Identifying children with dental care needs: evaluation of a targeted school-based dental screening program

School dental screening programmes for oral health

BACKGROUND

In school dental screening, a dental health professional visually inspects children's oral cavities in a school setting and provides information for parents on their child's current oral health status and treatment needs. Screening at school aims to identify potential problems before symptomatic disease presentation, hence prompting preventive and therapeutic oral health care for the children. This review evaluates the effectiveness of school dental screening for improving oral health status. It is the second update of a review originally published in December 2017 and first updated in August 2019.

OBJECTIVES

To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services.

SEARCH METHODS

An information specialist searched four bibliographic databases up to 15 October 2021 and used additional search methods to identify published, unpublished and ongoing studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs; cluster- or individually randomised) that evaluated school dental screening compared with no intervention, or that compared two different types of screening.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

The previous version of this review included seven RCTs, and our updated search identified one additional trial. Therefore, this update included eight trials (six cluster-RCTs) with 21,290 children aged 4 to 15 years. Four trials were conducted in the UK, two in India, one in the USA and one in Saudi Arabia. We rated two trials at low risk of bias, three at high risk of bias and three at unclear risk of bias.  No trials had long-term follow-up to ascertain the lasting effects of school dental screening. The trials assessed outcomes at 3 to 11 months of follow-up. No trials reported the proportion of children with treated or untreated oral diseases other than caries. Neither did they report on cost-effectiveness or adverse events. Four trials evaluated traditional screening versus no screening. We performed a meta-analysis for the outcome 'dental attendance' and found an inconclusive result with high heterogeneity. The heterogeneity was partly due to study design (three cluster-RCTs and one individually randomised trial). Due to this inconsistency, and unclear risk of bias, we downgraded the evidence to very low certainty, and we are unable to draw conclusions about this comparison. Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening, suggesting a possible small benefit (pooled risk ratio (RR) 1.07, 95% confidence interval (CI) 0.99 to 1.16; low-certainty evidence). There was no evidence of a difference when comparing criteria-based screening to traditional screening (RR 1.01, 95% CI 0.94 to 1.08; very low-certainty evidence). One trial compared a specific (personalised) referral letter to a non-specific letter. Results favoured the specific referral letter for increasing attendance at general dentist services (RR 1.39, 95% CI 1.09 to 1.77; very low-certainty evidence) and attendance at specialist orthodontist services (RR 1.90, 95% CI 1.18 to 3.06; very low-certainty evidence). One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation (RR 3.08, 95% CI 2.57 to 3.71; very low-certainty evidence). One trial compared referral to a specific dental treatment facility with advice to attend a dentist. There was no evidence of a difference in dental attendance between these two referrals (RR 0.91, 95% CI 0.34 to 2.47; very low-certainty evidence). Only one trial reported the proportion of children with treated dental caries. This trial evaluated a post-screening referral letter based on the common-sense model of self-regulation (a theoretical framework that explains how people understand and respond to threats to their health), with or without a dental information guide, compared to a standard referral letter. The findings were inconclusive. Due to high risk of bias, indirectness and imprecision, we assessed the evidence as very low certainty.

AUTHORS' CONCLUSIONS

The evidence is insufficient to draw conclusions about whether there is a role for school dental screening in improving dental attendance.  We are uncertain whether traditional screening is better than no screening (very low-certainty evidence). Criteria-based screening may improve dental attendance when compared to no screening (low-certainty evidence). However, when compared to traditional screening, there is no evidence of a difference in dental attendance (very low-certainty evidence). For children requiring treatment, personalised or specific referral letters may improve dental attendance when compared to non-specific referral letters (very low-certainty evidence). Screening supplemented with motivation (oral health education and offer of free treatment) may improve dental attendance in comparison to screening alone (very low-certainty evidence). We are uncertain whether a referral letter based on the 'common-sense model of self-regulation' is better than a standard referral letter (very low-certainty evidence) or whether specific referral to a dental treatment facility is better than a generic advice letter to visit the dentist (very low-certainty evidence). The trials included in this review evaluated effects of school dental screening in the short term. None of them evaluated its effectiveness for improving oral health or addressed possible adverse effects or costs.

School dental screening programmes for oral health

BACKGROUND

School dental screening refers to visual inspection of children's oral cavity in a school setting followed by making parents aware of their child's current oral health status and treatment needs. Screening at school intends to identify children at an earlier stage than symptomatic disease presentation, hence prompting preventive and therapeutic oral health care for the children. This review evaluates the effectiveness of school dental screening in improving oral health status. It is an update of the original review, which was first published in December 2017.

OBJECTIVES

To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 4 March 2019), the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Register of Studies, to 4 March 2019), MEDLINE Ovid (1946 to 4 March 2019), and Embase Ovid (15 September 2016 to 4 March 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases; however, the search of Embase was restricted to the last six months due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) (cluster or parallel) that evaluated school dental screening compared with no intervention or with one type of screening compared with another.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included seven trials (five were cluster-RCTs) with 20,192 children who were 4 to 15 years of age. Trials assessed follow-up periods of three to eight months. Four trials were conducted in the UK, two were based in India and one in the USA. We assessed two trials to be at low risk of bias, two trials to be at high risk of bias and three trials to be at unclear risk of bias.None of the trials had long-term follow-up to ascertain the lasting effects of school dental screening.None of the trials reported the proportion of children with untreated caries or other oral diseases, cost effectiveness or adverse events.Four trials evaluated traditional screening versus no screening. We performed a meta-analysis for the outcome 'dental attendance' and found an inconclusive result with high heterogeneity. The heterogeneity was found to be, in part, due to study design (three cluster-RCTs and one individual-level RCT). Due to the inconsistency, we downgraded the evidence to 'very low certainty' and are unable to draw conclusions about this comparison.Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening and showed a pooled effect estimate of RR 1.07 (95% CI 0.99 to 1.16), suggesting a possible benefit for screening (low-certainty evidence). There was no evidence of a difference when criteria-based screening was compared to traditional screening (RR 1.01, 95% CI 0.94 to 1.08) (very low-certainty evidence).In one trial, a specific (personalised) referral letter was compared to a non-specific one. Results favoured the specific referral letter with an effect estimate of RR 1.39 (95% CI 1.09 to 1.77) for attendance at general dentist services and effect estimate of RR 1.90 (95% CI 1.18 to 3.06) for attendance at specialist orthodontist services (low-certainty evidence).One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation, with an effect estimate of RR 3.08 (95% CI 2.57 to 3.71) (low-certainty evidence).Only one trial reported the proportion of children with treated dental caries. This trial evaluated a post screening referral letter based on the common-sense model of self-regulation (a theoretical framework that explains how people understand and respond to threats to their health), with or without a dental information guide, compared to a standard referral letter. The findings were inconclusive. Due to high risk of bias, indirectness and imprecision, we assessed the evidence as very low certainty.

AUTHORS' CONCLUSIONS

The trials included in this review evaluated short-term effects of screening. We found very low-certainty evidence that is insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening, there is no evidence of a difference in dental attendance (very low-certainty evidence).We found low-certainty evidence to conclude that personalised or specific referral letters may improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) may improve dental attendance in comparison to screening alone. For children requiring treatment, we found very-low certainty evidence that was inconclusive regarding whether or not a referral letter based on the 'common-sense model of self-regulation' was better than a standard referral letter.We did not find any trials addressing possible adverse effects of school dental screening or evaluating its effectiveness for improving oral health.

Social predictors of oral hygiene status in school children from suburban Nigeria

Oral hygiene, which is measured by the status of plaque-free tooth surfaces, is essential for the promotion of oral health. This study aimed to determine the social predictors of good oral hygiene for children in a suburban population in Nigeria. This was a secondary analysis of data. The study participants were 8- to 16-year-old children who were residents in Ile-Ife, which is a suburban population in Nigeria. Information on the age, gender, socioeconomic status, family structure, number of siblings and birth rank of each study participant was retrieved from the an interviewer-administered questionnaire. Oral hygiene status was determined through a simplified-oral hygiene index (OHI-S) and categorized as good, fair and poor. The association between oral hygiene status and sociodemographic variables was determined. The predictors of good oral hygiene were determined using a binomial regression analysis. Data on 2,107 individuals were retrieved, of which 44.8% had good oral hygiene and 17.1% had poor oral hygiene. The odds of having good oral hygiene were reduced for children who were 13 to 16 years old (p = 0.02) or male (P=0.002) and children with low socioeconomic status (p ≤ 0.001). The odds of having good oral hygiene increased for children who were last-born compared with those who were first-born (p = 0.02). Age, gender, socioeconomic status and birth-rank were significant social predictive factors of oral hygiene status among the study population. Based on these findings, targeted interventions can be conducted to improve the oral hygiene status of children and adolescents with these social profiles.

Modification and psychometric evaluation of the child perceptions questionnaire (CPQ11-14) in assessing oral health related quality of life among Lithuanian children

Background

Oral health related quality of life (OHRQoL) research among children and adolescents in Lithuania is just starting and no measures have been validated to date. Therefore, this study aimed to validate a Lithuanian version of the full (37 items) Child Perceptions Questionnaire (CPQ_11–14) within a random sample of children aged 11 to 14.

Methods

A cross-sectional survey among a randomly selected sample of schoolchildren (N = 307) aged 11 to14 was conducted. An anonymous questionnaire included the full CPQ_11–14 and items on global life satisfaction, oral health and oral life quality self-rating. The questionnaire was translated into Lithuanian using translation guidelines. In addition, an item on the oral pain was modified identifying the pain location. Standard tests (Cronbach’s α, construct validity and discriminant validity), supplemented with both exploratory and confirmatory factor analyses, were employed for psychometric evaluation of the instrument. The questionnaire was also tested by comparison students’ and their parents’ (N = 255) responses about oral symptoms and functional limitations.

Results

The modified Lithuanian version of CPQ_11–14 revealed good internal consistency reliability (Cronbach’s alpha for the total scale was 0.88). The measure showed significant associations with perceived oral health status and oral well-being, as well as with global life satisfaction (p < 0.01). Discriminant validity of the instrument was approved by comparison of children’s groups defined by self-reported caries experience and malocclusion. Factor analysis revealed a complex structure with two or three factors in each of four domains of the CPQ_11–14. Excellent or acceptable levels of indices of model fitting with the given data were obtained for oral symptoms, functional limitations and emotional well-being domains, but not for the social well-being domain. A significant association between child and parental responses was found (intraclass correlation coefficient was 0.56 and 0.43, correspondingly in domains of oral symptoms and functional limitations).

Conclusion

The Lithuanian version of the CPQ_11–14 (with a modified item that identifies location of oral pain) appears to be a valid instrument to be used in further studies for measuring OHRQoL among 11 to 14 year old children in Lithuania.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0701-5) contains supplementary material, which is available to authorized users.

Do Children of Working Mothers Experience More Dental Caries?

BACKGROUND

Pain and discomfort due to untreated dental caries lead to eating and sleep disruptions, behavioral changes, and poor quality of life. Among adolescents, severe dental caries may lead to activity restriction, school absenteeism, and poor academic performance. Dietary factors, parent's socioeconomic status, and family income have been associated with dental caries experience. The employment status of the mother is a measure of socioeconomic status of the family.

AIMS

This study aims to estimate the prevalence of dental caries and to find out its sociodemographic, oral health behavioral, and clinical determinants among older adolescent (15-18 years) students in Kerala.

SETTINGS AND DESIGN

This was a cross-sectional study conducted at higher secondary schools.

METHODS

Oral examination and sociodemographic and oral health behavioral data collection were done among 1065 older adolescent students in the age group 15-18 across five districts of Kerala by a multistage cluster sampling design. Decayed, missing, and filled teeth (DMFT) and Significant Caries (SiC) index were taken.

STATISTICAL ANALYSIS USED

SPSS version 16 software was employed. Multiple regression analysis was done to estimate adjusted odds ratios (OR) of predictors of dental caries experience.

RESULTS

The overall dental caries experience for the group was 59.8% (95% confidence interval [CI]: 56.9-62.7). About 40% of students had no caries experience, 43% had DMFT score 1-3, and only 16.8% had DMFT score 4 and more. Mean DMFT was 1.67 (95% CI: 1.56-1.79). Diet preference, timing of sugar intake, and sugar form were not significantly associated with caries. Mean SiC index was 3.90 (95% CI, 3.75-4.05). In the unadjusted analysis, age, gender, place of residence, mother's employment status, school type, frequency of sugar intake, oral hygiene status, and timing of last dental visit were significant. In the adjusted analysis, however, age, male gender, government schools, timing of last dental visit, and employed mothers were significant predictors for higher dental caries experience.

CONCLUSIONS

Mother's employment was the strongest predictor (OR 2.82, 95% CI: 2.15-3.69) for dental caries experience among adolescents when adjusted to other variables in the final multivariate model.

Missed opportunities: Do states require screening of children for health conditions that interfere with learning?

METHODS

Investigators reviewed websites of state departments of health and education, and legislation for all 50 states and DC. For states with mandated screenings and a required form, investigators applied structured analysis to assess HBL inclusion.

RESULTS

No state mandated that schools require screening for all 7 HBLs. Less than half (49%) required comprehensive school health examinations and only 12 states plus DC required a specific form. Of these, 12 of the forms required documentation of vision screening, 11 of hearing screening, and 12 of dental screening. Ten forms asked about asthma and 9 required documentation of lead testing. Seven asked about general well-being, emotional problems, or mental health. None addressed hunger. When including states without comprehensive school health examination requirements, the most commonly required HBL screenings were for vision (80% of states; includes DC), hearing (75% of states; includes DC) and dental (24% of state; includes DC).

CONCLUSION

The lack of state mandated requirements for regular student health screening represents a missed opportunity to identify children with HBLs. Without state mandates, accompanying comprehensive forms, and protocols, children continue to be at risk of untreated health conditions that can undermine their success in school.

School dental screening programmes for oral health

BACKGROUND

School dental screening refers to visual inspection of children's oral cavity in a school setting followed by making parents aware of their child's current oral health status and treatment needs. Screening at school intends to identify children at an earlier stage than symptomatic disease presentation, hence prompting preventive and therapeutic oral health care for the children. This review evaluates the effectiveness of school dental screening in improving oral health status.

OBJECTIVES

To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 March 2017), the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Register of Studies, to 15 March 2017), MEDLINE Ovid (1946 to 15 March 2017), and Embase Ovid (15 September 2016 to 15 March 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases; however, the search of Embase was restricted to the last six months due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) (cluster or parallel) that evaluated school dental screening compared with no intervention or with one type of screening compared with another.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included six trials (four were cluster-RCTs) with 19,498 children who were 4 to 15 years of age. Four trials were conducted in the UK and two were based in India. We assessed two trials to be at low risk of bias, one trial to be at high risk of bias and three trials to be at unclear risk of bias.None of the six trials reported the proportion of children with untreated caries or other oral diseases.Four trials evaluated traditional screening versus no screening. We performed a meta-analysis for the outcome 'dental attendance' and found an inconclusive result with high heterogeneity. The heterogeneity was found it to be, in part, due to study design (three cluster-RCTs and one individual-level RCT). Due to the inconsistency, we downgraded the evidence to 'very low certainty' and are unable to draw conclusions about this comparison.Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening and showed a pooled effect estimate of RR 1.07 (95% CI 0.99 to 1.16), suggesting a possible benefit for screening (low-certainty evidence). There was no evidence of a difference when criteria-based screening was compared to traditional screening (RR 1.01, 95% CI 0.94 to 1.08) (very low-certainty evidence).In one trial, a specific (personalised) referral letter was compared to a non-specific one. Results favoured the specific referral letter with an effect estimate of RR 1.39 (95% CI 1.09 to 1.77) for attendance at general dentist services and effect estimate of RR 1.90 (95% CI 1.18 to 3.06) for attendance at specialist orthodontist services (low-certainty evidence).One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation, with an effect estimate of RR 3.08 (95% CI 2.57 to 3.71) (low-certainty evidence).None of the trials had long-term follow-up to ascertain the lasting effects of school dental screening.None of the trials reported cost-effectiveness and adverse events.

AUTHORS' CONCLUSIONS

The trials included in this review evaluated short-term effects of screening, assessing follow-up periods of three to eight months. We found very low certainty evidence that was insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening there was no evidence of a difference in dental attendance (very low-certainty evidence).We found low-certainty evidence to conclude that personalised or specific referral letters improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) improves dental attendance in comparison to screening alone.We did not find any trials addressing cost-effectiveness and adverse effects of school dental screening.

Ephebodontics: A Little-known Branch of Dentistry

Adolescence is an age group defined from the onset of puberty to establishment of social independence. Chronologically it is defined as the age of 10 to 18 years but social and behavioral situations may dictate vari-ability.¹ Ephebodontics is the term coined for adolescent dentistry in the April 1969 issue of Dental Clinics of North America. The dental needs of adolescents differ largely from other established age groups. There are anomalous physical, emotional, and psychological changes in adolescents that need specific health care protocol.².

The development and psychometric properties of the Arabic version of the child oral health impact profile-short form (COHIP- SF 19)

Background

This study aims to cross-culturally adapt the original English-language COHIP-SF 19 to Arabic culture and to test its psychometric properties in a community sample.

Methods

The Arabic COHIP-SF 19 was developed and its psychometric properties were examined in a population-based sample of 876 schoolchildren who were aged 12 years of age, in Benghazi, Libya. The Arabic COHIP-SF 19 was tested for its internal consistency, reproducibility, construct validity, factorial validity and floor as well as ceiling effects. A Mann-Whitney U test was used to compare the mean scores of COHIP-SF 19 by participants’ caries status and self-reported oral health rating, satisfaction and treatment need.

Results

The Arabic COHIP-SF 19 was successfully and smoothly developed. It showed an acceptable level of equivalence to the original version. Overall, the internal consistency and reproducibility were acceptable to excellent, with a Cronbach’s alpha of 0.84 and an intra-class correlation coefficient (ICC) of 0.76. All hypotheses predefined to test construct validity were confirmed. That is, children who had active dental caries, and who rated their oral health as poor, were not satisfied with their oral health or indicated the need of treatment had lower COHIP-SF 19 scores (P < 0.05). Floor or ceiling effects were not observed. The exploratory Factorial analysis suggested a 4-component solution and deletion of one item.

Conclusion

The Arabic COHIP-SF 19 was successfully developed. The measure demonstrated satisfactory reliability and validity to estimate OHRQoL in a representative sample of 12-year-old schoolchildren.

Impact of Malocclusion on Oral Health-Related Quality of Life of 8-12 Years Old Schoolchildren in Southern Brazil

Abstract The aim of this study was to estimate the impact of malocclusion on the oral health-related quality of life (OHRQoL) of schoolchildren aged 8-12 years old in Southern Brazil. A two-stage cluster procedure was used to select 1,199 children in 20 public and private schools in Pelotas/Brazil. Cross-sectional data was collected, consisting of a socioeconomic questionnaire to parents, children’s interview and clinical oral examination. The clinical variables were obtained from clinical examination, and the Child Perceptions Questionnaire (CPQ) was assessed during children’s interview. To measure malocclusion and orthodontic treatment need the Dental Aesthetic Index was used. For data analysis multiple Poisson regression models estimating the rate ratios (RR) and their respective confidence intervals (95%CI) were used. Among 1,206 participants, 789 were aged 8-10 years and 417 between 11-12 years. The orthodontic treatment need was higher among the younger children (44.6%) than in the older ones (35.0%) (p value ≤0.05). There was a significant association in the CPQ social and emotional domains with malocclusion in the older schoolchildren. In the adjusted analysis (for socioeconomics and clinical variables) the effect of very severe malocclusion on OHRQoL was confirmed in both 8-10 and 11-12 age groups (RR(95%CI) of 1.24(1.02;1.51) and 1.28(1.01;1.62), respectively). The findings demonstrated that children with very severe malocclusion experienced greater negative impact on OHRQoL compared to those with mild or no malocclusion. The results suggest that malocclusion impacts the quality of life. The higher impact occurs in the social and emotional well-being domains.

Alternative scenarios: harnessing mid-level providers and evidence-based practice in primary dental care in England through operational research

BACKGROUND

In primary care dentistry, strategies to reconfigure the traditional boundaries of various dental professional groups by task sharing and role substitution have been encouraged in order to meet changing oral health needs.

AIM

The aim of this research was to investigate the potential for skill mix use in primary dental care in England based on the undergraduate training experience in a primary care team training centre for dentists and mid-level dental providers.

METHODS

An operational research model and four alternative scenarios to test the potential for skill mix use in primary care in England were developed, informed by the model of care at a primary dental care training centre in the south of England, professional policy including scope of practice and contemporary evidence-based preventative practice. The model was developed in Excel and drew on published national timings and salary costs. The scenarios included the following: "No Skill Mix", "Minimal Direct Access", "More Prevention" and "Maximum Delegation". The scenario outputs comprised clinical time, workforce numbers and salary costs required for state-funded primary dental care in England.

RESULTS

The operational research model suggested that 73% of clinical time in England's state-funded primary dental care in 2011/12 was spent on tasks that may be delegated to dental care professionals (DCPs), and 45- to 54-year-old patients received the most clinical time overall. Using estimated National Health Service (NHS) clinical working patterns, the model suggested alternative NHS workforce numbers and salary costs to meet the dental demand based on each developed scenario. For scenario 1:"No Skill Mix", the dentist-only scenario, 81% of the dentists currently registered in England would be required to participate. In scenario 2: "Minimal Direct Access", where 70% of examinations were delegated and the primary care training centre delegation patterns for other treatments were practised, 40% of registered dentists and eight times the number of dental therapists currently registered would be required; this would save 38% of current salary costs cf. "No Skill Mix". Scenario 3: "More Prevention", that is, the current model with no direct access and increasing fluoride varnish from 13.1% to 50% and maintaining the same model of delegation as scenario 2 for other care, would require 57% of registered dentists and 4.7 times the number of dental therapists. It would achieve a 1% salary cost saving cf. "No Skill Mix". Scenario 4 "Maximum Delegation" where all care within dental therapists' jurisdiction is delegated at 100%, together with 50% of restorations and radiographs, suggested that only 30% of registered dentists would be required and 10 times the number of dental therapists registered; this scenario would achieve a 52% salary cost saving cf. "No Skill Mix".

CONCLUSION

Alternative scenarios based on wider expressed treatment need in national primary dental care in England, changing regulations on the scope of practice and increased evidence-based preventive practice suggest that the majority of care in primary dental practice may be delegated to dental therapists, and there is potential time and salary cost saving if the majority of diagnostic tasks and prevention are delegated. However, this would require an increase in trained DCPs, including role enhancement, as part of rebalancing the dental workforce.

Socioeconomic and family influences on dental treatment needs among Brazilian underprivileged schoolchildren participating in a dental health program

BACKGROUND

The objective of this study was to compare the socioeconomic and family characteristics of underprivileged schoolchildren with and without curative dental needs participating in a dental health program.

METHODS

A random sample of 1411 of 8-to-10 year-old Brazilian schoolchildren was examined and two sample groups were included in the cross-sectional study: 544 presented curative dental needs and the other 867 schoolchildren were without curative dental needs. The schoolchildren were examined for the presence of caries lesions using the DMFT index and their parents were asked to answer questions about socioenvironmental characteristics of their families. Logistic regression models were adjusted estimating the Odds Ratios (OR), their 95% confidence intervals (CI), and significance levels.

RESULTS

After adjusting for potential confounders, it was found that families earning more than one Brazilian minimum wage, having fewer than four residents in the house, families living in homes owned by them, and children living with both biological parents were protective factors for the presence of dental caries, and consequently, curative dental needs.

CONCLUSIONS

Socioeconomic status and family structure influences the curative dental needs of children from underprivileged communities. In this sense, dental health programs should plan and implement strategic efforts to reduce inequities in oral health status and access to oral health services of vulnerable schoolchildren and their families.

Effectiveness and reach of a directed-population approach to improving dental health and reducing inequalities: a cross sectional study

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.

Coesão familiar associada à saúde bucal, fatores socioeconômicos e comportamentos em saúde

Pesquisas sobre saúde geral têm relacionado coesão familiar a fatores socioeconômicos e comportamentais. O objetivo deste estudo foi investigar a associação entre coesão familiar e fatores socioeconômicos, comportamentais e de saúde bucal. Este foi um estudo transversal com amostra por conglomerados em dois estágios. A amostra randomizada de 524 adolescentes era proveniente de escolas públicas da cidade de Piracicaba-SP. As variáveis foram avaliadas por questionários autoaplicáveis e os dados de saúde bucal, pelos índices CPO e CPI. A coesão familiar percebida pelo adolescente foi avaliada por meio da escala de adaptabilidade e coesão familiar. Análise univariada e regressão logística multinominal mostraram que adolescentes com baixa coesão familiar apresentaram mais chance de terem baixa renda (OR 2,28 IC95% 1,14-4,55), presença de cárie (OR 2,23 IC95% 1,21-4,09) e baixa frequência de escovação diária (OR 1,91 IC95% 1,03-3,54). Adolescentes com alta coesão familiar apresentaram mais chance que adolescentes com média coesão de terem alta renda e fator de proteção contra o hábito de tabagismo. Desta forma, a coesão familiar percebida pelo adolescente associou-se com variáveis comportamentais, socioeconômicas e de saúde bucal, indicando a importância de uma abordagem integral da saúde do paciente.

The influence of oral health conditions, socioeconomic status and home environment factors on schoolchildren's self-perception of quality of life

Background

The objective this study was to investigate the influence of clinical conditions, socioeconomic status, home environment, subjective perceptions of parents and schoolchildren about general and oral health on schoolchildren's oral health-related quality of life (OHRQoL).

Methods

A sample of 515 schoolchildren, aged 12 years was randomly selected by conglomerate analysis from public and private schools in the city of Juiz de Fora, Brazil. The schoolchildren were clinically examined for presence of caries lesions (DMFT and dmft index), dental trauma, enamel defects, periodontal status (presence/absence of bleeding), dental treatment and orthodontic treatment needs (DAI). The SiC index was calculated. The participants were asked to complete the Brazilian version of Child Perceptions Questionnaire (CPQ_11-14) and a questionnaire about home environment. Questions were asked about the presence of general diseases and children's self-perception of their general and oral health status. In addition, a questionnaire was sent to their parents inquiring about their socioeconomic status (family income, parents' education level, home ownership) and perceptions about the general and oral health of their school-aged children. The chi-square test was used for comparisons between proportions. Poisson's regression was used for multivariate analysis with adjustment for variances.

Results

Univariate analysis revealed that school type, monthly family income, mother's education, family structure, number of siblings, use of cigarettes, alcohol and drugs in the family, parents' perception of oral health of schoolchildren, schoolchildren's self perception their general and oral health, orthodontic treatment needs were significantly associated with poor OHRQoL (p < 0.001). After adjusting for potential confounders, variables were included in a Multivariate Poisson regression. It was found that the variables children's self perception of their oral health status, monthly family income, gender, orthodontic treatment need, mother's education, number of siblings, and household overcrowding showed a strong negative effect on oral health-related quality of life.

Conclusions

It was concluded that the clinical, socioeconomic and home environment factors evaluated exerted a negative impact on the oral health-related quality of life of schoolchildren, demonstrating the importance of health managers addressing all these factors when planning oral health promotion interventions for this population.

Screening for caries in targeted schools in the Blue Mountains and Hawkesbury districts, New South Wales, Australia: an evaluation of the School Assessment Program

AIM

  To determine if the school dental screening program in New South Wales, the School Assessment Program, achieved its aim of being the key entry point for high-risk children to receive care.

METHODS

  A secondary analysis was conducted on epidemiological data gathered in 16 primary schools in New South Wales (10 for the School Assessment Program and six for the non-School Assessment Program) in 2003. The validity of the School Assessment Program targeting criteria in identifying high-risk schools was determined. Post-screening treatment outcomes were evaluated from the assessment of treatment ratios.

RESULTS

  There were negligible differences in the caries experience and proportions of high-risk children, irrespective of their School Assessment Program status. Sensitivity and specificity values were approximately 60% and 40%, respectively, using various case definitions of high risk applied to both children and schools. Deciduous dentition treatment ratios for School Assessment Program and non-School Assessment Program children with decayed, missing, and filled teeth (dmft) ≥1 ranged from 0.48 to 0.79 and from 0.47 to 0.73, respectively. Respective permanent dentition treatment ratios for School Assessment Program and non-School Assessment Program children with Decayed, Missing, and Filled Teeth (DMFT) ≥1 were 0.49-0.82 and 0.64-1.08.

CONCLUSION

  The School Assessment Program failed to identify schools with high caries-risk children or confer post-screening caries treatment benefits.

Financial feasibility of a model school-based dental program in different states

OBJECTIVES

This article describes a model for a school-based program designed to reduce dental access disparities and examines its financial feasibility in states with different Medicaid reimbursement rates.

METHODS

Using state and national data, the expected revenues and expenses for operating the program in different states were estimated. Hygienists with support staff provided screening and preventive services in schools using portable equipment and generated surplus funds that were used to supplement payments to community clinics and private practices for treating children.

RESULTS

The program is financially feasible in states when the ratio of Medicaid fees is 60.5% of mean national fees. Of the 13 states examined, one-third have adequate Medicaid fees to support the program.

CONCLUSION

The model program has considerable promise for reducing access disparities at a lower cost per child than current Medicaid programs.

Disparities in oral health-related quality of life in a population of Canadian children

OBJECTIVES

To assess socioeconomic disparities in the oral health-related quality of life in a group of Canadian children.

METHODS

Data were obtained as part of a study designed to assess the functional and psychosocial impact of traumatic dental injury. Clinical data were collected on a random sample of children during a school-based dental screening program that included measures of dental decay experience, treatment needs, dental trauma, fluorosis, and malocclusion. Children with dental trauma and a comparison group of trauma-free children were selected for follow-up. Their parents were mailed a questionnaire concerning the child's personal and family characteristics. Also enclosed was a questionnaire for the child that contained a short form of the Child Perceptions Questionnaire (CPQ) 11-14. Bivariate and multivariate analyses were undertaken to determine whether there were disparities in oral health-related quality of life according to household income.

RESULTS

Complete data were collected from 370 children. Mean CPQ11-14 scores showed a gradient across income categories with children from low income households having poorer oral health-related quality of life. Children from households containing only one adult also had higher scores than children living with two or more adults. In both linear and logistic regression analyses household income and family structure remained significant predictors of CPQ11-14 scores after controlling for oral disease variables. Further analyses suggested that oral disorders had little impact on the health-related quality of life of higher income children but a marked impact on lower income children. The highest mean CPQ11-14 scores were observed among low income children with the more severe levels of oral disease.

CONCLUSION

The data indicate that in this group of children there were socioeconomic disparities in oral health-related quality of life. A potential explanation may be differences in psychological assets and psychosocial resources.

Assessing the oral health of school-age children and the current school-based dental screening programme in Freiburg (Germany)

Germany has a three-tiered system of education at secondary school level, divided into the school types 'Hauptschule', Realschule' and 'Gymnasium'. All students receive, when aged 6-12 years, a uniform annual dental examination and oral health education programme.

OBJECTIVES

The aim of this cross-sectional study was to report on the dental caries levels of school-age children stratified into these three different school types at secondary school level to enable oral healthcare personnel to administer a focused, school-based dental screening and education programme according to patients' needs rather than a uniform dental examination.

METHODS

A representative, random sample of 12-year-old school children in Freiburg (Germany) was examined and dental caries was recorded using WHO criteria.

RESULTS

A total of 322 12-year-old children participated. The mean DMFT was 0.69. An examination of the distribution of the DMFT score revealed that its distribution is positively skewed. For this reason, this study provides summary analyses based on medians and a non-parametric rank sum test. The non-parametric Kruskal-Wallis H-test showed a highly significant difference between median scores across the different school types (P-value = 0.004). The significance was a result of the 'Gymnasium' distribution of DMFT scores which differed markedly from the other two school types.

CONCLUSIONS

The finding of the present study suggests that it may be useful to stratify the school dental screening and education programme according to school type and to prioritize children who attend 'Realschule' and 'Hauptschule'. This shift should systematically target children with the greatest need for dental care.

Dental status and measures of deprivation in Clermont-Ferrand, France

BACKGROUND

Many background variables, such as socioeconomic status (SES), may be measured at the level of the individual or using some ecological indicators.

OBJECTIVES

This study aimed to examine, in 5- and 10-year-olds in Clermont-Ferrand, the relationship between household SES indicators, SES measured as an area-based ecological variable and dental status.

METHODS

All 5- and 10-year-olds attending public schools in deprived and semi-deprived zones (n = 15) and six other randomly selected schools in Clermont-Ferrand were invited to participate. All children were examined clinically. On a questionnaire, parents provided sociodemographic information.

RESULTS

Of the children invited, 84% (880 children) were examined. Mean dft of 5-year-olds was 0.93 (SD 2.27); 26.5% had at least one tooth affected. The caries experience (DMFT) of 10-year-olds was 0.85 (SD 1.14) and 37.2% had permanent tooth caries experience. Caries experience varied significantly with school deprivation status: the greater the deprivation score, the more likely was poor dental health. Country of birth, parents' employment status, family size and health insurance type were significantly related to dental status. Logistic analyses estimated the importance of SES and ecological variables; deprivation influenced dental status in 5-year-olds even when household SES indicators were considered. In 10-year-olds, caries experience was influenced by household SES, immigrant background, father's employment and family size.

CONCLUSION

The use of school deprivation as an ecological measure status was useful for identifying population subgroups with different levels of oral health, particularly in young children. This indicator of social deprivation could be used for targeting preventive programmes to high caries risk communities defined geographically.

School Performance Indicators as Proxy Measures of School Dental Treatment Needs: A Feasibility Study

OBJECTIVE

This ecological study assessed the feasibility and predictive ability of readily available educational indicators as proxy measures of school dental treatment needs in York Region elementary school children, Canada.

METHOD

Data sources included York Region Dental Health Unit dental screening data (2003-2004); area-based income data from Statistics Canada (2001) based on school address postcodes; grade three and grade six school performance results in reading, writing mathematics and English as a second language (ESL) data (2003-2004) obtained from publicly accessible educational websites.

RESULTS

Data analyses included 219 schools. Pearson's correlations showed that schools with a higher percentage of children needing urgent dental treatment had significantly higher proportions of children scoring below provincial averages in all six school performance categories. Hierarchical stepwise multiple linear regression analysis showed that two school performance variables remained in the model after controlling for area-based median family income and ESL variables: the percentage of grade six pupils scoring below the provincial average in writing and the percentage of grade 3 pupils scoring below the provincial average in reading.

CONCLUSIONS

The study established the feasibility of using school-level school performance indicators as proxy measures of school-level dental treatment needs. School performance results were good predictors of urgent dental treatment in York Region elementary school children. Further studies are needed using data from other jurisdictions to determine the utility of educational indicators in oral health programs.