Co-design of an oral health intervention (HABIT) delivered by health visitors for parents of children aged 9-12 months.

BACKGROUND: Dental caries (tooth decay) in children is a national public health problem with impacts on the child, their family and wider society. Toothbrushing should commence from the eruption of the first primary tooth. Health visitors are a key provider of advice for parents in infancy and are ideally placed to support families to adopt optimal oral health habits. HABIT is a co-designed complex behaviour change intervention to support health visitors' oral health conversations with parents during the 9-12-month universal developmental home visit. METHODS: A seven stage co-design process was undertaken: (1) Preparatory meetings with healthcare professionals and collation of examples of good practice, (2) Co-design workshops with parents and health visitors, (3) Resource development and expert/peer review, (4) Development of an intervention protocol for health visitors, (5) Early-phase testing of the resources to explore acceptability, feasibility, impact and mechanism of action, (6) Engagement with wider stakeholders and refinement of the HABIT intervention for wider use, (7) Verification, Review and Reflection of Resources. RESULTS: Following preparatory meetings with stakeholders, interviews and co-design workshops with parents and health visitors, topic areas and messages were developed covering six key themes. The topic areas provided a structure for the oral health conversation and supportive resources in paper-based and digital formats. A five-step protocol was developed with health visitors to guide the oral health conversation during the 9-12 month visit. Following training of health visitors, an early-phase feasibility study was undertaken with preliminary results presented at a dissemination event where feedback for further refinement of the resources and training was gathered. The findings, feedback and verification have led to further refinements to optimise quality, accessibility, fidelity and behaviour change theory. CONCLUSION: The co-design methods ensured the oral health conversation and supporting resources used during the 9-12 month visit incorporated the opinions of families and Health Visitors as well as other key stakeholders throughout the development process. This paper provides key learning and a framework that can be applied to other healthcare settings. The structured pragmatic approach ensured that the intervention was evidence-based, acceptable and feasible for the required context. TRIAL REGISTRATION: ISRCTN55332414, Registration Date 11/11/2021.

HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing): a qualitative exploration of the acceptability of a complex oral health intervention.

BACKGROUND: To explore the acceptability of the oral health intervention, HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing) to parents with young children aged 9-12 months and health visitors. METHODS: Following the delivery of the universal oral health intervention called HABIT, qualitative semi-structured interviews with parents and focus groups with health visitors were undertaken. Interviews were audio-recorded and transcribed. Health visitors completed self-reported diaries after delivering the HABIT intervention with parents. The qualitative data was analysed using framework analysis (guided by a theoretical framework of acceptability). RESULTS: Seventeen parents were interviewed, and five health visitors and three nursery nurses participated in two focus groups. Parents reported health visitors to be 'trusted' and valued the reassurance provided during the HABIT visit. Health visitors found the HABIT training and resources useful and valued the consistency and increased confidence in undertaking oral health conversations. There were, however, challenges in changing behaviour where families faced competing demands on time and resources. Both health visitors and parents described the importance of the intervention's timing and suggested that multiple visits may be needed to support optimal oral health habits. CONCLUSION: The HABIT intervention was acceptable to parents and health visitors. Health visitors would welcome a further refinement to enhance intervention delivery that specifically achieves a balance between using a guided script and retaining the flexibility to adapt the conversation to suit the needs of individual families. This, in turn, will maximise impact and enable parents of young children to adopt and maintain optimal home-based oral health behaviours for their child.

Reduced-step composite polishing systems - a new gold standard?

OBJECTIVES: To compare the surface gloss and surface roughness of three contemporary composites when polished with reduced-step polishing systems or a conventional multiple-step technique. METHODS: Fifty Discs (8 mm ø x 2 mm) were each fabricated from three composites; Essentia (ES), BRILLIANT EverGlow (EG), and Filtek Universal, (FU). 5 different polishing systems were randomly assigned 10 specimens from each composite group. The 'gold standard' multiple-step system consisted of Sof-Lex XT discs followed by DiaPolisher diamond paste (GC) (P1). The two-step systems were Polishettes (P2) and DIATECH ShapeGuard (P3) and the one-step systems used were; Opti1Step (P4) and OneGloss (P5). Surface gloss was measured using a glossmeter and surface roughness was measured by a profilometer. Statistical analysis was conducted using one-way ANOVA and Pearson correlation tests. Samples were also imaged across different length scales using scanning electron microscopy and macro-lens photography. RESULTS: The highest gloss was obtained when P2 and P3 were used in all composite groups (p < 0.05). EG composite showed the lowest Sa (0.08 µm) when polished with P3 and highest gloss when polished with P2 (96.7 GU). Polishing with P5 resulted in highest Sa and lowest surface gloss in all composite groups (p < 0.05). A high correlation was found between Sa and gloss, r = 0.73 (p < 0.05). Both SEM and macro-lens photography supported quantitative data. CONCLUSION: Both two-step composite polishing systems produced superior gloss compared to the traditional multiple-step polishing system. Mean surface roughness (Sa) and surface gloss are highly correlated with each other. CLINICAL SIGNIFICANCE: Some reduced step composite polishing systems tested in this study produced superior gloss outcomes compared to the traditional gold-standard multi-step polishing system. This may enable significant clinical chair-time reduction and faster polishing protocols.

Digital photographic technique for the production of an artificial eye.

The use of hand painting an iris button using oil paint remains the conventional method of artificial eye manufacturing. The authors found that replacing this technique with a digital photograph taken of a patient's unaffected eye offers several advantages over the conventional method but the process from capture to print must be standardised and colour accurate. The authors of this paper suggest a tried and tested formulated photographic process of capture and printing prior to polymerisation. It discusses issues that can arise and how these can be overcome in order to achieve a high-quality print that can be used to produce a 'life like' ocular prosthesis.

Novel artificial eye service evaluation using patient reported outcome measures.

BACKGROUND: This service evaluation explores patient reported outcomes from patients provided with high definition ocular prostheses (artificial eyes). METHODS: Validated patient questionnaires (FACE-Q, DAS24 and HADS) were utilised to evaluate patient experiences of their new ocular prosthesis. 10 patients were included in the service evaluation, which was conducted between December 2018 and September 2019. Descriptive analysis of the mean and 95% CI was undertaken for all questionnaires. Statistical analysis was performed using SPSS 21 Principal Component Analysis (PCA) for FACE-Q questionnaires. Correlations were significant when factor loading is at α > 0.4. RESULTS: A questionnaire response rate of 80% was achieved (n = 8). PCA analysis showed the number of variables tested could be reduced. Two principal components (PC1 and PC2) had very good to excellent internal consistency between variables with factor loading (α = 0.7-0.9). PC1 contained questionnaires 1-7, all of which were highly correlated. PC2 contained question number 8 with a factor loading of α = 0.8. This indicates good reliability, validity and responsiveness. CONCLUSIONS: We hope to demonstrate the importance of service evaluations with respect to rapidly evolving technological advances in medical devices, pharmaceuticals and imaging modalities. Further feasibility and full clinical studies are required to confirm the positive results of the novel artificial eye service we have evaluated with respect to the traditional approach.

COVID-19 decontamination procedures for photographic equipment in a secondary care setting.

This article provides an overview of how long COVID-19 (SARS-CoV-2) survives on the built environment, and reviews currently available resources to provide recommendations on effective decontamination of photographic equipment based within a secondary care setting.

Evaluation on the effectiveness of a peer led video on oral hygiene education in young children.

This study evaluated the effectiveness of a peer-led oral hygiene education video in improving oral hygiene knowledge and behaviour in year 2 (6- to 7-year-old) and year 3 (7- to 8-year-old) children. A novel peer-led oral hygiene education video was created, in which a group of 6- to 10-year-old children delivered key oral hygiene messages. The video was then shown to children of the same age group, whom oral hygiene knowledge and behaviours were assessed before and after the video. Results found that the video was an effective method of improving overall oral hygiene knowledge. It was effective in improving specific aspects of oral hygiene such as knowledge of the frequency of brushing and toothpaste amount, and in the behaviour of using the toothbrush in a circular motion. It was not an effective method in improving the overall oral hygiene knowledge and behaviour of Year Two children, demonstrating children may develop significantly in just 1 year.

"Strong Teeth"-a study protocol for an early-phase feasibility trial of a complex oral health intervention delivered by dental teams to parents of young children.

BACKGROUND: Dental attendance provides an important opportunity for dental teams to explore with parents the oral health behaviours they undertake for their young children (0-5 years old). For these discussions to be effective, dental professionals need to be skilled in behaviour change conversations. The current evidence suggests that dental teams need further support, training and resources in this area. Therefore, the University of Leeds and Oral-B (Procter & Gamble Company) have worked with the local community and dental professionals to co-develop "Strong Teeth" (an oral health intervention), which is delivered in a general dental practice setting by the whole dental team. The protocol for this early phase study will explore the feasibility and acceptability of the Strong Teeth intervention to parents and the dental team, as well as explore short-term changes in oral health behaviour. METHODS: Forty parents (20 of children aged 0-2 years old, and 20 of children aged 3-5 years old) who are about to attend the dentist for their child's regular dental check-up will be recruited to the study. Parents and children will be recruited from 4 to 8 different dental practices. In the home setting, consent and baseline oral health behaviour data will be collected. The researchers will ask parents questions about their child's oral health behaviours, including toothbrushing and diet. Three different proxy objective measures of toothbrushing will be collected and compared with self-report measures of parental supervised toothbrushing (PSB). DISCUSSION: The parent and child will then attend their dental visit and receive the Strong Teeth intervention, delivered by the dental team. This intervention should take 5-15 min to be delivered, in addition to the routine dental check-up. Furthermore, children aged 0-2 years old will receive an Oral-B manual children's toothbrush, and children aged 3-5 years old will receive an Oral-B electric rechargeable children's toothbrush. At 2 weeks and 2-3 months following the Strong Teeth intervention, further self-report and objective measures will be collected in the parent/child's home. This data will be supplemented with purposively sampled qualitative interviews with parents (approximately 3 months following the intervention) and dental team members (following delivery of the intervention). TRIAL REGISTRATION: ISRCTN Register, (ISRCTN10709150).

Instructional design of a clinical photography course for undergraduate dental students.

Clinical and dental photography is an acquired skill. It is learned, developed and practised at post-graduate level by medical photographers across the U.K. But where does the medical photography profession stand in terms of transmitting slowly acquired skills to a wider clinical audience? If some or all skills need to be passed on, how and to whom should they be taught? This paper considers how dental practitioners may benefit from training in specific aspects of clinical photography and suggests a tried and tested model of instructional design for a clinical photography course utilised and implemented for undergraduate dental students studying at the University of Leeds. The authors found a course of this nature demanded skills and theoretical understanding of cognitive architecture beyond the purview of most clinical field experts. A collaborative approach to instructional design between a field expert and clinical educator was implemented, which allowed the design of a dental photography course that worked effectively by linking new to prior knowledge.

Mirrorless cameras for medical photography - time to switch?

This article reviews the use of mirrorless systems in medical photography, based on the author's experience using Sony mirrorless systems. It is not aimed at being an in depth comparative technical review but aims to discuss the technology as a viable alternative to the digital single lens reflex (DSLR) when documenting the most common subjects a medical photographer will face.