Improving the oral health of young children through an evidence-based approach.
Explore the source record for details and available documents.
Child, Preschool↗
Biomedical subjects
Martin Tickle
Publications and source records attributed to Martin Tickle.
Service quality implications of dental undergraduate outreach teaching for Primary Care Trusts in England, UK.
OBJECTIVE: Primary Care Trusts (PCTs) assumed new responsibilities for dentistry in 2005. In dental education it has been suggested that more emphasis is made of primary care outreach schemes. The paper considers the service quality implications of dental outreach teaching for PCTs with particular reference to access and acceptability. RESEARCH DESIGN AND CLINICAL SETTING: A pilot of outreach teaching for Manchester undergraduates in relation to adult dental care began in 2001. Six groups of eight students, working in pairs, spent one day per week in one of three community dental clinics in socially deprived areas. The evaluation of the first year used data from 908 patient treatment summaries, 139 patient questionnaires, and records of patient attendance. MAIN OUTCOME MEASURES: Access and acceptability measured by patients' demographic characteristics, patients' attendance at the clinics; patients' reasons for attendance, use of services and satisfaction with the service. RESULTS: In terms of access, the new service was used by local patients. Their main reasons for attending were convenience, a dental problem, free treatment, lack of access to a dentist, and lay referral. Some 41 percent attended initially because of an emergency, 30 percent said that if they had not attended the clinic they would have gone nowhere or did not know where they would have gone, and 49 percent had not attended a dentist for more than two years. In terms of acceptability most patients were positive about being treated by a student, 96 percent thought the quality of care excellent or good, and the same percentage said they would return to the clinic. The main areas of criticism were waiting times and appointments. CONCLUSIONS: Students can provide an accessible and acceptable local primary care dental service for adult patients in socially deprived areas as part of their undergraduate learning, and in a way that complements the existing services.
Adolescent↗
The geodemographic distribution of caries experience in neighboring fluoridated and nonfluoridated populations.
OBJECTIVE: This study compares the geodemographic distribution of caries experience in neighboring fluoridated and nonfluoridated populations. METHODS: All 5-year-old children living in fluoridated (N=1,422) and nonfluoridated (N=4,779) areas of Cheshire, UK, were examined by trained and calibrated examiners. The Target Market level of the Super Profiles geodemographic classification was used to produce market penetration ranking reports for caries experience. The same area types were compared in fluoridated and nonfluoridated populations. Lorenz curves and Gini coefficients were generated from the outputs of the penetration rankings. RESULTS: There was a 12.4 percent difference in prevalence and a 29.4 percent difference in dmft between fluoridated (dmft>0=32.4%, dmft=1.01) and nonfluoridated (dmft>0=37.0%, dmft=1.43) areas. The area types at the top of both penetration rankings were deprived in nature and those at the bottom were affluent. The Gini coefficients in each area were 22.7 and 23.7 percent. CONCLUSIONS: The results demonstrate that water fluoridation is effective at preventing dental disease after controlling for confounding factors. In both populations the majority of disease was not confined to a small number of deprived area types. This undermines the contention that a targeted approach to caries prevention is a practical option.
Child↗
Comparing different methods to detect and correct nonresponse bias in postal questionnaire studies.
OBJECTIVES: This study compares methods for detecting and correcting the bias associated with nonresponse to postal questionnaires. METHODS: Questionnaires were sent out in three sequential stages to parents of all 5-year-old children examined in a clinical survey. Each stage progressively targeted nonresponders. Data on dmft and area measures of socioeconomic status were available for all children. Estimates for whole population dmft were produced by different methodologies comparing the relationship between dmft and stage of response and three area measures of socioeconomic status. RESULTS: A total of 1,776 children were examined and 1,437 questionnaires were obtained, a response rate of 80.9 percent. The mean dmft of the total population (1.49) was 17.3 percent more than responders (1.27). The dmft of the nonresponders was 2.41, 89.7 percent more than responders. There were significant linear trends in dmft and socioeconomic status across the mailing stages. The methodology using mailing stage regressed against dmft produced the most accurate adjusted dmft value (1.42). The methods using area measures of socioeconomic status produced nearly identical adjusted dmft values ranging from 1.31 to 1.32. CONCLUSIONS: Even with an "acceptable" response rate, nonresponse bias can still be present. Researchers should report the outcomes of analyses to detect nonresponse bias when publishing questionnaire studies.
Bias↗
Inequalities in the dental treatment provided to children: an example from the UK.
OBJECTIVES: To identify the relationship between the socioeconomic status of frequently attending children and the dental care of their primary dentition provided by dentists working in the General Dental Service (GDS) of the UK National Health Service (NHS). METHODS: The study design involved a retrospective investigation of the case notes of 658 children who were regularly attending patients of 50 General Dental Practitioners (GDPs) working in the North West of England. The socioeconomic status of each subject was measured using the Townsend score of their electoral ward of residence. Logistic regression models, taking into account the clustering of the subjects within dental practices, were fitted to identify whether or not socioeconomic status was significantly associated with the proportion of carious teeth that were restored, all dental extractions, dental extractions for pain or sepsis alone and courses of antibiotics prescribed after controlling other variables. RESULTS: A significant association between socioeconomic status and caries experience could not be found. There was also no association between socioeconomic status and the proportion of carious teeth filled or courses of antibiotics prescribed. Disadvantaged children were significantly more likely to have teeth extracted than their more affluent peers, but there was no association between deprivation and extractions for pain or sepsis alone. CONCLUSIONS: Children from deprived backgrounds who regularly attended this group of UK dentists were more likely to have extractions than their more affluent peers, irrespective of their caries experience.
Anti-Bacterial Agents↗
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.
Dental Caries↗
The 80:20 phenomenon: help or hindrance to planning caries prevention programmes?
OBJECTIVE: to compare the outcomes of population segmentation analyses according to caries experience using the distribution of dmft and the Super Profiles geodemographic classification. BASIC RESEARCH DESIGN: The study population consisted of all 15,747 children in seven districts in the North West Region, England who were examined in whole population surveys during the 1995/6 NHS epidemiological survey of 5-year-old children. Market penetration analyses were used to segment this population according to caries experience by their dmft score and by the Super Profiles geodemographic classification. Lorenz curves were plotted and Gini coefficients were calculated from the outputs. MAIN OUTCOME MEASURES: When dmft was used to segment the population approximately 80% of carious teeth were found in some 42% of the total population, producing a Lorenz Curve with a Gini coefficient of 66%. The population was then segmented using Super Profiles Target Markets. The target markets were ranked according to caries experience and the denominator population living in each of these area types. Some 81% of the total population dmft was found in the topmost ranked 73.8% of the total population. The resultant Lorenz curve produced a Gini coefficient of 16.2%. CONCLUSIONS: About half of the population disease was confined to a minority of the population but not to the extent of 80% of the disease in 20% of the population. Although these high risk children were more commonly found in underprivileged area types, they did not live exclusively in a small number of deprived areas. These findings shed doubt on the wisdom of a targeted approach to oral health promotion and disease prevention programmes.
Child, Preschool↗