What should we be doing for children in our general practices?

This paper reports the findings from a research project named FiCTION (Filling Children's Teeth: Indicated or Not?).Design FiCTION was a multi-centre, parallel-group, patient-randomised controlled trial comparing the effectiveness of three treatment strategies. There were three strategies within the trial: conventional caries removal and restoration plus prevention (C+P); biological sealing-in caries plus prevention (B+P); and prevention alone (PA).Case selection Children aged 3-7 years with at least one asymptomatic primary molar carious into dentine were included in the study. Participants were randomly allocated to one of the three treatment strategies. Dental professional's (DPs) attended one day training for treatment delivery. Seventy two practices randomised at least one participant. Ten practices withdrew but data collected to the withdrawal date were included in the analysis. The project ran for 3 years between 2012 and 2015. One thousand and fifty eight participants (C+P:352; B+P:352; PA:354) from 68 practices were included in the analysis set. Baseline demographic and clinical characteristics for each arm of the study were balanced.During routine practice visits data were collected on a case report form (CRF). The data included:A. Co-primary outcomes: pain due to caries and evidence of dental infection (without radiographic evidence)B. Secondary outcomes: cost effectiveness, oral health related quality of life (COHRQOL), parental and caregivers perception questionnaire (P-CPQ-16), modified child dental anxiety scale, child and parent-reported anticipatory and treatment-related anxiety, caries incidence at baseline and final visit, qualitative views of parents/carers and DPs.Sound methodology was described in the narrative of the paper. The median follow-up period was 33.8 months (IQR 23.8, 36.7).Results For the co-primary outcomes the proportions of participants with at least one episode of dental pain and/or infection were: C+P 42%, B+P 40%, PA 45%. When comparing C+P with B+P and PA, there were no significant observed differences, adjusted risk difference (97.5%CI): B+P vs C+P -2%(-10%, 6%), PA vs C+P 4% (-4%, 12%). The number of episodes of dental pain and/or infection were C+P 0.62 (sd 0.95), B+P 0.58 (sd 0.87), PA 0.72 (sd 0.98). When comparing C+P with B+P and PA no significant differences were observed, adjusted incident rate ratio (97.5% CI): B+P vs C+P 0.95 (0.75, 1.21), PA vs C+P 1.18 (0.94, 1.48).Secondary outcomes:• Cost effectiveness, PA was the least costly but least effective for both co-primary outcomes with little evidence in this paper as to how and why B+P and C+P would provide greater benefits• COHRQOL, P-CPQ-16, anxiety showed no statistical differences• Parent reported anticipatory anxiety showed differences between PA vs C+P; 6% lower in the PA arm, adjusted risk difference -0.06 ((97.5% CI): -0.11 to -0.003)• Caries incidence showed no differences in the caries in primary or first permanent molars• Qualitative views showed that all three approaches were generally acceptable but trust in the dental professional played a significant role. Local anaesthesia and dental extractions were generally viewed more negatively.Conclusions There were no statistical differences between the three strategies for the co-primary outcomes, namely the incidence or number of episodes of dental pain and/or infection experienced by the study participants. The secondary outcomes suggest less anticipatory anxiety in the PA arm of the trial and that local anaesthesia and dental extractions were viewed negatively.

Being a dentist in the pandemic.

Data sources The authors provide no detail as to how the review was undertaken. Therefore the paper does not provide any methodological processes for data extraction. The paper describes the assimilation of available information regarding 2019-nCoV at the time of writing. The authors provide information on the COVID-19 pandemic in order to inform front-line dentists.The paper is as essay on the available information relating to:Background to the pandemic• Coronaviruses in general• Pathogenesis• COVID-19• Clinical manifestations• Patient characteristics• Diagnosis• Protocol for managing the disease in the clinical setting• Transmission dynamics• Transmission dynamics in dentistry practice• Infection control• Mouth rinses• Rubber dam isolation• Anti-retraction handpiece• Appropriate disinfectants• Management of medical waste.Conclusions Face-to-face communication and consistent exposure to body fluids such as blood and saliva predispose dental care workers to risk of infection and there is high risk of cross-infection. The authors apply available international guidelines to provide a protocol for managing possible exposure to patients or those suspected of having a 2019-nCoV infection. Dentists play a significant role in disrupting the transmission trail of the virus by simply postponing non-emergency care for all patients.

General dental practice and improved oral health: is there a win-win for both the professional establishment and government?

General dental practice in the United Kingdom has been in a state of unrest for over two decades, with practitioners having been confronted by two contract changes. The latest contract change of 2006 resulted in much disquiet, and services continue to be piloted in order to develop a contract that satisfies the needs of both government and the profession. Within this context, this paper explores the issues surrounding the present situation. To date, the profession has expanded service provision into the private market which has resulted in an exaggerated inverse care provision. This could be perceived as a move towards a retail philosophy and away from healthcare. In order to restore an equitable balance of care provision, the authors present possible solutions that could satisfy both parties.

Long term impact of powered toothbrush on oral health.

Data sources The Study of Health in Pomerania (SHIP).Data extraction and synthesis Data were taken from SHIP1 to SHIP3 over an 11 year period. Mixed-effects linear regression models were constructed between the exposure (manual versus powered toothbrush) and outcome variables (probing depths [PD], clinical attachment loss [CAL], caries status DMFS and DFS, tooth loss) adjusting for potential baseline covariates.Results Power toothbrush usage was found to be significantly associated with reduced mean PD and CAL progression scores, for example after 11 years the entire sample showed MTB users to have 0.41 mm PD mean progression while PTB users had 0.09 mm mean PD progression. This demonstrates PTB users having 0.32 mm less PD progression. Similar trends were shown for CAL mean scores.Conclusions There are benefits of power toothbrush usage and long term protective effects on oral health in terms of reduced probing depths, clinical attachments and number of teeth lost.

Carious lesion activity assessment in clinical practice.

Data sources PubMed database. A manual screening among the references of selected articles. Study selection Original articles, published in English relating to in vivo techniques (concepts /tools) to activity assessment of coronal carious lesions (AACCL).Data extraction and synthesis Two reviewers independently and in duplicate screened the studies. A spreadsheet was used for data extraction and management. Results were described qualitatively.Results Twenty-five articles were included in the review.Conclusions Definition and harmonisation of standards for activity assessment-related concepts/tools is needed. Along with the above, further investigations are needed for in vivo validation of newly developed tools.

An audit of smoking behaviours among patients attending two general dental practices in South Wales: an awareness-raising exercise for the dental team and patients.

AIMS: This audit aimed to quantify the number of smokers attending two general dental practices. It also aimed to establish the demographic characteristics of these smokers in terms of age, gender and deprivation status, and to raise the awareness of practice staff about smoking cessation. METHODS: Data were collected from consecutive patients (aged over 16 years) attending two general dental practices over a period of one month. The information collected included smoking status, number of cigarettes smoked, age, gender, and postcode. A deprivation score (derived from the Welsh Index of Multiple Deprivation [WIMD] for 2008) was appended to each patient record in order to provide a measure of deprivation based on the postcode of the patient. Staff at both practices were involved in the audit. Staff were given a brief pre- and post-audit questionnaire to test their knowledge on smoking cessation. The audit standard was that no more than 29% of patients should be smokers. Where relevant, data were statistically tested using the chi-square test. RESULTS: Five hundred and sixty-one patients provided data on their smoking habits. It was found that 159 (28.3%) were smokers, smoking on average 12 cigarettes per day. The average age of the sample was 46 years and 242 (43.1%) were male. Forty-eight per cent of the sample was shown to be resident in a postcode considered to be deprived. Older patients were more likely to be nonsmokers (P=0.0001). Following the final audit meeting, correct answers among staff for knowledge of the National Institute for Health and Clinical Excellence guidelines regarding effective smoking-cessation practices improved from 6% to 71%. CONCLUSION: The issue of smoking cessation has been highlighted for two dental teams. Whether the audit will result in the delivery of smoking-cessation procedures within the dental practice settings cannot be established. It is clear that the desired smoking-cessation behaviours can now be contemplated by the dental teams. Further monitoring is required to establish outcomes as a result of the actions of the teams.

An audit of dental general anaesthetic referral from a general dental practice in South Wales.

AIMS: The aim of this audit was to quantify the number of patients that received a dental general anaesthetic (DGA) between 1999 and 2007 following referral from a general dental practice. It also aimed to establish the deprivation status of those referred and to investigate further dental treatment pathways of these patients. METHODS: Data were collected from all patient records held by the practice. The information collected included: postcode, gender, age at the close of the study, age at time of DGA, reason for DGA, number of teeth extracted, and details of further ongoing care. In the absence of individual level socioeconomic data, a deprivation score (derived from the Welsh Index of Multiple Deprivation [WIMD]) was appended to each record in order to provide a measure of deprivation based on the postcode of the patient. RESULTS: Two hundred and eighty-seven patients were referred for DGA during the nine-year period. Their mean age was 9.4 years (95% confidence interval [CI] = 8.4, 10.4) and 30.7% were children aged five years or younger. The most common reason for DGA was dental caries. The mean number of teeth extracted was 4.5 (95% CI = 4.1, 4.9). Patients living in deprived areas were more likely to be referred for DGA. Of the 87 who did not subsequently attend for continuing care, 72 were from deprived areas compared with 15 from more affluent areas (P=0.003). CONCLUSIONS: In proportion to the number of patients registered at a practice, the number of referrals for DGAs was relatively low. Patients categorised as deprived (based on their residential postcode) received more referrals for DGAs than those from more affluent areas. Patients from deprived locations were significantly more likely not to attend for continuing care after their DGA than those from more affluent areas.

Homeless who accessed a healthy living centre in Swansea, South Wales: an assessment of the impact of oral ill-health.

AIM: To quantify the way that oral diseases affect the lives of homeless and vulnerable people in Swansea, using the short-form Oral Health Impact Profile (OHIP-14). METHOD: A convenience sample of people using the services of a healthy living centre for the homeless was surveyed using a questionnaire and the short-form OHIP-14. RESULTS: One hundred subjects were recruited to the study. The mean score for the OHIP-14 was 21.8 (SD 17.0). The most commonly reported impacts experienced were problems with toothache, discomfort, ability to relax, and feeling ashamed regarding the appearance of teeth. Of the different categories of homeless people, rough sleepers experienced higher levels of impact (P=0.004). Those having more than 20 teeth were more likely to experience lower levels of impact (P=0.001). CONCLUSION: The survey highlighted an increased prevalence of oral health impacts in this special needs group. In addition to physical factors, psychosocial factors must be considered, particularly with regard to appearance and psychological disability and discomfort, in the development of services.

Changes in the balance between dentists, patients and funders in the NHS and their consequences.

This paper explores aspects of professional culture in dentistry that may impact on the delivery of equitable dental services in the future. After 2009, commissioners will have to ration National Health Service budgets for health services and dentistry will compete with other services. Therefore, the delivery of equitable oral health services may be an advantage in the case for dentistry and subsequent funding. We report our opinions on the changes currently occurring in dentistry in England and Wales, based on the evidence available to us from the literature, and consider the risks and opportunities that have arisen.

A specialism of primary dental care?

This opinion paper contends that a wide gap exists between the theory and practice of preventive dentistry. The reasons for this lie partly in the lack of recognition given to the potential for general dental practitioners (GDPs) to deliver health-focused care to their community of patients. This lack of recognition begins at undergraduate level and is also found among GDPs themselves. The creation of a specialism of primary dental care would help to bridge the gap between theory and practice, and help practitioners to create significantly improved levels of oral health within their respective communities.