Peter G. Robinson

Construction and validation of the quality of life measure for dentine hypersensitivity (DHEQ)

AIM To develop and validate a condition specific measure of oral health-related quality of life for dentine hypersensitivity (Dentine Hypersensitivity Experience Questionnaire, DHEQ). MATERIALS AND METHODS Questionnaire construction used a multi-staged impact approach and an explicit theoretical model. Qualitative and quantitative development and validation included in-depth interviews, focus groups and cross-sectional questionnaire studies in a general population (n=160) and a clinical sample (n=108). RESULTS An optimized DHEQ questionnaire containing 48 items has been developed to describe the pain, a scale to capture subjective impacts of dentine hypersensitivity, a global oral health rating and a scale to record effects on life overall. The impact scale had high values for internal reliability (nearly all item-total correlations >0.4 and Cronbachs α=0.86). Intra-class correlation coefficient for test-retest reliability was 0.92. The impact scale was strongly correlated to global oral health ratings and effects on life overall. These results were similar when DHEQ was validated in a clinical sample. CONCLUSIONS DHEQ shows good psychometric properties in both a general population and clinical sample. Its use can further our understanding of the subjective impacts of dentine sensitivity.

Environmental Correlates of Child Copula Verb Growth.

A recurring result from studies which relate the frequency of input variables to rate of language development, is the link between auxiliary verb growth and yes-no questions addressed to children. Explanations for this relationship usually concentrate on the advantages of hearing stressed and non-contracted auxiliary forms in sentence-initial position over hearing unstressed, contracted forms in medial position in declaratives. If such accounts are correct, then it can be predicted that yes-no questions which place forms of COPULA be in initial position will also increase the rate of growth of childrens COPULA verb development. This prediction was tested using a sample of 33 children, carefully matched for stage of language development at 1;9 and 2;0 years; rate of copula verb growth was then measured over the succeeding nine months. Analyses include an examination of the contribution of sub-categories of yes-no question, tag questions, and utterances containing sentence-final copulas to the growth of contracted and full copulas. Results confirm that the frequency of inverted copulas in yes-no questions predicts childrens copula development. Nevertheless, caution is urged before interpreting the relationship in terms of a direct causal model.

The acceptability of care delegation in skill-mix: The salience of trust

The aim of this research was to explore the acceptability of care delegation in skill-mix, using the views and experiences of patients and parents of children treated by dental therapists as a case study. A purposive sample of 15 adults whose care, or that of their children, had been delegated to dental therapists in English dental practices was interviewed using narrative and ethnographic techniques (July 2011 - May 2012). Experiences were overwhelmingly positive with the need for trust in clinicians and the health system emerging as a key factor in its acceptability. Perceptions of general and dental health services ranged from them being a collectivist public service to a more consumerist marketised service, with the former seemingly associated with notions of dentistry as a trusted system working for the social good. Interpersonal trust appeared built, sustained (and undermined) by the affective behaviour, perceived competence, and continuity of care with clinicians providing care, and contributed to trust in the system. It also appeared to compensate for gaps in knowledge needed for patient decision-making. Overall, where trust existed, delegation of care was acceptable. An increasingly marketised health system, and emphasis on the patient as a consumer, may challenge trust and acceptability of delegation, and undermine the notion of patient-centred health care.

How is research publishing going to progress in the next 20 years?. Transcription of Session for Editors, Associate Editors, Publishers and others with an interest in scientific publishing held at IADR Meeting in Seattle on Wednesday, 20 March 2013

On March 20th 2013, a one-hour session for Editors, Associate Editors, Publishers and others with an interest in scientific publishing was held at the IADR International Session in Seattle. Organised by Kenneth Eaton and Christopher Lynch (Chair and Secretary, respectively, of the British Dental Editors Forum), the meeting sought to bring together leading international experts in dental publishing, as well as authors, reviewers and students engaged in research. The meeting was an overwhelming success, with more than 100 attendees. A panel involving four leading dental editors led a discussion on anticipated developments in publishing dental research with much involvement and contribution from audience members. This was the third such meeting held at the IADR for Editors, Associate Editors, Publishers and others with an interest in scientific publishing. A follow-up session will take place in Cape Town on 25 June 2014 as part of the annual IADR meeting. The transcript of the Seattle meeting is reproduced in this article. Where possible speakers are identified by name. At the first time of mention their role/position is also stated, thereafter only their name appears. We are grateful to Stephen Hancocks Ltd. for their generous sponsorship of this event. For those who were not able to attend the authors hope this article gives a flavour of the discussions and will encourage colleagues to attend future events. Involvement is open to Editors, Associate Editors, Publishers and others with an interest in scientific publishing. It is a very open group and all those with an interest will be welcome to join in.

The acceptability of healthcare: from satisfaction to trust

The assessment of healthcare quality increasingly emphasises lay acceptability, as evidenced by the emergence of patient satisfaction and patient-centred care in the literature and in policy. In this paper we aim to provide a conceptual overview of acceptability and propose ways to enhance its assessment. Firstly, we map how acceptabilitys importance in quality assessments has increased and how the term acceptability has been used as synonymous with patient satisfaction, despite it being a broader concept. We then critique the concept of patient satisfaction and its measurement and challenge its use as an indicator of acceptability and quality. By drawing on our research and those of others, the second half of the paper describes how trust in clinicians and health services has emerged as a related concept, including a theoretical discussion of trust in healthcare outlining how it can be built, undermined and abused. We propose trust as an alternative indicator of acceptability in healthcare quality and review its measurement. Finally, we consider how healthcare policy may impact on trust and make recommendations for future research.

Structural Determinants and Children’s Oral Health: A Cross-National Study:

Much research on children’s oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors—the so-called structural determinants of health—play a crucial role. Children’s lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children’s clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health–related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization’s Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries (N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children’s oral health. The structural determinants accounted for between 5% and 21% of the variance in children’s oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda.

Oral care as a life course project: A qualitative grounded theory study

OBJECTIVE To report on a theory to explain the oral health of older people over the life course. BACKGROUND The study of ageing has burgeoned into a complex interdisciplinary field of research, yet there are few studies in oral health from the perspective of older people that bridge the gap between sociology and oral health related research. METHODS A grounded theory study involving a convenience sample of 15 men and 28 women aged between 65 and 91 years across different levels of education. Data were subjected to grounded theory analysis using QSR NVivo 11.0 and where relevant phenomenological theory. RESULTS Participants conceived of oral care as a life course project that resulted from an active plan to keep ones teeth into older age. This involved accessing the social world of dentistry, holding appropriate values, understanding the associated personality types, social practices, goals and outcomes. The life course project is a social project supported by social institutions. It involves ideas about appropriate ageing including how oral health is to be managed at different stages in the life course. The degree to which individuals are able to participate in this project is determined by both individual and social factors. CONCLUSIONS The theory explains why the loss of a single tooth might be experienced as traumatic but also why older people adapt to their changing oral health. Oral health in older age represented a lifetimes investment in oral care. Future health policies should consider this lifetime investment when considering care for older people.

Using classification and regression tree modelling to investigate response shift patterns in dentine hypersensitivity

BackgroundDentine hypersensitivity (DH) affects people’s quality of life (QoL). However changes in the internal meaning of QoL, known as Response shift (RS) may undermine longitudinal assessment of QoL. This study aimed to describe patterns of RS in people with DH using Classification and Regression Trees (CRT) and to explore the convergent validity of CRT with the then-test and ideals approaches.MethodsData from an 8-week clinical trial of mouthwashes for dentine hypersensitivity (n = 75) using the Dentine Hypersensitivity Experience Questionnaire (DHEQ) as the outcome measure, were analysed. CRT was used to examine 8-week changes in DHEQ total score as a dependent variable with clinical status for DH and each DHEQ subscale score (restrictions, coping, social, emotional and identity) as independent variables. Recalibration was inferred when the clinical change was not consistent with the DHEQ change score using a minimally important difference for DHEQ of 22 points. Reprioritization was inferred by changes in the relative importance of each subscale to the model over time.ResultsOverall, 50.7% of participants experienced a clinical improvement in their DH after treatment and 22.7% experienced an important improvement in their quality of life. Thirty-six per cent shifted their internal standards downward and 14.7% upwards, suggesting recalibration. Reprioritization occurred over time among the social and emotional impacts of DH.ConclusionsCRT was a useful method to reveal both, the types and nature of RS in people with a mild health condition and demonstrated convergent validity with design based approaches to detect RS.

Shaping dental contract reform: a clinical and cost-effective analysis of incentive-driven commissioning for improved oral health in primary dental care

Objective To evaluate the clinical and cost-effectiveness of a new blended dental contract incentivising improved oral health compared with a traditional dental contract based on units of dental activity (UDAs). Design Non-randomised controlled study. Setting Six UK primary care dental practices, three working under a new blended dental contract; three matched practices under a traditional contract. Participants 550 new adult patients. Interventions A new blended/incentive-driven primary care dentistry contract and service delivery model versus the traditional contract based on UDAs. Main outcome measures Primary outcome was as follows: percentage of sites with gingival bleeding on probing. Secondary outcomes were as follows: extracted and filled teeth (%), caries (International Caries Detection and Assessment System (ICDAS)), oral health-related quality of life (Oral Health Impact Profile-14 (OHIP-14)). Incremental cost-effective ratios used OHIP-14 and quality adjusted life years (QALYs) derived from the EQ-5D-3L. Results At 24 months, 291/550 (53%) patients returned for final assessment; those lost to follow-up attended 6.46 appointments on average (SD 4.80). The primary outcome favoured patients in the blended contract group. Extractions and fillings were more frequent in this group. Blended contracts were financially attractive for the dental provider but carried a higher cost for the service commissioner. Differences in generic health-related quality of life were negligible. Positive changes over time in oral health-related quality of life in both groups were statistically significant. Conclusions This is the first UK study to assess the clinical and cost-effectiveness of a blended contract in primary care dentistry. Although the primary outcome favoured the blended contract, the results are limited because 47% patients did not attend at 24 months. This is consistent with 39% of adults not being regular attenders and 27% only visiting their dentist when they have a problem. Promotion of appropriate attendance, especially among those with high need, necessitates being factored into recruitment strategies of future studies.

Dentine Hypersensitivity: Developing a Person-centred Approach to Oral Health

The original Dentine Hypersensitivity Experience Questionnaire (DHEQ) has 48 items, 34 of which comprise the scale that measures the subjective impacts of dentine hypersensitivity (DH). If a questionnaire is extensive, it is helpful to develop a short form to minimize participant burden by reducing the time to complete it. Doing so will also limit the cost of data collection. A short form of a questionnaire will facilitate its use in broader segments of the population and in special groups such as the elderly. It may also have applicability in clinical settings and in larger population samples. Further, a shorter version may reduce missing data. Naturally, such a short form should preserve the properties of the original when possible. This chapter reports the work to derive and evaluate short forms of the DHEQ. Two methods were used: the item-impact and the stepwise regression methods. The short forms were then evaluated cross-sectionally and in two randomized controlled trials, in part by assessing their performance compared with the original DHEQ. The two techniques produced quite similar short forms, so the choice between them required careful consideration. Aim: To derive and evaluate a short form of the DHEQ. Methods: Data from three previous studies of DH (n=353) were pooled and randomly divided in half. Ten-item and 15-item short forms were derived using the first half of the data using the item-impact and regression methods. The four short forms were evaluated using the second half of the data. Results: The 10-item and 15-item versions of the regression short form detected impacts in 37% and 61% of participants, respectively, compared with 68% and 93% using the item-impact method. All short forms had internal consistency (Cronbach’s α>0.84) and test–retest reliability (intraclass correlation coefficient, ICC >0.89). All correlated with the long form (all r>0.93, P<0.001) and with the impact of the effect on the mouth on everyday life (all r≥0.73, P<0.001). None of the short forms detected a treatment effect in two trials, although all four showed a tendency to detect an effect in a trial when the long form had also done so. Conclusions: The 15-item short form derived from the item-impact method performed better than other short forms and appeared to be sufficiently robust for use by individual patients.