Martin C. Downer

Concurrent Validity of an Epidemiological Diagnostic System for Caries with the Histological Appearance of Extracted Teeth as Validating Criterion

The ability of an epidemiological diagnostic system to distinguish tooth sites with carious cavities from those without was investigated. The diagnostic data were obtained during annual clinical and bitewing radiographical examinations of 551 teenage clinical trial subjects. 109 premolars and permanent molars, extracted during subsequent treatment of the subjects, were kept. Undecalcified serial sections of these teeth were examined in water at × 2.5 magnification under incident light, to compare the original diagnostic findings with the histological extent of caries. Quantitative methods were used to estimate the concurrent validity of clinical diagnosis of pits and fissures and the radiological diagnosis of posterior approximal surfaces. For fissure diagnosis a validity coefficient (rt) of 0.83 was obtained. 84% of cavities were detected while 22% of sites without cavitation were wrongly diagnosed as having cavities. For radiological diagnosis the validity coefficient (rt) was 0.95. Although 97% of surfaces without cavitation were correctly identified, only 73% of approximal cavities were detected radiologically. The effect of different factors on the validity findings is considered.

Evolution of policy leading to the 2006 General Dental Service contract and some possible outcomes

Background and objective This paper was designed to rehearse the evolution of policy for the UK NHS General Dental Service (and related services) since its inception in 1948, culminating in the establishment of a new contract for general dental practitioners in 2006. Methods Information was abstracted from the literature, historical records, relevant websites and government publications, and collated to form a concise account of the key developments in policy. Results Policy developments have followed a more or less logical sequence in response to the changing requirements and aspirations of the government, the dental profession and the public. The main events in the chain are presented. Conclusions The development of the new contract, its rationale and its possible consequences are discussed.

A critique of the Brushing for Life programme

Background and objective Brushing for Life is intended to promote regular brushing of children’s teeth with fluoride toothpaste. The programme is delivered by health visitors who provide toothbrushes, toothpaste and dental health education material at children’s 8, 18 and 36 month development checks. The purpose of the present paper was to suggest how all aspects of the programme could be comprehensively assessed; to consider the prospects for its success in the light of evidence from the literature; to review the role of the programme within the wider field of oral health promotion; and to examine appropriate approaches to a quantitative evaluation of its outcome compared with alternatives. Methods Evaluative reports, and studies of the benefits of toothbrushing in young children published in the literature, were collated. Relevant information was abstracted and assessed and a comprehensive evaluative approach to the programme was constructed and presented. Results Good practice in dental public health suggested that following implementation, it would be important to ensure that the scheme was fully monitored and evaluated to establish that it was working effectively and giving value for money. Conclusions Adoption of the programme as a national population-based strategy for the prevention of dental disease in children should depend on its being shown to be effective and economically efficient.

Evaluating a dental caries preventive programme.

AN important part of research in clinical dentistry /~ is to measure the effect of agents used in the prevention of dental caries. This is achieved by the use of the controlled clinical trial. In conducting a clinical trial of a caries preventive agent, the investigator wishes to make an unbiased assessment of its effect on the greatest number of individuals possible, within the limitations of available resources. It is of primary importance to be able to measure this effect in numerical terms. This enables a comparison to be made between the new agent and established procedures, and gives an indication of the reduction in clinical treatment loads which might result from its use in a public health programme, and ultimately the cost benefit which might be expected. The investigator tries to assess therefore, by how much dental decay will be reduced by the agent, in comparison with the amount which would be likely to occur if it were not used. The measurement of the agent’s effect is achieved by selecting a test and a control group of subjects. If the test group receives the agent, and the control group receives either nothing at all, or preferably, an inactive substitute, it will be possible, over the course of time, to compare the differences between the groups in the amount of decay which is observed. The amount of dental decay which occurs during the trial represents the ’caries increment’ over the period, and must be determined separately for each group. Caries increment is usually measured by the DMF Index, which is basically a count of the number of teeth in the mouth which are decayed, plus the number which