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Biomedical subjects

M Tickle

Publications and source records attributed to M Tickle.

At least 37 records · Page 2Linked to original sources
PubMed2000

Dental caries, contact with dental services and deprivation in young children: their relationship at a small area level.

OBJECTIVE: To measure the relationship between tooth decay, contact with dental services and deprivation at electoral ward level. SETTING: The study was carried out in 1998 in Ellesmere Port in the North West of England. SUBJECTS AND MATERIALS: All children younger than six years resident in Ellesmere Port registered with GDS services and those using CDS services were matched against the HA population register to identify unregistered children. Rates for children aged 3-5 years 'in contact' with primary dental care services, whether CDS or GDS, were calculated at ward level. One calibrated examiner examined all 5-year-old children in Ellesmere Port and dmft scores were calculated at ward level. Ward deprivation was measured using the Jarman score. Bivariate linear regressions at ward level were performed in turn between: dmft and Jarman score; rates for 3-5-year-olds in contact with dental services and Jarman score; and dmft and rates for 3-5-year-olds in contact with dental services. RESULTS: A significant linear relationship was observed between dmft and Jarman score (P=0.02, R2 = 0.43). Significant inverse relationships were found between rates for 3-5-year-olds in contact with dental services and Jarman score (P=0.001, R2 = 0.67), and also between dmft and rates for 3-5-year-olds in contact with dental services (P=0.002, R2 = 0.65). CONCLUSIONS: A strong inverse relationship was found between dental caries and contact with primary dental care services at electoral ward level. This relationship needs to be explored over a wider geographical area to establish if it is consistent and independent of deprivation.

Child Health Services↗
PubMed2000

Socioeconomic and geographical influences on primary dental care preferences in a population of young children.

OBJECTIVE: To compare the socioeconomic profiles of children registered in the GDS, with those using the CDS services and unregistered children. Secondly to examine the effects of socioeconomic status on travelling to access primary dental care, and finally to map out the location of unregistered children in relation to primary dental care services. SETTING: The study was carried out in 1998 in Ellesmere Port in the North West of England. SUBJECTS AND MATERIALS: The study population was all children younger than 6 years who used primary dental care services in, or were residents of, Ellesmere Port. The study population was categorized into those registered with a GDS dentist, those using CDS services and those unregistered by matching GDS and CDS data to the HA population register. Socioeconomic status was measured using the Super Profiles geodemographic classification. The relationship between service preferences and travelling to access primary dental care with socioeconomic status were compared using cross-tabulations and chi square tests. RESULTS: There was a significant socioeconomic trend evident in the use of dental services. Two thirds of those using CDS services came from the most deprived area types. Of those who were unregistered half lived in the most deprived area types compared with one third of those registered with the GDS. Those who travelled into Ellesmere Port to access primary dental care were significantly more likely to live in an affluent area. Unregistered patients were homogeneously spread across the town. CONCLUSIONS: The ability to match GDS and CDS data to the HA population register is essential to understand how dental services are used by the local population. Children from deprived areas are more likely to use the CDS and a service local to their homes, therefore primary dental care services for deprived communities have to be provided locally.

Case-Control Studies↗
PubMed2000

Predicting population dental disease experience at a small area level using Census and health service data.

BACKGROUND: Information on the dental disease patterns of child populations is required at a small area level. At present, this can be provided only by expensive whole population surveys. The aim of this study was to evaluate the ability of Census data combined with health service information to provide estimates of population dental disease experience at the small area level. METHOD: Clinical dental data were collected from a large cross-sectional survey of 5-year-old children. A preliminary series of bivariate linear regression analyses were undertaken at ward level with the mean number of decayed, missing or filled teeth per child (dmft) as the dependent variable, and the Census and health service and lifestyle variables suspected of having a strong relationship with dmft as independent variables. This was followed by fitting a multiple linear regression model using a stepwise procedure to include independent variables that explain most of the variability in the dependent variable dmft. RESULTS: All deprivation indicators derived from the Census showed a highly significant (p<0.001) bivariate linear relationship with ward dmft. The Jarman deprivation score gave the highest R2 value (0.45), but the Townsend index (R2=0.43) and the single Census variable 'percentage of households with no car' (R2 = 0.42) gave very similar results. The health and lifestyle indicators also showed highly significant (p<0.001) linear relationships with dmft. The R2 values were generally much lower than the deprivation-related Census variables, with the exception of the percentage of residents who smoked (R2 = 0.42). None of the health or lifestyle variables was included in the final dental disadvantage model. This model explained 51 per cent of the variability of ward dmft. CONCLUSIONS: The results demonstrate the strong relationship between dental decay and deprivation, and all of the commonly used measures of deprivation exhibited a similar performance. For this population of young children health and health services shelf data did not improve on the ability of deprivation-related Census variables to predict population dental caries experience at a small area level.

Child, Preschool↗
PubMed2000

Sentinel practices in dentistry: a preliminary evaluation.

The objectives of this study were to compare the socioeconomic make-up and the dental caries and dental treatment patterns of a general dental practice (GDP) population of five-year-old children with those of the total resident population of five-year-old children in a specific locality, and, secondly, to examine the process of gathering information on oral healthcare needs in primary dental care. The study was set in Halton, North Cheshire. Data were collected retrospectively from the patient records of four GDP sentinel' practices using a common data abstraction form. The socioeconomic profiles of the GDP population and the 1995/6 NHS child dental health survey population were compared using the Super Profiles geodemographic classification by plotting frequency distributions. The dmft of each population was compared by calculating 95% confidence intervals. The GDP population showed a slight over-representation in the more affluent groupings of the Super Profiles Lifestyle categories and a more dramatic under-representation in two of the more deprived groupings. The confidence intervals for dt and dmft of the GDP data did not include the mean figures produced by the NHS survey, indicating a significant difference at the P < 0.05 level. These differences may be accounted for by the differences in the socioeconomic make-up of the two populations. Local practice policies on patient selection may also have a consequential effect on population disease estimates derived from primary dental care. Data on population disease experience from primary dental care could only be produced by hand-sorting through patient records, which was time-consuming and inefficient. Standardised electronic systems will need to be developed to make GDP data-collection a viable proposition. Information from primary dental care has the potential to make a major contribution to locality oral health needs assessment and it should be seen as being complementary to information gathered from epidemiological surveys.

Child, Preschool↗
PubMed2000

A comparison of normative and subjective assessment of the child prevalence of developmental defects of enamel amongst 12-year-olds living in the North West Region, UK.

Analysis of data from a 1996-97 cross sectional epidemiological study of the dental health of a sample of 12-y-old children living in Crewe, in north west England was used to compare normative and subjective assessment of developmental defects of enamel. Five hundred and twenty two 12-y-old children from secondary schools in Crewe were examined. One hundred and eighty two children (34.8%), had home post codes within the optimally fluoridated part of Crewe. Using the Developmental Defects of Enamel Index, 178 children (34%) in Crewe were normatively identified as having enamel defects present on their upper incisors. Thirty five children (6.7%), were unhappy with the appearance of their upper incisors because of marks that would not brush off. Neither the normative nor the subjective assessment of enamel defects demonstrated any difference in prevalence between the fluoridated and non-fluoridated areas. In Crewe, one in 20 children normatively diagnosed as being free from enamel defects were unhappy with the appearance of their upper incisors because of marks that would not brush off. There are differences in perception between dental professionals and 12-y-old children over the presence and relevance of developmental defects of enamel. Further research is required if we are to understand the difference in professional and lay perceptions of developmental defects affecting upper incisor teeth.

Adult↗
PubMed2000

Comparing the ability of different area measures of socioeconomic status to segment a population according to caries prevalence.

OBJECTIVE: to compare the ability of different area based indicators of socio-economic status to segment a population of 5-year-old children according to caries prevalence. BASIC RESEARCH DESIGN: The study population consisted of all 5-year-old children in seven districts in the North West Region of England who were examined in whole population surveys during the 1995/6 NHS epidemiological survey. This population was segmented according to caries prevalence by market penetration analyses using Super Profiles and the ONS geodemographic classifications, Jarman and Townsend (at ward and ED level) deprivation indices, the single census variables of unemployment and percentage of households without a car, and also the school that the children attended. Lorenz curves were plotted from the outputs of the penetration analyses. MAIN OUTCOME MEASURES: Overall caries prevalence for the population was 55.3%. All the indicators provided a very similar picture. Large differences were detected between the highest and lowest market penetration rankings for each indicator, ranging from 42.5% for the ONS geodemographic classification to 31.4% for the Townsend index at enumeration district level. However, for each indicator, the fall between these two extremes was gradual. This picture was represented by the similar effectiveness scores of around 10% for each indicator which were derived from the Lorenz curves. Each indicator could identify approximately 30% of those with disease in the topmost 25% of the total population in the penetration ranking. When the analysis was restricted to those children with severe disease (dmft> or =5) a similar picture was found, however the effectiveness score increased to 19%. CONCLUSIONS: There was a remarkably consistent inequitable distribution of population disease prevalence found between deprived and affluent area types, irrespective of what measuring instrument was used. Although there was a large difference in prevalence (dmft>0 and dmft>5) found between deprived and affluent areas, there was a gradual fall between the two extremes. This gradual fall has implications for oral health improvement strategies.

Child, Preschool↗
PubMed2000

The utility of anonymised postcoded registration data provided by the Dental Practice Board.

OBJECTIVE: To evaluate the completeness of the postcodes held in the data sets of the Dental Practice Board (DPB), and the use of the location of the dental practice at which a patient is registered, as a proxy for the location of their residential address. BASIC RESEARCH DESIGN: A cross-sectional evaluation of anonymised person-based registration data held by the DPB. The study population was all children aged under 6 years registered with a dentist in the North West Region of England. The percentage of records that could be geo-referenced from the postcodes contained within the DPB's data sets was calculated. For all records which could be geo-referenced, the proportion of children who lived in the same health authority as the dental practice they were registered with was also calculated. MAIN OUTCOME MEASURES: A total of 193,466 children in the North West Region were registered with a general dental practitioner (GDP). Of this total 117,607 (60.8 percent) could be geo-referenced from the contents of the postcode field. However, there was considerable variation in the match across the region. The majority of children lived in the same health authority as the dental practice they were registered with. It was noticeable that a greater proportion (28.5 percent) of residents registered with a dentist located within the boundaries of Manchester Health Authority were not Manchester residents. CONCLUSIONS: Due to a significant proportion of missing postcodes, data presently held by the DPB cannot be used to calculate accurate registration rates at a small area level. Using the dental practice location as a proxy for residential address is inaccurate at health authority level, especially for large conurbations. This inaccuracy will increase at small area level. Registration data held by DPB are a potentially valuable information source, but before this information can be of use to commissioners the problem of poor postcode coverage will need to be resolved.

Child, Preschool↗
PubMed1999

The effects of socioeconomic status and dental attendance on dental caries' experience, and treatment patterns in 5-year-old children.

OBJECTIVE: To compare the dental caries' experience and treatment received by 5-year-old children registered with a GDP. DESIGN: Retrospective case note review of all 5-year-old children registered with seven GDPs. SETTING: The study was carried out in 1996/7 in Wirral and North Cheshire in the north west of England. SUBJECTS AND MATERIALS: Clinical, demographic and attendance data were collected from each practice using a common data abstraction form. Subjects were categorised according to regular/irregular attenders, and into five groups ranging from affluent to deprived using the Super Profiles geodemographic classification. The relationships between disease experience, treatment, attendance and socioeconomic status were compared using cross-tabulations, t-tests and multiple linear regression. RESULTS: The dental records of 430 5-year-old children were available for analysis. Irregular attenders had significantly higher dmft, dt and mt, and fewer filled teeth. Only 29% of disease experience of regular attenders was treated by restoration. Both socioeconomic status and visiting behaviour exerted significant independent effects on dmft, but dental attendance alone had a significant effect on ft. CONCLUSIONS: Significant inequalities remain in the disease experience and service use of young children. Regularly attending children have less than a third of their diseased teeth restored. Consensus is needed across the profession on the care of the diseased deciduous dentition.

Child, Preschool↗
PubMed1999

The identification of agreed criteria for referral following the dental inspection of children in the school setting.

AIM: To clarify the function of the school based dental inspection. OBJECTIVE: For representatives of the Community Dental Service, General Dental Service and Hospital Dental Service to identify an agreed set of criteria for the referral of children following school dental inspection. DESIGN: Qualitative research methodology used to establish a consensus for the inclusion of referral criteria following dental screening. SETTING: Ellesmere Port, Cheshire, England. MATERIALS: A Delphi technique was used to establish a consensus amongst the study participants on the inclusion of nine possible criteria for referral following dental screening. All participants scored each criterion in the range 1-9, with a score of 1 indicating that referral of individuals with the condition should definitely not take place, and a score of 9 indicating referral should definitely take place. Referral criteria were accepted only if they achieved a group median score of 7 or more, with an interquartile range of three scale points, with the lower value being no less than 7. RESULTS: Four of the nine possible criteria met the agreed group standard for inclusion: 'Sepsis', 'Caries in the secondary dentition', 'Overjet > 10 mm', and 'Registered & caries in the permanent dentition'. CONCLUSION: It is possible to agree clear criteria for the referral of children following the school dental inspection.

Child↗
PubMed1999

Socio-economic status and orthodontic treatment need.

OBJECTIVES: This study aimed to examine the relationship between socio-economic status and both normatively assessed and self perceived need for orthodontic treatment. METHODS: More than six thousand 14-year-old children were assessed for orthodontic treatment by trained and calibrated examiners. The Index of Orthodontic Treatment Need was the measuring instrument along with a questionnaire which asked: "Do you think your teeth need straightening?" RESULTS: Normative need for orthodontic treatment (IOTN >3) was more common amongst deprived children than among their affluent counterparts. The same was found for perceived need. However, the children who wanted treatment were not necessarily those who needed it and vice versa. CONCLUSIONS: Socio-economic status affects normatively measured orthodontic treatment need through, as yet, undefined mechanisms. It also affects a person's perception of need for orthodontic treatment, but these two associations are separate. The mismatch of need and desire for treatment is a problem for orthodontists.

Adolescent↗
PubMed1999

Is it better to leave or restore carious deciduous molar teeth? A preliminary study.

INTRODUCTION: The objective of this study was to compare the extraction and exfoliation experience of filled and unfilled carious deciduous molar teeth. METHOD: The study was carried out in 1997 in four general dental practices in south Cheshire, UK and involved a longitudinal retrospective review of case notes. A quota sample of 20 case notes of children from each practice was selected according to strict criteria. Subjects had to: Have had experience of approximal caries in one or more of the deciduous molar teeth. Have a date of birth between 1st January 1984 and 31st December 1985. Be a regular attender and in continuous contact with the practice. Data were collected on a common data abstraction form. Variables measured included: Base-line dmft. Site and number of filled teeth. Site and number of unfilled carious teeth. Number of courses of antibiotics. Site and number of pulp therapies. Site, number, method (local or general anaesthetic) of extractions. Reasons for extraction. All teeth not recorded as being extracted were assumed to have exfoliated. In addition, information was collected on the dentists' treatment philosophies. A series of group discussions revealed that the four dentists fitted into two groups according to treatment philosophies; two dentists shared a philosophy of minimal intervention, the other two shared the same views of treating more radically. RESULTS: There was no significant difference between the proportion of filled teeth and the proportion of carious unfilled teeth that were extracted (chi-square 0.05 P = 0.83). A logistic regression showed that for each course of antibiotics administered the odds of having an extraction was multiplied by 5.5 and children who were patients of the interventionist dentists were five times more likely to have an extraction than patients of non-interventionist dentists. CONCLUSION: Although the study was preliminary in nature no clear benefit could be found in filling deciduous molar teeth against leaving carious teeth unfilled, if avoidance of extraction was the desired outcome. The treatment philosophy of dentists was a major factor in determining extraction or exfoliation outcomes. This issue is complex with many interacting factors to be accounted for and will require multiple well-designed studies to provide an answer.

Anti-Bacterial Agents↗
PubMed1998

Health authorities, GDPs and TECs: a partnership for general dental practice development.

Major changes will occur in primary dental care over the next 5 to 10 years. These changes present a series of possible opportunities and threats to dental practices. This paper reports on how the health authority, the local training and enterprise council (TEC) and five general dental practices in North Cheshire worked collaboratively to support the development of the practices. Health authorities and dentists should be aware of the possibility of working with TECs to support general dental practice development.

Communication↗
PubMed1998

Toward a standardised information system for dentistry.

Information technology is growing rapidly in both its capability and capacity to support the delivery of health care. This paper describes the work of the Dental Interspec project, commissioned by the Department of Health. The aim of the project is to provide a framework for the development of information management and technology in dentistry. It is hoped that the work of this project can be built on to eventually produce integrated information systems which would have the potential to improve primary dental care delivery for both patients and dentists.

Computer Communication Networks↗
PubMed1997

Factors influencing perceived treatment need and the dental attendance patterns of older adults.

AIM: To identify variables influencing perceived treatment need of older individuals and to identify predictive variables for reported dental attendance. DESIGN: Cross-sectional study using a self-report, posted questionnaire. SETTING: Two electoral wards, one deprived and one affluent, in the city of Liverpool in 1994. SUBJECTS AND MATERIALS: Samples of older individuals (aged 60-65) were selected at random using the FHSA register as a sampling frame. A total of 500 questionnaires were distributed, 250 to each ward. The measuring instrument included the Subjective Oral Health Status Indicators (SOHSI). RESULTS: 342 questionnaires (68.4%) were returned. There was a highly significant (P < 0.001) association between living in a deprived area and reported poor dental attendance. Recent pain experience and concern about oral health and appearance were significant predictors for perceived treatment need. The main factor predicting subjective need for treatment was a reported history of regular, asymptomatic visiting. Such individuals were nearly six times more likely to have a perceived treatment need than poor attenders. CONCLUSIONS: Identification and quantification of these variables is necessary in order to promote regular, asymptomatic dental attendance and for the future planning of dental services for older individuals.

Aged↗
PubMed1997

A comparison of the subjective oral health status of older adults from deprived and affluent communities.

A comparative study of the subjective oral health status of 60-65-year-old residents was undertaken in two Liverpool electoral wards, Vauxhall, the most deprived, and Woolton, the most affluent in the city. The measuring instrument used was the Subjective Oral Health Status Indicators (SOHSI) questionnaire devised by Locker. The questionnaire was administered by post to random samples of 250 residents from each ward. The main aim of the study was to compare the reported impact of oral conditions on the lives of individuals living in deprived and affluent communities. Responses of 59.6% for the deprived ward and 77.7% for the affluent ward were achieved. The literature suggested that significant differences could be expected between the wards in the reporting of subjective impact. However, significantly greater impact for only one functional sub-scale and one psycho-social sub-scale was reported by residents from the deprived ward. Further analysis of the relationship between impact and socio-demographic variables revealed a strong association between self-reported general health status and the subjective oral health indicators. Finally, a stepwise regression analysis found that pain and chewing problems were the only significant predictors of psycho-social impact. This finding confirms that the individual's socio-economic circumstances are of secondary importance to pain and functional problems in determining the psycho-social effects of oral conditions, as predicted by the conceptual model on which the measuring instrument is based.

Aged↗