Helen D. Rodd

Assessment of the quality of measures of child oral health-related quality of life

BackgroundSeveral measures of oral health-related quality of life have been developed for children. The most frequently used are the Child Perceptions Questionnaire (CPQ), the Child Oral Impacts on Daily Performances (C-OIDP) and the Child Oral Health Impact Profile (COHIP). The aim of this study was to assess the methodological quality of the development and testing of these three measures.MethodsA systematic search strategy was used to identify eligible studies published up to December 2012, using both MEDLINE and Web of Science. Titles and abstracts were read independently by two investigators and full papers retrieved where the inclusion criteria were met. Data were extracted by two teams of two investigators using a piloted protocol. The data were used to describe the development of the measures and their use against existing criteria. The methodological quality and measurement properties of the measures were assessed using standards proposed by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) group.ResultsThe search strategy yielded 653 papers, of which 417 were duplicates. Following analysis of the abstracts, 119 papers met the inclusion criteria. The majority of papers reported cross-sectional studies (n = 117) with three of longitudinal design. Fifteen studies which had used the original version of the measures in their original language were included in the COSMIN analysis. The most frequently used measure was the CPQ. Reliability and construct validity appear to be adequate for all three measures. Children were not fully involved in item generation which may compromise their content validity. Internal consistency was measured using classic test theory with no evidence of modern psychometric techniques being used to test unidimensionality of the measures included in the COSMIN analysis.ConclusionThe three measures evaluated appear to be able to discriminate between groups. CPQ has been most widely tested and several versions are available. COHIP employed a rigorous development strategy but has been tested in fewer populations. C-OIDP is shorter and has been used successfully in epidemiological studies. Further testing using modern psychometric techniques such as item response theory is recommended. Future developments should also focus on the development of measures which can evaluate longitudinal change.

Content analysis of children's television advertising in relation to dental health

This paper provides some disturbing facts and figures about the amount of television being watched by children. In addition, it reports on the volume and type of television advertising aimed at young people, both in the United Kingdom and other developed countries. In view of recent public and professional concern as to the possible adverse effects of food advertising on childrens health, this study set out to examine what proportion of television advertisements, directed at children, promoted products potentially harmful to dental health. Forty-one hours of childrens television programming broadcast on ITV1, the main UK commercial channel, were recorded on to videotape for subsequent analysis. Almost 1,000 adverts were analysed; each was timed and broadly categorised as relating to a food/drink product or non food/drink product. Advertisements for food and drink were further subdivided according to their sugar and/or acid content. We found that, on average, 24 adverts were shown per broadcast hour, which accounted for 15.8% of the total schedule time. 34.8% of adverts related to food/drink products, and 95.3% of these promoted products that were deemed potentially cariogenic or erosive. The most frequently promoted food/drink products included breakfast cereals with added sugar (26.3%), confectionery (23.7%) and non-carbonated soft drinks (18.1%). It is very concerning that, despite recent specific codes of practice outlined by the Independent Television Commission for Childrens Advertising, many food and drink products promoted during childrens programming are potentially damaging to dental health.

Social judgements made by children in relation to visible incisor trauma

AIM There is evidence to suggest that negative social judgements are made on the basis of poor dental aesthetics. This study sought to determine how children view other children with visible incisor trauma. MATERIAL AND METHODS Year 7 (aged 11-12 years) and year 10 (aged 14-15 years) school children (the participants) were invited to look at colour photographs of four different childrens faces and to make a social judgement about these children (the subjects). Participants were randomly allocated either: (i) pictures of children with visible incisor trauma or, (ii) pictures of the same children whose photographs had been digitally modified to restore incisor aesthetics. Using a previously validated child-centred questionnaire, participants rated subjects using a four-point Likert scale for three negative and six positive attributes. Total attribute scores were tested for significant differences, according to whether the subject had visible incisor trauma or not, using multivariate analysis of variance (P < 0.05, MANOVA). RESULTS 291 children completed the questionnaires, giving a response rate of 73%. Year 7 children viewed children with visible incisor trauma more negatively than the same child with normal incisor appearance. However, the converse was true for year 10 participants. CONCLUSION Findings from this study concur with those from adult populations in that negative social judgements may be made on the basis of poor dental appearance. Interestingly, this would not appear to be the case in adolescence, which may relate to high levels of self-monitoring in this age-group. In view of the importance of appearance in adolescent social interaction, aesthetic dental treatment for children with incisor injury may yield important psychosocial benefits.

Child and parental acceptance of preformed metal crowns

AIM: To assess child and parent acceptance of preformed metal crowns (PMCs). STUDY DESIGN: This was a service evaluation using a child- and parent-centred self-report questionnaire in a convenience sample of hospital patients. METHODS: Questionnaires were developed with serviceusers and issued to 98 children who had received a PMC on a primary molar within the paediatric dentistry clinic, Sheffield Dental Hospital, UK. Children used a pictorial Likert scale to rate their treatment experience and views on PMCs. Parents were also asked to complete a 5-item questionnaire, to explore their attitudes towards the PMC and how they felt their child had coped with treatment. Both children and parents were invited to comment in a free-text box on any other issues relating to PMCs. Clinical data were extrapolated from the child’s dental records as follows: child’s age and gender; status of clinician who had placed the PMC (staff or student), and technique for PMC placement (Hall technique or conventional). RESULTS: 62 questionnaires were completed (63% response rate). The mean age of the child participants was 6.6 years (SD±1.51; range=3.8–10.3), and 65% (n=40) were male. Most children found the clinical procedure acceptable with 54.8% (n=34) reporting it was ‘really easy’, with no significant differences according to placement technique, or the experience level of the operator (P<0.05, chi-squared test). Only 4.8% (n=3) of parents expressed strong objections to the appearance. Both children and parents felt the clinical rationale had been fully explained to them (88.7%, n=55 and 100%, n=62 respectively). Themes commonly identified from the children’s accounts related to specialness, function and recollections of the treatment, with the perception that PMCs were valued for being different. CONCLUSIONS: This study revealed that PMCs were mainly viewed favourably by children and their parents. Clinicians who have been reluctant to use this restorative approach may be encouraged by these findings. However, communication and clinical expertise are paramount in ensuring children and parents have positive treatment experiences and attitudes towards PMCs.

Quality of life impacts following childhood dento-alveolar trauma.

BACKGROUND Dental injuries occur commonly in childhood and may necessitate demanding courses of treatment. The aim of this study was to investigate a variety of clinical and demographic factors that may influence the quality of life impacts experienced by children after a dental injury. METHOD A total of 244 children who attended a UK dental hospital, for management of traumatised permanent incisors, were invited to participate in the study. Clinical, demographic and psychosocial variables were collected at baseline, and outcome variables were assessed again at a 6-month follow up. Clinical variables included number of teeth injured; severity of the dental injury; visibility of the injury; time since injury; and number of dental appointments attended within the hospital. Psychosocial outcomes assessed included childrens oral health-related quality of life (OHRQoL) and health-related quality of life (HRQoL). RESULTS One hundred and eight children participated in the baseline study (44% response rate), and of this group of children, a total of 70 children completed follow-up questionnaires (65% response rate). The results indicated that the most affected areas of childrens OHRQoL and HRQoL were functional limitations and school-related activities, respectively. Of all the demographic and clinical variables, which were investigated within the current study, the only variable that significantly predicted OHRQoL and HRQoL for children was gender. Boys were found to report fewer impacts on their OHRQoL and HRQoL than girls. Interestingly, over two-thirds of children reported fewer impacts at the 6-month follow up. CONCLUSIONS The results revealed that girls were more likely to report higher level of impacts on their OHRQoL and HRQoL than boys following traumatic injury to their permanent incisors. Clinical variables were not significant predictors of child quality of life outcomes following dento-alveolar trauma at baseline or at the 6-month follow up.

Understanding children’s dental anxiety and psychological approaches to its reduction

BACKGROUND Dental anxiety is a common problem, which can affect people of all ages, but appears to develop mostly in childhood and adolescence. Childhood dental anxiety is not only distressing for the child and their family but is also associated with poor oral health outcomes and an increased reliance on costly specialist dental services. AIM This article will consider the prevalence, development, and implications of childrens dental anxiety. It will also discuss the opportunities for and challenges of psychological approaches such as cognitive behavioural therapy aimed at the reduction of dental anxiety in children.

Seeking children's perspectives in the management of visible enamel defects.

AIM To undertake a child-centred evaluation of treatment provision for visible enamel defects. DESIGN Postal questionnaires, developed with children, were sent to 88 patients, aged 7-16 years, with visible enamel defects of permanent incisors and who had received microabrasion, with/without additional composite restoration at Sheffield Dental Hospital, UK. The questionnaires sought childrens perceptions about their teeth before and after the intervention, as well as their evaluation of how they had been treated. Anonymised responses were graded using a 10 cm visual analogue scale (VAS) where a score of 10 indicated the most negative response, and zero the most positive response. RESULTS Sixty three questionnaires were returned (72% response). Prior to treatment, children reported high levels of worry (VAS=6.8), embarrassment (VAS=6.9) and a perception that their teeth looked yellow and discoloured (VAS=7.3). Following treatment, children thought their teeth looked much better (VAS=1.6), felt happier (VAS=2.2) and more confident (VAS=1.6). They also felt very positive about their clinical experiences, rating the staff as extremely friendly and kind (VAS=0.4) and reporting that procedures were clearly explained (VAS=0.6). CONCLUSIONS Simple non-invasive dental treatment can have a positive effect on appearance-related satisfaction. The use of child-centred approaches offers an invaluable insight into patient perspectives.

Pulpal status of human primary teeth with physiological root resorption

OBJECTIVE The overall aim of this study was to determine whether any changes occur in the pulpal structure of human primary teeth in association with physiological root resorption. METHODS The experimental material comprised 64 sound primary molars, obtained from children requiring routine dental extractions under general anaesthesia. Pulp sections were processed for indirect immunofluorescence using combinations of: (i) protein gene product 9.5 (a general neuronal marker); (ii) leucocyte common antigen CD45 (a general immune cell marker); and (iii) Ulex europaeus I lectin (a marker of vascular endothelium). Image analysis was then used to determine the percentage area of staining for each label within both the pulp horn and mid-coronal region. Following measurement of the greatest degree of root resorption in each sample, teeth were subdivided into three groups: those with physiological resorption involving less than one-third, one-third to two-thirds, and more than two-thirds of their root length. RESULTS Wide variation was evident between different tooth samples with some resorbed teeth showing marked changes in pulpal histology. Decreased innervation density, increased immune cell accumulation, and increased vascularity were evident in some teeth with advanced root resorption. Analysis of pooled data, however, did not reveal any significant differences in mean percentage area of staining for any of these variables according to the three root resorption subgroups (P > 0.05, analysis of variance on transformed data). CONCLUSIONS This investigation has revealed some changes in pulpal status of human primary teeth with physiological root resorption. These were not, however, as profound as one may have anticipated. It is therefore speculated that teeth could retain the potential for sensation, healing, and repair until advanced stages of root resorption.

Pulpal expression of TRPV1 in molar incisor hypomineralisation.

Aim: This was to compare the pulpal expression of the transient receptor potential ion channel (TRPV1), a noxious heat receptor, in sound and hypomineralised human first permanent molars. The rationale for the investigation was to gain further insight into pulpal changes in hypomineralised teeth and the possible biological mechanisms underlying thermal hypersensitivity. Study design: This was a laboratory study using a quantitative immuncocytochemical approach. Methods: The experimental material comprised 17 sound and 18 hypomineralised molars (10 with intact enamel and 8 with enamel loss), obtained from children requiring dental extractions under general anaesthesia. Coronal pulps were removed and processed for indirect immunofluorescence using antibodies raised against TRPV1 and either the general neuronal marker, protein gene-product 9.5 or alpha smooth muscle actin in conjunction with Ulex europaeus agglutinin 1 lectin to fully label the pulp vasculature. Computerised image analysis was used to quantify the expression of TRPV1 in both pulpal nerves and blood vessels within different regions of the pulp including the pulp horn, subodontoblastic plexus and mid-coronal region. Results: Mean neuronal and vascular TRPV1 expression was significantly greater in some pulpal regions of hypomineralised teeth (both with and without enamel loss) than for sound samples (P<0.05, ANOVA). Conclusions: Increased TRPV1 expression within the pulps of hypomineralised teeth may be indicative of an underlying pulpal inflammation and may help to explain the heat sensitivity experienced by some patients with this condition. However, future lines of enquiry should seek to correlate patient symptoms and responses to controlled hot and cold stimuli with pulpal expression of a variety of thermal receptors to gain further insight into dental pain mechanisms.

Initial management of paediatric dento-alveolar trauma in the permanent dentition: a multi-centre evaluation

Objective To investigate the time lapse prior to provision of emergency dental care and appropriateness of earliest treatment provided for children with dental trauma.Design A multi-regional prospective and cross-sectional survey.Setting Paediatric dental departments of Liverpool, Manchester and Sheffield.Subjects One hundred and fifty referred or emergency paediatric patients with trauma to the permanent incisors.Results One hundred and fifty subjects were recruited. Mean age of the subjects was 11.1 years (SD = 2.6; range = 6.2-16.6); 100 were male and 50 were female. The mean time interval from injury until initial presentation to a health care professional was 22.6 hours (SD = 76.1; range = 0-672). Thirty-six percent of children (n = 54) first presented to a general dental practitioner whilst 30% (n = 45) presented to accident and emergency medical staff. Following initial assessment, a further mean time lapse of 8.1 hours (SD = 43.7; range = 0-504) was incurred in 25% of cases prior to dental referral. In 39% of subjects (n = 58/150), treatment was considered inappropriate. The most frequent example of inadequate management was failure to protect exposed dentine, which was found for 71% (n = 24/34) of complicated crown fractures and 40% (n = 25/62) of uncomplicated crown fractures.Conclusion This study identified marked delays in the management of some paediatric dental trauma to permanent incisor teeth which, in itself, could be suboptimal. Greater educational and clinical support would seem to be warranted in this area of service provision.