.0
percent of the restorative treatment offered to adolescents accessing Public Oral
Health Services over the one year period. Preventive care provided by Therapists
for adolescents varied across Local Health Districts ranging from 32.0 percent to
55.8 percent of their clinical activity. Conclusions Therapists provided the majority of clinical care to adolescents accessing NSW
Public Oral Health Services. The proportion of time spent undertaking prevention
varied widely between Local Health Districts. The reasons for this variation
require further investigation.
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Affiliation(s)
- Angela V Masoe
- Faculty of Health, School of Health Sciences, Oral Health, University of Newcastle, Ourimbah, NSW 2258, Australia.
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Tickle M. Revolution in the provision of dental services in the UK. Community Dent Oral Epidemiol 2012; 40 Suppl 2:110-6. [DOI: 10.1111/j.1600-0528.2012.00729.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Martin Tickle
- Dental Public Health and Primary Care, School of Dentistry; The University of Manchester; Manchester; UK
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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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Ferracane J, Hilton T, Korpak A, Gillette J, McIntyre PS, Berg J. Use of caries prevention services in the Northwest PRECEDENT dental network. Community Dent Oral Epidemiol 2011; 39:69-78. [PMID: 21114514 PMCID: PMC3031425 DOI: 10.1111/j.1600-0528.2010.00570.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This cross-sectional study assessed the use of caries preventive services by Northwest PRECEDENT dental network practitioners and compared the caries experience of patients who received such services in the past 12 months with those who had not. METHODS An oral health survey was conducted on approximately 20 patients seen by each of 97 private practice dental practitioners in the network. Eligible patients (total of 1877 aged 3-92) were randomly assessed for the occurrence of one or more new caries lesions as well as having received the following preventive services within the past 12 months: fluoride varnish or gel, sealant in molar or premolar, and prophylaxis. Patients were stratified by gender and age (1-17 years old, 18-64 years old, and 65+ years old). Logistic regression was used to investigate the association between the practitioner characteristics and the use of preventive services, as well as the preventive services and the presence of a new caries lesion in the past 12 months. RESULTS The percent of patients in age category 1-17 years old/18-64 years old/65+ years old receiving each preventive treatment varied as follows: 95%/85%/81% for prophylaxis, 87%/24%/22% for fluoride, and 27%/2%/0% for sealant. There was a very limited association between the use of a specific preventive service and practitioner gender, and no significant association between use of services and practice location (rural, urban or suburban). There was a significant association between greater use of sealants for dentists with 0-15 years of practice experience as compared with those having more than 25 years of experience. For the 1-17-year-old age group, boys had about 1.7 times the odds of having a new lesion than girls in the past 12 months, and patients receiving a sealant had 1.9 times the odds of having a new caries lesion. In the 18-64-year-old group, receiving a prophylaxis in the past 12 months was significantly associated with lower odds for having a new lesion (odds ratio = 0.57). CONCLUSIONS This study reports that aside from prophylaxis, which more than 85% of the patients had received, about one-third of the patients overall received preventive services consisting of either sealants or some type of fluoride treatment in private dental practices in the Northwest PRECEDENT network.
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Affiliation(s)
- J Ferracane
- Department of Restorative Dentistry, Oregon Health & Science University School of Dentistry, Portland, OR 97239, USA.
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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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Richards W, Razzaq K, Higgs G. An Audit of Dental General Anaesthetic Referral from a General Dental Practice in South Wales. ACTA ACUST UNITED AC 2009; 16:143-7. [DOI: 10.1308/135576109789389441] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aims The aim of this audit was to quantify the number of patients that received a dental general anaesthetic (DGA) between 1999 and 2007 following referral from a general dental practice. It also aimed to establish the deprivation status of those referred and to investigate further dental treatment pathways of these patients. Methods Data were collected from all patient records held by the practice. The information collected included: postcode, gender, age at the close of the study, age at time of DGA, reason for DGA, number of teeth extracted, and details of further ongoing care. In the absence of individual level socioeconomic data, a deprivation score (derived from the Welsh Index of Multiple Deprivation [WIMD]) was appended to each record in order to provide a measure of deprivation based on the postcode of the patient. Results Two hundred and eighty-seven patients were referred for DGA during the nine-year period. Their mean age was 9.4 years (95% confidence interval [CI] = 8.4, 10.4) and 30.7% were children aged five years or younger. The most common reason for DGA was dental caries. The mean number of teeth extracted was 4.5 (95% CI = 4.1, 4.9). Patients living in deprived areas were more likely to be referred for DGA. Of the 87 who did not subsequently attend for continuing care, 72 were from deprived areas compared with 15 from more affluent areas ( P=0.003). Conclusions In proportion to the number of patients registered at a practice, the number of referrals for DGAs was relatively low. Patients categorised as deprived (based on their residential postcode) received more referrals for DGAs than those from more affluent areas. Patients from deprived locations were significantly more likely not to attend for continuing care after their DGA than those from more affluent areas.
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Affiliation(s)
- Wayne Richards
- Health Sport and Science, University of Glamorgan, Pontypridd, Wales, UK
| | | | - Gary Higgs
- Advanced Technology, University of Glamorgan, Pontypridd, Wales, UK
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Soldani FA, Young L, Jones K, Walsh T, Clarkson JE. One-to-one oral hygiene advice provided in a dental setting for oral health. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Francesca A Soldani
- Dundee Dental Hospital; Paediatric Dentistry Department; 2 Park Place Dundee UK DD1 4HR
| | - Linda Young
- University of Dundee; Dental Health Services Research Unit; The Mackenzie Building Kirsty Semple Way Dundee UK DD2 4BF
| | - Kate Jones
- GKT Dental Institute King's College Hospital; Department of Oral Health Services Research & Dental Public Health; Denmark Hill Campus Caldecot Road London UK SE5 9RW
| | - Tanya Walsh
- The University of Manchester; School of Dentistry; MANDEC, 3rd Floor, Dental Hospital Higher Cambridge Street Manchester UK M15 6FH
| | - Jan E Clarkson
- University of Dundee; Dental Health Services Research Unit; The Mackenzie Building Kirsty Semple Way Dundee UK DD2 4BF
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The incidence of dental caries in the primary molar teeth of young children receiving National Health Service funded dental care in practices in the North West of England. Br Dent J 2008; 205:E14; discussion 384-5. [DOI: 10.1038/sj.bdj.2008.582] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Baker RA. To screen, or not to screen, - that is the question:-. Br Dent J 2007; 203:449-51. [DOI: 10.1038/bdj.2007.945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2007] [Indexed: 11/09/2022]
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Threlfall AG, Hunt CM, Milsom KM, Tickle M, Blinkhorn AS. Exploring factors that influence general dental practitioners when providing advice to help prevent caries in children. Br Dent J 2007; 202:E10; discussion 216-7. [PMID: 17308533 DOI: 10.1038/bdj.2007.143] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2005] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To increase understanding about how and to whom general dental practitioners provide preventive advice to reduce caries in young children. DESIGN Qualitative study using semi-structured interviews. SETTING The North West of England. Interviews took place between March and September 2003. SUBJECTS AND METHODS Ninety-three general dental practitioners practising within the general dental service were interviewed about the care they provide to young children. The interviews were recorded, transcribed and analysed using a constant comparative method. RESULTS Children with caries were more likely to be questioned about diet and oral hygiene and if dentists believed parents to be motivated they were more inclined to spend time providing advice. Most dentists seemed to believe that education was the key to preventing caries and gave preventive advice in the form of a short educative talk. There was little use of visual aids or material for parents to take home. CONCLUSION Preventive advice is given in an ad hoc way with no formal targeting. Most dentists deliver preventive advice as a short educative talk with no props or additional materials. Use of visual aids, providing materials for parents to take home and greater emphasis on partnership might help improve the impact of advice.
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Affiliation(s)
- A G Threlfall
- Oral Health Unit, National Primary Care R&D Centre, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester, UK
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Wang NJ. Caries preventive methods in child dental care reported by dental hygienists, Norway, 1995 and 2004. Acta Odontol Scand 2005; 63:330-4. [PMID: 16512105 DOI: 10.1080/00016350500206769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Dental hygienists are used as first-line personnel in child dental care in Norway, and have an increasing influence on the delivery of preventive dental services. The purpose of this study was to describe: (1) preventive methods reported by hygienists in child dental care in Norway and (2) changes in preventive care during the 9-year period 1995 to 2004. Questionnaires were sent to all dental hygienists in the public dental services in Norway in 1995 and 2004; 70% (199 of 286) were returned in 1995 and 71% (210 of 297) in 2004. The hygienists considered one-third of children to be at risk of caries and spent 45 min of preventive care on these children every 16th month, while the remaining children were given 15 min of prevention every 20th month. One-third of the hygienists provided fluoride varnish for all children and one-fourth placed sealants routinely. Ninety percent of the hygienists reported that all children were given information on diet, hygiene, and fluoride. Most of the preventive practices of dental hygienists reflected limited changes in the period 1995 to 2004. However, the hygienists had reduced the use of fluoride varnishes and less often recommended fluoride tablets. The majority of hygienists reported that they individualized clinical prevention, while individual oral health information was standardized and given to all children. The results indicate that in 2004 a preventive approach combining individual information for all with intensified clinical prevention for children considered at risk was followed in child dental care.
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Affiliation(s)
- Nina J Wang
- Department of Dental Sciences-Pedodontics, University of Bergen, Bergen, Norway.
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Preventive or restorative care for children? Br Dent J 2003. [DOI: 10.1038/sj.bdj.4809945] [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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