A. G. Threlfall

The Effectiveness of School Dental Screening: a Cluster-randomized Control Trial

Dental screening of children in schools is undertaken in many countries. There is no evidence that this activity is effective. The objective of our study was to determine if school dental screening of children reduces untreated disease or improves attendance at the population level. A four-arm cluster-randomized controlled trial was undertaken in the northwest of England. In total, 16,864 children aged 6–9 years in 168 schools were randomly allocated to 3 test groups, which received screening according to different models, and a control, which received no intervention. There were no significant differences in caries increment in the primary and secondary dentitions or in the proportions of children attending a dentist after screening between the control group and the 3 intervention arms. School dental screening delivered according to 3 different models was not effective at reducing levels of active caries and increasing attendance in the population under study.

The introduction of the new dental contract in England - a baseline qualitative assessment.

Objective To record immediately prior to its inception the views of key stakeholders about the new dental contract introduced in April 2006.Method Nineteen participants (11 dental practice principals and eight primary care trust dental leads) were interviewed using a semi structured approach to find out their views and opinions about dental practice, the reasons for introducing the new dental contract, its implementation and content of the new dental contract. An analysis based upon the constant comparative method was used to identify the common themes about these topics.Results Practice principals expressed satisfaction with working under pilot Personal Dental Services schemes but there was a concern among dental leads about a fall in dental activity among some dentists. All participants believed the new contract was introduced for political, financial and management reasons. All participants believed that it was introduced to limit and control the dental budget. Participants felt that implementation of the contract was rushed and there was insufficient negotiation. There were also concerns that the contract had not been tested. Dental practitioners were concerned about the calculation and future administration of the unit of dental activity system, the fixing of the budget and the fairness of the new dental charge scheme. Dental leads were concerned about patient access and retention and recruitment of dentists under the new contract.Conclusions The study found a number of reasons for unease about the new dental contract; it was not perceived as being necessary, it was implemented at speed with insufficient negotiation and it was seen as being untested. Numerous and varied problems were foreseen, the most important being the retention of dentists within the NHS. Participants felt the contract was introduced for financial, political and managerial reasons rather than improving patient care. The initial high uptake of the new dental contract should not be viewed as indicating a high level of approval of its content.

Approaches taken to the treatment of young children with carious primary teeth: a national cross-sectional survey of general dental practitioners and paediatric specialists in England

Aim To measure the distribution of choices for the treatment of a child with differing severities of caries in a primary molar tooth among specialists in paediatric dentistry and general dental practitioners (GDPs) in England.Method Two surveys were undertaken using the same tool. The populations invited to take part in the study were confined to dentists practising in England in 2004. They were 500 GDPs selected at random from the list of all GDPs with a National Health Service (NHS) contract identified by the Dental Practice Board (DPB) and all 148 specialists in paediatric dentistry appearing on the General Dental Council specialist register. The selected dentists were sent a questionnaire containing four hypothetical clinical case scenarios in which the severity of dental caries in a single primary molar differed. Each clinical case scenario had a list of possible treatment options and participants were asked to select their single most preferred treatment option. To maximise the response rate there were three mailing rounds.Results Of the 500 GDPs and 148 paediatric specialists sent a questionnaire, 322 (64%) GDPs and 115 (78%) specialists responded. The answers to each of the case scenarios indicate differences of opinion both between and among GDPs and specialists in the care they would recommend for a child with caries in a primary molar tooth. This variation in opinion about care was more pronounced for a single deep carious lesion than for a less severe lesion. The spread of treatment options chosen in each scenario indicates disagreement among GDPs and specialists about restorative techniques and philosophy of care.Conclusion In England there is wide variation among GDPs and specialists in paediatric dentistry about the best way to treat a young child with caries in a primary molar tooth. Well designed studies are urgently needed to provide strong evidence for the most effective way to manage the dental care of children.

The treatment of primary molar teeth presenting with two surface caries - A review of care delivered by the Personal Dental Services in Bradford.

Abstract Objective To identify the outcomes of primary molars treated for two surface dental caries. Design A review was undertaken using clinical notes from two Personal Dental Service (PDS) clinics in Bradford. Data was abstracted from the notes of children deemed eligible for inclusion in the study. Results The majority of primary molar teeth considered in the study were restored with amalgam (45.7%). One in six teeth (15%) was restored with glass ionomer and 7.2 per cent of teeth were restored with stainless steel crowns. Overall, half of the primary molar teeth restored with amalgam (50%) required further treatment following initial placement of the restoration and one in four of these teeth (25%) went on to be extracted. A similar picture emerged when teeth restored with glass ionomer were considered. For the small number of teeth restored with stainless steel crowns, there was a 90 per cent success rate, with only two teeth requiring extraction. Conclusions Amalgam remains the most commonly used material for the restoration of primary molars presenting with two surface caries. Glass ionomer is less popular and stainless steel crowns are infrequently selected as the initial treatment of choice for such teeth. When the outcomes were considered for teeth restored with the different materials, the audit showed that stainless steel crowns were more effective than plastic restorative materials.