A cluster randomised, controlled trial of the value of dental health educators in general dental practice.

AIM: To test the effectiveness of dental health educators in general dental practice. OBJECTIVE: To evaluate the effectiveness and cost of primary care trusts seconding dental health educators free of charge to suitable general dental practices to provide dental health counselling to mothers of regularly attending pre-school children at risk to caries. METHOD: Two-cell, parallel group, cluster randomised, controlled clinical trial of two years' duration. CLINICAL SETTING: 30 general dental practices in North-West England. PARTICIPANTS: 269 mothers of 334 pre-school children. INTERVENTIONS: Those in the test group were given visits to a dental health educator over a 2-year period to counsel mothers of at-risk, pre-school children. The rest were held as a control. MAIN OUTCOME MEASURES: Caries prevalence of the children and dental health knowledge, attitudes and toothbrushing skills of the parents. The full costs of the exercise were kept throughout. The statistical analysis controlled for the clustering of children within practices. RESULTS: After 2 years, 271 (81%) children and 248 (92%) mothers remained in the study. There was an 18% difference in mean dmft between the groups in favour of the test group children but this was not statistically significant. At the end of the study there was an 18% difference in mean dmft between the groups in favour of the test group children but this was not statistically significant. No difference in plaque levels was found. The mothers in the test group were more knowledgeable, had better attitudes towards the dental health of their offspring and better toothbrushing skills than those in the control. Each 2-hour session to counsel ten parents cost pound 40. CONCLUSION: Primary care trusts should carefully consider the cost value of seconding dental health educators to counsel parents of regularly attending, at-risk, pre-school children when considering such an option.

Dental health knowledge and attitudes of regularly attending mothers of high-risk, pre-school children.

AIM: The aims of this study were to discover the knowledge of and attitudes towards dental health of a group of regularly attending mothers of young children at high-risk of caries, and to evaluate their toothbrushing techniques. METHOD: As part of the baseline examination of a randomised controlled trial to test the influence of dental health counselling on the caries increment of at-risk pre-school children, 268 mothers of 334 children completed a questionnaire enquiring about their dental health knowledge and attitudes, and were also observed brushing their children's teeth. RESULTS: Although most mothers (71%) knew that they should brush their children's teeth twice a day using a small toothbrush (94%) only 52% knew that they should use only a small pea-sized amount of paste, and only 3% knew the recommended level of fluoride in toothpaste for these at-risk children. 40% of the children insisted on brushing their own teeth and 40% of the mothers brushed their children's teeth inadequately. Although three-quarters of the mothers knew that sugary foods and drinks should be consumed only at mealtimes, only 7% knew the four foods and drinks supplying most sugar to a child's diet. Although three-quarters of mothers thought that dental decay in milk teeth was very important, only half wanted their children's carious teeth restored. CONCLUSION: Knowledge, attitudes and behaviour about dental health among these regularly attending mothers of at-risk, pre-school children were superficial. Their attitudes to dental health of primary teeth were equivocal and their demonstrated brushing behaviour on the part of their children was inadequate.

An investigation into the use of a dental hygienist in school screening.

OBJECTIVE: A pilot study to measure the validity of using a hygienist to carry out school screening. DESIGN: Following a standard training programme a dental hygienist (DH), recruited from general practice, a newly appointed dental officer (DO) and an epidemiologist (SDO), who acted as the standard, all screened the same group of school children on two occasions. SETTING: An inner city school with known high levels of disease. PARTICIPANTS: Ninety-eight 7- and 8-year-old children attending school. MAIN OUTCOME MEASURES: For each clinician the levels of referral, the reasons for referral and the repeatability were measured. RESULTS: The hygienist referred 26 children (27%) for further examination while the DO and the SDO both referred 61 (62%). The DO achieved the required standards of sensitivity and specificity when results were compared with the SDO but the hygienist did not. Intra-examiner reliability in all three clinicians was good. CONCLUSIONS: The standard training programme used to prepare dental officers to carry out school screening to an agreed standard was insufficient for this hygienist's needs.

Preventive technologies in dental practice in the UK.

Visits were made to 26 selected general dental practices in Greater Manchester, UK to record the preventive technologies used on 106 patients below the age of 18 years. In addition, the patterns of treatment of 72 general dental practitioners in three contrasting areas in England were recorded, 11 of whom used preventive dental units. No relationship could be found between the organisation of the practice and the amount or type of prevention supplied or the patterns of treatment provided. The value of the preventive technologies currently offered in general dental practice is questioned and further research is recommended to discover the best model of practice to achieve cost-effective prevention.