ABSTRACT
BACKGROUND: Recent studies have cast doubt on the effectiveness and efficiency of school based dental screening programmes in improving dental attendance or improving dental health. In 2002 the National Dental Inspection Programme was introduced in Scotland which categorises children by their dental health and informs parents of the findings via a personalised letter home and encourages dental registration. In addition, epidemiological data for local and national planning purposes is collected. This replaced an earlier school screening system in Lothian where a generic letter urging registration was sent to children who were identified as not being registered with a dentist. The objective of this study is to compare dental registrations rates among unregistered children in these two school inspection systems with a system where letters were sent home but no dental inspection was carried out. METHODS: The study was designed as a single blinded, cluster randomised, controlled trial involving 12,765 12-13-year-old children attending all 65 state Secondary schools in Lothian and Fife during the academic year 2003/4.After stratifying for school size and range of social deprivation, schools were randomly allocated to one of four groups:1. 'Traditional' inspection, letter to unregistered children only,2. Letter sent home to unregistered children only, no inspection,3. National Dental Inspection Programme, letter to all children,4. Control group in which the children were neither inspected nor sent a letter.Dental Registration status was compared at baseline and 3 months post inspection. RESULTS: The registration levels in both the 'Traditional' screening and the NDIP inspection groups rose 3 months post inspection (14% and 15.8% respectively) but were not significantly different from one another or the control group which rose by 15.8% (p > 0.05). The group who were sent a letter home but were not inspected also has a rise in registration levels of 18.1% which was not significantly different from either of the groups who were inspected or the control group (p > 0.05). The only significant predictors of registration were previous registration (p < 0.05) and within those who previously registered, the length of time since last registration (P < 0.001). CONCLUSION: Neither of the two dental inspection methods nor a letter home to unregistered children resulted in a significant rise in registration rates in 12-13-year-olds compared to a control group of children who received no intervention.
ABSTRACT
BACKGROUND: Previous research suggests there are significant differences between socio-economic groups in prevalence and amount of decayed missing and filled primary teeth (d3mft). The aim of this study was to describe the variation in obvious tooth decay experience amongst 5-year olds in Scotland and to look at the association between d3mft and deprivation in Scotland. METHODS: Data derived from 1993 to 2003 National Dental Inspection Programme were modelled using Bayesian multilevel zero-inflated Negative Binomial models, adjusting for age, sex and the deprivation. RESULTS: Deprivation is positively and significantly associated with having d3mft; the odds of a child in DepCat 7 (most deprived) having d3mft in 1993 were 7.49 (5.03-11.15) that of a child in DepCat 1 (most affluent). Inequalities in the prevalence of d3mft have reduced and in 2003 the odds of a child in DepCat 7 having d3mft were 4.60 (3.47-6.14) that of a child in DepCat 1. However, socio-economic inequalities in the amount of d3mft for those with d3mft have seen no reduction and have in fact increased between 1993 and 2003, with this increase approaching significance. CONCLUSION: While socio-economic inequalities in prevalence of children with d3mft have decreased in recent years, socio-economic inequalities in the amount of d3mft for those with d3mft persist. This suggests that improvements are only seen for those children with the potential for low d3mft. High d3mft persists among children from more deprived areas. The national target conceals this apparent inconsistency.
Subject(s)
Dental Caries/economics , Dental Caries/epidemiology , Health Status Disparities , Bayes Theorem , Child, Preschool , Cross-Sectional Studies , DMF Index , Female , Humans , Male , Poverty , Prevalence , Scotland/epidemiologyABSTRACT
OBJECTIVES: Previous studies have shown that fluoride mouthrinsing programmes are effective in reducing caries among children and adolescents. National surveys of child dental health in the UK confirm that there is variation in oral health. In particular, children of low socioeconomic status in Scotland have a disproportionately high share of dental disease. This study aimed to evaluate an existing school-based fluoride mouthrinsing programme on dental caries in populations stratified by socioeconomic status. METHODS: A random sample of 1333 children surveyed by the National Dental Inspection Programme with average age 11.4 years was included in the study. Caries prevalence data were collected for the 661 rinsers and 672 nonrinsers. Chi-squared tests and t-tests were carried out to test differences in proportion and in mean D(3)MFT, respectively. The data were modelled using multilevel logistic regression, adjusting for age, sex, deprivation and rinse status. RESULTS: There is a strong negative association between deprivation and prevalence of D(3)MFT = 0. There is no significant difference in prevalence of D(3)MFT between rinsers and nonrinsers, however, mean D(3)MFT is greater for nonrinsers within each deprivation category. After adjusting for age, sex and deprivation, the odds of a tooth being decayed missing or filled for a child who rinsed are 0.79 (0.64, 0.98) compared with those of a child who did not. CONCLUSIONS: Fluoride rinsing can be effectively targeted at children from deprived areas through school-based initiatives. There are some difficulties in recruiting all children from the more deprived backgrounds, but overall reductions in D(3)MFT were observed.
