Biomedical subjects

Ivor G Chestnutt

Publications and source records attributed to Ivor G Chestnutt.

7 recordsLinked to original sources

PubMed2006

Chlorhexidine varnish has caries-reducing potential.

DESIGN: A double-blind, randomised, placebo-controlled clinical trial was conducted. INTERVENTION: Children in the test group received 6-monthly applications of a 40% chlorhexidine varnish whereas children in the control group received a placebo varnish, over the course of 2 years. Clinical examination was undertaken at baseline and after 24 months by two calibrated dentists who did not know to which groups children were assigned. OUTCOME MEASURE: Decayed, missing, or primary filled molar surfaces (dmfs-molar) were monitored. RESULTS: At baseline, there was no significant difference between the mean dmfs-molar scores of the two groups (2.8 vs 2.6; P>0.05 ). After 2 years, 44 children (13%) were lost to follow-up, because some (n=31) had moved to other kindergartens, and some (n=13) objected to the taste of the varnish and refused to be examined. After 2 years, 290 children remained in the study, of whom 155 were in the test group and 135 were in the placebo group. The mean caries increment of the primary molars was 1.0 dmfs-molar in the test-group children and 1.6 dmfs-molar in the placebo group. The difference of 0.6 tooth surface equated to a 37.3% reduction in caries increment (number-needed-to-treat of 3), and was statistically significant (P 0.036; 95% confidence interval, 0.04-1.16). No side-effects (such as soft-tissue lesions and staining of teeth) were found at the 24-month examination. CONCLUSIONS: Six-monthly applications of chlorhexidine varnish were effective in reducing the incidence of dental caries in primary molars.

Comment↗

PubMed2005

Summary measures of caries prevalence to describe high-risk communities.

STUDY OBJECTIVE: This investigation compared the Significant Caries Index (SiC) with alternative summary measures of caries prevalence, designed to highlight high-risk communities and examined the implications of their use in health policy and planning in Wales. DESIGN: Data from the 2001 BASCD survey of 7,412, 12-year-old Welsh children were used in this analysis. As an alternative to the 33% cut-off value utilised in the SiC, the mean DMFT of children with the 10, 20 and 25% highest caries scores were calculated for 22 local health board areas, as was the mean DMFT for the whole population, %DMFT >0, and the mean for those with DMFT >0, >1, >2, and >3. SETTING: Examinations for the childhood epidemiology programme took place in Welsh secondary schools. PARTICIPANTS: 12-year-old children examined in the 2000/01 survey. MAIN RESULTS: The mean DMFT for the whole population was 1.31, and the mean DMFT of those with caries was 2.56. The mean DMFT for SiC 33%, 25%, 20% and 10% was: 3.39, 3.85, 4.28, and 5.31 respectively. When local health board areas were ranked according to mean DMFT score at different percentage cut-off points, variation in rank order was observed, the greatest difference in rank order being 6. Furthermore, when compared with summaries based on DMFT scores traditionally used in Wales, even greater rank differences were noted (up to 14 places). CONCLUSIONS: Rank order of geographical area is influenced by the definition of the index chosen when describing high risk populations using a variety of caries indices. This has implications for health policy planning and resource allocation.

Catchment Area, Health↗

PubMed2004

A comparison of a computer-based questionnaire and personal interviews in determining oral health-related behaviours.

BACKGROUND: A major challenge for survey-based research is to reduce bias. In an interview, subjects may claim more favourable behaviour to please the interviewer or comply with accepted norms. OBJECTIVES: This study aimed to: (i) determine if adolescents give different answers when using a self-completed computer-administered oral health questionnaire compared with a personal interview, (ii) ascertain if responses to a face-to-face interview are dependant on whether a dentist or nonclinical researcher administered the questionnaire and (iii) examine if responses were influenced by whether they undertook the computer questionnaire first or second. METHODS: A randomized crossover design was used to investigate the responses to 15 closed questions on oral health-related practices. These were administered to 453, 12-year olds attending school dental inspections in South Wales. RESULTS: A total of 449 valid pairings of computer/interview responses were available for analysis. Responses to the questionnaire variables demonstrated good to very good levels of agreement (kappa 0.68-0.90) when comparing the face-to-face and computer-administered questionnaire. With the exception of questions on dental attendance, responses were not influenced by whether the questions were posed by the research officer or the dentist. A minimal order effect could be detected when undertaking the computer-administered questionnaire first. CONCLUSIONS: Whilst a study such as this cannot determine the true validity of the responses achieved, it is concluded that a computer-administered questionnaire, comprising closed questions, can be utilized to determine oral health-related behaviours in oral health surveys.

Adolescent↗

PubMed2004

Internet-derived patient information on common oral pathologies: is it readable?

BACKGROUND: The evolution of the Internet has made available to the public vast reserves of information, and it represents a tremendous educational resource. However, it is obviously important that information directed at patients is readable and understandable. OBJECTIVE: This study aimed to evaluate the readability of patient-related Internet sites presenting information on dental caries, periodontal disease, oral cancer and mouth ulcers. METHODOLOGY: Four separate Internet searches seeking patient information on these pathologies were conducted in May 2003. In total, 5127 sites were identified. Within each search, the first 25 sites identified as of relevance to patients seeking information were downloaded (100 in total), and the readability determined using the Flesch reading score and the Flesch-Kinkaid reading level. RESULTS: A wide range of reading ease scores was obtained, equating to reading ages from seven years to university entry level. The mean reading age of the sites evaluated was 10-11 years of age, higher than the estimated reading age of the UK population in general (nine years). Scores were broadly similar across different pathologies. CONCLUSIONS: Practitioners and other members of the dental team involved in patient education should be aware that additional advice and support may be required to help patients interpret material downloaded from the Internet. Furthermore, those practices presenting educational material on their practice website should bear in mind the need to ensure that it is pitched at a level appropriate to the intended audience.

Comprehension↗

PubMed2004

Developing explanatory models of health inequalities in childhood dental caries.

OBJECTIVE: Long-term aim is to determine optimum interventions to reduce dental caries in children in disadvantaged communities and minimise the effects of exclusion from health care systems, of ethnic diversity, and health inequalities. DESIGN: Generation of initial explanatory models, study protocol and development of two standardised measures. First, to investigate how parental attitudes may impact on their children's oral health-related behaviours and second, to assess how dentists' attitudes may impact on the provision of dental care. SUBJECTS: Core research team, lead methodologists, 44 consortium members from 18 countries. To complete the development of the questionnaire, the initial set of items was administered to parents (n = 23) with children in nursery schools in Dundee, Scotland and sent to the same parents one week later. A standardised measure examining barriers to providing dental care for children aged 3 to 6 years was developed. 20 dentists working in primary dental care in Scotland completed the measure on two different occasions separated by one week. RESULTS: Explanatory models were developed. Family questionnaire: test-retest reliability excellent (r = 0.93 p < or = 0.001) with very good internal reliability (alpha = 0.89). Dentists questionnaire: excellent test-re-test reliability r = 0.88, (alpha = 0.90). CONCLUSIONS: Interaction between consortium members enhanced the validity of the questionnaires and protocols for different cultural locations. There were challenges in developing and delivering this multi-centre study. Experience gained will support the development of substantive trials and longitudinal studies to address the considerable international health disparity of childhood dental caries.

Attitude of Health Personnel↗

PubMed2004

Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economicall diverse groups.

UNLABELLED: OBJECTIVE; The aim of this international study was to develop a valid and reliable psychometric measure to examine the extent to which parents' attitudes about engaging in twice-daily tooth brushing and controlling sugar snacking predict these respective behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of deprivation or children's caries experience impact upon the relationships between oral health related behaviours, attitudes to these respective behaviours and to dental caries. CLINICAL SETTING: Nurseries, health centres and dental clinics in 17 countries. PARTICIPANTS: 2822 children aged 3 to 4 years and their parents. MAIN OUTCOME MEASURES: Dental examination of children and questionnaire to parents. RESULTS: Factor analysis identified 8 coherent attitudes towards toothbrushing, sugar snacking and childhood caries. Attitudes were significantly different in families from deprived and non-deprived backgrounds and in families of children with and without caries. Parents perception of their ability to control their children's toothbrushing and sugar snacking habits were the most significant predictor of whether or not favourable habits were reported. Some differences were found by site and ethnic group. CONCLUSIONS: This study supports the hypothesis that parental attitudes significantly impact on the establishment of habits favourable to oral health. An appreciation of the impact of cultural and ethnic diversity is important in understanding how parental attitudes to oral health vary. Further research should examine in a prospective intervention whether enhancing parenting skills is an effective route to preventing childhood caries.

Adult↗

PubMed2004

International comparisons of health inequalities in childhood dental caries.

OBJECTIVE: To undertake formative studies investigating how the experience of dental caries in young children living in diverse settings relates to familial and cultural perceptions and beliefs, oral health-related behaviour and oral microflora. PARTICIPANTS: The scientific consortium came from 27 sites in 17 countries, each site followed a common protocol. Each aimed to recruit 100 families with children aged 3 or 4 years, half from deprived backgrounds, and within deprived and non-deprived groups, half to be "caries-free" and half to have at least 3 decayed teeth. OUTCOME MEASURES: Parents completed a questionnaire, developed using psychological models, on their beliefs, attitudes and behaviours related to their child's oral health. 10% of children had plaque sampled. RESULTS: 2,822 children and families were recruited. In multivariate analyses, reported toothbrushing behaviours that doubled the odds of being caries-free were a combination of brushing before age 1, brushing twice a day and adult involvement in brushing. Analyses combining beliefs, attitudes and behaviours found that parents' perceived ability to implement regular toothbrushing into their child's daily routine was the most important predictor of whether children had caries and this factor persisted in children from disadvantaged communities. 90% of children with lactobacillus had caries. CONCLUSIONS: Parental beliefs and attitudes play a key role in moderating oral health related behaviour in young children and in determining whether they develop caries. Further research is indicated to determine whether supporting the development of parenting skills would reduce dental caries in children from disadvantaged communities independent of ethnic origin.

Adult↗