The effectiveness of school dental screening: dental attendance and treatment of those screened positive

OBJECTIVE: To determine dental attendance and treatment outcomes following two models of dental screening. DESIGN: An observational prospective cohort study. SETTING: Infant, primary and junior schools in the North West of England. SUBJECTS: Children aged six to nine years at the start of the study. INTERVENTIONS: Subjects received a screening examination according to either a 'Traditional model' or 'New model' of school dental screening. MAIN OUTCOME MEASURES: Attendance at a dentist within four months of the intervention and treatment received by children referred via the 'New model' with caries in their permanent teeth. RESULTS: In the 'New model' of school dental screening 46% of screened positive and 41% of screened negative children attended a dentist during the study period. Some 44% of children referred with caries in permanent teeth attended a dentist and 53% of those attending received treatment for the referred condition. Larger proportions of children from disadvantaged backgrounds were screened positive but higher proportions of children from more affluent backgrounds attended the dentist and subsequently received treatment. CONCLUSION: School dental screening has a minimal impact on dental attendance and only a small proportion of screened positive children receive appropriate treatment. The programme fails to reduce inequalities in utilisation of dental services.     

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 randomised control trial of the effectiveness of personalised letters sent subsequent to school dental inspections in increasing registration in unregistered children

Background  

Recent studies have cast doubt on the effectiveness and efficiency of school based dental screening programmes in improving dental attendance or improving dental health. In 2002 the National Dental Inspection Programme was introduced in Scotland which categorises children by their dental health and informs parents of the findings via a personalised letter home and encourages dental registration. In addition, epidemiological data for local and national planning purposes is collected. This replaced an earlier school screening system in Lothian where a generic letter urging registration was sent to children who were identified as not being registered with a dentist. The objective of this study is to compare dental registrations rates among unregistered children in these two school inspection systems with a system where letters were sent home but no dental inspection was carried out.     

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.     

The state dental nurse's role in the management of dental injuries.

Dental nurses are frequently called upon to assist when injuries to the teeth occur in children, particularly when these injuries occur when the child is at school. Procedures for referral are well established, and include advising parents to make an appointment with the family dentist. If there is no family dentist, a list of contracting dentists in the Dental Benefit Scheme is provided. No referrals are made to particular dentists. Acknowledgment of what care was provided is always appreciated by the nurse. Dental nurses have an important role in the prevention of dental injuries through health education programmes directed at parents' groups and in the classroom.     

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 relationship between anxiety and dental treatment experience in 5-year-old children

OBJECTIVES: To examine the relationship between dental anxiety, dental attendance and past treatment history in 5-year-old children after taking into account confounding influences. METHODS: A cross sectional study of all 5-year-old children living in Ellesmere Port and Chester. All children were clinically examined and dmft and its components were recorded. A postal questionnaire was sent to parents of participating children to identify whether children attended the dentist on a regular asymptomatic basis or only when experiencing problems. Additionally parents were asked to judge whether they and their child were anxious about dental treatment. The socio-economic status of the family was measured using the Townsend Material Deprivation Index of the electoral ward in which they resided. The bivariate relationships between anxiety and reported attendance experience, past extraction and restoration history were using chi-square and t-tests. Multiple logistic regression analyses identify predictors for dental anxiety. RESULTS: A total of 1,745 children received both a clinical examination and a questionnaire and 1,437 parents responded, a response rate of 82.3%. One in ten parents (10.8b) judged their child to be dentally anxious. Anxious children had significantly (p<0.001] more caries experience (dmft 2.58 vs 1.12). Multiple logistic regression analyses confirmed that anxious children were more likely to be irregular attenders (OR 3.33, 95% Cl 2.22, 5.00), have anxious parents (OR 1.60,95% Cl 1.09, 2.36), and to have undergone dental extraction in the past[OR 3.50, 95% CI 2.10, 5.85), after controlling for gender and socio-economic status. A past history of restoration was not a significant predictor of anxiety after controlling for other factors. CONCLUSIONS: Dental anxiety is a fairly common condition in 5-year-old children in the North West of England. It is closely associated with asymptomatic, irregular attendance pattern, a history of extraction and having a dentally anxious parent. The cause and effect dynamics of these relationships need to be determined.     

Designing and implementing a school-based dental program for students with developmental disabilities

Students with developmental disabilities in Atlantic County Special Services School District (ACSSSD) receive on-site dental care through a program created by UMDNJ-New Jersey Dental School (NJDS). The program's goal was to coordinate dental school resources with those of a school district, county agencies and the Delta Dental Foundation to provide quality dental services to the students, aged 3–21 years. The University developed a Needs Assessment Survey and distributed 450 surveys to the students' parent/guardian(s). Completed surveys were returned by 131 respondents. Of the 131 children represented, 75 had not been seen by a dentist within the past year. In response to guardian reported access problems, UMDNJ-NJDS and ACSSSD developed a school-based dental care delivery system and a program for health promotion and disease.     

The efficiency of the community dental service in England: a data envelopment analysis

OBJECTIVES: To assess the efficiency with which health authorities' Community Dental Services provide dental care in England. METHODS: A data envelopment analysis of inputs (hours worked by dental officers, therapists, hygienists and others) and outputs (screening, treatment, prevention) of the Community Dental Service (CDS) was conducted. Relative efficiency ratings of the CDS by health authority were further analysed in order to identify external factors which effect efficiency and are outside the control of the Community Dental Service. RESULTS: The relative efficiency of the CDS varies widely in England--on average the CDS is operating at 75% of efficient levels compared to best-practice services. This could not be explained by plausible factors outside the CDS's control, such as differences in deprivation and urban-rural differences between health authorities. CONCLUSIONS: These results, if validated by further studies, should be disturbing since many Community Dental Services services appear to be under-performing. However, this data-driven study could not uncover the detailed context of an individual service's performance. A useful next step would be detailed case-studies of several "star" and under-performing services to search for deeper reasons underpinning relative performance levels.     

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.     

Patterns of care and service use amongst children in the UK 2003

BACKGROUND: The 2003 Children's Dental Health Survey is the fourth of the 10-yearly surveys of children's oral health in the United Kingdom. AIM: To detail the reported experience of dental services and dental treatment amongst children in the UK. METHOD: A self-completion questionnaire was distributed to a 50% sub-sample of parents or carers of the children who were clinically examined in the 2003 UK Child Dental Health Survey. This included questions relating to parental and child experience of dental services and dental treatment. RESULTS: The proportion of UK five-year-olds reported as not having visited the dentist fell from 14% in 1983 to 6% in 2003 and the proportion reported as having visited the dentist before the age of two rose from 7% in 1983 to 31% in 2003. Over 80% of all children were reported to seek regular dental check-ups. Around 10% were reported to have had some difficulty in accessing NHS dental care while 5% of five-year-olds were reported to have experienced a general anaesthetic for dental procedures in 2003. Dental attendance was associated with social class and mothers' reported attendance patterns. CONCLUSIONS: In line with previously reported trends, the 2003 survey of children in the United Kingdom shows improvements in several areas but some aspects of attendance pattern continue to be associated with social class and mothers' attendance pattern. It is of concern that 10% of five-year-olds reported having experienced extractions and 5% general anaesthesia for dental treatment.     

Provision of general dental care for children with cleft lip and palate--parental attitudes and experiences

OBJECTIVE: To evaluate the attitudes of parents of 4-8 year-old children with cleft lip and palate (CLP) towards the provision of paediatric dental care and to assess their experience of treatment within the General Dental Services. DESIGN: Postal questionnaire distributed to all parents of 4-8 year-old children on the Birmingham CLP database. RESULTS: The response rate was 77%. Ninety-nine (91%) children were registered with a dentist. Seventy-five (69%) had previously received preventive advice and 32 (29%) had experienced restorative intervention. The majority of parents (64%) expressed a wish for a dental check-up to be provided at the designated Cleft Centre, with 42 (39%) requesting preventive advice. Fifty-eight (67%) of the parents who requested a dental check-up were agreeable for treatment to be provided in the primary sector. CONCLUSION: The survey indicates there is parental support for paediatric dental assessment at cleft clinics with subsequent arrangement of treatment in the primary sector. The inclusion of paediatric dental support within the multidisciplinary cleft team should be considered as Regional Cleft Centres are established     

The use of dental services among Norwegian adults in 1973

ABSTRACT The dental treatment pattern and its determinants were surveyed in 1973 by interviews with a sample comprising 1,632 persons drawn to cover the total Norwegian population aged 15 and above. In all, 58 % of the interviewees stated having visited a dentist during the year prior to the interview. In contrast, 16 % had not consulted a dentist for at least 5 years. Fifty-five percent of the sample reported having received fillings at the last dental visit and 15 % reported having received some periodontal and/or preventive treatment. Regular (at least annual) treatment attendance, was claimed by 52 % of the sample. However, some respondents had seemingly embellished their treatment behavior, and a relatively valid estimate for the current proportion of regular treatment attenders was considered to be 40 % of the adult population in Norway. Sex and geographic region were found to be the most influential predictors of the recent treatment pattern, whereas school dental treatment had a major influence in youth. Dental conditions including the wearing of dentures was the reason most often given for not seeing a dentist on a regular basis.     

Attitude of parents of disabled children towards dental visits in Riyadh, Saudi Arabia.

The objective of the present study was to determine the attitude of parents of disabled children in Riyadh, Saudi Arabia towards dental visits. A self-administered questionnaire was used to collect the required information. A total of 315 parents, 70 (22.2%) fathers and 245 (77.8%) mothers completed the questionnaire. Almost all (99.0%) the parents were aware that regular dental check-ups are important in maintaining good dental health. Two-thirds (66.7%) of the parents were of the opinion that one must visit a dentist every six months for dental check-up; and some (17.8%) even every three months. However, 83 (26.3%) children had never visited a dentist. Only nine (2.8%) children had visited a dentist for first dental check-up by the age of three years. A significantly (p<0.05) higher percentage of parents with "secondary school or higher" education (69.7%) were of the opinion that one should visit a dentist every six months as compared to parents with "middle school or lower" education (57.3%). About one-fourth of the older age groups (25.6% in 6-10 years old and 24.5% in > or = 11 years old) made their last visit to a dentist due to pain as compared with about one in every ten children (11.1%) in younger age group. The children with mental retardation had the highest percentage (81.5%) among those who had visited a dentist followed by cerebral palsy children (79.2%) and Downs syndrome children (68.4%). It can be concluded that the parents' attitude towards importance of regular visit in their disabled children is positive. However, there is a need to inform them about the importance of early first dental visit, and establishing a support mechanism to utilize their positive attitude.     

A retrospective study of dental general anaesthesia carried out in children living in North Wales 1995-1998

OBJECTIVES: To determine the reasons for referral for dental general anaesthesia (DGA) in children in North Wales and to ascertain the level of repeat DGA. RESEARCH DESIGN: Retrospective study of the clinical records for a random sample of 10-year-old children who had a DGA before November 1998. SETTING: DGAs carried out at two centres within the Community Dental Service (CDS) in the former county of Clwyd, North Wales. METHOD: A random sample of children who had a DGA between April 1995 and November 1998 from whose records data was collected regarding the reason for referral and outcome. RESULTS: It was found that 26.6% of children had received an additional DGA, but the total of 203 additional episodes (including third and fourth DGAs) represents a true rate of 31.8%. The General Dental Service (GDS) referred more than double the numbers of children than the CDS but the referral rate per dentist was reversed with the GDS referring an average of 5.2 subjects and the CDS 11.9 subjects. Around half of all referrals did not include a medical history. CONCLUSIONS: The repeat DGA rate was cause for concern as was the quality of referrals.     

Dental attendance and anxiety among public and private school children in Jordan

AIM: To evaluate the levels of dental attendance and anxiety among children of public (lower to middle socioeconomic groups) and private schools (higher socioeconomic groups), and to explore the perceived source of dental fear among them. METHOD: A group of 1,021 children selected by a simple random method from 10 public schools in the five geographic areas of Irbid Governate, Jordan and all 10 private schools were included in this study. All children (mean age 13.1 +/- 0.87 years) completed a questionnaire modified from the Dental Fear Scale (DFS) which also contained items related to dental attendance. RESULTS: Private school children (31.4%) visited the dentist regularly more significantly than public school children (15.0%) (P < 0.001). However, the majority of children (public = 82.6%, private = 67.4%) attended the dentist only in an emergency. The main reason for irregular attendance was 'treatment not needed' (42.2%). About 43-44% of children had dental fear of 'low to moderate type', while the prevalence of 'high dental anxiety' was slightly higher among children of public (11.6%) than those of private schools (6.9%). Fear of specific stimuli (pain and trauma) was the most common source of dental fear reactions among 60-65% of children. The sight and sensation of an anaesthetic needle and sight, sound and sensation of the drill were the most fear eliciting stimuli. Moreover, public school children were found to be more anxious with a significantly higher 'overall dental fear' than private school children (P < 0.05).     

Evaluation of a 7-year school-based community dental hygiene programme in Portugal by high school teachers

Abstract: Objectives: To obtain high school teachers evaluation of a Community Dental Hygiene programme, developed as part of a clinical trial designed to assess the safety of low‐level mercury exposure from amalgam restorations. Methods: A questionnaire to assess programme evaluation, personal opinion on programme relevance and satisfaction with activities was distributed among teachers. It had a total of 22 questions organized into three groups. Results: A total of 25 questionnaires were obtained from teachers who participated in the programme. Ninety‐two per cent of the respondents had a positive opinion concerning the existence of the programme. Eighty‐eight per cent of the teachers believed that the programme changed student’s knowledge about dental hygiene. Ninety‐two per cent of teachers supported the existence of the programme and 88% of them disagreed with a statement that participation in the programme was a waste of time. Teachers who did not collaborate actively with dental hygiene activities indicated belief that the programme affected school activities (P = 0.003). Teachers who actively participated in the programme believe that dental hygiene activities were important for students (P = 0.005). Conclusions: Teacher evaluations of this kind of programme are critical for the development of school‐based Dental Hygiene Education programmes. Teachers believe that Dental Hygiene Education is crucial for students’ well‐being.     

Adolescent dental care and the South Australian school dental programme

The problems of continuing dental care once eligibility for school care ceases have been discussed. A questionnaire of 18,976 high school students at 29 South Australian schools indicated that, compared with students with no history of school care, fewer students treated by the School Dental Service reported visiting a dentist since leaving primary school. Several programmes designed to encourage continuing dental care have been described.     

Reducing patients' state anxiety in general dental practice: a randomized controlled trial

Anxiety assessment by questionnaire provides information for the dentist and may also confer a psychological benefit on patients. This study tested the hypothesis that informing dentists about patients' dental anxiety prior to commencement of treatment reduces patients' state anxiety. A randomized controlled trial was conducted involving eight General Dental Practitioners in North Wales. Participants included patients attending their first session of dental treatment, and accumulating a score of 19 or above, or scoring 5 on any one question, of the Modified Dental Anxiety Scale (MDAS). Patients (n = 119) completed Spielberger's state anxiety inventory (STAI-S) pre- and post-treatment and were randomly allocated to intervention (dentist informed of MDAS score) and control (dentist not informed) groups. Intervention patients showed greater reduction in mean change STAI-S scores (F[1,119] = 8.74, P < 0.0001). Providing the dentist with information of the high level of a patient's dental anxiety prior to treatment, and involving the patient in this, reduced the patient's state anxiety.     

Knowledge and reported behaviour concerning the prevention of caries in children: a questionnaire survey of Japanese parents resident in London, UK

The objective of this study was to assess the knowledge and self-reported behaviours of a sample of Japanese parents resident in London, UK with respect to the prevention of caries in their children. Japanese parents were asked to complete a structured questionnaire which was distributed through the school authorities to seventeen primary schools. Data was collected on: socio-demographics, dental service use in their children, knowledge and reported behaviours with respect to the prevention of dental caries in their children. After one reminder the questionnaire response rate was 69 per cent (n = 111). The mean age of the children was 6.75 years (range 3-12 years) and 73 per cent had been born in Japan. Those respondents with children born in the UK were more likely to take their children to the dentist regularly and more likely to correctly identify the cause and prevention of dental caries. Whilst a majority of respondents reported that their children brushed their teeth twice daily, toothpaste was not used by one quarter of the children. Barriers to dental attendance were identified. Whilst there were some similarities in levels of knowledge and reported behaviours, the parents of Japanese born children were disadvantaged with respect to knowledge about the causes and prevention of dental caries and the use of UK primary dental care services. These parents should be offered information about these issues.