Randomized pilot study to disseminate caries-control services in dentist offices

Policy interventions to improve the accessibility and affordability of Dutch dental care. A scoping review of effective interventions

Caries and periodontitis remain prevalent in the Netherlands. Given the assumption that increasing the accessibility and affordability of dental care can improve oral health outcomes, policy interventions aimed at improving these aspects may contribute to better oral health. To identify possible solutions, this scoping review firstly identifies policy interventions from around the world that have effectively improved the accessibility or affordability of dental care. Secondly, this review discusses the potential of the policy interventions identified that are applicable to the Dutch healthcare sector specifically. A literature search was performed in four databases. Two reviewers independently screened all potentially relevant titles and abstracts before doing the same for the full texts. Only studies that had quantitatively evaluated the effectiveness of policy interventions aimed at improving the accessibility or affordability of dental care were included. 61 of the 1288 retrieved studies were included. Interventions were grouped into four categories. Capacity interventions (n = 5) mainly focused on task delegation. Coverage interventions (n = 25) involved the expansion of covered dental treatments or the group eligible for coverage. Managed care interventions (n = 20) were frequently implemented in school or community settings. Payment model interventions (n = 11) focused on dental reimbursement rates or capitation. 199 indicators were identified throughout the 61 included studies. Indicators were grouped into three categories: accessibility (n = 137), affordability (n = 21), and oral health status (n = 41). Based on the included studies, increasing managed care interventions for children and adding dental coverage to the basic health insurance plan for adults could improve access to dental care in the Netherlands. Due to possible spillover effects, it is advisable to investigate a combination of these policy interventions. Further research will be necessary for the development of effective policy interventions in practice.

Are general dental practitioners providing best practice in prevention in everyday general practice?

AIMS

To discover whether general dental practitioners are providing best practice in prevention, as defined by the 'Delivering Better Oral Health' toolkit, in everyday general practice.

METHOD

A questionnaire was created with five scenarios describing the key findings of the examination of five hypothetical patients. Dentists attending a postgraduate meeting were asked to list all the preventive treatment and advice they would give each patient. The content of their answers was compared with the toolkit by two researchers.

RESULTS

Twenty four dentists completed the questionnaire. In general terms, they did not mention much of the specific advice or recommend the treatment listed in the toolkit except that a significant proportion would apply fluoride varnish to children's teeth and all would give smoking cessation advice where appropriate. Suitable recall intervals, defined by the National Institute for Clinical Excellence, were suggested for three of the scenarios but the advice was inconsistent for the other two scenarios.

CONCLUSION

This small investigation suggests that dentists' implementation of prevention, as advised by the toolkit, is not thorough or consistent. Comprehensive adoption of prevention in dentistry will require intensive multifaceted education and organisational change such as might be provided by the new contracts being piloted at present.

An examination of the advances in science and technology of prevention of tooth decay in young children since the Surgeon General's Report on Oral Health

This paper addresses a number of areas related to how effectively science and technology have met Healthy People 2010 goals for tooth decay prevention. In every area mentioned, it appears that science and technology are falling short of these goals. Earlier assessments identified water fluoridation as one of the greatest public health accomplishments of the last century. Yet, failure to complete needed clinical and translational research has shortchanged the caries prevention agenda at a critical juncture. Science has firmly established the transmissible nature of tooth decay. However, there is evidence that tooth decay in young children is increasing, although progress has been made in other age groups. Studies of risk assessment have not been translated into improved practice. Antiseptics, chlorhexidine varnish, and polyvinylpyrrolidone iodine (PVI-I) may have value, but definitive trials are needed. Fluorides remain the most effective agents, but are not widely disseminated to the most needy. Fluoride varnish provides a relatively effective topical preventive for very young children, yet definitive trials have not been conducted. Silver diamine fluoride also has potential but requires study in the United States. Data support effectiveness and safety of xylitol, but adoption is not widespread. Dental sealants remain a mainstay of public policy, yet after decades of research, widespread use has not occurred. We conclude that research has established the public health burden of tooth decay, but insufficient research addresses the problems identified in the report Oral Health in America: A Report of the Surgeon General. Transfer of technology from studies to implementation is needed to prevent tooth decay among children. This should involve translational research and implementation of scientific and technological advances into practice.