School dental screening does not increase dental attendance rates or reduce disease levels

DESIGN: This was a cluster randomised controlled trial, in which the unit of randomisation was the school. INTERVENTION: Three models of screening were tested against a control. A 'new' model of school dental screening incorporated a consensus view, from clinicians in the northwest of England, on a set of clinical criteria that would prompt a referral following a screening examination. A 'traditional' model involved the delivery of the existing school dental screening programme according to the principle that a child is referred if, in the opinion of the screening dentist, dental care is required. The third intervention tested was a dental information leaflet, distributed via the schools, which encouraged parents to examine their child's mouth and to take their child to a dentist if any problems were noted. Children a ttending the control schools received no intervention during the study period. OUTCOME MEASURE: The main outcome measures were prevalence of teeth with active caries and mean number of teeth with active caries in the permanent or primary dentition. Secondary outcome measures were prevalence of oral sepsis, gross plaque or calculus, and dental trauma to incisor teeth. RESULTS: Seventeen thousand and ninety-eight children in 169 clusters (schools) were eligible for inclusion in the study. One school was withdrawn from the study because of failure to agree to follow the trial protocol. Of the total, 15 004 children were available for baseline examination in 168 schools and 13 570 children received a baseline and outcome examination, representing 80.5% of the eligible population. After adjustment for clustering of children in schools, there was no significant difference in the reduction from baseline in untreated caries between the study groups in either the primary or permanent dentition. Similarly there were no significant differences across the four arms of the study in the secondary outcome measures of prevalence of sepsis, presence of gross plaque or calculus, and trauma to the permanent incisor teeth. In the traditional arms, 42% of children attended a dentist during the study period, with 41% in the new-model arm, 37% in the information-leaflet arm and 38% in the control arm. Although more children in the traditional and new-model arms of the study attended a dental appointment these differences were not statistically significant.CONCLUSIONS: School dental screening delivered according to three different models was not effective at reducing levels of active caries and increasing dental attendance in the population under study.     

The effectiveness of school dental screening: a cluster-randomized control trial

Dental screening of children in schools is undertaken in many countries. There is no evidence that this activity is effective. The objective of our study was to determine if school dental screening of children reduces untreated disease or improves attendance at the population level. A four-arm cluster-randomized controlled trial was undertaken in the northwest of England. In total, 16,864 children aged 6-9 years in 168 schools were randomly allocated to 3 test groups, which received screening according to different models, and a control, which received no intervention. There were no significant differences in caries increment in the primary and secondary dentitions or in the proportions of children attending a dentist after screening between the control group and the 3 intervention arms. School dental screening delivered according to 3 different models was not effective at reducing levels of active caries and increasing attendance in the population under study.     

Effectiveness of the school dental screening programme in stimulating dental attendance for children in need of treatment in Northern Ireland

The school dental screening programme has been in existence from the beginning of the 20th century yet its value in encouraging attendance among children with a dental health need is not fully established. OBJECTIVE: To evaluate the effectiveness of school dental screening in promoting dental attendance among children with a treatment need and to examine the relative importance of screening, social class and other factors in dental attendance. METHODS: Sixty-four participating schools were assigned to study and control groups using a stratified, blocked randomisation technique. The study group children received the standard school dental screening and the dental attendance of those with a positive screening result was assessed after 2 months by means of a questionnaire issued to the children's parents. The control group children were not, at this stage, screened, yet their parents received the same questionnaire assessing dental attendance over the 2-month period. However, only questionnaires from control group children who had a positive result at a subsequent screening were retained for analysis. RESULTS: A total of 2,321 children were screened, with 980 having a positive result. The mean dmft of those screening positive was 4.85. In all, 664 completed questionnaires were returned, giving a response rate of 67.8%. Dental attendance was reported among 45.5% of the study group (n=352) in the 2 months following screening. In the same period, 27.6% of the control group (n=312) claimed attendance. The effect was found to be significant among the high employed group (P<0.01) and the unemployed group (P<0.05). CONCLUSION: School dental screening was capable of stimulating dental attendance. The strong effect among the lowest socio-economic group shows that school dental screening may be used to decrease dental health inequalities.     

A survey of school dental screening practise in community dental services of England and Wales in 2003

OBJECTIVE: To describe the school dental screening process in Community Dental Services across England and Wales. Basic research DESIGN: Cross-sectional study using a postal questionnaire. CLINICAL SETTING: Community Dental Services. Participants: Clinical Directors of Community Dental Services in England and Wales. MAIN OUTCOME MEASURES: Respondents answers about the objectives of school dental screening, criteria used for referring a child, methods of informing parents of screening results, and methods used to confirm subsequent dental attendance. RESULTS: The response rate for this study was 92.1%. Respondents identified dental registration (75.2%) and attendance at a dentist (82.9%) as objectives of school dental screening. Less than one third (29.5%) saw the activity as having a preventive role. Caries in the primary and secondary dentitions and soft tissue lesions were reported as key criteria for referral. Methods of follow-up of screened positive children differed and were often inadequate; approximately one third of respondents used a letter carried home by the child that did not allow parents to inform the CDS of action taken. Half of the respondents routinely collected data on the number of screened positive children who subsequently visit a dentist. CONCLUSIONS: School dental screening is delivered in a similar fashion throughout England and Wales but methods of informing parents of a positive screen and follow-up mechanisms for children with positive screens vary. Most school dental screening programmes do not collect sufficient data to evaluate the impact of their programmes on children's oral health.     

Mothers' dental attendance patterns and their children's dental attendance and dental health

Two hundred and ten 10-11-year-olds were selected at random from those attending schools in the Tameside and Glossop Health District. One hundred and eighty-eight were examined for caries, and the mothers of 177 of these children completed a questionnaire on their own and their child's dental attendance. Claimed attendance was subsequently checked with the dentist concerned. Sixty-one percent of mothers had attended a general dental practitioner during the previous 12 months and 89% of these mothers took their children with them. Of the non-attending mothers, 38% took their child to the GDS, 36% to the CDS, while 26% did not take their child to a dentist. The DMFT of the children was 1.72, and the differences in DMFT between the three attendance groups were not significant. However, there were significant differences in the decayed and missing components. The study demonstrates that the CDS and the GDS treat different populations of children by virtue of the mothers' attendance patterns. The methods developed for this study provide a basis for ongoing evaluation within a district of the implementation of the Department of Health's policy for the provision of dental treatment by the CDS.     

Oral health status and access to dental care for ohio head start children

PURPOSE: The purpose of this survey were to assess the dental caries prevalence rate among children enrolled in Ohio's Head Start programs and assess factors relating to their dental care access. METHODS: Oral screenings were conducted on 2,555 children, ages 3 through 5 years, at 50 Ohio Head Start centers using probability-proportional-to-size sampling. In addition, parental responses to 6 access-oriented questions on the consent form were analyzed. RESULTS: Overall, 38% of 3- to 5-year-old Head Start children screened had experienced dental caries, and 28% had at least 1 untreated decayed tooth. Of the children with caries experience, 73% had decayed teeth, while the remaining 27% had restorations only. Among children, there were no statistically significant differences associated with race or payment method. With regard to dental care access, 11% of Head Start parents reported they could not get wanted dental care for their children during the previous 12 months, most often due to cost of care/lack of insurance. Nine percent of children had a toothache in the previous 6 months. Although 85% of Head Start children had visited a dentist in the previous 12 months, another 10% had never visited a dentist. CONCLUSIONS: The significant prevalence rate of dental caries among Ohio Head Start children is consistent with other states' reports. Although almost 9 of 10 children visited a dentist during the year, three fourths of children with dental caries did not have their care completed by the time they were screened during the second half of the school year. Oral health disparities according to race and payment source were not found among Ohio Head Start children.     

深圳市小学生恒牙龋病的流行病学分析

目的：了解深圳市小学生恒牙龋病分布及治疗现状,为深圳市小学生恒牙龋病防治提供参考。方法运用整群随机抽样方法,在深圳市10个区中随机抽取63所小学,合计74308名在校学生,进行患龋情况调查。结果小学生恒牙患龋率为15.7%,龋均为0.37±0.18;不同性别、不同年龄组间的恒牙患龋率差异均具有统计学意义（P<0.05）;恒牙患龋率与学生年龄之间存在关联性（P<0.05）;小学生窝沟封闭率、恒牙龋充填率分别为31.17%、19.05%;控制年龄因素后恒牙龋充填率（c2=12.897,P<0.001）和窝沟封闭率（c2=5.659,P =0.017）的性别差异均有统计学意义（P <0.05）。结论深圳市小学生的龋齿预防需要加强。     

Assessment of dental treatment required and analysis of cost in the management of dental caries among semiurban primary school children of Kerala

The study was carried out with the purpose of assessing the dental treatment requirement and analysis of cost in the management of dental caries among primary school children of Kerala. The sample consisted of 750 primary school children and their parents. 68.5% children were affected with dental caries. Decayed teeth accounted for the largest component. One surface restorations were the most frequent type of treatment required followed by extractions, pit and fissure sealants and pulp therapy. The treatment cost increased in direct proportion to the number of teeth involved. The average cost incurred for various dental treatment varied from Rs. 50 (consultation) to Rs. 300 (for filling and extraction) depending on the nature of treatment. Only 1/3rd of children requiring immediate dental treatment had approached for any form of dental consultation. The study also revealed that all the children who had approached the dentist for consultation and treatment had only done for temporary relief in relation to emergency management.     

Nursing caries in Head Start children, St. Thomas U.S. Virgin Islands: assessed by examiners with different dental backgrounds.

The purposes of this study were to determine the prevalence of nursing caries in 3- to 5-year-old Head Start (HS) children on St. Thomas, U.S. Virgin Islands and to assess the reliability of examiners with different dental backgrounds. A dentist, hygienist, and nondental HS personnel participated in a 1/2 day training session (lecture and workshop) and then independently conducted visual examinations for caries of the maxillary anterior teeth including nursing caries. Twenty-three HS personnel examined a total of 375 children; the dentist and hygienist examined a random sample of 74 and 73 children, respectively. Seventy-one children received all three independent examinations. Reliability was assessed by percent agreement, sensitivity, specificity, and kappa value. The dentist found 41% of the children had caries of the maxillary incisors, which included nursing caries. The percentage of children with nursing caries was 12%. There was strong-to-good diagnostic agreement between the dentist and hygienist. The HS personnel also found that 12% of the children had nursing caries, but the diagnostic agreement between the dentist and HS personnel was only good-to-fair.     

Reported infant feeding, oral hygiene and dental attendance patterns in children aged 5 years and under referred for extraction of teeth under general anaesthesia

Summary. This study was designed to examine reported infant feeding, oral hygiene, and dental attendance practices in children who had established dental disease before attaining school age. Data were collected by structured interview from the mothers of 150 children aged 5 years and under who were referred to a hospital Paediatric Dentistry Unit for the extraction of teeth under general anaesthesia. Few children in this study had been exclusively breast-fed, and, although unconfirmed by data derived from matched caries-free controls, the development of dental caries would appear to be related to prolonged bottle-feeding, including the use of a night-time bottle until just before weaning, the early introduction and regular consumption of larger than average amounts of confectionery, coupled with reportedly regular but unsupervised toothbrushing. Although decay was already established in over a third of children before they visited a dentist for the first time, little evidence of restorative care was found. It would appear that the primary care services fail this youngest age-group.     

成都农村儿童患龋状况调查报告

目的：通过随机整群抽样的方法,了解成都农村地区儿童现患龋状况。方法随机抽取成都农村地区小学,对所抽取的每所学校7~11岁学生进行口腔龋病的全面检查并记录。龋病检查和记录标准采用Nyvad指数。检查结果均通过Epidada软件进行数据录入,使用SPSS 13.0统计软件分析数据。结果对四川省成都市农村地区6157名学生进行了口腔龋病的全面检查,其中男性3070名,女性3087名,平均年龄为（9.6±0.64）岁。本次调查中,乳牙患龋率为77.8%。恒牙患龋率为33.5%。早期龋患病率为9.7%。患龋者中,活跃性龋者占78.2%,非活跃性龋者占22.8%。乳恒牙活跃性龋多分布在(牙合)面、颊面、舌面。结论成都农村儿童患龋以活跃性龋损为主,乳恒牙活跃性龋多分布在(牙合)面、颊面、舌面。     

Dental caries, age and anxiety: factors influencing sedation choice for children attending for emergency dental care

OBJECTIVES: The aim of the study was to examine how physical (dental caries) and psychosocial (age, dental anxiety and dental health behaviour) factors, associated with child and parent, influenced dentists' sedation choice when a child presents in pain. METHODS: 600 parents whose children were aged between 5 and 11 years took part: 200 attended for routine dental care (RDC); the remaining 400 attended as emergency patients and were offered either dental general anaesthesia (DGA) or relative analgesia (RA). The subjects were approached and invited to take part. The researcher was blind as to the child's pattern of dental attendance and the type of sedation offered. All parents and children completed self-reported ratings of dental anxiety. The children's teeth were examined to determine past and present dental caries experience. RESULTS: The results showed that children who were offered DGA had greater experience of dentinal caries, were younger and dentally anxious. The children offered RA were older, had a higher frequency of brushing their teeth with fluoride toothpaste and were also dentally anxious. Discriminant analysis showed that 2 canonical functions provided clear categorisation of the three treatment groups. Function 1 was a physical (dental caries) factor, which was related to the child's experience of dentinal caries. Function 2 was a psychosocial factor, which was related to the child's age, dental anxiety and frequency of tooth brushing. A greater proportion of the variance in the treatment offered was explained by Function 1, suggesting that the most important factor in the decision to offer DGA was dentinal caries. Function 2 was of lesser importance. CONCLUSIONS: The findings have implications for the type of sedation offered to children presenting for emergency care. These children may not otherwise receive treatment and the need to provide less anxiety provoking forms of sedation must be promoted. By doing so, parents who have only brought their children when in pain may take advantage of RDC and the treatments offered to prevent and control dental caries and anxiety in their children.     

Association of smoking in household and dental caries in Japan

OBJECTIVES: The study investigated the relationship between smoking in the household and dental caries in Japanese children using nationally representative cross-sectional data. METHODS: This study included 925 children aged 1-14 years. A child was considered to have decayed and/or filled teeth if a dentist diagnosed these conditions in deciduous or permanent teeth. Smoking in the household was defined as positive if someone in the household reported smoking cigarettes. RESULTS: No statistically significant relationship was observed between household smoking and caries experience. However, smoking in the household was independently associated with an increased prevalence of decayed teeth. The adjusted mean of filled teeth among children exposed to household smoking was higher than that among non-exposed children. CONCLUSIONS: The results of the study failed to substantiate a positive association between passive smoking and caries experience in Japanese children.     

Assessing the prevalence of dental caries among elementary school children in North Korea: a cross-sectional survey in the Kangwon province

Objectives: The lack of epidemiological studies has made it difficult to assess the extent of public health problems in North Korea. In the absence of empirical data, less intrusive study designs acceptable to the North Korean government could be developed to gauge the public's health. To this end we developed a basic oral health survey in order to assess the prevalence of untreated dental caries among children. Methods: A cross‐sectional survey of 854 elementary school students was conducted in the city of Wonsan, North Korea. Students were screened and classified into one of three states of oral health: no caries, minor caries or severe dental caries. Verbal surveys were concurrently administered on children to collect basic information on oral health behaviours and demographic characteristics. Statistical analyses were performed to determine if any variables were significant predictors of oral health status category. Results: Among the 854 students screened, we found 255 students with no caries (29.9%), 316 students with minor caries (37.0%), and 283 students with severe caries (33.1%). The majority of students (70.1%) screened had dental caries. Almost all of the students (98.5%) claimed to brush their teeth daily and 71.2% of students visited a dentist in the past year. There were no significant predictors of oral health status. Conclusions: The oral health of children in Wonsan, North Korea is comparable if not slightly better than the oral health status of children of similar age in countries with similar Social‐Economic Status (SES). Basic oral health screens are useful to produce a snapshot of general oral health status among children in North Korea and may provide insight as to the general health of these children.     

Study of the dental health of children in remission from acute lymphoblastic leukaemia in Northern Ireland

Abstract – The dental health of 54 children in remission from acute lymphoblastic leukaemia was compared with a similar number of matched healthy control subjects. Frequency of dental attendance was similar in both groups but most children in remission from leukaemia attended a hospital dentist, whereas children in the control group visited a dentist in general practice or in the public health service. Children in remission from leukaemia used fluoride supplements significantly more frequently than their controls. There was no difference in plaque or gingivitis scores between groups. Children in remission from leukaemia had a significantly lower number of decayed primary teeth (d) than their matched controls but there were no significant differences between study and control groups of m, for Dmft values. There was a significantly greater number of extracted teeth (M) and a significantly greater overall decay experience (DMFT) in the permanent dentition of children in remission from leukaemia compared to their controls. There were no significant differences between study and control groups for D or F values. The mean number of sealed teeth per patient was significantly higher in the study than in the control group.     

School screening and parental reminders in increasing dental care for children in need: a retrospective cohort study

Objective: The objective of this study is to assess follow‐up dental care received by children given baseline screening and referrals as part of an ongoing clinical trial. Methods: A retrospective study with two cohorts of kindergarten children who had baseline and follow‐up (9 months later) dental exams was used. The parents/caregivers of children with routine restorative or urgent needs at baseline received a referral letter and telephone reminders to seek care for their child. Children with referrals were evaluated at follow‐up exam for the receipt of care. A baseline caregiver questionnaire provided information on the individual and family characteristics of the children. Results: A total of 303 children had dental exams at both time periods. At baseline, 42 percent (126/303) received referrals and among the referred group19 percent (24/126) received follow‐up care. A greater proportion with urgent referrals (10/30, 33 percent) received care than those with routine referrals (14/96, 15 percent). Baseline dmft decayed, missing, filled primary teeth and DMFT decayed, missing, filled permanent teeth was similar between children who did/did not receive follow‐up care (P = 0.178 and 0.491, respectively). Children receiving referrals had caregivers with less education, higher Medicaid participation, fewer routine care visits, poorer self‐rating of teeth, and a higher proportion of children reporting tooth pain. Children without receipt of follow‐up care had caregivers who were more likely to report not visiting a dentist within the last 5 years and a greater number of missed days from work because of tooth problems. Conclusion: The rate of dental utilization was low even with school screening, referral and parental reminders among poor, largely minority inner‐city kindergarten children.     

Community socioeconomic status and children's dental health

BACKGROUND: Although a substantial decline in dental caries has occurred among U.S. children, not everyone has benefited equally. The first-ever surgeon general's report on oral health in America indicates that the burden of oral diseases is found in poor Americans. This study investigates the relationship between community socioeconomic status, or SES, and dental health of children. METHODS: An oral health survey of 17,256 children, representing 93 percent of children residing in 62 Tennessee communities, was conducted in public elementary schools during the 1996-1997 school year. Portable dental equipment was used for examinations, and data from each examination were entered directly into a laptop computer. The authors performed analyses of covariance to examine the relationship between community SES (low/medium/high) and dental health, controlling for community fluoridation. RESULTS: Community SES was significantly related to caries experience in the primary teeth, the proportion of untreated caries in the primary and permanent teeth, dental treatment needs, dental sealants and incisor trauma. Overall, dental health was significantly worse for low-SES communities than for medium- and high-SES communities. CONCLUSION: The authors conclude that all specific dental indexes used to measure children's dental health in this study, with the exceptions of caries experience in the permanent teeth and sealant presence, were inversely related to the communities' SES. The percentage of children with dental sealants was directly related to the community's SES. PRACTICE IMPLICATIONS: Further improvements in oral health will necessitate that community-based preventive programs and access to quality dental care be made available to children who are identified as being at highest risk of experiencing oral disease.     

Relationship of dental treatment and oral hygiene to caries prevalence and need for periodontal treatment

The aim of this study was to examine the relationship between differences in dental attendance and oral hygiene patterns and dental caries and periodontal treatment needs. 1469 young people, aged 7, 12 and 15-19 years, and representing the urban (60%) and rural (40%) population from Spain were evaluated. Dental caries and periodontal treatment needs were registered according to the index D.M.F.T. and C.P.I.T.N., following the criteria of W.H.O. Regular dental attendance was observed in 16.6% of subjects examined, and only 9.4 saw a dentist regularly for dental prophylaxis. Statistical analyses showed that while the more frequent the dental visits, the lower the rate of caries, and periodontal treatment needs, the higher, however, the average number of fillings and the D.M.F.T. scores. These individuals had the higher number of functioning teeth, restored or sound, but they also had the disadvantage of having higher levels of disease experience. By the other way the individuals who saw the dentist regularly for dental prophylaxis presented the lower caries rate and periodontal treatment needs, the fewer tooth loss, and also an important reduction in the D.M.F.T. scores. Similar observations had been made in the individuals who brush their teeth frequently or with a correct technique. The results suggested that while frequent dental visits do not apparently help to prevent the onset of further dental disease, we can achieve this goal with regular preventive oriented dental therapy.     

Analysis of paediatric dental care provided under general anaesthesia and levels of dental disease in two hospitals

OBJECTIVE: To compare the level of dental disease and the pattern of dental treatment under controlled airway general anaesthesia for ASA I and II children and ASA III and IV children in two hospitals. DESIGN: Prospective analysis. SETTING: Hospital and postgraduate dental teaching institution, UK 1996 - 2000. SUBJECTS AND METHODS: During a four-year period (1996-2000), data were collected on children aged 1 to 16 years who were admitted for treatment of dental caries under general anaesthesia.Outcome measures Levels of dental disease (dmft/DMFT), treatment provided. RESULTS: A total of 515 ASA I and II and 430 ASA III and IV children were treated. The dmft and DMFT values of the ASA I and II children were significantly higher than those of the ASA III and IV children (p = 0.03). A significantly greater number of restorations and fissure sealants were carried out for permanent teeth in ASA III and IV children (p < 0.001). The number of extractions for both primary and permanent teeth was significantly greater in the ASA I and II group (p < 0.05). CONCLUSIONS: The ASA III and IV children had significantly lower levels of dental caries than the ASA I and II children and received a higher level of preventive and restorative care.