The relationship between health related knowledge, attitudes and dental health behaviours in 14-16-year-old adolescents.

A survey of 3,160 pupils aged 14 to 16 years, attending schools in the 16 districts of the North East Thames Regional Health Authority, was conducted to examine their dental health status, attitudes and behaviour. The objective was to examine factors that might affect the assimilation of dental health education information, attitude modification and behavioural change, both in terms of clinical and psychosocial indicators of dental health. In general the dental health of those surveyed was good. Female pupils from outer London schools with high educational aspirations tended to have better periodontal health, an increased experience of restorative treatment, a greater dental health knowledge and more positive attitudes than the remaining children. Pupils' dental health attitudes could be explained by their present self-care practices in addition to the wish to adopt positive dental health behaviours in the future. Their ability to adopt these was further associated with their positive and negative perceptions of their own dental health. The close association between positive behaviours towards, and feelings of control over future dental health suggested that health attitudes could reflect feelings of empowerment and this was conductive to the adoption of self-care practices. Those pupils who felt empowered were more able to promote their own dental health by means of their positive self-care actions. On the other hand those groups of pupils which appeared less able to assimilate dental health information, which had less positive attitudes and were therefore unable to promote their own dental health through the adoption of self-care practices, could be identified.

Sociodental approach to the identification of dental treatment-need groups.

The aim of this study was to propose a method that could be used to distinguish significantly different dental treatment-need groups, to assist in planning more appropriate preventive dental health programmes than are now generally available. This involved the use of alternative new measures of dental status in conjunction with an indicator of people's potential, or "propensity" to adopt appropriate dental self-care measures. One important finding, based on a detailed questionnaire and dental examination of a sample population, is that substantial groups have relatively low or medium levels of dental status even though they possess relatively high propensity for self-care measures. A cross-classification of oral health status with the propensity indicator is used to define different treatment-need groups. Significant differences among these groups emerge in relation to various social indicators like age group, gender, region and dental history, and in relation to preventive dental health measures such as dental attendance and efficacy of teeth cleaning. The methodology proposed for identifying such different treatment-need groups could be valuable in devising effective community dental health strategies.

Dental disease and health behaviour: the development of an interactional model.

This paper describes the development of an interactional model in which both the clinical and the socio-psychological aspects of dental disease and its prevention are considered. Clinical and social data were collected from two separate samples, and the interrelationships between antecedent, motivational and preventive health behaviour variables and their influences on each other and on dental health outcomes were measured by regression analyses. A complex pattern of significant interrelationships was revealed, in which direct and indirect influences on dental health and behaviour operated at different levels of intensity and in different combinations, sometimes reinforcing each other but sometimes in conflict. The model could have relevance to a multifactorial approach in health research and, by incorporating additional causal influences, it could be developed into a more effective analytical tool as well as an aid the promotion of dental health.

Dental attendance and dental status.

This article examines the relationship between differences in dental attendance patterns and variations in dental status. A sample of 336 dentate men and 110 dentate women were selected at random from employees of two industrial plants in N.W. England in 1980. They were given a dental examination and asked about visits to the dentist. Regression analysis showed that while the more frequent the dental visits, the lower the rate of tooth loss and the fewer the number of teeth with active decay, the higher, however, the average number of fillings. There were significant differences, moreover, between manual and non-manual workers, the former being more likely to lose their teeth and the latter to have their teeth filled, at each given age and frequency of dental visit. Though the more frequent dental attenders had the advantage over the less frequent of having, on average, a higher number of functioning teeth, restored or otherwise sound, they also had the disadvantage of having higher levels of treated disease and thus of disease experience. The results suggest that while frequent dental visits help to postpone tooth loss and to maintain dental function, they do not apparently help to prevent the onset of further disease.

The concept of need in dental care.

The most commonly used methods of assessing need for treatment are based solely on clinical criteria. Recently, it has been recognized that a wider interpretation than that provided by clinically assessed need is required. Measures of need should include the impact of ill health upon individuals, the degrees of dysfunction and the perceptions and attitudes of patients. Although there is no generally agreed definition of need, the taxonomy suggested by Bradshaw (1972) is recommended. He divides need into normative, felt, expressed and comparative types. One of the major shortcomings of all methods of assessing need is that they do not assess the need and propensity for preventive care and health education. A more realistic assessment of treatment needs should include the functional and social dimensions of dental disease and an assessment of the social and motivational factors which predispose people towards dental ill health and influence the effectiveness of treatment and health education. Some dental needs are not very well assessed. In particular, the assessment of the need for treatment of malocclusion, whilst claiming to be objective, does not incorporate measures of lay perception or impact of the condition. Instead of relying only upon purely clinical methods of assessing needs, the development of sociodental indicators is required. This will encourage a shift in emphasis away from the mechanical to the behavioural aspects of treatment and the development of a health-orientated model of care in preference to the sickness model that dominates current dental services.

Betamethasone valerate compared by the oral and inhaled routes in childhood asthma.

The value of betamethasone valerate by inhalation in the prophylactic therapy of severe childhood asthma has been established. To determine whether the efficacy of this drug is due to a local or a systemic action a double-blind crossover study of 28 days' treatment with oral betamethasone valerate and 28 days' treatment with inhaled steroid was carried out in 10 asthmatic children. Daily doses used were 1 mg orally and 800 mug by inhalation. Nine patients had fewer symptoms, higher peak expiratory flow rates, and a lower bronchodilator requirement on inhaled than on oral therapy. Exercise-induced bronchoconstriction was diminished on inhaled therapy. Five children requested early termination of the oral therapy period because of unacceptable symptoms. Nine parents stated a preference for the period of inhaled therapy. It is concluded that betamethasone valerate is highly effective by inhalation but that a comparable oral dose has no appreciable clinical effect.