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Timms L, Rodd H, Deery C, Brocklehurst P, Marshman Z. Silver diamine fluoride for the management of dental caries in children in primary dental care: protocol for a feasibility study. Pilot Feasibility Stud 2024; 10:95. [PMID: 38915111 PMCID: PMC11194932 DOI: 10.1186/s40814-024-01519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/12/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Dental caries remains a significant problem in England, affecting 11% of 3-year-olds and 23% of 5-year-olds. While current approaches have been extensively investigated, their ability to (1) control pain and infection; (2) prevent hospital admissions, and (3) be implemented within the National Health Service (NHS) contractual arrangements, remains unsatisfactory. Silver diamine fluoride (SDF) is an alternative, non-invasive approach that has proven efficacy in arresting caries progression in primary teeth, principally from studies conducted outside of Europe. Its use in primary dental care in the UK is limited, despite the acknowledged need. The clinical and cost-effectiveness of SDF has not been compared to usual care in the UK. Before a pragmatic randomised controlled trial (RCT) can be conducted to compare SDF to usual care for caries management in young children, there are several uncertainties that require investigation. This study aims to establish whether such an RCT is feasible. METHODS This mixed-method parallel design study is a feasibility study with an embedded process evaluation, to compare SDF with usual treatment in primary dental care in the UK. It will be individually randomised, with 13 dentists and therapists, in 8 different dental primary care sites with a sample size of 80 child participants aged 1-8 years old. The aim will be to recruit ten participants per site with equal arm allocation. Follow-up will be for 1 year. The study will inform whether an RCT is feasible by resolving several key uncertainties. The acceptability and implementation of SDF and the research processes will be explored. Patient and Public Involvement and Engagement representatives will be involved throughout recruitment and retention strategies, participant documentation, analysis, engagement and dissemination. DISCUSSION The ability to conduct an RCT will be evaluated. If feasible, this RCT has the potential to evaluate the effectiveness of a non-invasive approach for the management of untreated caries in young children. A feasibility study also offers the opportunity to consider factors associated with the implementation of SDF at an early stage through a process evaluation that will inform the definitive trial and an implementation strategy for SDF by identifying relevant barriers and facilitators. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT06092151. Date: 19/10/2023.
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Affiliation(s)
- Laura Timms
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| | - Helen Rodd
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Chris Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Paul Brocklehurst
- Dental Public Health, Primary Care Division, Public Health Wales, 10 Llys Castan Parc Menai, Bangor, Wales, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Hendry A, Baker SR, Tsakos G, McKenna G, Jenkins A, Syed SS, Harvey M, Mirza A, Morgan L, Brocklehurst PR. Using a theoretically informed process evaluation alongside a trial to improve oral health for care home residents. Gerodontology 2024; 41:159-168. [PMID: 37496265 DOI: 10.1111/ger.12705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Poor oral health is common among older adults residing in care homes impacting their diet, quality of life, self-esteem, general health and well-being. The care home setting is complex and many factors may affect the successful implementation of oral care interventions. Exploring these factors and their embedded context is key to understanding how and why interventions may or may not be successfully implemented within their intended setting. OBJECTIVES This methodology paper describes the approach to a theoretically informed process evaluation alongside a pragmatic randomised controlled trial, so as to understand contextual factors, how the intervention was implemented and important elements that may influence the pathways to impact. MATERIALS AND METHODS SENIOR is a pragmatic randomised controlled trial designed to improve the oral health of care home residents in the United Kingdom. The trial uses a complex intervention to promote and provide oral care for residents, including education and training for staff. RESULTS An embedded, theoretically informed process evaluation, drawing on the PAHRIS framework and utilising a qualitative approach, will help to understand the important contextual factors within the care home that influence both the trial processes and the implementation of the intervention. CONCLUSION Utilising an implementation framework as the basis for a theoretically informed process evaluation provides an approach that specifically focuses on the contextual factors that may influence and shape the pathways to impact a given complex intervention a priori, while also providing an understanding of how and why an intervention may be effective. This contrasts with the more common post hoc approach that only focuses on implementation after the empirical results have emerged.
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Affiliation(s)
- Annie Hendry
- Bangor Institute of Health and Medical Research, Bangor University, Bangor, UK
| | - Sarah R Baker
- Unit of Oral Health, Dentistry and Society, University of Sheffield, Sheffield, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Gerald McKenna
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Alison Jenkins
- Bangor Institute of Health and Medical Research, Bangor University, Bangor, UK
| | - Saif Sayeed Syed
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Michelle Harvey
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Afshan Mirza
- Department of Epidemiology and Public Health, University College London, London, UK
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Brown N, Foley C, Flanagan C, Fujita T, Harford S. Fluoride varnish applications provided in general dental practice for children of primary school age in three areas of the UK. Br Dent J 2024; 236:469-474. [PMID: 38519683 DOI: 10.1038/s41415-024-7171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 03/25/2024]
Abstract
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.
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Affiliation(s)
- Nathan Brown
- Clinical Adviser, NHS Business Services Authority, South West, UK.
| | - Charlotte Foley
- Clinical Adviser, NHS Business Services Authority, Wales, UK
| | - Colin Flanagan
- Clinical Adviser, NHS Business Services Authority, Midlands, UK
| | - Taro Fujita
- Associate Professor in Maths Education, Exeter University, UK
| | - Sara Harford
- Specialist in Special Care Dentistry, Great Western Hospital NHS Foundation Trust, UK
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Han DH, Kang HY, Ryu JI. The role of income and frequency of dental visits in the relationship between dental sealant use and resin fillings after extended coverage: a retrospective cohort study. BMC Oral Health 2023; 23:807. [PMID: 37891584 PMCID: PMC10612205 DOI: 10.1186/s12903-023-03387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship. METHODS This retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA). RESULTS The ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency. CONCLUSIONS Income and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.
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Affiliation(s)
- Dong-Hun Han
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry, Seoul, Republic of Korea
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hee-Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Jae-In Ryu
- Department of Preventive and Social Dentistry, Kyung Hee University College of Dentistry, Seoul, Republic of Korea.
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Wolf TG, Campus G. Cost-Effectiveness of Treatment Decisions for Early Childhood Caries in Infants and Toddlers: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1865. [PMID: 37893583 PMCID: PMC10608526 DOI: 10.3390/medicina59101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Early childhood caries (ECC) is a multifactorial, biofilm-mediated, sugar-related, dynamic disease of primary dental hard tissues occurring in varying degrees of severity in infants and toddlers. Untreated ECC may lead to pain, infections, and severe systemic complications. The aim of this study was to systematically review and evaluate the scientific evidence on the cost-effectiveness of treatment decisions in ECC in infants and toddlers. Materials and Methods: Observational epidemiological studies, i.e., cohort studies, case-control studies, and randomized controlled trials, reporting cost-effectiveness of treatment decisions in ECC in infants and toddlers were included in the systematic review following the PRISMA guidelines. Using an ad hoc search with search terms or keywords (MeSH), electronic databases Embase, MEDLINE via PubMed, Scopus, and gray literature were searched. Results: The search identified 494 articles, of which 446 remained after removing duplicates. A total of 417 articles were excluded after title and abstract evaluation; 29 full-text articles were screened for eligibility, and five articles were discarded. Twenty-four full-text articles were included in the systematic review, assigning 17 to prevention and seven to restoration. Results were heterogeneous; comparability of included studies is difficult because of the different methodologies used. Conflicting efficacies were demonstrated for different interventions implemented, and cost-effectiveness data were documented. Conclusions: Socioeconomic, cultural, and ethnic differences must be considered when comparing conditions in terms of cost-effectiveness. A paradigm shift from surgical towards preventive treatment decisions can be observed. Cost-effectiveness studies on therapies for ECC in infants and toddlers are needed to identify the best practice approach and the most cost-effective therapy decisions.
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Affiliation(s)
- Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, 55116 Mainz, Germany
| | - Guglielmo Campus
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Viale San Pietro, 07100 Sassari, Italy;
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He S, Choong EKM, Duangthip D, Chu CH, Lo ECM. Clinical interventions with various agents to prevent early childhood caries: A systematic review with network meta-analysis. Int J Paediatr Dent 2023; 33:507-520. [PMID: 36718540 DOI: 10.1111/ipd.13055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dental caries is one of the most prevalent chronic diseases among preschool children globally. Different preventive agents and combinations have been studied. However, the rank of the effectiveness of clinical interventions is equivocal. AIM To summarize and rank the effectiveness of clinical interventions using different agents for primary prevention of early childhood caries (ECC). DESIGN Two reviewers independently searched PubMed, Embase, and Cochrane Library to identify randomized controlled trials with at least 12-month follow-up. The network meta-analysis (NMA) on different agents was based on a random-effects model and frequentist approach. Standardized mean differences (SMD) with 95% CI of the caries increment were calculated in terms of either dmft or dmfs and used in the NMA. Caries incidences at the child level were compared using odds ratios (ORs) with 95% CI. The effectiveness of the agents was ranked using the surface under the cumulative ranking curve (SUCRA). RESULTS After screening 3807 publications and selection, the NMA finally included 33 trials. These trials used either a single or combination of agents such as fluorides, chlorhexidine, casein phosphopeptide-amorphous calcium phosphate, probiotics, xylitol, and triclosan. Compared with control, fluoride foam (FF; SMD -0.69, 95% CI: -1.06, -0.32) and fluoride salt (F salt; SMD -0.66, 95% CI: -1.20, -0.13) were effective in preventing caries increment. Probiotic milk plus low fluoride toothpaste (PMLFTP; OR 0.34, 95% CI: 0.15, 0.77), FF (OR 0.48, 95% CI: 0.37, 0.63), fluoride varnish (FV; OR 0.63, 95% CI: 0.48, 0.81), and fluoride varnish plus high fluoride toothpaste (FVHFTP; OR 0.73, 95% CI: 0.57, 0.93) were effectively preventing caries incidence. According to the SUCRA, FF ranked first in preventing caries increment, whereas PMLFTP ranked first in preventing caries incidence. CONCLUSION Fluoride foam, F salt, PMLFTP, FV, and FVHFTP all effectively reduce caries increment or caries incidence in preschool children, but the evidence indicates low degree of certainty. Considering the relatively small number of studies, confidence in the findings, and limitations in the study, clinical practitioners and readers should exercise caution when interpreting the NMA results.
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Affiliation(s)
- Shuyang He
- Faculty of Dentistry, The University of Hong Kong, Hong Kong City, Hong Kong
| | - Elaine Kar Man Choong
- Faculty of Dentistry, The University of Hong Kong, Hong Kong City, Hong Kong
- Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Duangporn Duangthip
- Faculty of Dentistry, The University of Hong Kong, Hong Kong City, Hong Kong
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong City, Hong Kong
| | - Edward Chin Man Lo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong City, Hong Kong
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Nguyen TM, Tonmukayakul U, Le LKD, Calache H, Mihalopoulos C. Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:53-70. [PMID: 36089630 PMCID: PMC9834378 DOI: 10.1007/s40258-022-00758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. RESULTS Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. CONCLUSIONS Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia.
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | - Long Khanh-Dao Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
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Murphy P, Hinde S, Fulbright H, Padgett L, Richardson G. Methods of assessing value for money of UK-based early childhood public health interventions: a systematic literature review. Br Med Bull 2022; 145:88-109. [PMID: 36542119 PMCID: PMC10075243 DOI: 10.1093/bmb/ldac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Economic evaluation has an important role to play in the demonstration of value for money of early childhood public health interventions; however, concerns have been raised regarding their consistent application and relevance to commissioners. This systematic review of the literature therefore aims to collate the breadth of the existing economic evaluation evidence of these interventions and to identify the approaches adopted in the assessment of value. SOURCE OF DATA Recently published literature in Medline, EMBASE, EconLit, Health Management Information Consortium, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Health Technology Assessment, NHS EED and Web of Science. AREAS OF AGREEMENT The importance of the early childhood period on future health and well-being as well as the potential to impact health inequalities making for a strong narrative case for expenditure in early childhood public health. AREAS OF CONTROVERSY The most appropriate approaches to evaluating value for money of such preventative interventions relevant for UK decision-makers given the evident challenges. GROWING POINTS The presented review considered inconsistencies across methodological approaches used to demonstrate value for money. The results showed a mixed picture in terms of demonstrating value for money. AREAS TIMELY FOR DEVELOPING RESEARCH Future resource allocations decisions regarding early childhood public health interventions may benefit from consistency in the evaluative frameworks and health outcomes captured, as well as consistency in approaches to incorporating non-health costs and outcomes, incorporating equity concerns and the use of appropriate time horizons.
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Affiliation(s)
- Peter Murphy
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Helen Fulbright
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - Louise Padgett
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
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9
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Goodwin M, Emsley R, Kelly MP, Sutton M, Tickle M, Walsh T, Whittaker W, Pretty IA. Evaluation of water fluoridation scheme in Cumbria: the CATFISH prospective longitudinal cohort study. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/shmx1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background
Water fluoridation was introduced in the UK against a background of high dental decay within the population. Levels of decay have dramatically reduced over the last 40 years following widespread use of fluoride toothpaste.
Objective
The aim of the CATFISH (Cumbrian Assessment of Teeth a Fluoride Intervention Study for Health) study was to address the question of whether or not the addition of fluoride to community drinking water, in a contemporary population, lead to a reduction in the number of children with caries and, if so, is this reduction cost-effective?
Design
A longitudinal prospective cohort design was used in two distinct recruited populations: (1) a birth cohort to assess systemic and topical effects of water fluoridation and (2) an older school cohort to assess the topical effects of drinking fluoridated water.
Setting
The study was conducted in Cumbria, UK. Broadly, the intervention group (i.e. individuals receiving fluoridated drinking water) were from the west of Cumbria and the control group were from the east of Cumbria.
Participants
Children who were lifetime residents of Cumbria were recruited. For the birth cohort, children were recruited at birth (2014–15), and followed until age 5 years. For the older school cohort, children were recruited at age 5 years (2013–14) and followed until the age of 11 years.
Intervention
The provision of a ‘reintroduced fluoridated water scheme’.
Main outcome measures
The primary outcome measure was the presence or absence of decay into dentine in the primary teeth (birth cohort) and permanent teeth (older school cohort). The cost per quality-adjusted life-year was also assessed.
Results
In the birth cohort (n = 1444), 17.4% of children in the intervention group had decay into dentine, compared with 21.4% of children in the control group. The evidence, after adjusting for deprivation, age and sex, with an adjusted odds ratio of 0.74 (95% confidence interval 0.56 to 0.98), suggested that water fluoridation was likely to have a modest beneficial effect. There was insufficient evidence of difference in the presence of decay in children in the older school cohort (n = 1192), with 19.1% of children in the intervention group having decay into dentine, compared with 21.9% of children in the control group (adjusted odds ratio 0.80, 95% confidence interval 0.58 to 1.09). The intervention was found to be likely to be cost-effective for both the birth cohort and the older school cohort at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year. There was no significant difference in the performance of water fluoridation on caries experience across deprivation quintiles.
Conclusions
The prevalence of caries and the impact of water fluoridation was much smaller than previous studies have reported. The intervention was effective in the birth cohort group; however, the importance of the modest absolute reduction in caries (into dentine) needs to be considered against the use of other dental caries preventative measures. Longer-term follow-up will be required to fully understand the balance of benefits and potential risks (e.g. fluorosis) of water fluoridation in contemporary low-caries populations.
Limitations
The low response rates to the questionnaires reduced their value for generalisations. The observed numbers of children with decay and the postulated differences between the groups were far smaller than anticipated and, consequently, the power of the study was affected (i.e. increasing the uncertainty indicated in the confidence intervals).
Study registration
This study is registered as Integrated Research Application System 131824 and 149278.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matt Sutton
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - William Whittaker
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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10
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McKenna G, Tsakos G, Watson S, Jenkins A, Algar PM, Evans R, Baker SR, Chestnutt IG, Smith CJ, O'Neill C, Hoare Z, Williams L, Jones V, Donaldson M, Karki A, Lappin C, Moons K, Sandom F, Wimbury M, Morgan L, Shepherd K, Brocklehurst P. uSing rolE-substitutioN In care homes to improve ORal health (SENIOR): a study protocol. Trials 2022; 23:679. [PMID: 35982457 PMCID: PMC9386206 DOI: 10.1186/s13063-022-06487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dental service provision in the care home sector is poor, with little emphasis on prevention. Emerging evidence suggests that the use of Dental Care Professionals (dental therapists and dental nurses) as an alternative to dentists has the potential to improve preventive advice, the provision of care and access to services within care homes. However, robust empirical evidence from definitive trials on how to successfully implement and sustain these interventions within care homes is currently lacking. The aim of the study is to determine whether Dental Care Professionals could reduce plaque levels of dentate older adults (65 + years) residing in care homes. Methods This protocol describes a two-arm cluster-randomised controlled trial that will be undertaken in care homes across Wales, Northern Ireland and England. In the intervention arm, the dental therapists will visit the care homes every 6 months to assess and then treat eligible residents, where necessary. All treatment will be conducted within their Scope of Practice. Dental nurses will visit the care homes every month for the first 3 months and then three-monthly afterwards to promulgate advice to improve the day-to-day prevention offered to residents by carers. The control arm will be ‘treatment as usual’. Eligible care homes (n = 40) will be randomised based on a 1:1 ratio (20 intervention and 20 control), with an average of seven residents recruited in each home resulting in an estimated sample of 280. Assessments will be undertaken at baseline, 6 months and 12 months and will include a dental examination and quality of life questionnaires. Care home staff will collect weekly information on the residents’ oral health (e.g. episodes of pain and unscheduled care). The primary outcome will be a binary classification of the mean reduction in Silness-Löe Plaque Index at 6 months. A parallel process evaluation will be undertaken to explore the intervention’s acceptability and how it could be embedded in standard practice (described in a separate paper), whilst a cost-effectiveness analysis will examine the potential long-term costs and benefits of the intervention. Discussion This trial will provide evidence on how to successfully implement and sustain a Dental Care Professional-led intervention within care homes to promote access and prevention. Trial registration ISRCTN16332897. Registered on 3 December 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06487-3.
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Affiliation(s)
- Gerald McKenna
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Science Block A, Belfast, BT12 6BA, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Sinead Watson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Science Block A, Belfast, BT12 6BA, UK.
| | - Alison Jenkins
- NWORTH Clinical Trials Unit, Bangor University, Bangor, UK
| | | | - Rachel Evans
- NWORTH Clinical Trials Unit, Bangor University, Bangor, UK
| | - Sarah R Baker
- Unit of Oral Health, Dentistry and Society, University of Sheffield, Sheffield, UK
| | - Ivor G Chestnutt
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Craig J Smith
- Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.,Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Geoffrey Jefferson Brain Research Centre, Salford Royal Foundation NHS Trust, Salford, UK
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Science Block A, Belfast, BT12 6BA, UK
| | - Zoe Hoare
- NWORTH Clinical Trials Unit, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Health Sciences, Bangor University, Bangor, UK
| | - Vicki Jones
- Community Dental Services, Aneurin Bevan University Health Board, Newport, UK
| | | | | | - Caroline Lappin
- Community Dental Service, South Eastern Health and Social Care Trust, Dundonald, UK
| | - Kirstie Moons
- Health Education and Improvement Wales, Nantgarw, UK
| | - Fiona Sandom
- Health Education and Improvement Wales, Nantgarw, UK
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11
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Ahn E, Kim SM. The cost- effectiveness of early dental visit in infants and toddlers focused on regional deprivation in South Korea: A retrospective cohort study. PLoS One 2022; 17:e0269770. [PMID: 35696402 PMCID: PMC9191701 DOI: 10.1371/journal.pone.0269770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background The aims of this study are to evaluate the cost-effectiveness of early dental visits (EDVs) and to investigate how regional deprivation impacts the economic evaluation. Methods This study used the South Korea National Health Insurance database, which included medical claim data and voluntary-based oral examination data. The subjects of this study included whole participants for oral examinations for infants and toddlers of the National Health Insurance Corporation. A retrospective cohort study was designed and measured all oral treatments, costs, and number of visits for 208,969 children (experimental group, 101,768; non- experimental group, 107,201) who underwent oral examination for infants and toddlers from 2007 to 2014. The cost-effectiveness was measured using the incremental cost-effectiveness ratio, and the T-health index was used as the measurement for effectiveness. In addition, the difference in the effect according to the level of regional deprivation was confirmed. Results The findings of this study showed that EDVs were cost-effective and that children who participated in EDVs had better oral health (T-health-2 index difference 0.32 point in most deprived regions) and needed 5 USD less costly dental treatments than those who did not have EDVs. The cost-effectiveness of EDVs varied according to the level of regional deprivation and was the highest in the most deprived regions. Conclusions The study findings suggested that the provision of oral examination for infants and toddlers was a cost-effective dental policy. Additionally, EDVs were more effective in children who resided in the most deprived regions, a finding that will lead to the development of policy intervention to improve dental care despite spatial inequality for disadvantaged population groups. Regarding the distribution of dental hospitals/clinics, incentive based dental polices for either dental providers or patients are needed that will assure the delivery of dental care despite spatial inequality.
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Affiliation(s)
- Eunsuk Ahn
- Department of Dental Hygiene, Daejeon Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sun-Mi Kim
- Department of Dental Hygiene, Wonkwang Health Science University, North Jula, Republic of Korea
- * E-mail:
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12
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Rodriguez GA, Cabello RA, Borroni CP, Palacio RA. Cost-effectiveness of probiotics and fluoride varnish in caries prevention in preschool children. J Public Health Dent 2022; 82:280-288. [PMID: 35567374 DOI: 10.1111/jphd.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/11/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the cost-effectiveness of two preventive interventions aimed at increasing the proportion of caries-free preschool children of low socioeconomic status using a decision analytic model. METHODS Two scenarios were tested, one with a school milk program (SMP) and one without (non-SMP). Fluoride varnish (FV) and a probiotic (PB) were compared to a do-nothing alternative among children in public nurseries/schools over a 4-year period. FV was applied biannually and a PB (Lactobacillus rhamnosus) added to milk powder prepared daily. A Markov decision tree model was utilized. Several sources of data were used to populate the model. Probabilistic and deterministic sensitivity analyses were performed, and a public provider perspective was used. RESULTS In the SMP scenario, PB was more effective and less costly than FV and, compared with do-nothing, increased the proportion of caries-free children by 14.5%, with a cost of USD 12.5 per child (June 2018). PB presented an incremental cost-effectiveness ratio (ICER) or cost per extra caries-free child of USD 86.2. In the non-SMP scenario, both interventions were cost-effective. FV (compared with do-nothing) increased the percentage of caries-free children by 8.3% with an ICER of USD 338.3 and PB (compared with FV) increased the effect by 6.2% with an ICER of USD 1400.2. CONCLUSIONS The findings showed that PB was most effective and less costly than FV in the SMP scenario only. This type of analysis and its results provide essential information for decision-makers to improve the oral health of preschool children.
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Affiliation(s)
| | | | - Catalina P Borroni
- School of Dentistry, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Raul A Palacio
- School of Dentistry, Pontificia Universidad Catolica de Chile, Santiago, Chile
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13
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Anopa Y, Macpherson LMD, McMahon AD, Wright W, Conway DI, McIntosh E. Economic Evaluation of the Protecting Teeth @ 3 Randomized Controlled Trial. JDR Clin Trans Res 2022:23800844221090444. [PMID: 35442091 DOI: 10.1177/23800844221090444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION An economic evaluation (EE) was conducted alongside a randomized controlled trial (the Protecting Teeth @ 3 Study [PT@3]), exploring the additional preventive value of fluoride varnish (FV) application at 6-monthly intervals in nursery schools compared to treatment as usual (TAU) in the same nurseries. TAU represented a multicomponent national child oral health improvement intervention, the Childsmile program, apart from nursery FV. METHODS The EE was a within-trial cost-utility analysis (CUA) comparing the FV and TAU groups. The CUA was conducted from a National Health Service perspective and followed relevant methods guidance. Within-trial costs included intervention costs and health care resource use costs. Health outcomes were expressed in quality-adjusted life years (QALYs) accrued over the 2-y follow-up period. The Child Health Utility 9 Dimensions questionnaire was used to obtain utility scores. National reference costs were used, a discount rate of 1.5% for public health interventions was adopted, multiple imputation methods for missing data were employed, sensitivity analyses were conducted, and incremental cost-utility ratios were calculated. RESULTS Data from 534 participants from the 2014-2015 PT@3 intake were used in the EE analyses, n = 265 (50%) in the FV arm and n = 269 (50%) in the TAU arm. Mean incremental cost per child in the FV arm was £68.37 (P = 0.382; 95% confidence interval [CI], -£18.04 to £143.82). Mean incremental QALY was -0.004 (P = 0.636; 95% CI, -0.016 to 0.007). The probability that the FV intervention was cost-effective at the UK £20,000 threshold was 11.3%. CONCLUSION The results indicate that applying FV in nurseries in addition to TAU (all other components of Childsmile, apart from nursery FV) would not be deemed cost-effective given current UK thresholds. In view of previously proven clinical effectiveness and economic worthiness of the universal nursery toothbrushing component of Childsmile, continuation of the additional, targeted nursery FV component in its pre-COVID-19 form should be reviewed given its low probability of cost-effectiveness. KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by child oral health policy makers and dental public health professionals. They can form part of the evidence to inform the Scottish, UK, and international guidance on community-based child oral health promotion programs.
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Affiliation(s)
- Y Anopa
- College of Medical, Veterinary and Life Sciences, Glasgow Dental School, University of Glasgow, Glasgow, UK.,Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L M D Macpherson
- College of Medical, Veterinary and Life Sciences, Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - A D McMahon
- College of Medical, Veterinary and Life Sciences, Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - W Wright
- College of Medical, Veterinary and Life Sciences, Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - D I Conway
- College of Medical, Veterinary and Life Sciences, Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - E McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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14
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Chou R, Pappas M, Dana T, Selph S, Hart E, Fu RF, Schwarz E. Screening and Interventions to Prevent Dental Caries in Children Younger Than 5 Years: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 326:2179-2192. [PMID: 34874413 DOI: 10.1001/jama.2021.15658] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A 2014 review for the US Preventive Services Task Force (USPSTF) found that oral fluoride supplementation and topical fluoride use were associated with reduced caries incidence in children younger than 5 years. OBJECTIVE To update the 2014 review on dental caries screening and preventive interventions to inform the USPSTF. DATA SOURCES Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews (to September 2020); surveillance through July 23, 2021. STUDY SELECTION Randomized clinical trials (RCTs) on screening, preventive interventions, referral to dental care; cohort studies on screening and referral; studies on diagnostic accuracy of primary care oral examination or risk assessment; and a systematic review on risk of fluorosis included in prior USPSTF reviews. DATA EXTRACTION AND SYNTHESIS One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. RESULTS Thirty-two studies (19 trials, 9 observational studies, and 4 nonrandomized clinical intervention studies [total 106 694 participants] and 1 systematic review [19 studies]) were included. No study evaluated effects of primary care screening on clinical outcomes. One study (n = 258) found primary care pediatrician examination associated with a sensitivity of 0.76 (95% CI, 0.55 to 0.91) and specificity of 0.95 (95% CI, 0.92 to 0.98) for identifying a child with cavities, and 1 study found a risk assessment tool associated with sensitivity of 0.53 and specificity of 0.77 (n = 697, CIs not reported) for a child with future caries. No new trials of dietary fluoride supplementation were identified. For prevention, topical fluoride compared with placebo or no topical fluoride was associated with decreased caries burden (13 trials, n = 5733; mean caries increment [difference in decayed, missing, and filled teeth or surfaces], -0.94 [95% CI, -1.74 to -0.34]) and likelihood of incident caries (12 trials, n = 8177; RR, 0.80 [95% CI, 0.66 to 0.95]; absolute risk difference, -7%) in higher-risk populations or settings, with no increased fluorosis risk. Evidence on other preventive interventions was limited (education, xylitol) or unavailable (silver diamine fluoride), and no study directly evaluated primary care dentistry referral vs no referral. CONCLUSIONS AND RELEVANCE There was no direct evidence on benefits and harms of primary care oral health screening or referral to dentist. Dietary fluoride supplementation and fluoride varnish were associated with improved caries outcomes in higher-risk children and settings.
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Affiliation(s)
- Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
| | - Miranda Pappas
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Tracy Dana
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Shelley Selph
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Erica Hart
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Rongwei F Fu
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
- School of Public Health, Oregon Health & Science University-Portland State University, Portland
| | - Eli Schwarz
- School of Public Health, Oregon Health & Science University-Portland State University, Portland
- School of Dentistry, Oregon Health & Science University, Portland
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15
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Lin PY, Wang J, Chuang TY, Chang YM, Chang HJ, Chi LY. Association between population-based fluoride varnish application services and dental caries experience among schoolchildren in Taiwan. J Formos Med Assoc 2021; 121:986-994. [PMID: 34353718 DOI: 10.1016/j.jfma.2021.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND/PURPOSE Taiwan government has provided population-based fluoride varnish application services for all preschool children since July 2004. This study investigated the association providing such services on dental caries experiences among schoolchildren. METHODS A cross-sectional study was conducted on schoolchildren aged 8-9 years. A questionnaire collected information on sociodemographic background, parents' oral health status, children's oral health-related behavior, and dietary habits. Dental caries was recorded through standardized oral examinations. The number of services was retrieved from the Taiwan National Health Insurance Research Database. Univariate, multivariable linear, and logistic regression analyses were performed. RESULTS The study involved 1246 children. The mean dental caries indices were 3.97 for decayed, extracted, and filled teeth (deft) and 0.94 for decayed, missing and filled teeth (DMFT). After adjustments for confounding factors, it was revealed that children receiving services were not associated with significantly lower deft and DMFT indices (P > 0.05). The adjusted odds ratio (OR) for untreated primary teeth of children receiving 3 or more services was 0.64 (95% CI = 0.44-0.95) compared with those who received no services (P = 0.025). However, subgroup analyses demonstrated that children in the low-risk group were mainly affected (adjusted OR = 0.36-0.89, P = 0.013). CONCLUSION This study revealed that children receiving 3 or more services were associated with a 36% decreased risk of having untreated caries in primary dentition, but these children were mainly in the low-risk group. These results illustrate real data that provides dentists and policymakers with valuable information.
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Affiliation(s)
- Po-Yen Lin
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tsai-Yi Chuang
- Department of Dentistry, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yung-Ming Chang
- Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan; Ministry of Health and Welfare, Taipei, Taiwan
| | - Hong-Ji Chang
- Department of Dentistry, Cheng Hsin General Hospital, Taipei, Taiwan.
| | - Lin-Yang Chi
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
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Araujo MP, Al-Yaseen W, Innes NP. A road map for designing and reporting clinical trials in paediatric dentistry. Int J Paediatr Dent 2020; 31 Suppl 1:14-22. [PMID: 33222306 DOI: 10.1111/ipd.12746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Unless clinical trials are well-designed, there is a risk that they will not be usable to improve patient care. AIM This paper discusses some factors important in designing clinical trials in paediatric dentistry. It uses the prevention and management of dental caries in children as the lens through which to look at these. FINDINGS Amongst the factors to consider are clear research questions and objectives; appropriate outcomes and outcome measures; sample size calculation and the level of randomisation; methods for random allocation; and operator/assessor training. Experts in trial design including statisticians and a trialist should be consulted early in the design process. The aspects of trial design unique to cariology trials such as 'clustering' of data items, mixed dentition issues and those related to trials involving children (communication, consent etc) should be considered. Comprehensive reporting of trial results is essential. CONCLUSION There are many readily available resources and tools to help the researcher design a trial of good quality that will yield results useful to the research community and beyond, to those who will implement the findings and ultimately those who will benefit from them.
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Affiliation(s)
- Mariana Pinheiro Araujo
- NHS Education for Scotland, Dental Clinical Effectiveness, Dundee Dental Education Centre - DDEC, Small's Wynd, Dundee, UK
| | - Waraf Al-Yaseen
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Nicola Patricia Innes
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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17
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Turton B, Durward C, Crombie F, Sokal-Gutierrez K, Soeurn S, Manton DJ. Evaluation of a community-based early childhood caries (ECC) intervention in Cambodia. Community Dent Oral Epidemiol 2020; 49:275-283. [PMID: 33200439 DOI: 10.1111/cdoe.12599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/28/2020] [Accepted: 10/30/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To critically evaluate an early childhood caries (ECC) intervention performed by non-dental primary healthcare providers. METHODS This mixed-methods investigation includes data from three sources: (a) a pilot non-randomized controlled trial to examine clinical outcomes at four health centres; (b) stakeholder focus group interviews; and (c) a survey of parents whose children were exposed to the intervention. The pilot study involved four Community Health Centres in rural Cambodia whereby mother-child (6-24 months of age)dyads received oral health education (OHE), toothbrushes, fluoride toothpaste and fluoride varnish on up to six occasions as part of the routine vaccination schedule. Outcomes were as follows: presence of ECC; impacts on oral health-related quality of life (OHRQoL); stakeholder perceptions of intervention delivery; and parental perceptions of fluoride varnish. RESULTS Participants in the intervention group had six times lower odds of developing ECC than those in the comparison group after controlling for socio-economic status (OR 0.13). Those in the intervention group also had a large reduction OHRQoL scale scores. Key knowledge and practice gaps were identified among stakeholders. Surveyed parents had favourable views of the fluoride varnish placement by medical professionals, and four out of five stated that they would recommend fluoride varnish for other children. Primary healthcare providers, commune council representatives and community health promoters supported oral health interventions being provided in CHCs. CONCLUSIONS OHE and fluoride varnish interventions provided by non-dental primary health workers were feasible and acceptable for stakeholders in a Cambodian setting. The intervention group had lower ECC experience and better OHRQoL at 2 years of age.
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Affiliation(s)
- Bathsheba Turton
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - Callum Durward
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - Felicity Crombie
- Melbourne Dental School, University of Melbourne, Melbourne, Vic., Australia
| | | | - Sopharith Soeurn
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - David J Manton
- Centrum voor Tandheelkunde en Mondzorgkunde, UMCG, University of Groningen, Groningen, The Netherlands
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Brocklehurst PR, Baker SR, Langley J. Context and the evidence-based paradigm: The potential for participatory research and systems thinking in oral health. Community Dent Oral Epidemiol 2020; 49:1-9. [PMID: 32813938 DOI: 10.1111/cdoe.12570] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/15/2020] [Accepted: 07/30/2020] [Indexed: 12/24/2022]
Abstract
The implementation of research evidence to promote oral health is critical, given the intransigent and emerging challenges for policymakers at a population level. Despite this, little attention has been paid to implementation research within the evidence-based paradigm. This is important as getting research evidence into clinical practice is not a linear path that consists of simple sequential steps. In this article, we argue that we need to consider a broader range of conceptual and methodological approaches to increase the value of information generated. This should be undertaken either in parallel with empirical and experimental designs, or in some cases, instead of. This is important if we are going to understand the complexity and contextual knowledge of the 'system', within which interventions are implemented. Involving key stakeholders alongside empirical and experimental designs is one helpful approach. Examples of these approaches include Patient and Public Involvement and the development of Core Outcome Sets, where the views of those that will be potentially affected by the research, are included. The use of theoretical frameworks and process evaluations alongside trials are also important, if they are fully integrated into the approach taken to address the research question. A more radical approach is using participatory designs and 'systems thinking'. Participatory approaches include subject matter 'experts by experience'. These include patients, their families, carers, healthcare professionals, services managers, policymakers, commissioners and researchers. Participatory approaches raise important questions about who facilitates the process, when it should happen and how the diverse actors become meaningfully engaged so that their involvement is active, democratic and ongoing. We argue that the issues of control, power and language are central to this and represent a paradigmatic shift to conventional approaches. Systems thinking captures the idea that public health problems commonly involve multiple interdependent and interconnected factors, which interact with each other dynamically. This approach challenges the simplicity of the hierarchy of evidence and linear sequential logic, when it does not account for context. In contrast, systems thinking accepts complexity de novo and emphasizes the need to understand the whole system rather than its individual component parts. We conclude with the idea that participatory and systems thinking help to unpack the diverse agents that are often involved in the generation and translation of evidence into clinical dental practice. It moves our conception of research away from a simple exchange between 'knowledge producers' and 'knowledge users' and raises both methodological and epistemological challenges.
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Affiliation(s)
| | - Sarah R Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Joe Langley
- Art & Design Research Centre, Sheffield Hallam University, Sheffield, UK
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19
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Anopa Y, Macpherson L, McIntosh E. Systematic Review of Economic Evaluations of Primary Caries Prevention in 2- to 5-Year-Old Preschool Children. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1109-1118. [PMID: 32828224 DOI: 10.1016/j.jval.2020.04.1823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/01/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To describe and summarize evidence on economic evaluations (EEs) of primary caries prevention in preschool children aged 2 to 5 years and to evaluate the reporting quality of full EE studies using a quality assessment tool. METHODS A systematic literature search was conducted in several databases. Full and partial EEs were included. The reporting quality of full EE studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS A total of 808 studies were identified, and 39 were included in the review. Most papers were published between 2000 and 2017 and originated in the United States and the United Kingdom. The most common type of intervention investigated was a complex multicomponent intervention, followed by water fluoridation. Cost analysis and cost-effectiveness analysis were the most frequently used types of EE. One study employed cost-utility analysis. The proportion of full EEs increased over time. The parameters not reported well included study perspective, baseline year, sensitivity analysis, and discount rate. The CHEERS items that were most often unmet were characterizing uncertainty, study perspective, study parameters, and estimating resources and costs. CONCLUSIONS Within the past 2 decades, there has been an increase in the number of EEs of caries prevention interventions in preschool children. There was inconsistency in how EEs were conducted and reported. Lack of preference-based health-related quality-of-life measure utilization in the field was identified. The use of appropriate study methodologies and greater attention to recommended EE design are required to further improve quality.
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Affiliation(s)
- Yulia Anopa
- Dental School, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, UK; Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK.
| | - Lorna Macpherson
- Dental School, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
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20
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Anopa Y, Conway DI. Exploring the cost-effectiveness of child dental caries prevention programmes. Are we comparing apples and oranges? Evid Based Dent 2020; 21:5-7. [PMID: 32221482 DOI: 10.1038/s41432-020-0085-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Data sources The following seven databases were searched: PubMed, EMBASE, DARE, NHSEED, HTA, Cost-Effectiveness Analysis Registry and Paediatric Economic Database Evaluation (PEDE).Study selection The review included trial and model-based economic evaluation studies and the participants included children aged from 0 to 12 years old who were healthy except for having dental caries. Studies of mixed populations of parents and children were included where the data for children were presented separately.The interventions included were:• Community-based oral-health education/training programs related to healthy oral habits.• Screening of children's teeth.• Supervised toothbrushing technique through the provision of toothbrushes, an appropriate amount of fluoride toothpaste, and topical fluoride.• Advice on dietary control, such as limitation of sugar or carbohydrates consumption, and enhanced fortified nutrition with an appropriate amount of calcium intake.• The comparators were situations where the populations were the same as the test group, but were receiving no intervention, or a dissimilar one .The interventions were oral-health promotion programs (OHPPs) implemented by oral-health professionals in the contexts of home visits, telephone calls, healthcare centres and primary schools.The outcome measures were reductions in the Decayed, Missing, Filled Teeth (DMFT) index for permanent teeth or (dmft) index for deciduous teeth among children and OHPP cost, incremental cost (difference between mean costs of intervention and mean costs of the comparator), and cost-effectiveness analysis (CEA).Data extraction and synthesis The title, abstract and full text of each study were screened. During the first phase screening of titles and abstracts, irrelevant records were removed. The exclusion criteria were: participant with health-related diseases or aged older than 12 years; interventions other than OHPP (such as implant dentistry or other invasive-dentistry programs); other economic-evaluation outcomes such as cost-benefit, cost-utility or cost-minimisation; authors' opinion (unoriginal records); reviews; and study language other than English. The second-phase screening assessed full texts of the articles using the same eligibility criteria. The risk of bias was assessed using the Drummond 10-item Checklist. Meta-analysis: The costs were converted to 2015 USA dollars. Data analysis was performed through dichotomous outcomes such as the number of children in the intervention and in the control group, the DMFT index in children, and the OHPP cost. Odds ratios (ORs), effect sizes with 95% confidence interval (CIs) and study weights were estimated from random effects analysis. Forest plots were constructed for each outcome, and chi-square tests used to assess homogeneity, where a p-value of less than 0.1 indicated statistically significant heterogeneity. An I2 test was used to quantify inconsistencies between studies as the percentage of variation across studies. Data synthesis was carried out using narrative demonstration, with a summary of the characteristics of each included study. For quantitative synthesis, a summary of the combined estimation related to the OHPP effect was measured. Three types of subgroup analysis were performed: by the age of the children (age under or equal to 6 years, and age 6-12 years), by publication year (studies published in the last five years, and earlier published studies) and by the country of the study. Egger's regression test and a funnel plot were used to assess and demonstrate publication bias. Publication bias was considered present if the p-value of the Egger test was more than 0.05.Results 19 full texts were included into qualitative synthesis and eight articles used in quantitative synthesis. Qualitative synthesis results: With regards to the country of origin, 32% of the studies were conducted in the United Kingdom (n = 6), 26% in Australia (n = 5), 16% in the United States (n = 3). There was also one study from each of the following countries Finland, Ireland, Japan, Nigeria and Singapore. Fifty-two percent (n = 10) were model-based economic evaluation studies and 47% (n = 9) were trial-based economic evaluations. The population of 14 studies were younger than six years of age, while in four studies the children were over the age of six years. In one paper the age of the children was not clearly stated. Just under a half of the papers (47%) were published in the last five years.The majority of the studies had a low risk of bias (n = 12, 63%) and seven (37%) had a moderate risk of bias. Various outcome measures were used in the included studies: DMFT, average number of dental visits, number of prevented caries teeth, average number of cavity-free months, probability of less cost, caries prevalence, number of specific OHPP visits, quality-adjusted life year, cost-effectiveness ratio, and percentages of not having debris.Quantitative synthesis results: The overall pooled impact of OHPPs showed that children with tooth decay had 81% lower odds of participating in OHPP (95% CI 61-90%, I2: 98.5%, p = 0) with considerable heterogeneity among studies. OHPPs were successful in reducing financial costs in 97 out of 100 OHPPs (95% CI 89-99%, I2: 99%, p = 0) with considerable heterogeneity among studies. The studies with participants under the age of six years old weighted 71% with an OR of 0.14 (95% CI, 0.05-0.39, I2: 99%). These children had the highest benefit of OHPPs to lower DMFT/S. The studies reporting children aged six years and over weighted 29% with an OR of 0.29 (95% CI, 0.08-1.01, I2: 99%), and these children had no benefit from OHPPs in lowering DMFT/S. Studies with under-six-year-old participants had an OR of 0.07 (95% CI, 0.02-0.32) revealing no cost-effectiveness effect to reduce OHPP incremental cost, whereas studies reporting children aged six years and older had an OR of 0.0 (95% CI, 0.00-48,704.6). The authors concluded that OHPPs involving the later (older) children were cost-effective in reducing the OHPPs' incremental cost.Conclusions A comprehensive analysis of the OHPPs confirmed that DMFT could be reduced, hence, lowering the financial burden of dental-care treatment. More effort is needed to manage the allocation of scarce resources, taking into account the economic impact of dental caries on healthcare systems. More studies on caries-prevention programmes among young children in high-, middle- and low-income countries are needed, in order to assess the clinical and financial effectiveness.
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Affiliation(s)
- Yulia Anopa
- Dental School, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK; Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - David I Conway
- Dental School, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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Mariño R, Ravisankar G, Zaror C. Quality appraisal of economic evaluations done on oral health preventive programs-A systematic review. J Public Health Dent 2020; 80:194-207. [PMID: 32311103 DOI: 10.1111/jphd.12368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 01/01/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES If economic evaluations are to be used by decision makers, such evidence has to be robust so that the relevant policy maker use them. This study was undertaken with the purpose of identifying economic evaluations done on oral health preventive programs and to assess the standard of economic evidence in this field. METHODS A systematic search was conducted using four major electronic databases in order to search for economic evaluations done on oral health preventive programs. This included economic evaluations that were published between January 1975 and May 2018 on preventive interventions for periodontal disease, oral cancer screening, and other common oral health conditions. To avoid duplications with previous studies, for dental caries interventions, this review included studies from April 2012 and May 2018. "Guidance to undertaking reviews in health care," developed by York University, was used to assess the quality of reporting in the evaluations, using which strengths and shortcomings were identified. RESULTS A total of 2026 records were initially found. After title and abstract screening, and elimination by full text review, 33 relevant economic evaluations were identified. Majority of the economic evaluations included were conducted on dental caries prevention; a few were done on oral cancer screening, periodontal disease, and general preventive dentistry (health promotion, oral hygiene etc.). CONCLUSIONS In comparison to the findings observed in previous reviews, there has been improvements in the quality of reporting in economic evaluations. Several areas still in need for improve were identified (e.g., productivity costs, currency and prices, and generalizability issues).
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Affiliation(s)
- Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | | | - Carlos Zaror
- Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
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Brocklehurst P, Tickle M, Birch S, McDonald R, Walsh T, Goodwin TL, Hill H, Howarth E, Donaldson M, O’Carolan D, Fitzpatrick S, McCrory G, Slee C. Impact of changing provider remuneration on NHS general dental practitioner services in Northern Ireland: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background
Policy-makers wanted to reform the NHS dental contract in Northern Ireland to contain costs, secure access and incentivise prevention and quality. A pilot project was undertaken to remunerate general dental practitioners using a capitation-based payment system rather than the existing fee-for-service system.
Objective
To investigate the impact of this change in remuneration.
Design
Mixed-methods design using a difference-in-difference evaluation of clinical activity levels, a questionnaire of patient-rated outcomes and qualitative assessment of general dental practitioners’ and patients’ views.
Setting
NHS dental practices in Northern Ireland.
Participants
General dental practitioners and patients in 11 intervention practices and 18 control practices.
Interventions
Change from fee for service to a capitation-based system for 1 year and then reversion back to fee for service.
Main outcome measures
Access to care, activity levels, service mix and financial impact, and patient-rated outcomes of care.
Results
The difference-in-difference analyses showed significant and rapid changes in the patterns of care provided by general dental practitioners to patients (compared with the control practices) when they moved from a fee-for-service system to a capitation-based remuneration system. The number of registered patients in the intervention practices compared with the control practices showed a small but statistically significant increase during the capitation period (p < 0.01), but this difference was small. There were statistically significant reductions in the volume of activity across all treatments in the intervention practices during the capitation period, compared with the control practices. This produced a concomitant reduction in patient charge revenue of £2403 per practice per month (p < 0.05). All outcome measures rapidly returned to baseline levels following reversion from the capitation-based system back to a fee-for-service system. The analysis of the questionnaires suggests that patients did not appear to notice very much change. Qualitative interviews showed variation in general dental practitioners’ behaviour in response to the intervention and how they managed the tension between professional ethics and maximising the profits of their business. Behaviours were also heavily influenced by local context. Practice principals preferred the capitation model as it freed up time and provided opportunities for private work, whereas capitation payments were seen by some principals as a ‘retainer fee’ for continuing to provide NHS care. Non-equity-owning associates perceived the capitation model as a financial risk.
Limitations
The active NHS pilot period was only 1 year, which may have limited the scope for meaningful change. The number of sites was restricted by the financial budget for the NHS pilot.
Conclusions
General dental practitioners respond rapidly and consistently to changes in remuneration, but differences were found in the extent of this change by practice and provider type. A move from a fee-for-service system to a capitation-based system had little impact on access but produced large reductions in clinical activity and patient charge income. Patients noticed little difference in the service that they received.
Future work
With changing population need and increasing financial pressure on the NHS, research is required on how to most efficiently meet the expectations of patients within an affordable cost envelope. Work is also needed to identify and evaluate interventions that can complement changes in remuneration to meet policy goals.
Trial registration
Current Controlled Trials ISRCTN29840057.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 6. 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
| | - Stephen Birch
- Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Ruth McDonald
- Manchester Business School, University of Manchester, Manchester, UK
| | - Tanya Walsh
- School of Dentistry, University of Manchester, Manchester, UK
| | | | - Harry Hill
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Tull K, Gray-Burrows KA, Bhatti A, Owen J, Rutter L, Zoltie T, Purdy J, Giles E, Paige C, Patel M, Marshman Z, West R, Pavitt S, Day PF. "Strong Teeth"-a study protocol for an early-phase feasibility trial of a complex oral health intervention delivered by dental teams to parents of young children. Pilot Feasibility Stud 2019; 5:100. [PMID: 31413863 PMCID: PMC6691530 DOI: 10.1186/s40814-019-0483-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Dental attendance provides an important opportunity for dental teams to explore with parents the oral health behaviours they undertake for their young children (0–5 years old). For these discussions to be effective, dental professionals need to be skilled in behaviour change conversations. The current evidence suggests that dental teams need further support, training and resources in this area. Therefore, the University of Leeds and Oral-B (Procter & Gamble Company) have worked with the local community and dental professionals to co-develop “Strong Teeth” (an oral health intervention), which is delivered in a general dental practice setting by the whole dental team. The protocol for this early phase study will explore the feasibility and acceptability of the Strong Teeth intervention to parents and the dental team, as well as explore short-term changes in oral health behaviour. Methods Forty parents (20 of children aged 0–2 years old, and 20 of children aged 3–5 years old) who are about to attend the dentist for their child’s regular dental check-up will be recruited to the study. Parents and children will be recruited from 4 to 8 different dental practices. In the home setting, consent and baseline oral health behaviour data will be collected. The researchers will ask parents questions about their child’s oral health behaviours, including toothbrushing and diet. Three different proxy objective measures of toothbrushing will be collected and compared with self-report measures of parental supervised toothbrushing (PSB). Discussion The parent and child will then attend their dental visit and receive the Strong Teeth intervention, delivered by the dental team. This intervention should take 5–15 min to be delivered, in addition to the routine dental check-up. Furthermore, children aged 0–2 years old will receive an Oral-B manual children’s toothbrush, and children aged 3–5 years old will receive an Oral-B electric rechargeable children’s toothbrush. At 2 weeks and 2–3 months following the Strong Teeth intervention, further self-report and objective measures will be collected in the parent/child’s home. This data will be supplemented with purposively sampled qualitative interviews with parents (approximately 3 months following the intervention) and dental team members (following delivery of the intervention). Trial registration ISRCTN Register, (ISRCTN10709150) Electronic supplementary material The online version of this article (10.1186/s40814-019-0483-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kerina Tull
- 1University of Leeds, Leeds Institute of Health Sciences, Clarendon Way, Leeds, LS2 9NL UK
| | | | - Amrit Bhatti
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Jenny Owen
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Lucy Rutter
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Timothy Zoltie
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Jayne Purdy
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Erin Giles
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Carron Paige
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Morvin Patel
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Zoe Marshman
- 3University of Sheffield, School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA UK
| | - Robert West
- 1University of Leeds, Leeds Institute of Health Sciences, Clarendon Way, Leeds, LS2 9NL UK
| | - Sue Pavitt
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Peter F Day
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
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Fraihat N, Madae'en S, Bencze Z, Herczeg A, Varga O. Clinical Effectiveness and Cost-Effectiveness of Oral-Health Promotion in Dental Caries Prevention among Children: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152668. [PMID: 31349691 PMCID: PMC6696287 DOI: 10.3390/ijerph16152668] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 01/08/2023]
Abstract
The objective of this study was to evaluate the clinical effectiveness and cost-effectiveness of oral-health promotion programs (OHPPs) aiming to improve children’s knowledge of favorable oral health behavior to lower decayed/-missing/-filled teeth (DMFT) while reducing the financial cost on health institutions. An electronic search was performed in seven databases. Studies were restricted to human interventions published in English. The search study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and the risk of bias was assessed based on the Drummonds Checklist. A total of 1072 references were found. Among these, 19 full texts were included. Most studies had a strong quality. The overall pooled impact of OHPPs estimates children suffering from DMFT/S to have 81% lower odds of participating in OHPP (95% CI 61–90%, I2: 98.3%, p = 0). Furthermore, the program was shown to be effective at lowering the cost in 97 out of 100 OHPPs (95% CI 89–99%, I2: 99%, p = 0). Three subgroups analyses (age groups, study countries, studies of the last five years) were performed to evaluate the influence modification on the pooled effect. A comprehensive analysis of the OHPPs confirmed a reduction effect on child DMFT, hence, lowering the financial burden of dental-care treatment on health institutions.
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Affiliation(s)
- Nadine Fraihat
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4002 Debrecen, Hungary.
| | - Saba Madae'en
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman 11942, Jordan
| | - Zsuzsa Bencze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4002 Debrecen, Hungary
| | - Adrienn Herczeg
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4002 Debrecen, Hungary
| | - Orsolya Varga
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4002 Debrecen, Hungary
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25
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Al Dehailan L, Martinez-Mier EA. Prevention Program Including Fluoride Varnish and 1450-ppm Fluoride Toothpaste Targeting Young Children in Clinical Setting in UK did not Stop Sental Caries From Developing but Slowed Lesion Progression. J Evid Based Dent Pract 2019; 19:207-209. [PMID: 31326059 DOI: 10.1016/j.jebdp.2019.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION A randomized controlled trial of caries prevention in dental practice. Tickle M, O'Neill C, Donaldson M, Birch S, Noble S, Killough S, Murphy L, Greer M, Brodison J, Verghis R, Worthington HV. J Dent Res 2017; 96:741-46. SOURCE OF FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme in UK. TYPE OF STUDY/DESIGN Randomized clinical trial with a parallel design.
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26
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Rogers HJ, Rodd HD, Vermaire JH, Stevens K, Knapp R, El Yousfi S, Marshman Z. A systematic review of the quality and scope of economic evaluations in child oral health research. BMC Oral Health 2019; 19:132. [PMID: 31262293 PMCID: PMC6604207 DOI: 10.1186/s12903-019-0825-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Economic evaluations provide policy makers with information to facilitate efficient resource allocation. To date, the quality and scope of economic evaluations in the field of child oral health has not been evaluated. Furthermore, whilst the involvement of children in research has been actively encouraged in recent years, the success of this movement in dental health economics has not yet been explored. This review aimed to determine the quality and scope of published economic evaluations applied to children's oral health and to consider the extent of children's involvement. METHODS The following databases were searched: CINAHL, Cochrane Library, Econlit, EThOS, MEDLINE, NHS EED, OpenGrey, Scopus, Web of Science. Full economic evaluations, relating to any aspect of child oral health, published after 1997 were included and appraised against the Drummond checklist and the Consolidated Health Economic Evaluation Reporting Standards by a team of four calibrated reviewers. Data were also extracted regarding children's involvement and the outcome measures used. RESULTS Two thousand seven hundred fifteen studies were identified, of which 46 met the inclusion criteria. The majority (n = 38, 82%) were cost-effectiveness studies, with most focusing on the prevention or management of dental caries (n = 42, 91%). One study quantified outcomes in Quality Adjusted Life Years (QALYs), and one study utilised a child-reported outcome measure. The mean percentage of applicable Drummond checklist criteria met by the studies in this review was 48% (median = 50%, range = 0-100%) with key methodological weaknesses noted in relation to discounting of costs and outcomes. The mean percentage of applicable CHEERS criteria met by each study was 77% (median = 83%, range = 33-100%), with limited reporting of conflicts of interest. Children's engagement was largely overlooked. CONCLUSIONS There is a paucity of high-quality economic evaluations in the field of child oral health. This deficiency could be addressed through the endorsement of standardised economic evaluation guidelines by dental journals. The development of a child-centred utility measure for use in paediatric oral health would enable researchers to quantify outcomes in terms of quality adjusted life years (QALYs) whilst promoting child-centred research.
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Affiliation(s)
- H J Rogers
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| | - H D Rodd
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - J H Vermaire
- Division of Child Health, TNO Institute for Applied Sciences, Leiden, The Netherlands
| | - K Stevens
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Knapp
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - S El Yousfi
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Z Marshman
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Anderson M, Davidson T, Dahllöf G, Grindefjord M. Economic evaluation of an expanded caries-preventive program targeting toddlers in high-risk areas in Sweden. Acta Odontol Scand 2019; 77:303-309. [PMID: 30636456 DOI: 10.1080/00016357.2018.1548709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To economically evaluate a caries-preventive program "Stop Caries Stockholm" (SCS) where a standard program is supplemented with biannual applications of fluoride varnish in toddlers and compared it with the standard preventive program. MATERIAL AND METHODS Data from the cluster randomized controlled field trial SCS including 3403 children, conducted in multicultural areas with low socioeconomic status was used. The difference in mean caries increment between the examinations; when the toddlers were 1 and 3 years old, was outcome measure of the intervention. The program was evaluated from a societal as well as a dental health care perspective. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental cost for each defs prevented. RESULTS Average dental health care costs per child at age 3 years were EUR 95.77 for the supplemental intervention and EUR 70.52 for the standard intervention. The ICER was EUR 280.56 from a dental health care perspective and EUR 468.67 and considered high. CONCLUSIONS The supplemental caries intervention program was not found to be cost-effective. The program raised costs without significantly reducing caries development. A better alternative use of the resources is recommended. TRIAL REGISTRATION www.controlled-trials.com (ISRCTN35086887).
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Affiliation(s)
- Maria Anderson
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Dentistry, Eastman Institute, Public Dental Service, Stockholm, Sweden
- Center of Pediatric Oral Health, Stockholm, Sweden
| | - Thomas Davidson
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Göran Dahllöf
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center of Pediatric Oral Health, Stockholm, Sweden
| | - Margaret Grindefjord
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Dentistry, Eastman Institute, Public Dental Service, Stockholm, Sweden
- Center of Pediatric Oral Health, Stockholm, Sweden
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Chi L, Lin P, Wang J, Chu Y, Chang Y. Can government‐supported preventive fluoride varnish application service reduce pulp‐involved primary molars? J Public Health Dent 2019; 79:238-245. [DOI: 10.1111/jphd.12319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 01/29/2019] [Accepted: 03/22/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Lin‐Yang Chi
- Department of Dentistry, School of DentistryNational Yang‐Ming University Taipei Taiwan
- Department of Education and ResearchTaipei City Hospital Taipei Taiwan
| | - Po‐Yen Lin
- Department of Dentistry, School of DentistryNational Yang‐Ming University Taipei Taiwan
- Department of DentistryShin Kong Wu Ho‐Su Memorial Hospital Taipei Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan University Taipei Taiwan
| | - Yu‐Roo Chu
- Department of Dentistry, School of DentistryNational Yang‐Ming University Taipei Taiwan
- Division of Medical Devices and CosmeticsTaiwan Food and Drug Administration Taipei Taiwan
| | - Yung‐Ming Chang
- Department of Oral Hygiene, College of Oral MedicineTaipei Medical University Taipei Taiwan
- Department of PlanningMinistry of Health and Welfare Taipei Taiwan
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Palacio R, Shen J, Vale L, Vernazza CR. Assessing the cost‐effectiveness of a fluoride varnish programme in Chile: The use of a decision analytic model in dentistry. Community Dent Oral Epidemiol 2019; 47:217-224. [DOI: 10.1111/cdoe.12447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/28/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Raul Palacio
- School of DentistryPontificia Universidad Católica de Chile Santiago Chile
| | - Jing Shen
- Institute of Health and SocietyNewcastle University Newcastle Upon Tyne UK
| | - Luke Vale
- Institute of Health and SocietyNewcastle University Newcastle Upon Tyne UK
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Brocklehurst PR, Baker SR, Listl S, Peres MA, Tsakos G, Rycroft-Malone J. How Should We Evaluate and Use Evidence to Improve Population Oral Health? Dent Clin North Am 2019; 63:145-156. [PMID: 30447789 DOI: 10.1016/j.cden.2018.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Generating and implementing evidence-based policy is an important aim for many publicly funded health systems. In dentistry, this is based on the assumption that evidence-based health care increases the efficiency and effectiveness of interventions to improve oral health at a population level. This article argues that a linear logic model that links the generation of research evidence with its use is overly simplistic. It also challenges an uncritical interpretation of the evidence-based paradigm and explores approaches to the evaluation of complex interventions and how they can be embedded into policy and practice to improve oral health at a population level.
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Affiliation(s)
| | - Sarah R Baker
- The School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Stefan Listl
- Faculty of Medical Sciences, Radboud University, The Netherlands
| | - Marco A Peres
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College, 1-19 Torrington Place, London, UK
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31
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Guidelines relevant to paediatric dentistry - do foundation dentists and general dental practitioners follow them? Part 1: diagnosis and prevention. Br Dent J 2018; 224:727-732. [PMID: 29747172 DOI: 10.1038/sj.bdj.2018.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/09/2022]
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32
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Brocklehurst PR, Williams L, Burton C, Goodwin T, Rycroft-Malone J. Implementation and trial evidence: a plea for fore-thought. Br Dent J 2018; 222:331-335. [PMID: 28281585 DOI: 10.1038/sj.bdj.2017.213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2017] [Indexed: 11/09/2022]
Abstract
In a world where evidence-based practice is see as the foundation of modern healthcare, this paper asks when and how should we be accounting for the input of patients, the public, dental professionals, commissioners and policy-makers in the evidence generation process?
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Affiliation(s)
| | - L Williams
- School of Healthcare Sciences, Bangor University
| | - C Burton
- School of Healthcare Sciences, Bangor University
| | | | - J Rycroft-Malone
- Research &Impact, Bangor Institute of Health and Medical Research, Bangor University
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Abstract
We focus on scalable public health interventions that prevent and delay the development of caries and enhance resistance to dental caries lesions. These interventions should occur throughout the life cycle, and need to be age appropriate. Mitigating disease transmission and enhancing resistance are achieved through use of various fluorides, sugar substitutes, mechanical barriers such as pit-and-fissure sealants, and antimicrobials. A key aspect is counseling and other behavioral interventions that are designed to promote use of disease transmission-inhibiting and tooth resistance-enhancing agents. Advocacy for public water fluoridation and sugar taxes is an appropriate dental public health activity.
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Affiliation(s)
- Jeremy A Horst
- Department of Biochemistry and Biophysics, University of California San Francisco, 1700 4th Street, QB3 Room 404, San Francisco, CA 94158, USA
| | - Jason M Tanzer
- Section on Oral Medicine, Department of Oral and Maxillofacial Diagnostic Sciences, University of Connecticut Health, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Peter M Milgrom
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475, USA.
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Eskyte I, Gray-Burrows K, Owen J, Sykes-Muskett B, Zoltie T, Gill S, Smith V, McEachan R, Marshman Z, West R, Pavitt S, Day P. HABIT-an early phase study to explore an oral health intervention delivered by health visitors to parents with young children aged 9-12 months: study protocol. Pilot Feasibility Stud 2018; 4:68. [PMID: 29610675 PMCID: PMC5870936 DOI: 10.1186/s40814-018-0261-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Parental supervised brushing (PSB) when initiated in infancy can lead to long-term protective home-based oral health habits thereby reducing the risk of dental caries. However, PSB is a complex behaviour with many barriers reported by parents hindering its effective implementation. Within the UK, oral health advice is delivered universally to parents by health visitors and their wider teams when children are aged between 9 and 12 months. Nevertheless, there is no standardised intervention or training upon which health visitors can base this advice, and they often lack the specialised knowledge needed to help parents overcome barriers to performing PSB and limiting sugary foods and drinks. Working with health visitors and parents of children aged 9–24 months, we have co-designed oral health training and resources (Health Visitors delivering Advice in Britain on Infant Toothbrushing (HABIT) intervention) to be used by health visitors and their wider teams when providing parents of children aged 9–12 months with oral health advice. The aim of the study is to explore the acceptability of the HABIT intervention to parents and health visitors, to examine the mechanism of action and develop suitable objective measures of PSB. Methods/design Six health visitors working in a deprived city in the UK will be provided with training on how to use the HABIT intervention. Health visitors will then each deliver the intervention to five parents of children aged 9–12 months. The research team will collect measures of PSB and dietary behaviours before and at 2 weeks and 3 months after the HABIT intervention. Acceptability of the HABIT intervention to health visitors will be explored through semi-structured diaries completed after each visit and a focus group discussion after delivery to all parents. Acceptability of the HABIT intervention and mechanism of action will be explored briefly during each home visit with parents and in greater details in 20–25 qualitative interviews after the completion of data collection. The utility of three objective measures of PSB will be compared with each other and with parental-self reports. Discussion This study will provide essential information to inform the design of a definitive cluster randomised controlled trial. Trial registration There is no database for early phase studies such as ours.
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Affiliation(s)
- Ieva Eskyte
- 1School of Dentistry, University of Leeds, Leeds, LS2 9LU UK
| | | | - Jenny Owen
- 1School of Dentistry, University of Leeds, Leeds, LS2 9LU UK
| | | | - Tim Zoltie
- 1School of Dentistry, University of Leeds, Leeds, LS2 9LU UK
| | - Susanne Gill
- Highfield Health Visiting Team, Highfield Health Centre, Leeds, BD4 9QA UK
| | - Victoria Smith
- Allerton Health Visiting Team, Allerton Health Centre, Bradford, BD15 7NJ UK
| | - Rosemary McEachan
- 4Born in Bradford, Bradford Institute for Health Research, Bradford, BD9 6RJ UK
| | - Zoe Marshman
- 5School of Clinical Dentistry, University of Sheffield, Sheffield, S10 2TA UK
| | - Robert West
- 6Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LU UK
| | - Sue Pavitt
- 7Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, LS2 9LU UK
| | - Peter Day
- 1School of Dentistry, University of Leeds, Leeds, LS2 9LU UK
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O'Malley L, Worthington HV, Donaldson M, O'Neil C, Birch S, Noble S, Killough S, Murphy L, Greer M, Brodison J, Verghis R, Tickle M. Oral health behaviours of parents and young children in a practice-based caries prevention trial in Northern Ireland. Community Dent Oral Epidemiol 2017; 46:251-257. [PMID: 29271079 DOI: 10.1111/cdoe.12357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The NICPIP trial evaluated the costs and effects of a caries prevention intervention delivered to 2- to 3-year-old children attending dental practices in Northern Ireland. This supplementary study explored the oral health behaviours of children and their parents to help understand the reasons for the trial's findings. METHODS A mixed methods study that included a questionnaire completed by all parents (n = 1058) at the time they brought their child for the NICPIP final clinical assessment. The questionnaire collected data on frequency of toothbrushing and sugar consumption. Questionnaire data were analysed by trial group and caries status. Parents of trial participants (n = 42) were invited to take part in telephone interviews. Parents were purposively sampled according to trial group and whether or not their child developed caries. The interviews explored how and why oral health behaviours happened. Interview data were audio-recorded, transcribed verbatim and analysed thematically. RESULTS The questionnaire data indicated that toothbrushing and between-meal sugar snacking were common in the majority of children. The children of parents who automatically reminded their child to brush their teeth were more likely to remain caries-free (Odds Ratio 1.24; 95% CI 1.08, 1.41; P = .002). Frequency of sweet drink consumption was associated with the child developing caries (Odds Ratio 0.88; 95% CI 0.79, 0.98; P = .021). The interview data showed that parents had positive attitudes towards brushing both in terms of perceived importance and expected outcomes. Attitudes towards sugar snacking were more complex, with parents reporting difficulties in controlling this behaviour. Sugar was described as being something that was "ever present" in children's lives. CONCLUSIONS Toothbrushing was widely adopted from a young age, but between-meal sugar consumption was highly prevalent. The results suggest that effective family-level and population-level interventions are needed to reduce sugar consumption if substantial improvements in caries prevention are to be achieved.
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Affiliation(s)
- Lucy O'Malley
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Ciaran O'Neil
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Stephen Birch
- Centre for Health Economics, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | | | | | - Lynn Murphy
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - Margaret Greer
- hVIVO, Queen Mary BioEnterprises Innovation Centre, London, UK
| | - Julie Brodison
- 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
| | - Martin Tickle
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Anderson M, Dahllöf G, Soares FC, Grindefjord M. Impact of biannual treatment with fluoride varnish on tooth-surface-level caries progression in children aged 1-3 years. J Dent 2017; 65:83-88. [PMID: 28739318 DOI: 10.1016/j.jdent.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This study describes caries progression at tooth-surface level in children from 1 to 3 years of age and the impact of biannual treatment with fluoride varnish. METHODS Children who participated in a cluster-randomized controlled trial and had shown signs of dental caries were included in this study (n=801). International Caries Detection and Assessment System (ICDAS) was used to classify dental caries. The present study compared children receiving a standard yearly intervention to children receiving the same standard preventive intervention supplemented with an application of fluoride varnish every half year. RESULTS The maxillary incisors were the first teeth to develop cavitation (ICDAS 3-6) and also mostly affected. Further analyses focusing on maxillary incisors buccal surfaces showed that sound surfaces had least progression and that progression to extensive decay was more common in teeth that had exhibited moderate decay. A summarizing progression index (PI) was calculated for the buccal surfaces of the maxillary incisors. Between 1 and 2 years of age PI was 26% and between 2 and 3 years of age PI was 21%. The progression on buccal incisors and on occlusal first primary molars did not differ between intervention groups (p≤0,05). CONCLUSION No impact on caries progression for biannual treatment with fluoride varnish was found. CLINICAL SIGNIFICANCE Using fluoride varnish as a complement to standard intervention in toddlers did not add in the prevention of dental caries or its progression. The education of parents in the use fluoride toothpaste as they start brushing the teeth of their children is essential.
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Affiliation(s)
- Maria Anderson
- Department of Dental Medicine (DENTMED), OF, Division 6, Pedodontics, Box 4064, 141 04, Huddinge, Sweden; Pediatric Dentistry, Public Dental Service, Eastman Institute, Dalagatan 11, SE-11324, Stockholm, Sweden.
| | - Göran Dahllöf
- Department of Dental Medicine (DENTMED), OF, Division 6, Pedodontics, Box 4064, 141 04, Huddinge, Sweden; Center for Pediatric Oral Health Research, Pediatric Dentistry, Public Dental Service, Eastman Institute, Dalagatan 11, SE-11324, Stockholm, Sweden.
| | - Fernanda Cunha Soares
- Department of Dental Medicine (DENTMED), OF, Division 6, Pedodontics, Box 4064, 141 04, Huddinge, Sweden.
| | - Margaret Grindefjord
- Department of Dental Medicine (DENTMED), OF, Division 6, Pedodontics, Box 4064, 141 04, Huddinge, Sweden; Pediatric Dentistry, Public Dental Service, Eastman Institute, Dalagatan 11, SE-11324, Stockholm, Sweden; Center for Pediatric Oral Health Research, Pediatric Dentistry, Public Dental Service, Eastman Institute, Dalagatan 11, SE-11324, Stockholm, Sweden.
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O’Neill C, Worthington H, Donaldson M, Birch S, Noble S, Killough S, Murphy L, Greer M, Brodison J, Verghis R, Tickle M. Cost-Effectiveness of Caries Prevention in Practice: A Randomized Controlled Trial. J Dent Res 2017; 96:875-880. [DOI: 10.1177/0022034517708968] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 2-arm parallel-group randomized controlled trial measured the cost-effectiveness of caries prevention in caries-free children aged 2 to 3 y attending general practice. The setting was 22 dental practices in Northern Ireland. Participants were centrally randomized into intervention (22,600 ppm fluoride varnish, toothbrush, a 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized prevention advice) and control (advice only), both provided at 6-monthly intervals during a 3-y follow-up. The primary outcome measure was conversion from caries-free to caries-active states assessed by calibrated and blinded examiners; secondary outcome measures included decayed, missing, or filled teeth surfaces (dmfs); pain; and extraction. Cumulative costs were related to each of the trial’s outcomes in a series of incremental cost effectiveness ratios (ICERs). Sensitivity analyses examined the impact of using dentist’s time as measured by observation rather than that reported by the dentist. The costs of applying topical fluoride were also estimated assuming the work was undertaken by dental nurses or hygienists rather than dentists. A total of 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 in the intervention group and 547 in the control group) were included in the final analyses. The mean difference in direct health care costs between groups was £107.53 (£155.74 intervention, £48.21 control, P < 0.05) per child. When all health care costs were compared, the intervention group’s mean cost was £212.56 more than the control group (£987.53 intervention, £774.97 control, P < 0.05). Statistically significant differences in outcomes were only detected with respect to carious surfaces. The mean cost per carious surface avoided was estimated at £251 (95% confidence interval, £454.39–£79.52). Sensitivity analyses did not materially affect the study’s findings. This trial raises concerns about the cost-effectiveness of a fluoride-based intervention delivered at the practice level in the context of a state-funded dental service (EudraCT No: 2009-010725-39; ISRCTN: ISRCTN36180119).
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Affiliation(s)
- C. O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - H.V. Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M. Donaldson
- Health & Social Care Board of Northern Ireland, Belfast, UK
| | - S. Birch
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Health Economics and Policy Analysis, McMaster University, Ontario, Canada
| | - S. Noble
- Northern Health & Social Care Trust, Antrim, UK
| | | | - L. Murphy
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - M. Greer
- hVIVO, Queen Mary BioEnterprises Innovation Centre, London, UK
| | - J. Brodison
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - R. Verghis
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - M. Tickle
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Brocklehurst P, Hoare Z. How to design a randomised controlled trial. Br Dent J 2017; 222:721-726. [DOI: 10.1038/sj.bdj.2017.411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 11/09/2022]
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Tickle M, O'Neill C, Donaldson M, Birch S, Noble S, Killough S, Murphy L, Greer M, Brodison J, Verghis R, Worthington HV. A Randomized Controlled Trial of Caries Prevention in Dental Practice. J Dent Res 2017; 96:741-746. [PMID: 28375708 DOI: 10.1177/0022034517702330] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a parallel group randomized controlled trial of children initially aged 2 to 3 y who were caries free, to prevent the children becoming caries active over the subsequent 36 mo. The setting was 22 dental practices in Northern Ireland, and children were randomly assigned by a clinical trials unit (CTU) (using computer-generated random numbers, with allocation concealed from the dental practice until each child was recruited) to the intervention (22,600-ppm fluoride varnish, toothbrush, 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized, evidence-based prevention advice) or advice-only control at 6-monthly intervals. The primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were number of decayed, missing, or filled teeth (dmfs) in caries-active children, number of episodes of pain, and number of extracted teeth. Adverse reactions were recorded. Calibrated external examiners, blinded to the child's study group, assessed the status of the children at baseline and after 3 y. In total, 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 intervention, 547 control) were included in the final analyses. Eighty-seven percent of intervention and 86% of control children attended every 6-mo visit ( P = 0.77). A total of 187 (34%) in the intervention group converted to caries active compared to 213 (39%) in the control group (odds ratio, 0.81; 95% confidence interval, 0.64-1.04; P = 0.11). Mean dmfs of those with caries in the intervention group was 7.2 compared to 9.6 in the control group ( P = 0.007). There was no significant difference in the number of episodes of pain between groups ( P = 0.81) or in the number of teeth extracted in caries-active children ( P = 0.95). Ten children in the intervention group had adverse reactions of a minor nature. This well-conducted trial failed to demonstrate that the intervention kept children caries free, but there was evidence that once children get caries, it slowed down its progression (EudraCT No: 2009-010725-39; ISRCTN: ISRCTN36180119).
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Affiliation(s)
- M Tickle
- 1 Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - C O'Neill
- 2 Centre for Public Health, Queens' University Belfast, Belfast, Northern Ireland
| | - M Donaldson
- 3 Health & Social Care Board of Northern Ireland, Belfast, Northern Ireland
| | - S Birch
- 4 School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,5 Centre for Health Economics and Policy Analysis, McMaster University, Canada
| | - S Noble
- 6 Northern Health & Social Care Trust, Northern Ireland, Antrim, Northern Ireland
| | - S Killough
- 7 British Dental Association, Belfast, Northern Ireland
| | - L Murphy
- 8 Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - M Greer
- 9 hVIVO, Queen Mary BioEnterprises Innovation Centre, London, UK
| | - J Brodison
- 10 DJ Maguire and Associates, Portadown, Northern Ireland
| | - R Verghis
- 8 Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - H V Worthington
- 1 Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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