Adherence to NICE guidelines on recall intervals and the FGDP(UK) Selection Criteria for Dental Radiography

Fluoride varnish applications provided in general dental practice for children of primary school age in three areas of the UK

Introduction Dental guidelines recommend professional application of fluoride varnish (FV) at least twice a year for children from the age of three.Methods NHS dental claims data were reviewed for children born in 2009 for the five-year period 2015-2019 and who attended the dentist in one of three geographical areas, labelled as Bristol, Birmingham and Cardiff. Data for 14,566 children were included in the study.Results Only 3.5% of children had been provided with ten or more FV applications at the dentist in the five-year period. Children in the Cardiff region fared less well for fluoride applications than their Bristol and Birmingham counterparts, including children that were seemingly at high risk of caries for part of the time period reviewed. For all three regions, the mean number of FV applications increased with an increase in the number of fillings provided.Conclusion Awareness of the apparent lack of FV application in the dental surgery may provide an opportunity to improve child dental health.

NHS general dental practitioner claims in the South West for provision of topical fluoride, fissure sealants, radiographs, fillings and extractions for children born in 2009: an analysis of a five-year period

Introduction Clinical guidelines related to diagnosis and preventive interventions for children are well established; however, childhood caries incidence remains high.Methods Secondary analysis of routinely collected data from the NHS Business Services Authority for children treated by general dental practitioners across a five-year period in four local authorities in South West England was used to assess whether children of primary school age attending general dental practices were receiving radiographs, fluoride varnish and fissure sealant applications in line with current guidelines.Results In total, 40,780 claims had been submitted in the five-year time period for the 4,805 children included in the study: 4.9% of children had ten or more claims that indicated fluoride varnish application; 4.0% of children had claims indicating they had been provided with four or more fissure sealants; and 7.6% of children had claims indicating two or more radiographs had been exposed. Increased filling experience was associated with increased fluoride varnish applications. For the children that had ten or more examinations and five or more fillings provided in the five-year time period, 27.2% had ten or more fluoride varnish applications, 7.6% had four or more teeth fissure sealed and 17.2% had two or more radiographs exposed in the five-year time period.Conclusion The claim data did not provide reassurance that guidelines relevant to prevention and diagnosis for children had consistently been followed.

Perspective and practice of root caries management: A multicountry study - Part II: A deeper dive into risk factors

BACKGROUND

The potential of an improved understanding to prevent and treat a complex oral condition such as root caries is important, given its correlation with multiple factors and the uncertainty surrounding the approach/material of choice. Deeper insights into risk factors may improve the quality of treatment and reduce the formation of root surface caries.

AIM

The present work aims to gain knowledge about dentists' opinions and experiences on assessing the risk factor related to the development of root caries and to help identify any overlooked factors that may contribute to less efficacious clinical outcomes.

METHODOLOGY

A questionnaire related to root surface caries was distributed among practicing dentists in nine different countries, namely the United Kingdom, Libya, Jordan, Saudi Arabia, Egypt, Brazil, India, Malaysia, and Iraq. Questionnaire responses were analyzed, and the results were compared among the groups.

RESULTS

Dentists around the world ranked the oral hygiene status of patients as the most important factor in the development of root surface caries. Patients with poor oral hygiene, active periodontal disease, reduced salivary flow, and gingival recession are perceived to have a higher risk of developing new root surface caries. There is a greater focus on prevention in the UK and greater levels of untreated dental disease in other countries, especially those recovering from civil wars.

CONCLUSION

This work identified some overlooked factors that may have contributed to the less efficacious clinical outcomes reported in the literature. It is hoped that this deep dive into risk factors coupled with the findings presented in Part I of this study will be used as a basis for a more comprehensive investigation into the management of patients with root surface caries.

The Seattle Care Pathway for securing oral health in older patients

There is a need for a structured, evidence based approach to care for older dental patients. The following article describes the development of the Seattle Care Pathway based upon a workshop held in 2013. An overview is provided on the key issues of older persons dental care including the demography shift, the concept of frailty, the need for effective prevention and treatment to be linked to levels of dependency and the need for a varied and well educated work force. The pathway is presented in tabular form and further illustrated by the examples in the form of clinical scenarios. The pathway is an evidence based, pragmatic approach to care designed to be globally applicable but flexible enough to be adapted for local needs and circumstances. Research will be required to evaluate the pathways application to this important group of patients.