To explore the views of patients, caregivers, and dental professionals on the factors that influence implementation, processes, and effectiveness of a guided self-help cognitive behavioural therapy (CBT) intervention, ‘Your teeth, you are in control’ (YTYAIC), in the CALM trial.
Semi-structured interviews were conducted as part of this qualitative component of the process evaluation, and data were analysed using a framework approach based on the Consolidated Framework for Implementation Research (CFIR) and the Five Areas Model of CBT.
Thirty-seven participants were recruited. Potential mechanisms of action were identified using the Five Areas Model of CBT. Participants felt the intervention may exert change through targeting unhelpful thoughts and feelings (e.g., building trust and perceptions of control) and behaviours (e.g., encouraging effective communication and coping strategies) and facilitating a more positive situational context (e.g., developing more supportive relationships). Enablers (e.g., adaptability, design and delivery) and barriers (e.g., time/resource constraints, cost) to implementation were identified using the CFIR.
This study revealed multiple potential mechanisms of action which could reduce dental anxiety and examined how implementation and contextual factors may influence this change process. The results of the research revealed that the intervention could be implemented in primary dental care and identified the potential barriers which should be addressed to aid successful implementation of the intervention in real world contexts.
This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420)
To examine the association between the lifetime utilisation of dental services and dental caries experience in mixed dentition among adolescents participating in the 2004 Pelotas Birth Cohort, Southern Brazil.
This longitudinal study analysed a sample of 996 adolescents aged 12–13 years. Dental caries experience and untreated dental caries were the outcomes, assessed by the mean of decayed, missed and filled in deciduous (dmfs index) and in permanent (DMFS index) teeth, based on World Health Organization criteria. The main exposure was lifetime use of dental services, defined as: always have gone to the dentist for preventive reason; have gone to the dentist at times for preventive reason, at times for problem-oriented reason; always have gone to the dentist for problem-oriented reason (reference category). Family income mobility during the first 4 years of the child's life, maternal schooling, adolescent sex and skin colour were the confounders. Crude and adjusted analyses were conducted using negative binomial regression, estimating mean ratios (MR), and 95% confidence intervals (95% CI).
In the adjusted analysis, adolescents who consistently utilised dental services for preventive reasons exhibited a mean 49% lower dental caries indexes (MR = 0.51; 95% CI 0.35–0.76) and 56% lower mean of untreated dental caries (MR = 0.44; 95% CI 0.26–0.74) compared to their counterparts who consistently sought dental care for problem-oriented reasons. The utilisation of dental services occasionally for preventive reasons and occasionally for problem-oriented reasons was also associated with lower caries indexes.
The lifetime utilisation of dental services, whether always or occasionally for preventive reasons, was found to be a protective factor for dental caries in adolescence. These findings reinforce the importance of raising awareness among the public regarding the preventive use of dental services. Additionally, there is a need to organise dental services to facilitate the provision of preventive dental care since early childhood.
The prevalence of dental caries is high in Japan, leading to a huge burden of overall expenditure on dental caries treatment for the population. School-based fluoride mouth-rinse (S-FMR) has been implemented as a public health intervention. However, its cost-effectiveness remains unclear, where universal health insurance covers a broad range of dental treatments at relatively low cost. The aim of the study was to determine whether S-FMR is associated with lower dental caries treatment expenditure in Japan, where the universal health insurance system widely covers dental treatments. In addition, the cost-benefit of S-FMR was estimated.
This ecological study examined the association between S-FMR coverage and dental caries treatment expenditure in all 47 prefectures of Japan. Data were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data (NDB Open Data Japan), national survey data on the prevalence of S-FMR, and other census data for each prefecture. The outcome variable was the average annual treatment expenditure of for children aged 5–14 per child. The explanatory variable was the S-FMR coverage of children per prefecture, divided into quartiles: (Q1) 0.0%–0.48%, (Q2) 0.54%–6.9%, (Q3) 7.2%–25.0% and (Q4) 26.9%–80.4%. Linear regression analysis was performed with adjustment for the number of dental clinics per 100 000 individuals, per capita prefectural income, and percentage of the population aged between 5 and 14 years.
The dental caries treatment expenditure was lower in prefectures with higher S-FMR coverage: (Q1) 2378 JPY, (Q2) 2215 JPY, (Q3) 2217 JPY and (Q4) 2065 JPY. Linear regression analysis showed that, compared to the prefectures with the lowest S-FMR coverage, the prefectures with the highest coverage exhibited significantly lower per person dental caries treatment expenditure by 186.0 (95% CI = 96.6, 275.4) JPY. When annual cost of S-FMR per person was lower, 200 JPY, S-FMR would save 0.9 billion JPY if all prefectures change from Q1 to Q4 (approximately 8.2 million USD).
Although public healthcare insurance in Japan covers most dental treatments at a relatively low cost, the current findings suggest that S-FMR could still be a cost-effective public health intervention.
The study aimed to estimate the effect of a periodontal treatment policy that would restrict the receipt of periodontal therapy to no more than once every second year, on the 10-year risk of tooth extraction among Danish adults.
Data from linked nationwide Danish registers consisted of a random sample of 20 000 50-year-olds who were followed from the beginning of 1990 to the end of 2021. The longitudinal modified treatment policies’ causal inference framework was used. In each of two slightly different counterfactual scenarios, the receipt of supragingival or subgingival periodontal therapy was restricted to no more than once every second year. The cumulative incidence of tooth extraction from 2012 to 2021 was compared between the counterfactual scenarios and the observed periodontal visiting pattern, while informative censoring, and time-varying and time-invariant confounding were accounted for using the social, economic and dental service utilisation history.
During the 10-year follow-up period, 5021 (25.1%) individuals received at least one tooth extraction. In the two counterfactual scenarios, the number of years receiving supragingival or subgingival periodontal therapy was 30%–50% lower than in the observed data. The 10-year cumulative incidence of tooth loss was practically the same in the two counterfactual scenarios as under the observed periodontal visiting patterns.
The findings indicate that a considerable decrease in the number and frequency of periodontal care visits would not have significant impact on the incidence of tooth loss in Denmark.
Engagement in preventive dental care is a complex health behaviour and is determined by multiple factors. The study aimed to understand the association of psychosocial determinants with poor dental attendance.
Survey data from 333 Mexican-identifying adults in California aged 21–40-year were analysed. Poor dental attendance was a composite of time since last dental visit and reason for visit. Responses of ‘more than 1 year ago’ for last dental visit, or ‘something was wrong, bothering or hurting/emergency dental problem’ as the reason for last dental visit were categorised as poor dental attendance. Psychosocial determinants including dental anxiety assessed using the Modified Dental Anxiety Scale, participant reported quality of provider interactions, and perceived social support were assessed. Logistic regression analyses examined associations after accounting for covariates.
Over half (58%) had poor dental attendance. Among those with poor dental attendance, 22% had high dental anxiety, 41% perceived low quality of dental explanation, and 48% reported provider occasionally/never checked patient understanding. Participants with high anxiety had twice the odds of poor dental attendance (OR = 2.07, 95% CI = 1.01–4.22) than those with low dental anxiety. Additionally, those reporting that providers did not explain oral health status or treatments well had two times higher odds of poor dental attendance than those reporting adequate explanation (OR = 2.06, 95% CI = 1.11–3.83). Checking patient understanding or perceived social support was not significantly associated with dental attendance.
Dental anxiety and poor provider interactions affect use of dental services. Interventions targeting dental staff should prioritise enhancing communication skills and checking patient understanding to improve their dental attendance.
The aim was to conduct a process evaluation of a multicomponent behaviour change intervention to reduce dental caries in secondary school children in the UK. The intervention was evaluated in the BRIGHT randomised controlled trial which investigated clinical and cost-effectiveness. The trial involved 4680 participants from 42 schools with a follow-up period of 2.5 years. Schools with an above-average proportion of free school meal (FSM) eligibility, an indicator of low household income, were recruited. The intervention, an oral health classroom-based session (CBS) delivered by school staff and twice-daily text messages aimed to improve toothbrushing frequency with fluoride toothpaste.
Key components of process evaluations were examined: Implementation (fidelity, dose delivered, adaptations and reach), mechanisms of impact (acceptability and dose received) and influential contextual factors. Data collection ran alongside that of the outcome evaluation. Mixed-methods data collection comprised pupil self-reported questionnaires, staff feedback questionnaires, CBS and text message delivery logs and semi-structured interviews/focus groups with school staff and pupils. Quantitative data were summarised descriptively, while framework analysis was applied to the qualitative data.
The intervention was generally implemented as intended, albeit with some schools not confirming CBS delivery and a technical problem resulting in text messages being stopped prematurely. Some adaptations to the CBS were made by school staff. In terms of reach, 21.9% (n = 1025) of participants were FSM-eligible. At baseline, 77.6% (n = 3631) of randomised participants reported brushing at least twice daily with no difference over time in the social cognitive determinants of toothbrushing behaviour. The intervention was generally found to be acceptable with varying levels of participant responsiveness reported. The actual dose received was unclear; some schools did not provide a CBS attendance register, and some participants reported blocking or muting the text messages.
This evaluation raises the question of whether the intervention dose and quality of delivery were sufficient to support the required behaviour change mechanisms. Moreover, a high proportion of participants brushed twice daily at baseline; this also calls into question the intervention's ability to bring about significant ch
Posttraumatic stress disorder (PTSD) is a disabling mental health condition arising from experiencing serious traumatic events. This study investigated if PTSD secondary to the World Trade Center terrorist attack on 11 September 2001 (9/11) is associated with self-reported doctor's diagnosis of periodontitis and count of missing teeth.
Data from the World Trade Center Health Registry, 2003–2020 (n = 20 826) were used to prospectively examine the rate of periodontitis and cross-sectionally the odds of missing teeth among enrolees with/without PTSD post-9/11 using a modified Poisson regression and generalised logit model, respectively, adjusted for covariates.
Approximately 17% reported a doctor's diagnosis of PTSD post-9/11 and 7.4% a doctor's diagnosis of periodontitis. There were 355 new cases of periodontitis (incidence rate = 7.6 per 1000 person-years) among those with PTSD and a rate of 4.3 per 1000 person-years among those without PTSD. The covariate-adjusted rate ratio for periodontitis comparing those with and without PTSD = 1.52 (95% CI: 1.33, 1.74). The adjusted odds ratio (OR) (95% CI) comparing those with and without PTSD were, respectively, OR = 1.15 (95% CI: 1.05, 1.25) and OR = 1.41 (95% CI: 1.09, 1.83) for missing 1–5 teeth and all teeth missing, respectively, as compared to no missing teeth.
PTSD post-9/11 appears to be associated with poorer oral health outcomes, underscoring the far-reaching consequences of traumatic events on oral health.
Within Aotearoa | New Zealand, rates of largely preventable severe caries and dental hospitalisations among children are increasing and inequalities exist. However, little population-based empirical evidence exists describing this oral health burden among children with neurodevelopmental disabilities (NDDs). This study aimed to estimate and compare the rates of dental hospital admissions in a near-national population of children aged ≤ 14 years with attention-deficit hyperactivity disorder, autism, intellectual disability or any NDD after accounting for key confounding variables. Caries status for these children was derived from an oral health screening at 4 years and also examined.
The cohort were children who had their B4 School Check (B4SC) national health screening assessment undertaken between 1 January 2011 and 31 December 2018 and followed until 1 January 2020 (the study end date). Linked administrative databases, which include NDD indication and dental hospital records, were utilised. Dental hospital admissions were assessed using unadjusted and adjusted Cox proportional hazard regression models treating NDD as a discrete time-varying covariate. Caries status at 4 years of age was investigated cross-sectionally and the area under the receiver operating characteristic curve used to assess predictive accuracy.
The eligible sample included 433 569 children (48.6% female) with a mean age of 9.3 years at the study end date. Overall, 16 359 (3.8%) children had at least one NDD indication and 38 574 (8.9%) had at least one dental hospitalisation. In adjusted analyses, the hazard ratio of dental hospitalisation admissions was 3.40 (95% CI: 3.22–3.60) for children indicated with any NDD compared to their non-NDD counterparts. At 4 years of age B4SC screening, 465 (17.6%) children out of 2640 indicated with any NDD had visible caries compared to 61 026 (14.3%) from 427 254 children without NDD indication (prevalence ratio = 1.24 [95% CI: 1.14–1.35]). However, the area under the receiver operating characteristic curve for this association was 0.52 (95% CI: 0.51–0.52), suggesting negligible predictive capacity.
Children with NDDs in Aotearoa, New Zealand suffer from substantial oral health inequities. Targeted preventive strategies and adaptation to primary oral health services are needed to meet the needs of neurodiverse children and redress this substantial inequity. However, targeting children with NDDs at the B4SC is unlikely to mitigate these oral heal
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