Are childhood oral health behaviours and experiences associated with dental anxiety in adolescence?

BACKGROUND: Dental anxiety is associated with untreated dental caries. Understanding which childhood behaviours or experiences have the strongest association with later dental anxiety may help focus preventive strategies, subsequently limiting the burden of dental caries and anxiety. AIM: The aim of this study was to explore whether behaviours and experiences during childhood were associated with adolescent dental anxiety. DESIGN: Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC). Multivariable logistic regression was used to explore associations between adolescent dental anxiety and childhood behaviours and experiences. 1791 participants answered questions about oral health behaviours and experiences at 8 years of age and dental anxiety questions aged 17 years. RESULTS: Children with experience of invasive dental treatment were more likely to have dental anxiety at 17 years of age than those who had not experienced dental treatment (OR 1.63; 95% CI: 1.12, 2.37; p = .011). Irregular dental attenders in childhood had over three times the odds of dental anxiety by adolescence, compared with regular attenders (OR 3.67 95% CI: 1.52, 8.88; p = .004). CONCLUSIONS: Adolescent dental anxiety is associated with invasive treatment and irregular dental attendance in childhood. A history of irregular attendance or invasive treatment may serve as a useful predictor when considering dental anxiety in young adult patients. Early preventive care supports good attendance and oral health. These actions may have secondary effects of reducing future dental anxiety.

Does prevention-focused dental care provision during recruit training reduce adverse dental outcomes in UK Armed Forces personnel? A retrospective cohort analysis.

Background Dental emergencies experienced during military operations may render individuals unable to operate effectively. To minimise this risk, UK Armed Forces (UKAF) recruits receive a prevention-focused dental care intervention during military training (known as 'Project MOLAR') before their entry to the trained strength of the Armed Forces.Aim To evaluate whether Project MOLAR is effective in preventing future dental emergency events and subsequent oral disease in UKAF recruits.Methods This is a retrospective cohort analysis of UKAF recruits who enlisted between 1 January 2011 and 31 December 2011, conducted by analysing electronic primary dental care records. Adverse outcomes were defined as: i) incidence of dental emergency events during the five-year follow-up period; and ii) further oral disease at 18 months measured by an increase in Decayed, Missing and Filled Teeth (DMFT).Results In total, 7,361 recruits met the inclusion criteria. The total follow-up time for the cohort was 31,957 person-years (mean follow-up 4.3 years/recruit). Individuals whose treatment was completed under Project MOLAR were found to experience a 30% reduction in dental emergency incidence (RR: 0.70-95% CI: 0.63-0.76) (p <0.001) and a 64% reduction in the odds of DMFT increase at 18 months (OR: 0.36-95% CI: 0.28-0.47) (p <0.001) compared to individuals whose treatment was incomplete.Conclusions Defence dentistry's focus on delivering prevention-focused dentistry early in a recruit's military career confers a downstream benefit to personnel who complete the intervention, such that dental emergency occurrences and DMFT progression are significantly reduced.

Defence dentistry: an occupationally focused health service with worldwide deployable capability.

Oral disease can cause substantial disruption to service personnel, resulting in debilitation and reduced effectiveness while deployed on military operations. As such, Defence dentistry delivers an occupationally focused dental service that is deployable, agile and holistic, to ensure service personnel are dentally fit for operations and that the impact of dental morbidity is minimised.Defence dentists provide a unique service, balancing the needs of the individual while considering their operational role requirements. This enables the UK Armed Forces' oral health to be optimised by mitigating morbidity and maintaining operational capability while deployed.The aim of this paper is to highlight the key principles of Defence dentistry by discussing the public health values and occupational focus which underpin a patient-centred approach and the agility of the uniformed military dental workforce in providing a responsive and deployable care capability.

An evaluation of civilian and military dental foundation training.

Background and aim There is little available material relating to the quality of continuing professional development for dental professionals and no studies to investigate whether dental foundation training (DFT) is meeting its aims and objectives. This study aimed to evaluate the components of DFT within the military and Oxford deaneries from the perspective of the educational supervisors (ESs) and foundation trainees (FTs).Method Questionnaires were sent to all 124 FTs and ESs involved in DFT in the Oxfordshire and military deaneries between 2012 to 2015. Following thematic analysis of the free text from the questionnaires, an interview guide was produced which mapped the main themes for a series of semi-structured interviews.Results Sixty-six questionnaires were returned (53% response rate) from 18 military and 3 Oxford ESs (21), and 30 military and 15 Oxford FTs (45). Eighteen interviews were carried out (6 ES/12 FT). The questionnaires highlighted the educational benefit of workplace-based assessments, joint clinical sessions and the importance of an ES as a positive role model, while the interviews highlighted the facilitative benefit of effective supervision, timely feedback, practice-wide teamwork, appropriate assessments and formal/informal peer review.Conclusions This study demonstrates the benefit of creating an optimal learning environment for DFT within the context of professional and ethical organisational support and appropriate clinical resources. ESs have a critical part to play as professional and clinical role models, and in ensuring an accountable and formal educational delivery, targeted learning goals, flexible delivery and timely feedback.

Area-level deprivation and oral cancer in England 2012-2016.

BACKGROUND: The relationship between deprivation and oral cancer is complex. We examined magnitude and shape of deprivation-related inequalities in oral cancer in England 2012-2016. METHODS: Oral cancer was indicated by cancers of the lip and oral cavity (ICD10 C00-C06) and lip, oral cavity and pharynx (C00-C14) and deprivation by the Index of Multiple Deprivation. Deprivation inequality in incidence and mortality rates of oral cancer outcomes was measured using the Relative Index of Inequality (RII). Fractional polynomial regression was used to explore the shape of the relationships between deprivation and oral cancer outcomes. Multivariate regression models were fitted with the appropriate functions to examine the independent effect of deprivation on cancer adjusting for smoking, alcohol and ethnicity. RESULTS: Incidence rate ratios (IRRs) and mortality rate ratios (MRRs) were greater for more deprived areas. The RII values indicated significant inequalities for oral cancer outcomes but the magnitude of inequalities were greater for mortality. The relationships between deprivation and oral cancer outcomes were curvilinear. Deprivation, Asian ethnicity and alcohol consumption were associated with higher incidence and mortality rates of oral cancer. CONCLUSION: This is the first study, to our knowledge, exploring the shape of socioeconomic inequalities in oral cancer at neighbourhood level. Deprivation-related inequalities were present for all oral cancer outcomes with a steeper rise at the more deprived end of the deprivation spectrum. Deprivation predicted oral cancer even after accounting for other risk factors.

Evidence into action: implementing alcohol screening and brief interventions in the UK Armed Forces.

INTRODUCTION: Alcohol-related harm continues to represent a major public health problem and previous evidence suggests that alcohol misuse within the UK Armed Forces is higher than in the general population. The aim was to introduce a population-level primary care intervention with an existing evidence base to identify and support Service Personnel whose drinking places them at greater risk of harm. IMPLEMENTATION: Following successful piloting, the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) brief screening tool was introduced as part of routine dental inspections by Defence Primary Healthcare (DPHC) dentists. Alcohol brief intervention (ABI) advice and signposting to support services was offered to personnel identified as being at increased risk and recorded in the patient's electronic health record. ACHIEVEMENTS TO DATE: Patients attending DPHC Dental Centres are now routinely offered AUDIT-C with 74% (109 459) personnel screened in the first 12 months rising to over 276 000 at 24 months, representing the single largest use of AUDIT-C and ABIs in a military population to date. DISCUSSION: Introduction of AUDIT-C has seen Defence successfully deliver a whole population alcohol initiative, overcoming implementation barriers to demonstrate the flexibility of a dental workforce to deliver a public health intervention at scale and contributing towards promoting positive attitudes towards alcohol use. The initiative represents a first step towards the goal of a standardised alcohol screening and treatment pathway across DPHC while recognising that the Defence Medical Services are only one aspect of the broader public health approach required to tackle alcohol-related harm in Service Personnel.

Exploring Dentist Opinions on the Provision of Intravenous Sedation in Primary Dental Care for UK Armed Forces Personnel.

INTRODUCTION: Anxiety toward dental treatment can lead to preventable morbidity, most notably oral pain and infection. This is of concern to the UK Armed Forces (UK AF), as dental care may not be immediately accessible during deployments and exercises, necessitating aeromedical evacuation. Current Defence Policy states that serving UK AF personnel requiring sedation to tolerate routine dental treatment are to have their Joint Medical Employment Standard (JMES) reviewed to restrict their deployability and employability. This article explores current sedation delivery, dentist opinion, and adherence to policy. MATERIALS AND METHODS: The total number and type of intravenous (IV) sedation appointments over a 6-month period was assessed using surgical logbooks. Questionnaires were sent to all dentists in primary care responsible for treating military patients to ascertain their attitudes toward the requirement for sedation in support of recruitment and deployability. Ten-year retrospective data analyses were used to identify current trends in sedation use in the UK AF. RESULTS: Responses were received from 117/137 (85%) dentists. All of the responding Civilian Dental Practitioners felt that there was a requirement for IV sedation in contrast to the Royal Navy (RN), where over a quarter (28%) disagreed. The majority, 48 (81%), of Army dentists felt that military patients unable to tolerate routine treatment under local anesthesia alone should not deploy on operations, compared with 7 (63%) of their civilian counterparts. Overall, 72 (62%) respondents felt that patients unable to tolerate routine treatment without sedation should not be recruited. CONCLUSIONS: Civilian Dental Practitioners in the sample indicated that they were less likely to recommend a patient for JMES review, less likely to prevent patients from deploying and less likely to believe that individuals requiring sedation for routine treatment should not be recruited into the UK AF. These attitudes are contrary to current Defence direction and could increase the risk of UK AF personnel experiencing morbidity on deployment requiring aeromedical evacuation. Over the longer term, civilianization of Defence dentistry is likely to reduce collective operational experience and Defence must ensure that clinicians understand the management of anxious patients in the military context and their responsibilities in relation to JMES. Furthermore, policy limiting the recruitment of personnel with significant dental anxiety is not being robustly adhered to. Based on the number of dental procedures undertaken under IV sedation in the UK AF, consistent application of this policy would not affect recruitment at an organizational level, but would limit the risk of deploying these personnel. Further work is required to understand dental anxiety within the UK Armed Forces so that the operational morbidity risks can be quantified and provision appropriately planned.

A bridge too far? The relationship between interventive operative dentistry and future dental morbidity.

Background and aim Unscheduled dental attendances (UDA) and the associated morbidity can cause individual distress, disrupt military effectiveness and have broader societal impacts. Preventing future dental morbidity is an essential component of dentistry. This, the largest study of its type, aimed to examine the relationship between clinical and demographic variables and UDA, and to quantify how well military dental risk categorisation predicts subsequent UDA events. Methods This is a retrospective cohort analysis of a clinical dataset containing 175,558 service personnel over an 11-month period. Statistical methods examined: sensitivity and specificity of the existing NATO 'Dental fitness classification system' (NATO Cat) in predicting UDA, relative risk (RR) of UDA by selected variables, Kaplan-Meier failure analysis and multivariate analysis. Results A total of 16,722 UDA events were recorded, the majority (66.7%) were due to caries, periapical pathology and fractured teeth or restorations, or a combination thereof. NATO Cat yielded poor predictive sensitivity (sensitivity 10%, specificity 93%). NATO Cat 3 (RR 1.47), age group (RR 1.06-2.05), gender (RR 1.46) and DMFT category (RR 1.09-3.05), were all significantly associated with increased UDA. The RR of UDA increased by 5% (RR 1.05) for each additional DMFT increment in a logistic regression model. Conclusions After adjusting for confounding variables, DMFT was significantly associated with UDA events. This study indicates that, even when treatment need has been met, a residual risk remains that is directly related to exposure to dental disease and operative dentistry. Strategies which prevent downstream operative treatment need and increases in DMFT may also reduce future UDA. UDA may be a useful quality outcome indicator for the success of NHS dental services in securing oral health.

Influenza syndromic surveillance and vaccine efficacy in the UK Armed Forces, 2017-2018.

INTRODUCTION: This paper describes the first ever analysis of health data to report influenza vaccine uptake and the effectiveness of the vaccine in preventing general practice presentations for influenza-like illness (ILI) in the UK Armed Forces (UK AF). This was undertaken during the 2017-2018 influenza season. METHODS: Clinical Read codes for ILI and influenza vaccinations were used to generate reports for the period from September 2017 to April 2018. Using a methodology adapted from Public Health England's (PHE) in hours syndromic surveillance, the ILI rate for the UK AF was calculated. Subsequent analysis explored vaccination uptake in target groups and compared the relative risk (RR) of ILI in vaccinated versus unvaccinated Service Personnel (SP). RESULTS: 4234 SPs had a record of ILI between September 2017 and April 2018, with a peak rate of 216 cases per 100 000 PAR. The absolute risk reduction for reporting ILI in vaccinated versus unvaccinated SP was 0.4% (p=0.0031), and the RR was statistically significant at 15% (95% CI 5% to 23 %) lower than in the non-vaccinated PAR. The number needed to vaccinate (NNV) to prevent one presentation of ILI was 241 (95% CI 145 to 714). The 8153 vaccinations recorded for the untrained strength equate to approximately 38% of overall training throughput and 65% of all Army SP recorded as being in phase 1 training at some point during this period. CONCLUSIONS: The relative risk reduction (RRR) for vaccinated personnel was modest and lower than reported elsewhere, but closely compares with ILI rates included in a 2018 Cochrane review. The small RRR and large NNV do not support widening the population of UK AF eligible to receive influenza vaccine. Regimental Medical Officers (RMOs) seeking advice on whether to vaccinate other groups of SP should be aware that this approach offers questionable clinical benefit. The ILI surveillance methodology used in this work could be adapted for syndromic surveillance of other infectious diseases.