P. Kearney-Mitchell

The fate of the carious primary teeth of children who regularly attend the general dental service

Objective To describe the care and resultant outcomes of the carious primary teeth of children who regularly attend the General Dental Service (GDS).Setting Four districts in the North West of EnglandSubjects and Materials A retrospective study of the case notes of 677 children who received their dental care from 50 general dental practitioners (GDPs). Each dentist must have had a minimum of 10 patients and a maximum of 20 patients whose care had been provided by the same dentist from or before the age of five to the age of 14. All of the children included in the study had a history of approximal caries. The outcomes of interest were extraction due to pain or sepsis, or exfoliation and whether or not a tooth had given rise to the prescription of a course of antibiotics. Teeth that did not have a history of extraction were assumed to have exfoliated naturally. Logistic regression models, taking into account the clustering of the teeth within patients, were fitted to compare the outcomes for restored and unrestored teeth according to size of lesion (one or two surface), age caries was first recorded and by tooth type.Results A total of 4,056 teeth had been either recorded as carious or had received an intervention of some kind. Some 44.1% (N=1,789) of these teeth were extracted, however only 475 (11.7%) were extracted due to pain or sepsis. Of the teeth with a documented history of caries or restoration and for which an outcome was recorded (N=3,145), most first (81.1%) and second (84.3%) carious primary molars were filled during their lifetime, but only 40.5% of primary carious anterior teeth were filled. The majority of carious primary teeth exfoliated naturally. There was no difference in the proportions of teeth extracted due to pain or sepsis whether a carious tooth was restored or left unrestored, either by cavity type or by tooth type, after controlling for age when caries was first recorded. There was also no difference in the number of filled or unfilled carious teeth that caused a course of antibiotics to be prescribed.Conclusions Treatment by extraction was common, but GDPs restored the majority of carious primary molar teeth of their regularly attending child patients. The bulk of carious teeth exfoliated naturally irrespective of whether they were filled or not. The reasons for these findings require further investigation.

A Cluster-randomized Controlled Trial: Fluoride Varnish in School Children

We conducted a school-based parallel cluster randomized controlled trial with 36-month follow-up of children aged 7 to 8 years. Primary schools were randomly assigned to 2 groups: 3 applications of fluoride varnish (22,600 ppm) each year or no intervention. The primary outcome was DFS increment in the first permanent molars, with the hypothesis that 9 applications of varnish over 3 years would result in a lower increment in the test group. Follow-up measurements were recorded by examiners blind to the allocation. Ninety-five schools were randomized to the test and 95 to the reference groups; 1473 (test) and 1494 (reference) children participated in the trial. An intention-to-treat analysis was carried out with random effects models. The DFS increment was 0.65 (SD 2.15) in the test and 0.67 (SD 2.10) in the reference groups, respectively. There was no statistically significant difference between the groups. We were unable to demonstrate an effect for fluoride varnish when it was used as a public health intervention to prevent caries in the first permanent molar teeth (Inter-national Standard Randomized Controlled Trial Registration: ISRCTN: #72589426)

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.

Outcomes associated with restored and unrestored deciduous molar teeth.

Introduction Most dental treatment for children in the United Kingdom (UK) is provided by general dental practitioners (GDPs) working in the National Health Service (NHS). A working party of the British Society of Paediatric Dentistry, in a special publication from the Dental Practice Board, has suggested that failure to provide restorative care for the deciduous dentition is unacceptable, yet GDPs are filling fewer teeth in young children. The study aimed to evaluate the health outcomes obtained from restoring carious deciduous molar teeth. Method The dental records of 677 children cared for by 50 GDPs in the north west of England were analysed. Results The results showed that 18.8% of deciduous molars with unrestored caries and 17.0% with a history of restorative care went on to be extracted because of pain or sepsis. Conclusion The results suggest that the risk of carious deciduous molars being extracted is similar whether these teeth receive restorative care or not.

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.