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Objective: To assess the cost effectiveness of a postal toothpaste programme to prevent caries in 5-year-old children in the north west of England., Participants: Birth cohorts of children aged 12 months were recruited from high caries risk populations in nine health districts., Design: The results of a randomised controlled trial to measure the effects of a postal toothpaste programme are used and related to the costs of running a similar programme. Children in the trial received free toothpaste on four occasions a year and a toothbrush once a year for four years from age 12 months to 5 years. When aged 5-6 years children were examined by trained, calibrated examiners using BASCD standards. Those who received toothpaste containing 1450 ppm F were found to have a significantly lower mean dmft than those who had not. The costs that would be incurred by a public dental service running such a postal toothpaste programme are identified, measured and related to the likely health improvement that could be achieved., Main Outcome Measures: The cost per tooth saved and the cost per child saved from caries experience and extraction experience., Results: The estimated cost per tooth saved from carious attack was pounds sterling 80.83 and the cost per child of preventing caries experience was pounds sterling 424.38 and avoiding any extractions was pounds sterling 679.01. Analysis resulted in an overestimation of costs and underestimation of benefits., Conclusion: The programme achieved a significant caries reduction in children who received the 1450 ppm F toothpaste and the costs are now available to those considering provision of treatment services in areas where children are at high caries risk.

Objective: To describe the health care seeking behaviour associated with orofacial pain (OFP) and determine factors associated with such behaviour., Design: Cross-sectional population-based study using postal questionnaires., Participants: Adults aged 18-64 years from a general medical practice in south-east Cheshire, UK (participation rate 74%)., Results: Of the 2,504 respondents to the questionnaire 646 reported OFP, of whom 555 (86%) indicated whether or not they sought professional help. A total of 255 (46%) responded that they had sought advice. The majority had sought advice from their medical practitioner (57%) or dentist (51%), and 64% had taken medication because of OFP. The likelihood of seeking treatment increased linearly with age (p < 0.001) while gender, education and psychological distress did not show a significant association with seeking treatment. Persons who were regular dental attenders had an increased likelihood of seeking treatment for OFP (RR 1.4; 95% CI 1.1,1.8). Perception of illness had moderate association with healthcare seeking (RR 0.8; 95% CI 0.7,0.96). There was a significant trend of increasing RR with increasing total number of pain symptoms (p < 0.001), frequency of pain, duration of pain episodes, pain intensity and disability associated with pain. Participants who reported pain duration of more than three months had almost double the likelihood (RR 1.8; 95% CI 1.4,2.3) of seeking treatment. Decrease in self-reported control over pain and ability to decrease pain were both associated with an increased likelihood of seeking professional care (p < 0.001)., Conclusions: The strongest predictors of health care seeking behaviour were different characteristics of pain.

Objective: To assess the impact of regularly supplying free fluoride toothpaste regularly to children, initially aged 12 months, and living in deprived areas of the north west of England on the level of caries in the deciduous dentition at 5-6 years of age. A further aim was to compare the effectiveness of a programme using a toothpaste containing 440 ppmF (Colgate 0-6 Gel) with one containing 1,450 ppmF (Colgate Great Regular Flavour) in reducing caries., Design: Randomised controlled parallel group clinical trial. Clinical data were collected from test and control groups when the children were 5-6 years old., Setting: A programme of posting toothpaste with dental health messages to the homes of children initially aged 12 months. Clinical examinations took place in primary schools., Participants: 7,422 children born in 3-month birth cohorts living in high caries areas in nine health districts in north west England. Within each district children were randomly assigned to test or control groups., Interventions: Toothpaste, containing either 440 ppmF or 1450 ppmF, and dental health literature posted at three monthly intervals to children in test groups until they were aged 5-6 years., Main Outcome Measures: The dmft index, missing teeth and the prevalence of caries experience., Results: An analysis of 3,731 children who were examined and remained in the programme showed the mean dmft to be 2.15 for the group who had received 1,450 ppmF toothpaste and 2.49 for the 440 ppmF group. The mean dmft for the control group was 2.57. This 16% reduction between the 1,450 ppmF and control group was statistically significant (P<0.05). The difference between the 440 ppmF group and control was not significant. Further analyses to estimate the population effect of the programme also confirmed this relationship., Conclusion: This study demonstrates that a programme distributing free toothpaste containing 1,450 ppmF provides a significant clinical benefit for high caries risk children living in deprived, non-fluoridated districts.

In dentistry many studies collect hierarchical data, but this is not always recognised or understood by the researchers. This paper sets out to describe such studies and discusses aspects of their design, data collection and analysis. Sometimes these studies may be dealt with in a simple way, but others may require the help of a professional statistician to deal with analytical problems that are encountered.

Objective: To assess the relationship between the care index and the mean dmft/DMFT in different populations of 5-, 12- and 14-year old children., Design: Information from recent studies of 5-, 12- and 14-year old children, co-ordinated by the British Association for the Study of Community Dentistry (BASCD) was used. The correlation between the mean dmft/DMFT and the care index for each health district was calculated for each age group, along with the linear regression equation of the care index in terms of dmft/DMFT., Results: All the correlation coefficients were negative indicating that the care index would be expected to increase as the disease levels decrease. For the 5-year-old children in 1995/96 three other factors for the same time period; dentist:population ratio, percent of children registered and standardised mortality ratio (SMR), were also included in the model. This did not change the negative relationship between dmft and the care index., Conclusions: The strong negative relationship between the care index and mean dmft/DMFT levels indicated that in a situation where disease levels are reducing over time, the care index would be expected to increase. Conversely in a situation where disease levels were increasing the care index would be expected to fall.

Objective: To develop and evaluate a classification and index of dental treatment experience for adults., Design: Twenty-four general dental practitioners recorded treatment experience at baseline on 4,211 regularly attending adults of whom 3,878 were re-examined after one year and 3,698 patients completed a questionnaire on factors related to treatment., Setting: Health authorities of Manchester and Salford., Method: Set theory was used to divide the baseline clinical data set into 7 mutually exclusive classes of dental treatment experience. Seven dental specialists used the nominal group technique to weight tooth status to form an index of dental treatment experience (DTE). The ability of the DTE classification and index to discriminate between groups of patients' responses to the questionnaire was compared with the THI and DMFT index., Results: Ninety-nine per cent of the patients fell into 5 hierarchical classes ranging from fillings only to wearing a denture in addition to a crown and/or bridge. When calculated on the baseline data, the classification discriminated between 16 of the 20 variables investigated in the questionnaire. Fifteen significant differences were found between mean scores for groups of patients on the DTE index, 14 on the THI and 8 on the DMFT index. Fifty-five (1%) patients moved their class as a consequence of the treatment carried out during the year. All three indices found significant differences for the same four variables of the 20 tested., Conclusion: A classification of dental treatment experience together with an index to measure the severity of that experience has been successfully developed and tested. It appears to have advantages over the traditional DMFT index and is at least as discriminating as the THI.

The aims of this study were to (1) demonstrate the feasibility of collecting dental epidemiological data suitable for planning purposes in Libya and (2) record the caries prevalence in Benghazi so that, following an increase in the fluoride concentration of the drinking water, potential changes in dental caries prevalence could be assessed. Random sampling resulted in the examination of 833 six-year-old and 704 twelve-year-old children from Benghazi (0.8 mg/t F-) and Jardinah (1.8 mg/t F-). For both six- and twelve-year-old children the caries prevalence in Jardinah was significantly lower than in Benghazi. Within Benghazi the caries prevalence was lower in state than private schools for the six-year-old children. Little evidence of dental treatment was found for the six or twelve-year-old pupils at either examination site.

A 2-year study has been completed to examine the dental health and patterns of treatment of samples of children registered under capitation in three areas of England. The opportunity was taken to compare some of these results with those reported in the same areas in 1989 when the dentists were remunerated under fee-for-service. In addition, the validity of the dental health information supplied by general dental practitioners on the FP17C form was assessed. The dental health of 14-15-year-old patients registered for more than a year was compared with that of similar patients in the same areas in 1989. There was a large reduction in the caries experience (mean DMFT) in these patients in all areas between 1989 and 1994 mainly due to a significant fall in the mean numbers of teeth filled. The mean number of teeth extracted for caries remained low in all areas. There was a small increase in the mean number of decayed, untreated teeth in all areas. There was a large increase in the proportion of patients with one or more fissure sealants present. The dental health of 7-8-year-old patients registered for more than a year was examined but, as this age group were not examined in 1989, no comparative data were available. Regularly attending child patients had, on average, one untreated decayed deciduous tooth, but few had more than two. Caries experience in first permanent molars was low in all areas. Data were collected from a sample of general dental practitioners in three areas on the treatment provided over a 12-month period for random samples of patients in two age groups: 6-12 and 13-15 years. There was an increase in two of the three areas in the provision of oral hygiene instruction and dietary advice. The level of fissure sealant use was maintained or increased. There was a reduction in the numbers of both deciduous and permanent teeth filled. Fewer children had teeth extracted. The proportions of patients having bitewing radiography reduced. The mean number of both visits and check-up examinations reduced. There validation of the dental health information on the FP17C was carried out by comparing the data collected for 7-8 and 14-15 year old patients during the dental health examinations with that submitted by general dental practitioners on FP17C forms to the Dental Practice Board for the same children. For the permanent dentition, agreement was good for missing and filled teeth but poor for decayed, untreated teeth. For deciduous teeth, levels of agreement were generally poor except for filled teeth where it was fair.

Traditional surveys of adult dental health have used calibrated examiners to collect clinical data. This study examines an alternative approach using data collected by general dental practitioners about their adult patients. Twenty-four dentists in Greater Manchester recorded both personal and intra-oral information on 3,832 of their regularly attending dentate patients over 24 years of age. The mean numbers of filled teeth, sound teeth and the proportion of patients with 21 or more teeth were all similar to those found in the 1988 United Kingdom national survey of adult dental health. For example, the mean number of filled teeth in the 25-34 year age group was 11.7 compared with 11.9 for subjects who claimed to attend regularly in the 1988 national survey, and these figures reduced to 11.2 and 10.0 in the 55-64 year age group. The proportion of adults with 21 or more teeth was found to be 99 per cent compared with 98 per cent in the 1988 survey for the 25-34 year age group, falling to 55 per cent compared with 56 per cent in the 55-64 year age group. The collection of epidemiological data by general dental practitioners is feasible, and has construct and internal validity. It is a possible alternative to conventional surveys of adult dental health.

A study was undertaken to compare the prevalence of dental caries and developmental defects of enamel between 3-year-old children who were lifelong residents of fluoridated areas of Huddersfield (1 ppm F) and non-fluoridated Dewsbury (less than 0.3 ppm F). An interview was also conducted with the parents of the children to provide information regarding previous dental experiences. The study populations were identified using the national child health system. The mean dmft was 0.30 in Huddersfield and 0.74 in Dewsbury. The percentage of children who had experienced dental caries and the percentage with carious teeth were significantly lower in the fluoridated area. The Dewsbury children had suffered more toothache. There was a significantly higher number of children in Huddersfield with diffuse enamel defects on their upper and lower first molars. This study has also demonstrated that the national child health system provides a method for obtaining a random sample of pre-school children from the general population, thus avoiding the problems associated with studies using selected populations. Fluoridation in Huddersfield ceased in October 1989 and it is hoped that this decision will be reversed as soon as possible.

Representative examiners from all regions in England and examiners from Wales and Scotland took part in a national calibration exercise conducted in Manchester for The British Association for the Study of Community Dentistry (BASCD). Each dentist examined the same group of thirty-three 5-year-old and thirty 14-year-old children independently, and they were asked to examine the children by the same method as that used within that Region when conducting the annual BASCD surveys. Comparisons of inter-examiner differences revealed that in the examination of 5-year-old children diagnoses were not significantly different for 14 out of the 16 Regional examiners. Differences in the conventions applied in the case of missing teeth and 'arrested caries' were found and are discussed. There were no significant differences in the diagnoses for the DMFT for the 14-year-old children amongst all 16 Regional examiners. The calibration exercise allowed a close examination of the application of the BASCD criteria in the field.

A 3-year clinical trial comparing capitation and fee-for-service remuneration systems for general dental practitioners for the treatment of children has been successfully completed. Capitation dentists restored carious teeth at a later stage in the disease process than fee-for-service controls, and carried out more preventive treatment and advice. However, the disease experience of their patients was little different from that of patients treated under fee-for-service. Capitation dentists saw their patients less frequently and took fewer radiographs than their fee-for-service colleagues. The prevalence of both fissue sealants and arrested caries was low in both groups, as was the prevalence of teeth extracted as a result of caries. Levels of oral cleanliness were similar under both systems. Private treatment was rarely prescribed for children, but was more prevalent for patients of fee-for-service dentists. The profession felt that capitation offered greater clinical freedom and more financial stability to dentists, but a greater temptation to under-prescribe treatment. The profession lacked commitment to capitation as a method of remuneration for the treatment of children in the General Dental Service. Fee-for-service dentists appeared to be more innovative, expressed a greater allegiance to their patients and felt a greater temptation to over-prescribe than capitation dentists. The parents had a high opinion of the service for children, irrespective of the remuneration system, and the children found the service very acceptable. Parents had a stronger allegiance to the fee-for-service than the capitation dentists. The study revealed several short-comings in the capitation model tested, but solutions to all of these became apparent. A capitation agreement of more than 12 months would simplify administration and reduce costs, as would a reduction in the number of forms. The need to notify parents when a dentist was replaced in a practice created considerable difficulties and increased expense. The treatment of trauma and extractions for orthodontic purposes should have been items excluded from the capitation fee. The need for information on dentists' activity in capitation was accepted but should be kept simple and relevant. Monitoring quality of care under capitation can be carried out from the routine data collected for administrative purposes. Capitation does not appear to increase participation. Costs of administering capitation are little different from those for fee-for-service. More resources were spent per dentist and per patient under capitation than fee-for-service. In the clinical trial fee-for-service was more cost-effective than capitation.(ABSTRACT TRUNCATED AT 400 WORDS)