Investigating the effectiveness of water fluoridation.

DESIGN: This retrospective cohort study used treatment claims data submitted over a 10-year period to explore the effect of water fluoridation on specified National Health Service (NHS) dental treatments, number of Decayed Missing and Filled Teeth (DMFT) and its cost-effectiveness. Ethical approval was granted and data was collected from NHS primary care settings via claims submitted to the NHS Business Services Authority (NHS BSA). To be included, participants must have attended dental services twice in the study period, been 12 years or over and had a valid English postcode. Those with claims related solely to orthodontic care were excluded, as were those who had requested NHS National Data Opt-out. Costs relating to water fluoridation were supplied by Public Health England. NHS BSA data was used to calculate NHS costs at 2020 prices. COHORT SELECTION: A personalised water fluoride exposure for the 2010-2020 period was assigned to all individuals, who were then split into two groups, above 0.7 mg F/L (optimally fluoridated group) or lower (non-optimally fluoridated group). Individuals in each group were matched for analysis using propensity scores, estimated via logistic regression. DATA ANALYSIS: Values of absolute standardised mean differences were used to determine covariate balance between the two groups, alongside a generalised linear model with matching weights and cluster robust standard errors and a patient deprivation decile as an interaction term. An Incremental Cost-Effectiveness Ratio (ICER) was calculated and differences in the overall costs to the public sector were illustrated by the return on investment estimate. RESULTS: The cohort contained data on 6,370,280 individuals. Negative binomial regression models were used to analyse health outcomes. In the optimally fluoridated group, the rate of invasive dental treatments was 3% less than in the non-optimally fluoridated group, and the mean DMFT in the optimally fluoridated group was 2% lower. There was no evidence of a difference in the predicted mean number of missing teeth between groups. There was a small reduction in the predicted number of invasive treatments in the optimally fluoridated group but the largest predicted reduction was in the most deprived decile. DMFT did not exhibit the expected social inequalities gradient, and for the mean number of missing teeth there were small differences in each decile of deprivation between groups but the direct effect was inconsistent. Water fluoridation expenditure between 2010 and 2019 was estimated to be £10.30 for those receiving optimally fluoridated water. The marginal effects estimate illustrated savings of £22.26 per person (95% CI - £21.43, -£23.09), which is a relative reduction in costs to the NHS of 5.5% per patient. A subsequent estimation of cost effectiveness calculated the cost of water fluoridation to avoid one invasive dental treatment (the ICER) as £94.55. The estimated return on investment using a variety of NHS dental attendance estimates all lead to a positive return. CONCLUSIONS: These results suggest that water fluoridation appears to be producing less impactful effects on oral health, with water fluoridation resulting in 'exceedingly small' health effects and very small reductions in use of NHS dental services. A positive return for the public sector was identified as the costs of NHS dentistry are high and costs of water fluoridation are low, though this study did not include the original set up costs of fluoridation programmes.

BDJ Open 2021 - our most successful year to date.

This paper aims to provide an update on the previous version published towards the end of last year, titled 'BDJ Open (2019-2020) and the advantages of open access publishing'. In this paper, we will highlight articles published throughout 2021, in order to focus on which areas authors felt were important to publish open access and also which areas have been expanded upon in the journal. Furthermore, this paper will examine how open access publishing in BDJ Open has enabled the continuous process of hypothesis testing to be shared more widely, as well as how publishing protocols and early results open access gives strength to that by allowing earlier opportunity for comment by other researchers, both through the peer review process and through further correspondence to authors directly and to the journal editors who publish their work.

BDJ Open (2019-2020) and the advantages of open access publishing.

BDJ Open is the open access sister journal to the British Dental Journal, and this paper aims to explore the various different articles that BDJ Open has published between 2019 and 2020, in order to highlight which areas authors felt were important to publish open access. Furthermore, this article will investigate the advantages of open access publishing to both authors and readers, as well as the scientific community in general, and will examine how open access publishing has allowed the BDJ Portfolio to publish a wide range of research, both in terms of topic and geography.

Quality measures for dental care: A systematic review.

Data sources MEDLINE, EMBASE and LILACS were searched. Reference lists of the included publications were screened to identify other potentially relevant documents.Study selection Articles published from 1 January 2002 to 31 December 2017. There was no language restriction for full-text articles as long as they had a title, abstract and description of the quality measures in English. Publications that either described the development process or described the clinimetric properties of oral healthcare quality measures for general dental care were included. Publications were only included if numerators and denominators of the quality measures were defined or could be directly derived. Editorials, randomised controlled trials, conference abstracts and letters to the editor were excluded.Data extraction and synthesis Two researchers independently screened the titles and abstracts. Information included study purpose, the country of origin, methods used to develop measures and stakeholder involvement. The data considered included the number of quality measures developed, the description, numerators and denominators of the measures and the type of quality measure as described by Donabedian ie process, structure or outcome measure. The Appraisal of Indicators through Research and Evaluation (AIRE) instrument 2.0 was then used to appraise the scientific soundness and applicability of the measuresResults Twenty-four publications were included yielding 215 quality measures. AIRE scores ranged from 38 to 78 out of 80 possible points. The majority of measures (n = 71) referred to treatment and preventive services. Comparably, few measures referred to the domain patient safety (n = 3). The development process of measures often exhibited a lack of involvement of patients and dental professionals. Few projects reported on the validity (n = 2) and reliability (n = 3) of the measures. Four projects piloted the measures for implementation in practice.Conclusions Provides an overview of existing quality measures in oral healthcare. Potential opportunities include the piloting and testing of quality measures and transparent data reporting on the quality of oral healthcare.

A comparison of the sedation provision of NHS dental services 2014-2016 for local authorities throughout England.

Background Conscious dental sedation is commissioned by NHS England for patients who are unable to accept dental treatment under local anaesthetic and behavioural techniques alone. Dental sedation provided by NHS England is carried out on a referral basis but this can be carried out in a primary or secondary care setting. This paper reports a study carried out to improve NHS dental services by supporting the work of multiple NHS England area teams in reviews of sedation services.Aim The aim of this paper is to identify variations in the provision of sedation services by NHS providers across England and explore possible factors affecting this variation.Method The project makes use of the recently developed NHS Business Services Authority (BSA) national public health data set, which Public Health England has developed in association with the BSA.Results Variations in population experience of sedation in England have been graphically demonstrated using a comprehensive BSA data set which captures all general dental service and public dental service (GDS/PDS) activity for a two-year period. There are wide and significant variations in population experience of sedation across England.Conclusion The variations in population experience of sedation across England are difficult to explain on purely clinical grounds.