The caries experience of 5 year-old children in Scotland in 2013-2014, and in England and Wales in 2014-2015. Reports of cross-sectional dental surveys using BASCD criteria.

OBJECTIVE: We report the findings from and comment on the surveys of the oral health of 5-year-old children undertaken in Scotland (2013-14), Wales (2014-15) and England (2014-15). This was the fourteenth survey in Scotland since 1988. In England and Wales it is the third survey since 2007 when changes were required in consent arrangements. METHOD: Representative samples were drawn within Health Boards across Scotland and local authorities across England and Wales. Consent was sought via opt-out parental consent in Scotland and opt-in parental consent in England and Wales. Children examined were those aged five in England and those in Primary 1 (school year aged 5 to 6) in Scotland and Wales. Examinations were conducted in schools by trained and calibrated examiners. Caries was visually diagnosed at the dentinal threshold. RESULTS: There is a continuing decline in d3mft in all three countries. d3mft was 1.27 (opt-out consent) for Scotland, 0.84 for England (opt-in consent) and 1.29 for Wales (opt-in consent). Tooth decay levels remain higher in more deprived areas across Great Britain, with clear inequalities gradients demonstrated across all geographies. Attempts to measure changes in dental health inequalities across the three countries show no conclusive trends. CONCLUSION: Inter-country comparisons provide further oral health intelligence despite differences in approach and timing. The third surveys in England and Wales using the new consent arrangements have enabled trend analysis. Dental health inequalities gradients were shown across all geographies and all of the indicators of inequality.

Knowledge of and attitudes to sports drinks of adolescents living in South Wales, UK.

Background The UK sports drinks market has a turnover in excess of £200 million. Adolescents consume 15.6% of total energy as free sugars, much higher than the recommended 5%. Sugar sweetened beverages, including sports drinks, account for 30% of total free sugar intake for those aged 11-18 years.Objective To investigate children's knowledge and attitudes surrounding sports drinks.Method One hundred and eighty-three self-complete questionnaires were distributed to four schools in South Wales. Children aged 12-14 were recruited to take part. Questions focussed on knowledge of who sports drinks are aimed at; the role of sports drinks in physical activity; and the possible detrimental effects to oral health. Recognition of brand logo and sports ambassadors and the relationship of knowledge to respondents' consumption of sports drinks were assessed.Results There was an 87% (160) response rate and 89.4% (143) claimed to drink sports drinks. 45.9% thought that sports drinks were aimed at everyone; approximately a third (50) viewed teenagers as the target group. Over two thirds recognised the brand logos, yet less than a third could identify brand ambassadors. About half were aware that dental erosion may result from consumption and approximately two thirds knew that they were linked to dental caries and energy provision. Despite this the majority claimed to drink them. As previously reported most of those drinking sports drinks did so because of the taste.Conclusion Whilst most of the respondents had some understanding of the detrimental effects on health the majority of them were drinking them regularly despite this knowledge. Work is therefore needed at a macro level, with soft drink manufacturers, to consider marketing and reformulation of products for adolescent consumers who appear to enjoy them.

Investigation of the erosive potential of sour novelty sweets.

Background The expansion of the novelty sweets market in the UK has major potential public health implications in children and young adults as they may cause dental erosion.Objective To investigate the erosive potential of the novelty sweets in term of their physiochemical properties and amount of enamel loss.Subjects and methods The pH of a variety of novelty sweets was tested in vitro using a pH meter and the neutralisable acidity was assessed by titrating the sweets against 0.1M NaOH. The viscosity of the novelty sweets was measured using a rotational viscometer. The wettability of enamel by each sweet was measured using dynamic contact angle analyser. Enamel loss was assessed using contact profilometry.Results The pH ranged from 1.8-3.2, the neutralisable acidity ranged from 9-201 ml of 0.1 NaOH. The viscosity of the novelty sweets that come in liquid form ranged from 2-594 mPa s. The surface enamel erosion ranged from 1.95-15.77 µm and from 2.5-17.6 µm with and without immersing in saliva for 1 hour before immersing in acidic solution respectively. The amount of subsurface enamel loss was ranged from 0.75 to 2.3 µm following ultrasonication at 0 min of acidic attack and from 0.23 to 0.85 µm at 60 minutes of acidic attack while immersed in saliva. The contact angle between enamel surface and four sweet was less than the angle formed between the orange juice and the enamel which caused more wettability of enamel.Conclusion The pH is lower than the critical value for enamel erosion (5.5), high neutralisable acidity and high sugar content strongly suggest that these sweets may cause significant amount of dental erosion clinically. In addition, the degree of wettability of enamel by solution is an important factor to consider in determining the enamel loss caused by acidic solution. Immediate tooth brushing would cause further enamel loss as a result of the mechanical removal of softened enamel. However, it has been suggested that postponing brushing after erosive attack should be reconsidered.

Fissure Seal or Fluoride Varnish? A Randomized Trial of Relative Effectiveness.

Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- to 7-y-olds. The study design was a randomized clinical trial, with 2 parallel arms. The setting was a targeted-population program that used mobile dental clinics in schools located within areas of high social and economic deprivation in South Wales. A total of 1,016 children were randomized 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-mo intervals. FV was applied at baseline and at 6-mo intervals for 3 y. The main outcome measures were the proportion of children developing caries into dentine (D4-6MFT) on any 1 of up to 4 treated FPMs after 36 mo. At 36 mo, 835 (82%) children remained: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV ( n = 73, 17.5%) versus FS ( n = 82, 19.6%) developed caries into dentine on at least 1 FPM (odds ratio [OR] = 0.84; 95% CI, 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly decayed teeth (OR = 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR = 0.85; 95% CI, 0.59 to 1.21) were examined. In a community oral health program, semiannual application of FV resulted in caries prevention that was not significantly different from that obtained by applying and maintaining FS after 36 mo (EudraCT: 2010-023476-23; ISRCTN: ISRCTN17029222).

Oral cancer: exploring the stories in United Kingdom newspaper articles.

Objective Reports suggest that patients with oral cancer delay seeking help because they are unaware of the symptoms. The majority of adults (95%) engage with news reports and 40% read newspapers. Newspaper oral cancer stories may influence awareness and health-seeking behaviour. The aim of this study was to explore how oral cancer is portrayed in UK newspaper print media.Design Qualitative content analysis of articles from ten newspapers with the widest UK print circulation. All articles using the terms 'mouth cancer' and 'oral cancer' over a three year period were retrieved. Duplicates, non-cancer and non-human articles were excluded.Results 239 articles were analysed. Common topics included 'recent research', 'survivor stories', 'health information' and 'celebrity linkage'. Articles were often emotive, featuring smoking, alcohol, sex and celebrity. Articles lacked a proper evidence base and often failed to provide accurate information about signs and symptoms, information about prevention and signposting to treatment.Conclusions Opportunities to save lives are being missed. Further work to improve social responsibility in the media and develop guidance to enhance the quality of information, health reporting and signposting to help are indicated.

The availability of novelty sweets within high school localities.

Background Reducing sugar consumption is a primary focus of current global public health policy. Achieving 5% of total energy from free sugars will be difficult acknowledging the concentration of free sugars in sugar sweetened beverages, confectionery and as hidden sugars in many savoury items. The expansion of the novelty sweet market in the UK has significant implications for children and young adults as they contribute to dental caries, dental erosion and obesity.Objective To identify the most available types of novelty sweets within the high school fringe in Cardiff, UK and to assess their price range and where and how they were displayed in shops.Subjects and methods Shops within a ten minute walking distance around five purposively selected high schools in the Cardiff aea representing different levels of deprivation were visited. Shops in Cardiff city centre and three supermarkets were also visited to identify the most commonly available novelty sweets.Results The ten most popular novelty sweets identified in these scoping visits were (in descending order): Brain Licker, Push Pop, Juicy Drop, Lickedy Lips, Big Baby Pop, Vimto candy spray, Toxic Waste, Tango candy spray, Brain Blasterz Bitz and Mega Mouth candy spray. Novelty sweets were located on low shelves which were accessible to all age-groups in 73% (14 out of 19) of the shops. Novelty sweets were displayed in the checkout area in 37% (seven out of 19) shops. The price of the top ten novelty sweets ranged from 39p to £1.Conclusion A wide range of acidic and sugary novelty sweets were easily accessible and priced within pocket money range. Those personnel involved in delivering dental and wider health education or health promotion need to be aware of recent developments in children's confectionery. The potential effects of these novelty sweets on both general and dental health require further investigation.

A survey of sports drinks consumption among adolescents.

Background Sports drinks intended to improve performance and hydrate athletes taking part in endurance sport are being marketed to children, for whom these products are not intended. Popularity among children has grown exponentially. Worryingly they consume them socially, as well as during physical activity. Sports drinks are high in sugar and are acidic. Product marketing ignores the potential harmful effects of dental caries and erosion.Objective To investigate the use of sports drinks by children.Method One hundred and eighty-three self-complete questionnaires were distributed to four schools in South Wales. Children in high school years 8 and 9 (aged 12-14) were recruited to take part. Questions focused on use of sports drinks, type consumed, frequency of and reason for consumption and where drinks were purchased.Results One hundred and sixty children responded (87% response rate): 89.4% (143) claimed to drink sports drinks, half drinking them at least twice a week. Lucozade Sport(™) was the most popular brand. The main reason for consuming the drinks was attributed to the 'nice taste' (90%, 129/143). Most respondents purchased the drinks from local shops (80.4%, 115) or supermarkets (54.5%, 78). More boys claimed to drink sports drinks during physical activity (77.9% versus 48.6% girls, P <0.001). Whereas more girls claimed to drink them socially (51.4% versus 48.5% boys, NS).Conclusion A high proportion of children consumed sports drinks regularly and outside of sporting activity. Dental health professionals should be aware of the popularity of sports drinks with children when giving health education advice or designing health promotion initiatives.

What proportion of dental care in care homes could be met by direct access to dental therapists or dental hygienists?

BACKGROUND: Many care home residents require simple dental treatment which is complicated by the need for extra time to deliver dental care. The proportion of their care which could be delivered wholly by hygienists or therapists is unknown. METHOD: 2010 Welsh dental care home survey data on clinical opinion of treatment need and special care skill level required was cross referenced with General Dental Council guidance on direct access. RESULTS: Care home residents treatment needs could be wholly addressed by a generalist dental hygienist or therapist for 22% and 27% of cases respectively. With special care experience these figures increase to 43% and 53%. DISCUSSION: A large proportion of need in care homes could be wholly provided by hygienists or therapists, especially those with special care experience. The potential efficiency gain of direct access arises from individuals who do not need to see a dentist for any aspects of their care. Direct access to hygienists/therapists for dental care of care home residents should be piloted and evaluated. CONCLUSION: Hygienists and therapists could make a large contribution to addressing dental treatment needs of care home residents and direct access could be an efficient model of care for this setting.

Food references in UK children's magazines - an oral health perspective.

OBJECTIVE: Children's magazines are popular in the United Kingdom, but their content is poorly regulated. Consequently, food and beverages high in fat, salt and sugar (HFSS), detrimental to oral and wider health, make unrestricted appearances. The study aim was to assess the amount of HFSS food and drink children are exposed to while reading magazines; with particular focus on foods containing free sugars due to their known cariogenic properties, and foods with low pH due to their erosive potential. DESIGN: Eleven of the most popular UK children's magazines were selected and purchased at four separate time points in 2012. These 44 magazines were examined using content analysis; any references to food/beverages (in advertisements, free gifts, editorial and general content) were recorded. RESULTS: Of the 508 food references observed, 73.6% (374/508) were for foods detrimental to oral health owing to their high sugar and/or acid content. 5.9% (30/508) were considered 'unhealthy' due to their fat or salt content. 20.5% of references were for 'healthy' foods (104/508). The most common food categories referenced were baked goods (181/508) and sweets (86/508). Over a third (36.4%, 16/44) of magazines came with free sweets. In terms of positioning, the food/drink references were predominantly found in the general content of the magazines, including the editorial spreads. Direct advertisements for food/drink only accounted for 9.6% (36/374) of the total number of references counted. CONCLUSION: Food references within children's magazines are biased towards unhealthy foods especially those detrimental to oral health; these permeate throughout the general and editorial content and are not restricted to direct advertisements. Magazine editors, journalists and illustrators are responsible for the editorial and general content of magazines. Without regulation, subliminal placement of advertisements within editorial and general content leads to 'advertorials' which are known to confuse children and parents alike. This study concludes that regulation may therefore need to cover more than just the direct advertisements. Dental professionals need to be aware of current trends in children's media when giving health education advice or designing health promotion initiatives.

Effect of second mailing for consent on child dental survey results.

INTRODUCTION: Written parental consent of young children has been required for dental surveys in Wales since 2006. The 2007/08 survey produced much lower caries scores than previous surveys, believed to be associated with low participation of children with caries experience. OBJECTIVE: To test the null hypothesis that decay variables from a second mailing of parental consent are no different from those generated from a first mailing. METHODS: Cross-sectional caries (d3mft) survey of children aged 5-6 during 2011/12. Survey criteria complied with British Association for the Study of Community Dentistry guidance. Comparison of dental epidemiological variables generated from data collected via first and second mailing for consent. RESULTS: The aggregate d3mft for all 7,734 children examined was 1.6. The mean d3mft for the first mailing was 1.5 (6,678 children) compared with a d3mft of 2.2 (1,056 children) for the second mailing. Equivalent data for d3mft(d3mft > 0) and %d3ft > 0 were: d3mft(d3mft > 0) 3.8 first mailing compared with d3mft (d3mft3 > 0) 4.1 second mailing; and %d3mft>0 39.5% first mailing compared with %d3mft > 054.1% second mailing. Mean d3mft and %d3mft > 0 showed statistically significant differences. CONCLUSIONS: Null hypothesis is rejected for d3mft and %d,mft>0O. The findings suggest non-responders to the first mailing do have higher prevalence of decay than responders. To facilitate comparisons of reported decay levels, future surveys using mailed forms for consent purposes should include at least two mailings and report the number of mailings used to facilitate comparisons of reported decay levels.

Does dental disease presence equate to treatment need among care home residents?

OBJECTIVES: This study aimed to explore the relationship between dental disease, complexity and dental treatment needs of care home residents. METHODS: Survey of residents in care homes in Wales. Random sample of participants from a random selection of care homes across Wales, UK. Data collection involved questionnaires and dental examinations. RESULTS: Data were collected from 655 care home residents in 213 care homes. Half of all residents reported good or very good oral health but most had dental treatment needs. 73% of dentate residents had active caries, of those, 53% required restorations and 37% needed extractions. All were deemed to require dental examination. 60% of dentate residents and 50% of edentate residents had case complexity, which influenced the delivery of care. CONCLUSIONS: There is significant unmet dental treatment need amongst care home residents. Dental disease presence alone is a poor indicator of the need for care and does not account for case complexity or the shift towards a patient centred rather than disease focussed approach to care. Measures for treatment needs and complexity are required when undertaking assessments of oral health needs in care homes. CLINICAL SIGNIFICANCE: Traditional oral health surveys measuring dental disease do not necessarily equate to treatments required for care home residents and do not reflect the complexity and difficulties involved in delivering dental care. This survey highlights dental needs in care homes, and the difficulties involved in delivering care to address these needs.

Knowledge of removable partial denture wearers on denture hygiene.

BACKGROUND: Regular good denture hygiene by individuals with removable partial dentures (RPDs) is an important component of oral health and in the prevention of further dental problems. These individuals should be provided with advice on the importance of denture care and be aware of this information. AIM: To establish deficiencies in patient knowledge surrounding denture hygiene by RPD wearers. METHODOLOGY: The study was undertaken as an audit. Data was collected from April 2012 to October 2012 via a questionnaire completed by 196 RPD wearers attending as patients at the University Dental Hospital Wales and the dental units at St David's Hospital and Cynon Valley Hospital. The audit criterion was patients with RPDs should have knowledge of denture hygiene, with the standard set at 100%. RESULTS: While 91.8% of participants stated they were provided with instructions on denture hygiene when provided with their current prosthesis, 60.2% were shown to have less than an appropriate level of denture cleanliness, with 9.2% reporting that they slept wearing their prosthesis. CONCLUSION: The audit criterion and standard set were not achieved. A lack of knowledge surrounding denture hygiene was demonstrated among participants. As a part of the audit process the health education of RPD wearers' hygiene needs to be improved and awareness levels of the whole dental team needs to be raised. All partial dentures should receive information and regular reinforcement of key dental hygiene messages.

Evidence-based prevention: a comparison of oral hygiene advice given by dental and dental care professional students.

AIM: This study aimed to examine the oral hygiene advice given by student dentists and dental care professionals (DCPs), focussing on adherence to evidence-based recommendations provided by the Department of Health and the Scottish Intercollegiate Guidelines Network. METHOD: A self-administered questionnaire was distributed to 121 fourth- and fifth-year dental undergraduates and 38 hygiene/combined dental hygiene and dental therapy students at a UK dental school. RESULTS: Completed questionnaires were returned by 39/64 fourth-year and 36/57 fifth-year dental students and 23/38 student DCPs, an overall response rate of 61.6%. Only 48% (36) of dental undergraduates in comparison with 95.7% (22) of DCP students stated that they would give oral hygiene advice to every adult patient (P<0.001). In addition, only 24 (32%) responding dental students were able to accurately state the recommended fluoride toothpaste concentration for adult use; this contrasts with 18 (78.3%) student DCPs. Dental undergraduates tended to accord less importance to oral hygiene advice when compared with student DCPs, only providing it when they felt it was clinically necessary. CONCLUSIONS: The role of the dental practitioner in providing oral health education requires greater emphasis in the undergraduate curriculum. Given the unfavourable comparison between the attitude and knowledge of dental students and that of DCPs, prequalification training for the dental team should be integrated wherever possible. The apparent lack of awareness of current guidelines is of concern.

The caries experience of 11 to 12 year-old children in Scotland and Wales and 12 year-olds in England in 2008-2009: reports of co-ordinated surveys using BASCD methodology.

OBJECTIVE: This paper brings together summarised findings on surveys of 106,828 mainstream school pupils aged 11-12 years old undertaken in Scotland, Wales and England in 2008/09. These surveys are the latest in a series using common criteria for measurement and a range of consent arrangements which, for this age group, allow comparison between the three "countries" and over time. METHOD: Representative samples were drawn within the geographies of primary care organisations in the three countries and within English Local Authorities according to BASCD criteria for sampling. Consent was sought from pupils in Wales and England and passive consent was used in Scotland. Children aged twelve were examined in England and children in school year 7 (rising 12) were examined in Wales and Scotland. Examinations were conducted in schools by trained and calibrated examiners using BASCD standard criteria and caries was diagnosed at the dentinal threshold using visual criteria. RESULTS: The trend for reducing caries prevalence and severity continues in this age group in all three countries. Unlike data for 5 year old children, the impact of seeking positive consent from pupils does not appear to have introduced bias into the results. Variation in caries levels between and within geographical areas continues. CONCLUSION: Caries prevalence surveys of children aged 11-12 years have been conducted across Great Britain. Those carried out with positive consent appear to produce unbiased results, comparable with previous surveys. Health inequalities in this age group persist, as does the burden of disease for those with end-stage caries.

The caries experience of 5 year-old children in Scotland, Wales and England in 2007-2008 and the impact of consent arrangements. Reports of co-ordinated surveys using BASCD criteria.

OBJECTIVE: This paper brings together summarised findings and comment on surveys of young children undertaken in Scotland, Wales and England in 2007-08. These surveys are the latest in a series using common criteria for measurement but changes in the consent arrangements for Wales and England mean that these datasets are no longer directly comparable with Scottish data. METHOD: Representative samples were drawn within the geographies of primary care organisations in the three countries, and in England within Local Authorities also, according to BASCD criteria. Consent was sought in three different ways. Children aged five were examined in England and those in Primary 1 (rising 6) were examined in Wales and Scotland. Examinations were conducted in schools by trained and calibrated examiners and caries was diagnosed at the dentinal threshold using visual criteria. RESULTS: The impact of seeking positive consent appeared to depress the caries severity and prevalence in Wales and England whilst the reduced caries levels in Scotland may be attributed to the pro-active health improvement measures affecting this cohort. The results for positive consent suggest bias against participation of children with higher levels of tooth decay. CONCLUSION: Caries prevalence surveys of children at the start of formal education have been conducted in Great Britain. Those carried out with the need for positive parental consent have produced new baseline data. Data presented after 2007-08 should be annotated to show the participation rate and the inappropriateness of comparing data collected using different types of consent.

Do parents of children with caries choose to opt out of positive consent dental surveys in Wales?

BACKGROUND: Recently, positive consent has been required for dental surveys in some parts of the UK. Concerns have been raised that when positive consent is used participation is reduced in deprived areas and reported caries levels are biased as a consequence. This paper analyses caries data collected under positive and negative consent arrangements to explore this issue further. METHOD: Retrospective analysis of response rates by deprivation fifth and by caries experience of participating children in NHS coordinated dental surveys in Wales undertaken from 2001/2 until 2005/6 using negative consent and in 2007/8 using positive consent. RESULTS: Across Wales, the change from negative to positive consent was associated with greatly decreased participation. In comparison with previous surveys there was a large increase in children sampled but not examined. The decrease in the proportion of children sampled, who were examined and found to have no decay was similar across all deprivation fifths, with no obvious deprivation-related trend. There was a much larger reduction in the number of children with decay who participated across all quintiles of deprivation. CONCLUSION: Caries status could be a more important factor than deprivation regarding opting out of the survey. It appears that children with caries are more likely to be opted out of the survey than similarly deprived peers without caries. Parents appear to be more likely to opt children with caries out of dental surveys when positive consent is used. These findings have significant implications for targets aimed at improving oral health which were set before the change in consent procedures, but reported upon after.

A comparison of the nutritional knowledge of dental, dietetic and nutrition students.

Conflicts in dietary messages remain widespread. Such conflicts can have negative effects on the behaviour, motivation and attitudes of individuals. Inconsistencies in dietary advice may be linked to inadequate training of professionals. Literature suggests that the nutrition training of dentists and oral health training of dietitians and nutritionists is limited. This study was designed to provide information on the nutritional knowledge of dental, dietetic and nutrition students and how this conforms to national nutritional guidelines, identifying differences between professional groups and conflicts in undergraduate training. Self-administered questionnaires were completed by 124 dental, dietetic and nutrition students at Cardiff University and the University of Wales Institute, Cardiff (UWIC). Significant inter-group differences (p <0.05) were observed in relation to recommendations concerning the between-mealtime consumption of a wide range of snacks and drinks. Dental students were mainly concerned with oral health problems (for example, acid erosion), while dietetic and nutrition students were mainly concerned with general health problems (for example, obesity). Just over a third of dental students felt that they had received sufficient training in the dietary management of patients. In conclusion, a common risk-factor approach and consistent nutrition guidelines are essential to improve health. In addition, recommendations should be made to incorporate oral health into the training of nutritionists and general health into the training of dentists.

An assessment of nutritional information in oral health education leaflets.

INTRODUCTION: Dental caries prevalence in UK children remains high and obesity, closely linked to Type 2 diabetes, is rising. Literature suggests that dentists may not give dietary advice due to a lack of clear and consistent guidelines. OBJECTIVE: The aim of the study was to determine whether oral health education leaflets with a food and nutritional focus conform to existing UK national nutritional guidelines from the Department of Health (DoH), the Food Standards Agency (FSA) and the Committee on Medical Aspects of Food and Nutrition Policy (COMA). METHOD: A sample of 30 information leaflets, aimed at parents and children aged 3-16 years, was sourced during the winter of 2005-2006. A qualitative content analysis was carried out to identify key recommendations on type, frequency and quantity of food and drink and general diet-related health advice. RESULTS: Most leaflets (21) promoted milk and water in agreement with nutritional guidelines. Timing of sugary food and drink to mealtimes (25) and decreasing frequency of 'sugary' e.g. non-milk extrinsic (NME) sugar containing foods (22) and drinks (25) reflected guidelines. Inconsistencies were, however, recorded in the leaflets. Five leaflets advised that frequency of consumption rather than the amount of sugary food or drink was important for oral health. This conflicts with nutritional guidelines, aimed at tackling obesity, to decrease both amount and frequency. There was conflicting advice on healthy snacks. Crisps were presented as 'healthy' by two leaflets; another two advised against snacking on dried fruit, conflicting with FSA guidelines that dried fruit contributes to "5 a day". Sixteen leaflets promoted cheese as 'healthy' with no limits on portion size; this could conflict with nutritional guidelines associated with percentage energy contribution of saturated fat to the diet. CONCLUSION: While there was agreement between leaflet content and nutritional guidelines, there were inconsistencies. Dental professionals should acknowledge these when selecting leaflets for lay dissemination.

The United Kingdom's specialist workforce in paediatric dentistry: current and future trends.

OBJECTIVE: To provide information relevant to the current and predicted future profile of the UK's specialist workforce in paediatric dentistry. DESIGN: Postal questionnaire. SUBJECTS: Two hundred and twenty-one registered dentists whose names appeared on the Specialist List in Paediatric Dentistry and who were identified as resident within the United Kingdom. RESULTS: Questionnaires were returned by 192 specialists, a response rate of 86.9%. This paper is, however, based on data provided by 187 respondents currently practising in the United Kingdom (54 (28.9%) male and 133 (71.1%) female). The majority of respondents were based in England (138) and practised in hospital settings (120). Eighty-two respondents (14 males and 68 females) stated that they were working part-time and 57 (5 males and 52 females) indicated that they had already taken a break at some time during their career. Eighty-four (45.2%) respondents plan to retire during the next ten years. CONCLUSIONS: Working patterns associated with a feminised workforce will have a considerable impact on the volume of service that can be provided. Workforce planners must be cognisant of the need to increase the number of specialists in training to take account of service lost through part-time working and career breaks.