Factors affecting dental attendance following treatment for dental anxiety in primary dental care.

AIM: To explore factors affecting patients' dental attendance behaviour following referral from a dental anxiety clinic to a general dental practitioner. DESIGN: A four-year follow up of patients who completed a course of treatment for dental anxiety by conducting semi-structured interviews, face-to-face or by telephone, with confirmation of dental attendance from the dental records. SUBJECTS: Forty-one patients who had completed a course of treatment for dental anxiety, in a specially designed community clinic. Mean time since last dental visit before treatment was 7.8 years (range 0.5-29). RESULTS: Twenty-three patients were successfully followed up and 11 (47%) were receiving regular asymptomatic dental care. The dental anxiety scores of those who subsequently became asymptomatic attenders were significantly lower at follow-up than the patients who became symptomatic attenders (P = 0.01). Effective dentist-patient communication was a common theme of the interviews. CONCLUSIONS: At four-year follow-up, dental anxiety was substantially lower in those who subsequently became asymptomatic attenders than those who became symptomatic attenders. A positive dentist-patient relationship had developed with the asymptomatic attenders.

The transfer of child patients from the community dental service to the general dental service.

OBJECTIVE: To determine an effective strategy for the transfer of children from the CDS to the GDS. DESIGN: Single centre study comprising a retrospective analysis of a 50% random sample of dental records for children transferred from CDO to GDP. SETTING: Community dental clinic in an urban area of south Manchester with relatively little material deprivation. SUBJECTS AND METHODS: Between 1990 and 1995, a GDP worked up to 5 hours a week in the CDS clinic seeing routine child patients referred by the CDO. MAIN OUTCOME MEASURES: Numbers of children registered with a GDP after varying periods of time. Attendance records of children transferred from CDS to GDS and rates of failed appointments. RESULTS: After 4 1/2 years, 264 child patients had been registered with the GDP under capitation and a further 55 adults were registered under continuing care. The majority of children had retained registration for more than 2 1/2 years. The mean rate of failed appointments was 16%. CONCLUSION: Children can be transferred successfully from the CDS to the GDS if the GDP works at the community clinic and there are further benefits which accrue to the scheme.

A dental support group for anxious patients.

OBJECTIVE: To evaluate, qualitatively, a support group for dentally anxious patients reluctant to visit the dentist and obtain dental care. DESIGN: Semi-structured interviews by group discussion, face-to-face or telephone. SETTING: Community: primary health care centre. SUBJECTS: 14 (50%) of the members of the support group. INTERVENTIONS: 13 interviewees were also monitored during a course of treatment following support group attendance. MAIN OUTCOME MEASURES: Views of interviewees concerning dental attendance and dental care before, during and after attendance at the support group. RESULTS: Attendance at the group was a major factor in dispelling fears and negative beliefs about dental care. The 13 interviewees whose progress was monitored through a subsequent course of treatment had a mean age of 43 years and had last attended for dental care 9 years previously. Treatment lasted for a mean of 5.4 visits with few failed appointments. They showed a significant (P < 0.01) reduction in Corah dental anxiety scale score. CONCLUSIONS: Attendance at the support group generated empathy between members and confidence to seek treatment. It increased trust in the dental team but tended to lead to dependence on the dentist group leader. Wider availability of such groups could help to reduce dental anxiety in non-attending adults and encourage treatment uptake.

Changes in caries prevalence in Ashkelon, Israel, children 1980-1994.

During the 14 years from 1980 to 1994, a marked reduction in caries prevalence was noted in Ashkelon. In the 7-year-old age group, the percentage of caries free children increased from 21 per cent to 29 per cent and the dmft dropped from 3.5 to 2.7. In the 13-year-old group there was also a marked improvement. The percentage of caries free children increased by 16 per cent (from 30 per cent to 35 per cent) with a marked reduction in the DMFT, from 2.3 to 1.9. The DT component halved from 1.8 to 0.9, with a marked rise in the FT component from 0.4 to 1.1. There is less decay and much less untreated dental decay in Ashkelon today than in 1980.

The future provision of specialist oral surgery and orthodontic services.

Many dentists express concern about the referral of patients within the NHS for specialist orthodontic and, to a lesser extent, oral surgery care. Most of these concerns relate to a lack of availability of such services. This article discusses possible reasons for these problems. It also explores some of the ways in which future changes in the organisation of the NHS may influence the availability of such specialist services. Strategies which could he used by FHSAs to address and overcome these problems are suggested.

Dental attendance patterns among mothers and their children in an area of social deprivation.

Dental attendance behaviour was recorded for 358 children aged 5-6 and 10-11 years and their mothers living in a socially deprived area of south Manchester. Information obtained by questionnaire was verified by the local dentists concerned. Forty-four per cent of mothers and 61 per cent of children had attended a dentist in the previous 12 months. The mothers' attendance was a good predictor of children's attendance, although a substantial proportion of mothers who did not attend the dentist themselves did ensure the attendance of their children.

The use of nitrous oxide-oxygen inhalation sedation with local anaesthesia as an alternative to general anaesthesia for dental extractions in children.

The aim of this study was to determine whether children who were assessed to require the extraction of teeth under general anaesthetic could be treated using an alternative technique of nitrous oxide-oxygen inhalation sedation with local anaesthetic. Consent was obtained for 61 children to enter the study. Fifty-three children were treated successfully using inhalation sedation and local anaesthetic. It was evident that general anaesthetic facilities would still be required for a small proportion of children who could not cooperate adequately for treatment to be performed under sedation and local anaesthetic.

Oral hygiene instruction and motivation in children using manual and electric toothbrushes.

The effect of individual chairside instruction and motivation on children using either manual or electric toothbrushes was investigated. From 123 children aged 9-15 years attending the Children's Department, Eastman Dental Hospital, four groups were constructed. Group 1 acted as the control, Groups 2 and 3 used manual toothbrushes and received instruction and motivation, and Group 4 used electric toothbrushes (Touch Tronic, Teledyne Aqua Tec) and also received instruction and motivation. For all children, modified Löe and Silness' Gingival and Plaque Indices were scored, a disclosing agent applied and a prophylaxis completed. Children in Groups 2, 3 and 4 were additionally shown the disclosed plaque, and its importance was discussed. Their attempts to "get the stain off" were checked and their own brushing techniques modified. Re-examinations took place after 1 and 3 months. To estimate the reliability of the diagnosis, 172 of the 344 examinations were repeated by a second operator. The overall coefficient of correlation (between operators) was 0.8. In the control group no detectable improvement in the gingival health or oral cleanliness occurred over the 3-month study period. However, both gingival and plaque scores decreased significantly, by 35-50%, in all instructed and motivated groups within 1 month and this improvement was still observable 2 months later. There were no significant differences in improvement between motivated children using manual or electric toothbrushes.