Blood Culture Contamination in a Community Hospital- less than 2% is achievable

Introduction/Objective

Blood cultures are commonly obtained to evaluate the presence of bacteria or fungal infection in a patient’s bloodstream. The presence of living microorganisms circulating in the bloodstream is of substantial prognostic and diagnostic importance. A positive blood culture indicates a reason for the patient’s illness and provides the etiological agent for antimicrobial therapy. Collection of blood culture is an exact process that requires time, the proper order of draw, and following of correct protocol. The busy Emergency department that requires multiple demands for nurse’s time, turnover of staff, rushing from one task to another can result in the improper collection and false-positive blood cultures. The national benchmark is set at 3% by the American Society of Clinical Microbiology (ASM) and The Clinical and Laboratory Standard Institute (CLSI). False-positive blood culture results in increased length of stay and unnecessary antimicrobial therapy, resulting in an increased cost burden to the hospital of about $5000 per patient.

Methods/Case Report

At our 150-bed community hospital, 26 beds Emergency Department, we have come a long way in reduction of our blood culture contamination rates from upwards of 4% to less than 2%, far lower than the national benchmark.

Results (if a Case Study enter NA)

NA

Conclusion

There are multiple devices available from various manufacturers claiming to reduce blood culture contamination. These devices do reduce blood culture (BC) contamination but at an added cost of the device. The rate of BC can be reduced and less than 3% is achievable by materials available in the laboratory. We have achieved this by providing training to every new staff by demonstration and direct observation, providing everything required for collection in a kit, using proper technique, the inclusion of diversion method that involves the aseptic collection of a clear tube before collecting blood cultures, and following up monthly on any false positive blood cultures.

A review of water fluoridation implementation strategy in England 2002-2005

Before 2002, there had been a long-term stalemate between private water companies and District Health Authorities across England. Between 2002 and 2005 the team in the Office of the Chief Dental Officer used leadership and advocacy skills to overcome political barriers, introducing the Water Act 2003 and a Statutory Instrument in 2005 providing indemnity for water companies. This legislation was key in removing obstacles towards the expansion water fluoridation across England.

Management of adults with diabetes on the haemodialysis unit: summary of guidance from the Joint British Diabetes Societies and the Renal Association

Diabetic nephropathy remains the principal cause of end-stage renal failure in the UK and its prevalence is set to increase. People with diabetes and end-stage renal failure on maintenance haemodialysis are highly vulnerable, with complex comorbidities, and are at high risk of adverse cardiovascular outcomes, the leading cause of mortality in this population. The management of people with diabetes receiving maintenance haemodialysis is shared between diabetes and renal specialist teams and the primary care team, with input from additional healthcare professionals providing foot care, dietary support and other aspects of multidisciplinary care. In this setting, one specialty may assume that key aspects of care are being provided elsewhere, which can lead to important components of care being overlooked. People with diabetes and end-stage renal failure require improved delivery of care to overcome organizational difficulties and barriers to communication between healthcare teams. No comprehensive guidance on the management of this population has previously been produced. These national guidelines, the first in this area, bring together in one document the disparate needs of people with diabetes on maintenance haemodialysis. The guidelines are based on the best available evidence, or on expert opinion where there is no clear evidence to inform practice. We aim to provide clear advice to clinicians caring for this vulnerable population and to encourage and improve education for clinicians and people with diabetes to promote empowerment and self-management.

Impact of providing free preventive dental products without health workers' counselling on infants' tooth-brushing and bottle-feeding termination practices: a randomised controlled trial

OBJECTIVE

To investigate the impact of an integrated oral health promotion intervention, within the Syrian national immunisation programme, which provided free preventive dental health products, without health workers' counselling, on one-year-old infants' tooth-brushing and bottle-feeding termination practices.

RESEARCH DESIGN

a randomised controlled parallel-group trial.

SETTING

A maternal and child health centre in Sweida city, Syria.

PARTICIPANTS

92 mothers of one-year-old infants, attending an infant vaccination clinic, were allocated into three groups: Test, Control One and Control Two.

INTERVENTIONS

The Test group received an oral health promotion package including an infant oral health pamphlet, a baby toothbrush, fluoride toothpaste (1,000 mg/L) and a trainer cup, without health workers' counselling. Control One received only the pamphlet, whilst Control Two received no intervention.

MAIN OUTCOME MEASURES

after one month, the presence of old plaque on infants' primary teeth was checked, to assess tooth-brushing behaviour. Also, a mothers' self-completed questionnaire was administered to assess bottle-feeding use.

RESULTS

The response rate was 100% and the attrition rate was zero. There were differences in tooth-brushing and bottle-feeding termination practices between the three groups (P⟩0.001). Infants in the Test group were less likely to have old plaque and more likely to stop bottle-feeding than their counterparts in the two control groups. There were no differences in the abovementioned outcomes between the two control groups.

CONCLUSIONS

Providing free preventive dental health products, without health worker's counselling, in an integrated oral health promotion intervention, was an effective measure to promote infants' tooth-brushing and bottle-feeding termination practices. These findings should be supported by long-term follow up studies.

Planning for future provision of dental services in prison: an international proposal of two systems

This article describes a proposal for the future organisation of the delivery of dental and oral health services for prisoners. This vision is based on an analysis of the existing prison dental programmes in England and the United States (Federal Bureau of Prisons, [FBOP]), together with discussions from two key individuals from both countries who championed changes to prison dental services and have published in the field of prison dental services. Both countries have similar visions. Some of the suggested work has already been addressed in the past (for example, introduction of state of the art dental facilities in the UK prison setting), some are in process (for example, electronic patients' records) and some may be addressed in the near future (for example, prisoners' involvement with the services provided for them). Some of the expressed visions for the future in this article are driven by evidence-based literature and dental workforce policy.

Patient safety in dentistry - state of play as revealed by a national database of errors

INTRODUCTION

Modern dentistry has become increasingly invasive and sophisticated. Consequently the risk to the patient has increased. The aim of this study is to investigate the types of patient safety incidents (PSIs) that occur in dentistry and the accuracy of the National Patient Safety Agency (NPSA) database in identifying those attributed to dentistry.

METHODS

The database was analysed for all incidents of iatrogenic harm in the speciality of dentistry. A snapshot view using the timeframe January to December 2009 was used. The free text elements from the database were analysed thematically and reclassified according to the nature of the PSI. Descriptive statistics were provided.

RESULTS

Two thousand and twelve incident reports were analysed and organised into ten categories. The commonest was due to clerical errors - 36%. Five areas of PSI were further analysed: injury (10%), medical emergency (6%), inhalation/ingestion (4%), adverse reaction (4%) and wrong site extraction (2%).

DISCUSSION

There is generally low reporting of PSIs within the dental specialities. This may be attributed to the voluntary nature of reporting and the reluctance of dental practitioners to disclose incidences for fear of loss of earnings. A significant amount of iatrogenic harm occurs not during treatment but through controllable pre- and post-procedural checks.

CONCLUSION

Incidences of iatrogenic harm to dental patients do occur but their reporting is not widely used. The use of a dental specific reporting system would aid in minimising iatrogenic harm and adhere to the Care Quality Commission (CQC) compliance monitoring system on essential standards of quality and safety in dental practices.

Cord blood molecular biomarkers of eosinophilopoiesis: kinetic analysis of GATA-1, MBP1 and IL-5R alpha mRNA expression

Eosinophil/basophil (Eo/B) progenitor phenotype and function in cord blood (CB) are associated with atopic risk at birth and infant clinical outcomes. Molecular analyses of eosinophil-basophil differentiation events could identify clinically predictive biomarkers. To determine CB kinetic patterns of Eo/B lineage-associated gene expression (GATA-1, MBP1 and IL-5R alpha) after IL-5 stimulation, CB non-adherent mononuclear cells were isolated from random fresh and frozen samples and incubated in the presence of recombinant human interleukin-5. Some underwent CD34+ positive selection using magnetic cell separation. At various time-points, mRNA expression of GATA-1, MBP1 and IL-5R alpha (total transcripts) was determined utilizing multiplex quantitative polymerase chain reaction (Q-PCR). Relative expression levels of the IL-5R alpha soluble vs. transmembrane isoforms were also analyzed. Stimulation of the non-adherent mononuclear cells with IL-5 resulted in early up-regulation of GATA-1, peaking at 48 h, followed by decreasing expression and down-regulation by 96 h. The CD34+ enriched population demonstrated an equivalent expression pattern (r = 0.963, p = 0.0349). MBP1 mRNA expression [non-adherent mononuclear cells (NAMNCs) and CD34+ alike; r = 0.988, p = 0.012] was slowly up-regulated in response to IL-5, maximal at 96 h. Total IL-5R alpha expression appeared stable over the time-course, mediated by differential expression of the soluble and transmembrane isoforms (i.e., initial increase in the transmembrane contribution followed by a predominance of the soluble isoform by 48-72 h). Multiplex Q-PCR analysis of mRNA from CB demonstrates expression of critical eosinophil-basophil lineage-specific events that are consistent with current understanding of eosinophil differentiation and maturation. The non-adherent mononuclear cell population provides a surrogate signal for the CD34+ progenitor population.

Human C/EBP-epsilon activator and repressor isoforms differentially reprogram myeloid lineage commitment and differentiation

CCAAT enhancer-binding protein-epsilon (C/EBP-epsilon) is required for the terminal differentiation of neutrophils and eosinophils. Human C/EBP-epsilon is expressed as 4 isoforms (32, 30, 27, and 14 kDa) through differential RNA splicing, and alternative promoters and translational start sites. The C/EBP-epsilon(32/30) isoforms are transcriptional activators, whereas C/EBP-epsilon(27) interacts with and represses GATA-1 transactivation of eosinophil promoters. C/EBP-epsilon(14) contains only DNA-binding and -dimerization domains and may function as a dominant-negative regulator. To define functional activities for these C/EBP-epsilon isoforms in myelopoiesis, human CD34(+) progenitors were transduced with internal ribosomal entry site-enhanced green fluorescent protein retroviral vectors encoding the 32/30, 27, and 14-kDa isoforms, purified by fluorescence-activated cell sorter, and analyzed in colony-forming assays and suspension cultures. Progenitors transduced with C/EBP-epsilon(32/30) default exclusively to eosinophil differentiation and gene expression, independent of interleukin-5, and regardless of inclusion of cytokines to induce other lineages. In contrast, the putative repressor C/EBP-epsilon(27) isoform strongly inhibits eosinophil differentiation and gene expression, including GATA-1, promoting granulocyte (neutrophil)-macrophage differen-tiation. The C/EBP-epsilon(14) repressor isoform strongly inhibits eosinophil development and gene expression, promoting erythroid differentiation, an effect enhanced by erythropoietin. Thus, C/EBP-epsilon isoforms can reprogram myeloid lineage commitment and differentiation consistent with their predicted activities based on activator and repressor domains and in vitro functional activities.

Dental caries in 5-year-old children attending multi-ethnic schools in Greater Glasgow--the impact of ethnic background and levels of deprivation

OBJECTIVE

To examine levels of dental caries of 5-year-olds attending multi-ethnic schools in Greater Glasgow and to explore the effects of deprived backgrounds and ethnic identity on their dental health.

DESIGN

Between October 2001 and February 2002 a cross-sectional dental epidemiology survey of a sample of 721 5-year-olds was undertaken in schools having at least 25 per cent of pupils from black or minority ethnic groups. Background data on participating children were obtained from school records, including: ethnic origin, mothers' ability to speak English, religion, and demographics. Statistical analyses included two way analysis of variance to determine the effect of ethnicity after adjusting for socio-economic factors.

RESULTS

Complete data were available for 649 (90%) children. The sample broadly divided into white (52%), Pakistani (33%), and other minority ethnic groups (15%). Based on repeat observations, diagnosis reliability was good (Kappa = 0.77). The caries experience of Pakistani children (d3mft = 4.1; 95% CI 3.6 to 4.6) was significantly higher (p < 0.001) than the white children (d3mft = 2.3; 95% CI 1.9 to 2.6). Only 25% (95% C1 17 to 34) of the Pakistani children had no obvious decay, significantly lower (p < 0.001) than their white contemporaries (48%, 95% CI 39 to 58). Pakistani ethnic origin was associated with significantly higher levels of dental caries (p < 0.001), after adjusting for socio-economic deprivation.

CONCLUSION

Children from deprived backgrounds have worse dental caries levels than their affluent counterparts and, over and above this effect, minority ethnic children of Pakistani background have higher levels than their white peers.

'Schools without walls?' Developments and challenges in dental outreach teaching - report of a recent symposium

During the 2004 annual meeting of the International Association for Dental Research, the Education Research Group held a symposium on dental outreach teaching. After a brief introduction, which reviews relevant aspects of the relatively sparse literature, this paper summarises the proceedings, the themes and conclusions that emerged and the research issues that were identified. It aims to describe aspects of current practice around the world and to promote future discussion. Presenters gave details of outreach programmes for dental undergraduates in Australia, Finland, Malaysia (and Southeast Asia), the United Kingdom and the United States. From these presentations four themes emerged. They were: reasons for the introduction of outreach teaching, its perceived beneficial effects, organisational issues, educational issues. The reasons included a recognition of the need to educate dental undergraduates as members of 'care teams' in the environments and communities where they were ultimately like to work and the current shortage of both suitable patients and teachers (faculty) in many dental schools. A wide range of potential benefits and some disadvantages were identified. The organisational issues were, in the main, seen to relate to finance and administration. The educational issues included the need to train and monitor the performance of teachers at outreach clinics and to assess the performance of the undergraduates whilst at the outreach locations. It was concluded that new technology made it easier to teach at a distance and it was possible to create a dental 'school without walls'. It was recognised that few evaluations of dental outreach teaching have been carried out and that there were many research questions to be answered, including: whether it should be a voluntary or compulsory part of the undergraduate curriculum, how long it should last and what type of outcomes should be assessed.

Potential role of Veillonella spp. as a reservoir of transferable tetracycline resistance in the oral cavity

Twelve out of 96 Veillonella spp. isolated from oral samples harbored tetracycline resistance genes. The most common resistance gene was tet(M). A tet(M)-positive Veillonella dispar strain was shown to transfer a Tn916-like element to four Streptococcus spp. by conjugation at a frequency of 5.2 x 10(-6) to 4.5 x 10(-5) per recipient.

Antibiotic resistance in the cultivable plaque microbiota of children from different ethnic groups

The presence of ampicillin-, penicillin-, erythromycin- and tetracycline-resistant bacteria in the dental plaque of White, South Asian and Japanese children was investigated. There was a high prevalence of antibiotic-resistant bacteria in children from diverse ethnic groups. The median percentage of the cultivable plaque microbiota that was resistant to tetracycline was greater in South Asian (2.9%, range 0.1-17.5%) and Japanese (7.7%, range 1.3-56.2%) children than in White children (0.7%, range 0-5.6%), suggesting that ethnic differences exist in the oral load of tetracycline-resistant bacteria (P<0.01). Multiresistant bacteria were frequently isolated, with 42% of isolates exhibiting resistance to two or more antibiotics. This study has demonstrated that antibiotic-resistant bacteria can be readily isolated from the plaque microbiota of children from different ethnic groups.

Awareness of mouth cancer in Great Britain

OBJECTIVE

There are more than 2,000 new cases of mouth cancer each year in Britain. Early detection is important yet little is known about population awareness of this disease and ability to recognise early signs, particularly among high risk groups. This study aimed to address this issue.

METHODS

Data were collected by means of household survey. A total of 3,384 adults were questioned using a national probability sample. Respondents provided information on demographic characteristics, smoking status, and frequency of alcohol use. They were asked whether they had heard of mouth cancer. Their knowledge of early signs and risk factors was assessed.

RESULTS

Whereas 95.6% of respondents said they had heard of mouth cancer, their awareness of early signs was low; for example, only 33.8% recognised that white patches in the mouth were a sign. The large majority understood that smoking and chewing tobacco were risk factors (84.7% and 80.1% respectively) but only 19.4% recognised alcohol use as a risk factor. In multiple logistic regression analyses controlling for relevant demographic factors, smokers and those with more frequent alcohol consumption were less likely to recognise early signs.

CONCLUSIONS

Awareness of early signs of mouth cancer is low and lower in people who as a result of their behaviour are at higher risk. There is a need to raise awareness in those at most risk.

Levels of toxins in oral tobacco products in the UK

OBJECTIVE

This study examined the constituents of smokeless tobacco products available in the UK and compared them with products available in India, Sweden, and the USA.

METHODS

Seven UK brands of smokeless tobacco, including a tooth cleaning powder, and four international brands of smokeless tobacco were tested for a range of toxins and known carcinogens, such as tobacco specific N-nitrosamines (TSNA), as well as nicotine availability.

RESULTS

Ten of the 11 brands tested had detectable levels of tobacco specific nitrosamines, which are proven carcinogens, and levels varied 130-fold. All had detectable levels of benzo(a)pyrene, another proven carcinogen (with around 175-fold variation) and several toxic metals (with nearly 150-fold variation). Nicotine availability varied in the UK products from 0.1 mg/g to 63.2 mg/g. All the tobacco products tested are likely to be hazardous to users' health, but the data indicate that it should be possible to reduce key toxins to non-detectable levels.

CONCLUSIONS

Smokeless tobacco products should be regulated and standards set for maximum levels of toxins and carcinogens.

Oral health, sociodemographic factors, dietary and oral hygiene practices in Jordanian children

OBJECTIVES

To investigate the association between oral health, in terms of dental caries and gingivitis, and sociodemographic factors, dental plaque, oral hygiene behaviours, infant feeding and dietary practices in 4-5-year-old Jordanian children.

METHODS

Two-stage random sampling procedure was used to select children enrolled in kindergartens in Amman, Jordan. Clinical examinations were carried out by one examiner. Mothers completed questionnaires relating to sociodemographic factors, oral hygiene behaviours, infant feeding and dietary practices of the children.

RESULTS

About 67% of the children had caries, 31% had dmft greater than 4 and 66% had gingivitis. Of the children who had been wholly breast-fed, 86% had been fed on demand. Mothers of children attending kindergartens with the lowest tuition fees were more likely to have breast-fed their children on demand and for more than 18 months (prolonged breast feeding) compared to those attending kindergartens with higher fees. Savory snacks were consumed by 82%, confectionery by 76% and teas with sugar by 42% of the children. Multivariate analysis showed age, dental plaque, sleeping beside the mother, use of comforters and selected dietary habits to have an independent effect on caries prevalence. Dental plaque and prolonged breast feeding exerted an independent effect on caries severity and gingivitis. The strongest association with gingivitis was dental plaque.

CONCLUSIONS

In Jordan as elsewhere health promotion strategies need to be targeted to mothers from less advantaged backgrounds. Messages about infant breast feeding should emphasise that the method is beneficial to the oral health of the children if appropriately used.

A study of satisfaction with dental services among adults in the United Kingdom

OBJECTIVES

To determine satisfaction with dental care services among the UK adult population, and to assess their knowledge regarding the dental complaints procedure.

METHODS

A national survey involving a multi-stage random sampling procedure with face-to-face home interviews of 5,385 UK residents was conducted in 1999.

RESULTS

The response rate was 69% and 3,739 adults took part in this study. Majority of people (89%) were satisfied with the quality of care they received. Only 2% (76) had actually complained, although 10% (388) had felt like complaining in the past. One third (32%, 1,188) did not know to whom to complain if they had a problem. Among those who knew whom to contact, over a third (36%, 1,359) would contact somebody outside the practice, while another third (31%, 1,169) would contact their dentist or dental practice.

CONCLUSION

Overall most people are satisfied with the quality of dental care they receive. However, 2% have complained and 10% have felt like complaining about their dentist/ dental care. In general, knowledge of the complaints procedure and whom to contact appears fragmented.

The prevalence of dental erosion in preschool children in China

OBJECTIVE

To describe the prevalence of dental erosion and associated factors in preschool children in Guangxi and Hubei provinces of China.

METHODS

Dental examinations were carried out on 1949 children aged 3-5 years. Measurement of erosion was confined to primary maxillary incisors. The erosion index used was based upon the 1993 UK National Survey of Children's Dental Health. The children's general information as well as social background and dietary habits were collected based on a structured questionnaire.

RESULTS

A total of 112 children (5.7%) showed erosion on their maxillary incisors. Ninety-five (4.9%) was scored as being confined to enamel and 17 (0.9%) as erosion extending into dentine or pulp. There was a positive association between erosion and social class in terms of parental education. A significantly higher prevalence of erosion was observed in children whose parents had post-secondary education than those whose parents had secondary or lower level of education. There was also a correlation between the presence of dental erosion and intake of fruit drink from a feeding bottle or consumption of fruit drinks at bedtime.

CONCLUSION

Erosion is not a serious problem for dental heath in Chinese preschool children. The prevalence of erosion is associated with social and dietary factors in this sample of children.

Effect of amoxicillin use on oral microbiota in young children

Dental plaque samples from 40 children were screened for the presence of bacteria resistant to amoxicillin. Fifteen children had used amoxicillin and 25 had not used any antibiotic in the 3 months prior to sample collection. All (100%) of the children harbored amoxicillin-resistant oral bacteria. The median percentage of the total cultivable oral microbiota resistant to amoxicillin was 2.4% (range, 0.1 to 14.3%) in children without amoxicillin use and 10.9% (range, 0.8 to 97.3%) in children with amoxicillin use, with the latter value being significantly higher (P < 0.01). A total of 224 amoxicillin-resistant bacteria were isolated and comprised three main genera: Haemophilus spp., Streptococcus spp., and Veillonella spp. The biodiversity of the amoxicillin-resistant microbiota was similar among the isolates from children with and without previous antibiotic use. The amoxicillin MIC at which 90% of the isolates were inhibited for isolates from children who had used amoxicillin in the previous 3 months was higher (64 mg liter(-1)) than that obtained for the isolates from subjects who had not used antibiotics (16 mg liter(-1)). The majority of the amoxicillin-resistant isolates (65%) were also resistant to at least one of the three antibiotics tested (penicillin, erythromycin, and tetracycline), with resistance to penicillin (51% of isolates) being the most frequently encountered. However, significantly more (P < 0.05) of the amoxicillin-resistant isolates from subjects with previous amoxicillin use were also resistant to erythromycin. This study has demonstrated that a diverse collection of amoxicillin-resistant bacteria is present in the oral cavity and that the number, proportions, MICs, and resistance to erythromycin can significantly increase with amoxicillin use.

Aesthetically objectionable fluorosis in the United Kingdom

OBJECTIVES

A cross-sectional national survey to explore perceptions of dental fluorosis and to determine the proportion of people regarding fluorosis as aesthetically objectionable at differing levels of defect.

METHODS

A survey using a multistage stratified random probability sample of 6,000 UK adult households. Face-to-face interviews were carried out using a structured questionnaire and photographs of different levels of dental fluorosis. Respondents were interviewed about the parameters of satisfaction, attractiveness and need for treatment for dental fluorosis.

RESULTS

The proportion of respondents perceiving teeth as unattractive, unsatisfactory and requiring treatment increased with increasing severity of dental fluorosis. Using agreement between the three negative perceptions as a measure, 14% of the sample perceived mild dental fluorosis as aesthetically objectionable, 45% at moderate level and 91% at severe levels.

CONCLUSION

Negative perceptions of dental fluorosis were lower than reported previously. Three parameters were included in the approach to estimate aesthetically objectionable fluorosis which may provide a more realistic measure than those used previously. The nature of the index and the sample included suggest that findings of this survey provide a reasonable indicator of the likely impact of water fluoridation. Findings may have important implications for fluoridation policies in the United Kingdom and elsewhere.

Prevalence of self-assessed tooth discolouration in the United Kingdom

AIMS

To determine the prevalence of perceived tooth discolouration in the United Kingdom and to investigate socio-demographic variations and satisfaction with own tooth colour.

METHODS

A national cross-sectional questionnaire study was carried out using a multistage random probability sample. Assessment of people's perceptions of their own tooth colour was conducted by asking study participants to match colour to the closest of a set of photocards demonstrating different levels of tooth discolouration. A separate question asked how satisfied they were with their tooth colour. Information on socio-demographic characteristics of the population were gathered at the same time.

ANALYSIS

Data was coded and entered into SPSS software. Descriptive statistics were used to determine the prevalence of perceived discolouration and satisfaction with own tooth colour. Bivariate and regression analyses were performed to explore the effect of socio-demographic variations.

RESULTS

The self-assessment exercise was completed for 3215 subjects. Half of the study population perceived their tooth colour to be normal and 6% perceived that they had severe discolouration, the remainder reported themselves to have levels of tooth discolouration between these two extremes. Satisfaction with tooth colour decreased with increased discolouration. Sex, age, income and smoking, had statistically significant effects on the prevalence of perceived discolouration (P< 0.01).

CONCLUSIONS

Half of the people in this study perceived themselves to have tooth discolouration. Results suggest that the general public is concerned about dental appearance in terms of tooth colour, indicated by public dissatisfaction with relatively mildly discoloured teeth. Findings may suggest that a further increase in the demand of tooth whitening services and cosmetic dentistry in general is likely. The changing emphasis and level of perceived dissatisfaction need to be taken into account in planning dental services. Evidence based approaches are needed for the appropriate management of patients who demand treatment of mild discolouration.

A national study of the importance of oral health to life quality to inform scales of oral health related quality of life

OBJECTIVES

To assess the content validity of traditional oral health status scales as measures of oral health related quality of life (OHQOL), based on a general public's perception of the most important ways in which oral health affects quality of life (QoL).

METHODS

A nationwide United Kingdom study involving a random probability sample of 1778 adults. Data were collected by face-to-face interviews in participants homes.

RESULTS

Most 75% (1332) perceived oral health as being important to QoL. Among them, 53% (699/1332) identified oral health's importance to QoL as being in a positive manner. Existing scales predominantly fail to include this dimension. The general public ranked oral health's importance to QoL through a range of physical, social and psychological domains. Most frequently though affecting eating or comfort; domains considered by all instruments. Other domains/ways are presented. It is apparent that even when some of the multidomain scales are employed, they frequently omit items that the public perceives as being most important to QoL.

CONCLUSION

The study raises concerns about the appropriateness of utilising many of the existing oral health status scales as measures of OHQOL because the concepts do not appear to be interchangeable.

Prevalence, proportions, and identities of antibiotic-resistant bacteria in the oral microflora of healthy children

The aims of this study were to determine the prevalence, proportions and identities of oral bacteria resistant to six antibiotics in 35 children (4-5 years old) who had not received antibiotics during the previous 3 months. Ampicillin-, penicillin-, erythromycin-, and tetracycline-resistant bacteria were harbored by 35 (100%), 34 (97%), 35 (100%), and 34 (97%) children, respectively. None of the children harbored metronidazole-resistant anaerobic bacteria or Gram-positive vancomycin-resistant bacteria. The median percentage of the oral microflora resistant to each of the antibiotics was ampicillin 1% (range 0.1-23), erythromycin 13% (1-45), penicillin 1% (0-14), and tetracycline 2% (0-88). A total of 432 antibiotic-resistant isolates were recovered that comprised 18 genera and 47 species. Ampicillin resistance was widely distributed throughout different genera and species, whereas tetracycline resistance was predominately found in the streptococci. Multiresistant bacteria were frequently isolated with 28% of isolates exhibiting resistance to two or more antibiotics. Veillonella spp., traditionally considered susceptible to penicillin and ampicillin, were found frequently to be resistant to these two antibiotics. This study demonstrates that a diverse collection of antibiotic-resistant pathogenic, opportunistic, and nonpathogenic bacteria can be readily isolated from, and in some subjects dominate, the oral microflora of primary school children in the absence of recently administered antibiotics.

Pattern of tooth loss in recipients of free dental treatment at the University Hospital of Amman, Jordan

The aim of this study is to document reasons for tooth loss in disadvantaged Jordanians who seek free dental care at the University Hospital/Dental Clinics. A 4-year (1998-2001) prospective study was undertaken involving 2200 randomly selected patients from this subpopulation. Of their 3069 lost teeth, 46.9% were lost due to caries and its sequel; 18% were lost because of periodontal disease; 8% were lost for a combination of caries and periodontal disease; 19.4% for pre-prosthetic reasons; 4% for orthodontic reasons; 2.8% for eruption problems and 0.7% due to trauma. Logistic regression analysis for reasons of tooth loss in this sector revealed that caries and its sequel was the predominant cause of tooth loss in patients <or=40 years of age whereas periodontal extractions were predominant for the above 40-year-old group. In addition, the most frequently extracted teeth, due to caries, were lower first and second molars while lower incisors were most commonly extracted for periodontal disease. Premolars were extracted for orthodontic reasons, upper incisors for trauma, third molars for eruption problems and canines for pre-prosthetic reasons. In conclusion, dental caries was the main reason for removal of teeth in adults attending the University of Jordan free dental casualty clinic. Therefore, in order to reduce the rate of dental extractions in this sector of the Jordanian population, efforts should focus on prevention and treatment of caries. Efforts should also be made to change the values and beliefs of this sector towards the importance of natural dentition.

Translation and validation of an Arabic version of the UK oral health related quality of life measure (OHQoL-UK) in Syria, Egypt and Saudi Arabia

OBJECTIVE

The aim of this study was to translate and evaluate the performance of an oral health related quality of life measure--an Arabic version of OHQoL-UK in three middle eastern countries: Syria, Egypt and Saudi Arabia.

BASIC RESEARCH DESIGN

Following forward and backwards translation of OHQoL-UK into Arabic and pilot testing the Arabic version among focus groups, a questionnaire containing the instrument was administered to 1,000 adults from the three Arab countries. In addition, the study participants were interviewed about their oral health status, experience of oral health problems in the past year, self-rating of oral health and also some socio-demographic information was collected.

RESULTS

Among the three study populations, variations in OHQoL-UK scores were apparent in relation to socio-demographic factors (p<0.01), self-reported number of teeth possessed (p<0.001) and experience of oral health problems in the past year (p<0.01) which supports the construct validity of the instrument. Furthermore, variations in OHQoL-UK scores were apparent in relation to self-rating of oral health status (p<0.01) which supports the criterion validity of the measure. The internal reliability of the instrument was high in the three groups with Cronbach alpha values of above 0.90, indicating good internal consistency.

CONCLUSION

The Arabic version of OHQoL-UK, an index of oral health related quality of life demonstrated satisfactory construct validity, criterion validity and internal reliability in Syria, Egypt and Saudi Arabia. This provides further evidence of the instrument's psychometric properties and its cross cultural use.

Traumatised permanent teeth in 11-16-year-old Saudi Arabian children with a sensory impairment attending special schools

- The aim of this study was to determine the prevalence of traumatised permanent teeth among sensory (visual (VI) and hearing (HI)) impaired children attending special schools in Riyadh, Saudi Arabia. All the dental injuries involved incisor teeth, and trauma was noted in 33 (6.7%) children attending government schools (control group) compared to 7 (9%) VI children and 24 (11.4%) HI children. Differences in the dental trauma only reached statistical significance between the HI and control group (P < 0.05). Gender differences were only apparent in the HI group, with males having higher levels of traumatised teeth. In addition, HI children aged 11-12 years were more prone to trauma than children in the control group of the same age (P < 0.05). In conclusion, sensory impaired children do have a tendency for more dental trauma. However, this was only statistically significant for HI children. Whereas a gender difference was most noticeable for the HI group, with males having higher levels of trauma, this was noticeable by its absence among VI children.

Orthodontic treatment need and self-perception of 11-16-year-old Saudi Arabian children with a sensory impairment attending special schools

AIM

To determine the self-perception and need for orthodontic treatment in young sensory [visual (VI) and hearing (HI)] impaired children attending special schools in Riyadh, Saudi Arabia. Also, to determine if gender and social class background influence the rating and self-perception of malocclusion among the children.

LOCATION

Riyadh, Saudi Arabia.

DESIGN

A prospective study on orthodontic treatment need in sensory impaired children.

SUBJECTS

Seventy-seven VI, 210 HI, and 494 control (C) children aged 11-16 years.

METHOD

The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) was determined using the standard 10 pictures for the C group and HI with a modified version (tactile graphic) for VI. The dental health component (DHC) and AC of IOTN were used to allocate each child to no need, borderline need and definite need for treatment subgroups.

RESULTS

Sixty-five per cent of VI, 21.8 per cent HI, and 18.7 per cent of the C were perceived to be in need of orthodontic treatment. However, 55.8 VI, 43 per cent HI and 34 per cent C were rated for treatment need based upon the AC. The difference between the examiner and the child's rating of treatment need was found to be statistically significant among the HI and control children (P < 0.001).

CONCLUSION

The VI children who were scored for treatment by the examiner as having need for treatment had similar perceptions of their treatment need irrespective of their social background. Male VI children had a higher DHC score, but both VI and HI males had a higher normative and self-perceived need based on AC.

An evaluation of the oral health quality of life (OHQoL) instrument in a Brazilian population

OBJECTIVES

To translate and evaluate the performance of a Brazilian Portuguese version of the United Kingdom Oral Health related Quality of Life instrument, OHQoLUK, in assessing the impact of oral health on quality of life among a Brazilian adult population.

DESIGN

Following forward-backwards translation the 16-item OHQoLUK measure was administered to adults utilising municipal dental health services in Araraquara, São Paulo, Brazil. The instrument's psychometric properties, validity and reliability, were assessed.

RESULTS

The response rate was 72% (323/450). OHQoLUK scores were associated with self-reported oral health status including number of teeth present (p < 0.001), denture status (p < 0.01) and self-reported dental attendance pattern; time (p < 0.05) and reason for last dental visit (p < 0.001), supporting the construct validity of the measure. In addition, OHQoLUK scores were associated with self-ratings of oral health (p < 0.0001) and perceived need for dental treatment (p < 0.001), supporting it's criterion validity. Internal reliability was high: Cronbach's alpha = 0.96, while the agreement for each of the 16 OHQoLUK items (Kappa values) ranged from 0.57 to 0.87.

CONCLUSION

The Brazilian Portuguese version of OHQoLUK measure of oral health related quality of life performed well, exhibiting good validity (face, construct and criterion) and reliability (internal and external). This confirms the sound psychometric properties of the OHQoLUK measure and the applicability of the Portuguese version among a Brazilian population.

Population based norming of the UK oral health related quality of life measure (OHQoL-UK)

OBJECTIVES

The aims of this study were to establish normative age-gender values for the UK oral health related quality of life measure (OHQoL-UK) in Britain and to provide a local reference for its interpretation. In addition, to identify key factors associated with oral health related quality of life in the UK.

MATERIALS AND METHODS

A national survey conducted with the assistance of the Office for National Statistics involving a random probability sample of 2,718 households. Participants were interviewed about their oral health status. The impact of oral health on quality of life was measured using the 16 item OHQoL-UK measure.

RESULTS

The response rate was 68% (1,838/2,718). The majority (75%, 1,378/1,838) perceived their oral health as affecting their life quality and did so across a wide range of domains. Age-gender norm values are presented. Variations in OHQoL-UK scores were apparent in relation to socio-demographics: age (P<0.05), social class (P<0.01), and self-reported oral health status: number of teeth possessed (P<0.01).

CONCLUSIONS

The impact of oral health on the life quality of Britons was substantial, in both positive and negative ways and associated with socio-demographic and oral health (self-reported) factors. National norm values presented should provide a reference source for meaningful interpretation of similar data and local studies.

Caries prevalence and patterns and their relationship to social class, infant feeding and oral hygiene in 4-5-year-old children in Amman, Jordan

OBJECTIVES

To investigate the relationship between social class, infant feeding, oral hygiene, and prevalence and patterns of caries in 4-5-year-old Jordanian children.

METHOD

Two-stage random sampling procedure was used to select children enrolled in kindergartens in Amman, Jordan. Clinical examinations were carried out by one examiner. Mothers completed questionnaires relating to social class, infant feeding and the oral hygiene habits of the children.

RESULTS

Sixty-seven per cent of the children had caries; 30% had the more extensive pattern involving molars and incisors. When the significant variables were taken into account, age, social class, sleeping with the mother, use of comforter and confectionery at bed/night time were shown to be independent risk factors for caries experience. Bottle-feeding at nap/bed/night time was associated with caries in incisors and caries in incisors and/or canines. Never being breast-fed, being breast-fed for more than 18 months, being breast-fed at nap/bed/night time showed a negative association with caries confined to molars although this showed a positive association with the more extensive pattern of the disease.

CONCLUSIONS

Education for mothers about appropriate breast and bottle-feeding practices should be considered in health promotion strategies.

Food and drink consumption, sociodemographic factors and dental caries in 4-5-year-old children in Amman, Jordan

OBJECTIVE

To investigate the association between type of food and drink consumption, sociodemographic factors and prevalence and severity of caries in 4-5-year-old Jordanian children.

METHOD

Two-stage random sampling procedure was used to select children enrolled in kindergartens in Amman. Clinical examinations were carried out by one examiner. Mothers completed a questionnaire relating to sociodemographic factors and food and drink consumption.

RESULTS

Snack foods were consumed by a high percentage of children. Amongst the most popular 'high in NME sugar snacks', confectionery was reported to be regularly consumed by 76% and biscuits and cakes by 71% of them. More than 50% had carbonated drinks. Children from a lower social class, attending a kindergarten with lower tuition fees had more dessert, squashes and more teas with sugar. When all variables were considered, consumption of confectionery was independently associated with caries prevalence and consumption of teas with sugar was independently associated with caries severity.

CONCLUSION

The types of foods and drinks consumed as snacks by young Jordanian children were similar to those of Western countries. In the absence of more widespread oral health promotion measures and in the presence of high prevalence and severity of caries,the oral health of Jordanian children is a matter of concern.

Are single mothers in Britain failing to monitor their oral health?

OBJECTIVES

This study was designed to identify association between self reported dental attendance patterns and family structure in the UK.

DESIGN

A national study involving 666 women with dependent children.

SETTING

Home interviews were undertaken exploring time and reason for last dental visit. In addition, numerous sociodemographic and service related characteristics were collected.

RESULTS

Bivariate analysis identified that family structure was associated with respondents' self reported dental attendance patterns: marital status (p<0.01), number of children (p<0.05), and age of children (p<0.05). When the combined effects of age, family structure, income, educational attainment, working status, and service factors (difficulty obtaining a NHS dentist and time taken to get an appointment) on dental attendance were explored, family structure emerged as a very important predicator of service use. Notably, young (age 16-34) single mothers and those with more than two children were less likely to have attended the dentist within the past year for reasons other than a dental emergency compared with older (age 35 or more), mothers from a two parent family and those with one or two children.

CONCLUSION

Family structure is associated with self reported dental attendance patterns. Young single mothers with more than two children may be failing to monitor their oral health appropriately.

Caries in preschool children in Amman, Jordan and the relationship to socio-demographic factors

OBJECTIVE

To determine the prevalence and severity of caries in children attending kindergartens in Amman and the relationship between caries experience and socio-demographic factors including age, social class based on the father's occupation, the level of mother's education and the fee level of the kindergarten attended.

DESIGN

Cross sectional survey including a dental examination of the child and a questionnaire completed by the parents.

SETTING

Kindergarten schools in Amman.

PARTICIPANTS

1,140 children including 569 4-year-olds and 571 5-year-olds.

RESULTS

Prevalence of caries in 4 year olds was 62% and in 5 year olds it was 73%. The dmft values were 3.1 and 4.1 in 4 and 5 year olds respectively. Lower caries prevalence was recorded for children of families where the father had a non-manual occupation, those whose mothers had higher levels of educational attainment and for children attending kindergartens with higher tuition fees.

CONCLUSION

Caries prevalence and severity in children attending kindergarten schools in Amman are similar to those seen in studies of children of the same age in Saudi Arabia and higher than those in children in westernised countries such as the UK. As in other countries, caries experience in young children in Amman is clearly related to social factors. Findings illustrate the need for effective oral health promotion accessible to all social groups in this middle eastern capital. Fee scale of the schools appears to be an effective measure to use in designing appropriate strategies.

Severe tooth loss among UK adults--who goes for oral rehabilitation?

A random probability sample of 2667 United Kingdom (UK) addresses was selected in a multistage sampling process. Participants were interviewed about their oral health status--number of teeth possessed and denture status. In addition information was collected about their socio-demographic characteristics (age, gender, social class and income level) and dental service factors--type of service used and difficulty accessing national health service (NHS) care. The response rate was 70%. Six percent (107) claimed they had less than 20 teeth but did not use a denture. Variations in this practice were apparent in relation to a number of socio-demographic factors: age (P < 0.05), gender (P < 0.01) and social class (P < 0.001) but not service related factors. In regression analysis, social class, gender and age emerged as important predictors of this practice. For example, those from lower social classes were approximately half as likely to use dentures despite experiencing considerable tooth loss (OR=0.53, 95% CI 0.34, 0.83), having controlling for other factors. More than one in 20, in Britain claim they have experienced considerable tooth loss but are without resource to a denture. Socio-demographic factors rather than service related factors are associated with this practice, particularly social class.

Oral cleanliness, gingivitis, dental caries and oral health behaviours in Jordanian children

The aims of the study were to investigate the association between oral cleanliness, gingivitis and sociodemographic factors, dental caries and oral health behaviours amongst 4-5-year-old Jordanian children. A two stage random sampling procedure was used to select children enrolled in kindergartens in Amman. Clinical examinations were carried out by one examiner. Mothers completed questionnaires relating to sociodemographic factors and oral health behaviours. Presence of gingivitis and of four or more sites with dental plaque were seen in 66% and 83% of the children, respectively. No differences in these outcomes were seen between ages and genders. Social class and oral hygiene behaviours were important risk indicators for the level of oral cleanliness and presence of gingivitis. Higher percentages of children with four or more sites with plaque and with gingivitis had a dmft score equal or greater than four. Due to the high level of dental plaque accumulation, presence of gingivitis and their association with social class, dental caries and oral hygiene behaviours, attention should be given to the oral health of these children. In particular to the oral health of children attending kindergartens in areas of lower social class in Amman.

Who has difficulty in registering with an NHS dentist?--A national survey

AIMS

The aims of this paper are first, to determine the extent of difficulties the public are experiencing in obtaining a dentist undertaking NHS dental care. Second, to describe the personal and socio-demographic details of these groups using data from a national study.

METHOD

The vehicle for this study was the Office for National Statistics Omnibus Surveys, undertaken in June and July of 1999. A random probability sample of 5,385 addresses was selected from the British Postcode Address File. Respondents were interviewed in their homes about how difficult they found it to obtain an NHS dentist.

RESULT

A total of 3,739 adults took part in this study and the response rate was 69%. Nineteen per cent (705) claimed they found it difficult to get an NHS dentist. Bivariate analysis revealed that difficulty in obtaining an NHS dentist [excluding those who claimed they did not seek NHS dental care (781) and those who refused to answer or did not know (66)] was associated with age group (P < 0.01), gender (P < 0.05), social class (P < 0.01) and area of residency (P < 0.01). Moreover, difficulty in obtaining NHS dental care was also associated with time since last dental visit (P < 0.01), method of payment for last dental visit (P < 0.01) and use of 'out of hours' emergency dental services (P < 0.01). Further analysis revealed that among the socio-demographic variables, area of residency emerged as the most important factor in determining difficulty in obtaining an NHS dentist. Those who lived in the South of England (London, South-East or South West) were more than twice as likely to experience difficulty in obtaining an NHS dentist, OR = 2.40, 95% CI 2.00-2.88 compared with those who lived elsewhere in Great Britain.

CONCLUSION

One in five adults in Britain claim that they are experiencing difficulties in finding a dentist who will provide NHS dental care. In particular, those using private dental services and residents of the South of England have experienced such difficulties.

Clinical and photographic assessment of erosion in 2-5-year-old children in Saudi Arabia

OBJECTIVE

To compare findings from photographs of incisor teeth in pre-school children in Jeddah, Saudi Arabia to those on clinical examination for dental erosion.

BASIC RESEARCH DESIGN

Cross sectional study of 2-5-year-old Saudi Arabian children using two methods of examination.

MEASUREMENT

of erosion was carried out clinically using a scoring system and criteria based on those used in the United Kingdom national surveys. Photographs of labial and palatal surfaces of maxillary primary incisors were taken for each child and scored in the same way.

SETTING

Kindergarten schools in Jeddah, Saudi Arabia.

PARTICIPANTS

987 children from 17 randomly selected schools in Jeddah, Saudi Arabia.

RESULTS

Readable photographs were available for 727 children. Two hundred and twenty (30%) had photographic evidence of tooth tissue loss. Prevalence estimates derived from clinical examination were higher than those for photographs (36% compared to 30%). Agreement was seen between the two methods for 93% of the surfaces included.

CONCLUSIONS

Photographs have been employed in research in dentistry as well as for documentation and illustration. In epidemiology they have proved to be valuable in measuring enamel defects but have not been used for other conditions. Photographs have potential in measuring erosion, but may benefit from refinement.

The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia

OBJECTIVES

The aim of this study was to investigate the possible association between dental erosion and caries, and variables including socio-economic status, reported dietary practices and oral hygiene behaviour, in a sample of children in Jeddah, Saudi Arabia. A cross-sectional study including dental examination and questionnaire survey was carried out at a number of kindergartens.

SAMPLE AND METHODS

A sample of 987 children (2-5-year-olds) was drawn from 17 kindergartens. Clinical examinations were carried out under standardized conditions by a trained and calibrated examiner (MAM). Information regarding diet and socio-economic factors was drawn from questionnaires distributed to the parents through the schools. These were completed before the dental examination.

RESULTS

Of the 987 children, 309 (31%) showed signs of erosion. Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%). Vitamin C supplements, frequent consumption of carbonated drinks and the drinking of fruit syrup from a feeding bottle at bed- or nap-time when the child was a baby, were all related to erosion. Consumption of carbonated drinks and fruit syrups was also related to caries but they were part of a larger number of significant factors including socio-demographic measures and oral hygiene practices.

CONCLUSIONS

There was no clear relationship between erosion and social class, or between erosion and oral hygiene practices; the reverse was true for caries. Dietary factors relating to both erosion and caries and/or rampant caries were found in this sample of children.